Health care costs
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I recently had a procedure...
Got scoped from above and below (I insisted on a fresh probe for the endoscopy). Everything was cool. I just saw the claim - the bill to my insurance company for this outpatient procedure was over $27,000. It was spread across about 10 different categories.
The nature of the hospitals contract with Aetna was such that they go zero dollars for all but 1 of those categories. The one they got money form was reduced from about $8,000 to just over $1400. Because I am past my deductible for the year and into my co-pay I was billed $330 - less a 10% discount for pre-paying.
The $1400 sounds about right for the work that was done. I do wonder how they came up with $27,000 in the first place, and who is the poor sap that ever has to pay that kind of a bill.
All that to find out that I have acid reflux, for the which I take a little pill that costs less than $2 for a one month supply.
But the pain is gone and it no longer hurts to swallow which - when you enjoy steak like I do is a good thing!
Got scoped from above and below (I insisted on a fresh probe for the endoscopy). Everything was cool. I just saw the claim - the bill to my insurance company for this outpatient procedure was over $27,000. It was spread across about 10 different categories.
The nature of the hospitals contract with Aetna was such that they go zero dollars for all but 1 of those categories. The one they got money form was reduced from about $8,000 to just over $1400. Because I am past my deductible for the year and into my co-pay I was billed $330 - less a 10% discount for pre-paying.
The $1400 sounds about right for the work that was done. I do wonder how they came up with $27,000 in the first place, and who is the poor sap that ever has to pay that kind of a bill.
All that to find out that I have acid reflux, for the which I take a little pill that costs less than $2 for a one month supply.
But the pain is gone and it no longer hurts to swallow which - when you enjoy steak like I do is a good thing!
It's kind of amazing, innit?
It's shocking that elective procedures that people have to pay for out of their own pocket, such that providers have to compete in order to earn the business, are priced efficiently....while most healthcare services, paid for by third parties, are catastrophically expensive.
I'm sure there are a number of valid reasons why boob jobs are significantly cheaper than most other surgical procedures. But somewhere near the top of that list is the implicit understanding that, for the time being anyway, we don't feel boob jobs are something to which we're entitled.
This post was edited on 10/28 10:43 AM by crazed_hoosier2
It's shocking that elective procedures that people have to pay for out of their own pocket, such that providers have to compete in order to earn the business, are priced efficiently....while most healthcare services, paid for by third parties, are catastrophically expensive.
I'm sure there are a number of valid reasons why boob jobs are significantly cheaper than most other surgical procedures. But somewhere near the top of that list is the implicit understanding that, for the time being anyway, we don't feel boob jobs are something to which we're entitled.
This post was edited on 10/28 10:43 AM by crazed_hoosier2
That would make sense...
...if not for all the other countries who somehow found a way to lower the cost of procedures we're "entitled" to.
...if not for all the other countries who somehow found a way to lower the cost of procedures we're "entitled" to.
I was disappointed that the linked article did not include stats for....
penile reduction. I'm trying to figure out if it might make sense for me to go overseas to have it done, as my carrier informed me last week that they considered it elective surgery.
penile reduction. I'm trying to figure out if it might make sense for me to go overseas to have it done, as my carrier informed me last week that they considered it elective surgery.
3 Prong Attack...
1. Insurance Companies, Pharma, and Hospitals in cahoots. 2. Doctors billing for everything they can and profiting from unnecessary treatments. 3. American Public not taking responsibility for their health.
I liken #1 to living in an area with a cable monopoly and they just bill you whatever the heck they feel like. No competition. Just set whatever price they want.
1. Insurance Companies, Pharma, and Hospitals in cahoots. 2. Doctors billing for everything they can and profiting from unnecessary treatments. 3. American Public not taking responsibility for their health.
I liken #1 to living in an area with a cable monopoly and they just bill you whatever the heck they feel like. No competition. Just set whatever price they want.
Not my problem or society's collective problem
Just because Jack wants to be Jill doesn't mean I should have to contribute towards that. There are plenty of things we all want and don't get.
I save my sympathy for situations where it is actually warranted.
This post was edited on 10/28 6:19 PM by mjvcaj
Just because Jack wants to be Jill doesn't mean I should have to contribute towards that. There are plenty of things we all want and don't get.
I save my sympathy for situations where it is actually warranted.
This post was edited on 10/28 6:19 PM by mjvcaj
More complicated than that...
There are some rare cases where there are serious gender issues and the genetics do not match with the gender. Though I am not in that situation, I can imagine there are some really tortured individuals. I can't think of something much worse. Before you make blanket statements, why don't you do some research?
And I'm not taking a position on whether these surgeries should be covered or not.
There are some rare cases where there are serious gender issues and the genetics do not match with the gender. Though I am not in that situation, I can imagine there are some really tortured individuals. I can't think of something much worse. Before you make blanket statements, why don't you do some research?
And I'm not taking a position on whether these surgeries should be covered or not.
It is better than cable IMO
Seen a competitor of our client get significant push back from both private insurers and medicare/medicaid for overcharging. Literally, the hospital was charging 75% higher than our client, even though it provides inferior service (according to public data) and resides less than 10 miles away.
But, you do have a point that there clearly isn't as much competition as there needs to be.
I point more towards number three. The fact that taxpayers have to pay for insurance and/or care for chronic smokers, obese people with diabetes or heart problems, drug users, alcoholics, suicidal attempts, etc. is unfair.
Seen a competitor of our client get significant push back from both private insurers and medicare/medicaid for overcharging. Literally, the hospital was charging 75% higher than our client, even though it provides inferior service (according to public data) and resides less than 10 miles away.
But, you do have a point that there clearly isn't as much competition as there needs to be.
I point more towards number three. The fact that taxpayers have to pay for insurance and/or care for chronic smokers, obese people with diabetes or heart problems, drug users, alcoholics, suicidal attempts, etc. is unfair.
I don't know enough about the industry to really truly judge
But your criticism does right true in the gut.
Insurance is a great idea in theory.
But your criticism does right true in the gut.
Insurance is a great idea in theory.
On number 2, let's use Doug's example from below
(Hope that's ok Doug).
Doug goes in for a procedure and it turns out to be relatively mild so it seems as though the procedure was unnecessary. Now if they would have found a bleed in his intestines and he had to have emergency surgery or he could have died I doubt he'd think it was unnecessary.
If the doctor just assumed he had reflux gave him some Prilosec and sent him on his way and he ends up bleeding out I'm pretty sure lawyers would be involved.
So was the procedure necessary? In this case maybe not, but the next person that has very similar symptoms could have a life threading condition and you're relying on the doctors training and expertise to provide what they think is the best care.
Are the doctors that do questionable/unnecessary procedures sure I know some but for the most part they don't want to do procedures just to do them.
(Hope that's ok Doug).
Doug goes in for a procedure and it turns out to be relatively mild so it seems as though the procedure was unnecessary. Now if they would have found a bleed in his intestines and he had to have emergency surgery or he could have died I doubt he'd think it was unnecessary.
If the doctor just assumed he had reflux gave him some Prilosec and sent him on his way and he ends up bleeding out I'm pretty sure lawyers would be involved.
So was the procedure necessary? In this case maybe not, but the next person that has very similar symptoms could have a life threading condition and you're relying on the doctors training and expertise to provide what they think is the best care.
Are the doctors that do questionable/unnecessary procedures sure I know some but for the most part they don't want to do procedures just to do them.
i was due for one of the procedures...
Overdue, actually, for the colonoscopy. We opted to do the endoscopy at the same time so I only got put under once. Because of my cardiac condition they wanted to do it at a hospital rather than the surgery center.
In this case we discussed my symptoms and, while the doc suspected reflux, she did not want to make that assumption, particularly since my father's cancer originated in his throat.
The bill for 27k was just the hospital. I haven't seen the doctor's bill yet.
Overdue, actually, for the colonoscopy. We opted to do the endoscopy at the same time so I only got put under once. Because of my cardiac condition they wanted to do it at a hospital rather than the surgery center.
In this case we discussed my symptoms and, while the doc suspected reflux, she did not want to make that assumption, particularly since my father's cancer originated in his throat.
The bill for 27k was just the hospital. I haven't seen the doctor's bill yet.
Did you think the procedures were unnecessary
And your doctor was just trying to make more money? That's the point I was making to respond to tb that doctors just do procedures for profit only...the cost is another topic.
I remember when I had an endoscopy a few years ago and woke up during it and tried to pull the tube out...I remember the Dr saying hold him down and get him some more something then I was back out, but I'll never forget waking up I thought I was choking to death.
And your doctor was just trying to make more money? That's the point I was making to respond to tb that doctors just do procedures for profit only...the cost is another topic.
I remember when I had an endoscopy a few years ago and woke up during it and tried to pull the tube out...I remember the Dr saying hold him down and get him some more something then I was back out, but I'll never forget waking up I thought I was choking to death.
Re: It's kind of amazing, innit?
possibly it has less to do with who's paying for it, and more to do with the fact that one is elective, while the others are mandatory or possibly die.
hard to make a priced based choice, if you basically have no choice but to have the surgery.
YA THINK???
possibly it has less to do with who's paying for it, and more to do with the fact that one is elective, while the others are mandatory or possibly die.
hard to make a priced based choice, if you basically have no choice but to have the surgery.
YA THINK???
Re: I recently had a procedure...
possibly the poor sap you are referring to, is the guy with no insurance.
the fact that the uninsured get charged far more for the same procedures etc as the insured, is beyond immoral.
possibly the poor sap you are referring to, is the guy with no insurance.
the fact that the uninsured get charged far more for the same procedures etc as the insured, is beyond immoral.
Not really, no.
If it's an urgent procedure, sure. But a small percentage of all procedures are urgent.
Why shouldn't people shop for hip or knee replacements?
It's a total canard to suggest that, in most (all?) cases other than plastic surgery and other elective procedures, healthcare consumers are incapable of shopping to make rational decisions. The problem is that, at present, they have no reason to.
If it's an urgent procedure, sure. But a small percentage of all procedures are urgent.
Why shouldn't people shop for hip or knee replacements?
It's a total canard to suggest that, in most (all?) cases other than plastic surgery and other elective procedures, healthcare consumers are incapable of shopping to make rational decisions. The problem is that, at present, they have no reason to.
Here's a few examples...
For the record, I never said all doctors do this and the ones I know on a personal level (multiple) are of high character in my non-medical dealings with them and I assume they conduct their medical practice in the same upright fashion.
My grandpa is 92 years old... for some time he was visiting a dermatologist who would apply MOSE on various potential skin cancers. This guy loved to chop and cut him to pieces and bill the insurance and Medicare for everything in sight and collect on very very few of the charges. My grandpa couldn't stand it and finally switched to someone who is taking a much more conservative approach. A skin issue that might kill someone in 30 years is a non-issue for a 92 year old man. The guy was milking the system for everything he could.
Another trick this guy pulled was asking my grandpa to come for multiple visits for issues that could be dealt with on the same day in order to milk extra appointments. My grandpa finally told the guy to eat it because why should he pay extra copays for no reason?
Another example... he was diagnosed with cancer on his upper palate a couple of years ago. The guy doing the chemo was suggesting extremely aggressive chemo to the point that the chemo was killing him and not the cancer. After 2 sessions my grandpa said enough and ceased and the guy was hounding him for more visits, etc. Total $ oriented no concern for the patient. My grandpa has had no issues since and no cancer. Regardless, there is something to be said about patient comfort and not the bottom line. This is 2 examples of doctors trying to milk every penny they can without any concern for the patient.
For the record, I never said all doctors do this and the ones I know on a personal level (multiple) are of high character in my non-medical dealings with them and I assume they conduct their medical practice in the same upright fashion.
My grandpa is 92 years old... for some time he was visiting a dermatologist who would apply MOSE on various potential skin cancers. This guy loved to chop and cut him to pieces and bill the insurance and Medicare for everything in sight and collect on very very few of the charges. My grandpa couldn't stand it and finally switched to someone who is taking a much more conservative approach. A skin issue that might kill someone in 30 years is a non-issue for a 92 year old man. The guy was milking the system for everything he could.
Another trick this guy pulled was asking my grandpa to come for multiple visits for issues that could be dealt with on the same day in order to milk extra appointments. My grandpa finally told the guy to eat it because why should he pay extra copays for no reason?
Another example... he was diagnosed with cancer on his upper palate a couple of years ago. The guy doing the chemo was suggesting extremely aggressive chemo to the point that the chemo was killing him and not the cancer. After 2 sessions my grandpa said enough and ceased and the guy was hounding him for more visits, etc. Total $ oriented no concern for the patient. My grandpa has had no issues since and no cancer. Regardless, there is something to be said about patient comfort and not the bottom line. This is 2 examples of doctors trying to milk every penny they can without any concern for the patient.
Of course not
all doctors do stuff for more money but there are some that see an income stream rather than a patient when you walk in. There are a lot of things that could be done a lot more efficiently. For example, not long ago I had a test done and had to go back in to get the results and then he wanted to send me to get lab work done. Of course I had to go back and get those. Why not send me for the test and if the test came back negative then mail me a script for the lab work and then give me the results over the phone if they were okay. Instead of 3 trips to the dr's office I would have had one.
all doctors do stuff for more money but there are some that see an income stream rather than a patient when you walk in. There are a lot of things that could be done a lot more efficiently. For example, not long ago I had a test done and had to go back in to get the results and then he wanted to send me to get lab work done. Of course I had to go back and get those. Why not send me for the test and if the test came back negative then mail me a script for the lab work and then give me the results over the phone if they were okay. Instead of 3 trips to the dr's office I would have had one.
In most hospitals the
left had doesn't know what the right hand is doing. We had a car accident in 2012 and of course we begged the hospital to bill State Farm but they would submit it to our health insurance (Of course they are going to want their money back if it's a car accident). To make a long story short it got down to where they were billing us for $67 and we told them to bill State Farm. Of course SF wants a medical code for the bill but the hospital would never send it to them. They finally turned it over to a collection agency and I immediately put a nastygram on the Facebook page(couldn't get a response any other way) saying if they had done their job correctly they would have had their money a long time ago. They immediately called off the collection agency. State Farm finally just got fed up and paid the bill. Within two weeks after that we got a check from the hospital for approximately $250 for over payment. They sent it to us even though we had NOT paid a penny of the bills. We told SF and our health insurance that we had it and that it wasn't ours. They said to just cash if and if they wanted it back later they would ask for it.
left had doesn't know what the right hand is doing. We had a car accident in 2012 and of course we begged the hospital to bill State Farm but they would submit it to our health insurance (Of course they are going to want their money back if it's a car accident). To make a long story short it got down to where they were billing us for $67 and we told them to bill State Farm. Of course SF wants a medical code for the bill but the hospital would never send it to them. They finally turned it over to a collection agency and I immediately put a nastygram on the Facebook page(couldn't get a response any other way) saying if they had done their job correctly they would have had their money a long time ago. They immediately called off the collection agency. State Farm finally just got fed up and paid the bill. Within two weeks after that we got a check from the hospital for approximately $250 for over payment. They sent it to us even though we had NOT paid a penny of the bills. We told SF and our health insurance that we had it and that it wasn't ours. They said to just cash if and if they wanted it back later they would ask for it.
Lab work with my Doc could not be more efficient
Via a telephone call they directed me to go to a particular lab that has locations all over the place - they send the prescription information directly to the lab and it's good for a year. All I do is show up at one of the branches. No money out of my pocket or into the doctor's yet. The lab is billed to my insurance and I pay based upon the contracted amount and the state of my deductible or co-pay.
So - for example - when I saw my cardioloigist a month ago - I'm already set up for the lab work that he wants done before he sees me a year from now. Of course, this is new to me, so I will call and check before I head to the lab..... sometime next September.
I'm going to miss that paper script that lived in my glove box and I always forgot to fill out until I actually showed up for the bloodwork.
Via a telephone call they directed me to go to a particular lab that has locations all over the place - they send the prescription information directly to the lab and it's good for a year. All I do is show up at one of the branches. No money out of my pocket or into the doctor's yet. The lab is billed to my insurance and I pay based upon the contracted amount and the state of my deductible or co-pay.
So - for example - when I saw my cardioloigist a month ago - I'm already set up for the lab work that he wants done before he sees me a year from now. Of course, this is new to me, so I will call and check before I head to the lab..... sometime next September.
I'm going to miss that paper script that lived in my glove box and I always forgot to fill out until I actually showed up for the bloodwork.
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