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Started By
Message
re: Everyone should request an itemized hospital bill, it is really interesting
Posted on 4/24/24 at 9:51 am to WhiteMandingo
Posted on 4/24/24 at 9:51 am to WhiteMandingo
quote:
Just imagine how low your insurance would be if 70% of the country wasn't on government Healthcare insurance.
It'd be about the same. The fact is that the uninsured and underinsured, no matter the reason, receive medical care because most providers will provide care because society expects it of them....anytime a story is released about someone being denied service folks get up in arms and raise hell. The only source of revenue for providers is paying customers....paying customers are going to either subsidize the uninsured or underinsured directly or indirectly....there ain't no free lunch.
If anyone doubts this please, please explain the number of debt collection agencies that are omni present in every medical community in the US. If the underinsured or uninsured were not being treated there would be fewer collection efforts.
We would all be better served financially if we simply eliminated the debt collection costs we all pay...and the way to do that is provide basic health insurance to everyone. Those of us who pay our own way are already paying for those who can't or won't...again, providers are expected to provide and the debt collection industry tells the tale....simply removing most of the collection effort costs would lower everyone's costs. Its bad enough to pay for someone else's health care, why we insist on also paying for chasing bad debt that is never going to be collected is a mystery....
1
Posted on 4/24/24 at 10:01 am to Ten Bears
quote:
Doesn't matter. Pricing should be pricing, whether a person has insurance or not. Otherwise, it is a racket.
Name one other business model that operates with such a discrepancy between pricing models?
Anybody want to know why? Back in the 70s and early 80s, almost all plans paid 70-80% of charges. 20-30% was coinsurance that the patient was responsible for. They paid 70-75% if you chose an out of network provider (really this wasn't till later 80s) and you paid more. In 1982 TEFRA (Tax Equite and Fiscal Responsibility Act) was passed by and that was the beginning of the DRG system where Medicare pays by diagnosis, rather than charges. This caused hospitals to completely change the way they did a lot of things. Patients went home sooner because you made more money if they did. The idea was that hospitals would operate more effeciently if they knew they got a flat payment no matter what. And they did. There's a lot more payment nuances, but through time, insurances went to similar methods of payment, but most of them switched to a per diem (per day) as most of their patients were healthier and had short stays.
So yes, began during Reagan and mostly pretty good legislation. But healthcare wasn't always like it is now. Remember the rule...you can pick 3, access, cost, and quality/technology, etc. You can't have all three.
Posted on 4/24/24 at 10:43 am to Scruffy
quote:
Because, whatever amount that is charged, your insurance company will pay 25%.
Tricare is the worst. I've had procedures that Dr will bill $1200-1500 and tricare wil pay $45.
You cannot get a plumber for $45.
Posted on 4/24/24 at 11:17 am to GetCocky11
I randomly get a copy from my health insurance or the state (since I am on Medicaid) asking me to verify the charges.
It’s interesting seeing a specialized MRI, for example, billing around $10K and the reimbursement is listed as like $250.
As expected with LA the return envelope does NOT match the contents so in order to respond I would have to get another envelope and find a stamp… not happening!
It’s interesting seeing a specialized MRI, for example, billing around $10K and the reimbursement is listed as like $250.
As expected with LA the return envelope does NOT match the contents so in order to respond I would have to get another envelope and find a stamp… not happening!
Posted on 4/24/24 at 11:41 am to GetCocky11
Gotta pay for the pillhead tweaker in there looking for pain meds or the illegals in there with a fever and runny nose somehow.
Posted on 4/24/24 at 12:01 pm to LaLadyinTx
quote:
So yes, began during Reagan and mostly pretty good legislation. But healthcare wasn't always like it is now. Remember the rule...you can pick 3, access, cost, and quality/technology, etc. You can't have all three.
The old quick, good, and cheap, and you can only pick two.
Posted on 4/24/24 at 12:06 pm to AwgustaDawg
quote:
It'd be about the same. The fact is that the uninsured and underinsured, no matter the reason, receive medical care because most providers will provide care because society expects it of them....anytime a story is released about someone being denied service folks get up in arms and raise hell. The only source of revenue for providers is paying customers....paying customers are going to either subsidize the uninsured or underinsured directly or indirectly....there ain't no free lunch.
If anyone doubts this please, please explain the number of debt collection agencies that are omni present in every medical community in the US. If the underinsured or uninsured were not being treated there would be fewer collection efforts.
We would all be better served financially if we simply eliminated the debt collection costs we all pay...and the way to do that is provide basic health insurance to everyone. Those of us who pay our own way are already paying for those who can't or won't...again, providers are expected to provide and the debt collection industry tells the tale....simply removing most of the collection effort costs would lower everyone's costs. Its bad enough to pay for someone else's health care, why we insist on also paying for chasing bad debt that is never going to be collected is a mystery....
BETA Page
After several years of working and paying for insurance and seeing how it goes down, I agree with this. It will be paid for one way or another. I think basic universal care (largely preventative) independent of an employer would be a good thing.
To the OP, I use a high deductible plan with a HSA. I find some providers expect to be paid for the intended service up front when my deductible hasn't been met. Thinking I'm going to start asking them for an itemized breakdown of what I'm paying for upfront. I'm going to have to get whatever they state, but they should have to show me what I about to pay for.
Posted on 4/24/24 at 12:09 pm to BilbeauTBaggins
Malpractice kills about 700 people a day in America so it's not exactly like doctors shouldn't have to answer for, oh I dunno, killing someone? Their malpractice insurance shouldn't have anything to do with my Healthcare costs.
Posted on 4/24/24 at 12:35 pm to LaLadyinTx
…and to get them to pay after billing them over and over may be as simple as submitting the CPT codes in a different sequential order. It all seems very arbitrary.
Posted on 4/24/24 at 12:37 pm to LaLadyinTx
AND… Most of these rates have not been renegotiated and/or have only been cut since TEFRA
Posted on 4/24/24 at 12:38 pm to Corinthians420
Just tell the hospital you don't have insurance and you want to pay.......You'll pay what the insurance Company would pay ......in cash of course.
Posted on 4/24/24 at 12:57 pm to GetCocky11
Rest of the civilized world: "What's a 'hospital bill'"?
Posted on 4/24/24 at 2:57 pm to DakIsNoLB
3 times in the past year my wife or I had minor surgery...each time the hospital, of all people, told us up front what it might cost us out of pocket. Its a shocking number each time but they make certain to mention that is the cost, what the contract price is and what our policy covers is not considered...it is an estimate of what the procedure may cost out of pocket. This has lead us to contact our insurance company...which is a good thing. Everyone is aware of what they are getting into...and it gives consumers an idea of what things actually cost which may, possibly, with an outside chance, cause some price stablization if not cost cutting....its far better than having no idea and thinking that outpatient procedure cost the $150 co-pay as many probably think.....
Employers should also tell employees how much their health insurance actually costs....most people see what is deducted and think that it all it costs. That is generally not the case....most employer plans have an employee portion and an employer portion. Everyone should be fully aware of what things actually cost, who knows, it might drive down prices or at least make people think twice about lifestyle choices that cost a fortune in health care....can't hurt
Employers should also tell employees how much their health insurance actually costs....most people see what is deducted and think that it all it costs. That is generally not the case....most employer plans have an employee portion and an employer portion. Everyone should be fully aware of what things actually cost, who knows, it might drive down prices or at least make people think twice about lifestyle choices that cost a fortune in health care....can't hurt
Posted on 4/24/24 at 3:51 pm to AwgustaDawg
quote:
3 times in the past year my wife or I had minor surgery...each time the hospital, of all people, told us up front what it might cost us out of pocket. Its a shocking number each time but they make certain to mention that is the cost, what the contract price is and what our policy covers is not considered...it is an estimate of what the procedure may cost out of pocket. This has lead us to contact our insurance company...which is a good thing. Everyone is aware of what they are getting into...and it gives consumers an idea of what things actually cost which may, possibly, with an outside chance, cause some price stablization if not cost cutting....its far better than having no idea and thinking that outpatient procedure cost the $150 co-pay as many probably think.....
Employers should also tell employees how much their health insurance actually costs....most people see what is deducted and think that it all it costs. That is generally not the case....most employer plans have an employee portion and an employer portion. Everyone should be fully aware of what things actually cost, who knows, it might drive down prices or at least make people think twice about lifestyle choices that cost a fortune in health care....can't hurt
An estimated cost is one thing (which I always have received), and itemized breakdown is another. The specific instance in question was ear tubes for my daughter. They quoted an estimated amount and wanted it all upfront before admitting her for the procedure. Again, I went through with it and paid for it, but as a matter of principle, I'll ask next time for exactly what I'm paying for. I speculate that this demand for upfront payment is due to too many people getting high deductible plans for the lower premium, and then getting sticker shock when they go in for something and don't understand what a deductible means.
I can't speak for all employers, but all of mine to date state the employer's share and the employee's share in the benefits handbook when hired. I do think, even if they don't give a hard number, employees should be told their employer's carry a portion of the cost.
Posted on 4/24/24 at 5:07 pm to GetCocky11
IMHO it matters whether or not the hospital is making an obscene profit or is just squeaking by. If they are making an obscene profit (very few do), then they are overcharging on these line items. If they are just squeaking by, then what is your solution? Close the hospitals? And yes you can say "be more efficient" to your non-tax paying hospitals who are just squeaking by, because they do waste a lot of money. But the "for profits", who have researched every way there is to be more efficient and are still just squeaking by, I don't see a solution. Bottom line is that every hospital has to make a profit to stay in business and the vast majority are not making much.
I had an argument with a "non-profit" hospital COO once. He was saying, "it only takes 15 cents to run a CBC". Told him every study I've seen and been involved with says it takes a minimum of $6.50 to run a CBC. He acted like the only cost was the reagent, he had no clue.
I had an argument with a "non-profit" hospital COO once. He was saying, "it only takes 15 cents to run a CBC". Told him every study I've seen and been involved with says it takes a minimum of $6.50 to run a CBC. He acted like the only cost was the reagent, he had no clue.
Posted on 4/24/24 at 5:13 pm to jeffsdad
quote:
You don't think they are attempting to be profitable?
I don't think their tactics are like any other business
Posted on 4/24/24 at 5:32 pm to Scruffy
Insurers pay less because it costs nowhere near what they charge to provide the service. Insurers have purchasing power and negotiate a rate where the medical provider still profits but not at a 100% margin or greater. Again it just shows they are screwing you. I remember when our first child was born they charged us $900 for two ibuprofen. No joke.
Posted on 4/24/24 at 5:35 pm to MRTigerFan
True
Posted on 4/24/24 at 5:37 pm to CDUBTX
100%? I assume you mean a line item and not overall.
Posted on 4/24/24 at 5:53 pm to jeffsdad
I mean they’re charging at least double or more their actual cost so technically 50% profit or higher. In some cases I think it’s even higher than 50%. If they send me an emergency room bill for $10,000, then I would bet their true costs are a good bit less than $5,000.
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