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Trip to Emergency Department: $1870.56

The best way to learn about health care costs is to incur some yourself.

Two weeks ago I got sick from eating bad refried beans, so I went to the ER because I was dehydrated and couldn't stop vomiting. Today I got the bill. It's really amazing.

The folks there took good care of me. They gave me IV rehydration, three liters. They gave me some IV antiemetic meds so I would stop vomiting. They ran a few basic labs. They didn't overtreat me, by any stretch. No abdominal X-rays, no CT scans. No ultrasounds. No crazy labs looking for zebras like porphyria.

Today I got the bill: $1870.56. Ridiculous. Outrageous! But that isn't really the amazing thing.

Why is it ridiculous, apart from its sheer size? First of all, the itemization is insufficient. Take drugs, for example. There's a line for "pharmacy" (298.95), "drugs/detail code" ($91.98), and finally, "other rx services" ($117.00). I was looking forward to finding out how much the ondansetron would cost, but how can I tell from this? I remember how many doses of each drug I got, but how can I tell whether they made a mistake? Are they charging me for five doses instead of three?

I'd like to pay this bill, but not until I'm confident that it's correct. This skimpy information gives me no way to know if it's right or not.

The biggest single charge on the bill is "emergency room." $697.00. Did I incur that cost by just showing up and getting in line? Perhaps there's something to this argument about reducing costs by making them more transparent to patients. If patients know they'll be hit up for seven hundred dollars just by showing up at an ED, a lot of them might choose not to go at all. If people are deciding between going to a movie or going into the ED for some unnecessary medical care, this might be a good thing. But, contrary to the evident beliefs of some of the most reactionary opponents of universal coverage, I don't think many people are like this. I was reluctant to go to the ED, and I want to spend my career in one. Most people, I think, try to avoid the ED until they see no other alternative (which sometimes happens at 3 a.m., I admit). This bill is really huge (but that's still not the most amazing thing).

For the curious among you, here's the entire bill for a simple ED visit for nausea and vomiting:

Pharmacy $298.95
IV Solutions $215.31
Med-Sur Supplies $20.37
Sterile Supply $67.95
Laboratory $23.10
Lab/Chemistry $449.20
Lab/Hematology $140.30
Lab/Urology $49.40
Emerg Room $697.00
Drugs/Detail Code $91.98
Other Rx Svs $117.00

When I was treated, I put a deposit on my credit card. Thus, the last line:

Patient Payment - Thank You! $300.00

Thus, the total bill is $2170.56. Outrageous (but not the most amazing thing). The next step, of course, is to call the hospital to see if I can get a more itemized bill. I'll keep you posted.

But hey -- what's the most amazing thing about this bill? It's not that it's so big, although that's part of it.

The most amazing thing about this bill is that, even if I find no errors in my favor, and I can't get the hospital to come down at all, I'm still coming out at least even with where I would have been had I signed up for the school's insurance plan! Yep, that plan had an annual premium of about 2000 bucks. When you throw in the copay of about 50 bucks, I'd have still been up shit creek -- even with this trip to the ED -- had I signed up for the insurance. I made the judgment that I probably wouldn't incur medical bills this year beyond that, and even with this huge bill, I was right!

Lesson? For someone like me (who's lucky enough to be reasonably healthy) the only thing more outrageously expensive than medical care is medical insurance.


Demand a completely itemized bill. You will be shocked some more when you see what they charge each item.

I broke a hip rollerblading a few years ago and the hospital had rolled the overhead trapeze into the "orthopedic room charge." The trapeze was in the hall waiting to be installed when I crutch-walked down the hall to be discharged. The itemized bill allowed me to fight the $1,400 charge for the uninstalled trapeze.

I tell my patients to always check an itemized bill -- we, as a society, demand itemized bills when our auto gets fixed, but not for our bodies.

What you say makes sense; I'll demand a much more itemized bill.

(Progress reports will be posted on my blog, of course.)

You could think of it this way: it wasn't "simple nausea & vomiting," it was dehydration, and that can be life threatening as you well know. You're not just paying for the items used; you're paying for the space, the expertise/experience/education of those who treated you & those who ran your labs, the supplies used and the supplies not used. I found out on one ER visit that when they open a pack of instruments I get charged for the whole pack even though only one may be used on me (I made them give me the rest of the pack so now I have all kinds of cool tweezers, scissors, and scalpels).

You should get a more itemized bill. Bills are sometimes negotiable - a lot of people don't realize that. The pricing is outrageous but thinking along the lines of above helps me.

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