1,000$ there must be some mistake?

[gryeyes]

So a few weeks ago i am awakened by the most intense pain i have ever experienced. Now i am a human who has a relatively high pain threshold but this was another level. The pain was originating from a molar in the back of my mouth. At first i tried to just suck it up till the morning so i could schedule an appointment, but that was not possible.

I lay in bed for hours mewling like a dying cat before driving myself to the hospital. By some act of god i got in to see a doctor from the emergency room almost instantly. He checks the tooth says i in all likely hood have an abscess and gives me a prescription for some pain medication. On a side note, the feeling of the pain medication overcoming the intense agony was one of the most pleasurable moments of my life.

Having no medical insurance i already was expecting to pay out of pocket. About a week later i receive a bill for 200ish bucks. I paid said bill and thought the matter was closed. About 1-2 weeks after paying the first bill i receive another for 1089$. I call the number on the bill and explained that i had already previous paid 200$ and that some mistake must be occuring.

They calmly explained that the first bill was for something ancillary to the bill they sent.

So i get to pay 1,200 dollars for about 2 mins worth of a doctors time and a fucking prescription that cost me near 100 dollars. So 1,300 bucks so i can survive to then pay a dentist damn near an additional 2,000 dollars.

How in the fuck is this possible. I mean i don't have fucking insurance this is coming straight out of pocket. Why would emergency care be so fucking expensive for such a brief amount of time?

It has got to be a rare thing for someone lacking insurance to be able to pay 1k just to SEE a doctor. I just don't understand how healthcare can be so fucked up. Also it was MORE expensive for me to pay for root canal/crown than my father had to pay from the SAME fucking dentist.

If you are insured you get a flat 20% reduction from the bill.

[Nebu]

Our healthcare system works best is a) you're wealthy, b) you're well educated, and c) you have LOTS of insurance.  If you don't fit into all three of those, you're pretty much fucked.  If you do a search on healthcare among these threads you'll see that we've gone over this at length. 

Sorry to hear about your situation.  I understand completely... I've done some ER work. 

[gryeyes]

I just dont understand the logic in the "pricing" me being uninsured yet able to pay these bills has got to be a rare occurrence. Do they just want to create overwhelming debt and then milk the uninsured?

[MahrinSkel]

It's a negotiating position, not an invoice.  If you were insured, they'd bill the insurance company for it, the insurance company would say "no, we'll pay half", they'd bill the insurance company for the remaining half, and at some point it would get easier to squeeze you than keep trading paper back and forth.  Then, at the end of the quarter, most of what the insurance company paid would get "rebated" back to them.  You'd have paid $200-300, the insurance company about the same (even though on paper you have a 20% co-pay).

You're talking with the wrong department, there's usually another office (I forget the name, and I think it isn't always the same anyway) that has the authority to knock that down to what they would actually collect normally (so about half).  But if you want to get steamed: That first $200 was probably the bill from the ER doc for that 2 minutes of his time.  They generally bill separately.

--Dave

[Abagadro]

But remember, we have the best medical system in the world!

But ya, you should be able to negotiate that down a bit.

[Paelos]

My medical insurance costs me $1200 a year even if I never use it.

So, welcome to the health care world. I'd recommend you just own up and get insurance, especially if you are young. The disasters won't cost you anywhere near as much, and you should actively use your regular checkups for the preventative part of your health.

[gryeyes]

I think i will just hold out till after the collapse of the entire healthcare industry. It cant be that far off.

[MahrinSkel]

I think i will just hold out till after the collapse of the entire healthcare industry. It cant be that far off.

Don't do that, they'll make your life hell, hassle your relatives and boss, and shoot your credit rating to shit.  And next time you show up in the ER, you'll find it somewhat less responsive if you're not genuinely at risk of death.

--Dave

[gryeyes]

I have already paid the bills. I meant withhold purchasing personal and comprehensive insurance.

Wait a moment...you are telling me they will hassle my relatives and boss?!? No fucking way can that be legal. And what happens if i dispute the bill in regards to my credit score and request justification for that expense (which they are law bound to provide).

There are no guidelines for the fee they can force upon me? What prevents them from claiming an emergency room visit cost 10,000$?

[Abagadro]

If it makes you feel any better I paid $1100 a month for my insurance for approximately 16 months not long ago. Go America!

[gryeyes]

If it makes you feel any better I paid $1100 a month for my insurance for approximately 16 months not long ago. Go America!

That better cover some amazing things. I wouldl be expecting cybernetic implants for 17 grand.

[MahrinSkel]

Between them, an employer and employee will generally pay $20-25K a year for your standard 80/20 PPO plan.  HMO's are a bit cheaper, but you get pencil-pushers deciding what your medical treatment should be, and if you need a specialist and your HMO is under-staffed on them (and they almost always will be for anything but the most common "specialties" like OB-Gyn), you can wait months for an appointment unless your Primary Care Physician is prepared to bet his job you have something that will be fatal if they don't get you right in.

That's one thing that annoys me: The "OMG Scary Socialism!" argument against a government-run healthcare system is that it would be run like an HMO, but with actual laws and political accountability limiting how badly you'll get screwed.  Except that the assholes using the talking points don't seem to realize that for most people, they are already fighting with bureaucrats over their healthcare.

When my mother had gallstones, her HMO tried to keep kicking the can down the road until her COBRA eligibility expired.  Her doctor was forced to talk to her in code "It's VERY IMPORTANT you keep taking your pills.  If YOU DON'T TAKE THEM every day as prescribed, your condition will become serious and we'll have to do surgery IN THREE MONTHS."  She was 5 months from losing her COBRA coverage.  Then he had a conversation with his medical assistant outside the open exam room door about how the HMO had denied coverage for someone because pharmacy records showed they hadn't been filling the prescriptions for their medications.

Every single day in this country, people die because insurance companies are focused on not providing any more care than they can avoid.  Government-run healthcare couldn't possibly be any worse.

--Dave

EDIT: Sorry, I didn't realize that I was in GenDisc instead of politics.  But I'm not editing that stuff out, Schild is reading this and he can redirect it if he wants.

[Nevermore]

How in the fuck is this possible. I mean i don't have fucking insurance this is coming straight out of pocket. Why would emergency care be so fucking expensive for such a brief amount of time?

It has got to be a rare thing for someone lacking insurance to be able to pay 1k just to SEE a doctor. I just don't understand how healthcare can be so fucked up. Also it was MORE expensive for me to pay for root canal/crown than my father had to pay from the SAME fucking dentist.

Because as everyone knows Capitalism is the answer to everything, therefore what you have experienced is for the best in the best of all possible worlds.

I mean, if the government were to run health care, it would be inefficient and expensive!

[IainC]

When we went back to visit my in-laws in Colorado a few years back, my wife came down with a mild case of pneumonia (which is a problem at 15,000 feet of altitude). Stupidly we didn't have travel insurance and, as neither of us were resident in the US, we didn't have health insurance that the hospital would accept. She refused to be admitted to the ER on the grounds that we couldn't afford it but the episode still ended up costing us a shade under five grand for the drugs and the doctors fees.

[Big Gulp]

Just on general principle I wouldn't pay that emergency room bill.  $2000 for a root canal and cap?  Dude, get another dentist.  That should run you around $1000, tops.

[Hindenburg]

Should cost under 150 USD to get a molar in a different country. Paid 60 to have mine extracted earlier this year. Flawless job.
For 2 k you might as well travel to another country.

[Engels]

Back when I was unemployed I did indeed travel to Spain and had 2 cavities taken care of. Airplane ticket cost ~$600. Fillings ~$200. Cost in the US without insurance for a similar proceedure ~$800.

[HaemishM]

I just dont understand the logic in the "pricing" me being uninsured yet able to pay these bills has got to be a rare occurrence. Do they just want to create overwhelming debt and then milk the uninsured?

They price the ER so high because they cannot legally turn you away regardless of ability to pay. So they have to end writing off a lot of the money they should be making in the ER to collections agencies, because most ER patients can't pay. If they were legally allowed to turn you away, they could charge less - but then you could only get help if you were insured or had a visible means of paying right then and there. It's part of why the system is so fucked.

[gryeyes]

Should cost under 150 USD to get a molar in a different country. Paid 60 to have mine extracted earlier this year. Flawless job.
For 2 k you might as well travel to another country.

I recently also had two wisdom teeth removed that did not require the oral surgeon to be present. So the extractions were priced as any other tooth would be. Fucking 300 dollars PER tooth with additional fees and shit for the x-rays. Cost me almost a grand just to get them removed!

Am i really getting ripped off? Another friend of mine had a root canal/crown and it also cost him 2k and he HAD dental insurance. I thought these prices were pretty standard for the area (washington state).

As to the emergency room fees. I was under the impression emergency fee's were heavily subsidized by the government for the very fact that nobody really has a choice both patient/hospital. So the hospitals end up being reimbursed regardless if its paid or not.

I am just really astounded that the current state of healthcare is something viewed as anything but a disaster. How could a socialized medical system be any worse.

A random accident in which you get very hurt but still able bodied should not destroy you financially for life.

[Fraeg]

ouch sorry to hear that.

I learned that lesson some time ago cept the bill was closer to 10k when i injured my back while uninsured.

Sad thing is you probalby could have found a dentist or oral surg. who would have seen you for that at a fraction of the cost.

[Paelos]

Back when I was unemployed I did indeed travel to Spain and had 2 cavities taken care of. Airplane ticket cost ~$600. Fillings ~$200. Cost in the US without insurance for a similar proceedure ~$800.

That's actually pretty brilliant. I'm going to have to remember that next time.

[gryeyes]

I just thought of "Bargain hunting" in regards to a medical procedure was asking for some horrible situation to go down.

You hear about all those people that do so in regards to plastic surgery and end up looking like mutants!

[NowhereMan]

In all fairness America has some of the best plastic surgeons in the world because it's something you only get done (generally) as a luxury thing so the people who do it have money. If you've got money and are getting something medical you're probably not going to be looking for the cheapest guy you can find and so anyone who's good charges a shitload.

The exception to this of course is people who go into it hoping to do some good. They're too busy restructuring jaws and trying to repair massive burn scarring to give you a boob job. (this isn't to totally denigrate people who go into cosmetic surgery. Making people feel good about themselves is a worthwhile career and there is, apparently, a very different set of challenges in that line of work. I imagine the challenges involve where to park the 3rd Porsche )

[Sheepherder]

I just thought of "Bargain hunting" in regards to a medical procedure was asking for some horrible situation to go down.

You hear about all those people that do so in regards to plastic surgery and end up looking like mutants!

Come to Canada and get gay married for relatively cheap healthcare.

[Hindenburg]

In all fairness South America has some of the best plastic surgeons in the world

FIFY. 

And yes, gryeyes, you're getting fleeced.

[Engels]

Back when I was unemployed I did indeed travel to Spain and had 2 cavities taken care of. Airplane ticket cost ~$600. Fillings ~$200. Cost in the US without insurance for a similar proceedure ~$800.

That's actually pretty brilliant. I'm going to have to remember that next time.

It was entirely unintentional and a happy coincidence. Dentist costs in Spain, out of pocket with no insurance, no government healthcare assistance at all, is still reasonable.

The irony is, the fillings material that they used in Spain showed up later on US dental x-rays as cavities, and the fothermucking US dentist 'fixed' these two entirely non-existent cavities.

[Hindenburg]

I am certain he did it entirely by accident, and didn't charge you for it 

[Engels]

Oh no, I got charged. Thankfully, I had work insurance that was only a little cash. Still, I will not be giving that dimwit any more business.

[Jimbo]

As to the emergency room fees. I was under the impression emergency fee's were heavily subsidized by the government for the very fact that nobody really has a choice both patient/hospital. So the hospitals end up being reimbursed regardless if its paid or not.

I am just really astounded that the current state of healthcare is something viewed as anything but a disaster. How could a socialized medical system be any worse.

A random accident in which you get very hurt but still able bodied should not destroy you financially for life.

Hi!  I'm the Emergency Department RN, I'm also a Paramedic, we've been bitching about healthcare for a while now welcome aboard!

What happened is that they made a law called EMTALA, which is part of the COBRA reform bill (COBRA is pretty broad, there is another section in it about how they change your health insurance if you switch jobs and providers).  It is an anti-dumping law and/or "fairness" law.
Links:
http://www.emtala.com/faq.htm
http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act
http://www.aaem.org/emtala/
http://www.law.cornell.edu/uscode/42/1395dd.html
http://www.ena.org/government/emtala/

What used to happen is that you could show up to an ER (I'm using that since more use it than Emergency Department, I have a 25 patient rooms in my ED, not just one big emergency room), they could ask for insurance, see if you are covers or able to pay, then refuse to see you if you couldn't pay or had coverage.  Plus there were dumping going on where patients were seen in the ER, the hospital staff refused to admit them, so they would send them to another hospital and let them absorb the patients without insurance.

What EMTALA did:
1.  Everyone who shows up to a participating ER and/or OB-GYN gets a seen (medical screening exam by a doc or mid-level...I won't go into how I don't think RN's should be doing that part).
2.  Everyone will get treatment up to that facilities abilities.
3.  Those needing admission will be admitted, those that need admission to a more specialized care will get appropriate transfer to the correct facility.

What it didn't do:
1.  Pay for it.

As to the cost, yeah $1000 sounds pretty freaking insane, but that doc spent a shit load of years getting to where he is, he isn't cheap.  Problem is you went to the most expensive place to get dental care, where a dentist might have seen you and charged you less especially if you were willing to pay some cash up front.

@ Engels, what type of filling material did they use in Spain?  The NATO doc's and troops were using the same amalgam (metal mix) we were using for filling in the back.  The plastic fillings won't seal a lot of times, causing decay to creep in under and around those types of fillings, hell it happens to the best placed metal filling too.  What you would need is someone who could look at your x-ray and see if there is a shadow next to the filling, shadows are sign of decay.  What type of x-ray did they use anyway?

I think most of the USA doesn't have a clue how health care works, or how bills are paid.  I had to explain that socialism isn't bad, and works way better on some things, like oh...cops, fire, EMS, health care, roads, schools, but hell most people think I want to not let them choose there own doc.

[Engels]

@ Engels, what type of filling material did they use in Spain?  The NATO doc's and troops were using the same amalgam (metal mix) we were using for filling in the back.  The plastic fillings won't seal a lot of times, causing decay to creep in under and around those types of fillings, hell it happens to the best placed metal filling too.  What you would need is someone who could look at your x-ray and see if there is a shadow next to the filling, shadows are sign of decay.  What type of x-ray did they use anyway?

I can't remember the specifics, nor what x-ray type they used but after they became suspicious that what they were drilling into wasn't a cavity, the looked at the charts from Spain that I had -handed to them- before the whole mess even started. Then there was some hmming and hawing, and finally the dentist said that the spanish were using an amalgam that showed up slightly lighter than US fillings material, and hence they thought it was some decay. It may have been a plastic filling, but I don't think it was a cavity under them, since it had hardly been more than 2 months since the Spanish dental session. I have very solid teeth for the most part.

[gryeyes]

As to the cost, yeah $1000 sounds pretty freaking insane, but that doc spent a shit load of years getting to where he is, he isn't cheap.  Problem is you went to the most expensive place to get dental care, where a dentist might have seen you and charged you less especially if you were willing to pay some cash up front.

But I did not even receive treatment! I got a prescription for pain killers and told to go see a dentist. Which i did.

I took up literally 2 minutes of the doctors time. 1,200 bucks for for 120 seconds of a ER doctors time is insanity.

[Quinton]

It's a negotiating position, not an invoice.  If you were insured, they'd bill the insurance company for it, the insurance company would say "no, we'll pay half", they'd bill the insurance company for the remaining half, and at some point it would get easier to squeeze you than keep trading paper back and forth.  Then, at the end of the quarter, most of what the insurance company paid would get "rebated" back to them.  You'd have paid $200-300, the insurance company about the same (even though on paper you have a 20% co-pay).

You're talking with the wrong department, there's usually another office (I forget the name, and I think it isn't always the same anyway) that has the authority to knock that down to what they would actually collect normally (so about half).  But if you want to get steamed: That first $200 was probably the bill from the ER doc for that 2 minutes of his time.  They generally bill separately.

This happened to a housemate of mine a few years ago.  He was unemployed, uninsured, and I took him to the ER one weekend day because he was really goddamn sick and decided he'd better see a doctor.  He got hit with a $1000ish bill.  He explained that he had no insurance and asked if they could do anything at all if he could pay some of it cash.  It got knocked down to about $300, which he could afford.  They didn't have to do the back-and-forth with an insurance company.  In the end, everyone was reasonably happy.

[MahrinSkel]

I knew some medical types when I lived in Provo (the 20-something social scene, such as it is in the only city on earth that is majority Mormon and contains BYU, is heavily represented with nursing and medical students).  One guy I ran into was talking about how he was going to take an ER residency, then work for an HMO while pulling as many ER shifts on the side as he could stand and get.  When I asked him why he wanted ER shifts, he told me it was because an ER doc will bill for 50-60 hours in a single 12 hour shift, and because their billing services make sure it gets in the mail the next business day they usually get to collect most of that (for the same reason gryeyes paid it: People assume it's their ER bill, think "that isn't so bad", and pay it promptly).  At $100/hour (this was 12 years ago), that was his best way to get his student loan debt paid back and build a nest egg for either starting or buying into a practice.

--Dave

[Jimbo]

As to the cost, yeah $1000 sounds pretty freaking insane, but that doc spent a shit load of years getting to where he is, he isn't cheap.  Problem is you went to the most expensive place to get dental care, where a dentist might have seen you and charged you less especially if you were willing to pay some cash up front.

But I did not even receive treatment! I got a prescription for pain killers and told to go see a dentist. Which i did.

I took up literally 2 minutes of the doctors time. 1,200 bucks for for 120 seconds of a ER doctors time is insanity.

You received treatment.  You went to the ER with a non-emergent issue, plus dental care is limited to dentist, so the ER doc and staff can give you pain and infection control, we can't place fillings, do root canals, or pull or replace teeth.  We can put your jaw back in place if you dislocate it, thank god the dentist haven't claimed that as their territory.

You presented with a complaint, someone checked you in (god I hope someone took your vitals and wrote up what you were there for) which is considered the nursing assessment (done by a RN or NREMT-P I hope too), then the chart went to the doc, he came in, looked you over, formed up a diagnosis, and then gave you treatment of prescriptions.

Usually you get 2 bills, one for the Doc (and Mid-Level, that is another story too, ER Doc's with a PA/FNP working under them, get a payment for there work), one for the Nursing/Hospital bill.  The ER Doc will be cheaper than the Nursing/Hospital part (I know that some have said the price for the ER Doc to look at your kids ear they get to charge $400), then the hospital part which might be in the $1000+!  That pays for the RN's and all the staff except for diagnostic parts.  You get X-rays or Lab work and it goes even higher with more bills.  You pay for the convince of one stop service.

Btw, some ER Docs are only getting collections of 50%, the hospital loves that we are seeing more patients and admitting more, they hate that more can't pay.

Health care isn't cheap.

[K9]

Its at times like this that I remember how lucky I am to have access to the NHS. For all it's flaws it's better than this.