What is the medical bill after breaking your ankle?

Answer 1

The cost of health care unfortunately is not as subject to market forces as are other goods and services. The reason for that is most people do not pay for their health care. Insurance companies negotiate rates based on what the provider charges in the area for similar services. Usually the rate that the insurance company is willing to pay is about 50% less. So providers have caught on and charge accordingly.

The starting price of an ER visit in NYC is $600 (that does not include pain medication, x-ray, physical exam, x-ray reading, pain medication, orthopedic consultation, casting, physical therapy, follow-up x-rays and orthopedic follow-up) about 6 hours of time.

An ankle fracture/ sprain can start at $1500-2000 for initial diagnosis and treatment. If you have insurance it will cost your co-pay and whatever they have pre-negotiated. The total bill can be well over $3000 (but no one seems to mind as long as they are not paying).

If you go through a direct access practice it would cost the office visit $150-300 or medical house call, x-ray & read is about $300, pain medication about $10-20 dollars. (Diagnosis would cost less than $800. If broken then referral to ortho or podiatry with casting $300-$500). PT if needed $100-$150 bucks per session X 8 sessions.

Prices are usually negotiable for cash payers except in direct access practices (because all patients in those practices are cash payers).

Total price in a direct access <$2000. With more personalized care, less waiting.

Hopefully you have a Flex Spending Account or a Health Savings Account.

Raymond Zakhari EdM, MS, NP-BC

MetroMedicalDirect.com

Primary Care Medical House Calls in New York City.