How Insurance Works

WOW: My $27,495 Appendicitis


As many of you might remember in October I
had appendicitis and had surgery, uh, here in Boston and I was out for a couple of shows.
One of the things that I’ve been telling you is that once I have the total cost of my procedure,
I would sort of open the books so that we could look together and uh, confirm once again
how absolutely and utterly insane our healthcare system is. I now have those numbers and I’m
ready to show them to you and they are shocking, truly. So, quick reminder. Last Monday I told
you about how my health insurance is changing from 2019 to 2020 if I choose to stay on the
same plan right now, I pay four 21 a month. That’s $421 a month. Uh, that same plan goes
up to $458 a month for inferior coverage. In 2020 my out-of-pocket maximum goes up.
My copays go up. Tons of people who are either from other countries or have employer subsidized
insurance emailed me shocked that this is how bad it is here in Massachusetts where
we’re supposed to be better off than lots of other places in Massachusetts. Now I am
ready to tell you the full cost of my procedure. Now, I had looked up what does an appendectomy
cost in the United States and I found a range that says it can go anywhere from $1,500 to
$180,000. Now. Presumably the high range of that is if it’s a more complex appendicitis
with a ruptured or perforated appendix where you often have to stay in the hospital for
several days to treat the infections that sometimes happen. Now, to be clear, I got
good care. The surgeon was great, the anesthesiologist
was great, the nursing staff was great. Really, you know, I don’t recommend getting an appendicitis,
but it was a made as least bad as possible by really great medical care that I received.
They don’t control the prices. This is not about them. My appendectomy costs $27,495
for the eight or so hours that I was in the hospital. Let’s put the numbers up so we’ll
go through this particularly for people that are listening. The anesthesiologist’s fee
was about 1700 bucks. The surgeon charged about 2,500 the ER visit to me at the emergency
room by a different surgeon to tell me about the procedure was $460 the emergency room
doctor who came over and told me they think I have appendicitis. That was six 82, of course
I had to pay a $368 or was a bill. This is not what I had to pay. The radiologists charged nearly $400 for looking
at my cat scan and telling me I have appendicitis. I had the urgent care visit earlier in the
day where they told me, we don’t think you have appendicitis. That was wrong. That was
four 45, uh, my postop visit and blood work. And then the big charge was the facility and
all of the different supplies, the operating room, the anesthesia, et cetera. More than
$20,000 there. My pain pill killer, prescription 85 for a total bill of $27,495 for my, as
they call it, uncomplicated appendicitis. So the next question is how much do I pay?
I told you I have a $2,000 annual deductible, uh, for my health insurance. And I expected
since my healthcare spending was minimal and I didn’t think I had made any progress towards
the deductible being covered earlier in the year, I expected I would have to pay $2,000
and I was right. But in fact it is more. So for me, my out-of-pocket
on my nearly $28,000 appendectomy is my $2,000 deductible, a $55 urgent care copay from earlier
that day, a $50 copay for my post operational, uh, blood work, a $30 a postop visit, copay,
a $300 emergency room copay. I also had to pay 20 bucks out of the 85 for the painkiller
prescription, which I didn’t even end up taking. And then of course, I also paid for my insurance
in October four 21. So my total October, 2019 spending including my insurance premium for
this appendectomy, $2,876. Just a few interesting items from my itemized bill. There’s so much
more to it, but just a few things I’ve found notable. Uh, when I arrived they said, Hey,
listen, we should just, we don’t know what’s going on yet, but anytime people come in,
we try to keep them hydrated. So we’re going to give you an Ivy. I said, sure. That was $188. Um, I, I’m glad
they did it. I mean, it does seem like a good practice, but that nearly $200 for the Celine
bag. Um, a CT, the CT scan, of course, they needed to do a CT scan to determine if I have
appendicitis. That was more than $2,000 billed to insurance. The Ivy Tylenol I was given
before the procedure was $153. And you know, they didn’t leave me in the hallway. They
brought me to a recovery room after the procedure that was $678. Now what’s interesting about
that is they said that because they would probably only keep me a few hours after the
procedure, they didn’t need to bring me upstairs to a room. Now, if I was brought upstairs
to a room, we would be talking about thousands more dollars because that would be considered
being admitted to the hospital. They didn’t do that. Instead, they put me
in the recovery room for 90 minutes. That was six 78 much cheaper than bringing me up
to a room. So once again, what’s the big picture here? The nurses were great, top-notch surgeon.
Anesthesiologist was great. Everyone’s bedside manner was great. They treated my girlfriend
really well. Uh, even after, as I was already on Valium and being wheeled in, I yelled out,
I hope I don’t die, which was not exactly in confidence, inspiring to her at the time.
They treated her well, they treated me well, but this is an insane system. Now I want to
be really clear, owing $2,800 it’s not going to bankrupt me. Right. I always assume that
at any time, because of the insurance I have with the $2,000 deductible, I might owe two
to $3,000 at any time if I have a need for medical services. So it’s not going to bankrupt me. But that
puts me in a privileged position because we know that half the country, I believe it is,
can’t afford an unexpected $400 bill. What happens with a $2,800 bill? It’s a sickening
and disgusting, uh, system. Nearly $28,000 and of course the hospital’s not getting $28,000
because my insurance will go to them and say, we’re only paying this amount, and the hospital
accepts it. And the fact that they know they only get part of it back from the insurance
causes them to have higher and higher sort of MSRP book rates for a lot of these things.
If the system is broken, I don’t pretend that what I had is even close to the most serious
or expensive thing that people would have. This is relatively simple, uncomplicated thing
and still look at what we’re doing, talking about sickening, disgusting system.
Hope this gives you some insight, particularly to our viewers outside the U S as to how all
of this works.


Reader Comments

  1. It's like Americans have Stockholm Syndrome when it comes to their healthcare. Americans pay more than double the amount a citizen of any other developed Western country pays and the quality is not measurably higher. Yet so many defend the ridiculous system you have. I don't get it, I really don't?!!

  2. Canada free, unless you are getting something you don't need. You can get extra coverage if you want, but even then maybe a couple hundred. Thats tests and medication also… I was in the hospital before Christmas for a week. Had to take an ambulance from a town about 30 km awat. Cost was 250 $, capped as a senior, of course more for others. And I have no extra coverage.

  3. You should have held on with your appendicitis until a hospital had a sale on that surgery. Also I know a small Place in Oregon they would have done it for half the money.

    Really, stop complaining and instead make use of the great possibilities of the free market!

  4. Sounded pretty reasonable to me. Currently employed in a healthcare profession making $130,000 a year. Boss makes $800,000 a year. Boss needs his Maserati.

  5. My appendix got removed in 2003 when I was 9 years old during vacations in Poland. The hospital didn't recognize my german health insurance as valid. My mom had to pay cash for the surgery and 17 days in hospital… it was 3000$. When we finally got home in Germany she send the bill to the abroad health insurance and we got the cash back. The abroad health insurance costs 10€/year.

  6. When capitalism goes too far, you get a cluster of company competitors for a monopoly, taking all power away from the consumer and lining their own pockets at the top of the pyramid. This isn't news, it isn't even hidden knowledge, but if past, and especially current, trends continue, then more people will be defecting from our government and the United States of America entirely.

  7. They did a CT scan to know if you had appendicitis?! They only looked at my blood and did quick ultrasound and they knew everything they needed…

  8. This is insane. In Canada if you break a leg, or need open heart surgery, or cancer treatment or an appendix removed, it's all free. Yes, you go to the doctor or hospital and it''s FREE. The only thing we pay for (if you don't have drug insurance) are the medications which can add up but never more than a couple hundred dollars

  9. Most people with universal healthcare would rather pay a little extra tax and not have to worry about getting sick. Its shocking that Americans don’t think the same

  10. Often times Americans are their own worst enemy. The propaganda in this country is on an unnatural scale. "Capitalism is the best. America is the best. Being poor means you're a bad and lazy person. Being rich means you're a good and hard-working person. War is necessary because we're the good guys."

    Unless you have grown up and gone to school in the U.S. you will never truly understand the collosal level of propaganda that it takes to make the average American ignorant and stupid beyond belief. I consider myself lucky that I was even able to think for myself and question all the problematic norms of this society IN SPITE of being brought up in it. It also helped that I was a History major in Undergrad. Most people are simply not able to recognize propaganda when they see it and as a result become the very victims of the propaganda they've come to trust in. But I'm hopeful (more than ever) that the tide is about to change.

  11. David, two questions.

    1. Can you determine what the insurance company actually paid to the hospital? And was there any payment by the government? (I guess that's two questions right there)

    2. Can you determine what would be the total cost for a typical (like yours) appendectomy in other countries such as Germany or Norway, or, to add some variations, Argentina, Egypt, South Africa, or Thailand?

  12. At an accredited hospital in India you could probably get the entire treatment at 60% of your copay amount including admission. You are paying the price for having an over regulated and closed healthcare system.

  13. This is why there must not be any compromise on Medicare for all. Bernie Sanders is the only person who is going to fight for it, hammer and tongs. Ignore the rest. Volunteer donate and VOTE for Bernie.

  14. USA is still a developing country with a flawed democracy. And I say this from the nordic point of view. For the patient this surgery in Finland costs about 32 euros per hospital day together with everything in your list. Without insurance. Medical care is top quality of the world.

    The real cost of the surgery here is 3200 euros total per patient and its paid in full by the goverment, still ridiculously less than in the usa. And you can focus on getting better, no need to take care of bills or paperwork.

    Where does your country waste all its money? :/ (not a serious question, I wish all the best for you and honestly hope everything gets better there)

  15. Question to all non-Americans: if a foreigner moves to your country what is the process for obtaining healthcare or is it not allowed since said person has no citizenship or would you only get it after becoming naturalized which takes a few years correct?

  16. My family visited the US, thankfully took (cheap) travel insurance beforehand. My grandmother ended up going to the hospital with some sort of flu (we're not sure, since they didn't actually diagnose her with anything). First thing they asked her was whether she had insurance. After waiting for 3 hours they prescribed her something and sent her right off. Once they arrived home, they found out the hospital charged their insurance for a bunch of things that weren't administered, including an _entire overnight stay_. It's insane how much hospitals make back there.

  17. We in Germany have a far better health care system than the US at far lower costs. And our universities are free too and many of them are world class. Consider our marvelous streets…… The US are a 3rd world country with many billionaries.

  18. In Canada, you walk in, your appendix is removed you go home and you get on with your life. You will receive NO bill of any kind and you will hear no more about it. If you need a heart bypass, a vasectomy, your tubes tied or your ass reamed, it's FREE. Just kidding about the ass reaming. Health care is a human right! If not, then you're NOT living in a free country.

  19. I had my appendix removed at a hospital in my town & u know how much it costs me ,absolutely zero, nothing, cause I'm Canadian & I pay 1/3 of my income in taxes

  20. I can’t give a cost breakdown for my apendectomy, because I live in Sweden. My appendix burst. I was transported by ambulance from the first hospital to the where I was operated. My body was poisoned and I ended up staying three weeks in the hospital, intensive care, surgery, a whole list of medicines. When I got home there were no further bills, nothing owed, nothing to be paid. Total cost $10. Something is wrong in the US.

  21. Both my newborns needed care when they born. One needed intensive care treatment. The other needed surgery. It cost me NOTHING. Here in the UK we all chip in with our taxes which goes towards the NHS. It is truly the best healthcare service IN THE WORLD

  22. Meanwhile in British Columbia Canada. It was just announced our 100 a month msp is going to be waved and covered through regular taxes. Meaning its fully covered. So grateful for this. Hope you figure things out USA, you were so close!!

  23. In Australia the amount that I had to pay for my quadruple arterial bypass surgery was a grand total of $0.00 … and I do not have health insurance. We have Medicare that we all contribute to through our income tax and this entitles me to free medical procedures. I dread to imagine how much that would have cost me in the United States.

  24. A US veteran here. I have Medicare For all thanks to my service.

    I would love for people I protected to have the same.

  25. Sorry to hear about your appendectomy! I think though you should not add the monthly premium expense of 421 to your appendectomy costs as this is an expense you always have to pay- you should only count the incremental costs of your surgery, so the surgery is actually a little cheaper 🙂

  26. double your income tax every year. Im sure david makes 100k+ now multiple the additional tax by the years working. You have spent 400k plus no matter what happened. All systems suck and resources are limited.

  27. I don't have insurance. Here's why.
    The lowest quote I could get was $268 a month okay multiply that by 12 months. very expensive then there's a 5000 to $10,000 annual deductible four major medical and then it's 80/20. For somebody who doesn't get sick oh, that's a lot of money. I have always been a healthy person I've never even had the flu. Get a cold once in awhile but most of the issues I've had surgery for are injuries. Knowing I don't have insurance I just don't take chances. So I go to my regular doctor for my blood pressure medicine and as long as my blood pressure is normal I only have to go once a year that $75 plus about $50 for any routine lab work. I have an endocrinologist I go to for my thyroid. She has a cash pay of $55 and that includes my blood work once again if my numbers are normal, I only have to go once a year. With discount prescription apps, my prescriptions for these two conditions are about $8 a month so if you do the math you'll see that really I am paying $500 or less per year for my so-called Healthcare. So you say what if something goes wrong? Well on one of my routine blood work tests my calcium was elevated and my doctor suggested it was more than likely a parathyroid issue. So one day I popped into my endocrinologist office and told them and ask them if I could just have the parathyroid test and could we just take it from there? they ordered the blood test no office call I just went to the lab and had a $30 blood test, and yes I needed to have surgery on my parathyroid to have them removed. The endocrinologist has a cash pay discount and her fee was $1,500. I went to a physician-owned private Day Surgery Center and their charge was 2160. The anesthesia was $550. The nuclear scan was 480. Add all this up it's right at $5,000. So the way I look at it, I still saved myself 260 something dollars a month buy just Private Bank rolling my surgery which I have emergency money set up for just such a thing. Had I had private insurance or even Obamacare I guarantee you this would have been $15,000 surgery. Is anybody understanding this? I went through THE FREE MARKET CASH FOR SERVICE MEDICAL CARE. And it was CHEAPER…..they gave me services. I paid them. No insurance middlemen. And they charged me fair market fees. Look what you had to pay and you HAD INSURANCE. Look how much I saved by going through THE FREE MARKET service for fee.
    No I won't have insurance.

  28. the whole system is just stupid…it isn't good for anyone except 1) the extravagantly wealthy who could care less about medical bills (this is very few people) and 2) the jackals who have figured out how to work the system to enrich themselves. It is not good for patients. It is not good for the professional health care workers. It is an old, anxiety inducing, bankrupting, broken system…it costs more to get less. But…it isn't socialism, so it is the right choice?

  29. That is same as the cost of kidney transplant where i live, maybe even cheaper. My friend's appendectomy cost around 2000 usd and all covered by insurance.

  30. Trump is trying to pass a law where hospitals have to tell you how much everything costs so you can shop around with pricing. This will make hospitals competitive and costs will come down. If it passes it should take affect by 2021.

  31. My daughter went into the ER with severe pain, they ran all the necessary tests, determined that it was a cyst that ruptured. She was never admitted. She was released after three hours. The cost was $13,000.
    I retired early (after working for 45 years) but I'm not 65 yet, so I'm not eligible for medicare. I pay $1,041 per month for health insurance.

  32. Holy Cow……WTF!! Here in Malaysia, we go to the emergency dept for appendectomy and we get to do it for free at the Public Hospital. If i have medical insurance i can do it at the private Hospital for a very resonable charge.

  33. So question: the doctors did not decide to keep you for a couple of hours to observe if you have any complications with the anesthesia?

  34. Canadian healthcare system is good but need a lot improvement. The reason is that public officials suck at business management — especially when working for the government. They need to privatize the system while keeping it tax funded (like in Sweden).

  35. I was having fevers and had trouble keeping any food down for a week. I went to see my own doctor $ 45 co payment he took my temperature and gave me a quick look over before sending me to the local hospital A &E. I was admitted on arrival examined by multiple doctors put on a drip sent for a ultrasound of my lungs and found to have atypical pneumonia. They thought I had brain encephalitis to start with. Five days of constant observation and IV antibiotics a course of antibiotics to take home , follow up appointments and a ultrasound at each follow up. Total cost $ 45 for my GP visit. I had three weeks off work . I live in Australia thank God. I just don’t understand why so many Americans think universal healthcare is evil. It’s like driving a car without a spare tyre !

  36. I’m in Ontario Canada and I pay zero. Other than parking and Tim Hortons, it’s zero. I can’t even believe having to pay this silly amount for such a routine procedure.

  37. you could've flown to india, get the surgery done in a luxurious multi speciality hospital with great doctors by your side and it would've been only around $3,000 including your flight ticket.

  38. This is ridiculous. $20227 for facility & supplies ? What kind of shit is that ?
    You paid more in one month that what I probably paid in my entire life (and I had an appendicitis)

  39. You could have done us all a favor and not gotten it. Save us the whining, save you 30 grand. You know when health care costs started growing at a far greater pace than income? When government got involved and guaranteed payment for Medicare. Then, the next MASSIVE boost in costs was Obamacare. Is your healthcare 4 times better than 10 years ago? Because it is 4 times more expensive.

    I think everyone who doesnt consider the the unintended consequences of government involvement in health care while pushing idiotic health care "solutions" should be bankrupted by healthcare costs, as they have forced this issue in the rest of us.

    Eff this guy. He is the problem.

  40. Wtf… My family members have the same u have but we only paid at least $2.200 total for 5 days in a top private hospital .. All together but in the Philippines… Sorry to hear that

  41. JEEZZZ
    Ten years ago I had an appendicitis, where my appendyx burst open, and I had to stay hospitalized for one week. I live in Portugal, so you know how much I paid?? ZERO EUROS!!
    Why? Because I'm a human being and here we treat people how people should be treated.
    I'm SHOCKED by your experience

  42. It's all made to keep the rich rich and the poor poor. The cost to manufacture medical equipment is a small fraction of what they charge the "patients"

  43. 400$+ for insurance. WHAT?! AND YOU STILL PAY FOR SHIT?!?! WHAT???
    We in Serbia pay 12% of our pay per month (at least when you work for state-funded things like the hospital) and pay 0 for that stuff since we are insured.

  44. Other people pay for insurance plus an additional 20% to 25% added taxes. They don'r count that added taxes when they tell you how little they pay.

  45. MA and all liberals in Congress voted for Obama Care the fix to our health care. Now these same moron liberals like AOC say they know how to fix global warming.

  46. I was in Australia on Vacation when i got appendicitis I had no health insurance or travel insurance eeek!!! cost me nothing as im from the UK 🙂 we get free healthcare in a number of countries not just UK 🙂

  47. Post op care is a no charge item from the surgeon for up to 90 days after this procedure. Why were you charged for post op care? It is included under global f/u. I was a certified professional coder and a certified medical assistant for a general surgeon so I do know what I’m talking about. You should get a refund and I’ll bet your insurance disallowed it.

  48. in Finland I paid €60 for my appendix removal and a 3 day hospital stay and the doctors said it wasn't easy to even identify

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