It's effectively a scam, don't give in to scammers.
Fucking. Ridiculous.
The ambulance ride alone from the accident site to the hospital (like, 5 miles) was several thousand dollars.
Probably the biggest surprise there is that a doctor saw you at all instead of you being filtered out by a triage nurse and sent to urgent care.
It is fairly common for someone to be advised to seek emergency treatment out of precaution to ensure that a minor symptom is not indicative of a severe problem.
For example dizziness can be a completely nothing-burger inner ear problem treated with a bunch of motions from youtube, or it can be a stroke. The ER exists to make that distinction.
Part of all those logistics and resources should be used to shunt people to the correct treatment center, but liability suits and extreme profitability mean that the incentive is to treat them in the ER.
Put into other terms, if you were hospital admin incentivized on billing, and could bill someone $5k instead of $160 for a non-urgent issue, wouldn't you? The fixed costs are the same, the ER is running 24/7 with a trauma team, might as well make it profitable.
Insurance did try to deny coverage, but fortunately I appealed and won.
I feel fairly comfortable assuming that they were being seen for a minor-to-moderate burn.
Well, at least, a functioning health care system shouldn't penalize for that sort of thing. We don't really have that in the US.
I don't know either, but the broader point is that people are referred to the ED by medical professionals for seemingly minor issues all the time, and that the incentives are all lined up to treat stupid shit in the ER rather than have someone tell them to go somewhere that makes more sense.
In that case part of the treatment they received was emergency evaluation for smoke inhalation. Just because they don't end up giving you drugs or doing surgery about it doesn't mean the assessment wasn't a valuable service.
Isn't it CYA for any EMS to recommend you visiting the hospital, so they just say it to anyone. That allows them to later say that you failed to follow recommended advice.
At no point did the ER staff ever talk to me. At no point was I in a room. Or in an ER bed, hallway or otherwise. Just ambulance, transport, and then to pre-op.
But, because the transfer physically happened in the ER, that second hospital tried to bill my insurance for an ER visit to the tune of $2,800 which I appealed (successfully, at least).
ER - life or death (if you can drive yourself, it's probably not an emergency)
Urgent Care - you have the flu, and your PCP isn't available; minor emergencies (but you can still drive yourself)
PCP - flu, check-ups, whatever
The balance billing and OON charges are separate issues from over-use of the ER.
How did the determination that you needed urology, "oops, no urology available", and ambulance transport get arranged? It seems like some level of triage, routing, unable, re-routing had to have happened, right?
But yes, hospital two tried to charge me for an ER visit, as well as the surgical billing (which of course was reasonable).
Shock, horror, you actually need to read through the form and select the appropriate checkboxes (around ability to stand, need for oxygen, fall risk and hazard, danger to self or others, etc., etc.)
Too many of them literally fill out patient demographics and a signature and say "here you go".
We push back because our organization policy is that we will transport those patients, BUT we would also much rather bill Medicare than the patient (our billing staff and C-suite may disagree, but EMTs and paramedics wholeheartedly understand that routine privately paid ambulance transport is not a viable option for 99.998% of the elderly).
Now the doctor has to put an appeal to explain medical necessity, I'm at his mercy.
An MRI shouldn't cost $26k, even with contrast, and at a hospital.
If this was non-emergency, it should have been pre-cleared with insurance per their policy.
You could fly to New Zealand, have a scan on a state of the art machine, get a good report, have 3 weeks holiday and fly home. You’d have heaps of money left over.
That solution doesn't really scream "emergency" and seems like a waste of their time and resources...
Some ERs don't always provide the level of care that they should, some doctors/insurance companies require patients to go to the ER for anything they need after office hours, and sometimes there's a need to be seen for something because of perfectly reasonable and valid concerns that it might be more serious than it ultimately ends up being.
While it's possible that the commenter's visit to the ER was a "waste of time and resources" I don't think it's fair to assume that from what was said.
Personally I am not qualified to determine what a treatable and non-treatable burn looks like. Where I went to school they don't teach that.
My order of operations for medical treatment are:
1) Virtual consultation. Free through my insurance. If you need to pay full price, this about as expensive as option 2. Also worth skipping if you can tell that an in person visit will be needed anyway.
2) A clinic. I use CVS's minute clinic. Looking at their price list [0], a minor burn treatment will run you about $100-$150, which is about what I would expect for talking to a professional.
3) Urgent Care
4) Emergency Room
This is further exacerbated by the limited safety nets in the US–even people who would on principle deign to sue others who tried to help them in a time of bad luck may find that a lawsuit is the only way they'll be able to maintain a decent lifestyle after the loss of a partner, or with a newfound need for long-term care.
One more layer is the fact that doctors are so overbooked. Many people cannot reasonably get appointments with their family doctor (if they have one) on short notice, so some things that, in the past, might have been a "wait-til-morning then call the GP to drop in same-day" are now "GP is booked three months out, guess we're going to the hospital".
Or maybe the patient didn't know what was required.
What matters is who picks up a bill (or challenges hospital and negotiates). I see little protection in US between patients and healthcare corporations, but its true I look from afar.
[1]: https://laeger.dk/media/mjpbsm2a/honorartabel-2023-januar.pd...
It’s terrible and the only thing worse than the exorbitant fees is the complete and utter lack of consideration to the patient’s time.
https://www.healthsystemtracker.org/chart-collection/health-...
The emergency care angle is what drives the socialism / capitalism bickering and that's what I see a the biggest impediment to actually making effective change.
Speaking of DI, DI is a money-printing machine, with CT and MRI machines that range from a few hundred thousand to over a million have breakeven points well under two years. And the DI companies work to find and gather physicians who want to start a DI practice. Offer financing, consulting, and then, shockingly, we find that physicians who own a DI practice or a share in one tend to over-refer their patients to imaging.
The democrats wanted to get subsidized healthcare for low income people and people with existing health issues that would guarantee they would be uneconomical to insure. The healthcare providers, insurance companies and pharma companies wanted to remain viable, profitable businesses.
The compromise was to essentially guarantee profits to healthcare companies by crafting legislation that overcharges young people, healthy people, male people, middle class and affluent people to subsidize costs for other groups, while giving a consistent profit margin regardless of costs to insurance companies.
There is nothing about American healthcare that resembles functioning markets or capitalism. It's a very heavily regulated industry where the government exerts extreme control, while choosing to legislate in a way that maintains a consistent flow of money to influential lobbying groups and political donors.
Frankly the difference I noticed post Obamacare was a friend of mine was able to get insurance in time to not go bankrupt treating her colon cancer.
I can't get behind the idea that Obamacare is somehow what broke our medical system.
Insurance companies had teams of people who, if you made a substantial claim, would look over your application for anything that was amiss. And if they found it, they'd drop you so they wouldn't have to pay.
Your health record became a criminal record. You just hoped there was nothing on it that would prevent you from getting coverage in the future.
Obamacare has some very serious problems, but at least you can't be denied insurance just because you have back pain.
Before Obamacare, some policies had lifetime limits, which could affect expensive treatments like cancer.
We celebrated the fact that now medicare can negotiate 10 drug prices. It should negotiate all drugs. The organization that gets the lowest prices is the VA. Congress could easily pass a law saying medicare will only pay that much and it would not cost much to implement.
System is very broken.
[0] https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an...
This is cope, just like "(socialist catastrophe) wasn't caused by TRUE socialism" is cope.
The mechanism by which capitalism causes concentration of wealth and power, and by which said concentration then creates means, motive, and opportunity for self-dealing is crystal clear.
Instead, our system is the worst* of both worlds. The government limits the supply to prevent competition, but allows those they've licensed to charge as much as they want.
*(That is, worst for patients; it's the best for profits)
Even if there were no insurance, I don't believe there exists a possible free market for expensive emergency medical procedures either.
The UK's death panel is called NICE: https://en.wikipedia.org/wiki/National_Institute_for_Health_...
We should have something similar in the US. 80% of all healthcare spending is consumed by people in the last 3 years of their life.
Your experience with insurance in the US is very different from mine.
My experience is insurance denying my 34 year old sister's MS meditation until she ended up in the ER.
SF Bay Area peninsula -> Stanford
Austin -> St David's
Since the American system doesn't allow people who can't pay for emergency care to die the system ends having a socialist component. Socialism is such a hot-button issue that we can't have mature conversation about funding it. Almost any conversation about it gets caught-up in partisan and "personal responsibility" bickering.
It would be easier if we just let people who can't pay die.
That's repugnant and wrong, but it would certainly make the conversation easier.
Ask anyone who has a dog, preferably a big dog, what it costs for a vet visit.
Better yet, talk to someone who has had a sick dog. Something terminal, or possibly terminal. Costs are wayyy lower. Same x-ray, same imaging, many similar medicines. I've talked with vets, human doctors, and doctors who own dogs. They all come to the same conclusion:
Only ONE key difference - there is no insurance or government regulation involved (obvously stuff like taxes, basic health codes, licensing, but I think you know what I mean).
I'm more than happy to agree with you if you could show me a plausible explanation for this enormous disparity in costs.
[0] hint: receiving bills for charges you never assented to is not a foundation of a working market, and should obviously be illegal.
I moved to Canada recently and caught a flu that I didn't take care of and, in turn, developed into pneumonia. It took me FIVE days to be able sit down with a doctor and get an antibiotic prescribed even thought it was more than evident I needed immediate care. I could have died if I waited another day. But was it free? ... ehrm ... yeah.
In Mexico, doctors are as free market as it can get, downsides and upsides of that considered; with cash in hand you can get any kind of attention you need in the exact moment you need it. And it's not even that expensive, after converting MXN <-> USD. I could've dropped by with any of the 1,000s doctors that are available, many of which don't even require appointments. I would've got the attention I needed and the antibiotic prescription in 2-3 hours. That would had cost me ~60 USD.
> About one-third of Mexico’s registered workers report earning the minimum wage, which will amount to about $1.75 per hour starting Jan. 1.
$60 is 4 days wages for 1/3 of workers in Mexico. It's the equivalent of $820 for someone making 75k per year in the US. So it's the same as any other free-market healthcare system: easy access for the wealthy at the exclusion of the poor.
https://apnews.com/article/mexico-minimum-wage-increase-peso...
I'm not saying it's fair, I'm saying it's cheap, compared to the US as that is implied by the context of this conversation.
When you buy a $1 dollar shirt from Malaysia, is it cheap? Yes. Is it fair? Who knows.
It's the same thing.
Also, doctors in Mexico make way more than minimum wage, it's not unusual for some of them to have incomes around 200k-300k USD/year, plus read about RESICO and your jaw will drop to the floor. The average person in the US would kill to have the income and purchasing power doctors have in Mexico.
[1]: https://www.washingtonpost.com/outlook/2020/08/06/health-ins...
I went through that ordeal ~4 months ago, me, personally, I didn't read it on a magazine or whatever.
The lack of regard for patient schedules is a direct result of how insanely packed the schedules of providers are. Fifteen minutes per patient is luxurious and my partner spends a lot of time after work entering notes for patients she saw that day (she "works" 32 hours / 4 days a week, which is really closer to 40-45 all told). My understanding is that the clinic does not have a high profit margin (serving medical / medicare patients + high overall costs), so every patient counts, and the admin staff will add people w/o permission. It's common for her to find patients scheduled over her breaks or for her to be scheduled after she should have left the building. Burnout has always been bad but it's reaching epidemic levels now in the wake of covid, which further restricts the supply of healthcare and makes people wait longer to be seen.
For a recent event, I got a whole nurse calling me from the "insurance" company, out of the blue, seemingly just to chat about the medical situation and how things are going. I haven't figured out what her KPIs are, but I doubt she remains so friendly when you bump up against them! And she obviously represents a severe misallocation of labor - the industry would be better off if someone with her education (and likely experience) was actually providing healthcare.
Worse the odds are good she was hired to help the insurance company prevent people from getting healthcare.
It's the same story every time. Something works relatively OK (US health care before 20 century big-gov), huge changes to incentive structure and overheads are introduced by statists ignoring higher order effects, everything goes downhill, statists blame capitalism.
Let me legally not have insurance, pay anyone in cash for my health care (no licensens and government enforced monopolies), and buy any medicine I'd like and opt out of this madness completely and let's compare with real capitalism.
If you try doing health care this way for long enough, you might even discover which incentives are poorly aligned without collective policy of some kind, but who knows, maybe not.
It should be noted their virtual visits are mostly performative. You're filling in a survey beforehand and the doctor is just there to read the survey and push a big green button.
Plus many of these places specialize in stigmatized products like anti-bolding, ED meds, anti-depressants, etc.
I've only ever had doctors that worked that way so didn't even know that there were some that did not.
I now wonder which is more common, and if there is some way to tell beforehand when choosing a new doctor which kind they are?
But I agree that for some appointments it obviously doesn't work because you can't examine the patient or take vitals the same way/at all.
Call me new-fashioned, but I don't want to spend a few hours of a workday several times per year to see a doctor for less than 5 minutes for prescription refill for a drug that I have been taking for years.
Why in the world would either of us need to see each-other in person when he can ask me the same 3 questions he always does over the phone?
For certain things, like common illnesses, it is pretty good.
But that being said, use caution. I had something minor turn into an ER visit because I used telemedicine instead of going to my GP. Telemedicine prescribed antibiotics, which was correct, but GP would have done a drain too. Lack of drainage caused uhh unpleasant problems down the road.
The US healthcare system is completely broken. Hospital systems and doctors offices in general lost a shit ton of money last year. There has been massive layoffs throughout this sector. There will continue to be this year. This year they all are going to try to survive by recouping their prior losses. Get ready for more fees.
In addition - there is consolidation in the physicians groups. Mom and pop groups are almost unfeasible at this point. Look for venture capitalists to scoop in. Guess what - you won't have better care with after those changes - I can promise that.
Lastly, the pharmaceutical industry is out of control. They hike prices on any and all medications that they are able to. They recently hiked flovent to a cost that no insurance companies or hospital will pay for it. There are limited alternatives at least for kids. This is medications that that has been out since the mid 80s. It is a controlled market, with high barriers to entry - you can either permit a wide west time of pharmaceutical environment or you can understand the need for a regulated marketplace and meet with with equivalent regulation in terms of pricing.
Finally the insurance companies are the worst. I don't know anyone with a good experience...the only ones that have a positive experience are those that don't use it. I try not to hate any single group but I hate insurance companies.
The system needs to be burned to the ground. It is fragmented and burdensome for healthcare providers and for patients. It benefits no one at this point. It creates additional workload for providers hospitals and patients alike.
I am afraid of what will come in it's place but can't we worse that this shit.
It costs 2-3x of healthcare in equivalent countries, with worse results. Where is that money going?
> In addition - there is consolidation in the physicians groups. Mom and pop groups are almost unfeasible at this point. Look for venture capitalists to scoop in.
Private equity already has, from what I've read.
Just went out and bought a bottle of Avamys (more modern version of Flovent) for $15 without any hassle. Shed a tear for poor Americans.
There are now 10 administrators for every 1 doctor.
Since 1970, the number of physicians has increased by 2x. The number of administrative staff has increased by 38x.
If each administrator is making 100k+ - 150k+, that's significant cost.
Some of these crazy billing practices are due to the private equity buy-ups and consolidation, creating workflows and fee structures that are hostile to patients and doctors, but benefit the PE firms.
https://www.commonwealthfund.org/publications/issue-briefs/2...
Lots more data here: https://www.healthsystemtracker.org/
It's the corporations, stupid.
https://www.mckinsey.com/~/media/mckinsey/dotcom/client_serv...
I worked in healthcare and this McKinsey report (exhibit 2 on page 81) is probably the best analysis I've seen that tries to isolate where the extra money is going.
The biggest driver of higher US healthcare costs is outpatient care. And it's not just that each healthcare event is more expensive (though it is), it's that Americans get a lot more outpatient care than other OECD countries.
They ask you to set a primary care doctor, but I have had more success with seeing a small group of their more available non-MD physicians.
Everything you're describing is screaming monopoly and artificial lack of competition.
If providers of class X are too busy to see you, then there's plenty of people who could, or you're just going to do it on your own. It needs to be more like that.
Obviously there are some limits, but educational pathways could be much more diverse, and there are many things that patients are capable of accessing on their own or through providers like pharmacists.
Then someone from outside the US says, "that would never happen in my country; here's how it works here..." and it's immediately assumed there's some sort of huge catch, that never, nowhere could a health care system work that well without some sort of major trade off or downside.
No! Stop this! A health care system should work for patients, not against them! Injured or suddenly-sick people are not in the best head space to make rational, informed decisions as to what level of care they need in the moment. Even if they were, nearly all lack the specific medical training that would always allow them make that decision with a comfortable level of certainty.
And even if someone should have known better, I just don't get the ire. Why should we put people into tenuous financial situations just because they made a mistake in how they sought medical care? Medical care! What the hell is wrong with people?
The US health care system is awful, despite having so many great and talented doctors, nurses, and staff! Let's get that through our heads! We pay so much more than other developed countries, for so much less care. And the reason we don't have something better is because the right public policy is labeled "socialism". This is so exhausting.
• I needed refills for two prescriptions that I've been taking for years. This time, for opaque reasons, I needed to talk to a doctor first.
• Fine, but I couldn't accommodate an in-person check-in. I chose a "video visit" that, due to logistics, I had to do while away from home. Because they were a half-hour late, I was effectively forced to do this from the couch of a Costco floor display so I could still pick up my kid on time.
• The appointment was 8m, at an out-of-pocket cost of $160+. I was not warned that I'd be forced to pay $20/minute for the privilege of being blessed with refills.
Land of the fee, baby.