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Clear Prices Can Constrain Medical Billing Epidemic
Townhall.com ^ | January 18, 2020 | Terry Wilcox

Posted on 01/18/2020 4:52:09 AM PST by Kaslin

At Tuesday's Democratic presidential primary debate in Iowa, the candidates admitted that ten years after the Affordable Care Act passed, healthcare costs are still unaffordable for ordinary Americans. Nearly two-thirds of adults say they've delayed medical care due to the fear of high bills.

They have good reason to be afraid. One-in-six non-elderly Americans have medical debt in collections. Over half are stressed by the cost of medical bills. It's now scarier to go to the hospital for financial reasons than personal health concerns.

A recent final rule issued by U.S. Health and Human Services that requires hospitals to post clear prices before treatments will help put patients' minds at ease. It will reveal the pocketbook impact of health services prior to care, so patients aren't shocked by the bills that arrive in the mail.

It's not only uninsured or open-heart surgery patients who are being devastated by stratospheric healthcare bills. Ordinary patients are routinely charged several thousand dollars or more for basic treatments. For median families earning about $60,000 a year, these bills are difficult to pay.

Consider the case of Carlos Ortiz, a gardener in Northern Virginia, who received a hospital bill for about $15,000 for tests to treat his dizziness. Or Zachary Bethune, who received a bill for $22,000 for some basic treatment for stomach pains. Donna Hernandez, a waitress in New Mexico, was charged $6,000 after being treated for the flu with two bags of saline and a couple of medications. Nina Deng, who fell off her bike in San Francisco and broke her arm, was charged $24,000. Heather Waldron was charged $2,000 for a feeding tube that costs about $20.

These are the faces of the country's healthcare billing crisis.

The proliferation of high-deductible health insurance, which now makes up about one-third of health plans, has contributed to the financial pressures facing patients. This "coverage" requires policyholders to pay the first few thousand dollars of annual healthcare costs out of pocket.  

The Srokas of Sterling, Virginia received a $937 bill for a half-hour hospital visit that included some ointment to treat their daughter's cut toe. The Smarts of Frederick, Maryland were hit with a $1,375 bill for a quick hospital visit to treat their son's ear infection. Both families had insurance but since the charges were within their deductibles, they were responsible for the entire payment.

Insured patients are also routinely hit with "surprise billing," which occurs when they are treated by out-of-network doctors working at in-network hospitals. According to University of Missouri economist Christopher Garmon, about one in five emergency room patients end up receiving such surprise bills.

Hospitals pursue outstanding bills aggressively. They routinely place liens on homes, seize bank accounts, and garnish wages over unpaid bills. According to a Kaiser Health News analysis, the University of Virginia hospital system sued former patients for outstanding bills for as little as $14 more than 36,000 times between 2012 and 2018. It garnished wages from Walmart employees more than 800 times. In the 2019 book, The Price We Pay, Dr. Marty Makary recounts how the local hospital had seemingly sued the entire town of Carlsbad, New Mexico.

Hospital prices are completely divorced from any underlying economic cost. Prices are regularly several times higher than Medicare reimbursement rates. This is nothing short of price gouging. And it's devastating ordinary American families across the country.

Hospitals can get away with this predatory pricing partially because they don't tell customers how much they have to pay until after treatment, putting the patient in a powerless position.

Yet the days of $1,000 bandaids, $10,000 tests, and $25,000 routine procedures may be numbered. HHS's rule requiring hospitals to publish their real prices will empower patients to choose less expensive alternatives.  

Clear prices are a necessary step toward finally achieving the bipartisan goal of making American healthcare affordable. At the very least, they will remove the unique shock that currently accompanies opening medical bills. 


TOPICS: Culture/Society; Editorial; Politics/Elections
KEYWORDS: surprisemedbilling
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1 posted on 01/18/2020 4:52:09 AM PST by Kaslin
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What the hospitals are doing is criminal in my opinion


2 posted on 01/18/2020 4:53:43 AM PST by Kaslin
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To: Kaslin

I just underwent bladder cancer treatment at Loma Linda University Medical Center. As of this date my insurance co.(Mutual of Omaha) has paid all but $3.40.


3 posted on 01/18/2020 5:03:40 AM PST by dearolddad
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To: Kaslin

It’s not only hospitals. Medical equipment supplies are through the roof. Mainly due to insurance reimbursement? I looked for an oxygen concentrator cover. 176 dollars, un-freaking believable. Looks like a garbage bag is in order.


4 posted on 01/18/2020 5:13:11 AM PST by OftheOhio (never could dance but always could kata - Romeo company)
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To: Kaslin
I had a routine set of blood and urine tests. The lab said the price was $1500. My insurance company said the contracted rate was $75 of which I had to pay $5.

Imagine shopping for a car where you can't see the sticker price until you've signed the purchase contract. The price for the car is $150k, but only $7500 if you have Allstate Insurance. You would say the car sales system is crooked.

5 posted on 01/18/2020 5:15:06 AM PST by KarlInOhio (Cutest internet video: Charlie bit my finger. Creepiest internet video: Joe Biden bit my finger.)
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To: Kaslin
My Dad was a country doctor in Appalachia. He charged $2 per house call. Although he had an office in our front parlor, most of his cases were house calls. Sometimes Dad was up 23 hours at a time calling on patients and delivering babies in the middle of the night..

He drove an old prewar car (maybe a Plymouth?) with a broken shift lever (not "three on the tree"). His shifted gears by kicking the stub sticking out of the floor.

There was no insurance back then. If a patient was unable to pay the $2, Dad would take barter, whatever you got — eggs, chickens, onions, whatever. If you didn't even have something to barter, Dad would let it slide and forgive the debt.

It was straight out of The Waltons. We weren't rich but by God we always had food on the table.

6 posted on 01/18/2020 5:22:59 AM PST by Governor Dinwiddie (Guide me, O thou great redeemer, pilgrim through this barren land.)
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To: Kaslin

The problem is that there are no consequences for the people involved in this egregious theft.

If the administrator authorizing the bill knew that he would be held PERSONALLY responsible for overcharging, this nonsense would stop overnight. No, I don’t mean being given a weeks paid suspension. I mean, literally, fired or worse. Maybe a good beating, public execution, torture, flensing, that kind of thing :).


7 posted on 01/18/2020 5:24:55 AM PST by Malsua
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To: Kaslin

Obamacare was purposely passed and implemented as a deceptive form of population reduction.


8 posted on 01/18/2020 5:27:33 AM PST by Openurmind (The ultimate test of a moral society is the kind of world it leaves to its children. ~ D. Bonhoeffer)
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To: Kaslin

If you have a heart attack or are diagnosed with blockage, it is not required for you to have bypass surgery and thus incur serious medical bills and debt

You can just die and get it over with


9 posted on 01/18/2020 5:28:28 AM PST by bert ( (KE. NP. N.C. +12) Progressives are existential American enemies)
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To: Kaslin
Had knee surgery a couple of years ago (torn meniscus while running). When I got the statement, it said the price of the surgery was 22500, BUT, because my insurance AND the hospital AND the surgeon are all one big company, the price was only 2500. Which tells me the actual cost and value of the surgery is 2500. (Didn't have to pay more than a couple hundred due to insurance).

Fast forward to today. Wife is diabetic. Insurance (out of pocket, etc.) reset on 1 Jan. Got a notice from pharmacy that insulin refill was in. Copay 1500!!! Called insurance about it and they said it was because we hadn't met the deductible or out of pocket yet. Pharmacy had a discount card that would bring it down under 500 (GoodRX did the same thing). Told them we didn't need it for a couple of weeks to send it back and we'll reorder. I reordered two days ago, picked it up yesterday, and copay was 100. Didn't ask, didn't question, just paid and left.
10 posted on 01/18/2020 5:33:11 AM PST by BikerJoe
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To: Kaslin

Bkmrk.


11 posted on 01/18/2020 5:34:49 AM PST by who knows what evil? (Yehovah saved more animals than people on the ark...siameserescue.com)
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To: Kaslin

great Tucker Carlson segment of HHS Alex Azar hammering hospitals for suing to stop regulations that they must publicly post prices for common medical procedures they provide:

https://youtu.be/d9Z5l8-uoAY


12 posted on 01/18/2020 5:40:37 AM PST by catnipman (Cat Nipman: Vote Republican in 2012 and only be called racist one more time!)
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To: Kaslin

Getting rid of insurance will constrain medical costs.

ML/NJ


13 posted on 01/18/2020 5:42:24 AM PST by ml/nj
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To: Kaslin

No one would believe the size and power of the industry which has arisen to parasitically feed off of the system of “reimbursement”.

With hundreds of entities that pay bills (maybe even thousands), tens of thousands of rules and guidelines, and zero resistance from the ultimate sources of funds (the government and employee benefit programs), the opportunities to tap into the revenue stream and skim literally billions of dollars are almost limitless.

And “criminal”? These guys own the people who write the laws. Every one of the leeching businesses has a “compliance department” to make sure what they do is (barely) legal.

People who defend this nightmare as “free enterprise” are living in the past. Free enterprise in “health care” is dead as a doornail.


14 posted on 01/18/2020 5:45:48 AM PST by Jim Noble (There is nothing racist in stating plainly what most people already know)
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To: Openurmind
Obamacare was purposely

No offense, but this subject has nothing to do with Obamacare.

15 posted on 01/18/2020 5:47:03 AM PST by Jim Noble (There is nothing racist in stating plainly what most people already know)
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To: ml/nj; allendale

“Getting rid of insurance will constrain costs”

Maybe that was sarcastic, but after practicing medicine for 40 years, I’ve concluded that reform is impossible.

If you thought of the existing “billing” structures as an invisible tax on all medical services, the purpose of which is to generate campaign contributions for permanent officeholders out of money set aside for people’s care, you wouldn’t be too far wrong.


16 posted on 01/18/2020 5:56:54 AM PST by Jim Noble (There is nothing racist in stating plainly what most people already know)
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To: dearolddad

Yeah, BLADDER CANCER, that’s the way insurance is SUPPOSED to work. Broken arms or ear infections shouldn’t cost as much as they’re billing for.


17 posted on 01/18/2020 5:59:19 AM PST by TalBlack (Damn right I'll "do something" you fat, balding son of a bitc)
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To: Jim Noble

Obamacare and the environment it created through the insurance companies and healthcare industry made the issue in the OP explode into what is now. So it does, it was the precursor for the inevitable result.


18 posted on 01/18/2020 6:03:29 AM PST by Openurmind (The ultimate test of a moral society is the kind of world it leaves to its children. ~ D. Bonhoeffer)
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To: Kaslin

an interesting shop

https://surgerycenterok.com/


19 posted on 01/18/2020 6:05:04 AM PST by mo ("If you understand, no explanation is needed; if you don't understand, no explanation is possible")
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To: dearolddad

“My insurance co”

Pretty broad, what type plan and what are your monthly premiums ?

I am guessing Plan F Supplement at 300 to 400 a month


20 posted on 01/18/2020 6:10:21 AM PST by Bell Bouy II
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