More Health Care Billing Nonsense

[audreyh1]

From the article
Read the entire article, it's very interesting. Emergency rooms see lots of people that would be better treated elsewhere.

If in the case of a badly bleeding wound, and the urgent care clinic is closed, and assuming the doctors office also, where is someone supposed to go?

 

[MichaelB]

If in the case of a badly bleeding wound, and the urgent care clinic is closed, and assuming the doctors office also, where is someone supposed to go?

I wasn't suggesting they go elsewhere, just acknowledging the basis for the article and the project Sarah Kliff is carrying out.

 

[travelover]

........ Emergency rooms see lots of people that would be better treated elsewhere.

I don't understand why emergency rooms don't have two sections, real emergencies and everyone else. The second half, an urgent care center could be staffed with nurses, PAs and other appropriate staff. Since the hospital is paying for the indigent anyway, it would seem to be in their interest to lower their real costs.

 

[JoeWras]

I don't understand why emergency rooms don't have two sections, real emergencies and everyone else. The second half, an urgent care center could be staffed with nurses, PAs and other appropriate staff. Since the hospital is paying for the indigent anyway, it would seem to be in their interest to lower their real costs.

Some do. They don't make it obvious, but they have two wings that they triage the patients to.

 

[TwoByFour]

If in the case of a badly bleeding wound, and the urgent care clinic is closed, and assuming the doctors office also, where is someone supposed to go?

If it can be treated with a bandaid, probably don't need to go anywhere except maybe the pharmacy to get some antiseptic ointment. If it requires stitches to get it to stop bleeding, and the urgent care place is closed, ER is the only choice. The article was about the former, not the latter and used it as evidence of excess costs. But I put a lot of the blame on a public that uses the ER for non-emergencies, and a public that is too prone to run to the doctor for a lot of things they can manage themselves.

 

[MooreBonds]

DW had ankle replacement years ago and the final cost to us and our health care insurance provider was about 10% of the claim the hospital submitted, IOW they billed at 10 times final cost. That’s outrageous, inexcusable IMO. What other business gets away with that? And IME its impossible to get any idea what costs will be in advance.

But I’ve just seen a worse case while my sister and I wade through claims from my Dad’s recent health care events, this one is settled:

First two weeks in the hospital they submitted a total claim of $108,549. Medicare paid $3836.67. Tricare $1340. Patient $0. So the hospital billed for 21 times what they settled on with no resistance. Ridiculous.

It's quite common in the wholesale market to use a "list price" as a standard, and then to discount it various amounts to various businesses, depending on the negotiated discounts you achieve.

For instance, for a certain project, we negotiated a discount of 89% off of list price for drains and other products from a foundry manufacturer. The 'standard' discount off of the list price we normally received from our good payment record from the manufacturer was 80%. Many other contractors might only get 60% or off of list if they don't buy as much volume. And if your service plumber is in a bind and goes to a wholesaler that you never buy drains from (or any products) you might end up getting stuck with paying "list price"! Same for pipe and fittings, and everything else we buy.

It's far easier for the hospital to have a high "list price" and then discount it large amounts to various insurers, than it is to have 20 different prices for 20 different health insurance networks, and another set of prices for the public that don't have insurance.

So, it wasn't the hospital "billing" Medicare or your insurer $100k, then "accepting" 10% of it - it was the hospital sending the list price to them, and then accepting the negotiated final price.

 

[SecondCor521]

I don't understand why emergency rooms don't have two sections, real emergencies and everyone else. The second half, an urgent care center could be staffed with nurses, PAs and other appropriate staff. Since the hospital is paying for the indigent anyway, it would seem to be in their interest to lower their real costs.

They essentially do. When you go to an ER, they typically triage you at the initial desk. If you complain of chest pain, you go to the front of the line; if you have a fever but otherwise are OK, you'll sit around and wait for a long while.

I don't know if they would be able to shunt simpler emergencies to a lower actual cost environment. I suspect that ER doctors and nurses don't get paid much differently than urgent care doctors and nurses. And bandaids cost the same at the wholesale level regardless.

 

[sengsational]

As to going to the doc-in-the-box for a minor* cut, I can say first hand, it doesn't always work.

DD cut her finger in the kitchen. I looked at it and thought it wasn't bad, but DW thought it needed a stitch. The doc-in-the-box said, "Nope. Go to the real ER." And she did get a stitch. That is to say, I was wrong. But then again, I couldn't get a very good look at it except that it wasn't gushing blood.


* wasn't my finger

 

[TwoByFour]

When I was a kid (60 years ago) I cannot remember anyone in my family or anyone we knew going to the ER. Well, I went once when I was 12 and had a compound arm fracture with the bones poking out of my skin. We are now programmed to rely on the ER for things that really aren't emergencies, instead of relying on common sense and a little patience until the doc's office opens. It seems nutty to me but I guess I am old fashioned.

 

[travelover]

They essentially do. When you go to an ER, they typically triage you at the initial desk. If you complain of chest pain, you go to the front of the line; if you have a fever but otherwise are OK, you'll sit around and wait for a long while.

I don't know if they would be able to shunt simpler emergencies to a lower actual cost environment. I suspect that ER doctors and nurses don't get paid much differently than urgent care doctors and nurses. And bandaids cost the same at the wholesale level regardless.

Hmmm, this doesn't make sense. We hear constantly about the enormous costs that indigents ring up at ERs over simple maladies that could be treated most less expensively at a regular doctor's office or urgent care facility. Sure, they triage incoming patients with respect to priority, but I've never seen a low cost alternative facility operating in tandem with an actual ER.

 

[audreyh1]

When I was a kid (60 years ago) I cannot remember anyone in my family or anyone we knew going to the ER. Well, I went once when I was 12 and had a compound arm fracture with the bones poking out of my skin. We are now programmed to rely on the ER for things that really aren't emergencies, instead of relying on common sense and a little patience until the doc's office opens. It seems nutty to me but I guess I am old fashioned.

When I was a kid the doctor always made house calls, so yes things have completely changed.

Hmmm - how did that ER habit get started?

MY father, a pediatrician, kept all his medical equipment in a black leather bag. He used to take it on house calls. My brothers and I would frequently tag along to watch him treat patients. He would remove stitches from over an eye or look into a throat and ears, providing a few pills to start a regimen of antibiotics for an ear infection.

Sometime in the late 1960s, he stopped making house calls. Instead, my father began routinely sending patients to the hospital emergency room.

And he wasn’t alone. In 1930, house calls accounted for 40 percent of physician interactions. By 1980, that number had dropped to 1 percent.

https://opinionator.blogs.nytimes.com/2013/09/05/hi-its-your-doctor/

 

[JoeWras]

Hmmm, this doesn't make sense. We hear constantly about the enormous costs that indigents ring up at ERs over simple maladies that could be treated most less expensively at a regular doctor's office or urgent care facility. Sure, they triage incoming patients with respect to priority, but I've never seen a low cost alternative facility operating in tandem with an actual ER.

I have seen this at Rex hospital in the Triangle area. There are literally two doors to two different rooms. It is also like a multi-stage triage. If you come in with a cough, they give you a mask and you go to the 'minor' triage area.

And here's their website and a quote from it:
https://www.rexhealth.com/rh/care-treatment/emergency-care/

• Two triage rooms for preliminary evaluation/initial assessments
• Two pediatric treatment rooms
• 10-bed minor treatment area for non-urgent conditions
• One decontamination room

...

• All life-threatening situations, treated at the REX ED
• Less-critical injuries in the REX ED Minor Treatment area (services include evaluation, treatment and discharge for patients with non-urgent minor emergency needs)

 

[travelover]

I have seen this at Rex hospital in the Triangle area. There are literally two doors to two different rooms. It is also like a multi-stage triage. If you come in with a cough, they give you a mask and you go to the 'minor' triage area.

And here's their website and a quote from it:
https://www.rexhealth.com/rh/care-treatment/emergency-care/

This is great!

 

[John Galt III]

Wow!
So I decide to call and ask for more details especially why wasn’t I credited for this prepayment on my bill or an explanation of how that factored in. Talking to billing, they look it up, and announce that my account has zero balance. I’m don’t owe anything. OK good for me, but Huh? They weren’t going to send me another statement. Do they just hope someone pays these bogus bills?

I think so. My elderly mother gets one or two of these nonsense medical bills every year. Sometimes it is a second billing for something she already paid, but using a different code. Sometimes it is for some task never performed. Sometimes the bill says 'your insurance company has denied this claim and therefore you owe $xxx' when she owes nothing. She will call about these bills, but will pay them if the provider says she owes it. If I am there and see the bills I can often get them corrected, sometimes with a good dose of shaming the providers/billers, done by me.