Aa
LP cost
I think the amount billed to my insurance is ridiculous. Can anyone tell me how much the hospital portion of the LP as an outpatient normally is (I will keep in mind prices obviously vary by region, but I thought I was in a lower cost area)? I'm going to call and get an itemized bill, but while waiting I was curious...
I'm sorry you have such a negative impression of the United States and Americans in general Jemm. Actually, I'm quite content to be American even as I realize we are a work in progress. That doesn't mean I'm jumping with glee and shouting out to others how happy I am to not be counted in their numbers.
I hope there are some members enjoying this discussion and learning useful things from it. I'm missing the usual support and encouragement this forum is known for. I think I'll just move along to other topics.
Mindwhirl, I hope you get your billing questions answered and your insurance carrier can recoup it's overpayment when it realizes what happened.
Mary
I hope there are some members enjoying this discussion and learning useful things from it. I'm missing the usual support and encouragement this forum is known for. I think I'll just move along to other topics.
Mindwhirl, I hope you get your billing questions answered and your insurance carrier can recoup it's overpayment when it realizes what happened.
Mary
2 Comments
It is now 7 years to the day later. ObamaCare is in place. Being called affordable health care. Nothing has changed except now deductable are mandatory if you have insurance. Here in Florida a person with MS who doesn't have insurance can easily see over 100K in costs and a complete chaotic maze of medical terrorism trying to get Medicaid/Medicare even with a definitive diagnosis. Yet treatment needs to be ASAP to halt progression. Sadley that treatment can be years away while you turn into a total invalid. If you can get the two tests so you have a confirmed diagnosis. Those are the lumbar puncture and an MRI. Everything will be denied without that diagnosis and for that it takes those two tests.
It is now 7 years to the day later. ObamaCare is in place. Being called affordable health care. Nothing has changed except now deductable are mandatory if you have insurance. Here in Florida a person with MS who doesn't have insurance can easily see over 100K in costs and a complete chaotic maze of medical terrorism trying to get Medicaid/Medicare even with a definitive diagnosis. Yet treatment needs to be ASAP to halt progression. Sadley that treatment can be years away while you turn into a total invalid. If you can get the two tests so you have a confirmed diagnosis. Those are the lumbar puncture and an MRI. Everything will be denied without that diagnosis and for that it takes those two tests.
COMMUNITY LEADER
Ahhh Jemm,
I've long given up trying to understand the medical health system of other countries, i was shocked and distressed at some of the things i've read here, sometimes really angry on behalf of someone getting a raw deal. The thing is, our Ozzie system isn't perfect but the one thing i know for sure is that we as a nation need to protect what we have or face following down the path of other countries, which from my perspective would not be good!
I btw do not have health insurance of any kind, costs me $0 for any test i've ever had, the only thing i pay for is my GP $42 and I get back over half, I will never ever ever complain about our health system, as i said its not perfect but it could be worse!! I dont have insurance because of experience, my father always believed in private health insurance and was on top cover for all his adult life.
When he got terminal cancer, he went to the best hospital (Peter Mac) which is public, he had the best medical team who also worked the public system. One of the other patients with the same cancer, had the same dr, same everything but the other patient didn't have insurance and it cost him nothing, but my dad paid. I'll never forget my dad telling me it'll cost him $20,000 more to die than the other guy just because he did the right thing and had insurance.
Having said that though, there are times when health insurance gets you more, faster etc than the public system, think of the waiting lists for 'elective' surgeries we have here, but if your unlucky enough to have a serious condition then not having insurance is not a disadvantage.
We are living in the lucky country and we should do everything in our power to not screw it up!!
Cheers........JJ
I've long given up trying to understand the medical health system of other countries, i was shocked and distressed at some of the things i've read here, sometimes really angry on behalf of someone getting a raw deal. The thing is, our Ozzie system isn't perfect but the one thing i know for sure is that we as a nation need to protect what we have or face following down the path of other countries, which from my perspective would not be good!
I btw do not have health insurance of any kind, costs me $0 for any test i've ever had, the only thing i pay for is my GP $42 and I get back over half, I will never ever ever complain about our health system, as i said its not perfect but it could be worse!! I dont have insurance because of experience, my father always believed in private health insurance and was on top cover for all his adult life.
When he got terminal cancer, he went to the best hospital (Peter Mac) which is public, he had the best medical team who also worked the public system. One of the other patients with the same cancer, had the same dr, same everything but the other patient didn't have insurance and it cost him nothing, but my dad paid. I'll never forget my dad telling me it'll cost him $20,000 more to die than the other guy just because he did the right thing and had insurance.
Having said that though, there are times when health insurance gets you more, faster etc than the public system, think of the waiting lists for 'elective' surgeries we have here, but if your unlucky enough to have a serious condition then not having insurance is not a disadvantage.
We are living in the lucky country and we should do everything in our power to not screw it up!!
Cheers........JJ
I believe most of what we hear is propaganda. We have been listening to it for so long that we eat it up as the truth. As a child I was told that the Russians were going to invade and take my bible. We even had plans for a bomb shelter. But I digress.
I am for national insurance here in the U.S. Some doctors are against it, I don't think they realize how much easier it will be with everything standardized. No more malpractice insurance. Just practicing medicine.
It's the managed care, lawyers, investors, and pharmaceutical companies that don't want us to have medicine for all.
The elitists don't want universal coverage. They have a vested interest in keeping people sick.
We spend billions on wars, billions on a space program, billions on 'The War on Drugs' (oh don't even get me started on that one) and billions bailing out the rich. It's disgusting.
The movie 'Sicko' was really interesting. It showed how the universal health coverage in each country was run and how happy both sides were, patient and physician. As I recall, France, U.K., Canada, Cuba, and I think Australia were all interviewed. Very interesting.
It's a shame really, that our country is so backwards in this area. I do think that this will change with time. And, I think this ridiculous 'War on Drugs' will come to an end. Talk about propoganda!!! Such a waste of our resources.
Marijauna should be legal for everyone.
I could really go on about all of this but I have to go to bed. See y'all tomorrow
(((Hugs)))
Red
I am for national insurance here in the U.S. Some doctors are against it, I don't think they realize how much easier it will be with everything standardized. No more malpractice insurance. Just practicing medicine.
It's the managed care, lawyers, investors, and pharmaceutical companies that don't want us to have medicine for all.
The elitists don't want universal coverage. They have a vested interest in keeping people sick.
We spend billions on wars, billions on a space program, billions on 'The War on Drugs' (oh don't even get me started on that one) and billions bailing out the rich. It's disgusting.
The movie 'Sicko' was really interesting. It showed how the universal health coverage in each country was run and how happy both sides were, patient and physician. As I recall, France, U.K., Canada, Cuba, and I think Australia were all interviewed. Very interesting.
It's a shame really, that our country is so backwards in this area. I do think that this will change with time. And, I think this ridiculous 'War on Drugs' will come to an end. Talk about propoganda!!! Such a waste of our resources.
Marijauna should be legal for everyone.
I could really go on about all of this but I have to go to bed. See y'all tomorrow
(((Hugs)))
Red
To add my opinion (I have watched and read a lot too), universal healthcare can not be as bad as they are selling it as here in the States. But those who stand to lose the most with a system overhaul have the most to spend to convince those of us who have the most to gain that it is evil. We don't even rank at the top in terms of how healthy we are, esp. when you look at infant mortality rates. It's a very broken system.
I can't keep up with my medical bills and my son's because our insurance doesn't have to cover autism!! And I have to wait over a month to see a GI specialist after going to the ER 2x's in a week and can't eat without nausea and pain meds. So, yes, we face long wait times here even when we're paying out the nose.
And as far as the negotiated price---insurance paid out $17,000 for the LP.
Sorry for the opened can of worms, but in the current political climate, it happens...
I can't keep up with my medical bills and my son's because our insurance doesn't have to cover autism!! And I have to wait over a month to see a GI specialist after going to the ER 2x's in a week and can't eat without nausea and pain meds. So, yes, we face long wait times here even when we're paying out the nose.
And as far as the negotiated price---insurance paid out $17,000 for the LP.
Sorry for the opened can of worms, but in the current political climate, it happens...
Quietly giving thanks? Mate, I feel like screaming from the rooftops with glee and thanks to the wonderful people who came up with our system!!!
And going YIPPPPPPEEEEEEEEE I AM NOT AMERICAN!!!!!!!!!
But, i was always a rather loud person......LOL
And going YIPPPPPPEEEEEEEEE I AM NOT AMERICAN!!!!!!!!!
But, i was always a rather loud person......LOL
Hi Red,
Just in relation to your comment to pushingupdaises and waiting times, here in Aus I was told on a Wednesday to book an LP and the next available appointment was the following Monday, so 5-6 days. So no wait. (I didn't want it that fast as I was in shock and ended up booking one a month later). The cost was $480, with Medicare (our taxes) covering all but $80 of that. All I have to pay up-front is 'the gap", ie, that 80 bucks.
I am a regular writer on a political forum and I am quite convinced after watching americans for near a decade that most of the stuff you people hear about universal health care is lies and right-wing propaganda designed to keep the 'market' (wall st) happy. They (the politicians) also seem to be having a right old fun tme playing on that deep seated fear of anything vaguely 'socialist" (which I find ironic seeing as the military and schools etc are paid for by taxes, therefore 'socialist') .
Not to mention the US pollies seem tied to the 'market', therefore profit is all, therefore for-profit health care is the norm.
And not forgetting that deep seated horror of taxes. Despite the fact a HUGE proportion of your taxes goes to idiotic wars in foreign lands, while you citizens go bankrupt paying medical bills. As I said earlier, the Medicare rate is 1.5% of our gross annual income. Doesn't matter if you are rich or poor, the % is the same.
Sorry, ranting here!
We can have private health insurance as well as medicare if we want to spend more of our income lining insurance company's pockets. Frankly I cannot see why anyone would. The previous gov wanted to go down the american path but was stopped, thank goodness.
Some non-life-threatening things DO have long waiting lists in the public system. That is when going private can be of benefit (not financially, but in the time factor)
Personally I have enough cash stashed in the bank to pay upfront to see a private specialist on the odd occassion I dont' want to wait for the public system. Funnily enough, Medicare covers most stuff ANYWAY, private or public, so why anyone chooses to have private health insurance I wonder at yet again. So if one has , say, $600 for a private MRI (yes that is the cost), and knows Medicare will refund $500 of that, why wait?
From helen's comment above, it sounds very similar in Canada.
So RedFlame, I reckon the majority of stuff you hear would be propaganda. And personally I would MUCH rather pay a tax of 1.5% and know I have health care which wont send me bankrupt than pay 10% (as stated above by.......someone) to a for-profit pack of greedy b****ards whose only concern is making a quid
Cheers!
Jemm
PS, this is a great discussion, I hope it continues!
Just in relation to your comment to pushingupdaises and waiting times, here in Aus I was told on a Wednesday to book an LP and the next available appointment was the following Monday, so 5-6 days. So no wait. (I didn't want it that fast as I was in shock and ended up booking one a month later). The cost was $480, with Medicare (our taxes) covering all but $80 of that. All I have to pay up-front is 'the gap", ie, that 80 bucks.
I am a regular writer on a political forum and I am quite convinced after watching americans for near a decade that most of the stuff you people hear about universal health care is lies and right-wing propaganda designed to keep the 'market' (wall st) happy. They (the politicians) also seem to be having a right old fun tme playing on that deep seated fear of anything vaguely 'socialist" (which I find ironic seeing as the military and schools etc are paid for by taxes, therefore 'socialist') .
Not to mention the US pollies seem tied to the 'market', therefore profit is all, therefore for-profit health care is the norm.
And not forgetting that deep seated horror of taxes. Despite the fact a HUGE proportion of your taxes goes to idiotic wars in foreign lands, while you citizens go bankrupt paying medical bills. As I said earlier, the Medicare rate is 1.5% of our gross annual income. Doesn't matter if you are rich or poor, the % is the same.
Sorry, ranting here!
We can have private health insurance as well as medicare if we want to spend more of our income lining insurance company's pockets. Frankly I cannot see why anyone would. The previous gov wanted to go down the american path but was stopped, thank goodness.
Some non-life-threatening things DO have long waiting lists in the public system. That is when going private can be of benefit (not financially, but in the time factor)
Personally I have enough cash stashed in the bank to pay upfront to see a private specialist on the odd occassion I dont' want to wait for the public system. Funnily enough, Medicare covers most stuff ANYWAY, private or public, so why anyone chooses to have private health insurance I wonder at yet again. So if one has , say, $600 for a private MRI (yes that is the cost), and knows Medicare will refund $500 of that, why wait?
From helen's comment above, it sounds very similar in Canada.
So RedFlame, I reckon the majority of stuff you hear would be propaganda. And personally I would MUCH rather pay a tax of 1.5% and know I have health care which wont send me bankrupt than pay 10% (as stated above by.......someone) to a for-profit pack of greedy b****ards whose only concern is making a quid
Cheers!
Jemm
PS, this is a great discussion, I hope it continues!
Here there are three 3 MS Speciality practices. One Doctrt will not see patients, period the PA does. One Practice will not take Meadicaid or SSI. The third charges an institutional fee that doubles the copay. I go to the one who doubles the copay because you get the better service. This is reality in our area with 10,000 patients.
But then new tires on my car were $1000 and I just had to pay it. I have to have dental work with insurance that is thousands.
That is why I am careful aboput my health. I co not put sugar in my gas tank or junk food in my mouth.
Alex
But then new tires on my car were $1000 and I just had to pay it. I have to have dental work with insurance that is thousands.
That is why I am careful aboput my health. I co not put sugar in my gas tank or junk food in my mouth.
Alex
Here in Canada there tends to be a lengthy wait for tests unless it is considered urgent. I was in Emergency and had an MRI and CT scan that day. Recently I had an MRI ordered from an internists office and he wrote on the request that it was not urgent. I ended up paying for it privately, because the wait was going to be months. When I did go privately, however, it was only $800
My fatherinlaw just spent a month in hospital, a lot of it in intensive care. He had wonderful care at no cost to him at all. Our system is far from perfect, but it's there for everyone. I feel blessed .
Thanks for listening- I'm off the soapbox now
My fatherinlaw just spent a month in hospital, a lot of it in intensive care. He had wonderful care at no cost to him at all. Our system is far from perfect, but it's there for everyone. I feel blessed .
Thanks for listening- I'm off the soapbox now
Hi Redflame, my Lumbar puncture was many years ago and unrelated to my problems now, it was also done as an inpatient whilst I was in hospital so there was no waiting. Sorry I cannot be of any help.
pushingupdaises, did you have to wait long for you LP? Was it difficult to have your doctor prescribe?
I don't mean to hijack this thread. I just wonder how much of what we here about universal insurance is just proproganda.
thanks, Red
I don't mean to hijack this thread. I just wonder how much of what we here about universal insurance is just proproganda.
thanks, Red
I cannot believe someone had a charge of $22,000 for a lumbar puncture. That cannot be right.
I am in the UK so get all my treatment whatever it is, for free. If I had to guess at the cost of a lumbar puncture for private patients it would probably be no more than £1,000.
I am in the UK so get all my treatment whatever it is, for free. If I had to guess at the cost of a lumbar puncture for private patients it would probably be no more than £1,000.
These amounts are ludicrous. A physician is certainly worth being highly paid for their expertise, education and training. And let's face it, it's huge responsibility. That being said, I do expect a doctor to 'pay attention' to us when in their care. Many of us have been brushed aside------yet they get paid. I don't know about you, but I don't get paid if I don't do my job.
I do think that some of these rates are ridiculous. One thing that hasn't been covered is the increased cost of malpractice insurance. This costs probably 100k a year. Patients sue all the time; some for legitimate reasons, many are not legitimate. All of the doctors, hospitals and/or clinics have to pay individually. We are a litigious country.
Then doctors often practice 'Defensive Medicine" due to the high rise of malpractice suits. They will order more tests then necessary to keep their malpractice rates lower. Again, because of those who sue.
The family therapist rates are ridiculous. His/Her insurance is nothing compared to the medical community.
Doctors are already 'opting out' of Medicare because reimbursements have actually gone down.
Our health system is a mess.
Why do people say we have the best healthcare in the world, I just don't get it.
Red
I do think that some of these rates are ridiculous. One thing that hasn't been covered is the increased cost of malpractice insurance. This costs probably 100k a year. Patients sue all the time; some for legitimate reasons, many are not legitimate. All of the doctors, hospitals and/or clinics have to pay individually. We are a litigious country.
Then doctors often practice 'Defensive Medicine" due to the high rise of malpractice suits. They will order more tests then necessary to keep their malpractice rates lower. Again, because of those who sue.
The family therapist rates are ridiculous. His/Her insurance is nothing compared to the medical community.
Doctors are already 'opting out' of Medicare because reimbursements have actually gone down.
Our health system is a mess.
Why do people say we have the best healthcare in the world, I just don't get it.
Red
LuLu makes a good point in explaining some of the intricacies of health insurance here in the US:
"One other point that someone made up there - our system is very confusing because of that negotiated payment amount that insurance companies set with the providers."
"Basically, it is a one-sided agreement. The insurance company says XX procedure is going to be worth $$ amount. No matter what is billed for XX, the insurance only pays $$."
I personally find it shocking some of the negotiated rates for doctor's visits and don't know how they can stay in practice. I'm not sure how often these rates are negotiated, but here are some of the doctor visit charges and amounts actually received, including the co-pay:
Neurologist Charge $264 Received $119
ENT $ 95 $ 73
Hematologist $155 $ 80
Internist $155 $125
Family Therapist $100 $ 60
My Internist/PCP must have recently negotiated her rate, because the rate before was much lower. It's sad to see a family therapist getting close to the same amount as medical doctors with advanced degrees and practices that involve significant staffing requirements and equipment.
When I was growing up, we used to think that doctors were rich. When you look at the cost of education on top of the cost of running a business against what they are reimbursed, that is no longer the case.
"One other point that someone made up there - our system is very confusing because of that negotiated payment amount that insurance companies set with the providers."
"Basically, it is a one-sided agreement. The insurance company says XX procedure is going to be worth $$ amount. No matter what is billed for XX, the insurance only pays $$."
I personally find it shocking some of the negotiated rates for doctor's visits and don't know how they can stay in practice. I'm not sure how often these rates are negotiated, but here are some of the doctor visit charges and amounts actually received, including the co-pay:
Neurologist Charge $264 Received $119
ENT $ 95 $ 73
Hematologist $155 $ 80
Internist $155 $125
Family Therapist $100 $ 60
My Internist/PCP must have recently negotiated her rate, because the rate before was much lower. It's sad to see a family therapist getting close to the same amount as medical doctors with advanced degrees and practices that involve significant staffing requirements and equipment.
When I was growing up, we used to think that doctors were rich. When you look at the cost of education on top of the cost of running a business against what they are reimbursed, that is no longer the case.
Lulu,
Your guess was pretty close except the $18,000 was how much less Medicare paid versus the total bill. Out of the $63K I had a copay of about $2000 total for doctors and hospital bills and it took me 3 years to pay that off.
When I was using Medicare for my health care typically for a doctor visit was about $125 and Medicare would pay the doctor $80 and I would end up paying $16 of that.
Unfortunately before the Medicare RX plan came into effect I had to pay full price for all of my medications. As a result I went close to $50,000 in debt in order to get my medications over the first 15 years of being disabled.This was mostly due to having a $1300 per month for medications for several years. Right now through the VA my medicine costs me about $200 per month.
I think the most outrageous thing I found in the way of health care was when I lived in Connecticut. Just prior to my daughter needing a tonsillectomy the state passed a new law that allowed hospitals to charge more for a day surgery if the patient ended up having to spend the night in the hospital that was not based on actual cost but the normal costs for intensive care. My daughter ended up spending the night so there was an extra $8000 on the bill which increased my copay significantly. The only reason they kept my daughter was because she hadn't come out of the Anesthesia enough by 5PM.
Dennis
Your guess was pretty close except the $18,000 was how much less Medicare paid versus the total bill. Out of the $63K I had a copay of about $2000 total for doctors and hospital bills and it took me 3 years to pay that off.
When I was using Medicare for my health care typically for a doctor visit was about $125 and Medicare would pay the doctor $80 and I would end up paying $16 of that.
Unfortunately before the Medicare RX plan came into effect I had to pay full price for all of my medications. As a result I went close to $50,000 in debt in order to get my medications over the first 15 years of being disabled.This was mostly due to having a $1300 per month for medications for several years. Right now through the VA my medicine costs me about $200 per month.
I think the most outrageous thing I found in the way of health care was when I lived in Connecticut. Just prior to my daughter needing a tonsillectomy the state passed a new law that allowed hospitals to charge more for a day surgery if the patient ended up having to spend the night in the hospital that was not based on actual cost but the normal costs for intensive care. My daughter ended up spending the night so there was an extra $8000 on the bill which increased my copay significantly. The only reason they kept my daughter was because she hadn't come out of the Anesthesia enough by 5PM.
Dennis
By now I'm sure all of you with universal health care in the UK, AUS, and elsewhere are giving quiet thanks. The weird thing about this is even though we are kicking around these gigantic dollar figures, the reality is the providers don't get that amount. So that "only 63,000 turns into maybe $18,000" (just a guess!) and then you factor in what part of that is our share to pay.
The patient's share is figured according to the insurance plan you are on. There is almost always a maximum amount a pateint will have to pay out of pocket, if you have reasonable insurance. The biggest problem is when you don't have insurance, or a lousy one. From all of our examples you can see how that can quickly cause financial insolvency if you are not among the fortunate to have good insurance and have a catastropic illness like MS or cancer.
You usually get good insurance by paying quite a bit in premiums. The higher your costs up front for the insurance, the less out of pocket you would usually be paying in the end if you use the medical services.
You can see that it is a crazy environment here when this procedure, done in different settings and different ways can range from $500 to $40,000. Yes, it's nuts!
This makes my head spin. Lu
The patient's share is figured according to the insurance plan you are on. There is almost always a maximum amount a pateint will have to pay out of pocket, if you have reasonable insurance. The biggest problem is when you don't have insurance, or a lousy one. From all of our examples you can see how that can quickly cause financial insolvency if you are not among the fortunate to have good insurance and have a catastropic illness like MS or cancer.
You usually get good insurance by paying quite a bit in premiums. The higher your costs up front for the insurance, the less out of pocket you would usually be paying in the end if you use the medical services.
You can see that it is a crazy environment here when this procedure, done in different settings and different ways can range from $500 to $40,000. Yes, it's nuts!
This makes my head spin. Lu
Hey my part of my recent gallbladder is over $3000 and I am still getting bills. We pay over 10 percent of our income to my medical with out hospitals and ER. Our income has been cut in half since 2001 and I do not qualify for disability. I will not get assistance from the government for twenty years. Ironically I got MS as a child but the documentation, my navy health record has was burned in a house fire. I do not worry what is fair,
Alex
Alex
Jean ........the bill was "only 40k"......and sailorsong ......."only 63,000"..............lawkes a lordy, I am more happy by the moment that I am NOT an American!
Why you're not all demanding full universal health care for everyone mystifies me!
Why you're not all demanding full universal health care for everyone mystifies me!
When I had my triple bypass surgery the total bill was only $63,000 which included all of the different doctor bills, 3 day in intensive care, and 2 days in the cardiac care unit. This was in 2006 and I doubt if costs have gone up that much since then.
Dennis
Dennis
Wow. I don't remember how much mine were, but 14k and 22k seem way out of wack. I spent 5 days in the hospital with double vision and had an LP, an MRI and lots of blood tests and the total bill was only 40k. Something is totally wrong with the system to have that much variability.
I just looked at the hospital bills. They submitted two separate claims that totaled $9,377. The first claim was for $5,615 and the hospital was received over $4,700 between insurance and my co-pay. The other claim of $3,762 was denied by the insurance company on the basis that the maximum amount had been paid for this procedure.
The procedure took less than 15 minutes (done on a tilt table) and I spent an hour on a gurney after that.
My son's tonsillectomy in January cost less than this, including charges from the surgeon, anesthesiologist and the hospital.
MRI's with contrast are billed at $4,920, but the negotiated rate is only $600. Doesn't make sense given the cost of equipment and the length of time the technicians spend with the patient.
Medical costs are definitely out of whack.
The procedure took less than 15 minutes (done on a tilt table) and I spent an hour on a gurney after that.
My son's tonsillectomy in January cost less than this, including charges from the surgeon, anesthesiologist and the hospital.
MRI's with contrast are billed at $4,920, but the negotiated rate is only $600. Doesn't make sense given the cost of equipment and the length of time the technicians spend with the patient.
Medical costs are definitely out of whack.
One other point that someone made up there - our system is very confusing because of that negotiated payment amount that insurance companies set with the providers.
Basically, it is a one-sided agreement. The insurance company says XX procedure is going to be worth $$ amount. No matter what is billed for XX, the insurance only pays $$.
But sometimes, the insurance company will say, they will pay 1/3 of the XX cost. So the provider finds a way of inflating the XX cost so the $$ increases. The provider gets more $$ that way.
Now, for the patient who does not have insurance, XX is usually the $$ they must pay to the provider, unless they negotiate with the provider (works with hospitals if you get lucky, but rarely with the individual doctors). Sometimes you can get a discounted rate because you don't have insurance and they will factor in a small $ discount.
It is a crazy system - I hope something in this makes sense.
-L
Basically, it is a one-sided agreement. The insurance company says XX procedure is going to be worth $$ amount. No matter what is billed for XX, the insurance only pays $$.
But sometimes, the insurance company will say, they will pay 1/3 of the XX cost. So the provider finds a way of inflating the XX cost so the $$ increases. The provider gets more $$ that way.
Now, for the patient who does not have insurance, XX is usually the $$ they must pay to the provider, unless they negotiate with the provider (works with hospitals if you get lucky, but rarely with the individual doctors). Sometimes you can get a discounted rate because you don't have insurance and they will factor in a small $ discount.
It is a crazy system - I hope something in this makes sense.
-L
You could also notify the compliance officer at the hospital (the operator should be able to connect you). HIPPAA requires hospitals to have one and they must investigate all complaints to be sure they are billing fairly and according to established rules and guidelines. This is surely an error.
Mary
Mary
This is why I'm happy the reform passed. No I do not think it is the best thing, but at least we are going SOMEWHERE! But I won't get started on a political (and ethical) soapbox :)
I had laparoscopic surgery w/ DaVinci robot (very high tech) with an unplanned overnight stay that only cost about $40,000. Insurance still hasn't paid (done in Dec.).
I hope it's an honest input error. I work at a (different) hospital, and I know those things happen. However, I am a little suspicious that this hospital might be trying to get more money since most of their patients are Medicaid or uninsured ,which translates to very little revenue of course. I am blessed to have coverage through 2 private insurances.
Anxious to see bill when it comes next week.
I had laparoscopic surgery w/ DaVinci robot (very high tech) with an unplanned overnight stay that only cost about $40,000. Insurance still hasn't paid (done in Dec.).
I hope it's an honest input error. I work at a (different) hospital, and I know those things happen. However, I am a little suspicious that this hospital might be trying to get more money since most of their patients are Medicaid or uninsured ,which translates to very little revenue of course. I am blessed to have coverage through 2 private insurances.
Anxious to see bill when it comes next week.
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