More Health Care Billing Nonsense

[Midpack]

DW had ankle replacement years ago and the final cost to us and our health care insurance provider was about 10% of the claim the hospital submitted, IOW they billed at 10 times final cost. That’s outrageous, inexcusable IMO. What other business gets away with that? And IME its impossible to get any idea what costs will be in advance.

But I’ve just seen a worse case while my sister and I wade through claims from my Dad’s recent health care events, this one is settled:

First two weeks in the hospital they submitted a total claim of $108,549. Medicare paid $3836.67. Tricare $1340. Patient $0. So the hospital billed for 21 times what they settled on with no resistance. Ridiculous.

 

[NW-Bound]

That's the way it always has been. Hospital billing makes used car salesmen look like saints.

 

[Sue J]

I had an MRI done. The bill was $5966. The allowed amount was $248. The discount was $5718. Insurance paid nothing. I will pay the $248.

Crazy!

 

[audreyh1]

DW had ankle replacement years ago and the final cost to us and our health care insurance provider was about 10% of the claim the hospital submitted, IOW they billed at 10 times final cost. That’s outrageous, inexcusable IMO. What other business gets away with that? And IME its impossible to get any idea what costs will be in advance.

But I’ve just seen a worse case while my sister and I wade through claims from my Dad’s recent health care events, this one is settled:

First two weeks in the hospital they submitted a total claim of $108,549. Medicare paid $3836.67. Tricare $1340. Patient $0. So the hospital billed for 21 times what they settled on with no resistance. Ridiculous.

Yes - billing is at least 10x if not more, and insurance makes a 90%+ discount.

It's been that way for a very long time.

Totally nuts.

 

[Midpack]

21X is the most ridiculous case I can recall. If anyone pays the claim amount, obviously they’re being ripped off, should be criminal IMO. Again, I can’t think of any other industry where discrepancies of that magnitude would be possible, or where price transparency would be so elusive.

 

[NW-Bound]

I had an MRI done. The bill was $5966. The allowed amount was $248. The discount was $5718. Insurance paid nothing. I will pay the $248.

Crazy!

I have had several CAT scans but not MRI. Is an MRI really that inexpensive?

 

[jollystomper]

One of our health providers billed us $200 in error. They were charging us a "new patient" fee when in reality they took over our previous provider (absorbed his practice into their group) and they and our insurance agreed we should not be charged that.

However, over a year later we get a bill every other month for that charge. We have contacted them every time, they insist it should not be happening, we fax them what we received, they say "okay - we'll fix it". But it has yet to be fixed.

Our concern is that the last couple of bills were marked OVERDUE... and that if not cleared it their system will send it off to a collection agency, creating even more problems for us.

 

[audreyh1]

I have had several CAT scans but not MRI. Is an MRI really that inexpensive?

That sounds pretty low - they got a major discount. I remember paying more like ~$1200 in 2010. I’d expect them to be at least $800.

 

[pb4uski]

I'd love to see a law that for any service that a medical provider provides that they can't charge any more than 200% of the negotiated rate for that service with their largest insurer.... or something like that to bring some reasonableness into the whole process.

And to allow for them to price gouge the occasional rich shiekh that might wantder in, say that it only applies to services provided to US citizens and residents.

 

[ivinsfan]

I wouldn't be surprised to see that claim resubmitted by the hospital, maybe some billing codes errors or something.

A payment of a little over 5K for two weeks in the hospital seems low. There has to be something else in play. My DH has an 8 day hospital stay for a complicated heart procedure and Medicare paid over 60K to the hospital as well as additional payments to the surgeon , and other medical professionals..

 

[Jerry1]

I'd love to see a law that for any service that a medical provider provides that they can't charge any more than 200% of the negotiated rate for that service with their largest insurer.... or something like that to bring some reasonableness into the whole process.

Actually, there is a law like that. I forget the particulars but if you don’t have insurance, providers can only charge you something (forget the percentage) based on the Medicare payment.

 

[audreyh1]

Actually, there is a law like that. I forget the particulars but if you don’t have insurance, providers can only charge you something (forget the percentage) based on the Medicare payment.

That’s interesting! I never heard of that.

 

[davebarnes]

Why I like Kaiser.

 

[pb4uski]

That’s interesting! I never heard of that.

Me neither. I'll be keen to learn the details.

 

[Jerry1]

Me neither. I'll be keen to learn the details.

I looked into this a bit and it may be a state by state situation. Here’s a link to the Illinois law for example.

https://www.team-iha.org/finance/ch...tance/hospital-uninsured-patient-discount-act

It's been awhile, and I worked in commercial insurance, so this did not impact my contracts, but around 2010, people began to realize that the people who pay hospital charges were the uninsured and usually those people were struggling financially. They were also the people being driven to bankruptcy from medical bills. Many states and most hospitals instituted laws and policies to protect against this issue.

The IRS also got involved and put pressure on non-profit hospitals to support that they were providing a social benefit as part of their tax exempt status. Most of them implemented uninsured discount policies at that time.

Bottom line, if you’re uninsured, never pay a hospital their full charges.

 

[TwoByFour]

21X is the most ridiculous case I can recall. If anyone pays the claim amount, obviously they’re being ripped off, should be criminal IMO. Again, I can’t think of any other industry where discrepancies of that magnitude would be possible, or where price transparency would be so elusive.

The hospital and the insurer know the billed amount is BS, but the real fraud in all of this is that if you don't have insurance, the hospital will try to make you pay their 21x BS charge!

There should be a law that every healthcare provider is free to set whatever charge they want for services they provide, but once that amount is set, it is set for everyone, insured or not, with no discounting. And it must be published for all to see. That is the only way that a system that relies on users making wise choices can work. The prices must be visible and not hidden behind secret deals with insurance companies.

 

[Rustward]

All this . . . and some here complain about the price of financial advice which, unlike healthcare, is 100% optional for everybody . . . doesn't make much sense.

 

[donheff]

It is insane.

 

[Rianne]

Where would insurance companies be if hospitals charged wholesale prices equally to everyone. Why would you need insurance companies? I'm not a conspiracy theorist but it seems hospitals and HI companies cooked up this plan a long time ago, forcing people to buy HI, win/win for hospitals and HI co. People pay premiums to HI co. while hospitals invent rates based on their whim! It's obvious because a hospital 5 miles away charges very different prices for exact same procedure. WTF, why aren't we screaming about this?

 

[Souschef]

One of our health providers billed us $200 in error. They were charging us a "new patient" fee when in reality they took over our previous provider (absorbed his practice into their group) and they and our insurance agreed we should not be charged that.

However, over a year later we get a bill every other month for that charge. We have contacted them every time, they insist it should not be happening, we fax them what we received, they say "okay - we'll fix it". But it has yet to be fixed.

Our concern is that the last couple of bills were marked OVERDUE... and that if not cleared it their system will send it off to a collection agency, creating even more problems for us.

I had the same problem when my late wife was taken to the hospital. There was a contest with the hospital, the insurance company and my provider. It took months to straighten it out.

 

[Jerry1]

You’d still need insurance for the large catistrophic event or for protection against a long term illness.

Note that this is no different than many industries. Do you think everyone pays the same to have a house built? Have their car worked on? Fly, hotel . . .

 

[MRG]

It's total nonsense. My friend's wife was a victim of medical malpractice, she bleed to death in a hospital after a tubal ligation. She only had one ovary but they cut both sides and apparently cut a vein and couldn't be bothered to save her life.

I remember months after being at my friend's house when he opened his mail. Another bill, threatening legal action against him. He started to get upset and said he needed to do what his attorney wanted. Opened up a cupboard and added this bill to a stack of hundreds of others he had been sent.

 

[gauss]

In my state, hospitals set up these 10x rates because auto insurers are forced by law to pay the full retail rate to the hospital for medical services that are due to an auto accident.

This results in my state having one of the highest auto insurance premiums in the country and the uninsured (at least those not inclined to negotiate) getting caught up in this 10x net also.

-gauss

 

[imoldernu]

My recent (June) 8 days in and out of the emergency room and hospital stay was pretty expensive. Don't know the total, 'cuz I couldn't bear too look at the bills that poured in, but am guessing possibly $120K. DW said "you've already met the deductible, so just wait. We kept the bills in a pile and waited...
The actual bills are totally unintelligible. Medicare paid this, Blue Cross that, and then some other numbers Medicare deductible, Blue Cross deductible...and then... the cryptic column... Other parties paid? and the payment due $o.oo.

I was awaiting something like $12K out of pocket, but jeanie said... just wait.

This is one time I was glad she was right. This AM, the final bill came in
You Owe... $0.00.

I dearly love that "other party".

Don't try to make sense of this.

 

[Jerry1]

It’s not just the auto insurance. There are still insurance companies that pay based on a percent of the charge. Even if it’s only 25 percent of the charge, hospitals raise their charges to gain that revenue. Most contracts now have a clause to limit this, but historically, that was the main driver of outrageous charge increases.