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(Business Insider)   California man gets routine appendectomy with 24-hour hospital stay. Billing charges are: A) $550 B) $5500 C) $55,000   (businessinsider.com) divider line 89
    More: Asinine, California Man, visual routine, medical billing, Archives of Internal Medicine, CPT, anesthesia  
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3509 clicks; posted to Business » on 01 Jan 2014 at 10:33 AM (29 weeks ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



89 Comments   (+0 »)
   
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2014-01-01 10:40:17 AM
That disparity in pricing seems to offer a real opportunity for lawyers to sue and allege discrimination based on this or that. That would be a good thing.

When prices vary wildly, the public comes to realize they are not real and that the expenses they encounter are no more about costs than an overweight suitcase means an airline needs to recover another $200 for their extra effort. When you operate that way, people cease to trust you, not only on matters of cost but it trickles down to whether the physicians, nurses, and facilities are really up to speed. Lose people's trust and folks won't come to even when sick.

And this once again nails the real reform need in health care: costs. Too bad everybody skipped out on that one.
 
2014-01-01 10:45:16 AM

edmo: That disparity in pricing seems to offer a real opportunity for lawyers to sue and allege discrimination based on this or that. That would be a good thing.

When prices vary wildly, the public comes to realize they are not real and that the expenses they encounter are no more about costs than an overweight suitcase means an airline needs to recover another $200 for their extra effort. When you operate that way, people cease to trust you, not only on matters of cost but it trickles down to whether the physicians, nurses, and facilities are really up to speed. Lose people's trust and folks won't come to even when sick.

And this once again nails the real reform need in health care: costs. Too bad everybody skipped out on that one.


Yep, this is what has a lot of people pissed off but there doesn't seem to be a real effort to fix it. They just want you to sign them a blank check basically, and they'll just make it up as they go.
 
2014-01-01 10:49:24 AM
Even the $11,000 that's left AFTER insurance is horrendously high.
 
2014-01-01 10:50:02 AM
My last trip to A+E (what ER is called in the UK) cost me 80 pence. And that was for the cup of coffee I bought during the twenty minutes wait to see the consultant.
 
2014-01-01 10:57:41 AM
Americans are SOOOOOOO screwed!
 
2014-01-01 10:58:53 AM
Only in the United States of Avarice. It would not happen in the civilized world.
 
2014-01-01 11:02:06 AM
I guessed he learned his lesson. Next time he needs to have his appendix removed, I suppose he's going to shop around and get a better deal instead of going to the first place he sees.
 
2014-01-01 11:05:27 AM
Well, I'm assured by a number of American farkers that its worth it because of the quality of care.

I mean, 5 grand for one night?  It must be a state of luxury that puts 5 star hotels to shame!
 
2014-01-01 11:10:09 AM
If you look at the rest of the documents- Aetna only allows the hospital to charge $17,581. they paid $6,461.47. Either he has really shiatty insurance, or something is weird here. I'd want to see his EOB as to why Aetna only paid for 1/3 of a necessary surgery. Especially since based on the hospital bill, it LOOKS like all normal expenses.

Also, I had an appendectomy on my parents gold-plated insurance (their only problem is a giant deductible), and paid something less than $2k out of pocket for it. Mine was an emergency burst on a sunday night, but I was out of the hospital in under 24 hours.
 
2014-01-01 11:29:47 AM

Katie98_KT: If you look at the rest of the documents- Aetna only allows the hospital to charge $17,581. they paid $6,461.47. Either he has really shiatty insurance, or something is weird here. I'd want to see his EOB as to why Aetna only paid for 1/3 of a necessary surgery. Especially since based on the hospital bill, it LOOKS like all normal expenses.

Also, I had an appendectomy on my parents gold-plated insurance (their only problem is a giant deductible), and paid something less than $2k out of pocket for it. Mine was an emergency burst on a sunday night, but I was out of the hospital in under 24 hours.


I'm guessing the difference is deductible.  But, even then, that looks like $5000, which for an individual is very high.
 
2014-01-01 11:30:49 AM
Best health care system in the WORLD!!
 
2014-01-01 11:36:52 AM
Medical pricing is so weird. When I slipped on the ice while curling, I hit my face and busted open my eyebrow. A trip to the ER resulted in a $8500 bill, which covered six stitches and an MRI to make sure I didn't have a concussion. When I told them I had insurance, the bill magically dropped to $4200. So if I was uninsured, I would be required to pay $4300 more. Guess I should have hired a professional negotiator before the accident to get the best rate on all potential treatments.
 
2014-01-01 11:44:14 AM
I have a hernia that I haven't had taken care of yet because even with insurance it will cost me more than $5,000. Probably a lot more. The doctor who would probably perform the operation, who provided me with a second opinion and whom confirmed the hernia, stated that his cost alone for it would be around $500.

Ridiculous that our health care system is the way that it stands now.
If you are sick you should be treated.
 
2014-01-01 11:50:10 AM
Blue Cross / Blue Shield denied coverage for my wife's emergency appendectomy. Yes, this is true.

I won on appeal. But, seriously, if 'the best insurance that money can buy' doesn't cover an emergency appendectomy, what good is it?
 
2014-01-01 11:53:10 AM

Another Government Employee: I'm guessing the difference is deductible.  But, even then, that looks like $5000, which for an individual is very high.


Pretty much that.  A $5k deductible and co-pays up to a $10k-range out-of-pocket cap (likely an HSA-compatible plan).  This type of plan makes perfect sense if you're A) reasonably healthy most years and B) have liquid assets of at least $100k.  That describes maybe 20% of the country.
 
2014-01-01 11:58:16 AM

Fiction Fan: I have a hernia that I haven't had taken care of yet because even with insurance it will cost me more than $5,000. Probably a lot more. The doctor who would probably perform the operation, who provided me with a second opinion and whom confirmed the hernia, stated that his cost alone for it would be around $500.

Ridiculous that our health care system is the way that it stands now.
If you are sick you should be treated.


Take a trip to Thailand - get the op done for less than $500 (in a First World class hospital)

Have a holiday on beach and still come out way ahead
 
2014-01-01 12:05:55 PM

EngineerAU: Medical pricing is so weird. When I slipped on the ice while curling, I hit my face and busted open my eyebrow. A trip to the ER resulted in a $8500 bill, which covered six stitches and an MRI to make sure I didn't have a concussion. When I told them I had insurance, the bill magically dropped to $4200. So if I was uninsured, I would be required to pay $4300 more. Guess I should have hired a professional negotiator before the accident to get the best rate on all potential treatments.


See what worries me is people are going to take their chances when they get an injury like that, and not worry (or know) about the possibility of a concussion.
 
2014-01-01 12:13:14 PM

EngineerAU: Medical pricing is so weird. When I slipped on the ice while curling, I hit my face and busted open my eyebrow. A trip to the ER resulted in a $8500 bill, which covered six stitches and an MRI to make sure I didn't have a concussion. When I told them I had insurance, the bill magically dropped to $4200. So if I was uninsured, I would be required to pay $4300 more. Guess I should have hired a professional negotiator before the accident to get the best rate on all potential treatments.


You'd be surprised how many "free market" folks would've blamed you for not shopping around in advance of your care - y'know, to find the lowest healthcare provider. Never mind that most ERs don't exactly post their prices in an accessible manner, of course.

Single payer universal healthcare. Until it happens, we're just going to continue going broke.
 
2014-01-01 12:16:34 PM

Lawnchair: Another Government Employee: I'm guessing the difference is deductible.  But, even then, that looks like $5000, which for an individual is very high.

Pretty much that.  A $5k deductible and co-pays up to a $10k-range out-of-pocket cap (likely an HSA-compatible plan).  This type of plan makes perfect sense if you're A) reasonably healthy most years and B) have liquid assets of at least $100k.  That describes maybe 20% of the country.


ah, makes sense.

Well, the good news is that ACA has fixed that- maximum out of pocket for an individual is $6,350 and for a family is $12,700.  http://www.bcbsm.com/content/microsites/health-care-reform/en/reform- a lerts/irs-announces-maximum-out-of-pocket-costs.html

So, unless he was on a family plan and hadn't spent anything else on healthcare for the year, he would have a smaller bill if he'd had the appendectomy in 2014.
 
2014-01-01 12:20:05 PM

FormlessOne: Single payer universal healthcare. Until it happens, we're just going to continue going broke.


Unless you work in the health care or health insurance industry. Then you can ride your gravy boat down that river of cash.
 
2014-01-01 12:22:18 PM
If I'm Aetna PPO, wouldn't I immediately challenge the costs and create my own stink over them?  Guy was totally over charged but so was Aetna.  I had an appendectomy in 2004 but i do not remember what the cost was.  I had no health insurance and had to cover it myself but I dont even remember it being more than $2k.

Things like this are why we cant have nice things.
 
2014-01-01 12:24:40 PM
Apparently, doctors and hospital officials think our economy is for everyone else to suffer in. Those Lexus sedans the Docs bought with the big red bow on top won't purchase themselves, you know.
 
2014-01-01 12:28:01 PM
Nothing wrong with this. It's the free market health care in action. The market only charges what demand says it can. Seriously he should have shopped around at a competitor... noob.

Oh wait...
 
2014-01-01 12:30:14 PM

The Flexecutioner: If I'm Aetna PPO, wouldn't I immediately challenge the costs and create my own stink over them?  Guy was totally over charged but so was Aetna.  I had an appendectomy in 2004 but i do not remember what the cost was.  I had no health insurance and had to cover it myself but I dont even remember it being more than $2k.

Things like this are why we cant have nice things.


Well, it's not like Aetna paid $40k... they paid $6k (negotiated rates).  That said, there's perverse incentives for them to not push rates down.  Under PPACA, they can't (theoretically) have overhead (i.e., paying the C-suite) rates over 20%.  20% of a $10k procedure is a lot more golf than 20% of a $2k procedure.

The check on that padding should be competition.  Everyone would switch to a cheaper provider in theory.  But, there's a lot of structural reasons that hasn't really worked out terribly well so far.
 
2014-01-01 12:42:09 PM

Lawnchair: The Flexecutioner: If I'm Aetna PPO, wouldn't I immediately challenge the costs and create my own stink over them?  Guy was totally over charged but so was Aetna.  I had an appendectomy in 2004 but i do not remember what the cost was.  I had no health insurance and had to cover it myself but I dont even remember it being more than $2k.

Things like this are why we cant have nice things.

Well, it's not like Aetna paid $40k... they paid $6k (negotiated rates).  That said, there's perverse incentives for them to not push rates down.  Under PPACA, they can't (theoretically) have overhead (i.e., paying the C-suite) rates over 20%.  20% of a $10k procedure is a lot more golf than 20% of a $2k procedure.

The check on that padding should be competition.  Everyone would switch to a cheaper provider in theory.  But, there's a lot of structural reasons that hasn't really worked out terribly well so far.


ah, i was guessing the only reason they wouldn't challenge that is they in turn billed the govt to pick that up with their own negotiated contracts, or something like that.
 
2014-01-01 12:44:09 PM
So, remind us all why Tort Reform is bad again?
 
2014-01-01 12:47:00 PM
But what we really need is tort reform?
 
2014-01-01 12:49:50 PM

Kyosuke: So, remind us all why Tort Reform is bad again?


This appears to have been in California, which passed MICRA, the gold-standard of tort reform laws, back in 1975.  In fact, possible malpractice payouts have shrunk every year since 1975, since the caps have never been adjusted for inflation.

So, remind us please?
 
2014-01-01 01:03:54 PM
Appendix eh?  Probably went to a non providing hospital because of all the pain he was in.
This bill does sound correct if that is true.

And don't forget about the Ambulance bill.
 
2014-01-01 01:06:05 PM
Is he sure the bill is correct?

When my wife was in the hospital they tried billing me for $8000 or so that I didn't owe.  For months I faxed and mailed them documentation that they ignored.  I tried calling them but they never answered their phone.  Finally I had to take some time off of work and all but camp in the cashier's office (the billing office wouldn't answer their calls either), though the head cashier saw what I was going through and spent a week cleaning it up.  I didn't owe them a dime because my deductible/max out of pocket was already paid out to other people.

There are also companies that audit hospital bills.
 
2014-01-01 01:08:19 PM

edmo: That disparity in pricing seems to offer a real opportunity for lawyers to sue and allege discrimination based on this or that. That would be a good thing.

When prices vary wildly, the public comes to realize they are not real and that the expenses they encounter are no more about costs than an overweight suitcase means an airline needs to recover another $200 for their extra effort. When you operate that way, people cease to trust you, not only on matters of cost but it trickles down to whether the physicians, nurses, and facilities are really up to speed. Lose people's trust and folks won't come to even when sick.

And this once again nails the real reform need in health care: costs. Too bad everybody skipped out on that one.


That's always been my biggest biatch about Obama Care since it does nothing to fix outrageous costs, the only universal health care that works are the ones who implement cost price controls.

On drugs and what can be charged in hospitals.
 
2014-01-01 01:23:21 PM
My appendix burst on Christmas morning 1986.  I was stuck in the hospital for a week (the infection spread in my body).  I wonder how much of my soul I'd have to sell to pay for that today.

/parents had great insurance at the time, we paid very little
//still have a cool scar on my stomach
 
2014-01-01 01:23:52 PM

TV's Vinnie: Apparently, doctors and hospital officials think our economy is for everyone else to suffer in. Those Lexus sedans the Docs bought with the big red bow on top won't purchase themselves, you know.


I was gonna come in here an say "inb4 someone complains that doctors get paid too much", but I'm too late.

/thank you for demonstrating that you have no clue how heathcare works, so that everyone can ignore you in kind
 
2014-01-01 01:24:42 PM

Flab: I guessed he learned his lesson. Next time he needs to have his appendix removed, I suppose he's going to shop around and get a better deal instead of going to the first place he sees.


A lot of insurance companies are returning to the days of having in-network hospitals, specifically because some hospitals are expensive as fark.  People are obviously upset because they can no longer go to the closest doctor or hospital anymore.

The loudest rumblings are when prestigious children's hospitals are no longer in-network.


EngineerAU: Medical pricing is so weird. When I slipped on the ice while curling, I hit my face and busted open my eyebrow. A trip to the ER resulted in a $8500 bill, which covered six stitches and an MRI to make sure I didn't have a concussion. When I told them I had insurance, the bill magically dropped to $4200. So if I was uninsured, I would be required to pay $4300 more. Guess I should have hired a professional negotiator before the accident to get the best rate on all potential treatments.


That's because insurance companies often negotiate lower prices for their members.  I recently had to have some lab work done that was below my deductible threshold.  When I received my bill from the lab, it had a 15% discount because I was a member of insurance plan X.  So even though I had to pay out of pocket, my insurance saved me cash.

On the opposite end of things, you have cash-only clinics that offer a significant discount to people without insurance.  Their whole system is that by not accepting insurance, they can avoid the extra personnel and paperwork that comes with dealing with insurance companies.  As example, the eye clinic that runs out of my local Costco only accepts cash, and getting an Rx renewal for contacts along with one box of contacts is only like $25 more than if I go to an in-network eye clinic and do the same.  I would probably save money if I dumped my eye insurance, but I keep it just in case I ever encounter a major issue with my eyes and need something more than a simple Rx renewal.
 
2014-01-01 01:24:55 PM
Shouldn't have gone to Sutter. Should have gone to UC Davis instead.

Sutter once billed me $8,500 for a 4 hour ER visit and a saline drip. UC Davis bent over backwards to help me pay for a 5-day stay when I had viral meningitis - My only bill from that was about $125 for an MRI.

They have prime rib on the dinner menu at UCD. It was a little dry, but still quite delicious.
 
2014-01-01 01:41:48 PM

Dinjiin: Flab: I guessed he learned his lesson. Next time he needs to have his appendix removed, I suppose he's going to shop around and get a better deal instead of going to the first place he sees.

A lot of insurance companies are returning to the days of having in-network hospitals, specifically because some hospitals are expensive as fark.  People are obviously upset because they can no longer go to the closest doctor or hospital anymore.

The loudest rumblings are when prestigious children's hospitals are no longer in-network.


EngineerAU: Medical pricing is so weird. When I slipped on the ice while curling, I hit my face and busted open my eyebrow. A trip to the ER resulted in a $8500 bill, which covered six stitches and an MRI to make sure I didn't have a concussion. When I told them I had insurance, the bill magically dropped to $4200. So if I was uninsured, I would be required to pay $4300 more. Guess I should have hired a professional negotiator before the accident to get the best rate on all potential treatments.

That's because insurance companies often negotiate lower prices for their members.  I recently had to have some lab work done that was below my deductible threshold.  When I received my bill from the lab, it had a 15% discount because I was a member of insurance plan X.  So even though I had to pay out of pocket, my insurance saved me cash.

On the opposite end of things, you have cash-only clinics that offer a significant discount to people without insurance.  Their whole system is that by not accepting insurance, they can avoid the extra personnel and paperwork that comes with dealing with insurance companies.  As example, the eye clinic that runs out of my local Costco only accepts cash, and getting an Rx renewal for contacts along with one box of contacts is only like $25 more than if I go to an in-network eye clinic and do the same.  I would probably save money if I dumped my eye insurance, but I keep it just in case I ever encounter a major issue with my eyes and need something more than a simple Rx renewal.


In case you hadn't noticed, my post was in jest. People with burst appendices can't always get to an "in network" hospital, nor would they know that their "in network" hospital will charge them $5000 a night for a room.

I don't know if it was your plan or not, but you made a very good argument for single payer healthcare, and govt-run hospitals.
 
2014-01-01 01:56:16 PM

grinding_journalist: TV's Vinnie: Apparently, doctors and hospital officials think our economy is for everyone else to suffer in. Those Lexus sedans the Docs bought with the big red bow on top won't purchase themselves, you know.

I was gonna come in here an say "inb4 someone complains that doctors get paid too much", but I'm too late.


Well, they do. Even Ric Romero comes in and says "Really? You actually need me to come in and reveal that?"
 
2014-01-01 02:00:30 PM
Looking  at a bill from OHSU for 25 days after a accident, 4500 per day for the bed, 1000 per day for the use of a bipap. total was well over 300,000. Health Net paid about 90%
 
2014-01-01 02:41:21 PM

Flab: People with burst appendices can't always get to an "in network" hospital, nor would they know that their "in network" hospital will charge them $5000 a night for a room.


My insurance company sent me a wallet sized card with the preferred in-network hospitals in my area that I'm supposed to hand to ambulance drivers in the event of an emergency.  Nice idea, but it doesn't do any good if it isn't on me or if I am unconscious.  Maybe I should staple it to my chest just to be safe.

But in the event that I inadvertently go to an out-of-network hospital for an emergency, my insurance will partially reimburse me.  But only to the point that I am stable enough to be transferred to an in-network hospital.  And I assume that they'll probably be d!(ks about when that point is and if it was an emergency at all.


Flab: I don't know if it was your plan or not, but you made a very good argument for single payer healthcare, and govt-run hospitals.


I'm for a single payer model, but for slightly different reasons.  Why should companies have to get insurance for their employees?  Unless the employee's job is dangerous, they shouldn't be involved.  It is just an added complexity that makes it harder to run a business.  A couple of international companies have publicly commented that they picked Canada over the US when opening North American facilities because they didn't want to have to deal with our insurance BS.

Next, I hate that the government now forces people to conduct business with a private company or co-op.  Have you seen the jump in stock prices for medical insurance companies in the past 5 years?  Nowhere else in our lives are we forced to do something like this.

On a side note, but if a state or national single payer plan was instituted and they did get serious about capping costs, I don't see the idea of health networks disappearing.  Some hospitals just charge a lot more for their services and would resist coming down in price unless price caps were written into law.  I think the carrot (networks) will result in much fewer unintended consequences than the stick (hard caps).  After all, if people are willing to purchase supplementary private insurance that covers those premium hospitals or are willing to pay out-of-pocket, then more power to them.

As to nationalized hospitals as they have in the UK, I'm not a proponent.  I believe it is easier to be the overseer than to run the places yourself.  The UK government seems to be under fire weekly because of some mishap in one of their hospitals.  Given how bad politics are in this country, it would allow for open season on whomever is in power.  They would also be susceptible to "starve the beast" tactics by the right and "closed union shop" tactics by the left, among a hundred other corruptible things I could think of.


Flab: In case you hadn't noticed, my post was in jest.


Sarcasm is lost on the Internet.  And is lost when the reader was up partying the night before.
 
2014-01-01 03:05:29 PM

Dinjiin: That's because insurance companies often negotiate lower prices for their members.  I recently had to have some lab work done that was below my deductible threshold.  When I received my bill from the lab, it had a 15% discount because I was a member of insurance plan X.  So even though I had to pay out of pocket, my insurance saved me cash.

On the opposite end of things, you have cash-only clinics that offer a significant discount to people without insurance.  Their whole system is that by not accepting insurance, they can avoid the extra personnel and paperwork that comes with dealing with insurance companies.


There have been stories about family medicine practices doing the same thing - running a cash-only business and posting all their prices in the lobby. Flat fees for checkups, office visits, prescriptions, etc. Those doctors are probably making money hand over fist... and unlike the Medicare profiteers, they're doing it honestly.
 
2014-01-01 03:11:11 PM

Dinjiin: As to nationalized hospitals as they have in the UK, I'm not a proponent.  I believe it is easier to be the overseer than to run the places yourself.  The UK government seems to be under fire weekly because of some mishap in one of their hospitals.  Given how bad politics are in this country, it would allow for open season on whomever is in power.  They would also be susceptible to "starve the beast" tactics by the right and "closed union shop" tactics by the left, among a hundred other corruptible things I could think of.


The UK system is very decentralised. The "CEO of the NHS" more or less sets central policies and stuff. Each city or area will have a Trust, where a CEO and board will run that hospital or group with a significant degree of autonomy. This is actually a costly thing in some cases since one Trust will get a good deal from a supplier while the Trust next town over might be paying twice the price. There are centralised buying services but each Trust is free to decide whether they want to use it or not.

Overall the vast majority here are very happy with it, and no politician would ever dare suggest cutting the NHS, it would be political suicide.

/My mother has just had cataract operations at Moorfields, a world class eye hospital. Not only did it not cost her a penny but even the coffee and biscuits were free! I had to pay 80 pence for my coffee!
 
2014-01-01 03:20:20 PM
Katie98_KT:
ah, makes sense. Well, the good news is that ACA has fixed that- maximum out of pocket for an individual is $6,350 and for a family is $12,700. http://www.bcbsm.com/content/microsites/health-care-reform/en/reform- a lerts/irs-announces-maximum-out-of-pocket-costs.html So, unless he was on a family plan and hadn't spent anything else on healthcare for the year, he would have a smaller bill if he'd had the appendectomy in 2014.
====================================================

Unfortunately, the 'out of pocket limit' does not cover deductibles themselves, copays, and about 10 other things.

So it's not really that great... but it WILL prevent getting ridiculous 55k bills in the mail. So... it's a start.
 
2014-01-01 03:29:41 PM
When I was 16 (1977) I ruptured a disc in my lower back. I spent 11 days in the hospital.  Had a spinal tap and major back surgery.  Then several months of physical therapy.  My dad's end of the bill?  $250!

Healthcare!  Just another way the 1% are draining away the wealth of the middle class and keeping the poors poor.
 
2014-01-01 03:35:49 PM

jake3988: Katie98_KT:
ah, makes sense. Well, the good news is that ACA has fixed that- maximum out of pocket for an individual is $6,350 and for a family is $12,700. http://www.bcbsm.com/content/microsites/health-care-reform/en/reform- a lerts/irs-announces-maximum-out-of-pocket-costs.html So, unless he was on a family plan and hadn't spent anything else on healthcare for the year, he would have a smaller bill if he'd had the appendectomy in 2014.
====================================================

Unfortunately, the 'out of pocket limit' does not cover deductibles themselves, copays, and about 10 other things.

So it's not really that great... but it WILL prevent getting ridiculous 55k bills in the mail. So... it's a start.


No, out of pocket limits are out of pocket limits.

IRS says: "and the annual out-of-pocket expenses (deductibles, co-payments, and other amounts, but not
premiums) do not exceed $6,350 for self-only coverage or $12,700 for family coverage "

http://www.irs.gov/pub/irs-drop/rp-13-25.pdf
 
2014-01-01 03:58:10 PM
Take a trip to Thailand - get the op done for less than $500 (in a First World class hospital)

Have a holiday on beach and still come out way ahead



No thanks. I've seen Bestgore.com.
If you take a trip to Thailand, you may as well write a will before you go.
 
2014-01-01 04:16:14 PM
Ha, his CT Scan was only $7k, that's half of what I was charged 4 years ago.
 
2014-01-01 04:25:41 PM

Flint Ironstag: The UK system is very decentralised.


Plus there's private insurance for non-NHS doctors and hospitals for those who want it. The insurance covers more than insurance here in the US does, costs a bundle less, and private hospital stays are far cheaper than hospital stays in the US. Long story short, the UK is whipping the US when it comes to health care provision in every possible way.
 
2014-01-01 05:17:17 PM

EngineerAU: Medical pricing is so weird. When I slipped on the ice while curling, I hit my face and busted open my eyebrow. A trip to the ER resulted in a $8500 bill, which covered six stitches and an MRI to make sure I didn't have a concussion. When I told them I had insurance, the bill magically dropped to $4200. So if I was uninsured, I would be required to pay $4300 more. Guess I should have hired a professional negotiator before the accident to get the best rate on all potential treatments.


Pretty much.  The uninsured get farked royally.  And the worst thing is?  Most uninsured people try to pay their bills; they're not a horde of deadbeats like the right claims.

My father was on the board of directors of a large healthcare company and ran their labs.  Worked a few summers in their billing department.  There's a very common blood test that if you've ever had bloodwork ran you've likely had it done.  Cost to the hospital was seven dollars and some change; this included all direct costs, overhead, building depretiation, courier fees, taxes, everything.  Depending on the insurance, the company would get 17 dollars to 110.

Uninsured people would be charged a few hundred dollars.
 
2014-01-01 05:34:28 PM
Usually restaurants have a menu posted outside with prices for everything. Perhaps it's time for hospitals to start doing the same? A little transparency never hurts.
 
2014-01-01 05:44:06 PM

clkeagle: There have been stories about family medicine practices doing the same thing - running a cash-only business and posting all their prices in the lobby. Flat fees for checkups, office visits, prescriptions, etc. Those doctors are probably making money hand over fist... and unlike the Medicare profiteers, they're doing it honestly.


But that "Dr. Quinn Medicine Woman" system won't work for the expensive, complicated, technological stuff that is responsible for longer life expectancies.
 
2014-01-01 05:45:20 PM

Coloman: Appendix eh?  Probably went to a non providing hospital because of all the pain he was in.
This bill does sound correct if that is true.

And don't forget about the Ambulance bill.


A friend of mine got in an accident and had to be transported to the hospital in an ambulance. Since she has Kaiser, they cover the ambulance. Unfortunately, she didn't know that, so when the ambulance company sent her a bill, she paid it. She's had to go thru hell with the ambulance company ever since to get her $1600 refunded. Moral of the story: whenever some scum-suckers send you a bill for something, particularly medically related, make sure you actually owe the money. If my friend had thought to call Kaiser and check, she would have found out that they handle the ambulance ride under her plan.
 
2014-01-01 05:46:12 PM

MrEricSir: Usually restaurants have a menu posted outside with prices for everything. Perhaps it's time for hospitals to start doing the same? A little transparency never hurts.


It would be nice, but I don't see it getting as transparent as a restaurant menu.  Someone checking into Dr. House's hospital would need a ridiculously complicated flow chart to cover all the costs associated with all the diseases they think it is and then figure out it's not.
 
2014-01-01 05:48:59 PM

Dinjiin: I'm for a single payer model, but for slightly different reasons.  Why should companies have to get insurance for their employees?  Unless the employee's job is dangerous, they shouldn't be involved.  It is just an added complexity that makes it harder to run a business.  A couple of international companies have publicly commented that they picked Canada over the US when opening North American facilities because they didn't want to have to deal with our insurance BS.


There's nothing preventing a company from telling the employee, "Here's X thousand dollars. Go buy your own insurance with it." Many, in fact, do.
 
2014-01-01 05:55:10 PM
What I don't understand is why the insurance company paid up. Wouldn't they challenge any charges that were way too high?
 
2014-01-01 06:18:00 PM
how Americans can ACCEPT their health care system, never mind DEFEND it

will always be a mystery to lil ol me.
 
2014-01-01 06:24:20 PM

drumhellar: Shouldn't have gone to Sutter. Should have gone to UC Davis instead.

Sutter once billed me $8,500 for a 4 hour ER visit and a saline drip. UC Davis bent over backwards to help me pay for a 5-day stay when I had viral meningitis - My only bill from that was about $125 for an MRI.

They have prime rib on the dinner menu at UCD. It was a little dry, but still quite delicious.


I will bet the cheaper one is state or federally funded or accepts funds which results in lower rates.
 
2014-01-01 06:33:50 PM
You are a total idiot if you think that the US has the best health care system in the world.
 
2014-01-01 06:38:53 PM
LGT Huffington Post article - worth looking at the charts:

http://www.huffingtonpost.com/2013/10/03/health-care-costs-_n_399842 5. html
 
2014-01-01 06:41:14 PM

DrewCurtisJr: What I don't understand is why the insurance company paid up. Wouldn't they challenge any charges that were way too high?


It's almost as if the hospital made up a completely ridiculous number, the insurance company pretended to pay most of it and the patient was stuck with the bill for full, actual amount of the services he received.

/Would anyone be surprised?
//Is there any way to confirm the actual payment from the insurance company to hospital?
///Am I being paranoid?
 
2014-01-01 07:28:39 PM

Starshines: DrewCurtisJr: What I don't understand is why the insurance company paid up. Wouldn't they challenge any charges that were way too high?

It's almost as if the hospital made up a completely ridiculous number, the insurance company pretended to pay most of it and the patient was stuck with the bill for full, actual amount of the services he received.

/Would anyone be surprised?
//Is there any way to confirm the actual payment from the insurance company to hospital?
///Am I being paranoid?


The guy's father likely had Aetna 80 PPO coverage, meaning that they were going to be stuck with 20% of the total.

I recently had outpatient shoulder surgery. I have UnitedHealthcare 100 PPO coverage; everyone involved, and the hospital, were in-network. The bills are probably not done rolling in, but this is essentially what's shown up so far in my benefits statements for the day of my surgery:

                                        Billed              Ins. paid
Orthopedic surgeon        9,200               1,600
Anesthesiologist              3,300               2,400
Hospital facilities            12,000                   0 (allegedly because approval wasn't obtained; I imagine this will change)
Orthotics (arm sling)         638                   340

I paid a $150 copay. I am on the hook for no other charges. Seems odd that the hospital/insurance company would go out of their way to gin up charges and discounts when I'm not paying much in any case, but maybe I'm just inexperienced in this field.

Frankly, the "discount" negotiated for the surgeon was the biggest shock to me. Almost doesn't seem worth his time (though I'm very glad he did it).
 
2014-01-01 08:40:14 PM

12349876: clkeagle: There have been stories about family medicine practices doing the same thing - running a cash-only business and posting all their prices in the lobby. Flat fees for checkups, office visits, prescriptions, etc. Those doctors are probably making money hand over fist... and unlike the Medicare profiteers, they're doing it honestly.

But that "Dr. Quinn Medicine Woman" system won't work for the expensive, complicated, technological stuff that is responsible for longer life expectancies.


It isn't meant to, and I don't advocate anything like that for specialty care or surgery. And I don't think anyone should ever go without insurance... but some people will. So the cash practices are a great alternative that some doctors are providing for the other 90% of medical services, like flu shots and immunizations, strep throat or ear infection treatment, referrals for mental health, etc.
 
2014-01-01 08:54:05 PM

Dinjiin: Flab: People with burst appendices can't always get to an "in network" hospital, nor would they know that their "in network" hospital will charge them $5000 a night for a room.

My insurance company sent me a wallet sized card with the preferred in-network hospitals in my area that I'm supposed to hand to ambulance drivers in the event of an emergency.  Nice idea, but it doesn't do any good if it isn't on me or if I am unconscious.  Maybe I should staple it to my chest just to be safe.

But in the event that I inadvertently go to an out-of-network hospital for an emergency, my insurance will partially reimburse me.  But only to the point that I am stable enough to be transferred to an in-network hospital.  And I assume that they'll probably be d!(ks about when that point is and if it was an emergency at all.


Flab: I don't know if it was your plan or not, but you made a very good argument for single payer healthcare, and govt-run hospitals.

I'm for a single payer model, but for slightly different reasons.  Why should companies have to get insurance for their employees?  Unless the employee's job is dangerous, they shouldn't be involved.  It is just an added complexity that makes it harder to run a business.  A couple of international companies have publicly commented that they picked Canada over the US when opening North American facilities because they didn't want to have to deal with our insurance BS.

Next, I hate that the government now forces people to conduct business with a private company or co-op.  Have you seen the jump in stock prices for medical insurance companies in the past 5 years?  Nowhere else in our lives are we forced to do something like this.

On a side note, but if a state or national single payer plan was instituted and they did get serious about capping costs, I don't see the idea of health networks disappearing.  Some hospitals just charge a lot more for their services and would resist coming down in price unless price caps were written into law.  I think the carrot (networks) will result in much fewer unintended consequences than the stick (hard caps).  After all, if people are willing to purchase supplementary private insurance that covers those premium hospitals or are willing to pay out-of-pocket, then more power to them.

As to nationalized hospitals as they have in the UK, I'm not a proponent.  I believe it is easier to be the overseer than to run the places yourself.  The UK government seems to be under fire weekly because of some mishap in one of their hospitals.  Given how bad politics are in this country, it would allow for open season on whomever is in power.  They would also be susceptible to "starve the beast" tactics by the right and "closed union shop" tactics by the left, among a hundred other corruptible things I could think of.


Flab: In case you hadn't noticed, my post was in jest.

Sarcasm is lost on the Internet.  And is lost when the reader was up partying the night before.


I'm sure the number of mishaps in UK or Canadian hospitals is very similar to that of US hospitals, but due to the private nature of the US ones, and a little lawyerly pressure, we simply don't hear about them.

As for networks, if every hospital in a province is owned by the same guy who also provides everyone's health insurance, not only does it completely eliminate having to worry about whether the ambulance dispatcher will route you to an in-network ER, since they all are, but it also completely eliminates price negotiations between hospitals and insurance providers, and greatly simplifies billing, allowing everyone to streamline the administrative overhead.
 
2014-01-01 10:11:46 PM
Subby, you forgot to say "Thanks Obama".
 
2014-01-01 10:23:32 PM

The Flexecutioner: If I'm Aetna PPO, wouldn't I immediately challenge the costs and create my own stink over them?  Guy was totally over charged but so was Aetna.  I had an appendectomy in 2004 but i do not remember what the cost was.  I had no health insurance and had to cover it myself but I dont even remember it being more than $2k.

Things like this are why we cant have nice things.


I had appendicitis in 2010 - had my wife drive me to the hospital at 2am - It took several hours to diagnose and prep me for surgery at 7am - I had the Laparoscopic surgery, I was out by 9am - after a few hours of recovery I checked myself out...less than 12 hours in the hospital - My bill was $30,000


/no i didn't have insurance...I was unemployed at the time
//have managed to finally pay that sucker off recently
///FTA - the average appendectomy is about 30 large...that was my experience - and it sucked
 
2014-01-01 10:35:21 PM
I just recently had the same thing. In October I went to the ER with sever abdominal pains and they said it was my appendix. After the removal and a 3 day stay in the hospital the bill was 65K. I did however have insurance and the "repriced" amount that the insurance company got was $6700.

fark hospitals and insurance companies.
 
2014-01-01 10:39:46 PM
I think you have to spend your entire life in a system this farked not to recognize it as farcical.
 
2014-01-01 10:45:17 PM
Wow.

Stories like these make me glad I'm in The Great White North.

My mother was diagnosed with breast cancer over the summer, and had surgery about three weeks later. She just finishing up chemo now.

The biggest out of pocket expense was for parking at the hospital.
 
2014-01-02 12:02:25 AM

rustypouch: Wow.

Stories like these make me glad I'm in The Great White North.

My mother was diagnosed with breast cancer over the summer, and had surgery about three weeks later. She just finishing up chemo now.

The biggest out of pocket expense was for parking at the hospital.


My mother just had cataract operations at Moorfields eye hospital, one of their satellite units in North London, and the only out of pocket expense was the parking, which is £1 for every two hours. Even the coffee and biscuits were free.
 
2014-01-02 12:33:02 AM
i1.ytimg.com
 
2014-01-02 12:56:46 AM
So the hospital slaps a sticker price of $55,000 on the surgery but will haggle down to the $17,000 the insurance company is prepared to pay? They sound like rug merchants or those perpetual "going out of business sale" stores.
 
2014-01-02 01:56:24 AM
My uninsured mother died after a week long stay in an ICU. The bill was over $100,000. They agreed to reduce it to $20k if we could pay that amount immediately, which we did, but then they tried to force us to pay the rest of it anyway. We hired a lawyer who immediately told us that the company that owned that hospital had just settled a huge class action lawsuit for overcharging uninsured patients. They were already back at it. After a few calls up the chain of command, they let it go after basically telling our lawyer that they "try to get what they can first."

Farking DISGUSTING. It's hard for me to imagine someone dumber and more uniformed than Americans who are OK with our current medical system. They really have no idea what a travesty it is.
 
2014-01-02 02:00:09 AM
The price of FREEDOM from dirty socialist libtards!
 
2014-01-02 05:19:24 AM
I had my gall bladder removed at 18. Bankrupted my family.

Just kidding, I'm Canadian so it's been paid over time through the reasonable taxes I pay out of my wages. Goddamn socialism. Oh, and if I need to I go to the doctor without any fear.

/you guys are farking stupid for fighting change to your broken and morally bankrupt system. Then again, your prisons are privatized as well so I shouldn't expect morality from down south. Canada's farked too, and getting worse with our current evil PM but you couldn't pay me enough to live in America. It's like 45th on the list of countries I'd live in, right behind Russia.
 
2014-01-02 05:30:52 AM

davynelson: how Americans can ACCEPT their health care system, never mind DEFEND it

will always be a mystery to lil ol me.


As a Canadian, it seems guano insane.

I'm mildly terrified for my close family that lives in the USA. Their two littles are just approaching playground age, the age of broken bones and a myriad of ills, and of course the parents are just broke twentysomethings.. :/
 
2014-01-02 05:31:55 AM
Oh, and I'm aware that our current evil PM's crew has been 'investigating' privatization of our prisons to 'save money. Because adding a middleman always saves money.

Don't go to jail kids. People want to make money off you if you do. People like judges and walking skeletons, you know, the soulless.
 
2014-01-02 05:44:52 AM
Why didn't he just make it a DIY like Soviet GP Leonid Rogozov?
 
2014-01-02 06:59:18 AM
This sounds about right. My co-workers thought I was having a stroke, so I was rushed to the hospital in an ambulance and held overnight for observation. They did a full diagnostic workup but performed nothing invasive. Total bill including ambulance ride: $19,550. Granted, my portion is only $100 after my insurance paid for it, but the fact remains that someone out there thinks a fancy taxi ride and a night in an overpriced hotel with bad food is worth $20-large
 
2014-01-02 07:45:15 AM

Lydia_C: Starshines: DrewCurtisJr: What I don't understand is why the insurance company paid up. Wouldn't they challenge any charges that were way too high?

It's almost as if the hospital made up a completely ridiculous number, the insurance company pretended to pay most of it and the patient was stuck with the bill for full, actual amount of the services he received.

/Would anyone be surprised?
//Is there any way to confirm the actual payment from the insurance company to hospital?
///Am I being paranoid?

The guy's father likely had Aetna 80 PPO coverage, meaning that they were going to be stuck with 20% of the total.

I recently had outpatient shoulder surgery. I have UnitedHealthcare 100 PPO coverage; everyone involved, and the hospital, were in-network. The bills are probably not done rolling in, but this is essentially what's shown up so far in my benefits statements for the day of my surgery:

                                        Billed              Ins. paid
Orthopedic surgeon        9,200               1,600
Anesthesiologist              3,300               2,400
Hospital facilities            12,000                   0 (allegedly because approval wasn't obtained; I imagine this will change)
Orthotics (arm sling)         638                   340

I paid a $150 copay. I am on the hook for no other charges. Seems odd that the hospital/insurance company would go out of their way to gin up charges and discounts when I'm not paying much in any case, but maybe I'm just inexperienced in this field.

Frankly, the "discount" negotiated for the surgeon was the biggest shock to me. Almost doesn't seem worth his time (though I'm very glad he did it).



An addendum: I just got home from being away for the holidays to find a letter from United Healthcare. Seems they've decided that my medical bills are the result of an acute injury (which they are), and they want more info on the circumstances in case there's someone else who should be "helping" to cover the expenses (i.e., someone they can sue). Comedy gold, I tell ya.
 
2014-01-02 08:56:22 AM
get insurance that has a flat rate fee for services.

my insurance has a $625 flat rate co pay for inpatient surgery and $315 co pay for outpatient surgery.
 
2014-01-02 09:59:26 AM
I had an appendectomy last New Years Eve (oh, what fun!). I also had a 24 hour stay because they really wanted me to poop before I left. It cost me a few thousand. Most of that was for the anesthesiologist. The total cost was about $30,000, which my insurance covered.
 
2014-01-02 10:13:58 AM
Three  years ago I was diagnosed with prostate cancer and had a prostectomy at a local Raleigh hospital. My urologist did the surgery and since he had residency at this one hospital, I didn't have much choice where to go unless I got a totally new urologist/surgeon to do the work.  The hospital was the better of the ones in Raleigh so I wasn't too concerned.

I was in and out of there in less than 36 hours. The bill came to $30,000, of which my insurance (BCBS) paid 75% of. We had an itemized bill and I was astounded at some of the charges. Over $100 for 'oral pain medication', which IIRC was oxycodone, one or two pills (I took neither since I was in no pain at all afterwards). The room charge was over $5000, the big cost was the DaVinci machine use, the disposable surgical instruments, and the anesthesiologist. I asked the urologist afterwards how much he personally was paid for the surgery (it took about 3 hours); he said "about $1000".

In another visit, my wife had to go to the ER after her doctor thought she had a free floating blood clot in her leg, and wanted the hospital to perform a more detailed test to find it. I drove her to the ER, where we sat and waited about 4 hours before getting to see a doctor. He spent 5 minutes talking to us and send my wife home; no tests, no blood work, no exam, nothing. A few weeks later we got a bill for over $600...

/hospital breakfast was at least free
//nearly choked to death on the sausage though
///throat was really sore after the surgery due to breathing tube put down it
 
2014-01-02 10:15:00 AM

TV's Vinnie: Apparently, doctors and hospital officials think our economy is for everyone else to suffer in. Those Lexus sedans the Docs bought with the big red bow on top won't purchase themselves, you know.


I would like to point out that not all doctors are like that, especially those in primary care.

That being said, there are a lot of docs that do drive to work in cars that are more expensive than my house. One guy in particular drives a masseratti. I knew of another who drives an audi r8. As far as in know, there's no other country in the world where a doctor can so easily make enough money to drive a Porsche or masseratti to work, or drive a ferrari at the track every weekend. Yet these are the same guys who are constantly biatching about money, taxes, the government, Obamacare etc. I find it amazing that they have no idea how good this country is for their finances and how they could move to any other place in the world and make just a fraction of what they are making now. Greed is an interesting thing, but it's particularly disgusting when you do find it among purple who took an oath to help fellow humans.
 
2014-01-02 10:25:30 AM
Hospital bills work like many services and industries - transportation pricing is what I am familiar with.

Let's say you have a 1500 lb pallet o' crap you want to ship from NY to CA.  If you just call up any old carrier and pay what they tell you, enjoy your $3500 bill (rack rates, non-discounted).  If you call and push a little, you get 20% off.  If you are a business and ship regularly, you can negotiate a pretty steep discount depending on what it is, where it is going to, and how often.  Usually in excess of 85% off rack rates.

CSB:
My father's combined stroke, heart attack, and diabetic attack (4-day coma) resulted in a 20-day hospital stay.  Factor in scans, meds, rehab, ambulance, and other related care, the total bill was over $1.5 million from all interested parties - AFTER insurance only paid a 20% courtesy discount because the ambulance took him to the closest (and out of network) hospital.  He would be dead if he went to the in-network facility.

Total paid to anyone: $0 because he filed for bankruptcy.  In court, there were 20 people on the docket for that morning and 17 were filing because of hospital bills.

My advice to anyone who has a crazy medical bill is to declare bankruptcy if you have the ability to.  Most bankruptcy judges will waive you through the system and tell the creditors to go pound sand because there are so many people in the exact same situation.

/end CSB
 
2014-01-02 10:33:19 AM

cgraves67: I had an appendectomy last New Years Eve (oh, what fun!). I also had a 24 hour stay because they really wanted me to poop before I left. It cost me a few thousand. Most of that was for the anesthesiologist. The total cost was about $30,000, which my insurance covered.


Health care costs have risen much faster than inflation. My appendectomy 35 years ago = $7000 and that was 2 days in the hospital.
 
2014-01-02 10:45:27 AM

togaman2k: Hospital bills work like many services and industries - transportation pricing is what I am familiar with.

Let's say you have a 1500 lb pallet o' crap you want to ship from NY to CA.  If you just call up any old carrier and pay what they tell you, enjoy your $3500 bill (rack rates, non-discounted).  If you call and push a little, you get 20% off.  If you are a business and ship regularly, you can negotiate a pretty steep discount depending on what it is, where it is going to, and how often.  Usually in excess of 85% off rack rates.

CSB:
My father's combined stroke, heart attack, and diabetic attack (4-day coma) resulted in a 20-day hospital stay.  Factor in scans, meds, rehab, ambulance, and other related care, the total bill was over $1.5 million from all interested parties - AFTER insurance only paid a 20% courtesy discount because the ambulance took him to the closest (and out of network) hospital.  He would be dead if he went to the in-network facility.

Total paid to anyone: $0 because he filed for bankruptcy.  In court, there were 20 people on the docket for that morning and 17 were filing because of hospital bills.

My advice to anyone who has a crazy medical bill is to declare bankruptcy if you have the ability to.  Most bankruptcy judges will waive you through the system and tell the creditors to go pound sand because there are so many people in the exact same situation.

/end CSB


And yet, some republicans claimed that there were medical bankruptcies in countries like Germany (and got schooled by Al Franken), so Obamacare or whaever still screwed up health plan they wanted blocked is bad.

http://www.youtube.com/watch?v=NcjMoihbIZc
 
2014-01-02 11:05:20 AM
In case this wasn't already said... The $55K is the billed charge which no one would ever pay (even those without insurance can usually negotiate a lower charge).  The $11K is the allowed charge, the negotiated amount between the insurer and the hospital.  The $11K is the total amount the hospital will receive and is really the true price of the surgery.  The insured would pay only part of this depending on the plan benefits. If, for example, the copay was $500, the insurance company would pay nearly all of the $11K.
 
2014-01-02 12:19:33 PM
i didnt have insurance when i got meningitis 3 years ago. still paying off a 28k bill for one week in a hospital and vicodins every 4 hours. thats all they did for treatment. it cost more than 2 years of my rent
 
2014-01-02 12:20:08 PM

rga184: TV's Vinnie: Apparently, doctors and hospital officials think our economy is for everyone else to suffer in. Those Lexus sedans the Docs bought with the big red bow on top won't purchase themselves, you know.

I would like to point out that not all doctors are like that, especially those in primary care.

That being said, there are a lot of docs that do drive to work in cars that are more expensive than my house. One guy in particular drives a masseratti. I knew of another who drives an audi r8. As far as in know, there's no other country in the world where a doctor can so easily make enough money to drive a Porsche or masseratti to work, or drive a ferrari at the track every weekend. Yet these are the same guys who are constantly biatching about money, taxes, the government, Obamacare etc. I find it amazing that they have no idea how good this country is for their finances and how they could move to any other place in the world and make just a fraction of what they are making now. Greed is an interesting thing, but it's particularly disgusting when you do find it among purple who took an oath to help fellow humans.


Many doctors in the UK, even NHS ones, are very well paid. My dentist lives in a house worth well over £1 million and drives a brand new Jaguar XJ.

Thousands of GPs paid more than the Prime Minister.

The average GP partner earned £103k. Even within the NHS system local surgeries are partnerships with the partners owning the business and keeping the profit. The Harley Street private specialists are in a different league. Same with dentists. Maybe they're not as well paid as American doctors but they're certainly capable of buying a Porsche or Maserati.
And don't forget that they will not have the huge student debt that US doctors would have to pay back. The NHS pays for a lot of the training.
 
2014-01-02 01:17:34 PM

Dinjiin: Next time he needs to have his appendix removed, I suppose he's going to shop around and get a better deal instead of going to the first place he sees.


From the time of a rupture, you have about 4-8 hours to get to an ER for an emergency appendectomy before they start filling out death certificates.  Not a lot of time to 'go shopping around'...
 
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