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tooth
Trad climber
B.C.
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This would be called price gouging in any other field. It can't last.
JL
Now that the insurance companies have Obama setting up the rules of the game for them it won't last as is. It is going to get worse.
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patrick compton
Trad climber
van
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This here be 'America, love it or leave it. Jesus wants you to have insane hospital bills.
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kaholatingtong
Trad climber
Nevada City
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oh man, i feel you guys on this stuff. i was oh so lucky to still be eligible to be covered by my moms hospital work insurance last fall when i was in a really bad car accident; otherwise, i would have and would still be been paying off the roughly 250k for the rest of my life.
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HighDesertDJ
Trad climber
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John Long said This would be called price gouging in any other field. It can't last.
It can't last, but any other field would be allowed to terminate delivery of services when it was shown you could no longer afford it. I don't think any of us want that.
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Bargainhunter
climber
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Wow, now this is a topic close to my heart.
This an ER doctor weighing in by the way. I have conflicted feelings about this topic, so I may sound a bit schizophrenic at times.
I think medical charges are outrageous, but just understand that the amount a hospital charges you doesn’t reflect what your insurer pays nor what you have to pay if you are uninsured.
So the original poster was charged $8k by the hospital for a simple collar bone fracture. Sounds crazy eh? I bet your insurance paid about $900 to the hospital to settle the bill and the hospital said ok. If you have no insurance, tell the hospital’s collections dept. that you can’t pay $8k, but you can pay some, they may cut you a deal like they do with insurance companies. Or they can be jerks and bill you for the outrageous fee of $8k that no insurer would ever pay, then submit it to a collection agency when you don’t pay, have liens placed against your assets, and ruin your credit record (which means no house nor car loans in the future for example).
If you are a true homeless dirtbag and don’t care about your credit, then Klaus’ argument to simply not pay is excellent advice indeed. Unfortunately, by not paying your bill at all, that means that the hospital will jack up its prices even more so that people who pay in full or have good insurance have to pay more to cover those who never pay.
At my hospital, only 25% of patients pay anything all, so their costs gets rolled into the bills of those responsible patients who struggled to stay insured. As for what the ER doc makes, my guess would be that that doc in Vegas makes about $100-$225/hour depending how fast they are (while seeing probably two other patients in the same hour as the collar bone fracture). Don’t think that the ER doc gets much of that $8k that was billed to you.
What complicates things in the Emergency Department setting is that there is a FEDERAL law called EMTLA that mandates all Emergency Departments to evaluate any person for any reason irrespective of their ability to pay. A drunk driver who has no intention of paying anything at all can rack up a easily $350k bill in 2-3 days if s/he is in a car accident and requires surgeries and comprehensive ICU care. The soccer Mom who can’t see her child’s pediatrician when she would like can go to any ER and demand to have her child’s problem addressed NOW despite the fact that it isn’t an emergency. Add on the endless customer base of drunks, drug seekers, mentally ill, self destructive, manipulative, non paying, irresponsible, incompetent people that also all seem to be on disability, Section 8 housing, or jail clearances that are trying to delay their arrest etc., not to mention those who call 911 and demand transport to the ER on a DAILY basis so they don’t have to take a bus or buy a single over the counter med for their simple headache, abrasion, cold, constipation etc. and you have a system that is burdened on many levels, especially financially.
Add on to the fact that any perceived miss or medical malpractice will face expensive litigation and protracted lawsuits, and that ups the price even more. (I have been sued by a patient that I never saw nor interacted with in any way, FYI).
To add even more to healthcare providers' burn out, “Customer Service” is now such a big manta with hospital administrators, that ANY complaint will often cause the doctor themselves to experience financial loss due to incentives aimed at keeping all patients “EXTREMELY SATISFIED”. If I don’t meet a certain customer service satisfaction number, HALF of my bonus disappears. A single disgruntled drug seeker, incarcerated prisoner, mentally ill meth tweeker, etc. can simple criticize me for not giving them a refill of the prescription narcotics that they are addicted to, and poof, there goes my bonus. It can be a thankless job at times dealing with the incessant asshattery that goes on in American ERs. Add on the decade or more spent training to be a doctor, plus the $200-300k in student loans that me and other doctors face, the entitled patients who confuse rights with privileges, plus our high marginal tax rates (ok, I don't expect sympathy for being paid well enough to be in a high tax rate), and the picture gets even more grim…
So, to get back to the OP’s original point about outrageous healthcare costs. I will tell you what I would have had to pay for the same service. I am a 44 year old healthy (no chronic medical problems) independent contractor but am FORCED to buy health insurance from my employer. Even I were covered by a spouse’s policy, the cost of my insurance would be deducted from my paycheck anyway. So, if the OP had my insurance, she would be paying $370 monthly plus a high deductible of $2700. That means each year I pay $4400 just to have insurance coverage, then I have to pay $2700 more until my insurance coverage kicks in. So if the broken collar bone were my only medical issue this year, I would have paid $7100 in total for that care. That’s pretty close to the $8k of the original bill. Who knows what profit my insurance company would have made, perhaps they made $7,100 off of me if the hospital would have settled the bill at $900 for their preferred insurers?
The big argument over healthcare in the country is really about COSTS. If good healthcare were affordable, no one would be griping. But go to an ER when you are uninsured and get stuck with an $8k bill when you are a climbing dirtbag, and you will be livid for years, and your rage is totally understandable to me. It sucks.
Now here’s my opinion about health insurance. It’s extortion. The insurance companies are preying on your fear that you or your family member might have some catastrophic illness or injury that could result in a $370k bill in no time, like the second poster Evel on this thread mentioned he encountered. That’s kind of like having a mortgage on house somewhere that you are required to pay, but you don’t have a house. Because no one wants a crushing financial burden like that, the responsible fork over hundreds of dollars monthly to the insurance companies to perpetuate a protection racket for your healthcare. It’s no different than the mobsters in little Italy in NYC where I went to high school. Pay us monthly fee, or we burn your business down. It happened to an auto garage where my Dad kept his car, a block away from our apartment. EVERY car got thoroughly worked over with sledge hammers because the garage owner didn’t pay up to these criminals. My Dad's care was totalled (and ironically he had forgotten to renew his auto insurance just a few weeks prior! ;)
If you want to roll the dice and go naked without insurance, you run a risk of being stuck with an outrageous bill, and you are also limited to care in ERs only or county facilities, as most doctors require payment for their services up front, unlike ERs. If you don’t care about your credit record, you can decline to pay your ER bill or declare bankruptcy.
The reason that healthcare reform is so difficult, is that there is big money involved. Insurance companies, drug companies, medical equipment companies, and hospitals have the big lobby voices that dominate the political debate. Doctors and patients have no voices in this debate. Meanwhile, the average American who is trying to be responsible gets the shaft. Things will continue to get worse until a crisis occurs.
I am not optimistic.
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TGT
Social climber
So Cal
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Well,
Obamacare puts the IRS in charge.
Like that's gonna work out well.
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Dimes
Social climber
Retired and thinking about a comeback?
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Three big contributing factors for expanding healthcare cost besides those already listed:
1. Alcohol
2. Obesity
3. Smoking
The sad part is these are all self correcting factors that lead to a host of medical conditions in which patients want someone else to remedy. See the trend.
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TGT
Social climber
So Cal
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4.Old Age
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Karl Baba
Trad climber
Yosemite, Ca
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The sad fact is that if you're uninsured, they will bill you probably 100% more than they would bill you if you had insurance because those companies negotiate lower rates.
But you had insurance and then there is what the hospital wants you to pay for that hour. Listen to those that counsel negotiation. See what you can do. If their number isn't low enough, say you need to make monthly payments, say $100 a month.
After a year, try to negotiate a "Paid in full" say for 50 cents on the remaining dollar. They want you off the books by then and MUCH more likely to settle. You might mention that your ability to pay might suffer soon but could fork out the lower sum if it would settle the matter, maybe your folks are helping. The costs are insane. They don't tell you what they will bill you in advance and some places charge FAR less than others for the same thing so some retroactive negotiation is fair play in my mind.
Peace
Karl
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Bargainhunter
climber
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The thing that sickens me is that the patients have no ideal what they might be charged. In what other industry are services rendered but the customer had no idea what the charges are going to be? It's like walking into a sandwich shop and ordering a sandwich, but not knowing if the sandwich will cost $5 or $500 or $5000 or $50,000. How many of you might pass on the sandwich under those circumstances?
As a medical intern I was ridiculed for questioning the use of the drug Xigris on a patient with multiple organ failure dying of sepsis in the ICU. The drug cost about $5k for a single dose but had some data to indicate that it MIGHT decrease mortality by a few percentage points. I explained that if I were that patient, spending $5k extra for those odds wasn't worth it to me; I'd rather die and have my family keep the $5k. This was not the popular answer and I was shamed for thinking differently from the established doctors in the group. Now Xigris is no longer used as there was no proof that it was helpful, and data indicates that it may have been harmful.
Why don't hospitals offer menus of prices to patients and state upfront what the costs are going to be based on the patients insurance status, and what the expected risk or benefit will be by having or not having a certain test or treatment?
I was uninsured for most of my 20s. I fell on an ice slope descending Mt. Formidable in the North Cascades and nearly severed my thumb at the wrist; that night I had an unplanned bivy on the glacier wondering if I'd loose my thumb or hand. It was unconceivable for me to go to an ER when I hiked out as I had no savings and very little income. I duct taped my thumb in place and hoped for the best. If it had gotten infected, perhaps I would have capitulated and gone to the hospital. Instead, I did a low budg fix and got lucky that it healed ok. Was it the best care? No, but I wasn't stuck with a $10k bill from a hand surgeon either, nor did I call for a rescue. At the time I was living in a garage for $75 a month, and had been living in a $500 station wagon for the three months prior. It never occurred to me to take advantage of the system nor insist on care that I couldn’t afford.
Part of the reason healthcare is so expensive is so many people feel like their trivial problem is an emergency and they don’t hesitate to take an unnecessary ambulance ride out of convenience to the ER. They neither pay for the ambulance nor for their ED visit, thus this cycle of irresponsibility continues unchecked.
A common is example is morbidly obese person complaining of a cough, who states he can't afford his inhaler medicine, but who has a new pack of cigarettes in his shirt pocket and $10K worth of fresh tattoos, the obligatory medical marijuana card, and is too busy texting on his new iPhone 5 to engage in a discussion with me. Of course chances are high that this 30 year old person receives disability for some absurd condition like chronic pain, or memory loss, or simple fatigue. While I explain that the medicine they want is on the $4 list at Walgreens, they complain that they can’t afford it. God forbid that their recently purchased pack of cigarettes that is causing the problem costs more than their meds, but I can’t have that conversation because my Press Ganey score will take a hit and I certainly don’t want my regional director calling me again after the hospital’s Risk Management Dept. receives another patient complaint. As I question my career choice for the 10th time that day, I snap back to reality when the patient yells at the nurse and demands transportation to get back to his Section 8 taxpayer subsidized housing or he is will call the hospital’s CEO (again). There is way too much irresponsibility and freed loading in the system. I have entire weeks of shifts where nearly every patient is entitled like this. It gets old fast.
Of course as I am finishing up my charting (this is the bulk of patient care today- charting to thwart the inevitable lawsuits), the middle aged Eritrean janitor comes by the patient’s room to empty the trash. He works the overnight shift because he also has a day job. He used to take the aluminum cans out of the hospital trash so he could made a few dollars more per night shift by recycling, but the hospital threatened to fire him because it looked unprofessional. The amazing thing was, he fled Eritrea after fighting in the civil war with Ethipoia. His village was bombed multiple times. He lived in a Sudanese refugee camp for 4-5 years with his wife and three children. He was elated to have the chance to come to America and escape the desperate conditions he faced in Africa. He doesn’t complain, he works hard, he is trying to better his life. Compare this janitor to the entitled American laying on the patient bed, demanding another meal before he is discharged, yapping on his phone about getting new rims for his new truck. This patient is my stereotypical patient, every shift, I see 15-30 patients per shift just like him.
As I said, I have lots of mixed feeling about healthcare, and I tend to digress…
The best care isn't always needed. Adequate care that is cost effective is more reasonable. I drive a '98 VW diesel. Would a 2013 Maserati be a better car? Sure in many peoples eyes. But again having the best car doesn't get me to work any better than my older car.
In my view, most Americans need to wake the F up. We are enabling the problem. Werner, please step in and now state the obvious.
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Sierra Ledge Rat
Mountain climber
Old and Broken Down in Appalachia
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The American ER is the most expensive place in the universe to seek medical care.
Think about it - you've got to staff not only the ER but also the associated hospital with support staff, including surgeons, operating rooms, radiology suites, etc.
And you've got to keep the place staffed and ready for the worse possible scenario 24/7. All of the materials and supplies have to kept up to date - and replaced when they expire, even if they were unused.
You've also got to pay the liability insurance for the staff, which can amount to over $100,000 per month for each doctor. (Thank your neighborhood lawyer for that added expense.)
If you have 4 or 5 doctors on the ER staff, then you've got to bring in half a million $$$ every month just to pay the insurance premiums.
Despite the incredible cost of seeking care in an emergency room, that is where most indigent and Medicaid/Medicare patient go for their care - "because it's free" (to them). Medicaid/Medicare pays pennies on the dollar... so SOMEONE ELSE has to make up the difference. People like you with insurance get gouged to help offset losses generated by a huge daily influx of uninsured (indigent) and Medicaid/Medicare patients.
That being said... $8,000 for your ER visit is about 10 times the going price.
Threads like these are testimony to the insanity in America. I don't get it at all. I plead Canadian.
Repugnicans and Tea Baggers are generally older white men with good jobs and good health insurance. They don't want any changes to the American health care system because they're "fine"..... and they don't care about anyone else but themselves and their families.
I could spend years telling you about how the American health care system is totally f*#ked up.
I can't wait for the entire system to implode.
Press Ganey score
The other reason that that the American medical system is totally f*#ked up....
Here in West Virginia, if the local Oxycontin addict doesn't get the Oxy prescription refill that he demands (800 tablets per month, paid for by Medicaid, street value $4,000), then the dumb-ass MBA hospital administrator will can your ass because of a zero tolerance for patient complaints...
No wonder WV leads the nation in deaths by accidental Oxycontin overdose...
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patrick compton
Trad climber
van
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It is only a 'market failure' if you are getting screwed, if you are the company doing the screwing, it is a huge success!
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TGT
Social climber
So Cal
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The thing that sickens me is that the patients have no ideal what they might be charged. In what other industry are services rendered but the customer had no idea what the charges are going to be? It's like walking into a sandwich shop and ordering a sandwich, but not knowing if the sandwich will cost $5 or $500 or $5000 or $50,000. How many of you might pass on the sandwich under those circumstances?
I'll take your analogy one step more.
The guy making the sandwich usually doesn't know what it costs either.
If you want to see some puzzled looks, ask a doctor what the procedure he's suggesting costs.
HSAs would fix this, put insurance companies back in their rightful place as INSURANCE providers and not retailers of general medical care and restore the commercial relationship between the provider and the patient.
Obamacare does not, it just adds one more hugely inefficient layer of bureaucracy over the top of the whole mess.
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Sierra Ledge Rat
Mountain climber
Old and Broken Down in Appalachia
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The thing that sickens me is that the patients have no ideal what they might be charged
When I didn't have health insurance, I need a vaccination series and asked local hospitals how much it would cost. No one could answer my question!
Finally I got one hospital to agree to a price of $450. I paid the money and got the vaccinations (3 shots) administered from that hospital.
About a month later, a whole bunch of other bills started rolling in... pathologist's fee... lab fee... nursing fee... doctor's fee (I never even saw a doctor!)... etc.
Total bill came to $2,500
I told them all to f*#k off
EDIT:
BTW Dee Dee what the hell are you doing riding motorcycles? When was the last time you were underwater?
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rottingjohnny
Sport climber
mammoth lakes ca
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Can't wait for the Obamacare death panels and concentration camps beneath the chemtrail crop dusters....RJ
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