Why our health care system is so expensive...

[jesaco]

I guess this is why our health care system is screwed up and expensive. I went to an orthopedic doctor for a trigger finger. (where one finger bends due to inflammation on the base). I knew what it was by researching and was told by the doctor's assistant that they treat it all the time and its a minor issue. After x-rays, The doctor went in, took a cortisone injection in his drawer and injected it in the base of the finger. The doctor then said if the swelling does not subside I can come back to his office.

The interaction with the doctor was very minimal and probably took about 5 minutes. Imagine my shock when I received the EOB from medicare and my supplement insurer. He billed medicare and supplement insurer $4,725 and including office visit, x rays and the cortisone his total bill is $5,655!!! repeated calls to his billing office won't change saying its what the doctor did during the visit. talked to the doctor and said he'll look into it but never did. (still charged same amount). He charged "incision" or "surgery" instead of "injection".

I know Medicare paid him $5,488.94 and he still bills me the balance as my responsibility since I have deductible with my plan G. This is ridiculous that they can charge whatever they want. Our health care system really needs to be fixed. I plan to call medicare and humana and though they paid for most of the bill and I'm only responsible for the balance, I believe its not right to file a false billing.

 

[Montecfo]

So are you saying it is so expensive because doctors opportunistically miscoded procedures?

I mean, there is plenty of fraud in medical billing. They bust people every once in a while.

But lack of transparency is a big issue. I bet if they told you in the office the cost was $5600 there would have been an interesting conversation.

 

[YellowSubmarine]

Our medical system is riddled with fraud and non transparency. Funny, Medicare request notification when fraud is suspected...lip service. If you attempt to read a statement for medical services you will find the services were performed several months ago. If that's not confusing enough, the statement does not provide vital information that permits validation of services rendered unless you know the CPT codes and take time to do a line item review; and everything needs cross referenced as multiple items are posted for a single service. The system is designed for fraudsters and system gamers. Thank lobbyist and congress for the professional opportunity for corruption.

 

[RetiredAndLovingIt]

I had a similar issue many years ago with a little cyst on my finger. Instead of just removing it in the office he scheduled me for surgery at the hospital and I was actually put to sleep for the procedure. Even the nurses at the hospital commented that this was way out of line and I shouldn't be there. He then had the balls to chase me for the balance that he was supposed to write off as an in network provider. When I threatened to go to the local newspaper and TV station he backed off but I wish I'd followed through, he needed to be put out of business.
In your case, I'd leave a Yelp and some online reviews of the experience noting the fraudulent billing error(?) along with the total cost and time involved and see how that plays out. We the taxpayers are paying for this fraud.

 

[GrayHare]

There's much more R&D than in other countries. Less expensive systems did not come up with a COVID vax, for example.

 

[ivinsfan]

this is unusual, are you saying that your Medicare EOB, did not reduce the original billing by even one dollar. My DH had an open heart surgery on Medicare and they reduced literally every single item on the multi-page EOB. Sometimes the charge was reduced by a few bucks and other times they literally zeroed out the charges saying this item is already covered under another charge in the billing summary. So in our experience they CAN charge whatever they want but Medicare actually decides what and how much they are going to pay out. Something doesn't sound right in your case.

 

[Time2]

I guess this is why our health care system is screwed up and expensive. I went to an orthopedic doctor for a trigger finger. (where one finger bends due to inflammation on the base). I knew what it was by researching and was told by the doctor's assistant that they treat it all the time and its a minor issue. After x-rays, The doctor went in, took a cortisone injection in his drawer and injected it in the base of the finger. The doctor then said if the swelling does not subside I can come back to his office.

The interaction with the doctor was very minimal and probably took about 5 minutes. Imagine my shock when I received the EOB from medicare and my supplement insurer. He billed medicare and supplement insurer $4,725 and including office visit, x rays and the cortisone his total bill is $5,655!!! repeated calls to his billing office won't change saying its what the doctor did during the visit. talked to the doctor and said he'll look into it but never did. (still charged same amount). He charged "incision" or "surgery" instead of "injection".

I know Medicare paid him $5,488.94 and he still bills me the balance as my responsibility since I have deductible with my plan G. This is ridiculous that they can charge whatever they want. Our health care system really needs to be fixed. I plan to call medicare and humana and though they paid for most of the bill and I'm only responsible for the balance, I believe its not right to file a false billing.

I have a couple questions, I have/had a trigger finger, I would describe it different though. When I closed my hand the finger would get stuck, when you tried to open it, it would trigger open. "TV commercials analysis would suggest you are describing Dupuytren contracture.'
I have been in twice in the last two years to have a trigger finger injection. The most recent in March 2025, For the outpatient visit, the provider charged $210, Medicare Approved Amount $74,66, Medicare Paid $58,55. For the Tendon Injection, the provider charged $172, Medicare Approved Amount $47.91, Medicare Paid $37.56. The cost for the triamcinolone acetonide 10mg, the provider charged $24, Medicare Approved Amount $1.80, Medicare Paid $1.41.
Have you received your Medicare statement? I have seen Medicare Approved amounts that are less than 10% of what the provider charged. The provider must eat it.

 

[Luvdogs]

Recently a friend went to CVS for a common vaccine. I'm not certain of the details but they thought that Minute Clinic and the pharmacy there were the same thing-but even though they are in the same building, they aren't (I didn't know that).

Bottom line is they were charged $400 for the vaccine when it would have been next to nothing at the other part of the store. (I don't remember whether it was the pharmacy or Minute Clinic that charged them this).

 

[MichaelB]

I know Medicare paid him $5,488.94 and he still bills me the balance as my responsibility since I have deductible with my plan G. This is ridiculous that they can charge whatever they want. Our health care system really needs to be fixed. I plan to call medicare and humana and though they paid for most of the bill and I'm only responsible for the balance, I believe its not right to file a false billing.

Medicare does not allow balance billing. A health care provider that accepts Medicare assignment can’t then bill more directly to the patient. The EOB should show the exact amount of your liability.

You do have to pay the deductible ($257), and this should be indicated on the EOB

 

[PaunchyPirate]

Why? Because we have allowed a "for profit" medical system to grow. You can't go much deeper without getting into politics.

 

[EastWest Gal]

You can report fraud to both the state and to the HHS Office of the IG. I also recommend that you get a copy of the record of the visit, as I'll bet he lied on that too. If he is fabricating you medical record, that could cause you harm.

If this physician is successfully sued for Medicare fraud, whistleblowers are entitled to a portion of the fine. If he is doing this to you, he is probably doing this to most of his Medicare patients.

I've seen multiple incorrect entries in electronic medical records over the years, including unreported medication allergies as well as nonexistent medication allergies, both which are dangerous.

When my son broke his foot, the ER reported a "complete review of systems" and parts of the physical exam that weren't done. For example, they described his skin as "clear" when he had widespread eczema. He was in his snowboard clothes so they did not examine him. I helped him through a six month process of fighting the excessive billing and we were only partially satisfied. They never changed the fabricated history and physical, much to my dismay. I'll never go to that ER again, and DS switched to a different hospital system to avoid dealing with them at all.

 

[Fermion]

Why? Because we have allowed a "for profit" medical system to grow. You can't go much deeper without getting into politics.

A lot more reasons than that and I don't think it is really political. Why do we allow massive medical malpractice paydays without real limits? Other countries do not do that.

 

[Midpack]

There are hundreds of good articles explaining why healthcare is so expensive in the US. The OP is just a small part.

1. Lack of price limits
2. Hospitals and doctors are paid dor services, not outcomes
3. Specialists get paid much more - and want to keep it that way
4. Administrative costs inflate health spending
5. Health care pricing is a mystery
6. Americans pay far more for prescription drugs than people in other wealthy nations
7. Private equity

What the articles leaves out is the crucial root of the problem, our legislators enable it all in return for campaign finances.

Seven reasons why Americans pay more for health care than any other nation

Americans pay more for health care but don't get better results. Why? The blame goes well beyond insurance companies.

www.usatoday.com

 

[Golden Mean]

My opinion is that things broke when the gov. incentivized employers to offer health insurance (back in the 60s?). Then, for decades, people didn't really look at cost. Add to that the crazy amount of expensive imaging doctors seem to want to do and the whole CYA (lawsuit) situation.

I'll also get out my minor rant that it's not really "insurance" to me. I don't have go through my home insurance to fix something in my house. I don't have to do through my car insurance to change the oil in my car, but I have to go through "health insurance" to have any interaction with a doctor.

 

[ivinsfan]

My opinion is that things broke when the gov. incentivized employers to offer health insurance (back in the 60s?). Then, for decades, people didn't really look at cost. Add to that the crazy amount of expensive imaging doctors seem to want to do and the whole CYA (lawsuit) situation.

I'll also get out my minor rant that it's not really "insurance" to me. I don't have go through my home insurance to fix something in my house. I don't have to do through my car insurance to change the oil in my car, but I have to go through "health insurance" to have any interaction with a doctor.

Well it's the someone else paid for it so I don't care what it costs syndrome. When you don't write the check yourself all kind of rational billing goes out the window. Except now it's gotten completely out of hand. It's gotten so expensive that many people have no insurance or insurance with high deductibles.

 

[gauss]

I was under the impression that Medicare determines rates that they will pay participating providers. If Medcare pays that amount, it is because that is the agreed upon amount.

This assumes that the billing was written up accurately and that there is no "funny business" there.

-gauss

 

[Koolau]

Why? Because we have allowed a "for profit" medical system to grow. You can't go much deeper without getting into politics.

For profit can have advantages as well. I saw a study several years back in which non-profit hospitals charged quite a bit more than similar for-profit hospitals. I don't have the details, so feel free to disregard this anecdotal info.

Also, in "for profit" there is competition, not only in price but in outcomes. I'll stop there for the reason you mentioned.

 

[Car-Guy]

My friend with Prostate Cancer is on a drug that has a list price of >$15k a month. I've seen them. They are just ordinary looking pills. (I guess they aren't ordinary ) How can a one months supply of any pills cost over $15k.

FYI, the drug was developed using a grant from the US government. Maybe the drug manufacturer has to pay back the grant money?

 

[Koolau]

There are hundreds of good articles explaining why healthcare is so expensive in the US. The OP is just a small part.

1. Lack of price limits
2. Hospitals and doctors are paid dor services, not outcomes
3. Specialists get paid much more - and want to keep it that way
4. Administrative costs inflate health spending
5. Health care pricing is a mystery
6. Americans pay far more for prescription drugs than people in other wealthy nations
7. Private equity

What the articles leaves out is the crucial root of the problem, our legislators enable it all in return for campaign finances.

Seven reasons why Americans pay more for health care than any other nation

Americans pay more for health care but don't get better results. Why? The blame goes well beyond insurance companies.

www.usatoday.com

Interesting article but it never goes very deep on reasons for the "truths" that it describes. Things like having enough capacity to provide timely "elective" procedures is expensive. I was recently in for a "procedure" and there must have been a dozen empty prep rooms. That's not always the case. Sometimes those rooms are full.

I counted 5 people in my procedure room as they administered steroid shots in my back. They were all busy and they hustled me in and out in minutes to get to the next patient. I'm sure it could have been done for less total cost, but I would have waited months for it instead of a few weeks.

Lots of issues with our health care system. Plenty of opportunities for fraud and abuse. But, for all its problems, I prefer it to "free" care. I'm sure I'm skirting the political area here.

 

[Koolau]

My friend with Prostate Cancer is on a drug that has a list price of >$15k a month. I've seen them. They are just ordinary looking pills. (I guess they aren't ordinary ) How can a one months supply of any pills cost over $15k.

FYI, the drug was developed using a grant from the US government. Maybe they have to pay it back?

Do you have the details on how the US gummint paid for "development" of that drug? I ask because a lot of drugs are created by gummint money - often at universities with gummint funding. I'm guessing most drugs are "found" that way. Most "Big Pharma" drug companies farm that part of the business out to universities and smaller drug companies.

And yes, drug companies "license" those drugs which are now a "chance" at treating/curing something.

But generally speaking, drug companies "develop" them and get them through the lengthy and expensive approval process. The drug companies are the ones who get sued when the one person has an adverse event that was not discovered among the 10,000 people in clinical trials.

Ordinary looking pills? Likely cost the drug company what? A dollar to make, right? Right. Maybe only 10 cents. But the clinical trials to get approval to treat a few thousand cases per year with that dollar (or 10 cent) pill cost a billion dollars (with a B).

How many treatments will a drug company create if they are not allowed to recoup costs and make a profit for their large investments?

Plenty of issues and lots of folks to blame for high health care costs. Drug companies are greedy and totally profit motivated. Not much altruism there, that's for sure. But we all want safe and effective health care. I can't think of too many things more valuable to spend my money on than that. I'm okay with making a drug company rich if they cure me or provide me quality of life. (Heh, heh and I buy their stock too). YMMV

 

[marko]

My brother's leg brace just needed new velcro straps.

Called the orthotic outfit that made it to come in and get $25 worth of velcro replaced.
"Oh no, you need a prescription from the orthopedic doctor before you can come in. "

Go see the ortho doctor for a $600 Medicare paid visit that took 12 minutes. "Yup, you need new velcro". $1200 more for the velcro.

 

[TickTock]

My opinion is that things broke when the gov. incentivized employers to offer health insurance (back in the 60s?).

During WWII. There were wage freezes, and offering healthcare insurance was a legal way to offer incentives to workers.

 

[MichaelB]

FYI, the drug was developed using a grant from the US government. Maybe the drug manufacturer has to pay back the grant money?

Nope, no need to repay. It’s a grant, and if it leads to a patented drug, all the better for the University where the research was done and the partner pharma company.

They probably won’t pay much in US tax, either. They transfer the IP to Ireland and pay taxes there when it’s exported. They show a loss on their US books.

 

[Fermion]

I'd recommend anyone who thinks drug companies make tons of money to sell their tech stocks and buy bio. Sure, you would miss out on a few million dollars in gain in your portfolio the past decade, but you would be benefitting from all that greedy pharma money! There is a reason Microsoft is worth $3T and Merck is only worth $200B

 

[Koolau]

Nope, no need to repay. It’s a grant, and if it leads to a patented drug, all the better for the University where the research was done and the partner pharma company.

They probably won’t pay much in US tax, either. They transfer the IP to Ireland and pay taxes there when it’s exported. They show a loss on their US books.

Heh, heh, time to load up on their stock!