Tch. Even if you believe his press releases, he’s only gotten a solid return once.
He was too busy lying about Obamacare.
Slee
For the Old Testament God, the future is all about the past.
Was he already on antibiotics for the strep? If not, and if it was really confirmed as strep, he should have been. IANAD, but it’s my understanding that this is necessary to prevent the strep from causing infected heart valves. If no one ever did a culture, h how do you know it was strep?
If it was JUST to get a painkiller prescription, couldn’t you have gone to a “doc-in-a-box” 24-hour facility instead of the full ER process?
The pediatrician I had when my kids were small would meet us at the office any time, day or night. I believe the group still does this. They charge an additional fee for this to keep parents from calling them out for every sniffle that could have waited until morning, but it’s not exorbitant, certainly not $400.
Yes, ER visits are very expensive, for a reason that it seems I seem to be unable to explain. Put it this way – if ER visits cost $5, people would show up for every scrape, splinter or sneeze.
Why do you assume there is one? Urgent cares here are open 8 to 8 at the longest, they close even earlier on Sundays. I won’t be surprised if they’re like that where he is too.
As for the woman in the OP, are there a lot of insurance plans that don’t cover out of network hospitals? I’d have to pay a deductible to go to an out of network hospital, but I certainly wouldn’t be on the hook for 50k.
Those here who are arguing this didn’t read carefully. The insurer DID pay 100 % of the in-network rate. However, the ACA allows balance billing.
Example:
In-network hospitals contract for $156K for cardiac arrest (although they may charge $200K out of network). If the patient goes to an in-network hospital, they pay 100% of contracted price and the hospital accepts that price.
Out-of-network hospital charges $254K for the same cardiac arrest. The insurance paid 100% of the in-network price, or $156K. The hospital was allowed to balance bill the remaining $98K to the patient. To it’s credit, the insurance company went to bat for the patient and negotiated that fee down by 90% (all numbers from linked article), or down to about $9-10K. However, the same thing happens with all other billers (doctors, radiology, pathology etc). Even if in each case the insurance paid the full in-network price, the patient could be billed for the difference.
I give her insurance credit for doing the right thing. Unfortunately, often the patient can only try to bargain with each creditor to settle for the contracted rate.
It is an absolutely crazy situation. I was seen for physical therapy and 9/10 visits were billed correctly. However, one week was billed incorrectly as out of network. Since I had an out of network deductible, it was billed to me for $216. I called the provider who said they had billed correctly and the insurance had denied it. I called the insurance who said it was billed incorrectly and needed to be resubmitted. I called the provider who resubmitted the bill which was rejected as a duplicate claim. I called them both again and got everybody on a conference call. They agreed to fix it. I got another bill for the full amount. The provider said that the insurance company was going to correct the problem. The insurance company said that the provider needed to resubmit the claim. I got everybody on another conference call and they agreed to fix it. I got another bill for the same amount. Rinse and repeat for a year. Finally, I got another bill stating that since I was paying the bill myself they would only charge me the “cash-paying” rate of $140. I almost caved and just pain it but I tried one last time. The last I heard, I got a cancellation of the original claim and a new claim submitted that appeared to be paid as in network. Keep in mind that I am a doctor, I do my own coding and I deal with claims every day and not only could I barely navigate this mess, but I could not even understand the paperwork. I really really don’t know how others do it. I am pretty sure a lot of patient just pay whatever bills they get and assume it’s correct. I do know for sure that a lot of patients just throw away their bills when they get them (which leads me into another rant about patients who don’t say anything when they get billed for things that should have been covered until we call them because they have a large balance and when we finally realize that there is a problem, the time limit for filing is up and since we can’t bill the patient since their insurance should have paid and the insurance won’t pay because the time limit is up, we are SOL).
tl;dr we need universal health care.
Does your insurance pay 100% of whatever the out of network hospital charges? Or do they pay 100% of what they would pay for an in-network hospital? Even if they cover out-of network hospitals, most insurances pay a percentage of UCR (usual, customary and reasonable fees). You are paying the percentage of UCR plus any balance billing. Not only that, but your out of pocket maximum often only applies to the percentage of UCR so that even if you meet your out of network limit, you can still be balance billed for anything above UCR. See the example above where the insurance plan did cover the out-of-network hospital at 100% of it’s in-network fees but the patient was still balance-billed.
In all fairness, God has footed the bill for paying off all those who were “touched” by his earthly servants. He’s a little cash strapped now.
So unreasonable health care costs (i.e. not tied to actual costs) are not rising as much as they could is making health care affordable? I don’t see that.
Have you ever gotten a quote for a low-deductable insurance plan? Most people can’t afford the monthly premium for an individual let alone family coverage.
So ACA is health INSURANCE reform and minimal (everyone can be covered) at that and does not significantly reduce actual consumer costs? I’ve been saying that since it passed so I’m glad you agree with me.
False analogy. I am NOT required to buy term life insurance. And if you want to compare it to auto insurance, the low deductable means I’m actually covered. Suppose your car insurance had a $5000 deductable fo the same premiums?
Expensive? Sure I get that but medical costs are excessive. $50 for tylanol? $Hundreds for a nurse to take your vitals? Plus they are not tied into actual costs. Hell there have been many stories where hospital admit they charge whatever. And if the prices were tied to costs and hospitals made moderate profits, how could theyafford to have prices for insurance companies drastically below what they charge people off the street?
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The doctor knew there was strep in the household since his brother was fighting a case of it. And a doctor says it’s classic strep by looking at it who am I to argue, especially as most doctor are “How dare you question me!” Oh and you say that he was worth $2400/hr because of his knowledge but he didn’t know you have to take a culture.
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No docs in a box round here. Hell we were lucky to find 24 hour urgent care.
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When was the last time you were in an emergency room? I see everything from rat bites to broken fingers to some lady who nearly died waiting 3 hours in the waiting room. I don’t know if they are on the dole or will refuse to pay or have money pouring out their ass but I have seen a fair share of relatively minor injuries. The only reason I took my son in that night was his fever spiked and he couldn’t swallow the anti-inflamatories and refuse to eat soup or drink water because the pain got so bad (after business hours of course because that’s how it always seems to work)
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I didn’t even tell you about Mrs. Cad who was ordered by her doctor (or else would refuse to treat my wife) if she didn’t take a $3000 sleep study to see if she had sleep apnea (she doesn’t). So some guy getting paid $15 an hour watched her sleep for 8 hours. Insurance covered $1800 so we got stuck with $1200. Oh and this was despite that I know she doesn’t have apnea (my grandfather had it so I know what it sounds like) and the entire test was because she is overweight and the doctor had heard of a study (I did too) that sleep apnea can screw up your hormones. Admittedly she didn’t ask about the cost and how much was covered because stupidly we thought having a guy run an EEG machine for a few hours is a few hundred bucks at most and that it would be covered as a “lab” because the doctor said it would be. Apparently it was not but try to fight the insurance company on that. Hell, they won’t even back up what their own people tell you <insert BCBS story here>
Okay, your doctor told you something different from what our doctors told us. Ours said you cannot reliably tell a strep infection from a viral infection without a culture. I know that as long as 30 years ago there were tests available that would give a result in literally 10 minutes.
Were your kids on antibiotics? Our doctors would never prescribe them without a confirmed culture. If they weren’t, why not if the doctor was so sure it was strep?
I have, unfortunately, been in ERs too frequently. My latest visits were about a year ago.
If your kid was unable to swallow liquids, I’m surprised they didn’t admit him and put him on an IV to avoid dehydration, which can happen fairly quickly with small children.
If my doctor refused to treat me unless I submitted to an expensive test that I was convinced was unnecessary, I’d find another doctor. I guess medical care and practice is different where you are than it is here.
Who told you (outside of Fox News or something) that anyone claimed healthcare was going to be affordable after a year of ACA? It is less unaffordable, especially for those who can get on Medicaid now, and available for those of us with pre-existing conditions.
I didn’t say people were stupid for getting high deductible plans. I’m saying people are gambling. And now there is competition, and going to be more, so, if you believe in capitalism, the prices should go down.
Yeah, ACA is not a single payer plan or National Health like plan. I’m more in favor of those, but considering how hard it was to get Romneycare passed nationally, I don’t think we can do better. I’m sure all those millions who are insured now and weren’t before would happily give up their insurance to wait for the best possible plan.
Those in plans with negotiated rates will probably reduced consumer costs. Healthcare is not going to start decreasing in price overall, but it has stopped increasing as quickly as it used to. Remember, the latest estimate of Medicare costs was way lower than before thanks to ACA and the improved trend.
I wasn’t talking about requirements. I was talking about value. The value of an insurance policy is not what you get out of it that year. My daughter and I taught this, since this explains why you invest in protection for events that may never happen. There are tons of examples.
Since no one feels the need to pay the survivors of a person without life insurance, it isn’t required. We do feel the need to pay the hospital bills of a person who can’t afford it (emergency ones). So a bit different.
High deductible auto insurance is the same kind of bet as high deductible medical insurance, except that for collision at least there is a cap on expenses.
I’ll go you one further - how come an operation costs $50k at one hospital and $20K at one across town? The answer is easy - before ACA started publishing comparative costs there was no way of comparing them, so there was no reason for a hospital to charge an uninsured patient less. Insurance companies have the power to find out and sometimes even dictate rates - that is why they are cheaper.
Capitalism doesn’t work for healthcare. Case in point - when your son got sick, did you call around to five emergency rooms to check out their prices? Of course not. You have even less choice if you collapse and get stuck in an ambulance.
If we kicked the Republicans out of Congress we might have a shot at the kind of reform both of us want. But criticizing ACA because it did not turn a disaster into paradise in one year doesn’t help at all. It just makes the situation you are in worse.
You not me. I have a good plan, and in two years I go on a single payer plan.
If more health care reform means elimination of severe financial disincentives for going to an emergency room for strep instead of getting a $17 test at Walgreens, I’m not certain more reform is what we need.
If it means eliminating the mess the lady in the OP is going through, I’m on board.
I don’t know - I live in a country with national healthcare and I’ve never been to an emergency room unless gushing blood or broken bones were involved. Everyone here knows that emergency rooms are for emergencies; anything else you see your GP or drop by a clinic.
Well, my first question is, why did you go to the ER for strep throat? Unless a kid can’t breathe or has an extremely high fever (>103F or 104F), that’s generally not necessary.
An acute care center or walk-in clinic (Concentra, After Hours, CVS Minute Clinic) would’ve handled this for less than $100.
People have to be educated about the most cost-appropriate choices. They aren’t, and it’s not just you. My cousin took her kid to the ER with a 101F fever and “not feeling well”.
Anyway, this wacky payment problem is a flaw in the system that needs to be fixed. It has existed for the twenty+ years I’ve worked in health insurance. It has nothing to do with the ACA and everything to do with how hospitals negotiate reimbursements with insurers.
If I go to Brigham and Women’s for a procedure, they get 30% more reimbursement than Tufts would. Tufts gets more than Lahey would. And so on. WHY?
There’s always Chap 7.
A nice little factoid to mention when you call the “provider(s)” and mention that “Your bill? The one that looks like a small country’s GDP? Insurance ain’t gonna pay. Let’s chat”.
If she got through all that for $50K, maybe they already know it isn’t covered.
$54K was what I ran up in just over 12 hours. That one is (so far) my “personal best”.
Wow! This thread is great! I’m going to bookmark it…
Every time I get pissed off with some idiocy of the National Health Service I’m going to re-read it and thank my lucky stars I live in the UK!
Slight hijack-but the doctor seen for the kid’s strep was perfectly correct in not getting a strep test. For diagnosis of strep; the most cost effective way is to look at the probability of a sore throat being strep.
If the history and physical give more than a 50-70% chance of it being strep, it is often more cost effective and better for the patient to treat rather than to run a rapid strep test, which adds cost and is not 100% accurate anyway (the gold standard is culture, which can take several days).
If there is a very low chance of it being strep, it is most cost effective and better for the patient to not treat with antibiotics, since treatment really only prevents possible heart complications, antibiotics can be started up to 10 days after symptoms start, and most mild cases of strep are self-limited without antibiotics and without complications. Remember that people also die from antibiotic-related complications.
It is when you have a case that falls in the middle that strep testing becomes more important in deciding whether or not to treat.
IOW:
Looks like strep, sounds like strep and/or known strep exposure-treat without testing
Looks sort of like strep or not really like strep but known exposure-get a rapid strep test
Doesn’t look or sound like strep-don’t treat
This would be the application of It’s almost never [DEL][COLOR=“Black”]Lupus[/DEL][/COLOR] a Zebra andSutton’s Law, correct?
CMC fnord!
What about my second question: what would have been different about this experience before Obamacare? From reading other posts in this thread it sounds to me like it would have been more expensive (health care costs rising by 5% vs. 9%) but not much else would have been different. So why blame Obamacare with size 20 type? (By the way, how does $500 + $400 = $2700. I could not figure that out.)
On further reflection, I will agree with you; Obamacare was not health care reform, it was insurance reform. I will even agree that Obamacare sucks as a law (you didn’t say this, but I assume you feel this way). So what? Why are you blaming it for your son’s medical bills? He would have had to pay the same amount if Obamacare had not been enacted.
Now you may retort that he would not have had to carry worthless insurance without the ACA. But I don’t think that his insurance is worthless, it was only worthless in this circumstance. If instead of strep throat he had a case of necrotizing fasciitis (it happens, I had a mild case when I was in my 20s and I know a person who died of it), his insurance would have probably shelled out enough to make the insurance a good deal. For myself, I am glad that your son is being forced to have insurance, as I was kind of pissed off that responsible me (always with insurance) have be subsidizing all the younger and poor people who didn’t take responsibility for their own health care.
Now if you want to have a discussion about a law to reduce health care costs instead of the “insurance reform” law we have now that addresses the free rider problem and extends health care to the millions of people that were previously uninsured or uninsurable, I am ready to have that conversation. But I find your personal complaints about the ACA as somewhat missing the mark.