After my son hurt himself badly at school, I wondered how much the hospital would charge us. Not the first time I thought the American health system is quite unhealthy.
Last Friday, my 8-year-old son Yann fell from the top of a slide and landed on his back 10 feet below. The pain was excruciating and took his breath away. Since the fall happened at school during recess, children were evacuated from the playground while the nurse and the principal rushed toward Yann. Before they called my husband and me, he was brought to the nurse’s room in a wheelchair.
At the hospital, the pediatrician in charge decided to take some x-rays. I was there when they took four pictures of his neck and back. Altogether, we spent a little over three hours in the emergency room.
I still don’t know how much the Suburban Hospital of Bethesda will charge us. I’m not too worried, as we have an excellent insurance coverage through my husband’s employer. After he broke a vertebra last month, I’ve thoroughly tracked bills from my husband’s health care providers and checked our Aetna payments. I’m 100% sure that I’ll observe similar findings once I receive my son’s claims
Thankfully, my son is fine. His guardian angel must be a superhero—no broken bones or concussion. He’s only suffering from muscular pain and is excused from PE.
Why do medical providers charge so much?
Here is a summary of my husband’s invoices, split between the amount billed, the negotiated member rate, and our out-of-pocket payments. For his injury, my husband got a CAT scan, and we spent almost six hours at the hospital.
| Amount Billed | Member Rate | Out-of-pocket expenses | |
|---|---|---|---|
| Bethesda Physician Services | $ 666.00 | $ 211.87 | $ 23.54 |
| Dr. A. H. Syed | $ 897.00 | $ 236.71 | $ 26.30 |
| Suburban Hospital | $ 1,226.68 | $. 817.36 | $ 392.67 |
I quickly noticed the difference between the amount billed and the member rate. Aetna paid 35% of the bill from Bethesda Physician Services, 30% of the CAT scan, but 67% of the Suburban Hospital bill. How am I supposed to understand this breakdown?
Is the member rate lower because health issues are negotiated like bulk products by the insurance companies? Or, are health providers overcharging patients? Are providers overcharging because they want to compensate for their losses after the member rate is applied?
Costs of service in Germany vs the US
When I go to Germany, I visit my gynecologist. I trust her a lot since she delivered my two youngest children and has treated me for over 15 years. Last summer, I paid $215 for a routine visit, including diagnostic sonography. My American OB-GYN charged $320 for a similar visit last February, without sonography.
Is the 50% surcharge in the US due to the costs of a professional liability insurance? According to this website, the average cost of an individual provider’s Medical Malpractice Insurance is $7,500 annually.
Just like in the US, German doctors may charge different amounts for the same service. But, I don’t understand the varied bills from psychologists that some family members have visited, ranging from $135 to $285. That disparity can’t be due to malpractice insurance alone.
When Obama Care launched, I wondered why the program didn’t try to limit the price of drugs or exams. As a result, I keep feeling that the American health care system is “unhealthy”!
Out of curiosity, I used this German website to get an idea of what a psychologist in Germany pays for professional liability. Depending on the insurance company, German psychiatric professionals pay yearly between $500 and $1000.
Germans, or more generally Europeans, are not as eager to sue others as Americans are. Maybe that’s why insurance policies for European medical providers are less expensive…
A few final thoughts on health care
I’ve known that I wanted to talk about the American health system for a while. I never did because my knowledge is limited to our insurance and family of seven. Furthermore, I’m not sure I fully understand all differences! Today, I’ve only shared my observations and asked many questions. Can anyone shed more light on my view of the unhealthy American health care system??
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As long as human being will need to keep surviving and push the day of the death, the one who will be able to offer the best medicine will have better chance to achieve this goal. I don’ t trust the medics, the layer, the insurance and whoever is trying to say to me that I will have a better ‘life’ with all of these….,
It is nearly a common sense to say that the US healthcare System is not healthy 🙂 nevertheless your real own experience is worthier than any article on the US healthcare system. Thanks for sharing! Actually the system in Europe is not really easy to understand either. The system is based on a solidarity basis and according to my own very European opinion, it is absolutely okay. The healthcare services are probably cheaper because they are controlled by the state which pays for them. Nevertheless the system is quite expensive. Until now I have been lucky enough to pay much more (through the social taxes) than I received medical services. The taxes are quite high but I know that if I or a family member get a bad disease we will be covered. I also know that my old neighbor will not have difficulties to pay her hospital stay or that no children will stay in pain because the family cannot afford the hospital. Nevertheless I would appreciate more transparency. Sometimes ago, the Austrian social security insurance sent each insured patient once a year the details of the interventions with their costs. I found this very informative. Some people complained that they felt guilty when receiving this. They stopped sending this statement, unfortunately.
Thank you Christine.
US healthcare is incredibly confusing and expensive. If you don’t have a good insurance plan through an employer, things can get even worse in the case of an emergency. What’s in network, what’s covered, what’s not. Makes my head spin. Posting on FB for you to see if anyone can shed more light on the complicated topic.
Great, thanks Diane
Pour comparer, une intervention en France avec une seule journée d’hospitalisation à l’hopital public en aout 2015 m’a couté 4000 euros (remboursable plus tard par mon assurance, mais c’était le montant de ma facture).
Intervention = chirurgie ? Et hospitalisation = 1 nuit à l’hôpital ?