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What I learned from reading a thousand emergency room bills

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Re: What I learned from reading a thousand emergency room bills

#101

Post by andrei_says_ »

jclay wrote: post #54
y-c-o-m-b wrote: post #28

I was a victim of the surprise out of network bill in the Portland, OR area. I did all my research before hand: hospital in network, surgeon in network, etc. but ONE person in that operating room was not in network and SURPRISE i'm out thousands of dollars. The worst part about this is my state passed a bill to stop this prior to my surgery, but the bill's effective date was roughly 3 months later. Talk about bad tim…

Exact same thing happened to my friend. He did all his research, and while he was under anesthesia a nurse assisted that was out of network. $5k out of pocket. He ended up getting it removed after some run around between insurance and the hospital.

What blows my mind is how a nurse costs $5k for the duration of a surgery. Surely the nurse did not make $5k. Where does this money go?

Re: What I learned from reading a thousand emergency room bills

#102

Post by Wowfunhappy »

manfredo wrote: post #83
serg_chernata wrote: post #11

Earlier quoted context omitted.

> without even getting a quote beforehand Reminds me of this really good article. TLDR: Man tried to call a number of hospitals to find out how much childbirth is going to cost him and received no answers. https://www.vox.com/2016/5/5/11591592/birth-cost-hospital-bi...

Realistically, no hospital is going to give out a price. They don't know what unexpected complication may arise that requires additional services.

Realistically, how am I supposed to act in a financially responsible manner when I don't even know the order of magnitude a service will cost?

Unforeseen complications are not exclusive to the healthcare industry. Imagine if you were trying to build a house, but had no idea how much it would cost. "Realistically, no construction company will give out a price; they don't know what unexpected complications may arise."

Something needs to happen here. Either healthcare is socialized (my strong preference), or the industry needs to implement some type of price transparency.

Re: What I learned from reading a thousand emergency room bills

#103

Post by ademup »

cabaalis wrote: post #57
UnpossibleJim wrote: post #26

Earlier quoted context omitted.

Exactly. It's the same reason we don't have free market police and fire services. You simply don't get to "shop around" for emergency services, which includes privatized ambulance services (which are outrageously expensive, on the order of $12,000 for the ride I took when I had to take one, and it was a relatively benign one... thank god I had insurance). EMS is covered, but that's the Fire Department. After that, it…

> You simply don't get to "shop around" for emergency services You do actually, by where you choose to live and also by the services as detailed in [1]. I think there's merit to investigating public health care. That line stops for me in eliminating private care. 1] https://www.theatlantic.com/technology/archive/2018/11/kim-k...

Although most humans are perfectly ambulatory, there are innumerable reasons why they don't get to "choose where to live". Income levels, employment availability, schooling, racial pressure, and many more factors come in to play. Not everyone can physically fit into the best areas. The best areas for emergency services don't necessarily align with the best education (although very high income levels tends to align with both). This comment essentially amounts to "Well if you don't like being poor, then just obtain more money". While everyone cannot live in the best places, nearly everyone will need emergency services at some point in their lives. Also, OP didn't suggest getting rid of private care entirely. A public option does not preclude a private system. If the private system provides value, it will likely survive.

Re: What I learned from reading a thousand emergency room bills

#104

Post by phyller »

Great article. I think the narrative around health care is often around who has access to good insurance and who doesn't, and as the cost has skyrocketed we have doubled down on that debate. The real problem is that health care providers won't or even can't tell you how much something costs. This has set up this situation where, since money is not part of the decision making process, they just keep raising costs. Imagine a grocery store where prices are not labelled, and you get a complex bill a month afterwards. And every grocery store does this. What are the chances prices for groceries are going to be competitive? Zero.

If we can find a way to bring market forces to bear, it will pressure healthcare organizations to reorganize themselves to provide services in a more affordable way. And before anyone gets sanctimonious about putting money over quality care, consider the actual harmful effects of these crazy bills on people's lives. I used to do title work, and I became familiar with a pattern of people quietly paying their mortgage on their house for a couple decades, no liens, and then all of a sudden a lien from a hospital bill shows up. And then everything starts to crumble, other liens accrue, and I'm doing the title search for the foreclosure. A family just got moved from middle class to living in poverty. Our healthcare system is becoming a vehicle to impoverish people.

Re: What I learned from reading a thousand emergency room bills

#105

Post by AlexandrB »

merpnderp wrote: post #53
edoo wrote: post #10

Health care is the only industry where the felony laws regarding up front pricing aren't enforced. It was allowed to become a twisted regulatory nightmare where the laws were written by the industry itself utilizing kneejerk methods to obtain profit at the cost of systemic corruption.

And yet it is by far the most regulated industry in the US. Almost as if the more invasive the regulations the more invasive the corruption.

This is a non-sequitur. For something like emergency care, where the choice can literally be "pay up or die", a private provider has every incentive/opportunity to charge outrageous fees. Because what are you going to do? Tell the heart attack to wait while you find another provider?

The price-opacity may be a product of regulation, but the prices themselves are free market capitalism working as intended. For another example of the same, consider the recent reporting on collusion between generic drug companies[1]. When you can't refuse to buy the product, the vendor has a ton of power to set prices as they wish.

[1] https://www.wsj.com/articles/generic-drug-makers-shares-drop...

Re: What I learned from reading a thousand emergency room bills

#106

Post by ceejayoz »

noja wrote: post #64
jclay wrote: post #54

Earlier quoted context omitted.

Exact same thing happened to my friend. He did all his research, and while he was under anesthesia a nurse assisted that was out of network. $5k out of pocket. He ended up getting it removed after some run around between insurance and the hospital.

Today is "don't believe the comments day" it seems. How is an unconscious person meant to be stop an "out of network" nurse assisting? Is there a tattoo that you can get?

> How is an unconscious person meant to be stop an "out of network" nurse assisting?

They can't. That's the problem - there's little you can do to stop it from happening, even if you're aware of this sort of billing problem and try to take steps to prevent it.

https://www.npr.org/sections/health-shots/2018/08/27/6408918...

> Surprise bills occur when a patient goes to a hospital in his insurance network but receives treatment from a doctor who does not participate in the network, resulting in a direct bill to the patient. They can also occur in cases like Calver's, where insurers will pay for needed emergency care at the closest hospital — even if it is out of network — but the hospital and the insurer may not agree on a reasonable price. The hospital then demands that patients pay the difference, in a practice called balance billing.

https://www.npr.org/sections/health-shots/2015/02/17/3869088...

> The surgeon's office later told her that he belonged to two different medical groups. One was in Morgan's husband's health plan network, the other wasn't.

Re: What I learned from reading a thousand emergency room bills

#107

Post by Wowfunhappy »

tschwimmer wrote: post #84

I'm surprised to see lots of people in the comments talking about line items. Line Items are irrelevant. They could include line items for oxygen and toilet paper if they wanted to. The hospital charges whatever the market (and where applicable, regulations) allow. The configuration of the line item is pretty much a customer service problem: 'how do we show what we've done in a way that will get the customer to pay i…

> The hospital charges whatever the market [...] will allow.

Except that in this case, the market is paying before being told the cost. So, what is enforcing the upper limit on price in this type of bizarro market?

Re: What I learned from reading a thousand emergency room bills

#108

Post by chadcmulligan »

thatswrong0 wrote: post #82
tgsovlerkhgsel wrote: post #62

Want to do something about it? Regulate it. Like literally, have some government body write a table: 1 pill of 400 mg paracetamol ............ $0.50 1 pill of 800 mg paracetamol ............ $0.60 prescribing medicine (once per day) ..... $4.32 base fee for an ER visit .............. $200.00 5 minutes of work by an ER physician ... $27.43 etc. and impose that as the maximum price that can be charged. It's not going t…

Shouldn't the max price of services (not things like RX of course) be different depending on the cost of living in that area? You'd need different prices in different areas otherwise the prices might be too expensive in some areas and too cheap in others. If the prices set are too cheap, you might see more people using the ER for non-emergency purposes, which would be bad for the people that need to use the ER for ac…

a healthcare industry schil sowing confusion

Re: What I learned from reading a thousand emergency room bills

#109

Post by wmil »

andrei_says_ wrote: post #101
jclay wrote: post #54

Earlier quoted context omitted.

Exact same thing happened to my friend. He did all his research, and while he was under anesthesia a nurse assisted that was out of network. $5k out of pocket. He ended up getting it removed after some run around between insurance and the hospital.

What blows my mind is how a nurse costs $5k for the duration of a surgery. Surely the nurse did not make $5k. Where does this money go?

Hospitals are required to treat the uninsured, but the government doesn't actually compensate them for that.

So they jack up everyone else's bills in the hopes that enough people will pay that they'll make a profit.

Insurance companies will usually push back, so (sometimes partially) uninsured people with decent credit hit with huge charges.

Re: What I learned from reading a thousand emergency room bills

#110

Post by ncallaway »

cabaalis wrote: post #57
UnpossibleJim wrote: post #26

Earlier quoted context omitted.

Exactly. It's the same reason we don't have free market police and fire services. You simply don't get to "shop around" for emergency services, which includes privatized ambulance services (which are outrageously expensive, on the order of $12,000 for the ride I took when I had to take one, and it was a relatively benign one... thank god I had insurance). EMS is covered, but that's the Fire Department. After that, it…

> You simply don't get to "shop around" for emergency services You do actually, by where you choose to live and also by the services as detailed in [1]. I think there's merit to investigating public health care. That line stops for me in eliminating private care. 1] https://www.theatlantic.com/technology/archive/2018/11/kim-k...

> I think there's merit to investigating public health care. That line stops for me in eliminating private care

I haven't seen a proposal yet that would eliminate private care (or even supplementary private insurance).

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