re: Can someone explain how charging for ER "facilities" and ER "physician services" works?

Right, back to my original point...it's price gouging

No, my gripe is the wording about the coverage is very misleading. They'd have you believe that a $150 co-pay covers all of the ER services until they refer you to a manual which is very vague with its wording.

You get 12 different bills from 16 different entities

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Right, back to my original point...it's price gouging

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Do you want people qualified to deal with anything available all the time or some of the time? It isn't like the flight is available for $300 when you want a lift from home to the grocery store but $3000 from home to hospital. The flight and personnel are expensive. Two very simple alternative models exist: offer fully trained personnel less often than always or offer less trained personnel always.


So, I would tend to think most people prefer the "highly trained always" folks. This is aimed at them.
How are these people supposed to justify the amount of time and money required to be ready for anything at any time if not to be paid while waiting for wild things to walk through the door?


That isn't gouging... That's the cost of a nation thinking that things like people in car wrecks, gunshots, and industrial accidents deserve a shot at living from someone who has seen those things before. (I, too, don't believe that a lot of traumas should be death sentences, so I like that we have a system of highly trained individuals to deal with trauma available; this comes at a high cost, which is unfortunate from w monetary standpoint, but it's great from an "I'd like to get in my car and drive across America angle")





The real problem is this, which also isn't gouging. Most people have insurance. Insurance pays up to some number for procedure X or service y. If the bill is less than that, they pay the bill. Over that, they pay some maximum. The number changes from time to time and varies from insurance to insurance. There is also a requirement that you must charge the same amount for these procedures and services to each patient, regardless of their payer status. You can offer the service free of charge at your discretion, but you may not charge less than your set fee schedule to anyone, legally.
Reply from person and hospital who want the max reimbursement from all the companies that pay for it? Bill a stupid number that is high, collect all the maxes. The people affected most are those who don't have insurance.



The system is due for an overhaul in a big way, but it is quite cumbersome in its present state and would take a very big jolt to move in any direction. It will and needs to come, but for now, it's what we work in and a big part of the reason that things work the way they do.



None of the above attempts to defend the current system as "good" or "ideal" but is meant to attempt to explain how it works with some pros, cons, and explanations for its current state.

Ambulances may be the biggest scam of them all.

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Ambulances may be the biggest scam of them all.

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Isn't using an ambulance a choice of the patient in most cases?
Is it supposed to be free?
$10000 for a ground ambulance as referenced in an earlier post does not sound realistic.

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That isn't gouging... That's the cost of a nation thinking that things like people in car wrecks, gunshots, and industrial accidents deserve a shot at living from someone who has seen those things before. (I, too, don't believe that a lot of traumas should be death sentences, so I like that we have a system of highly trained individuals to deal with trauma available; this comes at a high cost, which is unfortunate from w monetary standpoint, but it's great from an "I'd like to get in my car and drive across America angle")

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Sure it is.

Back before Obama care ruined everything, I had a procedure to remove a small mass in my back. The billed costs for everything was roughly 21k...the negotiated price my insurance paid was 2100. My only cost was a $50 co-pay, that tells me the markup on medical services is astronomical.

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Back before Obama care ruined everything, I had a procedure to remove a small mass in my back. The billed costs for everything was roughly 21k...the negotiated price my insurance paid was 2100. My only cost was a $50 co-pay, that tells me the markup on medical services is astronomical.

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That has nothing to do with the ACA and was happening long before it. See my post above- I explained in detail why costs are high. It's to capture reimbursement from the insurance companies. Cash pay gets screwed in the current system.