
SF hospital charged $15K ‘trauma response fee’ for baby that needed no treatment - jose_zap
https://khn.org/news/how-er-bills-can-balloon-by-as-much-as-50k-for-trauma-response/
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steanne
previous discussion:
[https://news.ycombinator.com/item?id=17468788](https://news.ycombinator.com/item?id=17468788)

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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.

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DanielBMarkham
My wife has sleep apnea, so during her normal annual checkup the doc wrote her
a prescription for a CPAP.

She goes to the local vendor, they tell her to pick out whichever machine
she'd like. She would rent it for a few months to make sure she liked it. The
insurance company would pick up the bill.

Many months later we just got a bill for $500.

She calls them. They tell her that this is the balance owed on the machine.
Now they've already billed the insurance company four thousand dollars for the
machine. The insurance company paid about a quarter of that. Then she the
rents on top of that. And now they want the balance. The bill came completely
out of the blue.

They won't take it back. So she's thinking about selling it. Going online the
machine is only worth 500 bucks brand new. They're basically selling the same
machine three different times: once to the insurance company, once on a rent-
to-own deal, and once as a bill coming from nowhere.

I don't know in what universe this is not considered plain old fraud. The
billing situation in healthcare in the U.S. has become so byzantine and
complicated that's it has basically turned into a shell game of screw-the-
consumer.

I don't want to talk about why it happens. I don't want to talk about
solutions. I will say that the politics of healthcare has led us here --
nothing else but that. And the more we argue the worst it will continue
getting. I _do_ want to note that it seems like every month or so there's some
new horror story. It's so bad that the vast majority of the time nobody talks
about it. It's an awful mess.

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firefoxd
Ok, in the US we are one medical trip away from complete bankruptcy. Not too
long ago there was an article saying the average person in America doesn't
have $400 stashed away for an emergency.

So what do you do when you get this bill? You can't pay, you don't have the
money. What do you do?

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Jach
You contest what you can, and then you arrange a payment plan... also I
believe the median surplus income (mean is higher) per month in America is
~$1k, most Americans just do something with it (leave it in checking account,
invest it, or spend it) instead of putting it in a separate savings account.

Your general complaint about high medical costs is on point of course, but for
most people in America they could pay off a dumb $18k bill over a period of
time if they had to.

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tscs37
What if something else happens during that time?

1k$ surplus income per month on a 18k$ bill means you'd have to forfeit all
surplus income for 18 months.

If any other medical emergency happens and you have another 18k bill? Or a car
accident (of which there are a lot)? Or car just breaks down? What if you get
fired and spend a few months searching a new job?

This isn't exactly financial security with such a bill pending over your head
plus numerous other bills being a possibility.

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Jach
> 1k$ surplus income per month on a 18k$ bill means you'd have to forfeit all
> surplus income for 18 months.

Sure, if you were intent on paying it off as quickly as possible. Most likely
your payment plan would be less than that.

Ultimately if enough "what if something else happens?" happen, you file for
bankruptcy.

There's no such thing as financial security for anyone when you deal in the
world of what-ifs.

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tscs37
There is financial security for me. I don't have to worry about not being able
to pay my hospital bill. I won't have to file for bankruptcy because I'm
unable to pay because that doesn't happen.

So there is certainly some financial security for anyone in the world of what-
ifs, atleast as far as medical coverage is concerned.

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Ra1d3n
One of the reasons I have basically given up my fantasy of moving to the USA
is the russian roulette that you seem to have to play with your health and its
insurance.

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rogerb
If you have insurance through your employer you'll be ok. If you don't you'll
pay anywhere between $800 and $3000, a month, for healtcare.

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pimeys
What happens if you get fired from your job suddenly? And if you happen to
have pre-existing conditions, such as a type 1 diabetes, that is known for
being very expensive to treat?

How can you live with this fear?

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Jach
My mom lost her job with benefits, and a month later fell down some stairs and
broke her arm. Eventually she was able to get an insurance plan (after getting
a new job) for something like $200 or $300 per month (there are in fact
cheaper ones depending on your need of coverage and state), while paying off
the bills from the broken arm event.

Personally speaking, I have no fear of a similar event happening to me. If it
happened, I'd figure something out, or die. Generally speaking, "what we think
is unbearable proves to be bearable."

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ewjordan
"figure something out, or die"

The Republican party salutes you, you speak their disgusting and morally
bereft "truth" with extreme accuracy.

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Jach
You left out a very important contraction from that quote, namely "I'd". The
subject of the sentence changes its meaning entirely. As you quoted, it reads
as an imperative, something I did not say.

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ewjordan
Fair, I upvoted you because that's a wrong interpretation of what you said.

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rogerb
In Australia we went to the doctor after my kid had an allergic reaction. They
medicated him, had a nurse within 10 feet and kept him for 6 hours until
symptons receded. Total cost - AUD$40. The US systom is absolutely insane,
expensive and delivers worse results.

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cm2187
I am pretty sure $40 isn’t the cost of the exams. It is being subsidised by
other tax payers. We can discuss the merits of this approach but it is not
necessarily cheaper overall.

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DanBC
The US government pays more for healthcare in the US than many other
countries. When you add in private insurance the US far outspends outher
countries for healthcare. But they don't have better results. For example, the
US has a shorter average lifespan than many countries.

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guidedlight
It sounds like this "trauma activation", has replaced the triage system. Where
a triage department will determine the severity of the emergency injury, and
associate an appropriate medical response.

The triage activation assembles a team of experts that treats every emergency
patient with the same high level response, similarly because doing so attracts
a higher fee.

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jblazevic
How is this practice of inflating prices while exploiting urgency and lack of
choice not clearly fradulent and illegal?

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ekianjo
There are emerging alternatives on the market:

[https://reason.com/reasontv/2017/10/16/doctors-direct-
primar...](https://reason.com/reasontv/2017/10/16/doctors-direct-primary-care)

Note that the current system is actively fighting off the development of such
alternatives...

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consz
What's the long term stable state for American health care? Given the
difference between the rate at which healthcare costs grow and the rate at
which wages grow, it will only take a couple decades before the former is
larger than the latter -- and at that point, only a few years until it starts
becoming (large) integer multiples of the latter.

So what's the plan then? Obviously, nobody will actually be capable of paying
those costs. Will people simply choose to die, or leave untreated most medical
issues? Even in the case in the article's title, how could any non-billionaire
justify paying such a cost? They don't even live here -- I could never imagine
what sort of calculus would lead me to even pay a single dollar to someone
requesting such an obscene price for so few services rendered.

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jarfil
US Healthcare costs are fake, hospitals don't really expect to get the whole
sum after they apply discounts for insurance companies, so they make them
appear bigger just to get what they intended. It's only people who don't have
a strong insurance company to fight on their side who get ripped to shreds.

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vinchuco
Can medical tourism grow enough to bring medical costs down by competition?

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Molaxx
Mean while corrupting and wrecking other countries healthy(ish) national
health systems? No thank you.

~~~
vinchuco
Could you clarify how? I don't see how that follows.

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williamdclt
a country healthcare system is not designed to support people of _other_
countries that come because their own healthcare sucks.

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geomark
Many countries have arranged to do just that because they make a profit from
it. The popular medical tourism desitinations provide world class care at a
fraction of the cost of the same or inferior care in the US. The medical
tourists pay cash on delivery. The providers make handsome profits, despite
charging substantially less. Lots of factors behind why it works. Mostly
rooted in market forces.

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purplelobster
Not a huge loss for the US, but I will probably never go back due to this.
Even if you have insurace, your life will be hell for a while due to having to
fight your insurance company over a tremendous bill. I don't want to have to
think twice if I should bring in my son to the hospital or not, and frankly,
the US doesn't have anything unique enough to offer to offset that risk. I'm
also doing my best to stay away from conferences, preferring instead Canada,
European or Asian destinations.

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jsumrall
Is this a case where having better insurance would protect you from the
hospital? Not sure how insurance or billing in the US works, but in the
article one person broke their ankle and their insurance negotiated the price
with the hospital, and then the hospital still came after the person for the
costs that the insurance company negotiated to not pay.

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yani
The hospitals are assembling a team of experts to deal with extreme injuries
of patients. Patients then refuse to pay this bill but forget that if this
team was not there they could have lost their life. Any trauma to the head is
life threatening - people die from slipping in the bathroom.

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amelius
Giving an upfront indication of the costs would have been the least they could
have done.

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Broken_Hippo
That is near impossible, and still gives folks little to no choice in an
emergency.

"to keep your child from possibly dying, you'll wind up paying at least
$15,000, depending on the diagnosis"

Of course, that last bit was completely unknown upfront. It is hard enough to
shop around for non-emergency gall bladder surgery, let alone actual
emergencies.

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cbluth
The medical system in the US is rampant with this sort of thing, what a shame.

