Hospitals slow to disclose prices

[Shadow01]

It's such a tough thing. Charges are one thing, but negotiated insurance rates are another. I can say my hospital charges $4000 for a level 5 ER visit. You have no idea what separates a level five from a level two, or when the next thing we do bumps you up a level.

The hospital may have a contract with Anthem that allows a $2000 charge, but a contract with United Health that allows $2600. Each patient has diff co-pays and deductibles. At the registration desk, the patient has no idea what these rates will be, or what imaging tests will be ordered, or labs, or meds. Neither does the doc or the nurse.

We can quote charges, but that has almost nothing to do with what the patient will be responsible for. My group collects under 20% of what we bill.

Price transparency is nice but it's hugely complicated and not as clear-cut as it sounds.

When's the last time Congress passed a budget? That's required by law.

What is the charge for an aspirin, or a bag of Ringers? For comparison my wife buys Ringers for $10 a bag. I would love to see what a hospital charges for that same bag.

 

[ed1838]

I was in a hospital in a different country, the costs was posted and with options for pain meds at a extra charge but if things went bad and you didnt have money to pay you did not get treatment or could die.

 

[wtburnette]

I honestly believe there is a happy middle ground between our byzantine system and "here are the clear charges but if you can't pay you'll just have to **** off and die".

 

[femurphy77]

I can neither confirm nor deny that if you're having various procedures such as labs, imaging work, etc. that it is cheaper to have it done in a non-hospital setting. I can neither confirm nor deny that hospitals are authorized to charge more for the same procedure simply because they are a hospital vs your strip mall imaging center.

I can neither confirm nor deny any of the above.

 

[bgcatty]

Of course the hospitals don’t want to reveal pricing! It is because they are so far leveraged due to all the new hospitals and buildings they are constructing all over the place. Something has to pay the monthly “nut” on all these facilities and that something is you and me? Talk about price gouging. Hospitals lead the way. Don’t believe me? Next time you are in a hospital for a serious medical incident obtain and review a itemized bill from the hospital. Your head will spin out of control! Good luck.

 

[hoosierdoc]

What is the charge for an aspirin, or a bag of Ringers? For comparison my wife buys Ringers for $10 a bag. I would love to see what a hospital charges for that same bag.

Usually at least a 10X markup. Which is more expensive? A bag of fluid? Or the nurse taking time to get it, spike it, prime the line, ensure the IV is patent, hook it up, run it in, and assume liability if there's a problem?

Hospitals are sneaky at separating all these charges. Simply giving the fluids increases the level of service, then there's pharmacy charge on the fluid, nursing fee to admin it, etc etc etc.

We could do it like mexico where you don't get to leave until your bill is paid. And the longer it takes you to pay, the higher the bill goes.

Spokane woman says Mexican hospital held her hostage, extorted her family

A Spokane woman and her family say she was held hostage in a Mexican hospital this week after receiving a punctured lung while on vacation in Cabo San Lucas.

www.spokesman.com

If you have a laceration that's a bit skewed, I can repair it without revising the wound edge. I can try to stuff the extra fat back inside the cut. Or i can simply cut the lac to have better edges and cosmetic appearance. I can cut out the little bit of herniated fat and make it close easier and cleaner.

Each of these two interventions adds to the complexity of the laceration repair, and thus the cost. Should i get consent from the person before I trim the wound a bit if it adds $200 to the fee?

I usually just do it and don't tell anyone or document it because it seems ridiculous for minor things. The lac repair charge is enough. But technically when I do that I am signing a fraudulent medical chart.

Underbilling and undercoding is fraudulent. Waiving co-pays is fraudulent.

Charges are so complex. There is no easy answer.

 

[PapaScout]

I had a reaction to something earlier this year and went to the ER in Mooresville. I was charged $1600 out of pocket for a shot of epi and two 1-minute visits from a doctor while I waited. Is my life worth $1600? I think so. Was the doctor and staff worth $1600? Not a chance.

 

[hoosierdoc]

I had a reaction to something earlier this year and went to the ER in Mooresville. I was charged $1600 out of pocket for a shot of epi and two 1-minute visits from a doctor while I waited. Is my life worth $1600? I think so. Was the doctor and staff worth $1600? Not a chance.

$1600 from the hospital or the doc? Should be separate bills.

Acute anaphylaxis is a serious issue. You were likely seen rather quickly without an appointment and received life-saving medication. You were then likely monitored with blood pressure, heart rate, and oxygen levels.

What is the convenience of that worth? You could have called your doc and gotten a script and waited and the pharmacy for it to be filled and then taken it, but that is risky.

Anaphylaxis can go bad in a hurry. Epi doesn't always work. There's not much to do other than a epi and watch, and more epi if first doesn't work.

What do you think would be a fair charge for the convenience of immediately available life-saving care without an appointment and the ability to sue the hospital and doc for a crap-ton of money if something goes wrong?

At what point is the reimbursement so low that we should just say "no"? Yeah, can't do that legally, and we really don't set our fee schedule for anyone other than the uninsured or out of network which is the vast vast vast minority. Doc reimbursement per person in the ER is just over what an hour long massage costs. Is that fair? I say no.

I work in MV. It's not unconmon for the doc to have 25 active patients in the ER. My record was 43 ER patients I was managing on a ridiculously busy day. We don't have extra docs available. We just work harder and faster. If i spent one minute in each room at bedside, not including Hand washing/walking to next room/charting, i could give each patient a minute of care every two hours. Fortunately we have PAs to assist in patient care because some days the doc cannot physically see everyone.

Not saying your day was one of those crazy days, but it is a reality. But if not, would you feel the charge was more appropriate if the doc spent longer in the room wasting time? Or maybe completed the whole chart whole BSing with you?

Time spend doesn't factor into the value of care received. I can reduce a shoulder dislocation often in 30 seconds with no sedation. Is the value of that less than when I need to sedate someone and have four people assist to get it back in? Nope. Frankly, it should be more. I'd much rather not be sedated and be out of pain in 30 seconds. That has value over a much longer stay and risky procedures.

But studies show patients are more "satisfied" when more procedurea/labs/imaging/meds are done. They like being "treated". The happiest patients are usually the ones that undergo the most testing or intervention. Sets up absurd expectations on both sides of the bed. Ideally it would be a cash-based system. Set fees for the five levels of care, needed procedures an additional fee. Doc is paid in cash at discharge. Would save so much money.

Nowadays, it seems patients don't want our advice or opinion, we are simply their tool to get what they want done medically. When our opinion of what they need differs from their expectation, it sets up problems. That cycles back to my comment about patient satisfaction and amount of stuff done. If we can accept a larger first-visit miss rate on things like appendicitis, it would save a TON if money. We image so many people for non-semse abdominal pain because our current system punishes any miss and the patient will blast us on social media. So everyone gets everything done and the system bloats and bloats.

 

[hoosierdoc]

I should add that I love being an ER doc, but I hate the system it exists inside now. It is not what it was when I started. Can't wait to no longer do it if this is how it's going to be.

It seems like the majority of ER docs I talk to want out. For the first time in years, EM residency match had 10% unfilled positions. There is a forecasted glut of ER docs becauce private equity companies are buying hospitals and opening up new residencies to train their own employees, reduce recruitment expense, and oversaturate the job market, depressing wages.

Emergency medicine is falling apart. Nurses don't want to do it. They're going to surgery centers and other 9-5 M-F jobs or just quitting nursing altogether. A local hospital has 35% of it's positions filled by employed ER nurses, the rest are travelers. It will not improve for years, if it ever does.

 

[PapaScout]

$1600 from the hospital or the doc? Should be separate bills.

Acute anaphylaxis is a serious issue. You were likely seen rather quickly without an appointment and received life-saving medication. You were then likely monitored with blood pressure, heart rate, and oxygen levels.

What is the convenience of that worth? You could have called your doc and gotten a script and waited and the pharmacy for it to be filled and then taken it, but that is risky.

Anaphylaxis can go bad in a hurry. Epi doesn't always work. There's not much to do other than a epi and watch, and more epi if first doesn't work.

What do you think would be a fair charge for the convenience of immediately available life-saving care without an appointment and the ability to sue the hospital and doc for a crap-ton of money if something goes wrong?

At what point is the reimbursement so low that we should just say "no"? Yeah, can't do that legally, and we really don't set our fee schedule for anyone other than the uninsured or out of network which is the vast vast vast minority. Doc reimbursement per person in the ER is just over what an hour long massage costs. Is that fair? I say no.

I work in MV. It's not unconmon for the doc to have 25 active patients in the ER. My record was 43 ER patients I was managing on a ridiculously busy day. We don't have extra help available. We just work harder and faster. If i spent one minute in each room at bedside, not including Hand washing/walking to next room/charting, i could give each patient a minute of care every two hours.

Not saying your day was one of those crazy days, but it is a reality. But if not, would you feel the charge was more appropriate if the doc spent longer in the room wasting time? Or maybe completed the whole chart whole BSing with you?

Time spend doesn't factor into the value of care received. I can reduce a shoulder dislocation often in 30 seconds with no sedation. Is the value of that less than when I need to sedate someone and have four people assist to get it back in? Nope. Frankly, it should be more. I'd much rather not be sedated and be out of pain in 30 seconds. That has value over a much longer stay and risky procedures.

But studies show patients are more "satisfied" when more procedurea/labs/imaging/meds are done. They like being "treated". The happiest patients are usually the ones that undergo the most testing or intervention. Sets up absurd expectations on both sides of the bed.

What if my bill have been $5,000? $10,000? The point I was trying to make is my only choice was going to the ER or not going to the ER. The hospital/doctor charges were beyond my control at that point and I paid whatever was demanded.

Oh, and I sat in the waiting room for 45 minutes before I was seen. I was mostly breathing okay but face was swollen. Not dying but I'd never had anything like that happen before so I was nervous.

 

[hoosierdoc]

What if my bill have been $5,000? $10,000? The point I was trying to make is my only choice was going to the ER or not going to the ER. The hospital/doctor charges were beyond my control at that point and I paid whatever was demanded.

Oh, and I sat in the waiting room for 45 minutes before I was seen. I was mostly breathing okay but face was swollen. Not dying but I'd never had anything like that happen before so I was nervous.

Technically you could have gone to a fire station and gotten the med then refused transport. Not suggesting that, but they carry Epi also.

Waiting room times have sucked lately. Two weeks ago our main campus was holding 35 inpatients in the ER, taking over half our beds. So we were supposed to see as many ER patients in a day with half as many beds. MV usually isn't as bad but times do stack up if beds are full. We will get anyone back immediately if the triage nurse feels you need immediate treatment. We'll code you in the hallway (it happens).

I agree our system is broken and the costs are absurd. Imagine you needed a quick CT scan for something, probably $5k but the outpatient test is $400.

I looked into opening a facility for procedures but the administrative and regulatory burden is insane. I think the only way to save it is eliminate patient satisfaction, let docs be brief and to the point, and create a secondary market of cash-only care that is shown to be superior in every way.

 

[PapaScout]

Technically you could have gone to a fire station and gotten the med then refused transport. Not suggesting that, but they carry Epi also.

Waiting room times have sucked lately. Two weeks ago our main campus was holding 35 inpatients in the ER, taking over half our beds. So we were supposed to see as many ER patients in a day with half as many beds. MV usually isn't as bad but times do stack up if beds are full. We will get anyone back immediately if the triage nurse feels you need immediate treatment. We'll code you in the hallway (it happens).

I agree our system is broken and the costs are absurd. Imagine you needed a quick CT scan for something, probably $5k but the outpatient test is $400.

I looked into opening a facility for procedures but the administrative and regulatory burden is insane. I think the only way to save it is eliminate patient satisfaction, let docs be brief and to the point, and create a secondary market of cash-only care that is shown to be superior in every way.

You're a lot closer to the problems than I am. I rarely need medical assistance and was surprised by the cost. I'm in no way trying to bash doctors (I have a couple of friends in the field) but yeah, the system is broken. Insurance was meant to be a buffer between people and high-costs. It sounded good in theory but it's done more to drive overall costs up than anything else.

 

[bwframe]

Apparently we all need to be on the obamacare?


.

 

[HoughMade]

Hospitals (and insurance companies) are full of

You can think the government and the existence of health insurance for that.

 

[wtburnette]

You can think the government and the existence of health insurance for that.

Agreed that at minimum they make it worse.

 

[femurphy77]

I had a reaction to something earlier this year and went to the ER in Mooresville. I was charged $1600 out of pocket for a shot of epi and two 1-minute visits from a doctor while I waited. Is my life worth $1600? I think so. Was the doctor and staff worth $1600? Not a chance.

Not a dis but a suggestion, if you're prone to allergic reactions perhaps have an epi pen handy?

 

[Shadow01]

Usually at least a 10X markup. Which is more expensive? A bag of fluid? Or the nurse taking time to get it, spike it, prime the line, ensure the IV is patent, hook it up, run it in, and assume liability if there's a problem?

Hospitals are sneaky at separating all these charges. Simply giving the fluids increases the level of service, then there's pharmacy charge on the fluid, nursing fee to admin it, etc etc etc.

We could do it like mexico where you don't get to leave until your bill is paid. And the longer it takes you to pay, the higher the bill goes.

Spokane woman says Mexican hospital held her hostage, extorted her family

A Spokane woman and her family say she was held hostage in a Mexican hospital this week after receiving a punctured lung while on vacation in Cabo San Lucas.

www.spokesman.com

If you have a laceration that's a bit skewed, I can repair it without revising the wound edge. I can try to stuff the extra fat back inside the cut. Or i can simply cut the lac to have better edges and cosmetic appearance. I can cut out the little bit of herniated fat and make it close easier and cleaner.

Each of these two interventions adds to the complexity of the laceration repair, and thus the cost. Should i get consent from the person before I trim the wound a bit if it adds $200 to the fee?

I usually just do it and don't tell anyone or document it because it seems ridiculous for minor things. The lac repair charge is enough. But technically when I do that I am signing a fraudulent medical chart.

Underbilling and undercoding is fraudulent. Waiving co-pays is fraudulent.

Charges are so complex. There is no easy answer.

You shouldn’t be jacking up prices on drugs to cover salaries. It should be a separate line item for labor. That circumvents income taxes owed. No different that car repair shops jacking up parts costs on the bill to avoid taxes on the labor charge.
go ahead and make the patient pay before leaving. I expect every patient that has no expectations or means of paying to be held indefinitely. Everything else posted is an excuse of why you can’t. More like just unwilling. The communications industry told the fed for years why they couldn’t maintain services as requested and required if they broke up Ma Bell. They did, they are, and still in business today Making more profit than ever. The only reason hospitals are pressing back is that they haven’t figured out the details needed to allow them to continue taking advantage of the system.

 

[eldirector]

Doctors/hospitals also should not be told by insurance companies and government regulators what they will be paid. They HAVE to mark up some consumables and labor to make up for ridiculous insurance payments, low .gov mandated rates, and all of the non-payment and write-offs.

The system is a **** show, from all sides. Government meddling doesn't help, and our so-called "insurance" Ponzi schemes started the mess.

 

[BehindBlueI's]

When I use auto insurance, body shops give itemized estimates regardless of deductible and who's paying what percentage.

When I use home insurance, same thing. I called 3 roofing companies, picked one, ate the deductible, insurance ate the rest.

When I use health insurance I have no idea what I'll pay. And I don't get *a* bill, I get a stream of them. Imagine if a garage worked like that. $X for use of the shop. A week later, you get a bill from the mechanic. A week later, you get a bill from the lube tech. Then you get one from the other mechanic the first mechanic consulted. Then the parts bill. Etc. Etc.

Last year I paid $5k to temporarily fix an issue that I'm currently paying about $25 to permanently fix because the clinic doc actually listened and ran a simple blood test and is treating the underlying issue instead of symptoms. I hope the GI doc who soaked me for a bunch of unnecessary and ultimately useless procedures enjoys his boat or whatever he needed to pay for by doing all that useless **** to me and not listening to my actual symptoms. Thankfully the surgeon disagreed with his diagnosis and we didn't cut things out of me that would also have not fixed the issue. If doctors were treated like cops and their mistakes that kill and maim people were splashed on the front page and they were criminally tried for them we'd have zero doctors. But they can kill you and still charge you for it. I've got to be pretty damned sick before I go to a doctor because going for small things just leads to you getting sicker and poorer. At least Comm South treated me decent and didn't actively steal my possessions while I was waiting for treatment like Louisville's VA hospital.

Blame whoever you like, but when I was in Qatar where there was public healthcare and private healthcare ran side by side I knew exactly what a procedure cost ahead of time, it was one bill and the hospital paid all their various providers, and the quality of care was good for all the routine things you need. I wouldn't want to be there for some rare cancer treatment, or even an organ transplant, but all the mundane illnesses, child births, basic traumas, etc. were readily available at a cost you could afford with or without insurance.

 

[PapaScout]

Not a dis but a suggestion, if you're prone to allergic reactions perhaps have an epi pen handy?

No dis perceived Far from prone - I've actually never had a reaction like that before and have no idea what caused it.