Miami, FL – When the sharp abdominal pain hit me earlier this summer, I thought it might be appendicitis. By the time I arrived at the emergency room of a nearby private hospital here in Miami, the pain was excruciating. I wanted to die — no matter what it cost.
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Next time, however, I’ll try to block out the pain and run the numbers. It turns out I didn’t have appendicitis. I had a less serious (albeit briefly unbearable) ailment: a kidney stone, about 3mm in diameter. But don’t let that fool you. It was a $12,000 kidney stone. (So you think you’re insured?)
The total bill came to exactly $11,960. That’s for less than four hours in an E.R. bed, intravenous painkillers, CAT scans, a doctor prodding my belly for a minute or so and, lest I forget, the catheter for an emergency urine analysis. The stone passed naturally that same night.
How that added up to $12,000 is an object lesson in how health care expenditures have run amok in this country, and how critical it is that whatever reform bill comes out of Washington this year tackles this economy-wrecking mess. That’s especially true in a market like Miami, which holds the dubious distinctions of having one of the nation’s lowest median incomes yet its highest medical costs. According to a study released Thursday by Families USA, a Washington-based healthcare watchdog, family health insurance premiums for Florida workers doubled over the past decade, rising four times faster than median earnings. (Are you underinsured?)
I don’t mean to slight the care I received, which was excellent. And fortunately, the total cost for my insurer was about $7,100 after its discount, a small part of which was my co-payment. But had I not been insured, I would have been stuck with the entire $12,000 bill. Reform advocates say charging even $7,100 for something as ordinary as a kidney stone just doesn’t make sense and points up what they call the rampant U.S. practice of “defensive medicine”: ordering excessive treatment out of fear of being sued for malpractice, which in turn points up how important malpractice reform is, as President Obama acknowledged this summer. “It underscores the problem of healthcare over-utiization,” says Linda Quick, president of the South Florida Hospital & Healthcare Association. “We have to change the way we pay for care and set more appropriate ceilings.”
Starting with expensive procedures like CAT scans. The clearer and more comprehensive x-ray imaging known as computerized tomography (CT) is certainly one of the most valuable recent advances in medical technology. But doctors are gorging on it: the number of CAT scans performed in the U.S. each year has leapt more than 200% in the past decade, and a third of them are likely unnecessary, according to the New England Journal of Medicine. The overuse is acute in cities like Miami because doctors and hospitals feel they have to justify the glut of CT machines and related personnel they have on hand.
That’s helping to drive costs through the roof. I had no idea when they wheeled me into the CT salon to detect my kidney stone that I was getting not one but two CAT scans performed — abdominal and pelvic — at almost $3,500 a pop. I’ve since learned from medical experts that one would have sufficed. And even if my insurance provider did end up paying closer to $2,000 for each scan, that’s still well above the less than $1,500 average CT screening cost in the U.S.
When I later asked the hospital why two had been ordered, I was told, “That’s the doctor’s decision.” But his call amounted to what was probably a redundant 30% of a $12,000 bill. “Physicians and radiologists and the like, they all make up their own protocols for the scans,” says Dr. Alan Whiteman, associate dean of health services at Barry University in Miami. “A lot of that needs to change.”
Another “protocol” that left me bewildered was the $3,013 charge for the physician’s care. It was coded on the bill as Level 5 — the highest, what you would think would be charged for, say, shooting victims or massive coronary patients. While I was admittedly in epic pain during those few hours when the stone drilled its way from kidney to bladder, my case was nowhere near life-threatening. Again, I was simply told, “The doctor determined your care was of the nature reflected by the level that’s on the bill.”
To be fair, the E.R. care level often has less to do with the severity of the case than with the diagnostic work required of the physician. Still, $3,000 for diagnosing a kidney stone “is unfortunately all too typical in Miami,” says one South Florida healthcare expert — a big reason the average annual private healthcare provider costs for a family of four in the city is a remarkable $20,282.
A possible remedy, which could get funding in a federal reform bill, is a healthcare delivery model called Patient-Centered Medical Homes. PCMH links patients up with personalized healthcare teams in their communities, which in turn provide more focused, efficient and less costly medical services. An important PCMH feature is making non-emergency care — like less expensive urgent care — more 24/7 accessible to patients who really don’t require emergency-level attention. (My kidney stone hit me at night, when my local urgent-care clinic was closed, leaving me with little choice but an E.R.) PCMH “is something we need to encourage because it redirects health care in ways that can save us a lot of money,” says Dr. John Rock, dean of the Florida International University College of Medicine in Miami.
In the meantime, when I’m next visited by a kidney stone, I plan to ask for more than a quick death. I’ll also request a cost rundown.
Sounds like Fair Pricing 🙂
$12,000 for just one small stone so why not $160,000 for an entire huge Kidney?
Here is another example. I went in to my ENT for removal of a wart from my upper palette. Total cost $1900.00 . Breakdown, 200 for injection , 1400 for procedure and 300 for pathology report. Total time of procedure 10 minutes. Can someone tell me why so much?
most doctors are happy with insurance reimbursment and don’t sendyou a seperate bill
The problem under ObamaCare is that it is not the doctor who determines what medical treatment you should receive, but politicians.
What is wrong with using Medicare? Kick off all non us citizens and allow everyone to use it. Problem solved!
12000 was for everything
the 160,000 dolars was the “shadcan fee’ to the broker
it has nothing to do with medical expenses
The doc ordered a CT because he didn’t want to get sued if the x-ray would miss anything, and that’s probably the reason he ordered the second CT too! Do you have any clue how high malpractice insurance is? It’s the lawyers that are killing the healthcare not the doctors.
I spent 2 hours in maimonides (waiting on a bed in the HALLWAY), the doctor took ONE sonogram and my bill was $3,500
This is interesting. I went to the ER at Weill Cornell in NYC, (one of the best in the nation). I had the exact infliction, and I received the same care. A CAT scan, painkillers ect.., my bill was approximately $3800, thats a huge disparity between NY and Florida.
2 words Tort Reform
In plain English this means the amount of Malpractice insurance doctors have to pay just to stay in business or for that matter be able to practice is outrageous and keeps climbing higher. Why? to defend themselves from frivolous lawsuits they must pass the cost on. Tort Reform means that the looser will pay all legal fees in turn that would eliminate all the trial lawyers bringing lawsuits to fill their own coffers most doctors go into the field of medicine because they genuinely want to help people and do care for their patients. After all a Rofeh is Shliach Hashem
The Hospitals post a very high charge in order to create a bargaining point to deal with the insurers. Also Medicaid and Medicare use the “self pay’ charges as a yardstick to measure how much they will pay. Both, the private insured as well the gov’t Meds pay a percentage of the full charge. The lower the full charge, the less they pay. The Hospitals and Dr.s are forced to way overcharge the private person in order to break even with the others.
The actual amount the insurers pay is not reflected on your statements. Those printed statements are often fictitious. The actual amount can be as low as 30% of the stated amount.
If the private individual was charged what the insures pay, most people wouldn’t be bankrupted if they paid privately.
Also, the hospitals are required to treat anyone who walks in regardless of cost even if the patient never pays a cent. These costs can’t always be recouped through medicaid. These costs can only be recovered by charging you more; so when you pay $10 for an aspirin, you are also paying for the aspirin someone else didn’t pay for.
Straightening out of the billing system with increased gov’t funding for shortfalls would be a lot cheaper and go a lot further than Obama’s socialist program.
While you are correct in your statements that Miami has some of the highest health care costs in the country. Part of the porblem could have been resolved by where you chose to go. There are many urgent care centers in the Miami area that are open 24/7 perhaps not as close as the ER you chose but open none the less and as you indicated your condition was not life threatening. As you plainly found out your self diagnosis was clearly off track and required the services of a trained physician to accuraetly come up with the correct diagnosis. Fortunately for you, you chose to consult Dr. Whiteman after you were better since he is a PhD and not an MD or DO, and while he is qualified in his field he is not qualified to pass judgement or second quess the treatment you received from your attending physician or his requests for diagnostic tests. From what you described the protocol followed was correct for the symptoms you outlined. I am not sure whether or not I would have ordered an abdominal CT, that would have depended upon what I observed during the examination, but otherwise your treatment was well in line with the accepted treatment protocol for kidney stones. What will help lower medical costs not only in Miami but around country will be the reduction of the number of frivolous law suits filed by attorneys who have nothing better to do than create malpractice cases. Also not only will the proposed health reform act not help but it will further drive up health costs. Another factor in the high cost of health care in Miami is the illegal immigrant population which is unique to Miami and other border cities. If a patient presents to a hospital legal or illegal under present law they must be treated untill they are well enough to be released or transfered to another facility regardless of there ability to pay. There is a recent case where the hospital had to spend $1 million dollars before the patient could be deported. That is one of largest waste of health care $$ in the Miami area and if you don’t beleive it just check the newspapers or better yet ask Dr. Whiteman. Another area is medicaid and medicare FRAUD. The government must crack down on this criminal activity as it is hurting us all. Illegal immigrants are NOT entitled to free medical care in the USA they are entitled to it in their own country.
re CT
first you in essense had only one ct scan done. you pass throught the machince and it scans your abdomen and pelvis. the probelm is your kidneys are in the abdomen and the bladder is in the pelvis. billing/procedure codes that are establsished by the govt and insruance companies for the sake of keeping track and billing decide where the abodmen is and where the pelvis is. you need to scan both to identify where your stone is. in the past you got an ivp which was llonger to perform did not give as much info but was cheaper. but i guarnatee that everyone would want the ct not the ivp. the technician in ct has to set the ct to make sure the relaviant structures are included. but does it make sense only to go for the kdineys and get part of the liver. if you had a liver tumro that was missed because you only looked to the top of the kidney would that be ok?
the hosptial and the radialogoist have to bill as per the govt for the procedure performed so you have the two codes to see the abodomen and pelvis.
along the way you get the liver and everyting else.
clincally it probably was a kidney stone, but would you have been satisfied to be treated just on the basis of the histgory and exam, or would you want to be sure that nothing was missed
I was also recently hospitalized with a kidney stone. I am pregnant and they couldn’t do a cat scan on me….thanks god my insurance covered most of it …that little booger cost me “only” 1,300.00!
The reason its so high is that we have to pay his insurance against slip n fall lawyers.
Is everything perfect with the system???? No. But you DONT rip it apart when all in all, very little is wrong.
The problem with malpractice claims is not greedy lawyers; it is horrendously bad medical practice. Some years ago, I was employed by a major oldline insurance company to survey closed malpractice claims. The intent was to gather evidence for tort reform and for an assault on the plaintiffs’ bar. What we actually found was that the vast majority of claims were completely justified, based on medical practice that at times verged on the criminal and often crossed the line (including altering of medical records as coverup). What we also found was that the insurance company routinely lowballed the claims, seldom paying what they were really worth. It took an aggressive plaintiff’s attorney to compensate the victim properly.
I experienced a serious medical emergency while living in the Netherlands which has universal, but not free, medical coverage and does not have the option to sue for malpractice. My attending physician made a huge mistake in interpreting my test results (as the nurses rushed to tell me). Fortunately he doublechecked before he acted on his mistake and thus didn’t kill me. However, thereafter he was terrified that I would return to the States and sue him for malpractice, and thus he was super careful with my treatment. Of course it doesn’t work that way (no harm, no foul), but he didn’t know that. LOL Had I been Dutch with no right of suit, he wouldn’t have felt it necessary to take extra care.
In fact, my Dutch officemate’s adorable toddler had a tonsillectomy while I was there. The surgeon who performed the procedure botched the job badly, and the child had to endure a second surgery to correct the error. There was no possibility of suit to compensate for the extra risk and discomfort, not even enough for a trip to EuroDIsney and an ice cream cone. Further because of Dutch law which restricts the choice of practitioner (and even of pharmacy), the second surgery had to be performed by the same guy who botched the first.
Dutch doctors are beyond arrogant because they have no accountability. They can’t be sued and their client base is assured by law. And of course they are no more willing to have effective self-policing than doctors (and lawyers) here.
Make no mistake, the right to sue for malpractice is an important tool for avoiding slipshod treatment. Don’t let the doctors and insurers tell you otherwise.
The reason you disagree with the care is that you don’t understand it. Of course a kidney stone is a simple problem. Severe back/abdomnal pain. How many things cause severe back pain? Kidney stone,aortic aneurysm,appendicitis,diverticulitis,pancreatitis. All of them different. All well visualized on CT. The reason you got a CT was that it’s the best test. You want to get an x-ray? Only works 10% of the time. Then you get the CT. Ultrasound isn’t good enough. CT is fast, and very accurate. It also immediately tells you the size of the stone which tells you the likelihood of passing it, possible complications such as hydronephrosis, urinoma, pyelonephritis.It’s the standard of care, and not for financial reasons. The reson you need an abdomen and pelvis is that you need to see the entire ureter. They are split into both parts because when CT was developed it was a big deal, it took a long time(an hour) to do one scan. Now a scan takes 10 minutes. The machine costs 1.5 million. Most of the cost of the scan is in the equipment. If you want to look at the liver, you order a liver. But if a person comes in with abdominal pain they get abdomen and pelvis because thats what gives the most info the fastest. yes, imaging is overutilized, mostly for legal reasons, but in your case the care would be the same wherever you go. unless you go to India. Where if you needed a stent, the doctor would send you back out to main street to buy yourself a stent, bring it back to be inserted. Your problem is you don’t realize that the advanced technology does supply better health care. Yes you had a kidney stone. Could have been an aneurysm, appendicitis,hernia etc. It’s always simple after the fact. You didn’t have a kidney stone before you went in. You had severe abdominal pain. If you had a leaking aortic aneurysm which was then repaired emergently you wouldn’t be complaining. Thankfully it was “just” a kidney stone.
Why does Torah say:
Tov Sheberofim Legehenim?
I think we all understand why.
lets face it. its not anymore than the cost of a steak dinner at the local diner. your pay covers the butcher, delivery man, cook, waiter and busboy (if i missed anyone add it yourself) but all you get is a small steak.
you went in as an emergency and not knowing it was only a kidney stone. (ill get to pricing soon) they need to do different tests to see what it is and how to treat you. that takes the bed in the e.r. the nurse, the doctor(s), the x-ray tech who took the test and the person who read the test and sent the report to the doctor, etc. and dont forget the janitor who cleaned the room before you got there so you didnt catch what the patient before you had.
small on the outside big behind the scenes.
about pricing, I AGREE ITS CRAZY, but if you follow the times it went up together with everything else like food housing clothing it just didnt go down when the economy went sour.
Now hospitals charge a price for a service, example X-Ray $500 if you buy, you need to pay the full amount. Insurance companies buy wholesale so they will get it for a discount of $275 (includes the one who takes the x-ray and radiologist who writes the report for the doctor to see) makes a little more sense this way if all have insurance.
The real problem is that some people who are healthy dont care to get insurance or/and instead of spending money on insurance they feel its important to buy a fancy car, ipod, harry potter books and then become a class of people who cant afford the insurance because they spend the money elsewhere not because they couldnt afford it. then when they get sick they are in the hospital which by law must treat you even if you cant pay which then makes the price for others go up to cover the cost……….
bottom line for most people there is affordable coverage if they work out their spending OR medicaid services for people who cant afford it. also there are many places out there to help people get this medicaid service.
AND “NO” THE ANSWER “IS NOT” NATIONALIZED HEALTHCARE
We all know that the United States Medical system is far from perfect. But if we have a leak in the system, fix it don’t dismantle the entire system. We don’t need the government to run anything. They are the best to mess up everything. Look at social security etc. Our system works best when there is competition. The government is not fair competition because they don’t have to show a profit and won’t show a profit. Eventually they will put limits on policies otherwise they will bankrupt faster than they would like to.
If you want to fix the system there are thing that you can implement. such as limit medical liability but also let us know how many times there is law suit against the medical practitioner and what they were all about. If the government program limits the amount a doctor can charge for a procedure, The better doctors will take only cash paying customers. The bottom line is fix the system don’t destroy the entire system
I just got a bill of $700 from the er & I am not covered yet for family health plus (applied more than 3 months ago) & bec I am a ‘high earner’ of $400 ‘unemployment’ funds, I will have to pay…
Obamacare is not going to fix that. When I got married 36 years ago and was living on $120 a week – partially funded by a meager kollel check, and 2 a part time jobs, food stamps and a little parental help, somehow, we were able to come up with the payments for health insurance (along with our rent, utilities, car insurance and misc.). Now we are living on a much higher budget and do not have health insurance at all. Why should I have to pay $8000 a year, more or less on insuarance, when I never go to a conventional AMA doctor? If I need a doctor and the visit costs $100, I pay it and I still am ahead, by not shelling out the thousands for insurance and having to foot a deductible to boot. If chas vesholom I’d need hospitalization, (which I’d try to avoid at all costs, because I think it is more dangerous than staying home), there’s something called charity care. The hospital has me fill out a form with my income and they have to treat me by law. I go to all sorts of natural doctors and boruch Hashem am healthy. I hope never to need anything else.
Instead of creating a new healthcare insurance system which will only create a new set of problems fix the one we currently have. What you might ask are some of things that need to be fixed?
The government needs to institute tort reform, which would in part lower operating costs for physicians and hospitals
The government needs to more aggressively monitoring and penalize insurance companies who deny coverage
The government more aggressively criminally penalize physicians & hospital for errors
The government needs to develop and institute national safety standards in health care
The government needs support implementing stronger fraud monitoring tools and techniques
The government needs support implementing stronger monitoring tools & penalties for those convicted of medical billing fraud
Your all missing the point if we allow the obama care to pass. If it were g-d for bid pass you would have to wait forever to see a doctor. As for a kidney stone the obama care wouldn’t kill you and you might have not had to pay a penny since you get to the er and they would leave u in the hall way all night in pain and the stone would have passed. But that night would feel like its never ending since you wouldn’t get any painkillers, catheter, care, etc. What would you have done if it would have been something worse and thanks to the stupid obama care you would need a “free” major operation how much would you have paid before hand not to reach that point. The fact shows that in other countrys where there is public health care like the obama health care people die and suffer a lot more.
to all the smart allecs who brought up the kidney guy. fyi: it was not 160k that number was exagerated. 2nd of all that was the total price incuding surgery, flying in the donors , hotel and all medical doctor and follow up fees. not to bring up the subject of whether he broke the law. he did save hundreds of people’s lives who were on waiting lists amd would probably have died. what would u do to save the life of a fellow member . all those that know him say only good things about him and that he helped many sick people in all areas. please don’t believe all the tainted lies and black pictures the”drive by” media conjures up, it was only exagerated to make all the other guys look bad and create sensational headlines of smuggling of body parts, when in actuality it was only one person saving human lives , inspite of the current system at hand .
In part the charges are inflated to cover the cost of uninsured. The ER can not turn away someone wuth an acute medical condition and must treat them. They pay $0 but require and get the same services as anyone else (if they didn’t they could/would sue and win)Thats why the ER waits are often so long , since the uninsured use the system for routine care cuz they can’t get into a regular doctors office. The hospital and physicians “cost shift” to those who are covered.
As an aside, I currently pay 800$ a month for medications for someone in your age group who lived life with the same philosophy. he was very healthy until 60. not overweight, didn’t smoke or drink. Then developed a chronic condition. Routine, run of the mill medical condition.The medications aren’t even that expensive, as medications go.No heart attack or anything costing 100k, just 800 a month, every month. I use maaser for it. It’s a valid form of tzedakah. But it tastes bad. Because I knew this guy could have afforded insurance before he got sick. he just chose not to get it. So instead of giving money to a yeshiva so it can pay its rabbeim in this economy, when I’m sure many people aren’t able to pay tuition, it goes to this guy who decided to buy a nice car, vacation, etc. To be honest I resent it. Of course it’s Hashem’s money anyway, so why should I care? But I resent it.The guy chose to do it. So what will you do if Chas Vshalom this happens to you? Rely on your kids? Do your kids have 800 a month to give you? is that something you want to do? They are supposed to be building a household. Do you want them to resent you? Just because you take some vitamins doesn’t mean you don’t age. It’s irresponsible to plan on using tzedakah. It’s unlikely that your philosophy will fly when you get to shamayim. What are you going to say? I wanted to vacation so I didn’t get insurance, then got sick so I needed tzedakah, so the rebbe couldn’t make his rent? You’re going to blame it on Hashem? Who are you kidding?
Why didn’t this clown go to Cuba and get world class treatment in state of the art facilities for free? Michael Moore could have spoken to some of his friends and no problem.
He got his stone removed without having to wait 6 months on a waiting list. I’d shut up and thank G-d that I’m in the US and paying for the medical care that’s available to us.
Under almost identical conditions and the same treatments same size stone…my bill was 3600 dollars in the Northwest, of U.S.I think patient got scammed by hospital
I can’t understand what US people have against nationalized health care. Sure, the NHS isn’t perfect, but:
I’ve had three C-sections (as well as other births) on the NHS — free.
One of my children had a kidney transplant and associated long-term care on the NHS — free.
One of my children has Type 1 diabetes, for which she receives superb care and all insulin and any other medications — free.
Another child has a mild condition which entitles her to free prescriptions for anything.
My husband has a heart condition. All his treatment is — free.
If we’d had to pay for all this we’d have been in the workhouse! And the taxes we pay aren’t excessive, either, in case you’re wondering.
On the other hand I know of a young person in the US who had cancer, and part way through the treatment the insurance company refused to pay, saying it wasn’t “cost-effective”. Elderly people I know there aren’t getting the care they need, even with Medicare. How can US people live with a system where such things can happen?
In the US we pay much more for medical inputs-eg physician salaries-than anywhere else in the world and our outputs as defined by life expectancy are close to the worst in the developed world.
We do have wealthy physicians who may give some of their income to local mosdos-perhaps a reqason why we don’t hear too much about the real reason of impossible medical care in this country.
Malpractice rates in general represent a lower percentage of income than many Americans pay on their commuting expense to work-you hear about certain very high gigantic malpractice rates-but they are not huge at all for the incomes of those specialties.
there is another great cost with not covering every citizen for health care.
a simple problem, like a routine check and meds for asthma patients that can be controlled for a minimal cost if they could go to a doctor or clinic.
However, if they do not have insurance they must wait until it becomes chronic or if they get an attack. Then the ambulance comes, emergency room, maybe a shot, and overnight stay that cost thousands.
If they had some insurance they could go to the doctor every 1 or 2 months and avoid all the above costs.
Make no mistake who do you think pays for all that. The people who have private insurance . So in essence we are paying for them anyway. at a much greater cost.
Keep your own insurance if you want so what is the problem.
You say they will drive out the private insurance, how is that the government can never do it right like the private sector so who in their right mind will switch.
On one hand you say they the goverment cannot run it correctly, and then on the other hand you say they can do it so good they will drive out the private insurance company which is it?
Bottom line: Doctors & lawyers are the only two professions that live high off the misery of other people. It’s digusting to see & hear doctors & lawyers driving around in fancy cars and earning in the top 2% of income in the U.S. What right does a top doctor or lawyer have in charging whatever the market will bear even in cash to save someone’s life or to prevent someone from going to prison?