6 ms·

I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

60 points by howard941 2y ago

Humphrey 2y ago
People should not need to make financial based decisions when seeking emergency health care.
elevatedastalt 2y ago
$10000 looks like he got off easy given he visited an ER. Some unfortunate ones have to pay close to that amount just for the privilege of sitting in an ER, without getting any meaningful treatment.
- throwup238 2y ago
  It's not just some ER, it looks like he went to the Mayo Clinic which is one of the top hospitals in the world. It's the kind of institution that world leaders from around the world travel to for complex treatments.
  - hnburnsy 2y ago
    He also bypassed multiple urgent care centers and went to the Mayo Clinic ER adjacent to North Scottsdale, instead of going to closer Banner University in Downtown Phoenix. He doesn't say if Mayo is in network, but that would be a shocker. Funny there is always a 'rest of the story' in these policy based stories.
- xpl 2y ago
  How it isn't a scam?
  - elevatedastalt 2y ago
    It's nicely itemized for your convenience. There will be a charge for the facility itself. There will be a charge for the nurse that initially took you in and triaged you by looking at you and deciding you weren't immediately dying. Then after sitting there for 4 hours, you might have gotten 10 minutes with a doctor who'd have said something like "You are ok, take a tylenol". This is not any run of the mill doctor, this is an ER doctor, so obviously their charges are in the thousands too. Whenever this gets brought up someone replies with, "Well, it needs medical training to confirm that you are indeed ok", and I completely agree. And I won't be complaining if the whole visit costed a few hundred dollars. But a few thousand?
- avs733 2y ago
  My wife had to go to the ER 24 yrs after delivering our second kid because of a medical error during post partum care at the same hospital. She sat in the ER from 9pm until 6am 72 hrs after giving birth and was offered the womens bathroom to pump in. She never saw a doctor or got past triage despite the delivery unit telling her to go to the ER immediately. We got a 4.5k bill, insurance paid most of it, but we’ve refused to pay the deductible on principal. After to many of these we just have a family policy that we are the final arbiters of a reasonable and fair medical bill given the error rates in billing. We have a high enough credit score that collections doesn’t scare us.
teeray 2y ago
> [surprise bills]… often stem from patients unwittingly receiving care from out-of-network providers… If you do not have the agency to select an in-network provider (because you are mortally wounded / incapacitated / etc.), then the out-of-network provider should be legally transmuted into an in-network one. The insurer should be compelled to pay, and the provider compelled to accept it.
- readthenotes1 2y ago
  I believe that's the way it works. And then you have to transfer to in network provider as soon as humanly possible (perhaps not as humanely possible...)
  - deathanatos 2y ago
    One of the problems here is that the patient can believe they're at an in-network provider — and be correct about that — and still get hit with "out of network" charges. One of the linked articles[1] explains it slightly better: > Surprise medical bills happen when a doctor or other provider who isn’t in a patient’s insurance network is unexpectedly involved in a patient’s care. Patients may go to a hospital that accepts their insurance, for example, but get treatment from emergency room physicians or anesthesiologists who don’t — and who then send patients big bills directly. I've seen this in my own medical billing: often times, I will get bills (to the insurance) from "providers" I had no (direct) interaction with. And that's the thing: if a in-network provider contracts/vendors/(who knows, I don't know how their business is structured) to some other company, you get billed "randomly". Sometimes I can piece together exactly what action caused it (e.g., okay, that ultrasound is this random charge), but not all the time. Insurers refuse to help: they claim it's not their problem, as they're not billing you. Providers will claim they know nothing; after all, it isn't them that billed you. [1]: https://www.nytimes.com/2021/07/01/upshot/surprise-medical-bills-biden.html https://www.nytimes.com/2021/07/01/upshot/surprise-medical-b...
    - ipython 2y ago
      This +1000. The whole billing / insurance system is intended to wear you down in a cascading swarm of bullshit. You want to know if a doctor is in network? Good luck, because the insurance company clearly states that they only provide that information on a best effort basis. The doctor can’t answer, as they refer you back to your insurance company. You want an outpatient surgery? Great! Make sure your doctor and facility is in network, right? Oops, wrong again! You forgot about the anesthesiologist who you can’t pick ahead of time and is rarely in network. Good luck figuring that out later! It’s intended to wear you down until you’re afraid of your “rating” aka credit score tanking enough that you just pay up.
wpollock 2y ago
Aren't you assuming that the healthcare system operates for the good of the patients? From my point of view, that doesn't seem to be the case in the U.S.
- candiodari 2y ago
  In all these cases, there is one constant: the patients get treated, and treated well. That's not the issue. It operates for the good of the patients (whereas for example, the NHS often gets criticized ...) It's the billing afterwards that's the issue.
  - darth_avocado 2y ago
    > the patients get treated, and treated well Absolutely anyone who’s ever dealt with healthcare system will tell you otherwise. From being denied necessary medical procedures because insurance doesn’t agree with it to subpar quality of care because how stretched the doctors and healthcare professionals are, US medical system is far from treating everyone well.
  - marcus_holmes 2y ago
    The NHS is being systematically destroyed by the Tories who want this broken US system in the UK because it makes them money. Aussie healthcare is the best I've seen (and I've seen a few). Basically free, with more speed or better care (or whatever) if you want to pay for it. Health insurance is like US$75 a month and not tied to employment.
mkoubaa 2y ago
The healthcare industry in the US sometimes gets me to seriously consider seeing a shaman next time I get sick
- HarryHirsch 2y ago
  Don a puppy mask, self-identify as a dog and go to the vet.
  - zen928 2y ago
    Following the trend on the level of care provided by overbooked veterinarian offices, an estimated bill greater than 1k would halt any procedure and ask for a signature and immediate upfront payment or to consider euthanasia as a humane alternative to being unable to afford services at your income level before continuing to provide care. If your injury is serious enough and you cant pay, your residency and citizenship will be immediately revoked and you'll be taken in as a ward of the state to then be forcibly euthanized with no representation from your former family or loved ones. Payment plans are ofcourse intentionally excluded due to 'abuse of the system' for others who can't afford to pay.
didacticBuffalo 2y ago
I have MS and receive an Ocrevus infusion every six months. It's a labyrinth of a process. UHC (insurer) sub-contracts(?) to CVS Caremark to provide specialty drugs. CVS insists on calling me to confirm they can ship it to my house. F no! I'm not running an IV for myself. Sort it out with the hospital. Last go around, the hospital coded the drug as coming from their supply instead of CVS so I got a surprise bill for $130,000+ Luckily, I've been through the process so there's records of the normal billing path. I fought the Hospital billing department and 5 months later I'm billed $700 which was about the expected amount. It was still stressful and time consuming to figure out if I screwed up to the tune of 6 figures.
- giantg2 2y ago
  For $700, I'll start my own IV.
  - droopyEyelids 2y ago
    Infusion medicine isn't given in the normal gravity-fed IV route, they're precisely controlled for flow rate and time. It's a whole other ball game.
    - giantg2 2y ago
      The machines take care of that. You just need to plug the numbers in.
- dools 2y ago
  Greetings from Australia. My brother has MS and gets a monthly infusion of Tysabri. All he does is show his Medicare card and it doesn't cost him anything.
  - didacticBuffalo 2y ago
    I looked at leaving the US years ago. Australia was on my short list after spending some time in Melbourne. Alas MS is one of those things that makes immigration harder nearly everywhere because it "puts an undue burden on the health system". Never found a way around that aside from maybe marrying a local; it's been a while. Glad he's getting the treatment he needs!! Drugs have made incredible advances in the last decade.
giantg2 2y ago
There are some good points in here. However, it feels disingenuous with the author being a former surgeon general. "the onus of the entire amount still fell on me due to my high-deductible health plan (HDHP)." I mean, yeah, that's how HDHP works. Anyone in healthcare should understand that.
- HarryHirsch 2y ago
  Meanwhile, it's entirely possible to be out of 3000 dollars after an animal bite with a regular insurance plan. Nothing more than an x-ray and a couple stitches, and the out-of-pocket cost was 3000 dollars. One wonders where the premium goes.
  - giantg2 2y ago
    The premiums go to subsidize other people's even more expensive care, like $80k helicopter rides, or $100k heart surgeries.
    - maxerickson 2y ago
      It's not really a subsidy though (it's a set of actuarial models and contractual agreements).
    - kiratp 2y ago
      Helicopter rides are pretty much never covered. > The average cost of life flight within the U.S. ranges between $12,000 and $25,000, according to NAIC (National Association of Insurance Commissioners). This is based on a 52-mile trip, which is also the average distance. This figure represents an out-of-pocket cost when not covered by insurance or calculated before an insurance company steps in. International flights can easily cost 3 to 5 times that amount. … In December 2020, Sean Deines was diagnosed with acute lymphoblastic leukemia (a fast-growing blood cancer) and took an air ambulance from Colorado to North Carolina, which also included ground transportation between hospitals and airports. His total bill was $489,000. https://www.emergencyassistanceplus.com/resources/what-is-the-total-cost-of-a-life-flight/ https://www.emergencyassistanceplus.com/resources/what-is-th...
a_bonobo 2y ago
What I find interesting is how in OP's original tweet, more than half of the comments blame him for the cost. Shouldn't have gone to that hospital! (it was the closest one). Should've drunken more water! etc. pp. Like the proverbial crabs in a bucket, only pulling each other down. https://x.com/JeromeAdamsMD/status/1761375417351430595 https://x.com/JeromeAdamsMD/status/1761375417351430595
- guyzero 2y ago
  "Shop around" is a great capitalist mantra, except that medical emergencies are pretty obviously a situation where you're absolutely not going to shop around.
  - brianwawok 2y ago
    This is the obvious case. What is even more shocking is the happy case. You have a week to make an appointment for an outpatient procedure. Call around. No one can even give you a price. Doctor doesn’t know; sends you to some billing department. They don’t know. You will spend a month to find the actual price at 5 places, and it’s not even locked in price. Bill come for another amount? Tough
    - nradov 2y ago
      Some of this has improved under the No Surprises Act. In certain situations the provider may be legally required to give you a "good faith estimate", or at least not send you excessive bills after treatment. https://www.cms.gov/medical-bill-rights/know-your-rights https://www.cms.gov/medical-bill-rights/know-your-rights
      - monkeyfun 2y ago
        I've yet to encounter a single clinic or hospital that complied when I tried making requests for an estimate of any sort. (In Texas)
        2y ago
SSJPython 2y ago
The US needs to adopt the healthcare model of Singapore. Universal coverage for everyone along with a strong private insurance market as well. The problem is the current system is basically a giant jobs program. Healthcare spending is approximately 17% of US GDP. Politicians are terrified of rocking the boat on this, so the system will always remain broken.
- janalsncm 2y ago
  There were proposals for Medicare for all, but unfortunately one of America’s scars from the Cold War is that any government program meant to help people is branded “socialism” which at that point you might as well have a Karl Marx tramp stamp.
xpl 2y ago
Another "fun way to lose money" is for example to get bitten by a wild animal. I am originally from a country where rabies shots are free. But here in an ER they could easily charge you $15k for that, which I was truly shocked about. ...or even $100k: https://abc7news.com/rabies-shot-hospital-bill-vacaville-ca-couple-northbay-healthcare-vacavalley/12788545/ https://abc7news.com/rabies-shot-hospital-bill-vacaville-ca-...
- Riseed 2y ago
  Related article quote about a bear attack: "Literally, as I was being eaten by a wild beast, I wasn't thinking about Jesus or my family or my son. I was thinking my insurance was not going to pay for this," she told The Independent. "I had to make this calculus as I was being eaten, 'Do I want to survive this?' Not, 'Can I survive this?' Not, 'What am I going to look like?'" [0] In an AMA, she said that the worst part of the bear attack wasn't the bear attack, but dealing with her health insurance. [1] [0] https://www.independent.co.uk/news/world/americas/us-election/bear-attack-allena-hansen-face-bernie-sanders-healthcare-insurance-2020-election-super-tuesday-a9370156.html https://www.independent.co.uk/news/world/americas/us-electio... [1] https://old.reddit.com/r/IAmA/comments/1byn1l/i_was_mauled_by_a_bear_fought_it_off_and_drove_4/ https://old.reddit.com/r/IAmA/comments/1byn1l/i_was_mauled_b...
mmastrac 2y ago
The incentives in US health care are so upside-down that Americans pay significantly more for the same results as many of the other western nations. While the public systems of the UK and former colonies aren't perfect, they are still significantly cheaper to run for approximately the same outcomes. Ditto for other European countries. I don't understand why this hasn't become a boil-over issue for Americans yet.
- sneed_chucker 2y ago
  > I don't understand why this hasn't become a boil-over issue for Americans yet. Media keeps people distracted with idpol
- ip26 2y ago
  Perhaps because it doesn’t impact you until it does, and we can’t seem to agree on what exactly is causing these outcomes. It’s a legitimately tangled problem, and I do believe how to unwind it is not well understood by anyone. (Ignoring single payer, which is more of a sidestep than a true fix) Many people are also insulated by expensive insurance plans. HDHP are a long term play to generally make the public more familiar with the problem, as they will no longer be fully isolated from the prices.
  - atmavatar 2y ago
    I'll posit single-payer is much closer to a true fix than you give credit for. A significant fraction of the additional cost in the US is due to all the administrative overhead that comes with negotiating prices with thousands of insurance providers, as well as dealing with not only primary insurance, but secondary, tertiary, and sometimes even quaternary insurance providers for any given patient. And, as mentioned elsewhere, it gets multiplexed over each doctor involved in your care, since each may work with a unique subset of insurance providers.
    - ip26 2y ago
      You don’t have to have single payer to get more transparency in pricing, for example.
abeppu 2y ago
I don't really think the suggestions made in the last section of this article really address the core issue here. > Enhance transparency in healthcare pricing So after you're in an emergency room, and a posted sign shows that to see any medical professional there, you'll be charged X plus a facilities fee Y. After you wait k hours to be seen, you're told that the treatment they think you need will cost Z. If you think that's too high, during an emergency do you try to go to a different hospital to see if they have the same treatment for W < Z? > Institute arbitration for billing disputes I mean, better than no arbitration, but if you're dealing with a serious illness , trying to recover from an injury or whatever, while getting time from work, bouncing between specialists for follow-up visits, still foggy from pain meds, etc should you need to navigate an arbitration process? Are you equipped to? > Advocate for consumer protections: Educate and empower patients to advocate for themselves through measures such as the right to appeal surprise bills and negotiate payment plans with providers. ... so again, placing the burden on patients to defend themselves during what already may be a very challenging time in their life. I think the highest level bit is that the most predictable cost for health care would be under a free-at-point-of-care, single-payer system, that lets us cut all the medical billing and medical insurance overhead out. Everyone pays the same (nothing!) for their care, and every earner pays a predictable amount for the system overall. Even if the exact same "amount" of health care was provided, we'd collectively pay less for it. But if we also went all-in on value-based/outcome-based care rather than fee-for-service, we might also be able to get people to live healthier longer lives with less total care (and costs). And no one who's sick or recovering from a medical crisis needs to spend their energy "advocating" for themselves, or in dispute arbitration, or researching which provider has the best prices for their needed service.
maztaim 2y ago
It is important to plan your emergency visits as early in the year as possible. That way if you hit your maximum deductibles and maximum out of pocket limits you get free-ish healthcare the rest of the year. Had a bad appendectomy happen in November. The limits reset Jan 1st. Out another $5000 for the second attempt at removal after a surgery to stare at my appendix before deciding a week of hospital stay with IV antibiotics, 4 CT scans to determine when they would feel comfortable removing my appendix (maxed my $12000) family out of pocket.
- jrs235 2y ago
  Government should regulate it to a rolling 12 month max...
briHass 2y ago
I'm generally a fan of HDHPs, but I echo some of the same complaints made in the article. For example, just a few months ago, my toddler was complaining about horrible pain in his stomach. Now, being 5, it's awfully hard to determine exactly how much he's hurting, and of course, the strong recommendation from every nurse, doctor, and UC clinic we talked to was to bring him to the ER. A UC clinic or PCP won't take the liability if it turns out to actually be appendicitis and not just a virus with nausea. I knew full well the ER visit was going to sting, but I had no idea how much. The amount after insurance was almost exactly what was quoted in this article (almost like they plan that). That pretty much maxed out his OOP max, but I'm not wealthy enough that 5k doesn't make me mad. It shouldn't matter, but it feels worse that it was just a stomach bug, so $2 worth of anti nausea meds (that the hospital charged $150 for) was all we got out of it. Rationally, I don't really see a way out for (possible) emergencies. That care is expensive, and HDHPs are a bit of a gamble that usually pay off if you're healthy. The OOP max ensures you won't be financially ruined, and 'cadillac plans' or gov care just means you pay far more in premiums or taxes for the majority of the years.
- hnburnsy 2y ago
  Yeah avoid the HDHP if you have children or know you comsume a large amount of healthcare services. Otherwise, HDHP, the associated HSA account, and typically an employer contribition create a triple tax free investment that can't be beat. Sucks though we have to guess how much health care we might use in the coming year. On a postivie note if you hit your family max for the year, try and stuff in as much medical care you can.
  - briHass 2y ago
    One relief was that it happened in March, not on Dec 31, so it's not like I wouldn't have paid some of that bill in care, which is now 'free' The other thing I learned, since the hospital was unwilling to negotiate on total price is that they just want you to commit to paying and will give you a long, low monthly, zero interest payment plan to make that happen. I'm a 'no debt' kind of guy, but if they'll float me a loan for free, I plan to just keep adding future visits to this network to my payment plan indefinitely.
onewheeltom 2y ago
Go to urgent care instead. I told my kid once, if you think you need to see a doctor, tell me before 8 so we can bypass the e-room. The last time we went to emergency, I got a $3000 bill for a strep check and a generic pill.
whodidntante 2y ago
We spend $14K per person, or $4.5T on healthcare in the US. The typical cost for healthcare in comparable countries is 1/2 of that per person. There is $2.25T per year of savings to be had. We can eliminate our national debt in 15 years, and with that also eliminate the $1T going to $1.5T of interest payments we pay each year on the debt, so a total savings down the road of about $3.5T per year. To put that in perspective, our entire national budget was a bit less than $4T pr year pre pandemic. There is absolutely nothing else that comes close to the potential savings on healthcare. All of the schemes I have seen whether they are tax increases or cutbacks in other programs, even the extreme ones, *might* save $2T over 10 years.
- from-nibly 2y ago
  The problem is that the solution is subtractive not additive. Its, at the very least, a lot harder to make a business where people stop doing stuff. What do we need to stop doing? All of the billing shenanigans with insurance. We need to stop insuring regular healthcare, and go back to insuring catestrophic healthcare. What we do now with healthcare is like buying car insurance that pays for oil changes.
  - dzhiurgis 2y ago
    > We need to stop insuring regular healthcare, and go back to insuring catestrophic healthcare. Good point. In NZ we are covered for accidents, infections, heart attacks, etc. But get lung cancer from smoking and you are paying yourself. It's not perfect, but sets priorities to live healthy.
    - nradov 2y ago
      If a patient is diagnosed with lung cancer there is no reliable way to determine whether the root cause was smoking, radon exposure, or some random mutation. https://www.cnn.com/2023/10/13/health/lung-cancer-young-and-middle-age-women/index.html https://www.cnn.com/2023/10/13/health/lung-cancer-young-and-...
      - 2y ago
karagenit 2y ago
I have zero medical expertise, but were the two blood tests and an xray really necessary for what seems like a simple case of dehydration? Anecdotally, I recently got a simple blood test to keep an eye on something that’s been borderline in the past. Unbeknownst to me, my doctor ordered nearly 30 things to be checked in the blood panel, at $50-$100 a piece. Luckily my insurance negotiated a much lower price and covered most of it, but I can’t imagine paying $2,000+ just to check e.g. your cholesterol level. I think the problem is alignment of incentives: for a doctor, over-testing has little to no negative consequences, but under-testing could lead to guilt due to a patient dying, loss of reputation because something was missed, lawsuits, etc. As a society, is this how we should be using our limited medical resources? What if we made fewer xray machines and instead spent more on something like cancer screening? How many net lives could we save?
rdl 2y ago
I didn't realize HDHPs were still available in the US post-ACA, due to requirements that all plans cover certain minimum services 100% from the first dollar, making them kind of silly (it basically means there's a doughnut of approximately $2k-$6k in cost where someone might be personally liable in a given year). HDHP plus great price transparency (especially pre service, where one can potentially cross-shop providers, vs. being in a facility and given only one option) would be good for cost reduction; if you can't surface and measure the costs, you won't have any incentive to lower them. I personally have a fairly mediocre $230/mo blue cross plan in Puerto Rico which largely only covers care within Puerto Rico (and which I've never actually used for anything), and rely on medical tourism where I pay 100% out of pocket, and until Amazon bought them, OneMedical for cheap clinic care which I also paid 100% out of pocket. I previously had a WA state HDHP for $100-200/mo pre-ACA which was great but ACA killed those/insurers left the state.
spants 2y ago
Interesting that IV hydration is available for $500 from clinics. I was taken ill in India. Went straight into hospital A&E and out within 90 minutes. I was given drugs for sickness, IV hydration and lots of tests. Total price = £33 It seems to me that the costs for treatment in the USA are actually more than covered by the deductible. The rest is holiday money for the criminals running the system.

60 points by howard941 2y ago

People should not need to make financial based decisions when seeking emergency health care.

$10000 looks like he got off easy given he visited an ER. Some unfortunate ones have to pay close to that amount just for the privilege of sitting in an ER, without getting any meaningful treatment.

throwup238 2y ago
It's not just some ER, it looks like he went to the Mayo Clinic which is one of the top hospitals in the world. It's the kind of institution that world leaders from around the world travel to for complex treatments.
- hnburnsy 2y ago
  He also bypassed multiple urgent care centers and went to the Mayo Clinic ER adjacent to North Scottsdale, instead of going to closer Banner University in Downtown Phoenix. He doesn't say if Mayo is in network, but that would be a shocker. Funny there is always a 'rest of the story' in these policy based stories.
xpl 2y ago
How it isn't a scam?
- elevatedastalt 2y ago
  It's nicely itemized for your convenience. There will be a charge for the facility itself. There will be a charge for the nurse that initially took you in and triaged you by looking at you and deciding you weren't immediately dying. Then after sitting there for 4 hours, you might have gotten 10 minutes with a doctor who'd have said something like "You are ok, take a tylenol". This is not any run of the mill doctor, this is an ER doctor, so obviously their charges are in the thousands too. Whenever this gets brought up someone replies with, "Well, it needs medical training to confirm that you are indeed ok", and I completely agree. And I won't be complaining if the whole visit costed a few hundred dollars. But a few thousand?
avs733 2y ago
My wife had to go to the ER 24 yrs after delivering our second kid because of a medical error during post partum care at the same hospital. She sat in the ER from 9pm until 6am 72 hrs after giving birth and was offered the womens bathroom to pump in. She never saw a doctor or got past triage despite the delivery unit telling her to go to the ER immediately. We got a 4.5k bill, insurance paid most of it, but we’ve refused to pay the deductible on principal. After to many of these we just have a family policy that we are the final arbiters of a reasonable and fair medical bill given the error rates in billing. We have a high enough credit score that collections doesn’t scare us.

teeray 2y ago

> [surprise bills]… often stem from patients unwittingly receiving care from out-of-network providers… If you do not have the agency to select an in-network provider (because you are mortally wounded / incapacitated / etc.), then the out-of-network provider should be legally transmuted into an in-network one. The insurer should be compelled to pay, and the provider compelled to accept it.

readthenotes1 2y ago
I believe that's the way it works. And then you have to transfer to in network provider as soon as humanly possible (perhaps not as humanely possible...)
- deathanatos 2y ago
  One of the problems here is that the patient can believe they're at an in-network provider — and be correct about that — and still get hit with "out of network" charges. One of the linked articles[1] explains it slightly better: > Surprise medical bills happen when a doctor or other provider who isn’t in a patient’s insurance network is unexpectedly involved in a patient’s care. Patients may go to a hospital that accepts their insurance, for example, but get treatment from emergency room physicians or anesthesiologists who don’t — and who then send patients big bills directly. I've seen this in my own medical billing: often times, I will get bills (to the insurance) from "providers" I had no (direct) interaction with. And that's the thing: if a in-network provider contracts/vendors/(who knows, I don't know how their business is structured) to some other company, you get billed "randomly". Sometimes I can piece together exactly what action caused it (e.g., okay, that ultrasound is this random charge), but not all the time. Insurers refuse to help: they claim it's not their problem, as they're not billing you. Providers will claim they know nothing; after all, it isn't them that billed you. [1]: https://www.nytimes.com/2021/07/01/upshot/surprise-medical-bills-biden.html https://www.nytimes.com/2021/07/01/upshot/surprise-medical-b...
  - ipython 2y ago
    This +1000. The whole billing / insurance system is intended to wear you down in a cascading swarm of bullshit. You want to know if a doctor is in network? Good luck, because the insurance company clearly states that they only provide that information on a best effort basis. The doctor can’t answer, as they refer you back to your insurance company. You want an outpatient surgery? Great! Make sure your doctor and facility is in network, right? Oops, wrong again! You forgot about the anesthesiologist who you can’t pick ahead of time and is rarely in network. Good luck figuring that out later! It’s intended to wear you down until you’re afraid of your “rating” aka credit score tanking enough that you just pay up.

wpollock 2y ago

Aren't you assuming that the healthcare system operates for the good of the patients? From my point of view, that doesn't seem to be the case in the U.S.

candiodari 2y ago
In all these cases, there is one constant: the patients get treated, and treated well. That's not the issue. It operates for the good of the patients (whereas for example, the NHS often gets criticized ...) It's the billing afterwards that's the issue.
- darth_avocado 2y ago
  > the patients get treated, and treated well Absolutely anyone who’s ever dealt with healthcare system will tell you otherwise. From being denied necessary medical procedures because insurance doesn’t agree with it to subpar quality of care because how stretched the doctors and healthcare professionals are, US medical system is far from treating everyone well.
- marcus_holmes 2y ago
  The NHS is being systematically destroyed by the Tories who want this broken US system in the UK because it makes them money. Aussie healthcare is the best I've seen (and I've seen a few). Basically free, with more speed or better care (or whatever) if you want to pay for it. Health insurance is like US$75 a month and not tied to employment.

mkoubaa 2y ago

The healthcare industry in the US sometimes gets me to seriously consider seeing a shaman next time I get sick

HarryHirsch 2y ago
Don a puppy mask, self-identify as a dog and go to the vet.
- zen928 2y ago
  Following the trend on the level of care provided by overbooked veterinarian offices, an estimated bill greater than 1k would halt any procedure and ask for a signature and immediate upfront payment or to consider euthanasia as a humane alternative to being unable to afford services at your income level before continuing to provide care. If your injury is serious enough and you cant pay, your residency and citizenship will be immediately revoked and you'll be taken in as a ward of the state to then be forcibly euthanized with no representation from your former family or loved ones. Payment plans are ofcourse intentionally excluded due to 'abuse of the system' for others who can't afford to pay.

didacticBuffalo 2y ago

I have MS and receive an Ocrevus infusion every six months. It's a labyrinth of a process. UHC (insurer) sub-contracts(?) to CVS Caremark to provide specialty drugs. CVS insists on calling me to confirm they can ship it to my house. F no! I'm not running an IV for myself. Sort it out with the hospital. Last go around, the hospital coded the drug as coming from their supply instead of CVS so I got a surprise bill for $130,000+ Luckily, I've been through the process so there's records of the normal billing path. I fought the Hospital billing department and 5 months later I'm billed $700 which was about the expected amount. It was still stressful and time consuming to figure out if I screwed up to the tune of 6 figures.

giantg2 2y ago
For $700, I'll start my own IV.
- droopyEyelids 2y ago
  Infusion medicine isn't given in the normal gravity-fed IV route, they're precisely controlled for flow rate and time. It's a whole other ball game.
  - giantg2 2y ago
    The machines take care of that. You just need to plug the numbers in.
dools 2y ago
Greetings from Australia. My brother has MS and gets a monthly infusion of Tysabri. All he does is show his Medicare card and it doesn't cost him anything.
- didacticBuffalo 2y ago
  I looked at leaving the US years ago. Australia was on my short list after spending some time in Melbourne. Alas MS is one of those things that makes immigration harder nearly everywhere because it "puts an undue burden on the health system". Never found a way around that aside from maybe marrying a local; it's been a while. Glad he's getting the treatment he needs!! Drugs have made incredible advances in the last decade.

giantg2 2y ago

There are some good points in here. However, it feels disingenuous with the author being a former surgeon general. "the onus of the entire amount still fell on me due to my high-deductible health plan (HDHP)." I mean, yeah, that's how HDHP works. Anyone in healthcare should understand that.

HarryHirsch 2y ago
Meanwhile, it's entirely possible to be out of 3000 dollars after an animal bite with a regular insurance plan. Nothing more than an x-ray and a couple stitches, and the out-of-pocket cost was 3000 dollars. One wonders where the premium goes.
- giantg2 2y ago
  The premiums go to subsidize other people's even more expensive care, like $80k helicopter rides, or $100k heart surgeries.
  - maxerickson 2y ago
    It's not really a subsidy though (it's a set of actuarial models and contractual agreements).
  - kiratp 2y ago
    Helicopter rides are pretty much never covered. > The average cost of life flight within the U.S. ranges between $12,000 and $25,000, according to NAIC (National Association of Insurance Commissioners). This is based on a 52-mile trip, which is also the average distance. This figure represents an out-of-pocket cost when not covered by insurance or calculated before an insurance company steps in. International flights can easily cost 3 to 5 times that amount. … In December 2020, Sean Deines was diagnosed with acute lymphoblastic leukemia (a fast-growing blood cancer) and took an air ambulance from Colorado to North Carolina, which also included ground transportation between hospitals and airports. His total bill was $489,000. https://www.emergencyassistanceplus.com/resources/what-is-the-total-cost-of-a-life-flight/ https://www.emergencyassistanceplus.com/resources/what-is-th...

a_bonobo 2y ago

What I find interesting is how in OP's original tweet, more than half of the comments blame him for the cost. Shouldn't have gone to that hospital! (it was the closest one). Should've drunken more water! etc. pp. Like the proverbial crabs in a bucket, only pulling each other down. https://x.com/JeromeAdamsMD/status/1761375417351430595 https://x.com/JeromeAdamsMD/status/1761375417351430595

guyzero 2y ago
"Shop around" is a great capitalist mantra, except that medical emergencies are pretty obviously a situation where you're absolutely not going to shop around.
- brianwawok 2y ago
  This is the obvious case. What is even more shocking is the happy case. You have a week to make an appointment for an outpatient procedure. Call around. No one can even give you a price. Doctor doesn’t know; sends you to some billing department. They don’t know. You will spend a month to find the actual price at 5 places, and it’s not even locked in price. Bill come for another amount? Tough
  - nradov 2y ago
    Some of this has improved under the No Surprises Act. In certain situations the provider may be legally required to give you a "good faith estimate", or at least not send you excessive bills after treatment. https://www.cms.gov/medical-bill-rights/know-your-rights https://www.cms.gov/medical-bill-rights/know-your-rights
    - monkeyfun 2y ago
      I've yet to encounter a single clinic or hospital that complied when I tried making requests for an estimate of any sort. (In Texas)
      - 2y ago

SSJPython 2y ago

The US needs to adopt the healthcare model of Singapore. Universal coverage for everyone along with a strong private insurance market as well. The problem is the current system is basically a giant jobs program. Healthcare spending is approximately 17% of US GDP. Politicians are terrified of rocking the boat on this, so the system will always remain broken.

janalsncm 2y ago
There were proposals for Medicare for all, but unfortunately one of America’s scars from the Cold War is that any government program meant to help people is branded “socialism” which at that point you might as well have a Karl Marx tramp stamp.

xpl 2y ago

Another "fun way to lose money" is for example to get bitten by a wild animal. I am originally from a country where rabies shots are free. But here in an ER they could easily charge you $15k for that, which I was truly shocked about. ...or even $100k: https://abc7news.com/rabies-shot-hospital-bill-vacaville-ca-couple-northbay-healthcare-vacavalley/12788545/ https://abc7news.com/rabies-shot-hospital-bill-vacaville-ca-...

Riseed 2y ago
Related article quote about a bear attack: "Literally, as I was being eaten by a wild beast, I wasn't thinking about Jesus or my family or my son. I was thinking my insurance was not going to pay for this," she told The Independent. "I had to make this calculus as I was being eaten, 'Do I want to survive this?' Not, 'Can I survive this?' Not, 'What am I going to look like?'" [0] In an AMA, she said that the worst part of the bear attack wasn't the bear attack, but dealing with her health insurance. [1] [0] https://www.independent.co.uk/news/world/americas/us-election/bear-attack-allena-hansen-face-bernie-sanders-healthcare-insurance-2020-election-super-tuesday-a9370156.html https://www.independent.co.uk/news/world/americas/us-electio... [1] https://old.reddit.com/r/IAmA/comments/1byn1l/i_was_mauled_by_a_bear_fought_it_off_and_drove_4/ https://old.reddit.com/r/IAmA/comments/1byn1l/i_was_mauled_b...

mmastrac 2y ago

The incentives in US health care are so upside-down that Americans pay significantly more for the same results as many of the other western nations. While the public systems of the UK and former colonies aren't perfect, they are still significantly cheaper to run for approximately the same outcomes. Ditto for other European countries. I don't understand why this hasn't become a boil-over issue for Americans yet.

sneed_chucker 2y ago
> I don't understand why this hasn't become a boil-over issue for Americans yet. Media keeps people distracted with idpol
ip26 2y ago
Perhaps because it doesn’t impact you until it does, and we can’t seem to agree on what exactly is causing these outcomes. It’s a legitimately tangled problem, and I do believe how to unwind it is not well understood by anyone. (Ignoring single payer, which is more of a sidestep than a true fix) Many people are also insulated by expensive insurance plans. HDHP are a long term play to generally make the public more familiar with the problem, as they will no longer be fully isolated from the prices.
- atmavatar 2y ago
  I'll posit single-payer is much closer to a true fix than you give credit for. A significant fraction of the additional cost in the US is due to all the administrative overhead that comes with negotiating prices with thousands of insurance providers, as well as dealing with not only primary insurance, but secondary, tertiary, and sometimes even quaternary insurance providers for any given patient. And, as mentioned elsewhere, it gets multiplexed over each doctor involved in your care, since each may work with a unique subset of insurance providers.
  - ip26 2y ago
    You don’t have to have single payer to get more transparency in pricing, for example.

abeppu 2y ago

I don't really think the suggestions made in the last section of this article really address the core issue here. > Enhance transparency in healthcare pricing So after you're in an emergency room, and a posted sign shows that to see any medical professional there, you'll be charged X plus a facilities fee Y. After you wait k hours to be seen, you're told that the treatment they think you need will cost Z. If you think that's too high, during an emergency do you try to go to a different hospital to see if they have the same treatment for W < Z? > Institute arbitration for billing disputes I mean, better than no arbitration, but if you're dealing with a serious illness , trying to recover from an injury or whatever, while getting time from work, bouncing between specialists for follow-up visits, still foggy from pain meds, etc should you need to navigate an arbitration process? Are you equipped to? > Advocate for consumer protections: Educate and empower patients to advocate for themselves through measures such as the right to appeal surprise bills and negotiate payment plans with providers. ... so again, placing the burden on patients to defend themselves during what already may be a very challenging time in their life. I think the highest level bit is that the most predictable cost for health care would be under a free-at-point-of-care, single-payer system, that lets us cut all the medical billing and medical insurance overhead out. Everyone pays the same (nothing!) for their care, and every earner pays a predictable amount for the system overall. Even if the exact same "amount" of health care was provided, we'd collectively pay less for it. But if we also went all-in on value-based/outcome-based care rather than fee-for-service, we might also be able to get people to live healthier longer lives with less total care (and costs). And no one who's sick or recovering from a medical crisis needs to spend their energy "advocating" for themselves, or in dispute arbitration, or researching which provider has the best prices for their needed service.

maztaim 2y ago

It is important to plan your emergency visits as early in the year as possible. That way if you hit your maximum deductibles and maximum out of pocket limits you get free-ish healthcare the rest of the year. Had a bad appendectomy happen in November. The limits reset Jan 1st. Out another $5000 for the second attempt at removal after a surgery to stare at my appendix before deciding a week of hospital stay with IV antibiotics, 4 CT scans to determine when they would feel comfortable removing my appendix (maxed my $12000) family out of pocket.

jrs235 2y ago
Government should regulate it to a rolling 12 month max...

briHass 2y ago

I'm generally a fan of HDHPs, but I echo some of the same complaints made in the article. For example, just a few months ago, my toddler was complaining about horrible pain in his stomach. Now, being 5, it's awfully hard to determine exactly how much he's hurting, and of course, the strong recommendation from every nurse, doctor, and UC clinic we talked to was to bring him to the ER. A UC clinic or PCP won't take the liability if it turns out to actually be appendicitis and not just a virus with nausea. I knew full well the ER visit was going to sting, but I had no idea how much. The amount after insurance was almost exactly what was quoted in this article (almost like they plan that). That pretty much maxed out his OOP max, but I'm not wealthy enough that 5k doesn't make me mad. It shouldn't matter, but it feels worse that it was just a stomach bug, so $2 worth of anti nausea meds (that the hospital charged $150 for) was all we got out of it. Rationally, I don't really see a way out for (possible) emergencies. That care is expensive, and HDHPs are a bit of a gamble that usually pay off if you're healthy. The OOP max ensures you won't be financially ruined, and 'cadillac plans' or gov care just means you pay far more in premiums or taxes for the majority of the years.

hnburnsy 2y ago
Yeah avoid the HDHP if you have children or know you comsume a large amount of healthcare services. Otherwise, HDHP, the associated HSA account, and typically an employer contribition create a triple tax free investment that can't be beat. Sucks though we have to guess how much health care we might use in the coming year. On a postivie note if you hit your family max for the year, try and stuff in as much medical care you can.
- briHass 2y ago
  One relief was that it happened in March, not on Dec 31, so it's not like I wouldn't have paid some of that bill in care, which is now 'free' The other thing I learned, since the hospital was unwilling to negotiate on total price is that they just want you to commit to paying and will give you a long, low monthly, zero interest payment plan to make that happen. I'm a 'no debt' kind of guy, but if they'll float me a loan for free, I plan to just keep adding future visits to this network to my payment plan indefinitely.

onewheeltom 2y ago

Go to urgent care instead. I told my kid once, if you think you need to see a doctor, tell me before 8 so we can bypass the e-room. The last time we went to emergency, I got a $3000 bill for a strep check and a generic pill.

whodidntante 2y ago

We spend $14K per person, or $4.5T on healthcare in the US. The typical cost for healthcare in comparable countries is 1/2 of that per person. There is $2.25T per year of savings to be had. We can eliminate our national debt in 15 years, and with that also eliminate the $1T going to $1.5T of interest payments we pay each year on the debt, so a total savings down the road of about $3.5T per year. To put that in perspective, our entire national budget was a bit less than $4T pr year pre pandemic. There is absolutely nothing else that comes close to the potential savings on healthcare. All of the schemes I have seen whether they are tax increases or cutbacks in other programs, even the extreme ones, *might* save $2T over 10 years.

from-nibly 2y ago
The problem is that the solution is subtractive not additive. Its, at the very least, a lot harder to make a business where people stop doing stuff. What do we need to stop doing? All of the billing shenanigans with insurance. We need to stop insuring regular healthcare, and go back to insuring catestrophic healthcare. What we do now with healthcare is like buying car insurance that pays for oil changes.
- dzhiurgis 2y ago
  > We need to stop insuring regular healthcare, and go back to insuring catestrophic healthcare. Good point. In NZ we are covered for accidents, infections, heart attacks, etc. But get lung cancer from smoking and you are paying yourself. It's not perfect, but sets priorities to live healthy.
  - nradov 2y ago
    If a patient is diagnosed with lung cancer there is no reliable way to determine whether the root cause was smoking, radon exposure, or some random mutation. https://www.cnn.com/2023/10/13/health/lung-cancer-young-and-middle-age-women/index.html https://www.cnn.com/2023/10/13/health/lung-cancer-young-and-...
    - 2y ago

karagenit 2y ago

I have zero medical expertise, but were the two blood tests and an xray really necessary for what seems like a simple case of dehydration? Anecdotally, I recently got a simple blood test to keep an eye on something that’s been borderline in the past. Unbeknownst to me, my doctor ordered nearly 30 things to be checked in the blood panel, at $50-$100 a piece. Luckily my insurance negotiated a much lower price and covered most of it, but I can’t imagine paying $2,000+ just to check e.g. your cholesterol level. I think the problem is alignment of incentives: for a doctor, over-testing has little to no negative consequences, but under-testing could lead to guilt due to a patient dying, loss of reputation because something was missed, lawsuits, etc. As a society, is this how we should be using our limited medical resources? What if we made fewer xray machines and instead spent more on something like cancer screening? How many net lives could we save?

rdl 2y ago

I didn't realize HDHPs were still available in the US post-ACA, due to requirements that all plans cover certain minimum services 100% from the first dollar, making them kind of silly (it basically means there's a doughnut of approximately $2k-$6k in cost where someone might be personally liable in a given year). HDHP plus great price transparency (especially pre service, where one can potentially cross-shop providers, vs. being in a facility and given only one option) would be good for cost reduction; if you can't surface and measure the costs, you won't have any incentive to lower them. I personally have a fairly mediocre $230/mo blue cross plan in Puerto Rico which largely only covers care within Puerto Rico (and which I've never actually used for anything), and rely on medical tourism where I pay 100% out of pocket, and until Amazon bought them, OneMedical for cheap clinic care which I also paid 100% out of pocket. I previously had a WA state HDHP for $100-200/mo pre-ACA which was great but ACA killed those/insurers left the state.

spants 2y ago

Interesting that IV hydration is available for $500 from clinics. I was taken ill in India. Went straight into hospital A&E and out within 90 minutes. I was given drugs for sickness, IV hydration and lots of tests. Total price = £33 It seems to me that the costs for treatment in the USA are actually more than covered by the deductible. The rest is holiday money for the criminals running the system.