I went to the US on business - our corporate insurance means there's a $1000 excess that we pay up front.
Went to a hospital for a minor issue. At no point was there any price list shown, at the end I was asked for $390 before been given my prescription. That was the end of it I thought, sickeningly high charge for 2 minutes with a doctor, a 10p tablet, and hours of waiting around. I asked for an itemised bill, but they couldn't give me one.
A few weeks later I get another bill through the post for another $390 (slightly different amount), complete with the entire bill. The whole bill was about $2k. The 10p tablet? $250. In fact they originally gave me a 50mg one for $9, then took it off the bill, then gave me 2x25mg ones for $250. I then had a $1100 "uninsured discount" which brought the total price down to just before $800.
The bulk of the bill was a single line that was fairly incomprehensible but seemed to cover pointless taking my blood pressure 3 times and the 2 minute consultation with a Doctor who barely spoke to me, and renting the chair for a few hours I guess.
edit: see http://imgur.com/ERjjQBil.png
The U.S. is seriously broken.
Urgent care would have had something closer to a $100 markup than $2,000, because you’re only paying for a few nurses and doctors to be on call, not for having used the resources that are meant for trauma and acute crises.
That hospitals are required make up fictitious itemized explanations for their very real costs is indeed broken, but it’s a very small part of the overall issue.
If you called the hospital billing department and offered 20% of the overall bill, they would likely have immediately accepted; uninsured hospital billing has expected value on the order of 10% of outstanding balances, so if you give them more than they can get from sending you to collections, they’re usually happy to compromise much more steeply than the 60% “discount” they offered you.
Oh yeah, I asked how much I would be charged before the doc saw me and they refused to answer.
$100 markup my arse.
Urgent cares used to be pretty upfront. I went to an urgent care a couple of years ago, $99 advertised in the window. I go in, fill out all the paperwork and they tell me it's going to be $150. When I point to the window, she says it's expired. I start to walk out and she tells me to come back and gives me price. This is not the only time I've had to walk out over various health things, it's ridiculous. They think you won't do it because you're ill and act that getting angry over this is some sort of insane response. So now I just pretend not to have the extra money.
Anyway, I use Heal now. So happy that the VCs are funding this, hope it lasts.
It's entirely possible that you're insured, but no facility within an hour's drive will take your plan, and if your kid becomes ill outside of business hours, tough luck. For liability reasons, they'll refer you to the ER anyway if you have symptoms beyond a sore throat.
The last time I had to go to an urgent care clinic in a state where no one took my insurance plan, I had to pay $700 out of pocket to talk with a doctor for 10 minutes and get prescribed a z-pack. I then paid $90 for 6 pills at the pharmacy.
Urgent care can get you antibiotics and test for strep, and I think x-ray and set simple fractures, and stitches of course. What else is within their scope, I find it fairly limited.
Just looked up the one near to my hotel. Closes 6PM. Not much use at 2330.
The pricing system is intentionally designed to be opaque so that everyone except the consumer benefits. It is not uncommon for a top surgeon to make 500-750K per year, nurses are paid well above the median and can make over 100K with overtime, hospital administrators, insurance companies... the way pricing and billing is handled protects all those interests.
Sounds like something you would want to fix, right? Well that too is complicated. Healthcare is one of the only sectors that is growing middle class jobs. A hospital is one of the only places someone with an associates degree and a certification can make 60K per year.
Furthermore, it is one of the only growing industries that provides many opportunities for women. Not many women want to move to Montana to frack shale oil.
Start socializing medicine and all that job growth and opportunity disappears.
It is a tough problem to solve. The utter irrationality of it used to drive me nuts and still does sometimes, but I prefer it to the alternatives.
Pegging growth to systemic inefficiency is monumentally stupid.
This is only a few steps of abstraction away from simply paying those nurses to dig holes then fill them back up, macroeconomically.
I feel like you are making a lot of assumptions about how we would fix our health care system that are unfounded.
Personally, I think it's unethical to keep a process inefficient even if the inefficiencies are profitable. And healthcare in the states is anything but cost-efficient.
The fact that the US has many leading medical research institutions is often abused to argue that we have the best care, but it's largely irrelevant for the overwhelming majority of delivered care and even more irrelevant for outcomes.
Is this supposed to be a good argument to drive desperate people into bankruptcy?
That sounds like straight up fraud. What the hell.
