Let's Argue About Health Care Costs

[MyTeamIsOnTheFloor]

So I got knocked out for a procedure. (I'll save the experience of telling 6 people the same info so that you can have ZERO confidence anyone involved in your health care plan actually knows what they are doing for another time. - this is about costs.)

The anesthesia DOCTOR bills $924.00. BUT ... he has agreed to accept only $92.80 from the insurer, and only $23.20 from me. Total bill - $116.00. $808.00 is the "discount/write off."

His NURSE is billed at $917 for the same procedure. Insurer pays $92.80 and I pay $23.20. Total = $116 - same as the doc. $808 is the "discount/write off."

An uninsured person would be charged $1,841.00 - which they probab ly never pay.

@stollcpa - who gets/does anybody get a tax deduction or tax credit for the two $808 write downs? for the unpaid $1,841 from the uninsured?

And @everybody - how does this makes sense?

 

[Univee2]

So I got knocked out for a procedure. (I'll save the experience of telling 6 people the same info so that you can have ZERO confidence anyone involved in your health care plan actually knows what they are doing for another time. - this is about costs.)

The anesthesia DOCTOR bills $924.00. BUT ... he has agreed to accept only $92.80 from the insurer, and only $23.20 from me. Total bill - $116.00. $808.00 is the "discount/write off."

His NURSE is billed at $917 for the same procedure. Insurer pays $92.80 and I pay $23.20. Total = $116 - same as the doc. $808 is the "discount/write off."

An uninsured person would be charged $1,841.00 - which they probab ly never pay.

@stollcpa - who gets/does anybody get a tax deduction or tax credit for the two $808 write downs? for the unpaid $1,841 from the uninsured?

And @everybody - how does this makes sense?

Anesthesia knee arthroplasty - Billed $2,877 / Insurance adjusted ($2,636.25) / Insurance paid ($224.53) // Amount Due $16.22

Injection of anesthesia - Billed $250.00 / Insurance adjusted ($188.94) / Insurance paid ($48.65) // Amount Due $12.41

Do I win?

 

[Marvin the Martian]

So I got knocked out for a procedure. (I'll save the experience of telling 6 people the same info so that you can have ZERO confidence anyone involved in your health care plan actually knows what they are doing for another time. - this is about costs.)

The anesthesia DOCTOR bills $924.00. BUT ... he has agreed to accept only $92.80 from the insurer, and only $23.20 from me. Total bill - $116.00. $808.00 is the "discount/write off."

His NURSE is billed at $917 for the same procedure. Insurer pays $92.80 and I pay $23.20. Total = $116 - same as the doc. $808 is the "discount/write off."

An uninsured person would be charged $1,841.00 - which they probab ly never pay.

@stollcpa - who gets/does anybody get a tax deduction or tax credit for the two $808 write downs? for the unpaid $1,841 from the uninsured?

And @everybody - how does this makes sense?

It makes no sense, good luck solving it though.

A few years ago I linked a story about a Dr whose wife was expecting. They went to the hospital and got estimates for their total costs to determine their OOP. What no one thought to notice, one anesthesiologist was not in-network, guess which one was on duty when she went into labor? So they could bill the full amount and the insurance puts that into a different pool that the consumer has to pay. It is a crazy system we have.

 

[mcmurtry66]

So I got knocked out for a procedure. (I'll save the experience of telling 6 people the same info so that you can have ZERO confidence anyone involved in your health care plan actually knows what they are doing for another time. - this is about costs.)

The anesthesia DOCTOR bills $924.00. BUT ... he has agreed to accept only $92.80 from the insurer, and only $23.20 from me. Total bill - $116.00. $808.00 is the "discount/write off."

His NURSE is billed at $917 for the same procedure. Insurer pays $92.80 and I pay $23.20. Total = $116 - same as the doc. $808 is the "discount/write off."

An uninsured person would be charged $1,841.00 - which they probab ly never pay.

@stollcpa - who gets/does anybody get a tax deduction or tax credit for the two $808 write downs? for the unpaid $1,841 from the uninsured?

And @everybody - how does this makes sense?

It’s completely absurd. Your standing dictates the bill. PI Lawyers like clients with no insurance since now juries get to know you had insurance

 

[i'vegotwinners]

So I got knocked out for a procedure. (I'll save the experience of telling 6 people the same info so that you can have ZERO confidence anyone involved in your health care plan actually knows what they are doing for another time. - this is about costs.)

The anesthesia DOCTOR bills $924.00. BUT ... he has agreed to accept only $92.80 from the insurer, and only $23.20 from me. Total bill - $116.00. $808.00 is the "discount/write off."

His NURSE is billed at $917 for the same procedure. Insurer pays $92.80 and I pay $23.20. Total = $116 - same as the doc. $808 is the "discount/write off."

An uninsured person would be charged $1,841.00 - which they probab ly never pay.

@stollcpa - who gets/does anybody get a tax deduction or tax credit for the two $808 write downs? for the unpaid $1,841 from the uninsured?

And @everybody - how does this makes sense?

what was your total bill for everything, including hospital?

what was paid for everything?

how long were you in the hospital? or out patient?

are we talking medicare, medicare advantage, or private insurance of someone under 65?

 

[MyTeamIsOnTheFloor]

what was your total bill for everything, including hospital?

what was paid for everything?

how long were you in the hospital? or out patient?

are we talking medicare, medicare advantage, or private insurance of someone under 65?

Total bill? Don't know. All the bills aren't in yet.

Out patient kidney stone removals.

Private group health insurance through bride's employer.

Deductible = 1,500 each individual, 2,750 family, then 80-20% up to out-of-pocket

Out-of-Pocket = 3,000 each, 5,750 family

 

[i'vegotwinners]

Total bill? Don't know. All the bills aren't in yet.

Out patient kidney stone removals.

Private group health insurance through bride's employer.

Deductible = 1,500 each individual, 2,750 family, then 80-20% up to out-of-pocket

Out-of-Pocket = 3,000 each, 5,750 family

heard they are a bitch.

brothers had them several times, did the breaking them up with sound the last time i think. no idea it that went bettor or worse.

keep us in the loop when the grand total comes in.

only then can we discuss bang for buck credibly.

hope it all went well and they don't come back.

 

[larsIU]

And @everybody - how does this makes sense?

PI Lawyers like clients with no insurance since now juries get to know you had insurance

 

[CO. Hoosier]

So I got knocked out for a procedure. (I'll save the experience of telling 6 people the same info so that you can have ZERO confidence anyone involved in your health care plan actually knows what they are doing for another time. - this is about costs.)

The anesthesia DOCTOR bills $924.00. BUT ... he has agreed to accept only $92.80 from the insurer, and only $23.20 from me. Total bill - $116.00. $808.00 is the "discount/write off."

His NURSE is billed at $917 for the same procedure. Insurer pays $92.80 and I pay $23.20. Total = $116 - same as the doc. $808 is the "discount/write off."

An uninsured person would be charged $1,841.00 - which they probab ly never pay.

@stollcpa - who gets/does anybody get a tax deduction or tax credit for the two $808 write downs? for the unpaid $1,841 from the uninsured?

And @everybody - how does this makes sense?

it’s really simple. Here is what I found:

All adjustments can be summarized in the following equation for the average fee for the ithprocedure, jth specialty, and kth Medicaid participation group:

AFijk=(1−RFBD)TCHQ=(1−RFBD)∑mwmAFm=(1−RFBD)∙ UFEE∙[NOHI+BS∙NPAR+NASGIMCARE]+BSFEE∙[BS∙PAR−.5∙MCARE∙MSUP]+COMFEE∙[COMM−.5∙MCARE∙MSUP]+MCARFEE∙[ASGN∙MCARE]+MCDFEE∙[MCD−MCARE∙MCAID]
(1)
where (TCH/Q) = total charges per unit of service; wm = share of charges from mth payer; AFm= average fee (allowable) of mth payer; PAR, NPAR = percent of Medicare physicians participating and not participating in Blue Shield; ASGN, NASGN = percent of Medicare patients' charges assigned versus nonassigned; and RFBD = percent of uncollected bills from patients. Average fees were discounted further for any remaining insura

 

[Univee2]

it’s really simple. Here is what I found:

All adjustments can be summarized in the following equation for the average fee for the ithprocedure, jth specialty, and kth Medicaid participation group:

AFijk=(1−RFBD)TCHQ=(1−RFBD)∑mwmAFm=(1−RFBD)∙ UFEE∙[NOHI+BS∙NPAR+NASGIMCARE]+BSFEE∙[BS∙PAR−.5∙MCARE∙MSUP]+COMFEE∙[COMM−.5∙MCARE∙MSUP]+MCARFEE∙[ASGN∙MCARE]+MCDFEE∙[MCD−MCARE∙MCAID]
(1)
where (TCH/Q) = total charges per unit of service; wm = share of charges from mth payer; AFm= average fee (allowable) of mth payer; PAR, NPAR = percent of Medicare physicians participating and not participating in Blue Shield; ASGN, NASGN = percent of Medicare patients' charges assigned versus nonassigned; and RFBD = percent of uncollected bills from patients. Average fees were discounted further for any remaining insura

LOL!

classic.

Post of the month.

 

[Stuffshot]

So I got knocked out for a procedure. (I'll save the experience of telling 6 people the same info so that you can have ZERO confidence anyone involved in your health care plan actually knows what they are doing for another time. - this is about costs.)

The anesthesia DOCTOR bills $924.00. BUT ... he has agreed to accept only $92.80 from the insurer, and only $23.20 from me. Total bill - $116.00. $808.00 is the "discount/write off."

His NURSE is billed at $917 for the same procedure. Insurer pays $92.80 and I pay $23.20. Total = $116 - same as the doc. $808 is the "discount/write off."

An uninsured person would be charged $1,841.00 - which they probab ly never pay.

@stollcpa - who gets/does anybody get a tax deduction or tax credit for the two $808 write downs? for the unpaid $1,841 from the uninsured?

And @everybody - how does this makes sense?

I think there is a fair number of wealthy or self employed people without insurance -- not all uninsured people are indigent.

Showing the higher billing costs but writing them off serves to establish that these are the "usual and customary charges" so that the wealthy uninsureds that have to pay full price have less to complain about.

 

[Joe_Hoopsier]

I had 24" of bowel removed. Dr said it looked like Goat. Cost me $3,600 out of pocket.
What's the problem?