DnvrFox

If you think that bill was bad, try going to an emergency room.

You won't get out for less than $4,000, in my experience.

In our last traffic accident, where we were totaled from behind, we debated whether or not to go to the ER. We decided not to, even though my wife was "borderline." We happen to hate ER's - endless waits, going over your med history again and again, etc., etc. At least 6 hours, even for a non-critical problem.

Even though I carry special high coverage auto medical insurance, I thought, "Well, I have been with this company 43 years. If I don't go to the ER, we will save them some $$, and us some time. And an ambulance trip and bill, etc."

WRONG!!

The next day the wife had an allergic reaction to some of the smells of the accident, and went into deep asthma-like symptoms. The paramedic had even warned us that might happen. We went to our personal doc.

So, then the insurance company refused to pay our personal doc because it was not "accident related."

We had to go the whole appeal route, took a lot of time and effort, AND, when we couldn't get the other company to pay my deductible, time, etc., no attorney wanted to work with us because the medical bills and potential damages were not high enough on a contingency basis.

I wanted to sue the driver in small claims court - BUT, she was not 18, and you can't sue anyone under 18.

Yes, the system stinks.

The Weak Link

Can't put my finger on it but something sounds illegal.

BTW, the huge ER bills reflect you subsidizing uninsured and undocumented aliens using the ER like their own private walk-in clinic. Federal law mandates (without paying one nickel for) ER's see all comers regardless of ability to pay (contrary to some out-and-out propaganda used during the political primaries).

WalterMitty

Read it again: I said "Preventative Medicine will never be cheap enough until you can afford it with, or without, a third party to pay for it."

I also said "if we can get the full body MRI (and other scanning technology) down to the cost of my 6 month teeth cleanings, then the world will change".

If polio vaccinations cost $3000.00 and you had to do them every year or every 2-3 years like you would have to do MRI's to catch cancers, artery blockages, and enlarged blood vessels in the brain that could lead to stroke, there would be more polio in the world today.

Maybe you just misread it, but my point is that until the costs of preventative medicine fall low enough that the cost of administering to everyone is significantly less than just treating the people that actually get sick; you won't be seeing the "annual MRI" funded by your HMO, or anybody else.

Retro Grouch 

You're right. Thanks for the clarification.

A lot of people seem to think that "insurance" is some kind of magic money multiplying machine. Actually, it's the opposite. Ultimately on average, with or without insurance, everybody has to pay for their own medical costs plus administrative expenses.

The two biggest departments in any insurance company are underwriting and claims. The job of underwriting is to avoid covering people who are most likely to have large claims. The job of claims is to pay out the least amount of money consistant with the letter of the policy.

solveg

I had the same doctor from age 12 to age 40. He switched to teaching or something because he didn't like doctoring the way it had become.

I want him back. What prevents a doctor from practicing out of the system and charging reasonable rates? Nothing fancy. An Xray machine, a couple gadgets for routine stuff. Anything out of the ordinary we'd have to use our insurance. I don't think it would save money, because you'd still have to pay for insurance for the big stuff, but you wouldn't get this runaround with the system. Plus, you'd have a doctor who really knows you. You can call him up instead of going in and say, "I have yet ANOTHER sinus infection" and he'll just write the normal script for it.

Although I'm mollified today because of selfish reasons. I looked up my insurance policy, and it's really really good. I only have a $1000 deductible, and after that all my tests and Xrays and stuff are free. Other stuff is covered at 80%. So I can go ahead and not worry about doing everything in the same year to save money. I was thinking my deductible was $5000 or something high.

But I won't forget my initial reaction. I know have HUGE empathy for those with bad or no health coverage.

wobblyoldgeezer

Solveg, I'm sorry to hear of your medical event, and I hope you're all better now.

Just to add to the thread - US medicine is, as all these replies agree, pretty dear!

I had 4 days in the emergency room/ICU in California between Christmas and New Year in California. I was in Dubai just before queuing for a plane - the fellow behind was being noisy on his cell phone about how ill he's been, gastric flu, norovirus. Oh great I thought.

I went from Dubai to Bahrain to London to San Francisco to skiing in N Cal, feeling worse all the way, tried a bit of skiing, interrupted by gastric flu symptoms, and then had a very "fluid releasing" day followed by a trip down the hill with paramedics. They were told I was a diabetic with norovirus.

Day 2 in the ICU (after being stabilised with fluid and insulin drips) a medic came in with a serious expression. "We think you might be diabetic". Well yeah, have been for 34 years, main information provided on the admission form, that's why I'm on an insulin drip.

So, bill for $38,000. Sheesh. Paid $15,000. Was told that as no insurance for 'pre-existing conditions' they'd take a view that this was fair.

Subsequent bills keep arriving. They have said that I owe $ 40,000, $22,000, and the last one was $ 1,435.
The billing function and the service function seem to be very disconnected.

I don't want to be a cheapskate - I arrived on a gurney and I left on my legs - but the billing seems to be inconsistent

tm3

when i get PO'd about a bill, and i often do, i go through the "well, how much should it be" exercise myself. like with recent service bill on my bike. sometimes helps the perspective, sometimes not.

the USA medical system has a number of major problems, and cost is one. unfortunately imo it is going to get worse.

but whatever, please do not delay or refuse to get a colonoscopy. colon cancer is (i think) the third leading cause of cancer deaths in the USA, and one of the few cancers that is totally curable if caught early enough, e.g. with colonoscopy. my colonoscopy was so easy i would have gotten it years earlier, had i known.

don't take my word for it -- go find someone with colon cancer and ask them if it would have been worth the copay on $1-3k to be rid of it. or the full amount. or triple that amount.

East Hill

Office /outpatient visit: 254.75
Preventive checkup: 180.00
Colonoscopy, diagnostic: 431.00
SG facility fee: 775.00
IV push single: 99.50
Injection, midazolam HCI: 14.10
IV sequential push of new substance: 45.50
Injection, fentanyl citrate: 5.44

Total of $1568.54.

East Hill

Neil_B

How horrible. Kansas is known for spiders, isn't it?

az_cyclist

I feel we have to address national health insurance in some manner. We need to keep that which encourages progress and better care, but, at the same time it must cover more people.

JanMM

Bingo! We have a winner!
US healthcare and the Iraq war are the two issues that need to be addressed yesterday.

CB HI

If you let them know that you expected them to take your temp as well; I am sure they would be happy to take a rectal temp for you - bend over please.

BillyBob1

Just don't let the government run healthcare, or your bill will double again and yes you won't have to pay the doctor, but you WILL HAVE TO PAY the TAX MAN for the increased inefficiency that government will put into the system.

Billy

DnvrFox

All research I know about says that Medicare is one of the most efficiently run programs around, while the private insurance companies are running close to 30% overhead, and paying the CEO's $100's of millions in compensation.

vitualis

Yes. Reading this thread is hard to believe for someone who doesn't live in the US.

In Australia, the cost of a usual consultation to a privately billing GP is about $60 (Australian dollars), even if you have no access to the Australian version of Medicare (e.g., an international visitor). If you are a local, then you end up out of pocket by about $25. If your GP "bulk bills" (i.e., directly bills the government; e.g., I bulk bill pensioners, concession card holders and the unemployed) then there are no out of pocket costs at all (i.e., seeing the doctor is free at point of access).

Going to a public hospital in Australia (all large tertiary hospitals and all district hospitals are public) is entirely free.

Most pathology and imaging in can be bulk billed.

Regards.

BillyBob1

I am a retired physician (15 years from Departure day- I actually retired young due to some medical issues). I totally agree the system is broke. I never had the nerve to charge some of the fees my contemporaries did. They milked the system big time. Back then I think my highest charge for a complete physical exam - I mean complete, which took almost 60 min, was about $60. I saw bills by others for hundreds. I had to look my patients in the eye the next time they came in and not feel embarrassed - most were elderly and on medicare with little else to pay the balance.

The coding system can be played for the doctor's benefit. Rarely does anyone check to see the record of what was done and how they came up with the charge. For several years, I was the medical director of two HMOs in addition to a full-time solo practice. I did look at fees and got records and when something seemed amiss, I had an in depth visit. Some guys were kicked out for billing too much.

On the defensive side, my salary was about 1/3 of charges, the rest went to two nurse assistants (not LPN or RN), mortgage payments, malpractice payments, the accountant, disability and health insurance for me and my employees, taxes local, state and federal and even a signage tax based on the number of signs you had on your building. Of course, then there are the lawyer's fees to keep the professional corporation in line, then the actuary who decides how much you can put away in a retirement fund for yourself and the employees, etc.

One other problem is that many docs have to sign up for HMOs that do not pay fee for service but use capitation based on the number of their subscribers that sign up as your patient. I think it was $17/month per patient. You got this whether you saw them or not, whether they were in office or hospital, etc. Then there is medicare. Normally you may charge say $100 for a procedure, but medicare in their wisdom decides that it is only worth $60 and then they pay you 80% of that =$48. If the patient can afford it, or if they have a supplement then you may get $12 bucks, but not the full amount. This is why those with private health insurance, not in a prepaid plan, get the shaft. Somewhere you need to make up for some of the large deductions, and losses you incur with capitation, etc. to make things meet at the end of the month. So the same patient with private insurance gets billed $100 and the doc get paid about $100. The real question is whether the $100 charge is appropriate or worth it?

Anyway, it is not a bed of roses on either side. For example, I recently had a quadruple coronary bypass operation at a University hospital. Total charges for my workup and 7 day hospital stay (doctors and hospital ) was about 125 thousand dollars. Hospital charges were about 85 thousand, but medicare only thought it was worth 32 thousand and paid 80% and my supplement picked up the 20%. All the surgeons involved had a charge of 10 thou, medicare thought it was only worth $2500 and paid the 80%. I would gladly have paid the 10 thousand for what they did for me. My total out of pocket expense for everything was $47.

Then there is the cost of education: 4 years pre med, 4 years medical school, a minimum of 3 years of internship and residency. Surgeons often go into residencies that are 6 years long and then do a fellowship on top of that. Many physicians straight out of residency are having a very difficult time to pay back all the loans that they took out get get the MD degree. Some are actually quitting. If the government takes over the health care, they will probably run to the open coffers of Uncle Sam to be consultants and bureaucrats.

In summary, it is a mess. I am glad to be out of it. The real question is how to solve it? No one has a good handle on it. IF this country slides more towards the socialist side, you can bet on seeing long waits for service, limitations of service and procedures that bureaucrats think you do not need, but doctors do; and a marked decrease in patient satisfaction just as in Britain and Canada. The Mass. experiment set up by Romney is running into big problems with finances - that was supposed to be the great experiment to answer our problem - it hasn't worked out that way.




Billy

Timtruro

Being able to stick it to the Man.........Priceless.

The Weak Link

I betcha you have "loser pays" in regards to your tort system. America is the only civilized country in the world that doesn't have "loser pays" which is one reason our malpractice situation is out of hand.

I also suspect that Australian expectations of their healthcare providers is a bit lower than in the States, meaning that the hospitals here spend a huge amount of money to make their institutions look like resort hotels.

Is it worth it? You decide......

Velo Dog

Seems about right to me, or at least about what we'd pay around here. My wife had a 30-minute dentist appt the other day that ran almost $1500, and my last OV with a general practitioner, really nothing more than a blood pressure check and a short interview, was $126 plus labs, another $70-something.

Condorita

It's paid, dammitall, not payed!

crtreedude 

I think you all are going to hate me for this, but...

First of all Costa Rica is rated one place higher than the USA for health care, so we are comparing similar services.

Salaries here tend to be about 25% of up there, and so is the cost of living (my estimates)

A few months ago, I had a boo-boo (okay, I had to lay down a motorcycle that was trying to accelerate me to a fiery crash) and ended up needing 6 stitches in total, in two locations. Lots of sand / gravel in the wounds.

Our farm manager ran ahead to the local clinic and put me in line with my identification, I went home and cleaned up. About the time I got out of the shower, I was told they were ready for me.

A nurse and doctor had cut short their lunch to be available for me, and for the next 45 minutes, the proceeded to clean me up, with sub dermal injections to make it less painful. The stitches were very well done, so much so that now I can't even find the scars.

They didn't give my a lollipop nor ice cream (nor pie) but they did a very professional job, happily. My total time was less than an hour. This was considered emergency treatment.

The cost was 23,000 colones which sounds like a lot till you realize that there are 550 colones to a dollar. In other words, less than 45 bucks. They did tell me that my inspection on the vehicle was up to date, so there for the country would pay for the treatment (I don't have Costa Rican insurance - I can pay for whatever I need at these prices!), but honestly, it just wasn't worth doing the paperwork...

They told me to come back to have the stitches removed (for free), but that is what needle nose pliers are for...

I can see 5 times more than here, but really, it normally is 10 to 20 times more in the USA. For our workers, it would have been free since all workers have health care, you pay a percentage of your salary. Just like social security up there.

It also covers loss days worked, etc.

alicestrong

Uninsured here...

A new Buddhist "free clinic' just opened up in my neighborhood, and I couldn't be happier.

I jabbed my leg really well recently working on an old, rusty bike. My "regular" doc wanted $165 to see me in the office and give me a tetanus booster. The clinic did it for $20.

a77impala

Several years ago I was having chest pains all the time, went to my GP and got referred to heart doctor.Long story short $4000 worth of tests later I was told nothing wrong with my heart. On my own I stopped taking my med for my prostate and pain went away, my GP had asked me what meds I was taking but did nothing, I looked on internet and chest pain was a side effect of my med.

Three years ago I was taken to emergency room in Austin Tx with a fractured shoulder suffered in a bike accident. The ER doctor came into my cubicle and told me he had a critical patient and he would be back to me. I never saw him again. His bill was $1010, the treatment was wrapping my arm to my chest because the bone was not out of position. The doctor coded his bill as surgery.

Bendico

After reading some these I am just shaking my head. My family doctor charges $25 if you are a patient and $35 if you are not. Now testing is more but that is not him that would be at the hospital but most of the time he will tell you what he thinks is wrong with out a bunch of what he calls worth less test. He still puts casts on in the office and will sew you up if you get cut. He also doesn't believe in giving you meds when you don't need them. He will take care of people from birth to death as he say that is why he became a doctor. He also hates the Insurance companies and say there are all full of )&*()&)(&()&()&^%&^&)( all the time and just want to take your money. I guess if more doctors were like him and stood up to them our health system would not be in the crappier like it is.

overthehillmedi

I saw my family doctor today to get my prescription renewed and go over my surgury.He took my B.P.130/70 which made both him and me happy. Then we went over the lab results and pathology of my recent surgury,everything is good.Talked about retirement and the weather.Total cost to me twenty minutes of my time and zero,nada,zip dollars.