[anigbrowl]

a two day hospitalization that the insurance company got for $2,100 (after the insurance adjustment), would cost an uninsured person over $21,000

Pooh, I ran up a bill of close to that size in only 12 hours without any serious injuries :-/ In fairness the hospital did tell me about their discount policy and cut it down by about half, but it was still kind of a ripoff.

Of course it seemed as if every doctor in the place took it upon themselves to have a quick chat with me, and then billed me for the privilege afterwards. I got copies of all the hospital records afterwards and the amount of duplication was ridiculous, not to mention dangerous; there's so much paperwork floating about that my discharge nurse initially gave me the paperwork for a patient in the adjoining room.

I think this is pretty unethical, really; ostensibly they're all there to help (and understandably want to to be able to defend themselves for accusations of poor medical care) but as I was recovering from a near-fatal accident the last thing I wanted was some new person coming around every 45 minutes to ask me the same questions afresh, when I had neither the energy nor the initiative to refuse.

[purplelobster]

From my experience, the weirdest thing is that you're rarely informed about something having a cost. It can be something as simple as a one minute chat that later shows up on the bill as a separate item. Not only that, but every time I've tried to ask what something costs, I can never ever get a straight answer out of them, I'll just have to find out when I get the bill and pray it's not too much. It's insanity.

[chris_mahan]

There should be a requirement that doctors post all prices like car mechanics.

[epoxyhockey]

Mechanics post prices? The only reliable way I've found to determine the real cost of car repair is to comparison shop and look online in enthusiast forums. Even then, there is still room for haggling.

[chris_mahan]

Not only do they post prices, they will write an estimate and you have to sign it in order for them to begin work, and they can't exceed estimated costs without your approval. (In California)

[mgkimsal]

My wife was in the ER a couple years ago - I asked multiple people (two nurses and a doctor) how much any of this would cost, and they all said "I don't know".

[guymcgwire]

My wife was also in the ER a couple of years ago. She was there for about nine hours. At one point the attending came by and spoke with us for less than a minute. He basically repeated what the nurses and PAs had been telling us for the past few hours. But he clearly wasn't paying attention to the case because his summary was clumsy and lacking in detail. It was no more helpful than what I was reading on Web MD on my iPhone. My wife's exact words when he left the room were, "That was weird." Later, when we looked through the bill from the ordeal, it turned out that this awkward, uninformative, 45-second interaction was billed at almost $1000. If he had told us ahead of time that his unnecessary analysis was going to cost $1000 (even if it was paid by insurance) I would have thrown a shoe at him and told him to get lost. Healthcare is not a marketplace.

[kamaal]

>>It was no more helpful than what I was reading on Web MD on my iPhone.

This kind of thing is what makes automation in the medical industry ripe for disruption. In fact close 80% of the information any doctor can give you in case of first 2-3 visits is what you would get by doing simple google search or reading WebMD or even looking up the Merck's manual.

Unless you have serious problem, automation can solve most of the problems people have.

>> If he had told us ahead of time that his unnecessary analysis was going to cost $1000 (even if it was paid by insurance) I would have thrown a shoe at him and told him to get lost. Healthcare is not a marketplace.

Exactly why we need automation. A while back CA's were considered accounting and auditing geniuses. Most of them are out of job today as accounting software got more automation and intelligence.

Wait till the time when most doctors go out of job as software automation sweeps health care industry.

[roc]

The sad part is that they usually truly don't.

Because not only do hospitals have largely-fictional rates they try to pass to insurers, there are also the medicare rates, the medicaid rates, the rates they pass to those trying to pay out-of-pocket, the rates for the generic equivalent they'll switch to after you agree to a drug/procedure due to your coverage, the discounted rates they pass to people who will almost certainly let the bill go to collections if it isn't heavily discounted, etc.

[kamaal]

What's surprising in all this is, do they actually keep track if a doctor passing by had a quick 2 minute chat?

How do you go about it? You go and tell the billing department- "I talked with patient X for 2 minutes" and then Y, Z , A, B so bill it? If you talked to something like 100 people how do you keep track of it?

Sounds like an extremely cheap way of ripping off people.

If only I could bill my company that way every time some comes to ask me a question or needs my help or a code review or whatever!!!

[rdl]

That's what the EHR is for.

[gbhn]

Hospital billing is an outrage, just like the article claims. This corresponds to what the NPR report on the topic concluded: chargemaster rates are absolute fiction, invented to offer insurance company negotiators good deals, and utterly unrelated to costs.

Unfortunately, they do relate to actual costs for those most unable to bear them -- primarily uninsured middle and lower middle class people who face these ludicrous bills at face value and too often have their financial lives severely encumbered by them. The article does a great job of illustrating this.

[wybo]

I think this whole system of differentiated / > 150% profit margin billing - when people are at their weakest, a.k.a. exploitation-based healthcare - is utterly unethical.

I honestly don't see how anyone, and American public opinion in particular, can accept that such things are happening in their country.

In any other setting such billing practices would clearly be considered criminal / outrageous. Say if a surf-instructor at the end of the day charged you $80 for his sun lotion, or if lawyers you had not signed up with started offering you advice, and charged for it at a rate only known to you after the fact. And they would be swindling you when you would not be in dire need...

How can parents still be proud when their children become medical professionals in the US? Why do people still donate money to 'non-profit' hospitals?

Healthcare, the market, and decency don't mix. At least I'm happy to live in the UK where healthcare works (a lot better). The market is great, but one has to pick the right tool for each job, and the market not always is.

[anigbrowl]

Not only are the prices outrageous and the process confusing even if you do have insurance, but patients are burdened with an absurd amount of unfriendly administration, in which all expenses are coded and the people you call up on the phone are little better at understanding these codes [1]. Now, those codes have some utility to medical bureaucrats, but because the healthcare system in the US is so unresponsive to people's needs the billing may as well be in a foreign language.

I used to live in the UK, and I really, really miss being able to go to the doctor and only having to worry about the medical advice you got, instead of trying to decipher pages of obscurantist documentation for your visit.

1. An example of (part of) the new system: http://en.wikipedia.org/wiki/ICD-10_Procedure_Coding_System The full ICD includes specific codes for things like being bitten by a turtle, sustaining a fall in an opera house, or 3 different situtions involving collisions with a lamppost.