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    US Healthcare billing

    So, as I shared on the Mundane Thread, I had a three hour trip to the ER for a skin infection. My (first?) bill arrived today - having done US healthcare before I know there may be more, as various doctors can bill through different things.

    On this bill I have:

    IV Therapy
    Laboratory
    Lab/Chemistry
    Lab/Hematology
    Lab/Bact-Micro
    Lab/Urology
    Emerg Room
    Drugs/Detail Code
    EKG/ECG

    Insurance Adjustments

    So - I know I had fluids, painkillers and antibiotics through IV. EKG, blood work and urine testing. If I hadn't gone I would have been more sick and risked blood infection (I had gone to an Urgent Care first which is cheaper).

    What do you reckon was the list price and how much discount did Insurance get vs an uninsured person?

    By way of guidance, the average billed price for an uneventful birth and stay in a hospital is $10,000. Based on levels of Insurance the amount the person will owe is around $4,500.

    **

    As a footnote, I am very lucky to be in a position to be incredibly well insured and my out of pocket is minimal (though I pay a pretty heavy hit every pay check). That is the cost of being a risk manager and having kids who are one heartbeat away from an expensive medical bill.

    There are many I work with who are younger and choose high deductible plans with less generous coverage at a lower cost. The risk for them is an event like this can be financially painful. There are tax-free savings accounts to help cover for such events, but some of these disappear in unused each year. You do, to an extent, have to gamble with your health based on what you can afford.

    #2
    I have absolutely no idea what sort of guess to make, but I am interested in the correct answer. I imagine the various lab tests are dear?

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      #3
      I will guess 8,000 dollars, reduced to 3,200 with insurance.

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        #4
        I'm going 18000, plus 25 dollars for the towel you nicked while you were in there.

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          #5
          $6000, reduced to $1800.

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            #6
            21,545 dollars reduced to 3, 125.

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              #7
              $27,500, with a $3,500 gap, as it’s called here.

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                #8
                c. $15,000, reduced to $4500.

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                  #9
                  I made my guess on the original thread

                  To clarify, is the second number you are looking for the one that the insurance company pays, rather than your out of pocket costs (which I would hope are minimal after any deductible)?

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                    #10
                    total cost $12k
                    amount to be coveredby you $2k

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                      #11
                      I'm going to guess that Sits is closest, as I'd have assumed 30k with about 65% knocked off by insurance 'agreed prices', leaving you paying your entire yearly deductible. I'd hope not, but that's my guess considering our entirely immoral, repulsive, broken healthcare system.

                      You also don't have your actual doctor's bill there, I think. Hopefully you only saw one.

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                        #12
                        I also made my guess on the original Mundane thread:

                        My prediction for Caja is $74,350 as the official "price", and then he'll learn that "thanks to discounts that the insurance company gets" his bill will be $44,560. The insurance will cover almost all of that because he works for some fancy Manhattan money company that'll have really good insurance, so he'll probably end up "just" paying about $1,200 out of pocket.

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                          #13
                          Originally posted by ursus arctos View Post
                          I made my guess on the original thread

                          To clarify, is the second number you are looking for the one that the insurance company pays, rather than your out of pocket costs (which I would hope are minimal after any deductible)?
                          Yeah, i was looking for how fake the original number is when they call up and say "It's Aetna" and the number magically falls.

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                            #14
                            It's yet another "feature" of the US health care "system" that makes no sense to outsiders, though the concept should be familiar with anyone who has tried to buy a rug in Istanbul

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                              #15
                              Originally posted by caja-dglh View Post

                              Yeah, i was looking for how fake the original number is when they call up and say "It's Aetna" and the number magically falls.
                              All the numbers are fake. It's totally disgusting and immoral.

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                                #16
                                Mercifully, after my recent cat-related travails, I spent a grand total of $9, which were the combined Walmart pharmacy dispensing fees for my meds.

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                                  #17
                                  Well, despite the relative disaster that is US healthcare, you are all serious doom-mongers on how expensive it is.

                                  Total Charges = $3,060.16 (the 16 cents was drugs related)
                                  Insurance Adjustment = $992.16

                                  So leaving me with the sum of $2,068 to cover depending on my insurance coverage. In my case that is $100 (see above - I am very cautious on Insurance and my work is actually very generous relatively on coverage). But - even so - while I suspected that was the case based on my coverage, I really didn't know until the bill came in the post and could quite easily faced the full $2k based on deductible. It is really hard to know and work out and, at that point, you are rather ill.

                                  The median household Income in the US is ~$31,000. That is (let's say) $26,500 after Federal Tax (the outrageous complexity of US taxes and deductions make this a very changeable projection).

                                  So $2,250 per month give or take.

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                                    #18
                                    I think US health insurance companies have a strong case for being the most evil corporations in the modern world, though it's a fairly crowded field.

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                                      #19
                                      What's wrong with your hospital? Why aren't they gouging more seriously?

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                                        #20
                                        Well...

                                        1. It is a Saint Vincent's hospital, the patron saint of charitable societies

                                        2. (Perhaps more relevant) It is in a somewhat less wealthy and diverse City which might impact things. I would expect had I chosen to drive toward NYC rather than away from the pricing would increase.

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                                          #21
                                          You guys do realize that the hospitals aren't the bad actors in all this, yes?

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