So I opened the letter last night and found a hospital bill:

[PCIntern]

As some of you may know, I had a recent (successful) stay in the hospital. What occasioned that stay was an ultrasound which I had performed at the outpatient center, which saved my life. Or at least 'life' as I know it.

The bill is thus: Fee for ultrasound $1066.00
Insurance Paid 106.50
Adjustment 919.50

You owe 40.00


Now something tells me that there are two, count 'em two, interesting issues here. On the one hand, the fee for that procedure is way out of line, the "list price" as it were. OTOH, the reimbursement is ridiculously low, and I have an EXCELLENT health care plan. BUT, if I didn't have insurance, I'd be responsible for the entire $1066.00 which is ridiculous, but then again, how could they possibly break even being paid $146.50 for the service? In this country, the pendulum always swings wildly.

Gouging the poor to pay for the rich.

Where have I heard that one before?

[justgamma]

1. My ultra sound cost

$1312.00 Insurance paid $453.03 Adj. $101.95 I owe $757.02.

Not many people have that kind of money laying around.

[PCIntern]

5. REALLY! WTF?

that's frightening...and of course, the cost of the TREATMENT required would have put me out of my home, if that ratio applied. total of 5 days with an operation and tons of nursing care...I can't wait to see that invoice.

[Mnemosyne]

19. I have no insurance and paid $748, that was with a forty percent discount

because I was fortunate enough to have the cash that day.

Disgusting that you paid that much with 'insurance'.

[ProfessorGAC]

33. I Had A Similar Sticker Shock

I'm on an MS medicine and one of the known side-effects is B12 deficiency.

So, my neuro sets me up for a blood test to get CBC, metabolic, and B12. Test was $960! FOR A BLOOD TEST!

Insurance paied $650. So, we're on the hook for $310. I told my neuro that his plan to have this done every three months was not going to happen. I'm not spending $103 a month to see if i need to take a supplement. It's easier just to take the supplement.

I could not believe the cost. Apparently, the B12 part nearly tripled the cost of the blood test.
GAC

[renate]

51. OMG... that's ridiculous

Especially since vitamin B12 is nontoxic for almost everybody, so there's no reason not to do what you're planning to do--just take a supplement (sublingual if you have any GI problems) or get a B12 shot on a regular basis. Ask your doctor whether you can just get an occasional CBC to see whether you're developing megaloblastic anemia as a result of any deficiency; you'd be behind the curve, if it was already developing, but it's a cheaper way to keep an eye on your B12 levels.

I just read a book about how f-ed up the health care system is; your doctor may have had absolutely no idea how much it cost to run the test. He may have been practicing responsibly, since the consequences of deficiency can be so severe, but as you said--just taking a supplement is so much cheaper.

[lbrtbell]

61. That wasn't "a" blood test

That was several blood tests. The metabolic panels are the expensive ones. The CBC and B12 ones are pretty cheap.

[ProfessorGAC]

64. Wrong

I got an itemized list. The B12 test was 50% of the bill. And i know it was A blood test. That's why i described the menu.

Sheesh.
GAC

[sinkingfeeling]

35. Was your deductible paid? My annual PET scans occur in Jan. and I always have to

pay my co-pay and my $750 deductible on those. Then all other medical costs for the year are just the co-pays.

[handmade34]

2. glad you're ok

despite the bill...

I went to the ER a month ago after finding a tick embedded in my hip (damn tick! he got where I couldn't reach him...it was a Sunday and I knew the tick had been there beyond the 2 day window for chances of Lyme ...anyways, no insurance and the bill was just shy of $600.00 just to have the Doc take 4 minutes and dig out the head and give me a large dose of anti-Lyme juice...

[Downwinder]

3. Looks like the gap between the uninsured and insurance cos.

has widened. 15 yrs. ago it 4 or 5 to 1. Yours is 10 to 1.

[Sancho]

4. Health care for profit is a bad idea....

you live in an uncivilized country. Sometime in the future people will look back on health care today as immoral stupidity - like slavery.

[PCIntern]

7. I agree...and I'm a "Provider". n/t

[WildNovember]

6. What's an "adjustment"? How do you wind up only owning $40?

Who's paying the $919?

I don't get it. Are you saying your excellent insurance forced them to take most of the charges off your bill?

[PCIntern]

9. sure am...

Providers, also known as docs, dentists, hospitals, podiatrists, make a deal with an insurance company that that company will set the fee. They could charge a million dollars, but only get paid 106.50 plus 40 from me. that's the deal.

[WildNovember]

11. how much do you (or whoever) pay for a policy like that? can i ask?

so it's bascially whoever has the least power or money pays the most, and even if they can't pay they;ll be punished by eternal debt?

it's like a horrible torture world.

[PCIntern]

16. My premium monthly for my family with Rx's is 2850.00

which is a SALARY, AFAIC.

[WildNovember]

17. how many people does that cover?

[PCIntern]

18. 3

[WildNovember]

20. jeez.

[Lasher]

24. Mine is $145.73 a month for 2 people.

Dental, vision, and prescriptions are included.

[MagickMuffin]

37. Care to PM me with more details, if you don't want to post it here

Although I'm sure there are other DUers who might benefit from your provider. I still wouldn't be able to afford it right now, but perhaps I could look over their plans and see if there is a way.


Thx :hi:

[Lasher]

43. Mine is a retiree medical benefit, so others can't buy in.

I was middle management in a large corporation, retiring after 33 long years. I have the union to thank for this good benefit, even though I was dropped from membership when I was promoted into management after having worked there 10 years. They were obliged to treat us management at least somewhat as well as union members, you see.

I am also fortunate to have VA benefits, mainly because these days I wouldn't be surprised if my former employer cut me off.

I hope nobody feels like I'm gloating. I'm just trying to help with the discussion. There is no good reason why everybody shouldn't have medical insurance as good as mine or better. That's what I want.

[RebelOne]

40. That is unbelievable. When I was working (was laid off in 2010),

my employer insurance was $200 a month for one person, but also included dental, vision, life insurance and prescriptions. I cannot understand how your insurance is only $145.73 a month for 2. Fortunately, now I have Medicare, but that does not cover everything and I pay $110 a month.

[Lasher]

45. Check out my reply just upthread and maybe you'll understand better.

This will take you there.

We had to work for this one employer at least 30 years before we qualified for this benefit. I am very fortunate to have been able to work there that long.

I will welcome more questions if you have them.

[RebelOne]

56. You are very fortunate. n/t

[WildNovember]

50. The more I think about this, the more evil it seems. Your insurance company is making

a bundle from you while more or less stiffing the medical sector, driving up costs for everyone else, and those costs fall on other less "musclely" insurance corps and people without high-priced insurance, and the working poor -- who if they lose the health lottery, wind up with unpayable medical bills and a lifetime scarlet letter of debt.

The only real winner seems to be Big Insurance & the finance sector. It's sick.

[PCIntern]

52. sure it's evil and despicable...

and it's a GROUP RATE thru an association...if I were independent, it'd be much more!

[WildNovember]

53. And what do they do for that money? I can't see that they do much of anything that's

worth the price. It's just rentier economics. They take a skim of every transaction.

[PCIntern]

54. "The Vig"...

what a racket...

[WildNovember]

59. Exactly.

[blueamy66]

32. Which is MORE than my monthly salary

after taxes, insurance, 401 etc.

Holy crap!

[tsuki]

23. Mom's hospital bill, no procedures, was $102,000. Medicare & TriCare For Life

paid almost $20,000. No co-pay. I had a business for 32 years. I would have been bankrupt if I could have only collected 20% of what was billed and had to eat the rest.

[Lasher]

12. Insurance companies negotiate contracts with hospitals.

In these contracts the hospitals agree to charge a certain amount for a given procedure. When the hospital charges more than the amount allowed by the contract, the insurance company tells them, "No, you can't charge $1,066 for an ultrasound. Our binding contract provides for a charge of only $146.50.

The 'adjustment' is the difference between what the hospital tried to charge and what they were supposed to charge under the contract they have with the insurance company. The hospitals are prohibited from charging you for any part of this 'adjustment', so nobody pays the $919.

[WildNovember]

13. I'm about ready to cry. Seriously, I didn't know that. So if you have a shitty

walmart policy you'll pay $1000 and if you have a dentist policy you'll pay $100.

Really, I'm going to cry.

[Lasher]

22. I'm sorry this is depressing you but you need to be aware.

These price differences are immoral, particularly where the uninsured are involved. I have read of cases where uninsured folks were able to negotiate lower prices when they were able to point out that hospitals, et. al, charge their insured patients much less.

Shitty Walmart policies (catastrophic only, high premium, high deductible & high copays) are where employers have been evolving for decades now. If you have such a policy, your employer probably contributes no money, and only acts as a mediator.

This is a good example of why we need Medicare for all (AKA single payer universal health insurance). Employers should not be providing health care insurance for their employees.

[LiberalEsto]

26. The word 'evolving' doesn't quite seem right

Employers have been devolving to worse and worse coverage.

Otherwise agree 100%!

[Lasher]

31. Global free trade, and free trade agreements in particular, are driving this.

We often discuss balance of trade, but when I think about free trade I am more concerned about the US middle class becoming the underclass. How often do we hear that we can't compete on a global scale if we provide decent employee medical insurance or a living wage?

In the '70s I had employee medical that paid for everything. I had no premiums, copays, deductibles, nothing. And it was not that unusual back then. Now such benefits are rare. They are scorned (and even penalized by a Democratic administration!) as 'Cadillac' plans. It was simply part of our overall compensation. And yet we managed to compete on a global scale just fine back then.

You are right, we have devolved, and the devolution continues apace.

[tblue37]

62. back in the day, employers chose to provide health care instead of

increasing salary or wages for employees, and the unions went along with the idea, since those benefits were not taxable income--so now we have employer-tied health insurance, but employers are cutting back on quality of coverage, and employees are forced to pay more and more for worse and worse policies. Meanwhile, millions of people can't find work at all, or can't find the kind of job that provides healthcare benefits.

This pretty close to the most screwed up healthcare system imaginable!

[Lasher]

63. True, and it's the same story with employee pensions.

Lots of people worked so many years with the promise of a decent retirement pension in lieu of higher paychecks. But corporations jerked that rug from our feet too, to one degree or another.

These are some reasons why we see so many older people involved in the Occupy movement. We remember what it was supposed to be like, so we understand what all of us - young and old - have been cheated out of.

[ehrnst]

29. The actual procedure may cost them less. But the sticker price is $1066

They charge others more to make up for the loss on the deals that they give to the insurance company.

The insurance company has more leverage if they have a bigger pool of potential patients.

[KT2000]

57. Do you know if

the hospital is allowed to take a loss (on taxes) on the difference between the charge and the binding contract amount?
If so, that would be another reason to inflate prices for the insureds.

[Lasher]

58. I'm sorry, I don't know the answer to that.

But I'm going to go ahead and guess that they cannot, since they are being paid what they contractually agreed to charge. These 'adjustments' therefore do not result in losses, but apparently reasonable compensation.

[Ruby the Liberal]

60. Tax writeoff.

Its a loss (unreimbursed).

[Lasher]

8. I have had similar experiences.

I am no fan of insurance companies but mine routinely sets hospitals straight on overcharges and charging twice for the same procedure that was performed once on a given day. They are very diligent at this.

Even at that, hospitals will sometimes send me a bill for an amount that the insurance company had already told them they couldn't charge. In those cases I call the insurance company and they call the hospital billing department to get them off my back. It's always a good idea to compare a hospital bill with the insurance company's explanation of benefits that you get in the mail.

Having had 8 operations since September last year, I consider myself somewhat of an expert in this. I'm lucky to have fairly decent insurance.

[Sherman A1]

10. Another round of the Health Insurance Billing Game

Featuring Wildly Overpriced Billings, followed by Wild Insurance Plan "Adjustments", followed by Plan (we are going to pay whatever we feel like) Payments, followed by "hopefully" reasonable co-pays.


In this case You are a Winner. Please feel free to play again!:freak:

[NNN0LHI]

14. Your insurance company has a contract with your provider with a separate price scale

If I go in for blood work the clinic charges are in the hundreds of dollars. My insurance actually only pays the provider about $40 bucks due to the contract they have and writes off the rest.

Like you my insurance company has its own contract with the provider and its own pricing.

That is how it works.

Don

[PCIntern]

15. Believe me I know how it works: I'm a dentist and we're 'paid'

variably...the worst is the Federal workers who elected the lower-tier coverage...we might clear 6 dollars from a 45 minute cleaning visit after expenses...but I take the plan...don't ask.

[flpab]

21. billing cost?

I am in a feud right now with one bill. I also found out that out of network people that show up and bill you during a surgery are illegal in some states. I fought a 1,900.00 bill and won that one!! Was I suppose to lay there and ask before she put me under? The hospital was suppose to clear these people when I pre-registered. Anyway, I am paying this one doctor 5.00 a month and had heard it averages 25.00 to send out a bill. Labor and cost to do this. The hospital set me up on a payment plan to pay my 10% of the bill. A 24,000 dollar bill for a 3 hour stay in the hospital for a gall bladder removal.

[HereSince1628]

27. It mostly seems about a gamed pricing structures used

to make insurance negotiators feel like they get good deals...The very same game is played with things from used car prices to college tuition.

No one can survive negotiating their fees for service down below a point where they break even. The game works plenty well enough to keep the providers and the insurance companies in business.

Dismissing the 10-15% extra overhead this game builds into American medicine, it seems to work out reasonably for those represented by a third party negotiators. On the otherhand, evidence suggests that it is brutal and punishing for those who don't. Why? Because "the uninsured" is the group that the providers use to set their high price point for the start of negotiations that make the actual negotiated price work.

[dipsydoodle]

25. I paid for a private ultrasound on my shoulder last year

here in the UK. It was £220 which is c. $330. I could have had it done on the NHS but I was more interested in having it done quickly rather than waiting.

They're 'aving a laugh at the figure you quoted.

[ThomWV]

30. Maybe they'e laughing at you for paying $300+ for something you could have had for free.

[ehrnst]

28. The actual procedure may cost them less - but they charge others more to make up for the $146

that your employer's insurance company negotiated.

Let's say the actual cost of the procedure is $700. If a one employer has negotiated a rate of $146.00 because they have a large pool of employees, then the employer with the smaller pool may be charged $500.

In order to make up for those breaks, they will charge someone who is uninsured $1066, or someone with an individual private policy $900.

Competition between insurers doesn't lower prices across the board - it increases them exponentially for others.

Maryland has created a system by which the state sets the price for a procedure - no matter who pays for it.

[Atman]

34. Similar story with my recent surgery.

I had tendon repair surgery on my foot, plus work on a bone chip on my ankle. I got the statement; $11,200 for the surgery, but my insurance only paid $1,100, and I had to pay $90. Something seems out of whack.

[w8liftinglady]

36. I was thinking the same thing

...when looking at my medical bills...Hospital charges $50k,insurance pays $30K...I owe 150....over and over again...

I understand that not-for-profit hospitals have to make up loss somehow..but as less people are insured,there will be a bigger gap.We are already seeing this in Dallas...our census is down...we only accept "X" number of uninsured..hence,only "x" number of uninsured get rehab...while the county hospital's census has skyrocketed.

[LibDemAlways]

38. I have a friend whose daughter is spending a year working in

Germany. She recently fell and required stitches to her chin. She walked into a clinic with great trepidation and was amazed that no one asked for her insurance information. They stitched her up and sent her on her way. No charge.

Here in the US the primary concern of the staff would be how she was going to pay. We have our priorities massively screwed up.

[a la izquierda]

48. I got horribly ill in Mexico with an intestinal parasite...

and had to go to a gastroenterologist for tests. He charged me $30 for everything, including an after hours visit. Didn't care if I had insurance (which I did, and had I used it, he assured me I'd pay a lot more, which is true). No ridiculous reams of paperwork, just the basics in case any further medical work was required.

Another time, I had a terrible stomach virus while visiting some friends of my advisor. The lady happened to be an epidemiologist, knew there was a terrible strain going around, gave me a shot for the pain and cramping, and in 5 minutes, I was resting comfortably. No charges.

Two words: civilized. medicine.

[LibDemAlways]

55. My sister-in-law's mother once took a fall in Canada and sprained her

ankle. She was x-rayed, bandaged, and given crutches. When she tried to "settle up," no one could figure out what to charge her. They agreed on $20.00 and told her to have a nice day. Civilized medicine for sure.

[Missy Vixen]

39. I had a CT scan in September

I was diagnosed with pneumonia as a result.

The CT scan cost $6,000. After insurance, my cost is $450.

We're making payments.

:eyes:

[dembotoz]

41. so insurance is just like having a super coupon

big expensive surgery becomes cheap little surgery.

maybe we should ask bout double coupon days
or buy 1 get one free promos.

professional????
my ass

[grasswire]

42. and insurance will soon be mandated for all

under penalty of law.

What a mess.

[MedleyMisty]

44. I nearly bled to death this summer from an ulcer

The bill for just the hospital stay was $14,000.

I have insurance. The deductible is $5,000. My company has a plan that pays $3,250 of the deductible, so that helped.

It's all paid off now. And we go out a lot less than we used to and buy a lot less books these days. But I'm alive.

Can I just say - FUCK EVERYONE WHO DOESN'T WANT NATIONAL HEALTH CARE, WHY DO YOU INHUMAN FREAKS WANT PEOPLE TO SUFFER AND DIE????!!!

There. I feel better.

[Lasher]

49. I'm glad you didn't become a statistic.

The harsh reality is, this would have been more likely if you had been uninsured.

So your personal deductible ended up being $1,750. Is that an annual maximum under your plan?

[supernova]

46. The other half of this equation

that no one is really focusing on is the hospital admins' fun with pricing structure, charging different prices for the same procedure based on ... well, the degree to which they can bully the individual/smaller insurance plan to pay for it.

It seems to me that hospitals, going forward (as well as insurance companies) will have to calm down their pricing gimmicks.

[recoveringrepublican]

47. Wow, it's amazing the difference in price for ultrasounds

I had one when I was 13 weeks pregnant that the insurance would not cover. We had to pay about $250. It wasn't an investigative ultrasound though, just crazy mommy worries that we couldn't hear the heartbeat yet. All the tech did was look for the heartbeat, she found it. Then she offered to tell us what the sex was for fun (amazing that early!). But there was no need to send it to my midwife or anyone else to determine anything. Was the U/S fee for JUST the ultrasound, or for someone reading it also?

But I agree with you. It seems like the uninsured end up subsidizing the insurance companies and the insured.