That's insane. Unfortunately politicians will not touch this issue because most people either have insurance which covers these idiotic baseless fees or indigent people go to the emergency room and avoid these fees as well. But the poor sap who wants to do things the right way gets effed over like these people. What a shame.
I don't care who, Bernie, Trump, some socialist, take this cause (hospital billing) and have them come correct. They need someone to get tough and straighten them out.
The amount an health insurance company pays is kept secret and we can assume is far less. Otherwise, insurance companies would find ways to open up more hospitals to compete with the large irrational ones, or face huge costs. The hospitals know they can get away these amounts on paper, so they do.
We should demand price transparency -- as we do for almost all direct-to-consumer purchases. Businesses can charge different amounts for volume purchases to other businesses, but it would be considered discriminatory if a restaurant didn't show their prices and then when you got your bill, it said -- oh, your company's not paying for it -- so it's $15,000 in extra fees.
No secret. It's all itemized on your insurance bill. What is secret is the deal insurance companies have with hospitals which allows hospitals to charge astronomical fees. That is then ultimately passed on to companies/patients through high premiums. And no one really chucks a stint over it with public shaming so the vicious cycle continues.
You're right, patients get an itemized bill. The thing is the bill is pretty cryptic with CPT codes (and modifiers, ICD codes etc) practically unique to each payer as each payer interprets the AMA's guidelines differently. Payer A, say Blue Shield, asks for codes 99453 while Payer B (e.g. Aetna) wants code 92502 for the same procedure. So the patient is really clueless to know if 1) it's the right code, 2) they got charged too much, or 3) the insurance made a mistake in adjudicating the claim.
I know a company that was trying to help patients understand their medical bills, and for one bill, the hospital accidentally put down 10cc for an antidote for a snake bite, 10 times, when it should have been just once. The cost was in the tens of thousands instead of the thousands, and the hospital eventually fixed the claim and resubmitted, but the insurance company simply billed the patient.
Is it a secret? I get letters from my insurance company about how much they paid for medical treatment and even the provider sends me invoices with how much insurance paid. Last one was for blood tests were the provider(think was labcorp) charged $200 for a test and insurance paid $20.
Good point. Prices for each CPT code accepted by by insurance company are kept secret, and the chargemaster published by a hospital is so inflated it's basically useless. For some diagnostic tests, it's pretty straightforward to understand, but for others like an ER bill where there can be dozens of claim lines and codes, it can be really hard to understand and the patient is relatively powerless to do anything about it after the fact.
Article mentions the bulk of the bill was a "trauma activation". This is an alert from the EMS units to the hospital that they are bringing a patient with indications of trauma requiring additional medical resources to be diverted. The reaction and resources differ per trauma facility. SFGH is a level 1 center [1]. There are better news sources that describe the trauma system within the context of this story.
My opinion based on limited information within the article is that the field EMS suspected a closed head injury. The trauma "doctors at the hospital quickly determined that baby Jeong Whan was fine". If the baby had an MRI instead of a medical exam by a team of specialists, the headline would lose some weight.
The fee is to staff ED specialists 24/7. I believe the better question is: "should we charge for resources that were used but stood down after initial assessment by the trauma team?" From the perspective of the EMS field, there are protocols that describe tbe patient condition, mechanism of injury and other indicators which dictate a trauma activation.
Just how many specialists were they keeping available, and how much do those specialists cost? Let's say five different preeminent medical professionals were needed to respond to that emergency. Let's say that it used an hour each of their time. That's still $1000 an hour, which is exorbitant regardless of your credentials.
And that's the most charitable evaluation. They "quickly determined that the baby was fine." So what did the hospital do, charge out the entire cost of running the ER to one unlucky family since they were the only case who was brought in that hour?
Bad comparison. Italy has far inferior health system, barely able to provide 2x better infant mortality rate at 1/3 the cost when compared to US. /sarcasm
MRI avg price is $2,611 in the US. Google it. A hospital once charged my insurance US$12,000 for a CT Scan through emergency. A CT scan costs $1K (avg based on resolution) in the US. When I pointed out the stupidity of this to my insurance (with public twitter shaming) they quickly decided to cover my copay. Robbery or what?
Any ideas on how to fix the healthcare market? The feedback loops seem to be totally broken, in more than one place. I've long wondered how they could be restored, short of government action to try to make things drastically more efficient. Unfortunately, there seem to be strong incentives for officials not to do anything, given that that inefficiency means that healthcare is a major, growing, and well distributed employer.
Improved price transparency might help, and would be a relatively easy thing to improve, but with most patients not being responsible for paying their own costs, I'm not very optimistic about that route.
"but with most patients not being responsible for paying" -- right there lays the answer and the problem. I thought about this a lot while doing my 1st healthcare startup in silicon valley and connected with many startups "disrupting healthcare through price transparency". 5 years later... None succeeded.
If one could incentivize every patient to upload their bills to an open source service that would crunch the data and spit it out anonymously online showcasing hospitals & services rendered + insurers et al.. then I think we might be on our way to true price transparency and a potential disruption in US healthcare.
I spent some time thinking about ways to incentivize patients to upload bills, you'd only need a very small fraction to get a representative sample of how much different services cost at different hospitals. I haven't come up with anything very motivating, except maybe the desire to expose how ridiculous some of them are.
I've often wondered if we could open up private clinics in Canada for Americans where we charge reasonable rates. Kind of start a medical tourism industry by the border.
Thailand has a fairly large medical tourism industry - a number of hospitals in Bangkok are considered world-class (if not world-leading). I know a few people who just go there once a year for a weekend for their annual check-up, since the difference in price from doing it in a decent private hospital in Hong Kong can cover the cost of flights and accommodation, plus you get a weekend in Bangkok which is nice...
While many would not be able to afford a trip to Canada, I would think there would still be a sizeable number who live within 1-2h from the border who could drive there for non-emergency care.
With universal healthcare come other issues like waiting months for a bed. The real solution (and it's maybe 100 years away) is automating hospitals to a point where humans no longer play a role in healthcare management and it's 100% funded by the state/country. Maybe we won't even have hospitals and instead a portable home healthcare unit. One can dream ;-)
We have universal healthcare in Germany.
The longest time I had to wait was 17 days for a stationary colonoscopy because I wanted that exact hospital. And a MRI of the knee would have been 12 days of waiting until I called different radiologists in my area and got one the nextday. *
Yes, our healthcare can be improved and politics is constantly trying to make it worse. But I doubt that the average person waiting for a bed in Germany can even afford a bed in the US.
* ah, no co-pay by the way, I have no idea how expensive those things are.
Co-pay / co-insurance can run into the thousands literally up to your out of pocket maximum. For me as an individual, I think that's about $4-5k and for a family about $8-10k but this is with the second best insurance available. That's every year, an amount that you might have to pay if you are sick. With a chronic condition or a major trip to the hospital one is very likely to hit those limits. Not to mention the months to years of dealing with bills afterwards, when one is trying to recover, and companies wrongly billing, billing for too much, not billing insurance, double billing. No drawbacks to universal healthcare even come close to this absolute fucking hell. It's hell for the patients' family, so one can only imagine how it is for the patient. And then, of course, there are the times when care is simply refused outright and your father dies the day after he leaves the hospital ... but hey, insurance companies gotta make money off of some people dying. They don't care it's someone's father or mother or children.
co-pay example: a friend broke his collar bone few months back in Tahoe and had surgery to fix it. Full cost ~$60K. Out of pocket: ~$7K on Gold (80/20) insurance. You can read about the metal categories (ie. Gold) and other things I wrote about the US healthcare here: https://medium.com/the-road-to-silicon-valley/us-healthcare-...
More market would also work. The problem is lack of transparency and unequal negotiating power. The former can easily be fixed with laws; the latter is a bit harder to fix, but probably there are other solutions as well except for "universal healthcare" (i.e. an even more powerful negotiator).
This is something I really hope Trump hits on. He's proven repeatedly he doesn't care what is popular, and was booed during the debates for saying that he wouldn't let people die in the streets, as sick as that situation is. I like that about Trump, he sets popularity aside in his decisions.
That said, this is my single biggest issue at the moment. I have great health insurance, probably better than 90 pct of people here. It's not about me, it's about a broken system. I, or any of us, could lose our coverage in the blink of an eye. I will fully support any candidate who runs on nationalised healthcare. I don't care if my taxes go up. Our country is gross that people are afraid to seek treatment, or even ride an ambulance, because of our broken system. And I say this as a fiscal conservative...
I don't think Trump, Clinton or anyone can tackle this issue. Remember presidents don't really run the country. Their essential backers do. Presidents need to support their keys to power, the telecom companies, the oil companies, the big Tech companies, big pharma ...
The only way this changes in our fucked up system is if one big supporter, say tech companies, have a reason to collectively force the politicians that support them to start an assault on the big health/pharma industries. But no company wants that. All industries benefit from the fucked up health insurance system because it means all American must have jobs. It's not an option because no one can afford to get sick or break and arm without one (with health insurance).
I'd suggest reading The Dictator's Handbook. It goes into this pretty extensively.
Trump/Hillary hate/loyalty we see in this country is really sad and misguided. It's attacking the runny nose and not the bacteria that's causing the infection. The people who run this country are not the Congress and Senators and President, but all the people who pay their wages: Microsoft, BASF, Boeing, Facebook, Timewarner, Exxon, Google, etc.
It'd be great if he or anyone did. Unfortunately, I don't think it will be picked up by traditional politicians because doctors are active donors and they don't want to upset that. But, who knows. If it becomes a populist cause, maybe... maybe.
Doctors aren't the schemers here. When a doctor submits a claim to your insurance for let's say $500 what he gets back is a magic and opaque number. His only choice is take it, or don't accept your insurance. For programs like medicaid this number is often a tiny fraction of what was charged, which is why some doctors or hospitals simply will not accept it. If you pay in cash at a doctor you'll often pay a much more reasonable price, and that's because they're not at the whims of insurance companies who incentivize them to charge as much as they possibly can.
That's what I don't understand. The parties are at each others throats, even physically. I think the majority of both parties support reform and/or single payer. It seems like such an easy political win, even if not an easily solvable problem.
John Cochrane, a well known financial economist and former president of the American Finance Association, last month wrote a blog post [0] reacting to a similar article in Bloomberg about the pricing of air ambulance services. If you want to see how bizarre the structure of our markets for healthcare services looks to an economist, I encourage you to read it.
I wonder if there’s a collection of this sort of article somewhere, all these journalistic accounts of ordinary people’s financially nightmarish encounters with the American market for healthcare. It feels like I’ve read dozens of them, and they’re all basically similar, not just in the facts they relate of each debacle, but also in their lack of insight into what’s really so fundamentally broken about our healthcare markets.
That's a superb article, and it makes some extremely valuable points.
It wouldn't be that hard to just take a bunch of tax money, and provide a bunch of health care. Or alternatively, provide a bunch of health insurance. But since the US isn't willing to do that, but does want the services, we get this.
There's no free lunch, and the harder you try and find one, the more warped (and, ultimately, expensive) it's going to end up being.
> "It wouldn't be that hard to just take a bunch of tax money, and provide a bunch of health care. Or alternatively, provide a bunch of health insurance."
I don't even get if you're trying to make a point. I'm french and for all my life a doctor appointment has never been higher than 1 euro. All important operations are covered and i could not even tell you one that's not exept plastic surgery (and maybe lasik "in some cases").
I'm not even sure the txation in france is higher than in the US.
Not sure if you're being sarcastic or not. If you want to raise a lot of money, you really want a VAT or GST, probably in the 15-20% level. These are excellent at raising revenue because they hit everyone, rich and poor alike, and they're extremely difficult to dodge.
Then you spend this money on health care (ideally), or (failing that) health insurance (the point of insurance is the spread risk, but the government is already a big enough risk pool, so anything other than self-insuring is a blatant waste of money), with a strong focus on just letting the market work. Do you wish that everyone had access to treatment A? Then just pay people to provide it. It's amazing how well that works!
(One of the ironies of this debate is that the US tends to be shockingly socialist in how it provisions care. Land of the free, home of the brave, right up until it involves medicine, and then it's the last redoubt of five year plans, price setting, and socialist planning, which works just as well as it did under Khrushchev. Northern European countries have eye watering taxes, but the saving grace is that they spend the money efficiently.)
This is the sort of thing that basically all other first world countries have done, and it works pretty well. It's not cheap (anywhere), and it would be especially not cheap in the US due to their very, very long history of making poor choices that drive up the cost of health care, but it's a viable option.
(Example: Most first world countries build hospitals in order to provide a lot of high quality care efficiently. This means things like large open wards, because that allows a smaller number of nurses to monitor a larger number of patients, and nurses are expensive, and it's not like having a private room is going to make your broken leg heal faster. In the US, hospitals are build without open wards, because patents prefer private rooms, and who cares if that makes things horrifically expensive, because the guiding principle of US health care is "I don't care what it costs, I'm not the one picking up the tab!". Unfortunately, those hospitals have been built, and they're not readily retrofitable to more sensible designs, and we'll be paying off the bonds used to finance them for decades. Which means everything in the US will be needlessly expensive regardless of how you pay for it, but it's too late to fix it now.)
Of course, politically, none of this is going to happen; instead Congress will just keep passing laws to mandate More Good Stuff and Less Bad Stuff, and then feeling very aggrieved when it doesn't work out. The history of US health care since WWII has basically been one long string of poorly thought out reforms that have driven prices up. Why stop now? But just because the US won't do it doesn't mean it wouldn't be easy if they wanted to.
Recently a friend of mine visited the emergency care in a private hospital in downtown SF with heavy stomach pain. It turned out to be a partial bowel obstruction, which thankfully sorted itself out with some conservative treatment.
My friend was discharged in a couple of days... with a bill of 70K USD. Except for an IV and a Ryles tube, there was hardly any other intervention.
Having just finished college, my friend did not have an insurance plan that could cover such a huge bill. Thankfully the state stepped in to help since the yearly income was below the federal poverty line. Otherwise, I can't imagine the plight.
For once, my friend was thankful for being a broke college grad.
Students in Germany usually have free healthcare from their parents mandatory insurance, if they are older than 25 most have to pay about €70 and from 30 they usually have to pay about €115.
These are the rates for the public insurances, private insurance are usually cheaper for youngpeople but have other problems.
American hospitals are just big ripoff machines. The whole nonsense with insurance negotiated, uninsured, in-network, out-of-network fees needa to go. Just post one price for a service for all. My girlfriend had a few surgeries over the last few years. The only conclusion I could draw from the bills was that
a) they make up prices as they go
b) they like to charge for things that never happened or put a several thousand percent markup on things
They said that Obamacare was broken beyond repair. The same should be said for the current system and its billing practices.
>>American hospitals are just big ripoff machines.
Same here in India. For all the talk about Medical Tourism to India, it works only because Americans come here to India with Dollars, and $1 = 70 rupees. Your purchasing power suddenly increases by 70 times.
For Indians in India. Its the same near US level rip off. Sometimes its also hard to not sympathize with the doctors. It takes the best years of your 20's and early 30's to get to be a good doctor, and its expensive to get all those degrees and training. So they charge whatever they have to, to not only recover all that money but also make a fortune worth profit along the way.
A lot of time this is done through unethical means. Ordering tests the patient doesn't need(commissions with the labs), prolonging treatments to optimize for per visit costs, writing medication the patient doesn't need(again commissions with the pharmacy) etc etc.
But yeah, I agree with you. Even In India, Most doctors I talk to want(ed) to go the US to settle there. Largely because of the apparently insanely high pay and perks. One person I talked in my extended family almost talked about it like it wasn't something they had to even think about. If you are a doctor you had to settle in the US. The profession is just too profitable in the USA, to not move to there.
> and $1 = 70 rupees. Your purchasing power suddenly increases by 70 times.
Don't want to be a snob, but $1 = 70 does not mean that the purchasing power of the dollar is 70 times. Purchasing power is related to the services and goods you can get.
Eg: For $1, you can get a single nissan noodle bar in the US. For Rs70, you get around 7 maggi noodle bar's in India.
In this case the purchasing power of the rupee is 8 times that of the USD.
India is nowhere near this much of a ripoff. Even in a reputed private hospital like Narayana or Manipal the "treatment" that this child underwent would cost Rs.350-500 for consultation and probably another Rs.500 or so for registration if he is a first time patient. In India ripping off a patient is still the exception and not the norm, unlike in the USA.
Apologies in advance for not truly contributing to the discussion.
> Same here in India. For all the talk about Medical Tourism to India, it works only because Americans come here to India with Dollars, and $1 = 70 rupees. Your purchasing power suddenly increases by 70 times.
By very definition. To illustrate to you. Rent in Bangalore for a good home is around 35,000 rupees a month, comes to around avg $500, its not exactly Silicon Valley level opportunity but a great one nevertheless.
In fact you will be a tad little surprised to know that people here fight for US work opportunities(a.k.a known as 'onsite opportunities'), work for a few years in the US, come back and buy homes. Many people even own multiple homes this way.
It was all the rage a few years back, crazy workplace politics for this though.
The current system is Obamacare, which is objectively terrible. It's just that the system before ACA was even worse. Until conservatives realize that there is no free market in health care without government intervention, guilds and cartels will continue.
I remember 2008, and the path to 60 votes, and this was simply not true. Perhaps if Obama had started negotiating from single-payer, they maybe had would have gotten a public option. But a decade ago not enough democratic voters supported single-payer.
It is true. The Democrats had a filibuster-proof 60-member caucus[0] in the Senate, full control of the House, and the Presidency. They didn't need (and didn't get) a single Republican vote. But as they delayed while busy loading the bill with even more disastrous spending (e.g. community pools, Risk Corridors, etc.), their Senate supermajority fell to 59.
Caucuses are full of actual people who are worried about representing^W being reelected in vastly different districts. Party leadership can never rely on getting every vote; this is why whips were invented.
In the case above, there was zero bipartisan cooperation past the original proposal, so the individual senators really mattered.
So, they had to cooperate, that is compromise, take more viewpoints into account! That the end result is worse (as in, it costs a lot more GDP wise) doesn't matter, as it wasn't important for the participants anyway. Conservatives wanted to emphasise the personal responsibility (and sweet, sweet personal freedom to not plan ahead), they got it.
Paying emergency/trauma patients get hit with the accumulated losses from all the trauma/emergency services they have to supply without compensation from the indigent and those here illegally. They have to accept everyone and treat them until stable. One MRSA or resistant-TB patient can ultimately cost them seven figures.
It's commonly trotted out that the non-paying ER patients force the higher list rate, and while it's a nice sob story cover that distracts from the outrageous audacity of the prices they charge, it just doesn't pass the sniff test.
Want to know the daily rental rate for half of a shared room at Stanford's hospital? $17,000. That's not including any of the services, that's just for half of a tiny room. If there was a Four Seasons next to the hospital, it would be a small fraction of the price. That can subsidize a LOT of unpaid medical care. When you tack on the other care for a few days, it comes out to about $100k for a few days and maybe 24 hours of caretaker time during that time.
I think the real reasons are much closer to the reason college tuitions are through the roof - a) there are far more "professional hospital administrators" now, drawing large salaries without a direct impact on quality of care, and b) relative price insensitivity by clientele, because they're either not paying for it themselves, or they're desperate for good medical care and are willing to pay any price at the time, and c) egregiously fancy expansions with fine woods everywhere in the lobby, marble, etc.
Healthcare in US is a best example of how a Healthcare shouldn't be. The citizens of the country shouldn't be scared of going to hospital. Countries like India may have corruption, but their people, even the poorest, have the option to consult doctor free of cost or at the cost they can afford. The Healthcare in US is in the clutches of Insurance companies.
>> Countries like India may have corruption, but their people, even the poorest, have the option to consult doctor free of cost or at the cost they can afford.
For something small, like Fever or Stomach Upset may be.
For bigger problems its not easy, and most of the time they just give up(Embrace death). In Bangalore, there is a hospital called Bowring and Lady Curzon Hospital, its sort of like a government hospital. For decades its well known that when burn patients arrive, and if the victim is really poor, they silently recommend euthanasia. And most people opt for it. Its just the cost of treatment is too expensive, and the whole family goes down in the financial burden that follows.
Also please take a look at government hospitals like NIMHANS in Bangalore, its like the most depressing place you will visit in your life. You have to pay bribes for simple things like IV drip. And most people are very ill and sleep on the footpaths and hospital compound. Most of the times let alone having money for treatment they don't even have money to go back home to their small towns and villages.
Personally I had experience with one relative who got Guillane barre syndrome, their family comes from Kolar(A place 70 kms from Bangalore). He was a flower seller. He refused our help out of self esteem, but we had to bribe through ward boys, nurses and doctor secretly without him knowing to speed up things and get him everything from a bed to the right treatment.
This is heartbreaking. How can we solve the problem of overpopulation? What happens to poor people in America under the same circumstances of poor in India when seeking healthcare?
My personal story from Germany:
My 14 month old son got a deaseae in the spine so he could not walk anymore.
We spent 4 weeks in the hospital. 1 week until it was diagnosed in the MRT, 3 weeks with 3 different antibiotic treatment and another two month antibiotics at home.
All this while my wife continued to study for her PHD so I stayed away from work and lived with my son in the hospital.
This whole experience did cost us around 200€ (incl. gasoline to drive to the hospital) while still getting full income from my employer.
My oldest bumped his head as a baby, went to the ER, he had a great time seeing and visiting with the nurses and doctors (he couldn't speak, but he knew how to get a response). I think it cost us $150 (with insurance) rather than 51k...
On the other hand his birth was near $200k because he was born early and had a long hospital stay (he's fine now, long term premature outcomes are amazing). Nothing we could have done to prevent it, know it was coming, it would have financially destroyed us at that time had we not had insurance.
It's entirely possible that the hospital charged the insurance $51k and the insurance only allowed $500, of which $150 was your portion. No one knows what the real cost of anything is at hospitals, and even if you do have the time to shop around, you can't. There's no way to price compare as no one will tell you the price of everything in advance, and often surgeons pick their hospital anyway.
If you look at your insurance paperwork it will tell you exactly what the hospital is paid and what your portion is.
Not uncommon for the hospital to be paid 25-33% of the bill. Sometimes a lot less than that.
One of the reasons the list price is so high is due to “usual and customary” laws. An insurance company can’t pay for than that, so hospitals set it extraordinarily high.
Also, contract negotiations are based on chargemaster rate and discount. They keep cranking up the list price and insurance comes back and increases the discount.
Is it insane? Did people read the article? The critical trauma unit was activated. I suppose if people are called in to work, they shouldn't get paid if it turns out they aren't needed?
18k without having you sign anything, why not 50k or 100k? How could anyone afford random bill like that? For an emergency visit? What if treatment was needed? Should a visit to the hospital be higher than multiple average salaries?
From a european perspective it is insane. While these services certainly can't be free, they should be covered by mandatory healthcare / insurance.
Other countries have figured this out long ago. If you have to go to the hospital in these countries, finances and costs are a non-issue - the only thing on your mind will be your health and a speedy recovery.
The alternative is encouraging people to wait for treatment and tests that they can’t afford in the hope that the problem isn’t serious.
Put another way, if this family does need the trauma unit for their child next month, will they hesitate? Which is worse for society?
Obviously there’s a balance to be struck (hypochondriacs), but I think we can collectively come up with a situation in which both the individuals get paid and the family isn’t being so financially burdened. False alarm or no.
The article states this trauma fee didn't exist 18 years ago. Unless the introduction of this fee immediately caused a huge surge in the number of lives saved we can assume it's not critical.
If they get called in every time a baby bumps their head, and they work at a busy hospital in a large city, then they would already be at work, because kids bump their heads constantly.
But then what OP said, that people had to be called in makes no sense, right?
There were people there anyway, an attending physician looked at the child, talked to the parents (all doctors want is your anamnesis!) determined that nothing to worry about, maybe keep them in observation, and that's it. There's not even a word about doing an Xray/CT or any kind of imaging to check for internal bleeding.
Probably the "activation" of the Trauma Unit is that when they called 911, the hospital booked them and was ready to receive them.
If there is one area ripe for disruption, it's US health care.
A few months ago my wife was showing me atrocious bills people were posting on FB, I didn't know whether to laugh or cry. It hit home because we "accidentally" got a bill when an in-network lab sent a blood test to an out of network testing facility and we got a $14k bill... for a blood test.
Just recently, a 2 hour ER visit for my toddler cost $3.5k for a breathing treatment, some Tylenol and some influenza tests. All part of my high deductible plan.
I used to be on the side against healthcare reform. I'm now counting the seconds until we have ANY regulation to stop this madness.
The issue here is that the head hit was activated as a trauma. Trauma activation criteria are different for every hospital. If the criteria is lower, you get situations like these.
Trauma teams legitimately require such expense. There are surgeons, nurses, neurosurgeons, and others on call 24/7 sleeping on the hospital so they can get to victims of trauma within 5minites. Gunshots, stab wounds, car accidents, massive balconies falling with kids on them, etc, all require legitimate trauma activations. So do drinks and homeless people who get hit by cars or stabbed in the middle of the night, and many who don’t have insurance are still treated by the hospital. Some hospitals bill all patients 7-10 times the actual costs, get paid 1-2 times actual by insurance. Uninsured either don’t pay, or negotiate down, or are plagued by the full bill designed to compensate for the others who don’t pay.
If a hospital isn’t able to cover the costs of a trauma team, that means they lose their trauma designation and any local patients bleeding out because of trauma have to be trekked by ambulance or helicopter to the next trauma center, which in SF is Stanford or John Muir in the East Bay. They might have needed to pay another 25k if a chopper was called for this.
Curiously enough this only happens in the US. It seems that there is a rationale behind every decision that is made here, and yet the overall system doesn’t work for most people.
In that case this case can as well be summarized as: hospital seizes opportunity to maximize profits on baby, then every decision in the chain becomes clear.
I've said here before that I hope I get mauled and eaten by wolves to avoid the entire healthcare industry, but now I'm thinking about offering wolves as a service.
First, they're from South Korea. Paying even a cent of this would be a stupidly bad financial idea. Why? There is absolutely no reason. Let the hospital send the bill to some creditors and let them try to collect in South Korea. Honestly, the situation is laughable.
Second, the article thinks that this was fraud. Figures. It may not be too late for them to call the hospital and point this out and ask them to zero out the balance. This hospital, when it had its prior name, did something similar for a friend of mine, albeit his bill was about $1-2k and it was not fraud. Considering they might be on the wrong side of the law, this seems like a solution both sides can get behind.
My insurance was billed $8000 for an MRI and paid out $7000. I was only responsible for $500, but it was really upsetting because I'd had one before and only had to pay $50. The high cost came from the facility being on hospital grounds, which I wasn't aware of since I entered the area leading to the radiology center through an entrance that didn't look anything like the inside of a hospital.
A number of years ago I called and asked what the cost for a procedure was at a local hospital.... they struggled to even tell me within a weeks time. The system is just insane.
I'm in the Kaiser Plan in California. The hospital is also the insurance provider. Generally they are pretty good but even they sometimes cannot tell you the costs ahead of time. Their saving grace is that for most things they have a copay system with a fixed amount out of pocket.
What’s crazy to me is that in 1997 I got an MRI for a back injury and precautionary CAT scan on my eyes for metal fragments (did a little work in a metal shop) and together it cost me nothing due to insurance. I’m afraid to know what the out of pocket cost is today.
The healthcare system is a literal financial minefield. Seems like you better have a lawyer by your side to negotiate these arbitrary prices the instant you realize you're going in for anything non-trivial.
My wife recently gave birth to our first child. Normal delivery - 2 nights in a hospital. Then we had to go back again for jaundice - nothing serious - but added another 2 nights in a hospital room. All said and done my insurance was billed $64,000 for what is considered a normal uncomplicated birth. That is insane to me. If you go over the bill carefully, instantly 50% of that disappears because I've "saved" by being with my insurance provider.
What if I had no insurance? Would I get billed that insane number and have to spend hours whittling it down?
My dad was commenting on how the drug he takes regularly in his home country (outside the US) is 1/10th the price of what it costs here.
The health insurance system is broken in USA (who knew?). Everything is artificially over-inflated because it all gets "negotiated" down in the end. This creates a lot of room to maximize your net revenue when you set prices arbitrarily high.
Break a leg. Well. I broke femur near San Luis Obispo.
I was admitted to hospital, was charged over $19000 (that is nineteen thousands dollars) per night for bed. Just for bed. And it was a "cheap" option with person crying in agony next to me whole time.
Total bill was 74k$ dollars just for hospital service. Emergency services, E.R., surgery, anesthesiology all Extra.
Welcome to US.
P.S. With that prices, hospital easily would make it in top 20 most expensive hotel rooms of the world, except I didn't have a choice but to pay for it.
I genuinely wonder where this money goes, if paid. It seems rather unrealistic to believe these costs can be genuinely justified, with an independent audit? Right? The genuine cost to business cannot be this high.
These values are utterly unreasonable. Someone, somewhere; is doing something extremely unethical.
The fact this can even happen somewhat indicates there’s a lot of “power” involved.
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Edit: another poster had mentioned that some costs are included to cover other admissions in which fees are not paid - no matter the reason.
So, whilst this seems quite logical; it bothers me this is not clearly indicated. Its a pretty poor attempt to fix a clear, and genuine, other problem.
I can get close to the math by being extremely generous. 15k of tramua fees. ~10 specialists on call for tramua. That implies each specialist got about 1.5k for the call. ~2 hours of work, maybe payment for transport time so super generous call it 4 hours. If normal pay is 1x and overtime is 1.5x, must stay by the phone critical on call is 2x? This computes the specialists as getting paid an average of $200 per hour normally.
This is all pretty crazy - $200/hour for a brain surgeon, sure, but there's no way the nurse is getting that. One of the big missing data points is how many people were called in. 15k is pretty reasonable if a 50 person team was called in - but then, why would a 50 person team be called in?
> if the patient is from a place that has a national system, they pay
This obviously varies by country. E.g. for travel within the EU, a country will pay for their travelers healthcare. I live in Japan, and while the universal health insurance will pay for treatment sought outside of the country, they will only pay what it would have cost if it was performed in-country. So that doesn't help travelers to the US.
That was hearsay from a foreigner who, it seems, may have not had all the facts. Looking around, it looks like while not impossible, it's unlikely the State Dept puts much weight on outstanding (medical) debt: from reddit:
OK so I know that emergency care not being free is madness, and _you_ know that emergency care not being free is madness, but what are the arguments from people who don't think this sound like?
Also, I wonder how feasible it would be for foreign governments to pay for the emergency care of their citizens when they have issues in America, and fund it by charging visiting American's American-style medical bills for any medical care they receive while there.
> but what are the arguments from people who don't think this sound like?
The two I see are mostly
1. "I don't want to pay for other people's healthcare. Other people make poor health [dietary, etc] and financial [they're poor] decisions and they should pay for it themselves." A lot of young people do not want to pay it forward for the healthcare they will need when they get old ("I haven't been to a hospital in years! I'm healthy!").
2. Distrust in the government in running a fair and efficient system ("death panels" etc)
I have two kids, and have used the emergency care unit a couple of times throughout my life. Total cost $0 in care fees. (They are allowed to charge for stuff like bandages and such for non layovers, usually $5-$20 each visit).
We don't have health insurance, but some insurance companies have begun selling "treatment guarantee" which guarantees start of treatment typically within 14 days of injury. (For non life threatening ailments of course. Elbow pains, leg pains, such..) The best thing about those are that they are usually paid for by your employer because they want you back at work as soon as possible :D
(The premium is added to our income tax though)
Every now and then I seriously consider moving to the US, but the healthcare system scared the crap out of me. I can't imagine how stressful it must be to have to depend on your employer for health insurance.
If you are a foreign traveller in the US, and you need medical attention, if at all possible use a drop-in clinic instead of any hospital. Even the so-called non-profit hospitals charge outrageous fees.
A French friend of mine needed some emergency operation while he was in the States. He bought a round trip ticket to Paris, left, got the operation done, came back to the States. Saved $10,000.
> in January 2008, Hannaford Bros., a supermarket chain based in Maine, began paying the entire medical bill for employees to travel to Singapore for hip and knee replacements, including travel for the patient and companion ...
> In 2000, Blue Shield of California began the United States' first cross-border health plan. Patients in California could travel to one of the three certified hospitals in Mexico for treatment under California Blue Shield.
What, do tell, is your definition of what should be posted to HN? I suppose you read this[0] and this [1], which address your question about what content is appropriate, and how to comment on content you believe is inappropriate?
I don't care who, Bernie, Trump, some socialist, take this cause (hospital billing) and have them come correct. They need someone to get tough and straighten them out.
I mean, it's legalized robbery. Nothing less.