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Sat Jan 5, 2013, 12:24 PM

my night in the hospital shows why we need universal health care

I have pneumonia and finally gave up and went to the hospital and spent the night last night.Spent about 11 hours in the hospital...two iv's ..an inhaler..some medicine..nothing special....Thanks to my insurance I'm paying $87 bucks....however,my insurance company was charged over 11k.

That's INSANE!

How can a night in bed..a b12 shot and some antibiotics..two Iv's...and a monitor cost over 11k?

98 replies, 6636 views

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Reply my night in the hospital shows why we need universal health care (Original post)
backwoodsbob Jan 2013 OP
Fumesucker Jan 2013 #1
backwoodsbob Jan 2013 #3
geckosfeet Jan 2013 #33
Amonester Jan 2013 #49
Skittles Jan 2013 #52
geckosfeet Jan 2013 #56
Skittles Jan 2013 #92
geckosfeet Jan 2013 #95
tavalon Jan 2013 #96
Lady Freedom Returns Jan 2013 #64
geckosfeet Jan 2013 #84
LisaLynne Jan 2013 #8
davekriss Jan 2013 #48
pangaia Jan 2013 #66
Fumesucker Jan 2013 #68
obxhead Jan 2013 #73
Jenoch Jan 2013 #2
proud2BlibKansan Jan 2013 #4
Jenoch Jan 2013 #12
NashvilleLefty Jan 2013 #41
Sekhmets Daughter Jan 2013 #58
julian09 Jan 2013 #67
abelenkpe Jan 2013 #57
Jenoch Jan 2013 #72
abelenkpe Jan 2013 #82
cbayer Jan 2013 #5
StatGirl Jan 2013 #16
cbayer Jan 2013 #17
SoCalNative Jan 2013 #6
backwoodsbob Jan 2013 #7
Lasher Jan 2013 #13
SoCalNative Jan 2013 #34
Tess49 Jan 2013 #38
Lasher Jan 2013 #51
Richard D Jan 2013 #36
Lasher Jan 2013 #50
spiderpig Jan 2013 #9
dhol82 Jan 2013 #10
backwoodsbob Jan 2013 #11
spiderpig Jan 2013 #14
smirkymonkey Jan 2013 #94
Glitterati Jan 2013 #15
renate Jan 2013 #25
Glitterati Jan 2013 #31
PATXgirl Jan 2013 #43
Glitterati Jan 2013 #77
Lucinda Jan 2013 #70
Glitterati Jan 2013 #75
DJ13 Jan 2013 #18
backwoodsbob Jan 2013 #19
DJ13 Jan 2013 #23
Scuba Jan 2013 #20
riverbendviewgal Jan 2013 #21
renate Jan 2013 #24
riverbendviewgal Jan 2013 #44
Tsiyu Jan 2013 #30
riverbendviewgal Jan 2013 #46
Arctic Dave Jan 2013 #22
In_The_Wind Jan 2013 #26
cantbeserious Jan 2013 #27
Festivito Jan 2013 #28
patrice Jan 2013 #29
riverbendviewgal Jan 2013 #47
patrice Jan 2013 #74
zazen Jan 2013 #32
TheKentuckian Jan 2013 #71
ileus Jan 2013 #35
matt819 Jan 2013 #37
heaven05 Jan 2013 #39
spinbaby Jan 2013 #40
Flatulo Jan 2013 #42
Earth_First Jan 2013 #45
hedgehog Jan 2013 #53
riverbendviewgal Jan 2013 #54
RC Jan 2013 #61
rppper Jan 2013 #55
4 t 4 Jan 2013 #60
rppper Jan 2013 #91
Sekhmets Daughter Jan 2013 #59
Lint Head Jan 2013 #62
limpyhobbler Jan 2013 #63
pediatricmedic Jan 2013 #65
Turbineguy Jan 2013 #69
Rosa Luxemburg Jan 2013 #76
RobinA Jan 2013 #90
pediatricmedic Jan 2013 #98
dkf Jan 2013 #78
FarCenter Jan 2013 #79
MFM008 Jan 2013 #80
Liberal_in_LA Jan 2013 #81
OccupyManny Jan 2013 #83
bongbong Jan 2013 #85
SomethingFishy Jan 2013 #86
riverbendviewgal Jan 2013 #87
riverbendviewgal Jan 2013 #88
rightsideout Jan 2013 #89
liberal_at_heart Jan 2013 #93
backwoodsbob Jan 2013 #97

Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 12:28 PM

1. That was the discount rate

Without insurance it would have been more.

ETA: Glad you're OK.



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Response to Fumesucker (Reply #1)

Sat Jan 5, 2013, 12:30 PM

3. it's just insane

I could have bought what they gave me and spent the night in my own bed for like 200 bucks...instead they charged my insurance over 11k.

And thanks..feeling MUCH better this morning.My temp spiked at 104.4...down under 100 now...feel way better

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Response to backwoodsbob (Reply #3)

Sat Jan 5, 2013, 02:56 PM

33. Nurses. Doctors. Lab work. Administrative. Maintenance. Security. Housekeeping. Technicians.

Good luck getting that for $200.

On edit - hope they were able to help you out!

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Response to geckosfeet (Reply #33)

Sat Jan 5, 2013, 05:03 PM

49. And the 'bottom-line' profit (prolly the highest tab). nt

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Response to geckosfeet (Reply #33)

Sat Jan 5, 2013, 05:19 PM

52. you left out the massive profit

let me guess: you are in the medical field?

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Response to Skittles (Reply #52)

Sat Jan 5, 2013, 05:26 PM

56. Hardly.

But I did have cancer surgery, radiation and chemo last year.

Prolly close to $400k when you add it all up.

I don't begrudge them anything.

on edit: not to say that I agree with their accounting practices - but I am not an accountant either. Just a human being who gets sick and needs professional services.

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Response to geckosfeet (Reply #56)

Sun Jan 6, 2013, 01:49 AM

92. it's a racket, and a sick one at that

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Response to Skittles (Reply #92)

Sun Jan 6, 2013, 09:25 AM

95. I agree. The insurance industry is simply an arm of the investment industry.

Just pointing out that a lot of facilities, expertise and trained people go into providing health care. I wouldn't throw them out with the bath water.

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Response to Skittles (Reply #52)

Sun Jan 6, 2013, 11:40 AM

96. No massive profit for me, but state of the art care for my tiny little patients

I have no idea how much it costs to have a baby in the neonatal intensive care unit for the many weeks and months we have some of them. But I do know they get the best care money can buy.

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Response to geckosfeet (Reply #33)

Sat Jan 5, 2013, 05:51 PM

64. At home you don't need 3 of those.

Administrative. Maintenance. Security.

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Response to Lady Freedom Returns (Reply #64)

Sat Jan 5, 2013, 09:24 PM

84. Maybe not. That's just an off the top of the head list.

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Response to Fumesucker (Reply #1)

Sat Jan 5, 2013, 12:36 PM

8. It's true, though!

It would have been more for the indivdual who has to pay than what they charge the insurance companies. I don't get it. I know I'm dumb about this stuff, but I don't understand that. And I just don't think medical stuff has to be quite as expensive as it is. I understand there is a LOT involved, but ... ugh, just doesn't seem right!!

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Response to LisaLynne (Reply #8)

Sat Jan 5, 2013, 04:58 PM

48. That was the retail price

When the OP gets an Explanation of Benefits back from his/her insurer, it'll likely show the hospital was paid something like $1,100. I see 10% paid as the "negotiated fee" all the time. And, although someone w/o insurance is likely to receive an initial bill close to that $11k, they usually can negotiate a payment for far less (albeit likely something between $1,100 and $11,000, i.e., the uninsured is still stuck for a larger bill).

Anyway, that has been my experience.

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Response to Fumesucker (Reply #1)

Sat Jan 5, 2013, 06:00 PM

66. ACTUALLY, without insurance..

if you just walked in for that care it would be much, much less. BUT, doctors, hospitals know that insurance companies will pay.....

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Response to pangaia (Reply #66)

Sat Jan 5, 2013, 06:28 PM

68. As someone who lacks insurance and has for over four years now I'm pretty attuned to this subject

I'm not so sure you are correct about that, I've read some real horror stories right here on DU.

Some doctors and hospitals maybe but many of them charge full price and more for the uninsured.

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Response to pangaia (Reply #66)

Sat Jan 5, 2013, 07:42 PM

73. Every medical bill I've ever received was always less with insurance

and I'm not speaking about what I pay out of pocket.

They have consistently showed what the uninsured rate vs the rate they charge under the insurance negotiation. The insurance companies ALWAYS pay less than an uninsured individual would.

The entire system is insane. We need single payer. It's the only way we'll ever control the insane costs of medical care.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 12:29 PM

2. Your experience is about more than

universal health care. Everyone could afford to buy health insurance if not for situations such as yours.

I recently found a bill from a hospital in Rochester, MN, the one with referrals from the Mayo Clinic. My father had back surgery in 1977. The hospital bill was $800 for TEN DAYS.

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Response to Jenoch (Reply #2)

Sat Jan 5, 2013, 12:32 PM

4. I had a baby in 1978 and had no insurance.

48 hours in the hospital was $1000.

Five years later, I had another baby. Same length of time in the hospital. $4000.

Today it's a LOT more than that. But at the time I was blown away that the cost had quadrupled in 5 years.

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Response to proud2BlibKansan (Reply #4)

Sat Jan 5, 2013, 01:00 PM

12. One of the reasons the OBGYN situations

are much more expensive is because the malpractice/liability insurance is really high.

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Response to Jenoch (Reply #12)

Sat Jan 5, 2013, 03:31 PM

41. I think you mean "artifically inflated" by the insurance companies, as

proven in Texas. Years ago, the insurance companies made this argument and claimed it was because malpractice suit payouts were so high. They told us that if the claims had caps, then insurance premiums would go down. The Texas Legislature believed them, and instituted the caps. Insurance premiums continued to go up, and insurance companies just kept the increased profits.

Hopefully, the ACA MLR restrictions will take care of most of that.

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Response to Jenoch (Reply #12)

Sat Jan 5, 2013, 05:35 PM

58. More BS from the AMA...

What actually happened is that health insurance went to the HMO & PPO system. The hubby was an insurance agent at the time....In 1979 I had a baby and I had a bunch of complications, needed surgery, transfusions, IVs and spent 6 days in the hospital. Total bill $4,000. In 1981 I had a second baby, went as smoothly as silk, total bill $8,000. Same doctors. But the insurance companies, seeing the deep pockets of employers, came up with these "negotiated' fixed prices. Sold it to the doctors & hospitals very easily, as they were making quite a bit more money. Employers had no say in the matter. Sold it to the congress because now they offered coverage for office visits for a cold and prescription coverage. it's been all downhill since.

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Response to Jenoch (Reply #12)

Sat Jan 5, 2013, 06:22 PM

67. I hope they don't have to get a seperate policy, for each patient.

 

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Response to proud2BlibKansan (Reply #4)

Sat Jan 5, 2013, 05:31 PM

57. I had a baby in 2004 130,000

He had to spend five days in nicu because he was a preemie. He came home only wieghing 4.5 pounds. Two years later I had my daughter. No comlications, delivery 15 minutes after arriving at hospital. Stayed one night. Total cost 30,000.

Healthcare, education, and energy should be nationized to cut costs and help improve the general economy

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Response to abelenkpe (Reply #57)

Sat Jan 5, 2013, 07:41 PM

72. $30,000 for a delivery

with no complications is ridiculous.

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Response to Jenoch (Reply #72)

Sat Jan 5, 2013, 08:50 PM

82. So true!

But she was the inexpensive one

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 12:32 PM

5. Your insurance has negotiated a rate with the hospital and it is unlikely they will

pay anything close to the 11K you see on the bill.

More likely, they will pay about $3000.

It's all smoke and mirrors.

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Response to cbayer (Reply #5)

Sat Jan 5, 2013, 01:10 PM

16. My insurance company always says how much they are paying . . .

. . . generally around 70%, depending on the type of bill.

But I often wonder if they are lying about that. You'd think they'd have better negotiating power than to pay, for example, $500 for 3 vaccinations (the clinic billed about $1000).

As long as I don't have to pay those exhorbitant amounts, I figure they are all grown-ups who know how to settle costs, and I don't worry about it.

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Response to StatGirl (Reply #16)

Sat Jan 5, 2013, 01:28 PM

17. Hospital charges are generally 3 times or more what they actually get from payers.

You EOB should accurately reflect what the insurance company actually paid. The bills themselves really tell you nothing.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 12:32 PM

6. THat's what the hospital bills

not what your insurance will pay. They likely have a contracted rate with the hospital and will actually pay about 1% of what they were billed for. Then the hospital can write off the difference.

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Response to SoCalNative (Reply #6)

Sat Jan 5, 2013, 12:35 PM

7. I know they negotiate rates but

1% is a little hard to believe

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Response to backwoodsbob (Reply #7)

Sat Jan 5, 2013, 01:02 PM

13. It's about 50% from my experience.

A loaded hospital bill will often include charging more than once for a service that's been provided a single time. The initial bill will also include excessive charges for each procedure, regardless of an agreement with an insurance company that specifies much lower rates.

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Response to Lasher (Reply #13)

Sat Jan 5, 2013, 03:00 PM

34. I can only speak from personal experience

Several years ago I had an angiogram at my local hospital. When I received the information from my insurance company on what they had billed, it was $18,000+. The amount the hospital actually was paid by the insurance company (contracted rate) was $1800+, so it was roughly about 1% of what was billed that was actually paid.

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Response to SoCalNative (Reply #34)

Sat Jan 5, 2013, 03:13 PM

38. Ten percent. 1800 is 10 percent of 18,000.

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Response to SoCalNative (Reply #34)

Sat Jan 5, 2013, 05:17 PM

51. I don't doubt that.

I had one charge for over a thousand dollars. Blue Cross denied the charge and said I was not responsible for any of it. They were right and the hospital relented. So in that one case it was 0%. But I was just trying to offer an average difference from my own experience.

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Response to Lasher (Reply #13)

Sat Jan 5, 2013, 03:04 PM

36. does the hospital

get to write off the difference as a loss?

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Response to Richard D (Reply #36)

Sat Jan 5, 2013, 05:13 PM

50. I have no clue about that.

Maybe somebody else will chime in.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 12:40 PM

9. My sister is employed, has health insurance, and had the flu.

After ten days of misery (and she's not a spring chicken) she went to the doctor, whoadvised her she had the flu (duh!) and told her go home and rest. The insurance company billed her $520.

The health system in this country is a complete disgrace.

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Response to spiderpig (Reply #9)

Sat Jan 5, 2013, 12:55 PM

10. what did they bill her for?


can't imagine that a visit to the doctor (even without insurance) would run that high.

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Response to dhol82 (Reply #10)

Sat Jan 5, 2013, 12:58 PM

11. at this point I could

our healthcare system is a disgrace

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Response to dhol82 (Reply #10)

Sat Jan 5, 2013, 01:03 PM

14. An office visit and 2 lab tests resulting that she didn't have influenza A or B

She's very detail-oriented and keeps meticulous notes.

Mr. pig just went ballistic. These people are out of control.

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Response to dhol82 (Reply #10)

Sun Jan 6, 2013, 07:47 AM

94. Yep, I have insurance (BC/BS) and went to a doctor at Mass General.

The initial office visit was over $600 (she is a specialist - cardiologist). Even though she was an "in-network" doctor, apparently our insurance plan charges you up to $275 for the deductible. Totally sucks.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 01:09 PM

15. Day after Thanksgiving, 5 hours in ER, 3 day hospital stay

The ER alone was $15,000.00 Haven't gotten the bill for the hospital stay. Saw one Dr. once, about 15 minutes, billed $630.00

I'm uninsured.

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Response to Glitterati (Reply #15)

Sat Jan 5, 2013, 02:25 PM

25. that must be so scary

I'm glad you're okay--I hope you can manage to argue your bill down.

Edited to add: I just found this old post by a new DUer, MoonChild. The information is too late to help you with your past bill, but it might help you get insurance in the future:
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=1479094

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Response to renate (Reply #25)

Sat Jan 5, 2013, 02:46 PM

31. Thank you

My problem is twofold - 1) I'm on social security survivor benefits, so don't qualify for Medicare for 7 years and 2) the "pre-existing condition" insurance in my state, for my age, is $535.00 per month which is more than 1/3 of my monthly income.

Obamacare won't kick in for me until 2014. In the meantime, I'm just screwed.

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Response to Glitterati (Reply #31)

Sat Jan 5, 2013, 03:49 PM

43. My sister has had to have surgery without insurance, she was able to negotiate with the hospital to

Get the bill down to a more manageable amount. They were willing to settle for much less.

And someone told me that you can request the same discounted rates that the insurance companies receive. If the hospital charges $500 but the insurance company only pays $50 and the doctor accepts that as payment in full, then they have to allow you the same or it is discrimination. Like I said, it's something I've heard but never had to do...but it might be worth looking into in your case.

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Response to PATXgirl (Reply #43)

Sat Jan 5, 2013, 08:21 PM

77. I will try that next

As I said below, I've applied for financial aid, but it isn't stopping collection calls. It's actually pretty stunning - within weeks the collection calls started.

I've yet to get the ER bills and only know how much it is because of the collection calls. They don't even BOTHER to send a bill unless you insist - LOUDLY. And, then it's a paper statement with no itemization.

I presume I'm just supposed to accept what they say without even seeing a bill.

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Response to Glitterati (Reply #31)

Sat Jan 5, 2013, 06:45 PM

70. Your hospital may have a system set in place to help you.

Call the billing office and ask them about help for patients with no insurance.
They may also be able to point you to local agencies that help with medical bills.

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Response to Lucinda (Reply #70)

Sat Jan 5, 2013, 08:18 PM

75. I have applied for financial aid, but

that doesn't stop daily collection calls for the bills.

But, thank you for the information.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 01:28 PM

18. Last June my wife had severe cramping and vomiting

She was initially diagnosed as having a tumor, but it was a gallstone (her surgeon said it was the size of a small chicken egg) fused to her intestine.

Went to the ER, then sent to ICU where she stayed a week, then to another room another week, then she was sent 250 miles away by ambulance to Stanford University Medical Center where she stayed another 2 weeks to have the stone removed.

That first 2 weeks in the local hospital was nearly $100k, which doesnt include Stanford or the 4 weeks total in there, and 2 operations.

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Response to DJ13 (Reply #18)

Sat Jan 5, 2013, 01:33 PM

19. dayum

is she ok?

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Response to backwoodsbob (Reply #19)

Sat Jan 5, 2013, 02:08 PM

23. Yes, she had her gallbladder removed at Stanford in August

She was off her feet until the end of September (4 follow up visits to Stanford, I really hate that 4 hour each way drive...), and she is back to her old self, eating well again.

Her surgeon took her images to a medical conference (Oncology) in Lisbon Spain in early September and asked his audience what it was, and the vast majority also misdiagnosed it as a tumor, just as our local hospital had.

Her doctor at Stanford is a bit of a peacock, but he is one heck of a surgeon.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 01:41 PM

20. You are correct about the need for Medicare for All, but remember ....

... your charges also include depreciation on plant and equipment and a host of other costs that have to be paid.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 01:52 PM

21. That is insane

Up here in 1998 both my husband and son were diagnosed with cancer two months apart
Son first...His treatments were April 17, 1998
ambulance to hospital for seizures at work. CT SCAN, ER treatment and scan showed something in brain
ambulance to city hospital that night. MRI right away.
Stayed in hospital until next day.
Returned after overnight at home for brain surgery.
In intensive care until recoverd to semi private, then released
2 weeks later another brain surgery.
4 weeks later started radiation
then had chemotheraphy, several blood transfusions and one ambulance to hospital due to seizures.
home visits by nurse during chemo.
3rd surgery. seizures during surgery. in intensive care for 4 weeks.
1 week in the hospital palliative care. died Oct 28, 1999 - 26 years old never sick as an adult

Cost other than parking fees - zero

Husband diagnosed with lump near belly button after ct scan ordered by GP..
2 weeks later gettinig operation.
Non hodgkins lymphoma found..
Chemotherapy started
radiation
then stem cell harvesting of his cells for
intensive chemotherapy for a month stay in the hospital
Regular checks by cancer unit.
March 2001 put in Palliative care until died May 21, 2001 never sick as an adul\
cost of treatment other than parking fees - zero
Have Ontario Hospital Insurance ....one payer.

don't know the hospital costs or doctor costs as there are never bills..

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Response to riverbendviewgal (Reply #21)

Sat Jan 5, 2013, 02:24 PM

24. all that in the space of three years... I'm so sorry

All that is horrific enough without the stress of having to worry about a medical bankruptcy (or two) on top of everything else. I can't imagine what you went through. I am so sorry you had to endure such tragic losses.

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Response to renate (Reply #24)

Sat Jan 5, 2013, 04:47 PM

44. yes it is life changing but

I got counseling for a few years and Prozac helped for a few years. I worked four more years after my husband died and retired early. I got survivors benefits from the government from my own pension and then at 60 collected my Canada pension. When they died my government gave me $2300 for each of them toward funeral expenses.

I have siblings in the USA who hate Obama and his health care. They know all about my son and husband but don,'t want the communistic social care Canada has. I sadly believe they are racist.

My older son now lives in UK. He married an English girl. Similar health care there. He is quite happy.

What I am adamant to try to get through people is you may be healthy one day and the next day not, I have lost three young friends from cancer since my guys died. Their families were able to take care of them and not have to think of medical bills. Even going to the doctor there are no bills. Flu shots are paid to. At 65 prescription drugs are paid for after the first $100 spent.

Thank you for your reply and kind words.

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Response to riverbendviewgal (Reply #21)

Sat Jan 5, 2013, 02:36 PM

30. What you've been through



I know I've seen you post about this before but .....Just...dayum

Had you been in America, you might have lost your house, your car and your sanity.

At least your government cares about its people enough to provide health insurance.

But I am so sorry for your losses...you must be a very strong woman, and I'm glad you didn't have to worry about $$$ in the midst of your grieving.


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Response to Tsiyu (Reply #30)

Sat Jan 5, 2013, 04:52 PM

46. my friends say I am strong but we all can go through this

You do what you gotta do.

I love Canada. It is a very caring country. One payer is not that old here. It started in the 60s.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 02:03 PM

22. My wife's trip to the ER and overnight stay cost about twice that.

 

We have pretty good insurance but I feel bad for people who do not.

It is absolutely enraging the cost of healthcare.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 02:29 PM

26. Wow. That's an expensive night.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 02:31 PM

27. For Profit Medicine At Its Finest

eom

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 02:34 PM

28. Hey, we pay extra for 24/7 card guards, plus billing coder armies, and PROFITS!

And, that money comes from US.

$8200 per year which is 2.5T$ per year. Instead of, you know, SOCIALISM, which costs:
$3000 per year which is 1.0T$ per year. Which means we spend:
$5000 per year which is 1.5T$ per year on card guards, billing armies and PROFITS for rich folks!

NOW, PAY UP! !!!11!! !! !111!!! 1 !11 !1 1!! 1 11

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 02:36 PM

29. Answer: Risk Managers making decisions about "care" in order to keep staffing low & volume high. nt

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Response to patrice (Reply #29)

Sat Jan 5, 2013, 04:57 PM

47. nothing like that in Canada

The doctor and family make the decisions. I do not know anyone who has ever been denied the best treatment. We even get travel grants if we have to go see a doctor or get treatment not in our area.

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Response to riverbendviewgal (Reply #47)

Sat Jan 5, 2013, 07:49 PM

74. There's a little known provision in the PATIENT PROTECTION & Affordable Care Act of 2010, a.k.a.

Obamacare, that implements processes directed toward what Canada is doing, i.e. to establish best practices; it's called The Patient Centered Outcomes and Research Institute and it was created by Obamacare:

http://www.pcori.org/

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 02:53 PM

32. and health care providers mislead you about what's covered



More and more insurers are ordering medical "reviews" to avoid paying legitimate claims. Apart from their moral repugnance, some health care providers--I've had two situations like this in the past year--are misleading patients into believing their services are covered. I've explicitly asked and been told TWICE, after expressing concerns about initial claim rejections, that oh no--something's covered. It's all paid. We've "met the copay, deductible, co insurance, whatever . . . They've got the paperwork." I think that's so I wouldn't cancel services. Yes, I needed them (and my daughter when she was in ER), but you can be damned sure I would have made slightly different decisions and certainly foregone some recommended treatment (for myself, anyway) had I known it wasn't covered.

I can't believe it's legal.

I told both providers I'm going to record their assurances from now on.

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Response to zazen (Reply #32)

Sat Jan 5, 2013, 07:12 PM

71. I'd say medical review is far more common than not.

Be aware that the contract ALWAYS supersedes absolutely anything they actually tell you and often they will tell you things that are absolutely false so your recordings may be of little help unless you resources to push the issue to a jury and that only if the contract allows such. Typically, you eventually get an arbiter as your end point.

If at all possible, you should get prior authorizations but often you have to do what you have to do but if it is something in advance and you can, get an approval before the service is performed.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 03:01 PM

35. For every one with insurance like yours they treat 8 without.

Our hospital is 85% medicare/medicaid. 15% of the other patients may have insurance and 85% without....so your 15% gets to make up the billable difference between what the hospital "loses" on the medicare/medicaid patients and what they actually lose on the uninsured.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 03:11 PM

37. Thanks for this

My adult daughter has the flu and spent the afternoon at the doctor - asthma treatment, bunch o' drugs, and a new Obamacare health plan. I'm looking forward to seeing the bill. So far, the drugs have been a few hundred dollars - not bad overall. WE'll see what the rest comes to.

You're absolutely right, though, 11,000 dollars for a night in the hospital is ridiculous. A private nurse, a night in a first-class hotel, and a little TLC away from home would cost less and probably help more.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 03:16 PM

39. simple

american corporate greed has pushed our prices to levels such as this. Pure greed. I cut two fingers while trimming my shrubbery. Cut them bad enough to end up with 11 stitches. 5 and six respectively. 4 hours in emergency. This was one of our top rated hospitals in the area. I ended up with 175.00 cost, insurance paid 8-thousand. Thank god I drove myself to the hospital, the ambulance would have pushed the cost up even more. It's sad to realize what people with no insurance must go through.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 03:24 PM

40. My recent 13-night stay...

13 nights in the hospital, room only, was billed at $20540.00. My insurance negotiated that to $2225.87.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 03:36 PM

42. I sat down with a neurosurgeon last year for five minutes. Five minutes.

He reviewed my MRI with me, then shook my hand and said goodbye.

The bill was $995.

I forgot what the insurance company actually paid him, but really, I wouldn't pay that much to sit down with Jesus Christ for five minutes.

As consumers of this product (health care) we have absolutely no say in what we're willing to pay for it.

The service providers fuck the insurance companies to a fare-thee-well, and the insurance companies turn around and fuck us in the form of never-ending rate increases, and we're without any input.

It's a sick, twisted system that can only end by bankrupting this country.

My wife now contributes over $1000 monthly towards our family medical plan. After taxes and deductions, she takes home less than 1/4 of her actual earnings. She got a 1% salary increase last year, but her medical deduction went up $100 per month, so every year she slides further back.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 04:50 PM

45. Last winter I paid almost $1,000 for a 30-second EKG

No insurance cost me almost 1K for a 30 second EKG when I thought I might have been having a heart attack.

The entire ordeal ended up costing me nearly $3500 out of pocket for a two and a half hour stay.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 05:19 PM

53. I'd love to turn a set of forensic accountants loose on any hospital's books -

I bet a lot of money gets siphoned off for huge managerial salaries at the top!


Most hospitals seem to take months to put a bill together. Why is it so advantageous to them to have such a baroque billing system?

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 05:22 PM

54. each province has their own plan.

I am in Ontario. I posted on this thread already. The health insurance is improving on getting services like hip replacements done faster. Ontario Health insurance Plan is OHIP
I was impressed as the OHIP has an outside agency that randomly does survey and conference s and follow calls to find out what is working or lacking. I was paid for the 3 hour conference with a group of people. We also had lunch provided.

OHIP is now doing teleconference at the local hospital with specialists who are 2 or more hour drive away. It saves on paying travel grants and patients don't have drive far to see the doctor for a 10 minute visit..

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Response to riverbendviewgal (Reply #54)

Sat Jan 5, 2013, 05:43 PM

61. And yet, the self proclaimed, "Greatest Country on Earth" right next door, has the worlds most

 

most expensive health care.
Literally,"Your money or your life". No money? Die and get out of the way for someone who has money.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 05:24 PM

55. A baseline sleep study or EEG runs about....

$2500 to $3000 depending on the outcome...that is whether or not I have to use cpap/bipap during the test....a split study....a cpap/bipap test cost $3500...out of those figures about $200 is mine for administering, staging and scoring, the rest to the doctors that interpret the test...lot of $$$ for half an hour of work....I administer two tests per night, 6 total each for 3 techs...18 tests per week at an average of 3k a test....54k per week....2.8 million a year....2k each test of pure profit after 3 months of software usage....

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Response to rppper (Reply #55)

Sat Jan 5, 2013, 05:40 PM

60. oh, for christ's sake

we're one of the only countries left in the world that health care is "for profit" really . Health care in the rest of the world, is a given privilege, and provided simply by being born.

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Response to 4 t 4 (Reply #60)

Sun Jan 6, 2013, 12:08 AM

91. It's Kind of sad...I agree....

Granted I work for a large neurology practice...7 doctors and a lot of staff, we have a full service physical therapy lab, sleep disorder center, do EEG's, sleep studies, MRI's on location....the doctors here go all out for their patients, but the charges are obscene! My take on the ACA is that after the inevitable start up problems we will have 30 million potential new patients, but the per test cost will go down....my job is secure, and we will probably have to add more techs and labs in the long run, but there is a lot of antipathy about the upcoming changes. I should add 80-85% of our patients are retirees...aka Medicade...we do a lot of work with stroke victims, Parkinson's patients, MS, altztimers patients etc....

I was always amazed during my time overseas how well other western countries take care of their people...France, England, etc....we are woefully behind the curve...

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 05:37 PM

59. Hope you're feeling better....

We need to get rid of the fee for service model...adopt the Cleveland Clinic practices and get rid of health insurance as we know it. Universal Health Insurance will bankrupt this nation for sure if we don't change that fee-for-service model.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 05:46 PM

62. Exactly. THAT is the problem with medical pricing. I know of doctors who charge a lot of money

for "debridement" of nails when it isn't even medically feasible and nothing more than trimming fingernails. Patients are ripped off daily and no one does a thing about it. Insurance companies set the pricing based on financial averages and other medically associated averages. The determination is made in a private office by bureaucrats who just want to get it done for the quarter or year so he or she can enjoy their weekend away from work.

There needs to be a complete overhaul and equity review of pricing for procedures and durable medical equipment by a third party.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 05:51 PM

63. I'd like to know how they come up with the prices.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 05:52 PM

65. We are lucky to collect 30 cents for each dollar billed

So that is part of the problem and an explanation for why prices are so high. We are a nonprofit with a lot of charity work as well, so the for profits may be a little different. In general, I would say prices are currently inflated by about 300% to 400% above what they should be.

The costs for people that don't pay DO get passed on to those that can pay. That is the reason for the huge markup in prices.

Obamacare was supposed to even things out and make it a little more fair for everyone. Can you guess what didn't happen?

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Response to pediatricmedic (Reply #65)

Sat Jan 5, 2013, 06:32 PM

69. This is something that wingnuts don't understand.

They seem to think it's paid with pixie dust.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 08:20 PM

76. hospitals and health centers are raking in money

hospitals shouldn't be treated like businesses.

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Response to Rosa Luxemburg (Reply #76)

Sat Jan 5, 2013, 11:18 PM

90. Most Hospitals

are not "raking in money." They collect a fraction of what they bill.

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Response to Rosa Luxemburg (Reply #76)

Sun Jan 6, 2013, 01:41 PM

98. No, the hospitals are not raking in the money

The lawyers, insurance companies, and big pharm are the ones raking in the money. The hospitals are mostly just passing the cost on and struggling to keep the doors open.

This year most insurance companies are considering a 20% rate hike on their policy holders despite the new laws. At the same time they are reducing what they pay out.

As far as being treated like a business, you still have to do that unless you have an endless supply of funding and can tolerate the massive waste. Most hospitals are trying to get as lean and efficient as possible right now using smart business principles. They are expecting massive funding shortfalls in the future.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 08:25 PM

78. Universal health care doesn't solve that...cost controls solves it.

 

You can have a universal system that still spends outrageously.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 08:28 PM

79. They are building the "Backwooods Bob Pneumonia Pavillion and Conference Center"?

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 08:32 PM

80. i must be worth a million

Ive had 2 knee replacements, appendix and gallbladder out (13 Total surgeries) and multiple hospitilizations including kidney stones...
I got the bill for 1 surgery (copy) it was 22 thousand without the fee for the surgeon or the anestheologist.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 08:38 PM

81. Two tiered society - those with insurance and those without

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 09:08 PM

83. They all overcharge

Because they can. My son spent one night in the hospital after he had a seizure. The stay, the MRI, the EEG, docs and meds cost $15,000. I had to pay $325.00 and my insurance company paid the rest if it.

The neurosurgeon who spent all of 25 minutes with us charged $2500.00

We're being ripped off by greedy doctors, hospitals and other care givers.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 09:35 PM

85. Medical care costs are exponential

 

My father had major surgery at one of the better hospitals in America in the early 1970s. Private room for recovery, and in the hospital a total of 4 weeks.

Total cost, including all tests, surgery, and private room: approx $4,100 (paid in full by his insurance, BTW). I'll always remember this because whenever he had to go to the doctor in his later years, he would repeat the anecdote, the amount, and shake his head.

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 09:39 PM

86. That was a bargain...

My wife had chest pains last year, 4 hours in the emergency room, (turns out it was bad gas) cost us $10,000. They wanted to keep her overnight for "observation" but we didn't have insurance and they wanted another $25,000 for the overnight stay.

Medical costs are out of control. The amount of profit made off of the sickest people in our society is obscene..

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 09:50 PM

87. those who have facebook should look up SOCIALZED MEDICINE

Last edited Sat Jan 5, 2013, 11:04 PM - Edit history (1)

My friend who is American Canadian and makes documentaries is looking for Americans and Canadians to find out what their health car experiences are. Please look it up
http://www.facebook.com/pages/Socialized-Medicine/260256930769685

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Response to riverbendviewgal (Reply #87)

Sat Jan 5, 2013, 10:03 PM

88. here is anothee good link from an american veteran

Go to WWW.g2mil.com/via.htm

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Response to backwoodsbob (Original post)

Sat Jan 5, 2013, 11:14 PM

89. I can relate

My daughter was away at college last year and had an upper respiratory infection. The school's health center was closed for the weekend so I offered to drive up to the school which is 3 hours away and bring her home but she was miserable and wanted to see a doctor quickly. We had her take a cab to the ER. The hospital gave her some antibiotics and called a cab to send her back to her dorm.

That was February 2012 and we just now got the bill for it. $950. We can't understand why we just got the bill and it looks like the ER only charged $453. We called the Hospital billing department and got it straightened out last week. We apparently don't owe anything because the insurance was going to take care of it. But none of the numbers on the bill made any sense.

I just went to the ER last week with a head injury and had stitches and a CAT SCAN. We'll have to see how that turns out.

The goal for 2013 is no more trips to the ER. All told it was 6 times last year between my kids and I. Mostly respiratory problems which always seem to get worse at night. My kids and I have asthma so respiratory infections make things worse. One emergency, I tried to get an appointment with our doctor but they couldn't fit me so I went to the ER. But the goal is this year, no more trips to the ER. We all got flu shots which we try to get each year.






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Response to backwoodsbob (Original post)

Sun Jan 6, 2013, 02:02 AM

93. wow. What's your copay?

We have a 20% copay so even with insurance our bill would have been over $200. I can't tell you how big my pile of unpaid copay bills is. They usually go to collections because after paying the premium I cannot pay the 20%. I'm glad you're better.

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Response to liberal_at_heart (Reply #93)

Sun Jan 6, 2013, 12:40 PM

97. mines a weird but very good system

plan year runs from august 1st to end of July.Overall family deductible is $1,500 for the plan year and once that is met(we have met it)coverage is something like this(trying to remember off top of my head)

ER visits are 100% covered including ER fees and ER physicians.
If admitted 100% coverage on semi private room minus amenities(phone service..cable)
Prescription's:
Name brand drugs 80% covered
Generics 90% covered.
Several different scenarios for surgery depending on circumstance anywhere from 80% to 100%

To say the least I have excellent insurance.It and my VERY generous 401(K) matches are the only reason I stay where I work.

Not a bad place to work,just VERY physical labor and my little 48 year old 150 pound body is feeling it

My biggest worry is this will be considered a cadillac plan.Last pay stub for year had an entry for plan worth and it was over 18K.

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