Urgent Care bill - does this seem high?
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Urgent Care bill - does this seem high?
A month ago my toddler poked me in the eye by accident, and I had a lot of pain and blurry vision. I went to Urgent Care, and they got me in quickly and were very nice and competent. They gave me a vision test, and then put some dye drops in my eye, and looked at it, diagnosed a scratched cornea, and prescribed some antibiotic drops. They told me I would feel a lot better in a few days, and that wound up being true. The whole visit took about 15 minutes. I paid $75 at the time of the visit.
I have a high deductible insurance plan. I just got a bill (not itemized or anything) showing that that cost of the visit was $449, and after insurance adjustments of $220 and my $75 payment, I still owe $154. Does this seem reasonable, or high?
This is the type of thing I would normally just grumble and pay, but I’d like to start paying more attention to fees and bills that seem excessive.
I have a high deductible insurance plan. I just got a bill (not itemized or anything) showing that that cost of the visit was $449, and after insurance adjustments of $220 and my $75 payment, I still owe $154. Does this seem reasonable, or high?
This is the type of thing I would normally just grumble and pay, but I’d like to start paying more attention to fees and bills that seem excessive.
Re: Urgent Care bill - does this seem high?
Sounds about right.
Re: Urgent Care bill - does this seem high?
Seems reasonable to me.
But if you want to try and save a few bucks, go ahead and grumble. Maybe you'll get lucky.
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Re: Urgent Care bill - does this seem high?
Do you get an explanation of benefits from your insurance? It should be itemized, and it may say provide some markdowns. The urgent care should give you an itemized bill that you can compare.
Re: Urgent Care bill - does this seem high?
Seems about right, you are not just paying for their actual time with you, but also their availability as an urgent care clinic. There are days few people show up, they get paid those days also. I would look at an itemized bill, no way you can judge without that, but doesn't seem crazy to me for an urgent care bill. They might knock to down a bit if you look at the itemized bill and complain about specific items. Hard to know until you try.
Re: Urgent Care bill - does this seem high?
$229
Sounds like a reasonable cost. Unfortunately, medical costs are high across the board. When you asked if it seems high, I was expecting a multi-thousand dollar bill.
Sounds like a reasonable cost. Unfortunately, medical costs are high across the board. When you asked if it seems high, I was expecting a multi-thousand dollar bill.
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Re: Urgent Care bill - does this seem high?
Sounds about right to me. From the title. I was expecting something like $5K. It's urgent care. A couple hundred bucks is to be expected. The staff, equipment, etc. is expensive, and you pay overhead when using a service designed to be ready at a moment's notice. Cheaper than an ER, that's for sure!
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Re: Urgent Care bill - does this seem high?
Well, this is the disconnect I have between how people say HDHP's work and what people post about their actual experience.
It's not at all high as a chargemaster rate. This is the weird rate that hospitals bill at. With normal insurance, the bill goes to a private insurer who pays a negotiated rate that is typically on the rough order of 1/4 to 1/2 of the chargemaster rate, or the bill goes to Medicare who pays the Medicare approved rate, which again is 1/4 to 1/2 of the chargemaster rate--and the provider accepts it.
If you are uninsured you get a bill for the chargemaster rate.
And in theory people say that on an HDHP plan, you personally pay the insurer's negotiated rate, not the exorbitant chargemaster rate. Yet we seem to get about one posting per year from people from people who seem to have been billed directly at the chargemaster rate, typically by an ER. I'm thinking urgent care might be similar.
It might be worth a couple of hours on the phone alternatively calling the urgent care office and the insurance customer service number to find out if you got billed the chargemaster rate and if you can get it reduced to the negotiated rate.
It's not at all high as a chargemaster rate. This is the weird rate that hospitals bill at. With normal insurance, the bill goes to a private insurer who pays a negotiated rate that is typically on the rough order of 1/4 to 1/2 of the chargemaster rate, or the bill goes to Medicare who pays the Medicare approved rate, which again is 1/4 to 1/2 of the chargemaster rate--and the provider accepts it.
If you are uninsured you get a bill for the chargemaster rate.
And in theory people say that on an HDHP plan, you personally pay the insurer's negotiated rate, not the exorbitant chargemaster rate. Yet we seem to get about one posting per year from people from people who seem to have been billed directly at the chargemaster rate, typically by an ER. I'm thinking urgent care might be similar.
It might be worth a couple of hours on the phone alternatively calling the urgent care office and the insurance customer service number to find out if you got billed the chargemaster rate and if you can get it reduced to the negotiated rate.
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Re: Urgent Care bill - does this seem high?
Thanks everyone. I will ask for an itemized bill, but it does seem that most of you think this was reasonable. I just wanted to confirm that it was. I don’t know how lower income people can afford bills like this every time they have a minor issue though.
Re: Urgent Care bill - does this seem high?
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Re: Urgent Care bill - does this seem high?
sounds fairly cheap
Re: Urgent Care bill - does this seem high?
I thought the "insurance adjustment" referred to the negotiated discount?nisiprius wrote: ↑Wed Mar 03, 2021 3:07 pm Well, this is the disconnect I have between how people say HDHP's work and what people post about their actual experience.
It's not at all high as a chargemaster rate. This is the weird rate that hospitals bill at. With normal insurance, the bill goes to a private insurer who pays a negotiated rate that is typically on the rough order of 1/4 to 1/2 of the chargemaster rate, or the bill goes to Medicare who pays the Medicare approved rate, which again is 1/4 to 1/2 of the chargemaster rate--and the provider accepts it.
If you are uninsured you get a bill for the chargemaster rate.
And in theory people say that on an HDHP plan, you personally pay the insurer's negotiated rate, not the exorbitant chargemaster rate. Yet we seem to get about one posting per year from people from people who seem to have been billed directly at the chargemaster rate, typically by an ER. I'm thinking urgent care might be similar.
It might be worth a couple of hours on the phone alternatively calling the urgent care office and the insurance customer service number to find out if you got billed the chargemaster rate and if you can get it reduced to the negotiated rate.
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Re: Urgent Care bill - does this seem high?
This might not have been a minor issue, though, but I’m glad it turned out to be.I-Know-Nothing wrote: ↑Wed Mar 03, 2021 3:12 pm I don’t know how lower income people can afford bills like this every time they have a minor issue though.
I think the problem with minor issues is when people go to the ER for symptoms of a cold or flu.
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Re: Urgent Care bill - does this seem high?
Since your bill was discounted by half with an insurance adjustment, seems like you received the discounted contract rate.
Bill seems reasonable for an urgent care visit. You were likely happy to receive same day care which is important with eye injuries in case of a detached retina or something else where time matters. Consider having a sinking fund where you deposit some money to cover your HDHP deductible so you are prepared after a provider visit for the larger out-of-pocket payments under a HDHP in exchange for lower upfront premiums.
Bill seems reasonable for an urgent care visit. You were likely happy to receive same day care which is important with eye injuries in case of a detached retina or something else where time matters. Consider having a sinking fund where you deposit some money to cover your HDHP deductible so you are prepared after a provider visit for the larger out-of-pocket payments under a HDHP in exchange for lower upfront premiums.
Last edited by HomeStretch on Wed Mar 03, 2021 3:42 pm, edited 1 time in total.
Re: Urgent Care bill - does this seem high?
For those $300 you also now have the right to sue for a million dollars if you perceive your care to be less than satisfactory.
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Re: Urgent Care bill - does this seem high?
Seems very reasonable to me.
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Re: Urgent Care bill - does this seem high?
Seems about right or slightly less than average.
Re: Urgent Care bill - does this seem high?
Sounds reasonable to me, whenever I go to urgent care I expect a bill around $200.
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Re: Urgent Care bill - does this seem high?
This sounds reasonable.I-Know-Nothing wrote: ↑Wed Mar 03, 2021 2:46 pm A month ago my toddler poked me in the eye by accident, and I had a lot of pain and blurry vision. I went to Urgent Care, and they got me in quickly and were very nice and competent. They gave me a vision test, and then put some dye drops in my eye, and looked at it, diagnosed a scratched cornea, and prescribed some antibiotic drops. They told me I would feel a lot better in a few days, and that wound up being true. The whole visit took about 15 minutes. I paid $75 at the time of the visit.
I have a high deductible insurance plan. I just got a bill (not itemized or anything) showing that that cost of the visit was $449, and after insurance adjustments of $220 and my $75 payment, I still owe $154. Does this seem reasonable, or high?
This is the type of thing I would normally just grumble and pay, but I’d like to start paying more attention to fees and bills that seem excessive.
Re: Urgent Care bill - does this seem high?
Nothing unique about this. In the US, can sue for whatever amount you want under whatever circumstances you want. Whether you'd win, lose, get dismissed or possibly even be sanctioned for a frivolous suit is the real issue.
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Re: Urgent Care bill - does this seem high?
Agreed, seems like a reasonable bill.
Even Urgent Cares have enormous overhead, many with full time CT scan and ultrasound capabilities. While you did not personally use those capabilities, the facility cost for carrying that overhead is passed on.
Your physician charge is going to be based on the acuity of visit, in this case that was likely not very high.
Many people carry HDHPs and are surprised by the costs they are now responsible for that traditional plans would cover. Keep in mind all those with employer / market purchased insurance are effectively subsidizing the care of the uninsured and medicaid supported population which under-reimburses. Regardless of how well your insurer negotiates the rate, your cost is going to feel high. 154 left to pay seems like a steal considering all those factors.
Even Urgent Cares have enormous overhead, many with full time CT scan and ultrasound capabilities. While you did not personally use those capabilities, the facility cost for carrying that overhead is passed on.
Your physician charge is going to be based on the acuity of visit, in this case that was likely not very high.
Many people carry HDHPs and are surprised by the costs they are now responsible for that traditional plans would cover. Keep in mind all those with employer / market purchased insurance are effectively subsidizing the care of the uninsured and medicaid supported population which under-reimburses. Regardless of how well your insurer negotiates the rate, your cost is going to feel high. 154 left to pay seems like a steal considering all those factors.
Re: Urgent Care bill - does this seem high?
The original charge was $449. That is the chargemaster rate.nisiprius wrote: ↑Wed Mar 03, 2021 3:07 pm Well, this is the disconnect I have between how people say HDHP's work and what people post about their actual experience.
It's not at all high as a chargemaster rate. This is the weird rate that hospitals bill at. With normal insurance, the bill goes to a private insurer who pays a negotiated rate that is typically on the rough order of 1/4 to 1/2 of the chargemaster rate, or the bill goes to Medicare who pays the Medicare approved rate, which again is 1/4 to 1/2 of the chargemaster rate--and the provider accepts it.
If you are uninsured you get a bill for the chargemaster rate.
And in theory people say that on an HDHP plan, you personally pay the insurer's negotiated rate, not the exorbitant chargemaster rate. Yet we seem to get about one posting per year from people from people who seem to have been billed directly at the chargemaster rate, typically by an ER. I'm thinking urgent care might be similar.
It might be worth a couple of hours on the phone alternatively calling the urgent care office and the insurance customer service number to find out if you got billed the chargemaster rate and if you can get it reduced to the negotiated rate.
This was discounted by $220, leaving $229 still due. That is the insurance negotiated rate.
OP paid $75 at time of visit, and since has not met the HDPD deductible yet, owes and additional $154.
That all seems reasonable.
We have a HDPD, and this is pretty much how it always goes.
I am not sure what you are seeing as a disconnect. Can you give some examples?
There is a separate issue of out-of-network "surprise" billing, but that is completely different issue. Perhaps, that is what you are referring to?
Once in a while you get shown the light, in the strangest of places if you look at it right.
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Re: Urgent Care bill - does this seem high?
This doesn't seem too bad. I know people grumble a lot about the cost of health care, but if you really want an eye-raiser, call an emergency service plumber.
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Re: Urgent Care bill - does this seem high?
I-Know-Nothing wrote: ↑Wed Mar 03, 2021 2:46 pm A month ago my toddler poked me in the eye by accident, and I had a lot of pain and blurry vision. I went to Urgent Care, and they got me in quickly and were very nice and competent. They gave me a vision test, and then put some dye drops in my eye, and looked at it, diagnosed a scratched cornea, and prescribed some antibiotic drops. They told me I would feel a lot better in a few days, and that wound up being true. The whole visit took about 15 minutes. I paid $75 at the time of the visit.
I have a high deductible insurance plan. I just got a bill (not itemized or anything) showing that that cost of the visit was $449, and after insurance adjustments of $220 and my $75 payment, I still owe $154. Does this seem reasonable, or high?
This is the type of thing I would normally just grumble and pay, but I’d like to start paying more attention to fees and bills that seem excessive.
It doesn't sound out of the ballpark. You can wait for the EOB from the insurance company which will have it broken down by code.
Re: Urgent Care bill - does this seem high?
Might be able to get the itemized bill on the Urgent Care's website but def ask for one.
My wife is a RN and said that it would be best to make sure it is what you had done - there are a lot of errors on med bills, good to ask. Glad it worked out, eye issues can be tricky.
My wife is a RN and said that it would be best to make sure it is what you had done - there are a lot of errors on med bills, good to ask. Glad it worked out, eye issues can be tricky.
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Re: Urgent Care bill - does this seem high?
Ha ha. Good thing you didn't come see me in the ED. That visit would have cost you at least $1,000 for the same care. And you probably would have waited longer.I-Know-Nothing wrote: ↑Wed Mar 03, 2021 2:46 pm A month ago my toddler poked me in the eye by accident, and I had a lot of pain and blurry vision. I went to Urgent Care, and they got me in quickly and were very nice and competent. They gave me a vision test, and then put some dye drops in my eye, and looked at it, diagnosed a scratched cornea, and prescribed some antibiotic drops. They told me I would feel a lot better in a few days, and that wound up being true. The whole visit took about 15 minutes. I paid $75 at the time of the visit.
I have a high deductible insurance plan. I just got a bill (not itemized or anything) showing that that cost of the visit was $449, and after insurance adjustments of $220 and my $75 payment, I still owe $154. Does this seem reasonable, or high?
This is the type of thing I would normally just grumble and pay, but I’d like to start paying more attention to fees and bills that seem excessive.
That price is totally fair. Pay your bill.
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Re: Urgent Care bill - does this seem high?
Very reasonableI-Know-Nothing wrote: ↑Wed Mar 03, 2021 2:46 pm A month ago my toddler poked me in the eye by accident, and I had a lot of pain and blurry vision. I went to Urgent Care, and they got me in quickly and were very nice and competent. They gave me a vision test, and then put some dye drops in my eye, and looked at it, diagnosed a scratched cornea, and prescribed some antibiotic drops. They told me I would feel a lot better in a few days, and that wound up being true. The whole visit took about 15 minutes. I paid $75 at the time of the visit.
I have a high deductible insurance plan. I just got a bill (not itemized or anything) showing that that cost of the visit was $449, and after insurance adjustments of $220 and my $75 payment, I still owe $154. Does this seem reasonable, or high?
This is the type of thing I would normally just grumble and pay, but I’d like to start paying more attention to fees and bills that seem excessive.
As White Coat Investor indicates - had you gone to an ER affiliated with a hospital OR to a stand alone ER - that would be VERY different price to pay. Nice move choosing an urgent care clinic for that type of injury.
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Re: Urgent Care bill - does this seem high?
Less than I would have expected, out of pocket, but we live in a VHCOL area.
Don't forget that they saw you quickly, when time may have mattered (turned out it probably didn't, but...), and seem to have taken care of it appropriately.
Eyes?
A bargain, in my opinion!
VERY glad it turned out okay.
RM
Don't forget that they saw you quickly, when time may have mattered (turned out it probably didn't, but...), and seem to have taken care of it appropriately.
Eyes?
A bargain, in my opinion!
VERY glad it turned out okay.
RM
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Re: Urgent Care bill - does this seem high?
This is incorrect. If covered by Medicare, this bill would fall under Medicare Part B and, therefore, Medicare would pay 80% of the Medicare-approved rate and the patient would pay the other 20% (assuming that the provider does not also bill an Excess Charge).nisiprius wrote: ↑Wed Mar 03, 2021 3:07 pm It's not at all high as a chargemaster rate. This is the weird rate that hospitals bill at. With normal insurance, the bill goes to a private insurer who pays a negotiated rate that is typically on the rough order of 1/4 to 1/2 of the chargemaster rate, or the bill goes to Medicare who pays the Medicare approved rate, which again is 1/4 to 1/2 of the chargemaster rate--and the provider accepts it.
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Re: Urgent Care bill - does this seem high?
Having been born in the US but spending much of my career abroad, I can say that the cost of medicine in the US is much higher and despite what many like to believe, not better. That being said, the amount is not too bad considering how much things often cost here.
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Re: Urgent Care bill - does this seem high?
Sounds very reasonable for Urgent Care. I would pay the bill and move on.
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Re: Urgent Care bill - does this seem high?
Thanks again everyone. I will pay my bill. The reason I asked is because I have been to Urgent Care many times in the past for issues like bronchitis, sinus infection, a twisted ankle, etc., and I don’t recall the full bill for a visit being as high as $449. It is possible that I didn’t pay as much attention to the full bill when I was on a lower deductible insurance plan though.
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Re: Urgent Care bill - does this seem high?
I just had a $174 bill for 20-29 minute visit. The $100 dipstick urinalysis I thought was a bit high.
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Re: Urgent Care bill - does this seem high?
plus a $208 deductible I believeModifiedDuration wrote: ↑Wed Mar 03, 2021 5:01 pmThis is incorrect. If covered by Medicare, this bill would fall under Medicare Part B and, therefore, Medicare would pay 80% of the Medicare-approved rate and the patient would pay the other 20% (assuming that the provider does not also bill an Excess Charge).nisiprius wrote: ↑Wed Mar 03, 2021 3:07 pm It's not at all high as a chargemaster rate. This is the weird rate that hospitals bill at. With normal insurance, the bill goes to a private insurer who pays a negotiated rate that is typically on the rough order of 1/4 to 1/2 of the chargemaster rate, or the bill goes to Medicare who pays the Medicare approved rate, which again is 1/4 to 1/2 of the chargemaster rate--and the provider accepts it.
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Re: Urgent Care bill - does this seem high?
The deductible is $203 for 2021, but that is a very good point!theplayer11 wrote: ↑Wed Mar 03, 2021 5:57 pmplus a $208 deductible I believeModifiedDuration wrote: ↑Wed Mar 03, 2021 5:01 pmThis is incorrect. If covered by Medicare, this bill would fall under Medicare Part B and, therefore, Medicare would pay 80% of the Medicare-approved rate and the patient would pay the other 20% (assuming that the provider does not also bill an Excess Charge).nisiprius wrote: ↑Wed Mar 03, 2021 3:07 pm It's not at all high as a chargemaster rate. This is the weird rate that hospitals bill at. With normal insurance, the bill goes to a private insurer who pays a negotiated rate that is typically on the rough order of 1/4 to 1/2 of the chargemaster rate, or the bill goes to Medicare who pays the Medicare approved rate, which again is 1/4 to 1/2 of the chargemaster rate--and the provider accepts it.
Re: Urgent Care bill - does this seem high?
Since this was an accident caused by someone else, you can send the bill to them
Seems reasonable and a typical part of life to me. It’s for things like this, that people are encouraged to have an emergency fund.
The good news is that if you need more medical care this year, you are part way done with your deductible. But I wouldn’t pay until I see the Explanation Of Benefits from the insurance company.
Seems reasonable and a typical part of life to me. It’s for things like this, that people are encouraged to have an emergency fund.
The good news is that if you need more medical care this year, you are part way done with your deductible. But I wouldn’t pay until I see the Explanation Of Benefits from the insurance company.
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Re: Urgent Care bill - does this seem high?
You got off cheap, my youngest son had a $1,300 glass of water in the ER a few years ago. Most expensive glass of water I ever paid for!
So funny longer story, we sat down to eat dinner which was pulled port sandwiches. He takes a bite and swallows only it doesn't go down. It doesn't come out either. He tried to drink water and it immediately comes back out, his esophagus is blocked! We wait about 30 minutes while he tried everything imaginable to get the food to either go down or come out to no avail. We call his pediatrician after hours hot line and they said NO go straight to the ER.
So off to the ER we go... We are rushed in under the 2nd highest urgency level. They explain if he does get that food loose it could choke him and cause a real emergency. So they page an endo doc telling us they are going to sedate him and either push or pull the food out.
While waiting for the endo doc they goto start an IV. I guess the fear of that IV needle cause must have caused him to relaxed his esophagus and the food went down. They gave him a glass of water and sent us on our way. I believe they billed insurance close to 6K negotiated down to $1,300 which I had to pay on my HDHP.
We never let him live that one down, he was a teen at the time so it was lots of fun to razz him about it. I guess this is also common with older folks eating steak dinners.
So funny longer story, we sat down to eat dinner which was pulled port sandwiches. He takes a bite and swallows only it doesn't go down. It doesn't come out either. He tried to drink water and it immediately comes back out, his esophagus is blocked! We wait about 30 minutes while he tried everything imaginable to get the food to either go down or come out to no avail. We call his pediatrician after hours hot line and they said NO go straight to the ER.
So off to the ER we go... We are rushed in under the 2nd highest urgency level. They explain if he does get that food loose it could choke him and cause a real emergency. So they page an endo doc telling us they are going to sedate him and either push or pull the food out.
While waiting for the endo doc they goto start an IV. I guess the fear of that IV needle cause must have caused him to relaxed his esophagus and the food went down. They gave him a glass of water and sent us on our way. I believe they billed insurance close to 6K negotiated down to $1,300 which I had to pay on my HDHP.
We never let him live that one down, he was a teen at the time so it was lots of fun to razz him about it. I guess this is also common with older folks eating steak dinners.
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Re: Urgent Care bill - does this seem high?
My son had the rubber tip of his ear bud come off and get lodged in his ear canal. School would not deal with it and said he had to go to urgent care which was a block away. I left work ran him over there, they literally took a tweezers, pulled the ear bud out and sent us on our way. The PA even said that was her easiest patient in a long time.
$450. Negotiated down to $220 by insurance. Normal urgent care visits are $120-$140 and I fully expected to have to pay that and was ok with it, but I did grumble quite a bit when I saw it was coded as "surgery".
Had I known ahead of time that would be the case we would have drove to Target instead and bought a tweezers.
$450. Negotiated down to $220 by insurance. Normal urgent care visits are $120-$140 and I fully expected to have to pay that and was ok with it, but I did grumble quite a bit when I saw it was coded as "surgery".
Had I known ahead of time that would be the case we would have drove to Target instead and bought a tweezers.
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Re: Urgent Care bill - does this seem high?
"For a glass of water"SimonJester wrote: ↑Wed Mar 03, 2021 7:47 pm You got off cheap, my youngest son had a $1,300 glass of water in the ER a few years ago. Most expensive glass of water I ever paid for!
So funny longer story, we sat down to eat dinner which was pulled port sandwiches. He takes a bite and swallows only it doesn't go down. It doesn't come out either. He tried to drink water and it immediately comes back out, his esophagus is blocked! We wait about 30 minutes while he tried everything imaginable to get the food to either go down or come out to no avail. We call his pediatrician after hours hot line and they said NO go straight to the ER.
So off to the ER we go... We are rushed in under the 2nd highest urgency level. They explain if he does get that food loose it could choke him and cause a real emergency. So they page an endo doc telling us they are going to sedate him and either push or pull the food out.
While waiting for the endo doc they goto start an IV. I guess the fear of that IV needle cause must have caused him to relaxed his esophagus and the food went down. They gave him a glass of water and sent us on our way. I believe they billed insurance close to 6K negotiated down to $1,300 which I had to pay on my HDHP.
We never let him live that one down, he was a teen at the time so it was lots of fun to razz him about it. I guess this is also common with older folks eating steak dinners.
Or, from another perspective, "for the opportunity to eat again and actually live the rest of his life"
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Re: Urgent Care bill - does this seem high?
I get annoyed too when I see gimicky pricing like $449. Why such a random and precise number? Why not add in the cents also to make it even more like ridiculous , like $449.98 .. This is the kind of pricing done to fool customers at Walmart. Not the pricing I would expect from a place where a high level of trust is expected.. End of rant.I-Know-Nothing wrote: ↑Wed Mar 03, 2021 2:46 pm
I have a high deductible insurance plan. I just got a bill (not itemized or anything) showing that that cost of the visit was $449, and after insurance adjustments of $220 and my $75 payment, I still owe $154. Does this seem reasonable, or high?
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Re: Urgent Care bill - does this seem high?
They don’t. Haven’t you heard the sad-but-true line: “If you go to the ER or UC and pay, you’re actually paying for the 6 people in line ahead of you too.”I-Know-Nothing wrote: ↑Wed Mar 03, 2021 3:12 pm I don’t know how lower income people can afford bills like this every time they have a minor issue though.
Re: Urgent Care bill - does this seem high?
Topic is locked (question was answered, topic exhausted).