How is the medical industry ripping you off? Let us count the ways! Here are eight (but by no means all) tricks of the trade you'll want to watch out for.

How is the medical industry ripping you off? As Shakespeare might have said, let us count the ways! More than a quarter of Americans say that someone under their roof is having trouble paying medical debt, according to a 2016 report from the Kaiser Family Foundation.

So let’s have a look at some obvious ways you can avoid getting a wallet-ectomy along with your other health concerns. Here are eight (but by no means all) tricks of the trade you’ll want to watch out for.

1. Ambulance Rides

If you think you’re in a serious medical emergency you call an ambulance, right? Of course, if you think it really is an emergency and you can’t safely drive yourself, call 911 and get to an emergency room ASAP. But if you just feel like crap and want to get to the ER faster, you might consider taking a ride service like Lyft, Uber or even a cab.

Back in the old days — 30 years ago — ambulance rides were usually free. Not anymore! Ambulances are billed to the patient, whether patients asked for them or not. And the charges can wind up being in the thousands of dollars, according to the New York Times.

The problem: Ambulance companies have trouble collecting for their services from insurers and patients alike, so they spread the costs on to others. Medicare, the insurance program for seniors, says the annual cost for ambulance rides in the U.S. has shot up to $6 billion.

Read more: How to Know When to Go to the ER vs. Urgent Care

2. Crazy Hospital Markups

If you nearly had a heart attack when you saw your last hospital bill charging crazy amounts for items you know to be inexpensive at the pharmacy, you’re not alone.

In general, all the hospitals in the United States charged patients or their insurers an average of 340 percent more than what the Federal government estimates as their true cost, according to the consumer advocate organization Health Affairs 4.

And that markup has skyrocketed over time: In 1984, it was just 150 percent, but by 2011 it was 330 percent. They also found that for-profit facilities marked up their prices the most (surprise, surprise).

3. Physician Burnout

What goes around comes around, and if your doctor is burned out, you’re definitely more likely to get burned. And, yes, it might cost you money, but it may also cost you your ongoing health as well.

More than half of American doctors showed at least one symptom of professional burnout, according to a 2017 Physician Well-Being study at Mayo Clinic. Meanwhile, the U.S. federal government projects that America will face a shortage of 50,000 physicians by 2020.

According to the New England Journal of Medicine, it costs between $800,000 to $1.3 million to recruit and train a doctor 5. One of the main culprits behind the burnout: unmeetable administrative duties for insurance documentation, according to Reuters.

4. Antibiotics

It’s widely known that the overuse of antibiotics has led to a surge in microbial resistance to them in recent decades. Doomsday scenarios and visions of flesh-eating bacteria aside, the overprescribing of these life-saving medicines also gets you in the wallet.

According to the Centers for Disease Control, about one-third of the 154 million antibiotic prescriptions that doctors write each year are unnecessary — that’s more than 51 million prescriptions.

On top of that, the expense of these unnecessary drugs is compounded by the fact that they cause even more illness and more need for drugs. The CDC has estimated that antimicrobial resistance costs the U.S. economy $20 billion annually in direct health care costs and an additional $25 billion per year in indirect costs.

5. Faulty Medical Devices

There’s big money in medical devices. And where there’s big money, there are big losers. Medicare, for one.

The Office of Inspector General for the U.S. Department of Health and Human Services looked at seven cardiac devices, including defibrillators and pacemakers, and found that Medicare paid out $1.5 billion for defective cardiac devices over the 10-year period between 2005 and 2014.

But that may be just a fraction of the overall costs from defective medical devices. Plenty of other kinds of implants — ranging from urological to neurological — weren’t included in the study. And, of course, Medicare is just one part of the health coverage industry.

Read more: 8 Medical Conditions That Could Bankrupt You

6. Unnecessary Prostate Procedures

If you’re a man over 50, your doctor will want you to get a PSA test. PSA refers to prostate-specific antigen, an enzyme the prostate gland produces. Elevated PSA levels may indicate a life-threatening cancer.

But there are other things that can result in elevated PSA levels, such as inflammation, and false-positive tests are abundant. And it gets worse: According to data from the U.S. Preventative Services Task Force, you’re 120 to 240 times more likely to be misdiagnosed because of a positive PSA test and 40 to 80 times more likely to get unnecessary procedures — such as surgery and radiation — than you are to have your life saved.

Both the task force and the American Academy of Family Physicians recommend against having routine PSA tests, but many doctors still insist.

7. Stents

For decades, chest pain caused by restricted blood flow to the heart was thought to be relieved by inserting a mesh tube — or stent — into the arteries that supply the heart with blood.

And while stents do hold the vessel walls open and increase blood flow to the heart, the procedure is invasive, expensive and (worst of all) unhelpful. While they were long believed to prevent heart attack and death, and recent research shows that stents can save lives when used as an intervention during a heart attack, they neither prevent cardiac episodes nor relieve pain associated with arteriosclerosis.

In fact, a 2012 review of research published in JAMA Internal Medicine found that for stable patients with heart disease, stents provided no advantage over medical therapy (including drugs and lifestyle changes) in the prevention of heart attacks or death for patients with stable coronary artery disease.

8. CPAP Machines

Sleep apnea is a not-uncommon condition in which a person stops breathing for a few seconds at a time during sleep, frequently regaining their breathing with window-rattling snores. It’s caused by airway obstruction and is highly associated with age and obesity.

And while there’s no controversy that sleep apnea exists — or that it increases risks of many things you’d rather not get, such as stroke, heart disease and dementia — it’s unclear if everyone with sleep apnea actually needs a continuous positive airway pressure (CPAP) machine, which is supposed to keep a snorer’s airway open during sleep.

That’s what insurers are asking, since the Office of the Inspector General reported that Medicare payments for sleep testing increased from $62 million in 2001 to $235 million in 2009. What’s more, CPAP machines don’t prevent heart attacks, according a 2016 New England Journal of Medicine study 5.