In any other industry, emergency medical billing would be considered fraudulent

Originally published at: https://boingboing.net/2019/12/09/drive-by-visits.html

5 Likes

My wife went to the ER a few months ago and we had a fairly odd American Experience.

They miscoded her as either not insured or that this visit wasn’t covered, not sure which. So we received a MASSIVE “explanation of benefits (this is not a bill)” for like $25k of which insurance covered almost nothing. We opted to wait for the bill and see what happened.

The hospital offered us off the hook for less than $2k because we were “uninsured” (we aren’t). We called our insurance company, they found the miscode and said they can fix it. The catch? We have a high deductible plan so in all likelihood we’ll pay the full amount that the insurance company negotiated with the hospital.

So now we’re playing a little game: the insurance-negotiated amount might be a bit more or a bit less than what the hospital offered. They won’t tell us what it would cost and they won’t let us choose after knowing the amount. So we have to just decide now whether to take a known $2k or roll the dice on paying $1k or $3k.

24 Likes

And in any other industrialised Western country, the American health system would be considered a complete disgrace.

The latest trend in this wasteland of greed and parasitic hangers-on: injured people begging bystanders to call them an Uber to the ER instead of an ambulance, because they know they’ll be charged at least $2000 for the latter.

A little Vegas-style excitement always makes emergency medical trauma better, right?

23 Likes

Oh god. I can smell the code that does that from here.

The radiologist gets a checklist of test things, but each one is actually an assembly of costs, each including a scan sub-item. It should reorganized as a scan item with optional test sub-items, or use an optimizer to eliminate duplicate items.

Heh. Any developer that suggests that would probably be immediately escorted* to the parking lot.

 * feet touching the ground optional.

12 Likes

The use of medically unnecessary and overkill procedures is exacerbated by another quirk of our system. Was a CT appropriate? Maybe, maybe not. An x-ray works quite well. But since an x-ray could miss something say 2% of the time, and hospitals are going to be on the hook for legal costs for not using the best medicine available, they just direct everyone to the CT even though it’s 10 times more expensive for the patient. Even if the hospital is non-profit, there’s no upside for the hospital to direct patients towards lower cost treatments, only downsides.

3 Likes

And you get billed more for that “service” whether you ask for it or not.

4 Likes

In the breakdown of the medical bill, each broken bone includes the cost of a hospital bed.

4 Likes

Why is this ok?:
A $1100 medical charge transforms into an “acceptable” charge of $130 by your insurer (or Medicare) and you pay your portion of that acceptable charge, whereas if that same charge is “not covered”, YOU are expected to pay $1100.

5 Likes

See my note upthread - the hospital will most likely cut you a deal. The whole thing is a grift from top to bottom, you’re not supposed to know what anything really costs and you’re supposed to be scared of it

12 Likes

Just came back from Thailand and had to take the little one to the ER after she gashed her leg at the beach and needed 7 stitches.
The hospital was small and very plain instead of our palatial ones with water features and sculptures other expensive shit. We went directly into triage and the doctor stitched her up within 30 min of arrival. Got antibiotics and ibuprofen and walked out the door after paying approximately $76. Granted, the USD is strong over there and I don’t know how much of a burden 2300 THB is for the average household in Thailand.
The US healthcare system is fucked…

14 Likes

Earlier this year my son went to the nearest ER for a dog bite to his face. By the time we got there, he was already stitched up (about 7-8 stitches total + an antibiotic shot) and ready to discharge (45 mins tops). Since he’s on our insurance I provided the discharge nurse with all the details expecting to pay the standard $150 ER co-pay.

About 10 days later we get the bill and it’s for more than $5,500!! - including a separate $120 charge from the ER doctor just to take his blood pressure.

Like most insured Americans these days, our employer-sponsored medical insurance is now a high-deductible plan where my wife’s employer contributes an annual payment (in the form of a tax deductible Health Savings Account) to “cover” the deductible ($1500 in our case). What’s not well known however is that on her plan the deductible is $1500 per person while the employer HSA contribution only applies to her and cannot be used for other family members on her policy.

So not only does the “in-network” ER charge outrageous fees for simple procedures, including additional doctor charges that are not covered since he is “out of network”; and because most employer insurance plans have moved to high-deductible policies with no other choices offered, there is clear disincentive to ever step inside an ER in the US.

Even with so-called “Cadillac” insurance, we are forced to come out of pocket for almost $2000 ($1500 deductible + 20% co-insurance + $150 ER co-pay) for a few stitches, some band-aids, and an antibiotic shot. (Oh, and a blood pressure reading).

I’m halfway curious to see what the non-insurance charges would have been.

10 Likes

After your first paragraph, I was thinking “Oh, $150…not bad”.
I’d rather be robbed at gunpoint, at least I know what it would cost.

1 Like

I have had a LOT of medical stuff this year, surgery, treatment, scans and more scans. As a Canadian, it cost me nothing. Directly, anyway-- its covered in my taxes.

So for taxes: I happen to be a dual citizen, so I have the pleasure of filing two returns each year. My US combined State+Fed vs my Canadian Province + Fed? It worked out to about $75 more to be a Canadian this year. Some years it goes the other way.

So instead of buying stealthy jets and nuke powered ballistic missile submarines, my Canadian government chooses to buy me healthcare.

I generally try and stay on the North side of the border. Certainly I would NEVER get anything medical done in the US.

Not that everything is perfect up North, Canadian ambulance services, which aren’t part of medicare, can get a little predatory too, but it still only amounts to a couple of hundred bucks. And I suspect that some of the referrals to specialists back and forth amount to medical log-rolling, but thats for the government auditors to catch, not me.

14 Likes

Sounds great to me! I’m voting Tory on Thursday! /s

5 Likes

the trauma clinic was only open for six hours a week

WHAT.

4 Likes

In my area, ten-ish years ago (I’m not sure if this same situation still applies today) the local ambulance company (there is only one) convinced the local hospitals that it was too dangerous for volunteer ambulance crews from smaller towns in the area to to deliver patients directly to hospital emergency rooms, because “they’re not used to driving in our local rush hour traffic”. Never mind that all of these drivers have been doing the majority of their shopping, and personal hospital visits in this town all of their lives, and the town is only a 60K population. So now, while they’re on their way to the hospitals here, they have to call ahead and have a local non-volunteer (ie, for-profit-corporation) meet them at designated points outside of city limits, and have the patients switch vehicles. It’s absolutely insane.

10 Likes

There are multiple issues at play here regarding US healthcare and none of them are well understood nor explained properly by the media.

One is the predatory pricing for ER services. Most ERs are now “free standing” ERs that are affiliated with private medical groups. They are not hospitals, but rather independent clinics that advertise prominently as “Emergency Care”…and can charge outrageous “facility” fees that a normal hospital is prohibited from charging. This was the case for my son, whose bill included almost $3500 in “facility charges” that wouldn’t have been there if he had gone to an actual hospital a few miles away.

This is a growing phenomenon in the US and is causing truly predatory price gouging on unsuspecting consumers.

https://revcycleintelligence.com/news/freestanding-emergency-departments-cost-22-times-more-than-doctor

Separate from the rise of freestanding ERs is the practice of “surprise” billing by out-of-network doctors even though they are working inside in-network facilities. Many states have started outlawing this and Congress is actually close to passing national legislation banning so-called “balance billing”.

Another factor is the wide spread adoption of High Deductible Health Plans among large employers as the only (or limited) option for workers to choose from. While on the surface, high deductible plans are designed to shield employers from rising insurance costs, many are finding that it is not having the desired effect. As in the case of my wife’s plan, there are lots of hidden “gotchas” that pass costs along to the employee.

So even those of us with so-called “great” employer sponsored insurance, actually using our insurance includes huge costs that causes real financial harm to many. A surprise $1000-$3000+ out of pocket medical bill even when you have insurance is not something most people think about.

https://www.hfma.org/topics/news/2019/08/enrollment-of-large-company-workers-in-high-deductible-plans-rea.html

The US healthcare system is truly fucked. Nothing short of burning it down and starting over with a single-payer system will suffice any longer.

12 Likes

I hate to break it to you, but not only are you getting hosed by the ER, you don’t have Cadillac insurance.

I happen to have my son’s bill next to me for a legit hospital ER. Treated for a potentially broken hand a month ago. $1184. Which is expensive enough. We are responsible for $250 of it, which will be covered by the HSA.

We normally go to the Urgent Care places if we can. My other son just got treated for a gash on the foot. $30 out of pocket for stitches and a prescription. I think insurance covered $180 or so.

Costa Rica was cheaper for his face stitches a few years back. $80 to get stitched up at the pharmacy. Heck, it might have been traumatizing, but as “vacation memories” go, that was a bargain!

But not as much as my treatment in China for kidney stones. $40. Including ultrasound scan, 2 doctor consultations, IV medication, and taxi ride to and from the hospital. In the “pay for memories, not for stuff” category, it’s also a bargain!

We’re kind of atypical when it comes to “shopping” for emergency care. We’re one of those families that ends up getting hurt often enough we have our favorite hospitals and clinics. It’s why we have the HSA!

2 Likes

I have the Pinto of insurance. It costs $500 to go to the ER, and that’s just my co-pay.

7 Likes

Chevy Nova:

Insured single, $200/MO $4500 deductible. Nothing appears to be covered until that deductible is met.

I checked and it only gets worse if I didn’t take the work provided plan.

Then Cygna has the gall to mail me extra shit aside from the explanations of benefits jerking themselves off about how much money they claim to have saved me. Then I check w/ the doctor’s office and discover it’s much cheaper to just pay with the HSA I have and not even send a code to insurance.

This system is so fucking broken.

There is no moral or ethical capitalist way to provide Healthcare. It is all rotten to the core.

16 Likes