Yesterday I received the list of charges for my emergency room visit earlier this month (for what was found to be a kidney stone). I added my best guess for what each of the charges were for:
| Summary of Charges | |
| Emergency Room (Doc + Room) | $926.00 |
| Laboratory (Blood Tests) | $137.00 |
| Pharmacy (Morphine + Others) | $91.26 |
| Professional Fees (Nursing?) | $387.00 |
| Radiology (CT Scan + Radiologist reading) | $2,375.61 |
| Total | $3,916.87 |
Of course, this is just what was submitted to my insurance, not what I’m actually going to have to pay. My insurance company may have negotiated lower prices, and I have an overall maximum out-of-pocket cap of $1,200 per year. I estimate my eventual bill to be between $500 and $1,000. I guess no Costco Vizio LCD TV this year for Jonathan 😉 I’m still just happy to be living a pain-free life right now, and am keeping myself well hydrated.
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Sorry to hear about your ER visit. Glad you are feeling better and pain free.
ouch.. kidney stones. When my dad had them, he keeled over and was sent to the emergency room too. I was so scared as a 12 year old. He recovered, changed his diet, and never had a problem with them again.
If your insurance plan has in-network and out-of-network providers that are billed at different rates, be on the lookout to see if your radiologist ends up out-of-network. Sometimes you can get radiology done at a network facility and (because you can’t control who reads it) still get professional charges from a non-network provider. The carrier will be content to let you pay the higher non-network copays, but will often capitulate if you put up a fight.
As Jonathan mentioned, the insurance company will probably negotiate lower fees but you pay your co-pay or percentage based on the “retail” rates. Then, the insurance company goes back and only pays half of what the “retail” charges were.
I just got married and switched onto my wife’s plan. I’ve spent the last 30 days making new doctors appointments and setting up a new primary care physician, eye doctor and dentist and NONE of it is easy. I try to follow the myriad of benefits only to have providers tell me a completely different story.
Example: At the eye doctor, my benefits say that I pay $15 copay for a single lens, $10 copay for a UV coating and $40 copay for anti-reflective glare crap. But, when they ring up my charges, it’s like $140 something. What gives? The girl doesn’t get it and I don’t get it, so I end up with crappy glasses because I refuse to pay the extra money. And, I give up with the girl on the phone from EyeMed because I don’t understand a thing she is saying.
Not only is our healthcare problem a cost prohibitive issue for many people, navigating the bureaucracy is 4x worse! If, and when, the politicians ever take a stand on these multi-billion dollar rackets, they should work on the KISS principle – KEEP IT SIMPLE STUPID! 🙂
-dave
I also have the kidney stone problem. I know the pain:-( I used to go to emergency room because of kidney stone pain. Now, I just keep a good supply of vicodin at my house. As soon as I feel the pain, I take the vicodin and pain goes away. No more going to the hospital and wait one hour to get the shot. No more paying emergency fees. Just my two cents.
When you start getting your bills make sure you ask for early payment discounts. We had a baby 2 months ago. The hospital bills for my wife and baby both had a 10% early payment discount clearly marked. The anesthesiologist bill for the epidural had no such discount, but when I called them they were happy to offer a 20% discount if I paid via credit card over the phone. Saved me a cool $50 with a 3 minute phone call!
Hey, wait! I thought you said you’re currently under your wife’s health insurance plan. And, with her plan, you have to pay a 20-30% coinsurance for outpatient hospital visits/services and lab/imaging and therapy? (if yes, that sucks; but oh well.) Or, is it just a flat fee of $75 or 100 or 250 for ER visits?
Oh, btw, any chance you can pay your hospital bill with your credit card, so at least you can accumulate points?
David:
As both a medical provider (granted, I don’t deal with billing that much) and a user of the American medical system, I have to disagree with you on how most insurance companies calculate co-pays/co-insurance. Most insurance companies pay 70%, 80%, or 90% of the billable amount (total charge-contractual allowances). Almost all consumers are only responsible for the remaining 20ish% of the billable amount–NOT the initial amount billed.
If you paid 20% of the original charge to a health care provider, call your insurance company on them. It’s probably not right.
Haha, I racked up over $100k of medical bills while I was in college, due to 3 lung surgeries. Thank God for health insurance!
Feel better! I was a freelancer for a couple years, and the insurance issue was non-stop stress.
The majority of hospital bills to insurance companies are over priced.
These places think us consumers are stupid. Hospital bills $5000.00. Insurance only paid $1800.00. In many cases this amount then is accepted by hospital as paid in full.
Now the insurance company and hospital sat down and negociated their prices probably last year or so for these services. So the hospital knew when they submitted the bill they were only going to get the lower amount. This lower amount probably actually represents the true cost of services.
The reason for the higher $5000.00 amount is incase your not covered by insurance you foot the bill to subsidize the hospitals profits.
Seems like a lot of $$$ to diagnose a kidney stone. Did they do a urine test before the CT Scan? Urine test and maybe a couple of x-rays should have done the trick…
@David Rocci: >
I don’t believe that is true. My insurance (BCBS PPO) provides that I pay my co-payment and then 30% of the negotiated rate – not the retail rate. Out-of-network is 50% (instead of 30), but still the same deal – off of the negotiated rate.
I don’t see how it would be ethical (bold word when dealing with health care!) or possibly even legal for a care provider to accept one dollar amount from an insurance company but then bill the insured another amount.
I really hope you don’t get an unpleasant surprise bill from the ER Doc. like I did. (A month or so after the rest of it came from the hospital.) I was shocked to see that the Dr. bill was seperate!
Goo, unfortunately it depends on the doctor as well. Urine analysis would demonstrated blood in urine, then an ultrasound would demonstrate hydronephrosis (backing up of urine to cause renal tubules to enlarge) and also the stone if large enough. X rays are rarely helpful in diagnosing kidney stone. Also, given the nature of lawsuits in this country, many doctors are afraid of not doing enough. So CT is a lot more specific for kidney stone than ultrasound, and that is usually why they are ordered.
The breakdown should almost certainly be…
Emergency Room (Room + Nursing)
Professional Fees (Doc)
Sorry bout your stone, but after seeing that you racked up a 3000 dollar medical bill makes me kinda sick. I just watched Michael Moore’s movie Sicko this weekend and it’s disgusting that in England, France or even Cuba you could have had all this done for free. I encourage everyone to check it out.
I also think it could be a good subject for a post because of the financial implications of healthcare for individuals.
you should have stayed overnight in the hospital…then your out of pocket cost would be capped (prob $100). and you’d of gotten a free breakfast too! Just kidding (not really).
Your summary of charges are VERY LOW (seriously).
You’ll prob pay 394 + 250 + 15 = 659 thats my guess.
You are too young for kidney stones!!
Socialized medicine as applied in other countries certainly has many downsides as well.
Higher taxes to pay for those services, lower availability of specialized care and equipment (I heared stories of Canadians / Brits waiting for months to get an MRI done). Governments would only allow a certain amount of MRI scanners per population, (an amount that can’t keep up with demand and creates huge backlogs), in order to contain costs. Some people will end up paying fout of pocket for private care since the public healthcare system is too slow and too inefficient.
And of course there are the large bribes that are paid in countries like Cuba and other formerly socialist countries.
I also want to remind you that a large amount of today’s healthcare expenses is due to defensive medicine… i.e. docs ordering more tests than actually required by common sense in order to cover their ass and not be sued by trigger happy patients and fast talking lawyers.
Tort reform should be high on the agenda if costs of medical care is to be contained.
I’d like to point out that those “socialized” medicine countries mentioned all have far better outcomes, despite delays, than their US counterparts… and for far less money.
God bless the NHS in the UK!!
Since hospital charges, and emergency room charges, are so inflated for simple items and procedures, it only is fair for the public to demand a fee chart, YES, like a restaurant menu. Getting hit with a humongous $1,000 bill for being seen for 5 min for a swollen eye would catch anyone off guard. Oh, this fee does not include the physician’s charges as noted by others. Sighhhhh.
So what can we as consumers do about these inflated charges. I recently had a visit to our local emergency room. I was charged and my insurance was billed $2204 for a bladder infection. There were no contractual adjustments made to lower the costs. I have had bladder infections in the past so knew that’s what it was going in. I had only a urine test. I know that a local lab billed insurance $84 for a urnine test last time I had a bladder infection. Unfortunately the lab was not open at 5am this time.
I had a similar kidney stone ER visit very recently.
I just got a notice that about $4300 was submitted to my insurance. I was shocked to see this. But it looks the fees are about the average for this type of cases in US. My out of pocket would be around $1050 including the 500 deductable.
I did receive CAT scan, i guess $1200 x 2 ( 2 sides?)
and some urine, blood tests. some pain killers. Also i was sent to ER by calling 911… I am not sure how they charge for ambulance . After 3 hours ordeal, the little stone passed and i was back to life again. Had no idea this could be such expensive and painful experience
I do not understand why there is a $1000.00 charge for the emergency room. since you are charaged for everything and everybody e test doctor supplies. In my opinion it is just a big rip off. but since we are IN PAIN we just accept it. we will sign anything to get help. Since the hospital is willing to give a discount for prompt payment that is what it really cost maybe even less.
but what can you do?
Sorry to hear of your ordeal. Your kidney stone experience was a heck of lot cheaper than mine. My total bill for this painful experience was $9,515.03. Although I have insurance and went to a panel Hospital, turns out the phyisicians are not panel so I have to pay the ER doctor $665.00. Not only did he bill me for the er service, he billed for after hours service (isn’t that what the er is for?) He billed for interpretation of the x-ray. Sam from June 23 response suggests keeping Vicodin around the house, good idea I will now do the same. Health care costs are out of sight. Because my physician could not find the stone, it took me 3 months and numerous visits to the doctor before I passed it. Think about how much cheaper and pain free this whole ordeal would have been if they would have broken up the .8cm kidney stone in the er. No wonder health care costs are out of control. Hope you are feeling better and are stone free.
I was told by my temp insurance provider to go to the ER when I had a very serious leg infection, that I would meet my deductible sooner. A doctor in the ER checked me an determined it to be cellulitis. They gave me an Iv but first did an ultrasound to rule out blood clots then wrote me a prescription for two different antibiotics and said to come back when they ran out, if it wasn’t any better. The bill from just the hospital was 5434.00 not counting the doctor or the ultrasound. I have ask tons of times for an itemized list and haven’t received anything to date. The next 8 times I had to go (because it wasn’t getting better) all that was done is an ER doctor looked at it and gave me a prescription for a different kind of antibiotics and the bills were 4356.00, so now they say I owe over 30k and this is after the insurance paid them which I’m still not sure how much that was and they never helped my condition. I also had open woulds on my legs from eczema which they new about but gave me nothing for, when I asked they said they didn’t want it to interfere with the antibiotics. It wasn’t until the last ER doctor asked how long I had been coming into the ER this was at the end of August and when I told him since May he about shit and ask why they hadn’t sent me to an infectious disease doctor. The next week I went to the infectious disease doctor he also couldn’t believe why they prolonged it for so long and put me on antibiotics for 7 days straight which final did the trick and also gave me a prescription for ointment to put on my eczema. But now I have a different problem because it was stretched out so long now my foot hurt so bad and most of the time they are like pins and needles, I can’t walk or stand very long without feeling bad pain in my legs and feet and if I lean on my right foot it almost feels like the bones in my ankle joint have deteriorated. I truly do not know what to do I just turned 60 this April and last week last my job.
I meet they infectious disease doctor put me on Iv’s for 7 days straight
My brother was uninsured at the time and had his hand bandaged from a terrier dog bite at San Gabriel Valley Medical Center in CA. The bill was $2900.00. I tried to negotiate with them and no dice. Ended up giving these bastards 2000.00 cash…
I was treated for a cut that I thought may require stitches on my forehead. The doctor decided that some medical glue would do the trick instead. I was out of there in 15 minutes. I was billed $805 for some super glue! $480 dollars for the doctor and $325 for the hospital! I used to have a $100 copay but with the insurance changes my company made I have to pay $700 to treat a cut. This is crazy!
I agree with the comments above, why are we not made aware how much a procedure will cost until afterwards. An estimate at least should be provided.
Due to the wonderful economy, I have changed jobs a lot in the past 5 years and currently have no medical insurance. I have no issues with medical providers and I haven’t seen a doctor in a long time because of the financial issues. I have a Ph.D. and (usually) a decent salary; but I’m not in a posistion to rack up emergency room bills that I can’t pay. Just a few days ago I had some GI bleeding (lower) so I went to an urgicare center (about $125) and they were great, I saw a NP, she checked me out and even gave me some IV fluids since I was barfing as well as bleeding. She made me feel better but told me to go to the local ER for further evaluation; rectal bleeding could be serious. I went to the ER and foolishly tried to explain that since I had no insurance I only wanted examined since I could not pay more than, say $500. I realize that they obviously can’t quote exact prices, but I got treated terribly. A nurse basically told me that I couldn’t dictate my medical care and told me that my symptoms were serious (duh!) and after sitting in a room for 1 hour a doc finally came in. I politely asked if he understood my financial limitations and the little jerk started yelling at me so I walked out. The clerk at the desk asked me to reconsider; they get in trouble if a patient leaves before being examined because they don’t get paid, which was fine with me. The “doctor” followed me into the parking lot asking me to sign something about leaving; I told him that I hadn’t signed a consent for treatment (and would not do so without at least a cost estimate). Wonderful treatment.
@medical care refuser – They can’t adjust their treatment based on your financial concerns, because they face the same liability no matter what. If they did something less-than-optimal to save you money and you suffered from it, you could still sue them for malpractice. In any case, I hope you feel better.
(update )thanks jonathon for your opinion): interestingly enough, the ER that treated me like crap actually had their CEO (an MD) call me to intervene in my case…she had me admitted and was overwhelmed that I was willing to front the $500 for just a simple ER exam…..yep, they sure can adjust prices..I stayed for 2 days and ran up a horrific bill and they were totally willing to accept the $500 as payment in full…it’s a hellof a situation when you have to request an estimate for medical care before treatment; I normally make more thanthe ER docs do, but due to the economy. I’m without insurance……no matter; after my lousy ER experience with a resident, they admitted me and treated me like a king……………I expected minimal care and got great care…….”liability” had nothing to do with it…the “jerk” doc in the ER was contrite; she said: “I’m sorry that I treated you badly (she really didn’t)…
I was rushed to ER in CA , treated well and released same day. X-Ray, blood test and some medicine. Suspected Pneumonia but it wasn’t or in the beginning stage.
Got a bill after few days. $4500 – 900 as uninsured discount = $3600
So that is the due amount. But wait, if I pay within a month then they would offer another $900 discount, which makes the total $2700.
Do they want to adjust to my situation because I was uninsured and trying to negotiate?
There was no breakdown of this bill, no itemized list; just a pure amount.
Shouldn’t they have sent me a detailed bill?
The amount was shocking to a college student like myself. The comments here are really helpful. Thanks guys!
Just got a $4500 bill from ER 🙁
Our deductable is $7500 – Happy 4th of July. God bless America I guess.
With out health insurance I had a two night stay in a ER for a heart attack.
My primary care doctors associate came in my room twice? asked me HOW DO YOU FEEL? A month latter I received a bill of $180.00 for “HOSPITAL SUBSEQUENT DAY MODER COMPLEX 25” My new hearts stents are laboring to keep up with this stress. The hospital was full of doctors I did not need his PROFESSIONAL SERVICE. Is there any way out of this mess?
Thank you
Kevin