About three months ago my daughter cut her leg with a craft knife. It was 9:30 at night, so none of the "Urgent Care" shops were open. My only choice was the ER.

In and out in 20 minutes, 2 stitches. They billed my insurance $7K.

My portion will end up being about $900.

$450/stitch.

Seems pretty standard these days to overbill insurance so our 20% our of pocket cost always is around $1k. God I would love to see all of them squirm in front of a congressional hearing trying to explain their logic.

Malpractice insurance?

I went without insurance for a short period of time and paid cash for all of my and my wife's medical needs. Just about every place out there that we encountered were offing a 75% to 80% discount if you're paying cash.
So basically, when you pay 20% co-pay when utilizing insurance, you're paying for it in full. I think they just bill the insurance company is the outrageously high amounts to cover all the freeloaders and illegal aliens.

Damn.

At that price I would have done it myself.

Why it's always handy to have a Veterinarian Buddy. Did the same thing several years back, Holiday weekend, Thanksgiving...Called him up and 8 stiches later I was in good shape. Never an issue...bought him a steak dinner...GTG.

Needless to say the statute of limitation has run out on this or I wouldn't print it. Totally illegal on his end, but what's the big deal.

I wonder how much of the ridiculous prices we pay for healthcare goes to cover the indigent who seldom if ever pay?

This message has been edited. Last edited by: FN in MT,

Sorry to hear that but no getting around that hospital ER service is expensive. What you pay depends also depends a lot on insurance and the copay amount, co-insurance amount, tier level of provider, and deductible. If you had not met your yearly deductible yet then that may have inflated what you paid. Always check your explanation of benefits statement and don't be shy calling them if you feel something does not look right.

The hospitals we go are in our top tier network and we get the best cost using them. My wife went to hospital last January due to flu and they ran a lot of tests and gave her some IVs. Hospital and ER MD billed insurance $5517 while "allowed amount" was $1618.91 and we paid a flat amount of $150. Hospital ER can not turn away anyone and those that pay end up covering the costs of those that don't pay which can be a considerable percentage of the patients they service.

They get that much because they can.
Insurance is out of control.
In the 90's some time my wheels/tires were stolen off my Bronco II in my drive way.
Insurance paid the tire/wheel guy $5400 (like $10K in todays money) for about $800~1000 worth of goods.
Amazing waste how great thou art.

Sounds like a mistake. Probably should have been $700. I'd contact billing.

ER deductible should be $100 and nothing else to pay.

The Emergency Medical Treatment and Active Labor Act (EMTALA)[1] is an act of the United States Congress, passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospital Emergency Departments that accept payments from Medicare to provide an appropriate medical screening examination (MSE) to anyone seeking treatment for a medical condition, regardless of citizenship, legal status, or ability to pay. Participating hospitals may not transfer or discharge patients needing emergency treatment except with the informed consent or stabilization of the patient or when their condition requires transfer to a hospital better equipped to administer the treatment.[1]

EMTALA applies to "participating hospitals." The statute defines participating hospitals as those that accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program.[2] "Because there are very few hospitals that do not accept Medicare, the law applies to nearly all hospitals."[3] The combined payments of Medicare and Medicaid, $602 billion in 2004,[4] or roughly 44% of all medical expenditures in the U.S., make not participating in EMTALA impractical for nearly all hospitals. EMTALA's provisions apply to all patients, not just to Medicare patients.[5][6]

The cost of emergency care required by EMTALA is not directly covered by the federal government, so it has been characterized as an unfunded mandate.[7] Uncompensated care represents 6% of total hospital costs.[8]

emphasis mine



https://en.wikipedia.org/wiki/...and_Active_Labor_Act

quote:

Originally posted by Oz_Shadow:
Sounds like a mistake. Probably should have been $700. I'd contact billing.

Nope.

This is SOP now.

They bill the insurance company 7 thousand dollars because they know if they billed the $700 it really cost, they'd get around $50 from insurance.

Basically they are billing 10x the amount to get paid what is due them because the whole system is so screwed up.

It is absolutely because of the existence of insurance (including the government as the insurer for some consumers) that medical care is so expensive. The payor for medical services is not the consumer. A free market system does not work under those circumstances.

quote:

It is absolutely because of the existence of insurance (including the government as the insurer for some consumers) that medical care is so expensive. The payor for medical services is not the consumer. A free market system does not work under those circumstances.

This is a good part of it. It is also very expensive to have doctors hanging around to care for people and to have the latest equipment available to treat every conceivable problem. Care has to be provided to the drug addict who gets shot five times in the middle of the night, has no insurance and requires very expensive care in the ICU, and the services of a trauma team. In case you had not guessed these patients often neglect to pay their bill, and may later initiate a malpractice action because they now walk with a limp. The ER is also the doctor for the poor. A pharmacist buddy told me that the most common prescription he fills from the ER is Claritin. What a joke!

quote:

Originally posted by jhe888:
It is absolutely because of the existence of insurance (including the government as the insurer for some consumers) that medical care is so expensive.

Oh, no. Too simple.

Insurance worked properly when it was simple, and a voluntary sharing of risk among health care consumers.

It became detached from "free market" when .gov put its massive, collectivist thumb on the scale.

The hordes of malpractice lawyer-thumbs on the same edge of the scale really accelerated the outlandish distortion of market pricing.

Big-.gov Socialism.

Tort-lawyerism.

Fascist ( yeah, Fascist, ) corporate/.gov collusion to facilitate the illegal invasion of the USA for cheap, well, coerced taxpayer-funded subsidization of foreign labor for farming, manufacturing, hospitality, etc. enterprises added in to the tsunami of bizzarely gargantuan medical care pricing.

quote:

Originally posted by FN in MT:
Why it's always handy to have a Veterinarian Buddy. Did the same thing several years back, Holiday weekend, Thanksgiving...Called him up and 8 stiches later I was in good shape. Never an issue...bought him a steak dinner...GTG.

Needless to say the statute of limitation has run out on this or I wouldn't print it. Totally illegal on his end, but what's the big deal.

I wonder how much of the ridiculous prices we pay for healthcare goes to cover the indigent who seldom is ever pay?

What did he charge you for a distemper shot?

A few months ago I was in Roatan, Honduras for a dive trip. One of the guys with us was getting a sinus infection. Not good when diving.

We happened to be staying right next to a clinic/doctor. He walked over and was back out in 30 minutes with an antibiotic and prescription anti-inflammatory. Cost $21 bucks. Granted I wouldn't want any life threating injury there.

quote:

They bill the insurance company 7 thousand dollars because they know if they billed the $700 it really cost, they'd get around $50 from insurance.

Completely wrong. What a carrier pays them has zero to do with billed charge in 99% of cases. Either paid a contracted rate or “usual & customary” if no contract.

I’m not saying carriers don’t suck. I’m just saying spreading BS doesn’t help the argument against them.

quote:

Originally posted by sgalczyn:

quote:

Originally posted by FN in MT:
Why it's always handy to have a Veterinarian Buddy. Did the same thing several years back, Holiday weekend, Thanksgiving...Called him up and 8 stiches later I was in good shape. Never an issue...bought him a steak dinner...GTG.

Needless to say the statute of limitation has run out on this or I wouldn't print it. Totally illegal on his end, but what's the big deal.

I wonder how much of the ridiculous prices we pay for healthcare goes to cover the indigent who seldom is ever pay?

What did he charge you for a distemper shot?

It wasn't the distemper shot as much as the flea dip! Plus he made me wear one of those neck things so I'd stop chewing on my wound.

I had a routine colonoscopy. My co-pay was $2,000. Even my doctor was shocked.