Are we transferring the cost of our medical care to the backs of the

[tsuki]

uninsured?

Recently, husband had a procedure. Our copay was $100.00.

I received the Summary of Claims Form today, (and I am rounding off the figures.)

The cost of the procedure was $3500. The insurance paid $350.

That means the insurance paid 10% of the billed, and we paid 2%. The bill is satisfied. (Note on bill: This provider has agreed to accept the eligible charge as payment in full. You are responsible for any coinsurance or deductible amount indicated on this claim.)

$100 was indicated, which we had paid.

But, if you were uninsured, the entire $3500 is due. The state of Florida has recently implemented laws which allow the medical provider to garnish wages or attach property. The provider can "forgive" up to 10% of the bill, but the person is responsible (personal responsibility, dontcha know.)

If the medical provider accepts 12% of the bill as payment in full, why don't the uninsured get the same deal?

Somebody speak to me. I am really upset about transferring the cost of our medical care to the backs of those that can least afford it. What can be done? Who can we contact?

[NorCalDem]

1. Yes, yes they are

its a terrible tradegy. :(

[tsuki]

4. What do we do? I am sending this paper to Dean.

I am talking about 12%, 12%, and the bill is fully satisfied. If it only cost 12%, how can they charge someone else the 88%.

May a 25%, or 30% reduction, but an 88% reduction? They can do the procedure for 12%, and make money?

Thieves. Pure and Simple. They need to be arrested for grand theft.

[indepat]

44. Yep, that's the way the system works and it stinks to high heaven

in Amerika.

[Mythsaje]

2. It's interesting...

Do you know that the patients are billed for things that most businesses would simply consider the cost of doing business? Surgical gowns and preparation kits, catheters, respiratory tubing, vascular tubing, saline, and other solutions, etc... More and more stuff is billed directly to the patient.

[donco6]

7. Yes the old, "switch operating costs to supplies" trick.

It's taught in like, Day 1 of business school. Banks learned it first, then everyone else followed suit.

[SPKrazy]

8. Hospitals Are Bleeding!

indigent care is expensive

and no, the person probably wouldn't have to pay the $3500, most places give discounts for cash

and if you don't pay, it will eventually be written off

of course there are those that will put garnish your wages

so, yes it does suck

the whole system is broken

but hospitals are going broke in many cases

[tsuki]

12. Not a hospital. A surgical care facility owned by the doctors.

And yes, in Florida, they do have to pay if they have any real property.

When Gov. Bush closed down the small business alliance that Lawton worked on, our premiums quadrupled to $900 a month. Imagine paying $900 a month for health insurance per employee so that you only have to pay 12% of the medical bill.

It stinks.

[Bluerthanblue]

3. thank you

for caring about this. And for voicing it. As an uninsured-uninsurable person, who won't even get medicare (not enough quarters before disability) and who won't sign a lien on my home, and childrens home, and stubbornly unwilling to live in complete poverty, not even doing the little work i can, in order to qualify for medicaid- So, because of that, I do have to pay more than the insurance co's pay, for the exact same procedures. It was explained that the Ins. co's negotiate for a lower fee if they agree to service the subscribers- but that leaves money to be made up- by those who aren't 'members' of the chosen-

Most folks say 'hey- tough break'- I appreciate that you care.

blu

[tsuki]

6. It's not enough. I want to do something, scream, holler, yell. This

is not right. The uninsured should have the same pricing structure that the insured have.

Any attorneys out there? How can the medical establishment do this legally?

[Bluerthanblue]

15. speaking out

IS doing something- it's a start, and your perspective is one I personally haven't heard much of.
Those of us who cannot get insurance are usually seen as lazy, or ignorant, or wanting 'something for nothing'. Maybe some folks really are that way, though I haven't known them. When it is a choice between stitches in a cut, or skipping routine exams in favor of my son being able to go on his class trip, I choose the class trip. That may seem like foolishness- no, that IS foolishness to many people, but because I've got the hand i've been dealt, shouldn't mean my kids can't have as normal a childhood as I'm able to give them.- Scars are simply a part of life, and catching a disease at a stage where there was a chance to treat it, but no money to pay for the treatment seems a bad trade.

I don't believe the 'medical establishment' is in favor of this. My doctors have been absolutely wonderful, and have tried in every way possible to keep my costs to the minimum, but the 'administrative system' has it's own agenda. Health is not a 'right' in this country- it is a privlidge- one that those who need it the most, have the least access to.

Gotta say, that providing medical care (I admit it is often inferior care) to people who are incarcerated is only 'humane. And yet the next of kin for the incarcerated person is not held liable for the costs accrued by the inmate. My sons, would be held responsible for my bills, and would have to repay the state for any care they provided for me, or find themselves homeless. THAT does rub me the wrong way- I don't want care taken away from those who are in prison, but I hate thinking if I broke the law, I'd lose my freedom, but perhaps extend my life, without having to burden my 12 and 22yr old sons, any further.

strange world this is,

blu

[pitohui]

26. what you say is not accurate

your sons are not responsible for your debt nor do they have to repay any debt you incur

have you never heard of thomas jefferson?

debt is not heritable in usa

[Bluerthanblue]

31. what I say is not only

true, it is fact.
In order for me to recieve medicaid services, I must sign a paper which gives the state a lien on our home, the one and only legacy i can leave my sons. While in the past, the state was not very 'tough' on collecting the debts of deceased medicaid recipients, it is now. Even putting my 'interest' in our home in my oldest sons name will not keep them safe from having the state require re-payment. The look back period used to be 3 yrs, then it was 5, now it is 15, and there is little chance i'll live that long-
Believe me, I have looked into this long and hard.- And sought out every 'option' available.- Having a terminal illness is criminal these days- especially if you have children who depend solely on you.
I've come to terms with this reality. But I'd like to see things change for others, in the future. Because I don't believe this is acceptable. We're not talking a million dollars here- we're not talking Mac Mansion. We're talking a run down, comfortable, well loved cape, a home that has sheltered 4 generations of my family so far. I'd like my sons to have the opportunity to make it 5 and more, if they choose- and if they don't, let it be because of their life choices, not my 'legacy' of debt.

[druidity33]

42. there's gotta be a workaround...

Can you gift the house to the children now (continue to live there and pay like $5 a month in rent)? Maybe create a Land Trust agreement? Do you have land to work with? The best way i know of to maintain health is to grow your own food and spend time out of doors...

Peace and goodwill to you...

[Bluerthanblue]

46. thanks,

for caring- and your well wishes.
The farm is in a 'living trust' now, with my older son- I thought that would 'protect' it, and so did the lawyer who helped us with this solution, but the laws changed. And oddly the law doesn't look at my individual 'life-expectancy' but at the 'average', so, based on my age, i'm supposed to have almost half my life left. That quirk, leaves my son having to pay off more than half the value of our homeplace- My son is a very responsible young man, has worked since he was 14- full time since he was 18, at the same job (blue-collar truck driver/mechanic). He doesn't carry any debt, or use credit-cards. He will be guardian of his young brother. I have a lot of respect and admiration for him, and trust his level-headedness, yet regret the responsibilities he's had to carry beginning so young. And, your suggestion about homegrown food is one I share- and something we've tried hard to continue. Raising your own produce nurtures folks ways beyond consuming the end product-

I would truly like to see this nation look at the health of its citizens as at least as much of a priority and as much energy as it does developing ways to kill our 'enemies'. Life affirming endeavors that reach beyond our borders would do far more to advance the cause of peace and stability in this world than all the military and 'defensive' activities we throw our money, and the lives of our fellow men and women away on, under the deluded mantle of "protecting freedom". And providing "security".

peace to you and yours as well.
blu

[pitohui]

25. it's wholesale versus retail

you really need an attorney to understand this?

an insurer has a contract w. the providers and in turn supplies a large number of patients who are guaranteed to pay SOMETHING even if not even much -- wholesale

the uninsured individual has no contract and half the time doesn't pay anyway and owns nothing wore litigating for, so the uninsured individual who does own something such as a house or a bank acct ends up paying for all -- retail

it's perfectly legal

i'm not saying it's the way the world should be

but certainly it's legal and it has been tested in court to boot, at least in louisiana, see my other post

[davekriss]

5. Incredible, isn't it

Yet we continue to tie access to healthcare to insurance chained to your job. Chained to your job. Hmmm. Someone benefits in that arrangement, but certainly not we who are chained. Yet our so called political "representatives" do nothing (and in fact make things worse). Whom do they represent?

We are not a democracy, this is not government for and by the people.

[alarimer]

17. I know; I am worried about my sister

who has been (tentatively) diagnosed with MS. For now all they are doing in monitoring it; they don't want her to start taking the medication which she will have to take forever if she starts (I have no idea what it is). Anyway, what if she takes another job? She will not be covered for this illness (pre-existing condition) or have to pay much higher rates. Same is true for anyone with almost anything chronic. We need universal health care now, dammit!

[pitohui]

27. yeah she's trapped in the same job for life now

one of my husband's co workers, same thing, he has never been able to even dream of another job because of brain cancer in the late 70s, he is tied to the same job forever because no one else will hire him and put him on their insurance

it stinks!!!!!

[Rosemary2205]

29. My state and many others have a 30/60 day clause

here, if someone changed health insurance in less that 30 days (other states may have a 60 day window) after stopping the old one, the new provider has to cover pre-existing conditions from the first day of premium coverage. The real problem here comes when small businesses decide they don't want to hire you because of the health insurance premium cost increases.

[suziedemocrat]

41. Retirement shouldn't be tied to our jobs either.

We should get paid for the services we provide to our employers - period. I'm VERY anti-benefits. Too much like the company towns next to the coal mine. (or even the Plantation owner taking care of the slaves' needs instead of paying them.)

But - I heard someone on CNBC saying GM has been complaining about how much the cost of health-care adds to their cars. And since they pay health care for retirees, that puts them at a huge disadvantage compared to a new company without retirees. I think the time is coming. If the big corporations want to get out of providing health care - then something might finally happen, because congress actually cares what the corporations want. Right now it's probably just the health insurance companies that wouldn't want change.

[davekriss]

47. Red Herring

The thing is the costs of universal healthcare are in fact extracted from the value stream created by a Honda, Toyota, BMW, and a Volkswagon too. The GM argument is a red-herring.

In the rest of the industrialized world, for example, these benefits are paid in greater part from revenues sourced from a Value Added Tax. That means, though the examples don't tack on the costs of healthcare in their base price, it gets added to the price the consumer pays in the form of a tax. Healthcare costs still factor in to the final price.

It's true the U.S. form of healthcare distribution and funding is highly inefficient, but it was left inefficient in part to tie workers to their companies (it was originally designed and offered for that purpose -- as you say, a more sophisticated form of the company store).

GM is clamoring for change to get out from its previous obligations to improve its bottom line, a bottom line squeezed red for reasons that have nothing to do with the healthcare benefits it pays it's workers. There troubles have more to do with a failure to anticipate market trends, a time-to-market much slower than the competition, a poor quality product, and even the tax policies of the Reagan-Bush years (rusting out our manufacturing base).

GM is mimicking our leader, who would reduce or destroy the social security program, claiming that we can't afford it, that it's going broke -- when all the while the cause of going broke are his several trillion dollars of tax breaks to mostly the top 1% coupled with his soon-to-be trillion dollar wars.

Arguing that we can't afford social security is an attempt to give our future benefits to Hallburton, Bechtel, Carlyle, GM, Lockhead-Martin, et al., and the top 1% that own them, and has nothing to do with the social security system per se. Similarly, GM argues it can't afford current and retiree health benefits but the reason has nothing to do with an oddity of benefits stucture, it reflects a failure of senior management in almost all other matters.

[suziedemocrat]

49. You're right - GM's problems have very little to do with health care.

And God knows I did not mean to defend them. I was just hopeful their complaining might end up getting us national health care. Probably just a pipe dreams. Nothing will ever get done unless someone can make a lot of money off of it.

[davekriss]

50. Actually that would be a great outcome

I just doubt it will materialize soon, given the orginal chain-to-job purpose of such benefits, and the rise in importance of hospital administrative services and the insurance industry, which together consume 33% of every healthcare dollar spent, more than 3 times the next closest nation (I believe).

[insane_cratic_gal]

9. Part of the reason the hospital care is so expensive

is because there are those who are uninsured and can not pay at all for their treatment. This, raises prices for the hospital, which raises premiums. It's a vicious cycle. By FL's action they probably feel they are going to lower the prices of insurance by doing so. We all know it won't do a damn thing but keep hurting the little guy.

What we really need is health care for everyone. I work in admission for a hospital, I see people come through everyday without health insurance. They always seem so guilty about not having it, it truly does break your heart and there is not reason we can't do it, other then Insurance in this country has become a big giant money maker.

[tsuki]

10. But how can the medical community target the uninsured? That

is what I feel they are doing by charging the uninsured 88% more than the uninsured.

I run a small business. Everyone gets the same price.

If they can do the procedure for $450 for the insured, why can't they do the procedure for $450 for the uninsured? That is what I am saying.

And if the uninsured were charged $450 like the insured, wouldn't they be more likely to collect?

[insane_cratic_gal]

11. Your 100 percent correct

I have no idea if that is done in the hospital I work for, I only collect information for the billing, I never actually touch or calculate a bill.

If this is indeed the common practice it just needs to stop period!

If we had a national health care plan, things unfair as these practices are would go away.

Do you remember Bush saying bullshit like malpractice suits were the reason for high health care? He does know that which comes out of his mouth is bullshit or Bushshit! But he someone tried to convince the general public during his debates with Kerry that this fact was true.

Perhaps the motivation for the hospital to charge 850 for a procedure that costs an insured person 450 is they know a poor person feels guilt and obligation to pay for their bills. An INsurance company has no moral objection to denying the hospital their asking price. Thus the costs are but right back onto the uninsured person.

So they use guilt, the same guilt I see on people's faces everyday when I have to ask them if they have insurance, they have to tell me they do not. They use it and apparently abuse it.

It's a hideous thing, we do nothing about it because insurance companies are big portion of business in the US

[pitohui]

28. if you really run a small business

perhaps you have noticed that hello the middle aged childless couple in your company is having $450 deducted from hubby's paycheck EVERY MONTH to pay for health insurance?

that is why we get a better price, we already paying HELLO $5400 a year for care!

in years when the uninsured person is sick, they pay NOTHING

to charge them the same for care as the insured person would be stealing, wouldn't it?

if i had that $5400 a year back, since we've never had a huge major problem, we'd be able to pay a lot of bills, wouldn't we?

[Dunedain]

32. Because

The uninsured isn't a billion dollar corporation.

[Iowa]

33. It's even worse than you state...

"...charging the uninsured 88% more than the uninsured."

Actually, it isn't 88% more --- it's ~778% more.

$3,500 is roughly 778% of $450.

I understand your concerns here, but let's look at it another way. Those of us who pay for insurance every month (I now pay $1210 per month for a family plan) face the very real possibility that we won't be able to pay for the insurance if it gets much more expensive. Let's say that after paying in for 30+ years and not getting much in return (because we were young and relatively healthy) we can no longer afford the premium. Of course this would be at precisely the age when we'd be more likely to need health care. If that happens, we'd be MUCH worse off than a family in similar circumstances who never carried insurance. Why? Because I'd be out all the money I spent on insurance all those years, and I won't have insurance at precisely the time we'd need the benefits most. In other words - many of us who are insured today could actually be much worse off when it's all said and done, than the family who never bought insurance and squirreled the excess $ (the $ not spent on premiums) into a mutual fund for 30+ years.

Bottom line: We could all be screwed - and those of us who HAVE insurance could end up being screwed the worst when it's all said and done. Fixing the health-care fiasco is priority number one IMO.

[Bluerthanblue]

14. the only time a hospital eats the cost

or even 'part' of the cost for those of us who have no access to insurance is if they recieve a hunk of federal funding- A private hospital is not required to treat anyone without insurance- I've been there- done that.
The Dartmouth-Hitchcock Medical Center used to have to provide a certian amount of 'free-care' to those who were unable to afford it, and to offer reduced fees, or interest free payment plans for those of us, who just don't have it.
The deal is struck between healthcare institutions, and insurance providers- THEY set what is 'mutually acceptable' to each other, while relying on self-pay, and more generous less savvy insurance providers to make up the lack.

I agree, health care should be a RIGHT, not a privlidge. If we believe education is an investment in the future of this nation, what good will it do to have a smart dead graduate?

I'm not without predjuce on this issue, I'll honestly admit.

blu

[RobbinsdaleDem]

13. Same thing happened to us.

My husband had a procedure that cost $5,000. The insurance company said the going rate was $895. We have a $500 per person deductible, so we paid $500 and the insurance company paid $395. Then I had an emergency room visit. That bill was close to $4,000. The insurance company said the going rate for that was $900. I paid a $100 co-pay, and the insurance company paid $800. It makes me wonder what happens to people who have medical savings accounts like the chimp is advocating. I'm pretty sure the person with the MSA would be charged the full amount just like uninsured people are charged. Our health care system is so screwed up it's pitiful.

[elehhhhna]

43. Oh the MSA people wil be smart shoppers, they'll call around for the best

price on emergency care, thus letting market forces drive prices waaaaay down (LOL). Don't you listen to the PRezzydent?

[seabeyond]

16. i had a baby uninsured. i had one insured. i paid more insured

than paying cash. no shit.

i dont know about your agrument though

[dysfunctional press]

20. were there more tests, etc, required by the insurance company..?

as a general rule- any procedure done in a hospital is going to be MUCH MORE expensive for the uninsured person, than it is for the insured person, OR their insurance company. insurance companies generally have negotiated big volume discounts.

[seabeyond]

21. normal on both. cash 1,200 for birth. insured two 500 deductible, two

200 co pay.

not to mention the months of misbilling and trying to get me to pay more with insured baby

[dysfunctional press]

22. i've never been there, so i don't know-

but from what i've heard, $1200 for a baby sounds dirt cheap- especially considering all the different costs- even things like malpractice for the ob/gyn, OR costs, & pre/post natal care, etc...

[TahitiNut]

18. Yes. It's actually well-known that the uninsured pay huge ...

... if the hospitals or their (very effective) collections operations can get hold of the assets. They'll take homes, autos ... whatever. The insurance companies negotiate huge 'discounts' and the cost is laid off on the people whose assets can be attached and liquidated.

Our economic system is fucked up royally. The taxpayers pay for the stadiums and pay full price to watch a game - while the wealthy are "comped" into luxury boxes. What kind of sense does it make for the wealthy to get something free that working people pay full price for? (I don't want to hear about 'influence' and 'investments.' It's the same song-and-dance that Abramoff used to rationalize his corruption.)

The inner city poor pay premium prices at the stores in their neighborhoods - often 25-50% more than they'd have to pay if they lived in the more affluent suburbs. The specious excuse of insurance costs doesn't wash when one considers real estate costs and low property taxes.

It's abysmal ... and getting worse daily.

[dysfunctional press]

19. back when i was uninsured, i had to get 6 stitches in my hand-

(deep cut from tuna can- i was taking out the trash for the lady next door).

i had to go to the emergency room, obviously...it ended up costing $825.00...for less than 1/2 hour, and i didn't need any transfusions,or anything- they washed it out, stitched it, bandaged it...$825.00

the uninsured don't get the big negotiated discounts that insurance companies dictate.

[eridani]

23. Are we transferring costs to the uninsured?

Is a fucking bear Catholic? Does the fucking Pope shit in the fucking woods? That'e the whole entire PURPOSE of for-profit insurance--getting people who are likelier to be sick off of their rolls. It's like having a fire department that puts out fires in every census tract except those which are more likely to have fires.

[pitohui]

24. have been for many years

abt a decade or maybe 8 yrs ago a woman in slidell, louisiana sued because she found that she was charged $27,000 for a procedure for which an insurance co. paid $3K

the woman lost the suit and i suppose she also lost her home

it is now well-established legal precedent that the uninsured, who do not have a contract for "bulk" or "wholesale" prices, are bearing the price burden

there is nothing to be done abt it because it is perfectly legal to have group (wholesale) and individual (retail) prices that are widely different

as far as "those who can least afford it" can YOU afford to pay $27K every time you have a simple procedure? incomes are just not that high down here, there would be no point in having insurance if you were beggared anyway and were forced to kill yourself so your family wouldn't lose their home every time you had a relatively minor procedure

i've known people personally to have had care valued at hundreds of thousands of dollars

we CAN'T pay it

we have no HOPE of paying it

my dad, college educated, an engineer, once pointed out that in his entire working life he never earned $600,000 -- the cost now of hodgkin's disease

at least w. insurance SOME of us can be saved

[Bridget Burke]

48. Is there really "nothing to be done about it"?

As long as SOME can be saved, let the others go.

[BrklynLiberal]

30. Absolutely yes.

My prescription cost me $200 when I had to pay cash for it. The same EXACT prescription cost me $20 when I had insurance.

When I went to the ear doctor, all I had to pay was a $20 co-pay. When it turned out that my insurance had been cancelled by my former employer, they sent me a bill for $125.
I was told by someone who deals with insurance companies that I am legally responsible only for the difference between the $20 and what they would have gotten from the insurance company since they accepted me as an insurance patient at the time. BUT, it does mean that a doctor DOES get paid less by an insured person than he does from an uninsured person.

Having worked in a Chiropractor's office, and doing billing for him, I can attest to the fact that this applies to them as well.

[anewdeal]

34. quite the opposite

I can only speak for Massachusetts, but there is a uncompensated care pool of 800 million dollars to reimburse hospitals for fees unpaid. The money is collected from an annual assessment on employers, insurance providers and hospitals, plus contributions of state and federal tax dollars.

[sandnsea]

35. Help me out

How did you come to just skip over the bills individuals have to pay?? Do you think that because that pool is there, hospitals aren't still charging the uninsured exorbitant rates because they can't negotiate the rates? In fact, how does it not occur to you that the hospital is likely to charge MORE because they want to collect a big chunk out of that 800 million dollars.

Did you seriously not think of any of this??

[anewdeal]

36. yes exactly

many of the uninsured don't pay, so the hospitals can get away with asking whatever they want from the fund. But the money for the fund is paid for by the employers and insurance companies, which are in turn funded by the insured.

[sandnsea]

37. Just flew right over your head

The uninsured who DO pay, or have their credit ruined because they can't pay, are STILL being billed more than insurance companies. So yes, the uninsured are bearing an unfair burden in this health care delivery system. It's stunning that it flew right over your head again.

And, most states don't have a fund that pays hospitals what the uninsured don't pay. And many hospitals and doctors are just flat not seeing people without cash up front unless they're literally dying. So no only are they charged more, they can't even see doctors in the first place because of that high charge.

The uninsured are paying in a lot of ways for this failed health care system.

[anewdeal]

38. there is a difference between billing and collecting

the hospitals bill the uninsured so much, as you said, because they can bill whatever they want and it will get paid for by the government. This is because the uninsured, in large part, don't pay thier medical bills. They simply cannot. Most people who haven't gotten health insurance probably don't have 4 grand lying around. So the tab is picked up. And as I said earlier, it is insurance companies, employers and hospitals who are picking up the tab.

[sandnsea]

40. We pay it off, month by month

And if we don't, it goes to collection and screws up our credit. All because hospitals can get away with charging us more because people are under some delusion that it doesn't hurt us. Hospitals mostly do this so they can take a big loss for tax purposes. Or, as in the case of Massachusetts, make a claim to a state fund. That state fund does not exist in most states so that is not the reason hospitals all over the country overbill.

And it doesn't change the fact that uninsured people are being hurt by these practice, either because they can't pay the cash up front fee and therefore can't even get health care; or because they have to cut other expenses to pay it off; or because it destroys their credit.

Massachusetts may be picking up the tab to help hospitals, but I guarantee you it isn't doing a thing to help people who have no insurance and they are under an unfair burden.

[Vinca]

39. That's the way it works.

The insurance companies negotiate a "deal" with hospitals and only pay a fraction of the billed cost. The uninsured get charged full tilt. Some hospitals will negotiate a fairer price, many won't. We're uninsured, but our local hospital seems more compassionate than most. After the last procedure I needed, I scanned the entire bill and didn't see anything I would call an "outrageous" charge (like a $2 aspirin). That said, I'm sure an insurance company wouldn't have paid the amount I did. (And, as a side note, being uninsured is why I'll be indentured to Mastercard for years to come. The corporations feed off each other.)

[stepnw1f]

45. The Way Average Americans Struggle for WHAT?!

so the rich can live a life of leisure and weild powers like spoiled brats at their own birthday party. I am sick of living this way so that the rich can get richer... I never knew I was a slave.