What I learned from reading a thousand emergency room bills • Hacker News Board

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

#21

Post by kevin_b_er » Wed, Dec 19, 2018, 8:58 PM UTC

> I started my project focused on one specific charge: the facility fee. I found this charge for walking through an emergency room’s doors could be as low as $533 or well over $3,000, depending on which hospital a patient visited and how severe her case was. I also learned that the price of this charge had skyrocketed in recent years, increasing much faster than other medical prices for no clear reason.

Is this why my local hospitals are advertising their ER wait times? The arbitrary profit from arbitrary "in the door" fees?

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

#22

Post by cableshaft » Wed, Dec 19, 2018, 8:59 PM UTC

lolsal wrote: post #3

I know $60 Ibuprofen can seem like a lot, but is anyone arguing that you're literally paying for only the pill(s) with that $60? Aren't you paying for the instant availability, the insurance that it's not expired (do they even expire? I really don't know), and confidence that your healthcare provider has signed off that XXX mg of Ibuprofen is a.) OK to have with your current medications and conditions and b.) suffici…

I don't think I have an issue with $60 Ibuprofen (or one thing being upcharged), it's everything being so upcharged, with the expectation that it's going to be negotiated down by an insurance company, and then if you don't have insurance, they try to get you to (or at least pretend) that they haven't overinflated everything and you owe them every penny, unless you just don't pay them, and only then will they consider accepting less.

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

#23

Post by BeetleB » Wed, Dec 19, 2018, 9:00 PM UTC

lolsal wrote: post #3

I know $60 Ibuprofen can seem like a lot, but is anyone arguing that you're literally paying for only the pill(s) with that $60? Aren't you paying for the instant availability, the insurance that it's not expired (do they even expire? I really don't know), and confidence that your healthcare provider has signed off that XXX mg of Ibuprofen is a.) OK to have with your current medications and conditions and b.) suffici…

My understanding is that the $60 ibuprofen was a line item amongst other charges. Everything else you mentioned is likely covered by another line item in their bill. It's not as if they went to the ER and got a bill of $60. They perhaps got a bill of $500, of which the breakdown mentioned $60 for ibuprofen.

It's kind of like going to a mechanic and getting a bill of $200 for a single headlamp bulb, and another $300 for labor. Then the mechanic arguing that the $200 for the bulb includes the mechanic's expertise, knowing which bulb to buy, etc. Umm...no. All that is included in labor costs.

>This seems absolutely reasonable to me, I wish I could charge a 'fill my email with RFPs' type fees.

Do you not think that fee should encompass doctor's expertise, instead of sprinkling that over cost of materials?

My initial reaction when I read the piece was in agreement. I think it makes sense for ERs to have a facility fee. However, it doesn't explain how one hospital's facility fee can be, say, double that of another. Is it that one hospital is using Hue lightbulbs compared to the other?

A $5751 bill which is almost entirely a facility fee is ridiculous.

I would imagine a facility fee should be relatively fixed - it is the cost to maintain the facility and has nothing to do with a given patient's medical condition. As such, it is trivial for a hospital to publicize the fee and provide transparency.

In general, I think all the items they bill for are reasonable. The amounts, though? Not at all. When you start looking at the variation in how much is charged for the same items across different hospitals (or even within), there is no good model that can provide an explanation.

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

#24

Post by ttcbj » Wed, Dec 19, 2018, 9:00 PM UTC

ams6110 wrote: post #5

I'm not an advocate of government paid health care, but hospitals and medical providers should see that this train is coming and if they don't become more transparent it's going to be forced upon them. I don't have a problem with ER care being more expensive -- that isn't necessarily unreasonable when you are getting care in an expensive facility open 24x7, fitted out with equipment to handle any possible medical eme…

I was not an advocate for gov't health care, but I am now for the same reason you stated. I have a high deductible plan, and have tried to get quotes in advance, but never can. I have been ripped off multiple times, despite trying to do my research, etc.

My wife is a doctor, and at this point, I think single-payer is the least bad option.

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

#25

Post by tivert » Wed, Dec 19, 2018, 9:01 PM UTC

ams6110 wrote: post #5

I'm not an advocate of government paid health care, but hospitals and medical providers should see that this train is coming and if they don't become more transparent it's going to be forced upon them. I don't have a problem with ER care being more expensive -- that isn't necessarily unreasonable when you are getting care in an expensive facility open 24x7, fitted out with equipment to handle any possible medical eme…

> But it is unfair to have no idea what costs you are facing and whether any of those costs are out of network on your insurance.

It's practically impossible to make an informed economic decision about truly emergency medical care without heavy regulation. It's not uncommon to be literally unconscious while all the care decisions for you are being made by others.

See this article for an example: some uninsured woman had a brain hemorrhage and woke up with $357,000 in medical bills:

https://www.nytimes.com/2017/03/29/magazine/those-indecipher...

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

#26

Post by UnpossibleJim » Wed, Dec 19, 2018, 9:01 PM UTC

vec wrote: post #14

Exhibit A for why "free market healthcare" is an oxymoron. I have yet to hear a coherent explanation for how anyone can reasonably expect for price discovery to even pretend to function in a market where the consumers can't even guess the prices until after they've already purchased and frequently couldn't reasonably be expected to refuse service even if they did believe it was overpriced.

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's all privatized. If it's cosmetic, then I could see the argument. But when it comes to emergency services, and for ambulances especially, the "free market" argument just doesn't hold water.

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

#27

Post by lolsal » Wed, Dec 19, 2018, 9:02 PM UTC

mikeash wrote: post #15

lolsal wrote: post #3

I know $60 Ibuprofen can seem like a lot, but is anyone arguing that you're literally paying for only the pill(s) with that $60? Aren't you paying for the instant availability, the insurance that it's not expired (do they even expire? I really don't know), and confidence that your healthcare provider has signed off that XXX mg of Ibuprofen is a.) OK to have with your current medications and conditions and b.) suffici…

I'm guessing you tell your clients, "I'm not really the right person to set up WordPress for you. I can do it, but it'll be incredibly expensive. You can probably do it yourself with a good online tutorial." Hospitals aren't telling their patients, "We're not really the right institution to give you ibuprofen. We can do it if you really want us to, but it'll be incredibly expensive. You can just go buy some at the st…

I think the difference just having a hospital triage you and tell you 'ibuprofen will handle the pain, it's nothing serious' is _already_ worth a boat load of money and peace of mind.

I agree with you - it would be really interesting to see honest and transparent itemized bills, with separate items for overhead. I wonder if people would have the same problem with high bills in that case. Probably wouldn't like the total any more, but maybe it'd be easier to understand.

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

#28

Post by y-c-o-m-b » Wed, Dec 19, 2018, 9:04 PM UTC

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 timing.

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

#29

Post by empath75 » Wed, Dec 19, 2018, 9:05 PM UTC

cronix wrote: post #20

lolsal wrote: post #3

I know $60 Ibuprofen can seem like a lot, but is anyone arguing that you're literally paying for only the pill(s) with that $60? Aren't you paying for the instant availability, the insurance that it's not expired (do they even expire? I really don't know), and confidence that your healthcare provider has signed off that XXX mg of Ibuprofen is a.) OK to have with your current medications and conditions and b.) suffici…

If they told me it would cost $60 for a simple Ibuprofen, I'd get out of bed and walk myself down the pharmacy on the first floor where they are regularly priced (in the SAME building), or send a family member down for that 10 minute walk to save $50 times how many you need to take. The pharmacists know the drugs I'm taking and interactions, yet the Ibuprofen isn't marked up a couple hundred percent.

They won't tell you that before they give it to you.

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

#30

Post by SlowRobotAhead » Wed, Dec 19, 2018, 9:05 PM UTC

ttcbj wrote: post #24

ams6110 wrote: post #5

I'm not an advocate of government paid health care, but hospitals and medical providers should see that this train is coming and if they don't become more transparent it's going to be forced upon them. I don't have a problem with ER care being more expensive -- that isn't necessarily unreasonable when you are getting care in an expensive facility open 24x7, fitted out with equipment to handle any possible medical eme…

I was not an advocate for gov't health care, but I am now for the same reason you stated. I have a high deductible plan, and have tried to get quotes in advance, but never can. I have been ripped off multiple times, despite trying to do my research, etc. My wife is a doctor, and at this point, I think single-payer is the least bad option.

>have tried to get quotes in advance, but never can. >I have been ripped off multiple times, >I think single-payer is the least bad option.

Can you help me understand why if everyone is paying for everyone's healthcare in a socialize system - how that reforms the transparency and stops the abuses?