Geez, lets not get into semantics. Call it whatever you want. Pryor is one of our best Senators and he’s been under attack by heavily financed media ads since this time last year by Tom Cotton. The last poll shows them neck and neck. Pryor may lose his seat for supporting Obama Cara. A shame because he worked hard to get it passed.
I can’t imagine where you got the idea Pryor is against Obama Care. His cancer was back in 1996. Before he was even a Senator.
Yes but we all know the long wait times in the ER ,months to see specialist , months after that for surgery.
When you have cancer you want to be seen ,diagnose and start treatment in the same month not 4 or 5 months after.
If you need hip surgery or knee surgery you don’t want to be seen and start surgery 6 month to 12 moths later.
“[N]egotiating price before treatment”? That’s a libertarian fantasy. You can’t walk into an emergency room and “negotiate” with them about price.
Nor are you likely to have the medical knowledge to determine whether or not something is an emergency. Do you really know whether that chest pain you’re having is a heart attack, or really bad acid reflux?
No, you understand. But you’re leaving part of it out.
All you have to do is go to the emergency room. You will be treated.
But then you will get the bill. Which may bankrupt you.
I know. I’m married to a Canadian (now resident in the US). She cannot get over how horrible our system is. And she’s even more horrified now that we have a child.
And yet, despite what you hear from the conservative wing of American politics, Canada has a stable economy and reasonable taxes. And managed to avoid the worst of our financial crisis a few years ago.
Some companies require an ER visit when you are injured on the job, I broke my ankle at work, job required I go to the ER to be seen instead of the minor emergency (should have fallen 10 minues earlier). I was there for 12 hours. 
My only other visit to the ER I went to the Walgreens clinic and they found an issue that concerned them and my regular doctor agreed and I spent 8 hours in the ER. $4,000.00 and a shot of insulin later they let me leave and acted like I was wasting thier time going to the ER.
In both cases I begged to not go to the ER, so please don’t slap me.
I waited several hours in the ER in Florida with a tibia and fibula shattered in several pieces, later requiring 4 rounds of surgery, a plate, and screws. There was no question that the ER was the appropriate place to be, but it was Thanksgiving weekend and they needed to get an ortho specialist in, decisions had to be made about doing surgery immediately more than 1,000 miles from where I lived vs. waiting a few days for the swelling to go down and getting me home where the person who did the surgery would be the same person to do the (literally) years of care coordination and followup…not everything is so straightforward. And then I arrived in my hometown hospital via Medicar in a cast up to my hip and a puke-covered bathrobe, several days later, after the flight home - and waited all day in the ER for another ortho consult and for a bed to open up in the ortho ward.
BTW this was 1996, two days short of my being covered by insurance at a new job (I had a 30-day gap in coverage because my old employer, with half a dozen full-time employees, was too small to be covered by COBRA). Those two days cost me nearly $5k out of pocket. That’s just fucked up. No treatment that I received in those 2 days was different than what I would have gotten 100 years ago; the most sophisticated test was an X-ray.
Stop throwing political jabs in threads not about them or you will be warned next time.
There can be multiple problems with something. Yes, it is outrageous for him to have been charged so much and yes the way medical billing works in America is screwed up. At the same time, it’s also outrageous for someone to go to the emergency room for a minor injury sustained several days prior. You’re not going to get stitches for a days-old laceration; since he went for days without seeking treatment it probably wasn’t a serious injury to begin with. He could have gone to his GP. He could have gone to a walk-in clinic. He could have called his insurance company’s NurseLine or chatted with them online to ask “should I see a doctor about this cut, and if so, should I go to the ED, and if so where?” He had plenty of options in front of him, he chose poorly, and got hit with a bill (which was then forgiven so I’m not sure what we’re supposed to have sympathy for here).
The last time I went to an ER is was for a broken nose. I got poked and prodded briefly, referred to an ENT and sent home. $200 co-pay.
The time before that was with what turned out to be necrotizing fasciitis. After a month in the (burn) ICU, 2 weeks on the general ward and 7 surgeries. I really didn’t notice my ER bill when added into roughly $500,000 bill…
I can answer this, only as an HMO insured American. Depending on the insurance company, type of coverage, or whether you’re insured at all, answers will be different. A lot different.
Any ER visit, for me, is a co-pay of $150. Anecdotal story: In 2010 I had a throat infection. By Sunday morning it was intolerable. I couldn’t eat or drink without a lot of discomfort. My insurance covers ER visits whenever my primary care doctor’s office is closed. They checked for strep, the doctor I saw decided it was an ear infection despite my insistence that it wasn’t. Sent home with an antibiotic. By Monday night (4am Tuesday), I couldn’t stand it any more. Swelling was worse, getting hard to breathe, couldn’t sleep, antibiotic wasn’t working, I hadn’t eaten since Sunday and only taken enough water to swallow one pill a day. Went back to the ER where they fast-tracked me and put me in a private room for about 8 hours while I received IV fluids, morphine and steroids. Got a CT scan of my head and neck because the swelling was so bad the (different) doctor wanted to make sure there wasn’t an abscess. Discharged at noon with the swelling gone (thanks to steroids), a different antibiotic and hydrocodone.
Total cost: $500 for the first visit, and $5,000 for the second. My personal payout was $300 ($150 each visit) plus the cost of the Rx meds I got on my way home.
One more anecdote and answers to your questions: Last December my gall bladder gave up the ghost. I went to the ER at 3pm on another Tuesday (what’s up with me and Tuesdays??). After bloodwork showing an elevated white blood cell count, and an ultrasound showing gall stones and swelling, I was admitted and scheduled for surgery the next day. Hilarity ensued and I ended up there until Saturday due to a minor complication that was the fault of my anatomy alone.
Total cost: I have no idea. I never saw a bill at all. My insurance waives the ER fee if admittance to the hospital happens. My personal payout was the co-pay for the Rx meds I took home, $10. Best guess by others who have had hospital stays that included surgery says the total was likely into six figures.
What would similar treatment have cost in the USA? My insurance would have called what you had an admittance to the hospital, so $0 plus the co-pay for medication to take home, purchased at a separate pharmacy.
What additional work would I have to do to deal with my insurance company? All I had to do was hand them my driver’s license and HMO card when I arrived. No paperwork on my part at all for any visits. Well, unless you count the surgical consent.
What consequences would it have for coverage in the future? None
I count myself lucky every day. I have an employer that pays the majority of my HMO premium (I pay $80/month, which is 20% of my total premium), and an employer that decided to hang on to our policy rather than do the UHC stuff. Also, I have given up some “control” in that having an HMO I have to use the doctors that are in the network, get referrals for things like an MRI on my sprained knee (which I got the next day, and also cost me exactly $0 out of pocket), and for my mammograms (which also take 24-48 hours for approval before I can make and appointment and which also cost me exactly $0 out of pocket).
IMO I have insurance that works like insurance is supposed to work, and I can only hope people with UHC will soon experience the same. I hope this because like every good thing, one day my health insurance will end and I pray things will be sorted out by then.
About 4 months ago I cut a notch in the end of my finger with a table saw. Off center so it missed the bone, but did nick the small artery in there. Total ER cost was about 2100 with my portion coming in at 800 and change after insurance. 6 stitches.
I think I’m on pretty solid ground when I state that 9000 is completely outrageous for an injury that appears to be no worse than mine.
That’s what I was thinking; my company would have seen something like that for under $200 in all likelihood, and probably had a real doctor stitch him up to boot.
(we have upwards of 300 occ health and urgent care centers in something like 47 states; I should know the exact numbers, but they’ve changed a lot recently)
Oh man! When i first read that I thought you got bitten by something in Australia. I thought you were going to die, mate! :eek:
Nurse practitioner. Not the same thing as a nurse.
The answer to the last is absolutely no consequences, thanks to Obamacare!
As for the first two-it depends. Let me show you why the system is so effed up.
A) Person has a typical low-level, high deductible Bronze Obamacare plan with a 12k deductible and yearly limit. They have not used their insurance yet this year. The hospital is in network so contracts with their insurance. The usual cost is $10K but the contracted cost is $5K. The patient pays $5K. If the hospital is out of network, the patient pays $10K. Now if the patient has already used $10K of the deductible, they will only pay $2K unless the hospital is out of network in which case they might have an $18K out of network deductible so they would pay $8K.
B) This person has a PPO with a $1300 deductible in network and a $3500 in network maximum and a $2500 out of network deductible with a $5000 out of network maximum. ER visits are $300 plus 20% in network and 20% of allowed fees out of network. The patient has so far not spent any money. The fee is still $10k with a contracted in network fee of $5K.
If the hospital is in network, the patient pays:
$300 (ER fee)
= $2100 total (which leaves $1400 total out of pocket maximum for the year)
If the hospital is out of network, the patient pays:
$2500 (out of network deductible)
+$500 (20% of remaining $2500 allowed hospital charge)
= $5000 total (with $0 remaining of out of network maximum)
C) This person has a $500 deductible in network, $5000 deductible out of network, with $3750 maximum in network and $12000 maximum out of network but has had three prescriptions filled already this year in network for a total of $197.31 and saw an out of network physician with a charge of $250. You can do the math because I refuse.
Or-here’s an example from my life (actually, now that I think about it very close to the OP. I went to the ER for a cut last year (required 6 staples and a tetanus shot). No X-rays, seen by an NP. Total charges were about:
=$1609.50 total charges (at one of the 100 best hospitals in the country)
=$49.34 (my coinsurance-don’t know how they came up with this number except that I was nearing my out of pocket maximum by the time they charged and I was OK as long as it was <20%)
The doctor fee breakdown was:
$87.36 (contracted fee)
-$17.47 (my 20%)
$69.89 (insurance paid)
$32.06 (insurance payment)
I had at that time no deductible and a $200 ER fee, plus I thought 20% at a participating hospital. (I called on the way with blood streaming down my leg to make sure they participated)
Grand total:
$606.11 (contracted fee)
$299.30 (insurance payment)
$306.81 (my share)
(Now of course, there may still be additional fees that I have not been charged but since I met my out of pocket maximum last year I don’t have to worry. I am, however, still dealing with a physical therapy bill from last October for which I had a $40 copay since it was in network which I did not have to pay because I had reached the maximum-but it was erroneously billed as out of network so I am still getting bills for $216, not to mention that the insurance company doesn’t have to tell you when you reach the maximum so I overpaid 6 x $40 copays before I found this out and had to try to get reimbursed from the physical therapy center which is difficult when they are telling you that you still owe $216!)
Remember that I am a physician and I can’t even figure this crap out. I would LOVE universal healthcare!
And I screwed up the math and was too slow editing so the corrected numbers are:
If the hospital is in network, the patient pays:
$300 (ER fee)
= $2040 total (which leaves $1460 total out of pocket maximum for the year)
Insurance pays 80% of $3700=$2960
If the hospital is out of network, the patient pays:
$2500 (out of network deductible)
+$500 (20% of remaining $2500 allowed hospital charge)
= $5000 total (with $0 remaining of out of network maximum)
Insurance pays 80% of $2500 allowed after deductible=$2000 + $3000 remaining non-allowed after out of pocket max=$5000
Interesting coincidence: one of the fathers of the Canadian Medicare system, Tommy Douglas, almost lost his leg as a boy, but for a specialist becoming interested in his case and doing it for free. The experience was one of the formative influences on Douglas, leading him to introduce the first single-payer system in Saskatchewan when he became Premier:
Husband spent 20 years in our military, I have this little orange card that I use to get medical treatment for free at any US military base. If I have to go off base to a civilian medical facility, I have Tri-Care. Last time I went to an ER it was for an anaphylactic reaction to a medication, and I had a $20 copay. I get all my routine medications that keep my sorry ass alive on base with the exception of one med that is not available through the base, copay is $15 a month, if I actually had to pay for what I get on base, I would be paying around $3000US per month.
It is not entirely true that being in the military sucks for retirees, being able to go in for major surgery at Yale New Haven and have the operation done by their head of surgical endocrinology, or gynological oncology for a reasonable copay is invaluable [and been keeping my ass alive] Of course I also have had to deal with being told on a message board that I used to hang out upon that they hoped that my husband would get killed while deployed sort of sucked ass.
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Lack of simple healthcare is the main reason I wouldn’t move to the States. How can you guys stand it? The example described by psychobunny is nuts. Ill people under stress should not have to deal with that kind of crap. ‘In-network’? ‘Out-of-network’? Just extending Medicare and Tricare to the entire population would be too simple, wouldn’t it?
Maybe some enterprising State will go the Saskatchewan route and set up its own single-payer plan. Then, when people see that it works, they’ll want their States to do it too. And then there will be reciprocality agreements, as there are between provinces in Canada.