I had my first kidney stone in over 8 years this past week. I knew what I was feeling was a kidney stone, but since it had been such a long time, I did not know how big the stone was. The pain started out as an 8/10. I took vicodin before I went to the hospital, and by the time I got an IV with some toradol, I was good. Abdominal CT scan showed 4 stones, with 1 passing. My pain got down to a 1/10, so I left.

Mistake.

2 hours later, with only vicodin and a toradol prescription, it turned to 10/10. Full on throwing up non stop from the pain (for those who havent had kidney stones, imagine a knife point being stuck into your back and continuously being twisted). Back in the ER. No imaging necessary. At this point, I demanded Dilaudid (sythetic morphine). After 30 minutes of 1 dose, pain was down to 5/10, and with a second dose along with 2 liters of fluid, was down to a 0/10. I left the ER with a prescription for dilaudid.

Did have one other 9/10 session of pain that night, but with the drugs I was given, I was ok. Passed the stone the next day.

So, the bill for
(2) ER visits
(2) IVs
(1) Dose of IV Toradol
(2) Doses of Dilaudid
(1) Abdominal CT scan
(2.5) liters of IV fluid

= $10,844

I am expecting the negotiated BCBS rate to bring this down to around 6.5k. Will still end up about 2k out of pocket after deductables and copays.

A few take-aways...

-If there is any doubt how horribly expensive our healthcare system is, this is a fairly good example.
-DON'T leave the ER with a kidney stone without demanding a powerful narcotic. If you don't end up using it, you'll have it for next time.
-If you decide to roll the dice and not have health insurance, hope nothing ever happens to you.

[Edited on November 20, 2012 at 10:29 AM. Reason : .]

11/20/2012 10:24:24 AM

Don't you have a lot of money anyway?

If so then the general opinion of TWW is probably going to be "fuck you LOL."

I'm sorry though... I agree this is bullshit. I haven't had them myself but I had a buddy a few weeks ago that had to go to urgent care and he was puking everywhere from the pain.

11/20/2012 10:29:49 AM

Mostly, I'm impressed you've gotten all of the bills for the visit within a week.

My wife had an ER trip after falling on a wine glass and ending up with a deep laceration. We didn't get all of the bills until over a month later.

11/20/2012 10:30:17 AM

Who reviewed the imaging, was it an outside contractor? I've had a bill from that surprise me a couple months later.

11/20/2012 10:34:47 AM

I havent received the bill yet. These are the claims from the hospital to my insurance provider. I'll likely get a bill in about a month.

^ No. This ER has its own attached imaging. I presume the 8k bill in the image above includes the image.

[Edited on November 20, 2012 at 10:35 AM. Reason : .]

[Edited on November 20, 2012 at 10:35 AM. Reason : .]

11/20/2012 10:35:01 AM

^^^yep. The bills for my last ER and UC visits started to come in about a month later and took about 1.5 months for all of them to come in. It's also annoying that you get about 10 bills from all over the place instead of centralized billing.

The total bill was stupid high for what I went in for, some of it due to unnecessary tests/procedures, which didn't help the ER diagnose the issue (they never gave one). My follow up to UC lead to proper tests and a diagnosis, and the correct medication.

[Edited on November 20, 2012 at 10:36 AM. Reason : ^^^]

11/20/2012 10:36:01 AM

Can you or someone else paint a plausible picture of the labor and materials than went into this case?

11/20/2012 10:41:56 AM

not to bring in politics, but obamacare is going to make things like this MUCH more expensive... mostly in the amount that insurance covers you.

it cost us about 4k out of pocket this year for our baby... if we had her a year earlier it would have been roughly half. projecting out to next year, it will probably be closer to 6-8k out of pocket for a baby. (based on my wife's insurance)

11/20/2012 10:43:55 AM

well, I was in the ER for about 4 hours total across the 2 visits. I had to go through triage 2x (one RN). There was a nurse and an attending for each visit. For the CT scan, the lab tech rolled me from the room to CT scan room herself. After each of my visits, housekeeping would have to come by, strip the sheets, and clean the room.

I would say there is likely more care and attention given to you at a 4 star hotel than was given to me during this trip.

I'm not complaining about the service, however. The bill is what is ridiculous.

^ We're lucky in that front. It will cost us about $500 from prenatal to birth to have a child with insurance. One of the only 'good' benefits of both my plan and my wife's.

[Edited on November 20, 2012 at 10:47 AM. Reason : .]

11/20/2012 10:46:04 AM

no it wont

dumbass

(to clarify, premiums would have risen regardless. CBO projects that premiums for employer sponsored plans at big companies will be the same and employer-sponsored plans at small companies to be the same or less)

[Edited on November 20, 2012 at 10:55 AM. Reason : .]

11/20/2012 10:47:04 AM

Next year I might have to give up on grad school and get a job if the student insurance continues to double in price and drastically cut their coverage.

11/20/2012 10:56:43 AM

Quote :

"(based on my wife's insurance)"

Seriously, what kind of dog shit back alley insurance does your wife have?

11/20/2012 11:01:30 AM

Wow...that's kind of ridiculous.

But yeah, this is why I made my boyfriend stay at home drinking Coke with his Toradol prescription, for his kidney stones, on a Saturday night so we wouldn't get hit with a $5k bill, and we both have health insurance. The ER racket sucks.

11/20/2012 11:07:28 AM

are there non-ER options for kidney stones? i've never had one, so i don't know how fast it hits.

11/20/2012 11:14:53 AM

Your boy must have had a much easier time passing that stone, or you must be one stone cold killa watching your boy throw up for hours nonstop The pain is bad enough that you do think 'death would be preferable'

^ I'm actually not entirely sure. I don't know if an Urgent Care can give you IV narcotics or not. That is really what it comes down to. as well as the passability of the stone. If you havent had a recent image, you'll likely want one to see if you can pass it without lithotripsy.



[Edited on November 20, 2012 at 11:17 AM. Reason : .]

11/20/2012 11:15:12 AM

So I just logged into my insurance to estimate an outpatient kidney stone fragmenting procedure cost

Quote :

"Results for Kidney, Lithotripsy (Fragmenting Kidney Stones) - Outpatient 5 results found Name : Treatment Cost : Your Out-of-Pocket Cost WakeMed Raleigh Campus : $13,621 - $14,191 : $2,250 - $2,250 Rex Hospital : $6,514 - $8,464 : $1,502 - $1,892 WakeMed Cary Hospital : $11,777 - $14,337 : $2,250 - $2,250 James E. Davis Ambulatory Surgery Center : $8,302 - $8,894 : $1,859 - $1,978 Durham Regional Hospital : $7,732 - $8,874 : $1,745 - $1,974"

I love the $8,000 swing in possible procedure cost.

11/20/2012 11:23:27 AM

Quote :

"Seriously, what kind of dog shit back alley insurance does your wife have?"

she works for the state.

11/20/2012 11:59:02 AM

While we were living in Japan, my husband had a serious asthma attack and I had to bring him to the ER. The ER admission, medication, testing, and prescription cost us about $100.

Last year, he had another serious asthma attack. We went to WakeMed's ER. The EXACT SAME CRAP that the ER in Japan did cost us about $2,000 at WakeMed.

I don't really understand how you can have two vastly different numbers for the same procedures.

11/20/2012 11:59:25 AM

You're paying for all the people that can't afford it. If you have money the goal is to take it all so you become one of the people that can't afford it.

11/20/2012 12:09:31 PM

Quote :

"I love the $8,000 swing in possible procedure cost. "

Whats really odd about that is that many of those places likely OUTSOURCE that procedure. Apparently, there is a guy who drives around an 18 wheeler with all the gear inside. You show up to the hospital, get sedated, get rolled into the bus and have the procedure done, then are wheeled out. He then drives it to the next hospital.

11/20/2012 12:16:37 PM

Quote :

"Next year I might have to give up on grad school and get a job if the student insurance continues to double in price and drastically cut their coverage. "

How has the price for this changed since it was implemented? I just remember hearing that even if you're beyond the copay and have to get some really expensive procedure it'll only pay 80%. Considering these are students, we might as well call them uninsured. Makes me think of

http://articles.latimes.com/2012/mar/31/local/la-me-lopez-erfollowup-20120401

Quote :

"Gary Larson has a $5,000 deductible insurance plan, but has found that his medical bills are cheaper if he claims he's uninsured and pays cash. Using that strategy, an MRI scan of his shoulder cost him $350. His brother-in-law went to a nearby clinic for an MRI scan of his shoulder, was billed $13,000, and had to come up with $2,500."

11/20/2012 12:23:27 PM

^ yeah, I was about to reference that story actually.

My boss was telling me he goes to Duke Hospital (not sure for what exactly, I think something heart related) and when he says he'll pay in cash, his bill is 50% less than with insurance.

Are ER trips similar?

11/20/2012 12:25:53 PM

^ Don't try that tactic at WakeMed. We tried it and they didn't go for it at all. Even the woman in billing said it was dumb they no longer do it. But they gave us a free loan to do monthly payments on the bill

11/20/2012 12:43:33 PM

Thanks for that. I went to Wake Med. I was pondering if I had made a mistake in not trying that.

Yes, the interest free payment schedules are great. I'll like ask for a 6 month payment plan on mine. In the last month. had to replace an HVAC unit, my wife had $3000 in dental work, and I am about to have a $2500 ER bill. Sucks having al that hit in a month.

11/20/2012 12:49:28 PM

Quote :

"The bills for my last ER and UC visits started to come in about a month later and took about 1.5 months for all of them to come in. It's also annoying that you get about 10 bills from all over the place instead of centralized billing"

This really pisses me off. When we had our second son, I had them consolidate all of the various bills and setup a payment plan. About three months after he was born I settled that up and paid it all off well in advance (but still giving the system time so if anything popped up as a late bill) and was given a sheet saying "Account Paid in Full". I run my credit every few months and about a year after he was born, I found that the hospital had hit my credit for like $60 in an unpaid bill. Out of $1000+ that I had already paid, and told it was paid in full, they somehow sent $60 to collections and had never even billed me, called me, or anything. I was really upset about that.

I hope that some of this shit will end with all of the hospitals in the area moving to Epic. Patient records can be sent across multiple hospitals, and they will have a single record that follows them, so hopefully this will streamline some of the BS.

Quote :

"We're lucky in that front. It will cost us about $500 from prenatal to birth to have a child with insurance. One of the only 'good' benefits of both my plan and my wife's."

Not so sure about that. Maybe her new one is different from the state plan, but when we had #2 I was on the BCBSNC 90/10 State Plan and I still had to go out of pocket for around $1200. And that was an easy delivery with no complications and a real short stay. So I'm not sure where you are getting your facts from, but I would anticipate that it would be at least a couple grand now.

11/20/2012 1:04:28 PM

Damn, I feel bad for you guys. For once I'm thankful that I chose to pay out of pocket for ridiculously expensive insurance

11/20/2012 1:13:11 PM

Quote :

"Maybe her new one is different from the state plan, but when we had #2 I was on the BCBSNC 90/10 State Plan "

She is on Duke's plan, which is pretty much laden with gold. A damned CT or MRI scan only costs $100 with her plan, and not subject to a deductable. You are probably right about the state plan. but she confirmed the birth costs with numerous Duke employees, and since she works in fertility, she should know.

11/20/2012 1:16:45 PM

^ Hell yeah Duke's plan rocks Looking forward to only paying $450 to pop out this baby.

11/20/2012 1:20:10 PM

Hmmm, I went to the ER the end of September after my doctor reviewed my CT scan and determined that I had acute appendicitis.

Including the CT scan the total cost was around $24,000.

Cost to me (thank you BCBS) was around $105.

11/20/2012 1:21:35 PM

Jesus christ remind me never to go to the hospital.

11/20/2012 1:35:01 PM

^ lol that's pretty much what I tell my students. Unless you're bleeding out go to student health services first. You've already paid your fee for that

11/20/2012 1:36:42 PM

Boyfriend was writhing around a bit, 9/10 pain, but we had already been at urgent care once that day already, and I wasn't excited about doing the same damn thing at the ER, albeit in a less comfortable setting.

I gave him a 12 oz can of Coke, and he passed that stone within 30 minutes. Should have just done that in the first place

11/20/2012 1:38:09 PM

I've passed upwards of 2 dozen stones. Still have 6 in my kidney at last check.

My urologist just keeps me with a standing painkiller Rx, so I can pass them.

I've passed one that was 6mm at it's widest, and 14mm long. That bitch put me on the floor in tears. I pissed everywhere.

11/20/2012 1:47:41 PM

Kidney stone pain sounds awful. Is this occurance pretty random? Or are there certain things you can do to prevent them?

Is the pain much worse than sciatic nerve pain? I'm talking about shooting, burning pain as if a thousands crabs were constantly pinching you?

11/20/2012 2:00:28 PM

Quote :

"6mm at it's widest, and 14mm long."

Holy shit balls. Mine was about 2mm wide and about 4mm long.

Quote :

"Kidney stone pain sounds awful. Is this occurance pretty random? Or are there certain things you can do to prevent them? Is the pain much worse than sciatic nerve pain? I'm talking about shooting, burning pain as if a thousands crabs were constantly pinching you?"

1> preventing kidney stones... they can be diet related. The south is considered the kidney stone belt. Affects white males more than anyone else. It is said that the diet here, along with heat and dehydration are main causes. pretty sure my issue was too much time on the boat during the last 2 summers and little to nothing to drink. I'll not make that mistake anymore.

2> The pain is universally compared to child birth, except in the end, you don't produce a baby. You produce a fucking stone. It has been described as the most pain a body can produce from non external forces.

Different people take to them differently. The various passages the stone has to pass through is going to determine how painful these are. Apparently, my passages are really small, because the last 2 I have passed have been in the 2mm range, and I could not function. Literally, it is so bad you can do nothing but throw up. When I said it feels like a knife being plunged into your back, that is intended to be a literal translation to what the pain feels like. It isnt a joke. In fact, the knife might actually not hurt as much. When the IV went in, it hurt, but it was actually a relief, because something was hurting less than the kidney stone, and my body wasnt processing the stone pain as much for a few moments.

Of course, so people pass these things and don't think twice. Too many variables.

[Edited on November 20, 2012 at 2:12 PM. Reason : .]

11/20/2012 2:08:59 PM

Quote :

"^ yeah, I was about to reference that story actually. My boss was telling me he goes to Duke Hospital (not sure for what exactly, I think something heart related) and when he says he'll pay in cash, his bill is 50% less than with insurance. Are ER trips similar?"

Quote :

"^ Don't try that tactic at WakeMed. We tried it and they didn't go for it at all. Even the woman in billing said it was dumb they no longer do it. But they gave us a free loan to do monthly payments on the bill "

It's really not a unique story.



In whatever context healthcare in the US becomes a business model where they provide a service to someone and have a price for it, it's not actually bad. This is the case for many procedures that are non-essential. No one is complaining that Lasik is more expensive than it should be. It's also the case for real important procedures that people get after shopping around to pay out of pocket.

Wakemed couldn't give less of a shit. Comparatively there's very little money in that, since they're the "go to" place, they don't need to worry about that.

It's nice and all that we want to provide care to those that can't pay and all, but that requirement exists in reckless disregard for the law of unintended consequences. Most people can be turned over to collections, so they can get treated, for the small pittance that the rest of their life is ruined. The tiny minority who are so hopelessly poor that they basically have impunity against any bill are more-or-less the homeless. It's actually common that these people will see literally dozens of ER visits per year, which, ironically, costs an order of magnitude than a safety net providing the basic necessities of life would. At the same time, the people who experience economic hardship to pay for this are the slightly less poor who get fucked because they have an emergency.

Call me paranoid, but I'm convinced Obamacare will make the situation far far worse. No one could have made this point better than dtownral.

Quote :

"(to clarify, premiums would have risen regardless. CBO projects that premiums for employer sponsored plans at big companies will be the same and employer-sponsored plans at small companies to be the same or less)"

CBO doesn't get to decide what assumptions they make. These assumptions are handed to them from the legislators who are promoting the legislation.

Now, even not crediting that fact, what do we reasonably believe will happen when the projection says the costs will stay level? What does history teach us about this? Liberals advocating that costs won't go up or down are the tell-tale sign that they'll grow uncontrollably if there ever was one.

[Edited on November 20, 2012 at 2:13 PM. Reason : sorry i went full-on political, i'm done]

11/20/2012 2:11:09 PM

i was in the hospital 2 different times over three days, probably about 8 hours total. i was passing a stone and it wouldn't pass. it was horrific. my emergency deductible was $2,500 so i paid that plus the co-pay for the few times and then all the follow ups with a urologist (oh plus the additional scans to see how many stones i had).

all in all mine was about $3,500 with crappy insurance.

that is insane that your bill was as much as it was. luckily i work for johns hopkins now and working for a medical school has some sweet benefits on the health insurance side.

11/20/2012 2:22:41 PM

Quote :

"Now, even not crediting that fact, what do we reasonably believe will happen when the projection says the costs will stay level? What does history teach us about this? Liberals advocating that costs won't go up or down are the tell-tale sign that they'll grow uncontrollably if there ever was one"

CBO is not partisan

ACA is not liberal

11/20/2012 2:45:31 PM

I have obviously never had a kidney stone and sounds like avoiding them is a good plan.. yikes!

11/20/2012 2:47:07 PM

it is the worst pain i've ever experienced and i've been hit by a car, knocked a tooth out with a beer glass and had my tonsils removed.

pretty sure i'm ready for child birth now

11/20/2012 2:52:49 PM

I can't really compare stone pain to my nerve pain from a ruptured disc. But nerve pain is pretty bad.

11/20/2012 2:58:21 PM

Quote :

"it is the worst pain i've ever experienced and i've been hit by a car, knocked a tooth out with a beer glass and had my tonsils removed."

11/20/2012 3:31:15 PM

if you spend the night at a hospital for anything.... you're looking at 30gs

11/20/2012 3:35:32 PM

^^ yup, took about five days to pass it

11/20/2012 3:52:34 PM

I had one a couple of years ago. Yeah, it hurt. Progression:

Wow, I have some really bad gas.
<seconds later>
Nope, I'm dying.
Puke.
Puke.
Puke.
Puke.
Puke.
Puke.
Whoa, there's nothing wrong with me. I feel 100%
lol, you're wrong
Puke.
Puke.
Puke.
Puke.
Puke.
Puke.
Why won't I die?

Mine wouldn't come out so they had to go up in there with a claw grabber. Coming out of that surgery I had three kinds of pain medication going through me, including two doses of morphine. I could see with my eyes shut but still it hurt. Of course at that point I had a stent in my ureter and I was urinating pure blood.

All said and done I believe it was in the mid $30K range pre-insurance.

I still fear that pain. I do my best to forget the procedure they did to get the stent out. Don't get a kidney stone.

[Edited on November 20, 2012 at 4:15 PM. Reason : -]

11/20/2012 4:12:50 PM

oh my god

11/20/2012 4:14:55 PM

Quote :

"if you spend the night at a hospital for anything.... you're looking at 30gs"

not quite anything

11/20/2012 4:18:09 PM

maybe by 2015 it will, but for now the people I've talked to who went to Wakemed when their kid had a fever and stayed the night wound up at around $8-9 k

11/20/2012 4:21:29 PM

I had two within a month of each other about three years ago. One over Thanksgiving and the other Christmas Eve. The day before Thanksgiving I went to my regular doctor and got them to open the door for me 10 minutes early. Thankfully everything was covered under my co-pay of $30 at the time. That included an x-ray off-site. The second one I went to an urgent care place, again first thing in the morning, and that only cost $50, including an off-site x-ray again.


Worst pain I had ever felt. Didn't puke with the first one, second one however different story. Whatever that shot of pain killer they gave me was the best drug ever. I wonder if mine cost less because of the lack of a CT and going to see a doctor instead of the ER. I know my out of pocket expenses for ER were much higher at the time.


Also I'm not sure if you've been to see a kidney specialist yet. I went to see one after having two in two months. Especially when the second one wasn't on the x-ray I had for the first one. I was worried so I went and was told that the Vitamin C my wife had me start taking was causing my kidney stones. I had never taken Vitamin C before that and quit taking it after that. No more issues with stones.

Sorry man, they suck. It's like peeing out stone babies.

11/20/2012 10:33:51 PM

Yeah that's what wikipedia said. Vit C and high protein diets.

11/20/2012 10:46:11 PM