Planning on dropping Health Insurance. Change my mind.

[two_bit_score]

Wow, WoodChuckDad, what a story! All that stuff would be free for us up here, but we keep hearing stories on the news like yours, and it gets really scary to think about how many in the U.S. have no insurance at all. I never did understand what happens when people like that get sick, and saddled with $$$ medical bills that they could never pay off.

It's not free. Someone is paying for it.

You got that right!

But somehow some folks think things are free. Where do they think that "free" comes from? Do the ones doing the work just do it without pay for those?

I just had to put these three posts together for clarity.


TBS

 

[goeduck]

They are generally individuals on assistance... like the premature baby with over a million in medical care mostly at Stanford... the Mom was 15... not even old enough to buy insurance and the Grandmother 31 years old.

I have seen many time those with no insurance received outstanding medical care without regard to payment or ability to pay.

You might know more better than most of us what the REAL cost of a $100,000 hospital bill is. My wifes cancer was nearly $500,000 last year. Insurance paid about $130,000 and our portion was $1,733 and no balance is due. So is $131,733 the REAL cost of her $500,000 bill? I totally understand that the hospital charges more for those that cannot pay or do not have insurance but since they do not pay, what is the point of the high billing? Government assistance (I hope) is not paying those prices. Those responsible without insurance file bankruptcy so no money there. Confused.

 

[ultrarunner]

You might know more better than most of us what the REAL cost of a $100,000 hospital bill is. My wifes cancer was nearly $500,000 last year. Insurance paid about $130,000 and our portion was $1,733 and no balance is due. So is $131,733 the REAL cost of her $500,000 bill? I totally understand that the hospital charges more for those that cannot pay or do not have insurance but since they do not pay, what is the point of the high billing? Government assistance (I hope) is not paying those prices. Those responsible without insurance file bankruptcy so no money there. Confused.

They make it up on volume in some cases...

The real answer is it depends... Cash pay can sometimes be 40% of rate for a number of reasons... the first is you do collect and second it is collected at the time of service so no lag for months and the customary back and forth to get paid... I have seen claims go for a year and documentation files the size of phone books...

One way to make it work is through the mix of cases/insurance... If we have a room doing only hernias for the day it is all set up with a team that is ready to go and will intermix patients with no or poor coverage...

If the Doc is already in the room and the room is set up a lot of the overhead is really made up by the economy of a volume of the same type of cases...

It can take minutes to hours to set up an Operating Room plus there is often lag between cases and the staff is getting paid.

One of our specialties is eye cases... we are very good and have the largest selection in house of thousands of lenses, etc... just for eyes... because we have two dedicated Operating Rooms and geared for eyes we can be very completive pricing and also demand concessions from vendors...

A skilled surgeon with a cracker jack team can alternate between two rooms at tremendous efficiency... as one is set up surgery is happening in the adjacent and vice versa...

Those with Government Assistance typically pay at the lowest tier... and sometimes it really is not enough to cover costs making it very hard to find anyone willing to work for the reimbursement offered...

The second part is county hospitals generally receive some taxpayer funding to keep the doors open... so this has to be taken into account.

A lot of docs will pick and choose... they might welcome Medicare but refuse Medi-Cal simply due to the fee schedule.

Complications often fall on the Doc and Facility as is with the case of flat rate reimbursement...

The mix is constantly changing... if no one offers a service due to low reimbursement then the fee may be adjusted accordingly... but, can be at the same time very stressful for patients being caught in the middle.

 

[Streetcar]

You might know more better than most of us what the REAL cost of a $100,000 hospital bill is. My wifes cancer was nearly $500,000 last year. Insurance paid about $130,000 and our portion was $1,733 and no balance is due. So is $131,733 the REAL cost of her $500,000 bill? I totally understand that the hospital charges more for those that cannot pay or do not have insurance but since they do not pay, what is the point of the high billing? Government assistance (I hope) is not paying those prices. Those responsible without insurance file bankruptcy so no money there. Confused.

With the discounted rates the hospital gets the dollar amount they want and insurance looks good for saving you money. Everyone gets what they want

 

[check]

They make it up on volume in some cases...

The real answer is it depends... Cash pay can sometimes be 40% of rate for a number of reasons... the first is you do collect and second it is collected at the time of service so no lag for months and the customary back and forth to get paid... I have seen claims go for a year and documentation files the size of phone books...

One way to make it work is through the mix of cases/insurance... If we have a room doing only hernias for the day it is all set up with a team that is ready to go and will intermix patients with no or poor coverage...

If the Doc is already in the room and the room is set up a lot of the overhead is really made up by the economy of a volume of the same type of cases...

It can take minutes to hours to set up an Operating Room plus there is often lag between cases and the staff is getting paid.

One of our specialties is eye cases... we are very good and have the largest selection in house of thousands of lenses, etc... just for eyes... because we have two dedicated Operating Rooms and geared for eyes we can be very completive pricing and also demand concessions from vendors...

A skilled surgeon with a cracker jack team can alternate between two rooms at tremendous efficiency... as one is set up surgery is happening in the adjacent and vice versa...

Those with Government Assistance typically pay at the lowest tier... and sometimes it really is not enough to cover costs making it very hard to find anyone willing to work for the reimbursement offered...

The second part is county hospitals generally receive some taxpayer funding to keep the doors open... so this has to be taken into account.

A lot of docs will pick and choose... they might welcome Medicare but refuse Medi-Cal simply due to the fee schedule.

Complications often fall on the Doc and Facility as is with the case of flat rate reimbursement...

The mix is constantly changing... if no one offers a service due to low reimbursement then the fee may be adjusted accordingly... but, can be at the same time very stressful for patients being caught in the middle.

Yup. It’s complicated alright.

 

[check]

My wife had some surgery one year ago this week. Her medicals bills are 1.5 million and counting. Even with insurance I am on the hook for a good portion of some of those bills.

How can anyone afford NOT to have health insurance?

Riptides, stories like yours is why we have universal medical care here. Your wife’s treatment would free, but you would have to pay an annual OHIP (Ontario Health Insurance Plan) premium ranging from $0 to $900 per year depend upon income. (The $900 premium would be for those making over $200,000 per year.)

The rest is paid by the government from tax revenues.

And Agvg, I did look up health care in Norway, and the system looks similar to that of Canada.

 

[riptides]

Riptides, stories like yours is why we have universal medical care here. Your wife’s treatment would free, but you would have to pay an annual OHIP (Ontario Health Insurance Plan) premium ranging from $0 to $900 per year depend upon income. (The $900 premium would be for those making over $200,000 per year.)

The rest is paid by the government from tax revenues.

And Agvg, I did look up health care in Norway, and the system looks similar to that of Canada.

Yeah, only half my clan is Canadian.

But no worries, I can always claim bankruptcy after hardship(s) <-plural, gets denied.

 

[Agvg]

Riptides, stories like yours is why we have universal medical care here. Your wife’s treatment would free, but you would have to pay an annual OHIP (Ontario Health Insurance Plan) premium ranging from $0 to $900 per year depend upon income. (The $900 premium would be for those making over $200,000 per year.)

The rest is paid by the government from tax revenues.

And Agvg, I did look up health care in Norway, and the system looks similar to that of Canada.

Yes, it probably much the same, the first line are the doctors out in the county, all more or less private driven by the GP or own by several doctors and other health professionals, the bill goes to the government even they are private.
And you have our "own" doc, so those that has a lot of issues doesn't meet a new face every time they visit.

And you has to go through this doc to get to more specialised care or hospital in general if it's not an emergency of course.


A lot of more specialised health care are driven in the same way, privately owned and state paid.

This system came to life to get things more effective, when all was state driven things that didn't had to be rushed tok a loooooong time.

 

[ultrarunner]

Riptides, stories like yours is why we have universal medical care here. Your wife’s treatment would free, but you would have to pay an annual OHIP (Ontario Health Insurance Plan) premium ranging from $0 to $900 per year depend upon income. (The $900 premium would be for those making over $200,000 per year.)

The rest is paid by the government from tax revenues.

And Agvg, I did look up health care in Norway, and the system looks similar to that of Canada.

This begs a question...

Why do Canadian Citizens fly to California for surgery when it is provided at no cost in Canada.

Every year... we have patients that fly in... most from Canada but also Central and South America.

I had a chance to speak with one older couple from Canada and he said his reasons are twofold... the Doctor he wanted to perform the surgery in Canada was booked 16 months out and the lens he wanted was not covered in Canada...

It does seem extreme to book a flight, hotel and car rental and then pay the facility, anesthesia and surgeon when he would not incur these costs in Canada.

One of my good friends is a Surgical Nurse at Queens Hospital in Hawaii... many of their patients are non-US citizens... they are cash pay and no shortage of them either.

A simple explanation would be that at least some see the value in spending out of pocket for US medical services.

 

[check]

This begs a question...

Why do Canadian Citizens fly to California for surgery when it is provided at no cost in Canada.

Every year... we have patients that fly in... most from Canada but also Central and South America.

I had a chance to speak with one older couple from Canada and he said his reasons are twofold... the Doctor he wanted to perform the surgery in Canada was booked 16 months out and the lens he wanted was not covered in Canada...

It does seem extreme to book a flight, hotel and car rental and then pay the facility, anesthesia and surgeon when he would not incur these costs in Canada.

One of my good friends is a Surgical Nurse at Queens Hospital in Hawaii... many of their patients are non-US citizens... they are cash pay and no shortage of them either.

A simple explanation would be that at least some see the value in spending out of pocket for US medical services.

Yup. Rich people who are not willing to wait their turn can always get what they want from a country where they can buy their medicine on an ad hoc basis. What I worry about is the guys who can’t afford $1.5 million for their wife’s treatment. It is just a shame.