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MD Anderson, Yale New Haven Hospital, you name any major, respected non-profit hospital or medical center in America and the truth is that they are ripping off the most vulnerable of Americans -- the uninsured -- and, at the same time, doing their best to force Medicare and private health insurers to pay absurdly inflated prices for everything from warm blankets to blood tests to hospital managers making hundreds of thousands of dollars more than Barack Obama. Oh, and don't you dare ask the hospital billing department to see the Chargemaster. No, seriously, don't you dare!

This is an article that will require a good half hour -- or more -- to savor, but I'll include some best hits below:

Nonetheless, Sean was held for about 90 minutes in a reception area, she says, because the hospital could not confirm that the check had cleared. Sean was allowed to see the doctor only after he advanced MD Anderson $7,500 from his credit card. The hospital says there was nothing unusual about how Sean was kept waiting. According to MD Anderson communications manager Julie Penne, “Asking for advance payment for services is a common, if unfortunate, situation that confronts hospitals all over the United States.”

The first of the 344 lines printed out across eight pages of his hospital bill — filled with indecipherable numerical codes and acronyms — seemed innocuous. But it set the tone for all that followed. It read, “1 ACETAMINOPHE TABS 325 MG.” The charge was only $1.50, but it was for a generic version of a Tylenol pill. You can buy 100 of them on Amazon for $1.49 even without a hospital’s purchasing power.

But, wait, there's more:
One night last summer at her home near Stamford, Conn., a 64-year-old former sales clerk whom I’ll call Janice S. felt chest pains. She was taken four miles by ambulance to the emergency room at Stamford Hospital, officially a nonprofit institution. After about three hours of tests and some brief encounters with a doctor, she was told she had indigestion and sent home. That was the good news.

The bad news was the bill: $995 for the ambulance ride, $3,000 for the doctors and $17,000 for the hospital — in sum, $21,000 for a false alarm.

Janice S. was also charged $157.61 for a CBC — the complete blood count that those of us who are ER aficionados remember George Clooney ordering several times a night. Medicare pays $11.02 for a CBC in Connecticut. Hospital finance people argue vehemently that Medicare doesn’t pay enough and that they lose as much as 10% on an average Medicare patient. But even if the Medicare price should be, say, 10% higher, it’s a long way from $11.02 plus 10% to $157.61.

Yeah, about those mythical chargemasters?
The price is the problem. Stamford Hospital spokesman Scott Orstad told me that the $199.50 figure for the troponin test was taken from what he called the hospital’s chargemaster. The chargemaster, I learned, is every hospital’s internal price list. Decades ago it was a document the size of a phone book; now it’s a massive computer file, thousands of items long, maintained by every hospital.

Stamford Hospital’s chargemaster assigns prices to everything, including Janice S.’s blood tests. It would seem to be an important document. However, I quickly found that although every hospital has a chargemaster, officials treat it as if it were an eccentric uncle living in the attic. Whenever I asked, they deflected all conversation away from it. They even argued that it is irrelevant. I soon found that they have good reason to hope that outsiders pay no attention to the chargemaster or the process that produces it. For there seems to be no process, no rationale, behind the core document that is the basis for hundreds of billions of dollars in health care bills.

And, in the headline, I said I sort of feel sorry for health insurers. Well, yes and no. Health insurers are now spending thousands to orchestrate a 'Time for Affordability' campaign to wage war against high health care costs. But, why are costs so high? Because providers are consolidating and making it harder than ever for insurers to negotiate low rates for policyholders:
Insurers with the most leverage, because they have the most customers to offer a hospital that needs patients, will try to negotiate prices 30% to 50% above the Medicare rates rather than discounts off the sky-high chargemaster rates. But insurers are increasingly losing leverage because hospitals are consolidating by buying doctors’ practices and even rival hospitals. In that situation — in which the insurer needs the hospital more than the hospital needs the insurer — the pricing negotiation will be over discounts that work down from the chargemaster prices rather than up from what Medicare would pay. Getting a 50% or even 60% discount off the chargemaster price of an item that costs $13 and lists for $199.50 is still no bargain. “We hate to negotiate off of the chargemaster, but we have to do it a lot now,” says Edward Wardell, a lawyer for the giant health-insurance provider Aetna Inc.
Ok, so basic economics. If I'm buying 100 people dinner at the local steakhouse, won't I have a bigger chance of getting 10% off the bill than if I'm buying dinner for 20? You bet. And that's why in sane, civilized countries the government takes the health care industry 'bull by the horns' and negotiates with providers and drug companies for the entire population -- all at once. Medicare For All isn't just about covering everyone, it's about a massive, powerful entity -- the government -- fighting the good fight against providers -- who have all the power in the world to set prices for the things that will prolong and save our lives -- to ensure that their citizens have access to affordable health care. If you have Cigna, Aetna, WellPoint and Humana -- no matter how big and powerful they are as corporations -- separately waging this war, of course the discounts will be lower, and the prices higher -- or, in the case of America, absolutely insane.

This is a good place for me to stop -- this diary could continue for ages, and I'll be sure to post updates of what you, dear readers, discover if you are kind enough to comment on what outrages you most.

Sit down, pop a $1.50 generic aspirin, and start reading.

P.S. If you're currently engaged in a hospital billing battle, here are some tips.

11:59 AM PT: A couple thoughts:

1.) 'This' -- meaning the outrageous pricing -- is exactly why Rick Scott turned around on the Medicaid expansion. And, remember, most Florida hospitals are in the game for profit (while this article focused on non-profit hospitals still making tons of money), so you can only imagine what their 'chargemasters' would reveal.

2.) MichiganChet makes a good point in the comments: please read the last couple of pages. They are where you'll find the connection between this outrageous pricing and the need for real health CARE (i.e. not just insurance) reform, including the value of Medicare For All (single payer).

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  •  Tip Jar (310+ / 0-)
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  •  You are so right ... (68+ / 0-)

    ... But good luck getting anyone to pay attention to the provider side problems.   The ACA really was health insurance reform.   If anying it pandered to providers to get there support... Same with pharma.  

    ACA is bending the curve on medicare/caid, but so called "non profit" hospital groups have carved out feifdoms.   Here in Pgh UPMC has literally bought or beaten out all competing hospitals.   They hammer the insurers for payplans that are multiples of what other hospitals get, which then puts those hospitals out of business.

  •  Watched the interview with Time's managing editor (48+ / 0-)

    this am on MoJo.  While living in Colorado, I had two significant surgeries at the city owned hospital (one for a badly fractured ankle and the other to repair a compression fraction of a vertebrae).  I'm sure both were very expensive even though one surgery was outpatient.  In neither case did the hospital provide a detailed statement and you literally have to beg to get one.  Kind of difficult to see what things cost if you are given nothing to work with.  Apparently one of the things discussed in the Time article is that people have no idea of the real cause of medical care.  Gee, I wonder why that is.

    ""How long does getting thin take?" Pooh asked anxiously." -- A. A. Milne

    by pittie70 on Thu Feb 21, 2013 at 08:36:11 AM PST

  •  I don't feel sorry for the Insurers... (69+ / 0-)

    It was their 'profits uber-alles' philosophy that has infected the healthcare system.  Now the hospital owners are realizing that they too can play the monopoly game - and better than insurers because hospitals can't be off-shored or move to a more sympathetic state.  What's the answer?  Take the profit out of the healthcare business.  Other countries have figured this out.  And yes, their doctors make a good living and graduate from medical school with out a lifetime's worth of debt.

    'Guns don't kill people, video games do - paraphrased from Lamar Alexander (Sen-R-TN)'

    by RichM on Thu Feb 21, 2013 at 08:43:35 AM PST

  •  I had very simply outpatient surgery (11+ / 0-)

    a few months ago.  I have insurance, but I looked at the stuff the insurance paid.

    It was insanely expensive, and I do not understand why.  

    Vets provide practically the same service that human doctors do in many cases - but charge about 5%.  Of course the human medicine is going to be more expensive - but not at this ratio.

    Perhaps we need competition?  Or some independent audits?

    by chloris creator on Thu Feb 21, 2013 at 08:46:44 AM PST

    •  There is no competition.... (18+ / 0-)

      and that's a huge part of the problem.

      The USA has a shortage of tens of thousands of doctors, and it's going to get far worse as ACA kicks in and 30+ million people get insurance and can finally see a doctor.

      I read recently that something like 30% of all the doctors in California are at or near retirement age..... and that is a scary number, isn't it?

      As long as there is a doctor shortage, there cannot be any competition, leaving doctors, hospitals and insurance companies with a real 'monopoly' (there are other technical terms for this type of cornering the market that I can't remember).

      That's where the government is supposed to step in to regulate the market, like they do with electricity, water and other basic necessitites that are subject to monopolization.

      Unfortunately, the corporate interests don't want regulation, and in our wonderful new world, they are winning.

      So we suffer.


      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Thu Feb 21, 2013 at 08:59:43 AM PST

      [ Parent ]

      •  Medical Cruises To Taiwan? (8+ / 0-)

        An ex-pat went back for Lasic surgery, granted, he knew where the best doctor/facility in the country was, but $1800 later, his eyesight is as fine as it would have been for the $5000 stateside cost.

        My biggest rant is that we all know what a gallon of milk costs, a gallon of gas.  The insurance company negotiates rates for procedures, etc.  Why isn't there a uniform pricing clause in the ACA?  Now that I can see what my company pays for it, I for one would SERIOUSLY consider dropping my companies $1800 a month plan (and my massive bi-weekly contribution) and get catastrophic or high-deductible coverage only.  $20,000 a year can buy an awful lot of services if there were a uniform pricing,  but I'd be screwed into paying double the insurer's rate out of pocket.

        •  FWIW, I paid, ~$3k for PRK a couple years back (2+ / 0-)
          Recommended by:
          james321, ladybug53

          Way more than $1800, but not too bad, I think.

          "He who fights monsters should see to it that he himself does not become a monster. And if you gaze for long into an abyss, the abyss gazes also into you."

          by Hayate Yagami on Thu Feb 21, 2013 at 10:21:50 AM PST

          [ Parent ]

          •  Yes, all medical/dental pricing (3+ / 0-)
            Recommended by:
            james321, qofdisks, ladybug53

            Depends a great deal on where you live.

            If its a high cost area, it's going to cost a lot. There's a lot of overhead to a hospital or clinic, and if building costs, utilities, insurance, salaries, etc. are higher, your cost will be higher. Doesn't matter what the product is, really. Every business has that problem to some extent.

      •  I live in California (15+ / 0-)

        and it seems to me that most of the doctors in our area are foreign born/educated in foreign medical schools, or foreign born/educated to premed in foreign medical schools, then get final education in American schools.  

        We are filling the need for doctors from outside the country, and I am guessing that will continue when that 30 percent retire.  

        That folds into the other major problems our congress can't seem to deal with -- immigration reform, wage reform, costs/quality of higher education, unprepared high school students, as well as as destroying access to medical care in third world countries.  

        •  Hello (1+ / 0-)
          Recommended by:

          my dad is one of those foreign doctors. He graduated from Taipei Medical University's 7 year program. It cost him about $100 (USD back in that time period) per semester and like the spoiled brat he was, he drove to school. Everyone else took the bus. His medical education was CHEAP. Oh he served in the [foreign] military too lol.

          He came to the united states during the late 70's and got his greencard in early 80's... thanks to a nice man named Dr. Elmer Brown (God rest his soul) who helped him out and gave him a position in a training program... and then a lawyer in Chicago whose dad was famous paid attention to changes in the law and really expedited this process.

          Fast forward to today... my brother is graduating from medical school in May.
          So his education after high school was...
          Washington University in St. Louis double major biology and anthropology
          Yale University Masters in Public Health
          some more classes at the local calstate across the street from our house
          Touro University in Las Vegas

          His education alone is like half a million dollars.  He is a lucky guy to have his mommy and daddy pay for everything and keep him debt free. 99% of other people do not get this luxury. It is a LUXURY to be debt free like this! There is something wrong with this picture!

          mum and dad were running out of money so I got my engineering BS at UCLA. my tuition bill to my parents: 39k. housing+everything else: ~54k. About 100k if you include the mom make me food the dorm food is getting boring. The bill for my PhD to my parents: ZEE-ROH like Bill Clinton says it. So apparently the country invests in scientists. :)

          Why hello there reality, how are you doing?

          by Future Gazer on Thu Feb 21, 2013 at 09:16:12 PM PST

          [ Parent ]

      •  Let's not be stupid! (15+ / 0-)

           The hair on fire claim that each and every person who will have health insurance via ACA will all require immediate healthcare is rubbish.

             The physician shortage is a problem, but the assumption is that every patient sees a MD for every health care need is also a stretch.  Most physicians have RNs, who do the intake and PA's for doing physicals and OMG follow-up.

              Many hospitals have "hospitalists" who are supplanting the "on-call" physicians.   Many intensive care units are using Nursing Specialists for the managing of critical care patients.  

               What we need to understand is that patient care by direct physician care has changed over the past decade and many are sticking to the old idea that the only person competent to care for an individual (outside of surgery) is a MD.    
               I'm old enough to remember when the very idea of having a Nurse Anesthetist was sheer tyranny and yet now they are commonplace.

        •  The trend towards "hospitalists" (0+ / 0-)

          is awful, in my opinion.  Having had to deal with them in the past year during my mom's various health crises has not made me a fan. Instead of having one doctor who follows up -- and knows what your treatment protocols are -- you end up having to reinvent the wheel every 12 hours or so and things fall through the cracks.  The upshot is you get less personal care, a greater likelihood of errors, and lots more stress for patients and family members who are trying to get information and ensure the best care for their loved one.  I don't mind PAs, Nurse Practitioners, etc., but there are still times when an actual doctor is needed, particularly during a crisis situation.  In addition, there are times when having the continuity of just one doctor familiar with your case is highly beneficial.  

      •  And the AMA keeps it that way deliberately (10+ / 0-)

        by controlling the accreditation of medial schools.

        Is it any surprise that when we let doctors control the supply of new doctors they keep that quantity artificially depressed?

        “What’s the use of having developed a science well enough to make predictions if, in the end, all we’re willing to do is stand around and wait for them to come true?” - Sherwood Rowland

        by jrooth on Thu Feb 21, 2013 at 11:43:18 AM PST

        [ Parent ]

      •  Occupational birth control. (8+ / 0-)

        The slots in medical schools are absurdly limited in this country in comparison to others.  The excess profits of university/med school hospitals go to fund research, PR, and building campaigns, as well as inflate salaries for everyone from the President on down to the janitors.  But increasing the number of students is strictly forbidden.  Supposedly it would interfere with "quality".  In fact, it would remove the prop under provider charges, which in turn are necessary to pay off exorbitant loans for the exorbitant charges of the medical education system.

      •  Ask. Why the Dr. shortage when (1+ / 0-)
        Recommended by:

        so many college grads have a biology degree? Medical school should be free.

    •  My daughter had heart surgery (27+ / 0-)

      in December for her afib condition... the first itemized statement ( the infamous "THIS IS NOT A BILL" document ) started the meter at $187,643.

      She was in the hospital for one night and discharged by noon the following day...

      Fear doesn't just breed incomprehension. It also breeds a spiteful, resentful hate of anyone and everyone who is in any way different from you.

      by awesumtenor on Thu Feb 21, 2013 at 09:53:50 AM PST

      [ Parent ]

    •  Your vet isn't held to the same standards (11+ / 0-)

      or as liable for millions if you sue.   They can actually just pop open a generic bottle of pills and dispense however many they need to your dog or cat.  They don't have to document receipt of pills by batch from the manufacturer, store them in a secure facility, individually wrap and label them according to the person prescribed, deliver them securely to a different location, store them securely again, dispense them, document the dispensation using computers and scanners, and triple check them by eye.

      Medicine prices in hospitals actually aren't nearly as insane as they appear, given the amount of human and computer time each and every pill requires.

      •  Thank you. (7+ / 0-)

        Few people realize their bill isn't for the pill-- it's for the person who negotiates contracts with the pill manufacturer, the people  who establish what the facility's formulary should be, the person who knows when to order more pills, the people who unload the pills off delivery vehicles, the people who get the pills to the appropriate places within the building so they'll be available to administer to the right person at the right time (without being accessible to the wrong people at the wrong times), the unit clerks who transfer physician orders to in-house pharmacies, the nurses who sign off on those orders and safely administer the right drug to the right person at the right time.

        You want we each should bill you, folks, or do you want your itemized charges to contribute to a decent living wage for the people behind your care?

      •  Lawsuits are an infinitesmal part of the cost (0+ / 0-)

        of doing business and it is incredibly hard prevail.  

        Things are documented, but you might be surprised how much documentation goes into other fields, like building and maintaining roadway and we can be sued for design elements 20-30 years later and have to keep all of our paperwork forever or until the road is rebuilt to new standards, etc.

        One of the big problems is that:

        There are not enough nursing schools, so we are importing a large number of our nurses.

        There are not enough doctors, so we are importing a large number of our doctors.

        The capital cost of hospitals is high, which creates a large barrier for entry.

        Insurance adds an additional layer of complexity that is completely unwarranted.

        If Government wasn't so busy downsizing itself, maybe it would put some effort into addressing these things.

        "I watch Fox News for my comedy, and Comedy Central for my news." - Facebook Group

        by Sychotic1 on Fri Feb 22, 2013 at 06:31:20 AM PST

        [ Parent ]

  •  And here's why we pay more and get less (11+ / 0-)

    than any other so-called "developed" nation, and less than some "developing" nations.

    you want to control costs? control them here.

    that said, I still don't feel sorry for the insurance companies.

    Remember this old diary? :-P

    Now who wrote this? :-)

    if necessary for years; if necessary, alone

    by SouthernLiberalinMD on Thu Feb 21, 2013 at 08:47:39 AM PST

  •  Who profits at the 'non-profits'? (11+ / 0-)

    I've never really found a good answer to that one, beyond the obvious: the doctors.

    After all, every dollar that goes in the front door of a hospital finds its way out some other door. We know nurses, janitors and the like don't make much. The hospital isn't paying more than a penny for the generic Tylenol in the story and they own the lab in the basement - and the lab tech isn't making any money, for sure.

    Yeah, insurance costs money, but most states have enacted tort reform, so that isn't a huge money drain.

    Equipment costs money, as does construction and renovation.

    But, in the end, I point to the doctors. Where else does the big money go?


    Against stupidity the gods themselves contend in vain. Friedrich Schiller

    by databob on Thu Feb 21, 2013 at 08:50:22 AM PST

    •  A lot does go to doctors (25+ / 0-)

      a lot goes into palace hospitals with huge atria.  Hospitals in Europe are a lot less ostentatious, but function at least as well as ours, a lot goes into the pockets of health care provision companies executives, a lot goes into the outside companies they contract with for lab tests. A lot goes into simple inefficiency (dealing with lots of insurers and uninsured patients, and simply doing things in inefficient ways) and, yes, a lot goes to doctors.  We could make savings at many levels, probably resulting in improved outcomes.  Right now the incentives for health care providers to be efficient are not strong enough to make it happen.

      I'm truly sorry Man's dominion Has broken Nature's social union--Robert Burns

      by Eric Blair on Thu Feb 21, 2013 at 09:12:16 AM PST

      [ Parent ]

    •  err (22+ / 0-)

      I'll defer to someone else to offer the numbers (which may mean that you can basically ignore my comment), but I think that while doctors make very good money compared to janitors and nurses (for instance) they aren't, in general, getting those CEO-sized salaries of millions of dollars.

      I think that a lot of the costs are associated with administrative costs. There are a couple of useful Center for American Progress articles.

      3 Strategies for Reducing Health Care Administrative Costs

      Paper Cuts: Reducing Health Care Administrative Costs

      Take it easy, but take it.

      by ltsply2 on Thu Feb 21, 2013 at 09:12:27 AM PST

      [ Parent ]

    •  Only certain doctors... (3+ / 0-)
      Recommended by:
      samanthab, ladybug53, TiaRachel

      The only way they can really make money is to own a hospital and they have to have capital or backing to do so.  So it will probably be only 1% of the doctors.

      'Guns don't kill people, video games do - paraphrased from Lamar Alexander (Sen-R-TN)'

      by RichM on Thu Feb 21, 2013 at 09:49:24 AM PST

      [ Parent ]

    •  Our local community hospital (17+ / 0-)

      which is partially supported by local citizens (property taxes/bonds) has a board elected in our local elections,  is run by and Administrator that makes in excess of $600,000. per year.   Her husband was just given a quarter of a million dollar grant for a charity project that he is working on.

      Meantime, they have just initiated layoffs for a sizable portion of the staff.  

      Our local newspaper has, for the longest time, not reported on any relevant information on this hospital/board candidates/doctors in our city/performance statistics/what we are getting for our tax money.  

    •  Administrators, I would bet. (21+ / 0-)

      Seven-figure annual salaries for a top tier at most of the biggies.

      Some DKos series & groups worth your while: Black Kos, Native American Netroots, KosAbility, Monday Night Cancer Club. If you'd like to join the Motor City Kossacks, send me a Kosmail.

      by peregrine kate on Thu Feb 21, 2013 at 10:27:29 AM PST

      [ Parent ]

      •  You are correct (4+ / 0-)
        Recommended by:
        samanthab, ladybug53, TiaRachel, Sychotic1

        The big bucks in health care are in administration. A few specialties do really well, but med school is no longer a path to riches, especially if you start out in a six-figure debt hole. I don't regret switching from pre-med to nursing in the 90's!

         I can think of no more stirring symbol of man's humanity to man than a fire engine.     -- Kurt Vonnegut

        by SteelerGrrl on Thu Feb 21, 2013 at 02:41:31 PM PST

        [ Parent ]

    •  Competition (14+ / 0-)

      Every hospital has to have all the latest equipment, even if its available at another hospital 10 miles away. They all need to do everything, regardless of the duplication and cost.

      Example - there are at least 6 hospitals in Delaware that I can think of offhand. That's full hospitals, not just clinics. Those hospitals all have extensive imaging units, and there are separate facilities for that scattered through the state. They all do every kind of major surgery.

      Remember, this is DELAWARE. All the major hospitals in philly and s. jersey, as well as those in Baltimore and DC, including major research hospitals and world class facilities, are no more than 3 hrs from anywhere in the state.

      I can understand some duplication, but really, that much? Most places where there is universal care of any type will have way more primary care facilities and way less of these expensive, super full service facilities.

      Which is what we need. More primary care, which is what everybody needs, and more geriatric and long term care, which we will need soon, and less of the 'we can do everything kinda ok' facilities.

      •  this is a big part of the cost of healthcare, (5+ / 0-)

        although it is invisible to nearly everyone who doesn't understand medical diagnostic tools and their value/cost.

        Most of the modern imaging devices cost upwards of 7 figures each.

        Most of these devices are not in use for a majority of the day.

        Nearly every single clinic and multiple physician group and hospital has all of these devices, no matter how big the population in the area is.

        Remember, each device must be paid for through patient billings before it can start to make a profit for the providing physician, clinic or hospital (be assured that the sales force for the company which manufactures the device pushes this information when urging another provider in a community full of the devices to buy one for his/her medical office/clinic).

        Simply mathematics could show that the biggest cost to Americans for healthcare today is hidden in the over-supply of diagnostic devices in every single area of the nation. The more of these devices in any area, the higher the cost for the diagnostic use of each one (because not enough patients use each one, so they charge more per use to pay off the cost of them sooner and to start seeing a profit off of them).

        If the hospitals would schedule the use of the these devices around the clock, and the company who manufactures them are only allowed to sell a specific number of such devices in any geographical area (based on population and access to the various units situated in their location)...

        the costs of healthcare would start declining in real time.

        Look, if there are 2,000 MRI devices in a population pool of 240,000 people and the percentage of time during the past ten years that the devices have been used is available (and it is), then a mathematical evaluation will tell if there are enough or too many of them in that community.

        It's a big money pit that most people just aren't aware of when it comes to the cost of healthcare.

        "I like paying taxes...with them, I buy Civilization" -- me

        by Angie in WA State on Thu Feb 21, 2013 at 12:17:24 PM PST

        [ Parent ]

        •  I question whether the imaging devices are not... (0+ / 0-)

          in use the majority of the day.  When I've had to make an appointment for a CT or MRI it's usually a week out.  Sometimes it's less than that, maybe a day or two in the future, but still these devices get a lot of use.  

          I mean, technically they may not be scanning literally nonstop with a conveyor belt dropping patients into place, but at the same time they certainly aren't collecting dust.  

          Also, the article linked in the diary indicated that an MRI or CT machine was paid off in like the first year.  Their initial cost doesn't explain the absurd rip-off prices we're charged for their use.  

          The fact is, when you enter the medical world it's like entering the Twilight Zone.  All of a sudden walking on a treadmill for 20 minutes with an attached heart monitor costs a thousand dollars.  It's fucking ridiculous!  

          •  Since hospitals operate on a 24 hour basis, I (0+ / 0-)

            note that the devices are not operating for a majority of the day, but what I meant was they are not in use for over 12 or 16 hours of each day.

            In addition to there being far too many of them in most geographical areas for the cost of each diagnostic test to be reasonable for patients and their insurers.

            In addition to Healthcare services being one of only two industries in These United States which are specifically exempted from the Anti-trust laws of the early 20th century. Thus clinics and hospitals and doctors can collude to fix prices as high as the market will bear - and then some. And they can do it all as often as they like, legally.

            So whenever one place in an area raises the cost of a test, you can bet your bottom dollar that every other clinic and practice and hospital in the serving area will do the same.

            I used to work for sole practitioner. He asked me to use my own cell phone and pretend to be a patient and call around to see how much the other doctors in his specialty were charging by the hour. He was a European immigrant. I explained to him he could just have me write a letter to the clinics and ask them, and why.

            In any other industry it would be a federal crime, with jail time, to collude and price fix - because it is not in the best interests of the consumer patient to do so.

            "I like paying taxes...with them, I buy Civilization" -- me

            by Angie in WA State on Fri Feb 22, 2013 at 11:03:36 PM PST

            [ Parent ]

    •  Executive pay for one thing (1+ / 0-)
      Recommended by:

      You can make big bucks administering a "non-profit".

      Freedom isn't free. Patriots pay taxes.

      by Dogs are fuzzy on Thu Feb 21, 2013 at 02:11:30 PM PST

      [ Parent ]

    •  I used to work (1+ / 0-)
      Recommended by:

      for a not-for-profit company, and I know where the profits went there - into bonuses for the exempt employees. I was the lowest level of exempt worker and I got up to 20% of my salary in a good year.

      The union workers went on strike one year. I may have been the only person in my department who was on their side - if there were others they were keeping quiet about it. I was the only one on my team that didn't eagerly volunteer to scab. I was prepared to refuse, but fortunately they didn't insist.

      I had a conversation with one of the managers in my department at this time, and asked her why the company had to be hard-assed with the employees when we didn't have stockholders to answer to. When I first started working there in 1982, it was a very good place to work, and it felt like it had a purpose other than making money. But over the years the executives talked more and more about growth and competition and cost-cutting and it got to feel like anyplace else.

      Anyway, she looked at me as though I were crazy and reminded me that the less the hourly workers settled for, the bigger our bonuses would be.

      Us v. them.

      So that's not-for-profit.

      We decided to move the center farther to the right by starting the whole debate from a far-right position to begin with. - Former House Majority Leader Tom DeLay

      by denise b on Thu Feb 21, 2013 at 08:10:09 PM PST

      [ Parent ]

  •  I have a question for anyone heathcare. (2+ / 0-)
    Recommended by:
    james321, ladybug53

    What exactly does the legal obligation to provide care entail?  Does it extend beyond physicians to other staff critical to medical decisionmaking--including Billing--of a hospital, practice or other healthcare institution?  I mean at some point insisting on payment from the uninsured and short of means runs up against the obligation to provide care for patients, right?  Or is this a case where the line is fuzzy and in truth Billing can get away with this crap?

    •  Is healthcare different than plumbing? (4+ / 0-)

      Are your  internal 'pipes' different from your home's pipes?

      You call a plumber, he does stuff, then charges you.

      You see the doctor, he does stuff, then charges you.

      If you can't afford to pay the plumber, your pipes don't get fixed.

      I'm not sure - in our current health-care system - how a doctor or hospital is required to behave differently.

      Having said that, I am NOT at all supportive of our current health-care system. It is broken in many ways.

      Medicare for all is the only rational solution.


      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Thu Feb 21, 2013 at 09:10:51 AM PST

      [ Parent ]

      •  Emergency stabilizing treatment is an obligation (7+ / 0-)

        The Emergency Medical Treatment and Active Labor Act (EMTALA) is a U.S. Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions. Participating hospitals may only transfer or discharge patients needing emergency treatment under their own informed consent, after stabilization, or when their condition requires transfer to a hospital better equipped to administer the treatment.

        "Don't be defeatist, dear. It's very middle class." - Violet Crawley

        by nightsweat on Thu Feb 21, 2013 at 10:18:35 AM PST

        [ Parent ]

      •  The plumber doesn't get millions in federal $$$ (12+ / 0-)

        He doesn't collect millions from the taxes you pay for grants, parking lots (yes, our local mega hosptial got $7 million of your tax dollars to build a deluxe parking garage), research institutions, researcher, nurse and physician's salaries, funds for uncompensated care, etc. etc. etc.

        The amount of money (unrelated to Medicare & Medicaid) that health care providers receive from the federal, state and local governments is staggering.  

        Those billions in tax dollars the docs and hospitals receive are given with the stipulation that they provide some level of charity care for the uninsured.

        So, fine, if they want to gouge the uninsured, they can give up their government funding.

        Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

        by Betty Pinson on Thu Feb 21, 2013 at 10:28:42 AM PST

        [ Parent ]

        •  Ironically... (0+ / 0-)

          Many plumbers actually end up financially better off than doctors.  They don't have the upfront costs of going to medical school.  Nor do they have the pressure on them to "look the part" and buy expensive houses, cars, etc.  

    •  My understanding (12+ / 0-)

      is that there is an obligation to treat patients, but no obligation to do it for free.  So if you are poor and uninsured and go to the emergency room, you will be treated, but you will be billed for the treatment.  The hospital is not obligated to forgive the debt and they can turn it over to a bill collection company if they want.  If you think about it, you get sick you are better off being poor enough to qualify for Medicaid than to be working in a low paying job without insurance.

      I'm truly sorry Man's dominion Has broken Nature's social union--Robert Burns

      by Eric Blair on Thu Feb 21, 2013 at 09:20:14 AM PST

      [ Parent ]

    •  Look up 'EMTALA' (16+ / 0-)

      The emergency treatment and active labor act' or somesuch, passed in '86.  That's the 'free emergency room care' that Republicans harp on and on about.  It's actually no such thing.  It only requires (most) hospitals to stabilize you when you've got an active acute problem.

      Ie, 'treat em and street em'.  If you're having a heart attack, going into labor, chopped a finger off, they're required to 'stabilize' you without regard for whether you can pay, are a citizen, etc.  But unless you actually can pay, I'm guessing you're not going to get finger re-attachment surgery, just the stump sewn up and bandaged.

      But the med staff generally totally ignores billing issues, other than offering generic prescriptions if you tell them you can't afford brand names.  You get to fight out the rest with the billing dept, who have no particular obligation to anything.

      •  Exactly what I needed. (1+ / 0-)
        Recommended by:

        Thank you.

      •  EMTALA - what it does, and what it doesn't cover (6+ / 0-)

        First off, only hospitals which accept Medicare patients are under the EMTALA provisions. (source:

        Second, patients who present and request care at these hospitals are only entitled to be assessed - and IF and ONLY IF their life is endangered or if their medical condition is unstable and their life is possibly endangered; THEN the hospital is requred to stabilize them.

        Which means a patient with insurance comes to the hospital with chest pain. They go to an ER exam room, where an EKG is done. If abnormal EKG presents, then (depending on a lot of factors, like age, weight and family history) they might order a troponin test (these are enzymes produced when a cardiac event is occurring). If positive, a diagnostic test might be ordered to view the heart and coronary arteries, to show any blockages. If any are found Angioplasty might happen (where they push a balloon into the artery, from the femoral artery in the groin!) and a Stent placed (a metal spiral to keep the artery open and not allow it to collapse and block the blood flow again). After all of this, the patient then goes to Cardiac Rehabilitation.

        If a non-insured presents with the same exact symptoms and disease, they go to an ER exam room. An EKG might be done. If it is, and a blockage is suspected by the attending, the patient might go to the Cath Lab and have an Angiogram, if a blockage is found, the patient might have Angioplasty and a Stent placed. As little as 2 days later, the patient is determined to be stable and discharged with instructions to see a Cardiologist for ongoing care.

        In the second scenario, all of those mights are there because at each step of the process Hospital Administration has instituted steps to reduce costs to them from the uninsured, and doctors are under different rules, depending upon the patient and their insured or uninsured status.

        None of the physicians like this system, but they are stuck with it until this country stops treating healthcare like a fucking Gym Membership (which only the well-off can afford)  and starts treating it like the system is SHOULD be, the way to keep the population healthy and useful throughout their working lifespan.

        EMTALA imposes 3 distinct legal duties on hospitals.

        According to the statute, only facilities that participate in Medicare are included, but this encompasses almost 98% of all US hospitals.

        First, hospitals must perform a medical screening examination (MSE) on any person who comes to the hospital and requests care to determine whether an emergency medical condition (EMC) exists.

        Second, if an EMC exists, hospital staff must either stabilize that condition to the extent of their ability or transfer the patient to another hospital with the appropriate capabilities.

        Finally, hospitals with specialized capabilities or facilities (e.g., burn units) are required to accept transfers of patients in need of such specialized services if they have the capacity to treat them.

        "I like paying taxes...with them, I buy Civilization" -- me

        by Angie in WA State on Thu Feb 21, 2013 at 12:37:48 PM PST

        [ Parent ]

  •  About 15 years ago, I had surgery (17+ / 0-)

    Laproscope to repair a hernia tear.  I remember getting a surgeon bill for like $20K dollars.  For like an hour of essentially out-patient surgery.  I called the doctor's office, and was told to ignore it.  They send the huge bill to the insurance company and simply accept whatever the insurance company sends.  They want to make sure they get the entire capped amount, and rather than charge LESS than that amount (which the insurance companies won't reveal), they make sure they charge more.  I never got another bill from the surgeon.  

    The struggle of today, is not altogether for today--it is for a vast future also. - Lincoln

    by estamm on Thu Feb 21, 2013 at 08:51:27 AM PST

    •  four years ago, (7+ / 0-)

      my husband had hernia surgery on an out patient basis.  He checked into the hospital in the morning and was released late that afternoon.  Our insurance paid all but $200 of the bill, but we were given a copy of the bill to see.  I was shocked to see that the total bill was five figures.  Of that amount, the least expensive charge was that for the surgeon.  Anestheology was slightly more with the bulk of the bill being various hospital charges.

      "Growing up is for those who don't have the guts not to. Grow wise, grow loving, grow compassionate, but why grow up?" - Fiddlegirl

      by gulfgal98 on Thu Feb 21, 2013 at 10:00:59 AM PST

      [ Parent ]

      •  The hospital charges are absurd... (1+ / 0-)
        Recommended by:

        I had nasal surgery to correct a deviated septum.  My insurance company received an astronomical bill for like $15000 for room cleaning and other miscellaneous bullshit.  For some reason when I had shoulder surgery to remove a plate in my shoulder (I'd broken my clavicle when in Europe the year before), this strangely high charge was not assessed.  

        The whole system is just ridiculous.  There's no rhyme or reason to anything, and I guess if I were uninsured I'd have bill collectors hounding me to pay that $15,000 bill.  I actually felt bad for my insurance company for having to pay it.  

        On another note, it cost less for me to get the plate put in my shoulder over in Germany, even though it was a much more difficult surgery since my clavicle had basically been shattered into 3 fragments, whereas the surgeon here just had to take it back out.  I paid cash for it and it was only about $2000.  Here the cost was like twice that for a 30 minute surgery.  

        It's just fucking bullshit.  

  •  Chargemasters are not documents but algorithms (27+ / 0-)

    The complex sets of algorithms used to calculate actual itemized charges are rules based engines that segment assets and charges according to whatever lines of business being used (e.g., Large Groups, Small Business, Individal, Medicare) with their specific and different charge back factors, they load in another complex set of factors that include r&d and administrative costs, staffing changes, they make reconciliation adjustments after previous months' budgets are corrected with actuals, and factor in time related price changes.

    Basically, the revenue "necessary" for the charge period is sliced and diced and allocated into the charges.

    An aspirin is never just an aspirin.

  •  Taxpayers hve a right to challenge the tax exempt (8+ / 0-)

    ...status of many institutions. Kaiser Permanente, for instance, has been not for profit in Ca for over 50 years but times have changed since that relationship worked for the state's residents. Now that KP competes toe to toe with a for profit industry by raising prices residents should be wondering if that status should be reconsidered!

    •  Well, if taxpayers had rights, I'd agree.... (6+ / 0-)

      but since we're not real (read corporate) people, there's not much we can do, is there?

      Health insurance companies are the only industry - other than major league baseball - that is exempt from the anti-trust laws, so they can legally collude and fix the markets they operate in.

      The result of that is that almost every market in the USA has 1 or 2 dominant carrier(s), making competition non-existant and the barrier to entry insurmountable.

      Medicare for All? It's the only rational answer to this mess.


      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Thu Feb 21, 2013 at 09:06:06 AM PST

      [ Parent ]

  •  Beneficiaries are NOT primary-care physicians (26+ / 0-)

    Primary front-line physicians (internists, family practice docs, pediatricians etc) hardly live a life of poverty, but by-and-large are not the ones reaping huge financial gains off the current insurance system.  A frequent source of tension in HMO organizations is the role primary-care physicians play in being  "feeders" for the higher-paid specialists with the 500k incomes, while the primary care docs make but a quarter of that.  Meanwhile, it is the hospital/HMO who receives the lion's share of the markup from all the tests, procedures, etc. ordered.

    •  Specialists suck... (0+ / 0-)

      I've been dealing with the health care system for the past 18 months due to strange health problems that have only now started to be diagnosed.  My primary care doctor has always tried to help, but then when I get shipped off to a specialist it's totally different.  

      Some of the specialists have treated me nicely, and others have treated me exceptionally rudely.  However, the following observations apply to all equally.  Rather than try to figure out why my problem is, the sense I have gotten is that their primary goal is to "prove" that the problem doesn't lie in their specialty, so they can boot me out the door.  They constantly attempt to disregard or downplay even obvious physical symptoms I have, as if I don't have two eyes of my own.  

      They appear to be so incredibly specialized that they have basically forgotten all of their general knowledge.  They're used to looking at problems wish such extreme focus, that they can't see the big picture at all.  If they can't figure out the problem off the top of their head, they are inclined to think it's not their problem, and send me back to my GP who can't so easily get rid of me.  

      I don't even think the specialists are appreciably smarter or better doctors than the GPs either.  Some of the ones I've seen have seemed pretty stupid.  In my opinion the specialist pay pay should be lowered by 30%, and GPs pay increased by 20% to make their pay roughly equal, but slightly reduced overall.  

  •  Isn't is also a problem that (11+ / 0-)

    insurers have to meet certain percentages regarding profit-to-cost ratio?

    If I can only make 15% profit on a bill, the bigger the bill, the better for me, as long as I can pass the costs along to my clients.

  •  All the problems would cease (18+ / 0-)

    if the profit motive were removed from health care. So much time and energy is spent making sure that share holders and individuals make a profit that patients just become ATMs.

    The last three days of my mother's life were spent in the hospital where she slowly bled out internally. My mother didn't want a DNR, she was clinging to life with all she had even tho I and her doctor knew it was inevitable.

    After her death I began going over the Medicare claims. My mother had had at least 25 "tests" ordered by every doctor on staff at the hospital. Along with the money paid to the hospital all of those doctors submitted claims. She was dying! I'm surprised they didn't do a prostate exam and a pregnancy test.

    Yes, I reported it and I have serious doubts anything was done.

    Remove the greed and mom could have died with peace and dignity, we are insane in this country.

    "The scientific nature of the ordinary man is to go on out and do the best you can." John Prine

    by high uintas on Thu Feb 21, 2013 at 09:13:02 AM PST

    •  Why didn't you (5+ / 0-)
      Recommended by:
      mmacdDE, Wednesday Bizzare, ltsply2, FG, anana

      Just take her home if she was dying and you didn't want any tests done? This is not a personal criticism but happens all too often in American hospitals today, driving up costs tremendously.

      The fact of the matter is, when someone is dyng in a hospital and not on hospice (or at least DNR) the physicians are in a difficult position. At any moment a family (not necessarily you, but this DOES happen) can change its mind and decide we now "have to do everything to save" someone. And, of course, sue the doctor if he or she fails to do so. This is the reason for continued testing. It's not greed-- depending on which hospital the physicians likely made no more or less money (personally) based on what tests she needed.

      The problem is, however, the combination of unrealistic expectations, unclear/poor prioritization of resources, and of course the threat of litigation that pervades all of medicine.

      •  Unless the patient is incompetent it is ONLY their (1+ / 0-)
        Recommended by:
        high uintas

        wishes which the hospital will follow, not the family.

        The mother "was clinging to life with all she had".

        Only the mother could have asked to go home to die with the family, and she did not want that.

        Please read comments more carefully before responding when the issue is a death in the family, otherwise you sound like a heartless turd by starting out the comment like ...

        "Why didn't you just take her home if she was dying and you didn't want any tests done?"

        "I like paying taxes...with them, I buy Civilization" -- me

        by Angie in WA State on Thu Feb 21, 2013 at 12:44:56 PM PST

        [ Parent ]

        •  If the patient (1+ / 0-)
          Recommended by:
          high uintas

          was competent, the patient wanted everything done, and the doctors were in fact following the patient's wishes, there is literally nothing to complain about. So one assumes that wasn't the case.

          It is far from being a "heartless turd" to tell someone what his options are to have the care they want for their family members, and answer his question honestly.

          Please think about your responses more carefully, otherwise you sound like a drooling idiot.

        •  You and mudfud 27 got it (2+ / 0-)
          Recommended by:
          Asak, Sychotic1

          It was mom's choice and she was lucid right up to when she died. To tell the truth the hospital was trying to cut her loose on the day she died. I was frantically trying to get things together to bring her home when I got the call to come quick.

          "The scientific nature of the ordinary man is to go on out and do the best you can." John Prine

          by high uintas on Thu Feb 21, 2013 at 05:48:19 PM PST

          [ Parent ]

      •  It was greed. (1+ / 0-)
        Recommended by:

        these were doctors who had zero to do with mom's care and test that were redundant and most of them were unrelated to her illness.

        This is a small hospital with less than a dozen Drs on staff. Everyone of them but the ortho guy got their test in. Mom's Dr. did everything but outright admit to me that it happened. All the tests were done at night when our Dr. wasn't there and they did nothing to help.

        "The scientific nature of the ordinary man is to go on out and do the best you can." John Prine

        by high uintas on Thu Feb 21, 2013 at 05:53:13 PM PST

        [ Parent ]

  •  One of the must frustrating aspects (9+ / 0-)

    of our current healthcare system is the absolute inability to estimate medical costs for any given procedure.  Pretty much other than standard x-rays and maybe co-pays for prescription medications, the costs are totally unknown to patients and many times even physicians.

    But since medical care is probably the most price inelastic commodity known to exist, people will continue to pay outrageous prices to keep themselves alive, because what other option is there?

    The only way to cut down on costs is to vastly increase the customer pool (i.e. - economies of scale) and eliminate the 20% of premiums that are line-itemed for profit right off the bat.

    Medicare For All satisfies both of those needs.

    It is done. Four More Years.

    by mconvente on Thu Feb 21, 2013 at 09:13:14 AM PST

    •  Crawl Across Broken Glass With Last Dime (2+ / 0-)
      Recommended by:
      high uintas, james321

      ... for something like a toothache, never mind a broken leg.

      Any discretionary purchase can be done without, any product can be offshored to slave labor, but what a gift that keeps on giving for the awesome business model to be on the payee side of that situation.  Add to that the protection of a powerful cartel (the AMA) and it keeps getting better.

  •  I'm sorry but your first sentence is untrue. (4+ / 0-)
    Recommended by:
    james321, mudfud27, sydneyluv, TiaRachel

    First, I thought we all knew that the health care business is an immoral one. I have never seen a hospital bill that wasn't inflated to some degree. I thought we also understood that not every hospital takes every type of insurance plan/discount plan.

    Second, MD Anderson has saved the lives of family members. Two had no insurance from the time of diagnosis. Another had insurance when accepted as a patient, but lost his job before treatment started. They are all still here. They are all still uninsured. None of them were "ripped-off" as you state.

    Having money or insurance is no guarantee that you will be accepted at MD Anderson. Not having insurance is not an automatic bar from being accepted.

    The article leaves the impression that MD Anderson is some kind of cancer corporation that is some how bloated and over built. The truth is that the place is a state institution. The truth is that due to massive budget cuts, massive layoffs were instituted. The truth is that one of the largest buildings on the "campus" looks grands, but houses patients and family that need extended treatment but cannot afford lodging.

    Another large building is solely for pediatric cancer patients. Another new building is for parking. Another building holds classrooms, faculty offices, and administrative offices.

    I wish Mr. Brill had done a better job describing the place in full. I wish he had a discussion about their Patient Assistance Programs. I wish he had talked to more patients. The place is a true wonder,it is imperfect as any other hospital that charges for treatment, but it does not rip-off uninsured people.

    "There is nothing more dreadful than the habit of doubt. Doubt separates people. It is a poison that disintegrates friendships and breaks up pleasant relations. It is a thorn that irritates and hurts; it is a sword that kills.".. Buddha

    by sebastianguy99 on Thu Feb 21, 2013 at 09:16:19 AM PST

  •  My problem was with ER quality of care (12+ / 0-)

    2 trips to the ER in 10 days, a surgeon wanted to take my gall bladder out on the spot.  Turned out it was IBS.  AND I'M AN RN!  Not a person off the street with little to no medical knowledge! They have an "advocate site" where you can post a concern, and get a response within 2 business days.  I posted my concerns back in October 2011.  I still do not have a response.    

    "The light which puts out our sight is darkness to us." Thoreau

    by NancyWH on Thu Feb 21, 2013 at 09:20:03 AM PST

    •  One of my many ER trips w/mom (6+ / 0-)

      A doctor told her she had liver cancer and it looked inoperable. We never figured out what he was looking at. Her liver was fine right up to the day she died.

      "The scientific nature of the ordinary man is to go on out and do the best you can." John Prine

      by high uintas on Thu Feb 21, 2013 at 09:43:56 AM PST

      [ Parent ]

      •  Was he trying (4+ / 0-)

        to make $ off her?  That was the clear impression I got from the gall bladder surgeon.  And I trusted him, because he saved our son's life as a toddler [he had an intessussuption, and would have died]. But Mr. WH had several infected lipomas removed by Dr. Gall Bladder, and eventually quit his practice.  The man was just greedy.

        "The light which puts out our sight is darkness to us." Thoreau

        by NancyWH on Thu Feb 21, 2013 at 10:18:50 AM PST

        [ Parent ]

        •  No, I really think he was incompetent (2+ / 0-)
          Recommended by:
          NancyWH, Asak

          Our ER is staffed by a rotating group of doctors who don't have a practice here in town. Some are very good, and some are scary bad. You gamble every time you go.

          When I went into sepsis from strep pneumonia there really wasn't time to get me to Salt Lake, I would have for sure died. I pulled the lucky straw and got a good doctor, but what happened with mom was just wrong.

          "The scientific nature of the ordinary man is to go on out and do the best you can." John Prine

          by high uintas on Thu Feb 21, 2013 at 05:45:42 PM PST

          [ Parent ]

  •  $17,000 for the hospital (12+ / 0-)

    is like a bad joke. This is the kind of number they pull out if you are uninsured (ironically, the uninsured, the ones least likely to be able to pay, get the worst prices). The minute they find out you have insurance, that number gets cut down 80% or so, which just goes to show that it was a ridiculous price in the first place. (Many uninsured patients don't pay that full price either, because they simply can't, and the hospital may agree to accept less).

    It is a crazy system. Not only is the price for things just made up out of thin air (and ridiculously high), it is a  system in which which everyone who walks through the door gets a different price, depending on what kind of insurance they have. It is complex and costly just to mange this kind of system and it drives patients crazy, in addition to saddling many of them with unmanageable bills.

    •  Remember - these are the numbers they used to (1+ / 0-)
      Recommended by:
      yoduuuh do or do not

      sell the mandate to the affluent.

      When they convinced white collar "liberals" that "free riders" were the cause of ever skyrocketing insurance costs, they used the ridiculous price charged to the uninsured.

      The assumption is that the uninsured won't pay the bill.  They inflate the bill massively so that they can 1) Write off two thirds as a "loss" 2) Sell it for 33 cents on the dollar to a collections agency.

      Then, they pretend that the problem is "the burden of the uninsured", and get greedy privileged upper middle class assholes to jump on the bandwagon and blame poor people.  

      income gains to the top 1% from 2009 to 2011 were 121% of all income increases. How did that happen? Incomes to the bottom 99% fell by 0.4%

      by JesseCW on Thu Feb 21, 2013 at 03:02:23 PM PST

      [ Parent ]

  •  The insurance discount (15+ / 0-)

    Five years ago, I had a cardiac procedure that required an overnight hospital stay, and operating room, a specialist cardiologist (not a garden variety cardiologist), an anesthesiologist and a lot of other sundries.

    After I got home, I got the bill, which was in the neighborhood of $21,000. (Almost sounds like a bargain.) I am fortunate enough to have insurance through my employer, so I actually only paid my deductible, $250.

    But the bill also showed me what the insurance company paid, which was in the neighborhood of $7,000.

    That's right, the insurance company got a 67% discount on my hospital bill.

    The hospital negotiates rock-bottom prices with the insurer to get their business. Then, they make up the difference to make a profit by grossly overcharging individuals. This is devastating for people who are self-employed or work at no-insurance benefit jobs.

    It's absolutely unfair. The less able you are to pay, the more it's going to cost you. (Unless you're destitute, in which case you may have Medicaid.)

    Obamacare does very little to alleviate this injustice. Obamacare works through the private insurance system which is what causes the problem.

    Single payer would solve the problem. But it isn't the only solution. The Japanese system (no insurance, government regulated prices -- the same for everyone and affordable enough for anyone) would solve the problem.

    Getting sick will continue to mean total financial ruin as long as we let insurers and hospitals fix the game.

    Wealth doesn't trickle down -- it rises up.

    by elsaf on Thu Feb 21, 2013 at 09:26:03 AM PST

    •  exactly. What a racket. (2+ / 0-)
      Recommended by:
      elsaf, ladybug53

      If the plutocrats begin the program, we will end it. -- Eugene Debs.

      by livjack on Thu Feb 21, 2013 at 10:16:15 AM PST

      [ Parent ]

    •  Actually, that's the insurance inflation. (12+ / 0-)

      If you'd told them you had to pay out of pocket, you too would likely have gotten a discount, possibly even a larger one.  They grossly overbill insurance companies because they KNOW insurance companies will deny giant chunks of that cost.

      Last March, I spent 3 days in the hospital for a potential heart attack, having every test under the sun done to me.  Happily, it was not, but still there were over 30k in bills racked up in a year in which I had $330 in income.  Insurance paid around 14k I think, denied most of the rest, leaving me to pay a couple of thou in various doctor bills, and $2800 owed to the hospital.  The hospital, learning how much I'd had in income, wrote off every penny of the remaining bill.

      (I'm ineligible for Medicaid, btw.  In Ohio, if you're an adult without children, you can't get medicaid, no matter how small your income.  Thanks, Republican-controlled state congress!)

      •  Actually, it's all about write offs and selling (1+ / 0-)
        Recommended by:

        debt to third parties for collections.

        It's assumed that the uninsured will not pay bills over a thousand dollars.  Ever.

        income gains to the top 1% from 2009 to 2011 were 121% of all income increases. How did that happen? Incomes to the bottom 99% fell by 0.4%

        by JesseCW on Thu Feb 21, 2013 at 03:03:49 PM PST

        [ Parent ]

  •  Global payment versus fee-for-service (5+ / 0-)

    Part of the issue is that we in America view healthcare through the same lens that we view purchasing other services or goods even though it is totally different. As someone pointed out if you walk into an ER, even if you aren't insured, you get some health care (even if it isn't the best or even sufficient), but if you go into a grocery store without money you get nothing.

    Hospitals, and other health care organizations, for years operated on a "fee-for-service" basis. You give me a drug or procedure, I pay you money for that. In part because of new regulations, some areas are moving towards a "global payment" system. The concept here is that you are paid a flat fee to take care of healthcare for a certain population regardless of what that means. In theory this means a greater focus on preventative health (as it is cheaper to convince someone not to smoke than to treat them for lung cancer).

    Basically what is happening in 'fee-for-service' situations today is that they are trying to artificially capture the totality of the costs of the health care it provides. So while, yes, the acetaminophen tablets appear to cost too much they are actually just standing in proxy for not just the cost of the drug, but also some of the doctor's time, and nurse's, and pharmacist's, and security, and HR, and utility bills, and uninsured, and marketing, and insurance, and underpayments, and all the other hundreds of little things that go into running a company (hospital or otherwise).

    Take it easy, but take it.

    by ltsply2 on Thu Feb 21, 2013 at 09:31:28 AM PST

    •  Fall out from global payment system... (3+ / 0-)
      Recommended by:
      ltsply2, SilentBrook, ladybug53

      An interesting side effect of this system is that it will also be more expensive to address certain issues. If a physician knows that the patient will be complex or that they will have to send them out, they will be losing money. In this case there are incentives to actually not perform treatments.

      Actually, hearing from physicians, there is now more rollout of 'firing' patients cause they won't be profitable to treat. Those people while getting some care, will be transferred to the least level of service possible.

      My wife as a provider has a high probability of closing her practice as it will likely no longer be profitable to continue. In the future, providers will most likely much less skilled (MS / BS level).

      "I know the meaning of life. It doesn't help me a bit."

      by dss on Thu Feb 21, 2013 at 10:09:55 AM PST

      [ Parent ]

      •  Absolutely (2+ / 0-)
        Recommended by:
        SilentBrook, ladybug53

        There is definitely a HUGE difference between how global payment works in theory versus in practice. As long as you can "fire" patients, it still doesn't solve the problem. Another reason why single payer works better. Global payment is a half measure towards real health reform that doesn't necessarily solve the real problems (like the ACA generally). I do, however, think it is useful in getting people to conceptualize health care differently.

        Take it easy, but take it.

        by ltsply2 on Thu Feb 21, 2013 at 10:20:05 AM PST

        [ Parent ]

      •  To be honest... (0+ / 0-)

        A lot of problems don't require an outright MD for treatment.  A smarter system would be to employ PAs and NPs to handle easy problems and only escalate to doctors when necessary.  That is probably a smart way to reduce costs.

        However, it still doesn't explain why right now we're paying twice as much for inferior care than other countries.  We start out with severe inefficiencies that even smart practices are insufficient to solve.  

    •  Grocery store actually does provide food to people (1+ / 0-)
      Recommended by:

       Have you heard of the phenomonon of dumpster diving at the back of the store to find things to eat?  
        Also our grocery store takes donations of cash from paying customers, and uses it to buy food at cost for the local food banks, and also  donates a lot of food to the free pantries.    They are very active in feeding the hungry.

  •  somewhat recent hospital stay (9+ / 0-)

    I have health insurance and the Explanation of Benefits (EOB) forms I got from my insurer after a hospitalization last year were a real eye opener. Each statement shows: the hospital’s “retail” price, the negotiated price agreed to between the hospital and my insurer, and how much not covered by insurance that I owe out of pocket.

    At the bottom line, the negotiated price between the hospital and insurer was about 70% less than “retail.” In other words, whereas my insurance company was billed $5,000 an uninsured individual would be billed $16,700 for the exact same scope of services. The hospital makes a profit on that $5,000. You can assume that because if they didn’t make money on privately insured patients they would be out of business.

    So, the 335% markup for uninsured patients is explained….how? Is this a fantasy number cooked up to make it appear the hospital is spending astronomical amounts on charity care? Is it to gin up large dollar amounts for purposes of tax deductions for business losses? I’m asking because I honestly don’t understand where these numbers come from. Meanwhile, they are definitely not a fantasy for real uninsured people who have these bills handed to them. The financial liability is real and people are pushed into personal bankruptcy for it.

    Let this be a lesson to anyone who is uninsured and is presented with a huge hospital bill they can’t pay. Ask for at least 60% off, and don’t feel the least bit shy about it. The hospital’s expenses will be covered and they will still make a profit from you.

    Outside of a dog, a book is man's best friend. Inside of a dog, it's too dark to read. - Groucho Marx

    by Joe Bob on Thu Feb 21, 2013 at 09:34:03 AM PST

    •  It's called a "good negotiation starting point". (11+ / 0-)

      Everybody in the game knows the score, except of course the patients.

      Moderation in most things.

      by billmosby on Thu Feb 21, 2013 at 09:42:51 AM PST

      [ Parent ]

    •  When a patient can't pay their bill, (6+ / 0-)

      after a certain amount of time it sells the bill to a collection agency, who pays for it for pennies on the dollar.   Hospital writes off the unpaid amount as a loss.
         The collection company reports to the credit bureaus the unpaid balance in full, and then continues to call and harass the patient until they get paid in full, while the patient suffers all the problems of ruined credit. They, in turn, sell uncollectable bills to other collectors at further discount.  Collection attempts at full price continue.
         Too bad that the hospital won't write down the value of that for the patient to pay off, clearing the books.  
         One the things the Occupay people have been doing is collecting donated money and buying debt from hospitals and then clearing it so that the sick people aren't ruined.  

      •  Just last week, I got a "personalized" robocall (0+ / 0-)

        from a collection agency. Second time in two years with the same thing, they wanted $3500. I could not figure out what this was for, redialing the phone # got the do-do-do This call cannot be completed as dialed...

        Well I got through, with the help of my phone company, and it involved a bill for $35 copay
        from 2.5 years ago when my husband died.

        Collection agent said they would eat the $35. What if I had paid them $3500? Someone inputting numbers got a little wild with zeros? And how in the hell did they get my name and phone # since it's not in the phone book?

        Americans, while occasionally willing to be serfs, have always been obstinate about being peasantry. F. Scott Fitzgerald, the Great Gatsby

        by riverlover on Fri Feb 22, 2013 at 02:07:27 AM PST

        [ Parent ]

  •  Why invoke sympathy? (2+ / 0-)
    Recommended by:
    james321, TiaRachel

    Even if your underlying thesis were to prove true: that the jig is up on price gouging and this one article is going to lead to wholesale changes across the healthcare landscape (though by what mechanism is a total mystery), it wouldn't exonerate the big insurers for their collusion in raping their customers for over 3 decades.

    Same as it ever was. Hospital administrators aren't discomfited one jot by articles such as this. Insurers and hospitals work together to see to it that there will be no political price to pay for abusing their authority. They contribute to candidates and offer other inducements to maintain the status quo. They've been systematically fighting reform for over 30 years. Their last attempt at watering down meaningful changes was very successful. They even got the President to attach his name to it, as if he were some sort of Disney mascot for the cause of advancing the interests of Big Insurance.

  •  CNN is doing something on that story too (8+ / 0-)

    One example they found: a $12 "medication delivery system" which is identical to those little paper cups you use for catchup at a fast food restaurant.

    Another example is a "mucous recovery system", otherwise known as a facial tissue. They didn't say whether they charge by the sheet or by the box....

    Moderation in most things.

    by billmosby on Thu Feb 21, 2013 at 09:39:55 AM PST

  •  Canadian: I feel like I won the geographic lottery (18+ / 0-)

    Good-looking people talk about winning the genetic lottery.

    Rich kids (rarely, but sometimes) talk about winning a lottery at birth.

    As a Canadian, I feel like I have won a geographic lottery.  Public health care is one of the big reasons why.

    It really makes me sad to see what America has become.  It used to be the country to look up to.  That people aspired to live in and to be like.  Now it's mostly a cautionary moral tale.

  •  MD Anderson also under investigation (6+ / 0-)

    for a questionable $20 million grant they received from Rick Perry's Cancer Prevention and Research Institute of Texas.

    The Houston Chronicle has a long list of excellent stories at the link above.

    Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

    by Betty Pinson on Thu Feb 21, 2013 at 09:52:40 AM PST

  •  lab rip-off (7+ / 0-)

    We've figured out the Big Pharma is making a killing off Americans who must pay the most outrageous prices in the world for medications.
    If Americans only knew how much they were being ripped off on labs.... Oh, sorry, "ripped off" = vulture capitalism.

    Labs are ENORMOUSLY marked up.  I know because as a practitioner I get practitioner pricing that I can offer to my patients. Even with a small mark-up, the labs I offer are 100's of percent cheaper than if they had to go straight to the lab as an un-insured.

    They can pay me $60 for a basic thyroid work-up and it would cost them $300+ straight from the lab. I charge $80 for a genetic test. The same test is $400 on the market.  I could go on, and on, and on.....

    If the federal government simply took over doing the #50 most common labs done in the country I bet we could save BILLIONS a year.  

  •  The med issue is, in large part, a matter of how (8+ / 0-)

    meds are treated these days in hospitals.  You don't just go to a bottle and 'pour one out'.  Every pill is individually packaged and bar-coded by a human in the pharmacy, after consulting with those prescribed for a specific individual, then delivered to the unit on which that individual is located, then taken out of a high tech 'drug safe' called a pyxis, that requires touch screen and thumbprint login for a nurse to remove it.  (It used to only be things like morphine that were in the pyxis, now everything is.) Then the nurse takes it down to the patient, scans the patient's wristband, scans the pill's barcode visually compares the actual pill type, dosage, route, and timing, and finally the patient gets it.  All to prevent medication errors, to automatically document what the patient received, and prevent liability issues.

    Yeah, if a nurse could simply pour a single pill out of a communal bottle in her pocket, that single tylenol would be far less expensive.  But given how many different drugs she'd have to carry around, you'd be right back again to more med errors, more lawsuits, more people getting wrong pills.

    •  They still make mistakes. (3+ / 0-)
      Recommended by:
      james321, ladybug53, Sychotic1

      Lots of them. Constantly. And the complexity of the system makes it almost impossible for a family member or patient to do squat about it, even when the error is crystal clear. Even when the RN admits an error has occurred.

      •  Fewer than they used to. (4+ / 0-)
        Recommended by:
        james321, sydneyluv, mamamedusa, ladybug53

        And if a mistake does actual harm, you've got a lawsuit, good to go, which is why RN's are required to carry major amounts of malpractice insurance.  (I've got a $6 million a year policy coverage, and I'm only even a student, not even working.)

        If the mistake doesn't actually damage you, such as giving you a bit too much mucinex that does nothing but make you snot out a bit more, then it's generally shrugged off.

        •  I'm thinking of (3+ / 0-)

          my father, with blood coumadin levels at 25, bleeding from his eyes, because pharmacy allowed him to take 11 different meds at once, without anyone figuring that such a cocktail required constant, not monthly, monitoring of blood levels.

          He lived. They gave him 5 units of whole bood, a freaking oil change, in absolute desperation. No lawsuit because 1) my parents are from a generation that believes MDs walketh on the right hand and 2) all the med records from that ICU stay were falsified.

          That's my father. I could go down the list of family members with  stories as chilling for most all of them. If you don't  know these stories yet you certainly are still a student.

  •  When I had a hospital visit (4+ / 0-)

    my insurance company got billed for the psychiatrist they sent in to (unsuccessfully) convince me to stay and get further unnecessary treatment.

    (Hey, hospital, it's been five years and I haven't had that "imminent heart attack" yet. It really was just indigestion ... )

    The thing about quotes on the internet is you cannot confirm their validity. ~Abraham Lincoln

    by raboof on Thu Feb 21, 2013 at 10:02:54 AM PST

  •  And then there is also the problem for many of (1+ / 0-)
    Recommended by:

    physicians not accepting Medicare patients.  What is the cause of that and what do we do about that?

    •  Hospitals like to lie and say they don't get paid (1+ / 0-)
      Recommended by:

      enough by Medicare to see patients -- totally not true.

    •  A couple of years ago, (0+ / 0-)

      I looked into this very question, akmk.  I had always heard that large numbers of physicians did not accept Medicare, yet everyone I knew who had Medicare had no problem finding a physician.  A member of my family was making a decision about Medicare, so I promised him I would find some numbers about how many physicians accept Medicare.  I found that NCHS does a survey every year, and every year, they conclude that 86 to 88% of doctors accept Medicare for new patients.  I think the concern about doctors not accepting Medicare may have been exaggerated.  Does anyone else know of any actual statistics about this?  Not individual stories, but statistics from serious studies.

      •  I live in a rural community. We have one medical (0+ / 0-)

        clinic (that is run through Indian Health) and beyond that two private doctors, neither of which accepts Medicare.  It's also known to be a huge problem in Anchorage.

  •  Could someone here explain to me (1+ / 0-)
    Recommended by:

    what "best practices" are as they relate to health care?  Are they implimented by the hospital/clinic, by the insurance industry or is this part of the ACA?  The reason I'm asking is because on a recent visit to my doctor he advised me that he could not diagnose me with what I truly had, he had to call it something else or they would dock his pay.  He said it had to do with new "best practices" rules that had been put in place.  I'm just curious.

    The first thing lost in war is truth.

    by KatHart on Thu Feb 21, 2013 at 10:17:51 AM PST

  •  Sorry, but this is a typical muck-raking article (8+ / 0-)

    with very little fire beneath the smoke.

    There is no question the uninsured get hit with "list price" bills that boggle the mind. But that's not because Hospitals set out to screw the poor. No, it's because hospitals and doctors are dealing with two far more powerful players, Medicare and insurance companies. The idea that hospitals and doctors can consolidate to the point they can say anything other than "yes sir, may I have another?" to Anthem/Wellpoint is rebutted by one very simple fact - they are subject to anti-trust laws enforced far more aggressively than anybody looks at the insurers.

    So what's this Chargemaster thing, anyway? Yes, it's a list of a hospital's "list prices." But it is far more complex than that. You see, big insurers insist on "most friendly nation" contracts, meaning they are assured a better price than anybody else in the region. What does that mean? It means not only that the hospital can't charge another insurance company's patient less, they can't charge an uninsured patient less, either. Why do they sign a contract like that? Why not just negotiate something else? Because Blue Cross of Michigan, for example, controls 70% of the state's health care market. Do you really think they negotiate anything, including the color pen you're allowed to use when you sign their contract?

    There is a great deal more there worth talking about, if I had the time. But the bottom lines are pretty simple - the US health system is based on health insurance, and those without it don't just fall between the cracks, they're pushed there. But non-profit hospitals' Chargemasters aren't the problem. They are a symptom of the problem.

    Done with politics for the night? Have a nice glass of wine with Palate Press: The online wine magazine.

    by dhonig on Thu Feb 21, 2013 at 10:30:30 AM PST

  •  My daughter went in to the hospital for obervation (2+ / 0-)
    Recommended by:
    james321, ladybug53

    No procedures, no surgery.  Just a bed, a room, and a few minutes of nurse/doctor time.  The bill for one night; $6,800.  The insurance paid it, but at the time I though "Wow, I never thought I'd say it, but the insurance companies are getting screwed!"

    Gentlemen, you can't fight in here! This is the War Room!

    by bigtimecynic on Thu Feb 21, 2013 at 10:41:39 AM PST

  •  My neighbor was recently showing me (3+ / 0-)
    Recommended by:
    james321, Cassandra Waites, ladybug53

    the hospital bill for an newborn infant in NICU (thankfully the baby's totally fine now!).

    One of the line items was for "self-administered" drugs.  Yeah, right.

    Now that the baby's alright and everything it's kinda humorous.  But still, the parent told me she thinks she has a rather strong case to dispute that particular charge . .. . I tend to agree, but of course, I'm not a lawyer or accountant.

  •  Even public hospitals require advance payment (3+ / 0-)
    Recommended by:
    james321, Cassandra Waites, ladybug53

    for certain procedures.  

    The hospital says there was nothing unusual about how Sean was kept waiting. According to MD Anderson communications manager Julie Penne, “Asking for advance payment for services is a common, if unfortunate, situation that confronts hospitals all over the United States.”
      A few years ago I was supposed to get a test done at a county run hospital that would cost about $2,000 (I don't have insurance).  Nurse told me I'd have to pay at least one-half of that before the test.
      OTOH, I was ripped off by one HMO that "neglected" to inform me they offered discounts for early payment on bills, so I ended up paying their exorbitant rate for a DR appt. and two simple tests (that the DR ordered without my knowledge).  It wasn't until a couple years later I found out the HMO gave at lest a 30% discount for "prompt payment."

    My Karma just ran over your Dogma

    by FoundingFatherDAR on Thu Feb 21, 2013 at 11:07:33 AM PST

  •  Why are insurer and provider separate.. (3+ / 0-)
    Recommended by:
    james321, Cassandra Waites, ladybug53

    This has always rankled me.  I could never figure out how any sort of cost control could be possible, while actually providing care when the insurer and the provider are separate.  All the insurer can do is try to reduce payments for services and deny payment for certain services.  The provider has to get enough to pay for people and equipment, so is looking to get paid.  The patient gets caught in the middle.

    Some people have bad things to say about Kaiser or in the PNW Group Health.  But, they are the only way a private insurer can have any control over costs.  They own the CT, MRI, pay the doctor, nurse, tech salaries, and own the buildings all fixed costs that are paid whether they are doing anything or not.  Now, they will tend towards a utilization level that is near the maximum because they don't want those things just sitting idle.  And, usage is not even.  So, non-urgent cases get bumped for the more urgent, and if you are the less urgent case that will piss you off.  But, there is less incentive to outright deny care on financial grounds.  

    Not saying it is perfect, but the underlying incentive structure seems better than the separate insurer provider model.

  •  Worst part of all this (5+ / 0-)

    The hospitals almost have to nickel & dime you because that's the only option that pays enough for them to stay open, but it costs a fortune to do all that nickel and dime accounting.  If we switched to single-payor everyone would probably save at least 30%-40% if not more on healthcare.

    Republican threats amount to destroying the present if we don't allow them to destroy the future too. -MinistryOfTruth, 1/1/2013

    by sleipner on Thu Feb 21, 2013 at 11:27:20 AM PST

  •  if you want it done right? do it yourself. (2+ / 0-)
    Recommended by:
    james321, ladybug53
    I soon found that they have good reason to hope that outsiders pay no attention to the chargemaster or the process that produces it. For there seems to be no process, no rationale, behind the core document that is the basis for hundreds of billions of dollars in health care bills.
    Large enterprises often have byzantine processs for change that do not obviously empower employees.  It's not at all clear that individual employees have or know they have a voice in setting those prices.

    Every publicly traded company is a takeover target.  HCA, one of the largest healthcare operators in America, has a 15.7B market cap.  For half that, you could buy the company out and change the rules.  A campaign which is roughly 10x as hard as electing a skinny black guy with a funny name to the presidency.

    Publish the list.  If you're making money at your published prices, anyone getting a worse deal will come to you and you will still make a profit.  If you're losing money at your prices, you should stop lying about how much things cost.

    "everybody chasing a deal" has obviously distorted the market, and a dose of straight up truth would be a good thing.

    -7.75 -4.67

    "Freedom's just another word for nothing left to lose."

    There are no Christians in foxholes.

    by Odysseus on Thu Feb 21, 2013 at 11:30:04 AM PST

  •  This is a fantastic example of how capitalists (2+ / 0-)
    Recommended by:
    james321, Brooke In Seattle

     suck money out of living human beings.

    And all too often you can't get your needs met even though they have taken your money.

    Americans just put up with it. They just lay there and take it.

    The System continues because of that: They KNOW nobody can or will do a thing about it.

    Full speed ahead: there will be no torpedoes.

    The path of the righteous man is beset on all sides by the inequities of the selfish and the tyranny of evil men.

    by xxdr zombiexx on Thu Feb 21, 2013 at 11:32:47 AM PST

  •  Pay attention to the last page for sure (3+ / 0-)
    Recommended by:
    james321, ladybug53, tofumagoo

    This is why we need real health care reform. Focus on the word accountability

    I have often thought of doing a series of diaries on health care policy. Now I think I really should.

    An empty head is not really empty; it is stuffed with rubbish. Hence the difficulty of forcing anything into an empty head. -- Eric Hoffer

    by MichiganChet on Thu Feb 21, 2013 at 11:54:14 AM PST

  •  Here's another issue: (4+ / 0-)

    My husband tripped on a stair and broke a bone in his foot.  I was out-of-town at the time.  Naturally, he went to the nearest hospital emergency room.  He gave them our insurance card, got x-rays and was told he needed surgery.  Because I was not home, they wanted him to spend the night in the hospital.  He returned hom the next day.  Then a week or two later, we got a bill for some $5,000 for that one night hospital stay.  "Why didn't you bill our insurance" we asked.  The answer, "Oh we don't accept your insurance for hospitalization."  Well, why didn't they tell us this before the hospital stay?  If we had known, he would have gone to a different hospital or simply refused to stay overnight.  Their answer:  "We can't do that."  We had to sign on to a payment plan and spent 10 months paying this off even though we had good insurance which would have covered this at another hospital.  Are we the only ones who have had this problem?  Has anyone else encountered this?

  •  **** YO**** (7+ / 0-)

    I know some history here, and the insurance companies are one of the big CAUSES of this problem.

    Insurance companies and HMOs would correlate pricing information from multiple hospitals, and force tests to be done at the lab that charged the least. Any mistake on a charge master would immediately be jumped on, causing a huge cash loss.

    This made tons of money for the HMOs and insurance companies.

    But it caused tons of other problems.

    First up, just the medical problems:

    1. Specimen splitting.
    2. Delays in test results.

    Those are be obvious, as the blood/urine/etc has to be shuttled amongst multiple facilities.

    Then there's the economic problems:

    3. Money siphoned from hospitals. Any mistake on charge master would immediately be jumped on, causing a huge cash loss. (Imagine a supermarket has a price misquote on the shelf, and immediately 100,000 people run in the door to buy only that item.)

    4. Charge Masters get inflated (as a reaction to #3).

    5. Some useful equipment gets idled
    When the Ins Co shifts work away from a hospital, it can easily fail to recoup investment in often expensive lab equipment.

    6. Other equipment gets over-stressed
    The lab the work gets shifted to may not have enough equipment, or barely enough, to handle the load. Workloads back up. Maintenance is deferred, leading to breakdowns and more backups. And no way the lab buys more equipment to ease the load ... it knows the work might just get shifted to another lab in a year or two.

    Bottom line:

    Hidden charge masters are a problem, but hospitals now have no choice on the matter because of the predatory actions of the insurance companies. This was literally a hide-it-or-die situation for any company that does insurance-reimbursed lab work.

    ... not that there weren't labs & hospitals already engaged in gouging. Oh, there definitely were, and are. But the insurance companies made it become universal practice.

    Should you feel sorry for the insurance companies? FUCK NO. This is their fault!

    BTW, how did my work relate to this history? I was intimately involved in the software used to route lab tests. I witnessed the systems impact of lab tests being re-routed. I could see volumes of tests being stopped at one facility and started at another.

    "What could BPossibly go wrong??" -RLMiller "God is just pretend." - eru

    by nosleep4u on Thu Feb 21, 2013 at 11:58:07 AM PST

  •  I'm reading thru the linked article (2+ / 0-)
    Recommended by:
    james321, ladybug53

    It's eleven pages long and does an excellent job of explaining why medical costs are so high.

    I agree that this is a "must read" for everyone here who's interested in the costs of healthcare in the U.S.

    The only trouble with retirement is...I never get a day off!

    by Mr Robert on Thu Feb 21, 2013 at 12:13:50 PM PST

  •  Excellent article. (2+ / 0-)
    Recommended by:
    james321, ladybug53

    I especially enjoy the fact that the writer is willing to challenge many of our automatic assumptions about what can be done to fix health-care spending head-on.  May I say, he even challenges the almighty rights of private enterprises to pay CEOs whatever they want to?  To charge whatever prices they can get away with, and to buy Congress so that they get special privileges to avoid having to negotiate?  It's an excellent article.  Now, can we print it out and pin it on the bulletin board in every congressional office?

  •  Health care is an absolute scandal in this country (4+ / 0-)
    Recommended by:
    stevej, james321, ladybug53, Ramoth

    My biggest and bitterest complaint about ACA is that it didn't attack the real problem.

    Yes, it did a few nice things with regard to insurance, but that's just the outer layer -- and a surprisingly thin one.

    I still get burned up thinking about last summer when my wife got a "possibly" bad result on a mammogram.  Trying to find the price of procedures was literally impossible. Getting doctors to talk to us like adults on the pros and cons of things was nearly impossible.

    To be honest, the whole thing felt like a care salesman trying to push you into the next expensive model and -- oh yeah! You want the rustproofing, don't you?

    And the final cost?

    LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

    by dinotrac on Thu Feb 21, 2013 at 12:33:01 PM PST

  •  Cash price vs insurance price (2+ / 0-)
    Recommended by:
    james321, ladybug53

    Recently, I did some research into getting an MRI. I called a place in the Chicago area that seemed to specialize in imaging thinking they would offer a good price since this was their specialty.

    After talking with two different people I got the story. One of them could only tell me the cash price while the other could only tell me the insurance price. Why this is the case was never made clear to me.

    The cash price? $1000. The price they charge insurers? $3500. They do this because they know an insurance company likely won't pay 100% and they want to make sure they make money if the patient stiffs them. I got the person on the phone to admit that in a roundabout way except for the part about getting stiffed. I inferred that from her explanation.

  •  Comment (1+ / 0-)
    Recommended by:

    Had the health insurers not been ideologically committed to the free market health care system, they could have come out of a single payer system with little harm to their bottom lines, and a much better regulatory environment to operate in.

    This could have been done with either Medicare for all (easier to write the legislation) or a mandatory single-payer reinsurance market (which could also be grafted on top of the existing Medicare system).  And none of this crap about how Medicare can't negotiate prices.

    This way, the insurance industry keeps its retail market (and even grows a bit since this eliminates the motivation for most employers self insure) and makes private insurance pretty much affordable to everyone.  And it makes Medicaid cheaper and easier to administer as well, since it can now ride on the combined Medicare/private insurance infrastructure.

    They chose to go the corporatist route instead.  Now they're facing a dicey business environment.  A large provider typically has a paid sales force to sell to insurance plans, and they are as dirty about this as big pharma pushing pills to doctors.  Most insurance company procurement is oriented toward stuff like IT, external business services, real estate,; it's their plan designers, not their purchasing group, that does the negotiation, and they are undermatched.  (For one thing, pharma salespeople are paid more than insurance underwriters, so there is a revolving door.)

    •  asdf (1+ / 0-)
      Recommended by:
      Had the health insurers not been ideologically committed to the free market health care system, they could have come out of a single payer system with little harm to their bottom lines, and a much better regulatory environment to operate in.
      single payer would have made a hufe dent in bottom lines and the last thing they want is a functioning regulatory environment - their brand of ongoing disaster capitalism requires a Wild West approach.
      •  Agreed. And.... (1+ / 0-)
        Recommended by:

        the Wild West approach is ideologic.  It's not sustainable because there is only so much wealth they can extract from the economy.  The CEOs take a nice chunk for themselves, but most of it is pissed away.  Disaster capitalism is not sustainable.

        So I stand by my argument that "they made the wrong decision" but it's not some lapse in judgment on their part.  It's a fundamentally reactionary view of the world combined with one of the most effective political patronage machines ever conceived.  Don't think of it as some kind of textbook profit maximizing engine, but as a machine that consumes all the resources it can get at.

      •  Wait a second, asdf, I think he has something -- (0+ / 0-)

        there's no reason that Aetna, Cigna, WellPoint et al. couldn't have been contracted to deal with regional variations of America's new Medicare For All system. Yes, they would have lost big commercial insurance accounts, but they still could have made a ton of money coordinating care and all that bullshit...whatever that means.

  •  MD Anderson wanted $1450. up front (2+ / 0-)
    Recommended by:
    james321, ladybug53

    when the BCBS insurance settled they showed I only met $1000. of my deductible. MDA admit I've over paid but have yet to see one dime

  •  I hate to say this, folks... (2+ / 0-)
    Recommended by:
    james321, TiaRachel

    But I had this argument with many people years back (and keep in mind, I am a proponent of wholly public insurance, if not NHS-style care outright)...

    Chargemasters apply to Medicare, too -- it's just that the bill goes to CMS.  

    In fact, in many ways -- the Medicare/Medicaid component of a chargemaster is worse than with an insurer because there is an absolutely dizzying array of required groupings, coding modifiers, etc.  Ultimately, a public system that simply shifts highly complex and indecipherable billing to a public payer is still not going to succeed because funding it likewise becomes an issue, just an indirect issue.

    The company I work for doesn't really dabble much in private care CMs -- since insurers negotiate their own rates and systems with providers, there just no scale beyond building and selling them a framework (which the insurers generally just bake themselves) -- but over the course of constructing some chargemaster update software (strictly for Medicare-based billing/coding/reimbursement) we did examine some private models and as scary as it might sound, the examples of horror stories in private billing complexity are walks in the park in comparison.

    While it's easy to say that at least this complexity doesn't fall to the patient -- it's important to remember that such complexity causes two basic problems:

    1) The thieves -- like Rick Scott's old health care system -- deploy tons of people who DO understand this complexity and get very, very, very good at bilking the public schema.... They're not just doing outright fraud -- billing for things not actually done (for the most part) -- but they absolutely employ a lot of financial modeling to maximize reimbursement.  They know precisely when a diagnosis can process map into a honey pot of reimbursement and they know the also very complex reimbursement formulas that mean they can steer patients NOT to the most healthy option... but the most profitable option

    2) The poor saps - providers - who can't afford to do 1)... Lots of public hospitals don't have the resources of above, and as such, actually end up UNDERBILLING Medicare... losing out on 10s of millions in legitimate reimbursement (which means less hospital revenue, which means less staff, which means poorer facilities...etc).

    There are plenty of 'bad guys' --- but I think the most critical idea that we need to accept is that in reality, there is no single 'good guy'....  The AMA, the hospitals, private insurers, even CMS/the government itself -- they're all contributing factors in the here and now.  In fact - the Medicare reimbursement formulas are generally the starting baseline for the private negotiations (like I said, we don't generally publish specifically towards private insurers, but they do sometimes buy our stuff just to get an early jump on where the providers will start from a baseline).

    Solving the costs of health care won't be a matter of merely identifying the villains and lopping them out of the mix -- we can't start to solve this from a preconceived idea turning portions of the system over to a public artifice will fix it...

    Full Disclosure: I am an unpaid shill for every paranoid delusion that lurks under your bed - but more than willing to cash any checks sent my way

    by zonk on Thu Feb 21, 2013 at 01:13:26 PM PST

  •  Bottom line: NEVER pay your hospital bill without (4+ / 0-)
    Recommended by:
    stevej, Mother Mags, james321, ladybug53

    arguing with them first.  Demand a detailed, itemized bill.

    If necessary, hire a professional to bargain/fight with them.

    To me, that's the take-away from the superb article that is the subject of this diary.

    •  Yup, I had a bill for $6,666 from a hospital just (1+ / 0-)
      Recommended by:

      bought by the Yale New Haven system mentioned in this article.

      My insurer negotiated it to $2,889, but I still think that's ridiculous -- it was for a a maybe half hour outpatient surgery.

      Just by calling and asking, I got a 25% discount if paid within 30 days.

      I'm sure if I wanted to waste more time and energy by forcing them to audit the bill, I could have gotten that 25% discount off a lower amount.

      This just goes to show -- they truly throw every charge at the wall, and hope they will all stick.

    •  Who are the professional bill-arguers? (0+ / 0-)

      I know I've read about exactly that specialty, but wouldn't know where to look for one.

      Freedom isn't free. Patriots pay taxes.

      by Dogs are fuzzy on Thu Feb 21, 2013 at 02:44:46 PM PST

      [ Parent ]

  •  Health care in this country (2+ / 0-)
    Recommended by:
    james321, ladybug53

    is insanely expensive. I had a minor shoulder surgery as an outpatient couple of months ago. All in all I was at the surgical center for 90mins.

    I was shocked when I got the bill. Surgical center charged me $65,000 and the doctor charged me $17,000

  •  Did you see the guest on Colbert last night? (2+ / 0-)
    Recommended by:
    james321, ladybug53

    He took his dad to the hospital for a routine procedure and his dad contracted a virus that killed him. Similar thing happened to me in October: I went in for neck surgery and contracted a virus that paralyzed my left arm. My neck is fine, but I've got at least a year of therapy ahead of me for the arm. Our good friends' mom also went in for knee surgery and died on the table. Ugh. And don't even get me going on the bills!!!!

    stay together / learn the flowers / go light - Gary Snyder

    by Mother Mags on Thu Feb 21, 2013 at 01:54:44 PM PST

  •  Provider reform, the blindspot of ACA (2+ / 0-)
    Recommended by:
    james321, ladybug53

    Hospitals are in an arms race for the biggest atrium, the plushest carpet, the most lavishly-equipped children's play room, and a whole host of other things that have little or even nothing to do with quality of care.  This then gets billed back to whoever squeals the least or has the worst access to legal representation or whichever insurer is the laziest and the least willing to fight back with auditors and rulebooks.  

    As for individuals, doctors, surgeons and so on, it's a more complicated picture.  In some cases, it's pure greed.  In others, it's a desperate race to pay back medical school loans or liability insurance premiums.  In yet others, it's collusion, sometimes among the medical schools or doctors' organizations themselves, to limit the number of practitioners in a certain field and artificially inflate the value of their labor.

    This — not universal health care — is, for me, the biggest piece of unfinished business, and the one with the potential for the great impact on affordability and access to health care.  Truly universal care cannot happen until provider reform is dealt with.

  •  Ah, the old "tort reform" solution (3+ / 0-)
    Recommended by:
    james321, ladybug53, riverlover
    Finally, we should embarrass Democrats into stopping their fight against medical-malpractice reform and instead provide safe-harbor defenses for doctors so they don’t have to order a CT scan whenever, as one hospital administrator put it, someone in the emergency room says the word head. Trial lawyers who make their bread and butter from civil suits have been the Democrats’ biggest financial backer for decades. Republicans are right when they argue that tort reform is overdue. Eliminating the rationale or excuse for all the extra doctor exams, lab tests and use of CT scans and MRIs could cut tens of billions of dollars a year while drastically cutting what hospitals and doctors spend on malpractice insurance and pass along to patients.


    “It’s malpractice,” a family physician who had practiced here for thirty-three years said.

    “McAllen is legal hell,” the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.

    That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn’t lawsuits go down?

    “Practically to zero,” the cardiologist admitted.

    “Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.

    "No one life is more important than another. No one voice is more valid than another. Each life is a treasure. Each voice deserves to be heard." Patriot Daily News Clearinghouse & Onomastic

    by Catte Nappe on Thu Feb 21, 2013 at 01:59:47 PM PST

  •  You say: (1+ / 0-)
    Recommended by:
    Ok, so basic economics.
    And what does basic economics say about "Your money or your life?"

    Captive markets for life saving goods and services is not basic econ. It's Extortion 101.

    Democracy - 1 person 1 vote. Free Markets - More dollars more power.

    by k9disc on Thu Feb 21, 2013 at 02:07:51 PM PST

  •  The truth is that if providers wanted singlepayer, (2+ / 0-)
    Recommended by:
    Renee, ladybug53

    the insurance corps would be gone overnight.

    Doctors whine and moan about 'bastard health insurers', but -- unless they're a poor country doctor -- they benefit tremendously from this insane system that provides lots of opportunities for gaming the system.

  •  I am a physician.. (6+ / 0-) an academic medical center. As I read this, I feel frustrated....depressed. Because the report is mostly accurate, not just a compendium of cherry-picked anecdotes.

    You are indeed at the mercy of the "chargemaster" if your insurance does not cover the charge, or if the test was done by an out-of-network lab, or if you don't have insurance. The capriciousness of the "chargemaster" is something to behold.

    There's a lot more than the "chargemaster". For example, in most states it is legal for hospitals to significantly "upmark" costs of diagnostic services. For example, if a test is performed by a third party for $1000, the hospital can turn around and charge the patient $3000. Go figure.

    We keep on railing about big oil and the military-industrial complex, but my own field is just as sleazy. I'm disgusted.

  •  As a former employee of a health insurer, (4+ / 0-)
    Recommended by:
    james321, TiaRachel, ladybug53, Amber6541

    I know that 'private pays' - people paying out-of-pocket - get the equivalent of retail pricing while those going with in-network with health insurance get the insurer-negotiated wholesale price which usually have a 'hold-harmless' clause which prevents the care provider from billing the patient for the difference between the asking and the negotiated price.

    Play chess for the Kossacks on Join the site, then the group at

    by rhutcheson on Thu Feb 21, 2013 at 02:20:01 PM PST

  •  It seems like a solution we could enact now (3+ / 0-)
    Recommended by:
    james321, ladelfina, Amber6541

    is a crowd sourced database that has various procedures and the prices for each hospital listed. I have actually seen a few of these, but a quick search didn't turn anything up.

    I prefer single payer. But making charging practices transparent might go a long way towards providing the data that would force such a move.

    Poverty = politics.

    by Renee on Thu Feb 21, 2013 at 02:47:23 PM PST

  •  I was especially struck by the outrageously (2+ / 0-)
    Recommended by:
    james321, ladybug53

    profitable hospital chain run by the Catholic "Sisters of Mercy". I wonder how much of that profit is going to pay hush money to victims of child abuse.

    These "nonprofit" hospitals brag about how much charity care they give, but they value these services at the appallingly inflated "chargemaster" rates, which can easily be 20X their actual cost (emphasis added):

    Mercy’s IRS filing reported that the chain provided charity care worth 3.2% of its revenue in the previous year. However, the auditors state that the value of that care is based on the charges on all the bills, not the actual cost to Mercy of providing those services — in other words, the chargemaster value. Assuming that Mercy’s actual costs are a tenth of these chargemaster values — they’re probably less — all of this charity care actually cost Mercy about three-tenths of 1% of its revenue, or about $13 million out of $4.28 billion.

    What is valued is practiced. What is not valued is not practiced. -- Plato

    by RobLewis on Thu Feb 21, 2013 at 03:59:05 PM PST

  •  One of the best quotes from the article: (2+ / 0-)
    Recommended by:
    james321, ladybug53
    When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?
    Exactly. I've wondered that for years.

    What is valued is practiced. What is not valued is not practiced. -- Plato

    by RobLewis on Thu Feb 21, 2013 at 04:01:12 PM PST

  •  Insurance companies have done nothing to control (1+ / 0-)
    Recommended by:

    medical costs.  They allow the escalating costs to be passed on to the patient and still make their profit.  If there was someone really trying to control costs, the US wouldn't be paying twice as much on healthcare as other countries with a similar outcome at best.  The insurance companies don't have the leverage to control what the hospital charges, nor are they motivated to do it.  What you need is government intervention.  The government comes in and says, this is what you can charge for that service.  You don't like it, then pack up your tent and go into another business.  We will take over.  Sorry, but that is the only way folks.  Do you think England, the Scandinavian countries. other European countries and Canada are stupid.  No, it is this country that is stupid.  Our Government is bought and paid for by the wealthy an they just love the status quo.  The fact is this country is a dam disgrace.

  •  This is precisely why people really can't (3+ / 0-)
    Recommended by:
    DWG, james321, Militarytracy

    comparison shop between hospitals, doctors, procedures, and tests.

  •  The first quote mentions MD Anderson (1+ / 0-)
    Recommended by:

    Just to turn your stomach that much more, MD Anderson is a cancer specialty center.

    Be radical in your compassion.

    by DWG on Thu Feb 21, 2013 at 04:20:12 PM PST

  •  Does a Hippocratic oath mean anything anymore?? (1+ / 0-)
    Recommended by:
    Sean was allowed to see the doctor only after he advanced MD Anderson $7,500 from his credit card.
    In every house where I come I will enter only for the good of my patients,


    "Think. It ain't illegal yet." - George Clinton |

    by jbeach on Thu Feb 21, 2013 at 05:18:16 PM PST

  •  Interesting article... (5+ / 0-)

    Thank you for your diary and insight into our very disfunctional healthcare system.  However, as a proud liberal and a general surgeon, I'm truly saddened and angered by some of the comments posted here.  I am civilian trained but currently serving on active duty in the military, so I've seen both private and govt systems.  Currently, I'm in the process of deciding on a civilian position.

    First, there seems to be a misconception that providers are determining fees for procedures they perform.  This is absolutely untrue, and there are laws in place preventing providers from doing just that.  Second, lets look at what went into training a single physician...namely me!  Four years of med school: $120k, then 5 years of surgical training working 80-100hrs a week to gain competence at my profession.  During those five years, I was paid 30k a year and we weren't allowed to moonlight because we were too busy in our training.  Today, on average a general surgeon will exit practice and make approx 275k/year.  This is certainly a substantial sum, but after malpractice, paying office staff etc, this number goes down quickly.  Add to this a constant pressure from hospitals/insurance companies to "produce" above and beyond what you are already doing, and it's easy to see where this leads: less patient interaction, longer work days, larger expectations from both the powers that be and the public at large, and the potential for bad outcomes.

    The obvious answer is a single payer healthcare system, but even this has it's downside.  With a single payer system, the need and the incentive to bend over backwards to care for patients is lost.  I see this daily at the MTF I work at, providers punching a clock rather than placing patients first. We live in a society that has everything at its fingertips and wants everything yesterday.  The stark reality is this is nearly impossible in the healthcare industry.  Sure, those needing emergent interventions and urgent care will be always be treated at an instant but elective cases have to wait.  My current schedule is blocked out 3 weeks for surgery.

    I love what I do, and I view myself as a servant to my patients.  I never came into this profession looking for an easy payday.  I work long hours and sacrifice time with my own family in order to ensure my patients get the care I feel they deserve.  I'm certain there are providers everywhere who have learned to work the system to their personal benefit.  Those that I've seen are typically in subspecialty fields.  But I believe they are in the minority.  Most physicians I know aren't looking to scheme a system, they merely want appropriate compensation for the time, energy and sacrifice they've made just to do their job.

    Physicians, for the most part, are not the problem.  We are, however, we are the face of healthcare and the easy target for frustrations.  I urge all of you not to lose sight of the people and faces you don't see, and the real culprits behind our healthcare crisis

    “Too often we honor swagger and bluster and wielders of force; too often we excuse those who are willing to build their own lives on the shattered dreams of others.” ― Robert F. Kennedy

    by docreed2003 on Thu Feb 21, 2013 at 06:54:02 PM PST

    •  Thank you for your thoughts! n/t (0+ / 0-)
    •  Agreed! Neither physicians nor hospitals are the (1+ / 0-)
      Recommended by:

      problem. I'm saddened by any article that doesn't put the blame squarely where it belongs, on the insurance companies.

      Do away with these middle men and real health care may be allowed in the US as it is in other countries. Bonus's for number of patients whose health improves (as in weight loss or smoking cessation etc.) rather than for tests ordered.

      Tracy B Ann - technically that is my signature.

      by ZenTrainer on Thu Feb 21, 2013 at 09:47:27 PM PST

      [ Parent ]

  •  Greed (2+ / 0-)
    Recommended by:
    james321, bigjacbigjacbigjac

    and greed will be the death of America

  •  I remember reading my laparoscopy bill (2+ / 0-)
    Recommended by:
    bigjacbigjacbigjac, james321

    there was a charge for "Pad, Telfa, Adhesive"....$22.00.  My insurance company was billed $22 for a band-aid.  The brilliant system gave them a discount, though -- they only had to pay $10 because this was a preferred provider hospital.

    The GOP -- Hating Women, Gays and People of Color since 1854

    by Former Chicagoan Now Angeleno on Thu Feb 21, 2013 at 10:42:29 PM PST

  •  Do you think (1+ / 0-)
    Recommended by:

    It would do any good to contact our representatives and senators to do something about these greedy hospitals, drug companies and device companies?  Probably not, as our so called "voices" in Washington who are supposed to be representing us, are getting rich off the system the way it is.  We are all pretty much f--ked.

    Democrat Without Suffix, Prefix, Apology or Explanation .

    by Lilredhead on Thu Feb 21, 2013 at 11:41:33 PM PST

  •  I have a friend who works in a HCA hospital (2+ / 0-)
    Recommended by:
    bigjacbigjacbigjac, james321

    She is a Manager, with insight into the pricing for services.  They are mandated each year to raise the prices for what her department does by 10%.  Do the math, that doubles prices in just over seven years.  A terrible situation for health care in this country.

  •  You don't make money off healthy people (1+ / 0-)
    Recommended by:

    And if you have a multi-trillion dollar "healthcare"(TM)" industry, the only way to make money is to convince as many people as you can that they are sick and need to go see a doctor (who didn't spend 10 years in expensive med school to work for FREE), who then convinces them they're sick, and sends them to a hospital -- where the REAL moneymaking takes place.
    The magnitude of problems in American business, government, social services, healthcare, banking, etc are so overwhelming they can only be solved after the entire system crashes and burns.

    Ash-sha'b yurid isqat an-nizzam!

    by fourthcornerman on Fri Feb 22, 2013 at 04:36:05 AM PST

  •  And good luck getting CPT or HCPCS codes (0+ / 0-)

    If you're uninsured, your chances of getting detailed billing that includes CPT or HCPCS codes is close to zero.  Those are the codes that insurers use; there is a price associated with each item.  So if you want to compare what you're being charged, to what the hospital pays insurers, you can't.

    For that matter, you'll have to push to even get any details.  For my excursion to hospital hell, I received a hospital bill with no detail at all.  It basically said, "you owe us this much.  Pay now".  I had to go the extra mile to get any detail, and they flat out refused to specify the aforementioned CPT/HCPCS codes.

    I am become Man, the destroyer of worlds

    by tle on Fri Feb 22, 2013 at 08:57:34 AM PST

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