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03/12/2014 01:35:45 PM · #151
My other peeve with healthcare comes with billing. Why can't they write what I'm being billed for in plain English? I received a bill from the hospital indicating that I was to pay $154.91 for "XRFINMIN2VW". WTF is that? I'm sorry but I'm not paying a penny until I know what it is I'm paying for. I know what it is now, but only because I called, wasting my time, and theirs to ask. Reading a medical bill should not require fluency in "hospitalese" to understand what's going on.

I will say that not all providers do this, I received another bill from a different provider that was very clear.
03/12/2014 02:11:58 PM · #152
If I were billing 40 bux for a "surgical sharpie" I'd mask it in as much code as I could muster :-(
03/12/2014 02:43:36 PM · #153
Originally posted by Bear_Music:

If I were billing 40 bux for a "surgical sharpie" I'd mask it in as much code as I could muster :-(


Two totally different events, but much the same in terms of decoding the bill afterward. I cannot imagine what it would be like if I were alone as a patient and received a long, complex bill full of cryptically encoded line items while recovering from something serious. I wonder how many of those people just pay without checking for mistakes or questioning excessive charges because they're in a weakened state.

03/12/2014 02:47:03 PM · #154
While I agree a $40 sharpie would be ridiculous, I'll share the insight that it may not be purely the hospital jacking the price. Any supply labelled with "medical grade" seems to double or triple in price. I'll give you a little example. Dragon voice recognition is about $600 for the premium version. The "medical" version which basically just has an expanded dictionary? $1,800. There is no way you can tell me that there is $1200 dollars worth of words in there. :)

So, while we all know a sharpie should be maybe $2, it might cost the hospital $10 because it's been certified as non-toxic or hypo-allergenic or some nonsense. It may have also been sterilized and wrapped to keep it sterile for use in the actual OR. They, then, jack it up even further in their charge to you.

Other things might be billed to include nursing time, etc. The $5 band-aid isn't just the band-aid, but the time to put it on, etc. The auto repair world would be familiar with such thinking.

Finally, most hospital charges assume a write-off in their contracts with insurance companies. So while they print $5 for that band-aid, the reality is they get $0.32 most of the time except for some esoteric insurance plan that actually pays the $5. Also the uninsured patient gets screwed because they don't have the insurance contract that negotiated a lower cost. If you see hospitals or doctors offer substantial discounts for "cash pay", it's usually to make up for this fact.

Welcome to our world...

Message edited by author 2014-03-12 14:48:16.
03/12/2014 03:02:04 PM · #155
The reason for the extreme markups are for tax write offs.
03/12/2014 03:18:27 PM · #156
Originally posted by coronamv:

The reason for the extreme markups are for tax write offs.

Say what? I think you can only write off what things COST you, not what you hypothetically could have made selling them at "full price"?
03/12/2014 04:03:33 PM · #157
Originally posted by DrAchoo:

While I agree a $40 sharpie would be ridiculous, I'll share the insight that it may not be purely the hospital jacking the price. Any supply labelled with "medical grade" seems to double or triple in price. I'll give you a little example. Dragon voice recognition is about $600 for the premium version. The "medical" version which basically just has an expanded dictionary? $1,800. There is no way you can tell me that there is $1200 dollars worth of words in there. :)

So, while we all know a sharpie should be maybe $2, it might cost the hospital $10 because it's been certified as non-toxic or hypo-allergenic or some nonsense. It may have also been sterilized and wrapped to keep it sterile for use in the actual OR. They, then, jack it up even further in their charge to you.

Other things might be billed to include nursing time, etc. The $5 band-aid isn't just the band-aid, but the time to put it on, etc. The auto repair world would be familiar with such thinking.

Finally, most hospital charges assume a write-off in their contracts with insurance companies. So while they print $5 for that band-aid, the reality is they get $0.32 most of the time except for some esoteric insurance plan that actually pays the $5. Also the uninsured patient gets screwed because they don't have the insurance contract that negotiated a lower cost. If you see hospitals or doctors offer substantial discounts for "cash pay", it's usually to make up for this fact.

Welcome to our world...


The Sharpie was not used in the OR, I watched them unwrap it in the pre-op waiting area. It might have been wrapped for sterile use, but it wasn't used that way.

The medical billing world is NOTHING like auto repair aside from the fact that it's customary to pay in the local currency. In the auto repair world, they charge for separately for "parts" and there's "labor", a fixed cost associated an estimated number of hours to do the job. The parts are usually not marked up beyond the normal retail cost and the labor might be something like $85/hour based on some estimated time to get the job done. If it takes longer, they don't charge more and if it takes less, the actual rate they make per hour goes up.

So if billed like a auto repair shop, the bandaid charge would look like this:

Parts: band aid 1 @ $0.12

Labor: 30sec @ $35,136/hr

Total: $5.00
03/12/2014 04:07:49 PM · #158
True, but too often I've seen a tail light repair that is billed at 15 minutes of $80/hour when we both know it took 2 minutes to do. So changing your lightbulb cost you $20 in labor. I guess you are right in that it is at least broken out between "bulb" and "labor", but still we're being gouged if we have a simple bulb to replace. I think about a specific example that happened to me. I didn't ask to have the bulb replaced and am quite capable of changing my own bulb. They just did it as a "service" to me.

I was only speculating about the sharpie. If it was unwrapped it was probably sterile to start with so you do have that cost, but listen, $40 is crazy no matter how you slice it. I'm just trying to give you a little behind the scenes view.

Message edited by author 2014-03-12 16:09:03.
03/12/2014 05:24:18 PM · #159
Originally posted by DrAchoo:

True, but too often I've seen a tail light repair that is billed at 15 minutes of $80/hour when we both know it took 2 minutes to do. So changing your lightbulb cost you $20 in labor. I guess you are right in that it is at least broken out between "bulb" and "labor", but still we're being gouged if we have a simple bulb to replace. I think about a specific example that happened to me. I didn't ask to have the bulb replaced and am quite capable of changing my own bulb. They just did it as a "service" to me.

I was only speculating about the sharpie. If it was unwrapped it was probably sterile to start with so you do have that cost, but listen, $40 is crazy no matter how you slice it. I'm just trying to give you a little behind the scenes view.


And on the other hand, I've had repair jobs where I know it took every second of that 2 hours or more. Usually the 15 minute jobs, I buy the part and just do the work myself.

I know you're just offering your perspective, and I do appreciate your insight, thank you. My beef isn't with you. By far the majority of doctors, nurses, PA's and other health care professionals I've dealt with are caring folks who really just want to help others, you seem no different. It's the industry that's built up around them over the years, that's the real problem.
03/12/2014 05:39:18 PM · #160
No doubt the system is broken. No doubt.
03/12/2014 05:43:56 PM · #161
Originally posted by Spork99:

By far the majority of doctors, nurses, PA's and other health care professionals I've dealt with are caring folks who really just want to help others, you seem no different. It's the industry that's built up around them over the years, that's the real problem.

I mostly agree, though (we) professionals have contributed to the problem over the years by engaging in "turf wars" over allowed scope of practice -- prior to the Vietnam war there was no such thing as a "Physician Assistant" ... and not all doctors welcome the"assistance" ...

Message edited by author 2014-03-12 19:19:14.
03/12/2014 07:17:32 PM · #162
Originally posted by Bear_Music:

Originally posted by coronamv:

The reason for the extreme markups are for tax write offs.

Say what? I think you can only write off what things COST you, not what you hypothetically could have made selling them at "full price"?


True for materials, but labor they can charge one person with insurance one price and a person without insurance another price. Say they do an X-ray on you well they submit a bill to the insurance company for $150 "just a number to use as an example" then the insurance company pays them $15 for said X-ray. Without insurance you pay $150 if you fail they will sue you for the $150 plus interest and legal fees. Then when you file bankruptcy they write off the later not the $150 or better yet the $15. The $5 aspirin, $5 Band aid, the crazy over inflated prices the medical field charges for items we can as consumers buy for pennies is due to the legal fees to protect them from law suits if said band aid was to fail. Along with the fact we have some crazy regulations that say these things have a limited shelf life. Granted I can understand not using a 20 year old band aid.
Example
03/12/2014 07:25:07 PM · #163
Originally posted by GeneralE:

Originally posted by Spork99:

By far the majority of doctors, nurses, PA's and other health care professionals I've dealt with are caring folks who really just want to help others, you seem no different. It's the industry that's built up around them over the years, that's the real problem.

I mostly agree, though (we) professionals have contributed to the problem over the years by engaging in "turf wars" over allowed scope of practice -- prior to the Vietnam war there was no such thing as a "Physician Assistant" ... and not all doctors welcome the"assistance" ...


And quite frankly, not to be insulting, but when I pay for a doctor and get a PA, it's a little like paying for a fine dining experience and getting a fast-food hamburger.

(with that being said, I do understand that PA's are perfectly well qualified - but I do not feel they should command MD rates)

BTW: you can't blame me for anything I say for the next week or so, as I'll be high as a kite on opiates. :)

Message edited by author 2014-03-12 19:26:19.
03/12/2014 07:31:16 PM · #164
I took a quick look at the link provided by ' . substr('//www.dpchallenge.com/images/user_icon/21.gif', strrpos('//www.dpchallenge.com/images/user_icon/21.gif', '/') + 1) . ' Coronamvand can really relate.

As some of you know, I was bitten by a spider during a trip in Germany, the bite got infected and I ended up spending almost 3 months convalescing at home and requiring daily visit from nurses.

During the course of their visits, they brought oodles of medical supplies, diposable gloves, IV materials and a host of other products. Most of the materials left behind are in sealed containers and have never been used... Guess what, I can either donate it to some organization that sends it abroad or give it to my vetenarian... but the service provider will NOT take it back.

...and we wonder why things are so expensive.

Ray
03/12/2014 07:32:03 PM · #165
Originally posted by Cory:

And quite frankly, not to be insulting, but when I pay for a doctor and get a PA, it's a little like paying for a fine dining experience and getting a fast-food hamburger.

(with that being said, I do understand that PA's are perfectly well qualified - but I do not feel they should command MD rates)

BTW: you can't blame me for anything I say for the next week or so, as I'll be high as a kite on opiates. :)

PA's are required to work with and "under the supervision of" an MD, so it is unlikely that the entire fee is accruing to the PA. But yeah, part of the theory behind "physician extenders" (PAs and Nurse Practitioners) is to deliver care of equal quality at a lower cost than if the same services were provided by an MD.

I've worked in a clinic for people with opiate addiction since 1986 -- let me know if you have any questions ...
03/12/2014 07:54:58 PM · #166
Originally posted by GeneralE:



I've worked in a clinic for people with opiate addiction since 1986 -- let me know if you have any questions ...


Fortunately the only thing I might arguably be addicted to is DPC.. I've never had a problem with pain killer addiction.. good thing too, cause I like to keep a handful around just in case... Sadly I had none this morning, but am well stocked now, and that'll hold me over until surgery on Friday. :)
03/12/2014 08:01:48 PM · #167
I don't know why but I read "Pain" and for some reason This came to mind.

Ray
03/12/2014 08:28:45 PM · #168
Originally posted by coronamv:

Originally posted by Bear_Music:

Originally posted by coronamv:

The reason for the extreme markups are for tax write offs.

Say what? I think you can only write off what things COST you, not what you hypothetically could have made selling them at "full price"?


True for materials, but labor they can charge one person with insurance one price and a person without insurance another price. Say they do an X-ray on you well they submit a bill to the insurance company for $150 "just a number to use as an example" then the insurance company pays them $15 for said X-ray. Without insurance you pay $150 if you fail they will sue you for the $150 plus interest and legal fees. Then when you file bankruptcy they write off the later not the $150 or better yet the $15. The $5 aspirin, $5 Band aid, the crazy over inflated prices the medical field charges for items we can as consumers buy for pennies is due to the legal fees to protect them from law suits if said band aid was to fail. Along with the fact we have some crazy regulations that say these things have a limited shelf life. Granted I can understand not using a 20 year old band aid.
Example


I think you are devolving into gibberish by the end there, but I can tell you your tax write-off theory has nothing to do with it. The charge is as high as the highest insurance carrier will pay then a little more added in case there is another insurance carrier you didn't know about who pays more. "Don't leave money on the table." would be the apt saying. Doctors and hospitals are contracted with each insurance company and part of the contract is you have to charge the same price for a procedure to everybody. You can't charge X to Insurance A, Y to Insurance B, and Z to non-insured patient C. You have to charge the same to everybody. If someone out there says they will pay $50 for the procedure and everybody else pays $20, what do you think the natural charge becomes? Right, $50. Then you write-off the $30 in all the other situations but get the $50 from the one company that pays that much. The non-insured patient gets squeezed because, by agreement, you can't charge less (thought the "cash discounts" skirt this issue). You would be in violation of your contracts and, better yet, the contract also says that the insurance company will reimburse you for the LOWEST charge you set. So if you feel bad for a non-insured patient and don't charge them at all and the insurance company gets wind of it on an audit (and they can come in and survey your charts) then they say, hey, I hear you are charging $0 for this procedure. We want it for $0. And, in fact, we want it for $0 for every patient of ours with that procedure for the last five years so you actually owe us $200,000. We want that now.

Practices have closed doors and gone out of business for such reasons. No lie.

So if you wonder why doctors don't just have a heart and charge uninsured patients less, now you know why.

Message edited by author 2014-03-12 20:31:28.
03/12/2014 08:48:19 PM · #169
Originally posted by DrAchoo:

So if you feel bad for a non-insured patient and don't charge them at all and the insurance company gets wind of it on an audit (and they can come in and survey your charts) then they say, hey, I hear you are charging $0 for this procedure. We want it for $0. And, in fact, we want it for $0 for every patient of ours with that procedure for the last five years so you actually owe us $200,000. We want that now.

Practices have closed doors and gone out of business for such reasons. No lie.

So if you wonder why doctors don't just have a heart and charge uninsured patients less, now you know why.

Good grief...

People who can't afford to pay get charged the most. Huge businesses that CAN pay, get charged the least. Out in the financial world, if you NEED money it's almost impossible to borrow at reasonable rates. If you DON'T need it, they practically throw it at you. In the food corner, fresh food costs more than processed food (the people who process food buy it at prices no consumer can find) so the poorer you are, the less able you are to have a healthy diet. And a concerned doctor who's willing to treat the indigent for free runs the risk of bankrupting his practice if his biggest customers (the insurance companies) find out what he's doing.

Things are SO messed up :-(

Message edited by author 2014-03-12 20:57:43.
03/12/2014 09:08:21 PM · #170
Originally posted by Bear_Music:


Good grief...

People who can't afford to pay get charged the most. Huge businesses that CAN pay, get charged the least. Out in the financial world, if you NEED money it's almost impossible to borrow at reasonable rates. If you DON'T need it, they practically throw it at you. In the food corner, fresh food costs more than processed food (the people who process food buy it at prices no consumer can find) so the poorer you are, the less able you are to have a healthy diet. And a concerned doctor who's willing to treat the indigent for free runs the risk of bankrupting his practice if his biggest customers (the insurance companies) find out what he's doing.

Things are SO messed up :-(


Quite right. The world doesn't work in a sensible fashion - I wonder if I'll see that change in my lifetime?
03/12/2014 11:35:53 PM · #171
Originally posted by Cory:

Quite right. The world doesn't work in a sensible fashion - I wonder if I'll see that change in my lifetime?

It's unlikely.
03/13/2014 10:38:22 AM · #172
That is why I don't like the term "Health Care Reform." It is not the CARE that needs reformed. What we need is INSURANCE reform.
03/13/2014 03:59:31 PM · #173
Originally posted by DrAchoo:

Originally posted by coronamv:

Originally posted by Bear_Music:

Originally posted by coronamv:

The reason for the extreme markups are for tax write offs.

Say what? I think you can only write off what things COST you, not what you hypothetically could have made selling them at "full price"?


True for materials, but labor they can charge one person with insurance one price and a person without insurance another price. Say they do an X-ray on you well they submit a bill to the insurance company for $150 "just a number to use as an example" then the insurance company pays them $15 for said X-ray. Without insurance you pay $150 if you fail they will sue you for the $150 plus interest and legal fees. Then when you file bankruptcy they write off the later not the $150 or better yet the $15. The $5 aspirin, $5 Band aid, the crazy over inflated prices the medical field charges for items we can as consumers buy for pennies is due to the legal fees to protect them from law suits if said band aid was to fail. Along with the fact we have some crazy regulations that say these things have a limited shelf life. Granted I can understand not using a 20 year old band aid.
Example


I think you are devolving into gibberish by the end there, but I can tell you your tax write-off theory has nothing to do with it. The charge is as high as the highest insurance carrier will pay then a little more added in case there is another insurance carrier you didn't know about who pays more. "Don't leave money on the table." would be the apt saying. Doctors and hospitals are contracted with each insurance company and part of the contract is you have to charge the same price for a procedure to everybody. You can't charge X to Insurance A, Y to Insurance B, and Z to non-insured patient C. You have to charge the same to everybody. If someone out there says they will pay $50 for the procedure and everybody else pays $20, what do you think the natural charge becomes? Right, $50. Then you write-off the $30 in all the other situations but get the $50 from the one company that pays that much. The non-insured patient gets squeezed because, by agreement, you can't charge less (thought the "cash discounts" skirt this issue). You would be in violation of your contracts and, better yet, the contract also says that the insurance company will reimburse you for the LOWEST charge you set. So if you feel bad for a non-insured patient and don't charge them at all and the insurance company gets wind of it on an audit (and they can come in and survey your charts) then they say, hey, I hear you are charging $0 for this procedure. We want it for $0. And, in fact, we want it for $0 for every patient of ours with that procedure for the last five years so you actually owe us $200,000. We want that now.

Practices have closed doors and gone out of business for such reasons. No lie.

So if you wonder why doctors don't just have a heart and charge uninsured patients less, now you know why.


Doctors and Hospitals Can charge what they want....
03/13/2014 04:03:48 PM · #174
Originally posted by coronamv:

Originally posted by DrAchoo:

Originally posted by coronamv:

Originally posted by Bear_Music:

Originally posted by coronamv:

The reason for the extreme markups are for tax write offs.

Say what? I think you can only write off what things COST you, not what you hypothetically could have made selling them at "full price"?


True for materials, but labor they can charge one person with insurance one price and a person without insurance another price. Say they do an X-ray on you well they submit a bill to the insurance company for $150 "just a number to use as an example" then the insurance company pays them $15 for said X-ray. Without insurance you pay $150 if you fail they will sue you for the $150 plus interest and legal fees. Then when you file bankruptcy they write off the later not the $150 or better yet the $15. The $5 aspirin, $5 Band aid, the crazy over inflated prices the medical field charges for items we can as consumers buy for pennies is due to the legal fees to protect them from law suits if said band aid was to fail. Along with the fact we have some crazy regulations that say these things have a limited shelf life. Granted I can understand not using a 20 year old band aid.
Example


I think you are devolving into gibberish by the end there, but I can tell you your tax write-off theory has nothing to do with it. The charge is as high as the highest insurance carrier will pay then a little more added in case there is another insurance carrier you didn't know about who pays more. "Don't leave money on the table." would be the apt saying. Doctors and hospitals are contracted with each insurance company and part of the contract is you have to charge the same price for a procedure to everybody. You can't charge X to Insurance A, Y to Insurance B, and Z to non-insured patient C. You have to charge the same to everybody. If someone out there says they will pay $50 for the procedure and everybody else pays $20, what do you think the natural charge becomes? Right, $50. Then you write-off the $30 in all the other situations but get the $50 from the one company that pays that much. The non-insured patient gets squeezed because, by agreement, you can't charge less (thought the "cash discounts" skirt this issue). You would be in violation of your contracts and, better yet, the contract also says that the insurance company will reimburse you for the LOWEST charge you set. So if you feel bad for a non-insured patient and don't charge them at all and the insurance company gets wind of it on an audit (and they can come in and survey your charts) then they say, hey, I hear you are charging $0 for this procedure. We want it for $0. And, in fact, we want it for $0 for every patient of ours with that procedure for the last five years so you actually owe us $200,000. We want that now.

Practices have closed doors and gone out of business for such reasons. No lie.

So if you wonder why doctors don't just have a heart and charge uninsured patients less, now you know why.


Doctors and Hospitals Can charge what they want....


That's just a letter to the editor, not a real article with facts to back it up. It might as well be about aliens and bigfoot.
03/13/2014 04:08:44 PM · #175
Hey Spork and I agree. But don't listen to me. It's not like my livelihood isn't dependent on knowing these facts and what my insurance contracts say...

Instead you should listen to Wendy Craig-Payne of Dallas who, according to LinkedIn, is an owner of a Jazzercise franchise. :D
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