Cost of emergency room care

15 Oct

I spent a day in the emergency room back in August. They thought I might have appendicitis so I was there for around 8 hours for observation. During this time, I had a CAT scan, blood tests, urine test and a few doctors came to examine me. They figured out that I had a kidney stone so they sent a Urologist to check me out. He gave me some prescriptions and sent me on my way.

For those of you who may not be aware.. this is what happens afterwards, billing wise. The hospital’s billing department assigns billing codes to all of the things that were done and sends the bill to my insurance company. Each billed amount has the amount the hospital asks for and then the amount that the insurance company agrees to pay. The insurance company pays the hospital the agreed amount (heavily discounted) and then everything is settled after I pay the co-pay and co-insurance.

Of course, the bill was rejected by my health insurance because the paperwork wasn’t filed correctly. But that is not what this rant is about.

For my visit to the emergency room, the hospital billed my insurance company in 2 parts:

  • Part 1 – $631.00 to cover the observation (cost of the bed, the nurse to observe me etc…)
    The discounted amount is $357.34.
  • Part 2 – $8,365.87 to cover the various tests, cat scans etc..
    The discounted amount was $866.08 . WTF!!!

WHY is the discounted amount so much lower than the cost billed? If I did not have insurance, I would be on the hook for over $9,000 for a simple medical concern.

So someone explain to me. Why do doctors/hospitals charge what they charge if they are not gong to be actually PAID that amount?



One Response to “Cost of emergency room care”

  1. Scott March 7, 2013 at 4:04 am #

    I’m afraid the entire thing is a house of mirrors. Or a sham.
    I don’t really think I want the government to take over all health-care, but I do see the value of single-payer to simplify the crazy system we have now.

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