Bitter Pill: Why Medical Bills Are Killing Us

[kuronosan]

I've had a ringing in my ear for years, initially it would come and go, but eventually it came to stay. I went to my doctor, and he goes to check my ear, and sees there is a lot of earwax, so he orders a nurse to clean it out. She comes in with a large syringe with a plastic tip, fills it with warm water, sprays it into my ear to clear it out, repeats about five, six times, and that's that. Doctor comes back in, looks at it, says there isn't anything physically wrong, tells me dick all about other options, despite my asking, and ends the appointment.

I wasn't terribly happy to begin with, but then I got the explanation of benefits from my insurance. The ear cleaning, just that and not the whole appointment, was around $600. I was floored. Literally anybody could do that.

Yep. The problem is doctors don't explain that to you because most of them want money and don't care about educating people.

[Plow]

In the last year I've been to the cardiologist twice regarding not-quite-so chronic fainting spells, the hospital for a tilt table test, an EP study and to the gastroenterologist (for an endoscopy) in order to figure out why the fuck I keep fainting at random moments not limited to a party, on a flight and while I'm taking a piss. Feelings include a cold sweat, a sensation of dying, eyes shutting down and nausea. You know, nothing too serious or anything.

Conclusion? None of them know whats going on, one conclusion was to get a pacemaker, the other suggested expensive as fuck pills that won't solve the issue moreso shotgun approach it, heart results were clean, the physicians assistant initially thought I was enhancing the truth till she saw my heartrate nosedive sending her into a panic before it then come back up after triggering a positive result during the tilt table test.

Considering I'm due to graduate with a surplus (I feel like Clinton), I'm simply disgusted with the healthcare system and I'd be so far underwater in debt if it weren't for my mothers insurance plan that I'd be busy paying back all these bills for eternity.

I'm not even going to get into how smug and detached these doctors act with regards to seeing you. It's like they should walk into the room and say:

"Sup I don't give a fuck, when do I start milking your insurance?"
"Alright, 3mins has elapsed I'm outta here. Talk to the nurse if you need anything important, I'll be busy milking other people for cash and not explaining anything even when asked."
"Oh we ran those tests but I wont bother to call back or plan a follow-up to give you the results cause I already banked that cash."
"Oh I don't know whats wrong with you, lets just throw shit at a wall and see what sticks."
"Make another appointment whenever you have more money, I have other people to see. Tata."

What exactly is a sensation of dying?

[Nephlite]

I'm a relatively healthy person and most of my hospital visits were due to job-related injuries. Been cut a few times, had a few bullets dug out but nothing too bad. Workmans Comp covered 100% of everything and never had to pay anything out of pocket. The problem is the damn Comp is so friggin slow that I've received a few bills in the mail for overdue payments from collections. Hospital collection agencies are seriously some of the worst people I've ever dealt with. Transport from a scene to a hospital (less than a mile away), got some lead dug out of me (luckily it was a target shot .9mm that stuck in my ribcage) that they claimed they didn't have enough time to numb me up before they started so it hurt like a bitch, a couple of other vaccines and whatnot and a script for Tylenol 3. Gave them the paperwork for comp and thought that was the end of it.

Bout 3 months later, got a bill from a collection agency and it outlined everything (very very comprehensive and nicely put together). The ambulance ride was $1800, the "surgery" to get the bullet out about $17,000 and another $4000 in medication and a "triage" fee. Called them up, said it was a Workmans Comp issue and forwarded them to HR. Received no less than 50-60 phone calls a week from the company demanding payment and one of them threatened my life on two or three occasions (had those recorded). Guy said to me "You fucking people (public safety) are the worst at paying because you think your shit don't stink. Make a payment or you'll never wake up again." Ended up filing a report for the whole mess and sued them for harassment (didn't go anywhere). Just couldn't believe how expensive it was.

Hell I went to the ER for an abscess in my jaw from a broken tooth and it was causing me to feel dizzy/nauseous. All I wanted was an antibiotic or something to clear it up (didn't have dental insurance at the time). Spent 3 hours waiting while some college ER nurse (she was hot at least) tried to give me an IV and ended up causing my blood to spatter all over the floor when she forgot to secure it to my arm. Gave me a script for Tylenol 3 and sent me packing saying I had to see my dentist. Insurance didn't cover it so grabbed a $3000 bill for "triage fee", some more meds (which I had plenty of) and couldn't do shit about it. Ended up watching a video where a guy drained the abscess at home and used expired/homemade antibiotics to clear up the infection. Cost? $0.

[Headspace]

Hell I went to the ER for an abscess in my jaw from a broken tooth and it was causing me to feel dizzy/nauseous. All I wanted was an antibiotic or something to clear it up (didn't have dental insurance at the time). Spent 3 hours waiting while some college ER nurse (she was hot at least) tried to give me an IV and ended up causing my blood to spatter all over the floor when she forgot to secure it to my arm. Gave me a script for Tylenol 3 and sent me packing saying I had to see my dentist. Insurance didn't cover it so grabbed a $3000 bill for "triage fee", some more meds (which I had plenty of) and couldn't do shit about it. Ended up watching a video where a guy drained the abscess at home and used expired/homemade antibiotics to clear up the infection. Cost? $0.

First world lol

[kuronosan]

Homemade antibiotics eh?

[BaneTheBrawler]

That last sentence just sounds all sorts of dangerous.

[kuronosan]

Expired antibiotics aren't so dangerous. Homemade? Yea. Dangerous.

[ronin sparthos]

What exactly is a sensation of dying?

All of your senses feel like they are shutting down. As far as I'm concerned that feels like dying.

[Talint]

Bout 3 months later, got a bill from a collection agency and it outlined everything (very very comprehensive and nicely put together). The ambulance ride was $1800, the "surgery" to get the bullet out about $17,000 and another $4000 in medication and a "triage" fee. Called them up, said it was a Workmans Comp issue and forwarded them to HR. Received no less than 50-60 phone calls a week from the company demanding payment and one of them threatened my life on two or three occasions (had those recorded). Guy said to me "You fucking people (public safety) are the worst at paying because you think your shit don't stink. Make a payment or you'll never wake up again." Ended up filing a report for the whole mess and sued them for harassment (didn't go anywhere). Just couldn't believe how expensive it was.

Isn't it a criminal offense to threaten a police officer?

Anyway, collection agencies love unpaid medical bills. When my doctor's company tried to pawn that bill off on me, I got contacted by a collections agency before I even got the bill in the mail. It was incredibly deceptive; they wanted me to agree to a payment plan before I knew what the fuck was going on.

[Kerberoz]

Over the course of 5-8 years I've seen three nutritionists

Nutritionists, or dieticians? The latter is a medical professional, subject to regulation, while the former is any idiot with a Google U education and a dubious allergy test for sale.

[Nephlite]

Expired antibiotics aren't so dangerous. Homemade? Yea. Dangerous.

I didn't try to make any but basically he made something like penicillin the same way this guy did:



Not sure exactly if it worked. The video I watched basically had him drain it and he took a bunch of crap and the homemade stuff to kill the infection. I just took some old antibiotics I had sitting around. While I'm not a packrat, I do tend to save stuff like old batteries, medicine, electronics, etc. for proper disposal. My caretaker scared the crap out of me when I was young by telling all the kids if you flush stuff like medicine down the toilet, it can cause fish to grow huge and be resistant to humans and batteries can leak acid through the groundwater and it'll eat your stomach up.

Isn't it a criminal offense to threaten a police officer?

Only if you're on duty and it has to meet very specific criteria along with intent and whatnot. If you're off-duty, the threat has to relate to someone you've dealt with in the past (retaliation, threatening to kill you if you testify or "witness tampering", etc.).

[kuronosan]

Making your own penicillin isn't dangerous. Making sure it isn't contaminated is dangerous. Penicillin may also not be very deadly on the outside of your body but breathing spores in because you don't have a negative pressure environment can actually give you respiratory mycosis.

[Lucavi]

I've had a ringing in my ear for years, initially it would come and go, but eventually it came to stay. I went to my doctor, and he goes to check my ear, and sees there is a lot of earwax, so he orders a nurse to clean it out. She comes in with a large syringe with a plastic tip, fills it with warm water, sprays it into my ear to clear it out, repeats about five, six times, and that's that. Doctor comes back in, looks at it, says there isn't anything physically wrong, tells me dick all about other options, despite my asking, and ends the appointment.

I wasn't terribly happy to begin with, but then I got the explanation of benefits from my insurance. The ear cleaning, just that and not the whole appointment, was around $600. I was floored. Literally anybody could do that.

Just had it done back in November. $65 through my insurance.

Yeah.

[Howie Roary]

just thought I'd chime in and say a close family friend has the exact same non-hodgkins lymphoma as guy in OP article, they've been in the hospital for over 3 weeks straight here in Canada and it's all covered and no one is front 85 grand or going into massive debt

not leaving Canada anytime soon, thanks

[Howie Roary]

although to be fair, some things are not covered and are stupidly considered cosmetic, this one guy was guaranteed to go blind and could not afford the "cosmetic" preventative operation that prevent him from going blind

so it's not all perfect here but yeah

[Callisto]

Really engrossing article, if not the most depressing thing I've read in ages.

[Acturus]

Hi, this is my world. I negotiate contracts for a large hospital system in the US.

Hospital pricing, by and large, is not a "raise prices as much as we can" system. Having said that, what I'm about to describe is because of my experiences at a not-for-profit institution. I assume for-profit hospitals are money-grubbing, but even then, they follow these same principles:

Like any other business, there is cost associated with a product. Overhead, materials, salaries, etc all factor into the cost of doing business. This is no different than a t-shirt company taking into account the cost of the thread, the machines, the employees, the plant, the utilities, and the shipping to distribution centers. Distribution centers mark up their own costs on the resell, and retailers pass all of that cost, plus their own, plus their profit margin on to the consumer.

In hospitals, there's this pesky problem of fair compensation. Hospitals are required by law to treat all patients with the same amount of care. I'm sure you each have personal experiences to say otherwise, but trust me, hospitals pretty much give the same basic care measures to all patients.

You have Medicare, which does not cover the cost of the visits.
You have Medicaid, which does not cover the cost of the visits.
You have the VA and worker's compensation, which do not cover the costs of visits.
These are government entities who artificially hold their prices low over time and do not keep pace with inflation, or, worse, cut prices due to budgetary measures.


And then you have Emergency Medical Treatment And Labor Act, a federal law that says all patients presenting with urgent need to a hospital with an emergency room MUST be treated without consideration for that patient's ability to pay. In industry terms, we call them "self-pay" or "no-pay" patients.

I won't bore you all with the interworkings of how limited networks and benefits afforded by Medicaid or the VA encourage ER utilization, but the bottom line is that every hospital with an ER has a certain amount of uncompensated care that must be accounted for.

Some of it is written off. It's called bad debt or charity care. The rest of it is factored into the cost of doing business.

So, when you see $1.50 for a Tylenol, that $1.50 is what the hospital is charging for that pill. It is not what that pill costs.

A hospital's charges are often the numbers that are quoted when discussing the problem with hospital pricing. And a hospital's charges include a certain amount of repayment for uncompensated care incurred by self-pay or non-pay patients.

I won't say that there isn't an inflator included in those charges to preserve a profit margin, but since US healthcare is a third-party payor system, the profits for most hospitals come from their commercially insured business (a/k/a employer groups, private insurers, BCBS, Cigna, etc). We don't make money off of Medicare, Medicaid, the VA, or Work Comp. It doesn't meet our costs, much less our charges.

So, the ugly truth about the US healthcare system is that it's already a socialized form of medicine. Those who can pay more, are forced to, becuase a hospital cannot close its doors to the undercompensation of so many consumers.

Those of you with private insurance, your insurer cuts a deal (that's where I come in) to pay an amount less than the total charges that would "normally" appear on a bill.

What most people don't tell you is that self-pay patients rarely pay 100% of billed charges either. One of my hospitals will cut a deal for self-pay that effects a 66% discount off of the charges, and increases it to 75% if the patient can pay totally up front.

So, I can't speak for the story in the article at the start of the thread, but I want to be sure that it's understood that hospitals as an industry don't arbitrarily sell services at inflated amounts, no matter how many horror stories we hear from popular media.

[archibaldcrane]

I want to be sure that it's understood that hospitals as an industry don't arbitrarily sell services at inflated amounts, no matter how many horror stories we hear from popular media.

One of my hospitals will cut a deal for self-pay that effects a 66% discount off of the charges, and increases it to 75% if the patient can pay totally up front.

You beg to differ.

[Ragnus]

How do people not pay bills from hospitals? Last time I was at an ER they took enough info from me to steal my identity if they wanted...

[Seraph]

You beg to differ.

You beat me to it, but this, so hard.

It's so bad now I almost think that the medical community doesn't even realize they do it.