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Old 12-17-2012, 04:08 PM
 
Location: Victoria TX
42,661 posts, read 77,748,316 times
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This question is about the data that goes into the calculation of Health Care costs, which is now stated to be $2.3-trillion. How is that figure arrived at?

I recently got my invoice from the hospital for surgery. Here are some lines:

Final bill: 18,618.70 (Total of all items)
Medicare contractual adjustment: 15,159.42 (deducted from above through Medicare agreement.)
(Amount to be paid) 3,459.28 (by somebody, to the hospital. Line 1 minus line 2, not shown on bill)
Receipts to date: 2,522. 03 (paid by Medicare)
Total due: 660.75 (My co-pay)
(Never mind the fact that they don't add up -- nobody expects disclosure anymore. That's not my question.)

Now, my question: Which figure gets added into that $2.3 trillion,
as the indicator of total health care costs?
18,618.70? Or 3,459.28?

That seems to make a huge difference, particularly with respect to the credibility of the total national health care cost..

(Also, never mind the fact that $18,000 seems a little high for outpatient surgery, no admittance, no lunch, sent home the same day, in a small town in the boondocks, not counting the surgeon's fee. I guess that's what an uninsured person would be billed. $2.3-trillion also sounds a little high, since that is $7,000 per person every year, which I guess then must be based on that phantom bill for $18,000, most of which is just blown off.)

Last edited by jtur88; 12-17-2012 at 04:28 PM..
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Old 12-17-2012, 04:26 PM
 
Location: The Triad (NC)
31,171 posts, read 68,120,185 times
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Quote:
Originally Posted by jtur88 View Post
This question is about the data that goes into the calculation of Health Care costs, which is now stated to be $2.3-trillion. How is that figure arrived at?
Ask the Magic Eight Ball a Question


Magic Eight Ball CGI
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Old 12-20-2012, 08:03 AM
 
Location: Victoria TX
42,661 posts, read 77,748,316 times
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So, apparently, none of you know the answer to this question, even though you accept $2.3 trillion as the cost of health care in the USA and assume that it has some relevant and comparative economic meaning.

Does $2.3 trillion represent the declared value of the delivered health care by the provider ($18,000 in my case), or the actual payment tendered for the delivered care ($3,500)? If it the former, then health care is actually provided for payment of only a half a trillion. If it is the latter, then health care is valued at over ten trillion, and sold at a steep discount. If we don't know which is the case, how do we discuss health care costs in perspective?

Medical billing is like Joeph A Banks suits. Everything is always on sale at 2/3 off, so what is the "real price"?.
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Old 12-20-2012, 08:46 AM
 
Location: WA
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I don't know what number gets added into the macro estimate... I think all of those high level estimations are approximate with a large variance and bet that nobody knows an exact number.

I do know that the health care industry generally attempts to keep billings as high as possible and with third party payers and seldom audited charitable write-offs manage to over charge for many products and services.

Since I pay out of my own pocket I have tried to challenge many charges including $12 band-aids, $9 cotton balls, $200 dollar blood pressure tests, and $300+ blood tests that could not be explained with results that were evaluated (only when I refused to pay) as 'normal' but without further explanation.

As long as we have third party payers, limited audits, bureaucratic regulation, and poorly informed consumers, health care costs will continue to escalate exponentially.
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Old 12-20-2012, 11:47 AM
 
Location: Victoria TX
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In my case, as I mentioned, that $18K bill was for outpatient services, for which I was inside the building for only 7 hours. They found a way to charge $43 per minute.

I had one good case myself many years ago of needing to challenge a charge. I went in on Monday pre-op testing, inchluding chest xray, prior to surgery on Tueadsy. Later I got a bill for an astounding charge by the radiologists, for reading and interpreting the xray. This was in a small town hospital, and the radioogist was from another town 30 miles away, so I phoned the hospital and asked if the radiologist drives over every day, and they said no, once a week, on Thursday.

So I refused to submit their bill to my insurance company for payment, and explained that they performed a "pre-op" interpretation two days after I, for all they knew, had already died on the operating table for a reason that their interpretation might have precluded had it been performed in a timely manner.

After numerous billings, they turned my account over to an attorney for collection, to whom I repeated my position to someone finally who understood plain English, and never heard from them again.

So these radiologists drive out to surrounding towns once a week, rubber stamp a stack of obsolete xrays, and bill each patient's insurance company about a week's wages, and keep a lawyer on retainer to collect it.
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Old 12-20-2012, 02:30 PM
 
Location: Floyd Co, VA
3,513 posts, read 5,547,607 times
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Quote:
Originally Posted by jtur88 View Post
This question is about the data that goes into the calculation of Health Care costs, which is now stated to be $2.3-trillion. How is that figure arrived at?


I guess that's what an uninsured person would be billed. $2.3-trillion also sounds a little high, since that is $7,000 per person every year, which I guess then must be based on that phantom bill for $18,000, most of which is just blown off.)
I don't think that you are factoring in the cost of insurance premiums at all. This year my cost for a single person has been $14,328 in premiums to United HealthCare. If I don't have need of any services from a physical or prescriptions from the pharmacy that that is my total cost for the year. If I do see the doc and get any meds then I have co-pays to add to that cost, along with a deductible of $500.00 and an additional $4,500 in out of pocket expenses.

Come January that premium jumps 8.9% to $1,294 per month for a total of $15,528 per year even if I am healthy as a horse as they say. This amount exceeds the interest on my mortgage by several hundred dollars a month.

I gotta wonder just what Steven Hemsley did to improve the health of any subscriber to justify $102 million in compensation in 2009. He received $98 million in stock options while I had to pay over $1,200 out of pocket for a colonoscopy?

Is it any wonder that I am in favor of a not-for-profit, single payer system?
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Old 12-20-2012, 03:49 PM
 
Location: Victoria TX
42,661 posts, read 77,748,316 times
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Quote:
Originally Posted by zugor View Post
I don't think that you are factoring in the cost of insurance premiums at all. This year my cost for a single person has been $14,328 in premiums to United HealthCare. If I don't have need of any services from a physical or prescriptions from the pharmacy that that is my total cost for the year. If I do see the doc and get any meds then I have co-pays to add to that cost, along with a deductible of $500.00 and an additional $4,500 in out of pocket expenses.

Come January that premium jumps 8.9% to $1,294 per month for a total of $15,528 per year even if I am healthy as a horse as they say. This amount exceeds the interest on my mortgage by several hundred dollars a month.

I gotta wonder just what Steven Hemsley did to improve the health of any subscriber to justify $102 million in compensation in 2009. He received $98 million in stock options while I had to pay over $1,200 out of pocket for a colonoscopy?

Is it any wonder that I am in favor of a not-for-profit, single payer system?
There is no need to factor in the cost of insurance premiums. The total amount paid for medical and health services remains the same, whether the patient, the private insurance, Medicaid, or a government single payer mails the check to the provider. The only thing that would need to be factored in is to count that portion of the private insurance premium that is used to pay for administrative costs, advertising and profits for the insurance company.
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Old 12-20-2012, 05:46 PM
 
Location: Baltimore, MD
4,095 posts, read 4,585,436 times
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Quote:
Originally Posted by jtur88 View Post
In my case, as I mentioned, that $18K bill was for outpatient services, for which I was inside the building for only 7 hours. They found a way to charge $43 per minute.

I had one good case myself many years ago of needing to challenge a charge. I went in on Monday pre-op testing, inchluding chest xray, prior to surgery on Tueadsy. Later I got a bill for an astounding charge by the radiologists, for reading and interpreting the xray. This was in a small town hospital, and the radioogist was from another town 30 miles away, so I phoned the hospital and asked if the radiologist drives over every day, and they said no, once a week, on Thursday.

So I refused to submit their bill to my insurance company for payment, and explained that they performed a "pre-op" interpretation two days after I, for all they knew, had already died on the operating table for a reason that their interpretation might have precluded had it been performed in a timely manner.

After numerous billings, they turned my account over to an attorney for collection, to whom I repeated my position to someone finally who understood plain English, and never heard from them again.

So these radiologists drive out to surrounding towns once a week, rubber stamp a stack of obsolete xrays, and bill each patient's insurance company about a week's wages, and keep a lawyer on retainer to collect it.
I don't know how many years ago this happened to you, but that's not likely today. Heck, even in 2005 when my daughter landed in a small town hospital following an early morning car accident, her MRI was sent electronically to an offsite radiologist.

A few months ago, I took my father to the ER after he fell. His CAT scans were sent to a radiologist somewhere on the other side of the planet and we received the interpretation in less than an hour.

BTW, you're paying for the professional's knowledge and judgement, not his or her time.
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Old 12-20-2012, 09:17 PM
 
Location: Victoria TX
42,661 posts, read 77,748,316 times
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Quote:
Originally Posted by lenora View Post
I don't know how many years ago this happened to you, but that's not likely today. Heck, even in 2005 when my daughter landed in a small town hospital following an early morning car accident, her MRI was sent electronically to an offsite radiologist.

A few months ago, I took my father to the ER after he fell. His CAT scans were sent to a radiologist somewhere on the other side of the planet and we received the interpretation in less than an hour.

BTW, you're paying for the professional's knowledge and judgement, not his or her time.
It happened in the 80's, when there was no technology that would permit what you described, which is why he drove 30 miles to the hospital every Thursday. And no radiologist in a strip mall in Atchison, Kansas, has professional knowledge and judgment that is worth a hundred dollars a minute. And finally, his judgement is not worth one cent when it is applied 48 hours too late to have its intended value. And his own lawyer agreed with me and stopped sending dunning letters. But it still counts as part of the $2.3 trillion.

My described incident was offered not because it, by itself, relates to the question at hand, but because it is illustrative of the contempt in which gullible patients are held by the Holy medical community, then and now. If they wouldn't do specifically that today, you can be sure they will invent comparably larcenous ways. The patients are geese from whom medical providers and their insurance industry sycophants are gathering their golden eggs.

Another recent example. I fell in my home, and took a glancing blow on sharp cornered cabinet to my forehead, which tore open the skin and required 20 stitches. I explained at the ER that there was no impact, it was a tangential wound, and I felt no head pain at all. Nevertheless, they rang up a $3,000 CAT scan before I was even seen by a doctor to sew it up. Needless to say, the CAT scan was perfectly negative, I bump my head harder than that every week, but not on sharp objects, usually.

Anyway, this has wandered off topic. The question remains, does that $3,000 get added into the $2.3-trillion health care bill (and all the other mathematically impossible invoice bloating), or just the $500 or so that Medicare and I paid?
Shouldn't the electorate know that?

Another example, I had an MRI abouit 5 years ago, and the bill I was presented with at the desk was for $2,400, reduced to about $400 for Medicare, with $80 as my copay. I asked if an uninsured patient had to pay the whole $2,400, she said yes, but if they can pay in full on the day of service, we give them half off, only $1,200 cash out of their pocket. Even with the discount, it is three times what they accept as payment in full from insurance. The poor subsidizing the rich, because the poor have no power to rearrange things fairly. If the poor need an MRI, there is a mayonnaise jar at the convenience store to collect nickels and dimes for them. Which is why red-staters say government assistance is not needed, because there is plenty of private voluntary charity going into those jars to take up the slack. For pretty white girls.

Last edited by jtur88; 12-20-2012 at 09:58 PM..
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