Another pitting of the US health”care” system

Kid suffers a sports injury. Badly sprained ankle.

Go to regular Pediatrician’s office. Sent for X rays. Nothing broken. Is told to use a brace. Asks if she wants the brace put on or will get it from the med-surg supply store in the building. Asks to have it put on.

So far we have gotten five bills for this one <1 hour visit.

Pediatrician (Nurse Practitioner)
Radiology to take the X-ray
Radiologist to read the X-ray (never met or spoke with them)
Orthopedist to diagnose injury (presumably from X-ray, never saw them either)
Med Surg supplies for the brace.

Brace was the kicker and really what’s driving this pitting. You can buy this exact same brace for 19.99 on Amazon, from the manufacturer. You can buy it for 73.99 from the med-surg supply store. You can get billed $170 for it by the doctor because it was “dispensed” not purchased OTC! It was “dispensed” by the same Nurse Practitioner for whom we were billed for the urgent care office visit.

Also, the orthopedist in the same building who we never met, or spoke to, or interacted with in any way, claims to be out of network and billed a huge amount ($700+). This is not allowed in Massachusetts. It took a call to the state department of insurance to reduce the bill to <$100.

The US system is appalling and rife with fraud. My father had an accident that required physical therapy. Even after he’d finished, the PT center kept sending bills for appointments that had never happened. When challenged, the center just cancelled them, but it was clear from their attitude that they basically regularly engaged in this sort of bill fishing on the assumption that amidst all the paperwork the patients may not notice the extra charges and they could scam a few extra hundreds or thousands out of them. Really quite infuriating.

I’m a real asshole in medical situations. I would have insisted on seeing the numbers before making my decision. The people in the office probably hate me, but I’ve saved thousands.

I laud those of you who pursue these things and expose what is nothing more than brazen corruption.

I do this for my annual physical which is supposed to be zero copay, but the labs ordered were once over $500 (seven years ago). So now when the doc says m ordering a full work-up, I say “You’re explaining each test you’re ordering, what you are looking for and what you will do if the results aren’t normal.

Since then he’s been ordering just a couple of tests. He doesn’t hate me. He actually appreciates patients who are assertive about their healthcare, particularly cost management and medication.

He was completely hammered by the COVID anti vax stuff though. He moved from Pediatrics to Internal Medicine twenty years ago because he couldn’t deal with the anti vax parents in that era!

What’s sort of fun to appreciate is that in this hideously complex system that routinely bankrupts Americans, the only advocate for the patient is the least informed person in the building.

The patient advocate has little to no experience in medical billing or insurance coverage, nor does this person have any medical training to understand the tradeoffs and options he’s presented with. But at least the patient has “skin in the game”.

I don’t think that is being an asshole. IIRC, aren’t hospitals actually supposed to list the fees for their services? I know that none do that but I think they are supposed to.

I think there was an odd ‘opt out’ feature in the law, something like the hospital can pay a fine/fee to not provide it.

When the hospital I was at wanted to move me to another hospital (5 minutes away) by ambulance, nobody could tell me the cost.

I used my cellphone to call my insurer (number on my card) and they told me the ambulance ride would be fully covered if it was my local ambulance company.

So, instead of the ambulance sitting there idling, I called one an hour away. Saved a bundle.

I live in the UK and can’t get my head round the fact that in the US you pay for an ambulance.

To make it worse, the anti-vaxxers today were the pediatrics then.
He can’t get away!.

Not just pay, pay a fortune. The conventional wisdom is don’t use an ambulance unless you’ll die otherwise

The whole “paying a fortune for an ambulance” is very dependent on variables such as do you have insurance, is there a volunteer ambulance in your area, is the ambulance provided by a government agency or by a hospital , etc. I myself have never paid more than a $50 copay for an ambulance and the volunteer ambulance bills insurance if you have it , but doesn’t collect anything from patients.

I’m surprised that you are surprised that we often pay for ambulances since it’s kind of well-
known that we don’t have universal healthcare. ( I’m sure it will surprise you even more that some places have a subscription only fire department that will not protect your property if you haven’t paid the fee)

My gf’s elderly aunt was hanging laundry to dry in her attic (their HOA doesn’t allow clotheslines outside) when she fell through the attic floor down 1 1/2 stories into her kitchen floor.

The ambulance came for her. Her husband, trying to be helpful, showed the EMTs that they had insurance to cover life-flight (helicopter ambulance service). So, although she was bruised/battered but stable, they transported her by helicopter!

Ah, I wasn’t surprised - just astonished that the situation continues.

On a visit to the US, I had chatted with an American friend who explained the situation.
Here’s a more dramatic comparison between healthcare.

I hadn’t been feeling well and went to my doctor, who was concerned at my symptoms and took a blood test.
The next day I went in for the result.
He calmly told me I had liver sepsis and needed immediate treatment in hospital.
I was to go home, pack a bag for at least a week’s stay and an ambulance would be at my door in 1 hour.
The ambulance crew were very reassuring and made sure I was admitted as a priority case.
I was given a private room (for isolation purposes) and stuck on a powerful antibiotic drip.
After 4 days, the hospital were pleased to tell me the sepsis had been sorted. However they wanted me to stay a few more days in a general ward just in case.
After 3 more days, I was released.

The cost for all that: £0.

I shudder to think what it would cost in the US to have:

  • two doctor’s appointments
  • blood tests
  • ambulance trip
  • 4 days in private room (with daily doctor visits, nursing care and meals)
  • 3 days in general ward (with daily doctor visits, nursing care and meals)

I’d eyeball that at roughly $30k in the US. Plus a year to litigate that down to maybe $5000.

That depends - it would cost me maybe $275 dollars , if I used the ambulance. I wouldn’t have used an ambulance if I was well enough to go home and pack a bag so around $225. Medical care in the US depends a great deal on insurance coverage - while those services will cost me a couple of hundred dollars , it might cost someone with different insurance coverage a few thousand. Of course , my insurance costs around $20k a year between me and my former employer.

The patient is really just the trigger for transactions between all the various entities (insurance, doctors, hospitals, durable equipment, pharmacy, etc. - most of which are profit-driven). And these transactions between all those entities are done with minimal to no transparency to the patient, but when there is a snag and one entity doesn’t want to pay for something to another entity, the patient is left holding the bag, and must negotiate or pay, on their own. This is why it’s critical in this system for patients to ask lots of questions, with the primary one at each stage being “What is this going to cost me?” (not “What is this going to cost?”). If you get an opaque answer, demand clarity, or decline the service.

Yep, and the crazy part about all this is there is a myriad of insurance policies people pay for that range from good to horrible. And a typical refrain is “you should get better insurance!”. SMH

Assuming of course that there weren’t any unexpected “out of network” charges.

The problem is, is that the doctor very rarely has any idea. And even if you ask the staff that deals with billing, they likely won’t know until the insurance remits what they are willing to remit.