Appendix - the final bill.

[drebo]

So it really sounds like healthcare prices are inflated for everyone, since insurance = very marked down price and no insurance = mostly marked down price. Is there really a reason to have the crazy prices to begin with? Most hospitals are non-profits, so they aren't really getting tax benefits from writing off that $25k markdown. Maybe the individuals (ex. surgeons) get a hefty tax deduction.

All prices in healthcare are based on what Medicare is willing to pay for any particular procedure.

If Medicare says they'll pay $5k for something, everyone gets charged $5k for that, even if it only really costs $500 to do the procedure.

So, for this, you can blame Medicare.

 

[techs]

All prices in healthcare are based on what Medicare is willing to pay for any particular procedure.

If Medicare says they'll pay $5k for something, everyone gets charged $5k for that, even if it only really costs $500 to do the procedure.


So, for this, you can blame Medicare.

That's completely false.

Medicare actually pays less than almost any other insurer due to the fact they are so large and hospitals need those patients to cover overhead.

If everyone paid Medicare fees the cost of health care in the US would plummet.

Though to be honest, many hospitals would close because they rely on higher paying private insurance to survice.

 

[Sho'Nuff]

The hospital finally sent me the bill for having my appendix removed a few weeks ago.

Hospital bill: $27,997.xx
Insurance adjustment: ~$25,xxx.xx
Insurance paid: ~$2,497.xx
I pay: $50.00

So tell me... who got ripped off?

The surgeon, who probably got paid $400-500 to save your life but spent 1/5 of that on liability insurance.

 

[techs]

The surgeon, who probably got paid $400-500 to save your life but spent 1/5 of that on liability insurance.

Yeah, I'm crying for the poor surgeons who are homeless and living on welfare.

 

[OutHouse]

Who is your health iinsurance with. I have bluecross and im sure they would rape me.

 

[SunnyD]

who is your health iinsurance with. I have bluecross and im sure they would rape me.

bcbsal.

 

[Mermaidman]

I'll sell you my still-usable appendix for $250.00.

Eons ago, I worked briefly processing health insurance claims. It was crazy some of the markdowns resulting from contractual rates.

 

[Homerboy]

Thats possible. Perhaps it turned out that they can actually get more individuals to pay a lower bill since its affordable versus how many people would declare bankrutpcy.

Or, the hospital is in a high demand vs. availability area and the health insurance company needed to pay more so the hospital would accept patients with that particular health insurance plan. Insurance companies are actually competing with each other for treatment facilities in some areas.

No. It was a serious F-up that the insurance company then jumped on and got corrected for me and for future patients. They thanked me by billing me 20% instead of my normal 20% (no typo)

 

[tcG]

Procedure prices are ludicrously high for many reasons, including requiring insurance for what should be routine, cheap procedures reducing consumer incentive to shop around as well as the stranglehold that the medical cartels like the AMA/ADA, insurance companies, licensing committees, healthcare companies, government-funded research grants, and physician education has on the entire industry.

 

[techs]

No. It was a serious F-up that the insurance company then jumped on and got corrected for me and for future patients. They thanked me by billing me 20% instead of my normal 20% (no typo)

Now you're getting the hang of it

 

[airdata]

The hospital finally sent me the bill for having my appendix removed a few weeks ago.

Hospital bill: $27,997.xx
Insurance adjustment: ~$25,xxx.xx
Insurance paid: ~$2,497.xx
I pay: $50.00

So tell me... who got ripped off?

So let's break this down :

Hospital bill: $28k : Grossly inflated BS fee.

Insurance adjustment: $25k insurance tells hospital to GTFO w\ trying to over charge them by 25k and quit trying to commit insurance fraud.

Insurance paid : $2,500 determined fair price of doctors time & materials to perform procedure.

You pay : $50 lucky you have a decent insurance plan.


Somebody without insurance may find themselves w\ debt collectors calling 24/7 trying to collect that 25k for a long time, ruin their credit, possibly bankrupt... who knows.

 

[zinfamous]

I ran out of whiskey and the isopropyl didn't taste very good...

I think I see the problem with your protocol.... :hmm:

 

[rivan]

Ask for an itemized list. Might be some LOL-worthy items on it.

It's been 15 years or so, but my brother really did a number breaking his ankle. Huge bill comes back, my mom's a nurse and asks for itemized bill. Among other (barely) less incomprehensible items was a pregnancy test.

To be honest, the crazy prices in healthcare will never be brought under control until there is direct consumer involvement in paying for things. As long as the consumer is paying a flat fee, there's absolutely no incentive for the consumer to watch what gets paid out.

 

[techs]

Ask for an itemized list. Might be some LOL-worthy items on it.

It's been 15 years or so, but my brother really did a number breaking his ankle. Huge bill comes back, my mom's a nurse and asks for itemized bill. Among other (barely) less incomprehensible items was a pregnancy test.

To be honest, the crazy prices in healthcare will never be brought under control until there is direct consumer involvement in paying for things. As long as the consumer is paying a flat fee, there's absolutely no incentive for the consumer to watch what gets paid out.

I strongly disagree. As a person who was trained to inspect hospital bills I categorically state that the average individual has no ablity to actually read and comprehend hospital bills.

To say that the average medical consumer could, for instance, decide what laboratory tests in a panel are appropriate for a specific condition is ludicrous.

The only real way that has worked has been in European countries, and Canada with national health insurance systems where trained professionals examine bills along with doctors input. This is one type of situation where consumers really can't make "informed" decisions unless they have had years of training.

 

[tcG]

^ I don't think bypassing the doctor's advice in favor of self-diagnosis is what "direct consumer involvement" means.

I think what rivan is getting at is there is no "shopping around" for medical services, nor can you easily get prices. The result is no meaningful competition in the industry and the accompanying high prices.

 

[techs]

^ I don't think bypassing the doctor's advice in favor of self-diagnosis is what "direct consumer involvement" means.

I think what rivan is getting at is there is no "shopping around" for medical services, nor can you easily get prices. The result is no meaningful competition in the industry and the accompanying high prices.

For some reason the old ad from Earl Shieb comes to mind.
"I'll remove any appendix for 99.95"

 

[rivan]

I strongly disagree. As a person who was trained to inspect hospital bills I categorically state that the average individual has no ablity to actually read and comprehend hospital bills.

You are most certainly correct in this, but I think that's part of the problem as well.

^ I don't think bypassing the doctor's advice in favor of self-diagnosis is what "direct consumer involvement" means.

I think what rivan is getting at is there is no "shopping around" for medical services, nor can you easily get prices. The result is no meaningful competition in the industry and the accompanying high prices.

This, exactly. If insurance companies provided some incentive for consumers to be responsible consumers, I think costs could come down or at least inflate at a more reasonable rate. And the only way I can see this being incentivized by insurers is with money, be it reduced rates, rebates, whatever.

 

[IronWing]

Last trip to the ER we were handed a piece of paper that explained that the hospital staff would not discuss prices as it would "interfere with the patient/doctor relationship and might lead to less appropriate care". Sounds much better than "We have no idea what we are going to charge for this; we'll just make sh$% up when it's time to send out a bill."

 

[Sho'Nuff]

Yeah, I'm crying for the poor surgeons who are homeless and living on welfare.

I'm just saying that the compensation system in the US is ass backwards, as the service providers get paid FAR less than the hospital they work in, but bear the majority of the risk.

Case in point - My daughter had open heart surgery at 3 months old. Total costs incurred were ~95,000. Greater than 90% of those charges were hospital charges. The remaining 10% was to be divided amongst the cardiothoracic surgeon, two anesthesiologists and seven OR nurses that attended to my daughter during a 6 hour surgery.

FWIW, my next door neighbor is an anesthesiologist and spends most of his time working cardiac cases. He's given me a pretty good breakdown of how doctors are paid. Ever wonder why there are almost no docs in private practice anymore?

Surgeons deserve to be well paid. To say otherwise is crazy. The hospital didn't save the patient's life, the surgeon did. My point is that in the grand scheme of things, the compensation scheme is backwards because the party who is doing the saving/treatment and who is bearing all the risk is not the party that recoups the bulk of the fees.

 

[rivan]

For some reason the old ad from Earl Shieb comes to mind.
"I'll remove any appendix for 99.95"

Like what we have currently is any worse?

Q: "What will my new muffler cost?"
A: "Why do you care? Your part will be $3. And the $182 that comes out of your paycheck every week. For the next three weeks. And all of your coworker's checks, too. Your total will be $3800.


...But nevermind that for now. You only need to give me $3 right now."

 

[IronWing]

You are most certainly correct in this, but I think that's part of the problem as well.



This, exactly. If insurance companies provided some incentive for consumers to be responsible consumers, I think costs could come down or at least inflate at a more reasonable rate. And the only way I can see this being incentivized by insurers is with money, be it reduced rates, rebates, whatever.

Our insurer lets us see the bills and agreed pricing but only after the fact. It allows us to plan for future expenses but doesn't help at all for shopping around. One can't say "For my next appendectomy, I'm going somewhere else."

 

[SirStev0]

Which comes to a rate of around $550/hr.

I wish I got paid $550/hr to do my job.

Just sayin'. :whiste:

(Yes, I know you're not taking out appendixes for 8 hours a day, 5 days a week... so grain of salt.)

That 275.00 for the operation ... and all the pre-op visits/workup AND the 30 days to 6 months (depending on the procedure) of free non-billable post-op followup.
That also gets split up to pay for malpractice insurance, office staff, billers, nurses, etc. The average surgeon is lucky to do 3-6 surgeries a day (of various types and lengths) and usually only 3-4 days a week.

How long is that surgery?

About an hour. Even shorter if you do it Open and not Laparoscopic. You get paid less for open though, unless it is Lap converted to Open which pays the same as just Lap.



The vast majority of that 28---.00 made up number is insurance company book cooking and them paying themselves to do nothing. The Hospitals/Insurance companies have made a great system that sounds grand and horrible but is all smoke and mirrors.

There is also Anesthesia costs/paying the Anesthesiologist and CRNA. Then there is the Operating room fees which pay the nurses and equipment and so on as well as all the preop and postop staff.


All things considered the guy actually taking out your organ is taking home about the same as an Auto Mechanic.

 

[SirStev0]

I'm just saying that the compensation system in the US is ass backwards, as the service providers get paid FAR less than the hospital they work in, but bear the majority of the risk.

Case in point - My daughter had open heart surgery at 3 months old. Total costs incurred were ~95,000. Greater than 90% of those charges were hospital charges. The remaining 10% was to be divided amongst the cardiothoracic surgeon, two anesthesiologists and seven OR nurses that attended to my daughter during a 6 hour surgery.

FWIW, my next door neighbor is an anesthesiologist and spends most of his time working cardiac cases. He's given me a pretty good breakdown of how doctors are paid. Ever wonder why there are almost no docs in private practice anymore?

Surgeons deserve to be well paid. To say otherwise is crazy. The hospital didn't save the patient's life, the surgeon did. My point is that in the grand scheme of things, the compensation scheme is backwards because the party who is doing the saving/treatment and who is bearing all the risk is not the party that recoups the bulk of the fees.

Some one gets it!
Thanks man. You restored my faith in humanity.
1 down. 313,914,039 more ignorant Americans to go.

 

[SunnyD]

Some one gets it!
Thanks man. You restored my faith in humanity.
1 down. 313,914,039 more ignorant Americans to go.

You have to admit, when you look at the thread itself, most of us get it. We understand that the hospital and insurance industry are to blame, not the individuals actually performing the task at hand.

Even I pointed out that that $550/hr isn't even remotely close to $550/hr, so tongue-in-cheek mockery was at play.

Without the skilled professionals, hospital administrators and the insurance industry wouldn't have anyone to rape.

 

[airdata]

The problem w\ medical billing is that unlike anything else you're going to pay for... there's not a price tag in most cases.

If you've gotta have your appendix out.. you're most likely not calling places trying to find out who's going to do it the cheapest, and they take advantage of that.