What are some of the most ridiculous markups that you've seen on a medical bill?

I had a cyst on the top of my foot. No big deal most of the time. Occasionally a little annoying if my shoes would grind it. Slightly more annoying when I flew, because my feet and cyst would expand. I was about to shift duties at work, requiring more travel. Thought process was to have it removed before having to fly all the time.

Did my research on my insurance provider’s website beforehand and they predicted 250 to 400 dollars. Having not met deductible for the year, meaning this would be all out of pocket, no problem. Worth the money to have the annoyance removed.

Meet the doctor, have tests done, schedule the surgery. Bells should have started going off when it was scheduled at a new hospital just down the road. I should have been asking why not do this at the office. Dr also wanted to put me under, but I knew the was not a big deal and a local would do the job, so I waved off the anesthesiologist.

Day of surgery, head to hospital. Wow, this place is gorgeous. Stone walls, huge fire place, private security walking the halls.

Meet with the paper lady, have to sign and commit to pay all bills, but insurance is in order. I ask for an approximation of bill. She has no idea and cannot quote anything. In the future, I'm walking if they can't quote cost. Like a dumbass, I figure with insurance how bad could it be? This was a quick 30 minute cut, remove and stitch job. Outpatient.

Dr arrives with anesthesiologist. “Doc, we can do this with a local”.

He replies “Agree, but I would like him around in case of complications.”

Surgery goes as expected. Couple of stitches, a little pain med and I'm on my way.

Bill comes. Doctor's portion - $288. Right in line with expectations. Hospital cost $25,000! Yes, that's right - twenty five thousand dollars. To add insult to injury, the anesthesiologist charged $4,000 for consultation fees. Granted insurance knocked both down to approximately $5,625. Still VERY ridiculously and unbelievable.

It’s why we cannot trust doctors, hospitals, or insurance to make proper health related decisions when they know how to turn the screws to extract profit within a very corrupt system. Being a conservative myself, I don't want the government in healthcare; however, they are the only body able to set regulations to help protect everyone. Please bring on single payer. The profiteers have brought this upon themselves.

Edit:

Thanks Gary Simon for the recommendation to read Elizabeth Rosenthal’s “American Sickness.”

EVERYONE SHOULD READ THIS BOOK! Be prepared to be absolutely blown away at how out of control our Healthcare has become.

My father was treated for undiscovered terminal stage four lung cancer last year at a top local hospital. We had gotten good (expensive) insurance coverage for him with only a $4400 deductible so I wasn't worried when the hospital spared no expenses. I had no idea how much the treatments and the hospital stay was costing, but I surmised it was pretty hefty and didn't dare to ask.

At one point, I'd overheard one of the doctors on his very extensive medical team discuss a surgical procedure as a last ditch effort. Curious that the head of his team didn't bring up this procedure as a treatment option, I forced the issue and asked why it wasn't being considered. While the medical chief danced around the issue, the bottom line was that the 15 minute procedure would cost the hospital around $150K and worse, prolong my father’s stay (survival) by several weeks. Rather than promote the procedure, the medical chief proposed and sold to my father that it was just better to give up and die quickly at a hospice facility in the next week or so.

Of course, that doesn't stand with me. After bringing in the surgical team and discussing the procedure with my father, he opted to give it a try and the hospital had to agree as it was a medically valid option. The procedure went smoothly and bought my father some time to seek further treatment. Ultimately, the cancer was so aggressive and late staged that there were no viable treatment options. So we brought him home for his final week and he passed away a month after the procedure. Maybe it was a waste of insurance money to spend that $150K for a few extra weeks, but I would have paid for it out of pocket if I had to.

Much later, we received his final bill. It was a jaw dropper. For his three weeks in the hospital and the procedure, the total bill was just over $2M. For every day he was in there, the hospital charged $25K for his stay, before the cancer treatments or the procedure. For that $25K, he had a cramped shared room and ate some of the saddest looking food I've ever seen.

Then I saw the insurance adjustment. Somehow the insurance company had the ability to renegotiate the $2M down to $225K, as if by magic. There appeared to be no rhyme or reason to the discount. The $150K procedure was negotiated down to $12K. The insurance company ended up paying something like $180K with the balance left mysteriously dangling. Well, I had paid for his deductible so that wasn't my problem.

What really got me was the thought that the hospital could have billed the estate of some uninsured person with the means for the full $2M and there was no way for the estate to similarly bargain down the bill. That full amount could bankrupt somebody. For what the insurance company ultimately paid, that isn't far off from all the insurance premiums we had paid for the past 20 years for my father. In effect, the insurance company broke even with their calculation.

In the end, I saw the real purpose of getting health insurance—getting somebody with the ability to renegotiate the exorbitant bills from hospitals. The system is rigged so that the hospitals are always taking their chances with insurance reimbursements. So, they have to mark up their rates to ridiculous levels. They never know when a tough insurance company will cut them off at the knees. Meanwhile, the rest of us are caught perilously in the middle of the battle.

During a routine doctors visit for my asthma, my doctor said it would be a good idea if I got a nebulizer. It just so happened that a medical supply company had dropped off a few at the office. If I wanted to take one, the supply company would bill me separately and I should submit it to my insurance. I agreed.

I have a very high deductible insurance plan so I am very conscience of every medical expense because I have rarely, if ever, met my deductible so everything comes out of my pocket. Once I got home with the device I immediately went to Amazon to see what these things cost. The average price online was about $75. So that is what I expected.

A couple weeks later I got a bill from the supply company for $450. I promptly called them to inquire why it was so high and how I could return it. The response was. “So isn’t your insurance going to pay for this?” I explained that all my expenses were out of pocket. With that he paused and said..”So what do you want to pay for it?” I said $75. He said “OK”.

Think of all the equipment that is being overpriced just because insurance covers it. The system is broken all around.

My brother went to the hospital to visit a friend who was admitted there for a procedure, and in the parking garage he slipped and fell on some oil-soaked pavement, resulting in a scrape that was bleeding profusely. So he went back into the hospital and cleaned himself up well with soap and water in the restroom, then because it was still bleeding, he asked at a nurses station for a bandaid. He was told that he could get one if he went to the ER, they were not allowed to distribute anything in that wing except to admitted patients.

So he trekked across the hospital to the ER, tried to ask a nurse for a bandaid, was told they had to have all his contact info first, to give it to the clerk. so he gives his info to the clerk, then is told to have a seat and wait, the nurse must deal with the others that were there before him. Finally the nurse comes and tells him she can’t just give him a bandaid, he has to go into an exam room so she can look at it and make sure it has been properly cleaned first. So he goes into the exam room and she scrubs it it iodine and puts gauze and a wrap on it and he finally gets to leave, about an hour and a half after he went looking for a bandaid.

Two weeks later, a bill arrives in the mail, $70 for the equivalent of a bandaid. Brother calls to try to get it forgiven since he just wanted a bandaid, not an hour and a half ordeal that made a mountain out of a molehill, but he has no luck with the billing clerks, or their managers. So he asks to speak to their legal department, where he explains to a lawyer that he fell in their parking garage, and while he initially had no thought of trying to prosecute the hospital for the negligence for the oil on the floor that caused him to fall, and all he ever asked for was a 50 cent bandaid after he finished cleaning his own wound, after the way the hospital turned it into an hour long ordeal of premium care and then had the gall to bill him so much for 5 minutes of a person’s time that he never wanted in the first place, that he was inclined to pursue legal action for negligence if the hopital was inclined to pursue him for payment for the minor treatment he got after much personal inconvenience. In fact, some reporter friends of his might find it a very entertaining story that reveals much about the high cost of US medical care.

Needless to say, the words had hardly left brother’s mouth before the lawyer was assuring him that he was certain they could get the bill forgiven if my brother was not interested in pressing negligence charges, and that was the last he heard from the billing department. Brother said that if he knew what all would ensue from asking for a bandaid, he would have used papertowels from the bathroom to wrap the wound and bind them on with duct tape from his car. Odd that the hospital is about the worst place to injure yourself if you want prompt first aid, due to rules about covering their ass legally.

Before Obamacare, we chose to not purchase health insurance because our premiums were about $1300 per month.

My husband had a routine physical at the doctor’s office, with blood work. The office staff explicitly told him “When the lab bill comes, call them and tell them you are uninsured. Don’t just pay it.”

A few weeks later, the lab bill arrives from LabCorp and it’s over $400. Ouch. So I call them as instructed and tell them we don’t have insurance. They respond, “Oh, let’s readjust this then. Ok. Your bill is $27.” I paid on the phone with a card that day.

I would go for a routine doctor visit and because I was uninsured, I paid $70 cash. With insurance, they bill $150 but the negotiated rate is $89. Hardly fair.

Now we have insurance as required by law, and it’s a very expensive high-deductible plan. My son had to have an MRI from a football injury - $2400. But because we “have insurance”, the hospital wouldn’t negotiate the rate. We pay over $9000 per year in premiums for a pretty healthy family and have to meet an $8000 deductible, which means our insurance is pretty useless to us.

1991, Inpatient for Anterior Cruciate Ligament (“ACL”) reconstruction.

Background - This surgery was my fourth on that knee, with a corresponding rapid progress in fourth generation of surgical procedures, technology, and post-op rehab. So, I was very familiar with the process of recovering from invasive surgery, which now included a constant passive motion (“CPM”) machine that mechanically flexed and extended my knee (THAT was a momentary “quiet freak-out” surprise when I awoke in recovery, as the previous three all involved hard-casting the leg…as I said, rapid progress).

The protocol then was for three days in-patient. Near the end of day one, I was all but ready to go, and the only show-stopper was waiting for my urinary system to “wake up” from the effects of anesthesia. Got past that obstacle, and with my orthopedic surgeon’s blessing (fantastic doctor and person, btw), left the hospital on the afternoon of the second day and went home.

Two weeks later, the bill shows up…that includes as having been delivered, an entire third day of charges that never took place. To add insult to injury, the insurer at first declined to cover the CPM, on the grounds that its “efficacy was unproven”. Hmm.

Fortunately, I was then employed at what was then the largest law firm in Chicago, and my care-giver for my hospital stay was a paralegal in another large firm where I had previously worked. One nasty letter to the carrier and hospital cleared it up, but I learned then that a lot of hospital bills were prepared this way, with a “menu” of services that would be deemed appropriate for a given procedure automatically billed, with no oversight as to whether those services were ever, in fact, delivered. As to the CPM, my employer would have been glad to litigate over a $600.00 charge that saved the insurer several thousand dollars by shortening both the in-patient stay and subsequent outpatient therapy sessions (alas, long experience means I can effectively rehab with minimal need for oversight).

Fast forward six years(!) later, I began to receive collection calls. By that time, I had gone to law school, passed the bar, married, and changed employer and address, so this was the first I’d learned of it.

Seems that the anesthesiologist failed to timely submit their billing to the insurer, and was now threatening me with litigation. When I asked the caller, “So, how should be that their failure six years ago to get paid because they breached their contract with the insurer is now my problem?” His response was to the effect of “Oh, I see, so you’re just going to ignore your moral obligation to pay the bill.” I responded by saying, “I’m very aware of my moral obligation not to put up with fraudulent collection practices. So now, I’d like your full name, and the fax number where I can send my demand letter for your violation of the Fair Debt Collection Practices Act”.

He hung up, and I never heard another word about it. I pulled a credit report from our recent house purchase, and the anesthesiologist’s outstanding charge wasn’t anywhere to be found. It infuriates me how many people who don’t have those kinds of resources get screwed over every day.

Single payer. It’s long past due.

I have worked within the supply side of TRICARE which is a single payer system and I find myself flabbergasted with civilian markups.

I pay $15 for all associated equipment for an IV and it takes 1min to administer/ a civilian hospital charges $500.

A BOX of morphine costs me $10 and takes maybe an hour of work out of my life if you add all of the auditing the comes with opening a narcotic locker/ you will pay over $100+ for this at a civilian hospital.

My favorite is a CT scan which costs about $20 for the Navy to do/ yet a civilian ER will charge $500-$1,000 the worst part is many of these CT scans are for fender bender car accidents where the doctors know full well everything is fine and give it anyways for liability reasons.

The reason TRICARE is cheap is because the incentive is to keep it that way.

The reason a civilian hospital can get so expensive is a combination of the fact that the incentive isn’t to keep it cheap (unless your doctor works for a HMO) and the hospital marked up your bill to make up for the homeless guy who just walked out the door without paying the bill(which is a somewhat controversial excuse because the hospital gets tax incentives to counter those patients).

My daughter and son ran into each other and hit their heads together. My daughter vomited as a result of that incident and as it was night we took her to the ER to make sure it is nothing serious. We waited for 20min, nurse took bios and the doctor spent 5min examining her. The total bill from the hospital for the visit was close to $10,000. After the insurance pre-agreed price it was reduce to $3000 and we needed to pay ~$700. When I looked at the bill the hospital charged us around $50 for the plastic part they put on the instrument they checked her ears with. This could not cost the hospital more than $0.01 and assuming with delivery and storage and disposal would cost the hospital a total of $0.03. The rest of the bill was as ridiculous, but man was I shocked to see that…

The markups don't seem ridiculous to me. They are simply how a free market medical system works. Its like paying several dollars at the theater for popcorn. The prices are high and they likely lose out on buisnesses because of it, but I I can see enough people still buy that it makes sense to a gouge those customers. That's popcorn at a theater though, I can't avoid those costs if I want to go to the theater, they end up being pretty universal, but I can choose not to go, that's not the same for healthcare. What seems ridiculous to me is that virtually everyone in this country places a high importance on fixing healthcare costs, yet roughly half the country voted for those who are pushing policies that would derugulate and encourage a more market based, for profit approach to medical care. I don't like, how healthcare works in this country and I don't presume the fixes will be easy from where we are, but on a macro level it seems patently obvious that what doesn't and what will never work for non-elective care is a profit based system. Ridiculous is having a system that just keeps getting more expensive, trying for decades to tweak it, and seeing it doesn't work, watching every other developed country switch away from purely profit based systems and see reduced costs, then saying we need to continue down the path we are on.

In a profit based system the goal is not to provide the most care for the least cost or even the highest quality care. The goal is simply to maximize the profit. In some cases maximizing quality and volume is how you do that, but if you can make more profit selling less healthcare at higher prices, that is what you will do even if it means less people get access to it and healthcare suffers. Even if you could solve the price transparency issues at the time of care, a for profit system still fundamentally is going to prioritize profit. Consumers will look for value, but their ability to capture it will always be overidden by the desire to stay alive. In healthcare cost is not king. Ridiculous is the game, not the players.

I am not going to post the actual bill so you will just have to take my word for it, as there is senesitive information on it.

Back in the good old days of about 2008, when I was in 4th grade, I was a little too cocky on my bike. As I cruised down the biggest hill on the block to hit that sweet jump my buddies and I made, my pants caught up on the chain, completely stopping the bike as I was about to hit the jump. I landed headfirst into the ground, with my bike (no joke) going about 50 feet forward, falling off a cliff, and landing in the ocean.

Luckily, I had the sense to listen to my mother (always wear that damn helmet) and I did not suffer too much head trauma, just got shaken up a bit. Thinking back on it, I really didn’t hit the ground that hard. I got up off the ground, and noticed a buckling, burninng sensation in my left arm. Low and behold, the Radius bone in my arm was snapped, and pinching a nerve.

When I looked down at my battle wound, I immediately began to feel a red hot, seering pain that I had never felt before. It was a different kind of pain, one you feel deep down, and someone who has broken a bone definitely know what this kind of pain is.

And so, when I realized that my bone was snapped I did what any fourh grader would do. I balled my eyes out and ran as fast as my two foot legs could hobble me back home, which was about 4 blocks. Usain Bolt couldn’t possible have caught me.

With my bone awkwardly protruding out of my arm, and me screaming at the top of my lungs, my mother rushed me to the hospital faster than the road runner. I don’t know where you are from, but American hospitals are fast. I mean really fast. As soon as I was in the hospital i was scooped up by a doctor and rushed to an emergency room. Because my arm swelled up so bad, it was wrapped up, and I was given some pain meds and sent home to have surgery in 2–3 days. The whole hospital visit took about 20 minutes.

Next day, my mother got a bill for about 5,000 dollars for that 20 minutes and the subsequent medication prescription write out, along with the drugs themselves. I was crusing at a low altitude on vikadyn and percocets, so my memory was a little fuzzy, but I do remember a lot of stress as my arm was elevated waiting for surgery. Not only stress about my arm, but stress about money also. I was only about 10 or 11, but I had felt absolutely terrible to put my family through a financial burden like that.

I don’t rightly know exact figures, but I remember my mother mentioning that we are still paying off the medical bills for that broken arm, and we have insurance. The last thing I want is hate from Europeans who will put me on blast over this, claiming that Jesus himself personally wrote out their healthcare laws, and how stupid my country is for having such ludicrous hospital bills, but I was given the best care by the absolute most professional group of people that has ever graced the Earth.

Here in the US, hospitals wont just send you a bill demanding that the full amount be enclosed immediately. You can set up just about any type of payment plan you want. $50 a month? $100? This is just what insurance doesnt cover. It is not such a deep black hole as everybody says it is, speaking from my personal experience.

Now, it’s hard to put a price on life. Especially one’s own. But I am in the unique position of knowing what mine cost, so far…Here are some ridiculous markups:

Less than 48 hours in the hospital to be diagnosed with stage 4 cancer have a lymphectomy and get a port installed: $98,000.00 USD

Three or four months of RCHOP Chemo and a bevy of additional drugs every three weeks: $35,000.00 USD per session.

Two and a half years of Rituxin therapy every 8 weeks: $10,500 USD per session.

Abdominal and pelvic CT scans every three months for the first 2 years and every six months now: $10,000 USD per session.

Bone marrow transplant and a year in quarantine (haven’t done that yet): $1,000,000.00 USD

Lost income: Staggering

Now, you may say “fuck it, it’s only money and you can’t take it with you”. But, it would be nice to leave some behind for the kid and the nurse, should it come to that. But the bottom line is:

Living long enough to fall in love with a nurse and see your kid become a teenager: PRICELESS!!

Before:

After:

My raison d'être (not gonna post a photo of my kid):