I had to go to the ER a couple of months ago. Holy moley, I just got the bill.

[Cleita]

I'm on Medicare with a supplemental insurance. I went to the ER because I got an infected animal bite. The bite had occurred the day before. So I went to the ER, because it was Saturday. The doctor spent five minutes with me. He said it was too infected to stitch up so he wrote me a prescription for an oral anti-biotic and had a nurse put some anti-biotic ointment on it and bandage it up. That was it. Today I got the bill that was submitted to Medicare. The charge was $829.73 Medicare approved the whole amount so it was entirely paid for by Medicare and my insurance.

But.........I was a little shocked at the amount. I did not get high tech care or tests run. The doctor billed Medicare for $194.00. Medicare approved $61.35. I don't get it. Why so little for the doc and why so much for a visit that was mostly fifteen minutes with the medicos and a lot longer dealing with the paperwork and insurance lady?

We really have to fix our health care and not the way Congress fixed it with the insurance companies running away with the prize.

[quinnox]

1. It is insane

I visited with a doctor for 25 minutes and the bill came to $225. He did nothing hardly at all, except discuss some things and give me a quick cursory examination of a small area. And this is supposed to be a non-profit insurance plan too.

[LWolf]

2. Good questions.

I don't have any answers.

I agree though, that a real health care fix does not involve insurance companies running away with the prize.

[CaliforniaPeggy]

3. This is my understanding:

The so-called full amount is what they charge folks w/out insurance. I think.

I could be wrong, but I believe this is what I was told.

:shrug:

[Doctor_J]

4. Look at the bright side

That's probably 1/10th what the charges would have been if you had private insurance

[Lithos]

5. Well, you know how the Pukes view this

Medicare paid too much, in fact you shouldn't have that coverage and should have paid for the hard working Insurance CEO's benefits out of your own pocket. I mean really, you must be some sort of welfare scammer.

(Note: Just be clear, this is sarcasm directed at the pukes who think the system is "just fine the way it is...")

L-

[Cleita]

27. If the pukes had their way, I would be on some

Medicare advantage program. The ER would have been forced to take me, but the doc could refused. Most likely the ER would be stiffed somehow because that's what Medicare advantage plans do cause they really don't like to pay. There isn't a doctor in my town that takes patients on Medicare advantage plans.

[Lithos]

62. Understood

The pukes seem to have no feelings about the hells on earth they perpetuate... I know of several people who would be alive had a more rational and humane health care policy been in place. But I guess profits for the 1% come ahead of the lives of the 99%...


L-

[Curmudgeoness]

6. Thank god you had insurance. And

I do hope all is well now.

I have not answers about why it should cost so much---it shouldn't. I always hear that the insured are paying for the uninsured who are not paying hospitals. Of course, who can afford it without insurance. But...if everyone was covered, wouldn't that have fixed that problem? Gotta wonder.

[Cleita]

29. I have insurance I can rely on, which is Medicare.

I never had that before as the deductibles were too high to get any insurance payment and I always feared that I would be denied if there was a pre-existing condition problem they could dig up. We really do need public insurance that operates like Medicare for everyone. We just need to update and modernize it.

[niyad]

7. several years ago, I was bitten (repeatedly) by a cat to whom we were trying to give meds.

I remembered an old remedy--after cleaning the bites with hydrogen peroxide, I applied very warm tea bags (black tea) as a poultice, for about 20 minutes 3 times that night. had to rewarm the tea bags several times, but, by morning, the swelling and infection were gone.

was the bill itemized? how did it break down?

[Cleita]

10. No, it was just the report I get from Medicare that

only breaks down the date of service and how much is approved and how much they will pay for. I assume the hospital sent an itemized bill to Medicare, but as I said there wasn't that much to itemize except the paper work to get me into the ER.

[kestrel91316]

46. Cat bites have an extraordinarily high incidence of potentially dangerous

infections, along with the mechanical damage they can do - they are considered potential career-enders for those of us who work with cats daily, so we take them VERY seriously. Antibiotic treatment is virtually always necessary for PROPER management of cat bites.

I have abundant personal experience in this regard, lol.

[Iwillnevergiveup]

53. Applying medium warm tea bags

to sunburn really helps, too. I would just pat them around and felt the burn leaving. Or, you could get someone else to do the patting in hard-to-reach places.

:hi:

[notadmblnd]

8. Were you running a fever with it? Was there a huge red line running up from the wound?

Why not just see your Dr at the office for the antibiotic on Monday? Did you think you would die before his office opened after the weekend? Better yet, maybe take a basic first aid class and you'll be better prepared to access an infected lesion? Soaking it in some hot salt water wrapping it in a bandage with some triple antibiotic ointment and giving it a couple of days to draw the infection out would have only cost a dollar or two.

Pardon me for saying this, but people running to emergency for something as silly as a topical infection with no fever or other health risk is part of what drives up the costs of health care.

I'm sorry you were bitten, but it was a needless expense for something that could have been treated after the weekend at the local clinic.

[Cleita]

13. Sorry, but it was swelling and pusing up quickly. I didn't go the

night before, a Friday, because I thought I could wait until Monday. It couldn't wait until Monday. It was already oozing pus, which is why they wouldn't stitch it. Really, I would have had a real problem by Monday. I did do all the hydrogen peroxide, antibiotic ointment and wrapping it with a bandage when it happened, but it was too deep and none of that did any good by the next day. Honestly, I'm not a moron and I needed to see a doctor to get the medicine I needed. I think though that the charge was pretty outrageous. However, they charge everyone who walks in the door a basic rate to be seen from what I understand whether it's an animal bite or a broken leg or heart attack. Everything after that is extra.

[Name removed]

49. Deleted message

Message removed by moderator. Click here to review the message board rules.

[notadmblnd]

65. In two freaking days? How Should I Take Care Of A Bite From A Cat Or A Dog?

* If necessary, call your doctor (see the shaded box below). Doesn't say run to ER
* Wash the wound gently with soap and water.
* Apply pressure with a clean towel to the injured area to stop any bleeding.
* Apply a sterile bandage to the wound.
* Keep the injury elevated above the level of the heart to slow swelling and prevent infection.
* Report the incident to the proper authority in your community (for example, the animal control office or the police).
* Apply antibiotic ointment to the area 2 times every day until it heals.

Call Your Doctor In Any Of These Situations:

* You have a cat bite. Cat bites often cause infection. You don't need to call your doctor for a cat scratch, unless you think the wound is infected.
* You have a dog bite on your hand, foot or head, or you have a bite that is deep or gaping.
* You have diabetes, liver or lung disease, cancer, acquired immunodeficiency syndrome (AIDS) or another condition that could weaken your ability to fight infection.
* You have any signs of infection, such as redness, swelling, warmth, increased tenderness, oozing of pus from the wound or a fever.
* You have bleeding that doesn't stop after 15 minutes of pressure or you think you may have a broken bone, nerve damage or another serious injury.
* Your last tetanus shot (vaccine) was more than 5 years ago. (If so, you may need a booster shot.)
* You were bitten by a wild animal or a domestic animal (such as a pet) of unknown immunization status.


Read more: http://www.righthealth.com/topic/Cat_Bite_Treatment/overview/FamilyDoctor20?fdid=FamilyDoctor_56fe4e7208de3f98fb44fdb00e6cd29c#ixzz0wpiGV0oE

[Obamanaut]

73. +1. I did those steps when a neighbor's rottweiler bit me on the butt

and dragged me off of my bicycle.

The neighbor apologized, chained up the dog until it was 'rehomed' two days later (it was not euthanized, but actually rehomed) and we've all lived happily for three years since.

And I have two tooth sized round scars on my butt.

ETA No doctors, no lawyers, no police, no ER

[elehhhhna]

82. puncture wounds are very tricky. and dangerous. i got your back here, cleita.

[Ruby the Liberal]

14. an "infected" animal bite that was "too infected to stitch up"

ie - needed to breathe/ooze out - could have been rabies. Moreso if the animal was unknown to the OP (which isn't mentioned).

I once adopted a stray with a bite that had a cyst-like bump that burst. Took her to the weekend emergency clinic and they told me that they would have to report me/her to the Dept of Ag and that I would have to quarantine her from other animals (not to mention human visitors) for 6 months.

They don't play around with this stuff, and neither should people who are bit.

[Cleita]

16. It was one of our animals, a cat, so the rabies thing wasn't an

issue because our animals are all up to date on their immunizations, vermin treatments and see vets regularly. It's just that cat bites are very infectious.

[Ruby the Liberal]

20. Thanks for adding that.

Still - I think you did the right thing.

[kestrel91316]

50. Rabies is NOT a bacterial wound infection, lol. But bacteria such as

Pasteurella and DF-2 and other nasties are DANGEROUS and never to be brushed off lightly. People can and do lose fingers and even hands from neglected cat bite infections, and I have a client who has permanently fused knuckles all over one hand from cat bites that went to the bone.

[KT2000]

15. Bad advice

infected bites can be serious. Our community has had several cases of community acquired MRSA that started out as bites. A man who has been featured in our paper lately is now up to tens of thousands in hospital bills. He delayed getting help because it was only swelling. A chunk of his leg had to be removed. He is now in the process of losing his house.
Around here the message is - infected? get help.

[notadmblnd]

21. I did not say not to get help

I asked if could have waited until her Drs office was opened after the weekend. Obviously the OP delayed treatment to begin with, otherwise there would not have been an infection to begin with.

[Cleita]

25. I can't win with you. I still would have had to go to

the ER and the outcome would have been the same except that I might have gotten stitches and that would have cost even more.

[snagglepuss]

57. I agree I don't you can win with that one. If the poster isn't already working

for an HMO, I think she/he would have a promising career. I think anyone would be crazy not to go to ER with any sort of animal bite let alone one that is getting puss. I hope the infection has cleared. What a bummer.

[KT2000]

32. the point of our articles is

No - do not wait
and I understood that was what you were suggesting.

[Name removed]

34. Deleted message

Message removed by moderator. Click here to review the message board rules.

[notadmblnd]

61. You know, I'm not going to alert on you

but your comment to me is inappropriate. Do you really think I could survive here for better than 7 years and be a republican? No, I'm not a republican and I explained my thinking in my other posts.

Don't people have common sense anymore? Have we become so filled with fear that we have to run to ER every time we fart and it doesn't smell right?

The OP is complaining about and 800.00 + bill and the Dr did nothing but put ointment and a band-aid on it and prescribe an antibiotic. Obviously, it wasn't an immediate threat to the OP's life.

Go ahead and run to the ER every time you sneeze. However, don't come here complaining about the outrageous bill when the Dr. just tells you to buy some otc cough medicine and get some rest.

[kestrel91316]

51. Delay in treatment of cat bites is extremely foolhardy. Ask how I know.

[Ignis]

19. "running to emergency"

:eyes:

Not every fucking citizen of the USA has the training, education, and/or wherewithal to properly diagnose an infection.

In other civilized countries, people go to the doctor when they need it.

[area51]

72. +1 (n/t)

[kestrel91316]

48. Cat bites can blow up into a potentially limb-threatening or even life-threatening mess

extremely quickly, especially in those with suboptimal immune function (by definition anybody old enough to be on Medicare). Delay can cause dangerous and UNNECESSARY complications.

I may be relatively young and healthy, but I keep a personal stock of antibiotics on hand for use WITHIN AN HOUR of any cat bite I receive. This is with my physician's knowledge and approval.

[Yo_Mama]

58. You are a jerk

The OP'r was bitten late on Friday. If he didn't have an urgent care clinic around (and in many less populated places they don't) then his only option to see a doctor over the weekend was to go to the ER. Since the ER wasn't crowded, the OP'r is probably in an area of low population in which the ER IS the urgent care clinic. Also this explains why Medicare paid more than usual - there is a Medicare adjustment for certain rural hospitals with a high percentage of Medicaid/Medicare patients. The extra money goes toward keeping medical care available.

Your medical and cost-cutting advice is terrible. If you have an animal bite that is clearly infected, it saves us all money to seek medical treatment ASAP. If the OP'r had waited until the infection was very serious, it would have cost much more to treat. It also might have caused him to lose a limb, or turned into a systemic infection. By the way, the definition of "emergency care" includes a condition that if not promptly treated would result in such hazards.

If you have a deep cat bite a doctor would prescribe an antibiotic anyway to prevent infection - it's getting to see the doctor if you are bitten late on Friday that's the impediment.

It is cheapest to go to a regular doctor, then to an urgent care clinic, and then to the ER. But regardless, going quickly is going to minimize the net cost, and only an idiot would wait two days to seek medical care for a deep, infected cat bite.

[notadmblnd]

63. Well she ended up being charged 800.00 for a bandaid and some ointment

so obviously it was a very serious injury that needed immediate treatment.

[RadiationTherapy]

9. Emergency prices are to discourage use and make you think twice about seeking help.

Next time you will think about it.

[kestrel91316]

55. Delay in treatment of cat bites of more than a COUPLE OF HOURS can lead to

permanent damage, loss of function, and/or loss of body parts.

EVERY CITIZEN OF THE US HAS THE RIGHT TO EXPECT COMPETENT EMERGENCY CARE AND IF A CAT BITE IN AN ELDERLY PERSON'S HAND ISN'T AN EMERGENCY, I DON'T KNOW WHAT THE FUCK IS.

[snagglepuss]

60. My mom is 80 recently got a kitten which now 6 months old and has

started to bite. Not hard enough,I don't think, to puncture but still I am concerned after reading your post. It is a male Siamese/Tabby cross with what I believe is a strong streak of dominence and super intelligent. Friends who have had cats for years say its a growing stage and will stop in a coupe of months. It sounds like you have a cat that bites. If so what has been your experience? Does it appear to be just a stage.

[Lisa0825]

64. It will probably grow out of it.... one trick that has worked for me with kittens and puppies is....

that when they bite, I stick my finger in their mouth enough so that they gag. They don't like it, it doesn't hurt them, and eventually they associate that "not good" feeling with having bitten.

I think that kitten teething usually lasts until about 6 months, so hopefully it will improve soon.

[snagglepuss]

66. Sounds interesting but my mom's skin is quite fragile so I'd be hestitant

to suggest that. The other thing that I would be concerned about is that I read that one should never be aggressive with a cat with a dominance streak as it will just make it extremely aggressive. Have any of yours been dominant males?

[Lisa0825]

68. I wouldn't say it was aggressive.... I just sorta turned my hand so

that the finger was in the mouth. But you are right if she has fragile skin.

Has he been fixed yet? At 6 months, he is plenty old enough, and that could lessen some of the dominance issues too.

[snagglepuss]

67. dup self deleete

[kestrel91316]

78. I don't have a cat that bites, lol, I'm a cat vet. Though one of my cats does give

love bites (but kisses when I reprimend him).

Your mom's kitten needs major discipline and NOW. A stern word, "NO! NO BITING!", and redirecting play toward toys is a big help. As is getting a second cat to provide negative reinforcement of inappropriate behavior, lol. Shaking a finger in the cat's face when reprimanding it is seen as a play enticement gesture, BTW.

[snagglepuss]

LOLOL I'm dying here. Way too funny I thought you had one mighty mean kitty.

It's was shocking to hear you keep antibiotics. LOL Thanks for your advice.:rofl:

[snagglepuss]

83. LOLOL I'm dying here. Way too funny I thought you had one mighty mean kitty.

It's was shocking to hear you keep antibiotics. LOL Thanks for your advice.:rofl:

[Ruby the Liberal]

11. The Doc can write off the difference between 'billed and paid' based on his normal billing rates

This is also why many Doctors are stopping seeing Medicade/Medicare patients - because of the 20% reduction in reimbursement rates the GOP fought for.

Why seniors vote (R) never ceases to amaze me.

[nightrain]

18. I don't think so actually... It's usually lost income. I've never been able to

make up for the difference between billed and paid. (Not a physician, another health care practitioner)

[Ruby the Liberal]

26. It isn't making up the difference (tax credit) it is being able to deduct the loss (tax deduction)

Talk with your CPA to make sure you are maximizing your filings. Their fee may pay for itself.

[nightrain]

33. I can check, but I believe that since the loss is on paper, it isn't deductible.

[Ruby the Liberal]

37. Definitely check

If nothing else, take a CPA you know to lunch and ask the generic question.

(This is why Doctors file amounts they know insurance/Medicare/Medicaid won't pay - for the bookkeeping paper trail).

[nightrain]

39. I have an accountant friend who I will ask. Thanks.

Turbo Tax won't let me "write them off as debt" or whatever the terminology is.

[Mimosa]

74. My MD says on paper losses aren't deductible

My best pal is an MD who has had that problem for years.

And yes, any senior who votes R is demented. ;)

[Ruby the Liberal]

81. I could have sworn my Dentist explained this was how he does it

The difference between what he charges and what is reimbursed. When I see him again, I am going to remember to ask him how he is doing that.

[Sgent]

54. No they can't

There is no write off in 99%+ of cases.

In medical situations (unlike others), you don't report income until you receive the cash. So since it was never reported as income, it cannot be deducted.

In addition, there was no 20% reduction in reimbursement, there was a 2.2% raise in reimbursement to physicians treating patients on Medicare (not Medicaid or Medicare Advantage plans).

The reason doctors (and hospitals) charge high rates, then write them off, is to capture 100% of the allowable charge from all insurances. Say I perform a 99213 (mid level office visit), and Medicare pays $65, Blue Cross $75, and Aetna $100. I will set my price at $110. If I were to set it at $95, I would lose money on the Aetna contract ($5) because they will only pay their allowable up to the charge.

Hospitals, unlike physicians, occasionally get even sweeter deals. One large hospital around here gives a straight % off their charges to private insurance companies, so the more they charge, the more they collect.

[nadinbrzezinski]

12. Part of your answer is that

you are paying for all those who will not, or cannot.

Average ER doc in the country is also 650, right out of the bat. Doing some research after dad had to go to the ER was shocking. I know some of the needs of keeping staff 24\7\365... but the costs we have are way out of line with that.

[Booster]

17. I had my gall bladder removed & it was $44,000. I flipped out.

Like you, Medicare paid & so did supplemental ins, but that is just insane.

[Cleita]

22. No wonder Medicare is going to hell.

They aren't getting together with the hospitals and doctors, like the Canadians do, to set fees that are agreeable to both sides.

Medicare needs to be updated and modernized in a responsible way. What's going on seems to me is hospitals and doctors padding the bills for what they can get away with to make up for what they are getting stiffed for. This is no help to seniors who rely on these programs for health care at a time of their lives when they are most vulnerable.

[csziggy]

23. Where it went - 50% to the for-profit hospital; 25% to administrative overhead

Which includes the clerks at the hospital that have to know how to bill Medicare to get the maximum amount. A few dollars to nurse that did the actual treatment.

Any more the doctors and nurses that actually give our care get very little of our health care dollars. Most goes to administration and profit for hospitals, clinics, insurance, pharmaceuticals, services that supply janitors, temp workers, and so forth.

[marmar]

24. Snapshot from a "health care" system entirely out of control.......

nt

[Skittles]

28. $61 for five minutes is pretty damn good pay

[Cleita]

31. Yes, it is, but the ER was fairly empty that day so

maybe it was all he got or maybe a few more like me. It could turn out that I make more in eight hours than he would on a slow ER day. I wonder why they don't pay the ER doctors by the hour? That would make more sense to me.

[tammywammy]

35. Because that $65 also goes to overhead and other personnel

The doctor doesn't just get the $65. Similar to labor hour charge at a mechanics vs what a mechanic actually makes.

[boppers]

42. $829.73

For a glance, a prescription, and a bandage. How much "overhead" is reasonable for such a thing?

[Skittles]

43. the charge was $829.73 for five minutes

what was the rest of the money for?

[joe black]

38. Yeah, I feel sorry for my doctor.

Driving that new cadillac escalade.

[boppers]

40. $9,760 per day.

61 dollars x 20 five minute periods per hour x 8 hours = $9,760
X5 days a week: $48,800 a week.
x52 weeks a year: $2,367,600 a year.

If you want to know why our medical system is so expensive, check out the staff's cars at a hospital. You're likely so see a mix of beaters (nursing, clerical, and support staff), and a small collection of European imports.

[tammywammy]

30. I'm currently going to physical therapy for my back

The last visit, they charged $305. Aetna's price was $111.41, the plan paid $73.30 and my coinsurance amount is $12.94 (I've met my deductible, so I'm at the I just pay 15% coinsurance until I hit $1500 spent, then Aetna pays for every thing at 100%).

Strange how it works.

[Redd817]

36. inflation from insurance

I think part of the problem is actually having insurance. It seems like the price of anything medical is way overinflated because people aren't as concerned with what things cost since "the insurance covered it" and they might not even look at the bill like you did. I know it sounds crazy but I almost feel like it would be better without insurance or if it only covered extreme things, then medical prices might be forced to come down because people won't/can't pay and will shop around. The way it is now people with insurance inflate the prices and people without insurance have no chance.

[Cleita]

41. In Canada, the provincial Medicare providers meet

once a year with doctors' representatives and clinical and hospital administrators to hammer out what the fees are going to be for the next year. So they come to an agreement that is satisfactory to both sides until the next year. It makes sense to me. If Medicare and the hospitals agree that the entry fee to the ER is $100.00 then so be it. It means that everyone they treat will bring in $100 and the other fees will be established as well for that year. Why can't we do something this sensible? Instead, Medicare and insurers decide what they will pay and doctors and hospitals charge as high as they can get away with because they know they will be paid less. It makes for a very unbalanced system IMHO. I mean it's okay if you are going to buy a car but not a very good system for health care.

[likesmountains 52]

44. An explanation...Medicare Part A pays for the facility fee and overhead of the ER..

imagine that this pays for the nurse, the pharmacy, the lab, the secretarial/medical records staff , the billing dept. and the housekeeper. Medicare Part B just pays for the doctor, and I agree that the reimbursement is pretty small. One thing people need to realize is that the hospital CHARGES are standard and not based on your insurance status. The nurses etc. are probably not aware of what insurance you have and just enter the charges as they occur. People are NOT charged according to their insurance or lack of.

[Kip Humphrey]

45. My 20 hour overnight visit to the ER & hospital cost $25K. Results? No diagnosis/no prognosis

i have no insurance.

[vanlassie]

47. Those are fantesy charges.

NO ONE pays full bore. Medicare subsidy drops the charge the most, but insurance contracting drops a good 50-75% off the price too. And if you have no insurance, I guarantee you the hospital will negotiate with you, too. Like I said, those are fantasy rates.

[Cleita]

52. Medicare approved the full amount of $829.73.

They paid approximately 80% or $668.51. My supplemental paid the $161.22 difference. The hospital was paid. The bill, or statement actually would be more accurate, basically informed me that this is what had happened. So this was no fantasy. It happened in real life.

[AnArmyVeteran]

69. The hospital sounds like it's stealing the money.

[Mimosa]

75. No, they're covering unreimbursed costs. n/t

[ThomCat]

70. Anyone who has no insurance ends up paying the full amount.

:(

Only people who have insurance get discounts.

[alcibiades_mystery]

56. BECAUSE YOU SUBSIDIZE THE UNINSURED!!!!

"But 'mandates' are going to force me to pay wah wah wah!"

[Sgent]

59. That sounds about right

the facility fee for an ER visit is probably $500-$800 depending on your location -- that's the minimum when you walk through the door.

If this was a weekend / evening an urgent care clinic would have cost about $100 (including physician's fee) for the same treatment.

[pecwae]

76. Not everyone has

the choice of an urgent care clinic. After the physicians close shop on early Friday afternoon here there's no choice except the tiny ER until Monday morning. You can call whomever is on call for your doc, but they generally tell you to go to the ER.

[Cleita]

80. That's exactly what happens in my rural community.

The doctors even have that on their after hours telephone recordings. They say, if it's an emergency, call 911. Well, not all emergencies require an ambulance but you do have to go to the ER. Most of the doctors here actually only open offices in this community once or twice a week as the majority of their practices are in our main city in the county.

[McCamy Taylor]

71. Dude(tte), My son got one asthma updraft in the ER---$2000 bill.

Doctor saw him for about 5 minutes total. No tests done. No xrays ordered. They gave him a nebuilzer treatment we could have done at home (except we were out of town)---and then submitted a $2000 bill to his private insurance.

Medicare's fee schedule is reduced. That $800 bill would have been much higher if they were billing Blue Cross or the patient. Part of why the medical industrial complex is fighting Medicare for all.

As a family doctor, I would have treated someone with the same asthma attack in the office with an updraft, and my charge would have been $60-80 for the whole visit. Hospitals inflate their ER charges to make up for the money they do not recoup from people with no insurance.

[Dyedinthewoolliberal]

77. Please send your story to

your elected state and federal officials telling them this is why health care needs further reform.

[Cleita]

79. Very good idea. I think I should also send it to the

President, Max Baucus and every other member of the House and Senate who obstructed real health reform.