http://www.latimes.com/health/la-me-lopez-erfollowup-20120401,0,6799675.column
The bizarre calculus of emergency room charges
By Patrick Follow Mon, 2 Apr 2012, 6:35pm 2,113 views 19 comments
In Menlo Park CA 94025
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Baltimore, MD
Gotta love this strategy:
Gary Larson has a $5,000 deductible insurance plan, but has found that his medical bills are cheaper if he claims he's uninsured and pays cash. Using that strategy, an MRI scan of his shoulder cost him $350. His brother-in-law went to a nearby clinic for an MRI scan of his shoulder, was billed $13,000, and had to come up with $2,500.
Schwarzman has an insurance plan with a high deductible ($7,000). Like Gary Larson (the guy at the top of this column), Schwarzman also paid about $350 for a scan on himself that would have cost much more if he went with his insurance company's negotiated rate. A couple of years ago, his daughter needed an ultrasound for a possible gallstone. If he'd gone through his insurance company, he would have been charged $3,200, with insurance paying $1,500, leaving him a $1,700 bill. He chose instead to leave insurance out of the equation and pay cash instead. The price was $250.
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Two questions to stop those who think the individual mandate is unconstitutional in their tracks(remember this was a republican idea because it requires personal responsibiliy
1. Do you have insurance?(all those opposed do)
2. If someone who can pay chooses not to, requiring you to foot the bill with higher premiums, should they be treated at the ER or turned away?
However, they answer, they are either heartless or clueless.
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zzyzzx says
That's what I keep trying to tell you Lady!
Everyone just takes the spin that costs are high, and you can't survive with out insurance in this country. It's a goddamn fuck job over the Oval office desk is what it is. My family gets along just fine paying doctor bills as we go along. One month, I bought a pair of glasses and got an eye exam, my wife got a pap-smear, and two daughters went to a general practitioner for a check up. The grand total that month was way below the $1400 a month premium my company calls a "BENEFIT" that I refuse to pay for.
A laugh at all you suckers every day.
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San Jose, CA
Yeah, I took my son to the emergency room for his earache. We waited for a couple of hours before seen by a doctor for 5 minutes. It turned out he was just lying to get out of violin practice. The cost to me was $100. And they charged my insurance company $1000. Go figure. It took 5 minutes for my son to fess up. It took less than one minute to figure there is no ear infection.
I normally pay 25 cents every time he plays a music on piano or violin. It's been about 5 days. He still has about 200 musics to go at this stage. The payback is a b*t*h.
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Boca Raton, FL
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Hospitals need to be sued for fraudulent billing. That's the only thing that's going to stop this short of a nationalization of the health care industry with standardize pricing.
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Dan8267 says
Nope I prefer a Nation Health care system ran from the School to the Hostpital.
I say we start by training the Troops that are returning back from Iraq and Afghanistan to be Doctors, since they can't find a job and have no useful Civilian skills anyway. But that's way to progressive for this country. Why we would need a party in Washington that actually gives a Rats Ass about anyone but them selves.
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Fightthefungus says
They should be turned away.
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You know who was good at running affordable health care?
Religious organizations.
Baptists, Islams, Christians, Shriners ect...
Just sayin' capitalism and healthcare doesn't mix, neither does federal mandated company patronage. Reason 101 Liberals have lost their soul.
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Boca Raton, FL
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Capitalism doesn't run the Highway Transportation System. Why should it run health care?
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Alamo, CA
I am an ER doctor.
I was having palpitations once while on a shift, so my colleague made me check in so we could see what was up. Of course my colleague didn't charge me, but our charge is a pittance compared to the hospitals facility charge.
My bill was $7800 for the visit for an EKG, ED visit (hospital charge) and labs. With my $5000 deductible not met, I owed $5K. Total joke. We tell our patients that it costs them $2500 the minute they walk in the door before any labs, doctor, xray, ct, us, etc.
As to uninsured patients or those who say they are uninsured and think they are going to get "free" care in the ED, hospitals and doctors are starting to fight back and here is how:
In the Emergency Department, we are obligated to determine if someone has an "Emergency Medical Condition" under EMTALA law. If they do, we must treat and stabilize without regards to ability to pay. However, affter treating, we will give you the hefty bill and you will have to deal with it. It might be $10,000 or it might be $100,000. We technically aren't even allowed to ask anything about your insurance or ability to pay until the Emergency has been stabilized, or we risk incurring the wrath of the Feds under EMTALA. In practice insurance discussion occurs after your have seen a doctor or PA to avoid the impression that we are treating based on financial status.
Depending on where you get your numbers anywhere from 60-95% of all comers to the ED do not have an emergency medical condition.
You are going to start finding at the ED that it will no longer be a free for all for anyone who refuses to pay.
A doctor (or more likely physicians assistant or Nurse practitioner) will be sitting in triage and performing screening/EMTALA examinations. If you don't have a true emergency (i.e. one of the 60-95% who go to the ED) you will be immediately asked for your proof of payment or copay up front.
If you can not provide this, you will not receive any treatment and you will be referred to a local clinic where you can work out payment with them and you will be shown the door.
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pedro3000 says
You know when I had an infection I was told more then once by those clinics to to go an emergency room. I didn't. I just went to a different clinic that actually prescribed me antibiotics that worked. I got the impression that they were more worried about liability than anything else, or just didn't know what they were doing.
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pedro3000 says
Why aren't they doing this already?
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Alamo, CA
We do, but we don't refuse to treat if they don't have any ability to pay. i treat them for free. That is how it works for now, but i suspect that will change.
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Alamo, CA
zzyzzx says
Probably some of both...also more common Friday afternoons when they don't feel like seeing any more patients in the clinic.
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Aptos, CA
CaptainShuddup says
There are two problems with health insurance (note this is not health care but insurance). The first is the free rider problem. Why get health coverage while you are healthy?
Which leads the second problem. Health care costs are not statistical independent. Once a major crises occurs, it is likely to have significant follow on costs. Insurance companies will rationally try to exclude risky people once the risk has been exposed. This is just free market economics, and even under the current regulated system, insurance companies often manage to.
If health care was elective, this would not be an issue, but the truth of the mater is over 90% of the population will need health care at some point in their life. Once you need it, you are often in no position to negotiate for it.
What we have is a classic free market failure. Market failures are exactly what governments are supposed to solve. Hence, while Obamacare sucks wind, it is a step in the correct direction. It is inconceivable that religious organizations can pick up the tab, as healthcare has grown so expensive.
100 years from now the health care crises might be over; we could all be living long healthy lives for a few dollars a year (in real terms). But right now, it is a crisis, and coverage is one of many problems that needs to be solved to make the most of the human capital we have available.
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ObamaCare worsens the problem, for several reasons.
If you are hit by a truck and taken to the nearest hospital, but it happens to be out of network, your ObamaCare policy may cover only around 40% of the charges. The rest lands on you. Most 'medical bankruptcies' happen to people who had insurance, and that will continue. In fact ObamaCare worsens it because you have to pay $10k/year in premiums that you could have saved for emergencies.
Los Angeles County reported they plan to close hospitals because ObamaCare will divert subsidies away from public hospitals and into insurance companies. So, the nearest hospital may be farther away.
The bizarre calculus of emergency billing illustrates the need for either a national hospital service or single payer or regulated pricing to charge the same regardless of payer. Currently hospitals negotiate with insurers to charge the real price as the insurer's co-pay, then overcharge everyone else triple. Sometimes they pretend to charge the same, but contract with a specific insurer to accept a fraction as "full payment" if it's from that insurer; everyone else pays the full overcharge. ObamaCare entrenches the existing system and forces everyone into it.
The more people learn about ObamaCare, the more likely they are to oppose it.
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Bellingham, WA
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curious2 says
LOL, that's not how insurance handles emergency care.
Care to try again with some more believable bullshit?
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Troy delurking says
Try reading an insurance policy. The practice is called "balance billing." You can read more about it here:
http://online.wsj.com/article/SB122834911902477643.html
It happens already, the difference is ObamaCare makes the system mandatory. In emergencies, ObamaCare requires insurers to pay at least as much as Medicare would pay, but that is by law the lowest of all payers. Retail charges for out-of-network emergencies are commonly triple, sometimes more.
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Emergency care is completely covered on my BlueShield PPO plan regardless of 'network'.
Your above example about "ObamaCare":
"If you are hit by a truck and taken to the nearest hospital, but it happens to be out of network"
is still bullshit since ObamaCare is just subsidized private insurance for all.
Please retract the above bullshit slagging on ObamaCare. Thanks.
Nothing really changes about the status quo other than low-income families get greatly subsidized health care insurance, and everyone has to get insurance or pay a nominal tax penalty (1% of income)