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fasted58
fasted58 Reader
5/22/11 3:27 a.m.

Received a Explanation of Benefits (This is not a bill) type letter yesterday. It was for disposable medical supplies for a CPAP machine (sleep apnea) I use. I 'bout fell through the floor when I read the totals.

2 disposable filters (bout 1X1.25X.5") $27.84 -- I found same filters online @ 26/ $25 inc. S&H

Flex tubing 1" X 6' $104.07 -- found online for $3.90 or 3/ $15 inc. S&H

Nasal Mask w/ straps $319.38 -- online $54

Mask pillow $77.13 -- online $7.50

Sure, I can see markup for handling, employee costs etc. but this is ridiculous. No wonder medical insurance is being downsized or eliminated these days. Hope this is just a billing error as it's always been PIF for years now but at least I know the score now. Geezus, I never knew.

BWTM: One doc billed insurance $65 for a smoking cessation consultation. She handed me a single-sheet tri-fold brochure (color glossy too, woohoo), said 'you oughta quit smoking, and read the brochure when you get home'. Done.

Ranger50
Ranger50 HalfDork
5/22/11 7:53 a.m.

Medical insurance= proverbial cash cow with immediate payments. So you charge the absolute maximum for everything, as certain services, normally medical procedures, can only be charged for at a certain amount set by the insurance company. The other stuff is where you make your money to keep the doors open. Your consultation was probably billed as 15min flat fee time block. So, the more people they can see in that hour above the 4 is "free" money, much like the flat rate mechanic trying to fix your hooptie.

I know one of the ER docs I work with pays 200-250k/yr in malpractice insurance, yet barely can afford a $50k new car for his wife on payments. Who is screwing who?

cwh
cwh SuperDork
5/22/11 9:46 a.m.

I recently had some skin work done, covered by Medicare. (Irish skin, 30 years of Florida sun = skin cancers) Office visit- 189.00. I was in there an hour. 15+ lesions frozen off- ~400.00. Couple extra things added to that, total bill was over 700.00. OK, skin doc is good, probably used 3.00 worth of liquid nitrogen and a band aid. But 700.00? OK, this was Cleveland Clinic, a world class place, but.... The kicker is that Medicaid paid less than 300.00 of the bill and I was advised that I "may" be billed for 184.00, which I have not. Strange stuff going on in those billing depts. Also, this is a very popular hospital for South Americans, who pay full price. I wonder what happens when Joe Normal with no insurance tries to get treatment there. Yeah, he heads to Broward General where signs in the ER tell you that you will not be denied treatment if you cannot pay.

pigeon
pigeon Dork
5/22/11 10:20 a.m.
cwh wrote: Yeah, he heads to Broward General where signs in the ER tell you that you will not be denied treatment if you cannot pay.

This is why everything in a hospital setting is more expensive than anywhere else - those who pay not only pay for themselves they pay for those who can't.

dollraves
dollraves Reader
5/22/11 12:08 p.m.

I got the finalized claims for my recent surgery this week...

Patient Responsibility: $460.11

Amount we paid: $4140.97

Amount billed by provider: $45,433.90

I thought I was going to have a heart attack...would I have to come up with the other $40k?? Then I noticed the "Amount saved by using a network provider: $40,832.82"

On one hand, WHEW! On the other... SERIOUSLY? We expect people without insurance to cough up $45k but with insurance only $5k?

I now understand where grocery stores got their club card idea. Sheesh!

DeadSkunk
DeadSkunk HalfDork
5/22/11 5:13 p.m.

You oughta see the bills for my bypass surgery ! My share will hit me for about $1400 for each of the last two years,and that's on top of a monthly premium of $1033. The whole thing is a big racket for the hospital and the insurance company. I walked into the hospital for a catheterisation test on Thursday and went home Monday afternoon after having the surgery. The total billings were over $150K.

Apis_Mellifera
Apis_Mellifera New Reader
5/22/11 5:52 p.m.
dollraves wrote: We expect people without insurance to cough up $45k but with insurance only $5k?

No, the total would be less for an uninsured person. The out-of-pocket might be more or less. Basically it like this: "That procedure will be $100. Oh, you have insurance? In that case, the procedure will be $1000, but you'll only have to pay $100 of that."

That's of course a generality, but the actual billed cost is a sliding scale. The same procedure can be ridiculously expensive or completely free. It all depends on how much the biller thinks they can get the payer to cough up.

fasted58
fasted58 Reader
5/22/11 6:46 p.m.

Per my OP, charges were for medical supplies only although there is 'nursing support' who I've only seen a cpl times in seven years. Once for the initial set-up of machine and once for verification of hours (that I was actually using it). Supply ordering is handled by an automated phone system, press 1 or 2, say yes/ no for this or that part. Supplies are then drop shipped from a warehouse. No docs or specialists involved here, at the very very minimum a biller and a picker at the warehouse, these are parts only. But a markup of $438 for supplies I could source myself for $90, c'mon man. Maybe they are taking notes from the Pentagon. They're not hurtin' either (not to start the us vs them) although they took a hit from Medicare payout restrictions:

Lincare Holdings Inc. reported net income of $181.6 million, or $1.87 a share, for 2010, compared with net income of $136.1 million, or $1.32 a share, for 2009. Revenue for the year ended Dec. 31 was $1.67 billion, a 7.7 percent increase over revenue of $1.55 billion in 2009. Gains through internal and acquisition growth offset the impact of $34.9 million in Medicare payment changes last year, a company statement said. For the fourth quarter of 2010, Lincare posted net income of $46.1 million, or 48 cents a share, on revenue of $422.1 million. In the same period a year earlier, Lincare had net income of $40.6 million, or 41 cents a share, on revenue of $405.8 million. Lincare (NASDAQ: LNCR), headquartered in Clearwater, provides respiratory therapy and other services to patients in their homes.

Everybody has taken a hit in this economy in either wages or bennies or worse yet the uninsured. I'm just not gettin' a $100 markup on a $4.00 disposable hose.

wbjones
wbjones SuperDork
5/22/11 6:47 p.m.
Apis_Mellifera wrote:
dollraves wrote: We expect people without insurance to cough up $45k but with insurance only $5k?
No, the total would be less for an uninsured person. The out-of-pocket might be more or less. Basically it like this: "That procedure will be $100. Oh, you have insurance? In that case, the procedure will be $1000, but you'll only have to pay $100 of that." That's of course a generality, but the actual billed cost is a sliding scale. The same procedure can be ridiculously expensive or completely free. It all depends on how much the biller thinks they can get the payer to cough up.

not so... a friend of mine needed his artificial hip replaced... (it was failing)... self employed mechanic...(read .. no insurance) the charge to him $50K.. or there abouts... if he had had ins. the charge to the ins co would have been $25K.... he begged them to charge him the "ins negotiated price" ... he would pay in cash (inheritance) ... they wouldn't even entertain the thought... if he wanted a new hip $50K or out you go...

porksboy
porksboy SuperDork
5/22/11 6:58 p.m.
wbjones wrote:
Apis_Mellifera wrote:
dollraves wrote: We expect people without insurance to cough up $45k but with insurance only $5k?
No, the total would be less for an uninsured person. The out-of-pocket might be more or less. Basically it like this: "That procedure will be $100. Oh, you have insurance? In that case, the procedure will be $1000, but you'll only have to pay $100 of that." That's of course a generality, but the actual billed cost is a sliding scale. The same procedure can be ridiculously expensive or completely free. It all depends on how much the biller thinks they can get the payer to cough up.
not so... a friend of mine needed his artificial hip replaced... (it was failing)... self employed mechanic...(read .. no insurance) the charge to him $50K.. or there abouts... if he had had ins. the charge to the ins co would have been $25K.... he begged them to charge him the "ins negotiated price" ... he would pay in cash (inheritance) ... they wouldn't even entertain the thought... if he wanted a new hip $50K or out you go...

Um... I have been without insurance before. Tell the doc as much and watch the price drop. Billing is easier and requires less BS. Collection can be a problem, offer to pre pay all or part. cash disscount etc. If your friend did indeed pay that he was an idiot, no offence to you. If the doc wouldnt negotiate the patient should walk and find another doc. I did it myself. I guarantee there is more than one doc willing to do the surgery, even on a repeat replacement. As I undersatand it is a more difficult opperation.

Appleseed
Appleseed SuperDork
5/22/11 7:48 p.m.

I'm an American. What the berkley is insurance?

Duke
Duke SuperDork
5/22/11 8:18 p.m.

It's that thing we're going to fix by legally requiring everyone to buy it.

Wally
Wally SuperDork
5/22/11 8:38 p.m.

My favorite charge after my accident was $675.00 to weigh me and determine I was overweight. I could have saved them a bit of money right there.

92CelicaHalfTrac
92CelicaHalfTrac SuperDork
5/22/11 8:45 p.m.

It's a vicious cycle. The "billed" charges are inflated like mad because the "in-network" rates are negotiated between the provider and the insurance company while they're drawing up their network contract.

The providers ask for a ludicrous amount, insurance comes back with what they're willing to pay. The providers thing that the more they ask, they'll get more money per procedure.

And that's somewhat true. Until they just can't come to a deal and they lose their contract.

OP, your problem doesn't lie with the insurance company, unless you're mad that they saved you a buttload of money from a greedy provider. That said, you should be mad that the insurance company panders to people like that.

I have LITERALLY seen claims come in for over ONE MILLION DOLLARS. It's beyond ridiculous.

Osterkraut
Osterkraut SuperDork
5/22/11 8:57 p.m.
92CelicaHalfTrac wrote: I have LITERALLY seen claims come in for over ONE MILLION DOLLARS. It's beyond ridiculous.

aircooled
aircooled SuperDork
5/22/11 9:16 p.m.

See... see how the government is destroying the best health care system in the world...

novaderrik
novaderrik Dork
5/22/11 9:21 p.m.

i went to the ER a couple of years ago with weird pains in my left arm.. at 3 am.. my mom thought i was having a heart attack or something, so she drove me to the hospital..

after i sat in the room for about an hour, the doctor finally came in.. he looked like i just woke him up a few hours after he passed out from partying too hard.. he looked at my arm, then walked out. total time with the doctor: about 2 minutes.

a few minutes later, a nurse walks in with a wrist brace and tells me to wear it for a couple of weeks.. i put it on, then leave.. the brace was uncomfortable and made my arm hurt worse, so i bought a better one 2 days later at K Mart for $12..

a few months later, i got a statement from the insurance company that said they would only pay $45 of my $1500 claim and that i'd be responsible for the rest of it.. i called them, and all they did was ask for money.. so i called the hospital and got an itemized bill of everything. they tried billing for all sorts of tests with weird initials that were never done, charged $75 for the wrist brace and $150 for the nurse to hand me the brace.. i went into their business office during the day and complained very loudly while i pointed out what a bunch of crap this was in front of a waiting room full of people.. my bill magically dropped down to $100 after the lady apologised for the mixup and any inconvenience it may have caused.. yeah, right.. they probably do this to everyone that has insurance because they assume it will just be paid and forgotten about..

i wonder what would happen if you go in and say that you don't have any insurance and settle on a price.. then turn it into insurance after you get an itemized bill...

fasted58
fasted58 Reader
5/22/11 9:22 p.m.
92CelicaHalfTrac wrote: OP, your problem doesn't lie with the insurance company, unless you're mad that they saved you a buttload of money from a greedy provider. That said, you should be mad that the insurance company panders to people like that. It's beyond ridiculous.

Yea, I was gonna get to that, how could an insurance co. bend over and take it like that? I only had two supplier options, one in-town, one 50 miles out. I chose local figuring to save a few bucks for the ins. co. (lesser of two evils). There are no other options at this time.

As long as these greedy providers remain in their network it's no sweat to them. My bennies will just be cut more down the road. BOHICA

Klayfish
Klayfish Reader
5/23/11 6:53 a.m.
Yea, I was gonna get to that, how could an insurance co. bend over and take it like that? I only had two supplier options, one in-town, one 50 miles out. I chose local figuring to save a few bucks for the ins. co. (lesser of two evils). There are no other options at this time. As long as these greedy providers remain in their network it's no sweat to them. My bennies will just be cut more down the road. BOHICA

They don't really have much of a choice. There are countless regulations about what they must pay. It's already been talked about to death in this thread, but providers will charge outlandish rates. Insurance companies don't have to pay those, but they do have guidelines in what they have to pay. A lot of it is based on the scale of what the government would pay through Medicare or Medicaid.

On the defense of the providers, somone touched on it already. Providers sometimes don't have much choice but to bill that high, given the rates for malpractice insurance. They're out of control. The number of frivolous lawsuits is driving this, and forcing a lot of medical professionals to either jack rates through the roof or just go out of business. Probably should start a rant about plaintiff attorneys... and the people that go running to them.

92CelicaHalfTrac
92CelicaHalfTrac SuperDork
5/23/11 7:47 a.m.
novaderrik wrote: i went to the ER a couple of years ago with weird pains in my left arm.. at 3 am.. my mom thought i was having a heart attack or something, so she drove me to the hospital.. after i sat in the room for about an hour, the doctor finally came in.. he looked like i just woke him up a few hours after he passed out from partying too hard.. he looked at my arm, then walked out. total time with the doctor: about 2 minutes. a few minutes later, a nurse walks in with a wrist brace and tells me to wear it for a couple of weeks.. i put it on, then leave.. the brace was uncomfortable and made my arm hurt worse, so i bought a better one 2 days later at K Mart for $12.. a few months later, i got a statement from the insurance company that said they would only pay $45 of my $1500 claim and that i'd be responsible for the rest of it.. i called them, and all they did was ask for money.. so i called the hospital and got an itemized bill of everything. they tried billing for all sorts of tests with weird initials that were never done, charged $75 for the wrist brace and $150 for the nurse to hand me the brace.. i went into their business office during the day and complained very loudly while i pointed out what a bunch of crap this was in front of a waiting room full of people.. my bill magically dropped down to $100 after the lady apologised for the mixup and any inconvenience it may have caused.. yeah, right.. they probably do this to everyone that has insurance because they assume it will just be paid and forgotten about.. i wonder what would happen if you go in and say that you don't have any insurance and settle on a price.. then turn it into insurance after you get an itemized bill...

Say what? Your insurance company doesn't collect your portion of claim payments....

92CelicaHalfTrac
92CelicaHalfTrac SuperDork
5/23/11 7:50 a.m.
fasted58 wrote:
92CelicaHalfTrac wrote: OP, your problem doesn't lie with the insurance company, unless you're mad that they saved you a buttload of money from a greedy provider. That said, you should be mad that the insurance company panders to people like that. It's beyond ridiculous.
Yea, I was gonna get to that, how could an insurance co. bend over and take it like that? I only had two supplier options, one in-town, one 50 miles out. I chose local figuring to save a few bucks for the ins. co. (lesser of two evils). There are no other options at this time. As long as these greedy providers remain in their network it's no sweat to them. My bennies will just be cut more down the road. BOHICA

They bend over like that because "we" as the consumer like to know that our "favorite" providers who come up with this utterly bullE36 M3 prices are still in the network. The insurance company knows that if they start REALLY playing hardball and tell these providers to go berkeley themselves, they become less effective to the consumer, and therefor, it's a harder sell to keep them enrolled.

Errrr... at least until "Health Care Reform" is totally in effect, that is. You know, the same bill that regulates a profit percentage of the companies, and yet, they're supposed to pay the providers at their ridiculous rates.

This will end well.

Hocrest
Hocrest Reader
5/23/11 8:09 a.m.
fasted58 wrote:
92CelicaHalfTrac wrote: OP, your problem doesn't lie with the insurance company, unless you're mad that they saved you a buttload of money from a greedy provider. That said, you should be mad that the insurance company panders to people like that. It's beyond ridiculous.
Yea, I was gonna get to that, how could an insurance co. bend over and take it like that? I only had two supplier options, one in-town, one 50 miles out. I chose local figuring to save a few bucks for the ins. co. (lesser of two evils). There are no other options at this time. As long as these greedy providers remain in their network it's no sweat to them. My bennies will just be cut more down the road. BOHICA

I spent about 1/2 of my life in the medical equipment supply business. So this will be biased on that side. I always hated that game between us and the Ins Co's but they forced us into it. If we billed them $100 for a part that cost us $70, they would pay us $25. Then with the contracts we were in we would have to accept that and not bill for the difference.
So instead we bill $300, they force it to $80. They look like a hero for saving you $220 and we make $10. And we deliver it, and make numerous visits to the Dr's office to get the Cert of Med Necessity completed (they won't allow us to bill with just a prescription) Most InsCo's also write language into their contracts that we can not sell items for cash at an amount less than what we bill them. So I would have to have separate part numbers to be able to sell it for $100 cash to un-insured. This is one of the reasons I'm no longer in that biz.

Like everywhere there are crooks in that business, but the providers that do things legally are working hard for a comfortable living.

A guy I worked with once described it as the only business that;
- Services one Group -- The patients
- Markets another group -- The Dr's, Social Service/Discharge Planners
- Follows the rules and regs of another group -- FDA, DOT, Medicare, JCAHO
- Gets paid by another group -- Ins Co's

92CelicaHalfTrac
92CelicaHalfTrac SuperDork
5/23/11 8:19 a.m.

^I agree. It's a vicious cycle, chicken and the egg scenario.

The problem is that MOST people (apparently the government included) only look at 33.3% of the problem.

But here's the thing.... even if someone goes to an out of network provider for that same part.... insurance will pay based on their same allowed amount, then the member pays $220 + their percentage of the allowed amount. I'm absolutely not calling you a liar, but MANY providers do not bill differently for patients that have insurance vs. those that don't. They make BANK off those that don't, or those that go outside their PPO or whatever network they may have.

wbjones
wbjones SuperDork
5/23/11 4:33 p.m.
porksboy wrote:
wbjones wrote:
Apis_Mellifera wrote:
dollraves wrote: We expect people without insurance to cough up $45k but with insurance only $5k?
No, the total would be less for an uninsured person. The out-of-pocket might be more or less. Basically it like this: "That procedure will be $100. Oh, you have insurance? In that case, the procedure will be $1000, but you'll only have to pay $100 of that." That's of course a generality, but the actual billed cost is a sliding scale. The same procedure can be ridiculously expensive or completely free. It all depends on how much the biller thinks they can get the payer to cough up.
not so... a friend of mine needed his artificial hip replaced... (it was failing)... self employed mechanic...(read .. no insurance) the charge to him $50K.. or there abouts... if he had had ins. the charge to the ins co would have been $25K.... he begged them to charge him the "ins negotiated price" ... he would pay in cash (inheritance) ... they wouldn't even entertain the thought... if he wanted a new hip $50K or out you go...
Um... I have been without insurance before. Tell the doc as much and watch the price drop. Billing is easier and requires less BS. Collection can be a problem, offer to pre pay all or part. cash disscount etc. If your friend did indeed pay that he was an idiot, no offence to you. If the doc wouldnt negotiate the patient should walk and find another doc. I did it myself. I guarantee there is more than one doc willing to do the surgery, even on a repeat replacement. As I undersatand it is a more difficult opperation.

wasn't the doc... it was the hospital.... they did offer him some help though not nearly as much as the "negotiated ins price" or what it would have cost him is he had been an illegal alien ....

TRX
TRX
6/2/11 7:50 p.m.

Here's another angle on it:

My wife was in the hospital overnight for a minor surgical procedure. We got a check from the insurance company, as things were done back then, which we were to use to pay the hospital bill.

The curious thing was that the bill listed three days in the hospital instead of two, and a few things I thought were questionable. We called the hospital, which was a waste of time. So we made an appointment with our GP to have him vet the bill, since the copay would have been substantial.

He went through all dozen-odd pages of the itemized statement, marking out things. "I didn't authorize this... there was no reason to charge for that... I don't even know what this is!"

We called the insurer, which was AETNA at the time. They acted like they couldn't understand what the problem was. Finally the exasperated woman on the other end of the line said, "So what, you got enough money to pay the bill, what is your problem with that?"

A paid doctor visit, a call that cost more than the visit, back in the days before cheap long distance, we figured we'd gone over and above any sane requirement for straightening things out, so we deposited the check and wrote one to the hospital for the adjusted amount, with a copy of the MD's marked-up bill. The hospital never complained, and we had enough money left over to buy a used but primo late-model RX7.

We liked the car, but we would have liked it a lot more without the knowledge we were paying for it with inflated insurance premiums.

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