Yves here. Is it just me, or is Kaiser Health News spending a lot more time covering medical industry scams? Given the relentless upward march of health care costs, one has to assume that a rise in MBA-designed monstrosities like trauma center price-gouging is what’s driving greater media attention. Unfortunately, the perps are so shameless that mere press exposes likely won’t do much by themselves, at least until they force legislators to crack down.
By Jay Hancock, Kaiser Health News Senior Correspondent, who wrote previously for The Baltimore Sun, The Virginian-Pilot of Norfolk and the Daily Press of Newport News. Originally published at Kaiser Health News
The care was ordinary. A hospital in Modesto, California, treated a 30-year-old man for shoulder and back pain after a car accident. He went home in less than three hours.
The bill was extraordinary. Sutter Health Memorial Medical Center charged $44,914 including an $8,928 “trauma alert” fee, billed for summoning the hospital’s top surgical specialists and usually associated with the most severely injured patients.
The case, buried in the records of a 2017 trial, is a rare example of a courtroom challenge to something billing consultants say is increasingly common at U.S. hospitals.
Tens of thousands of times a year, hospitals charge enormously expensive trauma alert fees for injuries so minor the patient is never admitted.
In Florida alone, where the number of trauma centers has exploded, hospitals charged such fees more than 13,000 times in 2019 even though the patient went home the same day, according to a KHN analysis of state data provided by Etienne Pracht, an economist at the University of South Florida. Those cases accounted for more than a quarter of all the state’s trauma team activations that year and were more than double the number of similar cases in 2014, according to an all-payer database of hospital claims kept by Florida’s Agency for Health Care Administration.
While false alarms are to be expected, such frequent charges for little if any treatment suggest some hospitals see the alerts as much as a money spigot as a clinical emergency tool, claims consultants say.
“Some hospitals are using it as a revenue generator,” Tami Rockholt, a registered nurse and medical claims consultant who appeared as an expert witness in the Sutter Health car-accident trial, said in an interview. “It’s being taken advantage of” and such cases are “way more numerous” than a few years ago, she said.
Hospitals can charge trauma activation fees when a crack squad of doctors and nurses assembles after an ambulance crew says it’s approaching with a patient who needs trauma care. The idea is that life-threatening injuries need immediate attention and that designated trauma centers should be able to recoup the cost of having a team ready — even if it never swings into action.
Those fees, which can exceed $50,000 per patient, are billed on top of what hospitals charge for emergency medical care.
“We do see quite a bit of non-appropriate trauma charges — more than you’d see five years ago,” said Pat Palmer, co-founder of Beacon Healthcare Costs Illuminated, which analyzes thousands of bills for insurers and patients. Recently “we saw a trauma activation fee where the patient walked into the ER” and walked out soon afterward, she said.
The portion of Florida trauma activation cases without an admission rose from 22% in 2012 to 27% last year, according to the data. At one Florida facility, Broward Health Medical Center, there were 1,285 trauma activation cases in 2019 with no admission — almost equal to the number that led to admissions.
“Trauma alerts are activated by EMS [first responders with emergency medical services], not hospitals, and we respond accordingly when EMS activates a trauma alert from the field,” said Jennifer Smith, a Broward Health spokesperson.
Florida regulations allow hospitals themselves to declare an “in-hospital trauma alert” for “patients not identified as a trauma alert” in the field, according to standards published by the Florida Department of Health.
At some hospitals, few patients whose cases generate trauma alerts are treated and released the same day.
At Regions Hospital, a Level I trauma center in St. Paul, Minnesota, patients who are not admitted after a trauma team alert are “very rare” — 42 of 828 cases last year, or about 5%, said Dr. Michael McGonigal, the center’s director, who blogs at “The Trauma Pro.”
“If you’re charging an activation fee for all these people who go home, ultimately that’s going to be a red flag” for Medicare and insurers, he said.
In the Sutter case in Modesto, the patient sued a driver who struck his vehicle, seeking damages from the driver and her insurer. Patient “looks good,” an emergency doctor wrote in the records, which were part of the trial evidence. He prescribed Tylenol with hydrocodone for pain.
“If someone is not going to bleed out, or their heart is not going to stop, or they’re not going to quit breathing in the next 30 minutes, they probably do not need a trauma team,” Rockholt said in her testimony.
Like other California hospitals with trauma center designations, Sutter Health Memorial Medical Center follows “county-designated criteria” for calling an activation, said Sutter spokesperson Liz Madison: “The goal is to remain in position to address trauma cases at all times — even in the events where a patient is determined healthy enough to be treated and released on the same day.”
Trauma centers regularly review and revise their rules for trauma team activation, said Dr. Martin Schreiber, trauma chief at Oregon Health & Science University and board chair at the Trauma Center Association of America, an industry group.
“It is not my impression that trauma centers are using activations to make money,” he said. “Activating patients unnecessarily is not considered acceptable in the trauma community.”
Hospitals began billing trauma team fees to insurers of all kinds after Medicare authorized them starting in 2008 for cases in which hospitals are notified of severe injuries before a patient arrives. Instead of leaving trauma team alerts to the paramedics, hospitals often call trauma activations themselves based on information from the field, trauma surgeons say.
Reimbursement for trauma activations is complicated. Insurers don’t always pay a hospital’s trauma fee. Under rules established by Medicare and a committee of insurers and health care providers, emergency departments must give 30 minutes of critical care after a trauma alert to be paid for activating the team. For inpatients, the trauma team fee is sometimes folded into other charges, billing consultants say.
But, on the whole, the increase in the size and frequency of trauma team activation fees, including those for non-admitted patients, has helped turn trauma operations, often formerly a financial drain, into profit centers. In recent years, hundreds of hospitals have sought trauma center designation, which is necessary to bill a trauma activation fee.
“There must have been a consultant that ran around the country and said, ‘Hey hospitals, why don’t you start charging this, because you can,’” said Marc Chapman, founder of Chapman Consulting, which challenges large hospital bills for auto insurers and other payers. “In many of those cases, the patients are never admitted.”
The national number of Level I and Level II trauma centers, able to treat the most badly hurt patients, grew from 305 in 2008 to 567 last year, according to the American College of Surgeons. Hundreds of other hospitals have Level III or Level IV trauma centers, which can treat less severe injuries and also bill for trauma team activation, although often at lower rates.
Emergency surgeons say they walk a narrow path between being too cautious and activating a team unnecessarily (known as “overtriage”) and endangering patients by failing to call a team when severe injuries are not obvious.
Often “we don’t know if patients are seriously injured in the field,” said Dr. Craig Newgard, a professor of emergency medicine at Oregon Health & Science University. “The EMS providers are using the best information they have.”
Too many badly hurt patients still don’t get the care they need from trauma centers and teams, Newgard argues.
“We’re trying to do the greatest good for the greatest number of people from a system perspective, recognizing that it’s basically impossible to get triage right every time,” he said. “You’re going to take some patients to major trauma centers who don’t really end up having serious injury. And it’s going to be a bit more expensive. But the trade-off is optimizing survival.”
At Oregon Health & Science, 24% of patients treated under trauma alerts over 12 months ending this spring were not admitted, Schreiber said.
“If this number gets much lower, you could put patients who need activation at risk if they are not activated,” he said.
On the other hand, rising numbers of trauma centers and fees boost health care costs. The charges are passed on through higher insurance premiums and expenses paid not just by health insurers but also auto insurers, who often are first in line to pay for the care of a crash victim.
Audits are uncommon and often the system is geared to paying claims with little or no scrutiny, billing specialists say. Legal challenges like the one in the Sutter case are extremely rare.
“Most of these insurers, especially auto insurance, do not look at the bill,” said Beth Morgan, CEO of Medical Bill Detectives, a consulting firm that helps insurers challenge hospital charges. “They automatically pay it.”
And trauma activation charges also can hit patients directly.
“Sometimes the insurance companies will not pay for them. So people could get stuck with that bill,” Morgan said.
A few years ago, Zuckerberg San Francisco General Hospital charged a $15,666 trauma response fee to the family of a toddler who had fallen off a hotel bed. He was fine. Treatment was a bottle of formula and a nap. The hospital waived the fee after KHN and Vox wrote about it.
Trauma alert fatigue can add up to a nonfinancial cost for the trauma team itself, McGonigal said.
“Every time that pager goes off, you’re peeling a lot of people away from their jobs only to see [patients] go home an hour or two later,” he said.
“Some trauma centers are running into problems because they run themselves ragged. And there is probably unneeded expense in all the resources that are needed to evaluate and manage those patients.”
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If trauma centers and doc-in-a-box places somehow turn out to be private equity investments would anyone be surprised? People expect medical professionals and their supporting cast to be more transparent and honest than politicians, but not by a decreasing margin. :/
This has been going on for a very long time though it is more intense now. About 15 years ago there was a TV series called “30 Days” by Morgan Spurlock of “Super Size Me” fame. Episode 1 was called “Minimum Wage” where he and his fiance were living on minimum wages for a whole 30 days. What kept killing their tight budget was hospital trips and one emergency room visit cost him $551 and $40 for an ace bandage. And this was back in 2005 remember which was about the same time that the minimum wage was frozen-
https://www.paleycenter.org/collection/item/?q=all&p=357&item=B:91097
Actual episode at-
https://www.youtube.com/watch?v=wmSGEGOVI34 (42:17 mins)
Not just you – there was someone from the Kaiser Foundation of Washington in NPR this morning (KUOW) talking about how to avoid insane billing.
Maybe I’m way too cynical and suspicious, but Kaiser is a huge HMO organization mostly on the West Coast. No surprise billings from them since everything is spelled out ahead of time. You may not get the treatment you want, but no surprise billings or excessive charges. My parents have Medicare Advantage thru Kaiser (and had Kaiser as their insurance prior to that) and love it because there is no administrative burden for them. It is one stop shopping for all their medical needs. BUT no specialists without a referral and very curated care.
I have been delighted with my non-capitalist Kaiser care. One MD went out of her way to find a surgically treatable hearing problem. She went on to surgically restore my hearing in one ear. A two hour surgery that they initiated cost me $200 out of pocket instead of a sizable portion of a $13k nominal cost.
The Kaiser Foundation, which supports Kaiser Health News, is completely separate from Kaiser the health care organization.
KFHP – Kaiser Foundation Healthplan is the business side of KP – Kaiser Permanente and is a non-profit. PMG – Permanente Medical Group is the doctors and that is a partnership. The nurses and medical staff fall under the Regional entities: KP NCAL – Kaiser Permanente of Northern California for example.
KPIC – Kaiser Permanente Insurance Company is a for-profit company under KFHP for slice products (Self-Funded, tiered Fully insured PPO, OOA or POS “products”. PPO = Preferred Provider Option, OOA = Out of Area and POS = Point of Service).
KHN is an independent from KFHP entity under the KP umbrella.
There are more but those are the “companies” under the KP banner.
(I’m a recent employee of KP, the 9th being my last day).
Dadgummit! I just stubbed my toe! Better go to the trauma center!
Just kidding. All of my toes are fine.
Sir, the trauma team will evaluate whether your toes are all fine or not.
Yes, they are on high alert.
Perhaps the scandal is not that they call the trauma team unnecessarily but that they charge $50,000 for doing so. Are we ever going to have medical cost controls in this country?
Undoubtedly the fear of cost controls underlies $100 million Nancy’s oppostion to single payer.
https://greenwald.substack.com/p/nancy-and-paul-pelosi-making-millions
Yes. Well, it only gets worse in California where medical oversight for malpractice is non-existent.
See: https://www.latimes.com/california/story/2021-07-16/who-will-police-californias-doctors-oversight-medical-board
America, you are dying. The buffalo will replace you.
I have heard multiple horror stories from friends over the last few years regarding this. These are just two and I’m aware of even worse that I won’t repeat here.
One friend took his daughter to a local hospital (Georgia) with possible food poisoning. One hour later, 10 minutes with a nurse, no contact with a physician, no direct diagnostic testing, he was handed a bill for over $4000.00 (he laughed about it when he told me, “Screw ’em, they did next to nothing and I told them I’m not paying it.”)
Another friend had a spontaneous nosebleed while driving home from work and pulled over on the highway (California). While she was cleaning it up a patrol officer pulled over and rightfully concerned (she said he thought she had been beaten up) made her go to the nearest emergency room. She was pretty intimidated and did so since he decided to follow her. She was handed a bowl of water and a couple of towels to finish cleaning up. After an hour of zero follow-up she told me she cleaned up the bowl and towels herself and left. One week later she got a bill for $15,000.00!! She never talked to a soul other than the admitting nurse.
She works for BCBS, so she played by the rules and fought the bill. She told me it took months and multiple hours upon hours on the phone before the hospital finally relented.
I know these are only just two examples of true anecdotes only and hopefully not the norm. But I happen to live in a town with one hospital and the Emergency Room staff is contracted through an out-of-state company. The contracting company does not accept Federal BCBS insurance in a town where at least 1/2 of the population is covered by Fed BCBS. Unless I break a leg or something more serious and completely debilitating, I’m driving the necessary 2 hours (or begging a friend to drive me) to the next available hospital.
Our Medical for-profit-system has gone completely off the rails and I find it more than a little frightening.
Imagine if we could elect for a non-facist Populist?
Our Medical for-profit-system has gone completely off the rails and I find it more than a little frightening.
You do not know how frightening I find it. And the very sad thing for me is I have living memory of what it was like 30 years ago before all this stuff really got going.
I tell people all the time that I work in the biggest wealth extraction machine that ever existed.
I would make sure everyone knows about another huge scam. In big non-profit systems, for every single visit from a physical to a sore throat, you as a patient will get to sit through a litany of someone asking you have you had this done or that done…..
The doctor you are seeing, let’s be clear, has a huge part of his income riding on whether or not he/she has strong-armed you into getting these things done. Whether the evidence is flimsy or not matters not. And you as a physician get monthly reports on how you are doing – and what your bonus will be and you better pick up the pace.
It would be one thing if these things were dietary education, elder care, mental health care, obesity training, exercise programs. I would be the first in line for that. BUT as you can tell, every one of those things is going to cost the system lots of money.
What are the things you get asked about? Colonoscopy, PAP smear, Mammogram, vaccine status, PSA, Lipid panels, bone density studies and on and on. They laughingly refer to these as “Quality Care Indices”.
Can you tell the difference? Every single one of the things they do are cash machines. Some of which are very iffy on the evidence. All the others I mentioned previously would be cash vacuums.
Let me make sure all understand what I am saying – THIS IS NOT ABOUT YOUR HEALTH – this is about maximizing every dollar from every “profit center” they can.
This is all the doing of the MBAs who started taking the system over in the 90s – they are now so entrenched it will take a nuclear bomb to get them out.
I see no hope for the entire system until it finally meets the brick wall. Not sure how long it will take – but I know for sure it is on the way.
IM Doc, the Asked About Things were exactly what I was asked about when I last saw a doctor in October 2018. I had gone to a local clinic, looking for help with excruciating back and leg pain.
The doctor was so caught up in Asking About Those Things that I had to interrupt and say, “Let’s solve the problem I came here for.”
So, he did a perfunctory exam, diagnosed me with sciatica, and said it would eventually go away, regardless of whether “we” did anything or not.
Horse hockey. I finally found relief for the sciatica in early December. It was as simple as learning the McKenzie Method. Link:
https://www.optp.com/Treat-Your-Own-Back?cat_id=200
Alas, after I vanquished the sciatica, I was still experiencing back and leg pain. While I was visiting my mother over the holidays, I went to see a massage therapist and, man-o-man, I really vented about my problems.
She recommended Dr. John Sarno’s book, Healing Back Pain, which I checked out of our local library in February 2019.
Talk about a game changer. I took to that book like a drowning person takes to a life raft.
I read it, took Dr. Sarno’s advice to heart, and here I am, pain-free.
Through Dr. Sarno, I learned that a lot of back pain is psychosomatic in origin, and that certainly was the case with me. Once I owned up to that fact, I was on recovery road, baby!
Hey, Slim — another grateful Sarno “patient” here. I have shared my “Healing Back Pain” book and story with many — and quite a few have benefited! Unfortunately, some of those closest to me will not consider cracking open a $14.95 paperback book, and continue to suffer.
IM Doc, I have a pretty good idea, though not as extensive as yours, of how it works today. Anecdotes are all I have to offer, but they are not worthless.
My father was a well respected surgeon in Upstate NY with years at Chief of Staff positions at his affiliate hospital. He took his profession very seriously, wanting to be a doctor “ever since I can remember”, he often told me. And he worked 7 days a week for years.
On occasion, when feeling fed up, he would give me blow-by-blow descriptions of the business changes in the system for years, very few of them good changes and all geared towards profit first. Patient Care was strictly a second-level concern, but not for him.
Stories of un-necessary expensive CAT Scan machine purchases, pharma reps offering him free trips to Hawaii and rolex watches for drug promotions and prescription issueing, charity/community hospitals run by outfits like the Sisters of St. Joseph being bought up by for-profit Corporations, amazingly high insurance costs based on whether his office purchased expensive and un-necessay diagnostic equipment that the hospital across the street already had (and under-utilized).
All that was 30 years ago. As time went on for him within his profession, like boats, he told me the second happiest day of his life was the day he finished his residency, passed his licensing tests and went to work for himself, and the happiest day was when he gave it all up and went to work for the local Tri-County Children’s Halfway Homes taking medical care of kids as their resident (travelling) physician.
He used to nag me constantly when I was a kid and during my college years about getting a medical degree. Ten years after I graduated he told the smartest thing I ever did was to ignore him.
And every story/anecdote (and my own experience) that has occurred within my life experiences since then has only verified that it continues to get worse.
@IM Doc …
Concur and as previously noted on my paternal side of the family I have the Chicago School of Medicine alumni of two noted people and grew up with the ethos of what they were on about in delivering their skills and approach to the science of medicine … that is lost now … not only in the clinical application but the approach to discovery.
Sutter Health is notorious for over-billing. They have acquired many physicians practices and hospitals over the years, and so are a near monopoly in many of the places where they operate. California and other states should never have allowed consolidation to occur in medical care practices and facilities. But of course governors and legislatures are so easily bought off.
I’ve posted this previously, but it seems apt.
I live in Lisbon, Portugal, and a couple of years ago broke a glass, a shard from which cut my lower leg. I could tell that it would likely need stitches, so I went to a local private (i.e. for-profit) clinic. Medical care in Portugal is generally excellent, and these clinics are no exception. There is always one doctor on site.
I spent around 45 minutes there, having the wound cleaned, inspected, and sutured up by the attending physician. I was also given a prescription, and some waterproof bandages to take with me.
The cost? The equivalent of about $120 – total. No insurance.
And people often laugh when I tell them that Portugal is more civilized than the U.S.
I needed stitches in Vancouver Canada in 1998. Had to wait 5 hours in emergency room, but it was a minor injury. $50 without insurance. No idea if that would happen today.
We need a new medical bracelet which states –
DO NOT TAKE ME TO THE HOSPITAL – ALLERGIC TO INHUMANE BILLING!
Here’s a opinion piece I wrote recently for the Kentucky Standard in Bardstown, on this very subject: https://www.kystandard.com/content/column-health-care-—-let’s-fix-one-thing-first
An excerpt: “I arrived at the hospital, got myself checked in. It turned out the clinic had been shut down as the COVID-19 pandemic was getting started, so I was to be sent to the emergency room. After a short wait, a nurse called me in and she got started getting my vitals. While this was going on, I made a terrible mistake: I asked, “How much is this going to cost?”
The nurse had no idea. I mentioned I was on Medicare and had supplementary insurance, did that help? No, it didn’t. Meanwhile, since the ER had no available rooms, I was sent back out to the lobby to wait for a space to open up. After a few more minutes, a young man came over, I asked about what I could expect to pay again, and the answer was the same. “We don’t have any idea. None of us here deal with costs and billing.” I asked, “Is the ER where I need to be? Is there a clinic nearby that might be a better choice for such a simple thing? Was there an administrator I could ask about cost?” He let me know there was indeed a clinic nearby, but that hospital staff were not allowed to advise patients. Just then, another young man brought over a card that advised that a separate company handled all billing and that I should call them.”
And so on.
Best…H
And I still remember the days when the ACA was in the works and one of the “we really need this” talking points was that patients needed to have “skin in the game”. The ACA would help in getting up front costs in order to make good “consumer” decisions.
Based on the article posted here a few days on new regulations requiring hospitals to post costs… and how well they hide those costs… my obvious question is, “So, how has that worked out?”
Maybe we should take a page from finance and impose fiduciary laws on the healthcare industry.
What I mean is every healthcare entity that negotiates a transaction on behalf of its customers would be bound by a fiduciary responsibility which specifically prohibits overcharging, excessive fees, improper payments, kickbacks, conflicts of interest, and self dealing. Customers could then sue for breach of fiduciary duty, and get compensatory and punitive damages from the fiduciary. It works with some success for investment managers and brokers, why not try it with hospitals, doctors, insurers, and pharmacies.
This could address surprise billing from hospitals, and obscene hospital charges for commonly available materials, and doctors that drop out of network so they can charge more, and kickbacks (rebates) from drug manufacturers or wholesalers to insurers.
Two weeks ago I suffered incredible pain in my back, so bad I thought was having an attack of kidney stones again. (Pain was about 8.5 out of 10 – kidney stones were an 11).
I managed to get myself over to the local emergency room and was immediately whisked in to see the triage doctor. Everyone was concerned, sympathetic, patient, good natured, extremely relaxed and reassuring. The nurse who took my vitals. The consultant and his assistant. Even the maid cleaning the bed pans was cheerful.
When MRIs found nothing alarming, they gave me essentially a complete physical. They found some minor issues and advised me to go easy on the flat refurb and purchase some OTC codeine. [After a few days, the pain went away].
After an hour or two, the doctors discharged me, declaring, “For a person of your age [Ouch!] you’re in excellent health.”
Total cost: $0.00.
Oh, did I mention that I live in London?
Oh yes. I am going through something like this now.
I am now on Medicare, and am being amazed at how many “wealth extraction” methods are embedded within it.
Having a previous heart related issue, and two stents, I am beginning to enter the cardiac medicine twilight zone.
The medica is also pushing a colonoscopy, while I am pushing back. The comment mentioning “suggested proceedures” coming down from on high to the desks of the public facing medical staff now sounds about right.
The cardiac department examination was yesterday. The department is taking over, and remodeling, the whole third floor of the big local clinic. “Excuse our remodeling” indeed! I got there early and filled out the obligatory paperwork. Then the first call I got was from the billing “specialist.” The very first interaction I had with a clinic was about my paying the bill. So, the Medicare decuctable was invoked and I paid $176 USD for an office visit. Fifteen minutes later, I’m in the back rooms.
The mood in the ‘back rooms’ of the clinic was decidedly impersonal. No one looked you in the eye. Everyone was “busy.” Nurses either typed on keyboards or moved from here to there with that eternal “sense of purpose” that good apparatchiks show. I did not see a single smile at all during the half of an hour I spent in the back rooms. I got the feeling that nobody working there was happy, about anything.
First, a nurse comes in and takes my blood pressure. When I asked about having my blood pressure taken at the end of the visit. I was ignored. It was as if I had not spoken. Some really good human programming must have gone into instilling that level of incuriousness in an employee. Then another nurse comes in and goes over some lifestyle issues: prescription medicines and my usage, then vitamins and supplements and their usage. Then, a general question about my ‘complaint,’ some typing on a keyboard and then; “The doctor will see you shortly.”
Suddenly, another, junior nurse comes in with a portable electrocardiogram machine. The shirt comes off and the sensors are stuck to my chest. The leads are attached and the test goes on. A minute of readings and off everything comes.
Then the doctor arrives. He is dressed up as if preparing to operate on someone: gown, gloves, cloth cap, and mask. He pulls out my paper file. He is the doctor who installed the two stents in me nine years ago. Some questions: about my fatigue levels, any swelling of the extremities, faintness, dizzyness, chest pains, etc. Onto the exam couch I go and he uses his stethoscope to ‘probe’ my heart and, curiously, lungs. (Is this normal proceedure?) Ah, so, now we schedule you for two tests. First, an echocardiogram. Second, a thoraxic PET scan. He mentions that the PET scan is both cheaper and less dangerous than the stress test I underwent nine years ago, plus, no radioactives this time. Off the doctor goes. Duration of face time with the doctor, five or seven minutes, maximum.
But wait, there’s more!
On my way out, I stop at the jury rigged exit desk. “Pardon our progress!”
I ask the nurse/clerk there how much the proceedures I am scheduled to have will cost. She calls someone in a back of the back room for the information. This young woman is the most personable of the lot I have seen that day.
The echo cardiogram: Retail $900 USD. After Medicare, (my 20%) $180 USD.
The PET scan: Retail $3700 USD. After Medicare, (my 20%) $740 USD.
I told the woman to schedule my tests two months away so that I could get Medigap insurance established first. Suddenly, that ‘extra’ $150 a month for Medigap insurance is looking like a good deal.
I am also going to do a bit of comparison shopping in the next week.
Welcome to Pain City. Bring lots of money.
Yves: KHN and scams coverage.
When I retired I signed up for the Kaiser Medicare Advantage plan and also started reading KHN daily. In these 6 years IIRC they have always covered medical scams in some of their articles. Perhaps you are detecting the impacts of increased PE infestation of the USA! “medical care”.
I am satisfied, so far, with my health care through them, and the main reason I am hesitant to switch is the lack of opportunities for PE within their system.
As a foreign reader I’ve become numb to the absurdities of the US hospital ‘care’ system. In terms of insurance and billing it seems the only sensible approach is to destroy it all and start again. It is beyond broken.
Two examples from Australia:
-A friend helicoptered in with a full trauma team mobilised to treat him. Cost ZERO, with ZERO insurance. As it happened the trauma team was largely not necessary as he was lucky.
-Myself. Self admitted to ER underestimating my own injury from trauma. Once they realised what they were dealing with I was scheduled for immediate surgery the next morning (<10hrs). Again, ZERO cost, with ZERO insurance.
It seems the US has mostly great medical care, but just has extremely perverse incentives in the way recipients are charged. The one time I've sought medical care in the US it was actually reasonably priced as soon as I negotiated a fee based on the fact that I was not insured in the US.
I can corroborate having just seen GP for some abdominal issues which might stem from diverticulitis and a pre 60th B-day look over with blood tests. GP also requested an abdominal CT scan.
Booked both blood and CT with in two days and at no out of pocket cost save the 75 bucks for the GP of which medicare will reimburse most of back to my bank account. Walked into the pathology clinic and was out in 15 minutes where it was a half hour wait and less than 30 minutes to do the CT scan. This all whilst under Covid restrictions IMO.
Both my paternal grandparents were MDs with the grandfather an accomplished on call surgeon back in the late 60s/70s. They looked after quite a few people in Chandler AZ and gave back not only to the city, but the entire state with civic activities. Those days are largely gone, but on TV, keeping the unwashed beliveing in the romanticized dream.
>>>but just has extremely perverse incentives in the way recipients are charged.
There is nothing perverse about it as the assumption that the system is supposed to serve the people rather than the pocketbooks of the companies, CEOs, and doctors is the wrong assumption; here in the Land of the Free, we serve those with the money, they don’t serve us.
It’s an ill wind….
A couple of years ago the escalation of a chronic problem I had been ignoring necessitated a journey through the public health system here in New Zealand, from a visit to my GP to a referral to a specialist at the local hospital to a transfer to a major hospital – fortunately I was still able to manage a commercial flight between ambulances at both ends – high-end surgery, recovery, a flight home to an observation stay at the local hospital and then back to GP for ongoing care. Cost = $0.00
On the way I crossed paths with two Americans working in our public system. Both were wonderful and I’m sure could have been far better off financially in the US. Both, though, told me in different ways that they’d come to New Zealand because all they wanted to do with their lives was to practice medicine to the best of their ability (and have a life outside it, one added), which I suppose implies they didn’t feel they could do that in the US.
The civilised World does not understand how the “Sepos” ( short for Septic Tank, which rhymes with Yank – Australian rhyming slang ) haven’t worked out that medicine/health services do not respond to the normal laws of pricing and supply and demand and that the only way to manage public health costs is to socialise them.
It’s insane and unfair!
I’ll add my anecdote. I spend most of my time in Italy. Last December, I suffered severe shortness of breath and weakness. It turned out that I had suffered a spontaneous pneumothorax in the right lung. I was admitted immediately at the “Pronto Soccorso”, where a thoracic surgery team reinflated my lung and admitted me for 5 days’ recovery. The doctors and nurses deserve high praise..they were not only very professional, but also seemed to care about their patients. The cost: €0.