Even if that’s true (that they are supposed to), the issue is that there’s no one set fee. It’s not unlike the “maximum room rate” card that’s on the back of a hotel room door; it’s highly unlikely that you, the patron, will wind up paying that.
A hospital will have a “standard” rate for a particular service, but most people don’t actually wind up being billed at that rate – typically it’ll only be the uninsured, or those with insurance, but for whom that hospital is completely “out of network.” If that hospital is “in network” for your health insurance, your insurance company has almost undoubtedly negotiated a different, lower rate for said procedure (and your Explanation of Benefits document for the procedure will probably show you both the “standard” rate, and the negotiated rate).
And, then, depending on the specific terms of your health insurance policy, how much you, yourself, wind up actually paying out-of-pocket will vary, as well.
That isn’t based on my experience alone. It’s part of the triage system, as the linked article says.
We don’t know why the doctor arranged for an ambulance. You’re guessing there was no good reason. I’m guessing there was, especially since this was in England, not the US. Sepsis is definitely a medical emergency. My mother died from it. My good friend had to be rushed to the ICU within an hour of her first symptoms. I don’t know why the doctor didn’t send for an ambulance immediately to transport the patient to the hospital. That’s a much more perplexing question.
(from the aticle)
All of the Priority One patients are seen first. Then, the Priority Two, etc. If you are assigned a relatively low priority during triage (cough, flu-like symptoms, rash, etc.), as you are waiting to be taken back to the treatment area, those who sign in with more complex, serious conditions will be prioritized ahead of you. What you may not see while sitting in the waiting room is the ambulance traffic. Patients arriving by ambulance take priority over everyone else.
I think that article is saying exactly what my experience has been , that patients are seen based on the priority assigned in triage but you won’t see the patients brought in by ambulance in the waiting room because they are brought directly to the treatment area. I’ve been with people brought in by ambulance directly back to the treatment area who waited an hour or more to be looked at because there were higher priority patients and patients who went to the treatment area immediately from the waiting room because they were bleeding or had chest pain.
I’m guessing it wasn’t urgent since the doctor didn’t arrange for an immediate transport. Makes more sense than guessing it was urgent and he just decided to put it off an hour.
Most insurers will not pay for cosmetic-only breast enlargement, but most of them will cover breast reconstruction after a mastectomy. As for breast reduction, that varies from doctor to patient to insurer, but I’ve heard that unless the doctor removed at least 1 pound of tissue, or thereabouts, from a breast, it’s considered a lift.
Male breast reduction is also a very common procedure, and is also frequently covered because of the psychological trauma that can be caused by gynecomastia.
Since I can’t edit the previous post, I’m going to add that a state’s insurance board is the place to go to report fraud, of ANY kind of insurance.
Yes, but in my specific case, it may have been an accident, rather than intentional fraud, as women were often expected to stay in the hospital for 48 hours after childbirth (though there was a rather horrifying trend right about then of trying to boot them out after less than 24 hours, or less than 48 after a c-section).
In my particular situation, my rather cynical take was to attribute it to deliberate malfeasance, given the rather low standard of care I received otherwise. I frequently comment that “One of my many regrets was that I hit the doctor once. No, I don’t regret hitting her, I regret doing it only ONCE”.
I can attest that the doctor has no idea what is covered or what it will cost you. The price of a service depends on:
The rate the providing facility charges
The rate negotiated by your insurance
Your particular deductible
How much of the deductible you have already fulfilled
Whether the deductible applies to this particular procedure
What your copayment is for this particular procedure
Whether you have an out of pocket maximum
Whether you have reached your out of pocket maximum
For example: I spent slightly less than a day in the hospital for pneumonia in January. If I had been discharged from the ER, I would have owed a $300 fee for the ER. If I stayed more than 24 hours, I would have been charged $400 daily for a room. Since I was there less than 24 hours, I was on “ observation “ statues and had no copay. The bill was $16,000 but the insurance price was $11,000. The only things credited to my deductible were the doctor fees for reading my EKG, X-rays, and Echocardiogram which came to about $300. However, I went into the ER expecting to pay my entire $1500 deductible and then $400 daily up to my maximum. Of course I have good insurance, but I pay over $1000 a month for it.
I will say, however, that doctors get blamed for bills they don’t control. Everybody wants a vitamin D test but Medicare only covers it if you already have documented low vitamin D or if I can demonstrate a qualifying bone disease. I have the responsibility of explaining all of this to the patient.
Another example: recommended screening for heavy smokers is to get a screening lung CT yearly from ages 50 to 80. I sent my 78 year old smoking patient for a scan. The facility submitted the request and found that Medicare only pays up until age 77. Instead of contacting me, they provided the patient with an Advanced Beneficiary Notice, which is a form acknowledging that the patient has been informed that the procedure is not covered by Medicare and that the patient will be responsible for all costs. However, this was just presented as one of a stack of forms she had to sign before the scan. When she subsequently got an $800 bill, she called me to fix it. I have to either tell her that I didn’t know that it wasn’t covered but I ordered it because it was standard medical practice and recommended, and that she signed the firm and would have to pay, to try to call the facility to find another code to justify the test, or to just pay it myself, eat the costs, and chalk it up to not being informed enough on the Medicare coverage. Now remember that this is one insurance and I deal with about 8 different companies that have hundreds of different plans. I can’t know everything. In this case, I was able to use option two and hopefully this new code will work for the test.
Also please stop asking me why I didn’t check your blood type. There is no medical reason for you to know it. If you need blood they will recheck anyway and if you are bleeding too fast to check they will be giving you universal donor blood until they can take the 30 seconds to double check. It’d you want your blood type, you will need to sign an ABN ( see above).and agree to pay for the test. Otherwise, you can donate blood and the Red Cross will let you know your type.
@elbows pretty much addressed this, and indeed prescriptions, dental, and vision is generally covered by employer plans, and for those who are retired, as said, prescriptions are covered by the public plan for those 65 or over. There is a proposal for public dental coverage but I’m not sure of the status.
But as I’ve often said, the great thing about UHC in Canada is that although they nickel-and-dime you on some of the small stuff, the big stuff – all medically necessary doctor visits, hospital stays, and surgeries are unconditionally covered 100%. When I went to the ER with chest pains some years ago, I ended up being admitted, staying for five days, getting a huge battery of tests, and ultimately getting three stents after I turned down the option of a triple bypass. There was no discussion of money or coverage in any of this, and when I was discharged, the whole thing cost me exactly $0. I hesitate to think what this would cost in the US, and even with insurance, the co-pay would likely be brutal.
Another thing to consider is that although outpatient prescription drugs are not normally covered for those under 65, brand-name drugs that are under patent are much cheaper in Canada, so drug coverage is typically much less of an issue. In this post I talked about the comparative cost of Brilinta, for example – an anti-platelet drug that I took for a couple of years and which was probably the most expensive drug I’ve ever taken. The cost of a three-month supply (180 pills, two pills a day) is typically well over USD $1200 in the US, or about CAD $1597. The price in Canada? CAD $300. My cost, since I’m retired, is free.
Also, the thing about vision care is primarily that vision tests for corrective lenses (glasses or contacts) are not covered, and neither are the lenses themselves. But medical conditions related to vision are covered. My exam for vision problems that turned up the fact that I have early stages of cataracts was covered, and cataract surgery (which I’ve been deferring) will be fully covered.
Interesting. I’ve been a blood donor since I was eligible, and it seems I’ve always known my blood type (O+). I never thought it was something your doctor couldn’t tell you without signing a form.
It’s not that they can’t tell you without signing a form - it’s that no one will do the test without your agreement to pay ( which often involves signing forms ) if the test isn’t medically necessary since your insurance won’t cover it. And if you need a transfusion, a hospital is not going to rely on what you tell them - they will check themselves.
I don’t think Americans (not just the rabidly anti UHC right) appreciate how comprehensive coverage is in most other countries. And how much cheaper the non-covered products and services are.
The other thing that doesn’t seem to be appreciated in the USA is that, although UHC countries pay slightly higher taxes, Americans pay ridiculous amounts of money for their insurance (when they can get it). Even if your most excellent health insurance is part of your employment, it’s also part of your compensation. Seems to me you would have more money in your paycheck if your employer didn’t have to pony up the cost of your insurance.
As reference above,
That’s $12,000 a year you could pay in additional “taxes”. Plus whatever co-pays and deductibles you have. So probably something like $15,000 a year that you could pay in “taxes” and not even notice. So add the cost of your health insurance to your tax burden and tell me what percentage of your income that is. And then compare that number to what people in UHC countries pay.
I’ve lived in the USA, and I’ve lived in (and currently live in) a UHC country. The tax burden in all of them was roughly 33% +/- of income but in the USA there was an additional health insurance burden. Additional. Like on top of income tax.
And then there’s the paperwork. Endless paperwork and arguing and appealing and aggravation to even get insurance to pay. When you’re sick or injured and that’s the very last thing you want or need to deal with.
As wolfpup said;
My husband had the same - triple bypass, five days in hospital, ICU, all the bells and whistles. Cost: $20 for my parking. Never saw a single piece of billing.
I had an ‘elective’ (non-emergency) fundoplication surgery. Three days in hospital. Parking was $10. No bills. No arguing. No negotiating pricing. No ‘in network/out of network’ bullshit. In fact, this surgery was done in an adjacent Province. I didn’t see any paperwork whatsoever.
Sorry if I confused anybody. I am glad to check your blood type and give it to you as long as you pay for it. I just can’t get it for free.
Also you are preaching to the choir with universal health care. My health care plan is not horrible but I still have that $1500 deductible that is a disincentive to get health care. My last plan was much better but they raised the price to $2400 a month and I refuse to pay more for my health insurance than for my mortgage.
The paperwork is the worst, though. It is an absolute nightmare. The estimate is that the average doctor spends $80,000 a year on unnecessary insurance paperwork.
Unfortunately in the US, the private medical insurance industry is large, wealthy, entrenched and a political entity. They will NOT be shifted away from the sweet, sweet cash that they harvest. Ever. The politicians that they own will not allow it.
It is huge. It is entrenched. It is highly politically connected. It’s not going anywhere. And this money being siphoned off by this huge industry is one of the reasons Americans pay much more than other countries; your money is simply propping up this industry, doing a job that is done much more efficiently by many other countries.
It absolutely, positively is. As an American who relocated to Europe, I can confirm. And the thing is, even where Americans know they’re being ripped off, they still underestimate the scale of it.
Here’s two recent experiences in my local system.
On the last night of a Mediterranean holiday, I found a tiny local seafood restaurant selling every day’s fresh catch. I got the scorpionfish, which I’d never had and wanted to try. But it wasn’t properly cleaned, so over the next 24 hours, including the flight home, I slowly sank into neuro toxic shock, which felt and looked a lot like food poisoning. On arrival, I went to the emergency room, and was checked into hospital. I spent three and a half days being repeatedly tested, rehydrated and stabilized.
My out of pocket cost: 30 euros, for three nights of parking.
A few weeks ago, I came down with covid. Called my physician. He diagnosed me on the phone (didn’t want me physically in the office) and emailed me a bunch of prescriptions for symptom relief (along with a note giving me a week off work). My wife printed the prescriptions and went to the pharmacy. Because they had been written, scanned, and emailed by the doc, and then printed by us, they weren’t originals with the doc’s signature, so the pharmacy couldn’t put them through the state’s coverage system; we had to pay full price, out of pocket, and then come back later with the original prescription sheet (which the doc put in the post) for a refund.
Total cost of half a dozen prescription medicines: 42 euros (most of which was refunded later). Plus 20 euros for the phone consult with the doc.
I’ve said it before and will say it again: we didn’t originally leave the US because of the health care system. But it’s far and away the number one reason we never want to go back.
