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It doesnt work for anything really except some extremely standardized medicines or procedures, but even there, most "consumers" are pretty much clueless and it causes providers to just charge whatever they can get away with. It just ends up with almost all providers charging the same high rate for even standardized stuff. Trying to compete on price isnt really profitable and its all about the profits, not about making people healthy. Our health care system is sick and the remedy is to join the rest of the civilized world and guarantee health care as a right for all Americans, regardless of the size of their wallet!
Of course most reimbursements are preset negotiated rates with third parties.
As you know, what a hospital bills an insurer is not what they agreed to be reimbursed by the insurer. When international costs of a procedure are compared, the initial amount billed in the US is often used as a baseline, instead of what the provider contractually agreed to and was actually paid. Why is this?
The difference shows as a contractual reduction on the patient's statement of benefits.
I never understood why the provider bills more than it contractually agreed to be paid.
To exaggerate 'losses' for those that are listening.
And the annual cap on her out of pocket costs, including deductible, was $7k and change.
I don't specifically recall her cap, but that sounds about right.
I'm almost embarrassed to say that her OOP for 2017 was negative! In a few months my accountant will be looking it all over. The bills are incredibly complicated. She paid very little OOP in year 2017, and we received more 'refunds' if you can believe it, than what she paid in OOP. It could be that the insured year is offset from 2017. My accountant will figure that out.
Medicare for all which most countries have. Why is it that I pay a co pay of $10 dollars for surgery when you have to pay....how much for surgery.
People and/ or spouses and employers have paid prepaid premiums ( Payroll taxes) for 40+/- years before one becomes eligible for Medicare. In absence of that front load, how much might one need to pay in premiums, above and beyond the existing Medicare Payroll Tax for old age healthcare, to achieve equal benefits?
Dont forget most E-room docs refuse to be in network, even when the hospital IS in network. AKA how to get a $1400.00 bill for 10 minutes of work or less. We got a bill for my wife from a doc we never saw, apparently he looked at a chart or something.
This is the most asinine part of the medical system here. Instead of getting a single bill from the hospital, you get individual bills from each and every doctor you see. For a surgery, you'll get bills from the surgeon, anesthesiologist, doctor doing after-care, and the hospital itself.
It becomes impossible to budget for this because the bills keep coming, sometimes months after the actual surgery.
It would be like going to Walmart and getting bills from the deli, soda aisle, and dairy department, months after you shopped.
I wonder if they would have any LEGAL RECOURSE if someone refused to pay a bill that high??
Yes its just sad how much they think they can charge!! -- Alot of people DO NOT have that kind of money!!
As it relates to the situation in the OP's link, a German hospital is unlikely to pursue a deadbeat US patient.
If the Kentucky woman had sought a Ky ER, she likely would negotiate the fees and agree to a payment plan.
If she chose to ignore, the hospital will turn the matter over ( sell the debt) to a collection agency. It will impact the patient's credit score which can have all sorts of downstream consequences.
I wonder if they would have any LEGAL RECOURSE if someone refused to pay a bill that high??
Yes its just sad how much they think they can charge!! -- Alot of people DO NOT have that kind of money!!
Oh yes. They hire the meanest collection agencies out there. A friend capped his insurance. After taking EVERTTHING they dragged is butt into court 4 times a year until the statute of limitations ran out.
I remember him saying, "What the hell am I supposed to do with an 800K bill?" He was worth ~$500K before (mostly home equity) and had never been laid off until he reached 63 years old.
Another friend had an X ray taken by one of those independent contractors that prowl E Rooms. They garnished like 4 months of wages. $6K for an X ray.
Anyone from Germany or Norway to confirm how much in income tax people there pay? The cult45ers say 75 to 80%, but I question that. I'd rather take the Word of a citizen of those countries who actually earns their money as opposed to the Trust Fund Trumpers who were gifted everything! I know they ALL claim to be 6 to 7 figure earners but based on their posts, they lack the intelligence and interpersonal skills to succeed on their own! So I'd take the Word of a German and Norwegian over theirs.
According to this link, the income tax rate is 38.52%. I don't know if there is a difference in statutory vs effective tax rates as their is in the US.
No comparison of rates is accurate unless you compare bang for the $.
Everyone's income, wealth and taxes is public information in Norway.
Noway also imposes a 25% VAT.
The US individual tax rate is quite low compared to the rest of the developed world. US effective corporate tax rates were competitive before the recent tax deduction, despite " what Trump said".
It would be an interesting exercise to compare bang for the $ and national per capita debt, Norway vs US.
Once again, what works in an oil rich country of 5 million does not translate to a country with 320 million more people.
All insurance is regulated at the state level. This was true before the ACA and remains true in a post ACA enviornment. No two states have the same regulations beyond the Ten Essential Healthcare benefits. The ability for an insurer to define medical emergency is one of the variables.
It's a state issue.
This, I never knew. As an adult, the few times I've used the ER was at the advice of a physician or the insurance nurse-care helpline. I always figured it was a "medical" issue with high bills reported by some due to "inadequate" or less complete insurance coverage. Never would it have occurred to me that the disparate treatment resulted from a definition of a medical emergency.
Quote:
Originally Posted by 2sleepy
Anthem doesn't have to follow Medline guidelines. What happened here is that Anthem got approval for this in four states that are notorious for lack of oversight of insurers. It's unconscionable, they are paying claims based on the diagnosis not the symptoms that caused the person to go to the ER and this is part of the argument against allowing insurers to use the rules of one state for policies sold across the US, if they could then I'm sure this policy would be nationwide. What this means is that if a person presents with chest pain even though they might have a history of heart disease, if it turns out not to be a heart attack they won't pay, and I'm sure they will be very subjective in what they deem "severe bleeding"
Agree.
What about the cancer patients who may have repeated ER use when the side effects of their illness periodically cascade and become too difficult to deal with at home at a set point in time? Better the periodic use of ER care I would think than placing the patient in a nursing home - not that insurance would cover a SNF.
As for paying claims based on the diagnosis, how might that work when the ER diagnosis may not be the final or ultimately correct diagnosis?
Last year I went to ER (again on medical advice) due to severe abdominal pain. Turns out that I'd been repeatedly misdiagnosed by very competent physicians and continued to be misdiagnosed at the hospital. BUT the CT scan done in the ER led to other tests that uncovered a highly unusual condition. Long-term it was life threatening and symptoms had reached the point where daily life was totally disrupted with acute symptoms erupting one night.
To get the diagnosis, I needed to be AT a medical facility with a CT scan at the exact time of the peak symptoms. And with the diagnosis (and so far only minor but the correct medical intervention), I'm now totally fine and continue to avoid what would be major surgery. ER availability was essential both for short-term relief and long-term health.
Last edited by EveryLady; 02-05-2018 at 09:46 AM..
About 4 years ago I had a heart attack, drove to emergency room, ended up having quad bypass.
"Never seen a bill."
That's healthcare in the United States
Thanks Medicare
You or your spouse prepaid Medicare premiums for 40+/- years.
Had this happened at say 55, you most certainly would have seen bills from the hospital, ER medical group and surgeon. Worst case, you would have been responsible for $7K and change, including your deductible, in out of pocket costs provided you were insured by an ACA compliant Plan.
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