A $41,212 Surgery Bill Compounded A Patient's Appendicitis Pain.

[Cattledog]

Joshua Bates knew something was seriously wrong. He had a high fever, could barely move and felt a sharp pain in his stomach every time he coughed.

The 28-year-old called his roommate, who rushed home that day in July 2018. The pair drove to the nearest emergency room, the Carolinas Medical Center in Charlotte, N.C.

After several tests, including a CT scan of his abdomen, the emergency team determined that Bates had acute appendicitis.

"They said my appendix was minutes away from rupturing," Bates said.

Not mentioned, he said, was that the hospital was out of network with the insurance plan provided through his job. Even so, he couldn't have jumped up and gone elsewhere. His appendix was about to burst.

Then the bill came.

Patient: Joshua Bates, a technical recruiter for a staffing firm, who lives in Charlotte, N.C. The Continental Benefits insurance plan comes with a deductible of $2,000 and an annual out-of-pocket maximum of $6,350.

Total bill: $41,212 covering the surgery, one night at the hospital and the emergency room charges. After payments by both Bates and his insurer, the hospital sent Bates a bill for the balance, just over $28,000.

https://www.npr.org/sections/health-shots/2020/01/29/800870904/a-41-212-surgery-bill-compounded-a-patients-appendicitis-pain?utm_source=facebook.com&utm_medium=social&utm_term=nprnews&utm_campaign=npr&fbclid=IwAR3k-9uLLO0RsdLrHravd247Klf46qdLpKguFvvbF8jl8OfRB3gqH_zrXXk

[LonePirate]

1. For DUers opposed to MFA/single payer, how do you fix this? Expanding the ACA does not fix this.

[jimfields33]

2. Out of network is the worst

I mistakenly went out of network with dental and ended up paying triple what I would have paid going to the correct dentist. Lessons learned and I wasn’t 28 but much older. This guy will find out what hospital to go to from now on. I do think 42K is crazy. And to have to pay 6K is just as bad.

[Midnightwalk]

3. Out of network is one of the biggest rackets going.

I’m for universal coverage.

If we don’t have single payer soon (I don’t think we will) we need to address this scam.

Why should a hospital or a doctor be able to charge vastly different amounts depending on who is going to write the check. Medicare reimbursement rates are a problem but at least have a law that says services provided by a hospital can’t vary by more than 5% for non Medicare reimbursements.

0% would be better

Fix this and prescription drugs and allow buy in and we can have majorities in the house and senate for years. Those 3 changes would also drive us to single payer within 10 years.

[marble falls]

4. Mine was for $137,000 in June and four day syat the first week of last Dec was $12,000 ...

thank goodness for my single payer, socialistic health care system, the VA.

[Mosby]

5. Hospitals need to be nationalized.

Fucking around with insurance, mfa, single payer will never address the underlying problems with cost.

ETA- this is a great example where the capitalistic model doesn't work. Ask yourself why there is such a huge range in pricing.

estimates that a laparoscopic appendectomy (the type that Bates had) ranges from $9,678 to more than $30,000 in Bates' ZIP code. The "fair price" it suggests for the surgery is a little over $12,000 — completely in the ballpark of the $12,944 that Bates and his insurer already paid the hospital. Fair Health, another site that collects claims data, estimates total costs for an out-of-network appendectomy at $19,292 — about $11,000 less than the hospital says Bates still owes.