
The Cost of Not Getting Tested for Coronavirus: A $10K ER Bill - smacktoward
https://thecity.nyc/2020/03/the-cost-of-not-getting-tested-for-coronavirus-a-10k-bill.html
======
platetone
We decided (slash "made the mistake") of going to the emergency room last
summer. Spent less than two hours in an exam room before being dismissed with
no conclusion and referral to another doctor. Got a $9500 bill about six
months later and have been billed a 10% copay on that (insurance paid $5500
already at their negotiated rate). Still fighting it as absolutely absurd, but
there's really no hope. This country is fucked. It's an embarrassment.

~~~
swozey
I paid something like $800 for one crutch when I sprained my ankle once. Think
another $300 for ibuprofen. Now I know why there's a crutch market on
craigslist/thrift stores. Not sure what my insurance paid for xrays, etc, but
my tab was something like $1100 for that ER rendezvous. Thought I broke my
leg.

I had a laparoscopic surgery a few years ago that was $35k.

~~~
bluntfang
to be fair, you paid a doctor to administer you a crutch and ibuprofen, I'm
certain that's not the raw material cost.

~~~
outworlder
I wish that was the case. If you sort the line items by cost, I would be
surprised if labor was on top. Maybe for surgeries, but I doubt that.

My insurance got billed 6k for a chest ultra-sound. They paid 4k. Hospital
still wanted around 2k, had to negotiate and pay a little over 1k at the end.

The line item for physician cost (billed separately) had 2 digits.

~~~
bluntfang
>If you sort the line items by cost..

Do you really think current health care is giving accurate line items on your
bill?

~~~
jfk13
Wouldn't a bill with inaccurate line items amount to a form of fraud?

------
aurelwu
The statement from the hospital management boggles my mind: "In addition,
there are different parts to a patient bill. One part is what the hospital
charges the insurance company, one part is what the insurance company
eventually pays [...]"

I can't think of any other business transaction where someone just puts a
giant number on a bill and then is happy if someone pays ~25% of it. Such
companies would be shunned by their customers and they'd go bankrupt. Is there
any economic theory which explains how such odd of an system can
emerge/survive?

~~~
karatestomp
Nothing about hospital billing would fly anywhere else. Bills just showing up
after the fact with little ability to verify their accuracy, _constant_ errors
one can catch anyway (so how many are missed?), bills showing up months later
from a half-dozen different sources when you only had one apparent "vendor",
and so on.

I bet we received between 100 and 200 pieces of mail for each of our kids'
births, including maternal care before the births. Probably averaged 40-60
hours dealing with billing and billing problems with each one, maybe more. And
ours were all totally normal and about as easy as it gets, and we had
insurance. I think we ended up missing some tiny bill we could easily have
paid in each one (oh, yeah, they also like to give you very little time to
pay) and had them go to collections.

~~~
beckler
I found a bill with a mistake on it, as one of my kids was charged twice for a
single procedure. I called to get it fixed, but instead of dealing with it
they just immediately sent it to collections.

~~~
karatestomp
My experience has been that no one at the insurers nor at medical providers’
billing departments give a shit until state regulators and/or legislators’
offices get involved. Which means yet more time on the phone.

The amount of time lost dealing with this system of ours is incredible. All
else being equal it would be a win just to eliminate that, and there’s no
reason to suppose that is the only improvement we could achieve.

------
lultimouomo
Side note: if you suspect a COVID-19 infection, DO NOT GO TO THE ER. Contact a
physician by phone, get instructions. By going to the ER you put a lot of
people at risk.

~~~
joe_the_user
At some point, the people who suspect COVID-19 infection are going to be
people who have full-on pneumonia. They would need to go to ER under normal
circumstance but indeed, that will have a bad result.

Basically, we desperately need a special COVID-19 program, not simply a
person's regular physician giving instructions. How many physicians are going
to be getting calls soon and how much time does that take important activity
on their part? Etc.

Note that Korea has ER wards set-up with pre-entry tents allowing COVID
patients to be routed elsewhere. Some multi-track system like this is going to
be necessary or more desirable than Italy, which has shut down the part of its
health care system not treating COVID patients and is still mostly watching
them die.

~~~
lultimouomo
> Some multi-track system like this is going to be necessary or more desirable
> than Italy, which has shut down the part of its health care system not
> treating COVID patients and is still mostly watching them die.

Please don't spread disinformation, this absolutely not what is happening in
Italy.

ERs are working, hospitals are working.

Planned and elective procedures have been delayed, to spare personnel and
rooms and to avoid creating new emergency cases in case the procedure goes
wrong.

Italy has less than 7000 hospitalized COVID-19 patients. Dealing with those is
not a problem. Even the 1000 people in ICU are not a problem themselves, the
600 in Lombardy are. Lombardy had around 900 ICU beds before the crisis (they
now have more but the extra ones are makeshift); this means that 2/3rds of the
bed are needed for COVID-19 patients only, which is obviously a huge problem.
In Bergamo, the city with the worst situation, some people cannot be tubed
because of lack of equipment will get will get a NIV instead, which is very
very bad, but it's not "wathich people die".

BTW, Italy has enforced the dual track system for suspect COVID-19 cases since
at least two weeks ago.

~~~
joe_the_user
References? I'd love to believe this is the case but I haven't seen any
mainstream news to this effect and I have indeed seen desperate shared tweet.

I mean, I'm happy if this is true but if you want to reassure people, give a
reference.

Edit:

 _ERs are working, hospitals are working._

Press I read says: ER isn't working for non-COVID cases and isn't able to deal
with a substantial number of COVID cases.

The term would be overwhelmed. And I know Italian hospitals are better than a
lot of American hospitals, which certainly couldn't be called "top notch".

~~~
lultimouomo
My direct source is Italian newspapers and personal conversation with ER
doctors.

You can use google translate to read this local newspaper from Bergamo that
quotes the Lombardy ministry of health about how this Monday they closed day
hospitals (clinics? not sure how it translates) and scheduled surgeries are
reduced to a minimum:

[https://www.ecodibergamo.it/stories/bergamo-citta/gallera-
st...](https://www.ecodibergamo.it/stories/bergamo-citta/gallera-stop-
attivita-ambulatori-da-lunediterapia-intensiva-corsa-contro-il-t_1343804_11/)

Don't get me wrong - the situation is bad, and it will get much worse. We can
probably help Bergamo by shifting people around, if we reverse the trend and
the rest of the country stays in a better situation, but if left unmanaged the
epidemic would definitely bring the healthcare system to its knees. But we're
not there yet and hopefully we'll be able to avoid it.

And again, because this is very important: COVID patients do not go through
ER. Please tell everyone around you that if they suspect COVID they must NOT
GO TO THE ER. In the beginning of the epidemic, before this information was
understood by people, infections in the ER have been a major factor of the
virus spread.

------
lostgame
As a Canadian who has also lived in America, I am consistently mortified by
the costs of health care in the states.

Are they intentionally designed to force the lower class into even more
poverty (I’ve seen $50 being charged for a pill of Advil - first hand) - or is
it just an unintended side effect?

I find it harder to believe it’s accidental than intentional.

EDIT: Due to jiveturkey’s pathetic and wholly inaccurate defense of this
system, and my inability to post in this thread further, I need to specify I
was changed $740 to see the doctor and identify the issue. The pill _itself_
cost $50. Please don’t defend this pathetic slavery of the lower class, guys,
unless you’re a part of it. I’ve actually got a photograph of this bill
somewhere on my backup drive I’d love to share.

EDIT 2: And before any of you say this isn’t intentional, please look up
Martin Shkreli. The only difference between him and the other guys at the top
of the industry is that he got caught.

Get real, guys. Please. Most of the comments here are beyond sad - I’m glad
this has so many upvotes from people who silently disagree.

~~~
munk-a
They are not - the effect these prices have on the poor is an unintended[1]
consequence of the true aim. Extracting the most money possible from insurance
payors - honestly, if hospitals could bill "You owe us 50$ or as much of that
that your insurance would cover" then they would. Nobody actively wants to
impoverish the poor (except for a small number of utterly terrible people) but
payors force cost pass on to their subscribers as a way to keep the costs from
getting too crazy and and the uninsured get hit by the full bill that
providers want to extract out of payors simply because it's impossible for
them to under bill without getting hit by lawsuits.

That paragraph was an attempt to be really fairly voiced so just to follow up
- this system is utterly rotten and terrible, the US has one of the worst
health care systems in the world when it comes to the non-super rich - and
even for them there are better options - and it needs to be fixed.

1\. Edit note: Originally I used "unavoidable" here which was a poor word
choice that's been pointed out below.

~~~
cosmie
Also good to point out - payors actually benefit from crazy costs. Insurance
companies had their profitability capped as a percentage of premiums
collected[1][2]. The easiest path to profit growth is just to let claims
balloon, then use that to justify premium increases.

[1] Technically it's a cap on all non-medical spending, rather than profit
margin specifically. But in effect it's a cap on profits, as there's only so
much overhead you can cut.

[2] [https://www.aeaweb.org/research/regulating-health-
insurers-a...](https://www.aeaweb.org/research/regulating-health-insurers-aca-
medical-loss-ratio)

------
thorwasdfasdf
Definitely need to start cracking down on predatory hospital billing. 10K
billed just for stepping into the ER Room without even getting tested is
absolutely insane. AT point do we decide this is criminal and start taking
actions against these guys? Normally, I would never be in favor of price
ceilings but this is one industry that desperatly needs it.

~~~
solotronics
I think once the dust has settled from COVID-19 the entire health system in
America will be totally changed.

~~~
smacktoward
I remember studying political science as an undergrad two decades ago. My
professors all said the same thing about the Electoral College: “it’s a relic
that has long since stopped serving a practical purpose, but people live with
it because it never rocks the boat. If there’s ever an election where the
winner of the popular vote doesn’t actually win because they lost in the
Electoral College, there will be a huge mass movement to finally get rid of
it.”

Since then we’ve had two elections in twenty years where a candidate who lost
the popular vote “won” thanks to the Electoral College. And the Electoral
College is still there.

In politics, never underestimate the power of inertia.

~~~
mrguyorama
It's not about inertia. Look at which party benefits from the electoral
college, and then recognize their attempts at voter disenfranchisement.

~~~
smacktoward
Indeed, this was a key misconception my professors and I all shared: we
thought there was a broad consensus in American society that democracy is a
good thing. It turns out there are a lot of Americans, disproportionately
gathered on one side of the ideological spectrum, who care less about
democracy than they do about their team winning.

------
joe_the_user
Wow, this brings home what a huge crisis this is for US health care system.
It's not just the huge costs or huge administrative overhead as such. It's
that the entire system is built as "we design a giant filter-rationing-
marketizing system to dole out services and _you_ pay for both the service and
the rationing process". This stuff can't work for the Coronavirus at all.
Testing needs to free and fast, not even "free eventually but there's
bureaucracy first". Who knows when or if this paradigm will be abandoned but
if it isn't, suffering will be tremendous.

But either way, the risks discrediting the filter-ration paradigm. If X can be
provided for free to everyone, the question of why can't you will loom that
much larger.

------
munk-a
Lets not forget that the US could dodge a lot of these issues (and increase
the chances of a good outcome) by simply putting out a few tens of millions
for tests and distributing them to providers free-of-charge with an agreement
that there be no administration fee.

That is, honestly, sorta what a government should do in a crisis, just eat the
cost to make sure everyone is safe - instead the government is "letting the
market decide" and continues to dump millions times the cost of resolving this
crisis into boondoggle never-gonna-work F-35 fighter jets.

------
bcrosby95
The US healthcare system is best described as a pack of wolves negotiating
about whose going to eat the sheep.

~~~
munk-a
I think that's close to accurate, but a better description would be "A pack of
wolves fighting over who is going to eat the sheep".

The different market players here, PBMs, Payors, Manufacturers, Providers,
Special Interest Groups, Advisory Boards and others - all are trying to
bankrupt one another much harder than they're trying to bankrupt customers
because customers have nearly no money to take - most of the inflow into this
market isn't coming from the consumers but from the employers of the consumers
(that are paying truly staggering amounts of money) and a lot of the damage
you see to customers ends up being, essentially, collateral damage from one
market player trying to stick it to another market player.

------
nimbix
Just yesterday I was reading an interview with the CEO of a German company
which produces coronavirus tests about how they charge 2.5EUR for a single
testing kit and that reasonable cost for processing it should be around 10EUR.
Where does the 1000x multiplier come from?

~~~
tedunangst
Huh? She wasn't tested. Whatever the ER charges, outrageous or not, why would
you assume there's any correlation at all to the cost of a test that wasn't
administered?

------
robbiep
This is unfortunately why the US is going to fail miserably at containing
SARS-CoV-2.

~~~
DannyB2
The reason we will fail to contain it is because we don't have any test kits.
So we don't know the true rates of infection.

Policy: ignorance is bliss!

It looks better to have lower numbers.

~~~
robbiep
Trump usually likes higher numbers

------
Dramatize
The American healthcare system is the main reason I'd not want to move there.

~~~
beckler
I live in the US, and the healthcare system is the primary reason I want to
move to another country.

------
XorNot
The US, judging from Italy, is about 4 weeks away from a complete collapse of
its healthcare system due to corona virus.

With no serious attempts at mitigation or contact tracing or testing, that
thing is going to spread like wildfire.

------
ksk
Is there anyone doing work on analyzing current legislation and providing
alternate wording to fix the issue?

~~~
toomuchtodo
[https://www.congress.gov/bill/116th-congress/senate-
bill/112...](https://www.congress.gov/bill/116th-congress/senate-
bill/1129/text)

~~~
ksk
Sorry, that's just an impermeable wall of text to me. I'd love to know from
someone who groks this, the specific wording in the bill that would address
the ER costs issue, and where the current legislation fails.

Basically I'm looking for the bug fix, not the entire source code.. :)

------
nojvek
Serious question, why can’t individual states rollout single payer healthcare
?

------
mikeInAlaska
Nobody should worry about Covid in the USA, 1) Trumps dead Uncle went to MIT
and 2) we have his hunches to keep us safe.

Further, as long as we don't test in mass, our case numbers will remain very
low.

~~~
munk-a
It is depressing that the hyperbole comment is just a list of easily
confirmable statements by the administration.

------
NoblePublius
This story is total fake news. The patient is a teacher with a Cadillac health
insurance plan. She paid $75 co-pay. The $10,000 bill is an illusion printed
by the insurance company to make her think that her insurance is actually
valuable. No one was paid $10,000. The hospital was paid a secret negotiated
rate much much much much lower than $10,000.

~~~
munk-a
The provider was paid 3,000 by the payor - that's how insurance billing works.
It absolutely is a rats nest when it comes to finding out pricing information
but the number on the bill is what ended up changing hands (less, possibly,
any amount not covered and defaulted on by the patient).

I believe you're thinking of the provider's chargemaster and the pricing
discrepancies there - this procedure was billable as 10,000 to a patient
without insurance with the 7,000 discount being the payor's preferred rate -
that 10k is the BS number that (mostly[1]) no one ever pays, while this 3k is
the actual amount changing hands - for the patient the out of pocket cost is
the most visible portion, but that bill was fully paid.

1\. Mostly everyone except for the uninsured or out of network - those folks
will get stuck with that BS price 7k price, which is there since payors always
want to feel like they're paying discount prices.

(edit - corrected numbers to be in line with the actual bill)

~~~
m0zg
Insurance _never_ pays as much as they bill. This is one of the reasons to
have it in the first place: each insurance company has negotiated rates with
the hospitals. Even if you have high deductible, you'll still be getting
negotiated rates, not the bullshit they (try to) charge people with no
insurance at all. IMO, this is one thing that should be made totally illegal,
no matter where one lands on the political spectrum: cash customers should be
"favored", meaning cash price must match or be lower than the lowest insurance
negotiated rate for each procedure. Anything else is just stupid and unfair.
That way if the insurance pays five cents for the paper cup the pills come in,
you can't charge fucking 13 dollars for the same thing if I pay cash.

~~~
munk-a
I agree and find it utterly outrageous. I'm lucky enough to have avoided any
hospitalizations in my adult life, but I am _quite_ familiar with this BS on
the pharmaceutical side, in another comment on this article[1] I broke down
that "preferred partner" price difference as I experienced it personally and
it is insane that these pricing differences are allowed to continue. Also,
bear in mind it's not just patients paying in cash - all these rules also
apply to anyone unlucky enough to be treated out of network, even if it's just
because they were brought to the wrong hospital while unconscious.

1\.
[https://news.ycombinator.com/item?id=22550564](https://news.ycombinator.com/item?id=22550564)

