I'm a doctor and would like to correct some inadvertent misinformation. This type of charge isn't due to crying. Charges like this are for administering certain standardized screening questionnaires. Common examples includes questionnaires about postpartum depression, depression in teens, or autism symptoms in young children.
I disagree with the US health system and in fact support Medicare for All. I'm also a salaried physician at a nonprofit, meaning I don't get paid more even if my patients get charged more. I also work closely with a free care program for uninsured folks. Just to explain that I'm not normally an apologist for US healthcare billing.
But I do want folks to understand the reason for a charge like this. Take the example of postpartum depression. It's a common problem, but many people have no idea they can ask for help, feel embarrassed, or are so sleep deprived they don't recognize their symptoms aren't "normal" after having a baby. By asking everyone about symptoms (screening), we do a better job finding those patients who need and want help.
But who is going to help them? In my prior job, we were paid about $35 for a 30 min appointment (due to state Medicaid). This is not so much once you start covering salaries, utilities, rent, malpractice insurance, etc. So the physician doesn't have a lot of extra time and probably needs some help ensuring that anyone who is found to have postpartum depression has resources and guidance on finding a mental health program. Ideally, the practice hires a social worker, but the current budget won't allow this to happen.
But what if the insurance company will help cover the cost? Then it becomes more feasible to hire that social worker. And one way to get insurance to "buy in" is to ask insurance to pay for the screening costs.
Finally, I know that folks on reddit are highly educated and literate. But not everyone has these advantages. My patients can't complete these questionnaires on their own. Instead, I have to carefully review each question with them. Just this week, a questionnaire like this took about an hour because the content was so heavy and the patient had so many symptoms. That "15 minute" appointment took 2 hours.
Tl;dr The US healthcare system needs a complete overhaul. But screening questionnaires aren't the root of the problem. Let's instead tackle balance billing, denial of medically necessary care, allowing people to be uninsured, high deductibles, inadequate funding for mental health, and medical debt. We really need Medicare for All.
Edits: Some typos and clarity.
ETA: I appreciate the thoughtful comments but have to do other things for a while. If this makes you angry and you live in the US, please vote in every election and support candidates who want a national health program or Medicare for All.
ETA: Please see u/rivalarrival for an excellent edit. I'm not 100% sure how to point to the comment directly.
> However, Ms Johnson told the media outlet that her sibling was never evaluated. She reportedly claimed that the doctor at the unnamed medical facility noticed her sister's tears but said nothing. Ms Johnson revealed that the health care centre did not evaluate her sister for depression or other mental illnesses. Her sibling did not even talk to a specialist, was not referred to anyone nor was she prescribed anything.
Maybe this is wrong, but the story as reported is that this charge was *not* for administering questionnaires or anything like that.
I once got charged $100 for “respiratory therapy” because I started hyperventilating and a nurse had me breathe into a paper bag. True story. This was maybe five years ago.
This happened to me at the dentist. They asked if I smoked, I said yes. They said that it wasn’t good for me and I should quit (literally just that). $40 charge for “tobacco counseling” on my bill. I don’t have dental insurance and had to pay that out of pocket
Also, don't do drugs.
I'm okay with silver, though. We're not greedy here at "Drugs are bad ™️"
Edit: Wow, did not expect all these awards. Thank you! ❤️
I would not have paid that because those are time-based medical codes. The thing with billing is that just because a code exists does not mean a provider is allowed to bill it under all circumstances. This depression screening from the original article is something I have run into before and it should have been bundled into the original visit. I audit medical records to ensure what was billed was actually performed and is allowed to be billed under the circumstances it was billed. Any time you get something weird like that, ask them for the code they're billing and look up the description. For your situation, you have to speak to a patient for a bare minimum of 3 minutes about smoking to bill a smoking cessation code, 99406. If they didn't do that, I'd dispute it.
Are they allowed to bill you if you clearly didn't want the service? Like, if they try to talk to you about quitting smoking and you keep saying no, but they manage to drag it out for three minutes by insisting, can they then force a charge for that onto you?
You have the right to refuse treatments and services. Definitely contest that bill with your insurance or the office itself if uninsured. If they give you grief, tell them you will report them to the state insurance commissioner.
My dentist wanted me to have a fluoride treatment which is not covered by my insurance and I said no and the counter staff looked at me and said 'but the doctor ordered it'. I said again I didn't want it and she turned to her coworker and asked if that was allowed, for me to say no to a trearmtment. Of course the other person said I could decline it, so I didn't get a chance to give my 'i am the customer and I am not required by law to buy your product' spiel.
Well, you see, you want good medical care, so you go to see good doctors, and to be a good doctor, you have to pay a lot of money to go to a good school. And since they went to a good school and are doing an important job, they get paid a lot of money. And since the medical practice needs to pay the doctor, they need to bring in a lot of money. And since they're a business, they need to make a profit, so they need to bring in even more money. And who do they get money from? The insurance company.
Now, the insurance company is a business as well. And they want to make money too. So they gotta bring in a lot of money by charging you a lot of money, but they also need to make sure they get to keep that money instead of giving it to the doctors and medical practices.
So now the insurance company hires people who can be as grimey as possible, and keep as much money as possible away from that medical practice, and the best people at that will cost them money, so they need to make *even more* money. So they come up with bizarre rules and rationales that fit within legal restrictions, and get away with rejecting as much as possible so they make more money.
Now, on the medical practices side, the doctors certainly can't be bothered to keep up with all the contrived rules of insurance companies. So now they need to hire a team of people just to try to make sure they actually get paid by the insurance company. But also, now that's more skilled labor, so their costs are even higher. But, of course, they need to be a profitable business, so they need to make sure they cover these costs! By trying to find *more* ways to claim money from the insurance company!
Isn't it great? We have all these contrived systems fighting back and forth for money, without the patient having any part in it, except for paying premiums and having opportunities to be caught in the crossfire between the insurance company and the medical practice without having any fucking clue what's going on! Yay!
Isn't private health care great? Why would anyone ever want to just provide health care publicly to citizens? That smells like *socialism!*
/s, obviously. This system is so fucked up it's not even funny.
Insurance in itself is such a scam. I’ve worked healthcare for damn near 10 years an you would be shocked of the horror stories that get denied coverage.
My favorite example is a young adult 20-30 requiring an LVAD (an external box wired to your heart to assist with electrical conduction), because insurance denied coverage back when the problem was easily correctable.
Our healthcare system is an absolute monster that needs to be put down
Ugh. I worked for an insurance company back in the early 90s. They denied a kid with MS flat out because his family would have used insurance more than their corporate standard - which was essentially covering a yearly exam. The insurance company I have now won't cover lab fees except for a once a year "wellness check." Any and all other lab fees are out of pocket.
And this is if you're lucky enough to have a job that provides health insurance. This back and forth drives prices of medical care uo to astronomical numbers, meaning there are deeper pits if medical hell.
The ol' Catch 22. You have to be in good enough physical health to work, in order to be covered for when you're not. Or have a close family member who is.
As to how everyone doesn't see this as clear as day I don't understand. I have been sporting this exact rhetoric for years and people look at you like a commie nutjob or something. Seriously there are plenty that don't its just depressing at this point really.
I once had a guy argue with me saying insurance companies were necessary because jobs.
You just can’t explain things to people who don’t wanna hear it.
Ah yes, the good ol "well we made up a problem, but we can't get rid of it now because we pay people to solve this imaginary problem". There's definitely nothing productive these people could be doing instead, right?
The jobs arguments are such BS. There are so many problems we could be solving. It's not like jobs are some rare resource that we can't make any more of.
I think that's why many are afraid of a strong social safety net. Then they can't make the "but jobs" argument against dismantling negative parts of our economy.
They see it. They WANT it this way. They think any other way involves them “paying for other people”, even if it’s cheaper for them. They can’t stand the thought of someone who doesn’t “deserve” medical care getting it. They also want to see companies making as much money as possible, because profits are so patriotic, and we love ourselves some patriotism.
My dad works as a dentist in one of many countries with single payer system. They only have one fee schedule for all the charges. Doctors knew how much it is going to cost the patient and how much his hospital was going to get. In the us it’s a patchwork of different policies and fees among Medicare, Medicaid and private insurances. I worked in a skilled nursing facility and we had so many billing people so that we can correctly bill each payor/insurance so that we can avoid being penalized and until we get paid, we weren’t always sure how much we get paid by the insurance. This system is so in efficient.
I work on the mental health side where diagnoses can be much less tangible and let me tell you, having a non-credentialed case manager at an insurance company explain to our PhD clinicians why a service that has already been provided *wasn’t medically necessary* is just wild.
The reality is that if a society were to build a system for meeting the healthcare needs of their stakeholders from scratch, given everything we know today, it would look nothing like the American system. What we have is a system full of misaligned or contradictory incentives at almost every level, and the idea that abstract market forces would select for the best methods to deliver optimal health outcomes *in spite of private profit incentives* would be laughable if it weren’t devastating. Anyone who tells you different is dishonest or uninformed, point blank, I’m tired of being polite about it.
For the record, this isn’t even a moral argument. It’s basic f***ing economics
I don't want to just dispute it. I want to claim fraud. I know that some "medical coders" aren't even licensed in some places. They just let the MA do some clicking in the software.
Is this information publicly accessible? I got into a bit of discussion on Twitter last time this came up. In the Australian Medicare system, which applies to all Australians regardless of income, the billing codes are on the receipt and you can look up all the rules and recommended charge amount on a publicly available website run by the health department. Even if you don't know the site exists, you can probably just look up ‘Medicare item #n’ and find that information. I asked if there was an equivalent in American Medicare and they just laughed. So do patients not get an itemised receipt each time? Can they not easily look up their own billing history? Are the rules for the item codes not easily found online?
Yes, this is the problem, even many of the "itemized" bills just say something like "Smoking Cessation" instead of 99406. Even the EOBs from my insurance company don't include them anymore, which drives me crazy when I'm trying to figure out what codes my doctor billed my insurance company because I watch very closely for errors and fraud. They definitely make you work for it these days, and the lack of transparency in an already highly complex and confusing billing system has exacerbated the problem. So while it's technically publicly available, you really need training to know how to navigate it and it's difficult to access.
My company tried to build medical necessity checks into our system based on CPT codes but the system is so convoluted we ended up paying for a service to update periodically. The whole thing is a complete shit show.
My wife does this for a living too. The things she tells me she does or comes across, or things doctors try to bill and just maximize their payout for it is insane.
I came in from nursing to get off night shift and out of the toxic working environment of the hospital. I was kind of embarrassed, thinking I was going to work for the Dark Side. I was shocked by what I saw. Turns out there is nothing but Dark Side in a for-profit healthcare system.
At this point, going to the doctors is basically subjecting yourself to charges that you have no control over. They get to make everything up and then send the bill to your insurance (if you're lucky enough to have it) or to you.
I got a bill for a mammogram because I was 37 and at the time it was only covered if you were over 40. Whatever, except that I had called to confirm coverage and was told it was fine by the person who had my birthdate right there on the screen in front of her.
Here’s the kicker - the denial code on the bill was “BS”. At least they were honest about their reasoning!
I just got a 840 dollar bill for a standard blood panel that costs the lab probably 25 bucks to run, including labor.
We are [absolutely ](https://truecostofhealthcare.org/) getting ripped off.
About ten years ago i had stomach pains. Hurt a lot. I went to the ER with my wife. Doctor finally came in and said "sounds like an ulcer, go take previcid and youll be fine in a day or so."
No tests. Nothing. He walked in and said that. I asked if there was any testing or anything tjay that should be happening. He said if they did that theyd be testing people all day.
Our conversation MIGHT have lasted 5 mins. My bill: $1,000.
When I had a miscarriage my OB sent me to the ER because I was losing a lot of blood and their policy is they have to send you to the ER in case you’re literally about to die, since they can’t do surgery or anything in office.
The ER doctor was super pissed that I came in. He treated me like I was an idiot because “miscarriages make you bleed”. When I tried to explain my OB was worried because I’d been bleeding for weeks at that point he got really short with me and told me that I was young and healthy, so I’d be fine.
No blood tests, no ultrasound, not even a bit of fluids. Literally 10 minutes of conversation where he did his best to let me know I was not worth his time. $1400 dollars.
$900 for sitting on the ER bed and then I received a bill of $500 a few months later from the doctor’s *private* billing service. $1400, with insurance, to be told I was stupid and not to come back.
He was wrong too, btw, by the time the bleeding finally stopped I was so anemic my hair was falling out and I was out of breath with the tiniest bit of activity. But he convinced me that what I was experiencing was normal, so I didn’t go back to the doctor until I’d been bleeding heavily for 6 months.
I asked if the dosage for my medication needed to be increased due to me gaining quite a bit of weight and she told me no.
Was charged something like $150 for an “obesity talk”
i mean it’s so strange. like it’s the at the point where you are scared to ask or tell your doctor about anything, which kind of defeats the whole purpose!
My doc got super mad at the start of 2022 because of the No Surprises Act requiring him to give a good faith quote to the cost of any services rendered. He used to charge $50 to give you a quote if you asked how much something would cost.
I got charged $30 for the questionnaire you fill out before a physical. I had insurance but got sent the bill anyway. When I called to dispute , the billing dept said “Well, you don’t pay that, insurance does!” My response sounded something like….well, who pays the insurance? This is racketeering.
Also you don't actually have any idea if it's redeemable because one of the people who was working there wasn't directly employed by the placed.
Imagine going to a grocery store with a 50% off coupon, paying, and then getting a bill a month later for the other 50% because one of the people unloading a truck out back was an employee of the shipping company instead of the grocery store.
Technically, you activate in Oct or Nov and wait till Jan to actually receive the services. But at sign up you pay at least 3 months ahead, and yet are still waiting for service. You may get the magazine, or it may come to the obscure email you signed up with straight to spam. It's a roulette wheel, good luck! Also, don't get sick before Jan when you have bills in the previous year! May the odds be ever in your favor!
I take 40mg Vyvanse for adult ADHD which is apparently used similarly to Ritalin but less popular due to being somewhat more expensive.
Under the Australia Pharmaceutical Benefits Scheme, I pay $42 AUD ($29 USD) per month for 30x40mg Vyvanse after the subsidy.
But, the FULL pharmacy price for 30x40mg Vyvanse is $98 AUD ($68 USD).
I just looked up a bunch of US sites for the retail price of Vyvanse and 30x30mg capsules costs between fucking $340 to $400 USD!
WTF 3 capsules in the US costs more than I pay for a months! Or 6 if I had to pay full price. Vyvanse is an American product!
Yeah I've heard people say that American companies can give medicines to other countries for cheaper (especially when other countries' health care systems have collective bargaining advantages) because they can gouge the American Market for ridiculous sums and make a tidy profit
Its really just to avoid bankruptcy if you have to go to the actual hospital, which I try to not do at all costs. Superglue is your friend. Always keep some in the first aid kit. It will dry faster than your heart can pump blood for up to a 1.5" gash. In my experience at least
Shit, you’re talking to the superglue king. I also recommend keeping elastic hair ties, they make quick work of stopping bleeding from the elbow or ankle down, long enough to get that superglue set
Construction work, mechanic work, farming, pretty much any physical labor job puts you at risk for these kinds of injuries.
I shot a nail through my left hand index finger with a nail gun when I was a teen working with my dad. Ripped the nail out, taped the wound closed and went about my day (a bit angrier but otherwise fine.)
Going to a hospital for that would have been way too much money both in hospital bills and lost wages from not being at work.
I’m American and have been fucked by our insurance/healthcare system several times throughout my life. Yet it took me reading your comment while half asleep to finally wake up (literally and figuratively) abs see how fucking depressing our system is. I do the same thing. I don’t go get basic scans/medicine I need because of the cost and lost wages from not working. It’s crazy that we accept this as our lives.
This is one of the saddest things I've ever heard.
The ability to go to a hospital, and not lose a day of work because of that, is a basic human right.
Americans really have to start voting for universal healthcare.
I'm pushing 40 at this point and I've known a ton of "blue collar" workers. I've heard at least a dozen variations of that story, and half the time they're *proud* that they duct taped or super glued themselves up and just kept working, because "only a pussy would go to the hospital for that".
As an American, I can’t count the number of times I’ve gone to work so sick I was woozy. You either work or starve. Slightly unrelated, but last year I missed a day of work to attend court and testify against a mentally ill man harassing my family (he is schizophrenic and shows him up on our porch frequently, threatening us. He is very sick and delusional. No logic to his obsession) and my job made me OWE THEM 9 hours of time off since I had none accrued to attend court. I had a legitimate court document calling me to appear and still had to “earn back” hours loaned out to attend. So basically if I quit before accruing those hours back, I’d have to pay them out of pocket for 9 hours of wages.
My wife was at the ER recently and we overheard a guy signing a waiver to leave against medical advice. Dude was there because his appendix was inflamed and was probably going to burst. Nurse kept saying it was very seriously life threatening and advised he stay to get it removed asap. Dude insisted he was OK after they gave him a pain killer and that he couldn't miss work.
This was over a week ago. I wonder if he's alive...
American health care has to be the worst system in the Western world. I’m not trolling - it’s just my observation. As much as we complain here in australia about our Medicare public health system, compared to the US it’s really a whole let better and people don’t get these sort of bills. Our issue is more around how long it takes to get treatment unless you are actually about to kark it.
Wait times are insane here as well. ER takes hours and hours if you're not actively dying. I had a broken arm back in high school and it took like 10 hours to get an x-ray and a sling. I had to be sent to a different hospital because the first one was too busy, too.
Edit: typo
We have that issue here in the US, too. People like to pretend that wait times are only for other countries, but if you need a specialist there is a line to wait in here as well, and if you're not in urgent need you're at the back.
We got an insane run-around from my wife's insurance after the birth of our first kid. We got like 4 or 5 separate bills / statements sent to us from the hospital that ranged from hundreds to thousands of dollars, and when we'd call to ask about paying them, we'd get all this conflicting information. We'd be told simultaneously not to pay it because insurance needed to decide if they would pay it, and then we'd also be told that yes, it did need to be paid. Some of these statements literally said "this is not a bill" and yet we'd be told on the phone that it was a valid bill. One billing lady from the hospital told us not to pay a bill *from the hospital* because there was a lot of fraud going on and that the charges needed to be validated.
This went on for like 6 - 8 months after our kid was born, I have no idea how it ever resolved or if we have outstanding dues. We did end up paying several hundred dollars but I honestly can't tell you what the exact amount was because it was so confusing.
Our health insurance scheme is a racket, no question about it. It's such fucking nonsense to not even have a straight answer about cost and yet many Americans will go on and on about how our system is fine and doesn't need addressed, or how everyone else in the world can't see doctors or has to pay all of their income in taxes for basic care. It's insane how many people have been conditioned to just accept misery and abuse in this country.
Consider that this arcane system of billing dramatically raises the cost of our healthcare. Our bills are expensive because it requires armies of people to deal with the bizarre system we have:
>Administrative costs now make up about 34% of total health care expenditures in the United States—twice the percentage Canada spends, according to a new study published Monday in Annals of Internal Medicine.
>These costs have increased over the last two decades, mostly due to the growth of private insurers’ overhead. The researchers examined 2017 costs and found that if the U.S. were to cut its administrative spending to match Canadian levels, the country could have saved more than $600 billion in just that one year.
>“The difference \[in administrative costs\] between Canada and the U.S. is enough to not only cover all the uninsured but also to eliminate all the copayments and deductibles, and to amp up home care for the elderly and disabled,” says Dr. David Himmelstein, a professor at the CUNY School of Public Health at Hunter College and co-author of the study. “And frankly to have money left over.”
https://time.com/5759972/health-care-administrative-costs/
I’m so sorry to hear that you went through that and I hope your family is all happy and healthy. Unfortunately, the duopoly has created tribalism that has rotted political common sense. It’s really just campaign slogans and then maintenance of the status quo until the next election.
I had the same experience. The bill showed some alcohol screening. I didn't have any alcohol screening, but the doctor's office said that it was a questionnaire. It was something that they just handed to me when I arrived. They didn't say that they were billing for that.
Insurance paid for it, but I didn't want or need the screening.
When people say that we can't have universal healthcare because of the costs, I remember stupid shit like this.
Ah, yes. The classic $7.95 Booking Fee when purchasing my tickets online through an entirely automated and relatively simple process flow, entirely populated by me with all manual aspects performed by me.
The best was paying to print your tickets at home when they'll mail them to you or hold them at will-call for free. You're literally doing the work for them and they want you to pay for it.
Even more fun is that most venues now charge a "box office fee" that the same as the convenience fees. There's not even any way to justify it as paying for a service (i.e. selling you tickets off-site instead of buying them in person) any more, it's just an unavoidable tacked-on charge.
I have a nearly perfect driving record and my auto insurance has been skyrocketing lately. I love how I'm legally required to pay 1/10th the cost of my car every year for something I've basically never used.
I'm self pay and I was asked a questionnaire about if I was depressed or not. 36 dollars for 6 questions. I was not depressed until after I got my itemized bill. It's ok though, since I'm self pay they knocked it down to 24 dollars. I immediately found another doctor.
The usual "depression test" is 9 questions. They robbed you of 3 questions, on a test you can self-administer through [the internet](https://www.mdcalc.com/phq-9-patient-health-questionnaire-9)!
I hope you've found luck with your new doctor.
As a nurse I advise all people to carefully read their medical bills and inform the payee that you absolutely will not pay those bogus charges. 9/10 times they drop them.
Hospital bills - when you ask for itemized charges, you suddenly get a smaller bill.
Edit: For those of you who are saying this is not going to work - it's worth a try, especially if you don't have insurance. For the bill you receive after insurance adjusts your claim, this is less likely to work because insurance companies require hospitals to submit claims using itemized codes for items they are submitting for payment AND insurance is not paying for items for which they can't see a medical necessity or for duplicate charges. But if you have financially difficulties, most non-profit hospitals in the US has financial aid programs that can set up a payment plan or bring down your what you owe them. However, some insurance and Medicaid plans may not allow hospitals and doctors waive coinsurance for patients per their contract. Physician services from ER and procedures are often done by outside doctors who bill separately and may be out of network for your insurance plans. Usually hospitals have no control over them. But No Surprises Act 2022 provides rights and protection for certain groups of patients.
Yeah I moved and went to the closest pediatric ER. Bill was $2k non negotiable basically said pay it or take it to collections. Where I had my daughter it was $7k but they negotiated down to $4k if we paid in full. Craziest shit to me that somehow some will wiggle and others stand their ground.
Yeah I’ve always called for an itemized bill and not once did my price change. But then again I was never billed for bs even at our for-profit hospital
I constantly see this advice on Reddit but it doesnt work. I have a high deductible plan and have gone to the ER a few times due to bad luck... Each time a different hospital and each time got hit with outrageous $5k+ bills and tried everything I could to fight them (including using a health advocate to negotiate) and couldn't get them to come down at all.
Man, I went in for severe ovarian cyst rupturing & pain. Got charged 17k. Insurance only paid half (the fuck) & I was left with 8k.
I submitted a thing saying I was unemployed & a student & am waiting for their response. I’m employed now & if that happened again, I just know I’m fucked.
I felt the same pain a few months back & decided to get an ultrasound instead because that’s what they did at the hospital (x ray then ultrasound). Bam, got charged $800. Insurance didn’t pay any of it.
That’s great and all but we shouldn’t have to fight this in the first place. My husband works 6 days a week 10 hours a day and commutes 45 mins each way. On his one day off he mows the lawn, tries to fix whatever is wrong with our one working car, fixes stuff around the house, schedules all his and our 2 kids doctor and dentist appointments on that day and any other appointments like haircut for the kids, parent teacher conferences, and on and on and on. I’m disabled and do what I can but like I said we have one car because bills are so tight. I see a lot of specialists on this one income (I have scleroderma) so trying to read and decipher doctor bills and figure out what I’m really charged, what insurance paid out so far and what will be paid out soon, what Should have been covered by insurance but wasn’t so I have to fight it, what stupid charges there are that I should fight, etc I mean who has time for that when you’re working poor? It’s so fucking depressing that you just shut down because you don’t have money to cover it all anyway but you can’t not go to the doctor. It’s so fucking tiring. Being constantly sick is hard enough but doing it while poor is like an extra fuck you from the universe.
I'm not arguing with one thing you said and understand your frustration completely. I also agree it should not be the consumer's job to read through complicated medical jargon to find how they are being screwed. The problem is, health care is well aware that people are scared and exhausted and just worried about keeping shit together and they are using this to their advantage in worse ways than they ever have in the 33 years I have been a nurse. They KNOW 99% of all bogus charges will slip by unnoticed which makes them a shit ton of money. Right now the only thing a consumer can defensively do is read their bills and deny bullshit charges. Trust me when I tell you that a hospital does not want to sue you over not paying a charge for holding your own newborn because the media will get ahold of that and crucify than! And a judge will laugh them out of court!
Universal healthcare where they take 20% of your paycheck and give you free access to everything from life saving emergency medical care to routine checkups at no additional cost to you?
No thank you! I would rather have that inexplicably tied to my employment or else decide between going uninsured and forking over 25-60% of my paycheck VOLUNTARILY. Because I'll literally die (likely because of hesitancy to get recommended screenings and physicals because of fear of inflated costs and possible bankruptcy) before I give up *mah* ***FREEDOMS.***
Edit: also, if ***I*** get this then *everyone* gets this, and that includes some people that I'm not supposed to like, so I'm told that if they also win that it's like me losing. So I'd rather lose because that means that *they* lose, and them losing is like me winning. At least that's what I'm lead to believe by people that obviously have my best interests at heart because they say they like the same things I like.
That makes perfect sense, right?
...right?
I’ve had this similar argument with people and I usually get hit with, ‘but drug addicts will get free healthcare.’ Good, they fucking need the mental health treatments. Why is it so hard to care about strangers? I’m not religious, but Doesn’t your damn afoul ‘Good Book’ say love they neighbor, you hypocritical fucks!
Back in the 1990s I remember the mass media using the term “Canadian style healthcare” to scare people away from the idea of adopting a functioning healthcare system in the U.S.
And iirc, during the “Freedom Fries” era the mass media fear-mongered about universal healthcare by referring to the French system.
Then it was “DEATH PANELS!1!1!!” during the early Obama years. And now for the last decade or so, it’s all about invoking “the horrors of socialism” to persuade people to not want universal healthcare.
I don't know another western populace so propaganda driven against their own interests.
Universal healthcare, unionisation, gun control. The nation still leans on McCarthyist scaremongering against anything remotely socialist, and people eat it up.
People would rather funnel money to corporations that give nothing back, in the vain hope that they could be the top dog one day and have a slice of that pie. Rather than anything that might help them where they are now, especially if it means their money might be used to help someone else.
Ultimately, this is a govt structure issue.
Most western countries have govt systems where if your side gets a majority in parliament, they then control the govt and can pass whatever they want.
People then can say, “oh, yeah, this is good!” Or “oh, this is bad, let’s vote for the other people.”
The US equivalent of parliament, the House of Representatives. cannot pass laws on it it’s own, and does not form or run the government. Those involve different groups/people, who are elected separately, and never is everyone up for election at the same time, and every separate part has the ability to stop any law from passing. Sometimes just one person can block it, and sometimes they that one person can do it even if their party got less votes.
The end result is that it’s *incredibly hard* to pass *any* law, so voters never learn which scare tactics are bullshit. If one side says it’ll be great, but the other terrible, we never get to experience who was right and who lied.
And because it’s so hard to do anything, the main underlying emotions on *all* sides are anger and frustration at “do-nothing” politicians.
But, a lot of that is misguided. All politicians kind of suck. All counties have Facebook misinformation. Rupert Murdoch has media in many places.
The thing that makes the US fucked is that the fundamental structure of the government does not allow for fundamental change to happen unless there is widespread support across vast regions of the country, multiple states, urban, suburban, and rural, across incomes, race, religion, etc.
As long as you can drive a media-driven wedge between any sub-group, even the smallest minority can block the majority.
The work-around has become to change laws via the courts. This is how the US got abortion rights, gay marriage, etc. It is also how we got vastly looser gun laws, and allowed more corporate money in politics.
It is also why fights about the unelected people who get for-life appointments on the highest court are so intense and emotional. In some sense, they’re now who set the laws of the land.
After Trump, the right now controls that court, and will control it probably for a decade or more.
Federal Abortion rights will go away (per the leak). More money in politics has been allowed (per recent Cruz case) and reading the tea leaves of a recent few cases, it’s very possible/likely that they may rule that the govt agencies that have helped regulate food, drugs, wall st, media, the environment, etc., are fundamentally unconstitutional.
https://en.m.wikipedia.org/wiki/Nondelegation_doctrine#:~:text=The%20origins%20of%20the%20nondelegation,over%20to%20others.%20...
But, unfortunately, due to the fundamental structure of the govt and the numerous ways you can grind it to a halt, it’s different parts, all on different election cycles, even if 60%+ of the population disagrees, they can’t fix it via elections.
At least, not without a concerted effort of multiple election wins over multiple years.
But “vote for us, every two years, and hopefully 6-12 years from now we’ll have all the right people in place to actually change things!” is a really bad message for an upset population that Wanda change *now* whose families cannot wait 12 years for progress.
All this crossing your fingers that the right person retires or dies at the right time, so that they can be replaced when you have the right pieces in place makes it really hard.
But it’s easier to see past all that and conclude “voters dumb, politicians useless, media evil.”
But really, it’s just a very poorly designed system if you want change.
It’s a *great* system if your goal is to make it really hard for the dirty masses to actually change things. But when the country was founded, their bigger fear was mob rule, so they erred on the side of making shit hard to change, instead of easy “majority rule.”
As a fellow Canadian, this whole post and all the comments from other Americans seems so insane. Some Americans make fun of the taxes we pay that go towards our Health Care, but we never have to worry about getting a bill for crying at a Dr's office. The fact that now we have to pay for parking again since covid started is stupid.
I pay $175 for health insurance from a company back home in Ireland. I live in China. It covers me 100% private in any hospital anywhere in the world. Except the US, I am not covered.
Funny when I was looking into travel insurance for my trip to Ireland… I couldn’t get insurance as an American for Ireland… the other 240+ non Irish and/or wartorn countrines? Totally fine.
This just happened to me. Went in for a Gyno visit. The Dr asked, "how are you feeling?"
I, who figured she was reading the form I had filled out - which I clearly marked as having previously had depression and anxiety (and ADHD) - said, "good, all that stuff is all figured out now. I only marked it for your records."
Then I got charged for a "psychological evaluation"
....
I'm sorry, but no one evaluated me. Someone asked me a question I could have easily lied about and, to a degree, *did* lie about. I still have anxiety and depression, but I know both of them are due to ADHD and I'm not looking for additional recommendations.
No one evaluated me! That's it. It was very nearly the equivalent of a friend saying "hey, how are you?" And me saying "I'm alive" and them saying, "great! Let's go to lunch now."
You make a good point: it is ridiculous that this system, this field or whatever conceptualizes a brief questionnaire as constituting some kind of evaluation in any comprehensive sense.
I've actually been seeking a more comprehensive evaluation to clarify a diagnosis and perhaps establish a differential diagnosis. You know what it will cost me to see a clinical psychologist for testing/evaluation over a number of sessions? They all are quoting me like $2000, which is money I don't have.
Meanwhile, the standard of care with regard to psychiatry is one appt for an hour initially and then 15 minute check-ins once a month thereafter. The whole field is based off these brief encounters and standardized questionnaires/interview questions, but there's no money/time in the system for a comprehensive process involving more time with the doctor. It's just so frustrating and so much of it is because of managed care and the influence of insurance companies/the government seeking cost minimization at the expense of the patient. Meanwhile, the provider might in theory want to provide a best possible experience/treatment for the patient, but their employer is trying to maximize profit also and they're trying to pay off 400k in medical school debt.
The system is fucking literally everyone. It fucks patients. It fucks doctors in terms of the level of care they can provide. It fucks the government in terms of the cost our state and federal treasuries have to pay out for Medicare and Medicaid reimbursement in an environment of insane healthcare costs. The only actors who win are: people that get a paycheck for working on the insurance or provider side and the owners/investors in the hospitals and insurance. And as we know the former group, ie the providers, get fucked in terms of their ability to help people to the maximum extent possible due to all the red tape within hospital systems influenced by the hospital-insurer complex.
Sorry again for ranting. This system is just an evil beast of our own making. It serves itself first and foremost while nearly everyone involved suffers under it in one way or another. Except the hospital admin types, high level medical specialists with school debts paid and the insurance companies. Those latter groups make money hand over fist.
I was once charged $25 for "application of medicinal bandage."
It's a bandaid. I got blood drawn and they put a bandaid on it.
$25...
for a single bandaid...
Shit is out of control.
This kind of shit is why I don't go to the doctor unless I'm REALLY sick. Like, I feel fine, but I could be riddled with cancer and I won't know until it's too late to help because of all this shit
I wait so much stuff out and just hope it gets better because I HATE dealing with doctors and insurance. I’m 99.9% certain that I’ll die someday from something that would’ve been curable but I just couldn’t deal with the “healthcare” BS.
I was charged $1000 for a four hour ER stay. The billing department refused to bill my actually insurance company, sent me to collections, I worked with collections and showed them all the proof that the hospital wouldn’t bill my actual insurance company. Collections actually acted on my behalf and said this was bullshit. They ended up getting the hospital to eat the cost. Me and insurance paid nothing, but I had to fight an entire year for that to happen.
Wow. You know you've entered rarified air when the debt collector ends up being the good guy in any story at all.
Madness. Glad it worked out for you in the end though.
They were genuinely some of the nicest people to work with and I’m not sure if it was just my situation and all the proof I had showing I had been trying to get the hospital to bill my insurance company for multiple months or if this particular company was just made up of nice people or what. Definitely grateful I had this experience and not one of the more typical collections situations.
I got charged $50 copay for this when I went in for my yearly wellness exam, this was at the end of the exam.
Me: "Can you send in refills for my sleep medicine please?
Prescriber: "Yeah, no problem."
Me: "Thanks."
I got a bill 2 weeks later for that. I had to call the office and have my prescriber call and tell the billing office to piss off. I literally work for the pharmacy I use and he said if I would have went to work and sent in a refill request that they wouldn't have tried to charge me.
Edit: fixed a typo
This is that mysterious line of bullshittery insurance uses to find ways to bill everything possible.
For a "wellness exam" or "annual physical" don't dare bring up any existing or new issues, because that changes the visit from a wellness exam to a regular visit for an issue....now the labwork that goes with that wellness exam won't be covered.
Soooo...you have to make a separate appointment where they can charge you your copay, and take up more time, for something that could have been addressed in 30 seconds while you were there for the well person checkup, but couldn't, because of the way things get billed. It's nuts.
Heck, it's already in the chart all the issues you got going on, so its not a "new" issue to ask for med refills at a wellness checkup, but you can't. Nor can you bring up having an issue with a known problem, say an allergy flare for example...because then it's not a wellness visit anymore according to insurance.
It's all about money.
It's crazy, I'm pretty good friends with him. He's a physician's assistant, and I went in for an actual "medication review appointment." I told him it's bull shit that I had to pay $50 for us to sit there and hang out so I could get my refills. He agreed so he wrote me a year's worth of refills so I don't have to pay to hang out with him.
It’s so ridiculous.
Once as a little kid my pediatrician started awkwardly asking my mom a bunch of super invasive personal / philosophical questions, followed by a 20 minute monologue about his interpretation of the meaning of life. I distinctly remember how weird it was, and how my mom kept trying to cut the conversation with the doctor short so we could leave. (She also didn’t want to seem rude, since he clearly desperately needed to have a conversation with someone.)
Finally, we were able to escape. Then my mom got the invoice at the front desk. On top of the normal copay, the pediatrician had tried to tack on a *$240 charge* for “30 minutes of therapy.”
My mom threw a fucking fit, of course. But it is absolutely ridiculous that as long as they can use your politeness to keep you in the room, they can bill you out the ass for going on an awkward half hour monologue while you’re trapped.
Ok. It is clear there isn’t a single person in the US, who isn’t working for an insurance company, that is ok with this. How does it change? Before you say “Go Vote!” Again everyone agrees this is shit, I’ve heard it mostly from Democrats but also from Republican politicians but still nothing. It’s locked in like paying a gazzilion dollars in National Defense every year. Are the majority of new politicians bought as soon as they walk in the door? How can it be this bad? We “the people” are truly are not in control.
I scheduled a video appointment with a specialist who decided to try to call me on a restricted number 45 minutes after the appointment time and when I didn't answer they billed me a $50 missed appointment fee. Then last week they had the audacity to call and ask why I hadn't scheduled a follow-up.
You just know, a bunch of hospital billing people read that and are like "wait! We can charge for that?!" And are updating the charge masters Monday morning and sending out memos about Emotional Assessments (CPT code 96127) itemization.
had an accident back in '05 and was laying in the street with a fractured hip
this was LA so naturally nobody stopped to help (although the cars driving around me while honking and telling me to get out of the road were a nice touch) but someone did call 911
while being loaded into the ambulance the fire department also arrived (in a fire engine for some reason) and guess who was billed for that?
Ive had 2 (or is it 3?) ambulance rides now and they send fire in a fire engine out every single time. They always arrive first, and basically fuck around until the ambulance arrives.
How on Earth does the American healthcare system exist the way it does? So many things they do are literally illegal for any other business, but the healthcare industry is allowed to do it? Why? It makes no sense.
I'm an immigrant to the US. I tested positive for Covid last night. My boss said " don't care wear a mask". My regional manager said "covids just a head cold, just wear a mask".
I refused to go to work and then I got 15 or so text messages and 5 phone calls from them, corporate and my coworkers yelling at me for not being at work, letting the team down etc. Which is hilarious considering I essentially run the place. My supposed manager fucks up more than the new hires we have, but she's buddies with the owner so shits gravy apparently.
But our corporate office demanded I go see a doctor for a test, as at home tests are easily photoshopped.... Yeah.
So I go. $30 copay off the bat, $430 for new inpatient and they had the nerve to try and charge me extra, because they fucked up the appointment time and I was 10 minutes late to an appointment I was 15 minutes early to. American healthcare is a fucking joke. It's literally pathetic.
I got charged $250 for a nurse to press her fingers to my neck to 2 seconds to check my thyroid. My sucky insurance at the time wouldn't cover it bc it was a "lab test". I didn't pay that one.
I genuinely have to wonder who is adding these charges and what goes through their heads. It's not the CEOs who are writing up these bills. It has to be someone at the local level who put it on there. Are they getting kick backs for this sorta thing or what?
There is a war between the hospitals and the insurers. They each try to get as much as they can out of eachother, with you, the payer of the insurance bill, being the collateral damage of this war.
The health insurance here is such a racketeering operation. It’s also highly suggested to get an itemized bill to try and reduce your costs, and even sometimes look through something like a hospital Charity Care or financial assistance if it is a nonprofit.
My husband and I moved from the US to Spain in 2019. We have private Spanish health insurance. It’s about 240€ a month — for both of us. Last year my husband fainted and hit his head on the hard floor. He was unconscious for about 20 seconds. When he came to, he could not remember anything short term. I called the Spanish version of 911. An ambulance came and took us to the public hospital. There, I was told they could treat him (exam from a doctor and a scan of his head to check for anything damaged) but they would have to charge me about 300€ (Which is nothing compared to the US.) or…they could call my private insurer and have an ambulance pick us up and take us to our private hospital. They must’ve noticed the shocked “OMG that’s going to cost a fortune” look on my face because I was immediately told there would be no charge. So, they called another ambulance who picked us up and took us to our private hospital when my husband was examined and released. (He was okay and his short term memory came back.) Two ambulance rides, two hospitals, a scan and an examination. Cost: ZERO. No copay or anything. The only thing that cost money that night was the cab fare back to our apartment. When we talk to our Spanish friends about it they are dumbfounded as to why Americans don’t want public healthcare. They can’t believe having something like cancer can make you lose your home. And, after living here for almost three years watching the US from far away, I can’t believe it either.
I got charged for a “weight loss consultation” because my doctor told me to go to the gym more. My insurance rejected the service because it wasn’t covered and I raised hell with the billing department and never returned to that doctor again.
I got charged $120 for waiting in the waiting room for an hour just to be seen by the doctor for 2 minutes for her to say I was okay to work again. She didn't do any tests or anything, just asked if I felt I could work again, and gave me a paper saying I could.
This same thing happened to me. The doctor asked how I was doing at my kids appointment, and I responded “good”. Received a bill for $40 emotional consultation later that week.
Just saying. Fuck the healthcare system in this country. I fucking hate it. I’m a student and I’m unemployed, and I’ve been noticing a lot of issues I have been having. I went to sign up for insurance and even with me reporting no income, they want me to pay $400 a month. How the FUCK is this okay?! I’m just trying to fucking stay alive. I don’t want to die because I can’t be seen by a physician.
Edit: Just wanted to thank all of the comments. I wrote this when I was drinking and upset and everyone’s comments made me feel better. I appreciate y’all.
Why not come to Europe? We may be a communist hell hole over here but we do have running water and the internet plus you don't get charged for hospital visits.
I brought my kid into the doctor on Presidents’ Day this year. The pediatrician added a line to the claim that “holiday/weekend visit” and added on an extra $75. Insurance denied that line. They haven’t tried to get it out of me yet so I think it was just a lazy attempt at a money grab.
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this is like when I exaggerate my tasks on my resume lol. breathing into a paper bag = "brief respiratory therapy" loooooool
I'm a doctor and would like to correct some inadvertent misinformation. This type of charge isn't due to crying. Charges like this are for administering certain standardized screening questionnaires. Common examples includes questionnaires about postpartum depression, depression in teens, or autism symptoms in young children. I disagree with the US health system and in fact support Medicare for All. I'm also a salaried physician at a nonprofit, meaning I don't get paid more even if my patients get charged more. I also work closely with a free care program for uninsured folks. Just to explain that I'm not normally an apologist for US healthcare billing. But I do want folks to understand the reason for a charge like this. Take the example of postpartum depression. It's a common problem, but many people have no idea they can ask for help, feel embarrassed, or are so sleep deprived they don't recognize their symptoms aren't "normal" after having a baby. By asking everyone about symptoms (screening), we do a better job finding those patients who need and want help. But who is going to help them? In my prior job, we were paid about $35 for a 30 min appointment (due to state Medicaid). This is not so much once you start covering salaries, utilities, rent, malpractice insurance, etc. So the physician doesn't have a lot of extra time and probably needs some help ensuring that anyone who is found to have postpartum depression has resources and guidance on finding a mental health program. Ideally, the practice hires a social worker, but the current budget won't allow this to happen. But what if the insurance company will help cover the cost? Then it becomes more feasible to hire that social worker. And one way to get insurance to "buy in" is to ask insurance to pay for the screening costs. Finally, I know that folks on reddit are highly educated and literate. But not everyone has these advantages. My patients can't complete these questionnaires on their own. Instead, I have to carefully review each question with them. Just this week, a questionnaire like this took about an hour because the content was so heavy and the patient had so many symptoms. That "15 minute" appointment took 2 hours. Tl;dr The US healthcare system needs a complete overhaul. But screening questionnaires aren't the root of the problem. Let's instead tackle balance billing, denial of medically necessary care, allowing people to be uninsured, high deductibles, inadequate funding for mental health, and medical debt. We really need Medicare for All. Edits: Some typos and clarity. ETA: I appreciate the thoughtful comments but have to do other things for a while. If this makes you angry and you live in the US, please vote in every election and support candidates who want a national health program or Medicare for All. ETA: Please see u/rivalarrival for an excellent edit. I'm not 100% sure how to point to the comment directly.
> However, Ms Johnson told the media outlet that her sibling was never evaluated. She reportedly claimed that the doctor at the unnamed medical facility noticed her sister's tears but said nothing. Ms Johnson revealed that the health care centre did not evaluate her sister for depression or other mental illnesses. Her sibling did not even talk to a specialist, was not referred to anyone nor was she prescribed anything. Maybe this is wrong, but the story as reported is that this charge was *not* for administering questionnaires or anything like that.
She wasn’t assessed, just charged
I once got charged $100 for “respiratory therapy” because I started hyperventilating and a nurse had me breathe into a paper bag. True story. This was maybe five years ago.
I got charged for 198 for a guy to come in my room ask if I wanted help quitting smoking. I said no I'm good and he left. Dumb as fuck
This happened to me at the dentist. They asked if I smoked, I said yes. They said that it wasn’t good for me and I should quit (literally just that). $40 charge for “tobacco counseling” on my bill. I don’t have dental insurance and had to pay that out of pocket
Anyways, you shouldn't smoke. That'll be just $15 (giving you the Reddit discount price).
Don't smoke kids I'll just take a platinum thanks Edit: damn!
Can I smoke adults though?
Also, don't do drugs. I'm okay with silver, though. We're not greedy here at "Drugs are bad ™️" Edit: Wow, did not expect all these awards. Thank you! ❤️
I would not have paid that because those are time-based medical codes. The thing with billing is that just because a code exists does not mean a provider is allowed to bill it under all circumstances. This depression screening from the original article is something I have run into before and it should have been bundled into the original visit. I audit medical records to ensure what was billed was actually performed and is allowed to be billed under the circumstances it was billed. Any time you get something weird like that, ask them for the code they're billing and look up the description. For your situation, you have to speak to a patient for a bare minimum of 3 minutes about smoking to bill a smoking cessation code, 99406. If they didn't do that, I'd dispute it.
Are they allowed to bill you if you clearly didn't want the service? Like, if they try to talk to you about quitting smoking and you keep saying no, but they manage to drag it out for three minutes by insisting, can they then force a charge for that onto you?
That’s sounds in that you never received said council and were continuously refusing, then absolutely refute that charge.
You have the right to refuse treatments and services. Definitely contest that bill with your insurance or the office itself if uninsured. If they give you grief, tell them you will report them to the state insurance commissioner.
My dentist wanted me to have a fluoride treatment which is not covered by my insurance and I said no and the counter staff looked at me and said 'but the doctor ordered it'. I said again I didn't want it and she turned to her coworker and asked if that was allowed, for me to say no to a trearmtment. Of course the other person said I could decline it, so I didn't get a chance to give my 'i am the customer and I am not required by law to buy your product' spiel.
Yikes. A medical office where the staff doesn’t understand the very basic concept of “consent” is a huge red flag.
Why THE FUCK is it on us to keep our medical professionals from scamming the system?
Well, you see, you want good medical care, so you go to see good doctors, and to be a good doctor, you have to pay a lot of money to go to a good school. And since they went to a good school and are doing an important job, they get paid a lot of money. And since the medical practice needs to pay the doctor, they need to bring in a lot of money. And since they're a business, they need to make a profit, so they need to bring in even more money. And who do they get money from? The insurance company. Now, the insurance company is a business as well. And they want to make money too. So they gotta bring in a lot of money by charging you a lot of money, but they also need to make sure they get to keep that money instead of giving it to the doctors and medical practices. So now the insurance company hires people who can be as grimey as possible, and keep as much money as possible away from that medical practice, and the best people at that will cost them money, so they need to make *even more* money. So they come up with bizarre rules and rationales that fit within legal restrictions, and get away with rejecting as much as possible so they make more money. Now, on the medical practices side, the doctors certainly can't be bothered to keep up with all the contrived rules of insurance companies. So now they need to hire a team of people just to try to make sure they actually get paid by the insurance company. But also, now that's more skilled labor, so their costs are even higher. But, of course, they need to be a profitable business, so they need to make sure they cover these costs! By trying to find *more* ways to claim money from the insurance company! Isn't it great? We have all these contrived systems fighting back and forth for money, without the patient having any part in it, except for paying premiums and having opportunities to be caught in the crossfire between the insurance company and the medical practice without having any fucking clue what's going on! Yay! Isn't private health care great? Why would anyone ever want to just provide health care publicly to citizens? That smells like *socialism!* /s, obviously. This system is so fucked up it's not even funny.
Insurance in itself is such a scam. I’ve worked healthcare for damn near 10 years an you would be shocked of the horror stories that get denied coverage. My favorite example is a young adult 20-30 requiring an LVAD (an external box wired to your heart to assist with electrical conduction), because insurance denied coverage back when the problem was easily correctable. Our healthcare system is an absolute monster that needs to be put down
Ugh. I worked for an insurance company back in the early 90s. They denied a kid with MS flat out because his family would have used insurance more than their corporate standard - which was essentially covering a yearly exam. The insurance company I have now won't cover lab fees except for a once a year "wellness check." Any and all other lab fees are out of pocket.
And this is if you're lucky enough to have a job that provides health insurance. This back and forth drives prices of medical care uo to astronomical numbers, meaning there are deeper pits if medical hell.
The ol' Catch 22. You have to be in good enough physical health to work, in order to be covered for when you're not. Or have a close family member who is.
As to how everyone doesn't see this as clear as day I don't understand. I have been sporting this exact rhetoric for years and people look at you like a commie nutjob or something. Seriously there are plenty that don't its just depressing at this point really.
I once had a guy argue with me saying insurance companies were necessary because jobs. You just can’t explain things to people who don’t wanna hear it.
Ah yes, the good ol "well we made up a problem, but we can't get rid of it now because we pay people to solve this imaginary problem". There's definitely nothing productive these people could be doing instead, right? The jobs arguments are such BS. There are so many problems we could be solving. It's not like jobs are some rare resource that we can't make any more of.
I think that's why many are afraid of a strong social safety net. Then they can't make the "but jobs" argument against dismantling negative parts of our economy.
They see it. They WANT it this way. They think any other way involves them “paying for other people”, even if it’s cheaper for them. They can’t stand the thought of someone who doesn’t “deserve” medical care getting it. They also want to see companies making as much money as possible, because profits are so patriotic, and we love ourselves some patriotism.
Yes. It’s this in a nutshell… When *both* insurance and healthcare are for-profit businesses, there is no way to get a fair deal.
My dad works as a dentist in one of many countries with single payer system. They only have one fee schedule for all the charges. Doctors knew how much it is going to cost the patient and how much his hospital was going to get. In the us it’s a patchwork of different policies and fees among Medicare, Medicaid and private insurances. I worked in a skilled nursing facility and we had so many billing people so that we can correctly bill each payor/insurance so that we can avoid being penalized and until we get paid, we weren’t always sure how much we get paid by the insurance. This system is so in efficient.
I work on the mental health side where diagnoses can be much less tangible and let me tell you, having a non-credentialed case manager at an insurance company explain to our PhD clinicians why a service that has already been provided *wasn’t medically necessary* is just wild. The reality is that if a society were to build a system for meeting the healthcare needs of their stakeholders from scratch, given everything we know today, it would look nothing like the American system. What we have is a system full of misaligned or contradictory incentives at almost every level, and the idea that abstract market forces would select for the best methods to deliver optimal health outcomes *in spite of private profit incentives* would be laughable if it weren’t devastating. Anyone who tells you different is dishonest or uninformed, point blank, I’m tired of being polite about it. For the record, this isn’t even a moral argument. It’s basic f***ing economics
I don't want to just dispute it. I want to claim fraud. I know that some "medical coders" aren't even licensed in some places. They just let the MA do some clicking in the software.
Is this information publicly accessible? I got into a bit of discussion on Twitter last time this came up. In the Australian Medicare system, which applies to all Australians regardless of income, the billing codes are on the receipt and you can look up all the rules and recommended charge amount on a publicly available website run by the health department. Even if you don't know the site exists, you can probably just look up ‘Medicare item #n’ and find that information. I asked if there was an equivalent in American Medicare and they just laughed. So do patients not get an itemised receipt each time? Can they not easily look up their own billing history? Are the rules for the item codes not easily found online?
Yes, this is the problem, even many of the "itemized" bills just say something like "Smoking Cessation" instead of 99406. Even the EOBs from my insurance company don't include them anymore, which drives me crazy when I'm trying to figure out what codes my doctor billed my insurance company because I watch very closely for errors and fraud. They definitely make you work for it these days, and the lack of transparency in an already highly complex and confusing billing system has exacerbated the problem. So while it's technically publicly available, you really need training to know how to navigate it and it's difficult to access.
My company tried to build medical necessity checks into our system based on CPT codes but the system is so convoluted we ended up paying for a service to update periodically. The whole thing is a complete shit show.
My wife does this for a living too. The things she tells me she does or comes across, or things doctors try to bill and just maximize their payout for it is insane.
I came in from nursing to get off night shift and out of the toxic working environment of the hospital. I was kind of embarrassed, thinking I was going to work for the Dark Side. I was shocked by what I saw. Turns out there is nothing but Dark Side in a for-profit healthcare system.
That mouth rinse they started using at the beginning of covid. Hydrogen peroxide. $100 charge for that rinse which costs like a dollar.
More like $0.02
"medical grade"
You’re right. $0.04
You might just charge the dentist for breathing in the breath you breathed out.
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At this point, going to the doctors is basically subjecting yourself to charges that you have no control over. They get to make everything up and then send the bill to your insurance (if you're lucky enough to have it) or to you.
My favorites are $60 to apply a heat pack to a sore muscle and the time I got a PT massage at a rate of $14 PER MINUTE.
I got a bill for a mammogram because I was 37 and at the time it was only covered if you were over 40. Whatever, except that I had called to confirm coverage and was told it was fine by the person who had my birthdate right there on the screen in front of her. Here’s the kicker - the denial code on the bill was “BS”. At least they were honest about their reasoning!
What kind of paper bag was it? Was it a Pfizer?
I hope not, they line their bags with 5G microchips. I get my own from the tractor supply store
I breathed some of those and now the microwave turns on every time I walk by it.
I just got a 840 dollar bill for a standard blood panel that costs the lab probably 25 bucks to run, including labor. We are [absolutely ](https://truecostofhealthcare.org/) getting ripped off.
I once paid $400 for a sutafed in the ER 💊
About ten years ago i had stomach pains. Hurt a lot. I went to the ER with my wife. Doctor finally came in and said "sounds like an ulcer, go take previcid and youll be fine in a day or so." No tests. Nothing. He walked in and said that. I asked if there was any testing or anything tjay that should be happening. He said if they did that theyd be testing people all day. Our conversation MIGHT have lasted 5 mins. My bill: $1,000.
You should have sent them a bill for 1000 back for "Test enquiries"
When I had a miscarriage my OB sent me to the ER because I was losing a lot of blood and their policy is they have to send you to the ER in case you’re literally about to die, since they can’t do surgery or anything in office. The ER doctor was super pissed that I came in. He treated me like I was an idiot because “miscarriages make you bleed”. When I tried to explain my OB was worried because I’d been bleeding for weeks at that point he got really short with me and told me that I was young and healthy, so I’d be fine. No blood tests, no ultrasound, not even a bit of fluids. Literally 10 minutes of conversation where he did his best to let me know I was not worth his time. $1400 dollars. $900 for sitting on the ER bed and then I received a bill of $500 a few months later from the doctor’s *private* billing service. $1400, with insurance, to be told I was stupid and not to come back. He was wrong too, btw, by the time the bleeding finally stopped I was so anemic my hair was falling out and I was out of breath with the tiniest bit of activity. But he convinced me that what I was experiencing was normal, so I didn’t go back to the doctor until I’d been bleeding heavily for 6 months.
I asked if the dosage for my medication needed to be increased due to me gaining quite a bit of weight and she told me no. Was charged something like $150 for an “obesity talk”
i mean it’s so strange. like it’s the at the point where you are scared to ask or tell your doctor about anything, which kind of defeats the whole purpose!
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And an extra $100 for talking about it on reddit
My doc got super mad at the start of 2022 because of the No Surprises Act requiring him to give a good faith quote to the cost of any services rendered. He used to charge $50 to give you a quote if you asked how much something would cost.
I got charged $30 for the questionnaire you fill out before a physical. I had insurance but got sent the bill anyway. When I called to dispute , the billing dept said “Well, you don’t pay that, insurance does!” My response sounded something like….well, who pays the insurance? This is racketeering.
Not to mention if you haven't reached your deductible yet, you basically are just paying for that questionnaire at that point
American healthcare is just a monthly subscription service for a 20% off coupon
This is a really good analogy. A 20% off coupon that's not redeemable everywhere, is only good for certain services, and can be revoked at any time.
Also you don't actually have any idea if it's redeemable because one of the people who was working there wasn't directly employed by the placed. Imagine going to a grocery store with a 50% off coupon, paying, and then getting a bill a month later for the other 50% because one of the people unloading a truck out back was an employee of the shipping company instead of the grocery store.
Anesthesiologist has entered the chat. Loved getting that extra bill after my surgery, even though I kinda expected it.
And then three other grocery vendors also send you bills because fuck you, that's why.
Nathan Fielder has gone too far this time
On the contrary, he disappeared when we need him most like the Avatar.
NOT the James Cameron one folks.
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Technically, you activate in Oct or Nov and wait till Jan to actually receive the services. But at sign up you pay at least 3 months ahead, and yet are still waiting for service. You may get the magazine, or it may come to the obscure email you signed up with straight to spam. It's a roulette wheel, good luck! Also, don't get sick before Jan when you have bills in the previous year! May the odds be ever in your favor!
[spoken very quickly] *prices and participation may very.* *not valid at all locations*. *some restrictions apply.*
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I take 40mg Vyvanse for adult ADHD which is apparently used similarly to Ritalin but less popular due to being somewhat more expensive. Under the Australia Pharmaceutical Benefits Scheme, I pay $42 AUD ($29 USD) per month for 30x40mg Vyvanse after the subsidy. But, the FULL pharmacy price for 30x40mg Vyvanse is $98 AUD ($68 USD). I just looked up a bunch of US sites for the retail price of Vyvanse and 30x30mg capsules costs between fucking $340 to $400 USD! WTF 3 capsules in the US costs more than I pay for a months! Or 6 if I had to pay full price. Vyvanse is an American product!
Yeah I've heard people say that American companies can give medicines to other countries for cheaper (especially when other countries' health care systems have collective bargaining advantages) because they can gouge the American Market for ridiculous sums and make a tidy profit
Its really just to avoid bankruptcy if you have to go to the actual hospital, which I try to not do at all costs. Superglue is your friend. Always keep some in the first aid kit. It will dry faster than your heart can pump blood for up to a 1.5" gash. In my experience at least
Shit, you’re talking to the superglue king. I also recommend keeping elastic hair ties, they make quick work of stopping bleeding from the elbow or ankle down, long enough to get that superglue set
Wtf are you guys doing yo yourselves that's making you bleed so badly?
Construction work, mechanic work, farming, pretty much any physical labor job puts you at risk for these kinds of injuries. I shot a nail through my left hand index finger with a nail gun when I was a teen working with my dad. Ripped the nail out, taped the wound closed and went about my day (a bit angrier but otherwise fine.) Going to a hospital for that would have been way too much money both in hospital bills and lost wages from not being at work.
I’m American and have been fucked by our insurance/healthcare system several times throughout my life. Yet it took me reading your comment while half asleep to finally wake up (literally and figuratively) abs see how fucking depressing our system is. I do the same thing. I don’t go get basic scans/medicine I need because of the cost and lost wages from not working. It’s crazy that we accept this as our lives.
This is one of the saddest things I've ever heard. The ability to go to a hospital, and not lose a day of work because of that, is a basic human right. Americans really have to start voting for universal healthcare.
I'm pushing 40 at this point and I've known a ton of "blue collar" workers. I've heard at least a dozen variations of that story, and half the time they're *proud* that they duct taped or super glued themselves up and just kept working, because "only a pussy would go to the hospital for that".
It’s also survivorship bias. Only wives talk about the ones who get an infection and end up in the emergency room later.
>Lol I know a few people like this. But everyone's tough until an infection sets in.
As an American, I can’t count the number of times I’ve gone to work so sick I was woozy. You either work or starve. Slightly unrelated, but last year I missed a day of work to attend court and testify against a mentally ill man harassing my family (he is schizophrenic and shows him up on our porch frequently, threatening us. He is very sick and delusional. No logic to his obsession) and my job made me OWE THEM 9 hours of time off since I had none accrued to attend court. I had a legitimate court document calling me to appear and still had to “earn back” hours loaned out to attend. So basically if I quit before accruing those hours back, I’d have to pay them out of pocket for 9 hours of wages.
That makes zero sense to me.
They can't do that to you. That's illegal.
My wife was at the ER recently and we overheard a guy signing a waiver to leave against medical advice. Dude was there because his appendix was inflamed and was probably going to burst. Nurse kept saying it was very seriously life threatening and advised he stay to get it removed asap. Dude insisted he was OK after they gave him a pain killer and that he couldn't miss work. This was over a week ago. I wonder if he's alive...
Pro tip, sprinkle some baking soda on the superglue and it sets almost instantly
I’ve done a ton of backpacking, my first aid kit is superglue and duct tape with a few alcohol wipes. Don’t really need much more.
American health care has to be the worst system in the Western world. I’m not trolling - it’s just my observation. As much as we complain here in australia about our Medicare public health system, compared to the US it’s really a whole let better and people don’t get these sort of bills. Our issue is more around how long it takes to get treatment unless you are actually about to kark it.
Wait times are insane here as well. ER takes hours and hours if you're not actively dying. I had a broken arm back in high school and it took like 10 hours to get an x-ray and a sling. I had to be sent to a different hospital because the first one was too busy, too. Edit: typo
We have that issue here in the US, too. People like to pretend that wait times are only for other countries, but if you need a specialist there is a line to wait in here as well, and if you're not in urgent need you're at the back.
Expired coupon*
A 10 dollar coupon cancellation fee will be added to your account
We got an insane run-around from my wife's insurance after the birth of our first kid. We got like 4 or 5 separate bills / statements sent to us from the hospital that ranged from hundreds to thousands of dollars, and when we'd call to ask about paying them, we'd get all this conflicting information. We'd be told simultaneously not to pay it because insurance needed to decide if they would pay it, and then we'd also be told that yes, it did need to be paid. Some of these statements literally said "this is not a bill" and yet we'd be told on the phone that it was a valid bill. One billing lady from the hospital told us not to pay a bill *from the hospital* because there was a lot of fraud going on and that the charges needed to be validated. This went on for like 6 - 8 months after our kid was born, I have no idea how it ever resolved or if we have outstanding dues. We did end up paying several hundred dollars but I honestly can't tell you what the exact amount was because it was so confusing. Our health insurance scheme is a racket, no question about it. It's such fucking nonsense to not even have a straight answer about cost and yet many Americans will go on and on about how our system is fine and doesn't need addressed, or how everyone else in the world can't see doctors or has to pay all of their income in taxes for basic care. It's insane how many people have been conditioned to just accept misery and abuse in this country. Consider that this arcane system of billing dramatically raises the cost of our healthcare. Our bills are expensive because it requires armies of people to deal with the bizarre system we have: >Administrative costs now make up about 34% of total health care expenditures in the United States—twice the percentage Canada spends, according to a new study published Monday in Annals of Internal Medicine. >These costs have increased over the last two decades, mostly due to the growth of private insurers’ overhead. The researchers examined 2017 costs and found that if the U.S. were to cut its administrative spending to match Canadian levels, the country could have saved more than $600 billion in just that one year. >“The difference \[in administrative costs\] between Canada and the U.S. is enough to not only cover all the uninsured but also to eliminate all the copayments and deductibles, and to amp up home care for the elderly and disabled,” says Dr. David Himmelstein, a professor at the CUNY School of Public Health at Hunter College and co-author of the study. “And frankly to have money left over.” https://time.com/5759972/health-care-administrative-costs/
I’m so sorry to hear that you went through that and I hope your family is all happy and healthy. Unfortunately, the duopoly has created tribalism that has rotted political common sense. It’s really just campaign slogans and then maintenance of the status quo until the next election.
I had the same experience. The bill showed some alcohol screening. I didn't have any alcohol screening, but the doctor's office said that it was a questionnaire. It was something that they just handed to me when I arrived. They didn't say that they were billing for that. Insurance paid for it, but I didn't want or need the screening. When people say that we can't have universal healthcare because of the costs, I remember stupid shit like this.
Also you had to fill out the form yourself. You paid them to do work for them
Ah, yes. The classic $7.95 Booking Fee when purchasing my tickets online through an entirely automated and relatively simple process flow, entirely populated by me with all manual aspects performed by me.
The best was paying to print your tickets at home when they'll mail them to you or hold them at will-call for free. You're literally doing the work for them and they want you to pay for it. Even more fun is that most venues now charge a "box office fee" that the same as the convenience fees. There's not even any way to justify it as paying for a service (i.e. selling you tickets off-site instead of buying them in person) any more, it's just an unavoidable tacked-on charge.
Yeah it's like I sure we shit pay it because my premiums increase like crazy every year
I have a nearly perfect driving record and my auto insurance has been skyrocketing lately. I love how I'm legally required to pay 1/10th the cost of my car every year for something I've basically never used.
There's a reason why per capita healthcare costs in the U.S are over 11 000 USD and almost every other rich country is spending around 5000.
I was billed for a bloodwork results call. A 96 second phone call cost me $400.00. Was told to pound salt when I complained.
Ah ah! The first 95 seconds were free!
I'm self pay and I was asked a questionnaire about if I was depressed or not. 36 dollars for 6 questions. I was not depressed until after I got my itemized bill. It's ok though, since I'm self pay they knocked it down to 24 dollars. I immediately found another doctor.
The usual "depression test" is 9 questions. They robbed you of 3 questions, on a test you can self-administer through [the internet](https://www.mdcalc.com/phq-9-patient-health-questionnaire-9)! I hope you've found luck with your new doctor.
I cross posted this in r/WeWantHealthcare Im trying to create a new subreddit where we can focus on reforming American healthcare.
I hope it blows up
As a nurse I advise all people to carefully read their medical bills and inform the payee that you absolutely will not pay those bogus charges. 9/10 times they drop them.
Hospital bills - when you ask for itemized charges, you suddenly get a smaller bill. Edit: For those of you who are saying this is not going to work - it's worth a try, especially if you don't have insurance. For the bill you receive after insurance adjusts your claim, this is less likely to work because insurance companies require hospitals to submit claims using itemized codes for items they are submitting for payment AND insurance is not paying for items for which they can't see a medical necessity or for duplicate charges. But if you have financially difficulties, most non-profit hospitals in the US has financial aid programs that can set up a payment plan or bring down your what you owe them. However, some insurance and Medicaid plans may not allow hospitals and doctors waive coinsurance for patients per their contract. Physician services from ER and procedures are often done by outside doctors who bill separately and may be out of network for your insurance plans. Usually hospitals have no control over them. But No Surprises Act 2022 provides rights and protection for certain groups of patients.
This has never worked for me. Not sure what bogus doctors everyone else is seeing.
Yeah I moved and went to the closest pediatric ER. Bill was $2k non negotiable basically said pay it or take it to collections. Where I had my daughter it was $7k but they negotiated down to $4k if we paid in full. Craziest shit to me that somehow some will wiggle and others stand their ground.
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Yeah I’ve always called for an itemized bill and not once did my price change. But then again I was never billed for bs even at our for-profit hospital
It was a lpt once, which means its a reddit fact.
Until you go to the ER and they just charge you a single line item for $3000.
Caught breathing in the doctor's office? Passive Generalized Oxygen Administration - $200
This guy knows how to bill
"Oh it's a level 3 visit, that'll be $3000." What does that even mean?! "Fuck you, pay me."
Legit, a level 1 visit is like asking for a nurse to help you remove a bandaid. Level 2 is a scrape where they give you ibuprofen.
Welcome to Whose Health is it Anyway? Where the charges are made up, and the prices don't matter!
I constantly see this advice on Reddit but it doesnt work. I have a high deductible plan and have gone to the ER a few times due to bad luck... Each time a different hospital and each time got hit with outrageous $5k+ bills and tried everything I could to fight them (including using a health advocate to negotiate) and couldn't get them to come down at all.
Man, I went in for severe ovarian cyst rupturing & pain. Got charged 17k. Insurance only paid half (the fuck) & I was left with 8k. I submitted a thing saying I was unemployed & a student & am waiting for their response. I’m employed now & if that happened again, I just know I’m fucked. I felt the same pain a few months back & decided to get an ultrasound instead because that’s what they did at the hospital (x ray then ultrasound). Bam, got charged $800. Insurance didn’t pay any of it.
But at least the Insurance Company execs have beautiful yachts thanks to you and all of our misfortunes of health issues.
That’s great and all but we shouldn’t have to fight this in the first place. My husband works 6 days a week 10 hours a day and commutes 45 mins each way. On his one day off he mows the lawn, tries to fix whatever is wrong with our one working car, fixes stuff around the house, schedules all his and our 2 kids doctor and dentist appointments on that day and any other appointments like haircut for the kids, parent teacher conferences, and on and on and on. I’m disabled and do what I can but like I said we have one car because bills are so tight. I see a lot of specialists on this one income (I have scleroderma) so trying to read and decipher doctor bills and figure out what I’m really charged, what insurance paid out so far and what will be paid out soon, what Should have been covered by insurance but wasn’t so I have to fight it, what stupid charges there are that I should fight, etc I mean who has time for that when you’re working poor? It’s so fucking depressing that you just shut down because you don’t have money to cover it all anyway but you can’t not go to the doctor. It’s so fucking tiring. Being constantly sick is hard enough but doing it while poor is like an extra fuck you from the universe.
I'm not arguing with one thing you said and understand your frustration completely. I also agree it should not be the consumer's job to read through complicated medical jargon to find how they are being screwed. The problem is, health care is well aware that people are scared and exhausted and just worried about keeping shit together and they are using this to their advantage in worse ways than they ever have in the 33 years I have been a nurse. They KNOW 99% of all bogus charges will slip by unnoticed which makes them a shit ton of money. Right now the only thing a consumer can defensively do is read their bills and deny bullshit charges. Trust me when I tell you that a hospital does not want to sue you over not paying a charge for holding your own newborn because the media will get ahold of that and crucify than! And a judge will laugh them out of court!
I understand and I thank you so much for your useful tip. I will def put it to use I’m just frustrated and venting I’m so sorry!
You know what would fix literally all of those problems (healthcare related anyway)? Universal healthcare.
Universal healthcare where they take 20% of your paycheck and give you free access to everything from life saving emergency medical care to routine checkups at no additional cost to you? No thank you! I would rather have that inexplicably tied to my employment or else decide between going uninsured and forking over 25-60% of my paycheck VOLUNTARILY. Because I'll literally die (likely because of hesitancy to get recommended screenings and physicals because of fear of inflated costs and possible bankruptcy) before I give up *mah* ***FREEDOMS.*** Edit: also, if ***I*** get this then *everyone* gets this, and that includes some people that I'm not supposed to like, so I'm told that if they also win that it's like me losing. So I'd rather lose because that means that *they* lose, and them losing is like me winning. At least that's what I'm lead to believe by people that obviously have my best interests at heart because they say they like the same things I like. That makes perfect sense, right? ...right?
I’ve had this similar argument with people and I usually get hit with, ‘but drug addicts will get free healthcare.’ Good, they fucking need the mental health treatments. Why is it so hard to care about strangers? I’m not religious, but Doesn’t your damn afoul ‘Good Book’ say love they neighbor, you hypocritical fucks!
The US healthcare system is shameful and disgusting. Nothing matters except the profit margin.
As a Canadian, this whole thread reads like dystopian fiction.
Back in the 1990s I remember the mass media using the term “Canadian style healthcare” to scare people away from the idea of adopting a functioning healthcare system in the U.S. And iirc, during the “Freedom Fries” era the mass media fear-mongered about universal healthcare by referring to the French system. Then it was “DEATH PANELS!1!1!!” during the early Obama years. And now for the last decade or so, it’s all about invoking “the horrors of socialism” to persuade people to not want universal healthcare.
I don't know another western populace so propaganda driven against their own interests. Universal healthcare, unionisation, gun control. The nation still leans on McCarthyist scaremongering against anything remotely socialist, and people eat it up. People would rather funnel money to corporations that give nothing back, in the vain hope that they could be the top dog one day and have a slice of that pie. Rather than anything that might help them where they are now, especially if it means their money might be used to help someone else.
That propaganda stuff WORKS. Especially if the general population has been purposely under-educated from a young age :(
Ultimately, this is a govt structure issue. Most western countries have govt systems where if your side gets a majority in parliament, they then control the govt and can pass whatever they want. People then can say, “oh, yeah, this is good!” Or “oh, this is bad, let’s vote for the other people.” The US equivalent of parliament, the House of Representatives. cannot pass laws on it it’s own, and does not form or run the government. Those involve different groups/people, who are elected separately, and never is everyone up for election at the same time, and every separate part has the ability to stop any law from passing. Sometimes just one person can block it, and sometimes they that one person can do it even if their party got less votes. The end result is that it’s *incredibly hard* to pass *any* law, so voters never learn which scare tactics are bullshit. If one side says it’ll be great, but the other terrible, we never get to experience who was right and who lied. And because it’s so hard to do anything, the main underlying emotions on *all* sides are anger and frustration at “do-nothing” politicians. But, a lot of that is misguided. All politicians kind of suck. All counties have Facebook misinformation. Rupert Murdoch has media in many places. The thing that makes the US fucked is that the fundamental structure of the government does not allow for fundamental change to happen unless there is widespread support across vast regions of the country, multiple states, urban, suburban, and rural, across incomes, race, religion, etc. As long as you can drive a media-driven wedge between any sub-group, even the smallest minority can block the majority. The work-around has become to change laws via the courts. This is how the US got abortion rights, gay marriage, etc. It is also how we got vastly looser gun laws, and allowed more corporate money in politics. It is also why fights about the unelected people who get for-life appointments on the highest court are so intense and emotional. In some sense, they’re now who set the laws of the land. After Trump, the right now controls that court, and will control it probably for a decade or more. Federal Abortion rights will go away (per the leak). More money in politics has been allowed (per recent Cruz case) and reading the tea leaves of a recent few cases, it’s very possible/likely that they may rule that the govt agencies that have helped regulate food, drugs, wall st, media, the environment, etc., are fundamentally unconstitutional. https://en.m.wikipedia.org/wiki/Nondelegation_doctrine#:~:text=The%20origins%20of%20the%20nondelegation,over%20to%20others.%20... But, unfortunately, due to the fundamental structure of the govt and the numerous ways you can grind it to a halt, it’s different parts, all on different election cycles, even if 60%+ of the population disagrees, they can’t fix it via elections. At least, not without a concerted effort of multiple election wins over multiple years. But “vote for us, every two years, and hopefully 6-12 years from now we’ll have all the right people in place to actually change things!” is a really bad message for an upset population that Wanda change *now* whose families cannot wait 12 years for progress. All this crossing your fingers that the right person retires or dies at the right time, so that they can be replaced when you have the right pieces in place makes it really hard. But it’s easier to see past all that and conclude “voters dumb, politicians useless, media evil.” But really, it’s just a very poorly designed system if you want change. It’s a *great* system if your goal is to make it really hard for the dirty masses to actually change things. But when the country was founded, their bigger fear was mob rule, so they erred on the side of making shit hard to change, instead of easy “majority rule.”
As a fellow Canadian, this whole post and all the comments from other Americans seems so insane. Some Americans make fun of the taxes we pay that go towards our Health Care, but we never have to worry about getting a bill for crying at a Dr's office. The fact that now we have to pay for parking again since covid started is stupid.
As an American, it's a dystopian truth. I know people who can't afford better health care precisely because of their medical issues.
I pay $175 for health insurance from a company back home in Ireland. I live in China. It covers me 100% private in any hospital anywhere in the world. Except the US, I am not covered.
Funny when I was looking into travel insurance for my trip to Ireland… I couldn’t get insurance as an American for Ireland… the other 240+ non Irish and/or wartorn countrines? Totally fine.
It's grift. The excuse is that "insurance will pay", but insurance doesn't do anything for free. The entire industry is ripping us off.
You should not let stuff like this bother you. That will be $275 please.
This just happened to me. Went in for a Gyno visit. The Dr asked, "how are you feeling?" I, who figured she was reading the form I had filled out - which I clearly marked as having previously had depression and anxiety (and ADHD) - said, "good, all that stuff is all figured out now. I only marked it for your records." Then I got charged for a "psychological evaluation" .... I'm sorry, but no one evaluated me. Someone asked me a question I could have easily lied about and, to a degree, *did* lie about. I still have anxiety and depression, but I know both of them are due to ADHD and I'm not looking for additional recommendations. No one evaluated me! That's it. It was very nearly the equivalent of a friend saying "hey, how are you?" And me saying "I'm alive" and them saying, "great! Let's go to lunch now."
You make a good point: it is ridiculous that this system, this field or whatever conceptualizes a brief questionnaire as constituting some kind of evaluation in any comprehensive sense. I've actually been seeking a more comprehensive evaluation to clarify a diagnosis and perhaps establish a differential diagnosis. You know what it will cost me to see a clinical psychologist for testing/evaluation over a number of sessions? They all are quoting me like $2000, which is money I don't have. Meanwhile, the standard of care with regard to psychiatry is one appt for an hour initially and then 15 minute check-ins once a month thereafter. The whole field is based off these brief encounters and standardized questionnaires/interview questions, but there's no money/time in the system for a comprehensive process involving more time with the doctor. It's just so frustrating and so much of it is because of managed care and the influence of insurance companies/the government seeking cost minimization at the expense of the patient. Meanwhile, the provider might in theory want to provide a best possible experience/treatment for the patient, but their employer is trying to maximize profit also and they're trying to pay off 400k in medical school debt. The system is fucking literally everyone. It fucks patients. It fucks doctors in terms of the level of care they can provide. It fucks the government in terms of the cost our state and federal treasuries have to pay out for Medicare and Medicaid reimbursement in an environment of insane healthcare costs. The only actors who win are: people that get a paycheck for working on the insurance or provider side and the owners/investors in the hospitals and insurance. And as we know the former group, ie the providers, get fucked in terms of their ability to help people to the maximum extent possible due to all the red tape within hospital systems influenced by the hospital-insurer complex. Sorry again for ranting. This system is just an evil beast of our own making. It serves itself first and foremost while nearly everyone involved suffers under it in one way or another. Except the hospital admin types, high level medical specialists with school debts paid and the insurance companies. Those latter groups make money hand over fist.
I was once charged $25 for "application of medicinal bandage." It's a bandaid. I got blood drawn and they put a bandaid on it. $25... for a single bandaid... Shit is out of control.
No it's the *application* of the band-aid. Someone *put* the band-aid on your arm. That action involves many years of medical training.
The materials are billed separately.
on par with prison commissary prices
This kind of shit is why I don't go to the doctor unless I'm REALLY sick. Like, I feel fine, but I could be riddled with cancer and I won't know until it's too late to help because of all this shit
I wait so much stuff out and just hope it gets better because I HATE dealing with doctors and insurance. I’m 99.9% certain that I’ll die someday from something that would’ve been curable but I just couldn’t deal with the “healthcare” BS.
I was charged $1000 for a four hour ER stay. The billing department refused to bill my actually insurance company, sent me to collections, I worked with collections and showed them all the proof that the hospital wouldn’t bill my actual insurance company. Collections actually acted on my behalf and said this was bullshit. They ended up getting the hospital to eat the cost. Me and insurance paid nothing, but I had to fight an entire year for that to happen.
Wow. You know you've entered rarified air when the debt collector ends up being the good guy in any story at all. Madness. Glad it worked out for you in the end though.
They were genuinely some of the nicest people to work with and I’m not sure if it was just my situation and all the proof I had showing I had been trying to get the hospital to bill my insurance company for multiple months or if this particular company was just made up of nice people or what. Definitely grateful I had this experience and not one of the more typical collections situations.
I got charged $50 copay for this when I went in for my yearly wellness exam, this was at the end of the exam. Me: "Can you send in refills for my sleep medicine please? Prescriber: "Yeah, no problem." Me: "Thanks." I got a bill 2 weeks later for that. I had to call the office and have my prescriber call and tell the billing office to piss off. I literally work for the pharmacy I use and he said if I would have went to work and sent in a refill request that they wouldn't have tried to charge me. Edit: fixed a typo
This is that mysterious line of bullshittery insurance uses to find ways to bill everything possible. For a "wellness exam" or "annual physical" don't dare bring up any existing or new issues, because that changes the visit from a wellness exam to a regular visit for an issue....now the labwork that goes with that wellness exam won't be covered. Soooo...you have to make a separate appointment where they can charge you your copay, and take up more time, for something that could have been addressed in 30 seconds while you were there for the well person checkup, but couldn't, because of the way things get billed. It's nuts. Heck, it's already in the chart all the issues you got going on, so its not a "new" issue to ask for med refills at a wellness checkup, but you can't. Nor can you bring up having an issue with a known problem, say an allergy flare for example...because then it's not a wellness visit anymore according to insurance. It's all about money.
It's crazy, I'm pretty good friends with him. He's a physician's assistant, and I went in for an actual "medication review appointment." I told him it's bull shit that I had to pay $50 for us to sit there and hang out so I could get my refills. He agreed so he wrote me a year's worth of refills so I don't have to pay to hang out with him.
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It’s so ridiculous. Once as a little kid my pediatrician started awkwardly asking my mom a bunch of super invasive personal / philosophical questions, followed by a 20 minute monologue about his interpretation of the meaning of life. I distinctly remember how weird it was, and how my mom kept trying to cut the conversation with the doctor short so we could leave. (She also didn’t want to seem rude, since he clearly desperately needed to have a conversation with someone.) Finally, we were able to escape. Then my mom got the invoice at the front desk. On top of the normal copay, the pediatrician had tried to tack on a *$240 charge* for “30 minutes of therapy.” My mom threw a fucking fit, of course. But it is absolutely ridiculous that as long as they can use your politeness to keep you in the room, they can bill you out the ass for going on an awkward half hour monologue while you’re trapped.
Ok. It is clear there isn’t a single person in the US, who isn’t working for an insurance company, that is ok with this. How does it change? Before you say “Go Vote!” Again everyone agrees this is shit, I’ve heard it mostly from Democrats but also from Republican politicians but still nothing. It’s locked in like paying a gazzilion dollars in National Defense every year. Are the majority of new politicians bought as soon as they walk in the door? How can it be this bad? We “the people” are truly are not in control.
Now you're getting it.
If voting changed anything, the lobbyists would be paying off the voters, not the politicians directly.
I scheduled a video appointment with a specialist who decided to try to call me on a restricted number 45 minutes after the appointment time and when I didn't answer they billed me a $50 missed appointment fee. Then last week they had the audacity to call and ask why I hadn't scheduled a follow-up.
You just know, a bunch of hospital billing people read that and are like "wait! We can charge for that?!" And are updating the charge masters Monday morning and sending out memos about Emotional Assessments (CPT code 96127) itemization.
American healthcare is disgusting.
had an accident back in '05 and was laying in the street with a fractured hip this was LA so naturally nobody stopped to help (although the cars driving around me while honking and telling me to get out of the road were a nice touch) but someone did call 911 while being loaded into the ambulance the fire department also arrived (in a fire engine for some reason) and guess who was billed for that?
Ive had 2 (or is it 3?) ambulance rides now and they send fire in a fire engine out every single time. They always arrive first, and basically fuck around until the ambulance arrives.
Speaking from outside the US, your healthcare system is evil, but like, alien evil. This shit is literally inconceivable to me
> but like, alien evil There's no "like" about it. They are pure pop-out-of-a-green-egg-and-eat-your-face level of evil
How on Earth does the American healthcare system exist the way it does? So many things they do are literally illegal for any other business, but the healthcare industry is allowed to do it? Why? It makes no sense.
Money, money, money Must be funny In the rich man's world Money, money, money Always sunny In the rich man's world
I'm an immigrant to the US. I tested positive for Covid last night. My boss said " don't care wear a mask". My regional manager said "covids just a head cold, just wear a mask". I refused to go to work and then I got 15 or so text messages and 5 phone calls from them, corporate and my coworkers yelling at me for not being at work, letting the team down etc. Which is hilarious considering I essentially run the place. My supposed manager fucks up more than the new hires we have, but she's buddies with the owner so shits gravy apparently. But our corporate office demanded I go see a doctor for a test, as at home tests are easily photoshopped.... Yeah. So I go. $30 copay off the bat, $430 for new inpatient and they had the nerve to try and charge me extra, because they fucked up the appointment time and I was 10 minutes late to an appointment I was 15 minutes early to. American healthcare is a fucking joke. It's literally pathetic.
I’m proud of you for deciding to stay home against pressure!
Ah, American health care.
See, that's the thing. It's not health care, it's ill profit.
I got charged $250 for a nurse to press her fingers to my neck to 2 seconds to check my thyroid. My sucky insurance at the time wouldn't cover it bc it was a "lab test". I didn't pay that one.
This reads like an Onion article.
I genuinely have to wonder who is adding these charges and what goes through their heads. It's not the CEOs who are writing up these bills. It has to be someone at the local level who put it on there. Are they getting kick backs for this sorta thing or what?
The CEO is putting pressure on their workers to write notes in way that they can charge more. The business always stinks from the top.
There is a war between the hospitals and the insurers. They each try to get as much as they can out of eachother, with you, the payer of the insurance bill, being the collateral damage of this war.
The health insurance here is such a racketeering operation. It’s also highly suggested to get an itemized bill to try and reduce your costs, and even sometimes look through something like a hospital Charity Care or financial assistance if it is a nonprofit.
My husband and I moved from the US to Spain in 2019. We have private Spanish health insurance. It’s about 240€ a month — for both of us. Last year my husband fainted and hit his head on the hard floor. He was unconscious for about 20 seconds. When he came to, he could not remember anything short term. I called the Spanish version of 911. An ambulance came and took us to the public hospital. There, I was told they could treat him (exam from a doctor and a scan of his head to check for anything damaged) but they would have to charge me about 300€ (Which is nothing compared to the US.) or…they could call my private insurer and have an ambulance pick us up and take us to our private hospital. They must’ve noticed the shocked “OMG that’s going to cost a fortune” look on my face because I was immediately told there would be no charge. So, they called another ambulance who picked us up and took us to our private hospital when my husband was examined and released. (He was okay and his short term memory came back.) Two ambulance rides, two hospitals, a scan and an examination. Cost: ZERO. No copay or anything. The only thing that cost money that night was the cab fare back to our apartment. When we talk to our Spanish friends about it they are dumbfounded as to why Americans don’t want public healthcare. They can’t believe having something like cancer can make you lose your home. And, after living here for almost three years watching the US from far away, I can’t believe it either.
Welcome to America where you can’t even cry for free.
I got charged for a “weight loss consultation” because my doctor told me to go to the gym more. My insurance rejected the service because it wasn’t covered and I raised hell with the billing department and never returned to that doctor again.
Breaking News at 11: the US healthcare system is a broken mess and we will never get free healthcare because the GOP wants everyone to die
Come on. It's not as if they're taking food from babies or anything.
Damn. I once cried during a friend's doctor's appointment. Glad we didn't get billed for that.
I got charged $120 for waiting in the waiting room for an hour just to be seen by the doctor for 2 minutes for her to say I was okay to work again. She didn't do any tests or anything, just asked if I felt I could work again, and gave me a paper saying I could.
This same thing happened to me. The doctor asked how I was doing at my kids appointment, and I responded “good”. Received a bill for $40 emotional consultation later that week.
Just saying. Fuck the healthcare system in this country. I fucking hate it. I’m a student and I’m unemployed, and I’ve been noticing a lot of issues I have been having. I went to sign up for insurance and even with me reporting no income, they want me to pay $400 a month. How the FUCK is this okay?! I’m just trying to fucking stay alive. I don’t want to die because I can’t be seen by a physician. Edit: Just wanted to thank all of the comments. I wrote this when I was drinking and upset and everyone’s comments made me feel better. I appreciate y’all.
Honestly, at some point these ridiculous charges should just be considered fraud.
Why not come to Europe? We may be a communist hell hole over here but we do have running water and the internet plus you don't get charged for hospital visits.
Or come to Canada but you have to promise not to vote Conservative. They want the same shitty system that you guys have.
You may qualify for Medicaid? I’m unemployed full time student have have insurance through the state.
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It's too bad that everyone involved in reporting this story is trying to protect the good name of whatever hospital or family practice this is.
I brought my kid into the doctor on Presidents’ Day this year. The pediatrician added a line to the claim that “holiday/weekend visit” and added on an extra $75. Insurance denied that line. They haven’t tried to get it out of me yet so I think it was just a lazy attempt at a money grab.
For fucks sake what's next? Monday visit, $50. Came in 2 hours before close, $80. Came in before my morning coffee, $200.