6 ms·

On the flip side.. as someone who pays their bills, the ER has become the #1 priority to avoid. I'd prefer not to pay 5000 or 6000 total - $3000 to a hospital

On the flip side.. as someone who pays their bills, the ER has become the #1 priority to avoid. I'd prefer not to pay 5000 or 6000 total - $3000 to a hospital and $3000 to an ER doctor agency for a small 2nd degree burn or small cut requiring stitches, or any other issue I may have been taken there in the past for. I'll sew my child up before I take them to a pediatric ER and I'll order the antibiotics from India or Mexico.. An ER doctor makes $150-300/hr. I'll pay double or triple or 10x that but in my experience you are billed something like 100x that. 10 minutes is 3k. We can meet at a Holiday Inn. We'll arrive by Uber.

cjbgkagh 4y ago
It is robber baron type stuff. It is absolutely nuts. I completely understand people escaping ambulances to avoid a $10K Aspirin. I avoid going to the US on the off chance that I might need medical care.
- denimnerd42 4y ago
  There's expensive insurance products for a short term trip. They'll even fly you back to wherever you're from if it's serious enough.
  - cjbgkagh 4y ago
    I do get the extra insurance, it’s still a major hassle I’d rather not deal with. Plus I don’t trust insurance companies who have a strong incentive to weasel out of their obligations. A commonly known strategy is Deny, Delay, Defend. You have to make sure you have enough money saved to hire a lawyer for when you need to sue the insurance company to get them to pay. Which is an extra hassle I’d rather not deal with.
- User23 4y ago
  Somebody has to pay for all the "free" care.
  - vkou 4y ago
    And also for the profit margins of the owners of the hospital, and for the doctors' dachas, and for the administrative bloat in medical schools that leads to a medical education costing a million bucks, and, and...
  - deleted 4y ago
    [deleted]
  - thatfrenchguy 4y ago
    Hospitals in the US (just like a lot of other market participants) have no incentive to save money. This is what universal healthcare would give you: more money spent on care, less on bullshit. Obama famously said you couldn't do universal / single payer healthcare in the late 2000s because it would destroy too many jobs in billing.
    - yamtaddle 4y ago
      The military is our blue-collar/lower-class jobs program. Our healthcare system is our white-collar/middle-class jobs program.
      - mindslight 4y ago
        Don't forget Wall Street! I guess that's the jobs program for the upper class. Honestly after many decades of technological growth, extreme offshoring, and the workforce nearly doubling due to women entering it, I'd estimate that 80% of positions are bullshit jobs.
        dredmorbius 4y ago
        Adtech?
        softjobs 4y ago
        And its cousin, Fintech.
davidw 4y ago
When we lived in Italy, my then toddler had one of these: https://en.wikipedia.org/wiki/Breath-holding_spell https://en.wikipedia.org/wiki/Breath-holding_spell and as the article says "a breath-holding spell is a frightening experience for observers", which is actually a monumental understatement. We called the equivalent of 911 with no thoughts whatsoever about money because it's simply not a factor there. He was fine before the ambulance pulled up (very quickly) but they took him and my wife to the hospital to check him up. Didn't pay a dime for any of it, although of course you do pay higher taxes there. But the peace of mind is worth it and overall, Italy spends less of its GDP on health care than the US.
- noorkersz 4y ago
  but the USA has more millionaires
  - ilostmyshoes 4y ago
    [dead]
- willcipriano 4y ago
  US taxpayers already pay, per capita, the most on earth for socialized medicine in terms of government spending[0], we just don't get universal coverage beacuse it is beyond the competency of our leadership. [0]https://www.oecd-ilibrary.org/sites/154e8143-en/index.html?itemId=/content/component/154e8143-en#figure-d1e10511 https://www.oecd-ilibrary.org/sites/154e8143-en/index.html?i...
  - ejb999 4y ago
    I don't think it's beyond the competency of our leaders - I think our leaders know that not enough people actually want it. If politicians thought it was a winning strategy (defined by getting re-elected), they would be all over it. People that already have subsidized insurance (i.e. thru employers), and are happy with it, see no reason for it to change. Especially people who have good health insurance and/or don't get sick very often.
yamtaddle 4y ago
After recently paying a fuck-ton for some stitches at an ER for a case that was a little hairier than urgent cares were willing to take on, but not at all life threatening, but also not something that could wait for a regular doctor... yeah, I'm seriously considering learning to apply sutures and buying a kit or something. I hate having to do "go, or don't and just hope it's OK?" when the best choice is clearly to go, and not having good options for taking care of it those kind of middle-grade problems myself. (I did try superglue—growing up rural didn't teach me nothing about avoiding paying doctors—but one of the cuts was too big and too bleed-y for that to take :-( )
- thatcat 4y ago
  A butterfly kit is a decent compromise that doesn't really require training. https://www.amazon.com/Sutures-Waterproof-Butterfly-Hospital-Laceration https://www.amazon.com/Sutures-Waterproof-Butterfly-Hospital...
  - Rebelgecko 4y ago
    The link isn't working for me, but FWIW buying medical supplies on Amazon is usually not the best option. Poorly made counterfeits abound and thanks to inventory comingling it doesn't necessary matter which seller you buy from.
- twodave 4y ago
  During a vacation a couple years ago I dropped a glass in the sink while washing it and reflexively tried to catch it. My hand made contact just as it was shattering in the bottom of the sink, resulting in a really nasty, irregular gash that immediately began bleeding badly. I ended up wrapping it in paper towels and driving myself to the nearest supermarket (~15 minutes), where I bought some anti-septic and super glue. I looked pretty funny walking around the store with my hand wrapped up and raised in the air, and I sounded pretty funny as I applied the anti-septic and screamed profanities from inside my car in the parking lot. But with my hand glued back together I was able to pretty much go back to doing normal things within the hour. There's a scar, but it's actually a bit difficult to distinguish from the natural lines in my hand. Total bill: ~$10. My wife was of course not amused. The kids thought it was cool, though.
lm28469 4y ago
I've always been told ER is for _emergencies_, I'd never go there for a 2nd degree burn or a small cut. Emergencies as in "if I don't go there _now_ I might suffer _grave_ long term consequences" not as in "ouchie it'll be painful until I get it looked at tomorrow"
- giraffe_lady 4y ago
  The thing is the doctor you would get to look at it tomorrow can simply decline to, the ER can't.
  - lm28469 4y ago
    Exactly, and that's why when you go there you have to wait 8 hours because you have 38 non emergency scenarios before it's your turn.
    - brewdad 4y ago
      ERs do triage on incoming patients. If you arrive with non-life threatening issues, you will be pushed to the back of the line repeatedly. Occasionally, a patient or intake nurse will misjudge the problem and the patient dies in the waiting room. Greatest health care system in the world.
      - ejb999 4y ago
        which health care system magically triages patients correctly 100% of the time and never makes mistakes?
- denimnerd42 4y ago
  Well we're not only talking about adults but also talking about children here. At 9pm you get a small AND deep cut requiring stitches. It won't stop bleeding if you take pressure off. what do you do? At 9pm your family member accidentally drops a kettle of of hot but not life threatening water on your child and they get a large blister on their chest, what do you do? These are probably not serious situations but the pediatrician will tell you to go to the ER even if you wait till the next morning.
annoyingnoob 4y ago
My daughter has needed to go to the ER several times, after 3 crap experiences with the ER nearby we now drive 40 miles to have a better experience. It is not only the billing issues, especially with the wave of 'Revenue Management' services providers are using, it is the patients in the ER. Dealing with the crazies, the people acting up to try to get attention, waiting for hours in this fun with a child, no thanks.
pcwalton 4y ago
> I'd prefer not to pay 5000 or 6000 total - $3000 to a hospital and $3000 to an ER doctor agency for a small 2nd degree burn or small cut requiring stitches, or any other issue I may have been taken there in the past for. In the US, this is what urgent care is for. If there's an urgent care clinic in the area, you should absolutely not go to the ER for that kind of stuff. The price of the ER reflects the fact that it's for major, life-threatening emergencies; if you go there for a cut requiring stitches, then you're not using the medical system efficiently, and that's why the costs are what they are. Personally, I've found the urgent care clinic I've gone to to be a better experience than both the ER and my primary care physician. It's gotten me in and out with quick, high-quality care, and it's cheap.
- denimnerd42 4y ago
  Of course.. and that's what happens most of the time but it's not that simple still. I've found urgent care experiences are highly variable even between same location. The ER is more a guaranteed thing with set standards.
- kayodelycaon 4y ago
  Urgent care varies a lot. Going to one around here is not a good idea. I don't think any of them has more positive reviews than negative ones. I decided to risk one of the better reviewed places. It was empty and I was completely ignored by the staff who were on their phones. My worst taxi experience was better. At least I left before they could rip me off. Ended up going to the ER and the nurse told me the urgent care place would have just sent me to the ER anyway.
- pcthrowaway 4y ago
  > life-threatening emergencies It's not really just for life-threatening emergencies. If you cut your toe off at 2 AM you probably want to go to an ER to see if there's a chance it can be reattached.
repiret 4y ago
Others have pointed these things out individually, but I wanted to say them all in one place: An urgent care is well suited to needing a couple stitches or a cast. At the ER, you're also paying for: * A facility and staffing equipped to handle serious trauma and critical illness. * (In the US) A facility that legally cannot turn away people for inability to pay. Exacerbated by being in a national medical system where lots of people can't pay for basic care, so they go to the ER to receive it. If you don't need those things, then don't go to an ER if you can help it. Some large hospitals essentially operate an urgent care with the same waiting room as the ER in order to lower their costs, but I've only seen that at the largest of hospitals, and I've been to at least one large hospital that didn't work that way.
- mrguyorama 4y ago
  As an insured person, an urgent care costs the same as an ER visit and does less for me. My equally insured girlfriend had to pay several hundred dollars to an urgent care facility for a rapid strep and rapid covid tests, about $50 in a civilized country.
  - maybeinsured 4y ago
    I pay $80 for Urgent Care services such as this in the US, a civilized country, the trick being I pay out of pocket then send in the receipt to my insurance for credit. Sorry to hear your girlfriend found a crap business. https://www.holycitymed.com/primary-care/?gclid=EAIaIQobChMI_Lutm93o_AIVibbICh0pLAKbEAAYASAAEgJgJfD_BwE https://www.holycitymed.com/primary-care/?gclid=EAIaIQobChMI...
  - repiret 4y ago
    It may cost you the same. With my insurance, if I'm admitted to a hospital, the time I spend in the ER is free to me, but if I'm not admitted, I pay for the time I'm in the ER. That doesn't make ERs cheaper when you get admitted. ERs are more expensive to operate then urgent care. Even when the ER is treating something that could be treated at an urgent care. That doesn't change just because some people's insurance hide that detail from them.
gnopgnip 4y ago
Half of children are covered by Medicaid and there would be zero copay. It is a great program that has saved and improved many lives. The ER might bill $6k for a cut requiring stitches, but most people have insurance, they will have a lower negotiated rate. A typical copay with insurance is more like $250, plus another $10-$20 copay to pickup medication. Something not immediately life threatening like a cut requiring stitches could go to urgent care, they might bill $400, and your copay is under $100.
- denimnerd42 4y ago
  Well. We have insurance. The insurance is also for emergency situations. It's high-ded at 3000 and the out of pocket max is something like 12,000. So yeah one ER trip a year is going to cost me 3000-12,000+. Urgent care is great in theory but I've not had great experiences. I'll also be paying the complete bill there too so 400+ which is fine. The problem is if they are too scared then it will be the $200 plus an ER bill and I'm back to where I started.
- briffle 4y ago
  It bothers me to no end that the cash price I pay is drastically higher than the cost the insurance company pays. especially since insurance is a royal pain to deal with, and requires specialists for billing, etc. But then again, I can't believe hospitals don't have to have a 'menu' on their web site that shows their cash and average insurance cost of their 20 most common procedures. I know almost nobody pays cash price, but I don't want my medical care to be treated like Kohls or JC Pennys where they show me a $7 t-shirt is "regularly $27" so I feel like i'm saving, even though we both know they never, EVER charged $27 for that t-shirt..
- schemescape 4y ago
  Plus deductible and coinsurance, which which are often much more…
LarryMullins 4y ago
> I'd prefer not to pay 5000 or 6000 total - $3000 to a hospital and $3000 to an ER doctor agency for a small 2nd degree burn or small cut requiring stitches For what it's worth, about 5 years ago I was without insurance and went to the ER to get 5 stitches in my finger. The total bill came out to $150. This was in America. I think if I had insurance then, they would have billed the insurance company 10x that at least.
- dredmorbius 4y ago
  Insurance has negotiated rates with providers. These typically start with the facility's chargemaster billing and are negotiated off of it. Depending on the relative negotiating strength of the carrier or caregiver network, that might be higher or lower. It's the uninsured who are far more likely to be billed the maximum amount, in the US, as they have no negotiating power, most especially in the moment urgent care is required.
patientplatypus 4y ago
[dead]

cjbgkagh 4y ago

It is robber baron type stuff. It is absolutely nuts. I completely understand people escaping ambulances to avoid a $10K Aspirin. I avoid going to the US on the off chance that I might need medical care.

denimnerd42 4y ago
There's expensive insurance products for a short term trip. They'll even fly you back to wherever you're from if it's serious enough.
- cjbgkagh 4y ago
  I do get the extra insurance, it’s still a major hassle I’d rather not deal with. Plus I don’t trust insurance companies who have a strong incentive to weasel out of their obligations. A commonly known strategy is Deny, Delay, Defend. You have to make sure you have enough money saved to hire a lawyer for when you need to sue the insurance company to get them to pay. Which is an extra hassle I’d rather not deal with.
User23 4y ago
Somebody has to pay for all the "free" care.
- vkou 4y ago
  And also for the profit margins of the owners of the hospital, and for the doctors' dachas, and for the administrative bloat in medical schools that leads to a medical education costing a million bucks, and, and...
- deleted 4y ago
  [deleted]
- thatfrenchguy 4y ago
  Hospitals in the US (just like a lot of other market participants) have no incentive to save money. This is what universal healthcare would give you: more money spent on care, less on bullshit. Obama famously said you couldn't do universal / single payer healthcare in the late 2000s because it would destroy too many jobs in billing.
  - yamtaddle 4y ago
    The military is our blue-collar/lower-class jobs program. Our healthcare system is our white-collar/middle-class jobs program.
    - mindslight 4y ago
      Don't forget Wall Street! I guess that's the jobs program for the upper class. Honestly after many decades of technological growth, extreme offshoring, and the workforce nearly doubling due to women entering it, I'd estimate that 80% of positions are bullshit jobs.
      - dredmorbius 4y ago
        Adtech?
        softjobs 4y ago
        And its cousin, Fintech.

davidw 4y ago

When we lived in Italy, my then toddler had one of these: https://en.wikipedia.org/wiki/Breath-holding_spell https://en.wikipedia.org/wiki/Breath-holding_spell and as the article says "a breath-holding spell is a frightening experience for observers", which is actually a monumental understatement. We called the equivalent of 911 with no thoughts whatsoever about money because it's simply not a factor there. He was fine before the ambulance pulled up (very quickly) but they took him and my wife to the hospital to check him up. Didn't pay a dime for any of it, although of course you do pay higher taxes there. But the peace of mind is worth it and overall, Italy spends less of its GDP on health care than the US.

noorkersz 4y ago
but the USA has more millionaires
- ilostmyshoes 4y ago
  [dead]
willcipriano 4y ago
US taxpayers already pay, per capita, the most on earth for socialized medicine in terms of government spending[0], we just don't get universal coverage beacuse it is beyond the competency of our leadership. [0]https://www.oecd-ilibrary.org/sites/154e8143-en/index.html?itemId=/content/component/154e8143-en#figure-d1e10511 https://www.oecd-ilibrary.org/sites/154e8143-en/index.html?i...
- ejb999 4y ago
  I don't think it's beyond the competency of our leaders - I think our leaders know that not enough people actually want it. If politicians thought it was a winning strategy (defined by getting re-elected), they would be all over it. People that already have subsidized insurance (i.e. thru employers), and are happy with it, see no reason for it to change. Especially people who have good health insurance and/or don't get sick very often.

yamtaddle 4y ago

After recently paying a fuck-ton for some stitches at an ER for a case that was a little hairier than urgent cares were willing to take on, but not at all life threatening, but also not something that could wait for a regular doctor... yeah, I'm seriously considering learning to apply sutures and buying a kit or something. I hate having to do "go, or don't and just hope it's OK?" when the best choice is clearly to go, and not having good options for taking care of it those kind of middle-grade problems myself. (I did try superglue—growing up rural didn't teach me nothing about avoiding paying doctors—but one of the cuts was too big and too bleed-y for that to take :-( )

thatcat 4y ago
A butterfly kit is a decent compromise that doesn't really require training. https://www.amazon.com/Sutures-Waterproof-Butterfly-Hospital-Laceration https://www.amazon.com/Sutures-Waterproof-Butterfly-Hospital...
- Rebelgecko 4y ago
  The link isn't working for me, but FWIW buying medical supplies on Amazon is usually not the best option. Poorly made counterfeits abound and thanks to inventory comingling it doesn't necessary matter which seller you buy from.
twodave 4y ago
During a vacation a couple years ago I dropped a glass in the sink while washing it and reflexively tried to catch it. My hand made contact just as it was shattering in the bottom of the sink, resulting in a really nasty, irregular gash that immediately began bleeding badly. I ended up wrapping it in paper towels and driving myself to the nearest supermarket (~15 minutes), where I bought some anti-septic and super glue. I looked pretty funny walking around the store with my hand wrapped up and raised in the air, and I sounded pretty funny as I applied the anti-septic and screamed profanities from inside my car in the parking lot. But with my hand glued back together I was able to pretty much go back to doing normal things within the hour. There's a scar, but it's actually a bit difficult to distinguish from the natural lines in my hand. Total bill: ~$10. My wife was of course not amused. The kids thought it was cool, though.

lm28469 4y ago

I've always been told ER is for _emergencies_, I'd never go there for a 2nd degree burn or a small cut. Emergencies as in "if I don't go there _now_ I might suffer _grave_ long term consequences" not as in "ouchie it'll be painful until I get it looked at tomorrow"

giraffe_lady 4y ago
The thing is the doctor you would get to look at it tomorrow can simply decline to, the ER can't.
- lm28469 4y ago
  Exactly, and that's why when you go there you have to wait 8 hours because you have 38 non emergency scenarios before it's your turn.
  - brewdad 4y ago
    ERs do triage on incoming patients. If you arrive with non-life threatening issues, you will be pushed to the back of the line repeatedly. Occasionally, a patient or intake nurse will misjudge the problem and the patient dies in the waiting room. Greatest health care system in the world.
    - ejb999 4y ago
      which health care system magically triages patients correctly 100% of the time and never makes mistakes?
denimnerd42 4y ago
Well we're not only talking about adults but also talking about children here. At 9pm you get a small AND deep cut requiring stitches. It won't stop bleeding if you take pressure off. what do you do? At 9pm your family member accidentally drops a kettle of of hot but not life threatening water on your child and they get a large blister on their chest, what do you do? These are probably not serious situations but the pediatrician will tell you to go to the ER even if you wait till the next morning.

annoyingnoob 4y ago

My daughter has needed to go to the ER several times, after 3 crap experiences with the ER nearby we now drive 40 miles to have a better experience. It is not only the billing issues, especially with the wave of 'Revenue Management' services providers are using, it is the patients in the ER. Dealing with the crazies, the people acting up to try to get attention, waiting for hours in this fun with a child, no thanks.

pcwalton 4y ago

> I'd prefer not to pay 5000 or 6000 total - $3000 to a hospital and $3000 to an ER doctor agency for a small 2nd degree burn or small cut requiring stitches, or any other issue I may have been taken there in the past for. In the US, this is what urgent care is for. If there's an urgent care clinic in the area, you should absolutely not go to the ER for that kind of stuff. The price of the ER reflects the fact that it's for major, life-threatening emergencies; if you go there for a cut requiring stitches, then you're not using the medical system efficiently, and that's why the costs are what they are. Personally, I've found the urgent care clinic I've gone to to be a better experience than both the ER and my primary care physician. It's gotten me in and out with quick, high-quality care, and it's cheap.

denimnerd42 4y ago
Of course.. and that's what happens most of the time but it's not that simple still. I've found urgent care experiences are highly variable even between same location. The ER is more a guaranteed thing with set standards.
kayodelycaon 4y ago
Urgent care varies a lot. Going to one around here is not a good idea. I don't think any of them has more positive reviews than negative ones. I decided to risk one of the better reviewed places. It was empty and I was completely ignored by the staff who were on their phones. My worst taxi experience was better. At least I left before they could rip me off. Ended up going to the ER and the nurse told me the urgent care place would have just sent me to the ER anyway.
pcthrowaway 4y ago
> life-threatening emergencies It's not really just for life-threatening emergencies. If you cut your toe off at 2 AM you probably want to go to an ER to see if there's a chance it can be reattached.

repiret 4y ago

Others have pointed these things out individually, but I wanted to say them all in one place: An urgent care is well suited to needing a couple stitches or a cast. At the ER, you're also paying for: * A facility and staffing equipped to handle serious trauma and critical illness. * (In the US) A facility that legally cannot turn away people for inability to pay. Exacerbated by being in a national medical system where lots of people can't pay for basic care, so they go to the ER to receive it. If you don't need those things, then don't go to an ER if you can help it. Some large hospitals essentially operate an urgent care with the same waiting room as the ER in order to lower their costs, but I've only seen that at the largest of hospitals, and I've been to at least one large hospital that didn't work that way.

mrguyorama 4y ago
As an insured person, an urgent care costs the same as an ER visit and does less for me. My equally insured girlfriend had to pay several hundred dollars to an urgent care facility for a rapid strep and rapid covid tests, about $50 in a civilized country.
- maybeinsured 4y ago
  I pay $80 for Urgent Care services such as this in the US, a civilized country, the trick being I pay out of pocket then send in the receipt to my insurance for credit. Sorry to hear your girlfriend found a crap business. https://www.holycitymed.com/primary-care/?gclid=EAIaIQobChMI_Lutm93o_AIVibbICh0pLAKbEAAYASAAEgJgJfD_BwE https://www.holycitymed.com/primary-care/?gclid=EAIaIQobChMI...
- repiret 4y ago
  It may cost you the same. With my insurance, if I'm admitted to a hospital, the time I spend in the ER is free to me, but if I'm not admitted, I pay for the time I'm in the ER. That doesn't make ERs cheaper when you get admitted. ERs are more expensive to operate then urgent care. Even when the ER is treating something that could be treated at an urgent care. That doesn't change just because some people's insurance hide that detail from them.

gnopgnip 4y ago

Half of children are covered by Medicaid and there would be zero copay. It is a great program that has saved and improved many lives. The ER might bill $6k for a cut requiring stitches, but most people have insurance, they will have a lower negotiated rate. A typical copay with insurance is more like $250, plus another $10-$20 copay to pickup medication. Something not immediately life threatening like a cut requiring stitches could go to urgent care, they might bill $400, and your copay is under $100.

denimnerd42 4y ago
Well. We have insurance. The insurance is also for emergency situations. It's high-ded at 3000 and the out of pocket max is something like 12,000. So yeah one ER trip a year is going to cost me 3000-12,000+. Urgent care is great in theory but I've not had great experiences. I'll also be paying the complete bill there too so 400+ which is fine. The problem is if they are too scared then it will be the $200 plus an ER bill and I'm back to where I started.
briffle 4y ago
It bothers me to no end that the cash price I pay is drastically higher than the cost the insurance company pays. especially since insurance is a royal pain to deal with, and requires specialists for billing, etc. But then again, I can't believe hospitals don't have to have a 'menu' on their web site that shows their cash and average insurance cost of their 20 most common procedures. I know almost nobody pays cash price, but I don't want my medical care to be treated like Kohls or JC Pennys where they show me a $7 t-shirt is "regularly $27" so I feel like i'm saving, even though we both know they never, EVER charged $27 for that t-shirt..
schemescape 4y ago
Plus deductible and coinsurance, which which are often much more…

LarryMullins 4y ago

> I'd prefer not to pay 5000 or 6000 total - $3000 to a hospital and $3000 to an ER doctor agency for a small 2nd degree burn or small cut requiring stitches For what it's worth, about 5 years ago I was without insurance and went to the ER to get 5 stitches in my finger. The total bill came out to $150. This was in America. I think if I had insurance then, they would have billed the insurance company 10x that at least.

dredmorbius 4y ago
Insurance has negotiated rates with providers. These typically start with the facility's chargemaster billing and are negotiated off of it. Depending on the relative negotiating strength of the carrier or caregiver network, that might be higher or lower. It's the uninsured who are far more likely to be billed the maximum amount, in the US, as they have no negotiating power, most especially in the moment urgent care is required.

patientplatypus 4y ago

[dead]