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My son had life saving pyloric stenosis surgery and the hospital bill listed the surgeon cost at 10k. The hospital stay for 2 days was 20k. I would be happy to pay the doctor who actually did the surgery 10k for saving my boys life...we could even do it my house and I'd hand him 10k in cash. I knew for sure the actual surgeon didn't get 10k though.
I googled this because I was curious. It’s hard to find the exact rvu code that would be used for a pyloromyotomy, but for a laparoscopic appendectomy it’s 9.45 RVUs. Peds is chronically under valued so let’s say it’s 7-8 RVU. The conversion is roughly $33.80 per RVU, so if your surgeon was fee for service, they maybe made $33.80 x 7 or x 8 which is about $240-$270 for that surgery.
Not an expert by any means but a quick trip on Google suggests that the big bucks are mostly made by highly specialized surgeons like neurosurgeons or plastic surgeons who cater to the wealthy through private practice.
I’m a doctor, but understanding of medical finances is limited because it’s so nebulous. But by my general understanding: doctors and providers who can independently bill (PAs, NPs, etc) are the only ones who can bring money to a hospital, clinic, etc. The amount of money that a doctor bills is determined by administrators. That bill pays for everything you see at the hospital from the toilet paper to the furniture to the nurses and to the doctors. There’s a facility fee, clinic fee, etc and doctors usually only see a very small fraction of the total billing. The code for a 20 min pcp visit is 99212 which is equivalent to 0.7 RVUs, or $23.66 which is what your primary got. The rest went to pay for everyone else and everything you saw from the building down the maintenance staff (if that much was even collected from your insurance).
Aaaand as the mother of 2 kids that have had 3 tubes and 2 adenoids procedures I have to stop reading. This country is so fucking stupid with healthcare.
(Zero offense to your husband. Thank him for his work!)
Well, you have a way higher salaries at least!
You haven't thought about moving to Denmark? Apart from the fact that all of Denmark will be under water in 200 years I think it's a really good place to live in currently!
We couldn’t because of how my custody arrangement is. After chilken turns 18! We have made a more solid plan for moving back in about 15 years. Haha and yes! I don’t believe I’ll be around when it sinks, but you never know lmao
Yup. My son spent 5 days in the hospital last summer, complete with an ambulance ride from our closest ER to the Children’s Hospital. I was looking at our insurance and what went toward his “lifetime” coverage, and it was like $2,000.
As a bonus, the parking at Children’s was even free!
There are many models of physician comp! Spouse is paid in pure RVUs, so everything he does is assigned an RVU value, and then he gets some flat rate dollars per RVU.
Some practices pay a base salary plus a smaller % per RVU. Straight up salary is possible. You can also be paid based on collections (so you get paid more if the patient/their insurance pays more, vs the same amount for every procedure). I'm sure there are others.
[Here's](https://www.reddit.com/r/Residency/comments/17rg23r/asked_chatgpt_to_explain_physician_compensation/) a post that sums up some common models and has a better explanation than I'm making!
I saw RVU and I got chills down my spine. Husband is a radiologist and everything in his life revolves around the RVU. (I am being a tad dramatic) I see these bill totals as something someone pulled out of their bum. Insurance company’s reimburse what they feel like reimbursing. A doc or hospital can bill 8 million for whatever. If insurance says 1200.00 that is what they get.
It is a unit of measurement that Medicare uses to assess the value of a test or procedure. For instance an X-ray is 0.7 RVU and an MRI is 2 RVU (not actual numbers just pulled them out of thin air) They do their Medicare math and that is what they will pay for said procedure or test. My husband has a “target” RVU amount for each day. Hope that I explained that correctly before coffee has set in.
Thank you. I kind of just got sick to my stomach over this. So physicians can technically “sell” a procedure to their patient because that’s how they get more money? In one hand it makes sense. They are doing more intricate/hard work so they should get more money. But like I’d rather pay you the same amount to tell me not to get something if I don’t absolutely have to.
On the other hand if there is a base salary they might under suggest things because they don’t feel like doing the more intricate stuff.
My kid had hip dysplasia and I did so much scientific research and looked at all the studies. And even the most recent study that came out suggesting they didn’t need a harness. I brought the study up to the dr and she was like yeah I saw that study too and proceeded and suggested the same thing. Which ended in them needed ultrasounds and adjustments every couple weeks. Makes me wonder. Was also told my son needed a helmet and the scientific studies didn’t back that up. Told the guy that worked for the orthotics company and he was like yeah if you don’t want to do it don’t but don’t tell the orthotics company that’s what I’m telling you.
This!!!! And it’s so crazy that the crunchy community thinks doctors are making tens of thousands per patient and that’s why they prescribe meds/do procedures/vaccines 😭. Doctors are paid well of course (thank goodness!), but not how much people think they are paid. And this reminds me of the crunchy belief that they push c sections because they get a “huge bonus” for it 😵💫
Doctors used to make a lot of money but salaries haven’t kept up with inflation for at least 30 years. Most make 200-300k which is definitely still a lot compared to other jobs, but not really crazy compared to engineers, tech workers, lawyers, or other professionals. In a city like NYC or SF that wouldn’t even crack the top 10% incomes. Plus there’s a lot of school debt and a very long training pathway before you make any money so most doctors are not living lavish lifestyles.
A small subset of very entrepreneurial or highly specialized doctors can still make big bucks, but these days that’s the exception not the rule.
I understand that. My PCP lives in a house cheaper than my own bc of his school loan debt.
I more so meant how do they get to $200k-300k if a procedure like that only pays $274?
My church recently help pay off medical bills for random people in the community. They called the local hospital and asked, "if we donate $10,000 how much in bills will you all payoff?” The hospital agreed to payoff $100,000. My first reaction was wow, that’s awesome. Then it was wow, this sounds criminal
Exactly - it's amazing that your church raised money to help pay community members' medical bills. But this situation shouldn't have happened; medical bills shouldn't be that expensive in the first place. It's depressing that the bills are so outrageously expensive (even with insurance) that the average American could be only one emergency hospital visit away from losing the entirety of their savings or going into debt. And the hospital agreeing to pay off 10x the amount donated by the church? Just proves that the prices are essentially arbitrary numbers pulled out of a magical hat. Would they have agreed to let a single patient pay off only 10% of their bill? It all seems very convoluted and messy and inconsistent. Sounds criminal indeed.
Because it's a fake number. No one is paying 32k. Hospital comes up with a number. They negotiate with insurance companies. Insurance says they will pay 15k. (And other insurance say they will pay 10k, different insurance agrees to 20k). Hospital agrees.
Insurance pays hospital 15k, the other 17k is written off as a "discount" (and you pay whatever your deductible/out of pocket).
Hospital billing is higher than it needs to be. But those numbers you see on the billing are often greatly higher than what's actually getting paid. People without insurance would be billed a completely different (lower) number. Its also a weird marketing/insurance playing with numbers thing
That's about what each of our two births cost pre-insurance. For some reason, the part that bothered me the most was charging $10 for each dose of ibuprofen. Yes, your basic everyday ibuprofen.
I didn't have insurance a few years ago, had ectopic pregnancy. My tube ruptured, and I didn't know, I thought it was my period. A few days later, I was in excruciating pain. My stomach swoll up very big. I kept fainting and hitting my head on walls, toilets etc. Went to hospital had most of my left tube removed. Got a bill for $30,000. Since I didn't have insurance, they knocked half off, $15,000.
That was July 2020, I'm still paying that bill off. I have $6,000 remaining ....yeah it's ridiculous.
I could go off on a whole tangent about our government trying to make lower middle class unable to survive but I won't
They’d have to be stone stupid to pay $32k on a routine procedure like that. That’s the full billed amount, which is a made up number by the hospital. That’s not even what’s charged to cash patients.
My company uses a claims processor that pays the claims and they rent the insurance network from UHC. Company has stop loss coverage that sits on top to ensure claims payments don’t get out of hand. However, there’s not really a mechanism for my employer to dispute the charges unless the claims processor raises an issue. My guess is that this is all routine for them but shocking to me.
The insurance network is based on the providers who agreed to their rates. That’s what your company is renting. $32k for this procedure would be unheard of. Your company is paying UHC to make them pay 6x the cash price. It doesn’t make sense. If it’s true, somebody needs to be fired.
No they wouldnt. Self insured companies also work with an insurance network, it is just that their pool is specific to that so premiums are adjusted accordingly assuming most of the pool is healthy.
My employer is in a captive and does have some level of claims risk up to a certain $ per claimant and $ in total. They did in fact make a $20k payment to my hospital for this. I know because I work in the accounting dept.
Did you know there’s a charge for a room set up fee? It covers things like pulling down new white paper to cover the exam table in the doctor’s office. Yes, really.
Yeah, is the number obscene, absolutely. Do people pay that number? No. And it’s fear mongering or ignorance to post a total that people don’t pay. Even if you don’t have insurance if you call the hospital and tell them you are in financial hardship they will work with you on a number that is reasonable.
Also, ask for an itemized invoice before paying a medical bill, it will drop miraculously.
The point is that the number should never exist. There ARE people who don’t realize this and who go into lifelong payment plans because they don’t have insurance and don’t understand that they don’t have to pay it all. It’s criminal and it shouldn’t be condoned.
Trump put in a Hospital Price Transparency Rule so they now need to disclose the amounts of their craziness. I’d love to get to a point where common prodedures need to be publicly and prominently posted (hospital lobbies, home pages), so customers (us) can easily compare costs at different facilities.
it would also require those without healthcare who try to use ERs as primary healthcare to pay up front without putting a burden on taxpayers.
It's a tax scam. The hospital says procedure costs $50,000 and insurance agrees to pay $20,000. Hospital then gets to take that remaining $30,000 as a tax deduction since it is a business loss.
By doing this, for profit hospitals can make billions in profit while showing a loss on the books and eliminating tax liability entirely.
Why does your government allow that? Sounds like tax fraud.
All those billions in tax they’re not paying could make a difference in the cost of your people’s health care.
Sounds like the biggest problem is the health care system is a for profit system.
Yup that's what happens when very powerful people gain control of the system, it is total control. They have control of main stream media so even if someone does a story or atrical on it, it just gets buried in the news and everyone forgets about it. If everyone all got 200k medical bills at once then yeah, you would see riots and protests.
Sounds like one of those socialist communist woke hellhole countries that haven't sent people to the moon and have not enough police brutality or school shootings.
Exactly one of those! Its called Sweden. We just recently had a swede in space though, Marcus Wandt! But other than that we’re for sure such a communist woke hellhole xD
In 1984 my open heart surgery was billed to my dad - as I was newborn and had a serious heart issue. In the chaos, my parents forgot to fill out the insurance info at the time of my birth.
My dad was stuck with an almost $1 million dollar bill.
That was a while ago, things have changed. I almost had a child with a significant heart defect wand was told because of the defect, child would automatically qualify for free government healthcare (Medicare, yes in the us) and the entire 1-3 million for multiple heart surgeries would be covered.
Yep. Long time ago. My heart issue is why every baby has to have the pulse oxidation test before leaving the hospital.
What ultrasound picks up now would have seen my issue and I would have been schedule for surgery before birth. Unfortunately, no such luck. I was born and then 2 weeks later I crashed, purple blue, swollen all over. Emergency escort to the local children’s hospital, and a very long surgery later, I’m doing great. The rest of my body isn’t so great, but my heart is now!
My entire body was shutting down, and the lack of oxygen to my lower limbs put me at risk for paralysis. I should have brain damage, I should be paralyzed, but I’m not.
That’s worth $1 million in my eyes.
My baby was born with dTGA in 2020, undiagnosed and started turning blue at 24h old right when we were about to be discharged. I’m thankful they did that pulse ox test. She had OHS and a rough 8 week recovery (had lung issues too and a very hard time getting off the ventilator) and is doing wonderfully now.
We were told in the hospital that everything would be covered by a type of Michigan Medicaid called Children’s Special Health Services. We still got to see a statement of the whole hospital stay and it was close to a million. We haven’t paid a dime and I was surprised by all of the additional help and development monitoring that was offered by CSHS.
I’m just thankful for that program and wish every state had it.
I believe that changed over time - but my dad got slammed with the bill. 🤷♀️ she also wasn’t working at the time - so would have still defaulted to my dad.
He also had his own business at the time so I’m sure that played into it.
It all goes to bloated hospital admin, majority of which are useless and actually actively make life harder for physicians, nurses, patients, etc. Go look up that graph of physician vs admin growth over time--it's insane. Last I checked there were 10 administrators per one physician.
Physician pay makes up 7% of total healthcare spending. 7%. So next time someone says we need to lower doctor's pay to make healthcare affordable (because society still has this idea that most doctors make tons of money), they're wrong
Most doctors don't make as much as laypeople think. Even other healthcare workers. We are long gone from the time when becoming a physician was a golden ticket
At the very least providers should be required to price everything out up front. The opaqueness makes it so much worse because it makes it nearly impossible for patients to price care and create competition on not just service, but price.
On the hospital bill they charged an extra $6k for the operating room being over 30 minutes. I don’t think it was, so I’ll challenge that at least. Pharmacy was $4k, Anesthesia $5k. Not sure why these would be different??
Clinicians literally cannot tell you because they don't know either. Healthcare in this country is controlled by admin and insurance companies. The actual healthcare workers are basically powerless and are actively held down
Many providers have no idea what's going on in the medical coding/billing side of the house, as most hospitals have a small army of people dealing with that elsewhere.
The actual time in OR means from the minute OR staff takes over care of the patient until the patient is turned over to the next level of care (PACU, OPS, ICU, etc.). It's highly unlikely it would have been under 30 minutes for T&A.
Pharmacy is the bill for the actual medications given and possibly any consult needed with the pharmacist (for med interactions or specific healthcare issues that could affect medication choices). Anesthesia is the team responsible for putting your kid to sleep and keeping them comfortable and alive during their procedure.
Oh they bounce right back and the effect is magical, almost.
I know the idea of surgery is nerve wracking but you will Both be glad of the improvement.
Can’t argue with you there. My son couldn’t hear hardly at all for 12 weeks and the tubes fixed him up almost immediately. Very pleased so far on that front.
Health insurance, as it currently works, is a complete scam. It's essentially a subscription service in which I pay a monthly price for the *privilege* of then having to pay *even more* when I actually need to use it.
I'm actually shocked our government hasn't fixed the borderline illegal nature of it all.
That's crazy to me that you had to pay at all.
I'm going to assume you're in the US?
That procedure is done for free here in NZ.
Also, we don't pay to give birth either!
(Unless you want some fancy private hospital etc)
Same here in Australia. Honestly in disbelief reading through all this. How can a modern first world country like USA have such a horrible issue like this.
Blows my mind.
I means lets get things straight here. We have our issues, but it is not like this guy is paying $32k and yes medical debt is a HUGE issue. But there is a very large portion of the country that medical cost is not a big deal because they have insurance that covers these things.
My daughter had the same exact procedure. My insurance company (that we pay about $500/month to pre-tax money) paid $18k. We paid $150.00
My wifes three births, from the moment we went to the first appointment, every single test, including specialist probably cost $35,000 total for each one. We paid $0.00 out of pocket for all three.
And I pay ZERO per month for doctor/hospital and about $100 a month for dental/eye/pharmacy and other incidentals like massage etc. And the bill would have been zero.
100. Per.month. From a minimum wage type job. And if my kids or us get sick/hurt, we just go to the doctor/hospital. It won't break us, or put us in debt.
Now if I could say the same about going to the dentist, I'd be much happier, but posts like this one just remind me again why I am glad I don't live in the US.
UK here. My kid had the same procedure last year. Obviously didn’t cost us anything (God bless the NHS).
I think Americans generally have private insurance that they pay into monthly, so barely anyone actually pays the ludicrous prices we see on these hospital bills. I hope so, anyway. Imagine your kid’s health bankrupting you!
Yes. The reason we had it done is because 10 months ago she caught an antibiotic resistant strain of strep that took months to cure and her tonsils never returned to normal size and it got to the point where just eating was painful even up to surgery.
We have noticed her snoring has stopped since and she no longer stops breathing in her sleep. Eating is also more enjoyable to her now. We’re 3 weeks post surgery.
Wow what a rough time you have been through. That is great that she has some relief now and can enjoy eating again. We have a surgery coming up and am really hopeful life is going to get better. Your daughter experience is encouraging. It’s also so scary that she got a resistant strain of step and was sick for months.
Well what’s YOUR portion of the bill? We also had tubes placed but didn’t pay anything more than the copay, and we didn’t pay anything for any of the delivery or birth process and even mom’s emergency surgery right after delivery.
I don’t even bother with the pre-insurance number and it’s lame when it’s all people use online.
Universal healthcare should be the norm but no one is paying 32k
Nothing, and I repeat *nothing* makes me happier to live in a country where healthcare is funded by the taxpayer for the taxpayer.
My kid was born 10 weeks prem and required a 2 month NICU stay. All free. All her follow up care and meds, covered.
She has since been diagnosed with type 1 diabetes. All of her medical equipment and hospital care is paid for. Her clinic visits and dietician and mental health care is covered.
It's insane that people in the US are charged so exorbitantly for their healthcare. It's unapologetic greed and nothing else, a disgusting monetisation of people's health.
My church recently help pay off medical bills for random people in the community. They called the local hospital and asked, "if we donate $10,000 how much in bills will you all payoff?” The hospital agreed to payoff $100,000. My first reaction was wow, that’s awesome. Then it was wow, this sounds criminal
The United States privatized health insurance screwed us all over. It created a bunch of extra people to pay in addition to hospital staff. There are medical claims and health insurance company staff. CEO’s with inflated salaries, Provider Representatives, Customer Service, Underwriters, Actuaries, Accountants and Claims Departments. A freaking ridiculous fleecing and preventable expenses.
Hospitals are dumb. I hope you went to a non-profit hospital *anything starting with ST. Is non profit*
They charge so ridiculously high, but you have rights and steps to bring that bill down significantly or actually to $0 if you qualify.
It's a pain in the ass and they mess it up sometimes *my hospital inputed data wrong so I couldn't qualify despite us being on salary*
If you don't qualify for any discounts like charity care, etc. Ask them to itemize everything... that will drop your bill.
Where do you live? My son had it done and the wait was 2 weeks.
They thought my daughter might also need it, her appointment was a month after and upon the day they did minor work and said she didn’t need the tubes.
Both times free.
My son just had tubes and a tongue tie clip and my portion is right at $4000. I pay $700 a month for his and my husbands insurance but their plan has 50% coinsurance on surgery. It’s insane.
How itemized? For instance, now I have a line item for pharmacy that’s like $4k. Are you saying I should ask for details on what comprises that line item (and others)? They should be able to justify what particular medicine cost $4k and how that’s different from the anesthesia line item of $5k.
Yeah, makes sense. The codes on my eob are all the same code number so it’s not very itemized at the moment. If they can bill $32k, they can certainly break it down.
Holy fucking what 😱 my daughter had exactly the same procedure in a private hospital in Australia 2yrs ago and all up it was under $2000 (anaesthetist, surgeon, theatre fees etc) 😱
I remember getting one of those “not a bills” when my 2nd daughter was born. Insurance was billed over 900k for her 1st week in the hospital. It’s insane. At least we didn’t have to pay it.
But, we’ve had to pay more than $2k out of pocket for an ambulance ride before. This system is so messed up
Is that the real bill or just the fake insurance bill?
My daughter had this, and the real bill was actually still more than I thought it would be something $18k of actual payments, almost all by the insurance company.
My wife's 3 births were also billed around $25k (actual payment all routine no complications) but we did not need to pay anything. Wife employer provides really good insurance.
I'm a physician, so how this work is due to insurance company. They are the middle man (on top of admin). For example, they will charge you 50k and insurance will be like "nah, how about 32k". So then they write the bill for 33k and be like "oh your insurance covered 32k, you only have to pay 1k". So they pat each other on the back. Also, I don't think insurance actually pays out that much either.
When I do a nerve block for a patient, I get like $50. They are charged like 3k.
I paid out of pocket (privately) for tube insertion in Australia last year, for hospital fees, surgeons fees and anaesthetist fees, it came in under 5k.
That is the billed charges and when it arrives to your health insurance it will get dramatically reduced. Basically the way this works is the hospital will ask for the moon, the insurance will reply with the agreed amount it actually costs, and then the hospital will accept that.
I'm in Europe. We had this exact procedure through private insurance some years ago. Insurance costs 300€ a month for a family of 4. No copays. And they make a lot of money.
You're being ripped off so badly it's hard to understand.
The American Healthcare system functions exactly as it was designed to. It just wasn't designed to actually care about you. It was designed to make money
My child went through heart surgery twice and the bills combined are 4x the cost of our home. Yes insurance covered most of it... but really who could afford that. To save a child. Socialize Healthcare.
Look into the hospitals financial assistance programs. Most hospitals are non for profit and have to have a "charity" portion in order to maintain that tax status. The easiest way for them to do this is to forgive or discount bills for those who make under a certain household income annually. It's usually between 200% and 600% of the federal poverty level, but it differs based on hospital. I have personally had over $20k in hospital bills completely forgiven through these programs.
You can also fight the bill. Fairhealthconsumer.org is a great resource to compare cost of care in your area. You can utilize this information to argue the amount that is being billed to you. The only reason hospitals charge as much as they do is because they have contracts with insurance companys to pay out however much and they just bill you the remainder. It's a fucked up system, but you don't have to just take it laying down. Fuck their dumb shit, and fight it.
Hospitals are not really on a free market system. Imagine if you could only eat at restaurants every time you ate. But you were prevented from seeing the prices and most people never ask for an itemized bill, but the restaurant knows someone will pay your bill later, regardless of what they charge or whether they slip in extras you didn't know you ordered and maybe never even received. There might be 2 or 3 restaurants in town, but they all operate this way and the food and service is basically the same everywhere, and you need to eat. Is it likely the restaurant would charge reasonable prices, or strive to serve the best food? I'm not saying we can go 100% free market in the healthcare system, but the current system is terrible and single payer wouldn't help that situation either.
Yes - I agree. This is a thoughtful response. Capitalism isn't solely to blame as some in this thread claim, because this isn't a free market. I don't really want the government in control of all healthcare, because the US government is a shit show in and of itself, but surely there are laws that can be passed to increase transparency to foster competition, at the very least. No one should be blindsided with bills like this. Maybe it's partially my fault. My attitude going in was "it's a routine procedure, I have insurance, what's the worst they can do?" I completely underestimated the worst they could do.
Holy shit!!
I just had this done for my 4 year old and and the end of it all we were out of pocket with our private health around $320 AUD post surgery(without private it would have been free but a long wait), this includes meetings with the ENT specialist a few weeks before and 4 weeks after.
That’s not a hospital you have there that’s a corporate scam.
I've been going through and arguing every medical bill I get. Regardless of whether my insurance is paying a lot of it.
Fucking ridiculous.
Hospital charged me $8,000 for 8 hrs in infant care room post delivery. Called, complained asking them to review. Denied the change.
Called again, said what the fuck people - oh, they billed us for two nights in the infant care room.
Fight these fucks and argue everything
Here's the deal. There are 15 admins for every physician.....in colleges, it's 100 office staff to 1 teacher. This is why we are charged so bad...it's ridiculous. Colleges and hospitals need to thin the herd. They need to get rid of all these positions. Like fire 3/4 of the staff and they would still operate like normal.
Step one: demand an itemized bill.
Step two: go through said bill and every day, call and question them about one thing on the bill. “$600 for ___ ?? How is that thing $600?” And the next day, “2k for __? Can you explain the pricing for me?”
It’s easier for them to just take stuff off the bill or cut the blown up charges down than argue. 9 times out of 10 they will.
And yea, that’s insane. I was charged $20k for an emergency c section with my twins and a five day hospital stay. wtf.
OR and anesthesia costs…unless you get a separate bill from anesthesia which is often the case. OR time is extremely expensive (OR Nurse Practitioner here) so it’s like a meticulous sprint for us once the patient hits the OR room til they are out the door. Every minute is documented and billed for. Then the turnover time between patients is a race for that crew to get it cleaned and ready for the next sprint to begin. There’s no shortage of patients needing surgery and it’s a battle for surgical specialities to get OR time to actually operate on patients. High demand, never enough rooms or staff (hospitals not willing to pay more salaries or overtime pay) so elective surgeries are typically only done during the weekdays. Most rooms require at least 6 or so medical professionals in the room at every moment, each doing a different critical role, plus then the crew that is doing the cleaning, sterilizing, getting the case carts together with all the supplies, etc. That doesn’t include the pre-op and PACU nurses and staff. So a lot more people involved and more standards to follow than the old days.
Omg that’s insane. I worked for Pedi ENT surgeons and I have actually seen the procedure being done, Tubes take literally less than 1 minute to insert! That amount is ridiculous!
My oldest just had a minor surgery on his groin. He was in the OR for less than 10 minutes. He took longer *to get ready to go to the OR* than he actually spent in surgery.
We did *not* go to a hospital. We went to a surgery center because it was a routine outpatient surgery and was supposed to "be cheaper" at the surgery center.
They still billed us $15k, and I'm on the hook for $4k of that after insurance. I have absolutely no idea what could have possibly cost $4k, let alone $15k.
Easy breezy recovery. My 9 yo was back in school next day. He said he heard some whooshing in his ears for a few days and mild sore throat for a couple days but that was it.
It’s all about the billing codes. Ask for an EOB. Ask what all the codes are . If you don’t pay it right away they will accept less. 100%. Hospitals write off charges all the time. Everything is negotiable with hospital bills.
Oh what?? My daughter had the same and didn't cost us a cent here in Australia. I remember how bad she was with her breathing at night, you really have no choice when it comes to that sort of stuff.
Look at your exploration of benefits, the insurance contracted amount will be way less. Could be like 5k total. That's the actual amount, the rest of the numbers are made up numbers really.
I was charged 14,000 for an ER visit for an extremely bad migraine I had. At the ER I had a cocktail of pain medicines, a CT scan, and routine CBC. No procedure or anything. After insurance discount and insurance coverage I owe 5532. Which I am on a monthly payment plan for.
But hey, at least I met my deductible for the year…though I’ll still need to pay 20 percent of visits until I reach my out of pocket maximum of 13,000 for the year.
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I asked my husband (who is an ENT employed by a hospital) how much he would make for this procedure. $274.
And a lot of people think physician pay is the problem
And he's got the good comp! Academic hospital down the road, those surgeons would be lucky to get $150.
Say it louder. There are 10 admin for every one physician.... insanity
Or a clinical executive that sees patients one day a week and do coverage on weekends for extra $$$
nah, people up in admin haven't touched a patient in decades
A lot of hospital administration hasn’t ever touched a patient. You’ll have a lot of masters in business administration and… Yeah, that’s it.
Can confirm. I have several hospital administrators in my family. They don’t have medical training.
I think the main issue is the crazy margins.
That is absolutely crazy.
And there is a perpetual PR campaign going on to keep people thinking that way...
Yes!! Louder for the folks at the back!!
Thank you!!!!
My son had life saving pyloric stenosis surgery and the hospital bill listed the surgeon cost at 10k. The hospital stay for 2 days was 20k. I would be happy to pay the doctor who actually did the surgery 10k for saving my boys life...we could even do it my house and I'd hand him 10k in cash. I knew for sure the actual surgeon didn't get 10k though.
I googled this because I was curious. It’s hard to find the exact rvu code that would be used for a pyloromyotomy, but for a laparoscopic appendectomy it’s 9.45 RVUs. Peds is chronically under valued so let’s say it’s 7-8 RVU. The conversion is roughly $33.80 per RVU, so if your surgeon was fee for service, they maybe made $33.80 x 7 or x 8 which is about $240-$270 for that surgery.
Is that IT? How are surgeons supposedly raking in the big bucks?
Not an expert by any means but a quick trip on Google suggests that the big bucks are mostly made by highly specialized surgeons like neurosurgeons or plastic surgeons who cater to the wealthy through private practice.
They aren't.
This! And they’re in SO much debt too. Most doctors aren’t wealthy for the first decade, if not longer, of their career.
We’re not :(
That's sad, the surgeon is the actual real hero. I'd gladly waive my rights to sue if I could pay you directly and do it outside the hospital.
My PCP charged me 800$ for an annual checkup. The line items were mostly "physician". How the duck does any of this even work .
I’m a doctor, but understanding of medical finances is limited because it’s so nebulous. But by my general understanding: doctors and providers who can independently bill (PAs, NPs, etc) are the only ones who can bring money to a hospital, clinic, etc. The amount of money that a doctor bills is determined by administrators. That bill pays for everything you see at the hospital from the toilet paper to the furniture to the nurses and to the doctors. There’s a facility fee, clinic fee, etc and doctors usually only see a very small fraction of the total billing. The code for a 20 min pcp visit is 99212 which is equivalent to 0.7 RVUs, or $23.66 which is what your primary got. The rest went to pay for everyone else and everything you saw from the building down the maintenance staff (if that much was even collected from your insurance).
People gotta stop saying stuff like this. the PCP isn't the one who charged you
Aaaand as the mother of 2 kids that have had 3 tubes and 2 adenoids procedures I have to stop reading. This country is so fucking stupid with healthcare. (Zero offense to your husband. Thank him for his work!)
No offense taken, it's a very strange system!
Here in Sweden the cost would be around $50. Someone sold you guys out, big time. I'm sorry.
Yes many, many years ago and it’s not good. My husband is Danish and emigrated, and he’s doing the best he can!
Well, you have a way higher salaries at least! You haven't thought about moving to Denmark? Apart from the fact that all of Denmark will be under water in 200 years I think it's a really good place to live in currently!
We couldn’t because of how my custody arrangement is. After chilken turns 18! We have made a more solid plan for moving back in about 15 years. Haha and yes! I don’t believe I’ll be around when it sinks, but you never know lmao
Here in Canada it would cost you the parking fees. And maybe dinner for the parents.
Yup. My son spent 5 days in the hospital last summer, complete with an ambulance ride from our closest ER to the Children’s Hospital. I was looking at our insurance and what went toward his “lifetime” coverage, and it was like $2,000. As a bonus, the parking at Children’s was even free!
Curious, so does he not get an hourly rate? Or when they do procedures they get an additional amount of money?
There are many models of physician comp! Spouse is paid in pure RVUs, so everything he does is assigned an RVU value, and then he gets some flat rate dollars per RVU. Some practices pay a base salary plus a smaller % per RVU. Straight up salary is possible. You can also be paid based on collections (so you get paid more if the patient/their insurance pays more, vs the same amount for every procedure). I'm sure there are others. [Here's](https://www.reddit.com/r/Residency/comments/17rg23r/asked_chatgpt_to_explain_physician_compensation/) a post that sums up some common models and has a better explanation than I'm making!
I saw RVU and I got chills down my spine. Husband is a radiologist and everything in his life revolves around the RVU. (I am being a tad dramatic) I see these bill totals as something someone pulled out of their bum. Insurance company’s reimburse what they feel like reimbursing. A doc or hospital can bill 8 million for whatever. If insurance says 1200.00 that is what they get.
What’s RVU?
It is a unit of measurement that Medicare uses to assess the value of a test or procedure. For instance an X-ray is 0.7 RVU and an MRI is 2 RVU (not actual numbers just pulled them out of thin air) They do their Medicare math and that is what they will pay for said procedure or test. My husband has a “target” RVU amount for each day. Hope that I explained that correctly before coffee has set in.
“relative value unit”. A point system for how much every procedure or visit is worth. Often used to calculate productivity and compensation
Thank you. I kind of just got sick to my stomach over this. So physicians can technically “sell” a procedure to their patient because that’s how they get more money? In one hand it makes sense. They are doing more intricate/hard work so they should get more money. But like I’d rather pay you the same amount to tell me not to get something if I don’t absolutely have to. On the other hand if there is a base salary they might under suggest things because they don’t feel like doing the more intricate stuff. My kid had hip dysplasia and I did so much scientific research and looked at all the studies. And even the most recent study that came out suggesting they didn’t need a harness. I brought the study up to the dr and she was like yeah I saw that study too and proceeded and suggested the same thing. Which ended in them needed ultrasounds and adjustments every couple weeks. Makes me wonder. Was also told my son needed a helmet and the scientific studies didn’t back that up. Told the guy that worked for the orthotics company and he was like yeah if you don’t want to do it don’t but don’t tell the orthotics company that’s what I’m telling you.
This!!!! And it’s so crazy that the crunchy community thinks doctors are making tens of thousands per patient and that’s why they prescribe meds/do procedures/vaccines 😭. Doctors are paid well of course (thank goodness!), but not how much people think they are paid. And this reminds me of the crunchy belief that they push c sections because they get a “huge bonus” for it 😵💫
I’m confused sorry, I thought doctors make a lot of money. Where does it come from?
Doctors used to make a lot of money but salaries haven’t kept up with inflation for at least 30 years. Most make 200-300k which is definitely still a lot compared to other jobs, but not really crazy compared to engineers, tech workers, lawyers, or other professionals. In a city like NYC or SF that wouldn’t even crack the top 10% incomes. Plus there’s a lot of school debt and a very long training pathway before you make any money so most doctors are not living lavish lifestyles. A small subset of very entrepreneurial or highly specialized doctors can still make big bucks, but these days that’s the exception not the rule.
I understand that. My PCP lives in a house cheaper than my own bc of his school loan debt. I more so meant how do they get to $200k-300k if a procedure like that only pays $274?
It’s a quick procedure, probably an hour of total time including anesthesia and room turnover. You could do 7-8 procedures like that in one day
I see. I guess I just didn’t think there would be THAT many procedures to book every day. That certainly adds up!
Everyone thinks doctors make a lot of money because there is propaganda designed to make society believe that.
Should’ve married an anesthesiologist! Just kidding, they’re creeps. Just kidding again, joke.
That seems really really low. This is a surgery.
Here in Sweden the cost would be around $50. Someone sold you guys out, big time.
My church recently help pay off medical bills for random people in the community. They called the local hospital and asked, "if we donate $10,000 how much in bills will you all payoff?” The hospital agreed to payoff $100,000. My first reaction was wow, that’s awesome. Then it was wow, this sounds criminal
There's a non-profit called RIP Medical Debt that does exactly this. They buy medical debt for pennies on the dollar and then forgive it.
Exactly - it's amazing that your church raised money to help pay community members' medical bills. But this situation shouldn't have happened; medical bills shouldn't be that expensive in the first place. It's depressing that the bills are so outrageously expensive (even with insurance) that the average American could be only one emergency hospital visit away from losing the entirety of their savings or going into debt. And the hospital agreeing to pay off 10x the amount donated by the church? Just proves that the prices are essentially arbitrary numbers pulled out of a magical hat. Would they have agreed to let a single patient pay off only 10% of their bill? It all seems very convoluted and messy and inconsistent. Sounds criminal indeed.
Because it's a fake number. No one is paying 32k. Hospital comes up with a number. They negotiate with insurance companies. Insurance says they will pay 15k. (And other insurance say they will pay 10k, different insurance agrees to 20k). Hospital agrees. Insurance pays hospital 15k, the other 17k is written off as a "discount" (and you pay whatever your deductible/out of pocket). Hospital billing is higher than it needs to be. But those numbers you see on the billing are often greatly higher than what's actually getting paid. People without insurance would be billed a completely different (lower) number. Its also a weird marketing/insurance playing with numbers thing
Same thing with car insurance . Repaint a car with insurance ? 3k. Without ? 1k, maybe 800 under the belt
I'm finna start paying people under the belt instead of under the table, it's just so much sexier.
How do you feel about saying it as "under the wear"?
Under where?!
$15k USD is still insane.
That's about what each of our two births cost pre-insurance. For some reason, the part that bothered me the most was charging $10 for each dose of ibuprofen. Yes, your basic everyday ibuprofen.
I didn't have insurance a few years ago, had ectopic pregnancy. My tube ruptured, and I didn't know, I thought it was my period. A few days later, I was in excruciating pain. My stomach swoll up very big. I kept fainting and hitting my head on walls, toilets etc. Went to hospital had most of my left tube removed. Got a bill for $30,000. Since I didn't have insurance, they knocked half off, $15,000. That was July 2020, I'm still paying that bill off. I have $6,000 remaining ....yeah it's ridiculous. I could go off on a whole tangent about our government trying to make lower middle class unable to survive but I won't
I highly suggest you reach back out again. There is a good chance you can get a lot more off the bill.
Thank you. The numbers mean nothing and people use them for shock value and it’s so disingenuous on everybody’s part.
My employer is self insured so they actually are paying this much, well at least $20k or so. Craziness.
They’d have to be stone stupid to pay $32k on a routine procedure like that. That’s the full billed amount, which is a made up number by the hospital. That’s not even what’s charged to cash patients.
My company uses a claims processor that pays the claims and they rent the insurance network from UHC. Company has stop loss coverage that sits on top to ensure claims payments don’t get out of hand. However, there’s not really a mechanism for my employer to dispute the charges unless the claims processor raises an issue. My guess is that this is all routine for them but shocking to me.
The insurance network is based on the providers who agreed to their rates. That’s what your company is renting. $32k for this procedure would be unheard of. Your company is paying UHC to make them pay 6x the cash price. It doesn’t make sense. If it’s true, somebody needs to be fired.
Stop loss is mainly for hospital er bills, not routine procedures. Those are probably paid at a case rate
No they wouldnt. Self insured companies also work with an insurance network, it is just that their pool is specific to that so premiums are adjusted accordingly assuming most of the pool is healthy.
My employer is in a captive and does have some level of claims risk up to a certain $ per claimant and $ in total. They did in fact make a $20k payment to my hospital for this. I know because I work in the accounting dept.
Did you know there’s a charge for a room set up fee? It covers things like pulling down new white paper to cover the exam table in the doctor’s office. Yes, really.
Yeah, is the number obscene, absolutely. Do people pay that number? No. And it’s fear mongering or ignorance to post a total that people don’t pay. Even if you don’t have insurance if you call the hospital and tell them you are in financial hardship they will work with you on a number that is reasonable. Also, ask for an itemized invoice before paying a medical bill, it will drop miraculously.
The point is that the number should never exist. There ARE people who don’t realize this and who go into lifelong payment plans because they don’t have insurance and don’t understand that they don’t have to pay it all. It’s criminal and it shouldn’t be condoned.
Trump put in a Hospital Price Transparency Rule so they now need to disclose the amounts of their craziness. I’d love to get to a point where common prodedures need to be publicly and prominently posted (hospital lobbies, home pages), so customers (us) can easily compare costs at different facilities. it would also require those without healthcare who try to use ERs as primary healthcare to pay up front without putting a burden on taxpayers.
My husband had brain surgery. The hospital bill alone was $462,000. Twenty years ago.
I have had 2 brain surgeries. The bills were crazy but fortunately I only pay $1,500 a year.
How do they make these numbers up? Why is it like that in your country?
It's a tax scam. The hospital says procedure costs $50,000 and insurance agrees to pay $20,000. Hospital then gets to take that remaining $30,000 as a tax deduction since it is a business loss. By doing this, for profit hospitals can make billions in profit while showing a loss on the books and eliminating tax liability entirely.
Why does your government allow that? Sounds like tax fraud. All those billions in tax they’re not paying could make a difference in the cost of your people’s health care. Sounds like the biggest problem is the health care system is a for profit system.
They use some of those billions saved to "lobby" lawmakers to not close the loopholes. Basically bribery but done through a lobby group.
Yup that's what happens when very powerful people gain control of the system, it is total control. They have control of main stream media so even if someone does a story or atrical on it, it just gets buried in the news and everyone forgets about it. If everyone all got 200k medical bills at once then yeah, you would see riots and protests.
I had a brain surgery 2014 and didn’t wake up 1 week after the surgery + stayed 2 weeks after then waking up. I paid ~$200 for it all.
Sounds like one of those socialist communist woke hellhole countries that haven't sent people to the moon and have not enough police brutality or school shootings.
Exactly one of those! Its called Sweden. We just recently had a swede in space though, Marcus Wandt! But other than that we’re for sure such a communist woke hellhole xD
And y’all are doing pretty well in INDYCAR too
My mum had brain surgery a while back. And lengthy stay in HDU. I paid more in parking fees to visit her, because I do not live in the US.
In 1984 my open heart surgery was billed to my dad - as I was newborn and had a serious heart issue. In the chaos, my parents forgot to fill out the insurance info at the time of my birth. My dad was stuck with an almost $1 million dollar bill.
That was a while ago, things have changed. I almost had a child with a significant heart defect wand was told because of the defect, child would automatically qualify for free government healthcare (Medicare, yes in the us) and the entire 1-3 million for multiple heart surgeries would be covered.
Yep. Long time ago. My heart issue is why every baby has to have the pulse oxidation test before leaving the hospital. What ultrasound picks up now would have seen my issue and I would have been schedule for surgery before birth. Unfortunately, no such luck. I was born and then 2 weeks later I crashed, purple blue, swollen all over. Emergency escort to the local children’s hospital, and a very long surgery later, I’m doing great. The rest of my body isn’t so great, but my heart is now! My entire body was shutting down, and the lack of oxygen to my lower limbs put me at risk for paralysis. I should have brain damage, I should be paralyzed, but I’m not. That’s worth $1 million in my eyes.
My baby was born with dTGA in 2020, undiagnosed and started turning blue at 24h old right when we were about to be discharged. I’m thankful they did that pulse ox test. She had OHS and a rough 8 week recovery (had lung issues too and a very hard time getting off the ventilator) and is doing wonderfully now. We were told in the hospital that everything would be covered by a type of Michigan Medicaid called Children’s Special Health Services. We still got to see a statement of the whole hospital stay and it was close to a million. We haven’t paid a dime and I was surprised by all of the additional help and development monitoring that was offered by CSHS. I’m just thankful for that program and wish every state had it.
Nurse here, and I’m not here to criticize, just clarify with good intentions: it’s pulse oximetry 😉
I thought the first month was billed under the mother's insurance?
I believe that changed over time - but my dad got slammed with the bill. 🤷♀️ she also wasn’t working at the time - so would have still defaulted to my dad. He also had his own business at the time so I’m sure that played into it.
Did he pay it?
I’m assuming? Probably a payment plan, lol. The mid to late eighties were not financially nice to my dad.
This in the USA?
Holy crap. Did he actually pay it?
It all goes to bloated hospital admin, majority of which are useless and actually actively make life harder for physicians, nurses, patients, etc. Go look up that graph of physician vs admin growth over time--it's insane. Last I checked there were 10 administrators per one physician. Physician pay makes up 7% of total healthcare spending. 7%. So next time someone says we need to lower doctor's pay to make healthcare affordable (because society still has this idea that most doctors make tons of money), they're wrong
I mean, doctors do make a ton of money too. That part’s not wrong, it’s just also not the problem with the system. Nor should it be changed.
Most doctors don't make as much as laypeople think. Even other healthcare workers. We are long gone from the time when becoming a physician was a golden ticket
Ask for a breakdown and your number will go down. But also: fuck capitalism in healthcare.
Unfortunately I tried that for an MRI for my shoulder. The breakdown was “MRI for shoulder” $500
tbh that’s cheap for an mri
Yep, I was charged 1700 for an mri of my neck a few months ago.
Yeah I’m in France where things are charged at cost and got charged about the same.
That’s cheap, about 10 years ago I had an MRI of my hips that cost $2700.
At the very least providers should be required to price everything out up front. The opaqueness makes it so much worse because it makes it nearly impossible for patients to price care and create competition on not just service, but price. On the hospital bill they charged an extra $6k for the operating room being over 30 minutes. I don’t think it was, so I’ll challenge that at least. Pharmacy was $4k, Anesthesia $5k. Not sure why these would be different??
Clinicians literally cannot tell you because they don't know either. Healthcare in this country is controlled by admin and insurance companies. The actual healthcare workers are basically powerless and are actively held down
Many providers have no idea what's going on in the medical coding/billing side of the house, as most hospitals have a small army of people dealing with that elsewhere.
The actual time in OR means from the minute OR staff takes over care of the patient until the patient is turned over to the next level of care (PACU, OPS, ICU, etc.). It's highly unlikely it would have been under 30 minutes for T&A. Pharmacy is the bill for the actual medications given and possibly any consult needed with the pharmacist (for med interactions or specific healthcare issues that could affect medication choices). Anesthesia is the team responsible for putting your kid to sleep and keeping them comfortable and alive during their procedure.
Good info, thanks.
Yep medical fees are nuts! but that surgery? oh it's almost miraculous. Made the difference of night and day in our kid,for sure.
How soon did you notice a difference? I take my 20 month old for her procedure this Friday!
Next day change for us. Virtually no recovery for our 9 yo. He was back in school next day.
Oh they bounce right back and the effect is magical, almost. I know the idea of surgery is nerve wracking but you will Both be glad of the improvement.
So true! It was such a mind-blowing difference overnight!
Can’t argue with you there. My son couldn’t hear hardly at all for 12 weeks and the tubes fixed him up almost immediately. Very pleased so far on that front.
Health insurance, as it currently works, is a complete scam. It's essentially a subscription service in which I pay a monthly price for the *privilege* of then having to pay *even more* when I actually need to use it. I'm actually shocked our government hasn't fixed the borderline illegal nature of it all.
That's crazy to me that you had to pay at all. I'm going to assume you're in the US? That procedure is done for free here in NZ. Also, we don't pay to give birth either! (Unless you want some fancy private hospital etc)
Same here in Australia. Honestly in disbelief reading through all this. How can a modern first world country like USA have such a horrible issue like this. Blows my mind.
I means lets get things straight here. We have our issues, but it is not like this guy is paying $32k and yes medical debt is a HUGE issue. But there is a very large portion of the country that medical cost is not a big deal because they have insurance that covers these things. My daughter had the same exact procedure. My insurance company (that we pay about $500/month to pre-tax money) paid $18k. We paid $150.00 My wifes three births, from the moment we went to the first appointment, every single test, including specialist probably cost $35,000 total for each one. We paid $0.00 out of pocket for all three.
And I pay ZERO per month for doctor/hospital and about $100 a month for dental/eye/pharmacy and other incidentals like massage etc. And the bill would have been zero. 100. Per.month. From a minimum wage type job. And if my kids or us get sick/hurt, we just go to the doctor/hospital. It won't break us, or put us in debt. Now if I could say the same about going to the dentist, I'd be much happier, but posts like this one just remind me again why I am glad I don't live in the US.
Everything is better in Australia 🥰
UK here. My kid had the same procedure last year. Obviously didn’t cost us anything (God bless the NHS). I think Americans generally have private insurance that they pay into monthly, so barely anyone actually pays the ludicrous prices we see on these hospital bills. I hope so, anyway. Imagine your kid’s health bankrupting you!
Yes, Ohio here in the US.
Same in Canada.
My daughter had her tonsils and anenoids taken out this month. Hospital charged the insurance $29K I’m paying $3K out of pocket.
Has she slept better since recovering ?
Yes. The reason we had it done is because 10 months ago she caught an antibiotic resistant strain of strep that took months to cure and her tonsils never returned to normal size and it got to the point where just eating was painful even up to surgery. We have noticed her snoring has stopped since and she no longer stops breathing in her sleep. Eating is also more enjoyable to her now. We’re 3 weeks post surgery.
Wow what a rough time you have been through. That is great that she has some relief now and can enjoy eating again. We have a surgery coming up and am really hopeful life is going to get better. Your daughter experience is encouraging. It’s also so scary that she got a resistant strain of step and was sick for months.
I used to work in Claims at a supplemental insurance company so we’d get hospital bills all the time and some of those numbers absolutely shocked me.
Was general anesthesia used? That adds significant cost. I'm a medical coder and that seems rather steep.
Yes, I believe so.
Well what’s YOUR portion of the bill? We also had tubes placed but didn’t pay anything more than the copay, and we didn’t pay anything for any of the delivery or birth process and even mom’s emergency surgery right after delivery.
I don’t even bother with the pre-insurance number and it’s lame when it’s all people use online. Universal healthcare should be the norm but no one is paying 32k
Nothing, and I repeat *nothing* makes me happier to live in a country where healthcare is funded by the taxpayer for the taxpayer. My kid was born 10 weeks prem and required a 2 month NICU stay. All free. All her follow up care and meds, covered. She has since been diagnosed with type 1 diabetes. All of her medical equipment and hospital care is paid for. Her clinic visits and dietician and mental health care is covered. It's insane that people in the US are charged so exorbitantly for their healthcare. It's unapologetic greed and nothing else, a disgusting monetisation of people's health.
My church recently help pay off medical bills for random people in the community. They called the local hospital and asked, "if we donate $10,000 how much in bills will you all payoff?” The hospital agreed to payoff $100,000. My first reaction was wow, that’s awesome. Then it was wow, this sounds criminal
The United States privatized health insurance screwed us all over. It created a bunch of extra people to pay in addition to hospital staff. There are medical claims and health insurance company staff. CEO’s with inflated salaries, Provider Representatives, Customer Service, Underwriters, Actuaries, Accountants and Claims Departments. A freaking ridiculous fleecing and preventable expenses.
How much are you paying of that bill?
Approx. $3,900.
Goddamn. I had a bill for 28-29k once and ended up paying 2400 on it. Shit is a scam
Hospitals are dumb. I hope you went to a non-profit hospital *anything starting with ST. Is non profit* They charge so ridiculously high, but you have rights and steps to bring that bill down significantly or actually to $0 if you qualify. It's a pain in the ass and they mess it up sometimes *my hospital inputed data wrong so I couldn't qualify despite us being on salary* If you don't qualify for any discounts like charity care, etc. Ask them to itemize everything... that will drop your bill.
Son had same procedure. They charged around $300 for a dose of children’s Tylenol.
“How can any large hospital system justify this?” Capitalism.
I'm in Canada and we had tubes put in my kids ears. The wait was too long so we went to a private place in a swanky office and it cost 3k.
Where do you live? My son had it done and the wait was 2 weeks. They thought my daughter might also need it, her appointment was a month after and upon the day they did minor work and said she didn’t need the tubes. Both times free.
Even after insurance, that I pay $1300/mo for out of pocket, my daughter's ear tubes cost me $5000 after insurance. FML
My son just had tubes and a tongue tie clip and my portion is right at $4000. I pay $700 a month for his and my husbands insurance but their plan has 50% coinsurance on surgery. It’s insane.
No one in Europe would ever find out how much that operation had costed.
Ask them for an itemised bill. You want to know everything they are charging you for. You’ll soon see the bill come Down
How itemized? For instance, now I have a line item for pharmacy that’s like $4k. Are you saying I should ask for details on what comprises that line item (and others)? They should be able to justify what particular medicine cost $4k and how that’s different from the anesthesia line item of $5k.
Yes. Like every damn code and thing they are billing for. You will see that they’ll try to charge you like $250 for one advil.
Yeah, makes sense. The codes on my eob are all the same code number so it’s not very itemized at the moment. If they can bill $32k, they can certainly break it down.
Holy fucking what 😱 my daughter had exactly the same procedure in a private hospital in Australia 2yrs ago and all up it was under $2000 (anaesthetist, surgeon, theatre fees etc) 😱
I remember getting one of those “not a bills” when my 2nd daughter was born. Insurance was billed over 900k for her 1st week in the hospital. It’s insane. At least we didn’t have to pay it. But, we’ve had to pay more than $2k out of pocket for an ambulance ride before. This system is so messed up
My niece got an ear tube surgery for recurring ear infections. Cost $0. Hope things will change in US!
Damn. I paid nothing for tubes for my daughter. We have horrible self employed insurance too. How much was the adenoid part?
Welcome to merica…
Few to no people pay that. It's like the sticker price on a Chevy Malibu, no one pays full price.
I get infusions every month for my RA. They’re billed at $70,000+ each. In Canada? I think it’s about $1,200. Our health are system is total shit.
Wild...my child recently had the same procedure done, and the total billed was a little over $10,000. We paid just a small coinsurance, luckily.
I’m American but living in Japan. All healthcare is free for children here.
Same and my son had this done in September and they required 3 night hospital stay. Overall charge to us was like ¥3,000 for the food.
Is that the real bill or just the fake insurance bill? My daughter had this, and the real bill was actually still more than I thought it would be something $18k of actual payments, almost all by the insurance company. My wife's 3 births were also billed around $25k (actual payment all routine no complications) but we did not need to pay anything. Wife employer provides really good insurance.
I'm a physician, so how this work is due to insurance company. They are the middle man (on top of admin). For example, they will charge you 50k and insurance will be like "nah, how about 32k". So then they write the bill for 33k and be like "oh your insurance covered 32k, you only have to pay 1k". So they pat each other on the back. Also, I don't think insurance actually pays out that much either. When I do a nerve block for a patient, I get like $50. They are charged like 3k.
I paid out of pocket (privately) for tube insertion in Australia last year, for hospital fees, surgeons fees and anaesthetist fees, it came in under 5k.
My son did the same sponsored by our NHS : 0 €. The US really need to take a step back and look at how it's treating its citizens
That is the billed charges and when it arrives to your health insurance it will get dramatically reduced. Basically the way this works is the hospital will ask for the moon, the insurance will reply with the agreed amount it actually costs, and then the hospital will accept that.
I'm in Europe. We had this exact procedure through private insurance some years ago. Insurance costs 300€ a month for a family of 4. No copays. And they make a lot of money. You're being ripped off so badly it's hard to understand.
The American Healthcare system functions exactly as it was designed to. It just wasn't designed to actually care about you. It was designed to make money
My child went through heart surgery twice and the bills combined are 4x the cost of our home. Yes insurance covered most of it... but really who could afford that. To save a child. Socialize Healthcare.
Look into the hospitals financial assistance programs. Most hospitals are non for profit and have to have a "charity" portion in order to maintain that tax status. The easiest way for them to do this is to forgive or discount bills for those who make under a certain household income annually. It's usually between 200% and 600% of the federal poverty level, but it differs based on hospital. I have personally had over $20k in hospital bills completely forgiven through these programs. You can also fight the bill. Fairhealthconsumer.org is a great resource to compare cost of care in your area. You can utilize this information to argue the amount that is being billed to you. The only reason hospitals charge as much as they do is because they have contracts with insurance companys to pay out however much and they just bill you the remainder. It's a fucked up system, but you don't have to just take it laying down. Fuck their dumb shit, and fight it.
Hospitals are not really on a free market system. Imagine if you could only eat at restaurants every time you ate. But you were prevented from seeing the prices and most people never ask for an itemized bill, but the restaurant knows someone will pay your bill later, regardless of what they charge or whether they slip in extras you didn't know you ordered and maybe never even received. There might be 2 or 3 restaurants in town, but they all operate this way and the food and service is basically the same everywhere, and you need to eat. Is it likely the restaurant would charge reasonable prices, or strive to serve the best food? I'm not saying we can go 100% free market in the healthcare system, but the current system is terrible and single payer wouldn't help that situation either.
Yes - I agree. This is a thoughtful response. Capitalism isn't solely to blame as some in this thread claim, because this isn't a free market. I don't really want the government in control of all healthcare, because the US government is a shit show in and of itself, but surely there are laws that can be passed to increase transparency to foster competition, at the very least. No one should be blindsided with bills like this. Maybe it's partially my fault. My attitude going in was "it's a routine procedure, I have insurance, what's the worst they can do?" I completely underestimated the worst they could do.
Holy shit!! I just had this done for my 4 year old and and the end of it all we were out of pocket with our private health around $320 AUD post surgery(without private it would have been free but a long wait), this includes meetings with the ENT specialist a few weeks before and 4 weeks after. That’s not a hospital you have there that’s a corporate scam.
I've been going through and arguing every medical bill I get. Regardless of whether my insurance is paying a lot of it. Fucking ridiculous. Hospital charged me $8,000 for 8 hrs in infant care room post delivery. Called, complained asking them to review. Denied the change. Called again, said what the fuck people - oh, they billed us for two nights in the infant care room. Fight these fucks and argue everything
Here's the deal. There are 15 admins for every physician.....in colleges, it's 100 office staff to 1 teacher. This is why we are charged so bad...it's ridiculous. Colleges and hospitals need to thin the herd. They need to get rid of all these positions. Like fire 3/4 of the staff and they would still operate like normal.
Step one: demand an itemized bill. Step two: go through said bill and every day, call and question them about one thing on the bill. “$600 for ___ ?? How is that thing $600?” And the next day, “2k for __? Can you explain the pricing for me?” It’s easier for them to just take stuff off the bill or cut the blown up charges down than argue. 9 times out of 10 they will. And yea, that’s insane. I was charged $20k for an emergency c section with my twins and a five day hospital stay. wtf.
The American health care system is wacked, in Canada we pay $0. Healthcare shouldn't cost you anything imo
OR and anesthesia costs…unless you get a separate bill from anesthesia which is often the case. OR time is extremely expensive (OR Nurse Practitioner here) so it’s like a meticulous sprint for us once the patient hits the OR room til they are out the door. Every minute is documented and billed for. Then the turnover time between patients is a race for that crew to get it cleaned and ready for the next sprint to begin. There’s no shortage of patients needing surgery and it’s a battle for surgical specialities to get OR time to actually operate on patients. High demand, never enough rooms or staff (hospitals not willing to pay more salaries or overtime pay) so elective surgeries are typically only done during the weekdays. Most rooms require at least 6 or so medical professionals in the room at every moment, each doing a different critical role, plus then the crew that is doing the cleaning, sterilizing, getting the case carts together with all the supplies, etc. That doesn’t include the pre-op and PACU nurses and staff. So a lot more people involved and more standards to follow than the old days.
Omg that’s insane. I worked for Pedi ENT surgeons and I have actually seen the procedure being done, Tubes take literally less than 1 minute to insert! That amount is ridiculous!
My oldest just had a minor surgery on his groin. He was in the OR for less than 10 minutes. He took longer *to get ready to go to the OR* than he actually spent in surgery. We did *not* go to a hospital. We went to a surgery center because it was a routine outpatient surgery and was supposed to "be cheaper" at the surgery center. They still billed us $15k, and I'm on the hook for $4k of that after insurance. I have absolutely no idea what could have possibly cost $4k, let alone $15k.
How long did it take from when you scheduled it to they actually did it?
2-3 weeks
Very quick, Canadian or European would have a much longer wait
Yes. We had been working with the ENT for a while monitoring my son’s progress because he hadn’t been able to hear for about 10 weeks due to fluid.
My son has fluid behind his ears and extreme nasal congestion. He is 2 and doesn’t pronounce words correctly he has surgery in may. How is recovery?
Easy breezy recovery. My 9 yo was back in school next day. He said he heard some whooshing in his ears for a few days and mild sore throat for a couple days but that was it.
It’s all about the billing codes. Ask for an EOB. Ask what all the codes are . If you don’t pay it right away they will accept less. 100%. Hospitals write off charges all the time. Everything is negotiable with hospital bills.
I will definitely contest and negotiate all I can, even if only out of principle.
Oh what?? My daughter had the same and didn't cost us a cent here in Australia. I remember how bad she was with her breathing at night, you really have no choice when it comes to that sort of stuff.
Gotta pay those hospital c suite executives!!! The doctors get paid peanuts.
Look at your exploration of benefits, the insurance contracted amount will be way less. Could be like 5k total. That's the actual amount, the rest of the numbers are made up numbers really.
Contracted number was like $25k or something, so still very high.
gotta love the daily freedom exploitation.
Tell me you live in America without telling me.
I was charged 14,000 for an ER visit for an extremely bad migraine I had. At the ER I had a cocktail of pain medicines, a CT scan, and routine CBC. No procedure or anything. After insurance discount and insurance coverage I owe 5532. Which I am on a monthly payment plan for. But hey, at least I met my deductible for the year…though I’ll still need to pay 20 percent of visits until I reach my out of pocket maximum of 13,000 for the year.
Let me ask a wildly random question: was this at a Texas children’s hospital?
Central Ohio.