Yeah. Easy. When I went to an ER because I had fainted multiple times they wanted to send me away, because "that's nothing too serious" ... and I thought that sounds reasonable and wanted to go home, they are the experts after all, aren't they? A good friend told them to do their fucking job instead and they grudgingly agreed to check me, but "you will be out of here in no time, there's nothing" ... so ... they did a blood check and I waited. And waited. "Well .. we don't know, something is off, we will keep you here for the night. But it's only a precaution, there's probably nothing wrong with you!" ... next day they found Stage 3 cancer, which had spread through my whole body. I almost died, had to spend weeks in intensive care, get chemo and operations and the full program.
And all of that only happened because my friend didn't take multiple "no" from the ER doctor for an answer and insisted that I get at least a rudimentary checkup by them, otherwise I would be dead. So, respectfully, your comment is bullshit.
You could also go to a primary care doctor who would be capable of performing a detailed exam to address your chief complaint.
Your friend was right in that the emergency room doctor should do their job, but their job isn't to be the primary physician, they're there to diagnose and treat emergencies.
If you were tachycardic, tachypneic, apneic, hypotensive, hypertensive, febrile, hypothermic, bloody, pale, in severe localized pain, slurring speech, paretic, then the ER would investigate until answers are obtained, because all of the above are concerning.
A complaint of only fainting has many non emergency causes, and you would have to provide additional information that would warrant investigation. Ordering fishing expedition tests in the ER is extremely wasteful in a non emergency situation. Imagine how many people go to the ER for nonemergency care and expensive tests are ordered unnecessarily! Because of defensive medicine, this happens way too much, which is why healthcare costs so damn much in this country.
> “I decided to decline treatment because I can’t really afford any surprise bills right now,” she said. “The bill I’d probably incur would not be worth saving my ear, which was sad but a choice I had to make.”
She felt that losing her ear was a possible outcome of the accident, which certainly seems like an emergency.
More broadly, it can be difficult for a layman to determine what warrants emergency care vs what doesn't.
Hitting your head hard enough to cause injury is almost always a reason to seek immediate medical attention, especially if the head injury is the result of losing consciousness in the first place.
What is it that does cost $5k? Keeping a mostly-unused tomography machine and crew ready in case someone at the ER needs it? Insurance premiums charged per patient who walks in the door?
We get these complaints in Germany too (where I currently live) BTW. "A five-minute drive with an ambulance shouldn't cost €500!" someone complained to the newspaper here recently. It doesn't, what costs €500 is keeping enough ambulances ready that one can arrive within x minutes with y% probability, for IMO overcautious values of x and y.
€500 is still something many people can pay in Germany, 5k isn't something the average American can foot (with no treatment to boot). It's not at all a comparable complaint.
IIRC an ambulance ride in the US is 10-20k, that's indicative of just how much more medical care costs over there.
I have never heard of an ambulance ride costing anywhere _near_ $10K-$20K. The average, out-of-pocket price of an ambulance ride is much closer to $1000 - and often less. New York's 2012 fee schedule offers a good example: https://www1.nyc.gov/assets/fdny/downloads/pdf/about/fee-sch...
Sure, there's an extra digit. Much US healthcare seems to suffer from Extra Digit Syndrome.
What might be similar that the billable item is not the costly item. Of course I don't know the first thing about US health care costs (as opposed to billable items).
> a mostly-unused tomography machine and crew ready in case someone at the ER needs it
No hospital administration would allow this: they would refer you to a separate medical imaging clinic, or run one on hospital grounds that all departments would refer patients to.
eh in germany driving the ambulance is free - if you really need one. of course there are people who call the ambulance without too much reasons and even than as long as the amublance doctor will allow you to take the drive to the hospital you would still be on the safe side.
Some of the PKV companies offer cheapish plans that effectively do not, or that make you pay the first €x00/month yourself. Things like that. They're marketed as insurance against big problems for a small price.
As far as I know, point of the exorbitant fees is the weird process of collective bargaining between the care-providers and insurers.
I.e. you, as the hospital, inflate your price, by X00% margin over what you actually plan to charge the insurance. Then you let the insurance negotiators negotiate, and you negotiate down to the reasonable price.
This looks really good on the paper. Unfortunately, you as a patient, if you don't have good coverage, you end up paying the inflated price, that you didn't really have the chance of negotiating (and wouldn't really have the chance even if you hadn't been unconcious ;)
Like, if I compare it to Czech Republic, where I live (or even Germany), the prices seem much more reasonable (i.e. you would be able to get a complication-free birth in hospital for ~400$, more complicated, i.e. cesarean section ~1500$, including hospital stay, in US it seem to be 5-10x as much)
> that you didn't really have the chance of negotiating
Not American, but from what I've read in these types of news articles, you often CAN negotiate it down a lot, but when you get a huge bill in the mail, the first thing you think isn't "I'm going to try to haggle down my $5000 bill with this huge hospital" you think "I'm so screwed. Time to google 'personal bankruptcy', was it 7 years?". Pharmaceutical companies are also always saying that they will subsidize prescription medications for those who can't afford it, but I dunno how much that is BS or not.
Oh, good to know. From the horror stories you usually read in the news it seemed that "try to haggle down my $5000 bill with this huge hospital" is something you just don't get to do, if you are a patient, I will remember that if that ever comes up (even though I hope it doesn't :)
If you use insurance they are less willing to negotiate.
(but you are getting the negotiated price anyway; the paranoid part of my brain thinks they run a scam here by recoding bills that come after the deductible has been met, which is a different sort of negotiation than agreeing on prices for services)
I wonder what the result would be of the US government requiring all hospitals to have a public, fixed, non-negotiable price list the same for all insured and uninsured.
In my view "emergency room" is a red herring. I once went to an ER for something. My first interaction was at a window where a worker asked me what was up, then pointed me down the hall to a facility that looked like and was just a regular urgent care clinic.
Medical care is anything if not statistical. If an ER is receiving non-emergency patients, they know it, and can design their care processes to handle those patients efficiently.
If they're billing patients $5k for a bandage, it's solely a financial boondoggle. There is also a political aspect -- blaming poor people for "wasting" care by making unnecessary use of the ER.
And if you do have an emergency you're fucked because the health insurance you were already required by law to pay for has incentives that, like the healthcare provider, do not align with actual patient care?
I remember when I was still a school kid there was another kid that fell on his head when he did skate boarding. He said that everything was alright. In the afternoon he got headache but still claimed it was alright. Next day he was dead...
And all of that only happened because my friend didn't take multiple "no" from the ER doctor for an answer and insisted that I get at least a rudimentary checkup by them, otherwise I would be dead. So, respectfully, your comment is bullshit.