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Is there any solution to this mess?
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Location: Blogs Sly Comments |
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| Posted by: Emory Schley |
5/1/2007 6:15 AM |
There are lots of puzzling episodes in life, but to me, one of the most puzzling of all is the system of billing coming from hospitals, clinics, medical offices and their allied disciplines.
We received a statement the other day in the mail detailing the expenses of an office visit and the associated laboratory and clinical work that my wife had about a month ago. What it boils down to, is that they took some blood from her arm, and ran a few tests on it, checking for various conditions in an attempt to assess her overall state of health.
What we received was a listing of the various tests performed, along with the associated cost of each procedure, the amount asked of the insurance company for these tests, and then finally the amount paid by the insurance company. Just a quick rundown of the list shows the insurance companies only allow about 20-25 percent of the charges made by the lab. Part of the understanding between the insurance company and the health providers, so I’ve been told, is that the providers will accept what the insurance company allows on each claim, and the provider further agrees not to attempt to collect the remainder from the policy holder.
What I don’t understand is how are the medical labs making money (else why would they be doing this) when they’re only being paid one-fifth to one-quarter of what they’re sending out bills for, unless of course, they are massively overbilling the insurance companies. So what is going on here? Doesn’t this seem to be just a wee bit outrageous? Who is ripping off who here?
When you go into a grocery store and find a can of beans, let’s say, selling for $1.49, you’re NOT going to be able to buy it for $.30, without driving the grocery store out of business, unless the grocery store is only paying a dime or so for that can. Something is desperately wrong with our medical care system and its billing practices. And the prescription drug industry is not very far behind, either.
If we don’t find some answers to some of these massive problems, and soon, all of our health care is going to put into jeopardy. I really hate the concept of price controls, and I’ve long believed the marketplace is the best determinant of price levels, but this medical and drug business has devolved into such a fiasco, it makes me wonder if I shouldn’t reconsider the price control thing. |
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Re: Is there any solution to this mess? |
By kay on
5/1/2007 6:33 PM |
This is exactly what my husband and I discuss whenever we get a bill. It's so weird.
The most awful consequence of the screwed-up health-care fiasco in the U.S. is the following example: My 40-year-old cousin in St. Pete had emergency surgery and was in the hospital for 10 days; and, because she and her father don't have insurance, she was billed almost $50,000...! She was able to negotiate a $30,000 CASH payoff to the county hospital because it was done in a timely manner. They happened to have that money in the bank. Have you ever heard or imagined such a thing? I always thought, if you weren't insured, you could pay on time for as long as possible, as long as you sent something each week or month. What happened to caring for anyone who was ill, no matter what the financial gain?!
I guess I'm still in the dark ages. Thank God I do have insurance, but for the millions of uninsured or underinsured, I say a special prayer each night. |
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Re: Is there any solution to this mess? |
By Daniel on
5/2/2007 9:50 AM |
| A couple years ago I went had to go to the emergency room for a broken arm while snowboarding in Idaho. The took X-rays and told me I needed surgery, and told me to fly back to FL and have a doctor here do it. That was all they did. I was a self-pay and they sent me an itemized bill for almost $3,000! In the items were things that they never did, such as setting the arm, giving me morphine, casting my arm, etc. When I called them about this they immediately took all the other items off. I believe they just make up charges and send it to the insurance companies and they pay it, no questions asked. If I would have had insurance, I may have never seen those charges, and my insurance company would have been overcharged. |
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Re: Is there any solution to this mess? |
By Emory on
5/2/2007 10:25 AM |
Kay, Daniel;
I had a cousin who had just sold a business before he had surgery, for which he was charged $16,000. He had no insurance, but because he was flush with cash at the time, he paid the entire $16,000. I've often told my wife that if he had been covered by insurance, the insurance company would probably have paid the hospital $4,000 and everyone would have been happy. This is NOT a very good system we currently have. |
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