Emergency room violence [Archive]

Sensei

07-07-2018, 09:13 PM

My observation is that many uninsured persons use ER's for all medical visits regardless of urgency. Hence a large number of lower socio-economic patients make up a significant number of ER cases. Among this group are over-represented subgroups of the addicted, under-educated, under-employed, and the population of ex--offenders. And then, then there are the gangbangers drawn from all three. Hence, waiting rooms and parking lots are not safe either.

This is partially true. The percentage of non-urgent ED visits sits somewhere between 2-10% depending on what you define as non-urgent. The main reason why EDs are bursting at the seams is because the entire hospital is bursting. That is to say, ED crowding is driven by hospital crowding as 30-50% of my beds are occupied by admitted patients waiting hours for their in-patient bed. Violence follows crowding for obvious reasons. When it comes to the lower socioeconomic patients being over-represented, this is true and the reasons are multifactorial. Yes, many are uninsured or Medicaid (synonymous to uninsured in my book) looking for free shit. However, the major reason for this is that behavior patterns that lead to being in the lower socioeconomic class also lead to more frequent emergency medical conditions. Smoking and drinking to excess are prime examples. When it comes to insurance status, there is surprisingly little evidence to support the notion that payor status drives ED visits with the possible exception of Medicaid which tends to slightly increase the likelihood of going to the ED.

You are certainly correct about the addicted being over-represented. At least 30% of my patients have substance abuse as a major factor for their visit to the ED.

Unfortunately, nothing can be done for several reasons. One is that denying service is illegal. A second is that these individuals see nothing wrong with this practice. The rest of us even must be careful when criticizing it. Doing so makes certain others uncomfortable. Complain vociferously and risk career damage. Another reason is that the number of persons in this broad category is increasing. Teen pregnancy fuels the engine driving this boat, and there's no solution for that either. Most of these folks vote Democrat so get ready for the ride. The fun ain't even started yet.

Technically, we can deny services in many instances but doing so gets risky. EMTALA requires that we provide an appropriate medical screening exam and stabilizing care whenever one is found. The problem is that what constitutes an emergency medical condition, appropriate screening exam, and necessary stabilization are matters of legitimate debate. Moreover, physician malpractice exposure is present even if we are not paid, so very few of us are going to scale back our work-ups for the uninsured. Yes, there are times that I perform a medical screening exam and then tell the patient that they are being discharged to see s primary doctor for treatment of a non-emergent complaint. However, this almost always results in a complaint to Patient and Family Relations. Enough complaints and you get sent to “Camp Nice.”

OlongJohnson

07-07-2018, 11:59 PM

I haven't spent much time in ERs, fortunately, but I did hear someone casting out demons in the name of Jesus in the hallway once.

07-08-2018, 06:25 AM

My best friend working in the ED was GEODON. Although at times its desired effects fell below expectation. Honorable mention for ativan also.

dkv

07-08-2018, 07:55 AM

The majority of injuries from patients that I have seen in the ED are actually from demented patients, who can have surprising strength, anger, and aggression.

The threats from the younger patients are more worrisome but rarer.

Nephrology

07-08-2018, 12:46 PM

However, the major reason for this is that behavior patterns that lead to being in the lower socioeconomic class also lead to more frequent emergency medical conditions. Smoking and drinking to excess are prime examples.

One of the pearls I've picked up in my time at DG so far is that "trauma is a chronic disease." One that, for some people, ends up with a GSW -> TBI -> PEG, trach and SNF-bound for life...

Sensei

07-08-2018, 01:46 PM

One of the pearls I've picked up in my time at DG so far is that "trauma is a chronic disease." One that, for some people, ends up with a GSW -> TBI -> PEG, trach and SNF-bound for life...

The saying, “Trauma is a chronic disease process that doesn’t happen serendipitously” goes back before my days in med school. It has been passed down the generations and I don’t see it stopping anytime soon.

As for the article, it made some good points but often wandered off into fantasy land. Statements like “address the mental health and drug crisis” are about as helpful as “common sense gun laws.” Nobody can tell me how it’s going to be addressed and truth be told we really do not really have a mental health crisis. Our EDs and psych wards are not overflowing with patients with true major depression or schizophrenia. What we have is a behavioral health crisis rooted in deep seeded personality disorders and substance abuse brought on by 60 years of cultural decay. While some may say that I’m dabbling in semantics, there is an important distinction there because true mental illnesses are often responsive to treatment. On the other hand, giving a pill to an asshole just means that you have an asshole with a pill. Good luck Paxiling our way out of that one.

45dotACP

07-08-2018, 02:34 PM

I don't work ER and I've had to shoot for a double leg on a buck nekkid fatass who was swinging at the nurses.

Too close to the danger zone....way too close.

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Duces Tecum

07-08-2018, 02:38 PM

What on earth even is the solution to this? What can be done?

Used to be that people with no insurance could be denied care. I know, I know the laws were different then. But it does seem to me that people who don't pay for their own insurance should not piggy back on those who do.

RevolverRob

07-08-2018, 03:26 PM

blues

07-08-2018, 03:33 PM

Emergency room violence

Not too make super light of this - but I can see why...I just saw the claim amount filed to my insurance for four stitches, a tetanus shot, and a six hour wait to get sewn up was nearly $3800. That's $633 an hour in costs.

I went into the wrong damn line of work.

I can't wait to see how much of this I'm on the hook for. :(

Wow...that sucks. In 2016 when I needed 15 stitches in my right palm and six in my left after a fall while running on gravel, the local hospital billed my insurance a mere $1500 or so...

...which was paid in full once the ER corrected the paperwork to indicate that it was in fact due to an accident (as opposed to me sitting around the house for a few weeks waiting to get my hands stitched back together :rolleyes:).

jellydonut

07-08-2018, 03:41 PM

Used to be that people with no insurance could be denied care. I know, I know the laws were different then. But it does seem to me that people who don't pay for their own insurance should not piggy back on those who do.

I mean, I guess, but does this really solve the problem?

RevolverRob

07-08-2018, 03:42 PM

Wow...that sucks. In 2016 when I needed 15 stitches in my right palm and six in my left after a fall while running on gravel, the local hospital billed my insurance a mere $1500 or so...

...which was paid in full once the ER corrected the paperwork to indicate that it was in fact due to an accident (as opposed to me sitting around the house for a few weeks waiting to get my hands stitched back together :rolleyes:).

I wish I had insurance that good. The policy available to grad students here is hot garbage. I'm going to be on the hook for the remaining amount of my deductible, plus the ER co-pay cost (probably 600 bucks before it's over). I realized now, I should have gone to a out-of-network hospital, because I've already met the OON Deductible for the year - so I would have only paid the ER Co-pay...:rolleyes:

As my wife noted, "You were also the only person in the damn ER actively bleeding. Everyone else was just there waiting for vicodin or oxy..."

This is why our shit is broken...

blues

07-08-2018, 03:48 PM

I wish I had insurance that good. The policy available to grad students here is hot garbage. I'm going to be on the hook for the remaining amount of my deductible, plus the ER co-pay cost (probably 600 bucks before it's over). I realized now, I should have gone to a out-of-network hospital, because I've already met the OON Deductible for the year - so I would have only paid the ER Co-pay...:rolleyes:

As my wife noted, "You were also the only person in the damn ER actively bleeding. Everyone else was just there waiting for vicodin or oxy..."

This is why our shit is broken...

I still have the vicodin they forced on me before sending me on my way. Told 'em I didn't want 'em but they were pretty insistent. I got tired of arguing and wanted to cut the night short so my buddy could drive me home.

Sherman A. House DDS

07-08-2018, 04:10 PM

I still have the vicodin they forced on me before sending me on my way. Told 'em I didn't want 'em but they were pretty insistent. I got tired of arguing and wanted to cut the night short so my buddy could drive me home.

I operate on the premise of, “Its better to have and not need, then to need and not have,” in surgical cases where I AM of the qualified opinion that someone may need drugs, even when they refuse them.

Because rest assured, they’ll have ZERO qualms about hitting up my after-hours number to bother me with a pointless question, as TN law doesn’t allow providers to phone in narcotics much heavier than Tylenol #3. Those do just about nothing for someone who has let post-operative surgical pain get out of control. If people would dose NSAID’s appropriately, they wouldn’t have any issues. But why would they listen to me? WEBMD is, “right,” 24/7!

[emoji23]

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blues

07-08-2018, 04:26 PM

I operate on the premise of, “Its better to have and not need, then to need and not have,” in surgical cases where I AM of the qualified opinion that someone may need drugs, even when they refuse them.

Because rest assured, they’ll have ZERO qualms about hitting up my after-hours number to bother me with a pointless question, as TN law doesn’t allow providers to phone in narcotics much heavier than Tylenol #3. Those do just about nothing for someone who has let post-operative surgical pain get out of control. If people would dose NSAID’s appropriately, they wouldn’t have any issues. But why would they listen to me? WEBMD is, “right,” 24/7!

[emoji23]

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You make a very good point, Sherm, one that I shouldn't dismiss so cavalierly. Thanks for raising it.

Duces Tecum

07-08-2018, 05:04 PM

I mean, I guess, but does this really solve the problem?

Well . . . it would probably help. Adam Smith was more often right than wrong. If it's free, people will consume a lot. See willie's post (below) and consider how those facts might change if people who do not care enough to insure their own health (their justifications do not concern us here) were legally denied service.

My observation is that many uninsured persons use ER's for all medical visits regardless of urgency. Hence a large number of lower socio-economic patients make up a significant number of ER cases. Among this group are over-represented subgroups of the addicted, under-educated, under-employed, and the population of ex--offenders. And then, then there are the gangbangers drawn from all three. Hence, waiting rooms and parking lots are not safe either.

jellydonut

07-08-2018, 05:17 PM

What about the ones who legitimately can't afford insurance? They've been priced out of the market. That's the problem I can't see a solution to.

Duces Tecum

07-08-2018, 06:20 PM

What about the ones who legitimately can't afford insurance? They've been priced out of the market. That's the problem I can't see a solution to.

I don't quite understand why their uninsured state is our problem. In any event the uninsured have options, one of which is to do a better job of budgeting. I can't tell you how many poor people are unfamiliar with budgets. Or, they could get a second job. They might even seek charity through a Go Fund Me page. Over and above these three, there is probably an entire bushel of alternatives that will occur to you.

Yesterday evening the Mrs. and I were walking to the bookstore to read their magazines for free. They always have the most current, you know. On the way we saw a woman with a sign and a small child. They were leaving the $6 ice cream store (two small scoops) with, naturally, six dollar ice creams. When they saw us the woman held her sign so we could read it. It was a plea for money because she was the single mother of four and homeless. She spent her begging money on frivolities, and she was teaching the child with her to do the same.

The major point here is that people buy what they can't get for free. Remove the "free" (in quotes because it really isn't, it's just "free" to them . . . you and I ultimately pay for it) stuff and let them sink or swim depending upon their fiscal decisions. That used to be called "Tough Love". It was a part of growing up, and back then it seemed to work more often than not.

Now, sir, I have offered a specific Tough Love solution to the "uninsured" issue: "No insurance, no medical care. Have a nice day. NEXT IN LINE!" At this point I would much appreciate learning your thoughts on the matter.

RevolverRob

07-08-2018, 06:35 PM

What about the ones who legitimately can't afford insurance? They've been priced out of the market. That's the problem I can't see a solution to.

But the Individual Mandate says that can't happen! Or something.

This was the fallacy of Obamacare and remains the fallacy of it. It doesn't matter how much we "wish" something into existence, there will always be a subset of our population who is unable to afford medical insurance and therefore expensive medical care. In the past we simply let those who cannot afford to live, die. Apparently, we can no longer do that, socially. Of course, a larger percentage of our population cannot afford to live now, than in the past. So, I understand the shifting social attitude, to a degree.

So, what are we prepared to do? So far the answer is, keep printing money and pretend the problem doesn't exist.

RevolverRob

07-08-2018, 06:44 PM

Now, sir, I have offered a specific Tough Love solution to the "uninsured" issue: "No insurance, no medical care. Have a nice day. NEXT IN LINE!" At this point I would much appreciate learning your thoughts on the matter.

I proffer a slight modification. Insurance shouldn't be a gateway to medical care, because insurance is one of the reasons why medical care is so damned expensive.

It should be, "Will you be paying by cash or card today? Neither? Great here are the directions to our payment plan office. Once it is determined how you will pay, we'll see you."

Also, seriously - no one is denied medical care, because they can't pay for it, on the spot, in this country. Paying medical bills on payment plans is as old and viable an option as buying cars on credit. Why don't hospitals offer medical payment loans? Imagine the amount of money they could make on interest alone...

Frankly, removing the insurance middle-man from the problem would be a step in the right direction for reducing the cost of medical care. I'm not sure why four stitches and a tetanus shot cost $3800. Tetanus vaccines have existed since the 1920s and sutures have existed far longer than that. What did I pay for? The R&D to make a tetanus vaccine? Nope. Did I pay for the x-rays I didn't have? Nope. Was I making a loan payment for the residency doctor I didn't see? No. Oh I know, it was the alcohol pads and gauze that cost $3500... Seriously, these costs were driven up, because of insurance, not because they "need" to be as high as they are.

willie

07-08-2018, 06:54 PM

Duces, many would say that your solution is mean sprited and would further exclaim that it places an unfair burden on persons in that broad category of the poor or afflicted or homeless or dispossesed or mentally challenged or mentally ill or whatever. And then these same individuals would say in a patronizing manner that even though the mother with the sigh is wasting money that she begged, she has the right to spend it as she wishes. Then they would say that your point is not relevant. That's our culture today.

BobLoblaw

07-08-2018, 07:38 PM

Duces, many would say that your solution is mean sprited and would further exclaim that it places an unfair burden on persons in that broad category of the poor or afflicted or homeless or dispossesed or mentally challenged or mentally ill or whatever. And then these same individuals would say in a patronizing manner that even though the mother with the sigh is wasting money that she begged, she has the right to spend it as she wishes. Then they would say that your point is not relevant. That's our culture today.

Precisely. The people demanding compassion and empathy refuse to acknowledge any responsible long-term solutions because they seem “callous.” Those same folks are the impenetrable walls that will result in a painful reckoning that they’ll likely never even witness firsthand.

Sensei

07-09-2018, 07:44 AM

BigT

07-09-2018, 07:55 AM

Sensei

07-09-2018, 08:22 AM

Am I reading this right? An unemployed person for example who is the victim of a stabbing for example should be left to die if they cant afford to pay for medical treatment?

Or a homeless person who gets an infection?

It’s actually very simple. We all get barcodes tattooed on the back of our necks that are linked to our insurance and HSA accounts. That way, the registration clerk can use a handheld scanner to know upfront whether you have adequate funds to receive care. As they do now, the nurse will first scan your bracelet before administering medications, but she will then scan the back of your neck to deduct $200 for the cost of the Tylenol that she just gave you. Once your accounts run dry you will be discharged - no matter what. Respiratory therapist will not only monitor ventilator settings in the ICU but also perform barcode scans ahead of morning rounds so that the team will not have to round on patients that have been desupported due to a lack of funds. Of course, your loved ones can transfer funds to your account should you get low - you do have loved ones, right?

Anyway, some small changes will need to be made to care algorithms. AEDs found in malls and airports will come equipped with scanners so that bystanders and first responders don’t begin resuscitation on someone who can’t afford it. Our trauma resuscitation protocols will need to be changed from ABCDE to SABCDE - the S stands for scan...

BigT

07-09-2018, 08:41 AM

It’s actually very simple. We all get barcodes tattooed on the back of our necks that are linked to our insurance and HSA accounts. That way, the registration clerk can use a handheld scanner to know upfront whether you have adequate funds to receive care. As they do now, the nurse will first scan your bracelet before administering medications, but she will then scan the back of your neck to deduct $200 for the cost of the Tylenol that she just gave you. Once your accounts run dry you will be discharged - no matter what. Respiratory therapist will not only monitor ventilator settings in the ICU but also perform barcode scans ahead of morning rounds so that the team will not have to round on patients that have been desupported due to a lack of funds. Of course, your loved ones can transfer funds to your account should you get low - you do have loved ones, right?

Anyway, some small changes will need to be made to care algorithms. AEDs found in malls and airports will come equipped with scanners so that bystanders and first responders don’t begin resuscitation on someone who can’t afford it. Our trauma resuscitation protocols will need to be changed from ABCDE to SABCDE - the S stands for scan...

Seems legit. We all know the poor have no rights , being left to die will teach them the error of their ways. I bet that every single person the hospitals leave to die will never be back without money or insurance.

Jeep

07-09-2018, 08:49 AM

I don't quite understand why their uninsured state is our problem. In any event the uninsured have options, one of which is to do a better job of budgeting. I can't tell you how many poor people are unfamiliar with budgets. Or, they could get a second job. They might even seek charity through a Go Fund Me page. Over and above these three, there is probably an entire bushel of alternatives that will occur to you.

Yesterday evening the Mrs. and I were walking to the bookstore to read their magazines for free. They always have the most current, you know. On the way we saw a woman with a sign and a small child. They were leaving the $6 ice cream store (two small scoops) with, naturally, six dollar ice creams. When they saw us the woman held her sign so we could read it. It was a plea for money because she was the single mother of four and homeless. She spent her begging money on frivolities, and she was teaching the child with her to do the same.

The major point here is that people buy what they can't get for free. Remove the "free" (in quotes because it really isn't, it's just "free" to them . . . you and I ultimately pay for it) stuff and let them sink or swim depending upon their fiscal decisions. That used to be called "Tough Love". It was a part of growing up, and back then it seemed to work more often than not.

Now, sir, I have offered a specific Tough Love solution to the "uninsured" issue: "No insurance, no medical care. Have a nice day. NEXT IN LINE!" At this point I would much appreciate learning your thoughts on the matter.

Unfortunately, when the ACA went into effect the feds made it our problem, at least for some people. Prior to the ACA it was possible to get limited coverage insurance plans with relatively high deductibles that did not cost an arm and a leg. The ACA--or at least its implementing regulations--outlawed all these plans, and the administration said they were issued by "bad apple insurers." In fact, they allowed people--particularly young people without health insurance at their jobs--to have insurance that would cover the really big costs.

The ACA/regulations eliminated these plans not because they were bad but because (1) they did not cover some costs the administration said needed to be covered; and (2) the design was to force lots of healthy people into the ACA marketplace, so their premiums would cover the costs of the many unhealthy people who they knew would be signing up.

The entire design, of course, proved to be defective, and now most ACA marketplace plans are facing financial catastrophe (it turns out that allowing people to sign up for insurance only when they desperately need it is not a sustainable business model--who could have foreseen that?). In addition, there are a huge number of people who are unable to afford any insurance (especially including the ACA plans), including all those who work in restaurants and found their hours cut to part time so the restaurants didn't have to cover healthcare (who knew that restaurants had low operating profit margins?).

Anyway, there are a lot of people--especially kids in their 20's--who would love to sign up for low cost, relatively low benefit plans who cannot do so because the US government has declared them to be illegal.

In other words, this is a mess that is at least in part of our own making (and I would argue it is mainly of our own making since, from the Great Society on the US government has been doing its best to create a huge culture of dependency).

Sensei

07-09-2018, 08:49 AM

Seems legit. We all know the poor have no rights , being left to die will teach them the error of their ways. I bet that every single person the hospitals leave to die will never be back without money or insurance.

Nah, poor people have rights. They just don’t have money.

Wayne Dobbs

07-09-2018, 08:50 AM

During my LE career, I got into several physical fights in the ER. My most fun was rendering a DWI arrestee unconscious in the ER after he was discharged by the charge nurse. Said drunk had called the charge nurse the C word and she slapped a butterfly or two on about an eight stitch head lac. When he figured out he wasn't getting to stay and was on the way to jail, the fight was on. Did the standard (at that time) lateral neck hold, cuffed and drug him out. There has been at least two or three OISs at Parkland's ER in Dallas over the years. Most involved a snatched police pistol and the attendant response. ERs are not safe places.

Duces Tecum

07-09-2018, 09:14 AM

Duces, many would say that your solution is mean sprited and would further exclaim that it places an unfair burden on persons in that broad category of the poor or afflicted or homeless or dispossesed or mentally challenged or mentally ill or whatever.

Willie, right now I cannot think of a society that uses the power of the state to guarantee equal outcomes. To put this into perspective, there are 193 countries in the United Nations and as far as I know none of them use their own money to equalize the "life" results of their citizens. That's the job of charities and NGOs. Charities, with their voluntary contributions, are free to equalize to their heart's content.

And then these same individuals would say in a patronizing manner that even though the mother with the sigh is wasting money that she begged, she has the right to spend it as she wishes. Then they would say that your point is not relevant. That's our culture today.

They'd be wrong, wouldn't they? When somebody spends limited resources to buy frivolities instead of necessities I think they lack standing to approach others and say, "I don't have the necessities. You must buy them for me!" I cannot imagine how that point could have been unintentionally missed.

TGS

07-09-2018, 09:37 AM

Emergency room violence

Not too make super light of this - but I can see why...I just saw the claim amount filed to my insurance for four stitches, a tetanus shot, and a six hour wait to get sewn up was nearly $3800. That's $633 an hour in costs.

I went into the wrong damn line of work.

I can't wait to see how much of this I'm on the hook for. :(

Completely serious here....you could just not pay the bill.

It's what everyone else does. :p

When I was under the care of the VA, I had an appendectomy at a local hospital which is a covered necessity by the VA. They didn't take responsibility for the bill for about 9 months, because after 6 months almost all of the bills were written off as charity. So instead of negotiating a $60k hospital stay down to a few grand (yes, you read that right, a simply appendectomy and two overnights was $60k), they only had to negotiate the remaining $5k in bills down to a few hundred dollars.

blues

07-09-2018, 10:05 AM

Completely serious here....you could just not pay the bill.

It's what everyone else does. :p

When I was under the care of the VA, I had an appendectomy at a local hospital which is a covered necessity by the VA. They didn't take responsibility for the bill for about 9 months, because after 6 months almost all of the bills were written off as charity. So instead of negotiating a $60k hospital stay down to a few grand (yes, you read that write, a simply appendectomy and two overnights was $60k), they only had to negotiate the remaining $5k in bills down to a few hundred dollars.

Nothing like the gov't welshing on its obligations. Does a body proud.

/sarcasm

Sensei

07-09-2018, 10:24 AM

Completely serious here....you could just not pay the bill.

As someone who is pretty savvy when it comes to healthcare billing, I completely acknowledge that the current situation is a mess of rampant overcharging, heterogeneity, and poor transparency. However, not paying your bill is far more likely to hurt you than the hospital. Now, more than ever, hospitals are sending delinquent bills to external collections which can be a bitch if you value your credit score (if you don’t, stop reading and ignore the bill).

I’ve already said that what has been posted sounds strange. A simple lac repair requiring 4 sutures to the hand is generally billed out to the tune of $1000-2000. Now, there is a big difference in what is billed to insurance, what your insurance pays, and how much of the outstanding balance is payed by the patient. Thus, my strong recommendation is that someone getting an outrageous hospital bill call the institution and ask for an itemized statement. You’d be surprised how often billing errors occur. Once you have your statement, see how much your insurance covers and if you are responsible for any balance. If you are being balanced billed for a fortune, make some calls to your insurance and the hospital to make sure your coverage is paying their responsible share and if the hospital might be willing to adjust down the balance.

It should not be this way, but sometimes a couple of hours on the phone or at the hospital billing office can save you a Wilson CQB worth of cash...

RevolverRob

07-09-2018, 10:29 AM

As someone who is pretty savvy when it comes to healthcare billing, I completely acknowledge that the current situation is a mess of rampant overcharging, heterogeneity, and poor transparency. However, not paying your bill is far more likely to hurt you than the hospital. Now, more than ever, hospitals are sending delinquent bills to external collections which can be a bitch if you value your credit score (if you don’t, stop reading and ignore the bill).

I’ve already said that what has been posted sounds strange. A simple lac repair requiring 4 sutures to the hand is generally billed out to the tune of $1000-2000. Now, there is a big difference in what is billed to insurance, what your insurance pays, and how much of the outstanding balance is payed by the patient. Thus, my strong recommendation is that someone getting an outrageous hospital bill call the institution and ask for an itemized statement. You’d be surprised how often billing errors occur. Once you have your statement, see how much your insurance covers and if you are responsible for any balance. If you are being balanced billed for a fortune, make some calls to your insurance and the hospital to make sure your coverage is paying their responsible share and if the hospital might be willing to adjust down the balance.

It should not be this way, but sometimes a couple of hours on the phone or at the hospital billing office can save you a Wilson CQB worth of cash...

Oh yea, fully agree.

$3800 is the amount that was claimed to my insurance. Once that claim is "processed" and I receive an itemized notice from the insurance company - I'll request an itemized bill from the hospital as well and I'll get down to brass tacks.

The good news is, I'm reasonably sure everything is covered, except my deductible and the ER co-pay. Which I'm fine with, that's the (unfortunate) cost of doing business these days.

Sensei

07-09-2018, 10:57 AM

Oh yea, fully agree.

$3800 is the amount that was claimed to my insurance. Once that claim is "processed" and I receive an itemized notice from the insurance company - I'll request an itemized bill from the hospital as well and I'll get down to brass tacks.

The good news is, I'm reasonably sure everything is covered, except my deductible and the ER co-pay. Which I'm fine with, that's the (unfortunate) cost of doing business these days.

Feel free to PM me if you need help deciphering what I refer to as “medical bill speak.”

willie

07-09-2018, 11:02 AM

HCountyGuy

07-09-2018, 11:37 AM

VT1032

07-09-2018, 12:11 PM

Before I had back surgery, I told my surgeon that if the hospital padded my bill with items and services not used, then I would protest and challenge the bill. It pissed him off. Yes the hospital did pad my bill, which I then considered to be fraud. Using tact and diplomacy, I proceeded, accomplished my aim, and pissed off a few other people.

When I got my bill for our kid's birth, I noticed we were billed for multiple visits by a "lactation consultant". We made clear up front that we were formula feeding and were not visited by any lactation consultant. They refused to remove the charges. We were also billed by two seperate hospitals and one private company for services recieved in the one hospital and were turned over to a collection agency for bills we never recieved, and which were never billed to our insurance. My first notification that I owed these bills was a call from the collection agency. This was after the hospital billing manager provided an email stating that I owed the hospital nothing else. When I went to the hospital's billing department to try and clear this up, they said I would have to deal with the collection agency and refused to pull the charges back and bill my insurance. When I refused to leave without answers they called security and tried to have me thrown out of the building. I hadn't even lost my shit or anything, this was because I refused to take that as an answer and leave. Luckily, the "security" is off duty local cops working a side gig and the guy who responded was a buddy who went through the part time academy with me and he flatly refused to trespass me after hearing the situation. I have been a patient with that group of practices since 2004 and after being treated that way, I quit and found a new doctor outside their group. I now drive 40 minutes instead of 5, but I wasn't going to give them another dime. I sent a letter to their President and their CFO explaining why I was leaving and never recieved a response.

Sensei

07-09-2018, 12:49 PM

There’s obviously some need of a bit of oversight to keep hospitals from financially ruining their patients lives with unnecessary crap.

Hell the last time I went to an ER (8 years ago) I wound up with about $1200 in bills for basically nothing. Granted I was also uninsured. I went in after getting bitten by a shoplifter’s accomplice (a story I’ve relayed here) just to get it checked out, so it wasn’t exactly an emergency. I was there no more than 30 minutes, got a tetanus shot and they bandaged where I got bit. But $1200? A bit ridiculous.

Keep in mind that the facility overhead fee for registering in the ED is about $200. That doesn’t even cover my bill, treatments, or any testing, but it does cover a complementary warm blanket and turkey sandwich if you’re homeless and nice to the nurse.

The emergency department is where you go to have your life, limb, or major organ function saved. It is not the place to get minor stitches, sprains, and strains addressed unless you are willing to pay a premium for the convenience of having the most technologically advanced care in the world brought to bear 24/7 by the most skilled doctors in your region. An urgent care or your PCP is where you go to get checked out. If an urgent care is not open because it’s 2AM, then I suggest waiting at home 5 hours until one opens rather than spending a similar time in our waiting room.

farscott

07-09-2018, 01:07 PM

As someone who is pretty savvy when it comes to healthcare billing, I completely acknowledge that the current situation is a mess of rampant overcharging, heterogeneity, and poor transparency. However, not paying your bill is far more likely to hurt you than the hospital. Now, more than ever, hospitals are sending delinquent bills to external collections which can be a bitch if you value your credit score (if you don’t, stop reading and ignore the bill).

I’ve already said that what has been posted sounds strange. A simple lac repair requiring 4 sutures to the hand is generally billed out to the tune of $1000-2000. Now, there is a big difference in what is billed to insurance, what your insurance pays, and how much of the outstanding balance is payed by the patient. Thus, my strong recommendation is that someone getting an outrageous hospital bill call the institution and ask for an itemized statement. You’d be surprised how often billing errors occur. Once you have your statement, see how much your insurance covers and if you are responsible for any balance. If you are being balanced billed for a fortune, make some calls to your insurance and the hospital to make sure your coverage is paying their responsible share and if the hospital might be willing to adjust down the balance.

It should not be this way, but sometimes a couple of hours on the phone or at the hospital billing office can save you a Wilson CQB worth of cash...

Here is my anecdote. My wife had a surgery that we coordinated with the insurance company beforehand, so that it would be approved. Part of that was paying our portion the day before, a bit over $1000. No issues. Wife has the surgery, and we get a bill from the hospital. This is not counting the bills we get from the anesthesiologist and the surgeon. Hospital bill shows we owe over $1800. Call hospital to get itemized bill. Never came. Finally schedule conference call with hospital accounts receivable and insurance company after threatening to report hospital for insurance fraud. All parties agree we owe the hospital nothing. Hospital sends us (insurance company and me) that in writing on letterhead.

Hospital "business affairs office" calls once per month, asks for the $1800, I tell them about the conference call result in writing that shows we owe nothing, they note it says that in my wife's file, and I repeat the request for the itemized billing. Never got the itemized bill.

I wonder how many people pay twice.

willie

07-09-2018, 02:48 PM

Historically, hospitals have justifiied bill padding with this logic: doing so helps pay for services rendered to those who don't or can't pay. Some billing padding results from errors. In my surgeon's case, his office sent a bill that violated his contract with the insurance company, which informed me after I continued to question why it was not payed. Fixing this misunderstanding required sending the surgeon a registered letter explaining my objection to pay. His clerk is an intelligent person who had ample opportunity to resolve the issue but did not. Hence, I think that the error was intentional. I would have eventually paid the bill but would have written scores of letters to scores of agencies until I tired of writing them.

Nephrology

07-09-2018, 02:51 PM

Here is my anecdote. My wife had a surgery that we coordinated with the insurance company beforehand, so that it would be approved. Part of that was paying our portion the day before, a bit over $1000. No issues. Wife has the surgery, and we get a bill from the hospital. This is not counting the bills we get from the anesthesiologist and the surgeon. Hospital bill shows we owe over $1800. Call hospital to get itemized bill. Never came. Finally schedule conference call with hospital accounts receivable and insurance company after threatening to report hospital for insurance fraud. All parties agree we owe the hospital nothing. Hospital sends us (insurance company and me) that in writing on letterhead.

Hospital "business affairs office" calls once per month, asks for the $1800, I tell them about the conference call result in writing that shows we owe nothing, they note it says that in my wife's file, and I repeat the request for the itemized billing. Never got the itemized bill.

I wonder how many people pay twice.

Anecdotally, I've absolutely been screwed twice for the same procedure or appointment, in moments of my life when I simply didn't have the time/energy/etc to fight it.

RevolverRob

07-09-2018, 03:17 PM

My wife used to work as an accounts manager and auditor for a company that took hospital bills and translated them to the insurance coverage of patients and then issued them on to the insurance company to be paid (or if they had authorization, they paid them on behalf of the insurance company). It was a complete and utter - clusterfuck - of truly epic proportions.

Every day something else happened that screwed something else up.

My wife is a notoriously OCD person when it comes to money. She's a penny counter, literally, balancing her books down to the penny. When she was hired, she was hired as an internal auditor of all accounts at the firm, which had grown from a seven person firm to a seventy person firm in 5 years and had never done an internal audit. Suffice to say - there were A LOT of errors, billing, pay, unexplained coverages, post-dates, back-dates, a lot of issues that were ignored by management, until they couldn't be anymore. She spent 18-months putting their books largely in order, rebuilding their databases, and restructuring their access protocols (anyone in the company could edit the database, without knowledge of who edited it) and exposed at least one person embezzling in the process. After 18-months of work to correct these issues - they asked her to leave the company, because she was "causing" too many problems for them to fix. Fortunately, she knew it was coming and got a better job elsewhere, just as they asked her to leave.

I absolutely, fully, and completely, believe that insurance companies and hospitals don't bill things right. Most of them aren't even running internal audits regularly or balancing their books regularly. Most places have no business managing money and billing simultaneously, but do so out of necessity.

Duelist

07-09-2018, 04:04 PM

Keep in mind that the facility overhead fee for registering in the ED is about $200. That doesn’t even cover my bill, treatments, or any testing, but it does cover a complementary warm blanket and turkey sandwich if you’re homeless and nice to the nurse.

The emergency department is where you go to have your life, limb, or major organ function saved. It is not the place to get minor stitches, sprains, and strains addressed unless you are willing to pay a premium for the convenience of having the most technologically advanced care in the world brought to bear 24/7 by the most skilled doctors in your region. An urgent care or your PCP is where you go to get checked out. If an urgent care is not open because it’s 2AM, then I suggest waiting at home 5 hours until one opens rather than spending a similar time in our waiting room.

Last time I needed stitches, I went to Urgent Care. I was in and out in less than an hour, and paid $60. That might have been my deductible, I don’t remember, but I never received another bill. My responsibility was fulfilled with comparative pocket change.

Sensei

07-09-2018, 04:35 PM

Last time I needed stitches, I went to Urgent Care. I was in and out in less than an hour, and paid $60. That might have been my deductible, I don’t remember, but I never received another bill. My responsibility was fulfilled with comparative pocket change.

I just Googled “cost of stitches” and “at urgent care vs. emergency department” auto-populated. The search yielded multiple articles and websites indicating the substantial cost savings of an urgent care ($250 vs. $2000 avg). A search of “cheapest place to get stitches” yielded similar results.

Folks, part of the reason why healthcare is so expensive is because people who wouldn’t buy a Gen 5 Glock 19 without spending 5 hours combing through the threads on P-F.com do not perform a 30 second Google search when it’s time to have their healthcare needs addressed.

Stephanie B

07-09-2018, 08:50 PM

I proffer a slight modification. Insurance shouldn't be a gateway to medical care, because insurance is one of the reasons why medical care is so damned expensive.
Pardon me for not crying for the hospitals.

About 10 years ago. I went into their emergency room because of excruciating stomach pain (having been cleared to do so by the duty nurse at the insurance company). What I remember was that the total bill was close to $9,000. Insurance repriced it down to about $1,100, in my co-pay was $475.

So they were happy to knock 88% off the bill because I had insurance, but if I didn’t have insurance, they would have wanted me to pay $9000. And they would’ve gone after me for that amount.

Is that fair? In a pig’s eye, it is.

RevolverRob

07-09-2018, 09:44 PM

I just Googled “cost of stitches” and “at urgent care vs. emergency department” auto-populated. The search yielded multiple articles and websites indicating the substantial cost savings of an urgent care ($250 vs. $2000 avg). A search of “cheapest place to get stitches” yielded similar results.

Folks, part of the reason why healthcare is so expensive is because people who wouldn’t buy a Gen 5 Glock 19 without spending 5 hours combing through the threads on P-F.com do not perform a 30 second Google search when it’s time to have their healthcare needs addressed.

The four urgent care clinics in my neighborhood all close at 5pm or earlier. Including the one run by the hospital. I called the to make sure they were closed and the phone message informed me that all after-hours Urgent Care needs are serviced by the ED. A second call to the University Professional Clinic, also confirmed that all students/employees with urgent care needs are 'supposed' to use the ED after hours.

Leaving me with a choice of driving an extended distance during traffic to find an Urgent Care that was open or going to the ED.

If Urgent Care is the solution to most ED calls - why don't hospital Urgent Care facilities stay open 24-hours and EDs redirect traffic to them?

FYI - this is partly a local issue that is coming to bear here. South side of Chicago has a dearth of medical care facilities, including Urgent Care facilities which are open after 5pm. If one lives on the north side of Chicago, there are Urgent Care rooms open 24/7.

In retrospect, the lesson I learned is - sew yourself up. :rolleyes:

Sensei

07-09-2018, 09:52 PM

Pardon me for not crying for the hospitals.

About 10 years ago. I went into their emergency room because of excruciating stomach pain (having been cleared to do so by the duty nurse at the insurance company). What I remember was that the total bill was close to $9,000. Insurance repriced it down to about $1,100, in my co-pay was $475.

So they were happy to knock 88% off the bill because I had insurance, but if I didn’t have insurance, they would have wanted me to pay $9000. And they would’ve gone after me for that amount.

Is that fair? In a pig’s eye, it is.

More information is required to determine if it was fair. What tests were performed? What treatments were provided? Were any procedures performed?

Keep in mind that a first class seat on a 9 hour flight to Europe costs about the same or more than the amount that your insurance was billed.

With that perspective in mind, you might have received a CT scan or ultrasound; tests that are not even available in many countries but may have been afforded to you that same day for less than the cost of a Wilson BrigTac. Multiple laboratory tests were probably ordered and run STAT to be available to your doctor within an hour; labs that generally take 2 days to run from a clinic. Moreover, you were probably given IV fluids, parenteral analgesia, and maybe antiemetics. In China they would have likely given you some magwa root to chew on to palliate your symptoms.

In other words, you probably received first class care that relatively few humans on the planet have access to in an attempt to identify a condition THAT MIGHT KILL YOU. Along with that, you were cared for by a team of highly educated and trained professionals (nurse, doctors, techs, secretaries, etc.) who were prepared to perform all manner of heroic procedures had they found something more than a wayward fart...all for less than the cost of a first class ticket to Europe. If you want to fly coach then feel free to start chewing on that magwa weed. ;)

Sensei

07-09-2018, 10:00 PM

In retrospect, the lesson I learned is - sew yourself up. :rolleyes:

Nah, just pour some Superglue on that bitch like a patient did a few weeks ago. Don’t even bother washing it out before you smear it on real thick. Hell, rub some motor oil in it to keep it from getting infected.

blues

07-09-2018, 10:05 PM

Nah, just pour some Superglue on that bitch like a patient did a few weeks ago. Don’t even bother washing it out before you smear it on real thick. Hell, rub some motor oil in it to keep it from getting infected.

Oh no you don't...everyone knows you're supposed to use CLP. Thought we weren't paying attention...dintcha?

Nephrology

07-09-2018, 11:13 PM

In other words, you probably received first class care that relatively few humans on the planet have access to in an attempt to identify a condition THAT MIGHT KILL YOU. Along with that, you were cared for by a team of highly educated and trained professionals (nurse, doctors, techs, secretaries, etc.) who were prepared to perform all manner of heroic procedures had they found something more than a wayward fart...all for less than the cost of a first class ticket to Europe. If you want to fly coach then feel free to start chewing on that magwa weed. ;)

To be fair, not every ED is an ACS Level 1 Trauma Center. There are community EDs that don't have 24/7/365 Ortho/TACS/MICU but still charge relatively high prices for services (i.e. freestanding EDs).

I've been on the pointy end of enough medical bills to know that you can do everything right and still hit a big financial pothole. For example, I am smart enough to have declined ambulance transport after I got rear ended in a high mech MVC earlier this month, but in hindsight that was only because I knew enough to be confident that my arm pain didn't warrant an ED trip. If I were like most people and the last time I saw a doctor was on TV, I might have shaken enough to eat a big medical bill for basically no reason, and I'm not sure I could fault them for it.

BCG

07-10-2018, 06:45 AM

... Some billing padding results from errors. ... Hence, I think that the error was intentional. ...

27925 (http://dilbert.com/strip/2011-05-04)

Nephrology

07-10-2018, 07:04 AM

27925 (http://dilbert.com/strip/2011-05-04)

This may or may not be apocryphal, but back in the 90s my mom was friends with the former VP for Blue Cross Blue Shield. Apparently she said it used to be SOP to deny ~1/8 claims regardless of coverage because most people won't fight it. Same woman cited this as the reason she left the health insurance industry.

blues

07-10-2018, 08:13 AM

This may or may not be apocryphal, but back in the 90s my mom was friends with the former VP for Blue Cross Blue Shield. Apparently she said it used to be SOP to deny ~1/8 claims regardless of coverage because most people won't fight it. Same woman cited this as the reason she left the health insurance industry.

I don't doubt it. Back in 1997 it took me at least six months or more to get Blue Cross to approve a minor emergency room visit in Breckenridge, TX for a detached tendon in the tip of a finger which occurred during a motorcycle trip.

Speaking to them on the phone they told me that the record didn't indicate that it was a "traumatic onset" or "accident" or such...I told them, yeah, you're right, I actually detached the tendon while home in FL but figured the ER in Breckenridge would be less crowded. So I rode up a couple thousand miles. :rolleyes:

I called the hospital in TX a few times to assure them that I wasn't a deadbeat and tried to get them to actually talk to the insurance company. (A virtual impossibility as I found out.) Eventually the matter was fully satisfied at no cost to me.

It so happened that the ER in Breckenridge was less crowded. I was the only one there when I arrived and had to wake up the attending physician who was sleeping on a gurney. LOL!

Sensei

07-10-2018, 09:16 AM

To be fair, not every ED is an ACS Level 1 Trauma Center. There are community EDs that don't have 24/7/365 Ortho/TACS/MICU but still charge relatively high prices for services (i.e. freestanding EDs).

No matter how you cut it, Americans demand and get luxury healthcare across the country. Even at the most rural critical access hospital in Alaska there is a CT scanner and helicopter (via Coast Guard) to shuttle the poorest among us to higher levels of care. The proliferation of free standing EDs is perhaps the worst example of excess; we wouldn’t want someone in an affluent zip code to drive 10 minutes to the hospital- especially the competition’s hospital.

In the US there are 50 CT scanners per million people. The only country beating us is Japan where most of the world’s scanners are built. In Greece there is less than half that number. Why? Because Americans put a premium on access to life saving and expensive technology. We get pissed when the expensive tests are not performed.

The disconnect comes when it’s time to pay the bill. Americans will not think twice paying a $10k bill to go on vacation or for good seats at the Super Bowel. However, paying that much to determine if you had a heart attack sparks statements about “fairness.” Learning that everything was just gas often leads to statements like, “the doctors are idiots and the hospital did nothing for me.” My point is that if people want budget care, then move to a country like Greece where the public hospitals look like shit and your family must bring you food if you’re going to eat.

One last word about being told to go the ED by nurses and paramedics. This advice is generally worth what you pay for it. Lots of people get taken to the cleaners following the bad (and often free) real estate, investment, and legal advice. Healthcare is no different. If you want expert medical advice over the phone, hire a concierge doctor. We are ultimately all responsible for our own risks and decisions.

secondstoryguy

07-10-2018, 09:47 AM

One of the big things I see in the emergency room is the unwillingness to mechanically or chemically restrain uncooperative/mentally compromised patients. Having worked in the medical field back in the 90s, medical staff nowadays seems to be a lot more heistiant to restrain patients now. My buddies who currently work in the medical field say that this is due to liability and staffing(sedation and restraints require closer monitoring).

Nephrology

07-10-2018, 10:39 AM

No matter how you cut it, Americans demand and get luxury healthcare across the country. Even at the most rural critical access hospital in Alaska there is a CT scanner and helicopter (via Coast Guard) to shuttle the poorest among us to higher levels of care. The proliferation of free standing EDs is perhaps the worst example of excess; we wouldn’t want someone in an affluent zip code to drive 10 minutes to the hospital- especially the competition’s hospital.

In the US there are 50 CT scanners per million people. The only country beating us is Japan where most of the world’s scanners are built. In Greece there is less than half that number. Why? Because Americans put a premium on access to life saving and expensive technology. We get pissed when the expensive tests are not performed.

The disconnect comes when it’s time to pay the bill. Americans will not think twice paying a $10k bill to go on vacation or for good seats at the Super Bowel. However, paying that much to determine if you had a heart attack sparks statements about “fairness.” Learning that everything was just gas often leads to statements like, “the doctors are idiots and the hospital did nothing for me.” My point is that if people want budget care, then move to a country like Greece where the public hospitals look like shit and your family must bring you food if you’re going to eat.

I don't disagree with your basic premise, and it's an argument that I make all the time: the kind of healthcare that Americans expect is inherently expensive, regardless of how it is funded. As much as many on the left tout the advantages of a single payer system, the NHS is grappling with exactly the same problems that plague our healthcare system: runaway costs due to increased healthcare consumption by an aging population, compounded by grossly inefficient utilization of resources and a deficit of trained providers. It's clear that these problems are inherent to the kind of healthcare we have come to expect in the global, first world society, and I don't think there is much of a way around that.

That said, I don't think that comparing the pricing of US healthcare to Superbowl tickets or a 1st class flight to Italy is really fair. Unlike vacation timeshares, healthcare is perhaps the most inelastic good on the market. Most people, including you and I, are likely to do whatever it takes (and pay whatever it costs) to get better when we are sick. This precludes a lot of rational consumer behavior we engage in when buying other goods, like price-shopping or deferring a purchase if it seems beyond our budget. As an extreme example, unresponsive patients brought into the ED have no say in their medical decision making at all, unless you count DNR bracelets/advanced directives.

The problem is that when this dynamic gets coupled with the "mess of rampant overcharging, heterogeneity, and poor transparency" that you cite, it arouses often justifiable anger and frustration, particularly given the imbalance of information inherent to the medical market. To continue your example, it shouldn't be considered the patient's fault if they call a nursing line and get told to go to the ED for a frivolous reason, particularly in vulnerable populations who are aware they are predisposed to medical risk (e.g. hem/onc patients) and instructed to call the nursing line/fellow on call if they are worried. In my opinion, that's a failure of the profession, and not of personal responsibility.

I don't pretend to have a better way of doing things, nor do I disagree really with your basic argument. However, I do think it's important to not forget that most folks are doing the best they can with what they have, and we can't expect everyone to be an expert at a system that still confuses the shit out of me after ~30 years of frequent flying. Just my 0.02 USD, as usual.

Totem Polar

07-10-2018, 11:19 AM

At least with the bowl tickets or the flight, you can find out what the price is before you click the buy button (or it gets clicked for you). That is a collosal fucking difference between luxury purchases and healthcare.

RoyGBiv

07-10-2018, 11:27 AM

I don't disagree with your basic premise, and it's an argument that I make all the time: the kind of healthcare that Americans expect is inherently expensive, regardless of how it is funded. As much as many on the left tout the advantages of a single payer system, the NHS is grappling with exactly the same problems that plague our healthcare system: runaway costs due to increased healthcare consumption by an aging population, compounded by grossly inefficient utilization of resources and a deficit of trained providers. It's clear that these problems are inherent to the kind of healthcare we have come to expect in the global, first world society, and I don't think there is much of a way around that.

That said, I don't think that comparing the pricing of US healthcare to Superbowl tickets or a 1st class flight to Italy is really fair. Unlike vacation timeshares, healthcare is perhaps the most inelastic good on the market. Most people, including you and I, are likely to do whatever it takes (and pay whatever it costs) to get better when we are sick. This precludes a lot of rational consumer behavior we engage in when buying other goods, like price-shopping or deferring a purchase if it seems beyond our budget. As an extreme example, unresponsive patients brought into the ED have no say in their medical decision making at all, unless you count DNR bracelets/advanced directives.

The problem is that when this dynamic gets coupled with the "mess of rampant overcharging, heterogeneity, and poor transparency" that you cite, it arouses often justifiable anger and frustration, particularly given the imbalance of information inherent to the medical market. To continue your example, it shouldn't be considered the patient's fault if they call a nursing line and get told to go to the ED for a frivolous reason, particularly in vulnerable populations who are aware they are predisposed to medical risk (e.g. hem/onc patients) and instructed to call the nursing line/fellow on call if they are worried. In my opinion, that's a failure of the profession, and not of personal responsibility.

I don't pretend to have a better way of doing things, nor do I disagree really with your basic argument. However, I do think it's important to not forget that most folks are doing the best they can with what they have, and we can't expect everyone to be an expert at a system that still confuses the shit out of me after ~30 years of frequent flying. Just my 0.02 USD, as usual.

Great post..

I believe transparency is key and forcing consumers to see and feel the cost of healthcare decisions is a critical part of reinforcing transparency. What good is a Doctor publishing rates when the end consumer doesn't have to pay anything approaching what's on the bill?

I don't have any idea what percentage of total healthcare costs are for exams and sniffles, compared to trauma care and serious things like heart attacks and cancer... But I'm betting the number of incidences of consumers interacting with a healthcare provider for the sniffles and routine stuff far outnumbers the more expensive interactions. So let's start by requiring transparency and changing consumer behaviors at the routine office visit first....

Every Doctor should be required to publish (somewhere accessible) a rate chart. Rates should be net of insurance discounts, by insurer. I know that would be a complex chart, but, fuck it... it's necessary. Next, we need to do away with zero-deductibles and artificially low co-pays, except for wellness visits. From the first visit of the year, consumers should see a bill that makes it clear what the provider is getting paid for the service and the consumer should have to pay 100% of the negotiated (by the insurer) fee out of pocket. Run that up to some reasonable out of pocket max before some insurance payments kick in... Today a plan like that is called a HDHP (high deductible healthcare plan). Most consumers would save the bulk of their deductible out of paying lower insurance rates for this type of plan and stick the savings in a HSA (healthcare saving account). It's the first best step in "requiring" consumers to face the real cost of healthcare, rather than a $40 co-pay on a plan where the real costs are hidden under their employers healthcare expense line.

We switched to a HDHP maybe 8 years ago and it changed the way we consume healthcare. I have zero tolerance for bad service, long waiting room times, etc. when I'm paying $180 out of pocket for an office visit. There are some great docs-in-a-box near me. No appointment. Call, wait at home, they call me when they're ready, no more than 10 minutes in the waiting room. We take the kids to the family practice doc for wellness visits, vaccinations and anything we think might be better served with some family history.

The old story of how much more efficiency and cost reduction we've experienced in elective eye surgery... because customers write the check for the full cost. Until there's similar visibility to other healthcare costs, behaviors will never change.

Totem Polar

07-10-2018, 11:38 AM

Every Doctor should be required to publish (somewhere accessible) a rate chart. Rates should be net of insurance discounts, by insurer. I know that would be a complex chart, but, fuck it... it's necessary.

https://media.giphy.com/media/7rj2ZgttvgomY/giphy.gif

Nephrology

07-10-2018, 11:48 AM

https://media.giphy.com/media/7rj2ZgttvgomY/giphy.gif

That list does already exist (https://en.wikipedia.org/wiki/Chargemaster). You just won't like it what it has to say.

It also is typically meaningless because the true billed amount is negotiated between your insurance company and the hospital in advance and not usually information privy to the average consumer. This is one of the defining features of a provider being "in network" vs "out of network," and why out of network care is so much more expensive.

We switched to a HDHP maybe 8 years ago and it changed the way we consume healthcare. I have zero tolerance for bad service, long waiting room times, etc. when I'm paying $180 out of pocket for an office visit. There are some great docs-in-a-box near me. No appointment. Call, wait at home, they call me when they're ready, no more than 10 minutes in the waiting room. We take the kids to the family practice doc for wellness visits, vaccinations and anything we think might be better served with some family history.

To give you some gentle pushback from Sensei's direction, it's worth knowing that usually you aren't going to be kept waiting for an appointment out of provider laziness.

To keep the lights on, primary care providers often have to book their work days very efficiently - often leaving very little time for individual patient visits. Every patient that shows up and rattles off a list of vague complaints of questionable medical relevance lengthens their stay in the exam room and increases the wait time for patients after them. Not to mention that sometimes appointments go long for perfectly legitimate reasons - explaining scary test results, unexpected medical emergencies, etc.

While medicine is historically a fee for service industry in the US, it can be rankling to be treated like a line cook when you're legitimately doing the best you can, particularly given the amount of sweat and blood that goes into becoming a physician or nurse. Medicine is more art than science, as they say, and you can't expect it it to always follow the same schedule as your mechanic or favorite restaurant.

Totem Polar

07-10-2018, 11:57 AM

That list does already exist (https://en.wikipedia.org/wiki/Chargemaster). You just won't like it what it has to say.

It also is typically meaningless because the true billed amount is negotiated between your insurance company and the hospital in advance and not usually information privy to the average consumer. This is one of the defining features of a provider being "in network" vs "out of network," and why out of network care is so much more expensive.

"In the United States, the chargemaster, also known as charge master, or charge description master (CDM), is a comprehensive listing of items billable to a hospital patient or a patient's health insurance provider. In practice, it usually contains highly inflated prices at several times that of actual costs to the hospital.[1][2][3] The chargemaster typically serves as the starting point for negotiations with patients and health insurance providers of what amount of money will actually be paid to the hospital. It is described as "the central mechanism of the revenue cycle" of a hospital.

Chargemasters include thousands of hospital services, medical procedures, equipment fees, drugs, supplies, and diagnostic evaluations such as imaging and blood tests.[6] Each item in the chargemaster is assigned a unique identifier code and a set price that are used to generate patient bills.[6] Every hospital system maintains its own chargemaster.[6] Usually, hospitals regard their chargemaster, alongside the medical codes that catalogue the billing items, as a trade secret that is central to their business, and state laws and courts have often accepted the view that these are proprietary information."

I have heard of chargemaster, and you are correct: I don’t like what it has to say.

Nephrology

07-10-2018, 12:04 PM

"In the United States, the chargemaster, also known as charge master, or charge description master (CDM), is a comprehensive listing of items billable to a hospital patient or a patient's health insurance provider. In practice, it usually contains highly inflated prices at several times that of actual costs to the hospital.[1][2][3] The chargemaster typically serves as the starting point for negotiations with patients and health insurance providers of what amount of money will actually be paid to the hospital. It is described as "the central mechanism of the revenue cycle" of a hospital.

Chargemasters include thousands of hospital services, medical procedures, equipment fees, drugs, supplies, and diagnostic evaluations such as imaging and blood tests.[6] Each item in the chargemaster is assigned a unique identifier code and a set price that are used to generate patient bills.[6] Every hospital system maintains its own chargemaster.[6] Usually, hospitals regard their chargemaster, alongside the medical codes that catalogue the billing items, as a trade secret that is central to their business, and state laws and courts have often accepted the view that these are proprietary information."

I have heard of chargemaster, and you are correct: I don’t like what it has to say.

You aren't the only person. Alternative insurance-free approaches have been tried, with mixed (https://www.npr.org/sections/health-shots/2017/06/20/533562142/a-pioneer-in-flat-fee-primary-care-had-to-close-its-clinics-what-went-wrong) success (http://time.com/4649914/why-the-doctor-takes-only-cash/).

Jim Watson

07-10-2018, 12:23 PM

Example:
When I passed out at a shooting match this time last year, I eventually got a statement.
It showed total charges of nearly $25,000 for an afternoon in the ER, labs, CAT scan.
"Adjustments" were over $24,000; Medicare paid something above $500, I paid $138.
It is hard for me to see how they could charge so much and settle for such a small fraction.

Ambulance service was separate and I had to pay around $100, which seemed not bad for the ambulance, fire engine, and crews.

RoyGBiv

07-10-2018, 01:20 PM

It also is typically meaningless because the true billed amount is negotiated between your insurance company and the hospital in advance and not usually information privy to the average consumer.
I thought I tried to acknowledge this in my previous reply, but maybe I was too subtle.
As for negotiated prices being confidential, I'll settle for a list of rates posted on my insurance company web site for my specific providers. I know that has to exist already, since providers get paid based on those negotiated rates. Just put it in a table with a code chart and descriptions, so I can read it.

To give you some gentle pushback from Sensei's direction, it's worth knowing that usually you aren't going to be kept waiting for an appointment out of provider laziness.

To keep the lights on, primary care providers often have to book their work days very efficiently - often leaving very little time for individual patient visits. Every patient that shows up and rattles off a list of vague complaints of questionable medical relevance lengthens their stay in the exam room and increases the wait time for patients after them. Not to mention that sometimes appointments go long for perfectly legitimate reasons - explaining scary test results, unexpected medical emergencies, etc.
I always call right before I head out for an appointment.

"Hi, this is RGB and I have a 3:15 with Dr. Jekyll. How are you doing on the schedule this afternoon? I'd prefer to wait at home if you're running late today."

When I'm told they're running on time, show up 5 minutes later, 10 minutes before my appointment, then made to wait 45 minutes or more (habitually) past my appointment time, I'm going to find a provider that better respects my time. I'm willing to be flexible. I know stuff happens. I think I have reasonable expectations and am willing to do my part to mitigate schedule changes. Just don't bullshit me or take me for granted.

Sensei

07-10-2018, 02:10 PM

"In the United States, the chargemaster, also known as charge master, or charge description master (CDM), is a comprehensive listing of items billable to a hospital patient or a patient's health insurance provider. In practice, it usually contains highly inflated prices at several times that of actual costs to the hospital.[1][2][3] The chargemaster typically serves as the starting point for negotiations with patients and health insurance providers of what amount of money will actually be paid to the hospital. It is described as "the central mechanism of the revenue cycle" of a hospital.

Chargemasters include thousands of hospital services, medical procedures, equipment fees, drugs, supplies, and diagnostic evaluations such as imaging and blood tests.[6] Each item in the chargemaster is assigned a unique identifier code and a set price that are used to generate patient bills.[6] Every hospital system maintains its own chargemaster.[6] Usually, hospitals regard their chargemaster, alongside the medical codes that catalogue the billing items, as a trade secret that is central to their business, and state laws and courts have often accepted the view that these are proprietary information."

I have heard of chargemaster, and you are correct: I don’t like what it has to say.

Before cementing an opinion, realize that every successful industry charges its customers “highly inflated prices at several times that of actual costs.” That is called covering your expenses and doing business. Moreover, no industry lists their costs next to the price being charged.

In addition, keep in mind that top performing hospitals operate at ~5% profit margins; most hospitals are barely breaking even. Any cuts to revenue will necessarily lead to cuts in service lines.

The reason why the amount billed to your insurance and you is so high is due to a business model called profit sharing whereby hospitals must use profits from insured patients to cover expenses from patients who are sheltered by price controls.

willie

07-10-2018, 06:02 PM

Why does my podiatrist make me take my pants off?

blues

07-10-2018, 06:06 PM

Why does my podiatrist make me take my pants off?

Because you had waders on underneath?

willie

07-10-2018, 06:26 PM

And now I understand why you are a detective.

Sensei

07-10-2018, 07:06 PM

Why does my podiatrist make me take my pants off?

Probably for the same reason why every time that you go to the dentist, you wake-up with your pants around your ankles and your head in the spit sink. ;)

mmc45414

07-10-2018, 08:41 PM

Not to mention that sometimes appointments go long for perfectly legitimate reasons - explaining scary test results, unexpected medical emergencies, etc.
In 2011 I had some kind of really serious cardiac deal that could have easily put my dick in the dirt. The cardiologist who became "my" cardiologist, simply because he was the guy that was there when I showed up, is very well regarded (I asked around) and a spectacularly nice guy. When I go to see him I know it is going to be a few hours, but when it is my turn I know I have his focus. And I think he enjoys our visits because I have recovered pretty well (went from EF11% to cycling 100mi) and I know many of his patients never will. But the office walls are probably not thick enough to be HIPA compliant and I have heard bits of conversations that I know cannot be fun for him or the poor dude being referred on for surgery (or not...).

OTOH, when I know I need an antibiotic for a something like a sinus infection, I know I need an antibiotic for a sinus infection because I have had a sinus infection that was solved by antibiotics, I have just started going to urgent care facilities and I think it is well worth the extra $25-$30 in copay. If I am sick enough to seek care I sure do not want to wait, especially until the following day. And I think the urgent care people tend to be more efficient and aggressive anyway, maybe because they know they need to move you through incase the waiting room is filling up.

In regard to cost though, it is even worse if you know how much your COVERAGE costs. For a number of years I worked with my wife at her small business and I took over managing the health care coverage for her. We were both in our fifties and between the premiums and what we were banking in HSA to cover the high deductibles we (since "we" were the company) were paying probably close to $1800mo for the two of us. I tended to have a service expectation level relative to what I knew we were paying in, but when I needed it and spent six days inpatient the care was fantastic. The room was nicer than most hotel rooms I stay in and the food was great, I also didn't croak... :)

dkv

07-10-2018, 09:05 PM

But $1200? A bit ridiculous.

Serious question; how much should it cost?

Think about keeping a major law firm open 24 hours a day to handle any legal problem that decides to walk through the doors, providing the same legal representation to anyone, regardless of their ability to pay. Not just that, but providing legal advice within hours, not next week.

Sent from my iPhone using Tapatalk

willie

07-10-2018, 09:25 PM

Before days of widespread corporate medicine when many physicians owned their own practice, I enjoyed valued doctor-patient relatinships. For example, if I had a sinus infection I could call and ask for an antibiotic scrip and then make an appointment for a followup visit if that were deemed necessary. In such relationships the art aspect of practicing medicine flourished. Another difference between now and then is the emergence of hospitalists, internists who treat hospitalized patients. Today, even though your family practitioner may initiate admitting patients to hospitals, his role then ends. My opinion is that this method marginalizes the family doctor and also limits oppornities for study and practice. It may contribute to dissatisfaction, and it may cement his position at the bottom of the totem pole. Might such be reasons that these physicians have a high burn out rate.

TGS

07-10-2018, 09:37 PM

I don't doubt it. Back in 1997 it took me at least six months or more to get Blue Cross to approve a minor emergency room visit in Breckenridge, TX for a detached tendon in the tip of a finger which occurred during a motorcycle trip.

Speaking to them on the phone they told me that the record didn't indicate that it was a "traumatic onset" or "accident" or such...I told them, yeah, you're right, I actually detached the tendon while home in FL but figured the ER in Breckenridge would be less crowded. So I rode up a couple thousand miles. :rolleyes:

I called the hospital in TX a few times to assure them that I wasn't a deadbeat and tried to get them to actually talk to the insurance company. (A virtual impossibility as I found out.) Eventually the matter was fully satisfied at no cost to me.

It so happened that the ER in Breckenridge was less crowded. I was the only one there when I arrived and had to wake up the attending physician who was sleeping on a gurney. LOL!

Stories like yours and mine (along with countless other Americans) are why it is unethical and morally bankrupt for hospitals to report patients to collections and make it reportable credit. None of the hospitals I knew of in NJ (including the one I worked at) did so for that reason, and I'm perturbed to hear from Sensei that the idea is apparently becoming widespread. Like you I kept in close contact with the hospital, and spent way more than a few hours on a phone and in offices trying to resolve it. Even with the fortunate paycheck I have these days, it'd still be virtually impossible for me to have been able to handle that bill before it would have gone to collections.

Elective procedures? Sure, go to collections on day 31. But a life saving or necessary (and actually very simple) procedure and then charge a person an outrageous, unequivocally unrealistic amount and ruin their credit when they obviously can't pay it?

I can't appropriately express my feelings on that while staying in the forum rules.

blues

07-10-2018, 09:56 PM

Stories like yours and mine (along with countless other Americans) are why it is unethical and morally bankrupt for hospitals to report patients to collections and make it reportable credit. None of the hospitals I knew of in NJ (including the one I worked at) did so for that reason, and I'm perturbed to hear from Sensei that the idea is apparently becoming widespread. Like you I kept in close contact with the hospital, and spent way more than a few hours on a phone and in offices trying to resolve it. Even with the fortunate paycheck I have these days, it'd still be virtually impossible for me to have been able to handle that bill before it would have gone to collections.

Elective procedures? Sure, go to collections on day 31. But a life saving or necessary (and actually very simple) procedure and then charge a person an outrageous, unequivocally unrealistic amount and send them to collections when they obviously can't pay it?

I can't appropriately express my feelings on that while staying in the forum rules.

I see this crap often enough on routine matters.

Every year I take my wife for her routine mammogram. Virtually every year I end up getting a bill in the mail even though it's covered at 100% by my insurance.

The problem is that the folks at the hospital who are responsible for billing are too damned incompetent, (even when told and shown specifically that either the billing address or some such minutiae from the newly issued insurance ID card has changed), to send the billing request to either the correct address...or even the right company. I kid you not.

So, this year, like last year, I have to waste my time trying to get some knucklehead on the line...(good luck with that)...to ensure that the hospital gets paid because their employees are nincompoops.

A year or two ago I actually got one of these letters, vaguely threatening, telling me that I had x number of days to pay the bill. I got the person on the phone and told them that our insurance covered it at 100 percent. She said she saw that on the record but the moron who submitted it checked off a box indicating that we had elected to pay for the procedure out of pocket! WTF? I asked her why in the world would I pay for something out of pocket when it was fully covered and wouldn't effect my annual insurance premium?

Unfuckingbelievable.

TGS

07-10-2018, 10:00 PM

I see this crap often enough on routine matters.

Every year I take my wife for her routine mammogram. Virtually every year I end up getting a bill in the mail even though it's covered at 100% by my insurance.

The problem is that the folks at the hospital who are responsible for billing are too damned incompetent, (even when told and shown specifically that either the billing address or some such minutiae from the newly issued insurance ID card has changed), to send the billing request to either the correct address...or even the right company. I kid you not.

So, this year, like last year, I have to waste my time trying to get some knucklehead on the line...(good luck with that)...to ensure that the hospital gets paid because their employees are nincompoops.

A year or two ago I actually got one of these letters, vaguely threatening, telling me that I had x number of days to pay the bill. I got the person on the phone and told them that our insurance covered it at 100 percent. She said she saw that on the record but the moron who submitted it checked off a box indicating that we had elected to pay for the procedure out of pocket! WTF? I asked her why in the world would I pay for something out of pocket when it was fully covered and wouldn't effect my annual insurance premium?

Unfuckingbelievable.

Bro, we have medical offices send our claims to insurance plans that we had 3 plans ago....plans that we got rid of before we even visited these offices.

We deserve to have our credit ruined because they send our shit to the wrong health insurance and then don't bother to tell us for months?

A hearty "Fuck off" to them. These people don't deserve to be rescued from a burning car.

blues

07-10-2018, 10:06 PM

Bro, we have medical offices send our claims to insurance plans that we had 3 plans ago....plans that we got rid of before we even visited these offices.

We deserve to have our credit ruined because they send our shit to the wrong health insurance and then don't bother to tell us for months?

A hearty "Fuck off" to them. These people don't deserve to be rescued from a burning car.

One of the guys on my SRT had to have a hip or knee operated on, I forget which. I remember thinking he was crazy for painting "the other leg" on the one that wasn't supposed to be cut on. (I no longer doubt the wisdom considering things reported in the news over the past several years.)

Sadly and ironically, he died a few weeks after the operation but for (mostly) unrelated reasons.

RoyGBiv

07-10-2018, 10:16 PM

Before cementing an opinion, realize that every successful industry charges its customers “highly inflated prices at several times that of actual costs.” That is called covering your expenses and doing business. Moreover, no industry lists their costs next to the price being charged.

In addition, keep in mind that top performing hospitals operate at ~5% profit margins; most hospitals are barely breaking even. Any cuts to revenue will necessarily lead to cuts in service lines.

The reason why the amount billed to your insurance and you is so high is due to a business model called profit sharing whereby hospitals must use profits from insured patients to cover expenses from patients who are sheltered by price controls.

There are sooooooo many things that are "easy" to fix about Healthcare costs. Malpractice insurance and other litigation costs. Association plans. Offering insurance across state lines. Transparency.

Seems we're so busy trying for perfection that we fail to make progress.

I realize "easy" is just a figment of my imagination. I'm just a tough love kinda guy. I prefer to rip my bandaids.

willie

07-10-2018, 11:38 PM

Inflexibility within bureaucracies may be the reason that there are not easy fixes. Billing departments interact with multiple insurance companies with different plans for identical services. I'm surprised that the system works as well as it does. And then there is out and out fraud. I saw this for the first time when my mother was a long term dementia patient in a nursing home. I got monthly statements showing charges to Medicaid for cognitive therapy delivered to a comatose person. That's merely one example. And yes. The people in charge hated me with a purple passion because of my protests.

VT1032

07-11-2018, 05:12 AM

We deserve to have our credit ruined because they send our shit to the wrong health insurance and then don't bother to tell us for months?

A hearty "Fuck off" to them. These people don't deserve to be rescued from a burning car.

They didn't even get that far with mine. For some reason, my hospital uses some private company to bill just anesthesia stuff. That company could provide no proof they ever sent me a bill, had my insurance info on file, but never billed them, and then turned me in to collections for the full pre-insurance amount without ever informing me of the debt in the first place.

Nephrology

07-11-2018, 07:35 AM

They didn't even get that far with mine. For some reason, my hospital uses some private company to bill just anesthesia stuff. That company could provide no proof they ever sent me a bill, had my insurance info on file, but never billed them, and then turned me in to collections for the full pre-insurance amount without ever informing me of the debt in the first place.

It's relatively common for certain parts of certain hospitals to be separate corporate entities for reasons that I don't really understand. Out in Oregon when I worked there, the medical ICU at Legacy Emanuel was incorporated separately from the rest of the hospital. I forget why, but it was explained to me at the time.

VT1032

07-11-2018, 07:58 AM

It's relatively common for certain parts of certain hospitals to be separate corporate entities for reasons that I don't really understand. Out in Oregon when I worked there, the medical ICU at Legacy Emanuel was incorporated separately from the rest of the hospital. I forget why, but it was explained to me at the time.

And I get that, and really don't have a problem with that. My issue is when the hospital billing department informed me, in writing, that I owed nothing further towards the pregnancy, but neglected to mention that there were two other seperate entities that I owed money to for a procedure that happened in their hospital. The least they could do is let me know that there might be other parties that I have bills with. If all of their anesthesia is billed through "Company X" and they can see that my wife had anesthesia, it stands to reason that I probably have a bill with "Company X"... Compounding that, as explained above, the "Company X" in question never sent me a bill or billed my insurance, and then turned me into collections for the full amount without ever having communicated with me.

I ended up finally getting to some higher level administrator at the hospital who had the bill pulled back and billed to insurance appropriately, but it took several months of visits, dozens of phone calls (most unanswered...), and the kerfluffle with security I mentioned to get that far.

Nephrology

07-11-2018, 08:01 AM

And I get that, and really don't have a problem with that. My issue is when the hospital billing department informed me, in writing, that I owed nothing further towards the pregnancy, but neglected to mention that there were two other seperate entities that I owed money to for a procedure that happened in their hospital. The least they could do is let me know that there might be other parties that I have bills with. If all of their anesthesia is billed through "Company X" and they can see that my wife had anesthesia, it stands to reason that I probably have a bill with "Company X"... Compounding that, as explained above, the "Company X" in question never sent me a bill or billed my insurance, and then turned me into collections for the full amount without ever having communicated with me.

Oh yeah, I mean, I understand. Preaching to the choir. Like I said, I've had $25 copays sent to collections at day 31. It's really annoying.

willie

07-11-2018, 08:37 AM

Long after my back surgery I received a phone call from a guy with a hood accent. He told me that I had overlooked paying a bill for a service that he could not describe. After figuring out that I was not an easy mark, he graciously agreed to forgive the debt. Neither of us was rude to the other. He had met his match and retreated.

rcbusmc24

07-11-2018, 08:38 AM

VT1032

07-11-2018, 08:42 AM

You all's stories about this stuff makes me happy I was born in a Naval Hospital and then joined the Marines at age 19, Navy Medical ain't all that bad it seems, at least I've never been sent a bill.....

I can't speak for Navy medical, but the Army clinic at Ft. Lee told me I had a rash and sent me on my way with some ointment. I had shingles...

rcbusmc24

07-11-2018, 08:51 AM

Only thing worse than Navy Medical I've been told..... is Army Medical.:p

TGS

07-11-2018, 12:23 PM

You all's stories about this stuff makes me happy I was born in a Naval Hospital and then joined the Marines at age 19, Navy Medical ain't all that bad it seems, at least I've never been sent a bill.....

I will say that working for a hospital system had a certain impact on the quality of my life. Any care we received in-hospital was free, so it made life extremely easy. Our pay was lower than some other systems in the area, but it certainly made up for it. It had the convenience of military medical care without the competing interests of keeping rosters at strength vs actually caring for a patient's condition.

RevolverRob

08-24-2018, 12:33 PM

Insurance companies are fun on a bun. I finally received a bill, 63-days after I went to the ER. And sure enough the amounts are wrong. At first glance, I knew something was wrong mathematically, so I crunched the numbers. Someone fat fingered my benefits statement and transcribed a 3 and a 4, paying 1345 instead of the 1435 they were supposed to. So, first I called the hospital and they said, "Well, you have to check with the insurance company." "Okay."

So, I called the insurance company. First thing out of the rep's mouth, "Did someone tell you about this?"
"No, I double checked your math, because I looked at the EOB and knew it was wrong."
"But how did you know?"
"Because it looked wrong, then I did the math and showed it was wrong."
"Okay, so let me get this straight, you did the math and its wrong?"
"Yes ma'am. If you take the total amount covered, subtract the cost of my deductible, the amount covered is this - right there on the EOB, correct?"
"Yes, I see that."
"Great, then you take that number and multiple it by .9 to achieve the 90% of coverage my policy provides. And the number is 1435, not 1345."
"Okay, I can see how you think that, but..."
"Ma'am listen, I may have had to take calculus three times in college, but I can multiply. The numbers are provided right there, by you. You've paid 84.3% of the covered balance, not 90%. My policy covers 90% and I owe the remaining 10%. I don't mind paying my portion of the bill, but not until you've paid your portion of the bill. And I damn sure am not going to pay a percentage of your portion of the bill."
"Well sir, please hold for a few minutes, while I review your benefits."
"Great you do that."

<Cue 35-minute hold, where I presume they hoped I'd hang up>

"Hi sir, so...can you run this math by me again."
"Sure it's X, Y, Z, etc."
"Well, I just don't see how this is a mistake?"
"What does my policy say is covered once the deductible is met?"
"90%."
"And what is the covered balance after subtracting the deductible?"
"It's X."
"And what is 90% of X?"
<Pause>
"It's Y."
"So, you paid Z, but the correct amount is Y. And you can't see the mistake?"
"But sir..."
"But what? You just did the math yourself."
"Uhh...well I can send this to claims and have them review it."
"Great, you do that."
"It will take 20-business days."
"Okay, I don't really care how long it takes. At the end of the day the math is going to be right, or we'll have this conversation again."
"Right..."

____

My parents taught me that you NEVER pay a medical or tax bill without first reviewing the circumstances and numbers surrounding it. They almost always make a mistake - in their favor - so dispute it. But if they make a mistake - in your favor - pay the balance fast and move on. :p;)

OlongJohnson

08-24-2018, 03:31 PM

I'm at nine months of disputing a bill. Every month, they issue a new invoice, somewhat different than the month before. Every month, I call and explain to CS the history on the case, having a conversation similar to Rob's above. They agree that I don't need to pay, and say it will be reprocessed. Every month, it's not reprocessed correctly. For every month after the first, it's been clear that they are not acting in good faith. They have no interest in correcting their error, only in collecting the money that the original error told them they should be paid. A neverending variety of different invoices all total up to the same amount on the bottom line, which is not actually owed, because the services it represents were never rendered. It does get tiring. It's the first of many, many medical billing errors that I haven't been able to resolve with just a couple phone calls.

Tabasco

08-25-2018, 02:50 PM

Only thing worse than Navy Medical I've been told..... is Army Medical.:p

When I was 6, we lived in Okinawa. Managed to break my leg on monkey bars, and was carted off to an Army Hospital. Dr. put a cast on it,and my Mom picked me up. Went back in a couple of days for a checkup, and the conversation was something like this:

Dr.: Who set this?
Mom: You did.
Dr.: Was I drunk?
Mom: I don't think so.
Dr.: We'll cut the cast off and re-break it.
Dr. to Me: Do you want a shot?
Me: No!

Dr. grabbed my foot and twisted. fortunately, I don't remember the pain but it wasn't fun. My foot still is slightly off.

eaglefrq

08-26-2018, 06:48 AM

Emergency room violence

Not too make super light of this - but I can see why...I just saw the claim amount filed to my insurance for four stitches, a tetanus shot, and a six hour wait to get sewn up was nearly $3800. That's $633 an hour in costs.

I went into the wrong damn line of work.

I can't wait to see how much of this I'm on the hook for. :(

I had to get 4 stitches and a tetanus shot last week. I went to one of the Doc in the Boxes, so I'm curious to see what the total bill will be. I just checked my insurance and the bill from the nurse practitioner that did the stitches is listed, but not from Urgent Care. For the FNP to evaluate my hand and do the sutures she billed $547.00. She spent approx. 30-40 minutes in the room with the evaluation, describing my options and treatment.

It will be interesting to see what the Urgent Care is going to charge for the visit and tetanus shot. I'll have to update this once all the bills have been posted to see the cost difference between an ER vs Urgent Care visit for the same issue.

Sensei

03-27-2019, 06:59 PM

For those of you sitting in a California emergency department waiting room with chest pain or appendicitis, rest assured that your care is being delayed as the doctors and nurses perform God’s work...

https://www.google.com/amp/s/amp.sacbee.com/news/local/homeless/article219683635.html

Beginning in July, hospitals must document in writing that shelters have beds for homeless patients before sending them to the facilities. Hospitals also must offer homeless patients a meal, appropriate clothing, medications and transportation upon discharge.

That’s right, the emergency department must now make sure that homeless people have a shelter among other things before they are discharged. Since there are far more homeless than shelter beds in cities like LA, that means they will sit in their ED bed eating turkey sandwiches for days at a time while hospitals wait for a shelter bed - just like psych patients wait for their hospital bed. And, since ED beds are a zero sum game, that means you will have to sit in the waiting room with your appendicitis while we get some more mayo for that turkey sandwich.

Sigfan26

03-27-2019, 07:50 PM

When I was 6, we lived in Okinawa. Managed to break my leg on monkey bars, and was carted off to an Army Hospital. Dr. put a cast on it,and my Mom picked me up. Went back in a couple of days for a checkup, and the conversation was something like this:

Dr.: Who set this?
Mom: You did.
Dr.: Was I drunk?
Mom: I don't think so.
Dr.: We'll cut the cast off and re-break it.
Dr. to Me: Do you want a shot?
Me: No!

Dr. grabbed my foot and twisted. fortunately, I don't remember the pain but it wasn't fun. My foot still is slightly off.

You have no idea how much I just cringed...

Sent from my iPhone using Tapatalk

Eugene

03-28-2019, 09:33 AM

Wait until you have to deal with mental health stuff. Take your kid to a counselor every week and pay your copay and deductible , then a psychiatrist every month and pay your copay and deductible. Then he gets out of control at school so they say take him to the children's hospital ED where they keep him overnight until he's stable and send him home and send you a bill. Then you go to the weekly counselor and the monthly psychiatrist until the next trip to the ED and another bill. Repeat until you run out of $.

Alpha Sierra

03-28-2019, 09:36 AM

Eugene

03-28-2019, 09:43 AM

We tried that one too. Then the problems started happening at home. Now we have broke tv's walls with holes in them, dented appliances in the kitchen, broken windows, etc.

Alpha Sierra

03-28-2019, 09:54 AM

We tried that one too. Then the problems started happening at home. Now we have broke tv's walls with holes in them, dented appliances in the kitchen, broken windows, etc.

My heart goes out to you and your family then. I thank God for my problems.

JRB

03-28-2019, 10:15 AM

We tried that one too. Then the problems started happening at home. Now we have broke tv's walls with holes in them, dented appliances in the kitchen, broken windows, etc.

I find it regrettable that moral panics and political correctness have reduced the options available to parents in response to such behavior.
My parents rarely implemented old-school punishments, but I tested those boundaries enough as a child to know that was 'on the table' if I started some shit like that.

My sister is a 6th grade teacher and she tells me about problem students like this every time we speak. Some of their home situations are heartbreaking, too.

I sincerely wish you and your family the best, Eugene. It takes a hell of a human being to maintain love and self-control in a situation like that.

Eugene

03-28-2019, 10:26 AM

And then the ACA snuck in a bunch of new 'rights' for those with mental health diagnosis. You can't send your kid to his room and stand them in a corner anymore because it violates their rights.
And they wonder why there is so many more people with mental health issues, its because the first one diagnosed has more rights so they can abuse their parents and siblings until those parents and siblings develop mental health issues. And of course the papers they give me every time shaming me for being a gun owner.

And the newest thing with our children's hospital is even if you negotiate a payment plan they will still send you to collections for the term of that payment plan.

Duces Tecum

03-28-2019, 12:19 PM

Sorry. Wrong thread.

Kukuforguns

03-28-2019, 01:34 PM

that means they will s[h]it in their ED bed
Fixed it for you.

The ER's inability to manage homeless persons and people with emergency needs is consistent with my experience of California ERs.

I visited an ER in Los Angeles area during winter at around 2 a.m. My 6 month old son had been vomiting every 30 minutes for several hours and was now dehydrated, exhausted, and lethargic. We got to the ER and expected to wait a little while. To my (untrained eye) none of the people seeking care displayed any urgent need for medical care. Several were obviously homeless seeking shelter from the cold weather. After waiting 30 minutes (and another episode of vomiting), we (my wife) lost patience and re-explained our situation to the intake nurse. We were seen immediately thereafter with an IV to rehydrate our son. I have to give full kudos to my wife. I was too stuck on staying in line. But the episode really pissed me off. The several homeless people were engaging scarce resources that could/should have been better allocated. That being said, I understand why the homeless people come to the ER - dying of exposure is not something I expect them to do. I understand why the ER was treating the homeless people in turn … that's the law. I'm pissed at the California Legislature.