4 Stitches at ER cost $1315 dollars?!

[Aardvark]

I recently moved to the US.
This is my first experience with the infamous US healthcare system.
I am on Sedera Health Share (due in large part to the support that this community has shown for it).

A few weeks ago I fell off of my bicycle and needed stitches on my chin. This was around midnight, so I went to a local ER (Boulder Community Health). Today I received two bills, one from the hospital, and one from the Emergency Physicians. The bills sum to $1315.

According to Healthcare Bluebook, prices for my zip-code are WAY less than what I have been billed (see attachments for screenshots).

So the big questions is:
Can anybody tell me what - in their experience - is the expected cost of getting 4 stitches at an ER?

[Omy]

Mine was just the copay for the ER in 2013. 7 stitches and a tetanus booster cost me $300, I think. Urgent care would probably have been a less expensive option.

[dandarc]

$1300 cash price for an ER visit sounds fairly reasonable to me - varies widely of course. Reasonable as in that's what I'd expect to pay at a US ER, maybe even low. Not to mean this is the way it should be, just the way it is.

I see one post on this whole forum that even mentions Sedara and only "a little better than some other one". Healthshares on the whole are insurance that don't really have to actually pay (so, not really insurance), so I'd personally stay away from them. Marketplace insurance is regulated in a way these things are not.

[Aardvark]

Thanks for the perspective.

@Omy  Urgent Care was not open - this happened at about 1am

@dandarc  MMM has an entire page dedicated to why Sedera is something worth considering. I am currently unemployed and started with Sedera before the open enrollment period. In certain circumstances Sedera would offer me some benefits over traditional healthcare... But in general I agree with you that if you can access healthcare via your employer that is almost certainly the best option.
https://www.mrmoneymustache.com/sedera/

[dandarc]

Pete is wrong on this for most people - unless you're a millionaire many, many times over like he is you probably can't afford to find out the hard way that your health share doesn't have the capacity to share as much as you need. One small accident like this obviously won't bankrupt you - worst case you pay the bills (again, that's a reasonable price at an ER - urgent care is generally less expensive but you'd probably still be looking at $500 roughly, maybe more) and get nothing from your <not insurance>. Something real bad happens? Good luck.

Anyway - submit your need (they cannot call it a claim - that sounds like insurance, just like they don't have deductibles, no - it is called an "Initial Unshared Amounts") and see what Sedara has to say about it. Probably too small to worry about for them, but please do report back your experience.

[terran]

What's done is done, but for anyone else reading this I wouldn't follow MMM's healthcare/health insurance advice. He seems a little out of touch, perhaps through some combination of being too healthy thanks to luck and too rich thanks to the blog.

It might be too late depending on when you moved, but moving to a new area is an open enrollment exception, so you could (have) sign(ed) up for health insurance regardless of when you moved. Since you're unemployed you could also see about getting on medicaid (not sure if it has an open enrollment period? Also not sure how it works for non-citizens?).

[boarder42]

i dont think there are any real issues with his healthshare advice.  I think its a good solution for people with very FAT Fires.  OP you can call and negotiate these rates down cash prices are almost always negotiable when you tell them you dont have insurance. Compound that with being unemployed and you can probably get some type of lower income support.   Typically with companies like sedera your full 1315  would count against your deductible and what ever you negotiate down is savings you can keep. 

[maisymouser]

What's done is done, but for anyone else reading this I wouldn't follow MMM's healthcare/health insurance advice. He seems a little out of touch, perhaps through some combination of being too healthy thanks to luck and too rich thanks to the blog.

It might be too late depending on when you moved, but moving to a new area is an open enrollment exemption, so you could (have) sign(ed) up for health insurance regardless of when you moved. Since you're unemployed you could also see about getting on medicaid (not sure if it has an open enrollment? Also not sure how it works for non-citizens?).

+1

You got off pretty lucky with an ER bill of only $1300 or so. Agreed with others- I would avoid MMM's healthcare advice like the plague. It works- if you are a gambler. There are a wide array of surprise injuries and sudden unavoidable health conditions anyone could have to deal with at any moment, and I sleep better at night knowing I have solid health insurance.

[K_in_the_kitchen]

We have health insurance.  For us, a trip to the ER would cost $500 for our deductible and then 20% of the rest of the charges, but to our benefit the charges are agreed upon between the hospital and the insurance.

Short of not being able to stop the bleeding, we wouldn't go to the ER for stitches -- we would clean up the wound, use steri-strips to close it, and show up at the urgent care when they opened in the morning.  Assuming we didn't suspect a concussion or broken bones, of course -- those we seek immediate care for no matter what time it is.  Urgent care for us is $20, plus another $20 if they take an X-ray.  ER always starts at $500 and goes up from there.  DH got sent to the ER (transfer from urgent care) last year for a bad concussion.  I just checked and our portion was just under $800.

[seattlecyclone]

I strongly encourage everyone considering a health sharing ministry to watch John Oliver's video on the topic before signing up. In short: it's not insurance, they pay for your care only if they feel like it, and they often don't feel like it.

[SimpleCycle]

It is $1795 to walk through the door at my local ER.  The stitches would be more on top of that, and the doctor fee.  You got a deal, honestly.

Health shares are not insurance, and shouldn't be treated as such.  I'd self pay for most medical care and get a catastrophic policy before I'd do a health share.  It's not the first $25k of health care that bankrupts you, it's the next million.

Edited to add: you looked up a 99281, is that what you were actually billed?  I have never gotten out of an ER without getting billed at least a 99283.

[HPstache]

Unfortunately, that's about right for an ER visit for stitches...  My son got 2 in his finger for closer to $2,000 .  On our HDHP we avoid the ER if we can and go to the walk-in clinic / urgent care, etc when possible.  FWIW, I think health shares are good for many... would definitely participate one if I didn't have insurance thru work.

[BeanCounter]

Spent 15 years in health insurance finance. Avoid any and all health shares at all cost. That is NOT insurance. They are not licensed and insured by the state so if they go bust your screwed. They don't have any legal obligation to pay any claims. Complete waste of money. Even for those with millions in assets. You're better off with an extreme high deductible plan.

If you are low income and uninsured call the hospital and negotiate.

[neophyte]

It is $1795 to walk through the door at my local ER.  The stitches would be more on top of that, and the doctor fee.  You got a deal, honestly.

Yep. I passed out at work a few years ago and paid $2k for the honor of sitting in the waiting room and vomiting for 4 hours.  Once I could stand without tossing my cookies, I went home. I saw the triage nurse when I first got there, but other than that I wasn't even looked at and I never left the waiting room. My coworkers called an ambulance and the 1 block ride was another $1000.

[jim555]

Get real insurance.  $1,315 actually sounds cheap.

[innkeeper77]

The majority of people here would NOT support a health sharing scheme, they are very suspect and many/all are “scams” by some definition.

I’m just here to add to the chorus of people saying GET INSURANCE. Even if it’s just catastrophic insurance (super high deductible, generally cheaper premiums) you need health insurance in this country to protect against life altering financial ruin.

$1350 is super cheap, we were charged $4000 for some ibuprofen and saline IV bags.

[Taran Wanderer]

Shoot, we paid about that for Canadian ER visit for stitches three years ago. We’re American, so so much for socialized healthcare, eh? No complaints on the quality of care, and TBH, here it probably would have cost $1,800 like my 45 minute local ER visit for a dislocated finger.

As for why it costs $1,800, you’re paying for a doctor, nurse(s), and supporting staff to be available 24/7 just in case you go in for stitches or a heart attack or stroke or car accident with major trauma. It’s not free to keep all those people and diagnostic and treatment equipment ready and available. The cost gets averaged out over even mundane stitches and dislocations.

[MoseyingAlong]

....
$1350 is super cheap, we were charged $4000 for some ibuprofen and saline IV bags.

Yeah, that $4,000 was for "some ibuprofen and saline IV bags."
The facility, equipment and staffing were free.
The years of training, education and experience of the staff and providers were free.
The knowledge that you just needed "some ibuprofen and saline IV bags" and weren't having a stroke was free.
The freaking electronic health records systems and storage were free.
The personnel to process insurance claims were free.

As you can tell, I get so frustrated when people reduce medical care to the most basic part of the treatment. If you didn't want all the associated services, go to Walgreens next time and pick up some OTC meds and drink some electrolyte water.

[Car Jack]

You got a bargain.

My son had excruciating pain in his stomach.  We brought him to the ER.  Got him checked in.  They quickly looked at him and said that it'll pass, go home.

ER standard fee (this is if he checked in and walked out) $1000
Gastro intestinal group fee  $800
ER doctor fee  $400

This is the US health care system.  If you have insurance, it's less expensive, but still a couple hundred for co-pays unless it's the beginning of the year and then until we hit $5k, they pay nothing.

[ChickenStash]

....
$1350 is super cheap, we were charged $4000 for some ibuprofen and saline IV bags.

Yeah, that $4,000 was for "some ibuprofen and saline IV bags."
The facility, equipment and staffing were free.
The years of training, education and experience of the staff and providers were free.
The knowledge that you just needed "some ibuprofen and saline IV bags" and weren't having a stroke was free.
The freaking electronic health records systems and storage were free.
The personnel to process insurance claims were free.

As you can tell, I get so frustrated when people reduce medical care to the most basic part of the treatment. If you didn't want all the associated services, go to Walgreens next time and pick up some OTC meds and drink some electrolyte water.

I'm glad to see this called out, particularly the line about the EHR costs (or healthcare IT, in general) since that happens to be the industry I work in. :) The costs to build and maintain those systems are staggering in equipment, software, and people needed to keep it all working. All that has to be accounted for if the hospital expects to stay open.

[SpaceCow]

I had a similar situation a few years ago. Fell off my bike avoiding a deer during a 1AM bike ride. Needed 10 stitches in the ER and copious (perhaps unnecessary) x-rays. IIRC it cost 3 grand. I wanted to wait till urgent care was open, but my parents who picked me up off the side of the road wouldn't let me.

[Dr Kidstache]

ER standard fee (this is if he checked in and walked out) $1000
Gastro intestinal group fee  $800
ER doctor fee  $400

I wonder if the OP has actually gotten all the bills and knows it's *only* $1315? Some ERs do bill separately for physician services and imaging/labs.

[innkeeper77]

....
$1350 is super cheap, we were charged $4000 for some ibuprofen and saline IV bags.

Yeah, that $4,000 was for "some ibuprofen and saline IV bags."
The facility, equipment and staffing were free.
The years of training, education and experience of the staff and providers were free.
The knowledge that you just needed "some ibuprofen and saline IV bags" and weren't having a stroke was free.
The freaking electronic health records systems and storage were free.
The personnel to process insurance claims were free.

As you can tell, I get so frustrated when people reduce medical care to the most basic part of the treatment. If you didn't want all the associated services, go to Walgreens next time and pick up some OTC meds and drink some electrolyte water.

You misunderstand. The bill was ITEMIZED. (I don't remember exavtly how much everything was, but I remember distinctly that each small saline bag was $800, this was an in network provider, and prices I am quoting were after insurance)

Yeah. We get that people need to be paid. Somehow other countries have figured out how to do that without costing the end users stupid amounts of money at the time of use.

[mjr]

In Australia, cost at a public hospital emergency room:  $0.  Cost at a GP's surgery, maybe $100.

I know you're all aware at how borked the US health care system is, but it's astounding to me how resigned you all are to it.

[Omy]

Because change seems impossible here....unless it's to go backward in time when abortions were banned and segments of the population couldn't vote.

[seattlecyclone]

In Australia, cost at a public hospital emergency room:  $0.  Cost at a GP's surgery, maybe $100.

I know you're all aware at how borked the US health care system is, but it's astounding to me how resigned you all are to it.

It's not actually free in Australia, you just have that cost covered by someone else. That cost is likely a fraction of what is charged in the US. Our prices here make no sense at all. Yes, of course you have to pay the doctor and other staff for their time. Yes, of course you need to pay for a share of the cost of the facility's capital and operating expenses. Yes, of course you need to pay for the cost of any supplies used. The fact remains that other rich countries build and run similar facilities for much less money.

[MoseyingAlong]

....
$1350 is super cheap, we were charged $4000 for some ibuprofen and saline IV bags.

Yeah, that $4,000 was for "some ibuprofen and saline IV bags."
The facility, equipment and staffing were free.
The years of training, education and experience of the staff and providers were free.
The knowledge that you just needed "some ibuprofen and saline IV bags" and weren't having a stroke was free.
The freaking electronic health records systems and storage were free.
The personnel to process insurance claims were free.

As you can tell, I get so frustrated when people reduce medical care to the most basic part of the treatment. If you didn't want all the associated services, go to Walgreens next time and pick up some OTC meds and drink some electrolyte water.

You misunderstand. The bill was ITEMIZED. (I don't remember exavtly how much everything was, but I remember distinctly that each small saline bag was $800, this was an in network provider, and prices I am quoting were after insurance)

Yeah. We get that people need to be paid. Somehow other countries have figured out how to do that without costing the end users stupid amounts of money at the time of use.

Okay, that the charge was itemized was not clear in your original post.
I agree that seems crazy.

[Cranky]

Because change seems impossible here....unless it's to go backward in time when abortions were banned and segments of the population couldn't vote.

Looks like we’re heading back there anyway.

[Case]

....
$1350 is super cheap, we were charged $4000 for some ibuprofen and saline IV bags.

Yeah, that $4,000 was for "some ibuprofen and saline IV bags."
The facility, equipment and staffing were free.
The years of training, education and experience of the staff and providers were free.
The knowledge that you just needed "some ibuprofen and saline IV bags" and weren't having a stroke was free.
The freaking electronic health records systems and storage were free.
The personnel to process insurance claims were free.

As you can tell, I get so frustrated when people reduce medical care to the most basic part of the treatment. If you didn't want all the associated services, go to Walgreens next time and pick up some OTC meds and drink some electrolyte water.

You misunderstand. The bill was ITEMIZED. (I don't remember exavtly how much everything was, but I remember distinctly that each small saline bag was $800, this was an in network provider, and prices I am quoting were after insurance)

Yeah. We get that people need to be paid. Somehow other countries have figured out how to do that without costing the end users stupid amounts of money at the time of use.

It seems I and others do not believe your 1am ER stitches bill is unreasonable, even though this is the US with it’s issues.  Healthcare is screwed up here, but also our taxes are lower than many progressive countries with free healthcare care.

[Plina]

Shoot, we paid about that for Canadian ER visit for stitches three years ago. We’re American, so so much for socialized healthcare, eh? No complaints on the quality of care, and TBH, here it probably would have cost $1,800 like my 45 minute local ER visit for a dislocated finger.

As for why it costs $1,800, you’re paying for a doctor, nurse(s), and supporting staff to be available 24/7 just in case you go in for stitches or a heart attack or stroke or car accident with major trauma. It’s not free to keep all those people and diagnostic and treatment equipment ready and available. The cost gets averaged out over even mundane stitches and dislocations.

Why would Canada susbsidize your healthcare? There are different pricelist for tourists and people living in the country. Tourist are expected to have travel insurance.

[Dr Kidstache]

It seems I and others do not believe your 1am ER stitches bill is unreasonable, even though this is the US with it’s issues.  Healthcare is screwed up here, but also our taxes are lower than many progressive countries with free healthcare care.

I think the amount he was billed is not unexpected. Very different from thinking it's not unreasonable. It's absolutely unreasonable. And the OPs shock at the first encounter with the commoditization of medical care in the US is a good illustration of just how unreasonable it is if you have experienced the health care systems of other developed countries.

{Side note: It's also a fallacy to equate the US tax structure with our failure to provide universal healthcare. There are interactions between taxes and healthcare provision but it is certainly not causal.}

[Taran Wanderer]

It seems I and others do not believe your 1am ER stitches bill is unreasonable, even though this is the US with it’s issues.  Healthcare is screwed up here, but also our taxes are lower than many progressive countries with free healthcare care.

I think the amount he was billed is not unexpected. Very different from thinking it's not unreasonable. It's absolutely unreasonable. And the OPs shock at the first encounter with the commoditization of medical care in the US is a good illustration of just how unreasonable it is if you have experienced the health care systems of other developed countries.

{Side note: It's also a fallacy to equate the US tax structure with our failure to provide universal healthcare. There are interactions between taxes and healthcare provision but it is certainly not causal.}

To be honest, I really wasn’t sure what to expect. In the end, the total price was lower than what we would be charged at home, our insurance paid most, and we paid some. What was a little different was that we had to pay up front about $500 before service began. (Technically, DW went with DS to treatment while I broke out the credit card at the admitting desk.)  We had excellent care, quickly, at a pretty reasonable price. No complaints.

[Abe]

You are being charged what the hospital bills to cover several things:

1. Discount they have negotiated with insurance companies (which never pay the billed amount)
2. Costs for under-insured (i.e. have insurance but can't pay the copay / deductible)
3. Costs for uninsured patients
4. Facility and staffing costs

So basically they're trying to make as much money off you as they can to compensate for losses elsewhere. There are many byzantine rules regarding what can be charged extra (usually items such as medicine) and what can't (staffing costs per day, for example). These vary extensively between states. Welcome to America!

Also agree that health shares are basically scams run by people that are morally opposed to government mandates on health insurance requirements.

[Aardvark]

Wow - This post saw more replies than I expected. Thanks for all the insights.
It's clear that my bills are standard or below standard - which is all that I really wanted to find out.

RE Sedera: Because my bills sum to more than $1.5k they are initiating a negotiation process to try and reduce the rates. As I understand it this can take a few weeks. The comments above are interesting as they clearly lean against MMM's opinions. I will give this some thought and possibly switch to the marketplace. Thanks for all the insights.

[Sibley]

@Aardvark Everyone has bias and eccentricities. MMM is no exception. One of his is his attitude towards insurance in general. Now, if you happen to have $5 million in the bank or whatever, odds are that you're going to be ok without insurance. You can afford to pay $1 or 2 million for cancer treatment, or shell out $300k to rebuild the house. Most people can't (even here!).

If you blindly follow anything or anyone, it's going to get you in trouble eventually. You blindly followed MMM's guidance on insurance, without truly understanding the health care situation here in the US. Be grateful that you got your reality check on a relatively small amount. The next reality check is that there are specific timeframes or situations during which you can sign up for ACA. I'm not current on those dates, but it's entirely possible that you've missed them entirely and could have to wait 6 or more months to sign up.

(Edit cause I hit the button too soon)

[dandarc]

@Aardvark Everyone has bias and eccentricities. MMM is no exception. One of his is his attitude towards insurance in general. Now, if you happen to have $5 million in the bank or whatever, odds are that you're going to be ok without insurance. You can afford to pay $1 or 2 million for cancer treatment, or shell out $300k to rebuild the house. Most people can't (even here!).

If you blindly follow anything or anyone, it's going to get you in trouble eventually. You blindly followed MMM's guidance on insurance, without truly understanding the health care situation here in the US. Be grateful that you got your reality check on a relatively small amount. The next reality check is that there are specific timeframes or situations during which you can sign up for ACA. I'm not current on those dates, but it's entirely possible that you've missed them entirely and could have to wait 6 or more months to sign up.

(Edit cause I hit the button too soon)

If you want coverage to start on January 1st 2022, tomorrow is the day. Open Enrollment is available through 1/15 but I think that would be a later start date for coverage.

ETA: Link with full explanation: https://www.healthcare.gov/quick-guide/dates-and-deadlines/

[Aardvark]

@Aardvark
If you blindly follow anything or anyone, it's going to get you in trouble eventually. You blindly followed MMM's guidance on insurance, without truly understanding the health care situation here in the US.

You are full of assumptions. You don't know me. You don't know how much time/effort I did or didn't put into researching Sedera before signing up for it. You also don't know anything about the context which I am operating in. You also assume that I don't know about open enrollment periods. You should choose your words more carefully or keep quiet.

[Aardvark]

If you want coverage to start on January 1st 2022, tomorrow is the day. Open Enrollment is available through 1/15 but I think that would be a later start date for coverage.

ETA: Link with full explanation: https://www.healthcare.gov/quick-guide/dates-and-deadlines/

Thanks for the link Sibley.

[ixtap]

@Aardvark
If you blindly follow anything or anyone, it's going to get you in trouble eventually. You blindly followed MMM's guidance on insurance, without truly understanding the health care situation here in the US.

You are full of assumptions. You don't know me. You don't know how much time/effort I did or didn't put into researching Sedera before signing up for it. You also don't know anything about the context which I am operating in. You also assume that I don't know about open enrollment periods. You should choose your words more carefully or keep quiet.

Or, perhaps you should choose your words more carefully, since you were the one who said this was MMM approved multiple times.

[Aardvark]

Or, perhaps you should choose your words more carefully, since you were the one who said this was MMM approved multiple times.

MMM certainly influenced my decision, but I did a lot of other research too. Given that this is a MMM forum I noted that MMM seems to strongly approve of Sedera.

I'm not trying to pick a fight here. But I am also not looking to be scolded for my decisions without even being asked why I made them. I did actually put a lot of time into this decision, and feel as though I understand the up and down sides of both Sedera and the marketplace quite well. If you disagree with my decisions that's fine, but don't make it personal.

I probably should have just ignored that message instead of reacting to it - sorry about that.

[Dr Kidstache]

I did actually put a lot of time into this decision, and feel as though I understand the up and down sides of both Sedera and the marketplace quite well.

At the risk of poking the bear, you absolutely don't understand the up and down sides of a health share. How do I know this? Because it's impossible for a consumer without special expertise to understand health care delivery in the US. I have multiple advanced degrees in medicine, I'm published in NEJM on health care delivery, and even I find many aspects of the incentives/disincentives of insurance options baffling. That said, I don't know a single person with expertise in health care delivery in the US who considers health shares a viable alternative to marketplace health insurance.

I'm not singling you out, because you're in the same position as most people in the US and just trying to make the best possible decision for your particular circumstances. At it's best, making health insurance decisions are frustrating. At it's worst, it can financially (and physically) devastate sick people. Get on a marketplace plan, get out of the health share, and count yourself lucky that your first exposure to US medical care was so cheap and uncomplicated.

[Aardvark]

Haha, thanks for the sensitivity @Dr Kidstache :)
I see what you're saying and agree with you. I should have been more particular with my words and said that although healthcare is an absolute mess in the US, and that understanding the up and downsides of Sedera is almost impossible... I did spend a lot of time on this, and - given the pretty unique situation that I am in - I decided to take the risk/gamble of going with them for a few months (probably 4 months max) until either (1) I get a job and go onto an employers healthcare or (2) the open enrollment period runs out.

From what I understand I'm probably not much worse off than I would have been with a catastrophic healthcare plan. And yes - I am super grateful that all I needed was 4 stitches.