Patients face difficulties getting accurate estimates for procedures
Article Source: msnbc.com
from:msnbc.comWant to know what a hospital charges? Good luck
Seeded on Tue Jun 29, 2010 9:49 AM EDT (msnbc.com)
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In order to reform healthcare you need to reeducate the public. Patients often try to stock up on supplies to take home, they stay as long as possible to avoid being at home with kids and family to deal with even though it may not be neccesary medically. In other words if they're not footing the bill they don't care what the cost is. It is ridiculous. Many time the worst offenders are patients that consider Medicaid insurance and they never even see a bill. So they don't have any idea what the costs are nor do they care.
I disagree.
There are problems with patients. Susie just can't bear to let Granny go and insists the docs pull out all the stops, even though Granny is 95 and has emphysema.
350 pound patients who want knee replacements (that will also break down because the human knee can't handle that much weight day after day).
Etc.
But for the most part, patients are not why hospitals charge $65 for asprin.
I agree that patients in general do not do enough to inform themselves and think that co pay is the cost of health care. However, ask any doctor what removing an ingrown toe nail cost and they haven't a clue...their answer is tha the insurance usually coves that....what kind of answer is that?
I don't think there is such a thing as cost based pricing in healthcare...I am sure that doctors fees are based on what they figure the insurance co. will pay and not what it costs....if cost was the base of pricing for procedure, then it would look a lot different.
Also consider: we as the patients go to the doctor/hospital wherever with the least amount of information of any of the people involved it what is going to be done to you. The doctor doesn't know how much he costs, the hospital doesn't know how much they will charge you and the insurance company is going to do its best to pay the least. Each of these other parties have large lobbying groups to promote their interests except for who? The patient who pays the bill. Just goes to show again, when health care is based on profit, you will get profit.
I think that's a bit absurd and a very slanted way of placing blame on patients. Although I agree there are incidents as you describe, they are rare in the overall scheme of things.
My wife is disabled, and has had many hospital stays over the past few years. Although she dreads being in the hospital, and always want's to get out as soon as she is able, we have fought on numerous occasions with hospitals trying to discharge her befere she is ready. Her last hospital visit she had her Gall Bladder removed (unnecessarily). The surgeon "nicked" her liver in the process and she had to be transferred to a larger hospital for more surgery. Being disabled, she is on Medicare, as well as supplimental insurance we pay for. Because she was admitted for Gall Bladder complications, the average stay is 3 days. She ended up being there 2 1/2 weeks, and almost died three times. In between those harrowing days, the hospital tried three times to discharge her due to the standard "3 day" limit for Gall Bladder removals. During that time, she also had a mild heart attack & recieved two units of blood due to the leak in her liver. The day after the heart attack they tried to release her on a Saturday. With the help of the nurses, We were able to have her heart doctor come in on Saturday Morning and recind the discharge papers.
All these discharges were initiated by the floors "head" doctor who never saw her once, and only went by what the insurance company and hospital policies dictated.
This is not the first time this had happened with us, and we are not alone. Had my wife been discharged, she would not be here with me today. Cases like this are common, and often do not include the attending doctor's evaluation - only hospital and insurance company's policies. They are the ones who dictate care based on costs!
So before blaming the patients wanting "A break from the kids", take a look at hospital and insurance company procedures - You will find that there are too many cases where this practice is the norm!
I agree Shadowfax........(sorry your wife endured such poor treatment...she's not alone.)
That's the majority of the time.
I'm sorry you went through that experience. But why did you give the authorization for them to remove the gall bladder if it was unneccesary. No procedure is ever completed without consent forms signed. Patients need to ask more questions and be their own advocates. Surgery is never without risks and should always be a last resort (in my opinion) especially with patients that are already medically compromised.
If the guy cut a deal with the hospital to pay $8800 then thats the price he should pay. End of story. The hospital probably cut a deal with an insurer to charge $4500, so they have $4300 toward the fancy doo-higgy thing the doc used to fix the leg - now THEY need to negotiate with their supplier to cut the price to them so it all works out for them - or - they cut a bad deal - end of story. The hospital cut a deal - they have to live with it. Why is this so hard to understand? Perhaps the hospital needed to keep an eye on what the doc was doing in the operating room to ensure their costs were met.
i just had a stent put in my superior artery witch supplys blood to the top of the colon. cost........105.000 plus copay of 1500.00 i was in icu for 12 days !
The Whole System is RIDICULOUSLY HILARIOUS. HHmmm....Let me see: 22% Unemployed, george bushi's Two country, to start with, war - Iraq and Afghanistan and soon Paki and soon Iran, Which, as we speak, has cost We Americans $1Trillion - yes that's right $1,000,000,000,000 Dollars while REPUBLICAN Industrialists and Politicians send our young to their deaths and make enormous profit on their contracts and give the "up yours" to returning severely wounded and Broken young soldiers, Wall Street moneychanger shell game scam artists putting the globe into a depression as they profit and live in undreamed of wealth, Big Pharma Pushing ALL KINDS of "mother's little helper" drugs on Americans to keep them oblivioius to what is happening so they can't revolt, "A National Healthcare Overhaul" which is another scam for the health insurance robber barrons - The CEO of US Healthcare took home $128,000,000 for his 2007 annual pay - And other countries who have A National Healthcare System look at The US - US and just shake their heads....FreeMarket Unbridled Outlaw Capitalism which is now a sanctioned Corporate Kleptocracy - Think of another country like us which has the best National Healthcare System - PreBastille Paris 1789 and after that revolution the Evil Elite Were given their own surgery compliments of The Madam. Thirty five thousand elitist heads rolled the first year.
Not much you can do price wise when you are in an emergency; however, a more precise generalized list of common procedures would be nice if I have time to "shop" around for the right one. This could let me take into account a doctor's reputation as well as price when selecting who to do a procedure.
Well done Rep Kagan--this one statement has given you my vote!
Hospitals and clinics should have to provide fee schedules. Here's the CPT code for your procedure and here's the fee schedule listing the cost. Simple!
Some doctors pay attention to costs and what the facility charges others feel that this is not their job. They may suggest a course of treatment that is extremely expensive because they have no clue about the costs. Doctors need to be better informed, so they can give the patient all the information they need to make a decision about their care. Perhaps procedure X is the best, but it's outrageously expensive, so most people with or without insurance will choose procedure Y, which is adequate, if the cost is less. Even with good insurance there are still co-pays!
Our doctor was always good about asking what our insurance covered, especially with respect to prescription drugs. He tried not to see his patients raked over the coals.
I'm afraid he's a rare bird, unfortunately.
Doctors, hospitals and insurance companies are all thieves working together. The markups on most basic items can exceed 15,000 percent. I got a bill and noticed a charge of $65.00 for TWO aspirin. How can anyone in the Government not see that this is a huge problem. ONE teaspoon of an anstethic to deaden the pain in my throat was $125.00...YES I SAID A TEASPOON
so you know, this is how it works. They are all not crooks. I don't work for a hospital. I work for an oncologist. We bill 3 to 4 times the rate of Medicare. Straight across. No matter the treatment. I agree, that asprin being 65 is redonkulous, but if Medicare pays 16 bucks for them, then that's what they do. You have to also factor in the cost of taking care of you. Say two cc's of chemo drug costs us about 2 grand or more and Medicare only pays about that much, we take a hit. You can not imagine the electrical bill hospitals have or water bill, the cost of staff, maintaining the hospital, taking care of equipment, the cost of equipment. Its outrageous. For those of you who do not have insurance, you can negotiate a price. Ask to be reduced to the Medicaid fee schedule. If you want to double check on the costs, request the CPT codes, the diagnosis codes, you can go online on any site and get a copy of the fee schedule for your local Medicaid. My thoughts are if you had insurance, this is all we are going to get any way and we have to write the rest off, so how fair is it that an uninsured has to pay the higher pricing? Just an FYI.
The system is broken. Keep in mind that while the hospital charges you $65 for 2 asprin, they don't get paid $65 for two asprin. Even if you are self pay. That asprin also pays for the housekeepers, securtiy staff, nurses, radiology techs, and pharmacy staff that are all a part of taking care of you during your stay.
Yes we've all heard that these charges are made to cover other expenses, but I have a suspicion that that is an excuse being used to cover a multitude of pricing sins. What does the room rate cover?
I would rather see every charge listed separately. I can see aspirin costing more for having to be controlled and issued through the hospital pharmacy...$5 for two pills...
Kay is entirely correct. If there is going to be an extra charge for miscellaneous services - let it be listed there rather than being buried in the cost of an aspirin.
Right here, on this vine we are seeing exactly why health care needs reform. If health care is brought back to some semblance of honesty then the insurance costs will fall into line.
The real kicker here is that if your insurance has a deal with the healthcare provider the cost is y, but if your insurer doesn't have a deal with the provider the cost is four times y. Does it really cost the provider four times as much to provide services to the person whose insurance doesn't have a deal with them? There you are stuck because they only tell you this after the services have been delivered. I don't like tghe idea iof the government setting prices, but the health care market is broken and needs to be fixed. Just making everyone get insurance isn't going to fix it. 90 percent of American can't figure out their cell phone bill. How are they going to figure out a hospital bill?
You are right! I do medical billing for a nursing home/rehab facility. For an example, we will charge an insurance company $500 a day for a rehab bed, so that we have leeway to negotiate the cost down to $200 a day (our usual cost). My facility is not the norm, they don't charge someone without insurance the $500 a day.
Even if you have insurance you are not protected. A facility bills $1,000 for a procedure which between co-pay and insurance payment they expect to receive $250. But your insurer does not cover this procedure and denies it, you will be expected to pay the entire $1,000! How is this fair?
The whole system stinks.
I used to blame the insurance companies completely, but then I came to see how some big hospital systems essentially corner a market in a region by buying all the other hospitals out. Then they play hard ball with in insurers.
It is close to criminal.
Enma, you shouldn't bill the patient if the insurance tells you that it is not a covered benefit and the patient owes zero. At least I don't. You're right it isn't fair. For example if there is a limitation on aetna for a charge and it says the patient is not responsible, I write it off. But one thing you guys need to realize, a lot of times, we don't even know if it is payable or not until we already bill it. The insurances do not always provide that information. I always call and check on the patient's insurance and tell them what we are performing before we do it, but some times this happens. I always tell the patients that they should know what their benefits are. If they have questions, please ask and I will help, but WE as insurers and non- insurers are responsible to take action and gain better knowledge of how the system works and work that way instead of getting the bill and complain because you were not told. YOU HAVE TO ASK!
Nobody would buy groceries or clothes or a car without knowing what the prices are. But when it comes to healthcare, most people are walking around with an insurance card that amounts to a charge card with a $1 million limit and a fixed monthly payment no matter how much you spend. So, everyone simply demands the best and doesn't care what the prices are because, in their deranged fantasy world, they imagine that some corporation somewhere is getting stuck with the bill.
On the other side of this equation is a healthcare industry that is capitalizing on the fact that, in America, the healthcare business model is a legalized form of "your money or your life". The profits that pharmaceutical and healthcare corporations generate are beyond sinful while the insurance corporations provide networks of dealers and reap a steady percentage of the take.
No doubt, organized crime must be green with envy.
My hubby would approve. He refers to his most recent experience as "white collar crime."
That your money or your life thing is a major culprit, more so that patients' demands (IMO).
Our son's delivery was attended by a neonatologist who charged over $150 a MINUTE to assess him and give 1 minute and 4 mintue APGAR scores. And that was in the late 80's. I can't imagine what they are charging now. I was totally blow away by that bill.
Seriously, something cost less in the '00s than in the '80s?
We had a neonatologist present for our daughter’s delivery last year. She was really just on stand-by since our daughter had a potential issue, and we weren’t sure if she’d need immediate attention. I guess she didn’t really do anything, but for her 30 min she only billed $80 which became $51.47 with the insurance company’s rates.
FEDFL,
You are brought into a hospital after a heart attack or stroke, HOW THE HE!! ARE YOU GOING TO PRICE SHOP. Explain that to us BIG MOUTH??????
My son is uninsured and was sick one night from eating something. He was taken to the emergency room (I know, big bill for that) and was there for 3 hours and given an IV. Total bill was $5,600 big ones. On top of that the individual doctor sent another bill for $650 dollars. He spent 4 minutes talking to my son. I can't imagine how an ER visist for an IV could cost that much. He is currently looking for insurance here in Florida. Anyone know of a low cost insurance for a young man? thanks
Next time, use an emergicare center. It won't be cheap, but it won't be $6000.
Hay seriously stupid,
You are in great pain, don't know what is wrong, You go where you can get treatment. Emericare is for cuts and coughs.
I wonder if said Dr. is getting a kick-back from some company to use that procedure, or if he's trying to accumulate cases to publish a paper.
I work for a manufacturer of hospital supplies so I see the costs to hospitals at the source. Although the margin of profit for suppliers is not high, over time, costs have increased due in large part to the layers and layers of middle men. Case in point is the flourishing business of GPO's (Group Purchasing Organizations). These organizations began cropping up about 20 years ago as a way for individual hospitals to band together as groups in order to negotiate better pricing from suppliers. Today, these organizations have taken on a life of their own, dictating to their members which suppliers to buy from and and taking a rebate from suppliers in the process. Also, suppliers like to "bundle" products which allows them to sell larger volumes of products to hospitals, even if they don't need them. The buying group negotiates with the manufacturer and works out a deal, then hospitals must live with that deal or go to another buying group...which does exactly the same thing.
When hospitals became for-profit, instead of non-profit, hospital care began to increase and has done so ever since. Why don't we go back to the days when suppliers set a price for their products, then let hospitals pick which products they want to buy? Goodbye middleman, goodbye attorneys, goodbye contract negotiations and all the headaches that go with them.
Hospitals charges are not based necessarily on the price of the item but more of labor cost + Cost of Building and equipment etc. so it is more like how much they are paying the nurse hourly to give you an aspirin for 5 minutes not just the cost of the aspirin.
and yes there should be a case rate like medicare does for hospitals, but the truth is hospitals dont like this model because it forces them to be more cost efficient and they dont like that
It also forces them to be accountable and to have more transparency in billing - two things they really, really don't want.
Hospital charges are based on those who WILL pay and those who WON'T pay....Those who WILL pay are charged 5 x's for the procedure to cover the percentage on NON-paying customer...........I'm sorry, but if more people were turned away from the ER with scratches and soar throats and told to see their primary care physician the next day.....it would cut down on a lot of unneccessary costs.
Exactly my point!!! People don't pay for insurance and show up in the emergency room because they don't want to spend $3 on a generic form of caladryl lotion for the hives. I recognize that many people people choose not to have insurance and do pay their bills however, there is a huge segment of the country that has made using the system a full time job and they know exactly how to get the rest of us to pay their expenses. No doubt Healthcare needs reform but I still say our points of view need an overhaul also. We need to lead healthier lifestyles, not expect to keep people alive well past their expiration date and ask questions about the care we are receiving and if there are alternatives. ASK QUESTIONS PEOPLE!! If your Doctor isn't willing to give you the answers you want then look for another one.
The charges at most hospitals far exceed the actual cost of services, due to the onerous practice of "cost shifting." Hospitals charge insured patients and those who pay out of pocket excessive amounts to cover those who cannot pay and to make up for supposed "losses" on Medicare and Medicaid patients. As long as hospitals and other providers are allowed to engage in this robbery of certain patients, there is no incentive to bring down health care costs. They just keep "robbing Peter to pay Paul" and go on their merry way.
If the practice of cost shifting were prohibited by law, it would force a resolution to many of the current health care problems. But the rich and powerful health care lobby will never let that happen.
I do accounting for a nursing home. It is a myth that there is no money made on Medicare and Medicaid patients. On Medicaid, you generally don't make much, sometimes barely enough to break even and each state differs in how their Medicaid dollars are spent. However, on Medicare the profit and loss is ever changeable. Some Medicare residents we make good money on, some we lose quite heavily. However, bottom line, Medicare is usually well in the black.
There is a lot more that goes into cost shifting than Medicare. No one, including private insurers, pay the full bill for caring for the critically ill. That cost is shifted to other patients. It is not jut nursing or other patient care providers that are factored into the charges on some items. The massive administrative apparatus that our insurance based health care system forces on providers must be paid for. Add in the hours spent by clinicians on peer to peer insurance reviews and appeals that clinician have to spend time on to get authorizations for patient care.
That is another fallacy. Hospitals don't set the rates The Insurance Company does. They have a set rate for each procedure and every patient. Regardless of what other complications might be going on with that patient the rate is set at what a normal healthy adult recovery would be like. Say 3 days for an abdominal surgery. However, if an 85 year old woman has her belly cut into she is not going to recover in 3 days and the hospital eats the rest of the stay normally at least 2x that length. Every Insurance Company has a payment amount they will pay for every procedure they agree to cover and the hospitals agree to except it or not take that insurance.
This is a very perplexing situation simply due to the way our billing system is set up with healthcare and the companies in the middle who make big dollars from the transaction processes to audit and submit claims. That is a huge chunk of what we pay for healthcare. The more complicated billing became, additional 3rd party companies appeared and thus their charges grew larger as complications grew. Many are now owned by private equity firms outside the US so profits don't even reside in the US all the time. This post reflects some of this.
http://ducknetweb.blogspot.com/2010/05/how-big-are-private-equity-investments.html
Also somewhat new on the scene are sites where a consumer can put their procedure up for bid and you sometimes wonder will sites like this be an enabling factor in being able to project what your cost maybe. This is one of such sites I wrote about recently, like a price line for doctors as we buy airline tickets.
http://ducknetweb.blogspot.com/2009/11/deal-or-no-deal-pricecom-launches.html
What in the world is a 63 year old man doing riding a motorcycle without health insurance? And why did this man have some type of insurance to cover him in case of an accident? Some about this story smells to high heaven. I ain't buying it! Look at the details of this story. No health insurance, yet he can afford an attorney! You'll also notice you can't go back and look at the story without being kicked out. You have to start over reading the story in order to make a comment. This story stinks! This man most likely has the resources to pay the bill. He just want to play the "Woe is me" card. Sure, there are patients who feel they are slighted by hospitals. But the way this story is being played, This ain't one of them. I just don't like how Mr. Rose's plight is being presented to us. I don't feel sorry him. NOT ONE BIT!!!
Paranoid much?
Thing is, any story you put up can be believed because of the lack of a healthcare system in this country. He could have a lawyer by calling a number off the TV that promises not cost to you if they don't get you money...doesn't mean he is good, just that he can be called a lawyer. Be sure, you have no power when it comes with dealing with any level of this so called system and you should be afraid, very afraid, of it for it will get you one day, whether you have insurance or not...I have learned from hard experience, not unlike many who have posted here.
How about we the people file an initiative, get the signatures, and vote to create our own health care transparency law here in Washington State!?
Do you have an legislator who will push the bill forward...we don't have any of that brand at a national level
On Dec 21 2009 I had my left jaw lymph node removed.
Sat right there at admission while the person called my insurance, and negotiate $4,800 leaving my % payment at $1395 which Mr Visa handled for me.
About 2 weeks after I get a "don't pay this - insurance submition only" in the mail for $28,000 -- WTF?
I was scheduled for release the next day before lunch [surgery was at 7am previous day] but my doctor what late from surgery by 3 hours. So like a late hotel, say 200-300 more on the $48,00.
Ok, I was asleep but it stubborn so a little extra dream juice , say 200-300 more.
And morphine sure is nice so 3-4 *extras* say another 300-400 more.
Where did the get this $28,000 from all of the sudden.
My opinion, I had a binding contract for $4,800.
What is worse......no itemized bill so I could see the dream juice, morphine, late check out, etc charges, just something like the phone companies do and get a way with ---- SEND US MONEY OR ELSE.
The bozos in DC are not any help of truly fixing problems...they are part of it.
They have money ties to everything - oil/gas/pharmacy/hospital........etc.
Remember a *patient cured is a customer lost*.
$10,000.00 more added to Bill Rose’s bill, what a surprise, NOT. If it were me I would put a five dollar check into the mail once a MONTH and pay it off.
Yeah and you would get sued and have your paycheck garnished and your credit ruined.
Sprayeir
NO in fact I would NOT. As long as I show that I am trying to pay that is not going to happen. If that were the case then millions of Americans would have this happen. There is always bankruptcy is all else fails. I see the bill that Bill Rose got as a breach of contract but for you butt kissers that is alright.
Healthcare costs are not subject to paycheck garnishments. As long as you pay a minimun amount each month the Hospital cannot report you to the credit agency. Also Healthcare bills are not considered in credit scores.
Wrong Kev, medical bills can and will jack your credit score up like no ones business. They too turn you over to collection agencies. Try not paying a medical bill then get back to me after they have screwed your credit up.
Yeah, you are correct if you make your payments on the agreed upon payment plan they cannot. My point is no hospital in their right mind is going to agree on $5 a month payments for a 18,000 bill. If you are delinquent on your hospital bill it can and will be reported to the major credit bureaus and will affect your score. As far as garnishing wages that is not federally regulated and done state to state. You need to check your resources. Yes people all over the USA are suffering from credit problem and wage garnishes due to unpaid medical bills. You really need to do your research.
Sorry, Iuvenia I thought your comment about send 5 bucks a month was pretty funny. When I said you would get sued and what not I was trying to say how messed up the system is and how little protection there is for people that get injured and have outrageous medical bills. You all enjoy the rest of your day.
My wife was mis-diagnosed by a doctor. Said she needed her appendix out immedietly due to rupture. Funny thing was, I'm no med student, but I know where the appendix is and she was feeling for it on the wrong side. Not to mention she only had one of several symptoms (a fever)
Things sounded fishy so my wife went for a second opinion and found out she had pneumonia (BIG difference). After talking with the doctors office on the misdiagnosis, we were still told we had to pay. We made the decision to refuse payment and indeed got sent to collections; however, I refuse to pay a doctor who doesn't know her ass from her elbow.
Attempted to correct issue by following recommendations to report the doctor to whomever you do that to for stuff like that and was told they could do nothing, even though this doctor has multiple claims against her.
Aren't we glad we have something that we can call a system...each state is different, each city is different, each hospital is different....and we put up with it, well maybe we have to but it is a disgrace that we have such poor health care
In this article it said the doctor was not a hospital employee and he most likely wasn't thinking about fee's or charges when he decided to perform the procedure that wasn't always needed. Last I checked surgeons are very smart, and also very rich. I'm sure fee's and charges were on the top of the list of things he was thinking about. Hmmmm, here is what said surgeon was thinking. Oh there is a little anomaly on this bone segment let me spend an extra 20 minutes getting this done even though it's not really going to affect the outcome of this procedure but I will bill the hospital $10,000 for it. Sweet this peon patient just bought my wife a mink coat. Mwaaaahhhh!!!
Funny. And most likely true. :(
I recently had a kidney stone and went to the ER for pain treatment. This was my second kidney stone, so i knew what the diagnosis was going to be. They did a quick blood test to determine that I was suffereing from a kidney stone and not a drug seeker. Then they gave me a shot of morphine. Then they Dr decided I needed to have 2 MRI's and I was discharged 2 hours after triage. I received the bill in the mail two weeks later for $8229.60 That is why health care costs are skyrocketing. The Dr.s just do whatever and the customer has not any say in treatment plans. The 2 uneccessary MRI's were over $7,000. I have insurance and my out of pocket costs are $1868.89 next time I should just seek a heroin dealer and pay $100 or whatever for the injection to get me over the initial pain and then pass the stone.
Kevhouston740
You are not far off when it comes to the next time. When my husband had his last kidney stone the doctor gave him some pain pills and sent him home. A man living close to us said that he had one every year or so and just got stoned until it passed. Either way it is a LOT cheaper than the hospital.
They (MRI's)cost $600 in Chile, for example.
MRI's are a scam. Doctors have developed the ethical mores and values of garage mechanics: "Wow, it's a good think you came to me when you did."
My father-in-law is a garage mechanic and he's bout as honest as it comes and charges a fair rate (at least 50% lower than any garage in the area). Now if you were talking about dealerships, I'm with you on that one. Knowing a lot of local mechanics in my area, I can say they are pretty honest or at least fairly priced.
And, they know they have to compete with each other, doctors are too worried about the next fur coat....hehe.
We have abdicated cost control to the insurance companies which has given them the leverage to control the debate.
No one can make an informed decision without the pertinent data which is almost impossible to acquire. Had health care reform actually tackled this issue, many of the others would begin to resolve themselves.
God help anyone who doesn't have insurance and needs any sort of care beyond an office visit.
The growing problem now is the increase in deductibles and copays which is how the insurance companies are quietly shifting the costs for insuring those they weren't inclined to insure before.
As long as costs remain undiscernable to the average person, we are at the mercy of the insurance companies and the cycle of dependency and excess will continue.
I agree with you to a point.
In some areas, however, insurers are at the mercy of the large hospital systems. For example UPMC owns and operates nearly every major medical facility in Pittsburgh as well as the surrounding suburbs in all directions. So over 1 million people in SW PA are likely to go to a UPMC facility for nearly everything.
This puts the power in UPMC's court. The insurers will take what UPMC is willing to give, or be locked out of the entire market. No one wants insurance that now major hospital in the area will accept.
This is more common than you would think.
When will the medical community figure out that the reason why beneficiaries allegedly "don't care" about cost is because it is impossible to get reliable estimates? Medical providers are the ones actually insulated from costs, not beneficiaries. And just because some beneficiaries allegedly don't care about costs doesn't mean *all* beneficiaries don't care about costs. So why does the medical community feel that because the alleged majority of beneficiaries don't care about costs as justification for not providing information to the minority who do care? Is that minority considered chopped liver?
I had some numbness in my face and it freaked me out so I went to the doctor. I have insurance and it's not that bad of insurance either. I had an MRI done, some blood work done, my MRI was looked at by them people then sent to another neurologist. I had to come in for another MRI but this time on my back. I was sent to another doctor who took more blood work. Then sent back to my doctor after several appointment and was told "oh we don't see any thing wrong sometimes it's normal to have numb areas of the body". This was 1 year ago and I still have a numb fricken face and am still paying the bills for it. My insurance covered most of the expenses but still cost a lot out of pocket. The first MRI bill was $1800 my portion was about $600. The second one was $1200 and my portion was about $400. I kept getting all these little added bills by different specialists. Like $157 for this doctor. $87 for this lab. Not to mention about 6 appointments all wanting a co-payment. This is the only time I ever used my insurance in 5 years. My job pays more than $200 a month for me to be insured, they have gotten probably over $10,000 from my work. I've paid about $3000 in payments. All this work that I had done, I was getting bills ever day for a couple weeks from different labs and doctors. I thought I had received all the bills but they just kept coming in. I'm scared to go to another doctor about my face and it has spread to other parts of my body. AND I HAVE INSURANCE!
I really feel sorry for you because I feel the same way, but it is clear
Insurance does not equal healthcare.
There has to be a better system than this...
I have MS - so I understand completely.
MRIs, blood tests (some really, really expensive ones, too) lumbar punctures, neurological assessments, etc. Lab bills, radiology bills, neurologist bills, facility fees, pharmacy bills. It goes on and on.
Been there, and still am there.
Fun, ain't it?
Admittedly some providers do a much better job at fair billing than others, but few mention the high cost of legal protection insurance, and ridiculous law suit settlements. Why blame health providers alone, when many factors add to the problems?
It seems that the government likes to publicly demonize insurers and anyone that stands in the way of "their view" of progress. In my opinion, we need to take a LONG look at how lawyers operate also, and how their buddies (and often colleagues) the politicians, manage to head-off any meaningful law reform that could help lower costs for hospitals, doctors and patients alike, and still protect those that have been harmed.
How many erroneous tests and procedures are performed "just in case" a legal situation could arise in the future? I believe that the US has one of the highest ratios of caesarian births in the developed world – easier to leave mothers with lifelong scars than to fight a birth defect lawsuit that may (or may not) have been caused or worsened by a decision from a doctor to proceed with a natural birth.
I come from the UK where there has been a national health system since WW2, and can assure the US public that service WILL suffer. Imagine waiting several months for an appointment to see a specialist? Or not being able to change doctors because no other will accept you – unless you are new to the area when they HAVE take you by law, or waiting two or three years for a hip replacement! As they say... be careful for what you wish for!
Ugh, this topic gets me so riled up. What are ya gonna do about it though? I'm thinking about becoming a hippie and doing all the herbal things and chiropractors and stuff. Screw this western medicine crap. I can picture the CFO, CEO, PRESIDENT, HEAD SURGEONS, MEDICAL LOBBYISTS AND PHARMACEUTICAL COMPANIES all on a yacht together drinking 500$ glasses of liquor laughing their asses off trying to think of how they can squeeze more money out of society. k, I'm done here good luck folks, whatever you do don't get hurt insured or not you'll still get screwed.
I always try 'home remedies' before going to the doctor for non-life threatening issues. Colds? Why go to the doc? Couple of days of bed rests lots of liquids are all they are going to tell you anyway. But what if it's the flu? So what? Same recipe for recovery. Most things that people go to the doctor for could be cured if they talked to friends/family before spending unnecessary bucks to be told to chill at home for a few days
Most people? Aren't you over stating your case a little?
Do you realize that 1 in 4 adults in the US will get some form of cancer in his lifetime? Bed rest ain't going to cut it with cancer.