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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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3507 clicks; posted to Business » on 01 Jan 2014 at 10:33 AM (27 weeks ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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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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