Scorpion sting leaves Arizona woman with $83K bill

[waggy]

Yep, because when you're dying an agonizing death from poisoning you've got plently of time to consult your insurance policy to find which hospital in your city you need to go to.

If you were dying you wouldn't give two shits if the nearest hospital was in your network or not, you'd still go there.

That's why your system is so fucking nuts. When you're dying you shouldn't need to think about these kinds of things!

it would have been better if she was dying. why? then the insurance would have covered it without a question.

PPO's suck ass for this reason. you do need to be careful when going to the hospital and make sure it is in network if not then they don't pay as much.

i really really dislike PPO's

 

[ScoobMaster]

Did any of you read the article that Lanyap posted?

Those of you wishing for the Government to swoop in with a healthcare takeover to "save us all" need to realize they are part of the cause of this problem. As someone else pointed out in an earlier post, for $12k to $40k a dose, it may be a good time to get into the Scorpion antivenom business. Hell, if you could buy it for a few hundred dollars accross the border and import it, you could undercut the Tennessee companies price by 80% and STILL make a generous profit.

Except (thanks to government in the form of the FDA) you can't. Regulations on drug imports, and more importantly RIGHTS see to that. from the article:
"The FDA has granted Rare Disease Therapeutics the exclusive right to sell the antivenom in the United States for seven years. Other drug companies may petition the FDA to sell the drug after that seven-year period. However, because the market for scorpion antivenom is so limited, it's uncertain whether any generic company would seek to compete with Rare Disease Therapeutics."

May petition my arse. You can bet some agents in the FDA, lobbyists, and executives of Rare Disease Therapeutics are pocketing some big bucks over this. I suspect many other cases play out just like this one too. This is why we need LESS government control, not MORE. Agencies like the FDA need to be impartial referees to enforce the rules for a level playing field free market. Not choose winners and losers in the market at the expense of consumers and citizens while they make backroom deals together.

You think Government takeover of the healthcare system will make this BETTER??!!

 

[RocksteadyDotNet]

Did any of you read the article that Lanyap posted?

Those of you wishing for the Government to swoop in with a healthcare takeover to "save us all" need to realize they are part of the cause of this problem. As someone else pointed out in an earlier post, for $12k to $40k a dose, it may be a good time to get into the Scorpion antivenom business. Hell, if you could buy it for a few hundred dollars accross the border and import it, you could undercut the Tennessee companies price by 80% and STILL make a generous profit.

Except (thanks to government in the form of the FDA) you can't. Regulations on drug imports, and more importantly RIGHTS see to that. from the article:
"The FDA has granted Rare Disease Therapeutics the exclusive right to sell the antivenom in the United States for seven years. Other drug companies may petition the FDA to sell the drug after that seven-year period. However, because the market for scorpion antivenom is so limited, it's uncertain whether any generic company would seek to compete with Rare Disease Therapeutics."

May petition my arse. You can bet some agents in the FDA, lobbyists, and executives of Rare Disease Therapeutics are pocketing some big bucks over this. I suspect many other cases play out just like this one too. This is why we need LESS government control, not MORE. Agencies like the FDA need to be impartial referees to enforce the rules for a level playing field free market. Not choose winners and losers in the market at the expense of consumers and citizens while they make backroom deals together.

You think Government takeover of the healthcare system will make this BETTER??!!

The success of UHC in every other western country says yes.

 

[sactoking]

it would have been better if she was dying. why? then the insurance would have covered it without a question.

PPO's suck ass for this reason. you do need to be careful when going to the hospital and make sure it is in network if not then they don't pay as much.

i really really dislike PPO's

Not 100% accurate. So long as there is a reasonable expectation that the insured needs emergency care then the insurer has to cover the hospital stay as in-network. That means they have to apply the in network coinsurance provision and not the lower out of network coinsurance. The caveat though is that while it's paid as in network (often 80%) the 80% is only applied to the "reasonable and customary" amount and the hospital can balance-bill.

For a true in network treatment (as opposed to forced network coverage for an emergency) the medical provider is prohibited by contract from balance-billing the insured.

 

[waggy]

The success of UHC in every other western country says yes.

NOt every country allows such silly stuff to happen. The US allows drug company's idiotic measures to insure a profit.

There is no good reason 1 company is only allowed to produce the anti-venom.

UHC will not fix stupid shit like this at all.

 

[CottonRabbit]

------------------------------------------------------------------------------------------
As I say Cotton R, you simply do not understand the concept of national health care insurance.

Lets start out with the question, do you Cotton R believe that the woman who was bitten by the scorpion or the person who was bitten by a brown reluse spider was somehow was engaged in riskey behavior and therefore deserved what happened to them?

Don't crawfish out here Cotton R, a simple yes no is the only answer I will accept.

Then we can ask, how rare is that, to be bitten by a scorpion, a brown recluse spirder, or even a more dehabilitating deer tick with Lymes desease? There by the grace of God maybe go you and I, but you forget to ask, what would you feel if you were the victim? And your heath insurancer dropped you?

As it the simple concept of insurance that we all pool the risks, and not allow insurance companies to crawfish out after the fact.

After than Cotton R, I think you are a piss poor human being because medical care should be the national birthright of all American citizens regardless of American for profit mangled heathcare. As the USA is the only country in the indudusrialed world who has not adopted such policies.

As I have another question for you Cotton R, do you believe American lack of universal heath care is the reason for continued (?) American prosparity or the reason for the decline of
American competitiveness?

WTF? Strange rant!

I don't know how you took my post to be against UHC, because I didn't comment on health insurance at all. I was simply pointing out the absurdity of thinking that 3 months of inpatient care for necrotizing fasciitis from MRSA is comparable to a couple shots of horse serum in the ER for a condition that likely would have resolved on its own.

As a matter of fact, I support UHC precisely because of cases like the one I originally commented on. Save your douchebaggery for someone who doesn't understand the need for UHC. You owe me an apology.

 

[RocksteadyDotNet]

NOt every country allows such silly stuff to happen. The US allows drug company's idiotic measures to insure a profit.

There is no good reason 1 company is only allowed to produce the anti-venom.

UHC will not fix stupid shit like this at all.

Actually, this is exactly the situation where UHC helps.

Under UHC the gov has massive power to negotiate lower prices for this kind of crap. The drugs company can either take it or leave it, there's no one else they can sell to.

In Australia I guarantee this antidote would cost a fraction of what it cost this woman.

 

[sactoking]

In the US it's not a supply/demand single/multiple payor problem, it's an R&D patent problem. The US patent system is designed to spur innovation and it does that by granting obscenely long patents. The obscene patents also lead to obscene price gouging/"cost recovery".

In a UHC system you wouldn't see a drop in pharma prices you'd see a drop in pharma innovation as companies decide that the .gov's lowball reimbursement offers couldn't sustain the R&D costs.

 

[RocksteadyDotNet]

In the US it's not a supply/demand single/multiple payor problem, it's an R&D patent problem. The US patent system is designed to spur innovation and it does that by granting obscenely long patents. The obscene patents also lead to obscene price gouging/"cost recovery".

In a UHC system you wouldn't see a drop in pharma prices you'd see a drop in pharma innovation as companies decide that the .gov's lowball reimbursement offers couldn't sustain the R&D costs.

Once again, facts disagree.

Countries like UK, France, Germany, Australia, etc, do massive amounts of R&D.

 

[sactoking]

Once again, facts disagree.

Countries like UK, France, Germany, Australia, etc, do massive amounts of R&D.

You have no facts, just anecdotal conjecture. You imply that other "Western" countries have large R&D departments with dissimilar patent laws, so my assertion must be wrong. You aren't thinking globally. R&D isn't necessary on a country-specific basis.

The Drug Price Competition and Patent Term Restoration Act of 1984 pretty much guarantees pharma companies a 20 year lock in US profits, even on "foreign" drugs. Those profit guarantees are definitely part of the global cost-benefit analyses that drug companies do. Without the US' messed up patent system guaranteeing global company profits then global innovation would decline.

 

[Hayabusa Rider]

It works pretty well here.

You aren't here. Notice how our elections work? These are the people who will be doing the greatest undertaking of all time, namely replacing one of the most complex and organic system of human technology and interactions, and replacing it with another. We aren't talking about the evolution of healthcare but something more akin to death and resurrection. A system can be had, but I've not seen those with power that have wit and wisdom to even begin. In fact to question ability is blasphemy. Thats a poor start.

 

[RocksteadyDotNet]

You aren't here. Notice how our elections work? These are the people who will be doing the greatest undertaking of all time, namely replacing one of the most complex and organic system of human technology and interactions, and replacing it with another. We aren't talking about the evolution of healthcare but something more akin to death and resurrection. A system can be had, but I've not seen those with power that have wit and wisdom to even begin. In fact to question ability is blasphemy. Thats a poor start.

I absolutely agree. I never said it would be easy to go UHC, I just said it works.

I think you're only hope is to let the current system collapse, then try and build a UHC out of the remains.

 

[chucky2]

You have no facts, just anecdotal conjecture. You imply that other "Western" countries have large R&D departments with dissimilar patent laws, so my assertion must be wrong. You aren't thinking globally. R&D isn't necessary on a country-specific basis.

The Drug Price Competition and Patent Term Restoration Act of 1984 pretty much guarantees pharma companies a 20 year lock in US profits, even on "foreign" drugs. Those profit guarantees are definitely part of the global cost-benefit analyses that drug companies do. Without the US' messed up patent system guaranteeing global company profits then global innovation would decline.

You know, this is one thing I was thinking of a long while back. If the US were to do UHC, would not innovation in the medical field slow down across the board? I've always got the feeling that other countries with UHC/UHC-like systems get to enjoy medical advancements that companies pushed so as to sell them vastly marked up in the US: In effect we're subsidizing the rest of the worlds healthcare innovation cost.

You are by far the most plugged in person on this Forum on HC, what is your opinion on this?

Chuck

 

[Hayabusa Rider]

I absolutely agree. I never said it would be easy to go UHC, I just said it works.

I think you're only hope is to let the current system collapse, then try and build a UHC out of the remains.

I catch hell for this all the time but...

We have a fundamental flaw in American governance. I believe in our Constitutional principles however making them work in an increasingly complex and busy society is problematic. At one time an educated person could sufficiently grasp the issues of his day and make reasonably sound decisions. Now we have a world beyond the comprehension of politicians. I'm not blaming them for that because with the hectic pace of life there is insufficient time to be educated and perform all necessary duties. Then we do have a problem with screening out potential solutions because of ideological and political predispositions. It doesn't follow the standard model of accepted thought or another outside the party might get into the limelight. Also there can realistically be no more than two ideas in the end.

I submit thats a poor way to do the business of governance. I'd like to see an effective fourth branch, one whose function is to determine an issues true nature, identify problems and solutions and have it done by those recognized by peers to be exceptional. Wed have a group for health care, job creation, etc. They could release information, bring up points not considered, identify several potential options with likely consequences as that pesky law of unintended consequences exponentially worsens as power driven by ignorance rules. Then with government and the public well informed,Congress has wisdom and knowledge to draw upon and the people have a standard to hold Congress to besides political expediency

So shoot me 😀

 

[actuarial]

I submit thats a poor way to do the business of governance. I'd like to see an effective fourth branch, one whose function is to determine an issues true nature, identify problems and solutions and have it done by those recognized by peers to be exceptional. Wed have a group for health care, job creation, etc. They could release information, bring up points not considered, identify several potential options with likely consequences as that pesky law of unintended consequences exponentially worsens as power driven by ignorance rules. Then with government and the public well informed,Congress has wisdom and knowledge to draw upon and the people have a standard to hold Congress to besides political expediency

I'm not sure that'd be much better. While not an official branch of government, it sure sounds like you could take what you're defining and basically end up with what is currently lobbyists.

 

[waggy]

Actually, this is exactly the situation where UHC helps.

Under UHC the gov has massive power to negotiate lower prices for this kind of crap. The drugs company can either take it or leave it, there's no one else they can sell to.

In Australia I guarantee this antidote would cost a fraction of what it cost this woman.

maybe in Austrailia it would cost less.

The fact the government gave this company a 7 year monopoly says different.

 

[Hayabusa Rider]

I'm not sure that'd be much better. While not an official branch of government, it sure sounds like you could take what you're defining and basically end up with what is currently lobbyists.

Except that's not what I'm talking about at all. I'm talking people who practice something besides bribery. In the case of health care I'm thinking several kinds of practitioners, actuaries (surprise! 😀), health care advocates, administrators experienced with billing issues, computer experts for things like a national centralized database for real time access of records etc., experts in law and regulations who could put it all into a formal document aimed at reducing unintended consequences and so on. Congressional staffers are way beyond their depth. Politicians bringing in "experts" who may be that but are chosen because their political ideology backs that of those on the Congressional panel? That's what we have now. Stack the deck and run with it. Not a really good idea IMO.

 

[Darwin333]

So I just learned you can breed scorpions to harvest venom and then sell antivenom to instantly become rich as hell.

It only costs $100 a dose in Mexico......

 

[Hayabusa Rider]

It only costs $100 a dose in Mexico......

True. What are the regulatory costs of bringing a drug to market in Mexico vs the US?

 

[Darwin333]

Once again, facts disagree.

Countries like UK, France, Germany, Australia, etc, do massive amounts of R&D.

Do you have any hard numbers? The best I can find is a wiki page that suggests that in 2001 Australia invested $1.7B in biomedical research while the US invested $94B. If these are "all in" accurate numbers I wouldn't exactly call $1.7B "massive" when compared with $94B.

 

[Darwin333]

True. What are the regulatory costs of bringing a drug to market in Mexico vs the US?

Hell if I know, I just googled the drug to see if there was a reason it cost so much and the first article I clicked said that it is made in Mexico and costs $100 per dose in Mexico.

 

[Darwin333]

You have to be real careful when you go out of network with a PPO.

I had that years ago with my first born child. The hospital was in-network but the Neo-natal doctors where out of network. I got stuck with a $2500 for expenses that my insurance considered beyond reasonable and customary. As if I am supposed to ask the doctor getting my child breathing again if they are in-network for my PPO. Anyway I negotiated and paid about $1500. The wife had a procedure in July and they charged 39k, the in-network negotiated amount was $4600 and I paid zero since my wife had already hit the maximum out of pocket. You have to be careful especially going to emergency rooms.

Just to make sure that I understand this properly, your wifes insurance was billed $39,000 for her procedure and the insurance company negotiated that down to $4,600?

If so, that is whats wrong with the damn system. If I had walked in with cold hard cash you better damn well believe I would have been stuck with the $39,000 bill (or at the very least not anywhere close to $4,600) even though they have FAR less expenses with a cash paying customer. No billing, no extensive paperwork, no negotiating and rebilling, no denial and having to go after the patient for uncovered costs, etc.... Just a trip to the bank to deposit the money.

I completely understand if you don't want to but would you mind telling us what the procedure was? I would like to compare it to the price that the Surgery Center of Oklahoma would charge.

 

[Darwin333]

The problem with that is lack of consistent real time billing. Perhaps it exists but even where it does prospective charges aren't guaranteed. I'd be fine with a list of optional charges but it would be impossible to determine what the patient would actually pay as they can't foresee what insurance will ultimately do. For others this includes government programs so any hypothetical appeal to UHC doesn't fix this problem.

I think he was talking about, at the absolute least, forcing hospitals/doctors to list the total price for XYZ procedure upfront. Obviously things can go wrong that can increase the cost but there should at least be a base cost listed up front. I am pretty sure that just about every other industry is forced by law to do this and I see no reason that the medical industry should be exempt.

Just for fun, call around and get the cash price of an MRI. I even went as far as to ask what machines they were using so I knew I was comparing apples to apples, the difference in price was mindblowing and for the life of me I can't figure out why it would be up to 7 times more expensive to get the same procedure with the same equipment done a few miles apart.

 

[Hayabusa Rider]

I think he was talking about, at the absolute least, forcing hospitals/doctors to list the total price for XYZ procedure upfront. Obviously things can go wrong that can increase the cost but there should at least be a base cost listed up front. I am pretty sure that just about every other industry is forced by law to do this and I see no reason that the medical industry should be exempt.

Just for fun, call around and get the cash price of an MRI. I even went as far as to ask what machines they were using so I knew I was comparing apples to apples, the difference in price was mindblowing and for the life of me I can't figure out why it would be up to 7 times more expensive to get the same procedure with the same equipment done a few miles apart.

I have no problem with an estimated cash price up front. Two caveats, sometimes you don't know what might happen during a treatment so a guarantee of a fixed price in that case couldn't apply. Second the patient needs to know this is a cash price, not what they will pay. Often I get "how much will this cost" and I answer "it depends on what your insurance and we can't know that in advance."

With these qualifications, sure.

 

[Hayabusa Rider]

Hell if I know, I just googled the drug to see if there was a reason it cost so much and the first article I clicked said that it is made in Mexico and costs $100 per dose in Mexico.

This is a 2009 article and it hasn't gotten any cheaper since then.

Since the development of the drug has already been done, the approval for sale comes at a cost, probably a few hundred million instead of the billion plus, but it could be more. Whatever that is, divide that by the number of doses expected to be sold before the patent goes away and that's the break even cost before a vial is sold.

Point is that there are substantial costs that cannot be avoided. That may be the price we have for drug safety, but the price is high in dollars.

Still I'm not justifying the costs charged. The figure I found for the wholesale price of a single vial is $3500. That's way below what was charged and the hospital is responsible for how this was done.

I have seen that the woman is going to get a substantial reduction or perhaps a complete dismissal of charges and that would be in the interest of the hospital. Otherwise expect a potential investigation into fraud. This was not cool.