Medical billing still broken


After cleaning up, covering the hole I realized I needed a tetanus shot. It was already 6:30pm, I called a couple of local urgent care offices and checked their prices. Both said the shot cost $40. I decided to head to the Boulder Community Urgent Care in Superior.

Having filled in my details on a tablet, I was called in and shown to a cubicle. A few minutes later a nurse/doctor practitioner came in, asked a few questions, cleaned the wound and agreed to the shot, having also explained I’d need to take a specific antibiotic that they’d supply the first dose of as my pharmacy would be closed at 7pm. We also agreed that as I was paying cash, an X-Ray wouldn’t be done, but if I had pain in a few days to comeback.

A few minutes later, I was done. I had to checkout and the front desk said that the bill was $192.40 – I was speechless. I asked for a line item/detailed statement and was told they couldn’t provide one then, but I could call the billing dept. later and get one. I paid by credit card and left with a credit card receipt.

BCH Bill for the actual tetanus shotImagine my surprise when a few weeks later when I got the bill from BCH. Yes, that’s right, the bill was for the administration of the tetanus shot. You have to be kidding?

I’d paid $192.40 and that didn’t even include the tetanus shot for $40, discounted by $6 for “cash”. I waited a couple of days and called the BCH Billing dept. I had a productive “how can this be accurate calls” and the woman I spoke with, after a few minutes, agreed to waive the $34 fee.

This though embodies everything that is wrong with the American healthcare business. You can’t get an accurate price up front; they then nickle and dime you for every small part of the process; when you checkout you get a final amount, but you can’t see how that is made up; you pay by credit card and leave, and then weeks later you receive an additional, unexpected bill. That’s if you are lucky.










Missing the point of Healthcare costs






An Apple a day keeps the Doctor Employed.

apple drCNBC has an interesting article about the number, and quality of Doctors they employ.  I’ve no idea what’s going on an Apple, for a number of reasons, I’ve never bought a single product of theirs.

However, given their deep pockets and ability to play a strategically long-game, I for one would be surprised if this isn’t significantly more than just about the watch and apps that can diagnose conditions based on data in collects.

Here are my thoughts, in the form tweets to @charlesarthur original tweet and link to his daily Startup link list overflow.


Maternity medical crisis





  • At least two women are dying every day




“Profiteering” in prescription drugs

The New York Times has an interesting piece on the price of drugs, of which Pharmacy Benefit Managers are only part of the story. Add to this the general secrecracy over prices and Pharmacy benefits and drug list (aka the formulary) which are their negotiated discount drugs, brand or generic.

This has been my experience, even without insurance, it’s almost impossible to find out how much specific drugs are going to cost in advance; if there are cheaper generics; and if there is a better price.

Glass full, not half empty!
Drugs R-US

I took an alternative route and did a deal with the devil for my most expensive drug. Despite having supplied the drug manufacturer with more financial information than I did to get a mortgage, they still declined to help financially, unless and until I applied for AND was declined for Medicaid.

I most probably would be eligible for (full scope) Medicaid, since I’ve already surpassed the 5-years/40-quarters requirement. That said, I’m really not comfortable in applying for any government assistance(despite assertions like this unofficial website) until I become a full US Citizen.

Faced with a circa $300 per month drug cost, I took an alternative route and was able to secure the best part of a years’ supply. Also, to get to this point, I’d spent probably 50+ hours trying to find alternative prices and supplies.

Like many other things, this is another example of the disgraceful profiteering in the US Medical for-profit business.

On the remainder of my medical billing, I’m about to give-up, the system has worn me to down, I just can’t waste any time or energy on it. In my last communication, I laid out specifically, in detail where the billing didn’t agree with what they’d told me the cost would be. Their answer:

Our financial aid has been applied and your balance is correct. If you have any other questions, feel free to contact our customer service team.

Which takes between 30-60 minutes per call since you have to go through multiple layers of call center and no one has any real authority to change anything which means they have to appeal to a “supervisor” and they never return calls. It’s time to pay them all off before they go into collection and hurt my credit rating.

Medical Billing update

After spending another hour yesterday making calls to try to come to a conclusion over the 2x appointments and treatment I had for my leg wound back in August and early September. I’ve been applying the lessons learned, experience I’ve had resolving my billing for my heart attack, which i close to, but not yet finally resolved. Here are some tweets I sent after getting off the phone yesterday.

Doctors and Money

The NHS is funded(or should be) to take care of everyone to a level of minimum care. No one(in practice) should have to pay for any medical care.

One question that comes up regularly when discussing how to fix the healthcare system in the USA, is Doctors and Money. While Doctors are far from the only important people in a healthcare service, they are possibly the most visibly important.

It is often asked, or asserted, that if you had a single-payer healthcare system where Doctors were possibly salaried this would act as a disincentive, and over time you’d lose the best doctors to purely private practice. This belies the fact that experienced doctors in the British NHS can make additional money in private practise.

It also completely ignores the fact that while the NHS is a meets minimum, free at the source of treatment health service, there is a thriving private, and private insurance marketplace.


However, these days the cost of drugs, the number of highly complex surgical procedures that are “standard” has grown beyond the normal funding of the NHS from say 20-years ago. Cancer care and the drugs for it now consume huge amounts of money, as does the treatment for obesity and the treatment of it, including heart disease.

If you are in a car crash, some form of violent attack, or other urgent care need, the NHS will supply an ambulance, emergency care, surgery, drugs, Dr’s, everything and you’ll never see anything related to billing or cost. Same for almost any minor health care problems, even many elective surgeries, and pregnancy, cancer care, pretty much any medical need.

Elective surgery does tend to get backed up, there are often long waits to see a specialist, as well as to get surgery. This depends though on the problem, the area of the country, and the time of year.

This time of the year the NHS is always stretched to and beyond its limit. It’s damp in the UK, older people tend to have been life long smokers and are very susceptible to respiratory illness. Both my parents died this way after a few weeks of gradually declining health as they were unable to recover from pneumonia. My Dads complicated by heart disease; my Mum a 7-year lung cancer survivor.

Both received 100% free NHS service, they were not rushed or hurried to move out of their hospital beds. The nursing and medical attention was top class. In fact, I’d go as far as to say  much better than here in the USA because there was never a discussion, question or insinuation that insurance might not cover something.

For those that a “meets minimum”, free healthcare service won’t do, you can always pay. Many companies offer private “top-up” insurance, which provides priority appointments, private hospital beds etc. And you can always elect to pay for the treatment you need need.

luton-news-sept-21st-1978I had two major hospital admissions, one on the NHS for a tib/fib fracture in 1978; the 2nd some 16-years later for corrective surgery. The 2nd I was working for IBM with top-up insurance. I saw the same specialist who’d saved my leg 16-years earlier. If I’d wanted to see him on the NHS, there was an 4-week wait; I saw him the next week at a local private hospital.

He recommended corrective surgery. On the NHS he would have done it in 4-6 weeks, depending on lots of things. I was able to schedule a specific day for 10-weeks out that better suited IBM’s schedule, private hospital, private staff, same consultant.

Fast forward to 2013. I’ve done over 100 triathlons and running races, including 6-Ironman races. Despite an initial prognosis in 1979 that I’d never run again. My knees are not so good. I wanted to see the same consultant, he is no longer practicing, wished me luck. I was recommended to the British Olympic Association’s Orthopedic Consultant. Chances of seeing him on the NHS, zero to very little.

I scheduled an appointment with him at Private hospital, flew to the UK, and he came in to see me especially. We spent the whole hour together, what I’d paid 450 UKP for. We discussed options, did measurements, x-rays, looked at different types of replacement knees etc.

He said that when I was ready for surgery to let him know, he would schedule me on his NHS roster and I could fly back. When discussing the same surgery here in the USA, he told me not to bother.

His experience had been that in the USA even dedicated specialist consultants didn’t have nearly the experience as NHS Specialist. In the USA they spend too much time consulting with patients and negotiating over billing. Patients in general take 3x as long to consult with in America because the options, cost and insurance options, and choices are so daunting and often when a preference is stated it has to be negotiated with insurance, co-pays, deductibles etc. all have to be understood by the Doctor and patient. The alternative is you get the Doctor, but little or no choice in replacement technology.

He has 2x 6-hour surgery days per week, they do 6-8 knee replacements per day; he spends 1-day NHS consulting, and 1-day private consulting and has 1-day open for Private surgery or additional consulting.. If he wants he can do private surgeries on Saturdays, vacation days or early mornings before NHS work. Average cost for NHS Surgery $0.

A US Specialist, according to him, does 6-10 operations per month, and my US research was cost around $30,000. In terms of knee replacements, the UK has much better insight, and much less medical device and insurance company influence on the type of replacement, they base their choices on OUTCOMES.

I’ll return to the discussion on healthcare systems shortly, but suffice to say, I’ll be going back to the UK when my time finally comes.

Healthcare perspectives











Guantánamo Adds Medical Staff Amid Hunger Strike –

This has been prime news in Europe today and yesterday, that 2/3 of the detainees are now on Hunger Strike, and more than 40 are being force fed. I’m sure this also more than news in many other countries. [BBC; Süddeutsche Zeitung (Germany)]

Whatever you think about the people being held, “terrorists that should rot in hell”, “that should be locked up forever” or “deserve their day in court”, the damage this is doing to the US reputation overseas is immeasurable, and it will be held against us.  Time to end this. The President promised 4-years ago to shutdown Guantanamo,  now is the time for action. While “waterboarding” may not qualify as “cruel and unusual punishment: under the US Constitution, Force Feeding is most definitely clearly a violation of international law.

Interestingly, while this is news outside the US, apart from blog entries, I hadn’t seen or heard it covered on US “News” 24hr or otherwise, TV or Radio, unless you did?

Guantánamo Adds Medical Staff Amid Hunger Strike –