This summer I had to take my kid to an emergency room, and now after months of asking, I finally received an itemized statement from the hospital. As you might guess, there are a lot of codes and abbreviated and truncated descriptions. I’d like to know what I was charged for and if the charges are reasonable. Stephen Brill’s article in Time Magazine has me very suspicious of hospital charges.
Is there some way for me to determine what the charges are by the codes, and more importantly, if the charges are reasonable?
Google “CPT codes” (current procedural terminology) for possible help. The system is licensed/copyrighted so I doubt you’ll find the whole thing online, but you may find some leads by searching on the exact code number with related terms.
Otherwise, call the hospital’s billing department and ask for definitions of what’s on the bill.
Why would this matter? I can’t imagine that the insurance company would be more helpful or forthcoming or easy to get a hold of than the hospital billing department, and it’s no less wrong if inflated charges are spread among the pool of insured.
Well, because trust me, the insurance company knows what all the gobbledygook means and they have experts who will make sure they aren’t be overcharged.
But the insurance company has no idea exactly which services were rendered, and they are dependent on the patients to alert them to those sorts of errors.
If you used medical insurance, ask them for an Explanation of Benefits for what was paid to this hospital. It might provide a better description of what was paid for.
I work for a commercial insurance company so I could probably field specific questions.
For starters, if you know the HCPCS / CPT code you can see what Medicare allows for a professional services at http://www.cms.gov/apps/physician-fee-schedule/
It returns an amount for each geographic location, but you can get a general sense.
To me “reasonable” would be a billed charge of up to 4 times that amount. Commercial insurance usually pays 2-3X what Medicare allows, and some discount off the billed charge is normally negotiated.
Another way of looking at it is unless you have a minor, obvious complaint at a small, rural ER, you’re not going to get out of their for a thousand dollars. Several thousand is not uncommon, and 5 figures is not unheard of if you need a sophisticated workup- labs, X-rays, MRI, at an elite city hospital.
Is this the only bill for the encounter? What kind of hospital? (urban / rural / well known / etc.)
I’ll reply more when I get time, but overall based on the information you gave I don’t think it’s either particularly cheap nor particularly out of line).
$2700 for an ER visit…yup, sounds about right.
I was in the ER for a kidney stone a few months ago. A bag of saline, little bit of morphine, some ondansetron (anti nausea med (also called Zofran)), Nsaids, CT, UA and blood work, came out to about $2500 or $3000.
I did the next kidney stone at home. I thought it was funny that the saline was $60 per bag (Sod Cl .9% on your bill), but the Nsaids, Morphine, Zofran, Maalox etc were only like $2.00 each.
In the end, even if you can find something they billed you for that you didn’t get, which (don’t get me wrong) helps when you don’t have insurance, it’s the ER charge that’s going to kill you. You paid $2500, just to walk in the door. I think I paid about $1700.
$2700 for an emergency room visit? Are you people insane?
(I don’t know who I mean by “you people.” It’s just way out of line for an ER visit, unless you’re actively trying to discourage people from getting healthcare for emergencies.)
It’s about normal. Note that one can go to an urgent care center for about a tenth of that. And, for anything that isn’t immediately life-threatening, that’s’ where you should go.
I assume you’re not from the US so aren’t familiar with our convoluted system of paying for medical services.
The reason ER charges are so high is to make up for the number of patients that don’t or can’t pay. Emergency rooms are uniquely required to treat everybody that comes in. Because of this, they get a disproportionately large number of patients who can’t afford treatment.
I suspect it also discourages people from using the ER for non-emergency problems (get billed $2000 to visit the ER or pay $300+ to get the appropriate treatment from a regular doctor).
That sounds like it could be correct but it’s not. Other nations also have the same high ER charges, if indeed you are not using their socialized medicine system . It’s very expensive.
True, a significant number of patients can’t pay, but the County, etc is billed for those.
