The Insanity Of Medical Costs

[STERLING351]

I am a medical provider and I do disagree with how the system is. Most places cant tell you up front how much your CT of the abdomen is going to cost upfront. The thing is most people who go to public hospitals don't have insurance or they have poor insurance plans which don't cover much. So when someone does not pay their $10,000 bill the hospitals try to pawn that debt off on other people to make up. It a poorly designed system but hospitals are required to see and treat people regardless if they have insurance. Urgent cares are good because they only take people with good insurance or have cash to pay the bill so there is no outstanding debts. I have a friend who is a provider in a urgent care and he says just to keep the lights on and break even they need to see 5 patients on average per shift, everything after 5 is profit. The hospital I work at we have a Medicare/Medicaid population of 56%, 25% are private the rest are "self-pay" aka no pay. This is a problem throughout the country. Imagine if 19% of people at Wal-Mart did not pay their bills and were getting $200-300 of groceries. The company would pawn the cost off to people who were able to pay their bills. The system is broken, insurance companies also deny paying for several hospital visits a day stating the patient did not have to be admitted. I have spent hours arguing with insurance companies to make sure the hospital get reimbursed for services rendered. If everyone would pay their bills it would not be such a problem. Also the common person does not have much negotiating power. My wife had to have knee surgery recently and the ortho surgeons follow up bills were quoted at $260 from his office, insurance negotiated it down to $130 per visit. If we did not have insurance the office would have held strong at the $260 a visit and would not be seen for follow ups until to balance was $0.

Oh and those "Advantage" plans are known in the hospital as a "Dis-advantage plan". Most will not cover rehab for the elderly who have had ortho surgeries. They often suck people in with no medication co-pays or other incentives. Best bet for elderly is Medicare with a supplemental plans not a advantage plan. Advantage plans are purely for profit and not patient care.

 

[ruffdog]

Yep, way too many "for profit" middlemen looking to pad their pockets while patient care suffers and prices climb. We were seeing this trend more than a dozen years ago too.

 

[5030]

A friend of mine sent me this article several years back.
https://time.com/198/bitter-pill-why-medical-bills-are-killing-us/
still shaking my head...

Interesting article and true. My wife and I keep close track of my ever mounting hospital bills (I'm retaining my infusion port which was surgically implanted in my shoulder for I don't know how long but, every 30 days I have to go to the infusion lab to have it flushed so it's an ongoing thing). I compare what Medicare pays for various procedures (contract amount) and what I'd be billed if I didn't have insurance and the difference is staggering. Medicare is my primary and BC/BS is secondary and BC/BS only pays the difference between the contracted amount and what medicare allows.

It's a helluva racket and I feel for anyone with no insurance because they are on the hook for the full tilt. Bankruptcy city.

 

[5030]

Good example is the last MRI with contrast I had. Bill was 10,500.00 Medicare allowed $3200 but only paid 2800 of it and my other carrier picked up the difference and I like the bottom line I get.... You owe nothing... Favorite part. Having said that, an individual with no or limited coverage would be on the hook for the $10, 500.

I have a stack of bills paid and owe nothing on as thick as a phone book. Get them monthly in a packet from BC/BS and a packet from Medicare too

 

[5030]

Do I want Canadian socialised medicine? Two word answer... **** no.

 

[Chris616]

Do I want Canadian socialised medicine? Two word answer... **** no.

Why is that, Daryl?

Chris

 

[Travelover]

I found this bill news encouraging - we shall see if it actually gets passed into law. It prohibits surprise billing, where you got to a hospital that is within your network, but someone involved with your care, like an anesthetist or co-surgeon bills you separately as an out of network service provider and you are stuck for the difference between the network price and their bill. Some companies actually make this practice a business model. Ban on Surprise Medical Bills May Pass After All - The New York Times

 

[goeduck]

I am a medical provider and I do disagree with how the system is. Most places cant tell you up front how much your CT of the abdomen is going to cost upfront. The thing is most people who go to public hospitals don't have insurance or they have poor insurance plans which don't cover much. So when someone does not pay their $10,000 bill the hospitals try to pawn that debt off on other people to make up. It a poorly designed system but hospitals are required to see and treat people regardless if they have insurance. Urgent cares are good because they only take people with good insurance or have cash to pay the bill so there is no outstanding debts. I have a friend who is a provider in a urgent care and he says just to keep the lights on and break even they need to see 5 patients on average per shift, everything after 5 is profit. The hospital I work at we have a Medicare/Medicaid population of 56%, 25% are private the rest are "self-pay" aka no pay. This is a problem throughout the country. Imagine if 19% of people at Wal-Mart did not pay their bills and were getting $200-300 of groceries. The company would pawn the cost off to people who were able to pay their bills. The system is broken, insurance companies also deny paying for several hospital visits a day stating the patient did not have to be admitted. I have spent hours arguing with insurance companies to make sure the hospital get reimbursed for services rendered. If everyone would pay their bills it would not be such a problem. Also the common person does not have much negotiating power. My wife had to have knee surgery recently and the ortho surgeons follow up bills were quoted at $260 from his office, insurance negotiated it down to $130 per visit. If we did not have insurance the office would have held strong at the $260 a visit and would not be seen for follow ups until to balance was $0.

Oh and those "Advantage" plans are known in the hospital as a "Dis-advantage plan". Most will not cover rehab for the elderly who have had ortho surgeries. They often suck people in with no medication co-pays or other incentives. Best bet for elderly is Medicare with a supplemental plans not a advantage plan. Advantage plans are purely for profit and not patient care.

Well said. That is pretty much how I have always believed it to be. Our insurance settles up for about 30 cents on the dollar and the bill is satisfied. Go figure. You are toast without insurance if you have assets.

 

[PILOON]

Always been my view that insurance, in general is worthless until you need it. At that point it's worth everything, especially medical insurance. Most any medical procedure can and will bankrupt you unless you have sufficient coverage and not having coverage is a fools way of thinking.

Yeah, like 2 choices as to when to buy it.
Before or after!

 

[5030]

Why is that, Daryl?

Chris

I don't care for your value added taxes (which finances your socialized medicine for starters) and I don't care for your barbaric firearm laws (that are apparently getting worse under Tredeau). Living 50 miles from the border is fine with me. I never intend to cross it. Besides, I'm more accustomed to the English system of measurement. Not a liter person.