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So my friends dad broke his leg the other night

tbone_

By tbone_
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tbone_

tbone_ 14123

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In a parking lot when he fell getting into the car. He’s 80, not in great health and overweight. Pretty bad break. Took him to the ER, they transferred him to another hospital where he stayed for 4-5 days before he had surgery.
 
After surgery they sent him to a rehab facility for about 2 weeks.
 
Anyone want to take a guess at what the hospital bill was? (Not including the rehab)

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Guest Lobo

Guest Lobo

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Username checks out, btw.  

I'm guessing this was the pure cash/no-insurance quote you got before they actually start speaking to you realistically?

Full surgery plus transfer?  And you say it dosn't even cover rehab?  I'd say $300k. 

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phdhorn

phdhorn 6224

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33 minutes ago, tbone_ said:

In a parking lot when he fell getting into the car. He’s 80, not in great health and overweight. Pretty bad break. Took him to the ER, they transferred him to another hospital where he stayed for 4-5 days before he had surgery.
 
After surgery they sent him to a rehab facility for about 2 weeks.
 
Anyone want to take a guess at what the hospital bill was? (Not including the rehab)

username really checks out

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Bevo

Bevo 13577

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I broke a few ribs playing ball. I was friends with an ER doc so I got right in without a wait. We did some imaging which was covered by insurance, but since there wasn't much danger of puncturing organs, I was told to just give it time. But basically, it didn't cost me anything out of pocket. On the other hand, I cut myself trying to take paint off concrete with an exacto knife. I drove to urgent care, and the nurse on call was hesitant to place stitches because it was close to nerves. So, I took care of it myself using urgent care supplies (luckily it was on my left hand). That visit was expensive.

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Wulaw Horn

Wulaw Horn 19070

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So- when my daughter swallowed a battery we got a bill for $36k from the experience. 
Insurance said they’d pay for $6500 or some such and the hospital said-sure, why not. We ended up getting stuck paying like 95% of the bill bc it pretty much maxed out our deductible. 
All the hospital stays were the same story. 
I’m convinced literally the only point in having insurance is bc hospitals and docs charge 10x their going rate and then the insurance negotiates down the cost to what is logical to be paid in the real world. 
this shit makes me ragey if I think about it too much. 

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Sawbonz

Sawbonz 27564

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55 minutes ago, tbone_ said:

In a parking lot when he fell getting into the car. He’s 80, not in great health and overweight. Pretty bad break. Took him to the ER, they transferred him to another hospital where he stayed for 4-5 days before he had surgery.
 
After surgery they sent him to a rehab facility for about 2 weeks.
 
Anyone want to take a guess at what the hospital bill was? (Not including the rehab)

Medicare reimburses based on DRG. DRG for tibia fracture with major comorbidity or complication will pay 10k or so. Doesn’t matter what the bill is

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Dahobbs

Dahobbs 17534

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Posted (edited)
15 minutes ago, Sawbonz said:

Medicare reimburses based on DRG. DRG for tibia fracture with major comorbidity or complication will pay 10k or so. Doesn’t matter what the bill is

Yeah, the billed rate is an imaginary number that no one pays. Either the person has medicare, which pays set rates for everything, or the person has private insurance, which generally contracts with providers for a percentage (or multiple rather) of medicare, or the person has no insurance and can generally get a cash rate closer to a typical insurance contract rate. 

Edited by Dahobbs
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conVINCEd

conVINCEd 21469

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1 minute ago, Dahobbs said:

Yeah, the billed rate is an imaginary number that no one pays. Either the person has medicare, which pays set rates for everything, or the person has private insurance, which generally contracts with providers for a percentage (or multiple rather) of medicare, or the person has no insurance and can generally get a cash rate closer to a typical insurance contract rate. 

So why have such a rate?  My dad spent a month in the ICU after having quintuple bypass surgery some time ago.  I was helping mom sort through the bills and it was really stressing her out.  I told her that they have really good insurance, it will be fine.  Showed her the maximum out of pocket provision in their health care plan.  Still stressed her out at a time when there was already enough stress in her life.

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smoky

smoky 840

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10 minutes ago, conVINCEd said:

Less than multiple years salary for the median American household.

Agree, but I think I lot of people think an ambulance ride, plus a 5 night hospital stay with surgery and two weeks at a rehab facility should be a $5 co-pay.

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Dahobbs

Dahobbs 17534

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1 minute ago, conVINCEd said:

So why have such a rate?  My dad spent a month in the ICU after having quintuple bypass surgery some time ago.  I was helping mom sort through the bills and it was really stressing her out.  I told her that they have really good insurance, it will be fine.  Showed her the maximum out of pocket provision in their health care plan.  Still stressed her out at a time when there was already enough stress in her life.

That's a really good question. Hospitals tend to treat their charge masters as highly secretive. I suppose it is mainly for negotiation with insurance companies, but the billed rates may occasionally come into play when a third party has liability for injury to an uninsured and judgment proof ER patient. 

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conVINCEd

conVINCEd 21469

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3 minutes ago, smoky said:

Agree, but I think I lot of people think an ambulance ride, plus a 5 night hospital stay with surgery and two weeks at a rehab facility should be a $5 co-pay.

I agree that is unreasonable as well.  My sister was completely stressed when their kiddo was in the NICU.  She is employed by a large corporation with excellent health insurance.  I looked at her coverage and told her $6k is going to be the extent of the damage out of pocket.  No reason whatsoever to send her a bill for $1.3M.

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Sawbonz

Sawbonz 27564

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Posted (edited)
17 minutes ago, Dahobbs said:

the billed rates may occasionally come into play when a third party has liability for injury to an uninsured and judgment proof ER patient. 

This plus it puts pressure on the insurance companies to negotiate reasonable in network rates, or they are looking at paying a percentage of the billed charges. Texas now has a no surprise medical bill law, so the carrier and provider have to fight it out if it’s an out of network facility. The patient doesn’t have to get involved

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Dahobbs

Dahobbs 17534

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4 minutes ago, Sawbonz said:

This plus it puts pressure on the insurance companies to negotiate reasonable in network rates, or they are looking at paying a percentage of the billed charges. Texas now has a no surprise medical bill law, so the carrier and provider have to fight it out if it’s an out of network facility. The patient doesn’t have to get involved

Also, most out of network facilities aren't really out of network. There is still a contract, it is just less favorable for the insurance company (and the provider depending on your perspective). The limitation on balance billing during emergencies or when the patient doesn't have a choice in providers seems like good law, but I haven't seen how it operates in practice (and it only helps a small percentage of Texans with state regulated plans). 

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Sawbonz

Sawbonz 27564

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6 minutes ago, Dahobbs said:

Also, most out of network facilities aren't really out of network. There is still a contract, it is just less favorable for the insurance company (and the provider depending on your perspective). The limitation on balance billing during emergencies or when the patient doesn't have a choice in providers seems like good law, but I haven't seen how it operates in practice (and it only helps a small percentage of Texans with state regulated plans). 

The federal plans and work comp plans are all take it or leave it for the providers, so the people with state regulated plans are the only ones who ever get surprise bills (unless the provider wants to go to jail). The OON facilities/providers I know of have no contracts with carriers or contracts with only certain carriers. The crazy thing to me is some of the big systems have contracts with carriers for 400% of Medicare or better. I should have been a hospital administrator 

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Sawbonz

Sawbonz 27564

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A tip for non emergency care if you have a high deductible plan: ask what the cash price is for any test/lab your doc orders, and get a quote from a few different facilities. You should do this even for minor procedures. Your insurance may allow the facility to collect 2k for your MRI for example (plus radiologist read billed separately), and the cash price might be 400. If you haven’t met your deductible you would be responsible for the whole 2k if you use your insurance 

Downside is your insurance may not count the 400 toward your deductible, but for my family (knock wood) we never come close to the individual much less family deductible so we usually pay cash

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royiv

royiv 9319

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2 hours ago, tbone_ said:

$400k.

For a broken leg.

It didn’t cost $400k. It cost what the Medicare DRG is for that service. Let us know what Medicare paid and what your friend’s dad’s out of pocket was after the claim is adjudicated.

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Updawg

Updawg 2266

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Buying a house is easier than dealing with health insurance

When my daughter was born some random doctor billed saying they were in the room. Luckily I saw the the letter/bill and called bullshit. I was in there as well and knew who else was as well

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52-80

52-80 19159

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5 hours ago, Wulaw Horn said:

So- when my daughter swallowed a battery we got a bill for $36k from the experience. 
Insurance said they’d pay for $6500 or some such and the hospital said-sure, why not. We ended up getting stuck paying like 95% of the bill bc it pretty much maxed out our deductible. 
All the hospital stays were the same story. 
I’m convinced literally the only point in having insurance is bc hospitals and docs charge 10x their going rate and then the insurance negotiates down the cost to what is logical to be paid in the real world. 
this shit makes me ragey if I think about it too much. 

i had good corp insurance in the US.  went to in-network doctor for small outpatient surgery thing.  1, 2, years down the line ,started getting all sorts of separate multi-thousand dollar bills from all different elements related to the operation.  anesthesiologist, hospital, etc etc. 

frustrating as all hell,and i can only imagine how people with less means and shittier insurance deal with that nonsense.

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Bullneck

Bullneck 19095

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8 hours ago, smoky said:

How much should it have cost?

Quote

The Countries Where A Broken Leg Will Cost You The Most

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(0 votes)

In today’s globalised world, consumers don’t think twice about conducting their lives across time zones. Increasingly, they expect coverage and access to the healthcare they need anytime, anywhere in the world, whether at home or when studying, living, travelling or working abroad.

However, whilst treatment standards may be comparable globally, the costs for the uninsured are not. As the ski season continues, Bupa Global, the international health insurer, has released its claims data for broken legs sustained in the world’s most popular winter sports destinations. The data reveals that a broken leg in Canada could cost consumers £5,097 more than in the UK.

 

Average cost of a broken leg*

Canada

£7,027

Switzerland

£6,691

Germany

£5,465

Italy

£5,327

Japan

£4,823

USA

£3,723

France

£3,086

Austria

£2,237

United Kingdom

£1,930

 

From this data it's clear the old guy should have offered to pay in pounds sterling.

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Bullneck

Bullneck 19095

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Posted (edited)
5 hours ago, Rholl said:

It sux but when everyone is onboard for fastfood and starbucks to “make a living wage” $15^...... actual life savers like ER docs and RNs are gonna make a killin..... that means a hospital stay gonna break the bank.....   neg at will.... nfg..... getwhatuaskfor!

Read the red banner that immamac posted.  Your views on a living wage don't have anything to do with medical insurance cost.

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Wulaw Horn

Wulaw Horn 19070

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9 hours ago, Sawbonz said:

Medicare reimburses based on DRG. DRG for tibia fracture with major comorbidity or complication will pay 10k or so. Doesn’t matter what the bill is

Yep. And therein is the rub for me. If you’d take 10k to driver our baby from literally everyone with insurance why you got to send me a 39k bill in the hopes that I won’t have insurance? 

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Wulaw Horn

Wulaw Horn 19070

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8 hours ago, Sawbonz said:

A tip for non emergency care if you have a high deductible plan: ask what the cash price is for any test/lab your doc orders, and get a quote from a few different facilities. You should do this even for minor procedures. Your insurance may allow the facility to collect 2k for your MRI for example (plus radiologist read billed separately), and the cash price might be 400. If you haven’t met your deductible you would be responsible for the whole 2k if you use your insurance 

Downside is your insurance may not count the 400 toward your deductible, but for my family (knock wood) we never come close to the individual much less family deductible so we usually pay cash

So this drives me even crazier about the medical system... I was uninsured before I got married. I needed to get an aids test (/‘d some other std) before we got married in Puerto Rico. I called around to like 4 or 5 places. One of them didn’t know how much they charged 3 of them I didn’t like, and then I decided on one place and did it. Paid cash. 4 months later they sent me a bill for a smooth tree fiddy. Told me they’d messed up my quote or collected a co-pay (I told them up front I’d called, gotten a price and told everyone so didn’t have insurance- and I fought about this for 6 months. 
The idea that the system is designed where not everyone knows the price and they can try to charge you more afterwards is so bizarre and anti consumer that I don’t understand how it can exist. 

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XYZ

XYZ 2154

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7 minutes ago, Wulaw Horn said:

The idea that the system is designed where not everyone knows the price and they can try to charge you more afterwards is so bizarre and anti consumer that I don’t understand how it can exist. 

It can exist because the government refuses to enforce the law against the medical industry.

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Sandman

Sandman 3403

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I spent 5 days in the hospital in October. Just the room bill was over 29k, I don't even want to know about the doc's or the ER stuff. After insurance, my share was $2900 and I thought I got lucky it was only that much.

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