Ask HN: Almost a thousand dollars for a 20 minute new patient visit?
14 throwaway052501 29 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.
Basically, HDHP is a yearly package deal. You choose it and accept that every year your initial hospital bill will look insane.
If your employer isn't contributing to your HSA I don't think there's any reason to choose HDHP. Or, if you (like me) don't like the feeling of doing the mental equivalent of income tax filing every time you go to hospital, HDHP isn't for you.
Disclaimer: I'm horrible with money and this comment is not financial or health advice.
Providing Health services is a side effect, and one to be minimized while maximizing profit.
There is no care in the system. It is barbaric, inhumane, brutal, cruel, unforgiving.
People will extract all they can, and even support high prices among other extractors. They're not thinking about healing. They're thinking about their kids (who are probably doing medical school), their loans, and getting compensated for their sacrifices – the years of schooling, late nights, low initial pay.
Eventually they overextract, same with the tech bubble leading into layoffs. It doesn't take that long, but long enough for people to be blindsided by it.
Problem 1 is that most of the electorate are healthy, and sickness is transitory, so it's not a "single issue" topic like say guns or abortion.
Problem 2 is that elections cost money. Lots of which is provided by industry, in this case the health care industry.
Problem 3 is that the political climate is such that partly politics requires disagreement. If Democrats are pro universal Healthcare then Republicans have to be against it. Even if the public are very much in favor of something, it's preferable to not do it, but rather just fight about it.
In short the system is clearly bonkers, but there's no political will in the electorate, and certainly not in politicians to change it.
Of course, capitalism doesn't see this as broken at all. The system, both democracy, and the "free market" are working perfectly. Only the customers are suffering and they are not enough to overcome the entrenchment.
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 with hybrid social systems, multi-payer, etc) 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.
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!
You know that the issue is not the salaries of doctors, right? Or the salaries of nurses.
Why are you making such an obvious bad faith argument in public?
Have you tried calling your local representative?
And because poor paying jobs tend to lack health insurance (and all gig economy work does), healthcare is a primary cause of personal bankruptcy.
I mean $867 is more than three weeks full time gross at the Federal minimum wage…but most minimum wage jobs don’t offer full time and the working poor have payroll taxes.
Concierge models? Subscription care?
These are premium products for people who can afford premium service.
Could this be a startup opportunity
No. Venture capital seeks above market rate returns. What you describe is below market rate. Or to put it another way, capitalism can’t fix capitalism because capitalism assumes capitalism is not broken.
whether there's a scalable path forward
Don’t get sick is one option.
Work for an employer offering good health coverage is another.
Be wealthy is the third.
Change your phone number to avoid collections is a fourth.
Or pay the bill if you are lucky enough to have that kind of money…and be glad its not your child and the condition is not serious. Good luck.
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.
Roosevelt tried to do it almost a century ago in 1935, but the moron greedy traitor racist fascist conservatives blocked it.
go to ChatGPT and ask it to ask you relevant questions w.r.t. what blood tests you should order. then book them at Quest Diagnostics yourself for like $100 total. then ask it how to interpret the results.
voice any other concerns you might have as well.
follow up with human doctor only if necessary.
In some ways they are right, the hallucinated drivel / slop unrealated to reality is unique. I guess.
And for people who cannot tell the difference, the slop synthesized to please them, well, pleases.