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I'm watching the charges show up on MyMedicare.gov after my husband's recent cataract surgery. The anesthesia was billed at over $1,000. Medicare is reimbursing about $120. The surgeon billed $2,600. Medicare is reimbursing him $613. At the ambulatory surgery center where he had the surgery, the admissions clerk wrote down the ludicrous figure of $6,750 on a slip of paper and waved it under our noses. That charge hasn't shown up on Medicare yet, and I'm curious as to what Medicare will actually reimburse them for this absurd number.
My husband would have like to have had this surgery about a year ago, but was not eligible for Medicare then, and the doctor and surgery center were not willing to budge on their prices. It was difficult to even get any sort of price quotes from them, and in fact, the charges I'm seeing now are over twice the amount we were told last year. It's ironic, because we would have been willing to pay $4 or $5 thousand out of pocket for the surgery, and now that he's on Medicare they'll only be getting a fraction of that reimbursed.
All of the numbers mentioned here are for surgery on one eye only, by the way.
I don't know why everyone isn't outraged about this, but I certainly am.
In my experience, some doctors and hospitals are perfectly willing to give discounts to cash paying customers, and others will not consider it at all. Seems like the more providers there are in an area, the more likely it is that you'll get a discount.
I am not sure why more people are not demanding something be done about healthcare. For myself, my husband, and my daughter, I am billed about $1200 per month for self-employed medical insurance -- goes up every year although none of us have met our deductible...ever, as for as I know. Every three months, I have to have my thyroid level checked to keep my medication levels accurate. So, that is a CBC blood test and an office visit. If I didn't have insurance, my bill for this would be $722. That is not a typo. However, my insurance discounts so much that I only end up paying $25 deductible, plus $73. Less than a hundred vs. over $700? This is medically necessary for me. I don't have a choice to skip healthcare.
Two days ago, I went to the pharmacy to pick up medications for a seasonal allergy infection. I was in shock to discover that my co-pay was $172.99 for 14 days of an inhaler and three other meds to clear up infection and help me breath. I got home and called my insurance company to see what was up. Long story short...I actually had paid for one of the medications because it was cheaper than my deductible. The cost to my insurance company is $51...however, without insurance that medication would have cost $188. They graciously agreed that I should pay only $56 because I did have insurance. Who is making money there?
Prior to this, I'd never ever heard of a $60 co-pay for medication. A second medication cost me $40 in co-payment, but if I did not have insurance, the cost would have been $179. Then, another medication was not even covered by my
expensive insurance because the insurance company, NOT my doctor, decided that there are cheaper choices, all of which I have tried and had bad side effects. The insurance company didn't even bother to look at my pharmacy history to see that. Frankly, why is my insurance company allowed to be the decision maker about my health care??? I am not seeking a second opinion from a pencil pusher about my care. I called the company that makes that medication and they gave me a coupon for a month's supply (honored immediately) and told me that I had the option to get a doctor's override if my insurance company won't pay, something my insurance company wouldn't ever mention. Called them back and, sure enough, it is true. This is not hypothetical. It is just one week of dealing with health care.
Negotiate with your doctor??? C'mon! I've heard that this is done, but never known anyone who successfully has done so.
I've been very upset this week, thinking about WHAT people who don't have insurance do? My medical insurance alone costs more than my house, including utilities, internet, etc. And, I do have a nice house. There is simply no justification for this gouging. There is a reason why the pharmacutical companies met with Obama two days before Obamacare was passed. What incentive is there for research and development if no one can pay for it. The whole situation is cruel and dumb.
Here's the details of an invoice I just got in today's mail for a recent hospital procedure and overnight stay:
Final bill: $4470
Medicare Contractual Adjustment -$3839.71
Elect MCare O/P Pmnt $504.23
Total due $126.06
In other words, I pay $126, Medicare pays $504, and the hospital just blows off $3,839 (86%), which my friends would be trying to collect in a jar on the counter of a convenience store to keep me out of the poorhouse if I didn't have insurance.
I am not sure why more people are not demanding something be done about healthcare.
I think most people agree that something must be done about healthcare. But the agreement ends there.
Many people expect that the government taking more control over health care will make it cheaper. They point to every other developed country spending less on health care than the U.S. with the same or better life expectancy. I disagree with this POV, personally, because our expireience with publicly funded health care in the U.S. (Medicare/Medicaid) is that the costs have gone up the same or almost as much as private insurance.
I believe we haven't had a true free market in health care since World War 2....before insurance companies and government middlemen began to distort the health care market. The middlemen, be they private or public, have inflated the cost with lots of administration and also hidden the true cost of health care.
Back in the day, you paid your doctor directly and knew the cost. Nowadays, it's almost impossible to know what your health care costs, let alone shop around for doctors, hospitals, etc. No wonder health care costs have skyrocketed....but I suspect my argument will fall on deaf ears to the "government sponsored health care will fix it all" crowd.
For those who are interested in more deatils, I recommend reading "Who Killed Health Care?" by Regina Herzlinger, who studies the economics of medicine:
I think most people agree that something must be done about healthcare. But the agreement ends there.
Many people expect that the government taking more control over health care will make it cheaper. They point to every other developed country spending less on health care than the U.S. with the same or better life expectancy. I disagree with this POV, personally, because our expireience with publicly funded health care in the U.S. (Medicare/Medicaid) is that the costs have gone up the same or almost as much as private insurance.
I believe we haven't had a true free market in health care since World War 2....before insurance companies and government middlemen began to distort the health care market. The middlemen, be they private or public, have inflated the cost with lots of administration and also hidden the true cost of health care.
Back in the day, you paid your doctor directly and knew the cost. Nowadays, it's almost impossible to know what your health care costs, let alone shop around for doctors, hospitals, etc. No wonder health care costs have skyrocketed....but I suspect my argument will fall on deaf ears to the "government sponsored health care will fix it all" crowd.
For those who are interested in more deatils, I recommend the following book, written by a woman who studies the economics of medicine: Amazon.com: who killed health care
You're failing to take into account the wastefulness of the US health care industry. There is no such thing as no-frills health care. Everyone with insurance automatically gets pipelined into 5-star health care. Imagine the cost of tourism, for example, in the US, if every hotel were 5-star and every meal were gourmet standard. Insurance companies pay whatever the provider charges, so there is no incentive for the provider to offer a more economical alternative.
For example, there is no such thing as a hospital ward anymore in the USA. You get private or semi-private with round the clock nursing. In the third world (or second), a patient sleeps in a 20-bed ward, and a family member stays there all night, sleeping in a chair next to the bed, to provide nursing care, and brings in meals from outside. If the patient needs an injection, the family member goes to the drug store next door and buys a needle. An overnight hospital stay costs $50, instead of $2,500.
Some Americans cannot afford to fly first class -- and should not be forced to
My experience was just the opposite! A surgeon, anesthesiologist, and surgery center all gave discounts (from insured rates) for cash payment.
Before the era of required electronic billing, I used to tell all my doctors that I paid cash. I got a lot better rates from all of the doctors and dentists that I dealt with. I would do all the paperwork myself and get the reimbursement directly.
The answer to your question is, "Because we've been conditioned to accept that that's the way things are."
The defense for "negotiated rates" is that buying power justifies it. In many things, we wouldn't think twice about it. You buy a kaiser roll at the supermarket and they charge $1.29. You buy a bag of six of the same exact rolls, $2.39. It wouldn't merit a second-thought in most anyone's mind. And let's not get started on the cost of a flat of bottled water at the supermarket compared to a single bottle sold at the ballpark. With health care, insurance companies conceptually buy service in bulk, and demand comparable discounts.
The thing, I believe, that causes you to be uncomfortable with what you noted, is that health care should be different from the typically "bulk" versus "convenience" purchase scenarios.
First, most "bulk" versus "convenience" scenarios are, for the vast majority of people, choices they make. Going to the ballpark, itself, is a discretionary choice, and there are alternative leisure opportunities that don't carry with them such a convenience cost. And there are ways of purchasing and storing bought food at the supermarket that allow you to avoid convenience costs for small packages of food, even as a solo grocery shopper. By contrast, there isn't any way to present your own family's patronage to health care service providers and pharmacies as a "bulk".
However, that's not really enough to warrant consideration. There needs to be a substantial distinction to make the inability to capitalize on these "bulk" discounts on health care a societal offense, i.e., showing that health care is more like food and less like going to the ballpark to see a game. That comes from the fact that we're talking about a very basic need of life: health. There is volumes of data showing that high cost drives the working poor without affordable health insurance to receive inadequate health care, driving overall more health problems, adversely affecting longevity, etc.
So we're been brow-beaten by a society shaped by large entities with a vested interest in keeping health care expensive to submit to the way they are willing to present their products and services to us. Note that where those entities have been less successful in dictating to the marketplace, costs are lower, and often with the same or better results. (Someone mentioned Switzerland, earlier this week, as a decent example... better health care at less than two-thirds the overall cost.)
It is wrong, and we should do something about it. Conceptually, that's what ACA is eventually supposed to bring about. It'll very effectively raise the disparities to public attention, providing the platform that is needed to prompt Americans to finally overcome their conditioning and demand government rectify this inequity, by insisting that every health insurance plan be eligible for the best prices offered any. Combined with the ACA's assurance of affordable health insurance for all, finally everyone will have equal access to the best prices, as it should be.
[I did sidestep the issue regarding whether insurance companies are actually buying in bulk, because they don't actually promise a certain amount of business from agreeing to the negotiated rates. That would be a childish argument, given the overwhelming correlation with causation that can be demonstrated regarding being "in-network" and patients choosing to use your services, and being "out-of-network" and patients choose to go somewhere else.]
This is pretty typical, when you buy health insurance you are really buying into a sort of discount program.
My wife had a visit, it included the doctor visit itself and several blood tests, the cash price came to $1110. The insurance payout was $110, or 10 cents on the dollar. Our co-pay was $15 so factor that in and you get $125 total for what a cash person would pay $1110 for.
Legal or not, that's just the way things are until the law is changed. It's kinda like buying a car at a dealership, almost no one pays the manufactures suggested retail price, there's always wiggle room in there so you can negotiate with the dealer. Insurance companies do the same thing, they negotiate with the doctors and hospitals, if you accept 30% of your "list price" we guarantee you'll get paid.
Just like car dealerships, a sucker occasionally walks through the door and wants to pay cash and doesn't care about the price. So the dealer charges them full price. Same thing with the hospitals / doctors, if your uninsured, and don't ask they will be happy to charge you full price for services rendered.
Two days ago, I went to the pharmacy to pick up medications for a seasonal allergy infection. I was in shock to discover that my co-pay was $172.99 for 14 days of an inhaler and three other meds to clear up infection and help me breath.
My wife screwed up and ordered her 90 days supply of medication too late, so she got her doctor to write her a 7 day prescription until her mail order came in. I went to fill it at the drug store, they charged me $150 for 7 pills! It wasn't covered by insurance because the insurance already paid for the 90 day supply and weren't going to pay again for 90 days. Fortunately my wife received her medication in the mail the next day and was able to return the unopened bottle of 7 pills for a refund. That's over $20 a pill, you can't tell me it costs anywhere near that amount to make those pills, even with all the research and testing required to discover/invent them factored in.
Quote:
Originally Posted by jtur88
Final bill: $4470
Medicare Contractual Adjustment -$3839.71
Elect MCare O/P Pmnt $504.23
Total due $126.06
The funny thing is if there were tiered pricing for race ($126 bill if your white and $4,470 bill if your black ) people would be all up in arms about the issue. Just change the words from "white and black" to "covered and uncovered", and it's perfectly acceptable.
Last edited by TechGromit; 04-01-2013 at 11:06 AM..
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There is simply no justification for this gouging. There is a reason why the pharmacutical companies met with Obama two days before Obamacare was passed. What incentive is there for research and development if no one can pay for it. The whole situation is cruel and dumb.
