Fascinating Article on Medical Bills

[GaPeach_in_Ca]

This article is very interesting. It's also very long, so I'm only on page 4.
Why Medical Bills Are Killing Us (http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/?hpt=hp_c3)

It talks about the profits non-profit hospitals are making, the bills that are charged to patients without medicare or insurance, that sort of thing.

It's really fascinating and scary.

[abh5e8]

i thought so too!

[TxCat]

Great article - unfortunately totally true and totally depressing. I'm constantly arguing with the CRNAs that I supervise about not giving certain drugs because the markup is so ridiculous.

[amatahrain]

Thanks for sharing it's crazy how the system is set up.

I went to the dentist today for the first time since being on DH's insurance (we had insurance under my old company). They gave me a quote for a root canal and crown and said $65.xx. I was like, say what?! I had a root canal and crown a few years ago and it cost me over $1500 out of pocket for just the root canal. I had her double check and then check again.

I have a prescription that I take daily. It was costing me $130 for a 90 day supply and now it $14 for 90 days! I got them both through express scripts (formally medco).

It also cost me over $5k out of pocket for my c-section and 3 night stay at the hospital for DD. I had her in December so we had already met our deductible. I still can't wrap my head around that considering what I was paying bi-weekly for insurance!

[vonfirmath]

It also cost me over $5k out of pocket for my c-section and 3 night stay at the hospital for DD. I had her in December so we had already met our deductible. I still can't wrap my head around that considering what I was paying bi-weekly for insurance!

A year ago, It cost me almost $5K out of pocket for a vaginal birth with overnight hospital stay. We have a 20% coinsurance. Plus I had to pay the deductible AGAIN for the baby from day 1 (when I had DS, he was covered under my deductible for the first 30 days)

[brittone2]

DD split her tongue open a little less than a year ago. We have a higher deductible (6k/family) plan.

We had to take her to the ER as it was after hours and a weekend IIRC. She saw a doc for 15 seconds, and a PA sutured her. They irrigated I think, she got a shot of novacaine, and then sutures. $3000. I realize there is a lot of overhead with an E.R. and so forth.

I started reading this article yesterday and haven't gotten to finish it yet. I am about halfway.

[wellyes]

I was just talking to DH about this. When his dad was at the end, the doctors ordered a half million dollars in tests and treatments in the last few months of his life, despite the fact that his prognosis was -- no question -- terminal. Covered by insurance mostly. Meanwhile, friends of ours with 2 young kids are going without insurance this year because it's cheaper to pay out of pocket. BUT, when you pay out of pocket, the medical bills are insanely higher because you don't have the insurance company negotiating for you. It's a crazy system. Designed for profit for the middleman. A textbook case for the limits of capitalism.

[marymoo86]

It's a crazy system. Designed for profit for the middleman. A textbook case for the limits of capitalism.

It is a crazy system but this isn't capitalism. Prices are obscured and its not like you can shop around easily based on price and quality for medical services. Unlike a service such as Lasik where time, efficiencies, and competition have lowered the price of the procedure with higher quality results. Based on this chargemaster system I highly doubt any medical center know the true cost of anything if it is just a % increase year after year.

[wellyes]

This isn't capitalism. Prices are obscured and its not like you can shop around easily based on price and quality for medical services.

Profits for shareholders are the driving force here, not clarity or fairness for consumers.

[AnnieW625]

I can't even read the article because it hits very close to home for my day job. I ax. medical treatment and ax medical bills. The rates these providers bill at is crazy because they know they will only get paid fee schedule. When I settle an outstanding balance I offer a max of 33% of the outstanding balance, but sometimes less.

example:
knee surgery, $15000
amount paid by insurance per fee schedule, $4500
amount remaining, $10,500

The minimum I will offer is $1000, but really a 1/3 of the remaining value is $3465. We still try to save money and not pay that full 33% ESP. on a higher value bill. There have been cases where a sx. cost $30000, we paid $9000 and they have accepted $1000 to settle. If they had billed $10k in the first place which is probably close to fee schedule seeing that they were paid $9000 then things would be a lot simpler.

Medical billing is a mad mad world, which is why I probably won't finish reading the article.

Based on my experience I agree with MaryMoo's statement.

[marymoo86]

Profits for shareholders are the driving force here, not clarity or fairness for consumers.

Competition is a hallmark of capitalism. In this system, competition based on the factors I noted isn't possible.

Profits for one class of people over another is an issue with any economic system and not only capitalism.

[scrooks]

It is really is scary how practically anyone is one major accident away from bankruptcy!!! I feel like the markup should somehow be regulated. So they have a certain price paid for Medicare patients and the hospitals claim they loose 10%..... So what if everyone else paid 30% higher than those prices to make up for it , giving the hospitals some profit.

And if hospitals acually end up collecting only a fraction of what they bill, couldn't they potentially save some administrative costs if they started out with more reasonable bills with subsequently less back and forth?


What also ticks me off is the markup on things like that pacemaker or whatever that guy in the article had installed. It's not like you as a patient can shop around for such an item and the fact that the doc may put in a more expensive one because he is getting some kind of cut is infuriating and seems so unfair and stacked against the consumer!

[mommylamb]

It certainly isn't capitalism working the way that capitalism is supposed to work. But I'm really not sure capitalism--even in its most ideal theoretical state-- would be better than a single payer system, at least in its most ideal theoretical state.

[GaPeach_in_Ca]

Competition is a hallmark of capitalism. In this system, competition based on the factors I noted isn't possible.


Yes, competition is not possible in emergency medical care.

I mean, really, how can it be? Even with the example of the man with cancer who had to pay in full UP FRONT, it's not like he's going to shop around when the potential outcome is death.

[wellyes]

Competition is a hallmark of capitalism. In this system, competition based on the factors I noted isn't possible.

Profits for one class of people over another is an issue with any economic system and not only capitalism.
Competition is between providers shopping their services to employers and hospitals and pharmaceuticals. And, of course, the pharmaceuticals themselves.

[speo]

Competition is a hallmark of capitalism. In this system, competition based on the factors I noted isn't possible.

In theory it would be nice for capitalism to drive costs in healthcare. However, at the heart of the system is the ER and surgeries done on a local level. A person cannot choose to go to the ER based on cost of treatment when they are incapacitated. Likewise, in a local area there may only be a few centers where surgeries are performed. How can costs really be driven down when there may only be 2 options?

I also think healthcare insurance breaks down the system in many ways. It is virtually impossible get hard numbers out of anyone when every person has a different plan and pays a different amount. DS2 was recommended to have an EEG. I made calls to the hospital and my insurance. Not one person could actually tell me how much I would have to pay.

I find prescription drugs crazy too. My OB prescribed Loestrin (birth control). I took it for 2 years and had to pay $45 every 21 days. I just asked about a generic and low and behold there is one. Now it is $15 every 21 days. Why do docs automatically prescribed the name brand?? It is just such a waste once a generic is on the market. The same thing happened with a ringworm cream. The one that was prescribed was $300. I call for a generic and it is only $15. This list could go on ...

[GaPeach_in_Ca]

Competition is between providers shopping their services to employers and hospitals and pharmaceuticals. And, of course, the pharmaceuticals themselves.

It did mention in the article that insurance companies have less ability to negotiate prices since doctors practices are consolidating into large systems.

[marymoo86]

Yes, competition is not possible in emergency medical care.

I mean, really, how can it be? Even with the example of the man with cancer who had to pay in full UP FRONT, it's not like he's going to shop around when the potential outcome is death.

There is always a lack of competition in emergent situations that don't allow time for comparison same with having a lack of resources to compare. If you are the only provider in town then really you are in essence a monopoly. This is true for any product or service.


Competition is between providers shopping their services to employers and hospitals and pharmaceuticals. And, of course, the pharmaceuticals themselves.

As it is now, there is no incentive for a hospital or any medical facility to shop its services to the individual.


In theory it would be nice for capitalism to drive costs in healthcare. However, at the heart of the system is the ER and surgeries done on a local level. A person cannot choose to go to the ER based on cost of treatment when they are incapacitated. Likewise, in a local area there may only be a few centers where surgeries are performed. How can costs really be driven down when there may only be 2 options?

I also think healthcare insurance breaks down the system in many ways. It is virtually impossible get hard numbers out of anyone when every person has a different plan and pays a different amount. DS2 was recommended to have an EEG. I made calls to the hospital and my insurance. Not one person could actually tell me how much I would have to pay.

I find prescription drugs crazy too. My OB prescribed Loestrin (birth control). I took it for 2 years and had to pay $45 every 21 days. I just asked about a generic and low and behold there is one. Now it is $15 every 21 days. Why do docs automatically prescribed the name brand?? It is just such a waste once a generic is on the market. The same thing happened with a ringworm cream. The one that was prescribed was $300. I call for a generic and it is only $15. This list could go on ...

Agree and noted those caveats above that creates imperfect competition. Just wanted to address the generic part. While many times, generics are often a good subsitute, often lower quality fillers are used with the active ingredient and these are not subject to the same level of testing. Can be a very big issue if you react to these. Generics aren't carbon copies and there tends to be more quality control issues. That being said they are still a good value. Could be that doctor doesn't have enough background/info to be concerned with studying the generic equivalent or that the drug rep has a great relationship so it is automatically prescribed unless the generic is requested.

[brittone2]

It did mention in the article that insurance companies have less ability to negotiate prices since doctors practices are consolidating into large systems.
Yep, exactly.

[speo]

Agree and noted those caveats above that creates imperfect competition. Just wanted to address the generic part. While many times, generics are often a good subsitute, often lower quality fillers are used with the active ingredient and these are not subject to the same level of testing. Can be a very big issue if you react to these. Generics aren't carbon copies and there tends to be more quality control issues. That being said they are still a good value. Could be that doctor doesn't have enough background/info to be concerned with studying the generic equivalent or that the drug rep has a great relationship so it is automatically prescribed unless the generic is requested.

I agree that generics don't work for everyone in all cases. I do find that the default of most doctors is to prescribe brand names. And when I have asked, in most cases, there has been a generic. The contiunation of prescribing brand names is just another way that more money is extracted out of consumers. The article stated that 20% of our GDP goes to healthcare with little measurable benefit over the 10% that other nations (that we would want to compare ourselves to) pay. Prescribing generics is just one way to lower those costs.

[abh5e8]

depending on how they sign the rx, you can usually sub in a generic at the pharmacy.

[Melbel]

I was just talking to DH about this. When his dad was at the end, the doctors ordered a half million dollars in tests and treatments in the last few months of his life, despite the fact that his prognosis was -- no question -- terminal. Covered by insurance mostly. Meanwhile, friends of ours with 2 young kids are going without insurance this year because it's cheaper to pay out of pocket. BUT, when you pay out of pocket, the medical bills are insanely higher because you don't have the insurance company negotiating for you. It's a crazy system. Designed for profit for the middleman. A textbook case for the limits of capitalism.

We have noticed the opposite - that you can negotiate the charge for acute care, MRIs etc. at about a 40% discount if you pay cash vs. submitting to insurance.

[AnnieW625]

We have noticed the opposite - that you can negotiate the charge for acute care, MRIs etc. at about a 40% discount if you pay cash vs. submitting to insurance.

Yes to this because insurance usually pays about 40%. I thought the couple highlighted at the beginning of the article were stupid for paying all of these costs up front without at least trying to negotiate first, at least the mother was $$$$ to pay for it, but still. It were those descriptions that really made the article kind of unreadable to me.

[mommylamb]

I don't think it's stupid at all that a couple, with no experience in medical billing issues, in a stressful time when one of them has been diagnosed with a serious cancer, would think they had no choice other than pay those fees. I feel badly for them. If I were in their shoes, I wouldn't want to waste the time to negotiate while my husband got closer and closer to death. Sometimes love, and not knowing that the healthcare system thinks it's some sort of Chinese flee market, can make you do things like pay that money up front, even if you're not stupid.

[niccig]

I don't think it's stupid at all that a couple, with no experience in medical billing issues, in a stressful time when one of them has been diagnosed with a serious cancer, would think they had no choice other than pay those fees. I feel badly for them. If I were in their shoes, I wouldn't want to waste the time to negotiate while my husband got closer and closer to death. Sometimes love, and not knowing that the healthcare system thinks it's some sort of Chinese flee market, can make you do things like pay that money up front, even if you're not stupid.

:yeahthat: and the article made the point several times that when you're dealing with serious illness of loved one, you're not thinking about the bills. You're worried if they're going to live or die and one lady quoted said she didn't have time/energy to deal with them so they went in a shoe box.

I only know about negotiating medical bills from posts here on the BBB.

[brittone2]

:yeahthat: and the article made the point several times that when you're dealing with serious illness of loved one, you're not thinking about the bills. You're worried if they're going to live or die and one lady quoted said she didn't have time/energy to deal with them so they went in a shoe box.

I only know about negotiating medical bills from posts here on the BBB.
I agree. And I used to work in healthcare. Fortunately, in early intervention I didn't really have to get involved with the billing part, etc. as much as PTs do in outpatient practice, for example. But the system is intimidating, confusing, and overwhelming, and I worked in healthcare, had classes on management issues that got into insurance a bit, etc. Add in the stress of dealing with a loved one who is very seriously ill, I can see how the sense of urgency makes it even worse.

[NJ_Mom2011]

I don't think it's stupid at all that a couple, with no experience in medical billing issues, in a stressful time when one of them has been diagnosed with a serious cancer, would think they had no choice other than pay those fees. I feel badly for them. If I were in their shoes, I wouldn't want to waste the time to negotiate while my husband got closer and closer to death. Sometimes love, and not knowing that the healthcare system thinks it's some sort of Chinese flee market, can make you do things like pay that money up front, even if you're not stupid.

:yeahthat: Later on in the article, there was even more heartbreaking story where a woman who made $40,000/year was stuck with hospital bills of $142,000 for the cancer treatment for her late husband. (I think the original bills for her husband was over $900,000, but she hired a medical bill specialist who was able to negotiate it down.) She said that she had no idea how she was going to pay the bills. In my mind, I was yelling, "File for bankruptcy! It's not worth that they take your last dime." Especially when the bill is so often padded, where the hospital blanket or the surgical stap on a operating bed are frivolously charged.

My medical insurance stinks to high heaven. I feel that if my family had a catastrophic illness, I would be in the same boat.

Overall, a very long, but informative, article.

[TxCat]

Yes to this because insurance usually pays about 40%. I thought the couple highlighted at the beginning of the article were stupid for paying all of these costs up front without at least trying to negotiate first, at least the mother was $$$$ to pay for it, but still. It were those descriptions that really made the article kind of unreadable to me.

I spent 5 months of my residency training at MD Anderson, the hospital where that couple went, and trust me, they didn't have any choice. First off, as the article stated, MD Anderson is one of a few elite centers that routinely refuses to negotiate any of its prices, even with insurers, much below 50%. Second, MD Anderson routinely treats very wealthy self-pay patients from around the world. Christopher Hitchens spent his last months there. Every time I've been there, there have been multiple VIP patients - wealthy Saudis, Kuwaitis, Jordanians, Russians (usually flown by private jet), movie stars, etc. I'm definitely not saying it's right, but just confirming that MD Anderson does business far differently than any other hospital I've ever worked at.

[o_mom]

I'm definitely not saying it's right, but just confirming that MD Anderson does business far differently than any other hospital I've ever worked at.

I would also point out that in that particular story, they had two very good cancer centers in their home state, one within driving distance. No guarantee that they would have not had billing issues, but they wouldn't be a thousand miles from home, with the added pressure that every day is more travel expenses and taking time to negotiate would cost them more money and time away.

Yes, sometimes (rarely) you need the best of the best, but if when they called to make the appointment, they knew they had inadequate insurance, perhaps researching the very good options closer to home would make more sense.

[AnnieW625]

Thanks for that info. O Mom, that is kind of what I was getting at.


I spent 5 months of my residency training at MD Anderson, the hospital where that couple went, and trust me, they didn't have any choice. First off, as the article stated, MD Anderson is one of a few elite centers that routinely refuses to negotiate any of its prices, even with insurers, much below 50%. Second, MD Anderson routinely treats very wealthy self-pay patients from around the world. Christopher Hitchens spent his last months there. Every time I've been there, there have been multiple VIP patients - wealthy Saudis, Kuwaitis, Jordanians, Russians (usually flown by private jet), movie stars, etc. I'm definitely not saying it's right, but just confirming that MD Anderson does business far differently than any other hospital I've ever worked at.

Thanks. It is just interesting that they went there when I am sure they could have found something closer, but who knows maybe they couldn't, and who knows the editor of the article could have left that information out if the article on purpose to dramatize it a bit more, but yeah it does make me sick to my stomach. I guess I really do take what I learned at my job in the last 10 yrs. for granted.

[GaPeach_in_Ca]

Thanks. It is just interesting that they went there when I am sure they could have found something closer, but who knows maybe they couldn't, and who knows the editor of the article could have left that information out if the article on purpose to dramatize it a bit more, but yeah it does make me sick to my stomach. I guess I really do take what I learned at my job in the last 10 yrs. for granted.

Well, they do tell you why they went there:

his wife Stephanie knew she had to get him to MD Anderson Cancer Center in Houston. Stephanie’s father had been treated there 10 years earlier, and she and her family credited the doctors and nurses at MD Anderson with extending his life by at least eight years.


Emotional response.

[KLD313]

I had no maternity insurance but I had medical insurance. Insurance paid for some ultrasounds and things and they negotiated some of my other bills. My hospital bill was over $24k and the bill for the baby was over $4k. Also, out hospital is hiring outside companies to run certain departments. DS was born right before labor day and my oed didn't work that day so they had to have the outsourced neonatoligists dishcarge DS. They were also present sy the birth. I got billed another $2,400 for them.

The hospital wouldn't negotiate the $24k bill or the bill for DS, they told me to call the state and get insurance retroactively and if they wouldn't do that then they would be apply for financial help through them.

DS's insurance didn't cover his birth or hospital stay so we had to apply through the state for him as well.

The outsourced neonatoligists keep rebilling my ins. company and saying they don't want me to pay they want them to pay. Well, ins almost paid the whole bill now they're writing to me saying they want the rest of the money and want me to work with them to appeal the ins co to get the rest. It's crazy.

I did end up qualifying for state ins because I don't work and my BF was between jobs for the three mos the state ins covered us. I'm happy I was able to get the bill paid but I can't believe how ridiculously easy it was to get state ins.

I also don't like how the hospital is using all these companies to take over their departments. It's like you have no idea who you're going to get or of they're any good.

[scrooks]

Thanks. It is just interesting that they went there when I am sure they could have found something closer.

I read that a wondered a bit too, although I read the part about their family member having good luck there. I really only wondered because they said they were from Ohio and we have many world class hospitals thought the state including one less than an hour from them. I guess it's a tough call to make in the throws of a serious illness.

[crl]

I tried very hard to get a total dollar amount before we had ds put under general for dental work at age three. I could not get the insurance company to tell me whether or not it would be covered. The numbers the hospital gave me in advance were thousands and thousand less than what they actually billed me. And nothing unanticipated happened. They just gave me the wrong numbers. Thankfully insurance covered it. Otherwise we would have been in an extremely difficult position financially.

You simply cannot shop medical care even when it is not an emergency because it is impossible to get true and accurate information about insurance coverage and cost, IME.

Catherine

[scrooks]

Listening to a discussion of this article on NPR right now!!!

Eta ... Diane Rehm show