So my friends dad broke his leg the other night

[Snake Diggity 4625]

What do y’all think would be reasonable for that service?  

For an ER visit where someone is seen by an MD and given x Rays and basic meds over the course of a few hours, $2000 seems ok.  

For an overnight hospital stay where the patient has 24/7 access to nurses, eats meals, and is seen by an MD twice a day, $1000/day seems reasonable.

Surgery is a different animal but 5 grand to have a leg fixed doesn’t seem outrageous.

So I think something around 10 grand for a broken leg that required 4-5 days in the hospital and basic surgery seems reasonable.  Nothing wrong with a 4500% markup.

I’d guess rehab should be around $200/hr.

Edited May 28, 2021 by Snake Diggity

[gyroprotagonist 2592]

9 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

yeah, MRIs are almost always like that.  last one i had you could go after hours to the facility and pay cash and it was ~$350.  Using insurance it would have been about $1200.  I could not count it towards the deductible though.  If you are doing MRI that will probably lead to surgery (in the same year) then better to use insurance and assume you will hit your max out of pocket.

Had a CAT scan that was the same way.  $175 cash money or $800 w/ insurance. 

[BearSchlong 8097]

my pacemaker tech says I'm going to need a new one next year, I'm sure the bill just for the device will be $250K.  Last one was 2010 and it was $95K.

[smuggs 9353]

1 minute ago, BearSchlong said:

my pacemaker tech says I'm going to need a new one next year, I'm sure the bill just for the device will be $250K.  Last one was 2010 and it was $95K.

Yeah but this new one will have a shitload of USB ports.

[Dennis Taylor 18828]

12 hours 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)

In Philadelphia it's worth 50 bucks 

[Superhero 8830]

27 minutes ago, smuggs said:

Yeah but this new one will have a shitload of USB ports.

Don’t forget hdmi ports as well.

 

I’ve been in and out of the hospital several times over the past 5 years. The longest was 5 nights for a long term EEG study. $20 for the experience. Kaiser Permamente is awesome. 

[Captainant 27669]

34 minutes ago, BearSchlong said:

my pacemaker tech says I'm going to need a new one next year, I'm sure the bill just for the device will be $250K.  Last one was 2010 and it was $95K.

hey man, health insurance execs and the human scum that profit off of exploitative medical pricing need private school and vacation homes too!

[Dahobbs 17534]

 

2 hours ago, Wulaw Horn said:

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? 

I don't believe that's why they do it that way. Again, 99% of the time, they'll just negotiate with you and offer roughly what insurance is paying. And you can usually do that up front. The billed number is really just a negotiating thing with insurance companies. But they can't represent that is the billed rate unless, you know, it actually appears on the bills. 

Also, keep in mind, providers will write off services that they don't get paid for (e.g., uninsured patients during ER visits). The billed rate may come into play there as well. . .

Edited May 28, 2021 by Dahobbs

[JohnLocke 115]

A good simple reform would be to not allow hospitals to charge more than 25% more to anyone of their average insurance rate.

[Dahobbs 17534]

1 minute ago, JohnLocke said:

A good simple reform would be to not allow hospitals to charge more than 25% more to anyone of their average insurance rate.

Neither insurance companies nor hospitals would like that reform because the negotiated rates are somewhat secret. They don't want the competition to know what they are paying/being paid. But it isn't a bad idea, but probably more difficult to implement in practice than you'd think. 

[Brisketexan 105142]

I had to go to the ER three weeks ago.  Ended up turning into an overnight stay, because they couldn't schedule my procedure till the next day.

Haven't gotten a bill yet.  I'm really looking forward to those.

[bluto 4929]

How much does a stroke set you back?

Ask rholl

[SurlyGator 865]

1 hour ago, BearSchlong said:

my pacemaker tech says I'm going to need a new one next year, I'm sure the bill just for the device will be $250K.  Last one was 2010 and it was $95K.

Nope.  Assuming its just a straight change-out, and not adding or replacing any leads, it will be less.  All based on the DRGs, like Sawbonz said.

Don't get me wrong, the bill will still be higher than you think it should be, but not that high.

[Murfdogg21 4412]

I am biased as a someone who has worked in medical devices and pharma, but my rankings for who is most to blame for price gouging starts with hospitals and their networks and whoever is next is a distant second. They make up bullshit amounts and have their billing people harass customers (errrr patients) and their insurance providers for weeks, months, or years. Often unknowing patients will just pay the bill without questioning. Double billing is often going on as well. They are trying to push physicians to all become employees, and/or doctor gets their fee, nurse and anesthesia staff/overhead has a cost, they nickel and dime negotiate their vendors on device, drug, and supply prices, then they catch all of the profit.

As insurance reimbursements have gone down, hospitals don’t want to eat the profit loss so they turn the screws on what they will pay for things like implanted devices. 10 years ago you might have got a choice of state-of-the-art knee implants or pacemakers. Now you might get stuck with whatever the pencil pushers could get the cheapest on contract. 

I fully support any legislation that forces pricing transparency by all facilities that accept Medicare and private insurance to demonstrate if every patient is paying the same and receiving the best care for that cost. 

[Dahobbs 17534]

15 minutes ago, Murfdogg21 said:

I am biased as a someone who has worked in medical devices and pharma, but my rankings for who is most to blame for price gouging starts with hospitals and their networks and whoever is next is a distant second. They make up bullshit amounts and have their billing people harass customers (errrr patients) and their insurance providers for weeks, months, or years. Often unknowing patients will just pay the bill without questioning. Double billing is often going on as well. They are trying to push physicians to all become employees, and/or doctor gets their fee, nurse and anesthesia staff/overhead has a cost, they nickel and dime negotiate their vendors on device, drug, and supply prices, then they catch all of the profit.

As insurance reimbursements have gone down, hospitals don’t want to eat the profit loss so they turn the screws on what they will pay for things like implanted devices. 10 years ago you might have got a choice of state-of-the-art knee implants or pacemakers. Now you might get stuck with whatever the pencil pushers could get the cheapest on contract. 

I fully support any legislation that forces pricing transparency by all facilities that accept Medicare and private insurance to demonstrate if every patient is paying the same and receiving the best care for that cost. 

*Looks at HCA*

Edited May 28, 2021 by Dahobbs

[TwiceHorn 31475]

31 minutes ago, Murfdogg21 said:

I am biased as a someone who has worked in medical devices and pharma, but my rankings for who is most to blame for price gouging starts with hospitals and their networks and whoever is next is a distant second. They make up bullshit amounts and have their billing people harass customers (errrr patients) and their insurance providers for weeks, months, or years. Often unknowing patients will just pay the bill without questioning. Double billing is often going on as well. They are trying to push physicians to all become employees, and/or doctor gets their fee, nurse and anesthesia staff/overhead has a cost, they nickel and dime negotiate their vendors on device, drug, and supply prices, then they catch all of the profit.

As insurance reimbursements have gone down, hospitals don’t want to eat the profit loss so they turn the screws on what they will pay for things like implanted devices. 10 years ago you might have got a choice of state-of-the-art knee implants or pacemakers. Now you might get stuck with whatever the pencil pushers could get the cheapest on contract. 

I fully support any legislation that forces pricing transparency by all facilities that accept Medicare and private insurance to demonstrate if every patient is paying the same and receiving the best care for that cost. 

Table 45 bears you out empirically. https://www.cdc.gov/nchs/data/hus/2019/045-508.pdf  $0.32 of every US healthcare dollar goes to hospitals.  It dwarfs the other contributors.  It's $0.38 when you consider "personal" health care, alone.

Even if you're conspiracy minded and don't trust the CDC's numbers, I've seen very similar from Kaiser Permanente Foundation and others.

Edited May 28, 2021 by TwiceHorn

[pacman 7355]

Lots of good talk here and you all haven't even gotten to the absurdity of medical billing, largest compliance book in the USA (I forget how many tens of thousands of pages).

Wife had a post-op follow up. Billing screwed the pooch and coded it as some sort of random consultation the insurance deemed not required. Wife tried for 9 months to get it fixed. Excuses and crickets from all parties ending up costing us $450 instead of a $35 copay.

[Sawbonz 27562]

2 hours ago, Dahobbs said:

Also, keep in mind, providers will write off services that they don't get paid for (e.g., uninsured patients during ER visits).

Write off in what sense

[Captainant 27669]

Just now, Sawbonz said:

Write off in what sense

it's a write off!

 

[DaysOff 7951]

Why do we hear stories of personal bankruptcy due to hospital bills like this? In fact why does anyone attempt to pay at all. The hospital can't seize your house, garnish your wages, or even send the debt to a collection agency. Tell them you cam afford ten dollars a month.

[Dahobbs 17534]

7 minutes ago, Sawbonz said:

Write off in what sense

As a loss, presumably for taxes purposes. I just know that is how hospitals document it in their accounting systems. Actually, often times the services are listed as charity/write off. I don't know how they report that to the IRS or what value they actually report. 

[Sawbonz 27562]

Just now, Dahobbs said:

As a loss, presumably for taxes purposes. I just know that is how hospitals document it in their accounting systems. Actually, often times the services are listed as charity/write off. I don't know how they report that to the IRS or what value they actually report. 

You cannot write off unpaid medical accounts receivable on your taxes. You don’t want to keep it on your books because AR that is > 180 days is basically uncollectible so if you are trying to get a loan for your practice or facility or FMF to sell all or part you want to get it off the books, but it is a complete loss

 

If you could write off the Medicare allowable for a given code, we could probably take care of the uninsured problem without making many other changes. 

[Sandman 3403]

12 minutes ago, DaysOff said:

Why do we hear stories of personal bankruptcy due to hospital bills like this? In fact why does anyone attempt to pay at all. The hospital can't seize your house, garnish your wages, or even send the debt to a collection agency. Tell them you cam afford ten dollars a month.

This is what I used to do, 20 years ago. I'd get a bill, then go to the accounts payable people and tell them I could afford $50 a month. They said fine. But after I got out of the hospital last year and tried this, they said I'd have no interest for 12 months, then they start charging interest. I don't know how that's possible, when I didn't sign any loan paperwork. My wife had to do the calling, so I wasn't able to ask that question.

[Dahobbs 17534]

6 minutes ago, Sawbonz said:

You cannot write off unpaid medical accounts receivable on your taxes. You don’t want to keep it on your books because AR that is > 180 days is basically uncollectible so if you are trying to get a loan for your practice or facility or FMF to sell all or part you want to get it off the books, but it is a complete loss

 

If you could write off the Medicare allowable for a given code, we could probably take care of the uninsured problem without making many other changes. 

Thanks makes sense. As I said, I don't know the mechanics of it, just how it is recorded in the system. I also realize that the systems I have seen generally relate to non-profit hospitals, so there may be a distinction there. I do know that hospitals receive certain tax incentives not available to physicians. 

[Sawbonz 27562]

11 minutes ago, Sandman said:

This is what I used to do, 20 years ago. I'd get a bill, then go to the accounts payable people and tell them I could afford $50 a month. They said fine. But after I got out of the hospital last year and tried this, they said I'd have no interest for 12 months, then they start charging interest. I don't know how that's possible, when I didn't sign any loan paperwork. My wife had to do the calling, so I wasn't able to ask that question.

No insurance? If so get the DRG they are basing the billing on and offer what Medicare will reimburse. If that doesn’t work tell them you are taking the bill to NPR

https://khn.org/news/tag/bill-of-the-month/

[Sbbruin 21853]

3 hours ago, BearSchlong said:

my pacemaker tech says I'm going to need a new one next year, I'm sure the bill just for the device will be $250K.  Last one was 2010 and it was $95K.

Make sure it's Bluetooth enabled.  And 5G.

[Sandman 3403]

7 minutes ago, Sawbonz said:

No insurance? If so get the DRG they are basing the billing on and offer what Medicare will reimburse. If that doesn’t work tell them you are taking the bill to NPR

https://khn.org/news/tag/bill-of-the-month/

No, I have insurance and I'm not looking to get out of paying the bill or even trying to slow-play it. I just don't get the idea that they can charge interest, I've never had that happen before. Maybe there's some fine print in the admission paperwork you sign when you first get there? 

[TwiceHorn 31475]

35 minutes ago, DaysOff said:

Why do we hear stories of personal bankruptcy due to hospital bills like this? In fact why does anyone attempt to pay at all. The hospital can't seize your house, garnish your wages, or even send the debt to a collection agency. Tell them you cam afford ten dollars a month.

While I am sure that "medical debt" is frequently scheduled in bankruptcy filings, and, as a "number" is a large component of the debt of debtors in bankruptcy, I very seriously doubt that it contributes much to the actual bankruptcy filing.  

Things may have changed, but hospitals and medical types aren't that aggressive in collecting debt, historically.  Such debt is an abstraction to the debtor.

People that file bankruptcy are in financial chaos, typically, and have been for years.  Defaulted car notes, outrageous credit card bills, behind on their mortgage.  It is the latter that most often drives bankruptcy filings.

 

[Sawbonz 27562]

1 minute ago, Sandman said:

No, I have insurance and I'm not looking to get out of paying the bill or even trying to slow-play it. I just don't get the idea that they can charge interest, I've never had that happen before. Maybe there's some fine print in the admission paperwork you sign when you first get there? 

Never heard of that either

[83Horn 1641]

I had a bit of a chuckle several years ago when I was going through a box of stuff I had picked up while cleaning out my mom's house after she passed away.  In this box was a diary my dad had kept in 1955.  There was an entry from about a week after one of my brothers was born, in which my dad says that he was feeling pretty ashamed of himself for making my  mom cry at the hospital.  Apparently he blew up at the staff when they handed him the bill for the stay.  "$140??? She was only in there for four days!"  My, how things have changed.

[Captainant 27669]

6 minutes ago, 83Horn said:

I had a bit of a chuckle several years ago when I was going through a box of stuff I had picked up while cleaning out my mom's house after she passed away.  In this box was a diary my dad had kept in 1955.  There was an entry from about a week after one of my brothers was born, in which my dad says that he was feeling pretty ashamed of himself for making my  mom cry at the hospital.  Apparently he blew up at the staff when they handed him the bill for the stay.  "$140??? She was only in there for four days!"  My, how things have changed.

Even adjusted for inflation (about $1400 in 2021 dollars), I can't imagine anyone leaving a hospital birth for under five grand. Even with insurance.

[Samson's Wig 3192]

15 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'm glad your daughter was okay.  My niece died in December after having swallowed a button battery.  If you have young ones in the house, keep those button batteries out.

[TwiceHorn 31475]

6 minutes ago, Samson's Wig said:

I'm glad your daughter was okay.  My niece died in December after having swallowed a button battery.  If you have young ones in the house, keep those button batteries out.

My word.  Sorry to hear.  What made it fatal?  The battery itself?

[Bevo 13577]

15 hours 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.

Insurance companies do not allow providers to have rates lower than what they have contracted. And quite possibly if the non-insurance rate was lower than the insurance rate, the insurance would only pay a percentage of that rate. So for legal reasons, the non-insurance rate needs to be higher than the insurance rate. I assume another reason is that most of the non-insured people walk their bill so the bill takes into account the likelihood of the person walking.

[Samson's Wig 3192]

Just now, TwiceHorn said:

My word.  Sorry to hear.  What made it fatal?  The battery itself?

Button batteries are activated by saliva.  So if they get stuck in the throat they start emitting electricity.  If you don't get it out quickly it's not good.  In her case, it burned a whole through her trachea and esophagus, creating a fistula between the two.   It happened around Halloween and she fought until right before Christmas before passing. 17 months old.  It's sadly a very common thing to happen. 

It manifests a lot like croup in the initial hours, which is what my niece was misdiagnosed with.  The result is that the battery sits in there for a day or two and has time to damage things beyond repair.

[Jiggy-Z 3432]

15 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. 

My youngest son did the same thing.  One of those nickel sized batteries.  Went to Seton SW then to to Dell Children's.  By the time we got Dell Childrens the Battery was already almost through his pyloric valve, so we were in the clear and noting else was done. $1,600 fro Seton SW who basically did nothing by call Dell and $2,600 at Dell for an X ray.  Ended up negotiating with Seton SW and Dell would not negotiate so they did not get paid.  What a night that was.

[elfenix 34242]

15 hours 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.

just have to find a judge who will agree that shit like this is intentional infliction of emotional distress

[HRSchenker 2268]

How much did insurance pay out? The billed amount is largely irrelevant to insured patients.

[XYZ 2154]

31 minutes ago, Jiggy-Z said:

My youngest son did the same thing.  One of those nickel sized batteries.  Went to Seton SW then to to Dell Children's.  By the time we got Dell Childrens the Battery was already almost through his pyloric valve, so we were in the clear and noting else was done. $1,600 fro Seton SW who basically did nothing by call Dell and $2,600 at Dell for an X ray.  Ended up negotiating with Seton SW and Dell would not negotiate so they did not get paid.  What a night that was.

I’ve gone to the Seton SW ER a few times, and every fucking time they sent me somewhere else. What the fuck is that hospital good for?

[Jiggy-Z 3432]

14 minutes ago, XYZ said:

I’ve gone to the Seton SW ER a few times, and every fucking time they sent me somewhere else. What the fuck is that hospital good for?

glorified med clinic.

[Wulaw Horn 19070]

2 hours ago, Samson's Wig said:

I'm glad your daughter was okay.  My niece died in December after having swallowed a button battery.  If you have young ones in the house, keep those button batteries out.

It was a terrifying 3 hours 

[conVINCEd 21469]

I’ve never heard of a button battery.  Are we talking the little round ones that go in key fobs?

Edited May 28, 2021 by conVINCEd

[Samson's Wig 3192]

2 minutes ago, conVINCEd said:

If never heard of a button battery.  Are we talking the little round ones that go in key fobs?

yep

 

Edited May 28, 2021 by Samson's Wig

[CooterBrown 18012]

I’ve gone to the Seton SW ER a few times, and every fucking time they sent me somewhere else. What the fuck is that hospital good for?

I had my appendix taken out there. I swear I was the only patient staying at the hospital. I never once saw anyone other than staff. Service was fantastic.

[Bevo 13577]

3 minutes ago, CooterBrown said:

I had my appendix taken out there. I swear I was the only patient staying at the hospital. I never once saw anyone other than staff. Service was fantastic.

Maybe it was an outpatient clinic.

[XYZ 2154]

43 minutes ago, CooterBrown said:

I had my appendix taken out there. I swear I was the only patient staying at the hospital. I never once saw anyone other than staff. Service was fantastic.

Maybe they told you that they took your appendix out.

[The Ace of Aces 5184]

Had a mild panic attack three years ago (funny, because a doctor caused it during a routine checkup). Was in the ER about 3 hours until they realized it was a panic attack and my heart wasn’t going to explode. 
 

They charged $580 for one Ativan. The bill for that experience was around $45,000. For three hours.  

[CooterBrown 18012]

About 5 years ago, my doctor sent me to a cardiologist due to having a weird feeling in my chest. After a brief visit , the cardiologist sent me to ER. Ended up with stents (90% blockage on two vessels) and a week stay at Seton. The bill was $210,000. Freaked out a bit a few weeks later when I received a notice from my insurance that they were denying coverage because the cardiologist shouldn’t have sent me to the hospital and the blockage should’ve never been discovered. Luckily, since I went to an in-network hospital, the hospital had to eat that $210K minus my copay.

[conVINCEd 21469]

12 minutes ago, CooterBrown said:

About 5 years ago, my doctor sent me to a cardiologist due to having a weird feeling in my chest. After a brief visit , the cardiologist sent me to ER. Ended up with stents (90% blockage on two vessels) and a week stay at Seton. The bill was $210,000. Freaked out a bit a few weeks later when I received a notice from my insurance that they were denying coverage because the cardiologist shouldn’t have sent me to the hospital and the blockage should’ve never been discovered. Luckily, since I went to an in-network hospital, the hospital had to eat that $210K minus my copay.

JFC about the letter denying coverage.

[Bevo 13577]

32 minutes ago, The Ace of Aces said:

Had a mild panic attack three years ago (funny, because a doctor caused it during a routine checkup). Was in the ER about 3 hours until they realized it was a panic attack and my heart wasn’t going to explode. 
 

They charged $580 for one Ativan. The bill for that experience was around $45,000. For three hours.  

I bet you wish the GP could have diagnosed the panic attack.