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The Problem with Healthcare in America
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Mar 6, 2017 12:17:39   #
jerryc41 Loc: Catskill Mts of NY
 
I cut my thumb with a rotary blade on a Dremel tool at the end of January. I came inside, cleaned it, bandaged it, and took it easy. It was still bleeding through the bandage the next day, so I called my doctor. "Go to the ER."

After waiting a while, I was taken to the "Express" area. A nurse washed my thumb, bandaged it, and gave me two shots for tetanus. Luckily, I was in the "Express" area, so that took only ninety minutes.

Today I received the bill.

ER Services $3,185.00
Pharmacy $2,488.30
Preventive Care $20.00 Maybe that was telling me to be careful.
Total $5,693.30

Medicare has paid $773.18 and "adjusted" $4,664.01, leaving me with a bill of $276.11. My secondary insurance hasn't paid yet, but I should be liable only for a copay of $25 for an ER visit. When I called the hospital, she said their new policy is to bill the patient after a certain period of time, even if they haven't heard from insurance. So, I'll wait another month and see what happens.

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Mar 6, 2017 12:27:44   #
Architect1776 Loc: In my mind
 
jerryc41 wrote:
I cut my thumb with a rotary blade on a Dremel tool at the end of January. I came inside, cleaned it, bandaged it, and took it easy. It was still bleeding through the bandage the next day, so I called my doctor. "Go to the ER."

After waiting a while, I was taken to the "Express" area. A nurse washed my thumb, bandaged it, and gave me two shots for tetanus. Luckily, I was in the "Express" area, so that took only ninety minutes.

Today I received the bill.

ER Services $3,185.00
Pharmacy $2,488.30
Preventive Care $20.00 Maybe that was telling me to be careful.
Total $5,693.30

Medicare has paid $773.18 and "adjusted" $4,664.01, leaving me with a bill of $276.11. My secondary insurance hasn't paid yet, but I should be liable only for a copay of $25 for an ER visit. When I called the hospital, she said their new policy is to bill the patient after a certain period of time, even if they haven't heard from insurance. So, I'll wait another month and see what happens.
I cut my thumb with a rotary blade on a Dremel too... (show quote)


If insurance did not exist the whole bill would have been no more than $50.00.

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Mar 6, 2017 12:29:37   #
ricardo7 Loc: Washington, DC - Santiago, Chile
 
That seems very high, but you went to a hospital. Two years ago, days before leaving for vacation I gashed
the fat part of my thumb. I went to a local walk in emergency place. They took care of me right a way because
I was bleeding like a pig and making a mess on the floor. After a half a dozen stitches and a tetanus shot my
total bill was a $20 co-pay.

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Mar 6, 2017 12:33:58   #
JamieLM
 
I always go to a doc in the box. It is usually manned by a nurse practitioner and they are more than qualified to handle incidents like you described. I believe it is covered by Medicare. I also get my flu shot, travel shots, and other minor ailments. If you have a CVS, your u can make an appointment and they will text you 30 minutes before they see you.

Unfortunately, because not everyone in the states can afford healthcare, the ER is used as a doctors office. Most cannot pay. ERs all over the country are closing, in part, because they cannot handle the financial burden of the uninsured. There should be a better way. Hope all is well. Jamie

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Mar 6, 2017 12:34:35   #
MichaelH Loc: NorCal via Lansing, MI
 
I hope your thumb gets better. Our form of "socialism" is quite crappy and not easy to understand. The hospital probably gets to write off the $4,664 as a "loss" AND the next person coming in the door with "deep pocketed" insurance gets to pay extra to make up the difference between what the hospital "wants" and what it can get. Those who have the need can blame Obama {until Trump "owns" the mess by throwing out the current system}.

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Mar 6, 2017 13:24:54   #
MtnMan Loc: ID
 
jerryc41 wrote:
I cut my thumb with a rotary blade on a Dremel tool at the end of January. I came inside, cleaned it, bandaged it, and took it easy. It was still bleeding through the bandage the next day, so I called my doctor. "Go to the ER."

After waiting a while, I was taken to the "Express" area. A nurse washed my thumb, bandaged it, and gave me two shots for tetanus. Luckily, I was in the "Express" area, so that took only ninety minutes.

Today I received the bill.

ER Services $3,185.00
Pharmacy $2,488.30
Preventive Care $20.00 Maybe that was telling me to be careful.
Total $5,693.30

Medicare has paid $773.18 and "adjusted" $4,664.01, leaving me with a bill of $276.11. My secondary insurance hasn't paid yet, but I should be liable only for a copay of $25 for an ER visit. When I called the hospital, she said their new policy is to bill the patient after a certain period of time, even if they haven't heard from insurance. So, I'll wait another month and see what happens.
I cut my thumb with a rotary blade on a Dremel too... (show quote)


The ridiculous charges appear on all insurance bills. The only ones that would badgered to pay them are those without insurance...who have no money anyway. I don't know why they do that. It is very stupid.

It has nothing to do with financial losses. If you think so you do not understand accounting.

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Mar 6, 2017 13:39:52   #
Architect1776 Loc: In my mind
 
MtnMan wrote:
The ridiculous charges appear on all insurance bills. The only ones that would badgered to pay them are those without insurance...who have no money anyway. I don't know why they do that. It is very stupid.

It has nothing to do with financial losses. If you think so you do not understand accounting.


It does have to do with losses per a doctor I knew who I paid cash to for services rendered.
I asked what it would cost for a physical where they would make the same profit as with insurance if I used cash. The response was $58.00. Yet they would bill the insurance for about $380.00 for the same physical. Here is the game. The insurance company discounts the bill to $96.00 and pays that amount. The doctor then pays staff the difference between the $96.00 and $58.00 for all the paperwork.
The discounted is shown as an actual loss and this is reflected in the taxes reported as a loss. Sweet deal.
Again I am not into accounting of hospitals but I would bet the discounted difference is shown as some form of loss.

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Mar 6, 2017 14:32:39   #
ricardo7 Loc: Washington, DC - Santiago, Chile
 
Our health care system is controlled by the insurance companies who write all of the legislation
related to health care. Their primary goal is money. When you get the insurance companies
out of the equation then you can start to provide affordable health care to everyone.

Reply
Mar 6, 2017 16:16:32   #
robertjerl Loc: Corona, California
 
Kaiser has "Urgent Care" clinics for things like that. One or two doctors supervising several PAs and Nurse Practitioners who take care of the simple stuff and send you on to the ER only if it is serious enough. The one for my region is in the same building as many of the GPs' offices so they have another option - send you upstairs for a Doctor to evaluate you or schedule follow ups. ER is in the building next door on the ground floor of the hospital.
Under my plan as a retired Los Angeles Unified School District teacher the co-pay and any Rx is all I pay.
PA or NP - $5
Dr - $20 for my family $5 for me because I am 71 and on Medicare
ER - $75 full co-pay and I think mine with Medicare is $25
The Co-pay for ER seems to have actually gone down under the 2017 rate chart. They were $100, of course before that it was $50.
Yes, my health plan is one of those "Cadillac" plans that actually seems to be a bit better than the ACA Platinum plan they list.
I know that to keep my daughter on her same coverage while she is getting ready for the MCAT tests and applying to medical schools (she graduated from Pre-Med in Sep so she is not on my plan at the present time) is $367 a month.

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Mar 6, 2017 17:51:49   #
rehess Loc: South Bend, Indiana, USA
 
JamieLM wrote:
I always go to a doc in the box. It is usually manned by a nurse practitioner and they are more than qualified to handle incidents like you described. I believe it is covered by Medicare. I also get my flu shot, travel shots, and other minor ailments. If you have a CVS, your u can make an appointment and they will text you 30 minutes before they see you.

Unfortunately, because not everyone in the states can afford healthcare, the ER is used as a doctors office. Most cannot pay. ERs all over the country are closing, in part, because they cannot handle the financial burden of the uninsured. There should be a better way. Hope all is well. Jamie
I always go to a doc in the box. It is usually man... (show quote)
I will not go to CVS. A couple of years ago, I walked to the one two blocks from my job to get a flu shot over my lunch hour. The woman at the pharmacy said nothing about appointments, only that I should "sit over there". During the next 30 minutes I saw several people come in, also clearly without appointments, and get their shots while I was still waiting. When I finally went over and asked, I was told that my slot was still nearly an hour away. I told them I was going back to work and would be back at the specified time. I am quite convinced that, since Medicare was paying for mine, they thought I had no time commitments, so they could put me off until the working class went back to work - and, besides, I might buy a snack or something else out of boredom.

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Mar 7, 2017 06:16:32   #
John N Loc: HP14 3QF Stokenchurch, UK
 
Don't think I'll be moaning about my National Insurance contributions for the N.H.S. any time soon! If they (Government) ask for it I'll pay a little extra, just so long as the money is ringfenced.

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Mar 7, 2017 06:31:15   #
Bob Smith Loc: Banjarmasin
 
Chopped two fingers off with a circular saw just before Christmas sewn back on, 10 sessions of physiotherapy since now healing ok. COST £0 NHS so glad I am old in the UK

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Mar 7, 2017 07:03:22   #
gplawhorn Loc: Norfolk, Nebraska
 
Hmmm . . . the general thinking is that the "cost" is what the individual pays. No, the cost is what is costs, period, regardless of who pays for it, regardless of the country you live in. 15 years ago I cut my finger on a trip to California. One stitch cost $2,500, around $300 for me, and $2,200 for my insurance. That's why I have superglue.

It obviously didn't COST $5,693 to treat the OP's injury, so the hospital gets blamed for blatant greed. But, the hospital HAD to bill that much to get more or less what it cost. Medicare "adjusted" more than $4,600 on the OP's bill - that means that Medicare told the ER to accept 22% of the bill and be happy. If Medicare (and insurers) would simply pay the bills as they were submitted, providers wouldn't need to grossly overbill in order to stay in business.

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Mar 7, 2017 07:06:28   #
sb Loc: Florida's East Coast
 
MichaelH wrote:
I hope your thumb gets better. Our form of "socialism" is quite crappy and not easy to understand. The hospital probably gets to write off the $4,664 as a "loss" AND the next person coming in the door with "deep pocketed" insurance gets to pay extra to make up the difference between what the hospital "wants" and what it can get. Those who have the need can blame Obama {until Trump "owns" the mess by throwing out the current system}.


Sounds like capitalism run amok to me. And, by the way, you cannot "write off money you have not taken in, so the insurance "write-off" does not gain anything for providers.

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Mar 7, 2017 07:09:27   #
viscountdriver Loc: East Kent UK
 
John N wrote:
Don't think I'll be moaning about my National Insurance contributions for the N.H.S. any time soon! If they (Government) ask for it I'll pay a little extra, just so long as the money is ringfenced.

Sure we get all free but we might have to wait eight hours in A and E or two weeks to see a GP.

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