Visiting the ER WITH Health Insurance and Without

girl and fence$2600.
$544.

Look carefully at those two numbers. The first is the sum of three bills I received for my husband’s day-after-Christmas visit to the emergency room for unusual dizziness. A CT and EKG ruled out a stroke or heart attack. Diagnosis? Vertigo.

(Note: both figures will likely be much higher once all the bills come in, but I needed a blog post so I’m going with what I’ve got now).

Now look at the second figure. That’s what I have to pay after the discounts my insurance company has negotiated with the hospital and radiologists. Note: there are no payments from the insurance company in there because we had not yet met our deductible. These are just the discounts.

Which points out a really critical issue when it comes to those who have health insurance and those who don’t. Merely by having health insurance–even before my insurance company spends a single cent on my medical care–I benefit. I benefit from the administrators who go to the hospitals and doctors and negotiate deep discounts in exchange for funneling more volume (i.e., patients) to their practices (and yes, I know that the doctors and hospitals on the receiving end aren’t thrilled about it, but that’s a topic for another blog post).

Someone without health insurance, however, likely because they can’t afford it, has no such benefit and so winds up paying that first figure–if they can afford it.

(Note to those who are counting: that would be about 35 million American citizens).

A few months ago Congress was close to providing insurance to those people, enabling them to enjoy the same discounts my family does. Today, they’re still stuck on the outside looking in. How is this good politics or good policy?

Because what all this talk about healthcare reform really comes down to in the end is the ability to go to the emergency room on the day after Christmas when you’re petrified that your husband may have a stroke, receive quality care, and be able to pay for the care you received.

It’s really not that complicated.

Your thoughts?

6 Responses to “Visiting the ER WITH Health Insurance and Without”

  1. Medical Insurance

    Very good blog post!

    In a recent conversation I had with a nurse, she explained that when a nurse administers insulin to a patient at her hospital, she takes one dose from the vile and throws the remaining insulin in the vile away. But…the patient is charged for the entire vile. This is the procedure the nurses are instructed to follow by the hospital.

    I called the hospital to ask what a vile of insulin costs. I spent 90 minutes being switched from one department to another…I spoke with the billing department, the business office, the Vice President of Patient Services, and yet no one was able to tell me who had access to this piece of information.

    I became quiet concerned when the conversation turned and I felt as though I was being interrogated by the Vice President of Patient Services…who was asking questions such as “Who are you?” and “Are you a reporter?” and “Why do you want to know?”

    Finally, I was told that if I wanted to know the price of any services offered by the hospital, I would have to go the hospital's business office and look in a book that has the list of prices charged for their services. I asked if I could call that office and have someone look up the charge in question. I was told very emphatically “no”! When I asked “why not” I was told by the hospital's VP of Patient Services, “because we don't have to, the law does not require that we give this information out over the phone”.

    I written more on this subject at: http://www.besthealthcarerates.com/medical_insurance_Blog/bid/25421/Secret-Medical-Charges-And-The-Bankruptcy-of-The-Healthcare-System

  2. Ciro Attardo M.D.

    What's your point? I'm proponent that all should have health care insurance. I also believe that your health care bill is much too high and much of it is due to lack of tort reform. A good physical exam would have shown that it was vertigo. But there is no ER doctor in his right mind that would not order those test and expose himself and the hospital to a lawsuit.

    Fortunately your husband is ok. But if he was having a stroke, he would have had access to treatment to dissolve the blood clot and preserve function. What is the dollar value of having a stroke prevented? This is something that is done many times a week in the ER you attended.

    But since you bring up numbers let me add some to you list.

    But let's put the numbers into perspective. Compare these number to what you may spend on health care in a year…. Better yet in 10 years.

    A family that smokes 2 packs of cigarettes per day in NYC spends the following :
    * $7300.00 – in the next year. Cigarettes not smoked= 14600
    * $21900.00 – over the next three years. Cigarettes not smoked= 43800
    * $36500.00 – during the next five years. Cigarettes not smoked= 73000.

    One estimate I read, stated if a 40 yr old person person stops smoking 1 pack/day and invests the money saved, he will have $250,000 by age 70. And we're not even considering health care cost for smoking related disease.

    How much would a family spend to see the Lion King and have dinner in the restaurant!

    How much do you spend on cable TV in a year! 10 yrs?

    I don't see any blog articles or congressional hearings calling for the government to pay those cost. Your $500 – $3000 hospital bill doesn't compare to what most people pay on frivolous or unhealthy habits.

    How much will it cost the taxpayer to cover the $3000 ER bill under a government sponsored plan! My guess it will be a lot higher.

  3. Anonymous

    Last fall, I was told I needed a biopsy of calcifications that had been followed on my mammogram for 5 years. The radiologist told me that it didn't matter whether they had changed. What changed the recommendation of watchful waiting to biopsy was the availability of a nonsurgical stereotactic procedure that could be performed right there in the radiologist's office. When asked about cost, the response was that it was certainly somethng my insurance would cover. As bc survivor, I turned to my oncologist for advice. She didn't have the time to pursue my questions and said, “Just do it.” I did and was not surprised the biopsy results came back with no evidence of cancer. Glad I didn't have to give up something like my antihypertensive meds to pay the deductable.

  4. Anonymous

    If you had the CT scan at a freestanding radiology center instead of the hospital, it would likely have cost about $500.

    We very much need to go to an insurance system that is more like auto insurance, with HSAs, and far more transparency of cost.

  5. Deb

    I agree Alisa. . the thing is, cost is all relative. Why does one blouse cost $500 and another $20? Because we will pay for it. And since 'we” the consumer, rarely actually pay for health care . . . we never know the cost. Also, I seriously doubt it cost your insurance company that much OR that your insurance company's negotiated rate was anywhere near that much.

  6. Alisa Bowman

    When I was in the ER recently and my doc wanted me to get a CT scan, I asked how much it would cost. He did a double take, recovered and then said, “4 thousand dollars.” I said, “How badly do you think I need a CT Scan, because that sounds like a lot of money to me?” It ended up that I really needed one. But the whole process took 10 minutes — tops. Hard to justify that 10 minutes of a radiologists time should really come to that total. Even if you have to pay off the cost of buying the machine. Just saying.

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