Can this really be true?

[RICHARD]

Originally posted by Edwina's Secretary






but don't tell anyone...

O.k..........

[RICHARD]

Originally posted by gini
But the deed has been done - they didn't need my lecture.

If Gini asks you to blow up ballons at the BBq make sure they are balloons, not left over condoms from her 'lectures'....

[gini]

You are just itching to stir up some trouble aren't you Richard?

[Edwina's Secretary]

An insurance agent explained to me that when people walk in for emergency care without insurance - the hospitals will really sock it to them - to try to re-coop some money against ALL of the people that walk in without insurance.

I call it "rack rate"..... those without insurance don't get the negotiated discount rate that insurance companies get for their customers...

"from each according to his/her ability not to pay...to each according to his/her ability to pay..."

[RICHARD]

Originally posted by gini
You are just itching to stir up some trouble aren't you Richard?

I already got Sara to agree with me....I feel troublesome today!



There is a billing method called DRGs (diagnosis related groups) each illness group (for example, all gall bladder operations are lumped together) has a code and a costing total associated with it.

A hospital bills with the DRG code and the insurance or government will pay the rate stated in that table, not one cent more....


I am not sure of the nuts and bolts of the system....it had just started when I left that department.....but that's the gist of it....

that's how hospitals make/lose money....I am sure there is a coder out there that can exploain it better.

[lizbud]

I'm not a coder, nor do I play one on TV, but,

The high cost of insurance cannot be layed at the feet of Tort
Law. How about the tremendous amount of money spent for ads
by drug companies in all media for certain brands of drugs. Drugs that should be pitched to the Drs. and not the masses.

Have you ever read an hospital itemed statement? Next to
impossable to decifer.Last one I received was 8 pages long
and a lot of it looked like double billing to me.

[Lady's Human]

Current tort law has driven doctors out of practice across the country because of the resulting 6 figure malpractice insurance rates. The ones who stay in practice are forced to inflate their rates to pay for their insurance.

[Edwina's Secretary]

I had someone in class recently from the company that advertises a diabetes testing devise used by BB King. They have had UNBELIEVABLE success. People go to the doctor and say..."prescribe that thing that BB King uses!" Advertising works! And costs the consumer ALOT!

[Corinna]

The bill doesn't surprise me my daughters er and surgical bill(miscarrage in Sept) Just the hospital was $2000.00 She had to pay a prorated prenatal care at the gyno's .!! years ago my hubbys cancer bills started coming in and I gave up add to them at $96,000.00 Then we had radiaton 5 days a week for 6 weeks $250.00 a time.
Insurance what is that? We have never had it.

[Twisterdog]

Originally posted by gini
An insurance agent explained to me that when people walk in for emergency care without insurance - the hospitals will really sock it to them - to try to re-coop some money against ALL of the people that walk in without insurance.

Exactly. Why is everyone charged $10 for one aspirin tablet in the hospital? Because the people that do happen to be lucky enough to afford insurance or have it through work are paying for all the people who can't afford insurance and can't pay their hospital bill. So when an insurance company pays that $10 charge for one aspirin, they are actually paying for the last 1,000 apirin tablets issued, that no one else could afford to pay for.

I don't have any health insurance. I am the self-employed owner of a small business, and the cost of getting an insurance policy for myself is absolutely absurd. I make too much money (barely) to qualify for medicaid, and not enough money to afford medical insurance. This country's health care system is in serious trouble. And, yes ... I do vote, therefore I can complain.

My son got two stitches in the emergency room last summer. It took approximately five minutes. The bill was over $400. My mom's five day hospital stay two years ago cost well over $100,000. The only time I've been in the hospital, $14,000 for 24 hours ... and that was almost fourteen years ago.

[janelle]

I bet you anything most of it will be written off if they can't pay. Most docs and hospitals do this all the time.

The aspirin costs so much cause it's not just the aspirin but the skilled nursing that is giving the aspirin, you are paying for their time and care. You don't want an aspirin right before surgery or your blood won't clot. They went to med school to learn when to give or not give you meds.

[Tubby & Peanut's Mom]

Originally posted by Twisterdog
So when an insurance company pays that $10 charge for one aspirin,

But the insurance company doesn't pay $10.00 for that aspirin. Like someone else mentioned, they have their "negotiated rates" and that's what they pay. They might actually pay $1.00 for that aspirin and the hospital will write off the other $9.00.

I have a lump on my thyroid that I have checked every couple of months. I have had biopsies done to see if it was cancer (it's not), ultrasounds to see how big it is and exactly where it's located, and bone density tests about every 2 years to make sure the medication isn't turning my bones to mush, along with the blood tests and the doctor's visits ($100.00 for about 10 minutes of his time). All of this is quite expensive. They do all the test "in-house" which saves money because I don't have to go to the hospital and pay their fees, but the bill for my most recent ultrasound came to over $2,500. The "net" bill, after discounting for negotiated rates, came to about $800.00.

Knowing how the insurance companies have these negotiated rates, had I not had insurance, the first thing I would have done when I got the $2,500.00 bill was ask them to discount it to something a little more realistic. Doctors and hospitals will do that for those who don't have insurance, but you have to ask - and may have to fight for it. There have already been programs on TV (60 minutes and such) where they discuss this. The hospitals charge everybody the same thing and it's up to the person/insurance company receiving the bill to negotiate the actual amount with them. The hospital would rather negotiate with someone without insurance because then they have a better chance of recouping at least some of the bill whereas if they say no way, we need the full amount, chances are theyw won't collect any of it.

[wolfsoul]

Wow, these prices are so harsh. I'm glad I live in Canada, with Medicare. I've never had to directly pay for any medical expenses in my life, save for the last few times I went to the chiropractor and massage therapist (Medicare doesn't cover those anymore ).

Last year I had heard that the US is going to buy Canada's medical plan in the next few years. Although that does seem a little odd because the US is constantly pressuring Canada to get rid of Medicare.

[Tubby & Peanut's Mom]

Health insurance is in a sad state in this country - and something that Terry and I are watching carefully since we both have good insurance now, but will be giving that up in the near future when we go full-time in the motorhome. I will need to get my own coverage and pay for it because of the thyroid problem I mentioned in the previous post.

The problem is that we Americans want everything. We want our health insurance, but we don't want to pay for it ourselves - can't happen! The consumer ultimately pays for everything - don't kid yourself about that. So, we keep on the way we are with hospital/doctor bills going through the roof and more and more people loosing their coverage because insurance rates are also going through the roof. Who pays? We all do in the long run.

We could implement a national health plan similar to Canada or other developed countries, but then our taxes would go up and heaven forbid we can't have that! (being sarcastic here) So who do you think is going to pay for it? Most people who do have coverage already pay a portion of the premium through payroll deduction. So what would be wrong with putting that towards a national health plan instead of their company's health plan?

Like I said, who do you think is going to pay? Ultimately we are all going to pay anyway. If Americans wouldn't be so darned paranoid about their taxes going up we could have a national health plan where everyone is covered. We are the only developed nation that does not have national health coverage and it's because we are all so worried about our darn taxes. You can't have the greatest nation in the world without paying for it.

[jennifert9]

Just an FYI from a single girl, thankfully WITH health insurance now but without it for years....Birth control is NOT covered by most health insurance plans. I used to have to go to the clinic to get my bc pills and even then, what I paid was based on my salary, gross not net and before taking into account any other bills I may have, like rent or food for example.
I was told once by the poor guy who answered the phone at the insurance company when I called up to find out why my pills were NOT the $10 copay for all other prescriptions but instead were $48!! for 30 days worth, "There has to be a medical reason for the prescription." I told him that there was a medical reason, it I got pregnant because I couldn't afford the pill, HE would need a doctor because I would come down there and punch him in the face! Not very nice I know, nothing like killing the messenger but it makes no sense!!!!

BUT, Viagra is covered by most insurance plans! Explain that one...could it be that most corporations are owed/ran by men in their 50s and 60s...?