Raped at the hospital

[Don Ro]

After my quad by-pass back in May, '11, I rec'd copies of the hospital bills in the mail. My insurance paid for all but $500 - $600.
I was shocked to see the prices.
Total was $165K.
$24,000 for what they called "Sterile Products."

[greglepore]

A couple of comments here-I refractured my right humerus in October after a cycling fall. Because I had a concussion, I went in as a trauma, even though I was conscious enough to request that the ambulance just transport me...oh well. Anyway, uninsured at the moment, for reasons I won't go into here.

Total bill from facility:65k plus for er, or and a 2 day stay.
Ortho 6k
Anesthesia-1500
Radiologist 1500.

What kills me is the variance in what they'll accept. Anesthesia was completely reasonable-they'd take 900 payable in installments if I wanted. About what they would get from local insurance rates.

Ortho-stupid and unreasonable. Offered to pay them immediately at Ins reimbursement rate. "No, we can't disclose that or do that, but we will take 50 bucks a month on the total INTEREST FREE until its paid off"-what does that tell you about the complete and utter unreasonableness of the quoted rate?? Pissed me off, paying them the 50/month. OUghta be a law requiring them to accept present value or something.

Radiologist-even more unreasonable. Balance in full, now. Not willing to discuss any self pay option.

Hospital-waiting to hear-they have some "program" for the uninsured that allegedly will "charitably" reduce your bill-likely I'll end up paying something like the 3rd party payor rate, but without them disclosing same and with me left feeling like they did me a favor-right.

The system needs transparency-the fiction that the insurance industry gets a volume discount is unjustifiable, it simply allows the actual cost to be hidden.

How a nation like ours has allowed such a fundamental right to get so f'ed up is beyond me.

[gacook]

I'm all for fee-for-service, too...until it gets stupid. The healthcare industry has gotten stupid. Whether it's because of all the litigation (I'm sure this is a HUGE part of it), or simple greed on the behalf of the insurance providers (who each are making BILLIONS in profit each and every year) is another story.

Paying 4 different people for one broken wrist is ridiculous.

As for insurers...with my auto/homeowner's policy, I'm part of a company that everybody's a shareholder. I pay in my premiums, as do all the other people. At the end of the year, whatever money is left over (after paying salaries, accidents, etc.) is divided up amongst all the customers/shareholders. I've been with this company for over 15 years now, and I can only remember 1 year I didn't get a check from them; usually to the tune of ~$200. Why can't health insurance work similarly? I know the money I spend each month would be just as well used as toilet paper. I've been to the doc/hospital exactly 3 times in my LIFE. I've been paying in for the past 20 years, on average $400/month. That's approx. $5000 per year, or $100,000 over the course of my working years up to this point. And I've used maybe $10,000 in services. Sounds pretty good...for the insurance provider.

[Noah930]

Originally Posted by greglepore

What kills me is the variance in what they'll accept.

Understood. But what each entity will accept depends exactly upon that--what each entity will accept. Each entity--the hospital, the ortho, the anesthesiologist, the radiologist, the lab--is a separate business.

Ortho-stupid and unreasonable. Offered to pay them immediately at Ins reimbursement rate. "No, we can't disclose that or do that, but we will take 50 bucks a month on the total INTEREST FREE until its paid off"-what does that tell you about the complete and utter unreasonableness of the quoted rate?? Pissed me off, paying them the 50/month. OUghta be a law requiring them to accept present value or something.

Well, it's their policy to be helpful or not. But at the same time, how much they get reiumbursed by an insurance company depends. Depends on the contract they have with that specific insurer. So it's not a simple answer to give you. There is a law, though, that they have to charge everyone the same amount (insurance companies/Medicare/Medicaid excepted). So they would have to charge you the same amount that they would charge any other customer. Effectively, though, you found out it's $6K for the services rendered. (I'm not commenting on the reasonableness or not of that $6K amount.)

The system needs transparency-the fiction that the insurance industry gets a volume discount is unjustifiable, it simply allows the actual cost to be hidden.

Again, not so simple an answer. Yes, it's a simple and reasonable expectation. But there are times I (as a health care provider) can't get a simple answer from an insurance company.

To wit: A patient wanted a particular injection. The company that supplies the kit for this injection charges me $350. Normally, just for an injection I wouldn't get reimbursed more than about $50-60. So I certainly don't want to spend $350 for materials for reiumbursement of $50-60. Times two, as he wanted it to both arms. And insurance may reiumburse 50% of the rate for the other side, as they often follow a Medicare policy of "while you're in there" mentality.

So my office rang up the patient's insurance company to inquire about coverage for this injection. "Well, that's experimental," they said. OK, will you cover it? Will you reiumburse for the materials cost? "You'll need to submit a claim." Well, what if I just give you the codes I'll bill out? Can you then tell me what you'll reimburse? "No, you need to submit a bill first and then you'll hear back from us." Granted this is a slightly uncommon situation, but how the F am I supposed to run a business when dealing with that?

How a nation like ours has allowed such a fundamental right to get so f'ed up is beyond me.

'Cause we're run by lawyers and businessmen?

[Noah930]

Originally Posted by gacook

Paying 4 different people for one broken wrist is ridiculous.

Understood from a consumer perspective. At the same time, you're dealing with 4 separate businesses. Thinking aloud: would a general contractor business arrangement be feasible/legal? When you build a house, you hire a general contractor, who then hires subs. You pay the GC, not the subs. The subs don't work for the GC, but are rather hired by the GC. Customer deals with one GC. Not sure regarding the legality of that scenario in medicine. But there goes any transparency of cost you're requesting.

That's approx. $5000 per year, or $100,000 over the course of my working years up to this point. And I've used maybe $10,000 in services. Sounds pretty good...for the insurance provider.

And for those who cost the insurance provider more than they pay in premiums. That's one reason why the ACA's mandate to include all pre-existing coverage issues without charging them higher rates sounds great from a humanitarian perspective, but may be a financial disaster for the healthy.

[RWebb]

Originally Posted by Noah930

Sounds like you should move to Qatar.

If you thick picking an oil for your air-cooled 911 was difficult, wait 'til you need to choose a medication for a serious medical ailment. One of the reasons why in America we have physicians as gate-keepers for medications is due to education and liability reasons. But hey, if pharmacists and individuals are willing to accept that responsibility, that's fantastic for everyone involved. I'd be all for it.

last part should be in green, eh

if you know the quality of pharmacy students and the training they get you sure do not want them prescribing meds. (exceptions exist, of course)

stick with a very highly selected pool of young people, who then receive extensive and intensive training for many years

--------------------------------------

now, let's rip on the drug companies...

[gacook]

I understand your "different company" perspective, Noah. However, when the "different companies" all operate under the same roof (which means they're sharing/splitting their overhead costs), they should not be charging me 3 separate charges (all on the same letterhead).

[techweenie]

I had a visitor from Germany over the weekend. He's a medical doctor. He is disgusted by the for-profit American health industry and the way people are treated by the insurance industry, in particular. As he said: 'you used to have the best healthcare in the world, and now it's among the worst.'

[Noah930]

Originally Posted by gacook

However, when the "different companies" all operate under the same roof (which means they're sharing/splitting their overhead costs), they should not be charging me 3 separate charges (all on the same letterhead).

They don't share any overhead costs.

In general, the hospital pays for the physical plant and everything within it (with the exception of the doctors, who are not employed by the hospital). The hospital does not pay the doctors anything. The doctors only pay an annual fee (several hundred dollars) for the privilege of working at the hospital. The office costs borne by the doctors are not paid for by the hospital. If the doctor has an office on hospital grounds, monthly rent must be commensurate with rent for any other business in the neighborhood.

[gacook]

Wasn't talking about the hospital; that's why I dropped my number of co-pays from 4 to 3. It was basically a medical suite with multiple docs in the same building. The X-ray lab was literally across the hall from my Doc's office. Now...last I checked, the electrical company doesn't charge per room in a building; they charge for usage on the ONE METER that's located with said building...therefore, all these offices are indeed sharing overhead costs (and if they're not all completely retarded, they're doing the same business with the cable company, phone company, etc.).

[Noah930]

OK, you're just using semantics at this point. So if this is a large building with multiple tennants, perhaps things like utilities are not paid for by the individual tennants. Perhaps the building's owner pays for that. And that dollar amount gets rolled into...RENT. Each tennant is responsible for their own rent. And each tennant is its own separate office, with its own separate office staff, nursing/technical staff, billing staff, furniture, office supplies, medical supplies, etc. To say that they're sharing/splitting overhead costs just because the utilities are rolled into the rent isn't a realistic view of the business model.

[Tobra]

Originally Posted by BE911SC

Stay out of hospitals if at all possible.

I tell at least one person this every single day. Nothing good ever happens at a hospital unless you are going to pick up a baby.

[Kraftwerk]

Zeke,
I buy my Levothyroxine is Switzerland. It is 1/3 the price and made there, in Basel. Its is about the ONLY thing which is cheaper in Switzerland. Says a lot about our system here.
Sorry to hear you must take Celebrex. I took that for awhile. I have no idea whats in it but I must say it worked..And its frickken expensive.