Hospital cost absurdity

I had my implant surgery on December 5, 2007. I finally received my hospital bill on June 13, 2008. Seven months seems like quite a delay. No details, just a one page bill for just under $2k (representing the balance of my annual deductible and a copay). They will be sending details in response to my request. From correspondence with my insurance company - the billed list price from the hospital was about $114k. Insurance only paid $27k. $84k was the negotiated price reduction achieved by the insurance company. I was in the hospital for a total of 7 days - all of the time in the coronary care unit. This price does not include insurance negotiated bills for Doctors and some diagnostics (multiple chest x-ray, CAT scan and MRI) but it includes everything else - including the PM itself. So the hospital is getting less than $30k for a week of 24 hour care and monitoring plus over 3 hours in the cath lab - I find this an amazingly low number. FYI - the hospital is in the San Francisco Bay area and is in financial difficulty. The insurance negotiators seem to have the upper hand. The rest of the Dr and diagnostics costs totaled under $10k. My unique situation required the one-week stay plus all the diagnostics so just a PM implant with a hospital overnight would be a lot less. To me, these almost sound like developing country medical care costs.

6 Comments

Who makes up these prices

by coryi711 - 2008-06-16 07:06:34

I died during my EP study on 12/04/07 and stayed 3 days and 2 nights in cardiac icu/ccu and got a dual chamber pacemaker with defibrilator on 12/05/2007. My hospital and doctor charged $ 144,000 and my insurance paid about $72,000 + my $1,250 deductible..Hey we were implanted on the same day...Mine has already had to pace for my heart for 12 seconds 2 weeks after implant @ 3am in the morning.

Insurance

by harley63 - 2008-06-16 09:06:28

…to borrow a phrase from another PM member

"YOU = PRICELESS!!"

To address your questions about discounted rate(s) or amount that the insurance company paid to the hospitals and any other providers… several things could have happened… IF the providers ARE contracted with the cardholder’s network, then they are informed upfront what percentage of reimbursement they will receive for services rendered. IF the providers are NOT contracted with the cardholder’s network then a company (typically a third party) will do the negotiation with the healthcare providers to come to a discounted rate. (This could really get into a lengthy discussion/explanation on how the prices are set and what is paid. As it’s a complicated process, that usually takes place behinds the scenes.) So the provider will set the “price” or “fee for services” and then submit the claim and the amount paid on the claim is adjusted according to the benefit language and subject to deductibles and any co-pays that apply. Not sure if that helps with understanding the amount paid for the services you received or made it worse. But it is truly priceless that you are here and going strong!

Healthcare dollars and how they are spent and how they are used is one of the hottest topics around!!

Take care,
Harley63

Costs

by Blueaustralia - 2008-06-16 09:06:46



I was watching a programme the other night - a journalist was writing a book and comparing the costs of health in different countries. UK Germany Japan America etc. America came up with staggering costs. Private health insurance seemed a staggering cost each month and it made us realise how lucky we are in Australia. My husband pays about $104 a fortnight for full private care. Co payment is up to $250 per year max ($50) per night in private hospital).

My implant in 2004 cost me one night's co payment of $50 because I elected to go private. There were no other charges and were completely covered by my medical fund. This medical fund has recently been bought out by BUPA I hope they don't push up costs. My implant and hospitalisation for my pacemaker was about $27000 total pm, drs, tests etc.

I could have had it all done on the public system like a friend of mine did the week before me. He had the same specialist and same pacemaker and it did not cost him a cent.

We seem to be extremely lucky in Australia here with our health care system. In Tasmania we have such excellent public health services although there are always those that whinge like mad. We live in a rural area with a small hospital and it gives a great public service.

It is always interesting to hear how other systems work so I thought this might me of interest to you. I hope that with the forthcoming political changes in America they fix the health system. There must be so many that suffer and cannot afford treatment and medications. Our medications are all susbsidised and we pay a max of about $28.50 per script. As we are seniors we pay $5 after about $300 intotal we get
them free. All the best Billie

Insurance

by candi51 - 2008-06-16 11:06:30

Be glad the hospital has an arrangement with your insurance company!

We have a high deductible Health Savings Account based policy. My husband and I are both self-employed and have to pay for our own premiums.

The upside to this insurance is they pay 100% after the high deductible.

The thing they don't warn you about is that they don't have contracts with the hospitals so we pay that HUGE inflated rate with no mercy from the hospital. I always call and negotiate with the providers since we are now considered "high volume" but that takes alot of time and posturing for sure.

We will see what happens with the insurance and hospital once the bills for my ICD implant have hit the fan so to speak.

The insurance company claims the hospital is overcharging by 400%. The insurance uses Medicare rates plus 46% as a base or average rate. Typically after nasty letters back and forth, refusing to pay and threatening court action the hospital will usually give us a 30% discount but that is far less of a discount than other big box companies receive.

I don't see how that is fair for us "little guys" that pay more out . Especially in years where we don't meet the deductible and the insurance kicks in. It is ALOT more out of our pockets. I'm sure we are all to familar with the old "reasonable and customary" phrase :-)

I don't know what the solution is because I think the hospitals and Dr's should get paid a good rate for the important work that they do BUT it is amazing to me that they can offer such huge discounts to some and not to others.

Candi

canada

by jessie - 2008-06-17 02:06:40

as seniors we pay 6.10 per script for drugs covered by the gov.t most are but if not we are covered for drugs thru my husband's plan from his former employee where we can get coverage for anything not covered. an ambulance ride is 50.00 we are covered for ward coverage but can pay the difference for semi or private. it really isn't worth it as if you are really sick you are in a private room as i was when i was intubated and taken to a different hospital with an intensive care. since we did not request it they provided the private room based on need.i am sure eventually in my lifetime we will pay for more medical needs just because of the escalating costs. i really hope that the usa will provide coverage for its citizens even if a premium is required. we do pay for it here. it is deducted from our pensions and every citizen pays around 500 a year. i hope i have explained this well as there is way for countries to offer care for it's citizens jessie at one time we did not pay but a few years ago began paying for healthcare

bit more

by winesap - 2008-06-17 12:06:48

I work at a small company and we too have a high deductible policy with the business owner and employee sharing the deductible costs (company covers most). Fortunately my providers all have contracts with the insurance company - why the wildly reduced rates.

Yes indeed, the small and independent pay more in this absurd system we have in the USA.

I lived and worked in Sweden for several years and found their single payer system superior. Actually I vested in their system so I have the option of retiring there if we do not get our system fixed.

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