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Sat Dec 7, 2019, 01:41 PM

David's $27,495 Appendectomy

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Response to tomhagen (Original post)

Sat Dec 7, 2019, 01:50 PM

1. Here in America, we value appendicitis...

...more than anywhere else.

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Response to dchill (Reply #1)

Sat Dec 7, 2019, 05:46 PM

5. Sad but true.

He could have gone back to his native Buenos Aires, and even in a private sanatorio (where locals with means go) it would have cost $5,000 or so - with comparable outcomes.

I'm glad he had good insurance at least.

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Response to tomhagen (Original post)

Sat Dec 7, 2019, 02:25 PM

2. U.S. health care priority is to profit off people. Whatever can be marked-up ...

up-sold or exploited, will be.

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Response to tomhagen (Original post)

Sat Dec 7, 2019, 03:02 PM

3. I noted a few things after watching the whole video

And one of the most important things is very near the end. He talks about the fact that the hospital, doctors, etc. didn't get the full $27,495, because he assumes his insurance company negotiated a lower reimbursement rate. That bullshit pricing is at the center of the problem, and it doesn't get mentioned until most people have turned off the video.

I also notice that he includes his monthly medical premium in his appendectomy expenses that were out of pocket. The flaw with that is that he would have had that premium even if his appendix did not become inflammed.

I do notice that he acknowledges that a high-deductible insurance plan may well cause him to pay out a sizable sum of money if something happens. However, one thing that should always accompany high deductible health coverage is a Health Savings Account. A younger person like him putting away even the difference between a "Cadillac" policy's premiums and the lower premiums for the high deductible plan would have that deductible saved up in just a few years. Maxing out contributions to an HSA like I did when I had coverage through my job really helped me be ready for almost anything.

One of my jobs from a dozen years ago involved putting together estimates of costs to various hospitals, doctors, etc. of medical scopes and the accessories that go with them, it was shocking to me to see that the same stuff had so very many different prices, for no apparent reason whatsoever.

The entire healthcare industry in the US has ambiguity, uncertainty, and downright unfairness shot completely through the pricing systems that need to be addressed in any meaningful reform of healthcare.

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Response to tomhagen (Original post)

Sat Dec 7, 2019, 03:42 PM

4. Granted, this was a long while back, but it does

serve the purpose of showing how much medical care has changed in the last 40 years. In December of 1973 when I was 19 years old, I quit my part-time (preloader) job at UPS where I had full coverage insurance, to move from Illinois to Pennsylvania to be back with my parents that had moved there 2 years earlier. Knowing I would be without health coverage I went to a local insurance agency that I knew from their sponsoring Little League teams. I bought a full coverage, BlueCross/Shield three month policy that cost $42. $14 a month.

Six weeks after being in PA still without a job, I got appendicitis. After emergency surgery and three days in the hospital I was released. Total bill, $452. For everything. My share of that was ZERO.

In the '80's, my wife had our three children. I was now working for local electric utility and had Blue Cross/Shield insurance. We paid nothing for any of the three births, prenatal care or follow up appointments.

Yes, I know there has been inflation, but our so called "health care system" is totally broken now. And it is not really a system. If you are over 65 there is Medicare, and if you are financially strapped there is Medicaid. Other than that, it is every man for himself. You are on your own and are paying extravagant premiums with high deductibles and co-pays. Not only is single payer a necessity, but I believe some sort of National Health Care system needs to be put in play.

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Response to tomhagen (Original post)

Sat Dec 7, 2019, 05:55 PM

6. Good news for him is that any more procedures he has this year

will cost him a lot less because he paid off his deductible. Of course he doesn't have another appendix to take out.

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Response to tomhagen (Original post)

Sun Dec 8, 2019, 03:50 AM

7. I was laid off a month after Sept 11th and applied for emergency medicaid the Monday

after my layoff. That very night I came down with appendicitis and had to be rushed to the hospital for an emergency appendectomy - I was in excruciating pain - and spent two nights in the hospital at NY Presbyterian.

The ER was a nightmare (freezing cold, lying on a metal bed with just a sheet over me while they waited for the results of my diagnosis) but the rest of the medical staff was superb. I did not have to pay one cent due to my emergency medicaid. It was such a blessing. I still cannot believe how lucky I was.

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Response to tomhagen (Original post)

Sun Dec 8, 2019, 04:45 AM

8. This two tier pricing is insane

When I had my heart attack in 2011, the bill came to $36,000, reduced for the insurance company to $26,000, of which I had to pay 10%. He is totally right about the MSRP system, and it is ONLY offered to insurance companies. I met a woman from Venezuela who was living in the USA in 2012. She was well-off, and told me that her mom was visiting from Venezuela and had a heart attack while she was in the USA. The hospital bill came to $75,000. She had $50,000 in a savings account the USA, which she offered the hospital. Their answer was that they could take it if she were an insurance company, but since she was a private individual, they had to insist on the full $75,000. Now THAT is perverted.

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Response to tomhagen (Original post)

Sun Dec 8, 2019, 06:50 AM

9. you won't believe this

In Texas my wife had an abdominal pain and we took her to the emergency room where they diagnosed her with appendicitis. My wife is a Nurse Practitioner so she know medicine and hospitals really good and she had an assumption of what the diagnosis was going to be. When she got the bill she called the hospital to complain that the cost of the procedure was extraordinarily high, I'm not kidding, $55k. When she was connected to billing she was told that it had already been adjusted downward. It was originally over $125k. This is why so many people lose their homes, jobs, health, and what one would call a normal life. This is life in the good old state of Texas where everything is big especially your medical bills...

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