Wow, what do people do who don't have health insurance?!

[CompoundInterestFan]

A little while ago I had an emergency appendectomy (as opposed to planned ), and I'd been wondering when the bills were going to start rolling in. I've already gotten the one for anesthesiologist, but today I got the "big" one: $19,000!!!

Luckily I only have to pay 10%, but wow, I was pretty shocked. How in the world would I have paid for this if I didn't have insurance? I can see how people end up declaring bankruptcy.

 

[retire@40]

A little while ago I had an emergency appendectomy (as opposed to planned ), and I'd been wondering when the bills were going to start rolling in. I've already gotten the one for anesthesiologist, but today I got the "big" one: $19,000!!!

Luckily I only have to pay 10%, but wow, I was pretty shocked. How in the world would I have paid for this if I didn't have insurance? I can see how people end up declaring bankruptcy.

I'd love to know the breakdown of that $19,000. Part of the trouble with the current health system is that there is a lot of overcharging.

 

[CompoundInterestFan]

I'd love to know the breakdown of that $19,000.

Yeah, me too. There wasn't a breakdown of the bill, just a total amount. It did involve a CAT scan and an overnight stay, so I assume that jacks up the price a bit.

 

[W2R]

A little while ago I had an emergency appendectomy (as opposed to planned ), and I'd been wondering when the bills were going to start rolling in. I've already gotten the one for anesthesiologist, but today I got the "big" one: $19,000!!!

Luckily I only have to pay 10%, but wow, I was pretty shocked. How in the world would I have paid for this if I didn't have insurance? I can see how people end up declaring bankruptcy.

And just when you think you have the hospital bill, even more bills start rolling in. Separate bills for the emergency room, the radiologist, and a bazillion other bills that weren't included in the first bill. Even $19K sounds small for an emergency appendectomy these days. Hospitals are Big Business.

 

[Ed_The_Gypsy]

Welcome to America, CIF.

 

[Cattusbabe]

Worry. A lot.

 

[Rich_by_the_Bay]

A little while ago I had an emergency appendectomy (as opposed to planned ), and I'd been wondering when the bills were going to start rolling in.... How in the world would I have paid for this if I didn't have insurance? I can see how people end up declaring bankruptcy.

Do a search on health insurance in this forum and you will be busy for weeks.

Bottom line, not to be glib about it, is that you need to do everything you can to never have a lapse in health insurance. For some, the system makes it difficult or impossible to achieve that goal, and for most it is exceedingly expensive or even prohibitive.

Regardless of politics, most agree that the current system is profoundly flawed but the solutions are elusive.

 

[CompoundInterestFan]

Regardless of politics, most agree that the current system is profoundly flawed but the solutions are elusive.

That's for sure. If there were an easy answer, it would've already been implemented. When I was younger, universal health coverage sounded fantastic, but that was before I realized that the money to pay for it just doesn't magically appear.

 

[Rich_by_the_Bay]

That's for sure. If there were an easy answer, it would've already been implemented. When I was younger, universal health coverage sounded fantastic, but that was before I realized that the money to pay for it just doesn't magically appear.

Yes, any thoughtful person realizes that we'll have to pay, and pay big.

But at least we need to allow everyone access to insurance - worst case scenario is to need it, be willing and able to pay for it (at pooled rates) and be turned down or denied repeatedly.

Tough nut to crack.

 

[bow-tie]

I'd love to know the breakdown of that $19,000...

The DW requested an itemized bill from the hospital for DS delivery for an AFLAC policy... we finally received an itemized bill... but I think it was in Chinese. I'm relatively sure I couldn't tell if there were any billing errors or not. Kinda hard to tell when you can't decipher the damned thing.

 

[retire@40]

The DW requested an itemized bill from the hospital for DS delivery for an AFLAC policy... we finally received an itemized bill... but I think it was in Chinese. I'm relatively sure I couldn't tell if there were any billing errors or not. Kinda hard to tell when you can't decipher the damned thing.

Don't you think it was done that way on purpose so the average person can't figure it out?

If it could be done more simply, then why isn't it?

The health insurance crisis could be fixed if we all knew what we were really paying for. This is the starting point.

 

[eridanus]

retire@40 is right. It's a *%^***) scam.

You'll need the CPT codes for each procedure, and that's only the start of the research. If it doesn't have a CPT, you'll have to find out what the charge means. If it does have a CPT, you'll need to research each one to see if it's bundled in another CPT (or should be).

 

[bow-tie]

Don't you think it was done that way on purpose so the average person can't figure it out?

If it could be done more simply, then why isn't it?

The health insurance crisis could be fixed if we all knew what we were really paying for. This is the starting point.

I suppose it's no different than getting a bill from the local auto stealership for what they did to your car. If you don't know much about cars, you likely can't read what they did, or if they did it. So... I guess the onus falls on us to become literate in, well, pretty much everything... from oil changes to appendectomies.

Methinks it sucks to be us sometimes.

 

[Martha]

It is not practical or reasonable to expect people to be expert shoppers for everything.

 

[kramer]

I have been actively developing my expertise in all aspects of health care, health care pricing, and health insurance. Not because I want to, but because I decided that this is the probably the thing that I will spend the second most money on in my life, after shelter, and because I am getting older and actually need to think about it more and can no longer take good health for granted. Sadly, I waited until close to FIRE to do this, because I wasn't paying directly before and so there were really no financial consequences to me personally. Now I take personal responsibility for everything.

For many of the same reasons, I made myself an expert on aspects of investing and taxation, as they apply to me, long ago.

There is an article in today's NY Times about negotiating prices for health care here:

http://www.nytimes.com/2007/02/27/health/27cons.html

I am always interested in hearing these negotiation stories. I would like to hear from more posters about their personal experiences. As much as I dislike it, I need to learn more.

Kramer

Patrick Fontana twisted his left knee last spring while hitting a drive down the fairway on a golf course in Columbus, Ohio. But what really pained him was the $900 bill for diagnostic imaging ordered by his doctor.

Mr. Fontana, a 42-year-old salesman, has a high-deductible health plan coupled to a health savings account. Since he was nowhere near meeting his deductible, he was on the hook for the entire bill.

So he did something that insurance companies routinely do: he forwarded the bill to a claims adjuster, in this case My Medical Control, a Web-based company that reviews doctor and hospital bills for consumers.

After concluding that Mr. Fontana was not getting the best possible price, the company’s representatives called the imaging facility and demanded a lower one, promptly saving him $200 — minus a 35 percent collection fee.

“I asked before I went in to the clinic how much it would cost, and they just will not tell you,” he said later. “I didn’t know until I got the bill, and at that point I figured I had nothing to lose.”

The savings are possible for one reason: medical care is often priced with the same maddening, arbitrary opacity as airline seats and hotel rooms.

 

[Peter]

I suppose it's no different than getting a bill from the local auto stealership for what they did to your car.

Hmmm, I'm guessing that you've not had the displeasure of seeing a typical hospital bill? Pages and pages of coded 'procedures', names of medical staff you've never heard of, etc., etc.

And if you have, say, cancer, you're supposed to be able to fathom all this out?

But you are right when you say that it sucks!

Peter

 

[kramer]

Hmmm, I'm guessing that you've not had the displeasure of seeing a typical hospital bill? Pages and pages of coded 'procedures', names of medical staff you've never heard of, etc., etc.

And if you have, say, cancer, you're supposed to be able to fathom all this out?

But you are right when you say that it sucks!

Peter

Yes, I wonder if these new expert intermediaries are going to pop up, like was mentioned in the NY Times article, and charge you X% for negotiating savings for you. Hopefully, the "X" will go down over time with more competition. Either way, this is a very difficult system to navigate.

Kramer

 

[Cut-Throat]

A little while ago I had an emergency appendectomy (as opposed to planned ), and I'd been wondering when the bills were going to start rolling in. I've already gotten the one for anesthesiologist, but today I got the "big" one: $19,000!!!

Luckily I only have to pay 10%, but wow, I was pretty shocked. How in the world would I have paid for this if I didn't have insurance? I can see how people end up declaring bankruptcy.

What Shocks me is that there are folks here that pay almost that much in insurance premiums - EVERY YEAR!

 

[mykidslovedogs]

President Bush has really been pushing providers and healthcare administrators to improve price transparency (disclosure of pricing) in order for there to be more success with consumer-driven health plans such as HSAs:

http://www.ncsl.org/programs/health/Transparency.htm

 

[mykidslovedogs]

What Shocks me is that there are folks here that pay almost that much in insurance premiums - EVERY YEAR!

Now you know why health insurance is so expensive....because healthcare is expensive! Healthcare providers are not overcharging....they are compensating for below cost services they provide to Medicare and/or Medicaid patients (gov't only pays avg of 30 cents on the dollar for Medicaid and Medicare services). With the rise in the babyboom population, it's only going to get worse. We should be thankful that our providers have the private sector to fall back on to retrieve lost income....otherwise, we'd start losing good doctors over time. In fact, we are already starting to see a shortage in primary care physicians, because young interns are discovering it's not worth it to go into that field since their income potential is greatly limited by price-controls for the masses of Medicare and Medicaid recipients that they would be required to provide services to.

 

[kramer]

In fact, we are already starting to see a shortage in primary care physicians

Interesting -- according to a chart on the front page of the WSJ last week, this is exactly correct. It looks like the number of medical school graduates filling family-residency positions has decreased from a peak of about 2300 in 1997 to about 1150 in 2006. Wow, that is a 50% cut. It takes awhile to see the effect in the overall market since the older doctors have to retire over time.

Also, the average salary quoted (2003) in the US for General Practicioners was $121,000, quite low for the caliber of people that become physicians, the amount of time and money it takes to become one, and the competing professions out there. (not to mention the chance of getting sued)

On the other hand, my brother-in-law (aged in late 40's) is making a killing as a surgeon in the Midwest as part of a small 5 surgeon practice. He makes a little over half a million a year in a modern city with moderate weather where the average house costs roughly $125,000. That is what I call a "4x salary," about 4 times the median house price. (then again, he had to pay over 75K for the malpractice "tail" insurance when he left his last job to protect him against malpractice suits from those past surgeries)

On the third hand, it seems like Physician's Assistants can do a lot of things that GP's used to do? Can't they prescribe medicine in certain states now, etc.? Maybe that is good enough for front line care?

Also, the AMA actively opposes allowing doctors to immigrate to America in order to reduce the supply. A good friend of mine (now US citizen) is married to a brazilian doctor and they live in the US. She was a practicing doctor in Brazil, is fluent in English, passed her US boards on first try last year, and also went to Brazil's best medical school. The immigration process has been very difficult. She must now serve several years of low paid residency. And it will take her at least five years from beginning of this process to become a practicing doctor in the US. And she may even have to serve several years in a low population, rural outpost first depending on how the visa situation turns out.

Kramer

 

[MasterBlaster]

Now you know why health insurance is so expensive....because healthcare is expensive! Healthcare providers are not overcharging....they are compensating for below cost services they provide to Medicare and/or Medicaid patients (gov't only pays avg of 30 cents on the dollar for Medicaid and Medicare services). With the rise in the babyboom population, it's only going to get worse. We should be thankful that our providers have the private sector to fall back on to retrieve lost income....otherwise, we'd start losing good doctors over time. In fact, we are already starting to see a shortage in primary care physicians, because young interns are discovering it's not worth it to go into that field since their income potential is greatly limited by price-controls for the masses of Medicare and Medicaid recipients that they would be required to provide services to.

Your point is valid.

However, there is a fairness issue here to the private sector payees. Why should they subsidize government based healthcare. Isn't that what taxes are for. If they government-based healthcare is not paying for the services it gets then there should be an adjustment to their payment structure.

We should have a real debate in this country about what level of treatment people getting government-based healthcare are entitled to and then pay the true cost through taxation. That is the only fair way.

This backdoor healthcare welfare just isn't right.

 

[MasterBlaster]

Interesting -- according to a chart on the front page of the WSJ last week, this is exactly correct. It looks like the number of medical school graduates filling family-residency positions has decreased from a peak of about 2300 in 1997 to about 1150 in 2006. Wow, that is a 50% cut. It takes awhile to see the effect in the overall market since the older doctors have to retire over time.

Also, the average salary quoted (2003) in the US for General Practicioners was $121,000, quite low for the caliber of people that become physicians, the amount of time and money it takes to become one, and the competing professions out there. (not to mention the chance of getting sued)

On the other hand, my brother-in-law (aged in late 40's) is making a killing as a surgeon in the Midwest as part of a small 5 surgeon practice. He makes a little over half a million a year in a modern city with moderate weather where the average house costs roughly $125,000. That is what I call a "4x salary," about 4 times the median house price. (then again, he had to pay over 75K for the malpractice "tail" insurance when he left his last job to protect him against malpractice suits from those past surgeries)

On the third hand, it seems like Physician's Assistants can do a lot of things that GP's used to do? Can't they prescribe medicine in certain states now, etc.? Maybe that is good enough for front line care?

Also, the AMA actively opposes allowing doctors to immigrate to America in order to reduce the supply. A good friend of mine (now US citizen) is married to a brazilian doctor and they live in the US. She was a practicing doctor in Brazil, is fluent in English, passed her US boards on first try last year, and also went to Brazil's best medical school. The immigration process has been very difficult. She must now serve several years of low paid residency. And it will take her at least five years from beginning of this process to become a practicing doctor in the US. And she may even have to serve several years in a low population, rural outpost first depending on how the visa situation turns out.

Kramer

When you need major medical care - we are going to send you to the doctor and hospital that makes the least amount of money !

I hope that it works out for you !

 

[mykidslovedogs]

We should have a real debate in this country about what level of treatment people getting government-based healthcare are entitled to and then pay the true cost through taxation. That is the only fair way.

The problem is, you can't tax people enough for government healthcare. If we were continually taxed to pay for the government programs, eventually, we would be taxed far in excess of what the cost of private insurance costs.

 

[cute fuzzy bunny]

Was talking to my RE agent last night. Sad story of a couple trying to "go bare". In the middle of selling their home, huge medical problem came up. At the end of it all, they lost all their money, and their house. Then some more lien holders showed up at the last minute and the real estate agents involved in the home sale had to kick in some money out of their commissions to resolve all the financial demands.

Penniless, no home, smashed credit. Very sad.