
SF hospital charged $15K ‘trauma response fee’ for baby that needed no treatment - guard0g
https://www.scmp.com/news/world/united-states-canada/article/2154017/san-francisco-hospital-treated-korean-tourists-baby
======
mc32
That's insane. Unfortunately politicians will not touch this issue because
most people either have insurance which covers these idiotic baseless fees or
indigent people go to the emergency room and avoid these fees as well. But the
poor sap who wants to do things the right way gets effed over like these
people. What a shame.

I don't care who, Bernie, Trump, some socialist, take this cause (hospital
billing) and have them come correct. They need someone to get tough and
straighten them out.

I mean, it's legalized robbery. Nothing less.

~~~
tolk460
Article mentions the bulk of the bill was a "trauma activation". This is an
alert from the EMS units to the hospital that they are bringing a patient with
indications of trauma requiring additional medical resources to be diverted.
The reaction and resources differ per trauma facility. SFGH is a level 1
center [1]. There are better news sources that describe the trauma system
within the context of this story.

My opinion based on limited information within the article is that the field
EMS suspected a closed head injury. The trauma "doctors at the hospital
quickly determined that baby Jeong Whan was fine". If the baby had an MRI
instead of a medical exam by a team of specialists, the headline would lose
some weight.

The fee is to staff ED specialists 24/7\. I believe the better question is:
"should we charge for resources that were used but stood down after initial
assessment by the trauma team?" From the perspective of the EMS field, there
are protocols that describe tbe patient condition, mechanism of injury and
other indicators which dictate a trauma activation.

[1]
[https://en.m.wikipedia.org/wiki/Trauma_center#Level_I](https://en.m.wikipedia.org/wiki/Trauma_center#Level_I)

~~~
riquito
> If the baby had an MRI instead of a medical exam by a team of specialists,
> the headline would lose some weight.

How so? In my country (Italy) for an MRI I would pay from 42 USD to 81 USD,
depending on my income.

Not saying that's its real cost since we pay taxes to grant this to everyone,
but from here to 18k...

~~~
rasz
Bad comparison. Italy has far inferior health system, barely able to provide
2x better infant mortality rate at 1/3 the cost when compared to US. /sarcasm

------
pash
John Cochrane, a well known financial economist and former president of the
American Finance Association, last month wrote a blog post [0] reacting to a
similar article in Bloomberg about the pricing of air ambulance services. If
you want to see how bizarre the structure of our markets for healthcare
services looks to an economist, I encourage you to read it.

I wonder if there’s a collection of this sort of article somewhere, all these
journalistic accounts of ordinary people’s financially nightmarish encounters
with the American market for healthcare. It feels like I’ve read dozens of
them, and they’re all basically similar, not just in the facts they relate of
each debacle, but also in their lack of insight into what’s really so
fundamentally broken about our healthcare markets.

0\. [https://johnhcochrane.blogspot.com/2018/06/cross-
subsidies.h...](https://johnhcochrane.blogspot.com/2018/06/cross-
subsidies.html)

~~~
Lazare
That's a superb article, and it makes some extremely valuable points.

It wouldn't _be_ that hard to just take a bunch of tax money, and provide a
bunch of health care. Or alternatively, provide a bunch of health insurance.
But since the US isn't willing to do that, but _does_ want the services, we
get this.

There's no free lunch, and the harder you try and find one, the more warped
(and, ultimately, expensive) it's going to end up being.

~~~
em3rgent0rdr
> "It wouldn't be that hard to just take a bunch of tax money, and provide a
> bunch of health care. Or alternatively, provide a bunch of health
> insurance."

Elaborate, please, if it is so easy.

~~~
malmsteen
You know, like in every european country.

~~~
em3rgent0rdr
Well you got me! Yeah, I guess they do just tax the hell out of people in
Europe and then provide basic healthcare, and call it an easy success!

~~~
malmsteen
I don't even get if you're trying to make a point. I'm french and for all my
life a doctor appointment has never been higher than 1 euro. All important
operations are covered and i could not even tell you one that's not exept
plastic surgery (and maybe lasik "in some cases").

I'm not even sure the txation in france is higher than in the US.

------
karterk
Recently a friend of mine visited the emergency care in a private hospital in
downtown SF with heavy stomach pain. It turned out to be a partial bowel
obstruction, which thankfully sorted itself out with some conservative
treatment.

My friend was discharged in a couple of days... with a bill of 70K USD. Except
for an IV and a Ryles tube, there was hardly any other intervention.

Having just finished college, my friend did not have an insurance plan that
could cover such a huge bill. Thankfully the state stepped in to help since
the yearly income was below the federal poverty line. Otherwise, I can't
imagine the plight.

For once, my friend was thankful for being a broke college grad.

~~~
ashildr
Students in Germany usually have free healthcare from their parents mandatory
insurance, if they are older than 25 most have to pay about €70 and from 30
they usually have to pay about €115. These are the rates for the public
insurances, private insurance are usually cheaper for youngpeople but have
other problems.

------
maxxxxx
American hospitals are just big ripoff machines. The whole nonsense with
insurance negotiated, uninsured, in-network, out-of-network fees needa to go.
Just post one price for a service for all. My girlfriend had a few surgeries
over the last few years. The only conclusion I could draw from the bills was
that

a) they make up prices as they go

b) they like to charge for things that never happened or put a several
thousand percent markup on things

They said that Obamacare was broken beyond repair. The same should be said for
the current system and its billing practices.

~~~
kamaal
>>American hospitals are just big ripoff machines.

Same here in India. For all the talk about Medical Tourism to India, it works
only because Americans come here to India with Dollars, and $1 = 70 rupees.
Your purchasing power suddenly increases by 70 times.

For Indians in India. Its the same near US level rip off. Sometimes its also
hard to not sympathize with the doctors. It takes the best years of your 20's
and early 30's to get to be a good doctor, and its expensive to get all those
degrees and training. So they charge whatever they have to, to not only
recover all that money but also make a fortune worth profit along the way.

A lot of time this is done through unethical means. Ordering tests the patient
doesn't need(commissions with the labs), prolonging treatments to optimize for
per visit costs, writing medication the patient doesn't need(again commissions
with the pharmacy) etc etc.

But yeah, I agree with you. Even In India, Most doctors I talk to want(ed) to
go the US to settle there. Largely because of the apparently insanely high pay
and perks. One person I talked in my extended family almost talked about it
like it wasn't something they had to even think about. If you are a doctor you
had to settle in the US. The profession is just too profitable in the USA, to
not move to there.

~~~
spdionis
Apologies in advance for not truly contributing to the discussion.

> Same here in India. For all the talk about Medical Tourism to India, it
> works only because Americans come here to India with Dollars, and $1 = 70
> rupees. Your purchasing power suddenly increases by 70 times.

How is this logic?

~~~
eesmith
US$1 = JP¥110 = ISK 107, so the same logic says the purchasing power of a
dollar in Japan and Iceland is even higher than in India.

------
bprasanna
Healthcare in US is a best example of how a Healthcare shouldn't be. The
citizens of the country shouldn't be scared of going to hospital. Countries
like India may have corruption, but their people, even the poorest, have the
option to consult doctor free of cost or at the cost they can afford. The
Healthcare in US is in the clutches of Insurance companies.

~~~
kamaal
>> Countries like India may have corruption, but their people, even the
poorest, have the option to consult doctor free of cost or at the cost they
can afford.

For something small, like Fever or Stomach Upset may be.

For bigger problems its not easy, and most of the time they just give
up(Embrace death). In Bangalore, there is a hospital called Bowring and Lady
Curzon Hospital, its sort of like a government hospital. For decades its well
known that when burn patients arrive, and if the victim is really poor, they
silently recommend euthanasia. And most people opt for it. Its just the cost
of treatment is too expensive, and the whole family goes down in the financial
burden that follows.

Also please take a look at government hospitals like NIMHANS in Bangalore, its
like the most depressing place you will visit in your life. You have to pay
bribes for simple things like IV drip. And most people are very ill and sleep
on the footpaths and hospital compound. Most of the times let alone having
money for treatment they don't even have money to go back home to their small
towns and villages.

Personally I had experience with one relative who got Guillane barre syndrome,
their family comes from Kolar(A place 70 kms from Bangalore). He was a flower
seller. He refused our help out of self esteem, but we had to bribe through
ward boys, nurses and doctor secretly without him knowing to speed up things
and get him everything from a bed to the right treatment.

~~~
sizzle
This is heartbreaking. How can we solve the problem of overpopulation? What
happens to poor people in America under the same circumstances of poor in
India when seeking healthcare?

------
Beldur
My personal story from Germany: My 14 month old son got a deaseae in the spine
so he could not walk anymore.

We spent 4 weeks in the hospital. 1 week until it was diagnosed in the MRT, 3
weeks with 3 different antibiotic treatment and another two month antibiotics
at home.

All this while my wife continued to study for her PHD so I stayed away from
work and lived with my son in the hospital.

This whole experience did cost us around 200€ (incl. gasoline to drive to the
hospital) while still getting full income from my employer.

------
duxup
My oldest bumped his head as a baby, went to the ER, he had a great time
seeing and visiting with the nurses and doctors (he couldn't speak, but he
knew how to get a response). I think it cost us $150 (with insurance) rather
than 51k...

On the other hand his birth was near $200k because he was born early and had a
long hospital stay (he's fine now, long term premature outcomes are amazing).
Nothing we could have done to prevent it, know it was coming, it would have
financially destroyed us at that time had we not had insurance.

The US healthcare system is borked.

~~~
labster
It's entirely possible that the hospital charged the insurance $51k and the
insurance only allowed $500, of which $150 was your portion. No one knows what
the real cost of anything is at hospitals, and even if you do have the time to
shop around, you can't. There's no way to price compare as no one will tell
you the price of everything in advance, and often surgeons pick their hospital
anyway.

~~~
refurb
If you look at your insurance paperwork it will tell you exactly what the
hospital is paid and what your portion is.

Not uncommon for the hospital to be paid 25-33% of the bill. Sometimes a lot
less than that.

One of the reasons the list price is so high is due to “usual and customary”
laws. An insurance company can’t pay for than that, so hospitals set it
extraordinarily high.

Also, contract negotiations are based on chargemaster rate and discount. They
keep cranking up the list price and insurance comes back and increases the
discount.

------
krapht
Is it insane? Did people read the article? The critical trauma unit was
activated. I suppose if people are called in to work, they shouldn't get paid
if it turns out they aren't needed?

~~~
wiradikusuma
so, you're saying that when somebody called, "my baby's head hit the floor",
they can assemble the whole Avengers just because?

~~~
mcphage
You just mentioned assembling The Avengers, so your Superhero Activation Team
Fee bill of $5.3 million will be arriving in the mail shortly.

------
dmarlow
If there is one area ripe for disruption, it's US health care.

A few months ago my wife was showing me atrocious bills people were posting on
FB, I didn't know whether to laugh or cry. It hit home because we
"accidentally" got a bill when an in-network lab sent a blood test to an out
of network testing facility and we got a $14k bill... for a blood test.

Just recently, a 2 hour ER visit for my toddler cost $3.5k for a breathing
treatment, some Tylenol and some influenza tests. All part of my high
deductible plan.

I used to be on the side against healthcare reform. I'm now counting the
seconds until we have ANY regulation to stop this madness.

~~~
flak48
> I used to be on the side against healthcare reform.

Why?

~~~
dmarlow
Because I had an amazing healthcare plan and was too naive at the time.

------
dzink
The issue here is that the head hit was activated as a trauma. Trauma
activation criteria are different for every hospital. If the criteria is
lower, you get situations like these.

Trauma teams legitimately require such expense. There are surgeons, nurses,
neurosurgeons, and others on call 24/7 sleeping on the hospital so they can
get to victims of trauma within 5minites. Gunshots, stab wounds, car
accidents, massive balconies falling with kids on them, etc, all require
legitimate trauma activations. So do drinks and homeless people who get hit by
cars or stabbed in the middle of the night, and many who don’t have insurance
are still treated by the hospital. Some hospitals bill all patients 7-10 times
the actual costs, get paid 1-2 times actual by insurance. Uninsured either
don’t pay, or negotiate down, or are plagued by the full bill designed to
compensate for the others who don’t pay.

If a hospital isn’t able to cover the costs of a trauma team, that means they
lose their trauma designation and any local patients bleeding out because of
trauma have to be trekked by ambulance or helicopter to the next trauma
center, which in SF is Stanford or John Muir in the East Bay. They might have
needed to pay another 25k if a chopper was called for this.

~~~
nerbert
Curiously enough this only happens in the US. It seems that there is a
rationale behind every decision that is made here, and yet the overall system
doesn’t work for most people.

In that case this case can as well be summarized as: hospital seizes
opportunity to maximize profits on baby, then every decision in the chain
becomes clear.

------
throw_away2
I've said here before that I hope I get mauled and eaten by wolves to avoid
the entire healthcare industry, but now I'm thinking about offering wolves as
a service.

------
mnm1
First, they're from South Korea. Paying even a cent of this would be a
stupidly bad financial idea. Why? There is absolutely no reason. Let the
hospital send the bill to some creditors and let them try to collect in South
Korea. Honestly, the situation is laughable.

Second, the article thinks that this was fraud. Figures. It may not be too
late for them to call the hospital and point this out and ask them to zero out
the balance. This hospital, when it had its prior name, did something similar
for a friend of mine, albeit his bill was about $1-2k and it was not fraud.
Considering they might be on the wrong side of the law, this seems like a
solution both sides can get behind.

------
xor1
My insurance was billed $8000 for an MRI and paid out $7000. I was only
responsible for $500, but it was really upsetting because I'd had one before
and only had to pay $50. The high cost came from the facility being on
hospital grounds, which I wasn't aware of since I entered the area leading to
the radiology center through an entrance that didn't look anything like the
inside of a hospital.

~~~
duxup
A number of years ago I called and asked what the cost for a procedure was at
a local hospital.... they struggled to even tell me within a weeks time. The
system is just insane.

~~~
maxxxxx
When I had an HSA I also tried to get prices upfront. It's pretty much
impossible to get any quote from medical providers. They just won't tell you.

~~~
pkaye
I'm in the Kaiser Plan in California. The hospital is also the insurance
provider. Generally they are pretty good but even they sometimes cannot tell
you the costs ahead of time. Their saving grace is that for most things they
have a copay system with a fixed amount out of pocket.

------
anonu
My wife recently gave birth to our first child. Normal delivery - 2 nights in
a hospital. Then we had to go back again for jaundice - nothing serious - but
added another 2 nights in a hospital room. All said and done my insurance was
billed $64,000 for what is considered a normal uncomplicated birth. That is
insane to me. If you go over the bill carefully, instantly 50% of that
disappears because I've "saved" by being with my insurance provider.

What if I had no insurance? Would I get billed that insane number and have to
spend hours whittling it down?

My dad was commenting on how the drug he takes regularly in his home country
(outside the US) is 1/10th the price of what it costs here.

The health insurance system is broken in USA (who knew?). Everything is
artificially over-inflated because it all gets "negotiated" down in the end.
This creates a lot of room to maximize your net revenue when you set prices
arbitrarily high.

------
Svoka
Break a leg. Well. I broke femur near San Luis Obispo.

I was admitted to hospital, was charged over $19000 (that is nineteen
thousands dollars) per night for bed. Just for bed. And it was a "cheap"
option with person crying in agony next to me whole time.

Total bill was 74k$ dollars just for hospital service. Emergency services,
E.R., surgery, anesthesiology all Extra.

Welcome to US.

P.S. With that prices, hospital easily would make it in top 20 most expensive
hotel rooms of the world, except I didn't have a choice but to pay for it.

------
gU9x3u8XmQNG
I genuinely wonder where this money goes, if paid. It seems rather unrealistic
to believe these costs can be genuinely justified, with an independent audit?
Right? The genuine cost to business cannot be this high.

These values are utterly unreasonable. Someone, somewhere; is doing something
extremely unethical.

The fact this can even happen somewhat indicates there’s a lot of “power”
involved.

—

Edit: another poster had mentioned that some costs are included to cover other
admissions in which fees are not paid - no matter the reason.

So, whilst this seems quite logical; it bothers me this is not clearly
indicated. Its a pretty poor attempt to fix a clear, and genuine, other
problem.

~~~
will4274
I can get close to the math by being extremely generous. 15k of tramua fees.
~10 specialists on call for tramua. That implies each specialist got about
1.5k for the call. ~2 hours of work, maybe payment for transport time so super
generous call it 4 hours. If normal pay is 1x and overtime is 1.5x, must stay
by the phone critical on call is 2x? This computes the specialists as getting
paid an average of $200 per hour normally.

This is all pretty crazy - $200/hour for a brain surgeon, sure, but there's no
way the nurse is getting that. One of the big missing data points is how many
people were called in. 15k is pretty reasonable if a 50 person team was called
in - but then, why would a 50 person team be called in?

~~~
gU9x3u8XmQNG
Interesting!

I guess minimum callout fees, etc - in your proposed scenario including a
large callout of resources.

Hmmm!

Thanks for your reply!

------
crazygringo
Curious... for international patients... if they just don't pay, is there
anything the hospital can do?

It's not like it's going to affect their credit rating in Korea or anything?

~~~
duxup
Nothing they can do, having said that I belive if the patient is from a place
that has a national system, they pay.

On the other hand medical bankruptcy is sadly frequent in the US so
international patients isn't really a concern.

~~~
kalleboo
> _if the patient is from a place that has a national system, they pay_

This obviously varies by country. E.g. for travel within the EU, a country
will pay for their travelers healthcare. I live in Japan, and while the
universal health insurance will pay for treatment sought outside of the
country, they will only pay what it would have cost if it was performed in-
country. So that doesn't help travelers to the US.

~~~
duxup
That would be more than the folks in the US who can't pay at all... so I'm
sure most hospitals are ok with it to some extent.

------
SCdF
OK so I know that emergency care not being free is madness, and _you_ know
that emergency care not being free is madness, but what are the arguments from
people who don't think this sound like?

Also, I wonder how feasible it would be for foreign governments to pay for the
emergency care of their citizens when they have issues in America, and fund it
by charging visiting American's American-style medical bills for any medical
care they receive while there.

~~~
kalleboo
> _but what are the arguments from people who don 't think this sound like?_

The two I see are mostly

1\. "I don't want to pay for other people's healthcare. Other people make poor
health [dietary, etc] and financial [they're poor] decisions and they should
pay for it themselves." A lot of young people do not want to pay it forward
for the healthcare they will need when they get old ("I haven't been to a
hospital in years! I'm healthy!").

2\. Distrust in the government in running a fair and efficient system ("death
panels" etc)

------
wattengard
I'm norwegian.

I have two kids, and have used the emergency care unit a couple of times
throughout my life. Total cost $0 in care fees. (They are allowed to charge
for stuff like bandages and such for non layovers, usually $5-$20 each visit).

We don't have health insurance, but some insurance companies have begun
selling "treatment guarantee" which guarantees start of treatment typically
within 14 days of injury. (For non life threatening ailments of course. Elbow
pains, leg pains, such..) The best thing about those are that they are usually
paid for by your employer because they want you back at work as soon as
possible :D (The premium is added to our income tax though)

Socialism hell yeah!

------
sexy_seedbox
Of all the news outlets available, why is Jack Ma's Hong Kong newspaper
linked?

------
ilotro
Every now and then I seriously consider moving to the US, but the healthcare
system scared the crap out of me. I can't imagine how stressful it must be to
have to depend on your employer for health insurance.

------
herodotus
If you are a foreign traveller in the US, and you need medical attention, if
at all possible use a drop-in clinic instead of any hospital. Even the so-
called non-profit hospitals charge outrageous fees.

------
peterwwillis
A French friend of mine needed some emergency operation while he was in the
States. He bought a round trip ticket to Paris, left, got the operation done,
came back to the States. Saved $10,000.

~~~
chrisper
What kind of emergency surgery is it if you can fly 9 hours before and after
going to surgery?

~~~
peterwwillis
Where in my statement did I say that? Though of course there are many kinds of
emergency surgery and flying certainly does not restrict all of them.

~~~
chrisper
It's literally your entire comment...

~~~
peterwwillis
I said he left, got the operation done, and came back. I didn't say it was
within 9 hours of flying.

------
pascalxus
There really should be laws against that sort of thing. Maybe some price
ceilings per service

------
BadassFractal
Follow the money, I guess. Who's pocketing the 15 grand worth of trauma
activation?

------
rusk
Privatise they said, run things like a business they said ...

------
mastrsushi
What does this have to do with HackerNews? This site is turning into mini
Reddit.

~~~
craftyguy
What, do tell, is your definition of what should be posted to HN? I suppose
you read this[0] and this [1], which address your question about what content
is appropriate, and how to comment on content you believe is inappropriate?

0\.
[https://news.ycombinator.com/newsguidelines.html](https://news.ycombinator.com/newsguidelines.html)

1\.
[https://news.ycombinator.com/newsguidelines.html](https://news.ycombinator.com/newsguidelines.html)

------
king_nothing
Holy $#17. I was in Stanford’s cardiac unit for some days, the actual bill
must be $35k.

------
yellowapple
"Zuckerberg San Francisco General Hospital (SFGH)"

This has to be satire.

...right?

~~~
sushid
Go give $75mm to your local hospital. I'm sure they're willing to do the same.

~~~
thatfrenchguy
California gave like 200m$ and it’s not called the California hospital though.

------
viach
It might be the hospital did an ICO and offers services for it's tokens now.
Understandable then.

