First high-deductible ER visit...

"Ash78, voting early and often" (ash78) 05/31/2017 at 10:43 • Filed to: None

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Back when I had a full coverage option at a smaller employer, ER visits were typically $150 copay, plus 10% of the final bill. Last year I started with a giant employer who, somewhat ironically, only offers higher-deductible plans for similar premiums.

Long story short, a little wooden plaque fell on my son’s head about 3 months ago. He started bleeding a little, so we feared the worst and headed over to the nearest ER, which is a brand new freestanding emergency center about 2 miles away. We saw the nurse for a couple minutes, then a PA, who put a single staple into the wound to keep it from opening back up. No stitches needed, we chatted with the doctor for about 2 minutes and we were on our way. 30 minutes door-to-door and no waiting.

Fast forward to yesterday when I got the final of three bills for the visit, totaling just under $1,200. (Had I been uninsured, it would have been over $1,500). I’m not going to debate the merits of different systems and plans, but that just seems REALLY excessive to me, given the amount of time we spent and attention we were given — about on par with a standard pediatrician appointment, which costs $60-$100.

I am so sick of healthcare — can’t live with it, can’t live without it. And worst part of the whole thing is the lack of transparency on the pricing. Would I have taken my son to the ER if I knew the cost in advance? Maybe, but I would have taken a closer look. And then he might have gotten infected, admitted, and cost the insurance company tens of thousands of dollars. As it stands, IMHO, these costs are a DETERRENT to preventive care, as well as to visiting doctors for minor ailments.

Textured Soy Protein > Ash78, voting early and often 05/31/2017 at 10:50

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Yes, high deductible plans suck and the only people they really work well for are rich people who can afford to fully fund their HSAs to cover the deductible, but they are pushed on everyone else who can’t necessarily afford to do that.

Also, as I’m sure you’ve now figured out, freestanding ER centers are a racket and ridiculously overpriced. That’s true of all healthcare providers to varying degrees, they all jack up the top-line price because it’s a point of negotiation with insurers, but no insurers pay that top-line price. Instead they pay a much lower negotiated rate.

Was this place in your network for your insurance? If so, even though you have a deductible, you should have it billed through your insurance as that way you will at least only be responsible for paying whatever your insurer’s negotiated rate is, not the full top-line price.

Patrick Nichols > Ash78, voting early and often 05/31/2017 at 10:58

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I’ve got pretty good coverage (always have since my mom is a teacher and now I pick the plan for the company I work for) and to limit even our minor costs I almost always went to my PCP to avoid both the line and the ER copay. He is a family friend and would come into the office or ask a coworker to cover in a pinch.

Ash78, voting early and often > Textured Soy Protein 05/31/2017 at 11:00

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Yep — top line was about $1,500 and the insurance price was only slightly lower. It was a large freestanding center that’s part of our own primary care network, so definitely within our plan. I don’t know if any other ER would have been any better, it’s just nutty. I’m going to write them and threaten to stop going to my primary care doc. That’s about the only leverage I have in this racket. The whole point of these newer healthcare plans is to put more negotiating and price-shopping in our hands...that’s about all I can do.

Nibbles > Ash78, voting early and often 05/31/2017 at 11:01

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We moved to a high deductible plan this year. Right off the bat my wife messed up her knee. One ambulance ride and an ER visit later, she was aat 70% out of pocket max

Downside, that was a shit-ton of cash to drop. Upside, she’s 100% now so things are basically free

Bob Loblaw Made Me Make a Phoney Phone Call to Edward Rooney > Ash78, voting early and often 05/31/2017 at 11:02

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That’s not a feature of high-deductibles, that’s a feature of freestanding ERs. ER trips have always been expensive and it’s never had anything to do with the fact that they were in hospitals before FSEDs existed. Your $150 ER co-pay on your old plan was not typical, even before higher deductible plans became the norm.

Never, ever go to a freestanding ER if you can help it. An urgent care center like a CareNow can handle a ton of the cases that wind up going to an FSED at the cost of a $60-100 co-pay.

Ash78, voting early and often > Nibbles 05/31/2017 at 11:02

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Yep, we had that situation last year — just a few days after the plan started, my wife had surgery and we hit the OOP max right away. It was sort of luxurious to not pay a dime for 8 months last year... (except the ongoing bills from surgery, which will be paid off by early 2018)

Ash78, voting early and often > Bob Loblaw Made Me Make a Phoney Phone Call to Edward Rooney 05/31/2017 at 11:04

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I ’ m gonna put some pressure on them, then. We had other options, but it was 9pm and we had just heard great thing about this facility — and it was part of the same hospital system where my wife had surgery last year ($5k out of pocket) and where our primary care doctors are. The best we can do is threaten to stop giving them business, I guess. I ’ m sure they ’ ll settle for less, we ’ ll have to see.

Gone > Ash78, voting early and often 05/31/2017 at 11:07

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A few years ago my wife went to the ER in massive pain during the day. Her normal GP couldn’t see her for...reasons I guess? Anyhow, she was there an hour or so, got checked up, had a few tests run, got some meds, and went home. She was on her own bronze plan at the time. She negotiated the final bill (some $12k) down to $4800 or so after not paying it for 3months. That was fun.

The problem, IMO, is we health INSURANCE, not heath CARE. Which are totally different and often with opposed goals. When we were in Europe we’d get asked about US healthcare randomly by locals. Most of them were aghast by the end of the conversation.

We have an HDHP with HSA now, which works for us. We’re already at max this year so 90% is paid for in network. We fully fund the HSA and then try to pay everything out of pocket which sucks at times.

Nothing > Ash78, voting early and often 05/31/2017 at 11:07

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The healthcare reform needed isn’t to make sure everyone has coverage. One, the coverage cost can be downright scary, and then the negotiated rates can STILL be unaffordable. What’s needed is the whole area of negotiated rates, the gray area of the proliferation of urgent care and boutique EDs and whether they are in market, out of market, or not even IN any market. Even then, negotiated rates for those boutique EDs can be different than if you go to the ED at the hospital.

TheRealBicycleBuck > Ash78, voting early and often 05/31/2017 at 11:09

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A friend of mine is in the health insurance industry. His advice is to wait util the second or third billing, then go, in person, to their business department and negotiate for a lower price.

Something similar happened to me when my wife fell down some stairs and hurt her back. We were nearly bankrupted that year because the health insurance refused to pay for most of the bill.

Deal Killer - Powered by Focus > Ash78, voting early and often 05/31/2017 at 11:09

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I liken the health care field to auto repair, if, when I take my car to the mechanic, they won’t tell me how much it will cost, I can’t shop around for a better price, and there is no transparency as to what, exactly the mechanic will be doing to my car. No one could operate a business like the health care industry does. It is absolutely insane.

Bob Loblaw Made Me Make a Phoney Phone Call to Edward Rooney > Ash78, voting early and often 05/31/2017 at 11:10

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Do it. FSEDs assume HUGE medical loss ratios as part of their operating structure; they expect to collect ten cents on the dollar or so for what they charge. Call and negotiate them payment down with them, almost all of them will be willing to work with you and will often cut a bill by 30-50%.

You’re onto the right track with not bringing them business. They often won’t even send outstanding amounts to collections because health systems aren’t in the business of alienating their patient base. I’m not saying to just ignore the bill because some will pursue, but they’re expecting those losses and don’t want to make a deal of getting bills paid.

Textured Soy Protein > Ash78, voting early and often 05/31/2017 at 11:10

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Unfortunately since you already went there and had it billed through your insurance I doubt there’s any negotiating you’ll be able to accomplish.

High deductible plans giving consumers more choice and negotiating power is a convenient talking point of the healthcare industry and the politicians they have in their back pocket but the reality is that until they start telling us prices before we have services performed, which they basically refuse to do, we as consumers still have little to no negotiating power.

themanwithsauce - has as many vehicles as job titles > Bob Loblaw Made Me Make a Phoney Phone Call to Edward Rooney 05/31/2017 at 11:12

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But the problem there is depending on urgent care places being nearby. WHen I dropped my car on my head (long story) I drove to the ER because there were 3-5 ER places near me (5-10 minute drive) that accepted my insurance while the nearest urgent care was over half an hour away. So I had to pay the 150$ copay + 300$ bullshit fees and another 125$ “fuck you, you’re poor” charge instead of the 100$ urgent care all-in-one co-pay because it was too far away.

Ash78, voting early and often > Textured Soy Protein 05/31/2017 at 11:17

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Well, I did get them to give me a $25/mo payment with no interest, which helps. It buys me some time to complain in writing, maybe get a little better concession. What I love most is I’ve got 3 bills from 2 agencies, so you can’t even negotiate centrally.

Wacko > Ash78, voting early and often 05/31/2017 at 11:17

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I don’t even want to know how much my last 3 months would of cost me if was american

I got 2 operations A colon resection and a temporary colostomy, then 2 months after my second operation to put me back together.

Here in Canada this Cost me 0.00$ and Cost me about 20.00 in pain meds

Since monday I am back to work.

FNKSS > Ash78, voting early and often 05/31/2017 at 11:18

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After obamacare, the premium for my family is about 7.5K/yr with 5000 deductible and its still rising at 3%-5% rate :(

My son got his appendix took out at January this year and we hit out of pocket max already. Good or bad, I don’t know.

TorqueToYield > Ash78, voting early and often 05/31/2017 at 11:20

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If you have a high deductible plan you should have an HSA to go with it. Take advantage of that to the max. HSA’s are great since you can contribute pre-tax moneys. The idea is to have enough in your HSA to always be able to cover your maximum out of pocket costs every year. So most high deductible plans have max out of pocket costs of say $5000, so you’d want to have at least that in your HSA so you know all your medical expenses can be covered for the year.

Also unlike FSAs, HSAs are your money and you’ll never ‘expire’ or lose it.

Really the government should offer HSAs to everybody (with the pre-tax contributions) to encourage health care savings, but that would make too much sense wouldn’t it...

Ash78, voting early and often > Wacko 05/31/2017 at 11:21

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Probably a couple thousand dollars (“out of pocket maximum”) but you’d have much lower taxes, so it’d be a net benefit in the end. But there’s something to be said for the peace of mind of knowing what you’ll get, no matter what. I believe that’s worth a premium — which is why I always opted for the best possible coverage until I started at an employer that didn’t offer that. At the very least, our plans ought to be standardized.

OPPOsaurus WRX > Ash78, voting early and often 05/31/2017 at 11:21

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i thought we were heading to the ER last night. I was downstairs working, and my wife was in bed directly above the room in which I was working. Our 6 month old some is teething and has ended up in our bed a couple times over the last week. Last night I hear a loud bang on the floor above me, so I take off my headphones. I can hear the baby screaming. I freak out thinking he had fallen out of the bed. what actually happened was my wife knocked her phone off the table getting out of bed to go get the child. this was not fun at 11pm

Ash78, voting early and often > FNKSS 05/31/2017 at 11:21

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That’s about the norm. Yeah, we had a surgery last year (early in the year) and it definitely encouraged us to go to the doctor a lot more after hitting that out of pocket max.

Ash78, voting early and often > TorqueToYield 05/31/2017 at 11:23

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Yeah, we’ve got one and it’s funded pretty well, but it’s just the surprise aspect of these bills that get me. 2 minutes with a physician, $402 (above and beyond the cost of the PA, who actually did the work, and the facility charge). I’m really in the wrong line of work.

Ash78, voting early and often > OPPOsaurus WRX 05/31/2017 at 11:24

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Funny how everything over a few ounces sounds the same when falling late at night, lol

Textured Soy Protein > Ash78, voting early and often 05/31/2017 at 11:25

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You may want to check with your insurer to see if there’s anything they can do on their end to lower your cost. Sometimes the way things are coded by the provider increase the negotiated cost that’s passed on to the consumer. If there’s some other way the provider can code the services that will lower your cost, you can go back to the provider and get them to re-bill your insurer with the different coding.

DipodomysDeserti > Ash78, voting early and often 05/31/2017 at 11:26

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With any blow to the head, especially on young heads, it’s best to have a professional look at them.

However, investing in a good med kit and some first aid training will go a long way. I’ve saved myself and my kids a few trips to the ER through the magic of butterfly bandages. We do a lot of backcountry camping an hiking so knowing first aid is a necessity.

As far as deductibles go, you’d probably be better off not using insurance in a situation like that as you’d be able to negotiate the price down with the hospital. My sister is an RN and that’s what she did with her boyfriend. She haggled a $2K ER visit down to like $700 and worked out a nice payment plan.

TorqueToYield > Ash78, voting early and often 05/31/2017 at 11:29

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Yea I know, I just had a kid last year and I’ve probably spent $3k in (routine) doctors vists alone since then.

What sucks is that I have a few docs in my family and they don’t even see most of that money. Yea they make OK money for a white collar professional, but it’s not investment banker money. Most of the dough for those bills is going to overhead (equipment/drugs/etc) and insurance. I really believe for profit health insurance is morally fucked and people will look back at us in 100 years like we’re barbarians.

Textured Soy Protein > FNKSS 05/31/2017 at 11:31

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I know it feels like Obamacare is what created these awful high deductible plans but the reality is this is the direction the health insurance industry had been going long before Obamacare came along. They and the politicians they support have done a good job blaming Obamacare for the higher premiums and lower benefits but they’re scapegoating something else to take the heat off themselves.

The insurers say that they’re losing money selling Obamacare plans on the exchanges and that forces them to offer worse coverage at higher cost to everyone else, but that’s not exactly the truth. The amount of money they’re losing on the exchange plans is more than offset by the amount of money they’re making on group plans sold to employers. They also would be losing less money selling plans on the exchanges if the GOP hadn’t blocked several parts of Obamacare that would’ve given higher subsidies to insurers selling plans on the exchanges.

vicali > Wacko 05/31/2017 at 11:32

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Amen eh?

Both our kids have done the croup -1am ER visit.. my son three or four times.. I can’t imagine having to pay for that out of pocket... yikes.

duurtlang > Ash78, voting early and often 05/31/2017 at 11:35

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You have to pay for emergency medical care for a minor? And even then, $1200 for something minor? It’s not my intent to be smug or anything, but something is seriously f-ed up in the US and there’s no good reason for it to be that horrible.

djmt1 > Ash78, voting early and often 05/31/2017 at 11:39

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I thought ER was free. What happens if you’re uninsured?

Wacko > vicali 05/31/2017 at 11:40

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Ash78, voting early and often > djmt1 05/31/2017 at 12:14

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Hello, bankruptcy. Seriously, they’ll put collections on you til the bitter end. You might end up paying 20 cents on the dollar, but only after your credit is ruined for a decade.

Ash78, voting early and often > DipodomysDeserti 05/31/2017 at 12:15

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They offered $25/month payments until it ’ s paid off. Not too bad, plus it buys me time to put it in writing and try to make a case. Nothing will happen unless people start balking at this stuff.

FWIW, I have a little bit of WFR training and told my wife I’d shave around the wound and take a look, maybe butterfly it. Needless to say, she was...um...reluctant (like chop-off-balls-place-in-disposal levels of reluctant). No regrets, just frustration.

RacingShark > TorqueToYield 05/31/2017 at 12:20

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With an HSA, you’re still spending your own money. Sure it’s pre-tax, but it’s dollars out of your own pocket.

I asked this to our HR rep last year when our healthcare changed to high deductible HSA plans and they suggested we fund it: Do you expect the information you’re giving us now will be correct and relevant in a year? 3 years? She laughed because she knew I was right.

I don’t think HSA’s are going away, but insurance seems to be changing all the time. Who knows what it’ll be in a year.

facw > Ash78, voting early and often 05/31/2017 at 12:38

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https://www.washingtonpost.com/business/economy/free-standing-emergency-rooms-offer-costly-convenience/2017/05/07/6255d052-2b98-11e7-b605-33413c691853_story.html

MyJeepGetsStuckInTheSnow > Ash78, voting early and often 05/31/2017 at 12:39

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You should have went to an urgent care not an ER. People who go to the ER for stitches are the reason healthcare is so expensive.

Ash78, voting early and often > facw 05/31/2017 at 12:40

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I was lulled into a false sense of security because it was part of the health system where we’ve been patients for almost 10 years. But I’ve come to learn that every healthcare experience is isolated, there’s no concept of being a “business” who wants to keep “customers.” Plus it was 9pm, my son’s head was bleeding, and all the urgent care places were closed...

MyJeepGetsStuckInTheSnow > djmt1 05/31/2017 at 12:41

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Please tell me you’re not serious or not in the US.

Ash78, voting early and often > MyJeepGetsStuckInTheSnow 05/31/2017 at 12:42

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People who go to the ER for colds are the real reason, especially the uninsured. We have no urgent care clinics (that I’m aware of) open late at night. Just hospitals.

facw > djmt1 05/31/2017 at 12:45

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ER is about as far from free as you can get (in the US). They aren’t allowed to refuse treatment if you can’t pay (though studies show you do get worse treatment and outcomes if that’s the case), but you’ll still be hit with huge bills.

ttyymmnn > Ash78, voting early and often 05/31/2017 at 12:51

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My son slipped in the kitchen and hit his head, and when he couldn’t stay awake we took him to the ER at the children’s hospital. They saw him in about 5 minutes, but that was for a potential head injury. The waiting room was FULL of people for whom the ER is the family doctor.

facw > Ash78, voting early and often 05/31/2017 at 13:02

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Couple thousand seems awful low, unless you have a very good plan. But yeah, it would almost certainly be under $10,000 (if insured individually, family plans go higher), and has a good chance of being under $5,000.

TheRealBicycleBuck > duurtlang 05/31/2017 at 13:18

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It’s the same issue as always. The poor don’t pay a dime and the middle class foots the bill by paying for health insurance and out-of-pocket deductibles.

TorqueToYield > RacingShark 05/31/2017 at 13:59

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Of course it’s your own money, but if it’s pre-tax it’s basically getting 25% or so free on top of that. It’s a good way to save for your own healthcare costs, which is basically what an insurance premium is anyway. Take what would have been your premium, stick it in a savings account instead.

RacingShark > TorqueToYield 05/31/2017 at 14:24

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‘what would have been your premium’? For me, my insurance costs went up, and I now have a high deductible plan. There is no difference to be saved. There is just a way to put un-taxed money into an account to spend on my increased healthcare costs.

MyJeepGetsStuckInTheSnow > Ash78, voting early and often 05/31/2017 at 18:03

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I agree with that too. Urgent care clinics have a lot more equipment than most people realize. It sucks that there isn’t one by you. Around my city they are building them like crazy.

TorqueToYield > RacingShark 05/31/2017 at 18:46

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My previous HDHC plan plus HSA premium ~$80 a month.

My current ‘normal’ plan premium ~$250 a month.

RacingShark > TorqueToYield 05/31/2017 at 19:22

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my HDHC plan plus HSA through my company is $85/2 weeks. Supposedly, the company pays 75% of the the total premiums, which makes my plan $740/month.