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(NPR)   "Soccer playing engineer" cries foul after hospital charges him $882 for a knee brace available online for $250. Subby just picked up a knee brace for $24 at Target and is prepared to call everybody involved in this story a moran   (npr.org) divider line
    More: Stupid, Medicine, Health care, Medial collateral ligament, Esteban Serrano, knee brace, Orthopedic surgery, Health care provider, health care service  
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2515 clicks; posted to Main » on 26 Mar 2019 at 8:56 AM (12 weeks ago)   |   Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2019-03-26 08:23:59 AM  
I wonder if the hospital had given him the name of the brace and discharged him home without it if he would have been okay with that?
 
2019-03-26 08:48:37 AM  
This is America.  Comparison shopping in health care is not allowed, and is dealt with very harshly.  You must not know the price of anything until you get the bill.
 
2019-03-26 09:01:49 AM  
Shipping and handling, dude, shipping and handling.
 
2019-03-26 09:04:09 AM  
He could have brought his own. Of course, then there's the $650 corkage fee.
 
2019-03-26 09:04:29 AM  

Marcus Aurelius: This is America.  Comparison shopping in health care is not allowed, and is dealt with very harshly.  You must not know the price of anything until you get the bill.


There are laws against that. And I did work for a DME dept of an ortho office, and if someone thinks the price of a brace is too high, they would tell them other places that might be cheaper, or to check for used ones, as most people have them for a week or two and then never need them again.

That may seem harsh to you, but it seems quite reasonable to me.

https://www.independenthealth.com/Ind​i​vidualsFamilies/Tools,FormsMore/Surpri​seBillLaw
 
2019-03-26 09:04:51 AM  
That actually seems like a small markup compared to some things in the medical industry.

On par with the markup you see on booze at a restaurant compared to a supermarket.
 
2019-03-26 09:05:41 AM  
I can imagine there may be different levels of knee braces between the one you may find at target and one, say an athlete may receive from his team doctor.
 
2019-03-26 09:06:03 AM  

spongeboob: I wonder if the hospital had given him the name of the brace and discharged him home without it if he would have been okay with that?


When I tore my calf muscle, the hospital was going to charge me some ridiculous amount of money (I don't remember how much but it was well over $400) for a cane.  I discharged, used my umbrella until I made it to CVS, then bought a cane there for about $25.  I was OK with it...  maybe he would've been OK as well.
 
2019-03-26 09:06:07 AM  
Is subby not aware there are different kinds of knee braces, some more complex than others?

Also, what kinds of people do these hospitals hire to do cost determinations? Sociopaths?

/there should be laws against hospitals charging whatever the fark they feel like
 
2019-03-26 09:08:19 AM  
From the pic in the article, it looks like the same kind of brace I have. It's to prevent dislocation and stabilize the joint during force applied under partial flexion, such as during sharp turns and lateral movement. Subby's $5 brace isn't going to do a damn thing to help that. A 4x markup is ridiculous, though.
 
2019-03-26 09:09:02 AM  
Hey when did you get here? Anyway, nice to meet you and welcome to America. A couple things to take care of first. Procedure and all that. Mostly just  some things we need to issue to you. Let's see....here is your red hat to show your support for our beloved emperor, here is your assault rifle with high capacity magazine and 500 rounds of ammo....wait....are you a felon? No? Promise? Works for me. Next, here is a 5 day supply of McDonald's to get you started, after that you'll need to get it yourself. Here is your dog, and here are your 7 credit cards. They each already have a little debt on them to help ease you in to the process, so you don't have to worry about spending right away. Remember, in this country, the more debt you have, the more worthy you are to get more credit. It's how we give equality to poor people so they can keep buying and keep the gears rolling on this wonderful society.  So, uh, yeah. Again welcome to Amercia, enjoy your new freedoms, and as a final piece of advice from me to you, stay the hell away from any street named Martin Luther King Jr.
 
2019-03-26 09:09:50 AM  
what $800 knee braces might look like

img.fark.netView Full Size
 
2019-03-26 09:10:33 AM  
/begin rant

I simply do not understand stories like this.  Why the fark does anybody feel compelled to pay a demanded price that is 1) not negotiated, 2) not disclosed in advance, and 3) objectively unreasonable?  Why $829?  Why not $1,829?  or why not $18,290?  I mean, the price clearly has no basis in reality.  Yet, incredibly, people feel compelled to pay it.

IAAL.  Patients caught by surprise with a non-negotiated, non-disclosed, non-reasonable price have no legal obligation to pay that price.  Their legal obligation is to pay "quantum meruit," which basically means "what's fair."  From this story, it's obvious that $829 is not fair.

I would tell a business trying to gouge me to fark right off and to sue me if they think they can justify the charge.  Guess what --- they've never sued.  I've also gotten the "we'll report it to your credit," to which I've responded, "go ahead.  You may want to give your legal department a heads up that it's about to receive a Fair Credit Reporting Act suit."  Again, it's never happened.

Folks, stick up for yourselves.  Tell these shysters to fark off.

/end rant
 
2019-03-26 09:14:12 AM  
Silly goof, the knee brace doe cost only 250.

This is how it works.

250 msrp of brace.
Medical supply warehouse place buys them at 175 and stocks them and sells them to hospitals at 500.
Hospital charges the patient another markup to make some profit, knowing some insurance company will pay the full amount charged on the bill.
 
2019-03-26 09:19:28 AM  
My wife needed a nebulizer, so the Doc wrote us a prescription for one and we went to the medical supply & picked one up.  I think the thing was about $50.00.  The air pump alone in there would have cost well over $50.00 if I bought one that powerful for my fish tank.  Frankly, if I need a new fish tank pump, I might buy another nebulizer!

When she needed a CPAP, we shopped around online & got one we could reprogram by hand (so we didn't have to pay some a**hole $200.00 to adjust it every 2 weeks!).

When it was somebody else's money Mr. Serrano was spending, cost was not an issue.  Now it's his money and he starts shopping around after the fact and, realizes he screwed up.

I appreciate medical billing is often outrageous; I've been burned, too.  This guy had the ability to handle this situation and didn't do his part.  This one's on him.
 
2019-03-26 09:19:56 AM  

Target Builder: That actually seems like a small markup compared to some things in the medical industry.

On par with the markup you see on booze at a restaurant compared to a supermarket.


Like my meds for Benign prostatic hyperplasia, $380 a month from Medicare, $256 for two years worth from Canada.  Good thing it has a long shelf-life.
 
2019-03-26 09:20:16 AM  
My son's pediatrician had prescribed a foam skin cleaner for my son to help with his acne.  When I went to fill the prescription it was over $400.

The pharmacy tech saw my reaction and mentioned that it was a non-prescription product, and that I might want to "shop around" and let me take a photo of the label.

I found the same stuff on Amazon direct from the mfgr for under $20.
 
2019-03-26 09:24:14 AM  
Reminds me of the modern corporate-feeling dentist office my wife went to once. It wasn't cheap and we didn't have a lot of money at the time, so she got the CareCredit card through them. Of course, her teeth weren't great so they reeeeeeally pushed some overpriced electric toothbrush, fancy toothpaste, etc which she almost fell for since it would at least maintain her teeth until next year when the new dental coverage kicked in. The toothbrush/etc were around $300, and no better than $50 ones at the pharmacy. Of course, it was some funky brand that required you also always buy the brush heads from the dental corporation.
 
2019-03-26 09:24:56 AM  

AntonChigger: Is subby not aware there are different kinds of knee braces, some more complex than others?

Also, what kinds of people do these hospitals hire to do cost determinations? Sociopaths?

/there should be laws against hospitals charging whatever the fark they feel like


It's not healthcare reform we need, it's insurance and billing reform.

Hospitals know insurance will want a discount. No matter what. If something costs the hospital 80 bucks, and they need sell for a modest markup of 100 to make enough money to pay bills and get a little profit and be low enough to make every happy, they insurance company is still gonna say they want it for 50. So they charge 1000. Then they can turn around and discount it to 500 for the insurance company to make then happy. Because insurance companys don't care about costs they care about getting discounts. It's like when I used to sell  CCTV systems. We sold a lot to gas stations and hotels. Which are largely owned by Indians (dot, not feather.) Indians are like insurance companies. Final cost doesn't matter, as long as they get a bargin.

We used to go in with our rock bottom price. This is the cheapest we can do it for. Any lower, and it's just not worth it. No dice. You can't deal, they don't buy.  So we learned early on that when we deal with Indians, we have to add extra money in the price to take back off. Often leading to them paying more if they just took the lowest offer we would have gone in with. But they got to bargain and they got a "discount" and that's all that mattered.

Insurance companies are like Indians. They don't care what the value of a service or item is. Only that they hospital gives them a huge discount. So the hospitals are forced to jack everything up 800%, so they can take off 60% and make the insurance company feel they got a good deal.

Not a horribly bad system of you have good insurance. Especially a plan that is paid for by work. What sucks is that if you're just some chump with no insurance, you still get that 800% markup and are expected to pay it like everyone else.


I don't know why we don't just stop this stupid game and make it that hospitals (and especially pharmaceuticals, you cock suckers) charge a fair markup for their service, and if you have insurance,  they just pay it.

It would save *everyone* money that way.
 
2019-03-26 09:26:02 AM  

Munden: what $800 knee braces might look like

[img.fark.net image 267x189]


Looks like that lady needs those braces for all the weight she packed on in cryo-sleep.
 
2019-03-26 09:30:35 AM  
Damn.  This actually suggests The healthcare system in the US is completely broken.  Huh.

I wonder how much money the healthcare lobby pays our lawmakers.
 
2019-03-26 09:32:49 AM  

Gunboat: Patients caught by surprise with a non-negotiated, non-disclosed, non-reasonable price


Except, the price was disclosed and accepted, ergo negotiated... I know, I know, why on would you read an article before ranting?
 
2019-03-26 09:33:44 AM  
CSB time.

My son recently had a soccer injury. He collided face first with another player and wound up with a cut under his eye that we weren't sure if it would require stitches. We went to our local walk-in facility which is both convenient and the wait is generally low.  My wife called in our arrival before I got there with my son.  We walked right in, a PA and an intern super-glued the cut and we were out the door in all of 20 minutes.

The cost?  $1080.
 
2019-03-26 09:34:38 AM  

scanman61: My son's pediatrician had prescribed a foam skin cleaner for my son to help with his acne.  When I went to fill the prescription it was over $400.

The pharmacy tech saw my reaction and mentioned that it was a non-prescription product, and that I might want to "shop around" and let me take a photo of the label.

I found the same stuff on Amazon direct from the mfgr for under $20.


OTC? Probably Differin (adapalene). Yeah, that's about normal. Prescription fexofenadine was around $300/mo vs. OTC Allegra when it first went OTC.

I've become one of those pharmacy techs not surprised by any insurance farkery or manufacturer overpricing crap. During the Epi-Pen price outrage/stock shortage, Auvi-Q started being manufactured again to the tune of $2,500 each. Of course they weren't covered by anyone, but we would get a special message about what phone number the patient could call to deal with the manufacturer to get some "deal".
 
2019-03-26 09:38:39 AM  
I work for an orthopaedic suegeon. Braces have the highest return of any medical supplies. We provide a back brace that costs us $110 and the average commercial insurance allows $1000 for the brace. Medicaid actually pays $1,600. It is ridiculous... and there are no laws that restrict our contracted allowables, the only way to lower it would be to decrease what Medicare allows for the braces (since most insurance contract allowables are based on a pecentage of Medicare rates.
About 6 years ago the state I work in passed a law to limit what Medicaid would pay for certain codes which dropped the allowable by half or more, but then Medicare came out w a new set of codes which would specify braces as either off the shelf or requiring fittings and adjustments. No one at the state noticed I guess so we are receiving on average 10x our cost from Medicaid for braces again (oh and Medicaid patients have no out of pocket costs so they will almost always say yes to a "free" brace and you all get to pay instead).
Improved Medicare for All or another type of single payer is the ONLY way to fix this cluster
 
2019-03-26 09:39:21 AM  

Marcus Aurelius: This is America.  Comparison shopping in health care is not allowed, and is dealt with very harshly.  You must not know the price of anything until you get the bill.



img.fark.netView Full Size
 
2019-03-26 09:42:25 AM  
Engineers tend to prove a corollary to the Dunning-Krueger effect: They're very knowledgeable in one field, so they assume that they are equally knowledgeable in multiple fields.

That's not to say that medical markup isn't quite high.  It is. I wonder how much they're charging for tylenol in the ER nowadays.
 
2019-03-26 09:45:08 AM  

Marcus Aurelius: This is America.  Comparison shopping in health care is not allowed, and is dealt with very harshly.  You must not know the price of anything until you get the bill.


I love pointing this out to people whose sole argument against real healthcare reform is based on socialism vs. the free market.
 
2019-03-26 09:46:15 AM  

MugzyBrown: I can imagine there may be different levels of knee braces between the one you may find at target and one, say an athlete may receive from his team doctor.


Because there are.

A basic neoprene sleeve, yeah, that might be only 20-30 bucks. A hinged brace, 65 and up. An immobilizer, hundreds. Notice I didn't call the neoprene a brace- it really isn't. It provides so little support that while it's fine for a minor sprain or strain, it's laughably weak when it comes to actual significant injuries.
 
2019-03-26 09:46:31 AM  

Demetrius: CSB time.

My son recently had a soccer injury. He collided face first with another player and wound up with a cut under his eye that we weren't sure if it would require stitches. We went to our local walk-in facility which is both convenient and the wait is generally low.  My wife called in our arrival before I got there with my son.  We walked right in, a PA and an intern super-glued the cut and we were out the door in all of 20 minutes.

The cost?  $1080.


Insurance will give them $100 and they will be ok with it.  I got an X-Ray of my knee then an MRI for a torn meniscus X-ray they wanted over $1000 for insurance said here's $50 and call it good.  It's insane that if I didn't have insurance I would be expected to pay $1,000 but since I had insurance $50 was acceptable.
 
2019-03-26 09:49:47 AM  

spongeboob: I wonder if the hospital had given him the name of the brace and discharged him home without it if he would have been okay with that?


A real engineer would have lashed an effective brace together while bored in the ER room. Then made a proper one out of longer lasting materials when he got home.
 
2019-03-26 09:51:10 AM  
Clinical markup is old news.

/my recent vasectomy was 20k!  Take that, balls!
 
2019-03-26 09:51:57 AM  
Did he get any of them $20 asprin too?
 
2019-03-26 09:54:13 AM  

spongeboob: I wonder if the hospital had given him the name of the brace and discharged him home without it if he would have been okay with that?


This....i wouldnt have taken the brace, and bought it later.  The hospital can soak someone else
 
2019-03-26 09:57:46 AM  

Plamus: Gunboat: Patients caught by surprise with a non-negotiated, non-disclosed, non-reasonable price

Except, the price was disclosed and accepted, ergo negotiated... I know, I know, why on would you read an article before ranting?


Don't be an asshole.  The article makes clear that he didn't see the prices until well after:
The doctor diagnosed .... and prescribed ....  Serrano used for several weeks.... Then the bill came.
 
2019-03-26 09:57:50 AM  
You paid for your knee brace AND the (4) other people that needed one and don't have or have garbage insurance. .  It's called helping those less fortunate than you.

Think of it like going to the grocery store.  You buy food AND the stock the food bank.   You eat, everyone eats.

Don't be such a dick.
 
2019-03-26 10:01:59 AM  

Gunner's Mate First Class Phillip Asshole: Demetrius: CSB time.

My son recently had a soccer injury. He collided face first with another player and wound up with a cut under his eye that we weren't sure if it would require stitches. We went to our local walk-in facility which is both convenient and the wait is generally low.  My wife called in our arrival before I got there with my son.  We walked right in, a PA and an intern super-glued the cut and we were out the door in all of 20 minutes.

The cost?  $1080.

Insurance will give them $100 and they will be ok with it.  I got an X-Ray of my knee then an MRI for a torn meniscus X-ray they wanted over $1000 for insurance said here's $50 and call it good.  It's insane that if I didn't have insurance I would be expected to pay $1,000 but since I had insurance $50 was acceptable.



Demetrius didn't say how much they paid vs. how much the insurance picked up. Are they a walk-in clinic, urgent care, emergency room, somehow associated with a hospital and billed as such, or private practice? The type of facility they are will determine how little your plan covers.
 
2019-03-26 10:07:39 AM  

groppet: Did he get any of them $20 asprin too?


My wife had a procedure and was prescribed ibuprofen a 2x the otc dosage. They wanted $50/dose (2 tabs). I asked if she could just take four otc tabs at about 10 cents. Yeah I guess that would work too.
 
2019-03-26 10:08:38 AM  

kittyhas1000legs: Demetrius didn't say how much they paid vs. how much the insurance picked up. Are they a walk-in clinic, urgent care, emergency room, somehow associated with a hospital and billed as such, or private practice? The type of facility they are will determine how little your plan covers.


I would be willing to bet it was an Urgent Care facility ran by the large hospital conglomerates.  He mentioned in PA and we have a lot of those.
 
2019-03-26 10:09:48 AM  
A couple of years ago I got a knee brace that's a little more elaborate than the one shown, (includes offloading and was custom fitted).  Ortho shop billed insurance approx. $3000.  Insurance allowed approx. $2000.  And paid every penny of that, we having hit our annual deductible by that time.
 
2019-03-26 10:09:55 AM  

Gunboat: Plamus: Gunboat: Patients caught by surprise with a non-negotiated, non-disclosed, non-reasonable price

Except, the price was disclosed and accepted, ergo negotiated... I know, I know, why on would you read an article before ranting?

Don't be an asshole.  The article makes clear that he didn't see the prices until well after:
The doctor diagnosed .... and prescribed ....  Serrano used for several weeks.... Then the bill came.


Either your reading skills leave a lot to be desired, or you're being deliberately obtuse.

"Serrano recalled that when he received the brace, an employee showed him a form with its estimated cost in writing. He remembered his share was more than $700, but he didn't pay too much attention because he assumed his insurance would cover it. "
 
2019-03-26 10:15:39 AM  

Gpzjock: spongeboob: I wonder if the hospital had given him the name of the brace and discharged him home without it if he would have been okay with that?

A real engineer would have lashed an effective brace together while bored in the ER room. Then made a proper one out of longer lasting materials when he got home.


A real engineer wouldn't have pushed his knee past its design limits.
 
2019-03-26 10:15:42 AM  
Welcome to for-profit healthcare.  Where most of the hospitals are now owned by a few companies and the doctors are all part of those hospital systems.  Added bonus, you have no ability to shop around to find the best price.  Basically the system is designed to separate you from you money and increase profits for the shareholders.
 
2019-03-26 10:16:43 AM  

groppet: Did he get any of them $20 asprin too?


Closer to $30-$35. And that was in 2000 when I had knee surgery.
 
2019-03-26 10:18:57 AM  

hobnail: Marcus Aurelius: This is America.  Comparison shopping in health care is not allowed, and is dealt with very harshly.  You must not know the price of anything until you get the bill.

I love pointing this out to people whose sole argument against real healthcare reform is based on socialism vs. the free market.


I saw a specialist earlier this year.  When I got to the office, they said my referral had expired, so my insurance wouldn't cover it.  I asked how much the visit would cost if I just paid cash.  They told me $145.  I said that sounded reasonable, and I would pay cash for the visit.  I paid.  I saw the doctor.  A couple of weeks later I got a bill demanding another $75, claiming the cost of the visit was $220.

Healthcare providers don't think the normal rules apply to them.  Good luck comparison shopping when they feel free to change the price after the fact.
 
2019-03-26 10:19:00 AM  

Gunner's Mate First Class Phillip Asshole: kittyhas1000legs: Demetrius didn't say how much they paid vs. how much the insurance picked up. Are they a walk-in clinic, urgent care, emergency room, somehow associated with a hospital and billed as such, or private practice? The type of facility they are will determine how little your plan covers.

I would be willing to bet it was an Urgent Care facility ran by the large hospital conglomerates.  He mentioned in PA and we have a lot of those.


No, he mentioned a PA (Physicians Assistant).
 
2019-03-26 10:19:08 AM  

Gonzo317: Welcome to for-profit healthcare.  Where most of the hospitals are now owned by a few companies and the doctors are all part of those hospital systems.  Added bonus, you have no ability to shop around to find the best price.  Basically the system is designed to separate you from you money and increase profits for the shareholders.


FARK needs a 'sad but true' button.
 
2019-03-26 10:19:31 AM  

Munden: what $800 knee braces might look like

[img.fark.net image 267x189]


[IUnderstoodthatReference.jpg]

/Are You Still There?
//I Don't Blame You
 
2019-03-26 10:22:50 AM  
Plamus: .... Either your reading skills leave a lot to be desired, or you're being deliberately obtuse.

"Serrano recalled that when he received the brace, an employee showed him a form with its estimated cost in writing. He remembered his share was more than $700, but he didn't pay too much attention because he assumed his insurance would cover it. "


I think we're seeing the same words but interpreting them differently.  Your view appears to be that the presentation of what he thought the insurance would cover should have put him on notice that he could very well be held to pay that amount, ergo, risk of loss/surprise is on him.

My view is different:  he is not an expert on the cost of medical equipment and was operating under the assumption that he would be treated fairly, i.e., that the charges roughly matched what insurance would cover.  Only later did he discover that the insurance would not, in fact, cover anywhere near the amount that was being charged, therefore he was surprised.  At that point, he does some research and discovers that he's being rooked.  I don't expect an injured person, sitting in a doctor's office, to go and do price comparison on the spot, especially when the doctor is prescribing a cure.  I'm leery to blame patients in that position because you end up with the "Animal House" defense:  You farked up --- you trusted us.
 
2019-03-26 10:22:50 AM  

ltdanman44: Marcus Aurelius: This is America.  Comparison shopping in health care is not allowed, and is dealt with very harshly.  You must not know the price of anything until you get the bill.


[img.fark.net image 400x351]


Aspirin for only two dollars!? That's a bargain!
 
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