We have many institutional problems in healthcare.
Posted on 12/03/2013 6:37:18 AM PST by Red in Blue PA
SAN FRANCISCO — With blood oozing from deep lacerations, the two patients arrived at California Pacific Medical Center’s tidy emergency room. Deepika Singh, 26, had gashed her knee at a backyard barbecue. Orla Roche, a rambunctious toddler on vacation with her family, had tumbled from a couch, splitting open her forehead on a table.
On a quiet Saturday in May, nurses in blue scrubs quickly ushered the two patients into treatment rooms. The wounds were cleaned, numbed and mended in under an hour. “It was great — they had good DVDs, the staff couldn’t have been nicer,” said Emer Duffy, Orla’s mother.
Then the bills arrived. Ms. Singh’s three stitches cost $2,229.11. Orla’s forehead was sealed with a dab of skin glue for $1,696. “When I first saw the charge, I said, ‘What could possibly have cost that much?’ ” recalled Ms. Singh. “They billed for everything, every pill.”
(Excerpt) Read more at nytimes.com ...
I’ll set your broken leg for $100. I have no training or experience but I’m cheap! Hows that for a cost reduction plan.
My daughter is having an MRI in a few weeks. "Hospital and Doctor fees: $900 out of pocket (%20 co-pay).
I called, asked for the cash price: only a 20% discount off the billable price (the "insurance" price).
something did NOT seem right.
I asked why so much cost, spent an hour on the phone. The nice lady (she really was trying to be helpful, not some "I don't give a *&#(" type) plugged in my insurance info and the out-of-pocket shot up to $1350....???!!!
She said "I need to talk to someone, this doesn't sound right!"
She called back. The "system" was messed up and my actual out-of-pocket would be $300.
She was floored and worried that others would be paying the "messed up" inflated rates for other procedures.
I don't tend to believe in honest mistakes at that level.
The only difference is that he didn't have one of those cool machines to take the cast off . . . so used a string saw. I had a strip of raw skin for a few weeks after.
This is how ‘free’ care has been delivered to American’s poor - hospital emergency rooms... at top dollar. No one’s done without medical care... and the old bargain included nice fat tax write offs for the Hospital taking ‘Jesus cases’...
I can assure you - that system- which was stupid and expensive - will be a million times better than the horror ObamaCare will become.
I asked him where the money was going to come for that, and he told me it was going to come from the 3% tax on health insurance premiums. I told him I didn't think the numbers added up. He just shrugged his shoulders.
Hospitals signed onto this with dollar signs in their eyes. Oddly, they can't see that they will be the next lambs brought to the slaughter.
Actually just getting the government out won’t do it. You have to get ALL third-party payers out and go back to a cash-as-you-go basis.
Right now, with all of the paperwork and ridiculous coding games that go on in billing insurers, the providers of course are going to massively inflate prices to cover for those that will be denied for BS reasons, or sit as open receivables for 200 days while the games go on.
I recently had a routine surgery and spent 1 night in a local hospital. The hospital’s bill almost beat me home. For the use of the operating room (1 hour), recovery room (1 hour), and the overnight stay I was billed $15,000. The surgeon and anesthesiologist billed me separately.
“Bombs away - The White House has laid out its preliminary plans for a potential bailout of the insurance industry. The regulatory filing, flagged by NYT’s Robert Pear, blames the bailout on President Obama’s sudden reversal of his long-planned regulations forcing insurers to cancel millions of policies. Obama nixed his rules after a public backlash over his misleading promise to voters in 2012 about keeping their insurance policies and doctors. But the bailout, allowed under a little-known provision of the law, may also be in answer to industry outrage over the technical and administrative failures of the president and his team. With huge sticker shock awaiting holders of cancelled policies, many may opt out even after they make it through the crash-prone Web site. Any relief to insurance companies would come on top of $1 trillion in subsidies they are slated to receive over the next ten years.”
[Ready on the right - Sen. Marco Rubio, R-Fla., saw this one coming. He has a bill on offer in the Senate closing the door on insurance bailouts.]
About a dozen years ago, my daughter tripped over a hose that I had left in the driveway, and sprained her wrist. I examined it, said "no, it's not fractured, put some ice on it." My wife insisted on taking her to the ER, and they examined her, obtained an x-ray, said "no, it's not fractured, put some ice on it", gave her a wrist brace (that she used for about a day) and sent her on her way. The bill -- to our insurance company -- was $1,700. The out of pocket cost was $50.
Our (heavily subsidized) health insurance costs us $33/month.
If I were made king, I could fix this in about a day. Pretty much anyone with a basic understanding of personal economic behavior could fix it. The problem is, and has been, that the only thing politicians are capable of is making the problem even worse and worse.
LOL, beat me to it. We work around sheet metal in the xray business. A lot. We all carry superglue in our tool bags.
The federal govt mandated a change to the number of billing codes. The new standard is called ICD10 and allows for 68,000 different codes.
Complicated by the insurance company, state, legal and medical necessity requirements.
The system is so complex few people actually understand it.
Just about 3 years ago I went into the emergency room and ended up spending 8 days in ICU. Had a couple of surgeries, good pain drugs, and some really really pretty nurses (although that might have been the drugs). I guess I stopped breathing during surgery and most of my organs started shutting down.
Bill was $185,000 before insurance. They saved my life. I find that a fair trade.
I am a member of a Sutter Health group up here in Northern CA. I just went into the emergency room two weeks ago, with a cut. Took 3 stitches, billed me a total of 300 bucks, after insurance it was 12 bucks. That was for about 3 hours lying in the treatment room because the doc was so busy.
Getting all third-party payers out of the system would help, too.
One bottle of magnesium citrate at the ER costs $500 to patient after insurance pays its part.
One bottle of magnesium citrate at Walmart costs $2.
Or a catastrophe...
IMO people paying cash should be able to pay what the insurance companies pay. Which is typically about 20-25% of the “list price.” Instead the hospitals will hand the uninsured - the uninsured with a fixed address and a US birth certificate, that is - the full list price. Negotiation will typically bring that down by 20% as you were first quoted.
My suspicion is that it’s collusion between the hospitals and insurance companies - maybe people could scrape together what the insurance companies pay for a procedure or hospitalization but the list charges will destroy them. Not unlike Mafia insurance, except the cartel doesn’t actually burn down your store, but the law of averages will do it for them, figuratively speaking.
Hospitals make a profit on the insurance payments.
“”I applied superglue”
LOL. Dr. Mom. “
Don’t laugh. Several years back I cut open my hand. I took an aerosol can of air, turned it over and sprayed it on my hand. That froze the hand. My wife sewed up my hand (4 stitches) and I used some leftover amoxicillin I had in my medicine cabinet.
Never saw a doctor. I have a scar but it isn’t that bad. Sometimes you do what you need to do.
We have many institutional problems in healthcare.
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