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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
    More: Asinine, California Man, visual routine, medical billing, Archives of Internal Medicine, CPT, anesthesia  
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3533 clicks; posted to Business » on 01 Jan 2014 at 10:33 AM (2 years ago)   |   Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2014-01-01 11:10:09 AM  
3 votes:
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 10:57:41 AM  
2 votes:
Americans are SOOOOOOO screwed!
2014-01-01 10:49:24 AM  
2 votes:
Even the $11,000 that's left AFTER insurance is horrendously high.
2014-01-01 10:40:17 AM  
2 votes:
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 08:54:05 PM  
1 vote:

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 07:28:39 PM  
1 vote:

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 05:34:28 PM  
1 vote:
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 03:29:41 PM  
1 vote:
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 01:56:16 PM  
1 vote:

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 01:41:48 PM  
1 vote:

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 12:49:50 PM  
1 vote:

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 12:30:14 PM  
1 vote:

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 11:58:16 AM  
1 vote:

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 11:53:10 AM  
1 vote:

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 11:50:10 AM  
1 vote:
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 11:44:14 AM  
1 vote:
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 11:30:49 AM  
1 vote:
Best health care system in the WORLD!!
2014-01-01 11:05:27 AM  
1 vote:
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 10:58:53 AM  
1 vote:
Only in the United States of Avarice. It would not happen in the civilized world.
2014-01-01 10:50:02 AM  
1 vote:
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.
 
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