I recall this subject being discussed recently. It is interesting that Texas seems to lead in the problem of surprise bills from out of network docs in the ER. I hope members will find this article of help.

A $5,571 bill to sit in a waiting room, $238 eyedrops, and a $60 ibuprofen tell the story of how emergency room visits are squeezing patients.
By Sarah Kliffsarah@vox.com Dec 18, 2018, 7:00am EST
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For the past 15 months, I’ve asked Vox readers to submit emergency room bills to our database. I’ve read lots of those medical bills — 1,182 of them, to be exact.

My initial goal was to get a sense of how unpredictable and costly ER billing is across the country. There are millions of emergency room visits every year, making it one of the more frequent ways we interact with our health care system — and a good window into the health costs squeezing consumers today.

I started my project focused on one specific charge: the facility fee. I found this charge for walking through an emergency room’s doors could be as low as $533 or well over $3,000, depending on which hospital a patient visited and how severe her case was. I also learned that the price of this charge had skyrocketed in recent years, increasing much faster than other medical prices for no clear reason.

But given the volume and diversity of bills I received, I’ve learned so much more.

I’ve read emergency room bills from all 50 states and the District of Columbia. I’ve looked at bills from big cities and from rural areas, from patients who are babies and patients who are elderly. I’ve even submitted one of my own emergency room bills for an unexpected visit this past summer.




Some of the patients I read about come in for the reasons you’d expect: a car accident, pains that could indicate appendicitis or a heart attack, or because the ER was the only place open that night or weekend.

Some come in for reasons you’d never expect. Like the little girl who swallowed a coin to hide it from her sister, the 12-year-old boy who was hit by a home run ball at a professional baseball game (who, incidentally, was given a $60 ibuprofen at the local children’s hospital), and the adult who ate an entire bag of chocolate candy … without realizing it was edible marijuana. Rest assured, they are all fine!

From our series: A baby was treated with a nap and a bottle of formula. His parents received an $18,000 bill.



In so many ways, patients find themselves in a vulnerable position during these encounters with the health care system. The result is often high — and unpredictable — bills. Hospitals are not transparent about the cost of their services, their prices vary wildly from one ER to another, and it’s hard to tell which doctors are covered by insurance (even if the hospital itself is covered). In many cases, patients can’t be certain what they owe until they receive a bill in the mail, sometimes weeks or months later.

I’ve also learned that there is a lot of interest in fixing these types of situations. Since we started this project, multiple senators have introduced bills to prevent surprise emergency room bills — including one directly inspired by our project.

I’ll stop collecting emergency room bills on December 31. But before I do that, I wanted to share the five key things I’ve learned in my year-long stint as a medical bills collector.

1) The prices are high — even for things you can buy in a drugstore
One bill that left an impression on me came from a woman seen in the emergency room the day after her wedding. Her eye was irritated from the fake eyelashes she’d worn the night before, and she worried that her cornea might have been scratched.

The providers checked out her eye, squeezed in some eyedrops, and sent her home. She later got a bill that charged $238 for those eyedrops, a generic drug called ofloxacin. According to GoodRX, a website that tracks drug prices, an entire vial of this drug can be purchased at a retail pharmacy for between $15 and $50.

This is something that I saw over and over again reading emergency room bills: high prices for items that a patient could have picked up at a drugstore.

From our series: Toe ointment, a $937 bill, and a hard truth about American health care



I see this a lot, for example, with pregnancy tests. They happen in emergency rooms for good reason: Doctors often need to know whether a woman is pregnant to determine her course of care. But the prices I’ve seen for pregnancy tests are really high.

The bills in our database include a $236 pregnancy test delivered in Texas, a $147 pregnancy test in Illinois, and a $111 test in California. The highest price I saw? A $465 pregnancy test at a Georgia emergency room. For that amount, you could buy 84 First Response tests on Amazon.

Or look at the price of a common antibiotic ointment called bacitracin (you might know it better by its brand name, Neosporin). The bills in our database show that one hospital in Tennessee charged a patient a pretty reasonable $1 for bacitracin — while another hospital in Seattle charged $76 for the exact same ointment. Since prices aren’t made public, it was impossible for these (or any) patients to know whether they were at a hospital that charges $1 for a squirt of antibiotic ointment or one that charges 76 times that amount.

These bills submitted to our database were in situations where there was not a life-threatening emergency, where a provider presumably could have sent the patient to a place where their drug is available cheaper, often over the counter. But that doesn’t seem to happen. Perhaps emergency room providers don’t know the price of the care they provide, either. Instead, patients are getting drugstore items in the emergency room at a significant markup — and paying higher bills as a result.

2) Going to an in-network hospital doesn’t mean you’ll be seen by in-network doctors
On January 28, 34-year-old Scott Kohan woke up in an emergency room in downtown Austin, Texas, with his jaw broken in two places, the result of a violent attack the night before. Witnesses called 911, which dispatched an ambulance that brought him to the hospital while he was unconscious.

Kohan, who submitted his bill to our database, ended up needing emergency jaw surgery. The hospital where he was seen was in network; he Googled this on his phone right after regaining consciousness. But the jaw surgeon who saw him wasn’t. Kohan ended up with a $7,924 bill from the surgeon, which was only reversed after I wrote about his bill in May.

Kohan’s case is something I see regularly in our database: patients who end up with big bills because they went to an in-network hospital but were seen by an out-of-network doctor.

Here’s how that happens: When doctors and hospitals join a given health insurance plan’s network, they agree to specific rates for their services, including everything from a routine physical to a complex surgery.

Doctors typically end up out of network when they can’t come to that agreement — when they think the insurance plan is offering rates that are too low but the insurer argues that the doctor’s prices are simply too high.

Unless states have laws regulating out-of-network billing — and most don’t — patients often end up stuck in the middle of these contract disputes.

Read more about Kohan’s case: You can’t avoid surprise medical bills, even with a “PhD in surprise billing.”

Ilana Panich-Linsman for Vox
Academic research has shown that most of these types of bills actually originate from a small number of hospitals.

These bills “aren’t randomly sprinkled throughout the nation’s hospitals,” one New York Times article from July 2017 noted. “They come mostly from a select group of E.R. doctors at particular hospitals. At about 15 percent of the hospitals, out-of-network rates were over 80 percent, the study found.”

These surprise bills appear to be especially common in Texas, where Kohan lives. As many as 34 percent of emergency room visits lead to out-of-network bills in Texas — way above the national average of 20 percent.

And, much like the bills with high prices, these bills are really hard to prevent. Out-of-network doctors won’t often mention that they don’t accept the patient’s insurance; they might not even know. And patients often have little choice about where to receive their care — like Kohan, who needed emergency jaw surgery due to his attack.

3) You can be charged just for sitting in a waiting room
Before I started reporting this project, I knew from my decade as a health care reporter that America has sky-high medical prices. But what I didn’t know was that patients can face steep bills even if they don’t see a doctor or have their ailment treated. They can decline treatment and still end up with a hefty fee.

I learned about this from a bill sent to me by Jessica Pell. She told me about going to an emergency room in New Jersey after she fell and cut her ear. She was given an ice pack but no other treatment. She never received a diagnosis. But she did get a bill for $5,751.

“It’s for the ice pack and the bandage,” Pell said of the fee. “That is the only tangible thing they could bill me for.”

Read more: She didn’t get treated at the ER. But she got a $5,751 bill anyway.

Jennifer Brown for Vox
After I saw Pell’s bill, I started looking through our database and finding similar bills from other patients. They all ended up with significant medical bills, in the hundreds or thousands of dollars. These fees were often on top of additional fees from another health care provider where they ultimately did receive treatment.

This is all due to the key fee I’ve been investigating this year: the ER facility fee. This is the fee that ERs charge for walking in the door and seeking care, something akin to a cover charge at a bar.

Hospital executives often argue that these fees help them keep the lights on and doors open for whatever emergency might come in, anything from a stubbed toe to a stroke patient.

But experts who study emergency billing question how these fees are set and charged, noting that they are seemingly arbitrary, varying widely from one hospital to another. A Vox analysis of these fees, published last year, shows that the prices rose 89 percent between 2009 and 2015 — rising twice as fast as overall health care prices.

“It is having a dramatic effect on what people spend in a hospital setting,” says Niall Brennan, the executive director of the Health Care Cost Institute, which provided the data for that analysis. “And as we know, that has a trickle-down effect on premiums and benefits.”

4) It is really hard for patients to advocate for themselves in an emergency room setting
Since I started working on this project, one of the questions I get most frequently is: How do I avoid a surprise ER bill? Or how can I get my ER bill lowered?

I wish I had a good answer, but I don’t. Patients are usually at the mercy of the hospital when it comes to ER billing.

I have talked to some patients who have successfully negotiated down their emergency room bills. Most of those people applied for financial aid, requested a prompt pay discount, or found an error on their bill.

From our series: An ER visit, a $12,000 bill — and a health insurer that wouldn’t pay.

Luke Sharrett for Vox
Some especially savvy patients have even had luck arguing that their facility fee charge was coded incorrectly — that the hospital used a billing code that should be reserved for really intense, complex visits when their visit was actually pretty simple. I’ve noticed that these patients tend to have a doctor in their family who can help them make this type of argument.

Most patients who have successfully negotiated down a bill tell me it wasn’t easy. Erin Floyd from Florida told me about her experience reducing two of her daughter’s bills — one by 90 percent and one by 45 percent — through a combination of financial aid and prompt care discounts.

On the one hand, she was happy to have the bills lowered. In total, she ended up saving $4,369. On the other hand, the whole process was exhausting. There were lots of phone calls and faxes involved.

“I spent at least three hours on the phone working on this,” she says. “I was scanning, faxing, emailing, all while I was at work.” Over email, she described it as an “incredibly stressful and long process.”

And then there are, as Slate has noted, patients who have had their bills reversed after journalists wrote about them. Our project, for example, has resulted in $45,107 in medical bills being reversed after Vox began inquiring about those charges.

But for all of investigative journalism’s merits, reporters writing about medical bills isn’t a great solution for the health care system’s woes.

What stands out to me is that in all these cases, it’s essentially the hospital that gets to decide whether it wants to negotiate or reverse a bill. And if a hospital says no? If it won’t change the facility fee code, or doesn’t offer a prompt payment discount? The patient is essentially stuck. The hospital has the trump card: It can send the bill to a collection agency, a move that could devastate a patient’s credit. In those situations, there isn’t anything a patient can do to stop them.

5) Congress wants to do something about the issue
As more journalists write about ER bills, there is a growing outcry on Capitol Hill — and more senators on both sides of the aisle who want to do something about it.

There are now two proposals in Congress that would make the types of bills I write about a thing of the past. One comes from Sen. Maggie Hassan (D-NH) and another from a bipartisan group of senators including Sens. Bill Cassidy (R-LA) and Claire McCaskill (D-MO).

“It’s unacceptable”: Sen. Maggie Hassan explains her plan to end surprise ER bills.

Aaron P. Bernstein/Getty Images
While the two bills aim to do the same thing (prevent surprise bills in the emergency room), they take different policy approaches. The Cassidy-McCaskill proposal essentially bars out-of-network providers from billing patients directly. Instead, they would have to seek payment from the health insurer, who would be required to pay a price similar to local market rates. (I’ve written in greater detail about how this works.)

Will either of these bills become law? It’s hard to tell. On the one hand, the safest bet with Congress is often inaction. But this issue seems to be gaining momentum. Just this week, for example, a large coalition of health plans and consumer advocates put out a statement supporting federal action on the issue. What’s more, there is bipartisan interest in working on this — making it the rare issue that just might bring Democrats and Republicans together on health care.


LINK: https://www.vox.com/health-car...h-care-costs-america

Oh boy, government trying to fix healthcare, why am I worried?

Not defending hospital billing at all, it's FUBAR'd. Just the tone of the article makes seem like it's all the big bad hospital's fault and doesn't go into any of the underlying reasons behind it. "Hey, we're going to pass a new law further regulating hospital billing practices, that will fix the problem that's been created by a lot of existing laws we already passed!" Insanity.

One hospital I worked at was proud of their high rate of payment on billing at 18%. Yes, only 18% of what they billed was paid and this was supposedly a high rate. Goes to the theory that those that can pay will pay for those who can't or won't.

An emergency room is intended for emergent care. A lot of the patients there could be served by different facilities such as the primary care's office or an urgent care. I'd love to see a process in triage of a triage assessment, quick exam by the doctor and then a statement of, "Your care is not emergent, we suggest being seen at an urgent care of other facility, but if you want to be seen here we're happy to treat you but you're going to have to pay upfront..."

The article mentions pregnancy tests, one of my pet peeves. I've checked in a lot of patients who's only reason for being there was a pregnancy test. I'd love to say, "Go to the dollar store and buy one, GTFO." Can't do that. Instead they come in for a pregnancy test ordered by a doctor after his exam and a nurse's assessment, handled by a nurse, processed by a laboratory technician, all done in a hospital with high overhead costs. call it a stupid tax for the patient coming in for something that they really didn't need to be there for.

So my reaction is if they want to do something about hospital billing practices, also address some of the underlying causes. Put in place a process to screen frequent fliers and those that really don't need to be there, have a means of reducing the deadbeats who don't pay (I know easy to say but I really don't have a solution on how to force people to be responsible). Reform the system so patients aren't using the ER as their primary care. We can thank Obama Care for a lot of that last point. After it passed a whole lot of people had access to healthcare that didn't before. Good luck finding a primary care physician to accept their newly found insurance so they turned to the ER because they can't be turned away.

Yes the problem sucks, but another law imposed by the government is not going to fix it. My prediction is that it will make costs go higher, if nothing else for the additional administrative processes it will cause to ensure compliance.

Part of the problem is that hospitals went from being a non profit to being for profit. You gotta charge $60 per Motrin if you are paying your CFO $2 million a year, right Atrium?

Well, a couple comments. My older grandson ended up the hospital when he was about 12. Broken leg from a sledding accident.

My wife and our daughter spent a lot of time with him and both have remarkable powers of observation and incredible memories.

When they received the bill, it was for several 1000s. They insisted in a detailed accounting of services and charges.

Quite a few items listed, and billed, never happened or never took place. Like medication charged but never administered, etc etc.

They protested every item they suspected and the hospital simply scratched them off the bill. When it was over the total bill was a few 100 bucks.

One problem with the exorbitant charges by hospitals is the number of "welfare" cases that use the emergency rooms for primary care, but have no insurance or money. And, as we were told, the hospital must treat them.

I have no problem with people visiting the ER when they have an emergency, but I do have a problem with the use of ERs as a free service.

I talked to a nurse at my PCP's office and she said that she decided to leave the ER and work instead in a doctor's office.

There are a host of problems with our medical care in this country and many of them are caused by insurance companies. When doctors have to pay outrageous premiums for insurance, they have to charge a lot per patient just to cover those charges. Then not to mention their costs for their staff, facilities, etc.

Seems to me that if the ERs were able to tell those who come there with the sniffles that they had to go to their PCP, things would be a lot different.

We have the wrong people running the medical industry in this country.

Maybe we could learn something of value and use if our "leaders" studied Germany's system.

Instead, they look at the UK system, and we know how that works. About like the old system in East Germany worked. IOW, it worked for shit.

One the one hand, the billing is arbitrary and absurd.

On the other hand, the patients are equally absurd and usually don't pay. Yeah, the motrin tablet is .25c at the drug store, but you didn't go there did you? No, you went to the ER in a big-ass expensive building staffed 24/7 by expensive nurses and MDs with expensive equipment.

If you had a michelin star rated chef make you a PB&J sammich what would that cost?

quote:

One problem with the exorbitant charges by hospitals is the number of "welfare" cases that use the emergency rooms for primary care, but have no insurance or money. And, as we were told, the hospital must treat them.

Keep in mind this law requiring the hospital to treat (stabilize and transfer, often the same thing) is the result of legislation signed by Ronald Regan. Talk about a law that sounded good on paper, but is a disaster in practice. Unintended consequences indeed.

quote:

If you had a michelin star rated chef make you a PB&J sammich what would that cost?

Only way to find out is to order it, eat it, and see what's on the bill. Nobody would ever expect a chef or a restaurant to tell you the pricing up front.

quote:

Originally posted by a1abdj:

quote:

If you had a michelin star rated chef make you a PB&J sammich what would that cost?

Only way to find out is to order it, eat it, and see what's on the bill. Nobody would ever expect a chef or a restaurant to tell you the pricing up front.

Agreed, that's why I led with the billing is absurd...

Transparent pricing would help...but not much IMO. the people who won't pay still won't and the honest people with real emergencies still have no choice.

quote:

Transparent pricing would help...but not much IMO. the people who won't pay still won't and the honest people with real emergencies still have no choice.

Since I always like to compare hospital pricing policies to that of the normal business world, I don't know why hospitals can't collect payment like the rest of the billing world.

I know insurance complicates things, as do serious events that rack up serious bills. But if you go to the hospital to fix your broken arm why shouldn't you arrange payment prior to treatment and/or leaving? The grocery store doesn't bill me. My mechanic doesn't bill me. My gun shop doesn't bill me. I rarely bill non-commercial customers.

Granted that the billing can be more transparent and upfront.

But to compare eye drop prices administered at the hospital versus what you can buy at the drugstore is completely nuts also.

You have the labor costs of the medical person to put those eye drops on you. You have the hospital, the lights, and all the other overhead costs. Plus they have to make up for the freeloaders they can't drop.

Our PCP has very large signs in her exam rooms that tells patients to call her before even thinking about going to an ER dur to high costs. A very large hospital chain in our metro area will charge expectant mothers a fee of $6000.00 for having the gall to present to the ER AFTER regular business hours.

quote:

Originally posted by ZSMICHAEL:
2) Going to an in-network hospital doesn’t mean you’ll be seen by in-network doctors

One of my few hot button pet peeves. I've been burned twice by this during scheduled procedures that were not a surprise. The worst offenders are anesthesiologists. In Texas, most anesthesiologists contract with "Anesthesiology groups" who in turn contract with hospitals and surgical centers. Some individual anesthesiologists bill in-network, but the rest don't, yet they all work under the same Group.

I usually start the phone calls 3 weeks prior to any known procedures for me or the wife just to begin documentation that I tried to find out if the anesthesiologist who will do our procedure is in-network. This always involves first calling the hospital billing department and asking enough questions to finally get the name of the Anesthesiology Group working in the hospital or surgical center. I continue to call until the day prior to the surgery and document the fact they STILL don't know who, by name, is going to show up to put me out and whether they are in-network or not.

Once I find out who the Anesthesiology Group is, I start the phone calls to them and ask which specific anesthesiologist is going to show up for my procedure and if he/she is in network. Of course they don't know because actually scheduling anesthesiologists more than a few hours in advance seems to be a difficult concept to understand. My last phone call is made just before COB the day prior to my procedure and I make them document that they still don't know who, by name, is showing up or whether they are in-network or not.

After each of these phone calls to the above two entities, I call my company's benefits coordinator and insurance company to document the fact that I am trying to identify whether my anesthesiologist is in-network or not. My benefits coordinator is awesome and follows up with her own phone calls to both entities. She is a bulldog, speaks the medical language and further documents that she also tried to find out whether my specific anesthesiologist is in-network or not.

By using this technique over the last five years I am 4-0 for having my insurance company fully pay for out-of-network anesthesiology services based on the insurance company's "Due Diligence" clause. When they go back and see I called a dozen times about this, and my benefits coordinator also called a lot it's easy to meet that criteria. Yes, it takes time out of my day to make these phone calls and do my own documentation (Date/time of call, exactly who I spoke with, result of call and other notes). But I have saved myself many thousands of dollars by doing this, so while it's a pain in the ass, it's worth it.

quote:

Originally posted by sigcrazy7:

quote:

One problem with the exorbitant charges by hospitals is the number of "welfare" cases that use the emergency rooms for primary care, but have no insurance or money. And, as we were told, the hospital must treat them.

Keep in mind this law requiring the hospital to treat (stabilize and transfer, often the same thing) is the result of legislation signed by Ronald Regan. Talk about a law that sounded good on paper, but is a disaster in practice. Unintended consequences indeed.

That was to prevent the "wallet biopsy" which was a real thing. Patient can't pay? Ship them the hell out!
As noted above, the hospital should be able to do a quick triage, a basic exam and tell someone to go to the pharmacy to get their pregnancy test, ibuprophen, etc.

Don't forget the A-HOLES that think calling the big red taxi with red & blue lights is the best way to get your bullshit over-dramatized malady treated.
I hope they enjoy the $600+ bill for not having the sense to call a taxi.
- -
Edit to add: Hospital billing is one of the biggest goat fucks in the system...Yes -> HONOR HEALTH <- I'm looking at you!

Well the biggest issue I see everyday is stupid patients the come to the ER for nonesene. I had a woman who checked herself in because she was “cranky.” Everyday I see kids for falls or bumps and bruises who are walking and moving the extremity without any problem but parents wants to make sure their child is “ok.” People who come in for car accidents at 5 mph with no damage or a acute complaints...”I just thought I should be looked at.” People who lie and say “I have chest pain” and get a 20K dollar work up when in reality they just wanted a work excuse for an $8 an hour job. If you think these cases are exaggerated of the 25-30 patients I see a day half will be there for a non-emergent issue that requires no assessment or treatment at all. People have no concept of what an emergency is. With that said you still have to investigate every complaints so you don’t miss something and get sued.

Often patients will try to go to urgent care or a PCP’s office first but will just be told to “go to the ER” so thier facility doesn’t have to deal with the headache. Some of these outside facilities are truly stupid. They will send a patient from their office in an ambulance to one of our free standing ER’s for lets say an appendicitis...then I have to confirm their findings and put them in another ambulance to another hospital where they can do the surgery when that office could have just sent them to that hospital in the first place. All of this costs money.

These same people will also bitch and yell about wait times when we are back up actually saving someone’s life. Recently I had a 6 year old girl who was actively dying from flu induced acute respiratory failure and an indignant woman with tooth pain told me “that’s not my problem” when she found out the cause of her wait. These overuses and outright abuse of emergency healthcare have lead to widespread overcharging because the vast majority of these people pay nothing. Some of these same people will rack up 20 visits in a month. The ER makes you lose faith in humanity almost daily until that one fleeting day that it completely restores it. There anreason ER burn out for providers and nurses is exceptionally high.

quote:

Originally posted by KMitch200:

quote:

Originally posted by sigcrazy7:

quote:

One problem with the exorbitant charges by hospitals is the number of "welfare" cases that use the emergency rooms for primary care, but have no insurance or money. And, as we were told, the hospital must treat them.

Keep in mind this law requiring the hospital to treat (stabilize and transfer, often the same thing) is the result of legislation signed by Ronald Regan. Talk about a law that sounded good on paper, but is a disaster in practice. Unintended consequences indeed.

That was to prevent the "wallet biopsy" which was a real thing. Patient can't pay? Ship them the hell out!
As noted above, the hospital should be able to do a quick triage, a basic exam and tell someone to go to the pharmacy to get their pregnancy test, ibuprophen, etc.

Don't forget the A-HOLES that think calling the big red taxi with red & blue lights is the best way to get your bullshit over-dramatized malady treated.
I hope they enjoy the $600+ bill for not having the sense to call a taxi.
- -
Edit to add: Hospital billing is one of the biggest goat fucks in the system...Yes -> HONOR HEALTH <- I'm looking at you!

I as a provider have no idea if someone does or doesn’t have insurance. My treatment doesn’t change. I can’t just send someone out after a basic triage without a comprehensive exam unless I want to be sued on a daily basis. That 6 year old girl I just discussed in my previous thread had been seen by 4 outside providers before me who told her she “just had a virus.” She currently in ICU with only about 20% of her lungs working. In the last week alone I had 2 patients who had been seen at urgent cares for back pain sent home with muscle relaxants and steroids that would be paralyzed today if I didn’t do comprehensive testing. There’s lot of bullshit that walks in the ER doors but we have to thoroughly investigate it all or we will miss something that will get us sued.

Also a pregnancy test is 99% of the time diagnostic so I can’t just tell them to go get one at the pharmacy and then come back to finish up thier work up. Pain treatment is also diagnostic. If you have a headache that won’t go away and after standard migraine treatment it’s hasnt gotten any better there is a chance it could be a serious neurological condition like subarachnoid bleed of dural venous sinus thrombosis.

quote:

Originally posted by 280nosler:You gotta charge $60 per Motrin if you are paying your CFO $2 million a year, right Atrium?

ONE problem (there are many) is medicare and medicaid are scooping up massive amounts of people, adding tons of regulatory costs, paying little and the hospitals have to cover the difference out of other revenue channels. Oh, and did I mention ED's have to treat everyone who needs it regardless of the ability to pay, by law. AND, the medically homeless (no personal physician) use the ED for the first medical contact for everything, particularly the low income uninsured as they don't have to worry about co-pays. and and and and and....

It's freaking complicated. If it weren't,.. it wouldn't be a problem, it wouldn't be at all.

But $60 ibuprofen makes good sensational journalism. Like that kind of thing? Well strap yourselves in for a lot more. Because MORE government regulations (read: more administrative costs to hospitals) require that the full charge-master be available in machine readable format on the hospitals websites starting Jan. 1, 2019.

I can't wait for the TV news teasers now. "See what Yourtown General tried to charge for an asprin last night!!!". Never mind that on that same night, the staff saved three uninsured people, and one Narcan case, the guy broke the jaw of the nurse helping him and she had to be treated and miss work (all covered by the self-insured hospital). Oh, and why is someone in the ED for an asprin? round-and-round-we-go...

It's complicated....

Few years ago I was in a car accident and was taken to ER.
The accident was in a small town and the hospital was very small.
I was under the care of ER for 3 hours.
I was released and walked out.
The first bill I received was a bit over $11k.
Few weeks later I received a bill from the person that looked at the X rays, $800.
Within a day I received a bill for transportation , $450(under 5 miles)
About a month after the ER visit I received another bill from the Dr that treated me, it was just under $300.
Few days later I got another bill from a Dr that reviewed first Dr work, $500(he was a specialist a bit more expensive). He reviewed it on Monday, I was in the ER on Sunday evening. I received few more bills, total was around $13,500 for a visit that lasted under 3 hours. In that 3 hours I was seen by 1 Dr, 2 different nurses, xrayed both wrists and right knee. Received 0 meds.
My wife's bill was $18k, she did receive 2 Tylenol pills.

The $13,500 shocked me. What shocked me even more was that the billing department could not answer 90% of my questions about changes they expected me to pay.

bottom line : you are are subsidizing the X % of patients who aren't going to pay a dime for their emergency care.

hazard a guess who a lot of those patients are.

town habitually unemployed drunks, illegals, homeless, dug addicts, etc

there are other factors of course - but 'cost sharing' is a big part of it

----------------------------------------------------

 
We have a $50 ER copay, and thankfully the local ER (Wickenburg Community Hospital) has transitioned from contracted doctors to staff doctors. They are not a full service hospital, but have extensive diagnostic equipment which will generally get you diagnosed prior to a trip to the "big" hospital, it it's necessary. When I had a colon perf, the local ER had me all diagnosed prior to the ambulance ride straight to Boswell, and straight to the OR table.

Wow, I just became worried. I switched my insurance to a hmo that is in net work only.
I wasn't thinking about emergencies that I might be un able to control what drs. See me.
Man that could be 100's of k's