My8 hr. visit to the ER cost $8,000.

[LLJsmom]

Cflutist, wonderful news for you! OP, if that $8k was my bill, I would have to pay it all under my new insurance (what insurance?). Lord help me...

If you are referring to a high deductible plan, your insurance would kick in to lower it to their negotiated rates, but you'd pay the full amount (approximately 2500).

Wildcat, I do have a high deductible plan, $9000 for the family. I was told I would pay 100% of everything, doctor visits for a sore throat, emergency visits, until we hit $9000. Then we are covered only 60%. So if the "retail" cost is $8000, before applying the negotiated insurance rate, wouldn't I have to pay $8000?? I thought that is what 100% means.

 

[ksinger]

Cflutist, wonderful news for you! OP, if that $8k was my bill, I would have to pay it all under my new insurance (what insurance?). Lord help me...

If you are referring to a high deductible plan, your insurance would kick in to lower it to their negotiated rates, but you'd pay the full amount (approximately 2500).

Wildcat, I do have a high deductible plan, $9000 for the family. I was told I would pay 100% of everything, doctor visits for a sore throat, emergency visits, until we hit $9000. Then we are covered only 60%. So if the "retail" cost is $8000, before applying the negotiated insurance rate, wouldn't I have to pay $8000?? I thought that is what 100% means.

I'm sure wildcat will answer, but in the meantime I'll chime in with my 2 cents.....

I don't have a high deductible plan, but on every insurance I've had over the years (except for the good old days when your company might self-insure, before healthcare costs took off like a rocket) and I've been on quite a few different ones, the only bill amount that mattered was the negotiated price. They can charge 5 million dollars, but if they participate with your network ("in-network"),they (the hospital) has agreed to set amounts for procedures, etc. That is the only 100% you have to worry about. But heaven help if you go out of network. BAD. I got dinged one time with that. I ended up having a surgery at a location that was not in network (I felt it was a bit of a gotcha, honestly), and it didn't break me, but it cost enough to hurt about as much as the surgery. I learned a lesson that day.

 

[Amber St. Clare]

Here's the actual reason


The hospital "chargemaster" sets whatever price it wants. It is arbitrary. They DO NOT expect anyone with insurance to pay that amount. It's just BS. Why?

Because the difference between the amount they charge ($8,000) and the amount your insurance "allows" is marked in their books as "charity". This way, the monster money machines can claim to be "non-profit caregivers".

“The chargemaster can be confusing because it’s highly variable and generally not what a consumer would pay,” Carol Steinberg, vice president at the American Hospital Association, told me when I reported on the new Medicare data. “Even an uninsured person isn’t always paying the chargemaster rate.”

In other words, the chargemaster price is likely irrelevant to most patients. But at Bayonne, Creswell, Meier and McGinty found another reason that may compel hospitals to set the high prices they know they won't get paid.

"Until a recent ruling by the Internal Revenue Service, for instance, a hospital could use the higher prices when calculating the amount of charity care it was providing, Gerard Anderson, director of the Center for Hospital Finance and Management at Johns Hopkins," said in the New York Times story. 'There is a method to the madness, though it is still madness,' Mr. Anderson said."

Charity care is incredibly important to facilities like Bayonne Hospital Center, which needs to demonstrate that it provides a high level of "community benefit" in order to maintain its status as a nonprofit hospital. The higher prices that a hospital charges, the bigger amount of charity care its providing.


I wish I could pull this scam off! I would claim my time is actually worth 10x more than I am paid, and declare charitable deductions every year with the IRS. I would never pay taxes if I could get that deal.

Full article: https://www.washingtonpost.com/news/wonk/wp/2013/05/19/heres-why-hospitals-set-high-prices/

Thank you Ilander. That was enlightening. Rage provoking but enlightening!

 

[GliderPoss]

WOWSERS! $8K for an ER visit for stomach cramps is utterly ridiculous... Seriously crazy....

Lucky for us if you are an Aussie citizen and have a Medicare card then every ER visit in a public hospital is totally FREE. If you don't have one/not a citizen you are charged $AU120 for the consultation. God bless Medicare is all I can say.... I still don't understand why the US doesn't want healthcare reform?!?

I'm glad you are feeling better OP.

 

[wildcat03]

Cflutist, wonderful news for you! OP, if that $8k was my bill, I would have to pay it all under my new insurance (what insurance?). Lord help me...

If you are referring to a high deductible plan, your insurance would kick in to lower it to their negotiated rates, but you'd pay the full amount (approximately 2500).

Wildcat, I do have a high deductible plan, $9000 for the family. I was told I would pay 100% of everything, doctor visits for a sore throat, emergency visits, until we hit $9000. Then we are covered only 60%. So if the "retail" cost is $8000, before applying the negotiated insurance rate, wouldn't I have to pay $8000?? I thought that is what 100% means.

No. You won't pay "sticker" price. You will pay your insurance's negotiated rate for the services, but you'll pay 100% of the the bill until you hit the deductible.

So, you get a hospital bill for $6,000. But, you go to an in-network hospital. The negotiated rate between your insurance company and the hospital for those services is $2,000. So, you pay the $2,000 (but you pay 100% of it).

If your health plan is HSA compatible (NOT FSA - they are different), I would strongly advise opening one.

 

[telephone89]

WOWSERS! $8K for an ER visit for stomach cramps is utterly ridiculous... Seriously crazy....

Lucky for us if you are an Aussie citizen and have a Medicare card then every ER visit in a public hospital is totally FREE. If you don't have one/not a citizen you are charged $AU120 for the consultation. God bless Medicare is all I can say.... I still don't understand why the US doesn't want healthcare reform?!?

I'm glad you are feeling better OP.

I remember talking to a friend who'd moved here (Canada) from florida, and didn't understand our system (likely similar to yours). All she'd ever heard of were loooong lines and some weird horror stories that I don't think were fully true. For example, she'd heard that there was a person in 'line' at the hospital with a cut/needed stitches. Then a guy having a heart attack came in. And the guy with the heart attack died because he had to wait so long for the other person to get stitches. And then I had to explain triage haha.

 

[purplesparklies]

Tonight we spent some time at my father-in-law's house going through old filing cabinets and going over mountains of old paperwork. My father-in-law passed away just over a month ago. We came across the itemized hospital bill for his mother's final hospital stay in 1977. She was in the hospital for 28 days and the total bill was just under $16,000. There was no insurance coverage. Reading over the statement made me think of this thread and the $8000 bill for an 8-hour stay in the ER these days. Amazing the increase in fees for things. I can not even imagine what the bill for a 28-day stay would be now.

 

[diamondringlover]

I will chime in here, I am a provider project analyst for a medical insurance company. That is a large bill but I have seen worse, just seen one the other day $166,000 for a 23 hour observation! anyway, if you are going to a participating provider with your insurance company then that provider and the insurance company have contract and they contract for all services with the insurance company. You would only pay your out of pocket based on the contracted rate..out of pocket would be copay, coinsurance and or deductible, or all of these depending on your insurance plan, the insurance company is suppose to write off the balance of the bill above the contracted rate, you are not responsible for that balance above the contracted rate. Some facilities and providers will try to balance bill you do not pay it, call the insurance company.

Now if your plan has both in-network and out of network benefits and you go out of network provider or facility then the reimbursement is based on usual & customary rates (or reasonable & customary) and once again this is based on your plan, most plans use this method but not all of them and on most plans you would be responsible up to the entire billed charge..so it pays to do your homework and stay in-network. In the case of a ER visit most plans have provisions for out of network providers and will pay up to the billed charges...but once again it depends on your plan.

My advice to everyone is know your insurance plan, if you don't understand it contact your HR person or the insurance company, knowledge is key! If you know your plan you will know if the claim is processed correctly or not and then if you get a bill and it doesn't seem to be paid correctly then call the insurance company they will explain how it was paid and if there is a mistake they will send the claim to be reprocessed. Keep in mind insurance claims are paid by everyday people like me, we make mistakes, the system makes mistakes if not programmed correctly, so always double, triple check any bills you get and call the insurance company if it doesn't seem to be paid correctly.

 

[OoohShiny]

WOWSERS! $8K for an ER visit for stomach cramps is utterly ridiculous... Seriously crazy....

Lucky for us if you are an Aussie citizen and have a Medicare card then every ER visit in a public hospital is totally FREE. If you don't have one/not a citizen you are charged $AU120 for the consultation. God bless Medicare is all I can say.... I still don't understand why the US doesn't want healthcare reform?!?

I'm glad you are feeling better OP.

+1 to this.

I don't know all the details of Obama-care (is that what it's called?) but I don't understand why many in one of the richest countries in the world, which prides itself in being the best place in the world (in its opinion, anyway ) think that those who are poor, either through misfortune or lack of opportunity or, yes, even through making mistakes and poor choices in life at a younger age, deserve to die if they can't afford insurance.

As I say, I don't know the ins and outs of medical insurance in the USA, or whether a 'free treatment cover' of some sort exists (??) but here in the UK we are very well served with regards to healthcare through the National Health Service. You are suddenly taken seriously ill or have an accident that requires immediate medical attention? Call an ambulance and get taken to Accident and Emergency, get seen, have an emergency operation if required, recuperate and receive food and medication as required, and the cost to you out of your pocket during the event is... Zero.

Yes, we all pay for the NHS system through our general taxes on income and things we buy, and yes, it is a giant, unwieldy, lumbering and inefficient machine, but it means that everyone, dirt-poor or a millionaire, is treated equally and freely at the point of requiring medical care, and it means that the poor don't die from a burst appendix because they couldn't afford to even see a doctor, nevermind the many thousands that an appendectomy would cost them if they had to pay for it.

If I was in agonising pain, would I want to lay there crying while contemplating which was preferable - going to a loan shark to get the money to pay for an operation at a massive interest rate, or accepting that I had to die in middle age because it was less overall hassle and wouldn't mean the next 5-10 years of my life would be spent in massive debt and fear for my limbs and family from what 'da boyz' might do if they come round to collect what I don't have...


I'm probably completely wrong in my perceptions of the US healthcare system and am happy to be corrected but it does seem to me that the whole health insurance situation is just one massive racket to make $billions for the insurance and healthcare industry at the expense of those who are least able to pay...

 

[missy]

Gosh I don't want to fuel anyone's fire here and I am certainly no expert and don't want to pretend I am but will chime in with a few things I do know. I work at a non profit multidisciplinary health clinic in the USA and we take care of people who have no money. They are either on medicaid, medicare or something else and they are taken well care of and have no out of pocket expenses. Unfortunately our clinic lost over 1Million dollars last fiscal year so not sure what the future holds for our clinic or our dear patients. All I know is Obama care seems to have left us worse off but again cannot go into the details as I don't know them. Just know the results I see daily.

If you don't have enough money there is Medicaid or other healthcare to help. No system is perfect. I have many friends in the UK and they tell me that there are very long waits for care in the NHS and privatization exists so if you have money you can get care sooner. And good luck getting into see a dermatologist in the NHS when you need one for example. Just like here money talks and gets you "special" care. Better care I cannot say but yes money makes a difference no matter where you live from what I understand talking with my friends who live all over.

I know people who come here to the USA and go to HSS because of long waiting lists for hip replacements in other countries (thinking specifically of someone I know from Canada just to share one example). I point this out only to share that there is no perfect system and finding timely and good and efficient and affordable healthcare is challenging no matter where you live.

When I had my surgery at HSS summer of 2014 the bill was over 50K (cannot say if that was just the surgeon bill or OR bill) and I stayed 4 days/nights in the hospital recuperating. Don't know the bill for that. I do however know my copay. Zero. And I had an excellent surgeon and excellent care. No complaints and I was amazed I had no copay. Shocked in fact.

But don't get me started on medication copays and the fact that almost all meds are no longer even covered. Frustrating from a doctor's point of view because the insurances are tying my hands with what I can prescribe i.e. no longer the best meds because they are too expensive and not covered and my patients cannot afford that and frustrating from my personal POV as a patient also. I cannot get my meds that are necessary covered so it is a huge pain. But show me the perfect system.

And just so you know I am not saying the USA has the best healthcare but I don't know who does and there are pros and cons of every country re healthcare.