Another example was the birth of my child. We prepared for this by setting up an FSA, and having really good PPO coverage that year, supposedly, with a 10% copay. After all the billing shenanigans, my copay was about 30% and well above the out of pocket maximum. How does that happen? You can go to an in-network hospital, and be treated by a mix of providers, all of whom bill separately. Some will be in-network, others will be out of network, so you are in effect deducting against two out of pocket limits.
Medical billing is fraudulent. Medical insurance is fraudulent. These people are all acting in violation of tons of existing laws - I don't understand why this isn't prosecuted.
Dignity Health deserves a special mention though. They obfuscate their billing as much as possible. The initial bill indicated they'd give me a cash discount and wanted something like $2500. Then they sent me another bill for $1800 if I paid promptly, with lots of weasel words to make it seem like I really owed more than $1800. So, of course I paid but I had no real idea if $1800 would be sufficient (in fact their online payment portal hinted it wouldn't be). The best part was getting a survey about the quality of their billing statements right after.
Imagine if every time you went grocery shopping you had to pay for the people stocking the shelves, putting the carts back if you used one, the cashier, and each wholesale distributor. It's crazy and senseless. Just the way they like it so they can get away with so much more.
Well, yeah, that's true by the definition of “subcontractor”, which doctors in hospitals often are not.
OTOH, healthcare isn't the only place where you might pay a fee to a facility for use of the facility and a fee to a service providers associated with the facility for services they provide in the facility. It's perhaps an inconvenient arrangement, but by no means unique.
Where else does this occur?
Event facilities (for weddings, etc.) often have established partners for various event services that you pay directly rather than through the facility, which you also rent.
Dance studios where the dance instructor is affiliated but not an employee of the studio (especially where the affiliation is non-exclusive) will sometimes (especially for private lessons rather than group classes) charge a floor fee which you will pay to the studio, while the instructor is paid directly.
Fairs, etc., often charge you a gate fee, while you pay for goods and services inside to vendors directly (which vendors are also paying the fair for the privilege of being there, too.)
Arguably, residential real estate leases without included utilities is a closer analogy than any of those: there are a number of non-optional service providers you pay separately, on top of paying the landlord to occupy the premises.
BUT STILL, weddings are a really bad example here.
The people getting married get to chose from whom they want the table and chair covers, flowers, singer/band, catering, belly dancers/entertainment, lights people, AV people.
Those are choices you got to make and the bills will obviously come separate since there is clear distinction of entities. Heck, the venue and the singers might not even of said a word to each other, let alone have a billing agreement.
...why?
Most (all?) states forbid whats called the "Corporate Practice of Medicine." The idea is that profit motive of a corporation can lead the corporation to manage physicians contrary to the interests of their patients. To mitigate this, states only allow certain business models for physicians:
* Sole Proprietorships - they can work for them selves
* Professional Corporations - a restricted sort of corporation that requires all shareholders and executives to hold a license for the profession the corporation practices (ie, they all must be physicians)
* Some states have exceptions for research universities, public hospitals, non-profits, and other sorts of organizations.
The exact restrictions of course vary from state to state. Here's a state-by-state rundown: [1]
Its my understanding that analogous restrictions are common for other licensed professions such as law and accounting, but I know much less there.
[1]: http://archive.healthlawyers.org/google/health_law_archive/p...
But businesses and some consumers do want things to be under one roof - no surprises on in vs out of network, they don't like separate bills from each doctor that sees them, easy referrals, etc.
Kaiser is sort of a funny workaround.
The Kaiser Foundation Health Plan, the Kaiser Foundation of Hospitals and The Permanente Medical Group = Kaiser Permanente
The win for the patient is everything in-network and under one roof. If you are in a Kaiser facility EVERYONE is basically in network (with the exception of some state mandated providers that have to go through their own state flows - yes, that's why sometimes you need to repeat info on forms even at Kaiser)
The win for doctors is you really don't have denied claims or the billing pain you might in private practice.
CMA I think has really fought these setups before, but now oddly (in part because of medical malpractice and EHR overheads etc) working for Kaiser isn't considered a dump job anymore.
Bad news, obamacare put demand through the roof at Kaiser (even though they are not the cheapest plan) so they are shortstaffed I think.
If you do or know anything about medical billing - medical providers probably hate it as much as you do. A patient with primary coverage through Kaiser and secondary through Medi-cal - just to bill Medi-cal for $40 - you could spend hours on that as you hoop jump.
"For those who are not familiar with the Kaiser system, here is a very abbreviated explanation. Kaiser Permanente is an HMO, and consists of the Kaiser Foundation Health Plan (the Kaiser insurance) and the Permanente Medical Groups (the Kaiser doctors). The patients buy the Kaiser insurance and they are only allowed to see Kaiser doctors. The Kaiser doctors are salaried from the pool of insurance premiums and provide service only to the Kaiser patients. In the Kaiser model, services are prepaid, so there is no financial incentive or penalty to providing or receiving medical care."
Wouldn't it be fun if whenever somebody criticizes their government, they also state who they voted for to force them to open their eyes to the fact that it's their own fault.
People rationalize it by saying that voting for a 3rd party is "wasting" their vote, but in that sense, voting for anybody is wasting their vote because it never comes down to one individual's vote deciding things. Really they just have two driving forces - allegiance to whatever tribe they randomly found themselves feeling like a part of (and mysteriously agree with all the inconsistent aims of), and wanting to be on the winning team. Healthcare be damned.
Without a switch to range voting, approval voting, or one of the condorcet variants, the party system will remain broken into two corrupt halves.
It's actually worse than what people say. First past the post voting systems have a lot of problems, one of which is called the spoiler effect. By not voting for the major party you prefer you are actually voting against said major party.
Take this simple example: Major party A has 51% of the votes, while major party B hast 49%. Party A wins the election. Next election party C makes a big campaign at party A voters and convinces 3% to vote for them. Now we have A 48%, B 49% and C 3%. Party B wins the election. And if we look at the paper trails it probably doesn't surprise who funded party C's campaign.
Assigning this well studied behaviour of rational voters to simple tribalism is trivialising the core issue in the US: Elected officials are not representing the people. The way to fix this issue is to fix their voting system.
I guess I am stubborn but I will never vote for one of the two big parties. However it would be great if smaller parties got some kind of representation in Congress. It seems ridiculous that in the 90s Ross Perot got 20% of the vote but that resulted in zero representation.
Also, I find it curious that while our community has generally settled on "incremental improvement" approach, we expect different from our governments and want the "big bang" changes. Then we are surprised when things get worse.
It’s not. It sends a signal that there is a desire for something else.
The public memory is so short and so malleable, people forget things week over week let alone the entirety of an election cycle.
The issue with third party voting is a classic case of the problem of coordinated collective action.
Would-be voters don't participate out of perceived futility or participate in the dual party system for similar reasons.
I don't know how to solve it but there does seem to be growing agitation in the electorate with the current system as it stands, with the Electoral College under public scrutiny and with media support. To me that is a signal that times are changing.
In reality, voting for someone who didn't win the election is a "wasted" vote. But people will say that a particular candidate has no chance of winning the election, so voting for them is "wasting" your vote. Unfortunately, because most people follow this line of reasoning, it becomes a self fulfilling prophecy.
I'm going through this now! It is completely baffling! I went to the ER, and then I received a steady stream of bills over a period of months. They were so numerous and so devoid of useful context that I began to worry that they were illegitimate. The billing process is absolutely insane.
$$$$$$.
The Medical system is being used to transfer wealth from the working and middle classes to the capital class under the guise of "free market". That money is being used to shape legislation, buy politicians, influence elections and kill threats to the system, allowing for even greater wealth transfer.
The rigged markets of socialist Europe are far more transparent, fairer and free, whereas our "free market" is opaque, completely unfair, totally impossible to understand and offers very little in terms of real free market choice. Yet we are brainwashed to think that our system is superior, due to the propaganda the industry pumps out.
Second, I would require that all medical products and services must have their prices acknowledged by the consumer before service is rendered. Obviously there would have to be some exceptions for extreme medical emergencies, but emergency care only makes up about 1% of healthcare costs, so that can slide.
I would disband medical unions such as the AMA, which spent decades artificially limiting supply of medical workers to keep wages sky high.
I would ban employer provided health insurance, decoupling healthcare from employment.
I would attempt to reshape the health insurance industry to actually work like insurance instead of total coverage. If you get the sniffles, just pay the market rate to visit the NP at the CVS minute clinic, get your antibiotic or whatever, and be on your way. Insurance should not be involved in that, and should be reserved for major medical emergencies or serious conditions like cancer.
I would have serious patent reform, moving pharmaceuticals to generics at a faster rate, and expedite FDA certification for generics. I would work to create a system of partner countries for healthcare certification. If your drug is approved in France, you get a greatly expedited process in the US and vice versa.
If those things didn't dramatically bring down the price of healthcare to a reasonable rate, then I'd consider some socialization of risk.
I'd like to understand why healthcare doesn't bill using time & materials plus markup. All current pricing seems little more than make believe.
I also don't understand why different people are billed different prices. I get that different providers will likely (hopefully) have different billing rates. But isn't billing different prices for the exact same thing illegal?
Oh, America, you will never change.
Simply examine the way the issue was presented by frontrunners in the supposedly liberal party of the United States on the debate stage yesterday.
Two candidates call for true universal coverage, a few call for a public option but brand it as universal coverage to confuse viewers, and several (with moderator and broadcast sponsor support) outright mislead by stating that universal coverage that eliminates private insurance will threaten access to health care.
We have a long way to go.
...
Loss aversion is a powerful emotion with destructive effects on our politics.
Once enough people have something to lose from a change, change becomes extremely hard, even if the overall net effect would be positive.
Not only does this preserve bad policies, it turns some into a one-way ratchet--where it's easy to make things worse and very hard to make them better.
Examples
- Medical middlemen (insurance, insurance brokers, billing companies...) are pure waste. But they employ so many people and generate so much revenue that they are very hard to attack. The US has slowly climbed to ~2x the per-person medical spending of our peers... so now, any effort to reduce that to 1.9x will be met with fierce resistance.
- Prison guard unions are powerful nationally and in many states, including California. They fight any and all attempts to reduce incarceration. That was true in 1980 with ~100 prisoners per 100k population... and it's true now with ~650, by far the highest in the world.
- Realtors and car dealers essentially tax the two biggest purchases most people in America make, house and car. They have powerful lobbies in all 50 states.
There is no particular amount that will placate these rent-seekers. They just never want their income stream reduced.
Both parties are economically right wing. Third party is easily squished by tribalism and system being unbalanced.
If private insurance was allowed (in Canada), the elite would have expensive plans that had physicians only caring for a few people each, and so on. This worsens the care in the general system but more importantly, it splits the interests of the elite from the general public.
Becuase that's where I get stuck.
From a less selfish perspective, there but for the grace of God go you.
Hoy por ti, mañana por mi.
Specialized illnesses don’t discriminate by class. Those without means don’t receive the care they need. We are fighting so that the system centers that care instead of revolving around a third party private payer that has every incentive to deny that care.
But they would never be able to outcompete it.
https://www.uhc.com/employer/news/consultant/irs-sets-new-20...
https://www.cigna.com/assets/docs/about-cigna/informed-on-re...
But I’ve never heard of a deductible actually being set equal to out of pocket maximum or even anything close to it. Even the bronze family plans on healthcare.gov had deductibles of a few thousand.
For many procedures, we’ve just been avoiding going to the doctors. Doctors have been a hit and miss too. Most really don’t know what they’re talking about.
I’m kinda hopeful that someone will really commoditize common procedures and checks and will make them dirt cheap. May be amazon. Can’t say.
But shit like LapCorp and a whole swath of vulture physicians and insurance companies need to die.
US healthcare is really fucked up.
I paid $850 at the ER and today I received another bill for $850.
The only thing on the Bill just says
> "Charges": $11,680 > "Adjustmnets: $9,980
I just got off the phone with them and they say that it will take 10 business days to receive an itemized bill. However, that means the itemized bill will be delivered after the current bill is due.
How are they going to charge somebody $1700 without an itemization?
Furthermore, I am expecting another bill from the ER doctor that saw me because they bill separately and are not covered by insurance. The ER legally cant tell you if the doctor or the hospital accepts your insurance. Thats so crazy.
My wife was absolutely mortified. In brazil I never carried insurance but going to the ER I just had to pay R$400 flat fee for a private hospital. Anything else for tests they would give me the prices up front.
My wife about started screaming when the woman brought in the credit card machine while I was still in pain in the ER hospital bed. It was so embarrassing.
All this is with the top insurance my company (a ~$500 million startup) offers and to make it worse it happened when I was on a company mandated trip.
If you really did just get the bill it will be several months (and several more copies of the bill sent to you) before a final bill would show up that would indicate the account is "PAST DUE" and heading for collections.
IANAL but you can safely wait for the itemized bill.
In the future to save on costs, you might try to find a 24-hour Urgent Care instead of full-fledged ER. Unfortunately the level of equipment that they have to keep in a full ER means just having someone in a bed costs them a lot of money, even if they are just swabbing your throat for a strep test.
Sure, just like you can't charge extra for using a credit card in California as payment in most scenarios (you can get a cash discount though). There may not be late fees, but the hospital will absolutely offer to settle for a hefty discount if you pay ASAP.
By the time you get something claiming "PAST DUE" the hospital may be less willing to negotiate.
Who said anything about getting nothing? If the hospital sells your debt to a collection agency they get something. If the hospital deals with it in house they can act like UVA[1] and sue you to garnish your wages or take out a lien on your property. Playing chicken with the hospital billing department is a bad way to deal with medical debt.
1: https://www.washingtonpost.com/health/uva-has-ruined-us-heal...
It'd be far more effective to aggressively regulate hospital billing, wouldn't it?
You should look into the efficiency of medicare and medicaid if you're really worried about this. It might put some of your fears to rest.
We were broke at the time we found out about the pregnancy and memories of the first two years of my boy's life are largely dominated by this kafka-esque nightmare that took time and security away from our family life. I refused to pay a cent until what we were told was honored, my thinking being any sort of payment may legitimize it.
Eventually I didn't hear back from the hospital about our latest contestation for two months after confirming their receipt of the documentation (about a four hour process each submission, always new fax numbers, life-wasting hold times to confirm receipt of said documentation, transfers to other agents and departments, then a promise of giving a decision in a few weeks, often just reprinting the last non-descript document they used in the previous round without any real detail). Decided to just do nothing and ignore it as long as I didn't get contacted again and got everything ready to go to court if someone ever decided to pursue it against us again. The documentation I've been holding from the ordeal is 60 pounds of paper.
I still have no idea what the true status is, but it hasn't shown up on credit checks and our boy is now 5 years old.
I could not find anyone in various governmental institutions to even look into the matter and the lawyers I talked to said the outlook of winning was grim and would have cost a lot of money on top of that to even pursue it. Our insurance company [Anthem] posted a $17 billion profit that year. The hospital had the highest gross profit of any hospital in our city and the surrounding area at $80.4 million declared. Both entities make so much money they give away individual debts amounting in the tens of thousands of dollars for pennies (maybe ours included?).
It's an absolutely depraved system and my point is maybe be careful showing good faith to an entity trying to screw you lest it be taken as consent.
The $42k is a fantasy figure which they collect approximately 0% of the time. It's the easiest $42k you ever saved.
At this stage, it seems like the US is the “land of the free”, whereby “freedom” is defined as the ability to freely exploit everyone.
I agree, though, the masses are exploited (us included), and it’s troubling.
50 years ago people had the same loyalty towards their companies, and look where that got US manufacturing workers. nowadays you'd be nuts to expect to stick with a company for 10 years. get yours and get out: others be damned.
so it shall be with citizenship. as more and more citizens have more and more power to up and leave, or work outside the confines of the US without too much hassle, questions such as "what on earth are we still doing here?" will be asked, at first in whispers (as they are now), later in louder volumes.
where things go from there, anyone knows.
All medical imaging I've had done has had pricing given up front showing what they where going to bill the insurance company and what the insurance company was going to pay and what I'd have to pay.
My non-emergency visits have a $40 copay up front.
Only the nightmare cases get talked about.
The number one cause of bankruptcy in the United States:
> "medical expenses"[0]
The average amount charged for an ER visit in the United States:
> between 2008 and 2017, the average price of hospital ER visits rose 135 percent, from $393 to $924[1]
The cost of an ambulance ride in the United States:
> $164/mile[2]
And make sure to compound the monetary cost with the cost of people avoiding medical care out of fear and unknowns surrounding the actual monetary cost.
[0] take your pick of any study done by anyone
[1] https://www.beckershospitalreview.com/finance/average-cost-o...
[2] https://www.consumerreports.org/consumerist/164-per-mile-sur...
The OOP is still averaging under 300, again, not the horror stories in this thread.
Problems exist, but it seems that only a small % of providers are horribly abusing the system.
(of course a small % across over 300 million people is still a lot of harm!)
I don't live in the US and I'm not American so perhaps I'm missing some information.
If the average ER visit was 5K of unknown miscellaneous charges than that would indicate nationwide maliciousness on the part of nearly all hospitals. If only a small # of hospitals are engaging in that level of unfair billing, then they can possibly be investigated one by one.
It is the same thing as "we have thousands servers that are crashing at random multiple times a day" versus "we have a bunch of servers that are low on RAM, and a couple servers that crash 5 times a day."
Neither scenario is good to be in, but it is possible to get a hand on the latter scenario, while in the first scenario a "burn it all down and rewrite" fix might be appropriate.
Why would health care be any different?
Otherwise most people don't want to leave their friends and family
Note: not defending the horrible system. Only suggesting that most people using their company provided insurance probably don't run into these issues.
I don't know how it's possible, but our healthcare system has been getting worse every year. Even simple stuff like refilling scripts has become Kafka Meets Keystone Kops. The insurer has interjected itself into every single transaction, second guessing everything, adding ever more hoops to jump thru.
It's a wonder that we even bother with doctors any more, since the insurers apparently know better than my doctors.
Things are so bad, I wouldn't even know where to start if anyone wanted to fix things.
Better to just start over.
https://www.desmoinesregister.com/story/news/health/2017/05/...
I am also a British citizen, so I'm at least waiting to see how this whole Brexit thing shakes out.
Get on the phone, try to keep cool, but realize you're probably going to yell at some poor customer service rep at some point. Apologize, keep going and get the full bill before you agree to pay anything. Then you gotta do the same thing with the full bill on ever bullshit charge, over and over again.
Honestly, how the fuck can they admit you and treat you and then bill you without telling you what the prices are up front? That's fucking madness right there. Imagine having to agree to having car or bicycle service without an estimate? Imagine the total cost being $2000 over the estimate? Would people pay? Of course not; it's worth it at that point to call a lawyer.
It shouldn’t cost that much in the first place. You shouldn’t need to shop around for health care, and you shouldn’t be bankrupted by an emergency. Why people aren’t marching through the streets right now is beyond me.
https://www.washingtonpost.com/health/uva-has-ruined-us-heal...
This year I had sepsis and had a two week stay in hospital - o dread to think what that would have cost
A world where 100% of Americans are covered under the existing healthcare system is still a disaster because everything still costs so much between premiums, deductibles, copays and coinsurance. And on top of that, patient responsibility is still largely unknown until post treatment.
If you look at the cheapest Bronze plans on the Obamacare market, you're probably looking at $400/month for the premium with a $7500+ deducible for a single person. If someone is coerced into buying insurance and they can barely afford the premium, how is that something worth celebrating?
In the UK, I could walk into a Boots (pharmacy), speak to someone there and get prescription eyedrops for cheap for an infection vs the crap you have to wade through in the US. Same for other doctor/healthcare visits I've had around the rest of the world.
https://en.wikipedia.org/wiki/Cyanoacrylate#Medical_and_vete...
I've used off-the-shelf superglue on cut fingertips where I couldn't get bandages to stay. I believe it's also commonly used in place of stitches where you don't want the scarring that stitching would cause (e.g., parts of the face.)
It wears off in 3-4 days.
It took a lot of reading through the 600+ page plan document and finding loopholes. For example, I asked them that if they thought it should be done for $700, who would actually do it for $700? They couldn't list one provider that would accept the payment rate they thought they should pay. And since this was a reimbursement, and they had already pre-approved the procedure (knowing the price), I think I caught them already saying they would do it, but them not following through. There was a lot of going back and forth about in-network vs out of network, but again, no one in-network would perform the procedure. In the fine print of the plan document, it said if there are no in-network providers, the plan must provide you were in-network rates and deductibles for using an out-of-network provider.
So I told them if they can't find anyone who will accept what they are willing to pay, their figure is obviously wrong. It helped that with my health insurance, everything was supposed to be covered, 100% with no copay. So the fact that they tried to charge me for the $3300 overage was very out of line for them.
They never just said "no, we're not going to cooperate" it was more just endless stalling on their part. It was never really a blunt refusal, or if they tried that, I just proved how ridiculous their arguments were. I kept a lot of documentation.
I think in the end, they just relented because they were spending more dealing with me than actually just paying me my money. But it was certainly an uphill battle the whole way, and not one I would recommend to someone who isn't well versed in legalese.
See also, the TSA precheck systems. By allowing people like frequent flying businessmen and politicians to avoid the standard TSA experience, they reduce the likelihood that such people might use their influence to advocate against the TSA, for the betterment of all passengers.
See also the US unemployment benefits situation, where many employers will contest an unemployment insurance claim by default even when the worker is actually eligible, in the hopes that some workers will not navigate the bureaucracy well enough to fight back. Because of the weakness of their case, however, they will then back down as soon as their denial is challenged.
I was reminded of this just yesterday by a similarly simple story: https://twitter.com/chrisalbon/status/1172161958759395333
It's sort of like "add to cart to see the real price" but they can't say that. And sometimes hospitals are in a different mode where they fight for it. It's not logical, it's screwed up, but anyway the first bill is usually just fake.
And guess what they won't ever vote for: Those of us younger than 65 ever having the same luxury. We may be visiting them in the hospital every day, but they don't really see us.
And it's hard, because our generation loves them and wants the best for them, but most of us know we won't ever get the same quality of care for ourselves unless something changes...and as a human, well, you know, you get kinda bitter counting up "Wow, this is awesome, but what would it cost if I had this happen to me?"
Vote, people, because if our elderly are getting state-of-the-art amazing life-saving care, why shouldn't our young people, upon which our economy depends, be getting the same great service?
I try not to get too bitter about it, though, because their great coverage means we don't go bankrupt trying to help them: we're very lucky for that (although eldercare is a whole other ball of wax)...
It just kills me to see all of these young people begging on GoFundMe just to afford insulin -- and dying! Over insulin! -- while it's stockpiling pretty nicely in Medicare-recipients' closets thanks to overzealous pharmacies that know Medicare will pay for whatever they keep shipping, and seeing young people cobbling together their own makeshift slings for broken bones while so many nonagenarians are technically part-robot thanks to Medicare's great coverage.
I was once charged $1,500 for a doctor to talk to me (without ever touching my physical body) to “prescribe” me over the counter motrin....
I then questioned them on this and they said “well it was a prescription” : i said you never even physically touched me. “So im going to tell you what this was worth to me: $50”
They then said “okay we will charge you $297 for the visit”
I said “you made me wait over 45 minites before even seeingg me, at 9:00 pm when i was the only person in the waiting room. NO; im am going to charge YOU $50 for my time wasted”
The dropped the entire bill completely.
Good samaritan hospital in los gatos ca.
(Where my grandmother worked for decades, and after el camino hospital bout them and i was the technology designer for their upgrade)
You can negotiate codes with hospitals.
Source: i have built more than ten hospitals; el camino, good sam, ucsf, nome, sequoia , zucks sf gen, etc...
Dont let their coding depts fuck with you - take a stand.
Frankly you should challenge every single hospital charge you ever receive, they will always go lower.
As an example, just two weeks ago I made an appointment to go see a doctor. They called me back (kaiser) and said “ just come into the ER”
I said why, they said I don’t know, that’s what they told me to tell you.
So I called and verified my copay $30 and coverage etc.
When I got there they took my blood pressure asked a few questions, and then gave me the prescription I was asking for.
When I went to pay they tried to charge me $250
I said fuck you, I called and made an appointment, my co pay is $30 so that’s all I’m paying you period.
They conceded and accepted.
Most people would be surprised how closely hospitals and other medical companies pay attention to their social media and Google alerts.
Similar to your situation, I went to a dermatologist concerned about a bump. Turned out to be a skin tag which she cheerily said "We can take care of this right now" and snipped. That snip cost $250 (wasn't on the genitals but was close enough for them to bump up the cost). I called their billing company and spoke to their office manager. She said that "the doctor just wants to make sure customers are happy and doesn't really concern herself with the billing part" when I brought up that if something is going to cost something they should say so upfront if it's something not necessary.
Thanks for the heads up about the glue. They really do take advantage even when you're a bad situation.
This is one of the areas that open pricing should help.
Z176 - Repair of lacerations - up to 5 cm = $20.00 Note: Wound closure via tissue adhesives (such as cyanoacrylate) is payable at 50% of the appropriate fee.
Meaning, in Ontario, your procedure would have cost us $10. I'd have to look through to see what other costs would be incurred for the ER visit, but suffice it to say, it's probably well under $6,000.
Oh, and that's $10 CAD, which is like 2 Freedom Bucks. ($7.52 USD)
I'm less concerned if they're scamming the insurance (although I'm existentially and politically interested) than billing of individuals.
Go to the hospital, let them bill you, and then throw the bills in the trash.
And you can wipe out all of it by filing bankruptcy.
Is it possible that they cannot garnish wages in your state? Where are you getting your information?
On top of the nearly $6k in other charges from the hospital, they charged $531 for one dab of superglue or "liquid stitches" on my forehead for something that would have healed by itself.
One of my friends died two years ago from pneumonia. He didn't go to the hospital when symptoms first started because he was afraid of the bills that would come from it.
They don't ask you if you want to spend $500 for a dab of glue on your forehead, they just do it and you're essentially writing them a blank check in the process. I hate our medical system.