After going decades without much engagement with American healthcare, I’ve had some recent encounters that I’m passing along to current or future ER people for their edification / amusement.
Encounter #1: elevated PSA
• I was referred by a physician group affiliated with a local nonprofit hospital (in-network) to that hospital’s radiology department for a prostate MRI to make sure my recent slightly elevated PSA reading was benign. The hospital quoted $6k for the MRI. I had it done by a local imaging center for less than $500. Who is paying $6k for an MRI? Maybe people with low-deductible insurance plans? (Later, I had my PSA retested and it was normal for my age).
Encounter #2: locked knee
• one of my knees “locked up” so that any joint movement was extremely painful (I suspect that over-use was the cause). I went to my primary physician’s office. The PA wanted to inject something into my knee to reduce the swelling. There was no way that I was going to allow him to insert a needle into the complex and delicate knee tissues without good reason. Sure enough, the swelling went away on its own after a few days. So, here we have one non-MD (me) negotiating with another non-MD (the PA). I’ve been in my primary care physician’s office several times and have never actually seen a doctor - it’s always been the PA. It seems that modern medical practices have turned PAs into pseudo-MDs - perhaps because PA salaries are much lower than MD salaries? Meanwhile, the insurance is always billed as if I saw an MD.
Encounter #3: home accident
• I had an accident at home that required transport to the ER via ambulance (cost: $900). The four hours in the nonprofit hospital ER getting patched up cost $12,000 (most of this time was spent waiting in a room to be stitched up. I felt like I was in an episode of “The Pitt”). I might have bled out and died without this help so I’m grateful to the paramedics and ER personnel for being available when I needed them. My ACA plan paid $8k and I paid $4k of the ER cost. My deductible under my previous non-ACA United Health Care short-term insurance plan was $25k, so I would have been responsible for the entire ER charge if I was still using that plan. I can easily afford these kinds of charges but other folks might not be so fortunate.
• Later, I returned to this hospital for a follow up. They charged my insurance over $900 for the initial visit (in-network); my portion was 50%. I saw a PA rather than a doctor. I haven’t had any follow-up visits. An equivalent visit to a local private practice (out-of-network) was $350 for the initial visit and $200 for follow-up visits. I always see a doctor at the private practice.
Summary: getting old sucks. Don’t do it!
Encounter #1: elevated PSA
• I was referred by a physician group affiliated with a local nonprofit hospital (in-network) to that hospital’s radiology department for a prostate MRI to make sure my recent slightly elevated PSA reading was benign. The hospital quoted $6k for the MRI. I had it done by a local imaging center for less than $500. Who is paying $6k for an MRI? Maybe people with low-deductible insurance plans? (Later, I had my PSA retested and it was normal for my age).
Encounter #2: locked knee
• one of my knees “locked up” so that any joint movement was extremely painful (I suspect that over-use was the cause). I went to my primary physician’s office. The PA wanted to inject something into my knee to reduce the swelling. There was no way that I was going to allow him to insert a needle into the complex and delicate knee tissues without good reason. Sure enough, the swelling went away on its own after a few days. So, here we have one non-MD (me) negotiating with another non-MD (the PA). I’ve been in my primary care physician’s office several times and have never actually seen a doctor - it’s always been the PA. It seems that modern medical practices have turned PAs into pseudo-MDs - perhaps because PA salaries are much lower than MD salaries? Meanwhile, the insurance is always billed as if I saw an MD.
Encounter #3: home accident
• I had an accident at home that required transport to the ER via ambulance (cost: $900). The four hours in the nonprofit hospital ER getting patched up cost $12,000 (most of this time was spent waiting in a room to be stitched up. I felt like I was in an episode of “The Pitt”). I might have bled out and died without this help so I’m grateful to the paramedics and ER personnel for being available when I needed them. My ACA plan paid $8k and I paid $4k of the ER cost. My deductible under my previous non-ACA United Health Care short-term insurance plan was $25k, so I would have been responsible for the entire ER charge if I was still using that plan. I can easily afford these kinds of charges but other folks might not be so fortunate.
• Later, I returned to this hospital for a follow up. They charged my insurance over $900 for the initial visit (in-network); my portion was 50%. I saw a PA rather than a doctor. I haven’t had any follow-up visits. An equivalent visit to a local private practice (out-of-network) was $350 for the initial visit and $200 for follow-up visits. I always see a doctor at the private practice.
Summary: getting old sucks. Don’t do it!
