I once had a flash burn and went to the hospital. Since I was blind at the time I couldn't read the forms the hospital wanted me to sign. I refused and had them read them to me. I was then told I was being uncooperative. As far as I know it's illegal to ask someone to sign a contract they can't read or is not filled out completely. Funny how large organizations think they can get away with doing illegal things. Keep the good stuff coming Steve.
I went into the er delirious and shaking from vomiting for like 8 hours or something and they wanted me to sign my induction for and I tried telling the lady I was too messed up to make a decision. She insisted so I just stabbed it with a pen and gave her a dirty look
This is why you should have a healthcare proxy and/or DPA in your wallet. It's a legal document that allows the people you designate to make medical decisions for you when are incapable of doing so. It has their names, addresses, and phone numbers and the hospital is legally required to contact them. I have my mother and a trusted friend on mine as well as treatment info such as treatments I don't want and my end of life instructions.
I encountered a similar situation at a Sheriff's Dept. Cops wouldn't give me my glasses or read the paper the wanted me to sign. I absolutely will not sign anything without knowing exactly what it says. Thankfully a female deputy that heard what was going on read the paper to me & I signed it. It infuriates me when any official or law enforcement officer breaks a law as if it's the most normal thing to do. "Rules for thee But not for me" It has become the common theme. Exasperating
Johnny if that had been needed in court for anything, it would easily be thrown out due to failure of the police to adequately explain it to you. That's why when reading your Miranda Rights they ask "do you understand your rights". If you don't speak English they're suppose to provide a translator. Otherwise you didn't know is actually usable.
Strange that the 'unpredictable' charges are never _lower_ than predicted. If they are unpredictable, then by balance of probability, some bills must be lower than initially predicted.
I think the problem is that people are almost always given the optimistic estimate about what something will cost. Whether it's car repairs, home repairs or health "repairs" it's not unusual to find out that there's more work necessary than you hoped, and more work always costs more. An honest and complete estimate would be a range based on the minimum that might need to be done, what's likely, and what's possible.
@@suedenim9208 Na, Everywhere in the world a medical procedure has a fixed price, it's based on an average cost calculation plus some profit. And that's even true in places where the patient never sees the actual bill. Medical costs are predictable inside a reasonable envelope....not a X to 250X amount envelope. There IS infact allways an average amount of costs!
Biggest issue is the insurance companies. Everything is a guesstimate on how much they will pay out bills are never lower than we predict because they never pay more than they are contractually obligated. For an office visit and you do nothing but talk to the doctor with no procedures I may know BCBS is going to pay all but $10 for United maybe it’s $15 we have charts for everything but “coverage does not guarantee payment” according to insurance companies. Now we see you and the doctor wants a CT exam now I have to do what’s called a prior authorization. Most insurance companies will flat out refuse to pay unless we do these we tell the insurance what we are planning to do what the diagnosis is and a history and we will be denied or “approved” and often it’s denied for stupid stuff. “Oh you have a massive deformation in your sinuses suspected that may require surgery? have you attempted Flonase and saline nasal sprays for at least 3 weeks? Oh you haven’t?…denied” But here’s the kicker even if the CT is “approved” the insurance company tells you all throughout the process “Prior Approval is not a guarantee of payment” We could enact laws like the mechanics law but I’m going to bet every doctors office in the nation is going to stop taking insurance until we get a guarantee of payment.
My Dad had to be life flighted after a boating accident. After we got the bill we learned there are two helicopter companies that service our town and switch off every other day. One company would have been $7500 and the one that we got which was around $200K for a 15 minute flight. We were told we should have asked for the one that was in network!!! WTF!?!? Who calls 911 and asks about which company is in network?!?! Insurance companies are the worst...hospital billing a close second!
Plus the emergency system does not work like that emergency life flights are based on availability and a triage system. So. They get a call. You are then triaged, a line of sorts. Those most life threatening closer to the top of the list. Next available transport grabs the one at the top of the list. If you have a routine transfer and non emergent transfer say from one facility to another or one country to another, then you can perhaps make a choice between transport companies. But not on am emergent basis.
Years ago I suffered a concussion during a softball game. I only remember snippits of images until about 2 hours after the injury. Later we were billed full cost for the ambulance because it was 'out of network'. My companiy's HR department (self insured company health insurance) went to bat (pardon the pun) for me and argued with the insurance company. They got it reduced to the regular cost.
My God, as a Brit, this entire conversation blows my mind. The idea that you call in an emergency and you have to worry about whether you can afford to be rescued is crazy
My friends husband was in the hospital. Every second of every day a family member was with him taking detailed notes. Then there was around $20,000.00 charges for tests and medicines he never had. She challenged it. They told her to disregard it because his insurance will cover it. She said, " F you. Our insurance isn't paying for anything my husband didn't get". She contacted her insurance. It went to court and her insurance didn't have to pay for what he didn't get. $20,000.00 was a huge amount 20 years ago. They are so shady.
@@madmatt2024 It was the hospital that billed the over charges. We've heard this is common to make up for the non insured or Medicaid patients who maybe they or their insurance won't cover the bill they owe. I don't know. I just know my friends husband was over billed by $20,000.00.
@@susanepp2707 It doesn't matter the reason, it's still fraud. You can't legally bill someone, especially insurance, for a service that was never performed. The legal way to offset your losses is to raise the prices for everyone, these idiots were too lazy to even do that and thanks to your friend's husband's family, they got caught.
Recently my significant other had to see a dermatologist about an auto immune situation that's fairly serious. The dermatologist never did a full examination and then she found out that her insurance was charged for a full examination and that there are only so many of those that could be done in a given time frame. So now she has to fight the dermatologist just so she can get the actual test that they fraudulently claimed that they performed. For her it's not about the money it's about the right to have access to medical care.
@@susanepp2707 I've heard that too, even though it may help a lot of folks in the short term, it hurts solving the actual problem in the long term. We need better more affordable access to health care for all americans and the billing for that and the insurance needs to be 100% transparent.
What gets me is how your veterinarian can tell you how much to neuter your dog, plus or minus added fees for the dog having only one, or a heart condition, or meds for after care, but the human surgeon/hospital can only waffle about your care coats
The surgeon can tell you what his charges are, but s/he has no say in hospital charges. The surgeon’s fees are a small portion of the bill, so knowing what the surgeon will charge will not help much.
The hospital should know its daily accommodation charge, and approximate operating theater time. It isn't that hard - other countries manage just fine.
Couple of reasons: People that can’t afford to take their pets to the vet for anything major…Don’t. So there is nothing to write off that then gets made up by those who do pay. And while some people will mortgage their house for a pet, most people will not so there isn’t nearly as much of a demand that you do everything possible to save a pet as there is for a person.
I've had a LOT of major dental work in my life and every time my dentist/periodontist/oral surgeon has been able to tell me down to the exact penny what my cost would be.
One of my cats was recently diagnosed with cancer. They gave us an estimate for the cost before any testing took place. If it's possible for non-human animal medicine, it should be possible for human medicine. Especially considering humans tend to me *more* medically robust than most pets and livestock. Non-human animals are prone to complications during medical procedures, the same as humans. All that bs about human medicine costs being unpredictable is purely fraudulent.
Yeah, it's "normal industry practice" to conveyor belt live newborn chicks into meat grinders because they are male and can't be used as egg layers. Something being a standard practice should never shield it from criticism.
In 1977 my first wife suffered a miscarriage of our first child. Her doctor ordered a D&C (dilate and clean) which our insurance covered the entire cost. While she was in the hospital prior to the procedure a group of medical students (it was a teaching hospital) numbering around a dozen came to the door of her room as a teacher explained what was to be done. This upset my (ex)wife and I ordered them out. Several weeks after we were home we started receiving bills from "doctors" we never heard of. Every bill was for $100.00 for "consultation. It turned out that every single one of the medical students had billed us for sticking their heads into the room. I told them to take a hike and refused to pay any of them. Never heard from them again.
A friend got hit with a $6000 bill because her doctor spoke to another in a hallway- this was classed as a ‘consultation’. The reason- because she ‘didn’t have insurance’. If she’d had insurance, it would’ve been less.
I used to joke saying in our hospital if one of the doctors needs to make a yacht payment. All he has to do is come in and say Hi to one of our patients and bill them for it.
When I worked for the Bankruptcy Court a group came in and examined our bankruptcy cases. They then presented a peer-reviewed article. They found that 80% of Chapter 7 and 13 bankruptcies were caused by extremely high medical bills.
@@thumper84 Yeah, they also bought coffee on the way to bankruptcy court. If they hadn't done that, there'd have been no need. Saying "not the sole cause" is the epitome of weasel words.
I'm read an article a while back that stated about 500k people a year file bankruptcy because of medical bills which makes it the number 1 cause of bankruptcy in the US.
Yeah, it is nothing new. Has been that way for decades and decades. Bankruptcy based on Medical bill debt is now longer held against job applicants, credit applications, home mortgage applications, etc.
That's why if you DONT have insurance most providers will offer you 30% to 40% off if you pay cash up front. There only going to get about 60% of the charge from insurance. The real shame of it is of you DO have insurance they dont allow that same option (unless you know how to demand it and even then the system is so integrated with insurance it will likely still be reported)
@MoneyThink that's because you went in on an emergency, must have services. They have you over the Barrel in that situation. The guy you're replying to was talking about negotiating planned services with the doctors.
@@alentrav as things are I think it's likely moved already to like them getting 20% from insurance but the billing is moved back and forth. reasoning being that neither are the insurance companies bankrupt from last 4 years and neither have the hospitals made that much money. so yea basically all the prices are fake, it also makes it easier to bill more for the insurance itself since they just paid 500k for you to stay in hospital for a while or whatever (billing which would be enough to have a dedicated doctor only for you and so forth, so the stuff just doesn't match to expenses OR to the money the hospital makes).
@MoneyThink I've heard hospitals lose money on Medicare patients, or at least they only cover marginal costs of the patient, and actually covering the costs of running the hospital requires patients with better insurance.
@@Br3ttM Kinda like the cheesy car commercials where the sales guy is crying into a handkerchief saying he's losing money on every sale...yet they keep having those sales and remain in business.
“Your honor look at the dust and cobwebs on the ropes and barrel we use to screw people over, those are super old, is goes without saying that we have been doing it this way FOREVER!!“
Remember how your parents used to ask you "If all your friends jumped off a cliff, would you?" Well the healthcare industry's answer to that question was to be the first one off the cliff
"Standard practice" is like someone saying "I have been doing it this way for 20 years". Well, maybe you have been doing it wrong for 20 years. - You are right, a very week argument.
This is EXACTLY what happened to me with a cardiologist that the ER referred me to. I showed them my Insurance card, and I asked if they accept my insurance, they said yes. Got billed $2,000 for a TAKE HOME heart monitor and 5 min ECG test. Tried to clear it up with their billing dept., they said my insurance went out of network a week before the appointment. Tried to clear it up with the billing dept, they won't answer my calls. Doctor avoiding me, front desk won't help...the medical industry/justice system is a SCAM.
I'm not a lawyer, but 15 years ago, when I was first presented with a paper to sign that said I would personally pay for all charges that the insurance doesn't pay, I thought to myself, this is crazy, they can literally charge me anything they want and there is no upper limit. So this is what I did: I crossed out the line that said I would pay all charges and wrote on the bottom of the form: "Do not perform any services or use any doctors that are not covered by my insurance." Surprisingly, they accepted the form. I've done this every time since and not one hospital or doctor has refused to accept the form as modified. If they did refuse, I am prepared to walk out and find another doctor. Open-ended contracts, like the ones hospitals are trying to put forward, should be against the law. What's next? Are they going to find out what your house is appraised at on the tax rolls and then charge patients based on their perception of your wealth? It seems like the door is wide open here for incredible abuse and apparently it has already taken place as in this case.
Strange. Perhaps your changes are agreeable to the hospital because they already know who is in network and have already negotiated those prices. I had a guarantor contract rejected because I simply wrote in "reasonable and customary". I think it is less and less common that they'll allow modifications to contracts.
What about drs charging a fee if you are late or you miss one appt. Meanwhile thay make you wait and change appts last minute. How can they charge for no services. Seems like coercion.
@@someguy6075 Generally, a hospital will say you HAVE to do something, when that’s not actually true and it’s just that they want you to do it but don’t want to go through the effort of convincing you.
Many already do. Many doctors and hospitals will charge 2X or 3X more for the same service if you have insurance. They do love to soak the insurance companies. But some will go easy on you if you do not have insurance. Also - I doubt many nurses will even bother reading the alterations. That paperwork won't be added into the system for many hours, or even days. By the time a bean counter or hospital manager sees the contract, most of the services have already been rendered. What are they going to do about it after the fact? Hound you at bedside to sign a new contract? If push comes to shove, they can argue in court that altering the contract is not an option. Banks have successfully made that argument for decades to prevent people from writing contractual stuff on the back of checks.
@@GirlofNicky You also have similar things in health care where they try to screw with you. I injured my knee and required physical therapy...they didn't inform me that rescheduled days counted as missed/canceled...and they put me in on both Thanksgiving and Christmas Day and refused to reschedule...then kicked me out due to blizzards making it so that the cops were saying they'd ticket anyone not in a certain job category if they were on the road. And they still tried to bill me for the entire course of physical therapy and because of the way the fuckers did it, it prevented me from getting into others despite my actual doctors throwing a fit because of it and leaving me with permanent effects to the knee from it. Found out later they did that kind of crap a lot to people...
The problem with the U.S. medical industry is the government gives Hospitals, insurance companies and drug companies monopolies. The U.S. government needs to stop protecting all the monopolies.
The problem with US health insurance is that it is private at all. It should be paid for by taxes like the fire department and police and public school
@@jaredneff5189 well considering every public healthcare system in the world is currently failing, I’ll pass. What happens when the US gov goes bankrupt? No more healthcare. Also, just medicare and medicaid alone are bankrupting the US. It patches the problem, doesn’t fix it. Ie: doctors are paid too much, drugs cost too much, and there is little to no oversight.
@@goldenhate6649 by what metrics are those countries failing in healthcare? They pay much less per person than us and have much better outcomes. Medicare and Medicaid are failing because it is small public program compared to the entire healthcare industry. If the US govt is the only buyer, then it would have 100% of the leverage and could force corporations to accept whatever price the govt is willing to pay, meaning cheaper drugs and services. Not to mention that the govt should produce all the drugs as well, in which case they would be sold at cost and would be about 100x cheaper than they are now when being sold for a profit.
@@jaredneff5189 Ask the Canadians how that is working out for them, look at the police and public schools that are paid for with taxes, the systems are failing.
as somebody who works in healthcare, we literally have zero idea how much patients are charged. we know when something is "expensive" because management will complain but as far as a dollar amount for literally anything? no idea. we're focused on patient care and are not associated with billing.
I took my sick sheepdog to a veterinary hospital. Before they even examined her I was given an estimate for the cost of the exam. The doctor who examined her recommended X-Rays and bloodwork. Again, I was provided an estimate for these services BEFORE they were done. Finally, the doctor said she needed chemo at an out-of-state clinic and provided an estimate for that service. All of the estimates were within $10 of my final bill. Why can't human medicine do this?
that's one of my opinions. how can anyone make a judgement on one side of the story? I think at bare minimum, it should be required to bring a transcript of the case to the appeal.
@@WhereWhatHuh You might be miffed now, but just wait until it happens to you!! Judges decide cases, they do NOT have to decide them in accordance with the law. It happened to me in a $10K case. I couldn't possibly afford the $12-$15K my attorney told me it would cost to appeal. JUSTICE IS GREEN, and you must have a lot of green to get justice!
You have to ask for an itemized bill. When my daughter was born we did this. They were trying to charge us $10 PER PILL for Tylenol as well as a number of other BS items. We told them to take all those charges off or we wouldn't pay. They did. Remember, hospitals aren't run by doctors anymore, they're run by business executives and Wall St. speculators with a profit motivation.
Healthcare and Profit-making Business are incompatible. When Wall Street became involved, prices went up and quality went down. The life expectancy in the USA has dropped for the last 5 years while it is increasing in every other country.
@@bobblacka918 Where have you been for the last century? Nothing has really changed, except that hospitals love to do unnecessary tests to shield them from lawyers.
I was in a car accident 13 years ago, and while in the emergency room, 3 doctors walked in at individual times to see if their help was required. When it wasn't, they simply left without any other connection to my treatment. I received charges on my bill for each one of them ranging from $300-$600 a piece for them simply being in the room and providing nothing more than 15 seconds of their time.
My aunt once told me a doctor tried to do this to my uncle. She said the only time either of them saw the doctor was one day he walked by my uncle's room, stuck his head in the door, didn't even step in the room, and said. "How are you doing?" My uncle said, "Fine.", and the doctor walked away. They never saw or heard from him again. My aunt refused to pay the bill. This was many, many years ago.
@@dwwolf4636 But they count on people not doing the math. Even if some people do, most people are dumb enough to just pay all the bills that arrive in the mail and assume someone up the chain decided it was a valid bill to send them. If they send out 200 fraudulent bills a year, and only 25 people question those bills, they still get 175 people to send them money.
This is routine practice. A friend was passed out in hospital for weeks. Every time a doctor walked by the room, looked in, did nothing, she was billed. They all said they looked in on her. Not sure if they were paid for this fallacy.
For a lawyer to stand in court and say "we can't predict our costs" while also having a master list of said costs, that is perjury. They straight up lied. If the costs are that wildly unpredictable, there would be no master list of prices.
Lawyer was disingenuous, but technically factually speaking the truth, yeah you can't pin down a firm price because minor things like amount of anesthetic or other meds can very based on the person (not talking even total weight or bwi, some people take to meds better than others), in a surgery you can't pin down the total time to a exact figure or how many sets of tools they will need, depending on the surgeon of the doctor they add things after the fact like, x-rays mris bloodtests etc, What the lawyer didn't say, is the hospital has historical records for the average cost of all procedure as well as the deviation, and has a list of all associated prices for anything related to that procedure that may come up. True you may not know what the price will be but you know all possible prices and have the ability to properly notify them. Well I'm certain no employees will be for procedure, they can almost certainly if given proper access to the data necessary give you a fairly close estimate. And excluding major complications give you a fairly generous highest amount that you would have to pay
The costs for each item, procedure, etc are listed. That's where the 5 dollar cough drop comes from. However a surgery is made up of hundreds individual items. Each scalpel dirtied, each tube inserted, each unit is medication run down an IV is billed. They're not looking at it as "hernia repair". The master list is artificially inflated so they can add discounts. It's like the illegal practice of raising a price to add a sale price
Master list of prices is different than what prices will be charged. For example, if a patient comes in with a deep cut to their leg... they wont know if it will need 1 stitch or 15. Sure they may have a master list that says it will be 10000$ per stitch but the master list doesnt say how many stitches would be needed.... However, i also think that this allows them to make mistakes of their own and bill the customer. Such as if they had a surgical knife and they dropped it on the ground. They should't be able to charge for sterilization of 2 knives if that was their screwup.
True story! My wife had to have a minor procedure done at our local hospital and out of curiosity I asked the admission clerk what the "cash pay" cost would be. It was actually SUBSTANTIALLY LOWER than what my out of pocket cost would have been if I had opted to use the insurance we were already struggling to pay the monthly payments for! WTF is wrong with this country?!?!
The problem is Americans have been taught that universal healthcare is "commie" and must be resisted cause some Mexican might use your tax dollars to not die or something. Stupid thing is that a universal healthcare system would be cheaper. Currently the vast majority of your healthcare dollars pays administrators and other pen pushers, not doctors and nurses.
The great majority of the problems come down to legal fictions, like that you can have a contract without explicit terms, or that terms can be changed on the fly.
The "clinics" here in Socal who caters to the undocumented just ask for cash. And the receptionist will you how much treatment is, etc. They are transparent on the pricing and they make money. I tried it once and they just made you write your name, address etc.
My Dad had to be hospitalized and then was sent to an assisted living facility afterwards until physical therapy gets him built back up to where he can be on his own. He asked how much all this is going to cost and they can't tell him. He's been quoted everything from "nothing, its covered by your insurance" to "over $1000 per day". If a person has no way of knowing what their costs are going to be, how are they supposed to make an educated decision?
I repaired, rented and sold MRI machines to hospitals when I was a young and the best day was when a super fat CFO in a brown suit came running down the road chasing the MRI machine waving a check to settle a dispute after the semi truck was already hooked up gone. We had warned them about repossession for non-payment. I have done tons of work for hospitals and they are the absolute worst about paying their bills.
I remember that in the beginning those MRI machines were in expand-o-van's parked behind the hospitals. My doctor, an Orthopedic Surgeon, arranged to bring the first one to Bexar County Texas, South Texas Medical Center. It was parked behind The Humana Women's Hospital. I know because I was the first one in "the tube" ! I'll never forget how excited he was to have this tool at his disposal. He was there with the technicians looking at and studying the images. His office had it's own X-ray equipment. The first set of films he took of me way back when I first met him. I asked him if they were going to the Radiologist. He said "never trust a doctor that can't read his own X-rays ! The man was a great surgeon and healer. He retired a few years ago. We are still friends to this day !
@@fposmith I worked commercial construction and hooked a couple of those to hospital buildings. The MRI units were on covered semi type trailers and we'd cut a hole or remove a door in the hospital and build an enclosed ramp to the MRI trailer so patients could be wheelchaired out to them during inclement weather. One hospital had an entrance that was already level with the trailer so it was parked about a foot from the wall. We just built a small extension out to the trailer and sealed it up. I was skinny back then so another crewmember held me by the ankles and dangled me between the hospital and the trailer so I could caulk up the sides to weatherproof the building extension to the trailer because a ladder wouldn't fit in the gap. I'd start caulking at the top and he'd lower me down a little at a time until he couldn't reach further, then another crewmember would squeeze into the gab from below and catch me to lower me to the ground. Fun times.
I had a shoulder surgery at a surgical facility and found out after the fact that the surgery and all the OR staff that preformed the surgery were out of network. The Surgical facility was one building split into two parts, one for the surgeons and their examination rooms for routine visits and the other for performing surgeries. I stipulated in writing up front that the entire procedure needed to be vetted and approved by my insurance company before it could be performed, and received confirmation that it was going to be totally covered as all of by 'Out-of-Pocket' deductibles had already been met for that year. Much to my surprise, after the procedure I was told that the OR surgical staff and OR were considered OUT OF NETWORK and I needed to pay for everything my my surgeons portion of the bill. Luckily for me I had everything in writing up front and when I threatened sue them, and my insurance company threatened to drop them for their practices the extra charges magically disappeared from my bill.
That's actually common really. My last two surgeries were in network, at in network facilities by in network surgeons, pre approved by insurance. Both times the anesthesiologist was billed separately and out of network. Apparently the anesthesiologists usually are sub contracted because of liability to the hospitals. This was never disclosed beforehand and I refused payment both times. I said that I never consented or authorized out of network services and if they chose to use such, it was on them. Insurance agreed.
And that is why we have socialized healthcare, payed by tax. No problems with networks or skyhigh insurance premiums, just walk in, get treated and walk out again (without risking a bankruptcy)
@@Fetguf ... Unfortunately our Government has a track record of totally messing things up once they take over ... just look at how they run the VA. Sad but I don't want bureaucrats overruling Doctors when it comes to my health care ... and the would do it without a single thought to my wellbeing.
@@Fetguf and in socialized medical systems, you have much longer wait times. There is a finite supply of medical services, and virtually unlimited demand. Rationing WILL occur one way or another, either via pricing or wait lists.
How long do you think our wait times are? month, years? Somehow I dont think you have ANY ideer how efficient such a system can be. Take a look around on YT, and listen to americans living in europe, and their experience with our healthcare system. And yes we pay more in tax, but we dont have any health insurance, like in the USA, so we actually pay less in tax (allmost ½) than you do in premium (if you are an american)
Good point made. A hospital does 120 surgeries of a particular kind per year costing on average $90,000. There is no way they can claim that it’s unpredictable. And you can’t tell me they don’t track these figures.
2013. That's when she had her surgery. 2013. And it's just getting done now! We're in 2024! That's 11 years of fighting! 11 years of not getting follow up care bc of this bs. 11 years of having your finances on hold. No buying a house, or selling yours, no moving to a different state bc you got a better job offer. No new cars bc of this hanging over your head. That's 11yrs of your credit being in the toilet, and your ability to budget being completely tossed aside. That's 11yrs worth of legal retainer fees, and waiting for court dates. Just imagine your past 11yrs needing to fight a costly legal battle, having your life completely screwed over because of this. THAT should be illegal. THAT should be criminally charged.
Heck, my vet gave my a quote on a cat oral surgery. They gave me an itemized list for most things, and upper and lower boundary dependent on how many teeth needed pulling, since fuzzy isn't really into them poking around ahead of time to check. Also, there was an "client may need recovery care" charge if he didn't wake up well, or if the surgery was hard on him. They gave me a probability (2%) and an average cost. It's not a complete prediction, but it's a lot better then no information. Their quote form comes with 3 check boxes. pay only the listed amount (call for further approval), pay up to 10% more, or pay all medically necessary. I understand that it's hard to get approval for further charges when you have someone under, but you could give them a range ahead of time. Any hospital worth their scrubs should be able to give the same amount of detail as my vet.
The problem is that if they give the range, the upper limit is always going to be in millions and everyone will be too scared to go into it. So it's better for the business to say "we can't predict anything, deal with it".
About 10 years ago I drove myself to the hospital because I thought I was having a heart attack. While in the emergency room they gave me an aspirin to thin my blood while they waited for tests to come back to confirm whether or not it was a heart attack. The nurse dropped the paper cup the aspirin was in and had to get another pill. It turned out to be a reaction to a new high blood pressure medicine I had started on the day before. When I got the bill they had charged for TWO aspirin at a total cost of nearly $30. Is it any wonder health care is so high when hospitals are charging $15 for ONE aspirin?
Whilst I can appreciate that hospitals have overheads etc, here in the UK a 24-pack of aspirin, paracetamol or ibuprofen costs around the equivalent of 50 cents in most shops, supermarkets etc. Any prescription that I require, be it a standard medicine or something more exotic, will never cost more than the equivalent of $10 per item. They're free if you're retired, unemployed, a child or are pregnant. Those of us outside the US are appalled that people can be bankrupted because of a medical emergency or even something like giving birth. This needs to change. Access to healthcare should not be predicated on your financial situation.
Same happened to me a few years ago, ended up in an emergency room at my local hospital . Had chest pains, and had a Dr diagnosis of viral whatever of the lining of my heart. Monster bills started coming in and I started going over them, The one that flipped me out was for an IV drip and for a push $250 . The drug was 7.00 . The push was for the nurse that gave it to me. ³thought I had the best insurance, come to find out after all the tests I still owed 17,000 . Settled for around 7000
You are missing the point. For someone to give you any king of medicine at a hospital they have to be licensed. The cost of hiring a registered nurse is about $50/ hr. God forbid they are in overtime. From that vantage point you should have been charged $100/ pill. Emergency Rooms are nothing but cash loss for hospitals. Don’t forget, you are paying for professional advice. That costs money. That’s like arguing an iPhone should cost 100 dollars coz it only costs 6 yo make it. You are paying for the technology, software and research time spent to make that phone
“Hospitals can’t predict exact care costs in advance” - what a dumb appeals court. A grocery store can’t predict next month’s electricity cost or produce cost when they sell it at a price.
It's somewhat true for individual cases as doctor's can't know if a specific patient will have expensive complications. But in aggregate they can predit the average cost of the procedures they do. Thus they can spread out the burden of the expensive cases among the cheap ones just like any business and specially insurance would do.
@@gjvnq I can pre-order an entire Thanksgiving dinner two months before in September. If there’s a Turkey pandemic and the government culls fifty million turkeys, they either refund me or get reimbursed by their insurance. They don’t say “we have no clue what our costs will be so just agree to pay anything.”
I had something similar happen where I had a kidney stone procedure and had a total cost of around 15k but after it was done found I was still in severe pain for about 3 weeks and after having a cat scan done found that the stone they were supposed to take care of was still there. The hospital still tried to collect on the bill even after I showed them the scan showing the stone still being there and wouldn't take back the bill until I threatened to file a malpractice lawsuit.
sounds like my interaction for a kidney stone. they tried charging me 6k for an MRI when they only charge $450 buy appointment for it. i told them good luck getting that out of me so they reduced it to $600, $450 for the MRI and $150 emergency fee. i talked my $10k bill down to $1200.
the real question is why is any of this necessary? Doesn't happen in any other country and the fact they can reduce the bills like this shows just how much the companies involved are over-inflating their costs.
@@Isador911 because an individual that pays there own bills has to compete with the government covering others bills. So there is no incentive for hospitals to do they right thing because they charge the government what ever they want and they always pay.
This exact same thing happened to me. I lived in Colorado Springs and had to go to Denver for a procedure that wasn't available in the Springs. The hospital representative said my insurance covered it. She miss read my insurance card and they tried to bill me. I fought it and won.
I had an issue with a dentist years ago. I needed a crown and asked several times what the cost would be and they could never tell me. A week later when I was in the chair shot up fill of novocaine, before the procedure, they shoved a clipboard in my face for me to sign and, magically, there was the very high price! I yelled at them, didn't sign it, didn't get the crown, and left the office, numb mouth and all.
Always request a pre treatment authorization from your insurance company for any major dental procedures. The authorization will state how much you are responsible for and what your insurance will pay.
My dentist is Korean. He came to the US when he was a child and went to dental school here. I lived in Korea and had such great doctors there I was glad to find him. I needed several crowns. Doctor Kim gave me an estimate way ahead of time. When I said I really couldn't afford it, he accepted a payment plan charging my credit card a little each month. It actually came out less than the estimate by a small amount, too. There is no excuse for what they did to you. I hope you found a better dentist.
I’m no American. But I can’t imagine paying hospital bills as expensive as my parents’ house in Southeast Asia. That’s utterly insane. This is 21st century. Healthcare should be widely accessible, or at very least transparent n affordable. Hospitals practice daily yearly, yet claimed unpredictable costs 🤯
I've actually found that sometimes it is better not to have insurance. I had a upper CT scan of my stomach, my aunt had the same thing done at the same place by the same doctor. The time between the procedures was less than 2 months. The difference is she had no insurance, I had insurance through my company that was pretty darned expensive. So what happened? She told them she had no insurance and would have to pay cash, they charged her 1700 for the procedure. I had insurance and my co-pay was over 2,400... So not only did I pay 2,400 to them directly for it I was still paying my premium of almost 400 a month and the insurance paid on my behalf several thousand more to the place/doctor that performed the test. And this was the same test. I would have saved lots of money by not having insurance. Even worse when I got my perscription from wal-mart I was having to pay 20 dollars for the co-pay... I then realized that if I just said I had no insurance I would be the prescription filled for $4... Frankly the biggest problem is the system allows price discrimination
Don't tell them you're on to their secret. I really think health insurance should work exactly like car insurance. It only pays for the big stuff. Anything under 3K shouldn't be covered and the insurance company can't put any conditions on payment. If they cover it, they pay out, no questions.
I work in Hospital Billing, albeit in a rather narrow area of the field. And I am horrified and disgusted by how the chargers work out based on what insurance you have, etc. And I work for a non-profit healthcare organization. I can't imagine what it's like at for-profit hospitals.
4:38 "Internal hospital charge master rates have become increasingly arbitrary and over time have lost any connection to the hospital's actual costs . . . " That judge is being incredibly kind. Delusional might be a more accurate word than arbitrary.
Again, they don’t care if they decimate this poor patient’s life with a bill that large. My gosh! It should be capped at a reasonable amount to not cause utter financial ruin to any patient.
Texas used to allow Doctors who were working in a hospital to refuse to take the insurance that the hospital accepts. So if you went into the emergency room from a car crash and were complaining of intense stomach pains, the ER doctor would likely consult with a GI specialist that did not have to accept the insurance the hospital already approved. So your insurance pays for the ER costs and you got a bill from the GI doctor for his consult at unjustifiably high prices. That has been fixed but the lack of common sense in the medical world is disturbing.
Insurance companies have a way of trying to strong arm docs and hospitals into taking too low of fees. One place I practiced they offered us rates lower than Medicare but got the city government to sign up with them. We held firm and a year later the city had a new insurance company after checking around to make sure local docs took it. I’ve seen major cities with more than one hospital get into bidding wars with insurance companies to be the exclusive provider.
It's not a lack of common sense, they do this on purpose so they can extort as much as they can from patients and it is frankly disgusting. I lived in multiple countries and I have never seen such a corrupt system anywhere else. This is literally state-sponsored robbery
@@kudukilla The reason insurance companies have to push back is because the medical industry would just run wild with costings that would be impossible to prove. There is already a problem in most hospital care systems of staff not believing in market practices.
I found out I'm diabetic the hard way almost 7 years ago. While I was in the ER the doc came in and told me they don't see many cases like mine and asked if some other doctors could come in and look me over. It was solely a matter of curiosity, they provided no care. I later looked at the charges sent to the insurance and there was a dozen or so consultation fees ranging from a couple hundred to a couple thousand dollars.
I had an option to stay in the in the hospital for a few days. They told me that insurance would pay 80% of the 400 dollar stay. What they didn’t tell me was it was $400 a day PLUS, all the costs of testing and medication etc.. which came out to be about 2,000 a day. Then I was told my insurance WOULDN’T pay for it. WHY? Because I opted to stay and it was not a required or 100% needed stay. Even tho the dr told me that I should, and it would be covered. All this type of thing is a scam. Nothing more. The dr knew exactly what he was doing.
@valcaron no, I just lost the genetic lottery. My tryglicerides we're so high it was literally off their charts. That's what prompted the 'consultations'.
You are forgetting one major point: Have you EVER heard of a hospital bill that came out CHEAPER? "We estimated 10k for the procedure, but we found we didn't need to do X or Y, hence, you get only charged 8k!" Never happened that I've seen it.
@@stevef68 that, I can see. Also, I've had a monthly payment plan before where all in a sudden, they stopped drawing the money and upon inquiry, they told me: "Oh, we've written off the rest, you are good!" This was a non-for-profit hospital which basically does an annual write-off if all costs were covered.
@@Thoringer My husband had to have his knee replaced in February. We knew we would have co-pays and deductibles, but expecting us to pay more than we make in a year is ridiculous. The biggest bill is the hospital. I called to set up a payment plan, and they told me they have a minimum monthly amount of $175 for any payment plan. Of course, we can't pay that thanks to Bidenflation, and because neither of us are getting as many hours as we were a year ago. Hospitals need to have their business plans upset and reformed. We know we pay much more than our costs because we are being forced to pay for all the people who treat the ER as a family doctor and won't pay a penny for it.
Glad the court sided with her! My hubby had been in the hospital for a few days with food poisoning, years ago. His insurance was in network & paid his hospital bill in full! About a month later, he got a bill from the hospital on a Saturday that he owed $14,000 due on Monday 2 days later! He called the insurance company, who made a conference call with the hospital…basically telling them they need to stop doing this crap or lose them as an insurance provider. They dropped the $14,000 bill. 🤦🏼♀️🤬
I love when you have a procedure done in a hospital and some random doctor sticks their head in your room for 1 minute and you get a separate bill from them for $1500.
"procedure" is the key. It can include imaging that is possibly administered by a radiologist who you never see, but who's expertise is critical for you having a good recovery.
Had this happen to me when I went into the hospital after I twisted my ankle so bad it swelled up to the size of a grapefruit. My ankle had already been assessed, X-Ray'd, and put in a splint by a single doctor and attending nurse, and they were preparing to discharge me. Then, after they left the room to finalize the paperwork, some other doctor walks into the room, picks up my charts, looks at it for all of 30 seconds, then walks out of the room. I was charged $1k Out-Of-Network for this "consultation".
Had this happen, and worse. Another podiatrist actually pirated me as a patient by lying and telling me that my doctor asked HIM to monitor my care until after surgery. I found it was a bogus charge, because I found it shady enough to call my doctor and find out!
Around 11 years ago, I was hospitalized by my Physician, on an urgent basis, for a sudden neurological issue. I spent three nights and days there, and was released home. A bit later, I got a letter from Medicare stating that they were not paying for the hospitalisation, but I was not responsible for paying it, either. The hospital soon sent me a letter, followed by a call a bit later, stating that Medicare wasn't going to pay. Poor, poor us, how will we ever survive, etc!!! And, buried in fine print at very bottom of the letter, also that I wasn't responsible for paying the bill. This went back and forth for quite some time. I even brought this up with my Physician, but she brushed me off, which was HIGHLY UNUSUAL for her, and wouldn't address it further. Clearly there was a screw-up with care rendered, but it was being covered-up, and I was not privy. I'm pretty sure what it was, but I was in no shape to do anything about it at the time of occurrence. Asses were being covered ALL AROUND!
When my wife went to the ER (and was later admitted for 9 days) I signed an agreement to pay the hospital to treat a life-threatening infection. I got a hospital bill for $99k. Then I got a $2800 bill for the ER doctor from a medical group with billing 4 states away. Next was a $1900 bill from a radiological group with billing 800 miles away. Then the $7500 bill for her in-hospital care doctors who are part of a medical group across the street. All the hospital bill covered was some of the facilities, the nurses, and the lousy meals. All this happened during the month between my work insurance ended (Feb. 28) due to retirement and Covered California started (Apr. 1). And neither of us had signed any agreement with anyone but the hospital and the ambulance service. Luckily, as we were actually attempting to pay all this out of pocket, the hospital gave us a 74% discount for paying cash. All up it still cost about $45k.
Back in the early 1990's, I was admitted into a hospital due to a black widow spider bite. I was in the hospital for 3 days. About 3 months later, I received a bill from the hospital for approximately $12K. Before I agreed to pay anything, I went to their business office, and told them that I wanted a comprehensive, and itemized, bill for the charges they are trying to get me to pay. At first, they tried to say that such information is confidential, and I was not entitled to see it. After making some threats about me going to the media, they gave me a copy of the bill. I went through the bill, and I found that they were trying to get me to pay for things that I never used - nor was used on me during my hospital stay. For example - they wanted me to pay for a case of what was called a "mucus recovery system" aka a box of tissues. That's right - they wanted me to pay for a case of approximately 50 boxes of tissues. They also wanted me to pay for a catheter - which was never used on me. After going through the bill, I found that I was being overcharged by about $10,800. I made a copy of the bill, and told them that they would have to prove to me that the overcharge was legal. Otherwise, I was only going to pay them the $1200 that I was legally obligated to pay them. They even had their in - house lawyer try to argue that I had no leg legally to stand on. After mentioning that the media would love a story about the hospital committing fraud, and I had some proof in my hand, they agreed to my $1200 bill. Just to piss them off, I paid them the bare minimum of $10 per month just so they couldn't say that I wasn't paying anything. They sent 3 debt collection agencies after me, but I told all of them to piss off. I finally paid that bill off a couple of years shy of Y2K. Good riddance. Now, I tell everyone to get a copy of their hospital/clinic bill in order to make sure that it's all correct before agreeing to anything.
You should have threatened to sue them. I had a similar experience when I had pneumoniae. I ask for an itemized bill as well, which they also didn't want to send me. When I finally got it I found out they had charged me $180 apiece for Tylenol, which they had listed by it's pharmaceutical name in the bill. When I went to the finance office off the hospital I took a bottle of Tylenol with me and threw on the desk, and told them that should pay should pay my bill in full. I was told they couldn't except that for payment, and the Tylenol wasn't worth that much anyway. When the overpaid accountant saw my smile she knew she had made a big mistake. After pointing out that what they had done was fraudulent billing, and they could be sued for it she tried threatening me by saying that if I didn't pay it it would go against my credit score. I pointed out that according to federal law it could not. Then I told her that I would give the hospital two weeks to send me a statement that said the bill was paid in full, or I would get a lawyer and sue them. It took less than a week before I got that statement and I never heard anything again about it. Knowledge is power, and most people don't realize that hospitals can be sued for fraudulent billing. That's why this case was found in favor of the plaintiff. I figure the hospital will settle out of court for damages stemming from this going all the way up to the state supreme court. At least they will if they're smart about it.
@@thebigdog2295 I thought about it, and I figured that the cost of an attorney would defeat the whole purpose. Karma, however, is a very vindictive bitch. Some time after I confronted them about the bill, an anonymous tip to the local newspaper started an investigation into this hospital's billing practices. When everything was all said and done, this particular hospital was cited with more than enough fines to make up for any lawsuit from me. It also led to a separate criminal investigation into the hospital's administration as well as a number of other staff members and doctors. This hospital also had supporting clinics which were also investigated because they participated in the irregular billing practices. No one went hard core to prison, but many lost their jobs, ruined their reputations, lost their medical licenses, etc.. I was satisfied with the conclusion.
I wonder why you tell a long story like it is really true and then are afraid to name the hospital, so I can avoid the crooks. You think they changed? yeah, right.
@@wadestanton It is true, and it did happen. The reason that I didn't name the hospital was because after Y2K it was bought out by another company. Even if I mentioned the name of the hospital, not many would remember what happened back then. The new administration even renovated the old hospital to the point that is no longer looks like the old hospital that I was talking about. So, does it matter?
One of the things I love about living in Japan (30+ years) is never ever having to be afraid to go to the hospital... except to get better. And yes, that is completely predictable and completely guaranteed. The American health care system is cruel and unusual, and a complete travesty. Hopefully this signals some improvement. Glad this ruling worked out, and thanks again Steve.
It's legit wild to me when I hear stories of Americans going abroad, getting sick or hurt, and *panicking* when someone calls for an ambulance. 'Land of the free', my ass... The only 'free' ones in this country are those rich enough to never face homelessness or insurmountable debt; everyone else is in fetters under their harsh, uncaring rule. America won't be the land of the free until every single citizen can live a day without fearing for their safety and security. No one should be scared of having an ambulance called for them.
@@hauntedshadowslegacy2826 I know one story where an American tourists broke her leg and went to an Austrian hospital. Their travel insurance was happy, that this happened in a "cheap" country. The whole stay in the hospital was around 5000 Euros and the insurance said something, stay as long as you want *ggg*
Hospitals should be forced to disclose estimated cost exceeding a certain limit-such as about $2400-and if they don’t, patients should only be responsible for something like 105% of the limit or the estimate they provided.
Funny that this is how it works when taking pets to the vet, yet human patients aren't afforded such luxury. My cat needed emergency surgery. I was provided an estimate up front with an expected cost range, with a maximum limit of something like 105% of the high figure.
The hospital has the responsibility to decide if they take your insurance before they treat you for something that isn't an emergency. Playing a little "bait n' switch" game after the fact should result in criminal charges.
Just put fixed prices on the common surgeries based on the actual average cost. Sometimes it goes well and the hospital makes a profit, sometimes it don't and racks up a higher cost and then the hospital has to take the cost. They in turn should have their own insurance against excessive costs due to unforeseen circumstances.
@@BillySBC If im not mistaken though it's your responsibility to see if your insurance is accepted. Not the other way around. But tbh i think this whole in network/out of network is ridiculous and that needs to just be done away with.
I don't have insurance, last time I was in the hospital they handed me a bill that said if you can pay in 2 weeks ~$4500, but if it takes longer it's going to be ~$13000. That right there shows how much of a rip off they are. They still calla askig for money, to hell with them I'll never pay!
@@JLee-rt6ve Yeah. If it involves me being alive instead of dead, or healed instead of crippled, you're damned right I think I can get something for nothing.
Yep. My cousin was a general surgeon. This was a decade ago. Maybe a little longer. He had to pay 100k a year for his insurance he has to carry. That was 10 or more years ago. All this crap adds up and up and up. I am not a supporter of socialized medicine. Mainly because the government would just make things worse but this system is so freaking messed up. Something needs to change for sure.
@@mikepalmer2219 Our system is so fucked up BECAUSE of the socialist aspects we already have in place. You can't mix private and government insurance and expect it to go well.
@@asmrmaroxa I'm American who just knows bits and pieces about how medical care in the various parts of Canada work but I've heard they actually have prices they'll give to foreigners like Americans when we need care while visiting and obviously haven't paid into the system. Presumably those prices are also what they charge the government.
In 2016, my doctor ordered both an MRI and a CT scan on my spine at a local in-network hospital. I had an HMO that covered the expense aside from about $150 out of pocket that I paid up front. No problem. However, when I looked at the bill, the hospital charged over $9,500 for both scans, even though my insurance company only paid a prearranged charge of about $400. I called the hospital billing dept.and inquired as to why they charged such an enormous amount for the two scans, even though they were happy with the $550 paid by me and my HMO as payment in full. They stated that $9,500 is the charge they bill patients who have no insurance. WTH? As Mr. Lehto stated above, the amount charged changes depending upon who makes the payment. Again, wth?
They can’t even quote for basic services because all they go off of are computer codes, not prices. Like Steve stated, they charge everyone differently based off of how your paying or who’s paying. I work for a veterinarian and we quote EVERY procedure and we don’t go over the quoted price without the clients permission.
My dog has had two ACL surgery's. $1500 each time. I knew that going in to the surgery. Great surgeon and results. We are getting screwed by our system. And nothing will be done about it.
I had hip replacement surgery on both hips last year and when I got my statement from the hospital that showed what my insurance was billed and paid there was a $750 charge for speech rehabilitation. This is the reason that insurance is so damn high the hospitals are crooked.
Had a similar thing happen at a dentist. They informed us the price after insurance and that we had to pay that amount before the procedure could be performed on our daughters teeth. So we paid that amount. After the procedure the insurance refused to pay because my daughter was not eligible for the procedure due to her age. a few weeks later then dental office billed us. We went round and round with the dental office until they finally wrote it off, or so we thought. Two years later a new office manager was hired and this new manager once again billed us for the procedure. We went round and round with her but it was not resolved. I then went in to have my teeth cleaned and the office manager came out to the lobby and said they would not clean my teeth or allow me or my family to make any more appointments until I paid the balance in full. So I got up and left and switched dentists and never heard another word about it.
This is my take on it. These "free healthcare" policies people argue about are just scratching the surface. WHY IS HEALTHCARE SO EXPENSIVE IN THE FIRST PLACE!? (Apologies for all caps, but it's so ridiculous) Last time I went, I calculated the cost per hour I was paying them for the time I was in there and it was $20-25k/hr.
@@KISSMYACE3203 When I went in to get my gall bladder removed I got 40 bills! And by the looks of it, it came from nearly every single staff person who worked on me. I only went to one hospital, in network. When I take me car in to get repaired, I don't get a bill from every mechanic, every delivery person and managers that were involved in repairing my car.
Because doctors want to make $300K, because nurses don't want to work for minimum wage, because MRI/CT machines can top a million dollars, because a hospital much be much larger than it needs to be because of potential pandemics, large fires, etc. Anyone is free to build a non-profit hospital, but oddly, nobody does.
Hospitals and Insurance companies are maddening. When our first kid was born, everything was in-network…EXCEPT the damn pediatricians that do rounds on newborns who they said were out of network. Of course nobody said anything before hand. I wrote a letter asking why that wasn’t disclosed before as we have no control over the pediatricians who contract with the hospital and did they expect me to throw my wife in a wheelchair and me 4 hour old kid into the car to find an in-network pediatrician? Also threatened to go to local media. It was charged as in-network. So ridiculous. If a hospital is in-network, then anybody that you see or touches you for any reason should automatically be charged as in-network.
Not only do we need single payer, we need single biller. This is the thing I hate with going to the hospital. You get a bill from the hospital, then the ER doctor, if they do any imaging it had to be read by a radiologist so another bill, oh and he/she could be out of network. If you need surgery you get a bill from the surgeon, then the hospitalist, and possibly the lab. We just got into one where the radiology practice had changed names, same people, same place, but at first the insurance company yelled "OUT OF NETWORK, WE AREN"T GOING TO PAY." Then they realized their error. It's kind of crazy,
Doesn't work that way. I saw a case recently that shows why. I Dr was performing a gastric bypass surgery. Saw a badly infected appendix. So he took it out. Saved the pt from a second surgery. Finding tumors is not all that uncommon in older adults. I even know of a recent case where they found an aortic aneurysm, (which is extremely dangerous.) Is a very complex issue for which I personally have no answer.
@@typoagain1 That would be like sending the car into the shop for a leaking oil pan, and the mechanic deciding to change out the catalytic converter because it was damaged and held on by one bolt, all without telling you about it until it's time to pay the bill. The most they can do is inform you of the issue with the strong recommendation to do the repair immediately, but they can't withhold the car even if it would be unsafe to drive. My possible solution to make it work for the medical field: they'd have to send a runner to inform the patient (if conscious) or next of kin (if unconscious/on drugs) of the new situation, the recommendation, and ideally the increased cost or at least the info that the price would go up. Then you can continue the operation or schedule the follow-up. If sudden situations arise mid-surgery, take care of it like the emergency it is; billing for that would follow along the lines of ER visits. And for goodness sake, get rid of the in/out of network crap. A doctor is a doctor, a hospital is a hospital, a life is a life. If going to a place two blocks over is the difference of a house down-payment, the system isn't working right. If going to be treated by a veterinarian who moonlights for humans on the side is cheaper, society has a problem.
@@typoagain1 that has nothing to do with the topic being discussed. They aren't charging more because they're doing more, which is what you're talking about. They're charging more because of who the entities paying are
As a medical biller for over 30 years for an orthopedic practice, ALWAYS check with your insurance carrier if the facility and/or provider is in -network. Do not take the word of anyone except your carrier. Get the tax ID number of the facilities and providers to confirm the participating status. Also document the name of the carrier employee that you spoke to, date and time of your conversation and reference number for your call. That reference number will officially document your call. Also note that it is not unusual for the facility to be participating and the anesthesiologist to be non-participating. Call the Anesthesia group, get their billing tax id number and check with your carrier.
I checked with my insurance company and the dentist I was going to see. They both said they were in network and I was covered. After 2 months of having a scheduled appointment, the dentists office called 2 days before (in the late afternoon) and said the treatment that was scheduled wasn’t covered. They neglected to mention that the cleaning and exam I was scheduled for was to soon after the last time. Just ludicrous.
An ex-girlfriend of mine had to deal with something similar (without the courts). She has a rare genetic condition that affects her spine, which led to her needing a risky surgery. She was left temporarily paralyzed after the surgery (not passing any blame) and required intense physical rehabilitation. Prior to going to the physical rehabilitation facility she confirmed they were in-network and assumed she would only owe her deductible(s) , copay(s), etc. After she was discharged and got home she received a bill for roughly $500k. When she called and stated her confusion as they confirmed they were in-network, they informed her the facility is in-network; however, the attending physician is out-of-network. She went back and forth with them until they agreed to charge her the in-network rate.
Health care is not free in Scotland or anywhere in the UK. It is paid for with our taxes. By the way, Nigel Farage, now leader of the Reform Party, wants us to have American style health insurance. Think about it.
Healthcare is not free in Scotland or anywhere in the UK; it is paid for with our taxes. Incidentally; Nigel Farage, now leader of Reform, wants us to have American style health insurance. Lets if my comments stays up this time or stays visible.
Hospitals just charge whatever they like, it seems. I have a friend who has been in and out of hospitals for years. She realized at some point that she was getting billed for doctors consults, and it turned out that it was a completely unrelated doctor who just came in one afternoon, asked her how she was doing, chatted for like 2 minutes and left. Then they billed her $150 for his "consult." Now she will not talk to anyone who comes in wearing a name badge until they say that they are on her case team already.
@@robbiddlecombe8392 She fixed the problem by doing this: If someone with a badge comes in and starts to talk to her, she asks "are you on my care team?" If the answer is "no" then she says "Thank you but I'm only talking to my care team." Suddenly she's not getting random $150 charges on her bill anymore.
It is insane that doctors and hospitals can bill anything they want AFTER the fact. My wife was in a hospital and needed testing, the doctor was discussing the advantages of one vs the other and couldn't decide which to do so I asked what they cost vs each other, HE HAD NO IDEA HOW MUCH EACH TEST COST! This is the problem in healthcare, there is absolutely no cost vs benefit analysis by healthcare people because they have no idea how much their services cost. This must be ended, the cost of procedures and test should be disclosed up front.
Don’t blame doctors. The hospitals and labs set the rates, and the doctors have no control over them. The hospitals often have different rates for different insurance panels.
It is willful ignorance. The doctors are hoping to make as much money as possible, of course, but they want to maintain the illusion that they are altruists motivated by pure compassion.
@@RaineStudio do you realize that doctors have no say in hospital billing? Providers’ (MD, DO, NP, PA) reimbursement only accounts for about 15% of healthcare expenses.
@@jasonandersen5975 When I do (non-medical) consulting, I can't set the prices of 3rd party products and services either, but I *AM* expected to know about what those prices are. If a vendor won't tell me, I recommend against them.
@@PyroNine9 yes, but do those 3rd party vendors have multiple prices depending on the payer? When I ask for the prices, I am told to refer the patient to finance. Those prices are not divulged to me.
We need more lawsuits like this to force the medical field into more transparency. I think we all understand things can change in process, but if I call them up they should be able to give me the base cost for the procedure.
@@-Big_Big We do. We have great health care that we can make our own choices with. I can choose to work a job that provides insurance, choose what level of insurance I want, choose what doctor I go to, choose to get another doctor's input, choose to shop around for what is the best price and provider for me, and if the private insurance company doesn't cover something, I have the right to pay for it myself and still get the service/product I desire instead of being told to die because the government said no. I retain the right of responsibility for providing for myself as well as my medical decisions. Granted, that freedom is rapidly being eroded by increasing government interference.
I had a dentist do something similar recently. Said it would cost me $150 out of pocket rest covered by insurance. A week after the dental work I was then told it was denied and I owed $1500. Crazy that this kind of stuff is allowed especially when you sign and agree to it beforehand.
I recently had something like that too; the original quote that I paid at time of visit was something like $117. I must have gotten a surprise bill that I didn't pay, because they called about a past due balance and I told them that I paid the quoted amount so they need to get the money from the insurance company or reduce their price to cover the missing amount because I'm not going to subside their mistakes. I don't even know the amount they're asking for; never got that far before I shut them down.
I was in a T-Bone accident (other driver ran a stop sign). I was sent to the nearest hospital which they gave me piss poor service. I and a lot of my family worked in hospitals (some for decades) so I know just how bad the service was (they even failed to give me discharge papers). Anyway my insurance company negotiated and came up with a price for everything (of course in the report they added things that I never got) both parties agreed then they wrote a check to the hospital. Several weeks later around the same time I would get the remaining money from the insurance (talk about great timing on their end) they sent me a new bill for over $1K say it's for the service that was already agreed upon prior to them cutting a check. I called them and stated that fact after hearing their BS about using a 3rd party contractor to do the procedure I told them that they agreed to the exact cost with the insurance company, the added cost on the report, and the violations of procedures that they committed during my stay in ER that I could file grievances with the State Board with witnesses. Needless to say I never heard from them about that charge ever again (so far). That was nearly three years ago.
As someone who has had into the double digits number of surgeries in the last 20 years…including one self pay/uninsured…anything related to medical billing is a freaking nightmare. If you can go out and find lists of average costs for a procedure broken down by facility, then why can they not give better estimates?
Medicine is a disgusting, disgraceful field.... They know people will agree to anything to save their lives or manage their pain. It is no longer a noble profession.
Any list would not be in good fate since it is the the US's hospitals interest to inflate it as much as possible. You can go to other countries and get the price they estimate when the hospital is not run for profit. England, Norway, Sweden, Denmark, Germany would be a places to start, but even if you get a good estimate for the real cost it would not help before there is a way to enforce what the hospitals can charge.
Bingo, I've always argued that they perform the same operations and procedures over and over thousands of times yet can't give an accurate estimate of total cost BEFORE any action is taken. They're the only industry that gets away with a blank check that they run up with ridiculous charges.
@@bknesheim Several years ago my chiropractor told me I would probably need a hip replacement in a year or too. I had reconstruction surgery on the hip as a child so I knew my procedure would not be standard. Costs on hip replacements have come down some but back the I was given ball park estimates between $25, 000 and $100.00. I had no insurance so It was going to be an impossible out of pocket amount. I have relatives in Canada and I asked them about getting it done there. They pointed me to a clinic in Quebec that did nothing but knee and hip replacements. You did not have to share a facility with communicable disease patients which is great because infection is a common occurrence and they had an attached nursing home for your rehab. Cash price was 12 grand. Thankfully I found an osteopath who treated me for a few months and never needed the surgery. Cost less than 3 grand paid over eight months.
Similar situation happened to my grandpa. The estimate they made was off by thousands and they said it was insurances fault even though insurance paid exactly the max they said they would. People at the dentist office kept telling me "oh insurance is unpredictable blah blah " when they were the ones who did not give the promised in network discount. Took me a lot of phone calls to get the charge resolved but these business practices are so shady! Especially taking advanced of elderly, sick, immigrants, etc
Totally understandable that the CO court ruled that way. The medical industry is sometimes a pack of robber barons. In my case, it all worked out well (in a sense) when my wife was diagnosed with colon cancer and needed emergency surgery. We were with an HMO and all I had to pay was about $750, though the cost of the surgery was somewhere north of $50k. She did ultimately pass away a couple of years later from the cancer, but I never had to pay another cent for hospice care including pain drugs. It made a very distressing situation have one less thing to worry about.
I worked in hospitals for forty-odd years. It was my observation that in privately owned hospitals the wallet biopsy was priority number one. The public hospitals took care of the patients' needs, and were experts at finding money to pay for the medical expenses of people who had no money. They also routinely handled cases that were too demanding for the private hospitals; they were good places to work. The public hospitals are now almost all gone, destroyed or given away by government agencies who thought that it was good management to reduce the number of their employees. The bean counters are in charge, not the doctors.
@JamesThomas-kx5sj they also gave me meds for the nausea, and they did send blood to the lab. How much is a doctor worth to you? He spent years in medschool so his time is very valuable to me, and I won't argue with him getting paid $100 for his hour minimum. That's a reasonable amount. Especially given the hospital can simply charge you whatever amount they want, and not tell you until the end.
Great story, Steve. Though a sad one. Having been a healthcare professional for many years, I'm still bummed out by the fact that medical costs -- including those of Big Pharma -- often appear predatory rather than appropriate. Let's hope more is done to move the medical industry toward transparency and away from the unreasonable profit motive.
they don't appear to be predatory. they are predatory. recently had an emergency surgery. the anesthesiologist that was on call went Hawaii, while they were on call. so they got an anesthesiologist from their sister hospital. they tried to bill me for 2,250 dollar because they weren't covered by the hospital. excuse me? my insurance is taxas based and thank God because that's the only reason I wasn't given that bill. so yeah. "appear" predatory? bs
Great video! There almost nothing in commercial transactions as arbitrary and unjust as medical billing. There’s more price transparency from a Loan Shark or a Protection Racket than from a hospital.
Through the years I've found that now, as an older adult, that my dealings with insurance companies, hospitals, doctors, dentists, optometrist and miscellaneous specialists can be more then just mind numbing. Frankly, I find that in general the healthcare system, as mentioned above, can be more harmful than helpful to a person. By that I mean do you think the woman Steve mentioned in the story had a little stress from all of this? How many years do you think that took off of her life and worrying and high blood pressure and cholesterol? You see they can't measure that in definite terms. But it's reality! The best way to go is always preventative, eat well, live a healthy lifestyle, exercise and keep your brain active and don't stress.
Precisely! As my friends gain Medicare, issues they tried to deal with are suddenly the interests of many specialists. The amount of medical intervention is not always associated with improved morbidity or mortality. Sad that our "healthcare" is harming & killing as many as it helps. Given medical errors are 2nd or 3rd cause of deaths, we could save thousands by limiting interactions with providers.
Boy I wish we could identify who generally owns those fields. Unless we find out that we actually really like those people and can then agree that the current system is perfect and working as intended.
@@katiekane5247 i never knew how utterly messed up the healthcare system was until i qualified for medicaid. i'm lucky as work sent me to the hospital for a week. if i hadnt qualified for medicaid i would have had at least a few years wage in hospital bills because my work forced me into an ambulance against my will. but now i have the best healthcare money cant buy and its wrong. i think healthcare should be affordable, but the way it is managed is horrendous. i worked for a health network that wastes so much money. not just in buying extremely expensive stuff and tossing it out a month later but also that they built the head of facilities a 6000sqft castle. all paid for under the guise of a new office building they also had built. the companies they made to funnel the money, the kickbacks, etc. i'm sure it happens nearly everywhere. thats why if you go to the er your bill will be at least $2500. it isnt even the doctors that make 800k a year.
I had this same issue when taking my son to a dentist appointment. It turned out his doctor's office only takes medicaid for dental visits. I was told that before the visit. I asked how much it would be and was told $50. I got a bill for another $200 in the mail a month later. It should be illegal to not disclose service prices upfront.
I need dental surgery. Insurance will not cover anesthia. i was told it would be $200. I have scrimped and saved it. They are now saying it has always been $275 for everybody. I have talked to several friends that have the exact same insurance (I have worked in insurance and know how to read the policies). They have been charged $200-$250. It is Medicaid.
I recently had a 1 hour test at a hospital and the total charges from the hospital was over $9,000 and my insurance paid them $246 and I paid 0. If I didn't have insurance the hospital would want 9k from me and that isn't fair for such an inflated charge.
That's a common misconception. You can actually negotiate directly with the hospital yourself if you don't have insurance. You just call up their billing department and be like "I don't know how I can pay this" and watch as the total drops. You can also try asking them for an itemized bill, that will also usually lower it quite a bit.
@@madmatt2024 Yes it is true that they will drop the rate, and they will take 60 cents on the dollar if you can pay the bill in full but even though they take off 40% that still leaves the uninsured with a large amount to pay.
Three changes would fix a lot of issues. #1 Outlaw the whole "in network or out of network" insurance thing. They have to pay no matter where you receive care. #2 Require medical procedures to be billed as flat rate and that the prices be posted on their website. #3 Regulate prices of medical care and prescription drugs based on their profit margins. This includes drug pricing directly from the manufacturer.
I live in the UK, so all this is insane to me. Many years ago i lived in South Africa, where most people used private health care. I took my 6-week-old baby for a check up, and the doctor told me i must start feeding him "three adult-sized bowls of porridge a day". I laughed st him and told him absolutely not, that i was going to continue to breastfeed. He had the cheek to bill me for "feeding advice". I phoned his office and told his secretary to cross that item off my bill because I was not paying it.
Why are the judges so out of touch with reality? there’s no basis to “buy” the attorneys argument! CO is a very punitive healthcare billing system who have destroyed patients finances due to predatory practices
My last c section was done at Providence hospital in California. About 1-2 weeks before my scheduled c section they contacted me and told me how much everything would cost. They broke it down for me and told me how much I would owe with my deductible. I went ahead and have them my credit card to hold the charges. No surprise charges afterwards. I also was concerned about the anesthesiologist being in network so the biller gave me their information, I looked them up and saw they were in network. It was the best experience I’ve ever had. Meanwhile this time I’m going into C-section at Wake Med in NC, no calls from billing beforehand, I called and asked them who their anesthesiologist and they had no clue and couldn’t tell me a thing. I finally found out no thanks to them. I’m really worried about the charges afterwards since I have gone to that hospital before for a miscarriage and the charges were outrageous.
This happened to me with some imaging. I received around a ten thousand dollar bill after being told by the heart center that I was in network. I was sent there by my provider. I believed that my provider would send me to an in network specialist and I believed the gal behind the counter when I confirmed I was in network and only had a 120 copay for all three imaging appointments. I gasped when I received the bill. I exercised all of my appeals. I won one appeal for 7500. The others were denied. I called the imaging center presented my case to the payment center. After a week of review they admitted their mistake and cleared all charges. They had paperwork with the wrong insurance provider on it. The gal had crossed it out and wrote in my current provider. She didn’t tell me she made a mistake. Don’t trust them to be correct. I made the mistake. Lesson learned.
Like I said lesson learned. I thought confirming with the people who did this for a living was enough. I will never let that happen again. My last surgery I confirmed EVERYTHING!! 👍
ALWAYS ask the insurance carrier. They are the ones you have "hired" to negotiate and pay the bulk of the bill. I.e. if you want to know if a bill is getting paid, always ask the person paying the bill, not the person charging you the bill.
I've fought this myself. I had an MRI done. Before it happened I asked what the charge would be. The nurses laughed, "we don't deal with costs, you should know that before you got here!" Ok. I needed the MRI, so I got it done. At the time, there were ads on the radio about $600 MRIs all over. I got a bill for ~$4,300. I argued. I was denied. I argued more, still denied. I talked to a lead billing clerk who told me that, "it is what it is" and would have to pay it. I didn't. It went to collections. They sent letters, called, whatever. Finally I got a "final bill" (i.e. we're f%$king your credit). I sent the video and a screenshot. They saw the "we don't know, lol, pay what we say" comments. They saw the ads for others in the market at 15% of what they billed. Been years now, and that bill was "settled". Removed from collections, not on my credit. Not an issue. FIGHT THEIR PRICES. They won't defend them. They just charge people what the can because nobody ASKS!!!!!!
Yep, took my dog to the vet and got an x-ray done for $85. Go to a doctor and they will charge $1,000. It's the exact same technology, yet for some reason, my x-ray is 10x what the dog x-ray is. I will never understand it.
Steve, you provide a great service to all the laymen AND lawyers in your listeners out there!! That is why yiu are followed worldwide. ❤ Rod LAM, Virginia
I walked into a hospital after a car accident, and requested they check for spinal damage, and a concussion. An xray, and a doctor with a flashlight. I asked them how much it will cost me before I decide to go through with it. They couldn't or wouldn't tell me. They then required me to sign a paper declining treatment to save them from liability. This is a ridiculous system we have.
Dealt with something similar, not to this degree money wise, but I was told I would only have to pay 300.00 max out of pocket for Molecular testing on a biopsy, and I was shocked when I got a bill for 4,000.00, which was negotiated down to 2K by my insurance. I made several phone calls, fought like heck, and I was honestly ready to take this physician's office to small claims court when they finally agreed to only charge me 300.00. I was given the Molecular testing consent, literally 2 minutes before I was to get the biopsy, so there was no time to read the fine print or to call my insurance company, and the medical assistant told me "if your insurance doesn't pay, the maximum you would have to pay is 300.00 out of pocket". What she didn't mention is that if I had a deductible, my insurance wasn't technically covering it, but that I would be responsible for paying for the test in full. Thankfully they were also complacent and never put the consent into my medical record, so I had them there, by not putting the content into my medical record they had no proof I even signed it, nor did it give me the opportunity to read the consent over and change my mind about the molecular testing prior to them doing it, and nor did they give me a copy of what I signed prior to me leaving the office. They made a multitude of errors which cost them a lot of money, but they got what they deserved and they will hopefully give people the consent when they are the consult appointment instead of waiting until they are about to do the biopsy, and not tell them the test will cost 300.00 when that is far from the truth! Fight for your money!!
Let me guess, it was deemed “not medically necessary” by the insurance company. I dealt with that when my 10 month old daughter was diagnosed with one of the rarest forms of cancer out there ( 1 of 30 people in history). The molecular testing is what lead to the diagnosis, yet it was deemed “not medically necessary” by insurance.
@@Prosecute-fauci No, I had a 2,000 deductible so I was responsible for paying the 2K they tried to charge me, BUT the medical assistant told me I would only have to pay 300.00 max out of pocket, and she never mentioned that, that excluded deductibles. I was under the impression that even with a deductible I would only have to pay 300.00 since in my mind if I had to pay for it because of my deductible, the insurance wasn't covering it, if that makes sense. Sorry about your daughter, I hope she is ok now. The medical system is so screwed up!!
Your guardian angel must have misplaced the consent for you. You are right though, they got what they deserved. I had a similar problem with a dermatologist and their lab. No notice there would be extra charges and a year later some billing company getting nasty with me. Out of the blue no previous notice or bill. I tracked down the lab and kept calling and yelling and told the doctor's office I'd die of melanoma before I'd come back. I went out of my way to make them feel bad. The collection people did stop bugging me.
Why would you expect a hospital or doctors office to know your specific deductible situation if they don't even know if a procedure will be covered? Also, pretty much every procedure needs to be pre-approved before you go and do it. Otherwise they will definitely not cover it. Only certain exceptions, like the ER, will they automatically cover a procedure.
I spent half of last year in and out of the hospital. I had to pay $4000 because they said something was out of network when I was told it was in network. They also said they were disregarding the "No surprises" law because they don't know if it covered me or not and I would have to go to court over it. Well I ended up going back in the hospital and my insurance covered all of that due to my max out of pocket. In the end I am only about $200 over my max out of pocket so it's really not worth my time and stress to fight it. I am VERY glad something is being done about this BS. In the end I got lucky. Also I am feeling better. I have a long way to go before I am 100%, but I no longer worry I won't make it.
@@realburglazofficial2613 Thanks, but it is not quite as bad as it seems. They WILL treat you even if you have no money. There were offers to wave my debt if I had proof I didn't have the money to pay. I can pay, so they make me pay.
I had an accident (fall) about 18 months ago. I went to emergency, had a CAT scan total bill was over 15k. I was paying cash, the cash price was 1300. Note that I'm far from eligible for any special programs or discounts. Of course it took several hours on the phone to actually reach someone who would give me the cash payment price since they kept repeatedly sending me paperwork to send to my insurance company and couldn't understand I just wanted the cash price to pay it. If I had put it through my insurance I would have paid 5k in deductible. Always check cash pricing even if you have insurance.
For most primary care, I pay cash then ask my insurance to pay me back, and usually they do. There was one place I went to that I told them I was paying in cash for everything. I was only able to pay for the initial visit upfront. After a month I was able to pay for one of 2 tests. I waited for 3 months to see if they had opened it so I could pay for the second test, but wasn't able because it was still "on hold awaiting insurance response". So I stopped checking in and am now just waiting for them to send me the bill for the last $125 - the visit was in last October, they have my home address, email, and phone number, nothing yet.
I've lived around Amish. They aren't against modern medical care but don't do insurance because it would connect them to the "English" world. They pay cash and my neighbor said he couldn't fathom why the "English" let themselves be robbed by insurance. He was paying at a hospital and overheard someone haggling about their bill and insurance and was amazed.
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There are actually terms for this practice: Predatory pricing, Price gauging, Fraud.
The only industry where it won't land you in prison.
And the real costs are nowhere near what they evencharge insured people, the U.S just loves shareholders making money.
Many people, if they were hit with $300,000 in medical bills, would just declare bankruptcy. Medical industry is so greedy and corrupt.
Gouging, not gauging
Having our health care follow a corporate / business model is nuts but worse than that it's clearly not working
I once had a flash burn and went to the hospital. Since I was blind at the time I couldn't read the forms the hospital wanted me to sign. I refused and had them read them to me. I was then told I was being uncooperative. As far as I know it's illegal to ask someone to sign a contract they can't read or is not filled out completely. Funny how large organizations think they can get away with doing illegal things. Keep the good stuff coming Steve.
I went into the er delirious and shaking from vomiting for like 8 hours or something and they wanted me to sign my induction for and I tried telling the lady I was too messed up to make a decision. She insisted so I just stabbed it with a pen and gave her a dirty look
I feel these digital signage contracts need to be made illegal. When asked to sign something you can't see, something's wrong.
This is why you should have a healthcare proxy and/or DPA in your wallet. It's a legal document that allows the people you designate to make medical decisions for you when are incapable of doing so. It has their names, addresses, and phone numbers and the hospital is legally required to contact them. I have my mother and a trusted friend on mine as well as treatment info such as treatments I don't want and my end of life instructions.
I encountered a similar situation at a Sheriff's Dept.
Cops wouldn't give me my glasses or read the paper the wanted me to sign. I absolutely will not sign anything without knowing exactly what it says.
Thankfully a female deputy that heard what was going on read the paper to me & I signed it. It infuriates me when any official or law enforcement officer breaks a law as if it's the most normal thing to do.
"Rules for thee
But not for me"
It has become the common theme. Exasperating
Johnny if that had been needed in court for anything, it would easily be thrown out due to failure of the police to adequately explain it to you. That's why when reading your Miranda Rights they ask "do you understand your rights". If you don't speak English they're suppose to provide a translator. Otherwise you didn't know is actually usable.
Strange that the 'unpredictable' charges are never _lower_ than predicted.
If they are unpredictable, then by balance of probability, some bills must be lower than initially predicted.
that is a great point
I think the problem is that people are almost always given the optimistic estimate about what something will cost. Whether it's car repairs, home repairs or health "repairs" it's not unusual to find out that there's more work necessary than you hoped, and more work always costs more. An honest and complete estimate would be a range based on the minimum that might need to be done, what's likely, and what's possible.
@@suedenim9208 Na, Everywhere in the world a medical procedure has a fixed price, it's based on an average cost calculation plus some profit. And that's even true in places where the patient never sees the actual bill. Medical costs are predictable inside a reasonable envelope....not a X to 250X amount envelope. There IS infact allways an average amount of costs!
By logic, yes. By actual practice, it's whatever they think they can get away with.
Biggest issue is the insurance companies.
Everything is a guesstimate on how much they will pay out bills are never lower than we predict because they never pay more than they are contractually obligated.
For an office visit and you do nothing but talk to the doctor with no procedures I may know BCBS is going to pay all but $10 for United maybe it’s $15 we have charts for everything but “coverage does not guarantee payment” according to insurance companies.
Now we see you and the doctor wants a CT exam now I have to do what’s called a prior authorization. Most insurance companies will flat out refuse to pay unless we do these we tell the insurance what we are planning to do what the diagnosis is and a history and we will be denied or “approved” and often it’s denied for stupid stuff. “Oh you have a massive deformation in your sinuses suspected that may require surgery? have you attempted Flonase and saline nasal sprays for at least 3 weeks? Oh you haven’t?…denied”
But here’s the kicker even if the CT is “approved” the insurance company tells you all throughout the process
“Prior Approval is not a guarantee of payment”
We could enact laws like the mechanics law but I’m going to bet every doctors office in the nation is going to stop taking insurance until we get a guarantee of payment.
My Dad had to be life flighted after a boating accident. After we got the bill we learned there are two helicopter companies that service our town and switch off every other day. One company would have been $7500 and the one that we got which was around $200K for a 15 minute flight. We were told we should have asked for the one that was in network!!! WTF!?!? Who calls 911 and asks about which company is in network?!?! Insurance companies are the worst...hospital billing a close second!
Plus the emergency system does not work like that emergency life flights are based on availability and a triage system. So. They get a call. You are then triaged, a line of sorts. Those most life threatening closer to the top of the list. Next available transport grabs the one at the top of the list. If you have a routine transfer and non emergent transfer say from one facility to another or one country to another, then you can perhaps make a choice between transport companies. But not on am emergent basis.
Out of network billing for air ambulances was banned by the no surprises act.
Years ago I suffered a concussion during a softball game. I only remember snippits of images until about 2 hours after the injury. Later we were billed full cost for the ambulance because it was 'out of network'. My companiy's HR department (self insured company health insurance) went to bat (pardon the pun) for me and argued with the insurance company. They got it reduced to the regular cost.
My God, as a Brit, this entire conversation blows my mind. The idea that you call in an emergency and you have to worry about whether you can afford to be rescued is crazy
You have to know what network you’re in as soon as you get insurance or you’ll be troubled when an emergency arises
My friends husband was in the hospital. Every second of every day a family member was with him taking detailed notes. Then there was around $20,000.00 charges for tests and medicines he never had. She challenged it. They told her to disregard it because his insurance will cover it. She said, " F you. Our insurance isn't paying for anything my husband didn't get". She contacted her insurance. It went to court and her insurance didn't have to pay for what he didn't get. $20,000.00 was a huge amount 20 years ago. They are so shady.
Wow, that's straight up insurance fraud.
@@madmatt2024 It was the hospital that billed the over charges. We've heard this is common to make up for the non insured or Medicaid patients who maybe they or their insurance won't cover the bill they owe. I don't know. I just know my friends husband was over billed by $20,000.00.
@@susanepp2707 It doesn't matter the reason, it's still fraud. You can't legally bill someone, especially insurance, for a service that was never performed. The legal way to offset your losses is to raise the prices for everyone, these idiots were too lazy to even do that and thanks to your friend's husband's family, they got caught.
Recently my significant other had to see a dermatologist about an auto immune situation that's fairly serious. The dermatologist never did a full examination and then she found out that her insurance was charged for a full examination and that there are only so many of those that could be done in a given time frame. So now she has to fight the dermatologist just so she can get the actual test that they fraudulently claimed that they performed. For her it's not about the money it's about the right to have access to medical care.
@@susanepp2707 I've heard that too, even though it may help a lot of folks in the short term, it hurts solving the actual problem in the long term. We need better more affordable access to health care for all americans and the billing for that and the insurance needs to be 100% transparent.
What gets me is how your veterinarian can tell you how much to neuter your dog, plus or minus added fees for the dog having only one, or a heart condition, or meds for after care, but the human surgeon/hospital can only waffle about your care coats
The surgeon can tell you what his charges are, but s/he has no say in hospital charges. The surgeon’s fees are a small portion of the bill, so knowing what the surgeon will charge will not help much.
The hospital should know its daily accommodation charge, and approximate operating theater time. It isn't that hard - other countries manage just fine.
Couple of reasons: People that can’t afford to take their pets to the vet for anything major…Don’t. So there is nothing to write off that then gets made up by those who do pay. And while some people will mortgage their house for a pet, most people will not so there isn’t nearly as much of a demand that you do everything possible to save a pet as there is for a person.
I've had a LOT of major dental work in my life and every time my dentist/periodontist/oral surgeon has been able to tell me down to the exact penny what my cost would be.
One of my cats was recently diagnosed with cancer. They gave us an estimate for the cost before any testing took place. If it's possible for non-human animal medicine, it should be possible for human medicine. Especially considering humans tend to me *more* medically robust than most pets and livestock. Non-human animals are prone to complications during medical procedures, the same as humans. All that bs about human medicine costs being unpredictable is purely fraudulent.
Why does the claim 'normal industry practise' not get laughed out of court?
That's no laughing matter. If untrue, they're lying to the court. If true, they're admitting to systematic widespread fraud.
@aelfheld
Used car dealerships have "normal industry practices" but should that be acceptable?
Congress has a “normal industry practice.” Other places call it a bribe.
So they admitted that they were running a scam and it was normal for them
Yeah, it's "normal industry practice" to conveyor belt live newborn chicks into meat grinders because they are male and can't be used as egg layers. Something being a standard practice should never shield it from criticism.
In 1977 my first wife suffered a miscarriage of our first child. Her doctor ordered a D&C (dilate and clean) which our insurance covered the entire cost. While she was in the hospital prior to the procedure a group of medical students (it was a teaching hospital) numbering around a dozen came to the door of her room as a teacher explained what was to be done. This upset my (ex)wife and I ordered them out. Several weeks after we were home we started receiving bills from "doctors" we never heard of. Every bill was for $100.00 for "consultation. It turned out that every single one of the medical students had billed us for sticking their heads into the room. I told them to take a hike and refused to pay any of them. Never heard from them again.
A friend got hit with a $6000 bill because her doctor spoke to another in a hallway- this was classed as a ‘consultation’.
The reason- because she ‘didn’t have insurance’. If she’d had insurance, it would’ve been less.
I used to joke saying in our hospital if one of the doctors needs to make a yacht payment. All he has to do is come
in and say Hi to one of our patients and bill them for it.
To think, if it was not a teaching hospital, the consultations would’ve cost way more! What a deal!
That sounds illegal
A D&C is a dilation and curettage. Not clean.
When I worked for the Bankruptcy Court a group came in and examined our bankruptcy cases. They then presented a peer-reviewed article. They found that 80% of Chapter 7 and 13 bankruptcies were caused by extremely high medical bills.
Yes people don't realize how bad it is. It wrecks lives and it's not like these folks went nuts in Vegas, they needed that medical care.
Incorrect. 80% had high med bills but that was not the sole cause of bk.
@@thumper84 Yeah, they also bought coffee on the way to bankruptcy court. If they hadn't done that, there'd have been no need.
Saying "not the sole cause" is the epitome of weasel words.
I'm read an article a while back that stated about 500k people a year file bankruptcy because of medical bills which makes it the number 1 cause of bankruptcy in the US.
Yeah, it is nothing new. Has been that way for decades and decades. Bankruptcy based on Medical bill debt is now longer held against job applicants, credit applications, home mortgage applications, etc.
I've said for years, "if I could pay what the insurance company negotiates to, I wouldn't need insurance!"
That's why if you DONT have insurance most providers will offer you 30% to 40% off if you pay cash up front. There only going to get about 60% of the charge from insurance. The real shame of it is of you DO have insurance they dont allow that same option (unless you know how to demand it and even then the system is so integrated with insurance it will likely still be reported)
@MoneyThink that's because you went in on an emergency, must have services. They have you over the Barrel in that situation. The guy you're replying to was talking about negotiating planned services with the doctors.
@@alentrav as things are I think it's likely moved already to like them getting 20% from insurance but the billing is moved back and forth.
reasoning being that neither are the insurance companies bankrupt from last 4 years and neither have the hospitals made that much money. so yea basically all the prices are fake, it also makes it easier to bill more for the insurance itself since they just paid 500k for you to stay in hospital for a while or whatever (billing which would be enough to have a dedicated doctor only for you and so forth, so the stuff just doesn't match to expenses OR to the money the hospital makes).
@MoneyThink I've heard hospitals lose money on Medicare patients, or at least they only cover marginal costs of the patient, and actually covering the costs of running the hospital requires patients with better insurance.
@@Br3ttM Kinda like the cheesy car commercials where the sales guy is crying into a handkerchief saying he's losing money on every sale...yet they keep having those sales and remain in business.
I love how the hospital's lawyers used 'this is an industry standard practice' as if it were a defense. As if somehow that made it okay.
“Your honor look at the dust and cobwebs on the ropes and barrel we use to screw people over, those are super old, is goes without saying that we have been doing it this way FOREVER!!“
Remember how your parents used to ask you "If all your friends jumped off a cliff, would you?"
Well the healthcare industry's answer to that question was to be the first one off the cliff
"Standard practice" is like someone saying "I have been doing it this way for 20 years". Well, maybe you have been doing it wrong for 20 years. - You are right, a very week argument.
Fallacy a priori
"Industry standard practice"
so he used the defense that "we all do it this way". Sadly, that doesn't make it right.
This is EXACTLY what happened to me with a cardiologist that the ER referred me to. I showed them my Insurance card, and I asked if they accept my insurance, they said yes. Got billed $2,000 for a TAKE HOME heart monitor and 5 min ECG test. Tried to clear it up with their billing dept., they said my insurance went out of network a week before the appointment. Tried to clear it up with the billing dept, they won't answer my calls. Doctor avoiding me, front desk won't help...the medical industry/justice system is a SCAM.
I'm not a lawyer, but 15 years ago, when I was first presented with a paper to sign that said I would personally pay for all charges that the insurance doesn't pay, I thought to myself, this is crazy, they can literally charge me anything they want and there is no upper limit. So this is what I did: I crossed out the line that said I would pay all charges and wrote on the bottom of the form: "Do not perform any services or use any doctors that are not covered by my insurance." Surprisingly, they accepted the form. I've done this every time since and not one hospital or doctor has refused to accept the form as modified. If they did refuse, I am prepared to walk out and find another doctor. Open-ended contracts, like the ones hospitals are trying to put forward, should be against the law. What's next? Are they going to find out what your house is appraised at on the tax rolls and then charge patients based on their perception of your wealth? It seems like the door is wide open here for incredible abuse and apparently it has already taken place as in this case.
Strange. Perhaps your changes are agreeable to the hospital because they already know who is in network and have already negotiated those prices. I had a guarantor contract rejected because I simply wrote in "reasonable and customary". I think it is less and less common that they'll allow modifications to contracts.
What about drs charging a fee if you are late or you miss one appt. Meanwhile thay make you wait and change appts last minute. How can they charge for no services. Seems like coercion.
@@someguy6075 Generally, a hospital will say you HAVE to do something, when that’s not actually true and it’s just that they want you to do it but don’t want to go through the effort of convincing you.
Many already do. Many doctors and hospitals will charge 2X or 3X more for the same service if you have insurance. They do love to soak the insurance companies. But some will go easy on you if you do not have insurance.
Also - I doubt many nurses will even bother reading the alterations. That paperwork won't be added into the system for many hours, or even days. By the time a bean counter or hospital manager sees the contract, most of the services have already been rendered. What are they going to do about it after the fact? Hound you at bedside to sign a new contract? If push comes to shove, they can argue in court that altering the contract is not an option. Banks have successfully made that argument for decades to prevent people from writing contractual stuff on the back of checks.
@@GirlofNicky You also have similar things in health care where they try to screw with you.
I injured my knee and required physical therapy...they didn't inform me that rescheduled days counted as missed/canceled...and they put me in on both Thanksgiving and Christmas Day and refused to reschedule...then kicked me out due to blizzards making it so that the cops were saying they'd ticket anyone not in a certain job category if they were on the road.
And they still tried to bill me for the entire course of physical therapy and because of the way the fuckers did it, it prevented me from getting into others despite my actual doctors throwing a fit because of it and leaving me with permanent effects to the knee from it. Found out later they did that kind of crap a lot to people...
The problem with the U.S. medical industry is the government gives Hospitals, insurance companies and drug companies monopolies. The U.S. government needs to stop protecting all the monopolies.
That's why I like Kaiser. It is the hospital and insurance. So you will know what you are paying
The problem with US health insurance is that it is private at all. It should be paid for by taxes like the fire department and police and public school
@@jaredneff5189 well considering every public healthcare system in the world is currently failing, I’ll pass. What happens when the US gov goes bankrupt? No more healthcare.
Also, just medicare and medicaid alone are bankrupting the US. It patches the problem, doesn’t fix it. Ie: doctors are paid too much, drugs cost too much, and there is little to no oversight.
@@goldenhate6649 by what metrics are those countries failing in healthcare? They pay much less per person than us and have much better outcomes. Medicare and Medicaid are failing because it is small public program compared to the entire healthcare industry. If the US govt is the only buyer, then it would have 100% of the leverage and could force corporations to accept whatever price the govt is willing to pay, meaning cheaper drugs and services. Not to mention that the govt should produce all the drugs as well, in which case they would be sold at cost and would be about 100x cheaper than they are now when being sold for a profit.
@@jaredneff5189 Ask the Canadians how that is working out for them, look at the police and public schools that are paid for with taxes, the systems are failing.
Meantime you go to a doctor and they said they've done this surgery thousands of times, but all of a sudden they can't give you a price.
as somebody who works in healthcare, we literally have zero idea how much patients are charged. we know when something is "expensive" because management will complain but as far as a dollar amount for literally anything? no idea. we're focused on patient care and are not associated with billing.
@@nekogirl2009Tell that to Management.
I took my sick sheepdog to a veterinary hospital. Before they even examined her I was given an estimate for the cost of the exam. The doctor who examined her recommended X-Rays and bloodwork. Again, I was provided an estimate for these services BEFORE they were done. Finally, the doctor said she needed chemo at an out-of-state clinic and provided an estimate for that service. All of the estimates were within $10 of my final bill. Why can't human medicine do this?
I hope your dog is okay.
They can. they just won't.
With Private Equity silently taking over most veterinary practices, expect this to change.
That judge who ignored the jury saying pay whole $300,000 must have been in cahoots with that crooked hospital.
that's one of my opinions. how can anyone make a judgement on one side of the story? I think at bare minimum, it should be required to bring a transcript of the case to the appeal.
Not at all. The judge simply decided that the contract was a contract, it said what it said, and that's that.
I am a bit miffed that the opinion of the jury would be over-ridden.
Would like to see that going to the supreme court, see what they say about the finality of justice by jury.
@@WhereWhatHuh You might be miffed now, but just wait until it happens to you!! Judges decide cases, they do NOT have to decide them in accordance with the law. It happened to me in a $10K case. I couldn't possibly afford the $12-$15K my attorney told me it would cost to appeal. JUSTICE IS GREEN, and you must have a lot of green to get justice!
You have to ask for an itemized bill. When my daughter was born we did this. They were trying to charge us $10 PER PILL for Tylenol as well as a number of other BS items. We told them to take all those charges off or we wouldn't pay. They did.
Remember, hospitals aren't run by doctors anymore, they're run by business executives and Wall St. speculators with a profit motivation.
Which is why we need to remove health care from capitalism entirely and permanently.
Healthcare and Profit-making Business are incompatible. When Wall Street became involved, prices went up and quality went down. The life expectancy in the USA has dropped for the last 5 years while it is increasing in every other country.
There are a majority of murricans just fine with that.
@@virginiamoss7045 And then watch it go into the shitter. You think the best doctors are gonna stay where their pay is set by government?
@@bobblacka918 Where have you been for the last century? Nothing has really changed, except that hospitals love to do unnecessary tests to shield them from lawyers.
I was in a car accident 13 years ago, and while in the emergency room, 3 doctors walked in at individual times to see if their help was required. When it wasn't, they simply left without any other connection to my treatment. I received charges on my bill for each one of them ranging from $300-$600 a piece for them simply being in the room and providing nothing more than 15 seconds of their time.
My aunt once told me a doctor tried to do this to my uncle. She said the only time either of them saw the doctor was one day he walked by my uncle's room, stuck his head in the door, didn't even step in the room, and said. "How are you doing?" My uncle said, "Fine.", and the doctor walked away. They never saw or heard from him again. My aunt refused to pay the bill. This was many, many years ago.
Baloney obviously.
Average costs are easily calculable.
its called insurance fraud....
@@dwwolf4636 But they count on people not doing the math. Even if some people do, most people are dumb enough to just pay all the bills that arrive in the mail and assume someone up the chain decided it was a valid bill to send them. If they send out 200 fraudulent bills a year, and only 25 people question those bills, they still get 175 people to send them money.
This is routine practice. A friend was passed out in hospital for weeks. Every time a doctor walked by the room, looked in, did nothing, she was billed. They all said they looked in on her. Not sure if they were paid for this fallacy.
Judges having wildly different rulings to the same facts can be explained by who had the bigger bribe.
For a lawyer to stand in court and say "we can't predict our costs" while also having a master list of said costs, that is perjury. They straight up lied. If the costs are that wildly unpredictable, there would be no master list of prices.
Lawyer was disingenuous, but technically factually speaking the truth, yeah you can't pin down a firm price because minor things like amount of anesthetic or other meds can very based on the person (not talking even total weight or bwi, some people take to meds better than others), in a surgery you can't pin down the total time to a exact figure or how many sets of tools they will need, depending on the surgeon of the doctor they add things after the fact like, x-rays mris bloodtests etc,
What the lawyer didn't say, is the hospital has historical records for the average cost of all procedure as well as the deviation, and has a list of all associated prices for anything related to that procedure that may come up. True you may not know what the price will be but you know all possible prices and have the ability to properly notify them.
Well I'm certain no employees will be for procedure, they can almost certainly if given proper access to the data necessary give you a fairly close estimate. And excluding major complications give you a fairly generous highest amount that you would have to pay
Lawyers also jack up their bills, agree on precent, then bill for phone call, Xeroxes, assistant, cockroach feeding fee, etc! When done 25% is 50%.
The costs for each item, procedure, etc are listed. That's where the 5 dollar cough drop comes from.
However a surgery is made up of hundreds individual items. Each scalpel dirtied, each tube inserted, each unit is medication run down an IV is billed. They're not looking at it as "hernia repair".
The master list is artificially inflated so they can add discounts. It's like the illegal practice of raising a price to add a sale price
Funny how they can't predict the costs but they can bill the exact amount down to the cent right after the treatment.
Master list of prices is different than what prices will be charged.
For example, if a patient comes in with a deep cut to their leg... they wont know if it will need 1 stitch or 15. Sure they may have a master list that says it will be 10000$ per stitch but the master list doesnt say how many stitches would be needed....
However, i also think that this allows them to make mistakes of their own and bill the customer. Such as if they had a surgical knife and they dropped it on the ground. They should't be able to charge for sterilization of 2 knives if that was their screwup.
True story! My wife had to have a minor procedure done at our local hospital and out of curiosity I asked the admission clerk what the "cash pay" cost would be. It was actually SUBSTANTIALLY LOWER than what my out of pocket cost would have been if I had opted to use the insurance we were already struggling to pay the monthly payments for! WTF is wrong with this country?!?!
Too many things to list.
The problem is Americans have been taught that universal healthcare is "commie" and must be resisted cause some Mexican might use your tax dollars to not die or something.
Stupid thing is that a universal healthcare system would be cheaper. Currently the vast majority of your healthcare dollars pays administrators and other pen pushers, not doctors and nurses.
The great majority of the problems come down to legal fictions, like that you can have a contract without explicit terms, or that terms can be changed on the fly.
It’s rigged to make you think you need health insurance
The "clinics" here in Socal who caters to the undocumented just ask for cash. And the receptionist will you how much treatment is, etc. They are transparent on the pricing and they make money. I tried it once and they just made you write your name, address etc.
My Dad had to be hospitalized and then was sent to an assisted living facility afterwards until physical therapy gets him built back up to where he can be on his own. He asked how much all this is going to cost and they can't tell him. He's been quoted everything from "nothing, its covered by your insurance" to "over $1000 per day". If a person has no way of knowing what their costs are going to be, how are they supposed to make an educated decision?
That is when you pay for an hour of time from a lawyer.
They aren't supposed to. That's the point.
8 years for this. absolutely obscene how long companies can drag these things through the courts.
Probably spent $2-300,000 in lawyer fees to destroy this woman.
If they fired their lawyers, they could agree to lower prices.
I repaired, rented and sold MRI machines to hospitals when I was a young and the best day was when a super fat CFO in a brown suit came running down the road chasing the MRI machine waving a check to settle a dispute after the semi truck was already hooked up gone. We had warned them about repossession for non-payment. I have done tons of work for hospitals and they are the absolute worst about paying their bills.
I remember that in the beginning those MRI machines were in expand-o-van's parked behind the hospitals. My doctor, an Orthopedic Surgeon, arranged to bring the first one to Bexar County Texas, South Texas Medical Center. It was parked behind The Humana Women's Hospital. I know because I was the first one in "the tube" ! I'll never forget how excited he was to have this tool at his disposal. He was there with the technicians looking at and studying the images. His office had it's own X-ray equipment. The first set of films he took of me way back when I first met him. I asked him if they were going to the Radiologist. He said "never trust a doctor that can't read his own X-rays ! The man was a great surgeon and healer. He retired a few years ago. We are still friends to this day !
@@fposmith I worked commercial construction and hooked a couple of those to hospital buildings. The MRI units were on covered semi type trailers and we'd cut a hole or remove a door in the hospital and build an enclosed ramp to the MRI trailer so patients could be wheelchaired out to them during inclement weather. One hospital had an entrance that was already level with the trailer so it was parked about a foot from the wall. We just built a small extension out to the trailer and sealed it up. I was skinny back then so another crewmember held me by the ankles and dangled me between the hospital and the trailer so I could caulk up the sides to weatherproof the building extension to the trailer because a ladder wouldn't fit in the gap. I'd start caulking at the top and he'd lower me down a little at a time until he couldn't reach further, then another crewmember would squeeze into the gab from below and catch me to lower me to the ground. Fun times.
I had a shoulder surgery at a surgical facility and found out after the fact that the surgery and all the OR staff that preformed the surgery were out of network. The Surgical facility was one building split into two parts, one for the surgeons and their examination rooms for routine visits and the other for performing surgeries. I stipulated in writing up front that the entire procedure needed to be vetted and approved by my insurance company before it could be performed, and received confirmation that it was going to be totally covered as all of by 'Out-of-Pocket' deductibles had already been met for that year. Much to my surprise, after the procedure I was told that the OR surgical staff and OR were considered OUT OF NETWORK and I needed to pay for everything my my surgeons portion of the bill. Luckily for me I had everything in writing up front and when I threatened sue them, and my insurance company threatened to drop them for their practices the extra charges magically disappeared from my bill.
That's actually common really. My last two surgeries were in network, at in network facilities by in network surgeons, pre approved by insurance. Both times the anesthesiologist was billed separately and out of network. Apparently the anesthesiologists usually are sub contracted because of liability to the hospitals. This was never disclosed beforehand and I refused payment both times. I said that I never consented or authorized out of network services and if they chose to use such, it was on them. Insurance agreed.
And that is why we have socialized healthcare, payed by tax. No problems with networks or skyhigh insurance premiums, just walk in, get treated and walk out again (without risking a bankruptcy)
@@Fetguf ... Unfortunately our Government has a track record of totally messing things up once they take over ... just look at how they run the VA. Sad but I don't want bureaucrats overruling Doctors when it comes to my health care ... and the would do it without a single thought to my wellbeing.
@@Fetguf and in socialized medical systems, you have much longer wait times. There is a finite supply of medical services, and virtually unlimited demand. Rationing WILL occur one way or another, either via pricing or wait lists.
How long do you think our wait times are? month, years? Somehow I dont think you have ANY ideer how efficient such a system can be.
Take a look around on YT, and listen to americans living in europe, and their experience with our healthcare system.
And yes we pay more in tax, but we dont have any health insurance, like in the USA, so we actually pay less in tax (allmost ½) than you do in premium (if you are an american)
Good point made. A hospital does 120 surgeries of a particular kind per year costing on average $90,000. There is no way they can claim that it’s unpredictable. And you can’t tell me they don’t track these figures.
2013. That's when she had her surgery. 2013. And it's just getting done now! We're in 2024! That's 11 years of fighting! 11 years of not getting follow up care bc of this bs. 11 years of having your finances on hold. No buying a house, or selling yours, no moving to a different state bc you got a better job offer. No new cars bc of this hanging over your head. That's 11yrs of your credit being in the toilet, and your ability to budget being completely tossed aside. That's 11yrs worth of legal retainer fees, and waiting for court dates. Just imagine your past 11yrs needing to fight a costly legal battle, having your life completely screwed over because of this. THAT should be illegal. THAT should be criminally charged.
Heck, my vet gave my a quote on a cat oral surgery. They gave me an itemized list for most things, and upper and lower boundary dependent on how many teeth needed pulling, since fuzzy isn't really into them poking around ahead of time to check. Also, there was an "client may need recovery care" charge if he didn't wake up well, or if the surgery was hard on him. They gave me a probability (2%) and an average cost. It's not a complete prediction, but it's a lot better then no information.
Their quote form comes with 3 check boxes. pay only the listed amount (call for further approval), pay up to 10% more, or pay all medically necessary.
I understand that it's hard to get approval for further charges when you have someone under, but you could give them a range ahead of time. Any hospital worth their scrubs should be able to give the same amount of detail as my vet.
The problem is that if they give the range, the upper limit is always going to be in millions and everyone will be too scared to go into it. So it's better for the business to say "we can't predict anything, deal with it".
About 10 years ago I drove myself to the hospital because I thought I was having a heart attack. While in the emergency room they gave me an aspirin to thin my blood while they waited for tests to come back to confirm whether or not it was a heart attack. The nurse dropped the paper cup the aspirin was in and had to get another pill. It turned out to be a reaction to a new high blood pressure medicine I had started on the day before. When I got the bill they had charged for TWO aspirin at a total cost of nearly $30. Is it any wonder health care is so high when hospitals are charging $15 for ONE aspirin?
Whilst I can appreciate that hospitals have overheads etc, here in the UK a 24-pack of aspirin, paracetamol or ibuprofen costs around the equivalent of 50 cents in most shops, supermarkets etc. Any prescription that I require, be it a standard medicine or something more exotic, will never cost more than the equivalent of $10 per item. They're free if you're retired, unemployed, a child or are pregnant. Those of us outside the US are appalled that people can be bankrupted because of a medical emergency or even something like giving birth.
This needs to change. Access to healthcare should not be predicated on your financial situation.
Same happened to me a few years ago, ended up in an emergency room at my local hospital . Had chest pains, and had a Dr diagnosis of viral whatever of the lining of my heart. Monster bills started coming in and I started going over them, The one that flipped me out was for an IV drip and for a push $250 . The drug was 7.00 . The push was for the nurse that gave it to me.
³thought I had the best insurance, come to find out after all the tests I still owed 17,000 . Settled for around 7000
You are missing the point. For someone to give you any king of medicine at a hospital they have to be licensed. The cost of hiring a registered nurse is about $50/ hr. God forbid they are in overtime. From that vantage point you should have been charged $100/ pill. Emergency Rooms are nothing but cash loss for hospitals. Don’t forget, you are paying for professional advice. That costs money. That’s like arguing an iPhone should cost 100 dollars coz it only costs 6 yo make it. You are paying for the technology, software and research time spent to make that phone
“Hospitals can’t predict exact care costs in advance” - what a dumb appeals court. A grocery store can’t predict next month’s electricity cost or produce cost when they sell it at a price.
It's somewhat true for individual cases as doctor's can't know if a specific patient will have expensive complications. But in aggregate they can predit the average cost of the procedures they do. Thus they can spread out the burden of the expensive cases among the cheap ones just like any business and specially insurance would do.
Even weather can be given a reasonable percentage of probability.
@@gjvnq I can pre-order an entire Thanksgiving dinner two months before in September. If there’s a Turkey pandemic and the government culls fifty million turkeys, they either refund me or get reimbursed by their insurance. They don’t say “we have no clue what our costs will be so just agree to pay anything.”
@@Excalibur-Sonic I disagree. The weather is 100% predictable, the meteorologists aren't!
🤣👍
You can predict care costs when everything goes EXACTLY perfect. That’s a rare occurrence.
The first issue is that she signed a contract under false pretenses presented by the hospital
Yes, if she knew it was out of network she would have used a different provider.
This is one reason why "pre-authorization" by your insurance company is sounding like a good idea.
I had something similar happen where I had a kidney stone procedure and had a total cost of around 15k but after it was done found I was still in severe pain for about 3 weeks and after having a cat scan done found that the stone they were supposed to take care of was still there. The hospital still tried to collect on the bill even after I showed them the scan showing the stone still being there and wouldn't take back the bill until I threatened to file a malpractice lawsuit.
sounds like my interaction for a kidney stone. they tried charging me 6k for an MRI when they only charge $450 buy appointment for it. i told them good luck getting that out of me so they reduced it to $600, $450 for the MRI and $150 emergency fee. i talked my $10k bill down to $1200.
Crash Oversize , so why didn't you file a malpractice lawsuit?
the real question is why is any of this necessary? Doesn't happen in any other country and the fact they can reduce the bills like this shows just how much the companies involved are over-inflating their costs.
@@Isador911 because an individual that pays there own bills has to compete with the government covering others bills. So there is no incentive for hospitals to do they right thing because they charge the government what ever they want and they always pay.
@@gavnonadoroge3092 After I threatened the lawsuit they wiped the bill out completely.
This exact same thing happened to me. I lived in Colorado Springs and had to go to Denver for a procedure that wasn't available in the Springs. The hospital representative said my insurance covered it. She miss read my insurance card and they tried to bill me. I fought it and won.
How much did it cost you to fight it in total?
I had an issue with a dentist years ago. I needed a crown and asked several times what the cost would be and they could never tell me. A week later when I was in the chair shot up fill of novocaine, before the procedure, they shoved a clipboard in my face for me to sign and, magically, there was the very high price! I yelled at them, didn't sign it, didn't get the crown, and left the office, numb mouth and all.
Always request a pre treatment authorization from your insurance company for any major dental procedures. The authorization will state how much you are responsible for and what your insurance will pay.
@@beealert911 Definitely but this was from a time I didn't have insurance which is why I was very concerned with the cost.
My dentist is Korean. He came to the US when he was a child and went to dental school here. I lived in Korea and had such great doctors there I was glad to find him. I needed several crowns. Doctor Kim gave me an estimate way ahead of time. When I said I really couldn't afford it, he accepted a payment plan charging my credit card a little each month. It actually came out less than the estimate by a small amount, too. There is no excuse for what they did to you. I hope you found a better dentist.
Asking for a pretreatment from health doesn't always work, the office will let you think it was all correct then a year later bill you for it. Peace!
Good for you!
I’m no American. But I can’t imagine paying hospital bills as expensive as my parents’ house in Southeast Asia. That’s utterly insane. This is 21st century. Healthcare should be widely accessible, or at very least transparent n affordable. Hospitals practice daily yearly, yet claimed unpredictable costs 🤯
I've actually found that sometimes it is better not to have insurance. I had a upper CT scan of my stomach, my aunt had the same thing done at the same place by the same doctor. The time between the procedures was less than 2 months. The difference is she had no insurance, I had insurance through my company that was pretty darned expensive. So what happened? She told them she had no insurance and would have to pay cash, they charged her 1700 for the procedure. I had insurance and my co-pay was over 2,400... So not only did I pay 2,400 to them directly for it I was still paying my premium of almost 400 a month and the insurance paid on my behalf several thousand more to the place/doctor that performed the test. And this was the same test. I would have saved lots of money by not having insurance.
Even worse when I got my perscription from wal-mart I was having to pay 20 dollars for the co-pay... I then realized that if I just said I had no insurance I would be the prescription filled for $4... Frankly the biggest problem is the system allows price discrimination
Don't tell them you're on to their secret. I really think health insurance should work exactly like car insurance. It only pays for the big stuff. Anything under 3K shouldn't be covered and the insurance company can't put any conditions on payment. If they cover it, they pay out, no questions.
I thought a '2-tiered' system was illegal...??? Something to think about!
I work in Hospital Billing, albeit in a rather narrow area of the field. And I am horrified and disgusted by how the chargers work out based on what insurance you have, etc. And I work for a non-profit healthcare organization. I can't imagine what it's like at for-profit hospitals.
4:38 "Internal hospital charge master rates have become increasingly arbitrary and over time have lost any connection to the hospital's actual costs . . . "
That judge is being incredibly kind. Delusional might be a more accurate word than arbitrary.
Again, they don’t care if they decimate this poor patient’s life with a bill that large. My gosh! It should be capped at a reasonable amount to not cause utter financial ruin to any patient.
Texas used to allow Doctors who were working in a hospital to refuse to take the insurance that the hospital accepts. So if you went into the emergency room from a car crash and were complaining of intense stomach pains, the ER doctor would likely consult with a GI specialist that did not have to accept the insurance the hospital already approved. So your insurance pays for the ER costs and you got a bill from the GI doctor for his consult at unjustifiably high prices. That has been fixed but the lack of common sense in the medical world is disturbing.
Insurance companies have a way of trying to strong arm docs and hospitals into taking too low of fees. One place I practiced they offered us rates lower than Medicare but got the city government to sign up with them. We held firm and a year later the city had a new insurance company after checking around to make sure local docs took it.
I’ve seen major cities with more than one hospital get into bidding wars with insurance companies to be the exclusive provider.
It's not a lack of common sense, they do this on purpose so they can extort as much as they can from patients and it is frankly disgusting. I lived in multiple countries and I have never seen such a corrupt system anywhere else. This is literally state-sponsored robbery
@@kudukilla
The reason insurance companies have to push back is because the medical industry would just run wild with costings that would be impossible to prove. There is already a problem in most hospital care systems of staff not believing in market practices.
I found out I'm diabetic the hard way almost 7 years ago. While I was in the ER the doc came in and told me they don't see many cases like mine and asked if some other doctors could come in and look me over. It was solely a matter of curiosity, they provided no care. I later looked at the charges sent to the insurance and there was a dozen or so consultation fees ranging from a couple hundred to a couple thousand dollars.
I had an option to stay in the in the hospital for a few days. They told me that insurance would pay 80% of the 400 dollar stay. What they didn’t tell me was it was $400 a day PLUS, all the costs of testing and medication etc.. which came out to be about 2,000 a day. Then I was told my insurance WOULDN’T pay for it. WHY? Because I opted to stay and it was not a required or 100% needed stay. Even tho the dr told me that I should, and it would be covered. All this type of thing is a scam. Nothing more. The dr knew exactly what he was doing.
@valcaron no, I just lost the genetic lottery. My tryglicerides we're so high it was literally off their charts. That's what prompted the 'consultations'.
Did the doctor charge you for introducing himself? "Hello." That'd be $250- plus a 10% discount.
You are forgetting one major point: Have you EVER heard of a hospital bill that came out CHEAPER? "We estimated 10k for the procedure, but we found we didn't need to do X or Y, hence, you get only charged 8k!" Never happened that I've seen it.
Yes- if you ask them for an itemized bill, it suddenly goes down dramatically.
@@stevef68 that, I can see. Also, I've had a monthly payment plan before where all in a sudden, they stopped drawing the money and upon inquiry, they told me: "Oh, we've written off the rest, you are good!" This was a non-for-profit hospital which basically does an annual write-off if all costs were covered.
Actually, that's happened to me.
TWICE.
I even received a refund where I overpaid my deductible when my son was born.
@@Thoringer My husband had to have his knee replaced in February. We knew we would have co-pays and deductibles, but expecting us to pay more than we make in a year is ridiculous.
The biggest bill is the hospital. I called to set up a payment plan, and they told me they have a minimum monthly amount of $175 for any payment plan. Of course, we can't pay that thanks to Bidenflation, and because neither of us are getting as many hours as we were a year ago. Hospitals need to have their business plans upset and reformed. We know we pay much more than our costs because we are being forced to pay for all the people who treat the ER as a family doctor and won't pay a penny for it.
@@freethebirds3578 Don't let them lie to you. The minimum is whatever they can get.
Glad the court sided with her! My hubby had been in the hospital for a few days with food poisoning, years ago. His insurance was in network & paid his hospital bill in full! About a month later, he got a bill from the hospital on a Saturday that he owed $14,000 due on Monday 2 days later! He called the insurance company, who made a conference call with the hospital…basically telling them they need to stop doing this crap or lose them as an insurance provider. They dropped the $14,000 bill. 🤦🏼♀️🤬
I love when you have a procedure done in a hospital and some random doctor sticks their head in your room for 1 minute and you get a separate bill from them for $1500.
Oprah doctors be like "You get a bill, you get a bill, you get a bill!!"
"procedure" is the key. It can include imaging that is possibly administered by a radiologist who you never see, but who's expertise is critical for you having a good recovery.
Had this happen to me when I went into the hospital after I twisted my ankle so bad it swelled up to the size of a grapefruit. My ankle had already been assessed, X-Ray'd, and put in a splint by a single doctor and attending nurse, and they were preparing to discharge me. Then, after they left the room to finalize the paperwork, some other doctor walks into the room, picks up my charts, looks at it for all of 30 seconds, then walks out of the room. I was charged $1k Out-Of-Network for this "consultation".
I was wondering why I had four doctors pop in to explain how viruses work when my baby caught RSV. Bunch of bloody crooks.
Had this happen, and worse. Another podiatrist actually pirated me as a patient by lying and telling me that my doctor asked HIM to monitor my care until after surgery. I found it was a bogus charge, because I found it shady enough to call my doctor and find out!
Around 11 years ago, I was hospitalized by my Physician, on an urgent basis, for a sudden neurological issue. I spent three nights and days there, and was released home. A bit later, I got a letter from Medicare stating that they were not paying for the hospitalisation, but I was not responsible for paying it, either. The hospital soon sent me a letter, followed by a call a bit later, stating that Medicare wasn't going to pay. Poor, poor us, how will we ever survive, etc!!! And, buried in fine print at very bottom of the letter, also that I wasn't responsible for paying the bill. This went back and forth for quite some time. I even brought this up with my Physician, but she brushed me off, which was HIGHLY UNUSUAL for her, and wouldn't address it further. Clearly there was a screw-up with care rendered, but it was being covered-up, and I was not privy. I'm pretty sure what it was, but I was in no shape to do anything about it at the time of occurrence. Asses were being covered ALL AROUND!
When my wife went to the ER (and was later admitted for 9 days) I signed an agreement to pay the hospital to treat a life-threatening infection. I got a hospital bill for $99k. Then I got a $2800 bill for the ER doctor from a medical group with billing 4 states away. Next was a $1900 bill from a radiological group with billing 800 miles away. Then the $7500 bill for her in-hospital care doctors who are part of a medical group across the street. All the hospital bill covered was some of the facilities, the nurses, and the lousy meals. All this happened during the month between my work insurance ended (Feb. 28) due to retirement and Covered California started (Apr. 1). And neither of us had signed any agreement with anyone but the hospital and the ambulance service. Luckily, as we were actually attempting to pay all this out of pocket, the hospital gave us a 74% discount for paying cash. All up it still cost about $45k.
This is antitrust issue. Which most of the medical industry is exempt from.
Back in the early 1990's, I was admitted into a hospital due to a black widow spider bite. I was in the hospital for 3 days. About 3 months later, I received a bill from the hospital for approximately $12K. Before I agreed to pay anything, I went to their business office, and told them that I wanted a comprehensive, and itemized, bill for the charges they are trying to get me to pay.
At first, they tried to say that such information is confidential, and I was not entitled to see it. After making some threats about me going to the media, they gave me a copy of the bill. I went through the bill, and I found that they were trying to get me to pay for things that I never used - nor was used on me during my hospital stay. For example - they wanted me to pay for a case of what was called a "mucus recovery system" aka a box of tissues. That's right - they wanted me to pay for a case of approximately 50 boxes of tissues. They also wanted me to pay for a catheter - which was never used on me.
After going through the bill, I found that I was being overcharged by about $10,800. I made a copy of the bill, and told them that they would have to prove to me that the overcharge was legal. Otherwise, I was only going to pay them the $1200 that I was legally obligated to pay them. They even had their in - house lawyer try to argue that I had no leg legally to stand on. After mentioning that the media would love a story about the hospital committing fraud, and I had some proof in my hand, they agreed to my $1200 bill.
Just to piss them off, I paid them the bare minimum of $10 per month just so they couldn't say that I wasn't paying anything. They sent 3 debt collection agencies after me, but I told all of them to piss off. I finally paid that bill off a couple of years shy of Y2K. Good riddance. Now, I tell everyone to get a copy of their hospital/clinic bill in order to make sure that it's all correct before agreeing to anything.
You should have threatened to sue them. I had a similar experience when I had pneumoniae. I ask for an itemized bill as well, which they also didn't want to send me. When I finally got it I found out they had charged me $180 apiece for Tylenol, which they had listed by it's pharmaceutical name in the bill. When I went to the finance office off the hospital I took a bottle of Tylenol with me and threw on the desk, and told them that should pay should pay my bill in full. I was told they couldn't except that for payment, and the Tylenol wasn't worth that much anyway. When the overpaid accountant saw my smile she knew she had made a big mistake. After pointing out that what they had done was fraudulent billing, and they could be sued for it she tried threatening me by saying that if I didn't pay it it would go against my credit score. I pointed out that according to federal law it could not. Then I told her that I would give the hospital two weeks to send me a statement that said the bill was paid in full, or I would get a lawyer and sue them. It took less than a week before I got that statement and I never heard anything again about it. Knowledge is power, and most people don't realize that hospitals can be sued for fraudulent billing. That's why this case was found in favor of the plaintiff. I figure the hospital will settle out of court for damages stemming from this going all the way up to the state supreme court. At least they will if they're smart about it.
@@thebigdog2295 I thought about it, and I figured that the cost of an attorney would defeat the whole purpose. Karma, however, is a very vindictive bitch. Some time after I confronted them about the bill, an anonymous tip to the local newspaper started an investigation into this hospital's billing practices. When everything was all said and done, this particular hospital was cited with more than enough fines to make up for any lawsuit from me. It also led to a separate criminal investigation into the hospital's administration as well as a number of other staff members and doctors. This hospital also had supporting clinics which were also investigated because they participated in the irregular billing practices. No one went hard core to prison, but many lost their jobs, ruined their reputations, lost their medical licenses, etc.. I was satisfied with the conclusion.
I wonder why you tell a long story like it is really true and then are afraid to name the hospital, so I can avoid the crooks. You think they changed? yeah, right.
@@wadestanton It is true, and it did happen. The reason that I didn't name the hospital was because after Y2K it was bought out by another company. Even if I mentioned the name of the hospital, not many would remember what happened back then. The new administration even renovated the old hospital to the point that is no longer looks like the old hospital that I was talking about. So, does it matter?
@@samuelchappell7280 Still won't name the hospital?
One of the things I love about living in Japan (30+ years) is never ever having to be afraid to go to the hospital... except to get better. And yes, that is completely predictable and completely guaranteed.
The American health care system is cruel and unusual, and a complete travesty. Hopefully this signals some improvement.
Glad this ruling worked out, and thanks again Steve.
Communist Japan!
(Kidding)
@@jupitercyclops6521 Healthy communists. 😄👍
It's legit wild to me when I hear stories of Americans going abroad, getting sick or hurt, and *panicking* when someone calls for an ambulance. 'Land of the free', my ass... The only 'free' ones in this country are those rich enough to never face homelessness or insurmountable debt; everyone else is in fetters under their harsh, uncaring rule. America won't be the land of the free until every single citizen can live a day without fearing for their safety and security. No one should be scared of having an ambulance called for them.
Nah. Private health care companies have all the power. Governments and patients have very little. Things are not going to change anytime soon.
@@hauntedshadowslegacy2826 I know one story where an American tourists broke her leg and went to an Austrian hospital. Their travel insurance was happy, that this happened in a "cheap" country. The whole stay in the hospital was around 5000 Euros and the insurance said something, stay as long as you want *ggg*
Hospitals should be forced to disclose estimated cost exceeding a certain limit-such as about $2400-and if they don’t, patients should only be responsible for something like 105% of the limit or the estimate they provided.
Funny that this is how it works when taking pets to the vet, yet human patients aren't afforded such luxury. My cat needed emergency surgery. I was provided an estimate up front with an expected cost range, with a maximum limit of something like 105% of the high figure.
The hospital has the responsibility to decide if they take your insurance before they treat you for something that isn't an emergency. Playing a little "bait n' switch" game after the fact should result in criminal charges.
Just put fixed prices on the common surgeries based on the actual average cost. Sometimes it goes well and the hospital makes a profit, sometimes it don't and racks up a higher cost and then the hospital has to take the cost. They in turn should have their own insurance against excessive costs due to unforeseen circumstances.
@@ehsnils they should be nationalized
@@BillySBC If im not mistaken though it's your responsibility to see if your insurance is accepted. Not the other way around.
But tbh i think this whole in network/out of network is ridiculous and that needs to just be done away with.
I don't have insurance, last time I was in the hospital they handed me a bill that said if you can pay in 2 weeks ~$4500, but if it takes longer it's going to be ~$13000. That right there shows how much of a rip off they are. They still calla askig for money, to hell with them I'll never pay!
So you think you can get something for nothing?
@@JLee-rt6ve Yeah. If it involves me being alive instead of dead, or healed instead of crippled, you're damned right I think I can get something for nothing.
Leaving aside the hospital employee's mistake, charging over $300,000 for spinal fusion surgery is simply outrageous.
Yep. My cousin was a general surgeon. This was a decade ago. Maybe a little longer. He had to pay 100k a year for his insurance he has to carry. That was 10 or more years ago. All this crap adds up and up and up. I am not a supporter of socialized medicine. Mainly because the government would just make things worse but this system is so freaking messed up. Something needs to change for sure.
@@mikepalmer2219 Our system is so fucked up BECAUSE of the socialist aspects we already have in place. You can't mix private and government insurance and expect it to go well.
@@aniquinstark4347 I am by no means supporting socialism.
@@mikepalmer2219 Literally every other wealthy country on Earth figured it out. And a lot of the poor ones too.
@@aniquinstark4347 "Government is the problem" Guess who said that?
Glad I'm Canadian! None of that crap to deal with! It's crazy!
I wonder what the hospitals charge OHIP?
@@asmrmaroxa I'm American who just knows bits and pieces about how medical care in the various parts of Canada work but I've heard they actually have prices they'll give to foreigners like Americans when we need care while visiting and obviously haven't paid into the system. Presumably those prices are also what they charge the government.
In 2016, my doctor ordered both an MRI and a CT scan on my spine at a local in-network hospital. I had an HMO that covered the expense aside from about $150 out of pocket that I paid up front. No problem. However, when I looked at the bill, the hospital charged over $9,500 for both scans, even though my insurance company only paid a prearranged charge of about $400. I called the hospital billing dept.and inquired as to why they charged such an enormous amount for the two scans, even though they were happy with the $550 paid by me and my HMO as payment in full. They stated that $9,500 is the charge they bill patients who have no insurance. WTH? As Mr. Lehto stated above, the amount charged changes depending upon who makes the payment. Again, wth?
People who don't have insurance can negotiate that fee down to what the insurance co. would pay. They just don't tell you that.
@@iamgabriel5823 This most bills are inflated by at least 25%
Yup
Also even though the hospital will never see the $9500 they can write it off as a loss on their taxes. (Assuming this is a for profit hospital).
If their business model is to be incompetent and rely on having rubes for customers, they deserve to have it broken.
They can’t even quote for basic services because all they go off of are computer codes, not prices. Like Steve stated, they charge everyone differently based off of how your paying or who’s paying. I work for a veterinarian and we quote EVERY procedure and we don’t go over the quoted price without the clients permission.
The unpredictability is in how much they can get away with charging before someone says it is unreasonable.
My dog has had two ACL surgery's. $1500 each time. I knew that going in to the surgery. Great surgeon and results. We are getting screwed by our system. And nothing will be done about it.
Health system is a conglomerate of hospitals, insurance companies and politicians.
What is worse, is getting a big bill after a failure to diagnose a problem or misdiagnosis.
I had hip replacement surgery on both hips last year and when I got my statement from the hospital that showed what my insurance was billed and paid there was a $750 charge for speech rehabilitation. This is the reason that insurance is so damn high the hospitals are crooked.
it's partly the fault of insurance companies too, they just pay it instead of checking the bill.
@@chriskwakernaat2328 exactly they are allowing them to get away with this.
Speech rehabilitation for hip surgery? The hospital is shameless.
SPEACH REHAB ? What the hell did they think you talk with ? Hip bones connected to jaw bones?
Had a similar thing happen at a dentist. They informed us the price after insurance and that we had to pay that amount before the procedure could be performed on our daughters teeth. So we paid that amount. After the procedure the insurance refused to pay because my daughter was not eligible for the procedure due to her age. a few weeks later then dental office billed us. We went round and round with the dental office until they finally wrote it off, or so we thought. Two years later a new office manager was hired and this new manager once again billed us for the procedure. We went round and round with her but it was not resolved. I then went in to have my teeth cleaned and the office manager came out to the lobby and said they would not clean my teeth or allow me or my family to make any more appointments until I paid the balance in full. So I got up and left and switched dentists and never heard another word about it.
Health care costs are absolutely criminal. I cannot understand why they are allowed to do stuff like this.
They're allowed to do this stuff because they lobby politicians and hand over a lot of campaign contributions.
This is my take on it. These "free healthcare" policies people argue about are just scratching the surface. WHY IS HEALTHCARE SO EXPENSIVE IN THE FIRST PLACE!?
(Apologies for all caps, but it's so ridiculous)
Last time I went, I calculated the cost per hour I was paying them for the time I was in there and it was $20-25k/hr.
It was much cheaper before the government tot involved. In the 90s even poor people with insurance could afford most procedures.
@@KISSMYACE3203 When I went in to get my gall bladder removed I got 40 bills! And by the looks of it, it came from nearly every single staff person who worked on me. I only went to one hospital, in network. When I take me car in to get repaired, I don't get a bill from every mechanic, every delivery person and managers that were involved in repairing my car.
Because doctors want to make $300K, because nurses don't want to work for minimum wage, because MRI/CT machines can top a million dollars, because a hospital much be much larger than it needs to be because of potential pandemics, large fires, etc.
Anyone is free to build a non-profit hospital, but oddly, nobody does.
Hospitals and Insurance companies are maddening. When our first kid was born, everything was in-network…EXCEPT the damn pediatricians that do rounds on newborns who they said were out of network. Of course nobody said anything before hand. I wrote a letter asking why that wasn’t disclosed before as we have no control over the pediatricians who contract with the hospital and did they expect me to throw my wife in a wheelchair and me 4 hour old kid into the car to find an in-network pediatrician? Also threatened to go to local media. It was charged as in-network. So ridiculous. If a hospital is in-network, then anybody that you see or touches you for any reason should automatically be charged as in-network.
Not only do we need single payer, we need single biller. This is the thing I hate with going to the hospital. You get a bill from the hospital, then the ER doctor, if they do any imaging it had to be read by a radiologist so another bill, oh and he/she could be out of network. If you need surgery you get a bill from the surgeon, then the hospitalist, and possibly the lab. We just got into one where the radiology practice had changed names, same people, same place, but at first the insurance company yelled "OUT OF NETWORK, WE AREN"T GOING TO PAY." Then they realized their error. It's kind of crazy,
All pricing for Hospitals should be transparent! Some things might be unpredictable but not by hundreds of thousands of $$
Years ago an elite diamond dealer mentioned to me that he prices rates much higher to medical doctors, and he chuckled.
Doesn't work that way.
I saw a case recently that shows why.
I Dr was performing a gastric bypass surgery. Saw a badly infected appendix. So he took it out. Saved the pt from a second surgery.
Finding tumors is not all that uncommon in older adults.
I even know of a recent case where they found an aortic aneurysm, (which is extremely dangerous.)
Is a very complex issue for which I personally have no answer.
@@typoagain1 That would be like sending the car into the shop for a leaking oil pan, and the mechanic deciding to change out the catalytic converter because it was damaged and held on by one bolt, all without telling you about it until it's time to pay the bill. The most they can do is inform you of the issue with the strong recommendation to do the repair immediately, but they can't withhold the car even if it would be unsafe to drive.
My possible solution to make it work for the medical field: they'd have to send a runner to inform the patient (if conscious) or next of kin (if unconscious/on drugs) of the new situation, the recommendation, and ideally the increased cost or at least the info that the price would go up. Then you can continue the operation or schedule the follow-up. If sudden situations arise mid-surgery, take care of it like the emergency it is; billing for that would follow along the lines of ER visits.
And for goodness sake, get rid of the in/out of network crap. A doctor is a doctor, a hospital is a hospital, a life is a life. If going to a place two blocks over is the difference of a house down-payment, the system isn't working right. If going to be treated by a veterinarian who moonlights for humans on the side is cheaper, society has a problem.
Yeah plus that wasn't even the issue, they gave her factually incorrect information which was the reason she had the surgery in the first place
@@typoagain1 that has nothing to do with the topic being discussed. They aren't charging more because they're doing more, which is what you're talking about. They're charging more because of who the entities paying are
As a medical biller for over 30 years for an orthopedic practice, ALWAYS check with your insurance carrier if the facility and/or provider is in -network. Do not take the word of anyone except your carrier. Get the tax ID number of the facilities and providers to confirm the participating status. Also document the name of the carrier employee that you spoke to, date and time of your conversation and reference number for your call. That reference number will officially document your call. Also note that it is not unusual for the facility to be participating and the anesthesiologist to be non-participating. Call the Anesthesia group, get their billing tax id number and check with your carrier.
I checked with my insurance company and the dentist I was going to see. They both said they were in network and I was covered. After 2 months of having a scheduled appointment, the dentists office called 2 days before (in the late afternoon) and said the treatment that was scheduled wasn’t covered. They neglected to mention that the cleaning and exam I was scheduled for was to soon after the last time. Just ludicrous.
An ex-girlfriend of mine had to deal with something similar (without the courts). She has a rare genetic condition that affects her spine, which led to her needing a risky surgery. She was left temporarily paralyzed after the surgery (not passing any blame) and required intense physical rehabilitation. Prior to going to the physical rehabilitation facility she confirmed they were in-network and assumed she would only owe her deductible(s) , copay(s), etc. After she was discharged and got home she received a bill for roughly $500k. When she called and stated her confusion as they confirmed they were in-network, they informed her the facility is in-network; however, the attending physician is out-of-network. She went back and forth with them until they agreed to charge her the in-network rate.
So glad I live in Scotland, where healthcare is free. You should not be punished for being sick.
Health care is not free in Scotland or anywhere in the UK. It is paid for with our taxes. By the way, Nigel Farage, now leader of the Reform Party, wants us to have American style health insurance. Think about it.
Healthcare is not free in Scotland or anywhere in the UK; it is paid for with our taxes. Incidentally; Nigel Farage, now leader of Reform, wants us to have American style health insurance. Lets if my comments stays up this time or stays visible.
Hospitals just charge whatever they like, it seems. I have a friend who has been in and out of hospitals for years. She realized at some point that she was getting billed for doctors consults, and it turned out that it was a completely unrelated doctor who just came in one afternoon, asked her how she was doing, chatted for like 2 minutes and left. Then they billed her $150 for his "consult."
Now she will not talk to anyone who comes in wearing a name badge until they say that they are on her case team already.
@@robbiddlecombe8392 She fixed the problem by doing this: If someone with a badge comes in and starts to talk to her, she asks "are you on my care team?" If the answer is "no" then she says "Thank you but I'm only talking to my care team." Suddenly she's not getting random $150 charges on her bill anymore.
It is insane that doctors and hospitals can bill anything they want AFTER the fact. My wife was in a hospital and needed testing, the doctor was discussing the advantages of one vs the other and couldn't decide which to do so I asked what they cost vs each other, HE HAD NO IDEA HOW MUCH EACH TEST COST! This is the problem in healthcare, there is absolutely no cost vs benefit analysis by healthcare people because they have no idea how much their services cost. This must be ended, the cost of procedures and test should be disclosed up front.
Don’t blame doctors. The hospitals and labs set the rates, and the doctors have no control over them. The hospitals often have different rates for different insurance panels.
It is willful ignorance. The doctors are hoping to make as much money as possible, of course, but they want to maintain the illusion that they are altruists motivated by pure compassion.
@@RaineStudio do you realize that doctors have no say in hospital billing? Providers’ (MD, DO, NP, PA) reimbursement only accounts for about 15% of healthcare expenses.
@@jasonandersen5975 When I do (non-medical) consulting, I can't set the prices of 3rd party products and services either, but I *AM* expected to know about what those prices are. If a vendor won't tell me, I recommend against them.
@@PyroNine9 yes, but do those 3rd party vendors have multiple prices depending on the payer? When I ask for the prices, I am told to refer the patient to finance. Those prices are not divulged to me.
We need more lawsuits like this to force the medical field into more transparency.
I think we all understand things can change in process, but if I call them up they should be able to give me the base cost for the procedure.
This country often can't fix even basic problems let alone complex healthcare problems.
think you just need to get proper health care
It is not the medical field it is the insurance companies that is the problem
@@BobSmith-kd4oc It is the hospital that won't tell me the base cost, not the insurance company.
@@-Big_Big We do. We have great health care that we can make our own choices with. I can choose to work a job that provides insurance, choose what level of insurance I want, choose what doctor I go to, choose to get another doctor's input, choose to shop around for what is the best price and provider for me, and if the private insurance company doesn't cover something, I have the right to pay for it myself and still get the service/product I desire instead of being told to die because the government said no. I retain the right of responsibility for providing for myself as well as my medical decisions. Granted, that freedom is rapidly being eroded by increasing government interference.
I had a dentist do something similar recently. Said it would cost me $150 out of pocket rest covered by insurance. A week after the dental work I was then told it was denied and I owed $1500. Crazy that this kind of stuff is allowed especially when you sign and agree to it beforehand.
I recently had something like that too; the original quote that I paid at time of visit was something like $117. I must have gotten a surprise bill that I didn't pay, because they called about a past due balance and I told them that I paid the quoted amount so they need to get the money from the insurance company or reduce their price to cover the missing amount because I'm not going to subside their mistakes. I don't even know the amount they're asking for; never got that far before I shut them down.
Same here. Dentists are the worst.
I was in a T-Bone accident (other driver ran a stop sign). I was sent to the nearest hospital which they gave me piss poor service. I and a lot of my family worked in hospitals (some for decades) so I know just how bad the service was (they even failed to give me discharge papers). Anyway my insurance company negotiated and came up with a price for everything (of course in the report they added things that I never got) both parties agreed then they wrote a check to the hospital. Several weeks later around the same time I would get the remaining money from the insurance (talk about great timing on their end) they sent me a new bill for over $1K say it's for the service that was already agreed upon prior to them cutting a check. I called them and stated that fact after hearing their BS about using a 3rd party contractor to do the procedure I told them that they agreed to the exact cost with the insurance company, the added cost on the report, and the violations of procedures that they committed during my stay in ER that I could file grievances with the State Board with witnesses. Needless to say I never heard from them about that charge ever again (so far). That was nearly three years ago.
As someone who has had into the double digits number of surgeries in the last 20 years…including one self pay/uninsured…anything related to medical billing is a freaking nightmare. If you can go out and find lists of average costs for a procedure broken down by facility, then why can they not give better estimates?
Medicine is a disgusting, disgraceful field.... They know people will agree to anything to save their lives or manage their pain. It is no longer a noble profession.
Any list would not be in good fate since it is the the US's hospitals interest to inflate it as much as possible. You can go to other countries and get the price they estimate when the hospital is not run for profit. England, Norway, Sweden, Denmark, Germany would be a places to start, but even if you get a good estimate for the real cost it would not help before there is a way to enforce what the hospitals can charge.
Bingo, I've always argued that they perform the same operations and procedures over and over thousands of times yet can't give an accurate estimate of total cost BEFORE any action is taken. They're the only industry that gets away with a blank check that they run up with ridiculous charges.
It would also encourage them not to waste.
EG. if you cant afford a tongue depressor don't drop one on the floor and you wont have to charge for 2.
@@bknesheim Several years ago my chiropractor told me I would probably need a hip replacement in a year or too. I had reconstruction surgery on the hip as a child so I knew my procedure would not be standard. Costs on hip replacements have come down some but back the I was given ball park estimates between $25, 000 and $100.00. I had no insurance so It was going to be an impossible out of pocket amount. I have relatives in Canada and I asked them about getting it done there. They pointed me to a clinic in Quebec that did nothing but knee and hip replacements. You did not have to share a facility with communicable disease patients which is great because infection is a common occurrence and they had an attached nursing home for your rehab. Cash price was 12 grand. Thankfully I found an osteopath who treated me for a few months and never needed the surgery. Cost less than 3 grand paid over eight months.
Similar situation happened to my grandpa. The estimate they made was off by thousands and they said it was insurances fault even though insurance paid exactly the max they said they would. People at the dentist office kept telling me "oh insurance is unpredictable blah blah " when they were the ones who did not give the promised in network discount. Took me a lot of phone calls to get the charge resolved but these business practices are so shady! Especially taking advanced of elderly, sick, immigrants, etc
Who would guess that 15 minutes in an MRI machine costs $2,300? I had no idea. And I'm not even sure who's rate that is.
They cost millions over their life time. They cost several thousand a week to run.
Totally understandable that the CO court ruled that way. The medical industry is sometimes a pack of robber barons. In my case, it all worked out well (in a sense) when my wife was diagnosed with colon cancer and needed emergency surgery. We were with an HMO and all I had to pay was about $750, though the cost of the surgery was somewhere north of $50k. She did ultimately pass away a couple of years later from the cancer, but I never had to pay another cent for hospice care including pain drugs. It made a very distressing situation have one less thing to worry about.
I worked in hospitals for forty-odd years. It was my observation that in privately owned hospitals the wallet biopsy was priority number one. The public hospitals took care of the patients' needs, and were experts at finding money to pay for the medical expenses of people who had no money. They also routinely handled cases that were too demanding for the private hospitals; they were good places to work. The public hospitals are now almost all gone, destroyed or given away by government agencies who thought that it was good management to reduce the number of their employees. The bean counters are in charge, not the doctors.
God bless her. In pain, in recovery and fighting over medical bills for 8 years ! Sad
I hate going to hospitals. The moment you even walk in it already cost you a 1000.
Depends. I walked in for dehydration a week ago, and paid 390 when it was all said, and done.
@@justinkaufman495That's a lot assuming all you got was an IV
@@justinkaufman495 Vote 💙 for any chance of changing that! AND batter Congress etc with campaigns for true universal healthcare.
20 dollar iv bag they charge you 200 for and over a hundred to administer it to you
@JamesThomas-kx5sj they also gave me meds for the nausea, and they did send blood to the lab. How much is a doctor worth to you? He spent years in medschool so his time is very valuable to me, and I won't argue with him getting paid $100 for his hour minimum. That's a reasonable amount. Especially given the hospital can simply charge you whatever amount they want, and not tell you until the end.
Great story, Steve. Though a sad one. Having been a healthcare professional for many years, I'm still bummed out by the fact that medical costs -- including those of Big Pharma -- often appear predatory rather than appropriate. Let's hope more is done to move the medical industry toward transparency and away from the unreasonable profit motive.
they don't appear to be predatory. they are predatory. recently had an emergency surgery. the anesthesiologist that was on call went Hawaii, while they were on call. so they got an anesthesiologist from their sister hospital. they tried to bill me for 2,250 dollar because they weren't covered by the hospital. excuse me? my insurance is taxas based and thank God because that's the only reason I wasn't given that bill. so yeah. "appear" predatory? bs
Then stop treating these companies as monetary interests. No insurance company of any kind should have stocks to trade
Great video! There almost nothing in commercial transactions as arbitrary and unjust as medical billing. There’s more price transparency from a Loan Shark or a Protection Racket than from a hospital.
Through the years I've found that now, as an older adult, that my dealings with insurance companies, hospitals, doctors, dentists, optometrist and miscellaneous specialists can be more then just mind numbing. Frankly, I find that in general the healthcare system, as mentioned above, can be more harmful than helpful to a person. By that I mean do you think the woman Steve mentioned in the story had a little stress from all of this? How many years do you think that took off of her life and worrying and high blood pressure and cholesterol? You see they can't measure that in definite terms. But it's reality! The best way to go is always preventative, eat well, live a healthy lifestyle, exercise and keep your brain active and don't stress.
Precisely! As my friends gain Medicare, issues they tried to deal with are suddenly the interests of many specialists. The amount of medical intervention is not always associated with improved morbidity or mortality. Sad that our "healthcare" is harming & killing as many as it helps. Given medical errors are 2nd or 3rd cause of deaths, we could save thousands by limiting interactions with providers.
@@katiekane5247 Medicare will pay anything, that's why they want your friend to come in
I grew up under communism in Eastern Europe. Be thankful for the healthcare you have because the alternative will end you.
Boy I wish we could identify who generally owns those fields. Unless we find out that we actually really like those people and can then agree that the current system is perfect and working as intended.
@@katiekane5247 i never knew how utterly messed up the healthcare system was until i qualified for medicaid. i'm lucky as work sent me to the hospital for a week. if i hadnt qualified for medicaid i would have had at least a few years wage in hospital bills because my work forced me into an ambulance against my will. but now i have the best healthcare money cant buy and its wrong.
i think healthcare should be affordable, but the way it is managed is horrendous. i worked for a health network that wastes so much money. not just in buying extremely expensive stuff and tossing it out a month later but also that they built the head of facilities a 6000sqft castle. all paid for under the guise of a new office building they also had built. the companies they made to funnel the money, the kickbacks, etc. i'm sure it happens nearly everywhere. thats why if you go to the er your bill will be at least $2500. it isnt even the doctors that make 800k a year.
Thank GOD for the NHS 🇬🇧
I had this same issue when taking my son to a dentist appointment. It turned out his doctor's office only takes medicaid for dental visits. I was told that before the visit. I asked how much it would be and was told $50. I got a bill for another $200 in the mail a month later. It should be illegal to not disclose service prices upfront.
I need dental surgery. Insurance will not cover anesthia. i was told it would be $200. I have scrimped and saved it. They are now saying it has always been $275 for everybody. I have talked to several friends that have the exact same insurance (I have worked in insurance and know how to read the policies). They have been charged $200-$250. It is Medicaid.
I recently had a 1 hour test at a hospital and the total charges from the hospital was over $9,000 and my insurance paid them $246 and I paid 0. If I didn't have insurance the hospital would want 9k from me and that isn't fair for such an inflated charge.
That's a common misconception. You can actually negotiate directly with the hospital yourself if you don't have insurance. You just call up their billing department and be like "I don't know how I can pay this" and watch as the total drops. You can also try asking them for an itemized bill, that will also usually lower it quite a bit.
@@madmatt2024 Yes it is true that they will drop the rate, and they will take 60 cents on the dollar if you can pay the bill in full but even though they take off 40% that still leaves the uninsured with a large amount to pay.
Three changes would fix a lot of issues.
#1 Outlaw the whole "in network or out of network" insurance thing. They have to pay no matter where you receive care.
#2 Require medical procedures to be billed as flat rate and that the prices be posted on their website.
#3 Regulate prices of medical care and prescription drugs based on their profit margins. This includes drug pricing directly from the manufacturer.
I live in the UK, so all this is insane to me. Many years ago i lived in South Africa, where most people used private health care. I took my 6-week-old baby for a check up, and the doctor told me i must start feeding him "three adult-sized bowls of porridge a day".
I laughed st him and told him absolutely not, that i was going to continue to breastfeed. He had the cheek to bill me for "feeding advice". I phoned his office and told his secretary to cross that item off my bill because I was not paying it.
Ben about to be snatched by those pesky Owls, Steve's RHS
Why are the judges so out of touch with reality? there’s no basis to “buy” the attorneys argument! CO is a very punitive healthcare billing system who have destroyed patients finances due to predatory practices
My last c section was done at Providence hospital in California. About 1-2 weeks before my scheduled c section they contacted me and told me how much everything would cost. They broke it down for me and told me how much I would owe with my deductible. I went ahead and have them my credit card to hold the charges. No surprise charges afterwards. I also was concerned about the anesthesiologist being in network so the biller gave me their information, I looked them up and saw they were in network. It was the best experience I’ve ever had. Meanwhile this time I’m going into C-section at Wake Med in NC, no calls from billing beforehand, I called and asked them who their anesthesiologist and they had no clue and couldn’t tell me a thing. I finally found out no thanks to them. I’m really worried about the charges afterwards since I have gone to that hospital before for a miscarriage and the charges were outrageous.
If they can't tell you they are probably a low quality hospital. Too late now
This happened to me with some imaging. I received around a ten thousand dollar bill after being told by the heart center that I was in network. I was sent there by my provider. I believed that my provider would send me to an in network specialist and I believed the gal behind the counter when I confirmed I was in network and only had a 120 copay for all three imaging appointments. I gasped when I received the bill. I exercised all of my appeals. I won one appeal for 7500. The others were denied. I called the imaging center presented my case to the payment center. After a week of review they admitted their mistake and cleared all charges.
They had paperwork with the wrong insurance provider on it. The gal had crossed it out and wrote in my current provider. She didn’t tell me she made a mistake.
Don’t trust them to be correct. I made the mistake. Lesson learned.
Next time, ask the insurance company. They have handy web sites with search boxes and everything!
Like I said lesson learned. I thought confirming with the people who did this for a living was enough. I will never let that happen again.
My last surgery I confirmed EVERYTHING!! 👍
ALWAYS ask the insurance carrier. They are the ones you have "hired" to negotiate and pay the bulk of the bill. I.e. if you want to know if a bill is getting paid, always ask the person paying the bill, not the person charging you the bill.
I absolutely HATE having to sign these ‘blank checks’ medical professionals want, no, demand that you sign or else you don’t receive care.
Try scratching it out and writing that everything has to go by you first, that isn't covered by insurance.
I've fought this myself. I had an MRI done. Before it happened I asked what the charge would be. The nurses laughed, "we don't deal with costs, you should know that before you got here!" Ok. I needed the MRI, so I got it done. At the time, there were ads on the radio about $600 MRIs all over. I got a bill for ~$4,300. I argued. I was denied. I argued more, still denied. I talked to a lead billing clerk who told me that, "it is what it is" and would have to pay it. I didn't. It went to collections. They sent letters, called, whatever. Finally I got a "final bill" (i.e. we're f%$king your credit). I sent the video and a screenshot. They saw the "we don't know, lol, pay what we say" comments. They saw the ads for others in the market at 15% of what they billed. Been years now, and that bill was "settled". Removed from collections, not on my credit. Not an issue.
FIGHT THEIR PRICES. They won't defend them. They just charge people what the can because nobody ASKS!!!!!!
Why the hell would a nurse know the cost? That's a business office and billing office function.
Yep, took my dog to the vet and got an x-ray done for $85. Go to a doctor and they will charge $1,000. It's the exact same technology, yet for some reason, my x-ray is 10x what the dog x-ray is. I will never understand it.
45 years ago my husband had brain surgery. Twice since then he has has MRI. $10,000 each
ee3x by o
@@mikealvord55 Well then, it would be pretty easy for the nurse to go and ask now wouldn’t it?
Steve, you provide a great service to all the laymen AND lawyers in your listeners out there!! That is why yiu are followed worldwide. ❤ Rod LAM, Virginia
I walked into a hospital after a car accident, and requested they check for spinal damage, and a concussion. An xray, and a doctor with a flashlight. I asked them how much it will cost me before I decide to go through with it. They couldn't or wouldn't tell me. They then required me to sign a paper declining treatment to save them from liability. This is a ridiculous system we have.
Dealt with something similar, not to this degree money wise, but I was told I would only have to pay 300.00 max out of pocket for Molecular testing on a biopsy, and I was shocked when I got a bill for 4,000.00, which was negotiated down to 2K by my insurance. I made several phone calls, fought like heck, and I was honestly ready to take this physician's office to small claims court when they finally agreed to only charge me 300.00. I was given the Molecular testing consent, literally 2 minutes before I was to get the biopsy, so there was no time to read the fine print or to call my insurance company, and the medical assistant told me "if your insurance doesn't pay, the maximum you would have to pay is 300.00 out of pocket". What she didn't mention is that if I had a deductible, my insurance wasn't technically covering it, but that I would be responsible for paying for the test in full. Thankfully they were also complacent and never put the consent into my medical record, so I had them there, by not putting the content into my medical record they had no proof I even signed it, nor did it give me the opportunity to read the consent over and change my mind about the molecular testing prior to them doing it, and nor did they give me a copy of what I signed prior to me leaving the office. They made a multitude of errors which cost them a lot of money, but they got what they deserved and they will hopefully give people the consent when they are the consult appointment instead of waiting until they are about to do the biopsy, and not tell them the test will cost 300.00 when that is far from the truth! Fight for your money!!
Let me guess, it was deemed “not medically necessary” by the insurance company.
I dealt with that when my 10 month old daughter was diagnosed with one of the rarest forms of cancer out there ( 1 of 30 people in history). The molecular testing is what lead to the diagnosis, yet it was deemed “not medically necessary” by insurance.
@@Prosecute-fauci No, I had a 2,000 deductible so I was responsible for paying the 2K they tried to charge me, BUT the medical assistant told me I would only have to pay 300.00 max out of pocket, and she never mentioned that, that excluded deductibles. I was under the impression that even with a deductible I would only have to pay 300.00 since in my mind if I had to pay for it because of my deductible, the insurance wasn't covering it, if that makes sense. Sorry about your daughter, I hope she is ok now. The medical system is so screwed up!!
Your guardian angel must have misplaced the consent for you. You are right though, they got what they deserved. I had a similar problem with a dermatologist and their lab. No notice there would be extra charges and a year later some billing company getting nasty with me. Out of the blue no previous notice or bill. I tracked down the lab and kept calling and yelling and told the doctor's office I'd die of melanoma before I'd come back. I went out of my way to make them feel bad. The collection people did stop bugging me.
Why would you expect a hospital or doctors office to know your specific deductible situation if they don't even know if a procedure will be covered?
Also, pretty much every procedure needs to be pre-approved before you go and do it. Otherwise they will definitely not cover it. Only certain exceptions, like the ER, will they automatically cover a procedure.
@@ZimZam131 because they are the ones billing for it. if your going to bill out the ass you better dam well know everything
I spent half of last year in and out of the hospital. I had to pay $4000 because they said something was out of network when I was told it was in network. They also said they were disregarding the "No surprises" law because they don't know if it covered me or not and I would have to go to court over it. Well I ended up going back in the hospital and my insurance covered all of that due to my max out of pocket. In the end I am only about $200 over my max out of pocket so it's really not worth my time and stress to fight it. I am VERY glad something is being done about this BS. In the end I got lucky. Also I am feeling better. I have a long way to go before I am 100%, but I no longer worry I won't make it.
I’m glad you’re feeling better, you have my sympathy for living in a country where your life _literally_ hinges on your bank balance.
@@realburglazofficial2613 Thanks, but it is not quite as bad as it seems. They WILL treat you even if you have no money. There were offers to wave my debt if I had proof I didn't have the money to pay. I can pay, so they make me pay.
@@ajosepi1976 somehow that sounds _worse!_
Thanks again Steve for a great video.
I had an accident (fall) about 18 months ago. I went to emergency, had a CAT scan total bill was over 15k. I was paying cash, the cash price was 1300.
Note that I'm far from eligible for any special programs or discounts. Of course it took several hours on the phone to actually reach someone who would give me the cash payment price since they kept repeatedly sending me paperwork to send to my insurance company and couldn't understand I just wanted the cash price to pay it.
If I had put it through my insurance I would have paid 5k in deductible.
Always check cash pricing even if you have insurance.
For most primary care, I pay cash then ask my insurance to pay me back, and usually they do. There was one place I went to that I told them I was paying in cash for everything. I was only able to pay for the initial visit upfront. After a month I was able to pay for one of 2 tests. I waited for 3 months to see if they had opened it so I could pay for the second test, but wasn't able because it was still "on hold awaiting insurance response". So I stopped checking in and am now just waiting for them to send me the bill for the last $125 - the visit was in last October, they have my home address, email, and phone number, nothing yet.
I've lived around Amish. They aren't against modern medical care but don't do insurance because it would connect them to the "English" world. They pay cash and my neighbor said he couldn't fathom why the "English" let themselves be robbed by insurance. He was paying at a hospital and overheard someone haggling about their bill and insurance and was amazed.