Thread: A friend had a kidney stone in April. Total ER bill was $17K. $1183 for “Hospital Misc,” $1675 for labs, $2606 for ER doc/facility, $11,534 for CT scan. 90 min visit. I called around & could order the same CT for $495 cash and a doctor would pay $11.50 for those labs. 1/

Hospitals make it sound like ER physicians are what drives the cost of that up, when in reality, for a kidney stone, the hospital could only bill less than $200 for the physician’s time. The ER charged 23X what the local imaging center charges for the same CT (and rad read). 2/

And I can only assume that “Hosp Misc” is for the fluids, morphine and Toradol he received. But why aren’t they listed in detail? Pts deserve to know what they’re being charged and why. There is no doubt that he belonged in an ER and not a clinic, but not all ERs are equal. 3/

In TX, we have freestanding ERs that can charge cash or bill private insurance but not Tricare, Medicaid or Medicare. If he’d gone there and said he didn’t have insurance, his total bill for same would’ve been $1500 and the ER still profits. 4/

Instead, his total with insurance was $3050.44. AND he still paid the insurance premiums for the year. He’d have been better off lying and not using insurance to save over $1500. Which makes you wonder, why do we bother paying insurance premiums anyway? 5/

According to his bill, using an in-network provider “saved” him $12,912.90. Who knows how to look up which ER is in-network? And then the ER doc often works for a corporate group which is NOT in-network. Clearly he’d have been better off at an out of network freestanding ER. 6/

Big healthcare systems are constantly trying to shut down freestanding ERs because they take business away from them but you can totally understand why. If my friend had called me first, I’d have let him in on the secret. 7/

However, these ERs are not allowed to charge cash prices if people say they have insurance; they have to bill the insurance. My friend’s insurance only paid $1034.66 of the $16,998 charges (6%) and he paid $3050.44 (18%). So he paid 3X what the insurance paid. 8/

In total, the hospital got $4085.10 for the visit which is much more appropriate. What other industry only gets paid 24% of what they charge? And what kind of deal would they make with the uninsured patient? I guarantee they would charge more than $4085.10. 9/

So, the hospital could profit more off the insured patient than one with insurance, assuming they paid the bill. That is absolutely criminal. They often blame their high prices on the fact that the insured patients have to make up for their losses on the uninsured. 10/

Given that 40% of Americans cannot afford a $400 expense, even a $4K bill would be devastating to many. But if they’re paying for insurance, they’d be better off saving that money and paying cash for bills. We shouldn’t be mandating insurance if it costs more than cash. /End