I’ve heard of absurd medical bills, and seen them myself. Every common item is massively increased in cost above the normal price for the same thing you’d find in the store. A few days of morphine, a drug that is about a century old, somehow costs $27,000 just for the drug.
I’m now wondering : is there any hard limit at all?
Can medical price inflation get to the point that if you stub your toe and need a bandaid, the charge is $100,000 if you aren’t in network? And the hospital won’t drop the debt and will call you incessantly and if you actually have any assets, they can just take em all by going to court, getting a judgement, and seizing them. And if you declare bankruptcy protection, that just means that your creditors, which the hospital would be the largest one in dollar amount, get to split up whatever assets you own that fall outside of the bankruptcy umbrella. How does that work?
Suppose that your medical insurance would cost you $15,000 a year and you make $45,000 a year. So you decide to save the money, since that’s 100% of your disposable income after rent and food and utilities, and you now have $45,000 saved. You get hit by a car that ran a red light or hit by a stray bullet or some other unavoidable injury that isn’t your fault.
Under every scenario, can the hospital ‘steal’ the $45,000 you saved? Even if the only treatment you get is a few stitches and an x-ray or something equally basic and cheap?
A large part of high medical costs is due to insured/well-off people paying for uninsured not-so well off people.
But there is astonishing waste. Mrs. FtG worked in the business and she would see medical supply catalogs charging 5 times more for a mundane item than the exact same product in a regular office supply catalog. And that’s non-medical stuff. If it appears medical at all the price skyrockets over actual production costs.
Everyone is in on the jack-it-up game since “insurance pays for it.” Either directly or indirectly as noted above.
Another place she worked at went to a single-vendor system. All purchases had to go thru one vendor. This was to save money. Of course everything doubled in price if they carried it at all. And then getting it without going thru the vendor took forever. Sometimes tests/procedures weren’t done because they couldn’t get the items in time.
One of the reasons for astronomical charges is not because they expect them to be paid, but because those nominal charges are part of the formula used by Medicare to calculate reimbursement in non-standard, complicated cases.
Anytime I’ve dealt with a hospital I’ve been aggressively proactive about cost. You do not have to “buy” anything they’re selling. Ask how much you’ll be charged for that bandaid, and if it’s not worth the money to you, decline it, even if it’s AMA (against medical advice). You may be asked to sign a waiver.
When I was being transferred from hospital A to hospital B (8 miles away) to have cardiac angioplasty/stent work done, they were going to load me into an ambulance. I pointed out that I felt fine and would rather drive. They argued (correctly) that I was not stable. So, I called my insurance company. It turned out that the ambulance was going to cost a small fortune and would not be covered. However if I ordered an ambulance from my hometown (50 miles away) my insurance would pay the whole bill. So, I waited patiently for the ambulance instead of using one that was sitting at the curb.
When I was being discharged from hospital B, the nurse brought me my morning dose of medications. I asked about cost, and declined the pills. She argued, but I held fast. On our way home my gf stopped at our pharmacy, got my meds, and I took them. Waiting 90 minutes saved me $85.
Mostly this.
From what I have been told, most fee schedules that insurance companies and hospitals agree to are based on Medicare payments which in turn are based of discounts against the “full” cost of certain procedures. As I understand it, the way the formulas work is there is a book of named procedures and different insurance companies get discounts to the cost of each procedure. No insurance company or medicare negotiates the cost of a bandaid, but the cost of the supplies is factored in to the cost of each procedure. Do the work to raise the cost of a bandaid and that propagates into increases in many procedures which raises income across the board. Like the man said-its complicated.
The concern for medical lawsuits has drastically changed how medicine is practiced. My mom had malpractice insurance during her career as a CRNA (Nurse Anthestist) and it is very expensive. Mom was lucky that she never got sued throughout her long career.
Your family GP rarely does procedures in the office anymore. Even something as simple as giving a kid four stitches. What if something goes wrong and the wound gets infected or the parents are upset by the scar afterwards? Why should the GP risk a lawsuit?
So the kid gets referred to the ER. Let the hospital and ER assume the liability.
jacking up the price of anything medical happens here too. When I worked for the NHS I saw a delivery of a pair of ordinary bolt croppers. There was a query about who had ordered them and it turned out that they were wanted by the orthopaedic team for cutting the titanium pins used to support broken bones. They were not required to be sterile as the pins were sterilised after cutting.
They had ordered them from a medical catalogue at three times the price of an identical (same make and size) pair in an engineering supplies catalogue.
For that particular procedure, probably not. But hospitals generally use equipment for more than one thing. So even if Doctor X doesn’t need sterile bolt cutters, Doctor Y might.
Whether or not the hospital’s charges are reasonable is irrelevant to the bankruptcy court. Bankruptcy involves a complex formula about how much of your money you get to keep versus how much creditors get.
However, the patient may be able to challenge the validity of the underlying debt on some grounds. In practice, hospitals will invariably negotiate their bills down for uninsured patients, often for pennies on the dollar.
No - It was just that being a medical team, that was the catalogue they used. I don’t know if you are familiar with the tools the orthopods use, but for the most part they are very similar to woodworking tools: saws of various kinds, chisels, mallets, augers, drills, screwdrivers - those tools have to be sterile though, so they are stainless steel and very expensive.
One other factor in the high medical costs is that the people (doctors, nurses) mostly have no idea of the costs for the items they are using.
A couple years ago, I was in the hospital for a couple of days due to an infection. While there, they treated my diabetes with daily shots of Lantus insulin – the exact same injector pen that I used at home. It’s about a 10-day supply for me in each pen. On the day I was to be discharged, I asked the nurse what they would do with the weeks-worth of insulin remaining in that pen. He said they could not use if tor anyone else (I don’t know why – it’s all sealed, and a new needle is used every time, but whatever), so they would just throw it away. So I asked if I could take it home with me. He said sure, I suppose that costs you $10 or $15 to buy. He was astonished when I told him it was about $85 for that pen, plus additional for the needles.
It seems to me that if medical people actually knew what the cost was of the items they use, they might be a bit more conservative in using them.
I had my middle finger on my right hand sewed back on that our family doctor’s office with catgut suture in 1950 and I didn’t get a lollipop . The stiches dissolved on their own .
I keep my insurance up but more and more friends are going without and telling me the hospitals will negotiate astronomical bills way down and are willing to wait a long time on payment instead of suing. The whole system has gotten absurd. I tore up one of my S.I. joints years ago and last time it acted up I couldn’t walk for a week and finally stumbled down to the E.R. At the time I was covered by the cheapest Obamacare bronze policy there was, which cost me 0 dollars a month. The E.R. staff treated me like a Trump in law, I had a full blood panel, x rays from every angle they could twist me into, specialists consulting, gurney rides everywhere, and when I went to the cashier to check out she just smiled and waved me out the door. Found out later it was a 3500.00 visit and Obama paid all but 500.00. What a deal, except they wouldn’t refill my Hydro.
I used to work in the medical benefits industry and I now now work in the medical devices industry and I can confirm that the whole thing is FUBAR. I actually don’t blame Congress that much for not figuring things out on the 1st, 2nd or 3rd pass. I have been doing it for many years and I still don’t understand all of it.
All I know is that I am currently dealing with $500+ screws that look exactly like anything you would get at Home Depot for less than a $5 but the regulatory requirements are so insane that countless people and equipment are used to track that one through its entire lifespan even after surgery. Hip and knee implants can cost as much as a new car.
There are lots of layers to explain why medical costs in the U.S. are so high but my personal opinion is that aversion to any risk that can be mitigated is the biggest one. It isn’t doctor or nurses salaries. The biggest ones are R&D plus parts. I could show you some things that are insanely expensive if they weren’t in a secure facility that only people with background checks have access to. That is just for parts, pharmaceuticals and hospital administration are a whole different layer.
To answer the OP directly, I don’t think there is anything stopping them from charging you anything including a billion-trillion dollars. That doesn’t mean that you have to pay it though. There are real-world ways to deal with such a situation. It certainly isn’t ideal but hospital billing specialists tend to be pretty flexible if you offer them any reasonable amount of money.
They would rather have something rather than nothing. The alternative is that you can just declare bankruptcy and tell them to go screw themselves. It almost never comes to that point however as long as you are willing to pay something reasonable. The dirty little secret is that hospital “rack rates” are a scam and almost nobody pays them. You usually have to call multiple times to find out what they real bill is. That is a travesty on its own and very inefficient but it does mean that no one is going to pay $100,000 for a Band-Aid.