7 ms·

I broke my foot recently. Calling around and asking for quotes ranged from a straight up "I don't know" to "Here is the cash price. We won't know your HDHP ins

I broke my foot recently. Calling around and asking for quotes ranged from a straight up "I don't know" to "Here is the cash price. We won't know your HDHP insurance price until after we bill them, which could be good for you or could be bad. It will probably be bad, because there are more middlemen." I tried paying the cash price. They inadvertently billed my insurance anyway. Turns out, I actually saved like 33% using the insurance price ($180 vs $120 for an xray + analysis). They said the only way to get a copy of the x-ray was to pay $5 for a CD. None of the computers I still use have a CD reader. The whole system is such a clusterfuck. I understand the aversion to giving a governmental bureaucracy more control (esp over something as important as healthcare); however, it's hard to imagine a worse way to pay for care than what we have now.

dheera 4y ago
I just got billed $5000 for a routine echocardiogram at Stanford, and in the process of fighting it. My insurance is supposed to cover preventative care 100% (not even a copay). They billed $18000 total (yes, for a 1-hour ultrasound) and insurance is leaving me to pay $5000. This is about the 6th time this has happened. It's always 15+ e-mails back and forth, then threatening lawyers, then they back off. I'm wondering if it would be faster if I just take it directly to a small claims court. I am insured and it is preventative care, so I believe I'm entitled to pay nothing. Advice welcome.
- mrexroad 4y ago
  My son had strep throat. Stanford billed us just shy of $50K, but not before sending us a letter letting us know they had stopped accepting our insurance (BCBS) a few weeks prior. Obviously, more done than just a throat swab for the 50K, but whole thing was insane.
  - dheera 4y ago
    I really want to expose Stanford's ridiculous billing and shame them to no end, but I don't have enough Twitter followers. I know healthcare billing in the US is f-ed up but Stanford is particularly bad.
    - dilyevsky 4y ago
      Not sure you need to expose them - everyone is pretty much aware it’s a shitshow. Not only in billing but quality of care and treatment of staff also
      - seesaw 4y ago
        Agree. After seeing the trauma some of my friends went through, I do my bit to recommend against going to Stanford. The standard of care is poor, and the cost is exhorbitant.
    - onphonenow 4y ago
      Not really that bad. San Francisco used to have crazy bills. Trauma response fees go up to 50k even if nothing is wrong. I can get the price of my fast food burger to the penny - but good luck getting a quote on something that will cost 50,000. I did medical billing for a bit and in my space 70% of the issue was stupid politics
      - dheera 4y ago
        San Francisco as in UCSF? I'm due for an ICD battery replacement later this year or early next year and trying to figure out where to get it done.
  - hanklazard 4y ago
    That is nuts. Was he admitted to the hospital or something?
    - mrexroad 4y ago
      Yeah, they kept him for a night. Kid complained about sore throat so my wife took him to doctor (regular pediatrician was busy, so another doctor). Kid kinda mentioned a stiff neck, and doctor told my wife to get him to the ER immediately, b/c meningitis. Wife took him to Stanford ER, they were all omg we’re kinda sure it’s meningitis, but we need to do a spinal tap first. While prepping for that they put him on an IV and after ~20min he perked up a bit. A nurse noticed that and said it wasn’t normal if really meningitis, and put spinal tap on hold. Then doctor said there was a chance of an abscess in his throat/neck and wanted to rule it out; ordered a CT scan. Once that returned negative, they were like, oh yeah, it’s just strep… but, let’s prescribe an uncommon liquid antibiotic that tastes like trash reheated. Kid refused to swallow it, despite efforts of 3 nurses trying to waterboard him with the liquid. So the only way to deliver the antibiotic as prescribed was intravenously. Learned several lessons about advocating during that ER trip.
- danachow 4y ago
  > I am insured and it is preventative care How or why do you think an echo is preventative care? While insurance plans are free to define any additional menu of services as preventative - an echo is not included in the minimum set required by the federal government - which are procedures based off of US preventative services task force guidelines - there are no published guidelines that include an echo. I wish you luck on your billing problem but I think you’re going to hit a wall on your own definition of “preventative”. https://www.healthcare.gov/preventive-care-adults/ https://www.healthcare.gov/preventive-care-adults/
  - deleted 4y ago
    [deleted]
  - namdnay 4y ago
    There are two categories of healthcare right? Palliative and preventative. Which one would an echo be in this case? If he had violent symptoms it would clearly be palliative, but in this case it can only be preventative
    - danachow 4y ago
      > There are two categories of healthcare right? Palliative and preventative. The simple answer to this is that “preventative” in the case of billed medical services has a specific and clearly defined meaning - it does not even mean all services that ever would be considered preventative. This definition will be found in your insurance paperwork and corresponds at least to the site I posted - so a further philosophical discussion is irrelevant. To your actual question - No, the echo is usually pallative. However, right off the bat I'll say this is an overly reductionist and not terribly useful schema for classifying the delivery of medical care. While it might be good as a way for the general public to think about prevention, it’s way too oversimplistic to be useful beyond that. An aside, palliative has a specific and different meaning within medicine: roughly, treating symptoms without a goal of cure. Reducing a broken arm or removing an inflamed appendix is not palliative care in that sense. But even if we widen the scope of palliative to be treatment an echo would be neither. An echo is diagnostic - it doesn’t prevent nor treat heart failure or disease. Often when an echo is ordered it leads to some form of treatment for some found disease, in which case if we’re going to stick to the simple classification would be “palliative” - we’re using it to guide treatment, we can’t prevent something that we already see. > If he had violent symptoms it would clearly be palliative It's just not that simple. Echos are sometimes used to further evaluate or manage asymptomatic disease, for instance A-fib or a concerning murmur. We're using the echo to rule out suspected coexisting conditions, that's not prevention, and it's not treatment either at that point. Also, echos usually have some symptomatic indication - and they don't have to be violent, whatever that means. > it can only be preventative Can you actually think of a disease that an echo would be used to prevent? But again, in practice we don’t think of delivery of medical care in such grossly general terms - it’s doesn’t simplify in a useful way.
- d136o 4y ago
  I had the same experience with a endoscopy/colonoscopy at Palo Alto Medical Foundation / Sutter Health. We should crowdsource a guide to navigating healthcare in Northern California, it’s utterly fucked up. Even getting a primary care physician is impossible, nobody is taking patients and the websites of any place (sutter, ucsf etc) don’t reflect any accurate info about who could actually become a primary care provider for you. The best healthcare situation I experienced was via Cedar Sinai while we lived in Los Angeles.
- davidkuennen 4y ago
  I'm from Germany and just recently got a preventative coloscopie. I'm not 50 years old yet, so I had to pay for it myself. A magical experience, since it's the first time I ever saw a medical bill in my life. It was two pages long. Everything from taking blood to the medication and doctor was listed there, but the price at the end was only 200€. I thought it was a joke and expected a lot more.
  - consp 4y ago
    Imagine the fact it would be cheaper to take a plane trip to Germany, also account for lost hourly work cost that takes out of your work schedule, and still be cheaper than doing it locally.
- bsimpson 4y ago
  Medical billing is the worst. I got a physical in Oct 2020, but the coronavirus spiked and it took me until April 2021 to go in and do the labs. One Medical screwed up the billing, coding them as diagnostic instead of preventative (or however that works). I got nasty letters from both LabCorp and One threatening to send me to collections and ding my credit and all that. I'd text One and they'd be like "oh, just ignore those. We'll fix it." Months go by. "Just ignore them. We'll get to it." It's such a massive what the fuck.
MomoXenosaga 4y ago
People don't want universal healthcare because then all the poors increase waiting times. But then they complain when healthcare is expensive?
pc86 4y ago
Hospital IT systems are incredibly locked down, especially from a network perspective. And DICOM images (the format things like x-rays are stored in) are very large, and not readable by most image readers. I honestly don't know if there are even free DICOM readers out there, but there probably are. CD is honestly the easiest way for them to send the images to you, because you can give them to any doctor and they can load them within minutes. For the hospital to send them directly to another hospital would literally take weeks (at a minimum) of back and forth between two overworked and incompetent IT teams.
- Temporal_Trout 4y ago
  I'm not sure if "proper" DICOM files are different (DRM?) but during my undergrad I had a medical imaging class working with anonymized DICOM files and we used Pydicom (With Jupyter Notebook) to display the images and annotations: https://pydicom.github.io/pydicom/stable/index.html https://pydicom.github.io/pydicom/stable/index.html
  - markus92 4y ago
    There’s (luckily) no such thing as DRM in DICOM, but there is a billion ways to interpret the standard. Pydicom does work for the more common things but there’s some rare types of DICOM it unfortunately can’t handle.
- mauvia 4y ago
  I've worked in a medical image processing field and there's a few out there, Orthanc is the most featureful one I know of.
- solumos 4y ago
  There are multiple free DICOM readers, but each imaging device manufacturer has its own interpretation of what a "DICOM" file is, so there are a lot of quirks.
  - zxexz 4y ago
    I've worked with DICOM files from at least 10 different sources. I was able to eventually parse/view all of them. I seem to remember trying almost as many open source libraries in the process, however. That's one of the many problems in healthcare - even the standards have competing standards.
lelanthran 4y ago
> "Here is the cash price. We won't know your HDHP insurance price until after we bill them, which could be good for you or could be bad." This is the reason that non-emergency healthcare is so expensive - the purchaser does not know the price of something at the point of purchase. This results in the price being significantly higher than what the market can bear. When consumers are informed and can force suppliers to compete with each other, prices go down to exactly what the market can bear. Emergency healthcare is a different beast, but will probably also decrease if non-emergency healthcare prices was left up to the market to set.
- nosianu 4y ago
  > the purchaser does not know the price of something at the point of purchase. This is only solvable for the cases where what needs to be done is completely known and certain in advance. Which for very complex human biological systems would not be the majority of cases, unless providers decide to only deal with health issues that fit that criteria and send everybody else to someone else. I think the problem of not being able to accurately predict the required care is an intrinsic part of health care. Some of it actually is taken care of in some way, for example, if you go to ER they will only fix any immediate urgent issues and then send you home. Or, they send you home after n days in the hospital no matter what (example links: https://www.ombudsman.org.uk/sites/default/files/page/A%20report%20of%20investigations%20into%20unsafe%20discharge%20from%20hospital.pdf https://www.ombudsman.org.uk/sites/default/files/page/A%20re... or https://pubmed.ncbi.nlm.nih.gov/12568426/ https://pubmed.ncbi.nlm.nih.gov/12568426/). > When consumers are informed and can force suppliers to compete with each other, Uhm... how do you imagine this would happen? Genetical engineering so all humans become standardized clones with identical completely predictable issues? I think you severely underestimate the inherent unpredictability. Simple stuff like teeth cleaning can be a price known in advance, or coming in only to renew a prescription for a known health problem, but many, most?, of the "real" issues are not. OR, what would happen if you enforce this is that the MDs would be forced to press the cases into the pattern. They may think they should order an additional test or imaging procedure after actually looking at the patient, but since it's not in the pre-approved plan it would not get paid, so they don't, only things that were known before any doctor looked at the person get treated and only using the predicted methods.
dham 4y ago
Broke my finger and did the whole CD thing to. I accidentally laughed on the phone when they told me what I had to do. Felt a little bad. I had to drive to the urgent care to get the CD and then drive it to the orthopedic specialist days before the appointment. As I was driving I just thought to myself, here is everything that's wrong with the medical industry, synthesized in a 700Mb metallic disk I'm holding in my hand.

dheera 4y ago

I just got billed $5000 for a routine echocardiogram at Stanford, and in the process of fighting it. My insurance is supposed to cover preventative care 100% (not even a copay). They billed $18000 total (yes, for a 1-hour ultrasound) and insurance is leaving me to pay $5000. This is about the 6th time this has happened. It's always 15+ e-mails back and forth, then threatening lawyers, then they back off. I'm wondering if it would be faster if I just take it directly to a small claims court. I am insured and it is preventative care, so I believe I'm entitled to pay nothing. Advice welcome.

mrexroad 4y ago
My son had strep throat. Stanford billed us just shy of $50K, but not before sending us a letter letting us know they had stopped accepting our insurance (BCBS) a few weeks prior. Obviously, more done than just a throat swab for the 50K, but whole thing was insane.
- dheera 4y ago
  I really want to expose Stanford's ridiculous billing and shame them to no end, but I don't have enough Twitter followers. I know healthcare billing in the US is f-ed up but Stanford is particularly bad.
  - dilyevsky 4y ago
    Not sure you need to expose them - everyone is pretty much aware it’s a shitshow. Not only in billing but quality of care and treatment of staff also
    - seesaw 4y ago
      Agree. After seeing the trauma some of my friends went through, I do my bit to recommend against going to Stanford. The standard of care is poor, and the cost is exhorbitant.
  - onphonenow 4y ago
    Not really that bad. San Francisco used to have crazy bills. Trauma response fees go up to 50k even if nothing is wrong. I can get the price of my fast food burger to the penny - but good luck getting a quote on something that will cost 50,000. I did medical billing for a bit and in my space 70% of the issue was stupid politics
    - dheera 4y ago
      San Francisco as in UCSF? I'm due for an ICD battery replacement later this year or early next year and trying to figure out where to get it done.
- hanklazard 4y ago
  That is nuts. Was he admitted to the hospital or something?
  - mrexroad 4y ago
    Yeah, they kept him for a night. Kid complained about sore throat so my wife took him to doctor (regular pediatrician was busy, so another doctor). Kid kinda mentioned a stiff neck, and doctor told my wife to get him to the ER immediately, b/c meningitis. Wife took him to Stanford ER, they were all omg we’re kinda sure it’s meningitis, but we need to do a spinal tap first. While prepping for that they put him on an IV and after ~20min he perked up a bit. A nurse noticed that and said it wasn’t normal if really meningitis, and put spinal tap on hold. Then doctor said there was a chance of an abscess in his throat/neck and wanted to rule it out; ordered a CT scan. Once that returned negative, they were like, oh yeah, it’s just strep… but, let’s prescribe an uncommon liquid antibiotic that tastes like trash reheated. Kid refused to swallow it, despite efforts of 3 nurses trying to waterboard him with the liquid. So the only way to deliver the antibiotic as prescribed was intravenously. Learned several lessons about advocating during that ER trip.
danachow 4y ago
> I am insured and it is preventative care How or why do you think an echo is preventative care? While insurance plans are free to define any additional menu of services as preventative - an echo is not included in the minimum set required by the federal government - which are procedures based off of US preventative services task force guidelines - there are no published guidelines that include an echo. I wish you luck on your billing problem but I think you’re going to hit a wall on your own definition of “preventative”. https://www.healthcare.gov/preventive-care-adults/ https://www.healthcare.gov/preventive-care-adults/
- deleted 4y ago
  [deleted]
- namdnay 4y ago
  There are two categories of healthcare right? Palliative and preventative. Which one would an echo be in this case? If he had violent symptoms it would clearly be palliative, but in this case it can only be preventative
  - danachow 4y ago
    > There are two categories of healthcare right? Palliative and preventative. The simple answer to this is that “preventative” in the case of billed medical services has a specific and clearly defined meaning - it does not even mean all services that ever would be considered preventative. This definition will be found in your insurance paperwork and corresponds at least to the site I posted - so a further philosophical discussion is irrelevant. To your actual question - No, the echo is usually pallative. However, right off the bat I'll say this is an overly reductionist and not terribly useful schema for classifying the delivery of medical care. While it might be good as a way for the general public to think about prevention, it’s way too oversimplistic to be useful beyond that. An aside, palliative has a specific and different meaning within medicine: roughly, treating symptoms without a goal of cure. Reducing a broken arm or removing an inflamed appendix is not palliative care in that sense. But even if we widen the scope of palliative to be treatment an echo would be neither. An echo is diagnostic - it doesn’t prevent nor treat heart failure or disease. Often when an echo is ordered it leads to some form of treatment for some found disease, in which case if we’re going to stick to the simple classification would be “palliative” - we’re using it to guide treatment, we can’t prevent something that we already see. > If he had violent symptoms it would clearly be palliative It's just not that simple. Echos are sometimes used to further evaluate or manage asymptomatic disease, for instance A-fib or a concerning murmur. We're using the echo to rule out suspected coexisting conditions, that's not prevention, and it's not treatment either at that point. Also, echos usually have some symptomatic indication - and they don't have to be violent, whatever that means. > it can only be preventative Can you actually think of a disease that an echo would be used to prevent? But again, in practice we don’t think of delivery of medical care in such grossly general terms - it’s doesn’t simplify in a useful way.
d136o 4y ago
I had the same experience with a endoscopy/colonoscopy at Palo Alto Medical Foundation / Sutter Health. We should crowdsource a guide to navigating healthcare in Northern California, it’s utterly fucked up. Even getting a primary care physician is impossible, nobody is taking patients and the websites of any place (sutter, ucsf etc) don’t reflect any accurate info about who could actually become a primary care provider for you. The best healthcare situation I experienced was via Cedar Sinai while we lived in Los Angeles.
davidkuennen 4y ago
I'm from Germany and just recently got a preventative coloscopie. I'm not 50 years old yet, so I had to pay for it myself. A magical experience, since it's the first time I ever saw a medical bill in my life. It was two pages long. Everything from taking blood to the medication and doctor was listed there, but the price at the end was only 200€. I thought it was a joke and expected a lot more.
- consp 4y ago
  Imagine the fact it would be cheaper to take a plane trip to Germany, also account for lost hourly work cost that takes out of your work schedule, and still be cheaper than doing it locally.
bsimpson 4y ago
Medical billing is the worst. I got a physical in Oct 2020, but the coronavirus spiked and it took me until April 2021 to go in and do the labs. One Medical screwed up the billing, coding them as diagnostic instead of preventative (or however that works). I got nasty letters from both LabCorp and One threatening to send me to collections and ding my credit and all that. I'd text One and they'd be like "oh, just ignore those. We'll fix it." Months go by. "Just ignore them. We'll get to it." It's such a massive what the fuck.

MomoXenosaga 4y ago

People don't want universal healthcare because then all the poors increase waiting times. But then they complain when healthcare is expensive?

pc86 4y ago

Hospital IT systems are incredibly locked down, especially from a network perspective. And DICOM images (the format things like x-rays are stored in) are very large, and not readable by most image readers. I honestly don't know if there are even free DICOM readers out there, but there probably are. CD is honestly the easiest way for them to send the images to you, because you can give them to any doctor and they can load them within minutes. For the hospital to send them directly to another hospital would literally take weeks (at a minimum) of back and forth between two overworked and incompetent IT teams.

Temporal_Trout 4y ago
I'm not sure if "proper" DICOM files are different (DRM?) but during my undergrad I had a medical imaging class working with anonymized DICOM files and we used Pydicom (With Jupyter Notebook) to display the images and annotations: https://pydicom.github.io/pydicom/stable/index.html https://pydicom.github.io/pydicom/stable/index.html
- markus92 4y ago
  There’s (luckily) no such thing as DRM in DICOM, but there is a billion ways to interpret the standard. Pydicom does work for the more common things but there’s some rare types of DICOM it unfortunately can’t handle.
mauvia 4y ago
I've worked in a medical image processing field and there's a few out there, Orthanc is the most featureful one I know of.
solumos 4y ago
There are multiple free DICOM readers, but each imaging device manufacturer has its own interpretation of what a "DICOM" file is, so there are a lot of quirks.
- zxexz 4y ago
  I've worked with DICOM files from at least 10 different sources. I was able to eventually parse/view all of them. I seem to remember trying almost as many open source libraries in the process, however. That's one of the many problems in healthcare - even the standards have competing standards.

lelanthran 4y ago

> "Here is the cash price. We won't know your HDHP insurance price until after we bill them, which could be good for you or could be bad." This is the reason that non-emergency healthcare is so expensive - the purchaser does not know the price of something at the point of purchase. This results in the price being significantly higher than what the market can bear. When consumers are informed and can force suppliers to compete with each other, prices go down to exactly what the market can bear. Emergency healthcare is a different beast, but will probably also decrease if non-emergency healthcare prices was left up to the market to set.

nosianu 4y ago
> the purchaser does not know the price of something at the point of purchase. This is only solvable for the cases where what needs to be done is completely known and certain in advance. Which for very complex human biological systems would not be the majority of cases, unless providers decide to only deal with health issues that fit that criteria and send everybody else to someone else. I think the problem of not being able to accurately predict the required care is an intrinsic part of health care. Some of it actually is taken care of in some way, for example, if you go to ER they will only fix any immediate urgent issues and then send you home. Or, they send you home after n days in the hospital no matter what (example links: https://www.ombudsman.org.uk/sites/default/files/page/A%20report%20of%20investigations%20into%20unsafe%20discharge%20from%20hospital.pdf https://www.ombudsman.org.uk/sites/default/files/page/A%20re... or https://pubmed.ncbi.nlm.nih.gov/12568426/ https://pubmed.ncbi.nlm.nih.gov/12568426/). > When consumers are informed and can force suppliers to compete with each other, Uhm... how do you imagine this would happen? Genetical engineering so all humans become standardized clones with identical completely predictable issues? I think you severely underestimate the inherent unpredictability. Simple stuff like teeth cleaning can be a price known in advance, or coming in only to renew a prescription for a known health problem, but many, most?, of the "real" issues are not. OR, what would happen if you enforce this is that the MDs would be forced to press the cases into the pattern. They may think they should order an additional test or imaging procedure after actually looking at the patient, but since it's not in the pre-approved plan it would not get paid, so they don't, only things that were known before any doctor looked at the person get treated and only using the predicted methods.

dham 4y ago

Broke my finger and did the whole CD thing to. I accidentally laughed on the phone when they told me what I had to do. Felt a little bad. I had to drive to the urgent care to get the CD and then drive it to the orthopedic specialist days before the appointment. As I was driving I just thought to myself, here is everything that's wrong with the medical industry, synthesized in a 700Mb metallic disk I'm holding in my hand.