April 6, 2010

My $2,374 cut-thumb emergency room bill

A few weeks back, I wrote about the surprisingly speedy service I received at John Muir Medical Center's emergency room. This was on a Sunday evening after I went in for a thumb I sliced with a potato peeler. The bleeding wouldn't stop after several hours, so I figured I had to go to the emergency room to have a doctor look at it. 

I feared that a cut thumb would be very low on the emergency department's priority list, and that I'd end up sitting in the waiting room for hours.  Instead, I was seen right away. My wound was cleaned out, I received a bandage, and I was out of the hospital in an hour. I've since learned that John Muir, yes, has instituted a new system for managing the flow of its patients in its emergency room. It identifies easy to treat patients, like I was that night, and gets them into an exam room as quickly as possible, to be seen, treated, and discharged. This system helps keeps the emergency room from backing up and lets the staff focus on more serious cases.

The bill came, and I was curious, to say the least, that the total bill is for $2,374. For an hour's service. Wow!

I'm not freaking out about it because my private health insurance covers all of that amount, except for the $100 co-pay that I paid at the time of treatment. My initial thought upon receive this bill: My health insurance damn well better cover this ER visit.

That's because for the past year or so, my family and I have been picking up a huge share of my employer-provided Health Net medical coverage--to the tune of $1,400 a month. We chose this somewhat more costly Health Net route because we wanted to maintain continuity of coverage for my husband who has a chronic health condition.

With these kinds of ER costs, I can imagine the person who would be reluctant to go in for something like a cut thumb--or even something more serioius--if they had to pay much higher out-of-pocket costs.
Of course, the health care reform bill was just signed last month. I know I should be more of a health care policy wonk. If I were, I might understand how the health care overhaul might reduce this kind of cost for an emergency room visit--to my insurance company or to me.

According to, the health care reform is supposed to make health care "affordable and accessible for everyone." The argument is that by expanding health insurance to all Americans, "and creating caps on the health care expenses that people pay out of pocket, health insurance reform will make health care affordable to everyone.  ... Premiums are high, in part, because of the 'hidden insurance tax' of more than $1,000 for unpaid costs of care of the uninsured."

If any health care policy wonks--pro and con--want to chime in. If you have suggestions of anyone to bug, who might be able to tell me whether health care reform will reduced the costs of a cut-thumb visit, please let me know.


Anonymous said...

Ok all you WC hippies, let me explain something to you that has been proven time and time again throughout history.

ANYTIME, a government has put price caps in place (on ANY good or service) there will by definition be shortages. It's simple economics 101, buyers will consume more than they would otherwise with a cap, and suppliers will supply less than they would otherwise. Viola - shortages abound.

Now the government could step in and put a price cap in place and a quota on the good or service that must be produced on the suppliers - GOLLY GEE that sure sounds like a certain system of centralized planning called communism.

That's not what our current government has planned is it?

Anonymous said...

OMG. Turn off FOX! The example is Medicare not Communism? Where did Communism come from? Sheesh.....

Anonymous said...

Anon 7:59 explain to me that CA carinsurance shortage again?

Anonymous said...

Anon 7:59,

Unfortunately, the new-agers don't understand basic economics.

They'll get it when they are standing in line for their next operation, but by then it will be too late to undo it.

Anonymous said...

I rcommend that everyone buy, or check out from the library, Thomas Sowell's book "Basic Economics" and read it.

Anonymous said...

And after you have read Sowell's basic economy I recommend you read Paul Krugman to learn why the free markets can't solve the health care problem.

Anonymous said...

Anon 8:44 actaully most people learn basic economy when they get diagnosed with a catastrophic illness and are being denied treatment because denying treatment is more economic.

Daffodil Hugger said...


Did you mean voila, or are you just "pulling strings" on your viola?

If your economic training is as good as your French, I think I will get my financial advice elsewhere.

David said...

Your husband has chronic health problems, what if you had no insurance?

We see the shortages in Europe, Japan, Canada and every other industrialized nation because they all supply basic healthcare to their citizens.

FACT: There is no shortage, only scare mongers with no proof spouting off. After spending 17 years in Canada there are no lines, there are no people dying in the streets! I think FOX would be there or anywhere this was happening, but it is not. Healthcare STOCKS went up after the bill was signed, do you think informed people would invest if HMO's were affected?

Anonymous said...

Just an aside. I get a kick out of people Canadian Health Care System". If you were to read and lesrn and not just listen to things like Fox you would know that there is no "Canadian" system. Every province has there own plan and they all differ to a certain degree.

And from what unbiased things I have read it works wonderfully.


Anonymous said...

I get a kick out of people who knock the "Canadian Health Care System.

Sorry, my computer is acting up.

Anonymous said...

One weekend afternoon my G.P. instructed me to go to the E.R. immediately because of headache and vomiting.

I was discharged around midnight. I got a bill for $24,585.00 which my insurance denied because my visit was discretionary.

About a month after I'd met with my banker and been approved for a 2nd Mortgage on my home, I got a followup bill from the hospital, and they were now asking for $23.83

I'm glad I got that revised bill before I made the payment on the $24K

DumbAsBricks said...

My hat is off to you Daffodil. My favorite thing about this blog are the spellcheckers. I can't get enough of them.

Economics 101 is very basic theory which includes extremes and infinite scenarios. When talking about health care, we are trying to optimally distribute an easily defined set of resources to a easily quantifiable consumer group. We know the limits of many of the variables in this economic model and can anticipate certain things. Other things we cannot.

We can anticipate that we will only be able to repair so many thumbs...if we exceed that...we put controls in place: If a person cuts their thumb x times, then they must amputate to save money.

I'm joking of course, but price caps are just a very basic control we can put in place and we should not limit ourselves to creativity just because we cannot get past our 101 thinking.

Masterlock said...

10:19, my wife works in the health care industry and they are seeing all kinds of gamesmanship on bills, things being triple charged, etc. If the hospitals and providers can slip a few of these by a year, think of the profits. I think the question that we should be asking is $2,400 a reasonable bill for the hour soccer mom was in the ER? You could probably argue both ways...

Also, SM, did the bill break down the tetanus shot you got? I'm really curious to see if what they charged you is in the same stratosphere of what a GP would charge.

Anonymous said...

Hey Anon 7:59:
I like having a "Communist" fire department, a "Communist" police department, and a "Communist" public library.

Thud said...

As a user of the American and the British national health system I can say that I have found that both offer a great service.The NHS here though has slowly changed from a health provider to a money eating monster accountable to no one...accountability is the key.

Anonymous said...

"accountability is the key."

Or maybe accountability to whom is the key .... Whether you like it or not private insurance companies are accountable to their investors, not to the patients and not to the providers. It is their business to maximize premiums and to minimize the payouts. One common way to achieve this is by excluding preceived high risks like people with pre-existing conditions or the elderly, or by limiting coverage (you are covered for cancer treatment but only two cycles etc.).

Anonymous said...

I have worked 16 years in a hospital as a registered nurse in intensive care...I see people with NO health insurance receive all FREE services including food cards for their families compliments of medi-cal. I see people with money and full coverage through wealthy corporations not pay a dime. EVERYDAY I see HARD working middle class people with mediocre health insurance, who pay monthly payments of 1000-1800 per month to humbly cover their families for catastrophic care. THEN these hard working Americans get sick or their children get sick and they get hit with HUGE bills from the hospitals,doctors,radiology,labs,ambulance companies etc...hundreds of thousands in bills ..they have to refinance or foreclose their houses and MAX out their credit cards to pay AND then the health insurance companies drop them due to pre-existing conditions or tell them they are "capped" out for the rest of their lives! They lose everything. Every hard working, tax paying American deserves equal access to quality health care for themselves and their families. We need to get rid of the middle men making money off the sick. Single payer is the only way to go. Our "communist" public school, fire department and public libraries run better than our health care! In the words of Congressman Anthony Weiner (Queens, NY)"What value does private health insurance bring to the provision of healthcare?" I have yet to hear a good answer to that one!

Anonymous said...

AKA SM not to burst your bubble but don't think the $2,374 charge is all you will get for your cut thumb. This is just the Emergency Room charge, you will get a separate bill by the ER physician.

DumbAsBricks said...


I forgot about that! Good point.

obiwan said...

Anon 2:23pm is right. The bill you got isn't for bandaging up your thumb - you'll get a second bill from JM Emergency Room Physicians for that. The $2,374, is "rent" for sitting on their hospital bed for an hour. And that's a fine example of what's wrong with "free market" health care. Hospitals can get away with charging rates that have no relation to the services provided because they have a more-or-less monopoly in their geographic area. Insured customers don't care about the bill because the health insurance company will pay for it. The health insurance companies can afford to pay for it, because except for rare exceptions like your potato peeler accident, they only sell insurance to healthy people aren't likely to file claims. People with pre-existing conditions who need insurance can't afford either the insurance or the hospital bill. The hospital knows it's going to get stiffed serving uninsured people, so they jack up their rates even more to cover those losses. And every step along the way, somebody is making a "profit" so the free market folks say everything is just fine.

Anonymous said...

aaahhuuummmm***clears throat***
A couple facts to add to some of the lame arguments stated here. These figures are from the Lancet Oncology Journal (a well respected peer-reviewed journal). The survival rate for all types of cancer for woman in the US is 63% In Europe it is 56%. It's 53% England and 58% in Canada specifically. For men the rate is 66% in America and 47% in Europe. It's 45% in England and 53% for Canada. This is based on you being alive 5 years after discovering the cancer and includes even those in the US without any coverage. For the minior stuff the government run care certainly has some benefits in getting everyone covered. It's when you or someone you care about gets really sick that you have to worry about rantioned care and being denied advanced treatments. All you people spouting ObamaCare would sing a different tune if it was you or a family member that needed treatment. Kinda like Canadian MP (and single-payer cheerleader) Danny Williams did when he flew to Florida last month for treatment of a heart condition he couldn't get in Canada. Same with former PM Jean Chretien (who regularly attends private clinics in the US), liberal MP Blinda Stronch who gets her breast cancer treatment here in California and Socialist leader Jack Layton who opts for surguries at non-government private clinics in Canada. Good enough for us little people anyway.....

Anonymous said...

Oh and is basically a "please don't vote me out of office in November" list of talking points for the Democrats that voted for ObamaCare (the other 34 House members are safe enough). Not exactly non-partisan.

Anonymous said...

Anon - 5:11 the Concord study published in Lancet Oncology, while interesting can't be used at face value the way you seem to do it. Comparing 5 year survival rates among different countries is like comparing apples and oranges. The data is based on data from registries and there are different pathology standards in different countries. One cannot even straight forward compare different regions within one country. Because for example the survival rate for colon cancer for a white male in Rhode Island is 64.9% but only 55.6% in NYC.

Also when you look at different types of cancer in that study you will see the USA scored highest for prostate cancer but came in second behind Cuba for female breast cancer and scored third for female colorectal cancer (behind Cuba and France for women and behind Japan and Cuba for men).

By the way out of 31 countries Canada scored third for breast woman, third for prostate, fourth for colorectal women and sixth for colorectal men.

Your other point about the different foreign politicians coming for treatment to the USA is utterly ridiculous. It's like saying there can't be homelessness in San Francisco because the last time I was there I had a beautiful room at the Ritz-Carlton.

Anonymous said...

You beat me to it 6:39. People just state the facts they want to make them feel good, but anyone with basic statistics and reasoning can see the flaws in his numbers and post.

Anonymous said...

Boy, some of you people will believe anything you heart despite actual facts staring you in the face. OK, if you don't believe the Lancet Study how about the one from the Commonwealth Fund, the Royal College of Radiologists, the American Cancer Society, the study by respected economist (and former CBO Director)David O'Neil or the report from the Annals of Oncology (showing the US has much greater access to life saving drugs than Europe or Canada). It's not just treatment it's also prevention. The US has MUCH higher rates of screening (Paps and mammograms)than both Canada and England. Government run systems deem many of these preventative tests too expensive. There are mountains of data that show the American health care system is your best bet if you have cancer, heart conditions and many other aliments. If you people would do your own homework and not simply nod your head at Obama's speeches when he tells you costs will good down while quality will get better. Deep down you know he is full of B.S. but you continue with the left-wing talking points. Facts...those don't mean anything! Obama and MSNBC told me so! Idiots.

Anonymous said...

Agreed. And that guy's an idiot if he/she doesn't think that all the Canadian politicans coming to the US for care isn't revealing. That was a real eye opener for me. Typical policians. Do you really think Obama would put his kids into government run healthcare? Come on! These guys just want to be the "champions" of the those in the inner cities that don't pay taxes already. Socialism at its finest. The funny thing is some of the people singing Obama's praises (there aren't many left these days) are some of the same ones that are going to end up paying for this crap. Wait for tomorrow's paper. Obama advisor Paul Vokler endorsed a European style Value Added Tax early tonight. If you're in the middle class bend over cause here it comes!

obiwan said...

Anon 9:48pm said: "the American health care system is your best bet if you have cancer, heart conditions and many other aliments." That's true. And if you've got $2,374 you can get your finger bandaged too!!!

Anonymous said...

Okay 9:56 since you call me an idiot, I'm sure you can explain to me why it is widely accepted that an estimated 6 million US citizen this year will travel abroad to get their medical treatment? The main destinations being: Brazil, Singapore, Mexico, Panama, Costa Rica, South Africa, Malaysia, South Korea, Hungary and India.

Following your superior intellect this must clearly mean that all these countries have a better health care system.

Or maybe the world is more complex than the soundbites you seem to get from Rush and Glenn?

ALCO Medic Dave said...

Wait a minute. All they did was clean out your wound and dress it? You could not do that or have a family member do that? If you needed sutures then I could understand the ED visit. But a simple wound debridement and dressing I don't get.

Anonymous said...

"Do you really think Obama would put his kids into government run healthcare?"

If you check your facts you will see that they are already in a government run program.

Anonymous said...

9:56 why does the US rake 37th in the world in life expectancy?
I think you have heard of Warren Buffett he said we needed a change, how about drug and healthcare stocks out-performing the market, are those companies worried, NO.

obiwan said...

ALCO Medic Dave - you're saying that if someone isn't knowledgeable enough to evaluate whether their wound is a simple "debridement" or will require sutures, the local hospital should be free to charge them $2,374 for their lack the medical training?

AKA Soccer Mom said...

Dear Obiwan and 2:23 p.m.
Yesterday, I received the physicians' bill. $225.

The doctor was very nice and friendly and efficient. She did her job in about five minutes, and that service is worth $225.

Masterlock: The bill didn't specify if the charge for the "drugs" was for the tetanus. I didn't receive any drugs... so it must have been the tetanus.

And AlCO Medic Dave, I did clean and dress it myself. But it just kept bleeding, and my husband thought I would need stitches. Believe me, I didn't want to go to the emergency room. I thought it would eventually stop on its own, but it wasn't.
The cut turned out to be pretty deep--close to the bone, but there was no "flap" of skin to do the stitches. I can't remember what the material is called, a faux "skin." Possibly silicon based. Amazing stuff. I should stock up on that. Because it did the trick.

Annie and Maggie said...

Sheesh. For $2,374 I'll overnight you a band-aid. Hell, I might even drive it down there.

Glad you have health insurance. I'm curious how many of your commentors have health insurance (whether or not they pay any monthly premiums).

My daughter doesn't have health insurance and she's "hard working" - and her husband is "hard working" too -- neither have health insurance. Yes, we have an Oregon health plan but believe it or not, my daughter and her husband make too much money to qualify. And, they don't make enough money to afford premiums on their own, as well as being considered high risk due to pre-existing conditions. God help them if they ever need an effin' band-aid.

Anonymous said...

To the rocket scientists posting "I like my communist fire dept. etc." anon 7:59 here.

So those are all government employees, are you proposing that the doctors, nurses, etc become government employees?

Anonymous said...

You seem to be a very mean-spirited person and you should be ashamed for labelling anyone that disagrees with you a communist. The rocket scientists that I have met during my career were a lot nicer than you.
Oh, and where did you come up with the silly "Walnut Creeks hippies" nonsense? I hope you do not live here!

Anonymous said...

Thousands of Americans go abroad (mostly India) to have surgeries they can't afford to have here. Even if they have insurance.

Anonymous said...

One of the reasons Crazy had such a large bill is that hospitals are allowed to shift costs to private pay patients and patients covered to cover all of those people who have no insurance or adequate insurance and need ER care.

Your taxes go to pay for that. We all pay one way or another -- why not ensure that everyone has minimum access to medicare care?

As far as 'shortages' or the rationing that posters here are referencing: Insurers deny people all of the time. They refuse prosthetic arms to children. They refuse to cover one kid because he's a couple of pounds over his ideal weight. They deny another because she's a couple of pounds under her ideal weight. They deny liver transplants, which result in the patient's death. In New York, one insurer discontinued an entire class of people in the entire state so they wouldn't have to pay claims for one high-cost subscriber.

Crazy has Health Net. I nearly died while I was on Health Net because they discouraged me from going to the ER after a miscarriage. I was later admitted and have to have four units of packed red blood cells and a D&C.

Health Net refused to cover a referral for my friend's daughter when she fell of the school jungle gym and broke her arm. My friend took the girl anyway, paid out of pocket and appealed, but not everyone can afford to fork out a few hundred dollars.

If you think your care isn't being rationed now, you are smoking way, way too much pot.

Anonymous said...

Hello, I am a producer for CNN's medical unit and would love to speak with you about a series I'm working on showing examples of shocking medical bills. Please contact me at and I can provide more details. Thank you so much for your time.

Anonymous said...

Hey AKA SM you might be soon on CNN. How about this? Who knows how long it will take for you to get your own show on FOX? The Soccer Mom and the Hockey Mom on FOX having a little Tea Party.

Also I have to say I'm surprised how clueless CNN seems to see. You ER charges were pretty much standard and I'm sure there are thousands of them issued each and every day across this country.

Anonymous said...

Don't do it Soc Mom. CNN is just an ultra left wing liberal bastion. If you do do it I guess anon 7:59 was right, you are a WC hippie.

Anonymous said...

Anon 4:01 you are kidding right? "CNN is just an ultra left wing liberal bastion" who do you have in mind?

William Bennet? Alex Castellanos? Mary Matalin? Erick Erickson?

Anonymous said...

Please don't insult everyone by saying CNN isn't a left-wing network. That's like saying MSNBC isn't liberal or FOX isn't right leaning. CNN's left-leaning slant is the reason FOX is so popular today with conservatives (and while it blows CNN out of the water in ratings). Conservatives said watch for network's like CNN to start do pieces to support ObamaCare and sure enough it's happening. this is a great example (if true). And Soccer Mom is a liberal but she's one of the good ones :)
And yes people from the US go all over the world for medical treatment. New boobs, tummy tucks, facelifts you name it. If that's the argument against the US health care system you'd better find something else.

Anonymous said...

anon 603: so having rationing through insurance companies is an argument for even more rationing??? At least you can switch providers. Who you going to switch to when the government denies you???????????????????????????????????????

Anonymous said...

"The main destinations being: Brazil, Singapore, Mexico, Panama, Costa Rica, South Africa, Malaysia, South Korea, Hungary and India."

That's all related to cost, not quality. They can get standard treatments at a fraction of the cost we pay here in the US. A quad-bypass in India may cost $10,000 with 3 weeks hospital stay. Of course, the hospitals in India are not required to treat those who cannot pay, thus they can keep their costs down.

Note for advanced cancer treatment and the like, the US is still the #1 destination.

But not for long if Obamacare takes hold. I'm hoping we can start the process of undoing Obamacare this November.

Anonymous said...

Anon 5:05 you got quite some chutzpah accusing people of insult.

First of all clean up your potty mouth. In my country the Office of the President commands respect.

The proper names of the Health Care Bills are "Patient Protection and Affordable Care Act" along with the "Health Care and Education Reconciliation Act of 2010" and not "ObamaCare". If you don't like this you might want to move somewhere else.

And if you would once in a while turn off FOX news and read some real news you would have noticed that medical tourism is not just for cosmetic surgery, but more and more Americans travel abroad to get all kind of medical care.

Anonymous said...

5:12 do you actually think when you argue or do you just make things up?

"At least you can switch providers"

So if BlueCross denies coverage for you colon cancer treatment your suggestion would be to simply call up Aetna and sign up with them?

What are you smoking and can I get some of that too?

Anonymous said...


I couldn't agree more with you. Being conservative is not an excuse to not behave civil. I'm too sick and tired of these people not showing any respect for the institutions and elected officials in this country.

You have all the right to voice your opposition and to criticize but do it in a respectful manner. You are behaving like rotten spoiled little brats.

It is just a matter of time until this behavior leads to a catastrophe. We have already seen the arrest of unhinged crazy folks in Washington State and San Francisco.

Anonymous said...

Basically, as evidenced by the post above, liberals are a big bunch of dumbasses.

Anonymous said...

You've proved my point Anon 10:26.

Nee said...

We are 37th because of the distribution of medical care not because of quality or access. The WHO is judging what they deem too be fair "distribution" of health care! At the very least, it’s subjective.

Some of you are ill- informed in regard to the countries being touted with national health system that you think is free. They pay taxes for that, make no mistake.

The US effectively serves 308 million Americans and does spend the most money on health care.

The UK, Canada, Germany and others serve populations considerably smaller than ours. Do you even have a clue?
Yes, the U.S. does spend more money on health care than any other nation. But the WHO is not comparing like systems, number one. It compares free market or privatized systems to socialistic ones. Population deviances are not considered. The population of Canada is 33.2 million, Germany, 82.3 million, UK is 60 million and let’s not forget Sweden, Norway respectively at 9 and 4.7 million.

All of those populations are considerably smaller and apparently have trouble with quality of care and access. You've read the horror stories, do you think people are lying?

In other countries access is pitiful, as is quality of care. Ask yourself why people come here for surgeries or treatments if where they live has such a wunderbar system? Canada made it impossible for private practice outside of the social system. It drove docs to other countries, but of late it has changed. Now, the best doctors practice privately making them accessible to those who can afford the cost, the rich. The government care is left with the remainder and by it’s own emission on the brink of failure.

Daniel Castonguay, the original architect of Canada’s system has himself said, ” "We thought we could resolve the system's problems by RATIONING SERVICES or INJECTING MASSIVE AMOUNTS OF MONEY into it. We are proposing to give a greater role to the private sector so that people can exercise freedom of choice."
A single payer system will not work more efficiently than we have now UNLESS they ration care. Then quality and access inevitably drop. And doctors will leave the profession in droves if they are not paid what they are worth.

Anonymous said...

Nee -- First I disagree with you. The WHO study is not only based on fair distribution of health care. As a matter of fact it compares five different indicators:

"WHO's assessment system was based on five indicators: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system's financial burden within the population (who pays the costs)."

But second I would agree that none of these comparisons are all that helpful. Comparing health care across different nations is comparing apples and oranges.

Thirdly the argument that some wealthy politicians travel to the USA for special procedure is meaningless. Only a fool would claim that it is not true that some of the best medical facilities are located in this country. But the fact that some of the best medical facilities are in the US is not indicative of the overall health care system in the USA in the sense that for example luxury resorts in third world countries are not indicative of living conditions in these countries either.

Why not look at the current system? Can you really say this is the best system anybody can think of? Do you simply not believe that a large percentage of bankruptcy filings are due to medical bills? Do you not believe that many Americans out of a job or self employed can't get medical insurance due to pre-existing conditions? Don't you think that system needed to be reformed?

I know that you feel that reform might result in a drop of quality. I don't share this fear with you. Wasn't Medicare a major reform for the retired people (which of course by definition do make up a very substantial part of the patient population)? I didn't see that Medicare resulted in a drop of quality and access and let to rationing.

So, as a conservative where were your suggestions on how to reform the system? All I saw was criticism but no ideas.

Anonymous said...

Anon 3:29,

BLOW ME! You liberal douchebag.

David said...

Nee- How do you not see how flawed your thinking is?
Others pay taxes for their health systems, but it is still half of our cost. You said Germany, well they like other countries have private insurance companies but they are regulated to not profit on the sick and dying.
Find me one Canadian that would give up their system for ours, being from BC I do not know of any.

Anonymous said...

9:09 that is your best argument why we should give you the keys to the Congress in 2010 and to the White House in 2012?

Anonymous said...

The liberals are burning this great country of ours to the ground.