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Posted: 1/9/2006 1:50:25 PM EDT
[#1]
This could get ugly, and yes, it's B.S.
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Posted: 1/9/2006 1:50:25 PM EDT
[#2]
Wow....that's insane.
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Posted: 1/9/2006 1:50:35 PM EDT
[#3]
money making deal within the medical world....Discounted fees for certian Ins agencys
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Posted: 1/9/2006 1:51:11 PM EDT
[#4]
They must be participating providers and agree to accept whatever the insurance guys pay up for for the procedure itself. The amount you have to pay is probably for incidentals that aren't covered under the insurance plan.
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Posted: 1/9/2006 1:51:14 PM EDT
[#5]
Your insurance prob has a pre arranged agreement with the hospital for a flat cost on the procedure. I know I received a bill for #2's birth and then a letter from my insurance informing me that the hospital made an error as all neo natal care was included in their agreement for maternity care...unless it went above and beyond normal. |
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Posted: 1/9/2006 2:00:20 PM EDT
[#6]
Oh no bud!  Just kidding. What exactly are you looking at? The insurance statement isn't a hospital bill and no insurance company in the US has that deep a discount. Let the negotiations begin. You just keep saying the insurance is suppose to pay this much and let them fight it out for a while. Then it'll settle hopefully not too bad for you. Tj |
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Posted: 1/9/2006 2:02:50 PM EDT
[#7]
That's just it. We paid our money and it's all considered done and over with. My point/rant is if a person did not have insurance they would be on the hook for $11,000 but yet insurance only has to pay $950. |
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Posted: 1/9/2006 2:03:42 PM EDT
[#8]
I had an ACL repair done this last year. My hospital bill was 11000 + and the INS co. only paid about 2000 to the hospital.
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Posted: 1/9/2006 2:04:26 PM EDT
[#9]
My insurance left me with a total bill to be paid by me in the sum of about 1700 bucks. Totall billed
by the hospital and all doctors was about 37,000. That's good insurance! Blue Cross/Blue Shield. Adjustments on the bills accounted for about half the total. What bugs me is, the hospitals are "not for profit" organizations, yet they sure do charge a lot for some pretty simple stuff! I smell something bad here... CJ |
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Posted: 1/9/2006 2:06:19 PM EDT
[#10]
+1. It's called capitated rates, the insurance company agrees to always pay on time and to send "X" amount of patients to the hospital, some such agreements have a guaranteed number of bed/days. SO the hospital gets a steady stream of customers whose bills get paid on time, albeit at rates lower than the bil reflects. Now, of the uninsured people who "have" to pay that whole $11,000 bill, how many do you think actually pay it? That's why the bill is so high, because if you have no insurance, they make you pay for the other 11 people who didn't pay any part of their $11,000 bill. |
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Posted: 1/9/2006 2:07:39 PM EDT
[#11]
LMAO. They ain't going to write off that much. Several possibilities here: 1] simple mistake. If so it will get worked out by the hospital and the ins company. 2]Maybe it was a typo and they paid $9500. You pay 500 for a total of $10,000 which may well have been the agreed upon rate with the ins company. 3] Only part of the bill was paid as yet and there will be more statements forthcoming. IOW, you may have just gotten the anesthesiologists bill or some such thing. Look at your bill more carefully. Don't sweat it. You will not have to pay 10K if you are insured. Very unlikely anyhow. Wait for the whole thing to get finalized before you pay a dime. If you are really worked up about it just call the hospital billing office and talk to them about it but still don't pay off the rest until it gets worked out with the ins company. |
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Posted: 1/9/2006 2:08:46 PM EDT
[#12]
Damn bud, that's about the simplest I've ever seen explained. 
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Posted: 1/9/2006 2:10:39 PM EDT
[#13]
I did think it was a big split, but ya never know. They wrote off a LOT last year when I had the neck operated on. |
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Posted: 1/9/2006 2:14:15 PM EDT
[#14]
I can see this thread is spinning out of control.
NO ONE IS GOING TO PAY ONLY $1450 FOR AN $11,000 PROCEDURE. IT AIN'T GOING TO HAPPEN. THE ONLY PEOPLE WHO WILL GET OFF THAT CHEAP ARE THE ONES WHO JUST DON'T PAY. They might knock off 10-15% for a capitated contract but that's about it generally. |
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Posted: 1/9/2006 2:16:13 PM EDT
[#15]
That was just the hospital bill, did not include surgen, etc. |
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Posted: 1/9/2006 2:17:21 PM EDT
[#16]
the real reason, they know MOST, not all, are not going to pay the 11k without insurace. so the hospital writes it off as a loss, thus saving taxes on year end profits, its the American way 
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Posted: 1/9/2006 2:21:19 PM EDT
[#17]
Of course not. Rates are jacked up everywhere. From your perspective, however... Why the hell do things cost so much, Re: Medicine? Is it because they can charge that much? I don't mind at all paying a fair price for the physicians expertise, but the additional costs are ridiculous. I had my hand sutured up three years ago, and over half the bill was extra crap. The attending physician and radiology fees for the X-rays were fine. No problem. Reasonable, even. But $270.00 for a package of five sutures? $187.00 for a couple CCs of Lidocaine? Does this stuff get marketed by DeBeers along with the diamonds? |
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Posted: 1/9/2006 2:28:25 PM EDT
[#18]
These situations result from discounts negotiated by the insurance companies. Some are based on volume but most are based on what medicare/medicade would reimburse for the same procedure. Co-pays also vary with each insurance company. The authorized payment for that surgery sounds like it was $1450 with the insurance company paying $950 and you $500 as a co-pay or cost-share.
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Posted: 1/9/2006 2:32:33 PM EDT
[#19]
I guess one of the reason why I have issues with this is because a friend of mine was involved in an accident, did not have insurance. Medical bills were $50,000. Had to file bankruptcy. So if, they would have settled for $5000 it would have been all taken care of with out a bankruptcy.
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Posted: 1/9/2006 2:35:11 PM EDT
[#20]
If only I had access to my moms medical bills. All told she racked up about $1.2 mil in bills over 10 years of cancer (7 of that in remission). That's what the insurance company paid. The amounts actually billed were even higher, probably +60%.
Then there's my Dad's eye surgery. The doctor billed $105K. $98K of that was an "accounting error" nobody could figure out, something to do with laser time. The sad thing is, he caught the error, not the insurance company. They were going to pay the inflated amount. |
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Posted: 1/9/2006 2:38:08 PM EDT
[#21]
Re-read what I posted.
My kidney stone episode and the treatments cost a total of abou 37,000 billed from the hospitals, doctors, and other assorted service providers. My total out-of-pocket share to pay is just 1700 bucks or so. LESS THAN FIVE PERCENT of the total bill. Yes, I'm pleased. I bust my ass for the company I work for because I know full well that the benefits they give me are first rate, and I wish to keep on working for this company and eventually retire from it. CJ |
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Posted: 1/9/2006 2:40:03 PM EDT
[#22]
It is sad how a hospital will take $5K from an insurance company for a $50k accident but if you tried to negotiate that with them as a private citizen they would tell you to piss up a rope. My wife probably incurred $200K in medical bills over the last two years. Insurance paid only about $50K of that. My co-pays and cost shares were only about $2k. The rest was written off by the companies as part of those discount agreements. People complain about Tricare Prime but I'm damn sure glad I had it. |
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Posted: 1/9/2006 2:46:14 PM EDT
[#23]
If you didn't have someone negotiating for you, what would you have done? Who would pay such an obviously unsubstantiated bill?
Hardly anyone I know has ever signed an agreement to be responsible for a certain amount. It's always just agreeing to be responsible. The cost of medical care is dis-connected from reality. How would you know what a fair amount is? |
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Posted: 1/9/2006 2:47:08 PM EDT
[#24]
That's my point, it ISN'T an $11,000 procedure. I litigated a case exactly like this. They charged something over $180/minute for surgery, I had insurance records showing routine discounts over 50 percent, much higher on many other procedures. Flat amounts are typical pricing methods. You think any insurance company is paying $8 for an aspirin? No, the billed amounts are meaningless unless you BOTH have no insurance and have money to pay. Then you are shafted. A problem with third party payment is that nobody really looks at the price of stuff because the consumer isn't paying it, they are happy to see the Ins co "doing a good job" paying half or less of a bill. Meanwhile, the ins co ignores the price portion of the bill, they plug the medical procedure codes in and pay whatever the contract spits out. |
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Posted: 1/9/2006 2:49:45 PM EDT
[#25]
No man, it is bullshit!!! SO if some poor bastard has NO insurance, he or she is on the hook for the NONE negotiated fee? Fucking CROCK, CROOKS!! |
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Posted: 1/9/2006 2:51:53 PM EDT
[#26]
Welcome to my fucking everyday world.
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Posted: 1/9/2006 2:52:03 PM EDT
[#27]
Insurance companies get to decide what to pay, despite how much it costs the hospital or doctors office. My wife works at a private doctors office and she can tell you horror stories about how much money they lose to insurance companies underpaying for services rightfully performed. Doctors have no choice its either limited payments or no payments. Because of this some hospitals an offices will intentially overcharge and add on procedures that are extremely overpriced, just so they will receive a payment from the insurance company close to what the real charges should be. Some time in the next few years it will reach a boiling point, believe it or not this is one situation where I think a union might be beneficial. Doctors will have to organize if they are ever going to have enough power to say no to the insurance companies.......
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Posted: 1/9/2006 2:53:20 PM EDT
[#28]
But then who would pay the lawyers?...
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Posted: 1/9/2006 2:56:26 PM EDT
[#29]
All the hospitals I worked at will negotiate payments if you are uninsured. Also, it the illness is catastrophic, at least in California, Medical or MSI will kick in a few months.
This is assuming that you are a legal resident. If you are a "undocumented worker", your healthcare is FREE...  |
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Posted: 1/9/2006 2:57:14 PM EDT
[#30]
That's not entirely true. I used to work at a health insurance company processing medical claims. If you're enrolled in a PPO plan, cnce your deductible is met you only have to pay co-insurance on procedures up until you hit your MOOP, which is the maxiumum out of pocket dollar amount outlined in your insurance policy. After you've paid that, all other eligible costs are paid for by the insurance company, or eaten by the health care provider. The exception to this is if the doctors are not part of the insurance company's network of providers, in which case the patient can be balance billed beyond the co-insurance payment and above what the insurance provider pays. I've also had first hand experience with the same when I had hip surgery several years ago. The total bill, including anesthesia, physical therapy, the MRI, and all other costs was about $10,800. I was only accountable for my $350 deductible and 20% co-insurance up until I paid a total of $1,850. After that, I wasn't required to pay a single red cent ... not because I just didn't pay, but because that was all I HAD to pay. |
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Posted: 1/9/2006 3:01:34 PM EDT
[#31]
Far from true. |
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Posted: 1/9/2006 3:02:14 PM EDT
[#32]
How much of hte 37,000 bill was paid by insurance? Your situation is different than the one the guy who started this thread is describing. |
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Posted: 1/9/2006 3:02:15 PM EDT
[#33]
Apples......have an orange
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Posted: 1/9/2006 3:03:34 PM EDT
[#34]
Absolutely, but since the profession is being taken over by women it isn't ever going to happen. FWIW, the AMA is a fucking joke anymore. It seems ludicrous to me that the profession with our best and brightest is the only one has that has its income limited by the gov't, that a bureacracy has been set up to essentially force MDs to work for clinics and under circumstances where administrative costs have pushed the price of healthcare up to incredible levels. You can blame lawyers, defensive medicine, etc but in reality it all falls on the gov't and its bureacracy. The same one that stuck its nose in everything under the guise of bringing down healthcare costs. |
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Posted: 1/9/2006 3:04:34 PM EDT
[#35]
This should be between the insured person and the insurer. Insured person presents the ins company with a hospital bill (claim) for X. Insurance company says your contract only covers X-$1000. It doesn't mean the person doesn't still owe the $1000 to the hospital. |
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Posted: 1/9/2006 3:08:01 PM EDT
[#36]
Doc....I believe you are a brilliant doctor......but where in the hell does this come from? 
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Posted: 1/9/2006 3:09:43 PM EDT
[#37]
To replace a hip on a sled dog costs $800.00
To replace a hip on you costs???? I use veterinarians whenever I can  GM |
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Posted: 1/9/2006 3:11:02 PM EDT
[#38]
Well, a good place to start would be with what Medicare or medicade would reimburse. If hospitals, doctors and specialists don't accept the standard medicare reimbursement rates for care, medicare can bar them from treating medicare patients. Most heath care providers can't survive without taking medicare patients. |
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Posted: 1/9/2006 3:13:08 PM EDT
[#39]
Medicare pays WAY less than what the doctors need to profit from the business. Docs make up the money they lose on medicare patients by jacking up the prices on the rest of us who work for our health insurance or pay for our health expenses out of pocket. Thank you socialist government for driving up the prices I pay for healthcare. |
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Posted: 1/9/2006 3:15:48 PM EDT
[#40]
Look up EMTALA...
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Posted: 1/9/2006 3:17:22 PM EDT
[#41]
Yep. |
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Posted: 1/9/2006 3:18:54 PM EDT
[#42]
I already stated that I tried a case involving this subject. The evidence showed what I have stated. "Far from true" sheds little light on the subject for those of us interested in this topic. Care to put up? I'm always willing to learn. |
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Posted: 1/9/2006 3:20:22 PM EDT
[#43]
I agree. I'm still amazed at the number of Libtards (including my brainwashed mother) who keep pointing to Canada and the UK and saying "look how good socialized medicine works there."  I spent three years living in England. It doesn't work there! |
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Posted: 1/9/2006 3:21:10 PM EDT
[#44]
+1! Medicare / Medicaid is a LOSER for hospitals - my wife worked in a county hospital for a year and her floor (long term acute care) was the only floor making the hospital any money at all! 7 floors total, the 6 below her served between 75 and 100% medicare/medicaid patients, her floor was the only one where people actually had private insurance that paid. |
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Posted: 1/9/2006 3:24:32 PM EDT
[#45]
I've just recently reviewed the bills for the birth of my daughter. The hospital bills were for just over $10,000. However, on each line item, you could see the price paid by the insurance company. The lines basically looked like:
Hospital stay $4600 Amount paid by insurance $2100 with a footnote explaining that the amount paid by the insurance company was accepted by the hospital as complete payment. The "bill" read $10,000, but the insurance company paid about $3,000. My wife and I paid about $300. |
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Posted: 1/9/2006 3:24:56 PM EDT
[#46]
Hospitals suck, doctors suck and insurance companies suck the most.
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Posted: 1/9/2006 3:25:09 PM EDT
[#47]
Kharn |
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Posted: 1/9/2006 3:26:25 PM EDT
[#48]
Nevermind ... I misread the portion of your comment I quoted. I read it as they ignore the price and just pay the bill. What you said is right. Unless it's a large case they'll just plug in the codes and pay the smaller of the billed amount or what pops up on the computer as "reasonable and customary". |
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Posted: 1/9/2006 3:26:53 PM EDT
[#49]
Yep it damn well does NOT work in Canada - what major hospital in the US that serves a population of 100k + people does not have an MRI machine? You want socialized medicine Canadian style? Talk to my nurse wife and she'll give you pointers on how to have a Canadian style BAKE SALE to raise money for hospital equipment that is standard in even small US hospitals.
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Posted: 1/9/2006 3:42:17 PM EDT
[#50]
Roger that. Had me worried for a second. |
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