Emergency Room Summary Of Charges Arrived
Yesterday I received the list of charges for my emergency room visit earlier this month (for what was found to be a kidney stone). I added my best guess for what each of the charges were for:
| Summary of Charges | |
| Emergency Room (Doc + Room) | $926.00 |
| Laboratory (Blood Tests) | $137.00 |
| Pharmacy (Morphine + Others) | $91.26 |
| Professional Fees (Nursing?) | $387.00 |
| Radiology (CT Scan + Radiologist reading) | $2,375.61 |
| Total | $3,916.87 |
Of course, this is just what was submitted to my insurance, not what I’m actually going to have to pay. My insurance company may have negotiated lower prices, and I have an overall maximum out-of-pocket cap of $1,200 per year. I estimate my eventual bill to be between $500 and $1,000. I guess no Costco Vizio LCD TV this year for Jonathan 
I’m still just happy to be living a pain-free life right now, and am keeping myself well hydrated.
June 23rd, 2007 at 2:27 am
Sorry to hear about your ER visit. Glad you are feeling better and pain free.
June 23rd, 2007 at 5:36 am
If your insurance plan has in-network and out-of-network providers that are billed at different rates, be on the lookout to see if your radiologist ends up out-of-network. Sometimes you can get radiology done at a network facility and (because you can’t control who reads it) still get professional charges from a non-network provider. The carrier will be content to let you pay the higher non-network copays, but will often capitulate if you put up a fight.
June 23rd, 2007 at 5:40 am
ouch.. kidney stones. When my dad had them, he keeled over and was sent to the emergency room too. I was so scared as a 12 year old. He recovered, changed his diet, and never had a problem with them again.
June 23rd, 2007 at 8:05 am
As Jonathan mentioned, the insurance company will probably negotiate lower fees but you pay your co-pay or percentage based on the “retail” rates. Then, the insurance company goes back and only pays half of what the “retail” charges were.
I just got married and switched onto my wife’s plan. I’ve spent the last 30 days making new doctors appointments and setting up a new primary care physician, eye doctor and dentist and NONE of it is easy. I try to follow the myriad of benefits only to have providers tell me a completely different story.
Example: At the eye doctor, my benefits say that I pay $15 copay for a single lens, $10 copay for a UV coating and $40 copay for anti-reflective glare crap. But, when they ring up my charges, it’s like $140 something. What gives? The girl doesn’t get it and I don’t get it, so I end up with crappy glasses because I refuse to pay the extra money. And, I give up with the girl on the phone from EyeMed because I don’t understand a thing she is saying.
Not only is our healthcare problem a cost prohibitive issue for many people, navigating the bureaucracy is 4x worse! If, and when, the politicians ever take a stand on these multi-billion dollar rackets, they should work on the KISS principle - KEEP IT SIMPLE STUPID!
-dave
June 23rd, 2007 at 8:20 am
I also have the kidney stone problem. I know the pain:-( I used to go to emergency room because of kidney stone pain. Now, I just keep a good supply of vicodin at my house. As soon as I feel the pain, I take the vicodin and pain goes away. No more going to the hospital and wait one hour to get the shot. No more paying emergency fees. Just my two cents.
June 23rd, 2007 at 9:49 am
When you start getting your bills make sure you ask for early payment discounts. We had a baby 2 months ago. The hospital bills for my wife and baby both had a 10% early payment discount clearly marked. The anesthesiologist bill for the epidural had no such discount, but when I called them they were happy to offer a 20% discount if I paid via credit card over the phone. Saved me a cool $50 with a 3 minute phone call!
June 23rd, 2007 at 11:57 am
Hey, wait! I thought you said you’re currently under your wife’s health insurance plan. And, with her plan, you have to pay a 20-30% coinsurance for outpatient hospital visits/services and lab/imaging and therapy? (if yes, that sucks; but oh well.) Or, is it just a flat fee of $75 or 100 or 250 for ER visits?
June 23rd, 2007 at 12:06 pm
Oh, btw, any chance you can pay your hospital bill with your credit card, so at least you can accumulate points?
June 23rd, 2007 at 3:48 pm
David:
As both a medical provider (granted, I don’t deal with billing that much) and a user of the American medical system, I have to disagree with you on how most insurance companies calculate co-pays/co-insurance. Most insurance companies pay 70%, 80%, or 90% of the billable amount (total charge-contractual allowances). Almost all consumers are only responsible for the remaining 20ish% of the billable amount–NOT the initial amount billed.
If you paid 20% of the original charge to a health care provider, call your insurance company on them. It’s probably not right.
June 23rd, 2007 at 5:16 pm
Haha, I racked up over $100k of medical bills while I was in college, due to 3 lung surgeries. Thank God for health insurance!
June 23rd, 2007 at 7:45 pm
Feel better! I was a freelancer for a couple years, and the insurance issue was non-stop stress.
June 23rd, 2007 at 7:59 pm
The majority of hospital bills to insurance companies are over priced.
These places think us consumers are stupid. Hospital bills $5000.00. Insurance only paid $1800.00. In many cases this amount then is accepted by hospital as paid in full.
Now the insurance company and hospital sat down and negociated their prices probably last year or so for these services. So the hospital knew when they submitted the bill they were only going to get the lower amount. This lower amount probably actually represents the true cost of services.
The reason for the higher $5000.00 amount is incase your not covered by insurance you foot the bill to subsidize the hospitals profits.
June 23rd, 2007 at 8:20 pm
Seems like a lot of $$$ to diagnose a kidney stone. Did they do a urine test before the CT Scan? Urine test and maybe a couple of x-rays should have done the trick…
June 23rd, 2007 at 9:06 pm
@David Rocci: >
I don’t believe that is true. My insurance (BCBS PPO) provides that I pay my co-payment and then 30% of the negotiated rate - not the retail rate. Out-of-network is 50% (instead of 30), but still the same deal - off of the negotiated rate.
I don’t see how it would be ethical (bold word when dealing with health care!) or possibly even legal for a care provider to accept one dollar amount from an insurance company but then bill the insured another amount.
June 24th, 2007 at 3:05 pm
I really hope you don’t get an unpleasant surprise bill from the ER Doc. like I did. (A month or so after the rest of it came from the hospital.) I was shocked to see that the Dr. bill was seperate!
June 24th, 2007 at 6:17 pm
Goo, unfortunately it depends on the doctor as well. Urine analysis would demonstrated blood in urine, then an ultrasound would demonstrate hydronephrosis (backing up of urine to cause renal tubules to enlarge) and also the stone if large enough. X rays are rarely helpful in diagnosing kidney stone. Also, given the nature of lawsuits in this country, many doctors are afraid of not doing enough. So CT is a lot more specific for kidney stone than ultrasound, and that is usually why they are ordered.
June 25th, 2007 at 3:46 am
The breakdown should almost certainly be…
Emergency Room (Room + Nursing)
Professional Fees (Doc)
June 25th, 2007 at 6:41 am
Sorry bout your stone, but after seeing that you racked up a 3000 dollar medical bill makes me kinda sick. I just watched Michael Moore’s movie Sicko this weekend and it’s disgusting that in England, France or even Cuba you could have had all this done for free. I encourage everyone to check it out.
I also think it could be a good subject for a post because of the financial implications of healthcare for individuals.
June 25th, 2007 at 12:21 pm
you should have stayed overnight in the hospital…then your out of pocket cost would be capped (prob $100). and you’d of gotten a free breakfast too! Just kidding (not really).
Your summary of charges are VERY LOW (seriously).
You’ll prob pay 394 + 250 + 15 = 659 thats my guess.
You are too young for kidney stones!!
June 28th, 2007 at 8:19 pm
Socialized medicine as applied in other countries certainly has many downsides as well.
Higher taxes to pay for those services, lower availability of specialized care and equipment (I heared stories of Canadians / Brits waiting for months to get an MRI done). Governments would only allow a certain amount of MRI scanners per population, (an amount that can’t keep up with demand and creates huge backlogs), in order to contain costs. Some people will end up paying fout of pocket for private care since the public healthcare system is too slow and too inefficient.
And of course there are the large bribes that are paid in countries like Cuba and other formerly socialist countries.
I also want to remind you that a large amount of today’s healthcare expenses is due to defensive medicine… i.e. docs ordering more tests than actually required by common sense in order to cover their ass and not be sued by trigger happy patients and fast talking lawyers.
Tort reform should be high on the agenda if costs of medical care is to be contained.
July 1st, 2007 at 11:35 pm
I’d like to point out that those “socialized” medicine countries mentioned all have far better outcomes, despite delays, than their US counterparts… and for far less money.
July 2nd, 2007 at 6:39 am
God bless the NHS in the UK!!