Ask HN: Almost a thousand dollars for a 20 minute new patient visit?
10 throwaway052501 18 5/23/2025, 10:17:54 PM
I live in the Bay Area and have a high-deductible health plan. Recently, my primary care doctor left UCSF to become a concierge physician — tired of the bureaucracy and low pay despite managing thousands of patients annually.
I booked a new-patient visit with a UCSF physician. The appointment lasted about 20 minutes. A few weeks later, I got the bill: $867. I assumed it was a mistake, but after calling, I learned this was the correct charge for CPT code 99204 (new patient visit, 45–59 minutes). Insurance won’t cover it due to my deductible.
This feels absurd. I get that healthcare is broken, especially in tech-heavy cities like SF, but $867 for a routine visit is hard to justify.
Is anyone working on viable alternatives? Concierge models? Subscription care? Could this be a startup opportunity or is regulation the only fix? Curious how others are navigating this and whether there's a scalable path forward.
- A 10 min visit to a specialist office, where I was seen by a nurse practitioner who was able to refer me to an exam without involving the main physician, costed $800 (just the visit, not the followup exam), which also went through deductible.
- A routine colonoscopy came at $19k with bills that kept coming for the next 6-12 months from various parties. Consumed my deductible in one shot as the first bill came.
- A visit to the ER that lasted 10 mins with an XRay costed me $5k, also sent in tranches for the next 6 months, to the point where I thought I was victim of some scam (I wasn’t). Maxed my deductible as well.
I have a couple non-critical health concerns right now I’d like to consult a doctor about, but I won’t drop another huge deductible just for that.
I am a dual citizen from a European country with a high quality healthcare public system (but admittedly longer waits than the US ). I’m not eligible for it since I’m not a resident anymore (I will when/if I move back), but as I went visiting family I booked a private appointment with a well known cardiologist and he spent a good 50 minutes with me, for a total of EUR 100.
Made me wait 30 minutes for a 60 minute new patient appointment (based on the billing code) when the actual time with them was 10-15 minutes (and spent discussing history).
They didn’t even possess an Otoscope for looking inside the ear.
Charged >$400 and still cost me over $250.
I’ve seen other specialists that charge $100 for a visit.
The real issue is that healthcare in the US has no functioning market and no effective regulation: prices are arbitrary, patients only see costs after the fact (even if you insist cash on something simple, the itemized bill takes forever), and insurers mostly exist to extract value. Both major parties keep allowing this to exist.
In other countries (even those without single-payer systems) there’s at least transparency and accountability. You know what you owe upfront, and regulators monitor excessive price disparities. Differentiation is allowed, but it’s still regulated.
Do you really believe UHG's 6% profit margin? US Insurance is basically private equity draining cash through inflated bills, with providers and insurers passing the buck while fleecing patients.
Here are a few aspects of the Affordable Care Act:
- In the before times, health insurance was strongly tied to American employers. Their group purchasing power made it affordable, and it is counted in the benefits package. A quitting employee, or a firing employer, would have the understanding that, barring COBRA and other mitigations, the separated employee would lose their group insurance benefit.
- Many hospital systems have offered financial assistance, and self-pay plans, to uninsured patients. Qualify for Medicaid/Medicare, or avail yourself of one of these plans.
- The Affordable Care Act is a tax on the uninsured. Purchase insurance with the tax, or pay the tax directly. "Uninsured" is now the worst situation to be in, financially.
- The ACA signaled to employers, "fire at will." If an employee needs to be fired then they can scoop up insurance on the marketplace. The employer no longer needs to worry about the separated employee's well-being.
- Meanwhile, the employees have received the message "quit all you want." If you can live without the salary then you can scoop up an ACA plan on the Marketplace. Your risk of crippling medical debt is thereby somewhat mitigated.
- Various groups have been setting up Health Sharing plans which affirm that the Health Insurance model is irreparably broken. A Christian Health Sharing Ministry is a mutual-aid fund where members pool their funds and then expenses are paid according to their needs, per the Book of Acts, and mostly conforming to quasi-insurance regulations.
We're all limping towards Universal Healthcare and Single-Payer Insurance. That's the eventual end-game for most pundits. It may go back and forth for a while. But nobody can deny that we're aiming to replicate models in the UK and Canada.
Have you tried calling your local representative?
i kid you not. everyone in health care knows this. and a patient have no way of knowing.
if it goes to your plan, they just pay the cheap code and the provider doesn't even say anything. if it's on your copay only, the plan will not help you and will laugh at your face. and it's all legal.
My provider billed $411 for the same CPT. My insurance slashed it by 50%. My copay was $40. No deductible applied, due to the plan's provision for a PCP visit.
You'll need to ensure that your insurance did their job and issued an EOB. Once the insurance has ruled on it, then you can proceed to negotiate with your provider. If the provider directly sent you a balance bill and you've not heard from your insurance carrier, then you need to reach out to insurance, not your creditors.
The creditor will also have avenues you may pursue, such as financial assistance or self-pay plans. Some may not be available due to your insurance coverage. Some people fly without a parachute and rely on the self-pay. You'd be surprised how zero-sum that can be.
Most notices demanding payment are subtly deceptive, even from legitimate creditors. I always rely on the online billing portal, or a human being who can pull up my account over the phone. Always get the latest statement. Compare all the paperwork, because timing and wording always matter a lot, especially when they're wrong!
Roosevelt tried to do it almost a century ago in 1935, but the moron greedy traitor racist fascist conservatives blocked it.