And the Government thinks they can fix this mess? If it wasn't so bad it would be totally laughable!

Background info: I'm mid 50s, excellent health, no prescription meds, just daily vitamins, nonsmoker.

July 2016 I had a nosebleed, left nostril, very high up. Went to the ENT doctor, said he needed to see it when it was bleeding. He said next time it bleeds, come straight in (about 3 miles away). Paid office visit.

Next day, it starts again, it's gushing, go to straight to ENT doc, he says it will be uncomfortable to get it to stop in office (due to how high up in the nose it is), recommends going to hospital, quick procedure under general anesthesia. I agree.

Go to hospital, fill out forms, pay $1500 up front. Doctor comes, an hour later I wake up in recovery. Nurses are wonderful and to this day no more nosebleeds.

The billing starts:
We paid the ENT and Anesthesia bill, about $700 total.
November - I get a bill showing the hospital charges to be $23,722, (yes, $23,722) we are responsible for $4300! I call the billing office and the lady says I need to ask for a review of the bill "this doesn't look right".

December - I get a bill, showing we are responsible for $23,722, I call the billing office (major runaround) and they said the insurance company took back their payment. Further investigation shows the insurance co and their share was different from the contracted amount by $5(!), so they took all their payment back. THE INSURANCE COMPANY AND HOSPITAL ARE OWNED BY THE SAME PARENT ORGANIZATION.
I get an itemized statement (with medical codes) and show it to two of my doctor friends. They are amazed.

January - I get a bill showing I owe $4300. I call billing office and ask for information on what the codes mean. They say my bill is "on hold" as their billing office is reviewing it.

Feb, March & April - I get same bill ($4300) for three months. I am told bill is "on hold" and the business office is reviewing it. In Feb I am told as a result of this review "You may not owe anything more".

May - I get a phone call saying the billing review is finished and I owe $4300. I finally get the phone number of the Hospital Director of Revenue and speak with her. I ask her what some of the codes mean and she helpfully tells me. The biggest charge is $4600 and that is for the operating room, first 30 minutes. The next biggest charge is $3600 for the next 30 minutes of operating room time. I ask her if it is normal to charge $18,000,000 per year(!) for an operating room, she asks where I got that number, I explain their hourly charge, times 2,000 hours per year equals $18,000,000. She stammers and ask if I have any more questions. I said that I would like a face to face review of my bill of every charge over $100 and that I wanted to know what the item is, how much was administered and in what size they purchase the item in.
She says she will review with the hospital CFO and call me back.

Three days later I get a call that I owe nothing more and they are writing off the balance. I later get a statement showing zero balance

I know this is a game, but it's a stupid inflated cost game where jobs are created to perpetuate the game. If the hospital charged levels it will accept in the first place think how much better it would be for consumers.

In all the time this has been going on:
The hospital closes monthly profit/loss books and yearly books. How do they really know what their revenue is? Granted this is insignificant $, but I will bet anyone, any amount that this is not an isolated case.

And the US government thinks it can fix this mess? hahahahaha

You done good. Now check your credit to see if they screwed you. If so, it can be fixed.

Congrats to you on your successful fight. It no longer about health care, its about greed. The numbers they used on your bill prove it.

Hell, my ankle replacement cost $104,000. $23K is pocket change.

quote:

Originally posted by Fredward:
You done good. Now check your credit to see if they screwed you. If so, it can be fixed.

This happened to me. I was disputing the bill, the doctor was well aware of it. They had all my contact information and told me not to pay until it was finalized.

I got sent to collections. Ending up having to pay the $1,600 in dispute plus a bunch more. A week after I paid money the doctors office called me up and said they were sorry and where would I like the refund check sent to.

quote:

Originally posted by Gustofer:
Hell, my ankle replacement cost $104,000. $23K is pocket change.

Only $104,000? My knee surgery was >$130,000. Patient responsibility $1,600, Insurance responsibility $4,000-$5,000, remainder written off. The surgery center was $46,000 by itself. I wonder how they can stay in business writing off more than 90% of the cost of surgery?

My little boy fell and gashed his forehead and required 3 stitches at the ER.

The hospital charged Aetna $5,000 for this.

$5,000 for 3 little stitches?

We ended up paying around $700 out of pocket.

The system is screwed.

I suspect it is all a game of greed and let's see if we can get by with this, this time.

My other half takes several scripts per month and they were all running $16.00 and north and that was just my part the total monthly for our part was between one and two hundred. She talked to the druggist about it and they have come way down. Still the same script will vary from month to month by three or four dollars. They are never the same. It is an Ins. Co. game I'm sure.

It's clear that the insurance business and the mandate to care for the uninsured has placed some very illogical facets in the system. It's a strange game, and with these cosmic shifts in regulations, it will get bumpy for a while. strap yourself in!

If you want proof that they use a bunch of random made up numbers, ask for a price up front. They can't tell you because they don't know.

Like the democrats, you have to have the procedure to find out what's inside the bill.

I believe this to be one of the biggest problems with healthcare. When you go to a mechanic, the law says that they have to display their pricing on the wall so that everybody understands the charges. Why shouldn't the medical field do the same?

quote:

Originally posted by a1abdj:
If you want proof that they use a bunch of random made up numbers, ask for a price up front. They can't tell you because they don't know.

Like the democrats, you have to have the procedure to find out what's inside the bill.

I believe this to be one of the biggest problems with healthcare. When you go to a mechanic, the law says that they have to display their pricing on the wall so that everybody understands the charges. Why shouldn't the medical field do the same?

I'm not sure I agree with this.

Part of working on stuff (cars, human body) is a discovery process. You don't know what is wrong until you get in there and see. Can you imagine how thick a price list would be for surgeries with just a few complications listed? It would be untenable.

The doctors and nurses in the field are usually excellent, hard working professionals who genuinely care about patients. Yes, the doctors make a good living (I am close personal friends with 3 docs), yet they work long hours and get calls/texts from people constantly. They are also highly educated and have periodic recertifications they must complete.

My complaints are the ridiculous hospital overcharging and the insurance shell game that is rampant in the industry that results in the hassle/negotiations that result in large amount being "written off" .

There must be a tax break for hospitals to be able to do this.....

My ex wife worked on the billing/insurance side of healthcare and some of the stuff she dealt with was crazy. What gets written off, almost every bill is coded and billed incorrectly somewhere. The upside was she could destroy people on the subject so we never were miss billed.

Having been on both sides of the scalpel, I can tell you that they count on you paying without question. Most costs are negotiated with the payer (insurance, Medicare, etc), but they will try to stick you with $2.50 aspirin wherever they can.

It's not truly the hospitals' fault, but a requirement of the reimbursement climate in which they exist.

They have to write off so many nonpaying patients that the costs have to be made up somewhere and then there is the liability aspect. Insurance for malpractice is ridiculous for physicians, just imagine what it is for a hospital. Running a hospital is not for the faint of heart. No wonder administrators are such assholes!

It is a convoluted system of our own making and .gov's involvement has made it even worse if you can believe that.

RMD

quote:

Originally posted by heathtx:


I'm not sure I agree with this.

Part of working on stuff (cars, human body) is a discovery process.

Assuming your procedure wasn't life or death or emergency based, could the hospital have come up with an estimate of charges and how your insurance would have addressed the total bill? I can't think of another industry where the charges and fees are determined afterwards with no regard to cost effectiveness or controlling costs. It's whatever goes.

My two week hospital stay in 2007 came out to $85K (cheap in hindsight). I think the insurance paid about $40K, I paid my $500 deductible, and the rest was written off. The guy in the next room with the same procedure and no insurance, the hospital simply wrote off.

quote:

Originally posted by heathtx:

quote:

Originally posted by a1abdj:
If you want proof that they use a bunch of random made up numbers, ask for a price up front. They can't tell you because they don't know.

Like the democrats, you have to have the procedure to find out what's inside the bill.

I believe this to be one of the biggest problems with healthcare. When you go to a mechanic, the law says that they have to display their pricing on the wall so that everybody understands the charges. Why shouldn't the medical field do the same?

I'm not sure I agree with this.

Part of working on stuff (cars, human body) is a discovery process. You don't know what is wrong until you get in there and see. Can you imagine how thick a price list would be for surgeries with just a few complications listed? It would be untenable.

Except they can't even tell you what a normal exam costs. My wife got a MRI last year and was quoted $650 out of pocket. When she went to get the MRI the admin at the front desk again said it was $650 and asked if she was okay with that. She agreed and paid $650 right there. Then a few months later we got a bill for an additional $300. Turns out the building qualifies as a hospital so they can charge more and so the price went from $650 out of pocket to $950.

Around the same time she went to see a ENT doc and paid our $50 copay for a specialist. A few months later we got a bill for $300 because he looked in her nose. When I called I was told that if he actually looks in her nose it costs extra. I asked if he could do his job without looking in her nose and they admitted that 99% of the time he has to look in the nose of all his patients, but that "procedure" is not covered in the normal visit bill. Of course it was never told to us that looking in her nose was an extra charge.

Then there was the time we got billed $75 (our cost) for a doctor to remove some ear wax from my daughters ear. We got that bullshit overturned.

I compare mechanics to doctors a lot. Yes there is a discovery process but A mechanic can still give accurate pricing as the inspection goes along and every mechanic I have been to talks to you before doing any work beyond what was agreed to and explains if there will be an extra charge. Mechanics also know what the charge will be. If a mechanic quotes me $1000 to change my radiator and finds that I need a new hose in the process, he will tell me I need it, ask me if I want it and tell me a set price for replacement. And when I pay at the garage I am done. I won't get a bill in the mail a month later telling me that they didn't know their garage qualified as a dealership so they get to charge me more. And finally, if the radiator that he replaced doesn't fix my problem they will typically at least inspect the car for free and probably gie me a credit for the work already done. If you go to the doctor for a headache and they charge you a few thousand dollars to fix it and they don't, next time you go in they will be charging you again.

Of course they won't tell you how much they are charging. You will find out in a couple months

The fundamental problem, I think, is the disconnect caused by the fact that payment is made by someone (insurers or the government) who is not the consumer. This disrupts all the normal market forces that keep providers and consumers in a mutually beneficial relationship. The providers, on an institutional level, are more beholden to the insurers/government that they are to the patient. Patients can't effectively vote with their pocketbooks by going somewhere better.

The market keeps everyone honest. But there isn't a real market for healthcare.

I had dental work done this morning. They very proudly told me the "normal" price would have been $5000, but my insurer's price was $2500, and my share would be $1000. Bullshit if the "normal" price would be double. That is the usual shell game with the pricing of medical services.

quote:

Originally posted by Skins2881:

quote:

Originally posted by Gustofer:
Hell, my ankle replacement cost $104,000. $23K is pocket change.

Only $104,000? My knee surgery was >$130,000. Patient responsibility $1,600, Insurance responsibility $4,000-$5,000, remainder written off. The surgery center was $46,000 by itself. I wonder how they can stay in business writing off more than 90% of the cost of surgery?

Tax write offs.