[nostrebored]

But this is _not the case_ in other countries. In South Africa, if you go into a private ER, there are buckets of severity and a clear price tag. If they are going to do something to you that might change the price at discharge, they will tell you. If you have a discrete problem like 'my ear hurts and I want to go to an ENT doctor' then they tell you what the price will be upfront.

It does not have to be a gigantic mess. Being back in the US, I just went to the ER and it was shocking being discharged and not being able to know what I owe.

[mwerd]

Well in the u.s. the decision about severity has to be supported by medical documentation from a licensed provider. That medical documentation has to be converted to billing codes and put on a Medicare designed claim form. Payers, primarily government institutions like Medicare and state Medicaid offices, regularly audit these claim forms by random sample. If they find errors on those forms, such as a severity code that was not supported by the documentation, they extrapolate the number of failed tests in their sample to the population of claims they paid and claw back those payments. Depending on context, they might actually impose treble penalties as well and run your name through the press as committing fraud.

Do they do something like that in South Africa? It's not exactly known for the high quality of it's institutions.

Paying for better care and experience is possible in any country. Perhaps it's relatively easy, in a high inequity country like SA, to pay for an experience you like. Labor is pretty cheap there. It's gonna cost you more in the U.S. but you can get that experience here too, if you want. Find a doctor who doesn't take insurance or maybe look at Atlas. Bring your checkbook...

[yamtaddle]

> It does not have to be a gigantic mess. Being back in the US, I just went to the ER and it was shocking being discharged and not being able to know what I owe.

One of the outright-grossest things about US ERs is they have dedicated vulture-like staff wandering around to extract billing information from the sick, injured, and distraught, but those folks can't even tell you anything about what it's going to cost (and neither can anyone else).

[DavidPeiffer]

My personal favorite is when they come around with their computer cart and have you sign on a 2x6 inch signature pad without showing you the documents. Growing up as the son of an attorney, I read documents before signing and get annoyed that this ever became the status quo.

It seems to be about 3 signatures. But if you don't insist they print the documents off and give you a copy, you could be signing away tons of rights you wish you had down the line.

--

Tangentially related to billing, the workflow to check in with one of my clinics requires me to give them permission for more aggressive collection practices than are legally required. I can revoke that permission anytime, but there's no option to turn it down while checking in. So every time I check the box, then immediately talk with the receptionist to add a flag on my account. She takes a screenshot and prints it off for me. From doing that interaction a couple times, I think I'm one of very few people who do it.