10 ms·

We decided (slash "made the mistake") of going to the emergency room last summer. Spent less than two hours in an exam room before being dismissed with no concl

We decided (slash "made the mistake") of going to the emergency room last summer. Spent less than two hours in an exam room before being dismissed with no conclusion and referral to another doctor. Got a $9500 bill about six months later and have been billed a 10% copay on that (insurance paid $5500 already at their negotiated rate). Still fighting it as absolutely absurd, but there's really no hope. This country is fucked. It's an embarrassment.

CydeWeys 7y ago
Meanwhile, I went to the emergency room in a hospital with my girlfriend in London two years ago and it was free for her. We're Americans. Guess which country has better health outcomes.
- makomk 7y ago
  Yeah, here in the UK she could've been told that she wasn't going to get tested for coronavirus over the phone for free. It's a much more civilized system. (Though to be fair, we did a little better at adding Italy to the list of qualifying countries promptly than the USA.)
  - Veedrac 7y ago
    UK tests per million: 387 USA tests per million: 26 Not really the same.
    - tedunangst 7y ago
      There should be some adjustment for expected exposures, no?
      - Veedrac 7y ago
        If you believe the numbers, the UK has 6.9 per million infected, and the USA has 4.1, so they're pretty similar. You shouldn't believe the numbers, though, because the USA is barely testing people—and not because they aren't sick; testing in the US is often expensive, as obviously idiotic as that is. I'd expect the USA to have a higher number of infected per capita in actuality.
- ______---______ 7y ago
  >Guess which country has better health outcomes. The US, by all objective measures. https://en.wikipedia.org/wiki/List_of_countries_by_quality_of_healthcare https://en.wikipedia.org/wiki/List_of_countries_by_quality_o... It's actually not uncommon for Brits to travel to America to pay for treatments not available on the national health or to avoid the often years-long waiting lists.
  - jacobush 7y ago
    Mmm yeah I wonder. UK: someone dies of cancer or whatever. Enters the statistics as cancer death. Drags down outcome. USA: someone dies of cancer or whatever. Was poor. Gets buried. Cancer statistics unharmed.
    - lostmsu 7y ago
      You still have to report some cause of death.
      - jacobush 7y ago
        And how well does that work do you think? Given how many are misdiagnosed or undiagnosed before death, how much money and effort do you think is spent on the cause of death for some random, (literally) poor corpse? Of course "some" reason will be logged.
        lostmsu 7y ago
        You were implying, that sloppiness leads to reduced cancer statistics, painting a better picture for the US. Well, if another cause of death is used instead, the picture will look worse for it. There is no escape.
        jacobush 7y ago
        I think it might actually! (Like obesity, heart failure, complex some-or-other, "natural causes", take your pick.)
godzillabrennus 7y ago
People take UBER to the hospital now instead of an ambulance. #Merica
- jimbob45 7y ago
  IMHO, you're mis-stating the problem. One should take an uber/friend to the hospital if the ailment is not time-sensitive or in need of ongoing treatment so that the ambulances are freed up for more critical patients. Ambulances should have some level of cost associated with them to dissuade using them for minor ailments. Should that level of cost be thousands and thousands of dollars? Probably not.
  - jacobush 7y ago
    Shouldn’t dispatch triage if you need an ambulance or not?
    - jopsen 7y ago
      In other countries they do that so aggressively that we have stroke victims dying, which an ambulance being dispatched. On the other hand, given that triage failures are rare -- cost/benfit wise it's probably better.
      - jacobush 7y ago
        In countries where you can call an ambulance like a taxi, won't that lead to ambulances not being available to people who actually need them?
        jopsen 7y ago
        GP was making the argument that high costs of an ambulance is necessary.
  - jopsen 7y ago
    Don't need to be a cost... We could just have 911 send a taxi instead. I know in other countries ambulances are not always dispatched, because 911 operators decide it's not critical. Mostly this decision is correct, but from time to time a heart patient dies. (Maybe the alternative should be to send a taxi)
swozey 7y ago
I paid something like $800 for one crutch when I sprained my ankle once. Think another $300 for ibuprofen. Now I know why there's a crutch market on craigslist/thrift stores. Not sure what my insurance paid for xrays, etc, but my tab was something like $1100 for that ER rendezvous. Thought I broke my leg. I had a laparoscopic surgery a few years ago that was $35k.
- bluntfang 7y ago
  to be fair, you paid a doctor to administer you a crutch and ibuprofen, I'm certain that's not the raw material cost.
  - javajosh 7y ago
    That's not fair, because the doctor no-doubt billed separately.
  - ska 7y ago
    separate line items, typically
    - bluntfang 7y ago
      Do you really think current health care is giving accurate line items on your bill?
      - ska 7y ago
        Accurate or not clinician time is typically billed separately, as are drugs, individual procedures, equipment, etc. Some stuff is rolled up but not that much; hospital accounting systems are quite comprehensive and structured in such a way to help them argue with insurance companies. So the argument that the crutch is expensive because an MD handed it to you probably doesn't hold, the clinician files something, probably under a CPT code, and you were billed for that separately. This depends on the service of course, you may see say a CT scan where the room time & tech etc. are rolled into one item, but the radiologist review is separate. So it isn't just people vs. equipment, etc.
halfmatthalfcat 7y ago
An opposite example, went to the ER last year and spent a couple hours there. Paid a $100 copay. Haven’t seen any other bills.
- CydeWeys 7y ago
  Gonna go out on a limb and assume you have good health insurance. Many (most?) Americans do not. I'm on an HDHP for example, so the first several thousand dollars in medical expenses per year come directly out of my pocket before insurance starts helping at all.
  - platetone 7y ago
    i work for a tech company in the fortune 500 top 25... i would assume the best insurance possible, still killing us (paid nearly $7000 out of pocket last year + the actual premium costs of several thousand more). i've got three small kids including one with a heart condition, so it's particularly bad right now.
    - sailfast 7y ago
      For insurance, I have found it's difficult to beat the negotiating power of the multiple large Federal Government offerings - and you can shop before you decide to join: https://www.opm.gov/healthcare-insurance/healthcare/plan-information/plans/ https://www.opm.gov/healthcare-insurance/healthcare/plan-inf...
    - outworlder 7y ago
      > i would assume the best insurance possible That's usually not a good assumption to make, not even among the FANG. There is extreme variability even with the same insurance company, depending on the negotiation between the company and the provider. And very few companies actually have any incentive to even provide the best 'possible' coverage.
      - platetone 7y ago
        Just looked it up and we're only in the top 50 (insert crying smiley).
streblo 7y ago
My daughter had an allergic reaction to food last year, which required us to give an epipen. We were told when this happened that we needed to call 911 and have her taken to the emergency room for observation and potentially for further treatment. We did, the ambulance came and took her to the hospital, which is under a mile away. We then had a similar experience to yours - spent about 2 hours in the hospital being observed, then were dismissed. We eventually got a $2k bill from the ER, which our insurance paid, and a $4k bill from the ambulance company, which our insurance didn't pay.
- munk-a 7y ago
  That ambulance bill is insane. Up here in Canada ambulance charges are paid out of pocket but my wife had a low blood pressure emergency and got an ambulance called and was only out 300$ for a three mile drive (through dense city streets even). I'm even of the opinion that that bill was a bit excessive.
  - jariel 7y ago
    $300 seems low. 'The distance' is basically irrelevant. You're paying for a highly available, rapid response team to be prepared for almost any medical emergency, 24/7, literally almost at the press of a button. 'Preparedness' is expensive. What happened if the Ambulance broke down? Or a medic decided to say f-it and skipped a day. Or the phone didn't work. Or the critical piece of gear didn't work. Or ooops ran out of gas (hey doesn't happen often, but it happens!) To get all of those things to 99.999% is quite a bit expensive. Constant vehicle checks/repairs/updates. Backups. Process, procedure. The amount of training required for Medics should be quite a lot, considering the first few minutes of any problem are usually the most critical, and it can be 'anything'. My unscientific 'instinct' is that $1K per call seems to be more or less in the right ballpark. There should be some kind of insurance for this, one way to make it more palatable would be to have it subsidized. People who call more often I think can be expected to pay a little more but we can't be breaking the bank on folks. Given that healthcare is a skyrocketing part of the economy, I wonder if we're going to end up with a kind of triage in Ambulances as well - i.e. ambulances for crazy life-threatening things, and ambulances for more common things which mostly require 'getting to a doctor quite soon, please' i.e. this is important, I need to go to the front-of-the-line'. Edit: actually, $300 is definitely 'too low', there probably is some kind of subsidy. Very crudely suppose an average call may last 1 hour. Suppose due to scheduling, that an ambulance may be idle for 1 hour in between calls. So the 'average call' would be 1 driver, 2x medics, for 2 'man-hours' each. Of course, there's other labor overhead: for each ambulance, there might be 0.3 mechanics, 0.3 dispatchers, this before we get into all the other unit an ancillary costs. $100K/year for any kind of professional in the medical field is ballpark reasonable, that's $50/hour - so we're looking at roughly $300 just for the immediate staffing - not including the mechanic, dispatch, op staff, gas, insurance, training, facilities, advanced equipment etc.. So very crudely ... ambulances are expensive. Edit 2: yes, I'm talking costs here, obviously this is different than what people end up paying as a commenter has indicated.
servalan 7y ago
Hopefully, the hospital won't put a lien on your home. Some states allow them to do that.
skeletal88 7y ago
As someone not from the EU, this is something totally insane and crazy. Once, after my country got out of the Soviet Union, the US was seen as the dreamland of everyone. Now.. I don't think so, when getting sick with something easily treatable will ruin your whole life. That's just not a place I'd like to live in. Once I was on a date with a younger girl and she was going on about how she'd like to live in the US, and I, being kind of a nerd had a Sheldon type of moment told her how awful it is, and she said "thanks, you ruined my dream". And she was talking about how she spent a summer as a barmaid there, got tonsilitis, visited a doctor who made her take a test for tonsilitis and got billed for it. Here where I live.. you can see that when someone has 1) a high fever 2) inflammation in their tonsils 3) has a swollen throat and white stuff there because of it then they have tonsilitis and you don't need to make additional lab tests, because it's 100% obvious, you don't need to waste time and money on useless stuff.
- azimuth11 7y ago
  It is not always obvious (e.g. strep throat is similar, but one or the other sicknesses may or may not need medicine) and doing things on a hunch is not how scientific fields should do things when there are simple tests. Testing also provides safety for doctors against medical malpractice lawsuits.
dhuduehe 7y ago
What made you decide to go to the ER instead of scheduling an appointment with your GP out of curiosity?
- platetone 7y ago
  it was acute gut-wreching pain that we weren't sure what to do about, didn't know if it was going to get worse... we should have gone to an "urgent care" clinic, which was our mistake.

CydeWeys 7y ago

Meanwhile, I went to the emergency room in a hospital with my girlfriend in London two years ago and it was free for her. We're Americans. Guess which country has better health outcomes.

makomk 7y ago
Yeah, here in the UK she could've been told that she wasn't going to get tested for coronavirus over the phone for free. It's a much more civilized system. (Though to be fair, we did a little better at adding Italy to the list of qualifying countries promptly than the USA.)
- Veedrac 7y ago
  UK tests per million: 387 USA tests per million: 26 Not really the same.
  - tedunangst 7y ago
    There should be some adjustment for expected exposures, no?
    - Veedrac 7y ago
      If you believe the numbers, the UK has 6.9 per million infected, and the USA has 4.1, so they're pretty similar. You shouldn't believe the numbers, though, because the USA is barely testing people—and not because they aren't sick; testing in the US is often expensive, as obviously idiotic as that is. I'd expect the USA to have a higher number of infected per capita in actuality.
______---______ 7y ago
>Guess which country has better health outcomes. The US, by all objective measures. https://en.wikipedia.org/wiki/List_of_countries_by_quality_of_healthcare https://en.wikipedia.org/wiki/List_of_countries_by_quality_o... It's actually not uncommon for Brits to travel to America to pay for treatments not available on the national health or to avoid the often years-long waiting lists.
- jacobush 7y ago
  Mmm yeah I wonder. UK: someone dies of cancer or whatever. Enters the statistics as cancer death. Drags down outcome. USA: someone dies of cancer or whatever. Was poor. Gets buried. Cancer statistics unharmed.
  - lostmsu 7y ago
    You still have to report some cause of death.
    - jacobush 7y ago
      And how well does that work do you think? Given how many are misdiagnosed or undiagnosed before death, how much money and effort do you think is spent on the cause of death for some random, (literally) poor corpse? Of course "some" reason will be logged.
      - lostmsu 7y ago
        You were implying, that sloppiness leads to reduced cancer statistics, painting a better picture for the US. Well, if another cause of death is used instead, the picture will look worse for it. There is no escape.
        jacobush 7y ago
        I think it might actually! (Like obesity, heart failure, complex some-or-other, "natural causes", take your pick.)

godzillabrennus 7y ago

People take UBER to the hospital now instead of an ambulance. #Merica

jimbob45 7y ago
IMHO, you're mis-stating the problem. One should take an uber/friend to the hospital if the ailment is not time-sensitive or in need of ongoing treatment so that the ambulances are freed up for more critical patients. Ambulances should have some level of cost associated with them to dissuade using them for minor ailments. Should that level of cost be thousands and thousands of dollars? Probably not.
- jacobush 7y ago
  Shouldn’t dispatch triage if you need an ambulance or not?
  - jopsen 7y ago
    In other countries they do that so aggressively that we have stroke victims dying, which an ambulance being dispatched. On the other hand, given that triage failures are rare -- cost/benfit wise it's probably better.
    - jacobush 7y ago
      In countries where you can call an ambulance like a taxi, won't that lead to ambulances not being available to people who actually need them?
      - jopsen 7y ago
        GP was making the argument that high costs of an ambulance is necessary.
- jopsen 7y ago
  Don't need to be a cost... We could just have 911 send a taxi instead. I know in other countries ambulances are not always dispatched, because 911 operators decide it's not critical. Mostly this decision is correct, but from time to time a heart patient dies. (Maybe the alternative should be to send a taxi)

swozey 7y ago

I paid something like $800 for one crutch when I sprained my ankle once. Think another $300 for ibuprofen. Now I know why there's a crutch market on craigslist/thrift stores. Not sure what my insurance paid for xrays, etc, but my tab was something like $1100 for that ER rendezvous. Thought I broke my leg. I had a laparoscopic surgery a few years ago that was $35k.

bluntfang 7y ago
to be fair, you paid a doctor to administer you a crutch and ibuprofen, I'm certain that's not the raw material cost.
- javajosh 7y ago
  That's not fair, because the doctor no-doubt billed separately.
- ska 7y ago
  separate line items, typically
  - bluntfang 7y ago
    Do you really think current health care is giving accurate line items on your bill?
    - ska 7y ago
      Accurate or not clinician time is typically billed separately, as are drugs, individual procedures, equipment, etc. Some stuff is rolled up but not that much; hospital accounting systems are quite comprehensive and structured in such a way to help them argue with insurance companies. So the argument that the crutch is expensive because an MD handed it to you probably doesn't hold, the clinician files something, probably under a CPT code, and you were billed for that separately. This depends on the service of course, you may see say a CT scan where the room time & tech etc. are rolled into one item, but the radiologist review is separate. So it isn't just people vs. equipment, etc.

halfmatthalfcat 7y ago

An opposite example, went to the ER last year and spent a couple hours there. Paid a $100 copay. Haven’t seen any other bills.

CydeWeys 7y ago
Gonna go out on a limb and assume you have good health insurance. Many (most?) Americans do not. I'm on an HDHP for example, so the first several thousand dollars in medical expenses per year come directly out of my pocket before insurance starts helping at all.
- platetone 7y ago
  i work for a tech company in the fortune 500 top 25... i would assume the best insurance possible, still killing us (paid nearly $7000 out of pocket last year + the actual premium costs of several thousand more). i've got three small kids including one with a heart condition, so it's particularly bad right now.
  - sailfast 7y ago
    For insurance, I have found it's difficult to beat the negotiating power of the multiple large Federal Government offerings - and you can shop before you decide to join: https://www.opm.gov/healthcare-insurance/healthcare/plan-information/plans/ https://www.opm.gov/healthcare-insurance/healthcare/plan-inf...
  - outworlder 7y ago
    > i would assume the best insurance possible That's usually not a good assumption to make, not even among the FANG. There is extreme variability even with the same insurance company, depending on the negotiation between the company and the provider. And very few companies actually have any incentive to even provide the best 'possible' coverage.
    - platetone 7y ago
      Just looked it up and we're only in the top 50 (insert crying smiley).

streblo 7y ago

My daughter had an allergic reaction to food last year, which required us to give an epipen. We were told when this happened that we needed to call 911 and have her taken to the emergency room for observation and potentially for further treatment. We did, the ambulance came and took her to the hospital, which is under a mile away. We then had a similar experience to yours - spent about 2 hours in the hospital being observed, then were dismissed. We eventually got a $2k bill from the ER, which our insurance paid, and a $4k bill from the ambulance company, which our insurance didn't pay.

munk-a 7y ago
That ambulance bill is insane. Up here in Canada ambulance charges are paid out of pocket but my wife had a low blood pressure emergency and got an ambulance called and was only out 300$ for a three mile drive (through dense city streets even). I'm even of the opinion that that bill was a bit excessive.
- jariel 7y ago
  $300 seems low. 'The distance' is basically irrelevant. You're paying for a highly available, rapid response team to be prepared for almost any medical emergency, 24/7, literally almost at the press of a button. 'Preparedness' is expensive. What happened if the Ambulance broke down? Or a medic decided to say f-it and skipped a day. Or the phone didn't work. Or the critical piece of gear didn't work. Or ooops ran out of gas (hey doesn't happen often, but it happens!) To get all of those things to 99.999% is quite a bit expensive. Constant vehicle checks/repairs/updates. Backups. Process, procedure. The amount of training required for Medics should be quite a lot, considering the first few minutes of any problem are usually the most critical, and it can be 'anything'. My unscientific 'instinct' is that $1K per call seems to be more or less in the right ballpark. There should be some kind of insurance for this, one way to make it more palatable would be to have it subsidized. People who call more often I think can be expected to pay a little more but we can't be breaking the bank on folks. Given that healthcare is a skyrocketing part of the economy, I wonder if we're going to end up with a kind of triage in Ambulances as well - i.e. ambulances for crazy life-threatening things, and ambulances for more common things which mostly require 'getting to a doctor quite soon, please' i.e. this is important, I need to go to the front-of-the-line'. Edit: actually, $300 is definitely 'too low', there probably is some kind of subsidy. Very crudely suppose an average call may last 1 hour. Suppose due to scheduling, that an ambulance may be idle for 1 hour in between calls. So the 'average call' would be 1 driver, 2x medics, for 2 'man-hours' each. Of course, there's other labor overhead: for each ambulance, there might be 0.3 mechanics, 0.3 dispatchers, this before we get into all the other unit an ancillary costs. $100K/year for any kind of professional in the medical field is ballpark reasonable, that's $50/hour - so we're looking at roughly $300 just for the immediate staffing - not including the mechanic, dispatch, op staff, gas, insurance, training, facilities, advanced equipment etc.. So very crudely ... ambulances are expensive. Edit 2: yes, I'm talking costs here, obviously this is different than what people end up paying as a commenter has indicated.

servalan 7y ago

Hopefully, the hospital won't put a lien on your home. Some states allow them to do that.

skeletal88 7y ago

As someone not from the EU, this is something totally insane and crazy. Once, after my country got out of the Soviet Union, the US was seen as the dreamland of everyone. Now.. I don't think so, when getting sick with something easily treatable will ruin your whole life. That's just not a place I'd like to live in. Once I was on a date with a younger girl and she was going on about how she'd like to live in the US, and I, being kind of a nerd had a Sheldon type of moment told her how awful it is, and she said "thanks, you ruined my dream". And she was talking about how she spent a summer as a barmaid there, got tonsilitis, visited a doctor who made her take a test for tonsilitis and got billed for it. Here where I live.. you can see that when someone has 1) a high fever 2) inflammation in their tonsils 3) has a swollen throat and white stuff there because of it then they have tonsilitis and you don't need to make additional lab tests, because it's 100% obvious, you don't need to waste time and money on useless stuff.

azimuth11 7y ago
It is not always obvious (e.g. strep throat is similar, but one or the other sicknesses may or may not need medicine) and doing things on a hunch is not how scientific fields should do things when there are simple tests. Testing also provides safety for doctors against medical malpractice lawsuits.

dhuduehe 7y ago

What made you decide to go to the ER instead of scheduling an appointment with your GP out of curiosity?

platetone 7y ago
it was acute gut-wreching pain that we weren't sure what to do about, didn't know if it was going to get worse... we should have gone to an "urgent care" clinic, which was our mistake.