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She didn’t get treated at the ER, but she got a $5,751 bill anyway

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branfont    218

On October 19, 2016, Jessica Pell fainted and hit her head on a nearby table, cutting her ear. She went to the emergency room at Hoboken University Medical Center, where she was given an ice pack. She received no other treatment. She never received any diagnosis. But a bill arrived in the mail for $5,751.

 

“It’s for the ice pack and the bandage,” Pell said of the fee. “That is the only tangible thing they could bill me for.”

 

Pell’s experience is not unique. Submissions to Vox’s ER database project found multiple examples of ERs charging patients hundreds or even thousands of dollars for walking through the door. Some never got past the waiting room. Some were triaged, but none received treatment from a doctor.

 

Pell left the ER when she discovered the plastic surgeon who would see her was out of network for her insurance. She decided to go to an in-network facility instead. She thought this was a smart way to avoid the costly fees that came with seeing a provider that wasn’t included in her health plan.

 

 

 

 

 

Full article @ Vox

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+jnelsoninjax    12,152

What was the ice made from, gold? :D Seriously the ER's prices are outrageous!

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sidroc    1,201

I am not defending the private medical system here, but they were seen. By a nurse, a triage nurse, a tech, radiologist, and a doctor. I can guarantee if she hit her head on a table she got a full blood workup and a CT. Either the bill was a mistake or she’s lying. I see lots of bills and this is simply not how it works. It is career suicide for an ED doc to NOT do a full workup on a syncope with head trauma. I can tell you it went something like this. Patient gets an EKG to rule out bradycardia. Patient then gets blood work and is taken to CT for a head CT without contrast. Patient EKG is normal, Patients CT is normal. Lab work comes back ok. Patient is then given an ice bag by the tech and given discharge instructions by the ED doc and RN. She is not given a diagnosis because they could not definitively determine the cause of the syncope diagnostically. A referral is provided to an outpatient provider with instructions to follow up within 3 days. This is what happened, and I would be shocked to find out different. Now, if you want my opinion on how we run our system, that is a different story. I support single payer 100%. But I am sick of patients leaving the ED saying we did nothing for them but give them an ice pack and I have heard it allot and 99% of the time its BS.

Edited by sidroc
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adrynalyne    12,375
35 minutes ago, sidroc said:

I am not defending the private medical system here, but they were seen. By a nurse, a triage nurse, a tech, radiologist, and a doctor. I can guarantee if she hit her head on a table she got a full blood workup and a CT. Either the bill was a mistake or she’s lying. I see lots of bills and this is simply not how it works. It is career suicide for an ED doc to NOT do a full workup on a syncope with head trauma. I can tell you it went something like this. Patient gets an EKG to rule out bradycardia. Patient then gets blood work and is taken to CT for a head CT without contrast. Patient EKG is normal, Patients CT is normal. Lab work comes back ok. Patient is then given an ice bag by the tech and given discharge instructions by the ED doc and RN. She is not given a diagnosis because they could not definitively determine the cause of the syncope diagnostically. A referral is provided to an outpatient provider with instructions to follow up within 3 days. This is what happened, and I would be shocked to find out different. Now, if you want my opinion on how we run our system, that is a different story. I support single payer 100%. But I am sick of patients leaving the ED saying we did nothing for them but give them an ice pack and I have heard it allot and 99% of the time its BS.

“I am not defending the private medical system here”

 

Proceeds to defend the medical system. 

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sidroc    1,201
9 hours ago, adrynalyne said:

“I am not defending the private medical system here”

 

Proceeds to defend the medical system. 

 

Again, I support Universal coverage, the fact of the matter is (I know this from experience with Canadian Doc's and Nurses I work with) she would have got the same care I said she most likely got in a Canadian hospital. She would have (rightly) left without a bill (although the medical coding the hospital billed the government for would include the same services), but I can guarantee she would also claim nothing was done for her. What irks me is not the bill, but her attitude on what the ED did for her. I work the ED, I see this all the time. You always do a full workup on syncope with head trauma, period. To not do so could get you a malpractice suit. These patients just cant appreciate the care we did give them. This person did not walk out of that ED without care I can bet that. I had a patient yesterday come to the ED I work at yesterday saying

"I came from the hospital down the road, they did nothing for me."
Me:"Can I see your discharge instructions?"
*hands them to me*
Me: "It says here they gave you you a chest X-Ray, an EKG, blood work showed negative Troponin, vitals were stable, nitro tab, and a cardiology referral"
"Well, they didn't fix the problem and didn't give me a prescription for Percocet like I need for my pain"
Me: "You have angina, and need a cardiologist workup like their paperwork says"
*Doctor proceeds to discharge patients to that effect"

Edited by sidroc

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adrynalyne    12,375
1 hour ago, sidroc said:

 

Again, I support Universal coverage, the fact of the matter is (I know this from experience with Canadian Doc's and Nurses I work with) she would have got the same care I said she most likely got in a Canadian hospital. She would have (rightly) left without a bill (although the medical coding the hospital billed the government for would include the same services), but I can guarantee she would also claim nothing was done for her. What irks me is not the bill, but her attitude on what the ED did for her. I work the ED, I see this all the time. You always do a full workup on syncope with head trauma, period. To not do so could get you a malpractice suit. These patients just cant appreciate the care we did give them. This person did not walk out of that ED without care I can bet that. I had a patient yesterday come to the ED I work at yesterday saying

"I came from the hospital down the road, they did nothing for me."
Me:"Can I see your discharge instructions?"
*hands them to me*
Me: "It says here they gave you you a chest X-Ray, an EKG, blood work showed negative Troponin, vitals were stable, nitro tab, and a cardiology referral"
"Well, they didn't fix the problem and didn't give me a prescription for Percocet like I need for my pain"
Me: "You have angina, and need a cardiologist workup like their paperwork says"
*Doctor proceeds to discharge patients to that effect"

You automatically assume all that happened. If it did, why did they instantly drop the charges when a reporter contacted them? There is nothing to hide at that point. 

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branfont    218
2 hours ago, sidroc said:

 

I know this from experience with Canadian Doc's and Nurses I work with) she would have got the same care I said she most likely got in a Canadian hospital. She would have (rightly) left without a bill (although the medical coding the hospital billed the government for would include the same services)

And only if she were Canadian, if she were american or from any other country she'd get billed.  I know this because I work with americans and south africans every summer, and they've gotten bills from the hospital.  Granted, some have private insurance, some have company provided insurance.

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Emn1ty    4,085
1 hour ago, adrynalyne said:

You automatically assume all that happened. If it did, why did they instantly drop the charges when a reporter contacted them? There is nothing to hide at that point. 

You're assuming it didn't happen and are just taking their word for it. What costs more? The legal battle to defend themselves or just eating ~$6,000 bill not being paid? Simple math, there. We probably won't know the entire story here; but just because a big company charged an individual a lot of money that they claim they didn't deserve to be charged doesn't mean you simply believe their story. Even more so when the article has them posing for a bunch of glamour shots (totally unnecessary).

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adrynalyne    12,375
14 minutes ago, Emn1ty said:

You're assuming it didn't happen and are just taking their word for it. What costs more? The legal battle to defend themselves or just eating ~$6,000 bill not being paid? Simple math, there. We probably won't know the entire story here; but just because a big company charged an individual a lot of money that they claim they didn't deserve to be charged doesn't mean you simply believe their story. Even more so when the article has them posing for a bunch of glamour shots (totally unnecessary).

I’m not taking anyone’s word for anything.  I’m just laughing that someone says they aren’t defending our medical system while defending it. All on their *own* assumptions. 

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Brandon H    3,143

I cant stand our country's medical system; its a pure for profit cesspool of a system.

The ONLY real reason we don't go Universal Healthcare to begin matching with the rest of the 1st world countries is because Drs don't want to lose the excessive profit. our system is ran by greed and nothing else.

 

Sure we have some better Drs here and there but that only helps so much when things like this happen all the time; Most people try to avoid going to the Dr regularly because even WITH insurance paying for a Dr is stupid expensive; especially if you need any kind of operation/surgery.

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sidroc    1,201
2 hours ago, adrynalyne said:

You automatically assume all that happened. If it did, why did they instantly drop the charges when a reporter contacted them? There is nothing to hide at that point. 

I recently attended the annual legal meeting for providers and nurses at my hospital. At our hospital and my last one, the policy was to settle cases bills entirely in most challenged circumstances if the chargers where small (this is small as far as the hospital is concerned) and if they hit the media) the hospital feels defending itself would cost more in most circumstances. The hospital is bound by Hippa and cannot comment on her case publicly, so the next best alterative is to settle. I know these things were done because it is a standard of practice because you could miss the need for a pacemaker killing the patient, or miss a head bleed again killing the patient. Hospitals practice offensive medicine to prevent these things. 

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adrynalyne    12,375
1 minute ago, sidroc said:

I recently attended the annual legal meeting for providers and nurses at my hospital. At our hospital and my last one, the policy was to settle cases bills entirely in most challenged circumstances if the chargers where small (this is small as far as the hospital is concerned) and if they hit the media) the hospital feels defending itself would cost more in most circumstances. The hospital is bound by Hippa and cannot comment on her case publicly, so the next best alterative is to settle. I know these things were done because it is a standard of practice because you could miss the need for a pacemaker killing the patient, or miss a head bleed again killing the patient. Hospitals practice offensive medicine to prevent these things. 

What is there to defend from a reporter? They cannot litigate. 

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sidroc    1,201
15 minutes ago, adrynalyne said:

I’m not taking anyone’s word for anything.  I’m just laughing that someone says they aren’t defending our medical system while defending it. All on their *own* assumptions. 

These are assumptions, but if they did not do these things, the hospital needs investigation by the joint commission. It is a standard of practice to do these things. Not doing so is medical malpractice. 

1 minute ago, adrynalyne said:

What is there to defend from a reporter? They cannot litigate. 

Public opinion can ruin a hospital. Not all services are emergent. Allot are outpatient. Hospitals loose allot of money if the public turns against them. 

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sidroc    1,201
19 minutes ago, Brandon H said:

I cant stand our country's medical system; its a pure for profit cesspool of a system.

The ONLY real reason we don't go Universal Healthcare to begin matching with the rest of the 1st world countries is because Drs don't want to lose the excessive profit. our system is ran by greed and nothing else.

 

Sure we have some better Drs here and there but that only helps so much when things like this happen all the time; Most people try to avoid going to the Dr regularly because even WITH insurance paying for a Dr is stupid expensive; especially if you need any kind of operation/surgery.

I 100% agree. My comments only refer to the medical side of things. ED providers and RN's suffer enough abuse from ungrateful patients who think we did nothing because they don't make the connection that the diagnostic tests sometimes result in an idiopathic finding and no diagnosis. 

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cork1958    1,710
25 minutes ago, Brandon H said:

I cant stand our country's medical system; its a pure for profit cesspool of a system.

The ONLY real reason we don't go Universal Healthcare to begin matching with the rest of the 1st world countries is because Drs don't want to lose the excessive profit. our system is ran by greed and nothing else.

 

Sure we have some better Drs here and there but that only helps so much when things like this happen all the time; Most people try to avoid going to the Dr regularly because even WITH insurance paying for a Dr is stupid expensive; especially if you need any kind of operation/surgery.

Between the Drs., insurance companies and pharmaceutical companies, are there any bigger rip off's in the world?

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Emn1ty    4,085
46 minutes ago, Brandon H said:

I cant stand our country's medical system; its a pure for profit cesspool of a system.

The ONLY real reason we don't go Universal Healthcare to begin matching with the rest of the 1st world countries is because Drs don't want to lose the excessive profit. our system is ran by greed and nothing else.

Doctors don't make all that profit. You have to understand that doctors don't start seeing big money until they've spent a significant part of their careers paying of their 6-8 years of medical school debt. People think that doctors make a lot of money because they overcharge you, they don't. They make that money because they're directly dealing with people's health, typically are saddled with tons of debt out of school and because the liability is insane for them to practice.

The real costs come from the system as a whole. Insurance companies being provided inflated costs so the hospital can actually make some money off what they are doing and the pharmaceutical companies charging incredible prices whilst pushing new product. If you look into the actual cost breakdowns of why things are so expensive it's decidedly not the doctors doing it. Other situations are similar to what my sister experienced. Being married at the time to a member of the army the government paid for her to have her child. All expenses covered, she didn't get any bills at all. But the government only paid 30% of the costs. The hospital could either take a huge hit, or jack up the price to make money. This is how it works with insurance. Insurance will only cover so much and hospitals can only charge the patient so much; so they inflate the prices. Without insurance a lot of these things would cost less (though how much is debatable).

The most money in medicine is not spent by hospitals, not spent on doctor's paychecks, etc. It's spent on R&D and big pharma, which to be honest if you spent a decade or more developing a new drug and billions of dollars on getting it approved of course you're gonna push the living hell out of it to try and make your money back.

Quote

Sure we have some better Drs here and there but that only helps so much when things like this happen all the time; Most people try to avoid going to the Dr regularly because even WITH insurance paying for a Dr is stupid expensive; especially if you need any kind of operation/surgery.

This has not been my experience. Expensive, yes but not stupid expensive. After getting an appendectomy the cost to me was barely more than it cost to repair my car this year (~$2300). And I was able to pay that off over time. And the Universal Healthcare systems have their own problems, typically better at preventative care and routine medical care but slower and less effective on specialist care. My family has personally had a member die after getting stuck in a referral loop between different doctors (in Canada) and having to wait a month or more between each visit before finally getting a diagnosis (to which if they'd figured it out earlier they'd have been treatable). That kind of stuff is precisely why I have a PPO plan, I don't want to be saddled with having to get referrals and be stuck going to in-network offices to get care at an affordable price. I'd rather pay a little more out of pocket and have some debt than end up with a death sentence.

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Xilo    928

This happened to me as a kid. Went to the ER, got put in a room. Never saw a nurse or doctor not even to check vitals. Waited an hour before we just left. Got a several thousand dollar bill. We never paid it.

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sidroc    1,201
18 minutes ago, Xilo said:

This happened to me as a kid. Went to the ER, got put in a room. Never saw a nurse or doctor not even to check vitals. Waited an hour before we just left. Got a several thousand dollar bill. We never paid it.

Who discharged you? It wasn't the tech, since you were placed in the room, a triage nurse saw you and did vitals (joint commission standard) and assigned an ESI score to you. A doctor had to sign off on your discharge after writing an entry in your medical file and certifying that he examined you (legal requirement). Vitals are to be done within 30 minutes of discharge as a standard of practice. Either you are incorrect, or the hospital is far below the standards of practice from a legal standpoint. I don't believe you because I get to read charts of patients who say nothing was done thousands of them now, and have yet to see a legitimate nothing was done at all for someone case. My personal favorite is "I've been waiting 2 hours for care!". The computer shows you checked in 40 miutes ago. These events are the exception, not the normal. We have a terrible billing and insurance system in America, but not terrible doctors and nurses and the public needs to make that distinction. 

Edited by sidroc

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dead.cell    4,374
5 minutes ago, sidroc said:

Who discharged you? It wasn't the tech, since you were placed in the room, a triage nurse saw you and assigned an ESI score to you. A doctor had to sign off on your discharge after writing an entry in your medical file and certifying that he examined you (legal requirement). Either you are incorrect, or the hospital is far below the standards of practice from a legal standpoint. I don't believe you because I get to read charts of patients who say nothing was done thousands of them now, and have yet to see a legitimate nothing was done at all for someone case. My personal favorite is "I've been waiting 2 hours for care!". The computer shows you checked in 40 miutes ago. These events are the exception, not the normal. We have a terrible billing and insurance system in America, but not terrible doctors and nurses and the public needs to make that distinction. 

We have a garbage hospital in Houston (Bayshore) which turned to hell after they were bought out. I've got a friend that worked there too, and it's just a mess on all ends.  The sad part is that we'd drive twice the distance for another hospital just because of it.

 

With that in mind, I had to take my grandmother to the hospital back in February for a heart condition she had. Saw her within 10 minutes, had her hooked up and on necessary meds within 20... ended up staying from Monday through Friday. Her hospital bills after medicare and all that came up; she worked with the hospital to work out the financing which ended up being about $1000 total. Still paying it off, but they gave her quite a few options to get what she needed to help her, as she's on a fixed income as it is.

 

Overall, I was pretty pleased with the situation. The doctors and nurses especially were amazing. (Memorial Hermann)

 

That isn't to negate anyone else's experience, but just a reminder that you can't paint it all with a brush of generalizations. Yes, medical is expensive, we need a better way of handling it, but I'm not one to take my blessings for granted either.

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Xilo    928
1 hour ago, sidroc said:

Who discharged you? It wasn't the tech, since you were placed in the room, a triage nurse saw you and did vitals (joint commission standard) and assigned an ESI score to you. A doctor had to sign off on your discharge after writing an entry in your medical file and certifying that he examined you (legal requirement). Vitals are to be done within 30 minutes of discharge as a standard of practice. Either you are incorrect, or the hospital is far below the standards of practice from a legal standpoint. I don't believe you because I get to read charts of patients who say nothing was done thousands of them now, and have yet to see a legitimate nothing was done at all for someone case. My personal favorite is "I've been waiting 2 hours for care!". The computer shows you checked in 40 miutes ago. These events are the exception, not the normal. We have a terrible billing and insurance system in America, but not terrible doctors and nurses and the public needs to make that distinction. 

I realize that it's a pretty common excuse, but we actually were there for several hours in total. A doctor never even saw me. I was assigned to an exam room and was waiting there for a good hour. My mom got fed up and we just walked out the exam room and out the ER. This was at a crappy ER in south San Antonio (the poor, ghetto side).

Edited by Xilo

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Jim K    13,735
36 minutes ago, Xilo said:

I realize that it's a pretty common excuse, but we actually were there for several hours in total. A doctor never even saw me. I was assigned to an exam room and was waiting there for a good hour. My mom got fed up and we just walked out the exam room and out the ER. This was at a crappy ER in south San Antonio (the poor, ghetto side).

Southwest General Hospital?

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sidroc    1,201
40 minutes ago, Xilo said:

I realize that it's a pretty common excuse, but we actually were there for several hours in total. A doctor never even saw me. I was assigned to an exam room and was waiting there for a good hour. My mom got fed up and we just walked out the exam room and out the ER. This was at a crappy ER in south San Antonio (the poor, ghetto side).

So you left AMA because sicker patients were being treated and you didn't want to wait? You were advised that Insurance does not cover patients who leave AMA because that's part of the AMA paperwork. That's why you didn't see a doctor, you left before he could see you. They werent playing cards at the desk I can assure you. 99% of the time it's because we have more sick than we can handle (happens at the best of hospitals on bad days) that day and probobly a few strokes and STEMIS. If you are an ESI 3, dlthen you will be behind sick ESI 2 and ESI 1's. This isn't a US problem. ED in Canada and the UK run into this problem because its a simple matter of volume vs available hospital staff. 

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Xilo    928
42 minutes ago, sidroc said:

So you left AMA because sicker patients were being treated and you didn't want to wait? You were advised that Insurance does not cover patients who leave AMA because that's part of the AMA paperwork. That's why you didn't see a doctor, you left before he could see you. They werent playing cards at the desk I can assure you. 99% of the time it's because we have more sick than we can handle (happens at the best of hospitals on bad days) that day and probobly a few strokes and STEMIS. If you are an ESI 3, dlthen you will be behind sick ESI 2 and ESI 1's. This isn't a US problem. ED in Canada and the UK run into this problem because its a simple matter of volume vs available hospital staff. 

Getting charged over 1k for what amounted to was taking blood pressure and temperature is extremely ridiculous. We didn't pay it and it got dropped from our credit reports. I still wouldn't have paid it now.

 

44 minutes ago, Jim K said:

Southwest General Hospital?

I think so yeah.

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sidroc    1,201
10 minutes ago, Xilo said:

Getting charged over 1k for what amounted to was taking blood pressure and temperature is extremely ridiculous. We didn't pay it and it got dropped from our credit reports. I still wouldn't have paid it now.

 

I think so yeah.

You held a bed in a busy ER, when patients of varying levels of need came in that could have used your bed but had to wait in triage that could have been placed in your stead. while you could have clearly gone to a clinic given that you left the ED without problem (the ED is not a clinic no matter how many Medicaid patients believe it to be so). The bill would have been covered by your insurance if you had patiently waited for the doctor. 

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Xilo    928

 

4 minutes ago, sidroc said:

You held a bed in a busy ER, when patients of varying levels of need came in that could have used your bed but had to wait in triage that could have been placed in your stead. while you could have clearly gone to a clinic given that you left the ED without problem (the ED is not a clinic no matter how many Medicaid patients believe it to be so). The bill would have been covered by your insurance if you had patiently waited for the doctor. 

You have done nothing but misread and assume way way too much in this thread. 1) It was the only thing open. 2) We had no insurance. 3) Just because we left doesn't mean I wasn't really sick/in horrible pain/etc.

 

I'm honestly surprised you're defending our countries crappy health care system.

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