Sorry for the extremely long response to such a short statement. The pain medication I'm now on makes me "speed" and talk a lot. The girlfriend has already told me once this evening "I like you better when you're not talking". :)

> The people doing the treatment and the billing department don't talk to each other.

Don't be so sure. While you're almost certainly correct in the literal sense ("[they] don't talk to each other"), the medical staff working directly with the patients almost certainly know of your ability to pay.

Anecdote

On October 3rd, I was on the losing end of a (not-at-fault) head-on motorcycle vs. Jeep Cherokee collision. I had insurance on my motorcycle, of course, but did not have health insurance at the time. [0]

Five days in the hospital plus three surgeries quickly added up to roughly $106,000 USD, according to a hospital lien that was filed with the courts -- and that doesn't even include all of the follow-up visits, the ambulance ride (over $3,000 for a couple mile trip across town), the home health nurses, nearly three months of physical and occupational therapy, and so on. I haven't actually added everything up yet, but the total cost is probably somewhere around $150,000.

(Since someone usually asks... Both of my wrists were broken along with the femur in my right leg. Initially, they thought that my nose and ankle were also broken but that turned out to not be the case. I was wheelchair-bound and couldn't walk for about six weeks, couldn't bathe myself, and couldn't perform a few other "self-hygiene" activities that I won't mention (use your imagination -- it's hard to reach certain places when you can't bend your elbows). Side note: the old joke about having a nurse come and give you baths? In reality, it's not nearly as hot or sexy as it might sound. :)

However, on pretty much every form that needed a signature while I was in the hospital, it was noted quite clearly right at the top that I had no health insurance. That said, I have no reason to believe I was treated any differently than if I did have health insurance and I am very satisfied with the level of care that I received. The highly recommended specialist surgeon who operated on my extremely messed up left wrist cleared his calendar for the day and made a two-hour (one-way) trip to perform the surgery after finding out that my injuries were sustained in a motorcycle accident (he is also a biker).

Another anecdote

I have had a sore throat since Saturday which progressively got worse. After becoming completely unable to eat or drink anything due to the extreme pain when swallowing and not being able to sleep at all last (Tuesday) night, I was waiting at the local walk-in clinic before 0800 this morning when the staff arrived.

In under an hour, I had been seen by one of the intake nurses, been checked out by a doctor, diagnosed with an abscess on my tonsils [1], had arrangements made with an ENT specialist (handled completely by the staff, of course) and was on my way across town to see the specialist.

At her office, I was "jumped ahead" in line due to the immense pain I was suffering (as I found out later when I asked just how I managed to get seen so quickly when the waiting room was packed) and was in the exam room talking with the specialist within about 20 minutes of my arrival.

Very quickly, her staff had brought in all the necessary tools she needed, and she went to work spending nearly an hour performing a "needle aspiration" [2] on a patient whose gag reflex was making it extremely difficult. =)

Fortunately, everything went well. I left and picked up several prescriptions at the pharmacy and was feeling wonderful just two hours later. I'm writing this just 10 hours after leaving the specialist's office.

When asked about health insurance upon my arrival at both the walk-in clinic and the specialist's office, I told the receptionists that I was a "self-pay" and offered to pay up front. Both times I was told, in effect, "we'll have to wait until afterwards because we don't know what all will need to be done". They made a note on the paper work which was passed around between the nurses and doctors but I wasn't treated any differently in the least (at the specialist's, "self-pay -- will pay balance at end of visit" was written in red ink at the top of the first page; it clearly stood out). At the time I was seen and treated, no one had any idea whether I actually had the ability to pay a single penny. Despite that, the specialist had already explained that they were prepared to quickly perform a tonsillectomy (which would, obviously, have been a much, much more expensive procedure) if the needle aspiration was not successful.

Before leaving each of the offices, I wrote a personal check to cover the costs of the exams and procedures (in full). I have no evidence to cite but, based upon personal knowledge, I would wager that the average uninsured U.S. resident is not in a position to do so, financially. I am confident, however, that they would not have been treated any differently. (I was told up front at the specialist's that I would need to pay at least $35 today but I was not required or even asked to pay it prior to any services being rendered.) Keep in mind that this is the same hospital system where I currently have an outstanding balance of $150,000 or so (although this is more of an issue between the two insurance companies and not really "my problem" and the hospital is aware of that).

Again, during the five-day hospitalization after the crash and during my visits today, I do not feel that I was in any way treated differently because I do not have health insurance. Perhaps my experiences are anecdotal, but I simply do not feel that it is correct that ...

> The people doing the treatment and the billing department don't talk to each other.

I should make it clear that I am absolutely NOT a fan of the health care system in the U.S. and I likely wouldn't even believe what I have written above had I not experienced it firsthand myself.

Side note: I called up an ex-girlfriend while typing up this novel of a comment. She's an MSN and the charge nurse in the cardiac department at the largest local hospital (the same one where I spent five days recently). According to her, there are some "extras" that a person without health insurance might not receive (think "fringe benefits" or "above and beyond") but an individual's insurance coverage/ability to pay (or lack thereof) "isn't even something that we pay attention to. Insurance info is usually on the paperwork if they are an existing patient but in my department the patients are often well into their recovery or have died by the time we would even know anything about their insurance. If you come onto my floor my first priority is treating you and doing everything in my power to save your life. Whether or not you can pay the bill is not an exception to the oath [3] that I took. Personally, I don't give a shit. That's up to billing to deal with later." (I quoted here but I'm paraphrasing.)

[0]: After leaving my previous job, I maintained COBRA for 18 months but it had since elapsed and I had not gotten around to signing up with my current employer's health insurance plan (and still haven't, actually. Note to self.).

[1]: https://en.wikipedia.org/wiki/Peritonsillar_abscess

[2]: using a large needle to puncture the abscess and withdraw the built-up pus and blood

[3]: https://en.wikipedia.org/wiki/Hippocratic_Oath