6 ms·

-- An ambulance in Ontario is $40 if you have OHIP - I know plenty of non-OHIP folks who have gotten hit with $200+ ambulance bills - myself included --

morelisp 4y ago
My last ambulance trip in the US was billed at $12000. With my (good!) insurance I still had to pay $500.
- lotsofpulp 4y ago
  $500 for a specialized vehicle on demand 24/7 with somewhat trained workers who have to deal with undesirable work seems pretty good. Assuming that was under the deductible, so the ambulance provider did not get paid anything else, and $500 was the negotiated pricing for members of your insurance plan.
  - morelisp 4y ago
    [flagged]
  - freeflight 4y ago
    Would you also calculate the economics of privatized firefighters like that? Or are you at some point willing to admit that not everything should be a private, purely for profit/shareholder value, venture?
    - lotsofpulp 4y ago
      I did not claim anything about what should or should not be subsidized by taxpayers. My comment was simply about the actual cost of providing ambulance services. The fact that the insurance company can negotiate the bill to $500 indicates what the real price is. The $12k number is just fantasy numbers that healthcare providers throw out to start the negotiation.
      - freeflight 4y ago
        > The fact that the insurance company can negotiate the bill to $500 indicates what the real price is. That really depends on your definition of "real price", particularly considering how in a lot of developed countries that'd still be considered a pretty outrageous price to pay for such a situation, particularly while even having insurance.
        lotsofpulp 4y ago
        I am using price in the economic sense of price, where the supply and demand curve meet. Such as the price of a good when you go to a market and haggle with various vendors. It does not depend on who pays for it. I did not intend to comment on who should or should not be liable for paying this price, simply that $500 seems like a reasonable price for an ambulance service.
  - oops 4y ago
    The $40 in Ontario sounds even better tho right? Just as the billed imaginary $12k figure that only exists to make “$500 seem pretty good” sounds absurd.
    - lotsofpulp 4y ago
      I did not write that the ambulance should not be subsidized by the government, merely that the negotiated price between the ambulance business and the insurance company seems reasonable considering the services provided. I would have made the same statement if the government had paid the ambulance company $500, or if the government’s cost for providing that instance of ambulance service was $500.
    - missedthecue 4y ago
      I wonder what the Ontarian government pays. Are Ontario ambulance companies that much more efficient? Surely there are heavy subsidies in play.
      - pigtailgirl 4y ago
        -- The government decides how much the healthcare industry is allowed to charge - there is a schedule set down by the government - they won't pay more than it - health care providers are allowed to bill the government $240 per for a basic ride - A005 is the fee code for a general consult - it's set at $77 - that's why most clinics will only do 15 minute appointments - unfortunately -- most doctors are earning about $150/hr - the good ones who are smart go to the states because they can earn considerably more --
  - mindslight 4y ago
    $500 could be a reasonable fee if it were generally predictable, but you're completely ignoring the fraudulent $12,000 bill and the fact that OP had to sign up for "good" "insurance" to access the real price.
    - lotsofpulp 4y ago
      My intention was the opposite. By pointing out the $500 being reasonable, meaning that the insurance company negotiated a decent price. Obviously, the $12k is ludicrous, proven by them being willing to accept $500 for people who belong to an insurance plan. Health insurance in the US is not just insurance against a one time high cost event. One aspect of it is paying a business to gain access to lower pricing due to volume that you would be unable to get as an individual, which seemingly this person’s insurance plan did.
      - mindslight 4y ago
        > One aspect of it is paying a business to gain access to lower pricing due to volume that you would be unable to get as an individual It only makes sense to talk about volume discounts when there is actual savings from providing volume (for example, less packaging). Many different instances of individual care do not create such savings, for anything but handling the make-work billing paperwork that this system itself generates. This idea that individuals shouldn't be market participants is a broken assertion that underlies much of our healthcare dysfunction. In the situation you're describing, the "insurance" company has zero market leverage over the ambulance provider, and so you're championing a specious "negotiation". Meanwhile individuals that need a ride to the hospital avoid calling 911 since they have no idea what it will cost, and instead look to markets with price transparency to fill in (ie markets where they're welcome). A straightforward healthcare reform would be to eliminate this cartel dynamic of providers having a different price for each "insurance" company, and mandate that they charge the same published prices regardless of who is paying. At that point, insurance companies would financially provide real insurance rather than their current function of bundling and obfuscating price signals. There would no longer be this "out of network" nonsense, but rather insurance coverage would be based on percentages of market prices. Insurance companies could then recommend providers that charge lower prices to save money for themselves and their customers, while still allowing their customers to be market participants when their preferences differ.
  - yellowapple 4y ago
    > Assuming that was under the deductible, so the ambulance provider did not get paid anything else Hm? The insurer would've paid the difference (minus some additional discounts depending on the size of the insurer and its bargaining power). That the patient paid $500 does not in the slightest bit indicate that the insurer negotiated the rate down to that pricepoint. Even at $500 (and let's assume that was an hour-long ride, for easy math that's maximally generous to your argument), EMTs on average make around $20/hour at best, and maybe double that for a nurse - so a fully staffed ambulance would run around $80/hour for labor. Round it up to $100 to be generous and that still leaves $400 for the ambulance itself. Ambulance itself costs up to $150,000, so earmarking another $100 would pay it off after 1,500 hours of service - so less than a year, even if it's only running for 40 hours a week. Maybe it's really fuel-inefficient and breaks down frequently, so we'll say another $100 for fuel and maintenance. Throw in another $100 to pay off $150,000 worth of equipment and medical supplies. So of that $500 price the patient pays, we're left with $100. At the price billed to the insurer, that's an eye-watering $11,600 of what appears to be pure profit. Maybe there's some excuse for that, but to me it's pretty obvious that something's way out of whack. $500 or even a bit more than that would be reasonable if EMTs and nurses were being paid better, but they largely ain't.
    - lotsofpulp 4y ago
      I doubt the $12k that was billed was paid by insurance company. Typically, the provider bills a ludicrous amount, and then they apply a ridiculous “adjustment” for being a subscriber to the insurance plan, and then you pay per your deductible/coinsurance/out of pocket maximum situation. I have no idea how much ambulances and personnel cost, but I do know that whatever the costs are, they have to be distributed amongst the emergency events. An ambulance and redundant staffing is paid to be available 24/7, but there might only be 3 or 4 or 10 trips per day. I assume there are also considerable liabilities and hence insurance costs.
      - yellowapple 4y ago
        > I doubt the $12k that was billed was paid by insurance company. Typically, the provider bills a ludicrous amount, and then they apply a ridiculous “adjustment” for being a subscriber to the insurance plan, and then you pay per your deductible/coinsurance/out of pocket maximum situation. That doesn't make the fact that they bill such a ridiculous amount in the first place any less unacceptable.
  - vkou 4y ago
    > somewhat trained workers Those workers are paid ~minimum wage, and the amortized cost of the vehicle and its equipment is not $500/ride. The reason they charge $500, $800, or $12,000 is because ambulance firms have monopoly licenses, because you're not going to haggle over the price when one arrives, and because they can charge you whatever the hell they want, and when the dust settles, some people might even pay it.
- stop50 4y ago
  Despite me knowing the american system, it still freaks me out seeing the numbers. the last time i had to pay anything for anything medical was the deductible of 5€ (minimum 5€ maximum 10€ 10% of the price for everything you buy in one go, except generica which are free from deductions)
  - morelisp 4y ago
    I've lived in Europe for a decade now and I have a similar reaction when my family still in the US talks about medical expenses or I think back to how I weighed financial vs. medical decisions during those years. It's inhumane, and seemingly impossible to impress on middle-class Americans how unnecessary and pervasive the cruelty is. Living or even thinking within its frame leaves one a broken person.
- reaperducer 4y ago
  I find this hard to believe. I work in healthcare, and occasionally see billing numbers as part of my job. Even when we send an air ambulance helicopter to a remote part of the desert, it doesn't cost $12,000. Related to the rest of this thread, a family member was hurt at work about six months ago and needed a 12-mile ambulance ride. The ambulance company billed the company's insurance $1,400. The company's insurance actually paid a little over $300.
  - deleted 4y ago
    [deleted]
  - bombcar 4y ago
    Someone is subsidizing something on an air ambulance if it doesn't hit $12k. Those things are $1k/hr just as a baseline, and that's before you even try to pay for a pilot or anyone else. However, they're usually managed by air/rescue and therefor part of the fire department or equivalent.
  - morelisp 4y ago
    I don't know what to tell you, it's what the bill said. Like everyone has already mentioned, I'm sure my insurance didn't pay that much but that doesn't make the situation make any more real sense; and even at the minimum of $500 the unfavorable comparison to a worst-case situation in Canada remains.
Waterluvian 4y ago
That’s still orders of magnitude less than many American ambulance visits.
kyrra 4y ago
I paid $1400 for an 8 mile ambulance ride this year in Colorado. I think this was applied to my high deductible health plan, but I got to pay the full amount (and they don't provide any kind of discounts to insurance companies).

morelisp 4y ago

My last ambulance trip in the US was billed at $12000. With my (good!) insurance I still had to pay $500.

lotsofpulp 4y ago
$500 for a specialized vehicle on demand 24/7 with somewhat trained workers who have to deal with undesirable work seems pretty good. Assuming that was under the deductible, so the ambulance provider did not get paid anything else, and $500 was the negotiated pricing for members of your insurance plan.
- morelisp 4y ago
  [flagged]
- freeflight 4y ago
  Would you also calculate the economics of privatized firefighters like that? Or are you at some point willing to admit that not everything should be a private, purely for profit/shareholder value, venture?
  - lotsofpulp 4y ago
    I did not claim anything about what should or should not be subsidized by taxpayers. My comment was simply about the actual cost of providing ambulance services. The fact that the insurance company can negotiate the bill to $500 indicates what the real price is. The $12k number is just fantasy numbers that healthcare providers throw out to start the negotiation.
    - freeflight 4y ago
      > The fact that the insurance company can negotiate the bill to $500 indicates what the real price is. That really depends on your definition of "real price", particularly considering how in a lot of developed countries that'd still be considered a pretty outrageous price to pay for such a situation, particularly while even having insurance.
      - lotsofpulp 4y ago
        I am using price in the economic sense of price, where the supply and demand curve meet. Such as the price of a good when you go to a market and haggle with various vendors. It does not depend on who pays for it. I did not intend to comment on who should or should not be liable for paying this price, simply that $500 seems like a reasonable price for an ambulance service.
- oops 4y ago
  The $40 in Ontario sounds even better tho right? Just as the billed imaginary $12k figure that only exists to make “$500 seem pretty good” sounds absurd.
  - lotsofpulp 4y ago
    I did not write that the ambulance should not be subsidized by the government, merely that the negotiated price between the ambulance business and the insurance company seems reasonable considering the services provided. I would have made the same statement if the government had paid the ambulance company $500, or if the government’s cost for providing that instance of ambulance service was $500.
  - missedthecue 4y ago
    I wonder what the Ontarian government pays. Are Ontario ambulance companies that much more efficient? Surely there are heavy subsidies in play.
    - pigtailgirl 4y ago
      -- The government decides how much the healthcare industry is allowed to charge - there is a schedule set down by the government - they won't pay more than it - health care providers are allowed to bill the government $240 per for a basic ride - A005 is the fee code for a general consult - it's set at $77 - that's why most clinics will only do 15 minute appointments - unfortunately -- most doctors are earning about $150/hr - the good ones who are smart go to the states because they can earn considerably more --
- mindslight 4y ago
  $500 could be a reasonable fee if it were generally predictable, but you're completely ignoring the fraudulent $12,000 bill and the fact that OP had to sign up for "good" "insurance" to access the real price.
  - lotsofpulp 4y ago
    My intention was the opposite. By pointing out the $500 being reasonable, meaning that the insurance company negotiated a decent price. Obviously, the $12k is ludicrous, proven by them being willing to accept $500 for people who belong to an insurance plan. Health insurance in the US is not just insurance against a one time high cost event. One aspect of it is paying a business to gain access to lower pricing due to volume that you would be unable to get as an individual, which seemingly this person’s insurance plan did.
    - mindslight 4y ago
      > One aspect of it is paying a business to gain access to lower pricing due to volume that you would be unable to get as an individual It only makes sense to talk about volume discounts when there is actual savings from providing volume (for example, less packaging). Many different instances of individual care do not create such savings, for anything but handling the make-work billing paperwork that this system itself generates. This idea that individuals shouldn't be market participants is a broken assertion that underlies much of our healthcare dysfunction. In the situation you're describing, the "insurance" company has zero market leverage over the ambulance provider, and so you're championing a specious "negotiation". Meanwhile individuals that need a ride to the hospital avoid calling 911 since they have no idea what it will cost, and instead look to markets with price transparency to fill in (ie markets where they're welcome). A straightforward healthcare reform would be to eliminate this cartel dynamic of providers having a different price for each "insurance" company, and mandate that they charge the same published prices regardless of who is paying. At that point, insurance companies would financially provide real insurance rather than their current function of bundling and obfuscating price signals. There would no longer be this "out of network" nonsense, but rather insurance coverage would be based on percentages of market prices. Insurance companies could then recommend providers that charge lower prices to save money for themselves and their customers, while still allowing their customers to be market participants when their preferences differ.
- yellowapple 4y ago
  > Assuming that was under the deductible, so the ambulance provider did not get paid anything else Hm? The insurer would've paid the difference (minus some additional discounts depending on the size of the insurer and its bargaining power). That the patient paid $500 does not in the slightest bit indicate that the insurer negotiated the rate down to that pricepoint. Even at $500 (and let's assume that was an hour-long ride, for easy math that's maximally generous to your argument), EMTs on average make around $20/hour at best, and maybe double that for a nurse - so a fully staffed ambulance would run around $80/hour for labor. Round it up to $100 to be generous and that still leaves $400 for the ambulance itself. Ambulance itself costs up to $150,000, so earmarking another $100 would pay it off after 1,500 hours of service - so less than a year, even if it's only running for 40 hours a week. Maybe it's really fuel-inefficient and breaks down frequently, so we'll say another $100 for fuel and maintenance. Throw in another $100 to pay off $150,000 worth of equipment and medical supplies. So of that $500 price the patient pays, we're left with $100. At the price billed to the insurer, that's an eye-watering $11,600 of what appears to be pure profit. Maybe there's some excuse for that, but to me it's pretty obvious that something's way out of whack. $500 or even a bit more than that would be reasonable if EMTs and nurses were being paid better, but they largely ain't.
  - lotsofpulp 4y ago
    I doubt the $12k that was billed was paid by insurance company. Typically, the provider bills a ludicrous amount, and then they apply a ridiculous “adjustment” for being a subscriber to the insurance plan, and then you pay per your deductible/coinsurance/out of pocket maximum situation. I have no idea how much ambulances and personnel cost, but I do know that whatever the costs are, they have to be distributed amongst the emergency events. An ambulance and redundant staffing is paid to be available 24/7, but there might only be 3 or 4 or 10 trips per day. I assume there are also considerable liabilities and hence insurance costs.
    - yellowapple 4y ago
      > I doubt the $12k that was billed was paid by insurance company. Typically, the provider bills a ludicrous amount, and then they apply a ridiculous “adjustment” for being a subscriber to the insurance plan, and then you pay per your deductible/coinsurance/out of pocket maximum situation. That doesn't make the fact that they bill such a ridiculous amount in the first place any less unacceptable.
- vkou 4y ago
  > somewhat trained workers Those workers are paid ~minimum wage, and the amortized cost of the vehicle and its equipment is not $500/ride. The reason they charge $500, $800, or $12,000 is because ambulance firms have monopoly licenses, because you're not going to haggle over the price when one arrives, and because they can charge you whatever the hell they want, and when the dust settles, some people might even pay it.
stop50 4y ago
Despite me knowing the american system, it still freaks me out seeing the numbers. the last time i had to pay anything for anything medical was the deductible of 5€ (minimum 5€ maximum 10€ 10% of the price for everything you buy in one go, except generica which are free from deductions)
- morelisp 4y ago
  I've lived in Europe for a decade now and I have a similar reaction when my family still in the US talks about medical expenses or I think back to how I weighed financial vs. medical decisions during those years. It's inhumane, and seemingly impossible to impress on middle-class Americans how unnecessary and pervasive the cruelty is. Living or even thinking within its frame leaves one a broken person.
reaperducer 4y ago
I find this hard to believe. I work in healthcare, and occasionally see billing numbers as part of my job. Even when we send an air ambulance helicopter to a remote part of the desert, it doesn't cost $12,000. Related to the rest of this thread, a family member was hurt at work about six months ago and needed a 12-mile ambulance ride. The ambulance company billed the company's insurance $1,400. The company's insurance actually paid a little over $300.
- deleted 4y ago
  [deleted]
- bombcar 4y ago
  Someone is subsidizing something on an air ambulance if it doesn't hit $12k. Those things are $1k/hr just as a baseline, and that's before you even try to pay for a pilot or anyone else. However, they're usually managed by air/rescue and therefor part of the fire department or equivalent.
- morelisp 4y ago
  I don't know what to tell you, it's what the bill said. Like everyone has already mentioned, I'm sure my insurance didn't pay that much but that doesn't make the situation make any more real sense; and even at the minimum of $500 the unfavorable comparison to a worst-case situation in Canada remains.

Waterluvian 4y ago

That’s still orders of magnitude less than many American ambulance visits.

kyrra 4y ago

I paid $1400 for an 8 mile ambulance ride this year in Colorado. I think this was applied to my high deductible health plan, but I got to pay the full amount (and they don't provide any kind of discounts to insurance companies).