patrick.net

Assuming all that work was actually necessary and done correctly, have you checked what it would have cost in Mexico, Canada, or India?

Glad to see you are still with us!

Yup, just another example of how America is still the only country in the world that rewards healthcare workers for just filling-out reimbursement forms. Every other country rewards healthcare workers for PATIENT RESULTS at usually 1/10th the cost.

Past surgery due to a auto accident (not my fault): $100K+. State Farm PIP approved: nothing. Reason? "You are a veteran. Have the VA pay for your medical care."

True story!

curious2 says

Mexico, Canada, or India?

::eyeroll::

The argument is continually made that without health insurance, all costs would be lower.

Bellingham Bill says

Mexico, Canada, or India?

That was exactly my thought--especially on the first and last ones!

What was the surgery for?

9 Top Notch (JCI accredited) Hospitals in Mexico

http://www.jointcommissioninternational.org/about-jci/jci-accredited-organizations/?c=Mexico

22 Top Notch (JCI accredited) Hospitals in India

http://www.jointcommissioninternational.org/about-jci/jci-accredited-organizations/?c=India

Apollo Hospitals Group’s flagship in Hyderabad—have recorded equivalent or better outcomes than the international standards for medical complications associated with knee, coronary, and prostate surgery as well as for infections related to the operating theater and catheters.

NH’s 30-day postsurgery mortality rate for coronary artery bypass procedures at its Bangalore hospital is below the average rate recorded by a sample of 143 hospitals in Texas.

Similarly, the five-year survival rate for breast cancer patients at HCG Oncology is comparable to U.S. benchmarks. Deccan’s five-year survival rate for peritoneal dialysis patients is the same as that for patients in the U.S. undergoing hemodialysis,

Cardiothoracic surgeons, nephrologists, ophthalmologists, and oncologists in India earn anywhere from 20% to 74% what their American counterparts do. For instance, Aravind’s ophthalmologists earn $50,000 annually compared with the $253,000 average for U.S. ophthalmologists

https://hbr.org/2013/11/delivering-world-class-health-care-affordably

As I've pointed out repeatedly, Narayana health does more heart procedures than Mayo Clinic and Cleveland Clinic combined with a lower rate of complications.

http://www.wsj.com/articles/SB125875892887958111

But please, continue to roll your eyes while your heads are up your respective asses.

2000 dollar CABG at NH is 20K-42K in the US

Also they do 6x as many as Mass General (Harvard)....better than them too.....please look it up for once if you don't believe me.

Or you can stick to your shitty obamacare plan which many doctors in the US won't even take.

I'm waiting for actual facts not dismissive retarded eyerolls....

Very useful post, Elliemae. And I hope you're doing well in the aftermath.

The sky-is-the-limit billing practices have only gotten worse in the last five years. About 6-7 years ago I saw a surgery bill that was billed as 10k with insurance paying 3.3k and patient co-pay paying essentially zero, meaning that the real cost was 3.3k.

Compare that with 44k/4.3k/0.75k (roughly adding up your numbers), and it is clear that 3x overbilling a few years ago now has become 10x overbilling today.

I'm still trying to find out whether hospitals and doctors get to claim the difference between billed and paid as a "loss" for tax purposes.

elliemae says

Billed amount $44,000.00. Aetna approved: $2,800.00. My share: $800.00

OK, so if I understand you correctly, the bill was $44,000, but they only got a total of $2800, with that being $2000 from your insurance company and $800 from you, correct?

P N Dr Lo R says

That was exactly my thought--especially on the first and last ones!

Racist much?

Hell, you could even go to belgium and it would be 75% cheaper, but please, don't let facts get in the way of your analyses. If it is an emergent procedure, that is one thing, but people unwilling to shop around for elective procedures then complaining about prices....well, that's rich.

http://www.nytimes.com/2013/08/04/health/for-medical-tourists-simple-math.html

jvolstad says

State Farm PIP approved: nothing. Reason? "You are a veteran. Have the VA pay for your medical care."

That was it, you didn't pursue it further?

justme says

The sky-is-the-limit billing practices have only gotten worse in the last five years. About 6-7 years ago I saw a surgery bill that was billed as 10k with insurance paying 3.3k and patient co-pay paying essentially zero, meaning that the real cost was 3.3k.

Why can't you ever find out the cost of treatment in advance? Then you could shop around and force prices down.

justme says

I'm still trying to find out whether hospitals and doctors get to claim the difference between billed and paid as a "loss" for tax purposes.

That is very interesting. Might explain a lot.

Elliemae is in the medical field and I'm supposed to be impressed that her HR department found insurance that would actually pay stuff, rather than the HR lady picked the best insurance package based on the perk package the insurance rep gave her.

zzyzzx says

elliemae says

Billed amount $44,000.00. Aetna approved: $2,800.00. My share: $800.00

OK, so if I understand you correctly, the bill was $44,000, but they only got a total of $2800, with that being $2000 from your insurance company and $800 from you, correct?

I'm waiting on an answer for that as well. This is just wrong on so many levels.

First of all, the fact that the bill came to 44K and then the bill was jewed down to 2800, there should be serious investigation into that, as to why the hospitals is playing favorite with insurnace companies. THere shouldn't be any fucking around, and the bill should be what it is. Otherwise, we all should be able to walk around uninsured and when the shit hits the fan and we go to the hospital and get a 44K bill. We should all be able to send in just 5% and tell them to go fuck them selves. Who needs insuance for that Ellie? Do we all need insurnace to fuck over the hospitals?

Secondly seeings hows the REAL BILL you know the one for realzies if Obamacare didn't come along and fuck everything UP! That bill only came to $2200 and you paid $800 of it.

NOW!!!!

So you mean to tell us you're here to brag about insurance that puts you on the hook for more than 30% of the total tab?

CaptainShuddup says

realzies

Classic, a coined word the mutts would never use...

CaptainShuddup says

Obamacare didn't come along and fuck everything UP! T

Tru dat but don't discount the wonderful legacy of LBJ

Health insurance is just like paying protection to the Mafia. If another group of thugs come in to shake you down they stand up and negotiate with extreme prejudice until your bill is payable, pay a token amount, and walk away claiming a job well done.

zzyzzx says

OK, so if I understand you correctly, the bill was $44,000, but they only got a total of $2800, with that being $2000 from your insurance company and $800 from you, correct?

Yes, that's correct (for the surgical suite, nurses and supplies). The pathologist, labs, other "extras", physician and anesthesiologist cost extra as well.

CaptainShuddup says

there should be serious investigation into that, as to why the hospitals is playing favorite with insurnace companies. THere shouldn't be any fucking around, and the bill should be what it is.

Thank Godess you were here to tell us this information. No one has ever complained about this issue before. You, sir, are a true pioneer of thought.

CaptainShuddup says

Elliemae is in the medical field and I'm supposed to be impressed that her HR department found insurance that would actually pay stuff, rather than the HR lady picked the best insurance package based on the perk package the insurance rep gave her.

I do work in the healthcare field, and my company provides marvelously adequate insurance. I don't know about my current policy, but in years past we weren't even a contracted provider for the insurance company we had. If you, in your infinite wisdom, actually believe that healthcare contractors provide excellent healthcare for their employees, you, sir, are fucking nuts. Of course, I mean this respectfully.

CaptainShuddup says

So you mean to tell us you're here to brag about insurance that puts you on the hook for more than 30% of the total tab?

I wasn't bragging, merely following up with a post from months ago. And, even though you blame Obama for my medical costs, I looked at policies past and this insurance provided the same coverage I had several years ago. I also forgot to mention that I had already met my deductible for the year or I would have paid for pretty much the whole thing.

Unlike you, I don't blame Obama. I do blame greedy hospitals and a system that allows multi-tiered billing.

Blurtman says

The argument is continually made that without health insurance, all costs would be lower.

Which is a really, really stupid argument.

elliemae,
Since your here why didn't you get a mental evaluation while in the hospital?
Don't you know that following Patnet will make you looney? Hell,I'm proof.

So far as Mexico, Canada, etc... I needed surgery and felt like shit. The cost of traveling, difficulty finding providers, etc wouldn't have been worth it. Besides, I have insurance and therefore was able to afford my out-of-pocket costs.

I blame Obama for that. :)

elliemae says

I do blame greedy hospitals and a system that allows multi-tiered billing.

Once again economic illiteracy...

Bellingham Bill says

Which is a really, really stupid argument.

Here is one view that pertains to employer sponsored health insurance.

"Stanford Nobelist Kenneth Arrow famously described third-party insurance as one of the principal flaws in America’s health-care market. That is to say, because patients don’t pay for their health care directly, they’re insensitive to the cost and value of that care."

"It is, therefore, no surprise that insurers cave in when hospitals demand higher prices. Workers have no idea what their employers spend on their health plans, and therefore get upset when their employers buy insurance that doesn’t provide access to brand-name hospitals. “Of critical importance [to increased hospital leverage] was employer resistance to choice-limiting networks with few providers,” write the Health Affairs authors."

http://www.forbes.com/sites/theapothecary/2012/05/12/how-employer-sponsored-insurance-drives-up-health-costs/

Here is another that pertains to the inefficiency and waste at insurance companies.

"But the thing that few people talk about, and that no serious policy proposal attempts to fix—the arrangement that accounts for much of the difference between health spending in the U.S. and other places—is the enormous administrative overhead costs that come from lodging health-care reimbursement in the hands of insurance companies that have no incentive to perform their role efficiently as payment intermediaries."

"Because insurers are paid a fixed percentage of the claims they administer, they have no incentive to hold down costs. Worse than that, they have no incentives to do their jobs with even a modicum of competence."

http://www.bloomberg.com/bw/articles/2013-04-10/the-reason-health-care-is-so-expensive-insurance-companies

elliemae says

Unlike you, I don't blame Obama. I do blame greedy hospitals and a system that allows multi-tiered billing.

NOOOOO! Of course not... now why on earth would I suggest such a preposterous notion about something that started out touted as Healthcare reform would create fair "Transparent" and honest medical billing?
Just what kind of Idiot do you think I am anyway?

My Car insurance went up out of the blue yesterday. NO reason I haven't had as much as a traffic ticket since my twenties.
Called them up no reason, they just raised it because, Obamacare makes it look so easy.

I don't blame Obama really, I blame his Sheep for that.

CaptainShuddup says

My Car insurance went up out of the blue yesterday. NO reason I haven't had as much as a traffic ticket since my twenties.

Maybe they read Patnet and believe you to be oozing with a deep-seated anger, expecting you to explode with road rage when you see a commercial for a healthcare provider? It's a distinct possibility.

CaptainShuddup says

Just what kind of Idiot do you think I am anyway?

How much time you got?

First of all, the fact that the bill came to 44K and then the bill was jewed down to 2800, there should be serious investigation into that, as to why the hospitals is playing favorite with insurnace companies.

I agree, why isnt there an investigation into the jewing down of the bill?

errc says

I agree, why isnt there an investigation into the jewing down of the bill?

The tax payers are being screwed over, seeings hows Obamacare is a tax and all.
Gotta save the Company store!

Those billions not being paid, could have been use to create the next million dollar cancer treatment breakthrough.

The simple reality is that healthcare is another example of the tragedy of the commons. AKA fuck the taxpayer in the ass...

Tim Aurora says

Why can't you ever find out the cost of treatment in advance? Then you could shop around and force prices down.

That is one of the biggest scams in the medical industry

I work in the healthcare industry and I agree that the lack of price transparency is a complete scam to keep competition from driving prices down. Everyone blames the insurance companies, but it's not all their fault...the providers have a scam going to overcharge patients ridiculous amounts of money, and the insurance companies benefit because it forces people onto health plans so that the massive discounts can be had.

debyne says

I work in the healthcare industry and I agree that the lack of price transparency is a complete scam to keep competition from driving prices down. Everyone blames the insurance companies, but it's not all their fault...the providers have a scam going to overcharge patients ridiculous amounts of money, and the insurance companies benefit because it forces people onto health plans so that the massive discounts can be had.

AKA the tragedy of the commons

CaptainShuddup says

Secondly seeings hows the REAL BILL you know the one for realzies if Obamacare didn't come along and fuck everything UP

The "real bill" has been inaccessible for decades, long before HillaryEmailCare.

And bills have been bouncing back and forth between the insurance company and the provider for decades. The usual drill is that the bill gets smaller with each bounce.

Where have you been living?

indigenous says

Once again economic illiteracy...

Citation please

sbh says

and the insurance companies benefit because it forces people onto health plans

Plus the higher health costs increase the MLR payout the ins cos can take (limited to 15 - 20%)

Philistine says

Citation please

The definition of inflation:

3 Then, following the common idea of inflation, Mises (1912, , p. 272) tries to develop a more precise definition of inflation: In theoretical investigation there is only one meaning that can rationally be attached to the expression Inflation: an increase in the quantity of money (in the broader sense of the ...

The definition of the tragedy of the commons:

The tragedy of the commons is a dilemma arising from the situation in which multiple individuals, acting independently, and solely and rationally consulting their own self-interest, will lower the yield a shared limited resource, even to the point of ultimately depleting it, even when it is clear that it is not in everyone's short or long term interest for this to happen. This dilemma was first described in an influential article titled "The Tragedy of the Commons," written by Garrett Hardin and first published in the journal Science in 1968.[1]
In 1940, Ludwig von Mises wrote concerning the problem:

If land is not owned by anybody, although legal formalism may call it public property, it is utilized without any regard to the disadvantages resulting. Those who are in a position to appropriate to themselves the returns — lumber and game of the forests, fish of the water areas, and mineral deposits of the subsoil — do not bother about the later effects of their mode of exploitation. For them the erosion of the soil, the depletion of the exhaustible resources and other impairments of the future utilization are external costs not entering into their calculation of input and output. They cut down the trees without any regard for fresh shoots or reforestation. In hunting and fishing they do not shrink from methods preventing the repopulation of the hunting and fishing grounds.[2]

For purposes of this conversation, I'm using this to apply to tax revenue and money printed against the good will of the reserve currency status

The definition of cronyism:

the appointment of friends and associates to positions of authority, without proper regard to their qualifications.

That should give you a rudimentary understanding of why her statement shows economic illiteracy.

We recently decided to go out on our own. So, we left the big medical practice with all its egomania and dysfunction and are opening our doors under our own flag in the next two weeks. Developing our web page, I was trying to figure out the best way to reflect prices. First, we are a mostly cash business (about 70% cash/30% insurance) because what we do isn't typically covered by insurance in the state of CA. So I started to do some research to see how other clinics have handled this. I thought that since we are dealing mostly in cash patients, there would be no confusion when it comes to listing a fee schedule. We wouldn't be dealing with differing amounts from network contract to network contract, for example. In our field of reproductive medicine, I couldn't find a single practice that listed a specific fee schedule. Some might give a range, but that was the most specific they got. The range wasn't even really for a specific treatment... It was more like an average cost for a full treatment. For example, you might find something like "an average cost for IVF will range from $12k - 15k, excluding medications." So even though it seems like they are listing fees... they really aren't. IVF has a lot of moving parts. I couldn't figure out why clinics didn't just list it broken out in its component parts (monitoring, saline sonogram, retrieval, mock transfer, transfer, laboratory, storage, ICSI, assisted hatching, thawing, etc...) First, not everyone needs everything. Some might require more monitoring than others, for example. What's the big secret? However, NO ONE lists prices. And it isn't just California.

My initial reaction is that there must be some reason why no one (maybe a few, but I couldn't find them) does it in this country. Is there a way this could come back to bite you legally, perhaps? When we were in Ireland, they did list out all the fees by each individual treatment. What's different? IVF isn't covered there, either.

For in-network fees, it's not really that hard to figure out what an insurance company might reimburse an in-network doctor. Doctors network contracts are usually between 120% and 200% of the Medicare reimbursement rates. The exact percentage depends on market and specialty. But it will fall within that. As for cash treatments, what's the secret? You'll have to fess up at some point. Okay, I'm rambling...

Getting back to Ellimae's original question... My only thought is that not listing specific numbers has more to do with out-of-network charges. That's where the reimbursement is based on a percentage of charges.... which is why you'll see absurd charges in this particular scenario. Since you cannot have multiple fee schedules (you are only supposed to have one... you can discount it, but you cannot have multiple schedules for in-network, out-of-network, and cash) this is probably what's driving your original $44,000 charge. They have to have one set of fees... The fees make no difference for in-network, as the reimbursement amounts were already agreed to and doctors are barred from balance billing. The fees do make a difference with out-of-network patients, as the reimbursement is a percentage of CHARGES.