Scotties Toy Box

December 18, 2018

Vox: I read 1,182 emergency room bills this year. Here’s what I learned.

Filed under: News — Scottie @ 10:05

I read 1,182 emergency room bills this year. Here’s what I learned.

A $5,571 bill to sit in a waiting room, $238 eye drops, and a $60 ibuprofen tell the story of how emergency room visits are squeezing patients. Read the full story

Shared from Apple News

Sent from my iPad,Hugs and Best wishes,


  1. My brother works in a hospital in information systems. He has shown me why the ER and hospitals are so expensive.

    1) Malpractice insurance is 30-50% of the entire bill. Hospitals get sued for stupid shit and lose. Even when no harm came to the patient at all. An example is in his state you must provide along with discharge paperwork a medicare/medicaid form. You must get the patients signature on a privacy notice. So much paperwork and if anything was out of order, signed on a wrong spot, not given ect then you can sue.

    A patient sued Sarah in the ER. He had a nasty gash on his face and it needed stitches. She put an extra stitch or two so to minimize the scar. The patient found she should have used 8 stitches to patch a wound that size and she used 10. In court when asked she said the patient had a cut on his face and the extra stitches minimized his scar. The judge looked and admitted you can barely see the scar now and it was fine work. The patrient admitted they were NOT harmed by the extra stitches but the manual said 8! His bill was 3200$, His portion was 200$, Insurance paid 900$, hospital wrote off (per insuirance agreement) 1100$. He won 125,000$ in his lawsuit. He again was NOT injured in anyway and the scar was very hard to see thanks to Sarah. But that meant nothing because hey hospitals have insurance!

    So want to reduce costs immediately? Tort reform. Throw out frivilous cases like this one.

    Since becoming a doctor she has been named and involved in 9 lawsuits. Not one was the patient harmed in anyway nor the family harmed. But in everycase the hospitals either settle to avoid litigation or have to litigate which cost them money.

    A second example of her getting sue and the other time someone won a lot of money was a mother gave her child asprin in the ER. Because it is against the law to give medications to a patient and not be licensed the mother sued the hospital for allowing her to give her child asprin when in fact she snuck it to the child while no one was in the room. She won 80,000$.

    2) That Medicine for 60$. Sure you can buy it in a store for 50 cents a pill. But in the hospital everything is regulated and controled. That pill is handled only by a licensed pharmacist who has to fill out forms for the governemtn. patient name, age, sex, number, time of day ect… After the pharmacist gets the meds and logs all the places required by law (all of which takes time and time cost people hours aka salaries), It then gets sealed in a cupand transfered to a nurse (again man hours) and paperwork that it was delivered to the proper station (ER, floor/wing/room ect), Now the ER nurse gets it but only after the doctor (more man hours) reviews the pills are what was ordered and then the nurse gets to take them to you (more man hours).

    So break it down my brothers numbers 62$ for a motrin, 8$ in regulatory paperwork, 15 minutes pharmacist time (@25-30$/hour) 30$, 10 minutes nurse time and paperwork for delivery (15-20$/hr) 4$, Doctor review and regularoty paperwork (5 minutes at 1$/minute) 5$, The nurse who delivered it 3$. That is 50$ just in overhead. The hospitals need computers and storage soace for the regulatory requirements, electricity for lights, heat/ac, ect.. They do all that with the 12$ remaining but wait the insuirance will write off pare of that 12$ usually 1/4. 50 cents per pill 2 pills. The hospital made 8$ on that pill to keep the lights on, beds, equipment, heat, ac, ect…

    So it’s not as black and white as people pretend it is. Even things like an MRI. Those machines cost huge money and must be maintained and kept under warrenty. People tend to overlook simple facts.

    You expect a hospital to have the latest equipment… costs moneu
    You expect them to follow all the laws and safe guard your health…costs money
    You expect they will have power even during outages…..costs money
    You expect them to have heat and ac and lights and water and….. costs money
    People never think of the frivelous lawsuits and most are all too eager to sue for any reason…. costs money in litigation, payouts to avoid litigation (cheaper often even when the hospital would win easy except they don’t win because juries think oh rich hospital has insurance let them pay this poor patient), payouts if they lose in litigation even a frivilous lawsuit can make lots of money in payouts because of the misconception that hospitals make so much money… ect..

    Anyway this is going long i’ll stop now. Hospitals aren’t the villans though and most of the expenses are government regulations requiring certain handling and verifications of testing, medicine, patient care and more…

    Liked by 2 people

    Comment by Michelle Styles — December 18, 2018 @ 11:12

    • I disagree with you on tort reform, and here is why. Here in Florida former Gov. Bush pushed through tort reform. He and those supporting the legislation promised it would do everything, solve all medical costs, and cure the common cold at the same time. Nothing changed. The costs of medical care still jumped every year. Same with insurance and medications. So the legislature passed a law saying a not for profit hospitals and anyone affiliated with it could only be sued for a max of $250,000. Almost all the doctors in the area joined up and they were all sheltered under the hospitals umbrella. It was pitched to the doctors and community as the way to save everyone money and lower health care costs. Wrong. Nothing changed, cost still kept soaring and now doctors are pissed and leaving the affiliation with the hospital.

      I am sorry what happened to Sarah. Some times I think people have lost common sense. But on the other hand lets talk MRI. I have to have them at least every two years. It use be cheaper for us to go through the hospital systems competitors as they gave us a courtesy discount off our co-pay for being in the medical profession. Now the hospital system we belong to is self insured and they fight like heck to make us use their equipment because they can charge them selves a lot of money and then write it off.

      Our hospital system is Lee health system. They own a four local hospitals and a bunch of clinics and hundreds of doctor offices and specialty places. The hospital Ron ( and I use to work at ) works use to be doing rather well. Then payments for medicare and medicaid went way down, yet the cost to deliver those services did not go down. There is some serious problem right now.

      One thing I noticed when I worked in the ICU was some drugs were incredibly expensive yet there were no generics or other drug able to be used. $5,000.00 for a shot of Epoetin or Procrit. Factor VII is 10 grand a dose, and I remember having to go to the pharmacy and hand carry it back to the unit as they wouldn’t send it via the tube system. Drug prices are incredible. I am not talking the mark up the hospital does, but the price the companies charge for the drugs to begin with. There is some serious price gouging going on.

      One last thing I think makes the price of medical care higher is the weird tier system hospitals must use to try to balance the books. The many deals with the different insurance companies, and each group pays differently. So you as a PT see different amounts from someone else that has a different insurance company. The person with out insurance doesn’t get any of the discounts and gets slammed with a bill most can never pay. So the hospitals in our system have to try to figure out how to get paid from the different groups and try to cover the people who they either don’t get paid to treat or who they don’t get paid enough to treat. I feel our health care and healthcare delivery system is broken in the US. I feel there are too many middle people between the care a person needs and what finally gets delivered. I know both of us are giving basically overviews as the subject is complex one. I know some regulations are needed so hospitals don’t cut corners, and some of the audits are just stupid. Several times a year the hospital system gets audited by several different groups. They go nuts just before the visits and we have gotten violations for stuff that never effected PT care. It seems to me Michelle that every one in every step of the healthcare / delivery system is trying to make as much profit as possible while not paying out any more than they are forced too.

      I believe health care is a right, not a privilege. There should never be a profit motive and profit should never drive care. Now I am not saying Doctors, ARNPs, PA-Cs, Nurses and all other staff should not be paid well. These are people who paid a lot of money from their educations / skills and should be compensated. However I think we can do what other countries do, they pay for the education of doctors, nurses and others in exchange for the person working a few years for the system where needed. Then these professionals wouldn’t have huge mountains of debt hanging over them. At the hospital I worked at it was most children of a two doctor family that were going through med school. That is sad I think. I wont pretend to have all the answers, but I will say I think our system needs some drastic reforms.

      Shoot now I have to proof read all this for typos and grammar mistakes and out of place capitals. Yuck. Be well. Hugs

      Liked by 2 people

      Comment by Scottie — December 18, 2018 @ 13:13

      • What was passed was not true tort reform.

        “he law, which was strongly supported by then governor Jeb Bush, limited non-economic damages in malpractice cases in which a patient was injured to $500,000, or $1 million if the injuries were catastrophic.

        At the time the legislation was passed Florida physicians were faced with skyrocketing malpractice insurance premium rates with many exiting practice in the state.”

        All it did was limit damages for pain ajnd suffering. It did nothing to curb frivalous lawsuits. That is not tort reform. Not even close. Tort reform would set standards in which a patient would need to demonstrate they’ve been harmed by a pohysician or facility such as a hospital. There would be standards set as to what constitutes injury. Obviously if I cut the wrong leg off as a doctor I should be sued for every penny you can get. But extra stitches?

        See the two cases above 200,000$ paid out and the hospital premiums go up. Who pays those increased premiums? You the patient my friend.

        Tort reform needs to be national and not some stop gap limit on how much pain and suffering you can get. Oh and read up even the limited law signed did result in lower malpractice premiums for doctors. Which ultimately leads to lower costs.

        Further you have my second point. Hospitals should ALL be not for profit. None of them should own and insurance company or self insure. Sarahs hospital is not for profit and it turns back 500million dollars plus every year for free or mostly free health care for vets and poor. So point 2 to bringing down costs is hospitals should all be not for profit!

        Drug costs. point 3 we need to allow sideways buying like in canada. Allow hospiutals to pool money and buy larger quantities of medicines for bulk price reductions. Pharmacies should be able to do they same. Cyrrent law does not allow this kind of buying. We also need to not allow someone to buy up all the generics and competition like in the case of the Eppie pen. Once 30$ for this life saving device now 500$ because the original eppie pen bought up all generics and competitors then closed them.

        One last thing. No hospital can refuse care nor give substandard care to any person seeking care. No matter how much they owe or how poor. The hospital can and will treat you. Even the for profit ones. That is the law. So you will never be denied “health care” you just may not be able to pay it back. Just saying. And you can get health related collections removed from you credit report because the fair credit act does not allow medial expenses to be used against you in credit related matters. Know the laws, use the laws 🙂

        Liked by 1 person

        Comment by Michelle Styles — December 18, 2018 @ 13:48

        • I will take your word for the malpractice insurance coming down. The doctors I heard complain about it when I worked in the ICU seemed to think it had not reduced their costs at all. That is why so many joined the hospital system so they were covered by the hospital and did not have to carry malpractice insurance. The hospital did and awards were capped. If it reduced any costs no one in the system seemed to know about it.

          I agree with you we need national healthcare reform in every aspect to our medical system. I hate to see fifty different state systems and then every county in a state having their own regulations. That really screws up the healthcare a person gets. If I go on a trip to say Ohio and they have different regulations than Florida I could get hit with huge costs, not being able to get some medications, and some of the rights I have as a PT in Fl will not be the same as in Ohio. When I was in the VA system Ron and I spent a summer in New Hampshire on lake Winnipesaukee. I told my VA provider and asked how I get my weekly shots and the meds and monthly testing they were doing on my blood and bones. He looked up the nearest Va clinic to where we were staying and set it up. When we got there I went to the VA clinic and they had my stuff ready. I got my care uninterrupted. When we were ready to return to Florida I told them and they again switched things and I was right back in the system near out home. That is the kind of care we need in all states. Yes I know the VA is now badly overwhelmed and underfunded. That was back in 2001 and it was a bit better then.

          I understand how much care a not for profit hospital systems give. Our local healthcare system is not for profit. They have established so many convenient and support care places and the make a difference. They looked at community needs and put facilities in those areas. I have used the one near our home for my flu shot last year. I forgot to get it, and the walk in care was just down the road. Of course I have employee insurance for the system through Ron so I was taken right in , shot, and was on my way. If you are wondering if it was just because I was on the system insurance. Nope. I took James in twice when he had no insurance. They treated him well and timely. I talked to people as I waited for him, and they told me how much of a difference these clinics made in their lives. Some had insurance, some did not. I am not complaining about the amount of care our system gives, I am saying this last year was tight, this year the system has given out far more financially in care than they can support. It is a serious situation.

          Why should they not self insure? Lee Health System keeps telling its employees the reason they can give insurance coverage is they self insure. Yes the costs go up every year, and this year is a jump from 50 dollars a month to 150 just for having a spouse on your plan, plus the costs of the individual insurances amounts you choose. So before Ron chooses which levels and stuff we want insurance for, he has to pay an additional 150 a month for me to simply be on his plan. Remember he pays also of the individual things he selects for me. So he has to pay twice just to have a spouse on the plan. But we have to as it does cover me for things Medicare doesn’t pay for.

          You sure are correct on the drug costs. I have to have an Eppie pen. The sudden raise in cost caused me to not get mine replaced last year after they expired. In September my doctor noticed I had not asked for a script in a long time for it, and wanted to know if I was getting it from another provider. When I said I did not want to pay the co-pay he got upset and basically read me the riot act. Needless to say I have the two new ones. But they only last about six months even if you never use them. What is a real hurt from Ron and I are diabetic medications. They slam us on those.

          Thank you. Many people I know have had to declare bankruptcy because of medical bills. I know a hospital has to treat you, but is that the best way to do healthcare? The emergency rooms as Sarah must have told you are overwhelmed. Sometimes Ron and I have been asked to go down to the ER because as ICU techs we knew the ER systems. It is friggen crazy in an ER. Plus you have tired, sick , irritated people waiting who are not in a great mood when they are finally seen and take it out on the staff. I heard a republican congressman ( forget which one ) say everyone has healthcare because they can go to an ER and get treated. That is the worst way to provide anything but emergence care. I would hate to have to go to the emergency room for regular healthcare needs. On the other hand, when I collapsed and they thought I was having a heart attack, I was taken to Healthpark Hospital ( the one Ron and I both worked in ) and they were superb! I can not give the ER more credit . From the time they wheeled me in telling the staff I had been in a doctors office , got dizzy , fell over and passed out and gave all the medical information the staff rushed me right in. They had me cat scanned and blood test done , when I started to be able to process everything they were working on all the results. Ron was so worried and James was also. They said they needed to keep me over night, and do some heart tests in the morning, moved me to the cardiac observation floor, all in a matter of hours. Turned out my heart was fine. One of the ICU doctors came down and looked over my labs ( at Ron and I requests he was added as a provider on my chart ) and had the “hospitalist” ( doctors who work in the hospital to care for the PTs of doctors who do not come to the hospital. ) run tests to see if I was anemic. Turned out that was the problem, I was so low on red blood cells it acted like a heart attack. So they now watch that for me about every three months and I am on twice a day vitamins and I am good. But as good as the care was, I wouldn’t ant to have to go to the ER every time I needed medical care. That is the most expensive way to get care.

          Thank you Michelle this has been a great conversation on a complex subject. If you have any other thoughts on healthcare later, send them my way. Hugs


          Comment by Scottie — December 18, 2018 @ 15:02

          • Is it the best way? NOPE!

            My point was the slight difference in what you said. You can always get healthcare the real issue is not obtaining it. It’s paying for it after. I always wonder why people file bankruptcy after large medical bills. They can not under the law put it on your credit. They do until you challenge it and point to the sections of the law that prevent medical costs from being used against you in credit rating and decisions. As soon as you write in and point to this section of the law they remove them promptly. Does it require a little work on your part? Yup! But it’s very little work to restore your good credit. One letter, one signature required registered letter. I’ve seen fax work but letters always work.

            Self insurance leads to greed in for profit hospitals. Look in pittsburgh. The area is dominated by a hospital system called UPMC. They also control the insurance UPMC health insurance. It’s a vicious cycle and this hospital group turned over 3 billion in profits last year. That is obscene. How much good could be done with that 3 billion? All because they self insure and run for profit businesses. Meanwhile in pittsburgh our poor and vets have to beg for care they can afford! It’s a crime.

            No hospital system should ever own the hospitals, insurance provider, the medical school, the doctors, express centers, ect… You end up with a monopoly in one industry where you reall don’t want a single choice.

            UPMC is also way behind of the tech. They still use the older mamagram machines, they use older mRI equipment. In todays world older equipment means less effective and no advanced medicine.

            Liked by 1 person

            Comment by Michelle Styles — December 18, 2018 @ 15:29

            • Michelle you say they can not put it on your credit report. You will be surprised to know they do. Two years ago Ron and I had to file bankruptcy due to my high medical bills and the long time frame it took to get my disability. They did not remove them from our records, and the calls were non stop and getting more and more threatening. Yes I was still being treated and we were making payments as we could, but the hospitals and the individual doctors offices had referred me to collections, ( standard business practices they claimed, nothing personal ) which went on my credit reports. Finally after one collections group tried to take our van Ron decided the only way to protect us was to file. We did, and then in the next five months we got my disability and we payed off the bankruptcy. ( the lawyer got 6 grand also and did not one thing ) However even though we paid the bankruptcy off in less than a year, the entire amount of it haunts us. This year we bought a new car. We decided to put down 12 grand and still had trouble getting financing. The finance guy said it was nuts. We are paying almost 3 times the amount we should in payments due to the huge interest we had to take to get the loan. In one more year we can refinance the car and it should drop the payment to less than half Even the finance guy was stunned, he was the one who told us to refinance. He said ” You are giving them 12000 reasons to finance the loan and I can not get anyone to take it”.
              So we are still dealing with the fallout of my medical bills and the fact we couldn’t pay all the costs soon enough. Ron was trying to keep it all going with his CNA wages and taking all the OT he could. Now that I have my disability we can handle everything. But on just his wages, about 2 grand or a bit more a month, we couldn’t. So yes it does happen. Most Americans are one large healthcare bill away from getting very behind and having to file bankruptcy. The law may say they can not do it, but they dang well do, I am living proof.

              As for hospital systems that limit choices and are a monopoly I am worried about the many hospitals the Catholic church is buying up. They are the single largest growing healthcare system in the US. In many rural areas they are the only hospitals in a large area. Then they force their religious views on the population that needs health care. I posted on this not too long ago. Many services need are simply no longer available if it goes against the church teaching on sexuality, gender roles, contraception, and so much more. It is insidious as many times the medications needed are from the hospital pharmacy and they wont give any non church approved medications.



              Comment by Scottie — December 18, 2018 @ 15:56

              • Here are some tips should it happen again.

                A bill collector can not harrass you. If you are making ANY good faith payments at all even just 5$/month. You can tell them to stop calling you or it is harrassment. You file a letter with thier office certified and signature required demanding they cease the harrassment and notifying them all communication needs to be in writting from this day forward. If they call again file a complain with the FCC and you get paid 500$ which you can applyn to your bill or keep. Your choice. Each call is a seperate complaint and subject to seperate payments.

                Write the credit bureaus (all three) dispute the entry under the FCRA and advise this is a medical bill which by law can’t be used against you in crefit reporting or decision matters. The bureaus will remove them. You do need to watch the agency may try readding them or selling the debt and a new agency add it. Same letter, same result. Items removed. You must contest each item individually.

                You have a right to force the collection agency to consolidate your debt into a single debt. Though each time they get something new you need to write and demand this again.

                Just remember after telling them to stop harrassing you by phone that you will need to also write any communication.

                A creditor may not harrass you, threaten you, say they will send you to jail, use obscene language, call repeatedly (or call at all once they’ve been instructed to correspond via written communication. You can even in writting demand they cease and desist all communications.

                It’s a matter of knowing your rights. Not that I advocate not paying your debts. BUT there is only so much they can do and you have rights under FCRA and the FCC. Know your rights and flex the muscle when needed.


                Liked by 1 person

                Comment by Michelle Styles — December 18, 2018 @ 16:12

                • It was all wiped out by the bankruptcy. The only one we are having trouble with is a bank account that we closed and had no debt of any kind but they wont record it as closed so it shows as an open account, even though we don’t have it, and it is closed. It was not related to the medical debt except the lawyer told us to take the money out and close the account as the collectors were trying to take it.

                  That is the thing Michelle, we paid the debts. We paid the bankrupts all 16 plus grand of it. It was all medical related. But it is over and done. We pay our bills and if we can not afford something we don’t buy it. But healthcare is not something you can decided not to have. I have to have it, and now at 63 Ron’s health is failing. We are not alone in this country of older people going under because of health needs.

                  Thanks but we are OK and in a few years we hope it will come off our record. It is such a shame as we never had a credit problem and we always lived with in our means. But my health was the straw that broke the camels back. Hugs


                  Comment by Scottie — December 18, 2018 @ 16:52

                  • Write a letter to each of the credit reporting agencies. Thier addresses can be found easy enough but here they are just in case.

                    Credit Bureau Mailing Address Phone Number
                    TransUnion P.O. Box 1000 Chester, PA 19022 1-800-916-8800
                    Equifax P.O. Box 740241 Atlanta, GA 30374-0241 1-800-685-1111
                    Experian P.O. Box 2104 Allen, TX 75013-0949 1-888-397-3742

                    In the letter copy the item from the bank and ask the bureau to have the item proven. The letter would look something like this..Be sure to print a copt of your report from that bureau and circle the offending item. I like to circle in red so it stands our but color doesn’t really matter.

                    Your Name
                    Your Address
                    Your City, State, Zip Code

                    Complaint Department
                    Name of Credit Bureau
                    City, State, Zip Code

                    Dear Sir or Madam:

                    I am writing to dispute the following information in my file. The items I dispute also are encircled on the attached copy of the report I received.

                    This item (identify item(s) disputed by name of source, such as creditors or tax court, and identify type of item, such as credit account, judgment, etc.) is (inaccurate or incomplete) because (describe what is inaccurate or incomplete and why). I am requesting that the item be deleted (or request another specific change) to correct the information.

                    Enclosed are copies of (use this sentence if applicable and describe any enclosed documentation, such as payment records, court documents) supporting my position. Please reinvestigate this (these) matter(s) and (delete or correct) the disputed item(s) as soon as possible.


                    Your name

                    Enclosures: (List what you are enclosing)

                    Include anything proving the account was closed with a zero balance and in a satisfactory manner. You can get this from the bank if needed by visiting a branch. Or you can simply ask in the second paragraph that they prove the account is open and it’s current standing. When the bank can not the bureau must close the item. You can even ask it be removed because it was reported incorrectly and may be influencing your credit negatively.

                    You can request it be deleted or you can request it be modified to accurately reflect a close account zero balance. I ussually tend toward delete but if closed satisfactory would help your score at all you should consider that. 🙂


                    Liked by 1 person

                    Comment by Michelle Styles — December 19, 2018 @ 08:30

                    • Oh yes last thing send it US Postal Services, certified and signature required. Because the bureau only has 30 days from receipt to prove the debt or toremove the item.

                      hugs and hope this helps with that last pesky item.

                      Liked by 1 person

                      Comment by Michelle Styles — December 19, 2018 @ 08:31

                    • Thank you. I will try it. I tried the automated dispute thing on one of the reports and nothing happened. I will try again. Hugs


                      Comment by Scottie — December 19, 2018 @ 12:11

              • PS It will take you some research and I could likely help some. Get the bankruptcy removed from you credit.

                You need a carefully written letter to each agency (all 3). It needs to request how they verify a bankruptcy. They will respond by saying “with the courts’ This is pattently false. The courts do not report fillings. When the court gives you in writting that the agency never verified the information you write another careful letter demanding the removal of unverified information and include the court letter. That same letter needs to advise that any attempt to readd it is against the law under FCRA. See all debts must be verified and the courts never report in a way that is legally verified.

                They may choose to ignore your letter which must be certified and signature required. If in 30 days they have not responded in writting you simply file a contest letter that states no reply to the verification request means the debt or item is immediately seen as invalid and must by law be removed.

                You have other options as well to accomplish the same thing. But bankrupcy can be removed increasing your credit scores by 100-200 points instantly!

                Wish I knew when you had these problems I could have sent you all the letters you needed.


                Liked by 1 person

                Comment by Michelle Styles — December 18, 2018 @ 16:34

                • Thank you Michelle. We did not tell any one as we felt ashamed. We did what we had to. I will show this to Ron and see what he wants to do. I know it is a subject he doesn’t like to talk about. He and the lawyer handled everything and I simply signed where told, as I did not understand it all. I was told this was the only way to save our home and stuff. We are doing OK now, we have food in our bellies and a roof over our head. We kept our home. Hugs Thanks for your advice. Hugs


                  Comment by Scottie — December 18, 2018 @ 17:26

  2. “I believe health care is a right, not a privilege.” $Amen$, to that, brother! You lovable, liberal, leftist bastard you! 🙂

    Liked by 1 person

    Comment by inspiredbythedivine1 — December 18, 2018 @ 13:26

    • Yup that is me a proud liberal. I never understood letting the republicans making that word a pejorative. I say take back the word and be proud of it. Hey we gays did it, we took their hate for gays and created LGBTQ pride. I think you are a liberal also and a dang good one. So I join you in the progressive cause. Hugs

      Liked by 1 person

      Comment by Scottie — December 18, 2018 @ 15:16

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