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Why American ambulance rides are so expensive

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Re: Why American ambulance rides are so expensive

#351

Post by pshirshov »

anonym29 wrote: post #336
pshirshov wrote: post #293

I worked at a company which was doing medical billing for ambulances among other things. Essentially, the bills are always inflated so when the settlement comes the providers get 20..50%. The crucial procedure is so called "medical coding" where medical notes (sometimes - scrawled on paper with a pencil) are being turned into bills - and that's where additional codes are getting added and more expensive codes are sel…

$500k? There entire helicopters you can just buy outright for less money than that. Does the $500k ride come with the helicopter itself included in the purchase?

I do vaguely remember seeing some bills with such figures. I've been literally developing various OCR and medical coding crap to process the cases and I've seen plenty of real cases. Some cases had eye-popping bills attached, yes.

The $500K spike was some sort of a highway accident response, can't recall any additional details apart from some serious head/brain trauma.

Keep in mind that everything gets significantly inflated, x2 multiplier is guaranteed, x5 is likely, x10 is not uncommon. Again, from what I can remember.

Also keep in mind that billed != settled. If I recall correct, that bill was settled at something around $55K. That was many years ago.

Re: Why American ambulance rides are so expensive

#352

Post by pshirshov »

Ntrails wrote: post #319
pshirshov wrote: post #293

I worked at a company which was doing medical billing for ambulances among other things. Essentially, the bills are always inflated so when the settlement comes the providers get 20..50%. The crucial procedure is so called "medical coding" where medical notes (sometimes - scrawled on paper with a pencil) are being turned into bills - and that's where additional codes are getting added and more expensive codes are sel…

> an average helicopter bill was smth around $200K if I remember correctly, with spikes up to $500K. Those numbers made me blanch somewhat! Having been in a helicopter (aka Air Ambulance) in the UK, all of which operate as charities iirc, I was curious about their costs. > The average cost of a helicopter mission is £4,748* and the average cost of a critical care car or rapid response vehicle mission is £2,054*[1]. h…

In the UK maybe, but in the US you should expect higher bills for _ground_ transport. Like literally, the linked story is about $12K bill for short distance ground transportation not involving any complex procedures. The cases I vaguely remember did include long lists of medical codes.

Re: Why American ambulance rides are so expensive

#354

Post by chrisra »

milleramp wrote: post #211
grogenaut wrote: post #170

He refused to go in an ambulance the first time. He could have refused the second ride. You can refuse transport or medical care at any time as long as you are able to make rational decisions. As an EMT if you're A&Ox4, alert to time, place, person and event, you make the choices. You do sign a release so we have proof we didn't abandon you, but you make the choice. If we move you without your approval, it's kidnappi…

The physician can mandate ambulance transfer.

And what would they do if you refuse?

Re: Why American ambulance rides are so expensive

#355

Post by closewith »

newaccount670 wrote: post #340
onion2k wrote: post #205

Earlier quoted context omitted.

I don't think the question is "Should ambulances be a thing?" though. It's a question of "Should someone in a situation where they need an ambulance have to balance the potentially life-threatening impact of saying no versus the potentially financially ruinous impact of saying yes?" The (fairly obvious) answer to that no one should be in that situation. It's horrible. Society should find a better way to pay for ambul…

[flagged]

> Only a complete moron would think the answer to this is no. If there's no personal cost to using an extremely expensive service, every one is going to use it regardless of whether it's actually necessary. It will quickly turn into a free taxi service for anyone who wants to go anywhere near a hospital.

Okay, so why don't we see this behaviour more in other countries?

In my jurisdiction, the incentives are actually weighted towards pushing people to ambulances, as there is a €100 fee for self-referral to ED which is waived if you're transported, but while there are time wasters and frequent flyers, the service is actually less abused than US ambulances under EMTALA.

Re: Why American ambulance rides are so expensive

#356

Post by charcircuit »

spzb wrote: post #282
charcircuit wrote: post #35

Earlier quoted context omitted.

>from everyone the service stands ready to rescue So compelled health insurance to use an ambulance? You could just as well make it optional and charge people without the insurance the full price.

One thing that's often overlooked is the cost of administering a billing system. If you're going to distinguish between the insured and uninsured you need a system that keeps track of who has insurance. You need paperwork (or digital equivalent). You need accounts payable staff to send invoices and chase up unpaid bills. It can, counter-intuitively, work out cheaper just not to charge anyone.

That is not required complexity. You can just send the bill to the customer.

Re: Why American ambulance rides are so expensive

#357

Post by HelloNurse »

x______________ wrote: post #308
otherme123 wrote: post #212

Earlier quoted context omitted.

> Society should find a better way to pay for ambulances Society has this figured out, at least a decent solution that works until we find a perfect one. Only the US society seems to be unable to find a solution.

> Only the US society seems to be unable to find a solution. Unwilling. It's absolutely feasible to find a solution, as seen everywhere else in the world.

Unable to be willing. The combination of not knowing any better, political parties and media that don't care or exert a contrary pressure because they belong to billionaires, and powerful health sector businesses appears to be very effective.

Re: Why American ambulance rides are so expensive

#358

Post by gosub100 »

Ntrails wrote: post #319
pshirshov wrote: post #293

I worked at a company which was doing medical billing for ambulances among other things. Essentially, the bills are always inflated so when the settlement comes the providers get 20..50%. The crucial procedure is so called "medical coding" where medical notes (sometimes - scrawled on paper with a pencil) are being turned into bills - and that's where additional codes are getting added and more expensive codes are sel…

> an average helicopter bill was smth around $200K if I remember correctly, with spikes up to $500K. Those numbers made me blanch somewhat! Having been in a helicopter (aka Air Ambulance) in the UK, all of which operate as charities iirc, I was curious about their costs. > The average cost of a helicopter mission is £4,748* and the average cost of a critical care car or rapid response vehicle mission is £2,054*[1]. h…

There are stories where the air ambulance sues patients who are still in ICU because getting paid depends on being first in line to file the lawsuit.

Re: Why American ambulance rides are so expensive

#359

Post by sevenseacat »

King-Aaron wrote: post #238

Here in Australia, you can be 2,000km in the bush and an ambulance will fly out to you and fly you back to the city for free. That being said, we also have private ambulance companies here that will sting you for a huge bill if you don't have private ambulance cover.

Yay for the RFDS.

If only ground ambulances were as universally awesome

Re: Why American ambulance rides are so expensive

#360

Post by panny »

His mistake was going to an American hospital at all. For what he paid, he could get a round trip ticket to literally anywhere in the world, then just get realistically priced medical care. The entire American medical establishment needs to end. It's cancer. I won't go. Not even if the alternative is my death. I just won't go. I should probably get some kind of dogtag to wear that explicitly states this if I'm ever knocked unconscious. Just leave me in the ditch man, American medical care is a fate worse than death.
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