There once was a time in our history when the government had to intervent in the marketplace and no one outside of the vested interests complained. What the government did then was called \”Trust Busting\” I am in principal against Government Intervention, but we have come to another point in time where it is needed.
We have arguably the best medical system in the world. Because of the issue of pricing, it has become, arguably, one of the most unfairly delivered systems in the world.
The seeds of the problem were sewn when Medicare and Medicade began keeping tract of what was charged for which proceedures in which portions of the company. Our National government decided to pay, I believe, on something called the 60th percentile. Now that does not mean 60% of what the provider charges. What it means is they will pay no more than what 60% of the providers in that group charge for that proceedure. They assigned computer codes covering every possible proceedure. These were called \”CPT Codes\”. Then they tracked what was charged in that geographical zone for that CPT code. Now, you can buy a book as thick as the largest dictionary you have ever seen that will give the most current CPT codes for that region. Guess what, it is updated periodically based on what the providers actually \”charged\”.
There arose a whole industry providing the latest revisions to the pricing basis. More importantly, there arose another industry dedicated to expanding that pricing basis. Today, most medical providers have a medical pricing subcontractor dedicated to capturing the maximimum for what was done to the patient and to escalating the cost basis.
We have an economy where inflation is around 2 to 3 percent. Why has medical cost inflated 18 to 20 percent annually?
Is it because of unbelivable costs associated with some minor breakthroughs? I think not.
The reason is that the pricing of our medical service delivery system is finally reflective of a decade of intentional inflation. Now we are handling a seven tiered pricing system as follows:
Tier one — No insurance, no PPO — pay full retail
Tier Two — Insurance, If no PPO involved, pay level one premiums
Tier Three — Have insurance associated with PPO, pay premium and a co , pay deductible and co- pay — Pay level Two premiums
Tier Four — have some PPO probably marketed as medical insurance. Pay amount chaged by provider subject to review by PPO
Tier Five — Have nothing, and try to pay the bill you are given
Tier Six — Have nothing and declare Bankruptcy
Tier Seven, — Have Nothing and get the welfare system to handle it.
I submit the entire pricing system is unfair and requires a complet overhaul.
I submit the entire payment system is unfair and requires a complete overhaul.
Some people claim that they cannot get insurance because of their health history. Do not be fooled by that. The real truth is that these people at some point and time elected not to take Cobra coverage. Even is Cobra runs out after 18 months (36 months is some cases) then their is another continuation option called \”HIPAA.\” Also, by law, small group application cannot be declined by an insurance company due to health history. This applied to groups with a minimum of 2 employees (5 in some states). Finally, nearly every state has options for those who cannot get insurance because of health history. Folks, the bottom line is, nearly everyone can get insurance, but they don\’t because they know me and you will pay their health care bills. These people are snakes, they would take a vacation, go out to dinner, buy a nice car, but they will not buy their own health insurance. Yes, there are a very few select mentally ill people who cannot get coverage because they do not know how to, let alone pay for it and this does not include anyone on this board. For those of you in California who cannot get insurance, please click the link below and find out how good you have it! http://www.coverageforall.org/
As the first comment refers to, look at what the hospitals, doctors, labs, etc. send you a bill for and then look at what the insurance actually pays. If you are uninsured, you should not be required to make up for the difference which is basically what those entities are trying to make you do. IF they can make it on what the insurance companies are willing to pay, why are they charging/billing so much in the first place? To make their write offs look \”good\” which benefits hospitals in many ways? That is part of what is causing the crisis of people being uninsured with the other part being ambulance chasing/perfection requiring attorneys.
I know what you mean, Phil. I spent one night in the hospital last Labor Day.
Fortunately (?) I have an HMO – my co-pay was $1,000. The hospital felt the need to send me a copy of a \”bill\” showing what the hospital fees were ($34,000) what the insurance company actually paid ($5,600)
and that the balance of $28,400. was being \”written off\”. Are they trying to give me some sort of guilt complex because I\’m not paying my \”fair share\”? Should I succumb to private insurance at triple the rates and half the coverage? What is one to do? Can\’t wait to see the piece on \”60 Minutes\”.
How about when hospitals don\’t properly diagnose a patient because he\’s uninsured? It happened to my brother. He injured his foot went to the ER & was told by the attending dr. he had a sprained ankle, given care instructions, meds & released. After 3 mos. his ankle still wasn\’t healed; he went to a county hospital where an XRay tech took a look at his Xrays and told him he had a broken foot!!!
Insurance negotiates the price because they send such a large block to the hospital. The uninsured do not have negotiating power and are not efficient for hospitals as many do not even pay their bills. The uninsured are flipping off soceity, they don\’t want to pay for their insurance nor do they want to pay their hospital bills. The bottom line is, me and you are paying for these fools health care and this is dead wrong!
There is a large piece missing here. It is NOT as easy or clear cut as this article or probably the 60 Minutes piece would have you believe. Self pay & uninsured pay the published hospital charges. Right or wrong insurance carriers negotiate rates with the hospitals based on the strength of the size of their insured population. IN MANY CASES THEY THREATEN TO PULL THE AFFILIATION WITH A PARTICULAR HOSPITAL IF THEY DON\’T GET THE RATE STRUCTURE (DISCOUNT OFF OF PUBLISHED RATES) THAT THEY WANT. In many cases, what this means is that hospitals loss money on every insured admission – in essence their costs are higher than the reimbusement an insurer gives them.
The only way a hospital can survive (and many are not going to survive under the present system) is to have their self pay rates high enough to offset the losses the insured population generate.
In New York State, 2/3 of all hospitals operate at a loss, despite decades of paying attention to costs. In New York State,those few not for profit hospitals who do manage a surplus of revenue over expense have a margin of 1%. Imagine if the operating profit of YOUR business was $100,000 on 100,000,000 in sales? If you sneeze – the margin could be gone. In New York State, in the aggregate, hospitals lost $3 Billion dollars last year and gee do you know what the profits of the health insurers were in New York State – $3 Billion dollars – amazing.
The legislature of NY State will not address this obvious imbalance because of the insurance company lobby – but will have to eventually. Probably when some state senator goes to his local emergency room and finds it closed – because the hospital can no longer afford to stay open.
The statesmenship of many elected officials is lacking in this day and age – and unless they address the imbalances – and there are many – in the healthcare system, we will have a disaster sooner than later.
Maybe because the uninsured medical bill takes about 20-30 years to be paid off by the patient, perhaps hospitals are building inflation costs into the bill because they aren\’t going to get paid right away or even anytime soon? Also there are so very many people uninsured using these services it has really severly hurts the economy of hospitals and their employees who are looking for their paychecks. Talk to an ex-employee of a hospital who got laid off because the hospital closed due to lack of money.
Hospitals need money and so does their employees to stay opened the money has to come from somewhere. Change the law to force employers to give their employees health care coverage, California had a chance to do this but the voters voted it down.
Just because a person does not have health insurance does not mean they are \”flipping off\” society. I am one of the health uninsured, not because I don\’t want to secure insurance, but because I cannot secure health insurance; due to uninsurablility issues. And because I work for a living (for a small business owner, so group insurance would not apply to me) I cannot rely upon government based welfare insurance, which I wouldn\’t do even if I had the opportunity. It\’s people like \”IndAgent\” that make me \”MsAnThropic\”
My friend Carrie was laid off in a company reorganization, is now working fulltime but considered a contractor so she does not qualify for benefits. Since she took an antidepressent briefly years ago, she now cannot find a health insurance company that will accept her as a customer, for any price – and look at the high doctor/hospital prices she is now subject to should she get sick or hurt. That\’s just one example of many as to why there\’s health uninsureds in this country.
The issue real issue is getting folks access to affordable health care, not access to insurance.
And don\’t tell me $20 per Tylenol tablet is just retail vs. an insuance company\’s discounted rates, when I can go to Walgreens and get two whole bottles for the same price. That argument does not fly.
Hospitals are not alone in this practice. It is widespread in the medical community from doctors to clinics to outpatient surgery centers. If you are uninsured, you don\’t get a discount and are expected to pay more than an insured person pays. A form of discrimination and trying to collect from those that can\’t pay.
The supposed losses incurred by hospitals in NYS are designed that way by the hospitals themselves. Their administrators pay themselves a fortune; they provide first class benefits to all employees; they don\’t charge rents or expenses to their physicians who all make a fortune. In short, the hospitals excess revenues are sure to be scoffed up each year by those who are \”in charge\”. This way they can cry to Albany and Washington and the insurance companies for more money! What a system. I do agree that the insurance companies are gougers too – look at the Empire Blue Cross going private in exchange for $1 billion to NYS a few years ago and now being sold to a larger for-profit carrier from Indiana, Wellcare, I think, with the Empire Board Chairman being given a $45 \”bonus\” late in 2005!! Outrageous. I\’d socialize the whole mess!
Socialization is not the answer! I was married to a military man for 10 years, and that is socialized medicine at its best, or shall I say worst! You have to wait months for an appointment, and while it is a service that is provided free of charage, it is not free. The health care is not the greatest, and forget about seeing the same doctor more than once. And forget about getting the newest prescription medications, or surgical proceedures. You work with what you are offered, and when it isn\’t offered, you don\’t get it. I am for regulation, not socialization.
The correct way to change health insurance in this country is not to socialize coverage. Health insurance shouldn\’t be paid by employers but my individuals. It should be guaranteed issue or a basic high deductible and insurers can compete on cost. Insurers can offer more expensive plans which they can underwrite. Then everyone would have some basic coverage you wouldn\’t have to risk losing coverage if you lose a job and you can still have some subsidies for poorer people.
The issue, alluded to by several of my fellow agents is simply: the system is broken, and until our legislators are no longer beholden to hospital, and for that matter, insurance lobbyists, the system is unlikely to change. And unlike \”indAgent\”, I agonize daily for businesses, individuals and families, who want to buy insurance, but are denied, or offered waivers or multi-year pre-existing condition exclusions because of various of health problems. I represent 5 top-of-the-line health insurance carriers, and have underwriters who earnestly try to help, but with current system, there will be more, not fewer uninsured. And we\’ll all pay the consequenses.
All good points BUT many have missed the mark. Our parents had insurance and when the bill from the doctors or hospital came they usually ended up paying half of it. It\’s come full circle and it\’s our turn. Personally I have a HSA and provide the same for my employees (Retail Insurance Agency). We STRONGLY recommend them to all of our individual and group accounts. Simply…they work. NY has a problem with them as do other states. When our good legislators stop trying to legislate what a free enterprize market can do then you will see some return to competition and price reductions.
This is a very complex issue but hospitals do win with large write offs. Consumers do lose with insurance companies (think of the HMO\’s and the NO HEALTH consideration of the client…in other words, bring me your aids, your cancer, your fill in the blank) and try to make a profit from that. Personally I don\’t sell nor recommend HMO\’s except in cases were underwriting issues are so extreme that they are the last bastion of coverage.
Medical Malpractise Insurance, Law Suits, Outragous Settlements…all contributors to a system in need of an over haul. Can anyone explain to me why at the point of sale the pharmacy can apply my discount for my drugs but my doctor or hospital can only ask me for a co-pay and do I need a referral? Better yet my doctor\’s receptionist asked in shock \”I see you DON\’T have a co-pay…Is THAT RIGHT?\” Yes dear that\’s right… HSA\’s have been the future, are here today and will be with us for the rest of our lives…get knowledgable now….
Not so in the real world: If Ilose my job and somehow manage to pay $600+ a month cobra premiums for 18 months, but have failed to find another job and group plan I will be one of the uninsured you so belittle – by edict of the industry itself. I had a potentially serious health problem fixed four years ago so that I would be healthy and live longer. Now I am a \”high risk\” to – and rejected by – the industry.
There are hundreds of thousands of us out here – uninsurable because we had a health problem sometime in the past. Wonder what the premium is for someone who is perfectly healthy?
I am a semi-healthy 44 year old male in NC. I own my own biz. I pay $214 a month to BCBS Blue Advantage. It is full HMO coverage. I pay $15 for office visits. If I choose generic drugs they are free. This is an individual plan with $250 deductible. Try them. I am not a BCBS employee or agent. I had heard that I would never be able to get insurance, but I have it for a great price.
I somewhat agree with your statement concerning the length of time it takes for some patients to pay off their bills. People should be more responsible in paying their debts, and medical providers should be able to bill for minimum monthly payments to avoid repayment being prolonged indefinitely. A fair interest rate on past due balances would also encourage timely repayment.
But, why should the state FORCE employers to provide health insurance to their employees? Health insurance is not a RIGHT; especially employer provided health insurance. Employers provide health benefits to attract and maintain good employees, the cost of which is passed along to consumers in the price of goods and services a company provides. This means you and I are paying for their employees\’ benefits. It\’s just simple economics; and there is nothing wrong, irresponsible, or immoral about it.
Why not have the state FORCE all individuals to buy their own health insurance? Would you vote for that?
\”When our good legislators stop trying to legislate what a free enterprize market can do then you will see some return to competition and price reductions.\”
This one comment says it all. The hidden problem in the health \”care\” issue is the various statutory requirements placed on health insurers by state legislatures. From rating to required benefits, the insurance industry is the most widely regulated in the country.
Excessive regulation destroys any possible benefit of competition.
If you want a look into how the government would do with socialized health care, just look how \”well\” they did with the Medicare prescription drug benefit.
Government is not even capable of running out healthcare system, just ask anyone who is on medicare. The medicare system is so incompitent, it is incredible. Try calling medicare, good luck! When you call a private health insurance company, no the service is never perfect, but it does get done. Medicare is just downright broken, I was trying to get something done for somebody on medicare and every person I talked to gave me a completely different story and little did they do it with any enthusiasm. It was a nighmare! Also look at the service you get at the post office, what a joke! I have more and more of my small business clients just staying on their group health plan because they are frightened as hell to go on medicare. Only a fool would want government to run out healthcare system.
This is where many of you are wrong. Gov. run \”optional\” health care is the only solution. The premiums would be based on you annual income, and the deductible/co-pay would also reflect the individuals income. If you make something totally free people will always abuse it. I know people with full coverage that visit there doctor once a week for minor symptoms. Why do they do this? Because it cost $5 to see the doctor and $0 for drugs. It just does not make sense to offer medicare and Medicaid for FREE we need to make seniors/low-income/middle class pay initial cost of seeing a doctor and brand name prescription drugs and costs related to Health care will go down.
It is a simple solution. Instead of $5 doctor visits make them pay 30.00. When think with their wallets in this country.
The government is NOT the solution! This has not yet become a socialist government; although we are well on our way.
Don\’t forget that insurers and medical service providers are all private businesses (excluding state run charity hospitals, and the like), and government regulation of these businesses has caused many of the problems with the system today. Lawmakers try to \”fix\” every little issue that comes up with a new regulation which just causes problems somewhere else.
People who think the government is the cure-all have no clue what this great country was founded on… INDIVIDUAL FREEDOM, not the gimmee, gimmee, gimmee, society we have become. If we turn to the government to solve all of our problems, we are simply slaves of the state.
Work hard, be responsible, and take charge of your life. Don\’t rely on someone else to make things better; you will always be disappointed.
I have an old indemnity policy the same as was in effect 50 years ago They pay 100% of the bill and up to the usual and customary and pay what 90% of doctors in my zip code do.
It goes like this. For an appendix operation a ppo or managed care policy would be charged say 25000.00. My insurence pays $50,000. The problem is because I have indemnity and it is not managed care, I am charged a bill of $75,000.00 or full sticker price. Even after being paid 100% more then the best managed care plan pays from my insurance, they then want another $25000 from me out of pocket.
Billing people say 75000.00 is not an over charge in spite of the fact they usually receive $25000.00. As billing agents always tell me, We can charge you anything we want, you are not under managed care. I tell them I can go anywhere I want and I do. You would think a hospital or doctor who has 85% of his patients under a managed care product would welcome a patient under the fullpaying indemnity. NOt true, I can actually prove doctors and hospitals like the managed care patients whose insurance discount there rates over those patents whose insrance pays 100% more. This because they shove the indemnity patient away by balance billing after having been paid so well. Now if this isn\’t greed, I don\’t know what is.
I don\’t believe hospitals (or any medical provider) are the losers when they negotiate contracts with insurers (or goverments on behalf of the military and goverment employees). A contract is a negotiation. Both parties give up something in return for something else. Hospital and medical providers negotiate fees in order to assure access to a large number of patients. It is a business deal. No party would sign a contract if it was a lose-lose one sided contract.
I watched 60 minutes, and read, many of your readers comments. The 60 minutes segment pointed out that hospitals have a license to steal. They have twisted so many arms in Washington that they now have almost everything they could dream of, but they still want more. They want the state and national governments to make them immune to lawsuits. That is why you keep hearing their appeals to lawmakers to limit medical malpractice awards, and this year in Florida it is do away with joint and several liability. They will not be satisfied until they have every advantage possible over the people that they are suppose to serve. I feel exactly like the person testifying before Senator Joseph McCarthy\’s subcommittee. I just want to address the hospital associations by saying \”Sir, Do you have no shame?\”
The fact remains that hospitals charge the least able to pay four or more times what they charge anyone else. It\’s all about the hospitals showing large writeoffs on paper – would you rather write off $20,000 or $5,000 if you are trying to justify your non-profit (pays no taxes) status and to try to increase their Medicare payout from the government. It is not about the cost of the services – the hospitals still make money on what they charge insurance companies. Many \”non-profit\” hospitals show healthy profits even after all the writeoffs.
Here is the rality of the hospital financing situation and why there are set charges that the self pay and uninsured are charged – and why they end up being higher than what insurers pay:
1- Medicaid emergency room rates have NOT INCREASED since the early 90\’s
2- Medicaid fee for service pays 24 cents of every $1.00 of the cost to treat a patient in an emergency room
3- Medicare pays 82 % of patient costs
4- In 2004 New York Hospitals provided a documented $1.6 billion in health care to people who could not/would not pay – a relatively small portion of which comes back to the hospital
5- Overall 2/3 of hospitals in NY are either losing money or at less than 1% gross margin. The only way they continue to operate or enhance their plant or services is through donations.
I know for many of you involved in this conversation, think that this can\’t be correct and somehow the hospitals are gaming the system. I can assure you it is not the case.
I would agree that there are hospitals in other parts of the country that are doing well – with 4% to 6% margins – which are adequate to maintain and grown their services – but that is not the case in NY where labor costs are so much higher.
There were very valid arguments being made for better access to healthcare.
The reality of hospital operation is that this is where the rubber meets the road for many of us and if the overall system is not repaired, we are facing a significant health crises as we move forward.
If you are so worked up about this – instead of *****ing about the docs making money and complaining about how the hospitals have it so good – GET INVOLVED. Call you local community hospital – ask if there is an opportunity to serve on the Board of Directors (if it is a non profit). I believe you will understand the true picture then
THE PRICE? Well paid in full by the current and past healthcare systems run by HMO corporate Executive\’s and their quest for profit position\’s. They and their counterparts (Mega Hospital Chains) cut the throats of everyone else but their selective group of player\’s.
Tenet is a major player along with HCA who had convinced localities to buy into the Royal Screw.
I personally know full well how far they will go to deduct and add to gain control, Health Net belongs to club med, and when I say club med, it\’s the full range on the NFL Player\’s Association too.
In my case SF #8 is the selective player on their rooster. Stats off these trading cards is all apart of their accounting process. Number\’s, Number\’s…..I have your calling cards.
Health Net if your are reading this, does card number 510 Indianapolis Colts 1989 Team Leader\’s.
Topps, TRUDEAU BEGINS A REVERSE.
Health Net, HCA & Tenet How well do you do under fire in your \”now\” REVERSE position?
Your rushing yardage of my medical records, now total down\’s is in a loss.
I\’m your friend NFL, HealthNet is drafting much more than that…sorry to say it can manage.
Rushing Eric Dickerson
c 1990
NFLPA and other markings offer up you any clue\’s? Health Net HMO?
Health Nets legal team and their coaching team wants you to enroll in their health plan. What you will get is rolled.
and it also has points to Saudi Arabia $$$$$ & Malik Hasan, M.D., Neurologist.
Is there any signs of problems with these two above Royalties having total control of the U.S. Healthcare systems and beyound with the health minds of corrupt individuals?
I have nothing nice to say about these hospital mega corporations and what they did. The State of California, where I live is not the sunshine state. It\’s a dirt bag for Corporate Pigs who have no spine! feed off from Delaware Incorporator\’s along with the Department of Health & Human Services.
Sacracmento, State Capital of California:
Get on this…
One last card for you healthnet, any dimonds or points off,Topps 40 years of baseball Yankee\’s card, P Dave LaPoint, that you could not have set the record straight with in the first place?
Healthnet Corp, it\’s was your desire to be deceitful and totally disreguarded my son\’s position, other than (A) major player to your accounting\’s, manipulative practices.
See this HealthNet, how does it feel to make decisions on healthcare you don\’t produce?
First of all, I no longer watch 60 minutes regardless of that the subject is. When they got caught doing a story on the forged Bush military documents, that was the end for me, they have no credibility.
Seconly, I agree with you 100%, people will spend $$$$ on cars, going out to dinner, vacations, but they will not spend it on health insurance. When something happens and they get a real bill, they go cry mommy! Then they don\’t pay their medical bills because they don\’t think they have to and end flipping off society by going BK.
These people are who they are, they have no pride, the have no shame. These very people will go to the labor board if their paycheck is a day late, yet they don\’t pay their doctor\’s share of his or her salary that they owe. Yes, it is not okay for them to get their paycheck a day late, but how dare a doctor ask for their deserving salary!
Do we want to flip off doctors to the point where there will be no more doctors? For those of you who play this game, it is time to quit paying these kind of games and get some dignity into your life! Unless someone is mentally ill or disabled beyond the point of help, I do not feel sorry for anyone else one iota!
Pretty clear when you read that some of these hospitals are non-profit and charging 900% above cost such as in New Jersey.
People can point to medicare as the reason, pricing discounts, what ever the reason. Bottom line though everyone in this country should have equal access to health care and equal access means access to hospitals excepting as payment in full the same charge for everyone. This is about preserving life, not any business arrangement.
The easy solution is pay the hospitals cost (and verify those costs are vaild and correct) – plus 4% so they can reinvest in the physical plant – and add new technology.
The question I have for you all is – in doing that, your health insurance premiums will go up 15 to 20%. That will put this on a level playing field. I assume all of you are comfortable with that.
This is the same concept a s the implications of a flat tax – you will have winners and losers.
There is a famous saying in Washington DC – \”Don\’t tax you, don\’t tax me, tax that fellow behind the tree\”
It\’s not about Insurance companies negotiating for better prices, which they no doubt do, it\’s simply a win / win situation for the hospitals. If they collect from a non-insured they get 3 times their normal rate; if they don\’t collect they can write off a great deal.
Can\’t say enough about the California State of Social Service\’s and the need to exceed the limits of information provided for the profits of HMO\’s and the Insurance Carrier\’s hell bent on denying claims.
Those fools are \”myself & my son\”. Yes, I stayed on the straight and narrow of providing necessary information so that corrupt insurance dodger\’s can gleam vital static\’s, and create false ML-104 reports with mega files to riffle through. I\’d thought I\’d throw that in too, Health Net.
4. The Department of Managed Health Care\’s? My Point
I guess I am one of those people who have no pride. I still owe a doctor ten-dollar co-pay. I have owed it to him for nine years this March 15th. He was the doctor that should have performed an operation for my wife, but choose to go on vacation instead. He assured her there would be no problem. She died the day after he left for his vacation.
I filed a lawsuit, and reported him to the Board of medicine. Two years later and two weeks before going to trial his insurance company paid off to the limit of his insurance policy. Five years after my wife died I found out that the Board of Medicine had found him guilty of malpractice. I had to dig that information out of their database, no one informed me. Five years is about the average amount of time the Board of Medicine takes to make a decision. I think they do that so there is no way their finding can be used in a lawsuit. A lawsuit must be filed within two years of the incident, or maybe I should say crime. But, then there is no way you would ever get local law enforcement to look into that.
We are talking about money, so here is the money part of it. This doctor saw my wife twice. They were twenty-minute appointments two weeks apart. He billed my insurance company over a thousand dollars, and that last time we left his office I forgot to stop at the desk and pay our ten dollar co-payment. After my wife died he had the nerve to send me a bill for the ten-dollar co-payment. You are right IndAgent I am a bad person, and I will fight that doctor in hell before I pay him that ten dollars.
Ernie, you didn\’t pay the $10 not because you were irresponsible in life, but you didn\’t pay it because you had an issue with the doctor, a big issue.
You were responsible, you had insurance, you felt the doctor did your wife wrong and either his malpractice insurance company or a jury agreed with you and settled.
My gripe certainly is not with people like you, it is with people who do not have insurance and don\’t pay their bills (and for pete sakes, I am not talking about $10!!!).
You complain that the doctor only spent 20 minutes with you wife. Well with people not paying the medical bills,with malpractice lawsuits, as well as malpractice premiums, how can a doctor afford to be in business nowadays. There are so few doctors left who put up with all the nonsense, that they only have 20 minutes because there is a line outside of their door due to the lack of Doctors!
I re-read the comments I posted on Government Run just to be sure, and I was right. No where did I say that working hard, being responsible, and taking charge of your life was easy. In fact, these are difficult to achieve, and impossible if you don\’t put forth some effort.
Yet, so many like you think that difficulties in achieving an education or opportunity are your excuse for demanding the government hand you whatever you want. If you feel it was the government that put you in the situtuation you are in, what makes you think they care about getting you out.
The government did not create \”unequal schools and unequal opportunity\”. It is most likely the government\’s incompetance which allowed these conditions to exist. Now, how would the government fair if called upon to \”fix\” the health care problems we face today?
Stop looking to the past, and work HARD for the future!
So after watching the show how do you feel? I was left wondering why a two person household making 50K a year could not afford at least an HMO plan for the husband (HMO\’s MUST TAKE EVERYONE). Then I got to thinking and that can be dangerous. See I have alot of clients and they all have two cars, dinners out 3 or 4 nights a week, new clothes, in short \”lifestyles\”. Perhaps if a car was sold \”POOF\” health insurance for the hubby (equals NO BURDEN on society). Oh you mean they made a \”Choice\” to maintain a lifestyle vs. paying for health insurance because \”it\’ll never happen to me!\” Roll the dice, sometimes you pay the price.
What ever happened to personal responsibility for ones own actions and living with the consequences of our choices? I see and hear these tails all day long in my insurance practise and frankly I\’m not surprised. People create most of their own problems and then they want someone to clean up their mess. It must be someone else\’s fault. The system is broke but so are our ethics in this country. FREEDOM doesn\’t mean FREE RIDE!
Not true. The guy on 60 minutes had been turned down for health insurance.
I buy my own policy and the cost is $1400.00 per month for a comprehensive policy.But even the very low end policy is $600 per month for someone making $1400 per month. And that\’s if they will take you. So not eveyone can afford insurance because of the cost and then if you can buy the lowest price policy, only about half of a catistrophic hospital bill will be paid. Because of the full sticker price, and after insurance paid half, the individual is left filing bankrupsy. It is the same as walking onto a car lot and being told you will pay the full sticker price for this car. This while you know that 90% of the customers are given discounts.
The fact that so many of you commented on this article tells me something, our medical care is something we are passionate about. So I will let you in on a little secret, as long as the medical professionals can blame the insurance companies, and vis versa, this will never, ever be solved. I am so anti big government it is silly, but I think this is an area where we will soon have no choice but to have government regulation. These children will not play nice until dad comes home and lays down the law. I am not advocating socialized medicine, I have Canadian friends, it does not work. If you are passionate about your helth care contact your legislator, not for a hand out, but to tell him you want the system fixed. Hospital bills are only a symptom of the greater disease that could eventually bring down the best healtcare system in the world today.
Gene the fact of the matter is you made a choice to be responsible for yourself and not a burden to society. Thank You. Yes it is expensive…no the guy on TV said he was turned down for health insurance BUT did not say he could NOT GET HEALTH INSURANCE which I GUARANTEE he could have BUT choose NOT TOO because of PRICE. That\’s the back story that no one wants to talk about when airing a show like 60 minutes. It plays well to the un-educated public but for folks in the industry we KNOW BETTER. He made a choice…period.
The system is broke and needs to be fixed. Assuming everyone bought a individual health care policy, works hard, sacrifices second cars, eating out and does everything possible to satisfy society\’s requirements of appropriate suffering. Guess what? You\’ll still over-pay the medical community. They have us over a barrel and are laughing themselves silly all the way to the bank. How else are you planning to stay alive or to end you or your loved one\’s suffering? Until you take the money card off the table, you\’ll have this continued lopsided issue. Human life is being bartered for a Mercedes. Regulate the medical community.
I think many of you are forgetting about another large drain on the medical system in this country. Many in California and Texas are already accutely aware of it. Many of the millions and millions of illegal immigrants in this country use the hospital emergency room as their personal physician because anyone who walks into that door and is in need of medical care is treated (without regard to ability to pay and the illegals usually can\’t). There are numerous emergency rooms in Southern California that have been shut down because the hospital couldn\’t afford to keep them open because of these non-paying \”guests\”.
If you want to do something about the medical crisis, start there. Kick the illegals out or change the law so that hospitals don\’t have to treat people who can\’t prove they are citizens or that they are here legally.
No, the individuals shown on the show were not really given a fair choice. First, the individuals in the show never chose to pay 3X the value of the services. They chose to pay a fair price in the event they got sick. The fact that they are paying 3X the value of the services received is proven by the fact that the hospital accepts 1/3 of the billed amount when an insurance company is involved.
This is further complicated by the fact that when you have an emergency, you have no bargaining power. What the hospitals are doing is exactly what an efficient player would do in this situation: Clean out anyone who has assets and did not have the ability to do prior price bargaining.
The real solution: require all uninsured paitents be charged the lowest rate given to any bulk payer plus a reasonable fee of 10-20% to cover potential administrative burdens they escape by not buying insurance.
Who likes the current system: The insurance companies–this pressures people to pay through inefficient insurance companies. Also the liberal wing — it creates obvious injustice and an opportunity to fix it with socialized medicine. And of course the hospitals, which get the money.
The costs of \”illegal\” immigrants on the medical community is just the tip of the iceberg. The drain is also noted in un-insured motorist claims in personal lines as well. Until we secure our borders, nothing will change.
IndAgent – It would seem that you have never experienced \”hard times\”.
Years ago, when I had been laid off from a job, the COBRA offer came and it was twice my rent per month – half of the salary I had been making. I had no chronic conditions or other issues making me uninsurable. THIS is NOT an ability to get insurance. Sure, I made a choice – no insurance, but I could still afford to maintain the address where my medical bills would come, eat, and pay for the transportation to find a new job.
Now, as an underwriter, rather than refuse coverage for an undesirable risk, we\’ll \”price them out\” – surcharge to a point that the coverage offer is not really an offer at all, and either the risk will go uninsured or seek coverage elsewhere.
So, IndAgent, sometimes when people say that they \”cannot get insurance\”, it may just mean that by buying insurance from the one company that will offer it at an extreme price, they will not be able to pay their modest rent or buy auto insurance or any number of basic needs. Not living lavishly, but just adequately. They take the gamble, hoping that they won\’t get sick or that an accident won\’t happen.
The SYSTEM is broken.
I honestly believe much of it (not all) stems from personal injury lawyers suing frivolously and then hospitals and physicians order extra tests and must buy malpractice insurance at higher and higher prices, which drives up the cost of care. The uninsured are also more likely to file malpractice claims simply because they cannot pay.
The SYSTEM sucks and needs to be fixed.
Dear IndAgent: I am \”one of those\” who does not currently have health insurance. YOu want to know why? BECAUSE WE CAN\’T AFFORD COBRA @ 1,000 per month. Why am I not working? I took a FMLA November 2005 because my spouse\’s health. 2005, brain surgery, now 100% DISABLED. What\’s wrong with you? We went from six digitis a year in income to less than $50,000 last year! You explain to me how my spouse and I can afford to pay for health insurance (since I left my job) SINCE HIS WC CARRIER – A FLORIDA BASED PEO hasn\’t paid us a dime! $7,000 for the year 2005. That\’s it! SSI $1500 permonth? 3 sons, two in college, one left in high school? ON the flip side. You and I who are TAXPAYERS are paying for people whose income is extremely low. They need some help right? Well, I happen to be a ex. legal secretary. Worked for EVP of a large health care company. Know why we both left our firm? THE ALMIGHTY $$$ He\’s making about 4 mill a year? IT\’S THE MEN IN SUITS WHO OWN THE HEALTHCARE COMPANIES WHO ARE COSTING THE WHOLE NATION OUR HEALTH INSURANCE AND ANY SORT OF INSURANCE PERIOD. THEY OWN US. WE DON\’T OWN THEM. IF WE ARE LATE ON A PAYMENT – DONE. If they are Late? What to do? After almost 2 years, I just FINALLY RECEIVED A LOUSY $79.99 REIMBURSEMENT FROM AETNA that was submittted November, 2004! What do you have to say about that? That 80 bucks was spent in the supermarket on daily essentials! That\’s it. Yes. My son\’s work and work hard.
Well said. I should have read all before I started to write! YOu are so dead right. If you went to your stock broker and asked \”what type of fund/stock should I invest in?\” HEALTHCARE is what they tell you. I saw myself, my stock grow and couldn\’t believe it – but I know who is making the money. I have been there, done it, saw it, counted it!!! BED COUNTS That\’s what counts to the healthcare indusry.
Just because the couple didn\’t have health insurance is no justification for charging them 3 times more than anyone else pays. At most, the insurance companies should only get a 10-15% discount.
Doctor\’s don\’t make $800,000 per year. Where did you get that? a newspaper from the 70\’s? I have an ulcer from NAPROXEN. took for 14 years for cramps. Twice a month! When I finally realized something was wrong, I made an appt. with a gastro. 3 weeks! I was scared. When we finally met – I had to ask him – Why so long for me to see you? His reply: \”med mal is very high in my field and there are no medical students interested becuase ultimately – no money.\” You know what? When I received my nsurer\’s invoice? They paid him $45 dollars FOR 10 YEARS OF COLLEGE AND POST GRAD? I wouldn\’t go neither.
I posted earlier saying I pay $1400 per month for comprehensive insurance. You see, I don\’t have a PPO or an HMO. I have the old fashion indemnity policy which pays at 100%. What I face though is that while the PPO and HMO pays a hospital $5000 for such an operation, my insurance works off the full sticker price so the hospital is paid $15000. The problem is I am still stuck paying $10,000 out of pocket because the hospital billed me a total of $25000. So, from $5000(HMO,PPO) to $15000 (my Insurance payment), to $25000 (the overcharge).
I tell the hospital they usually get $5000 for this surgery, My insurance paid you $15000. Why ask me for another $10,000. They say that\’s our price. Pay it or go to collections. I now go to John Hopkins as they do not over charge me.
When Government creates unequal schools and unequal opportunity, people do not have the same opportunity to \”Work hard, be responsible, and take charge of your life\”. If it were only that easy, we would all be doing that.
People seem to hospitals and doctors are going to go broke from treating the uninsured. Personally I think they will go broke from providing deep discounts to 90% of there patients through there carrier.
What many people do not know is that 20 years ago the state of Maryland began to set the amount everyone is charged for health care. The state sets the fee which is charged. The results after 20 years appear to be a rising model of the new health care system. This because no hospital and very few doctors have gone under with the 20 year system. What happened is the discounting was cut out providing an evening out of fees paid for service. From what I read the hospitals are not operating on margin either but are in middle of the road America which profit. There is no problem with treating the uninsured there either as the system is far more stable and they can see those with out insurance, charge a reasonable amount, and still maintain a business. While I come from another part of the country, I use the medical facilities in Maryland because I know my insurance will cover at 100%. By the way, oddly Maryland is the very lowest for medical charges in the country yet have some of the best medical care there. This is a system which works and it is not a Canadian system. It has only price control which has shown to be reasonable.
I am not familiar with the Maryland system – but based on what you are describing, it seems to be a reasoned approach. You are correct, whatever the charges presented to the patient – outrageously high for self pay and stupidly discounted for insured, the system must be adjusted to provide balance. I say again – the carges should be based on verafiable cost plus 4% – and everyone should pay the same. The insurers will have the money because they collect the premiums – the hard part is the self pay and uninsured who don\’t have the money or refuse to pay. Dan Rather\’s comment \”and here is the outrageous part – they send the bill to a collections company\” is designed simply to be either inflamatory, without considering the implications of not trying to collect – or totally naiive. I am voting for the former.
While there certainly are some hospitals having financial trouble, more typically they have big profits. Check out http://www.wherethemoneygoes.com for more details about hospital finances. The tax returns of non-profits are public record so it is easy to follow the money.
I HAVE BEEN DIAGNOSED WITH CARDIO MYOPATHY AND UNABLE TO OBTAIN INSURANCE FOR 13 YEARS.WE WERE ONCE BEFORE WIPED OUT WHEN I HAD OPEN HEAART SURGERY AND WAS IN THE HOSPITAL FOR 30 DAYS. NO COMPANY WILL COVER US. SHAME ON ANYONE WHO TALKS ABOUT THE COSTS OF LIPITOR AND COMPARES THIS TO THE INABILITY TO WRITE EVEN CATASTROPHIC INSURANCE. MY MOST RECENT TWO DAY STAY FOR APPENDICITIS RAN 50K. WE PAY FOR MANY OF THOSE THAT INVADE OUR BORDERS AND ASSIMILATE AS CITIZENS THROUGH BIRTH BY ILLEGAL ALIENS . WAKE UP THE SYSTEM NEEDS SERIOUS FIXING. OUR COUNTRY SHOULD STOP FIGHTING IN A COUNTRY THAT COULD CARE LESS. BRING BACK OUR KIDS, CUT THE DEFICIT AND DO SOMETHING FOR THOSE THAT CONTRIBUTE TO THE ECONOMY AND ARE PREVENTED THE PEACE OF MIND AS EVERYTHING COULD BE GONE IN A SECOND.
INSURANCE COMPANIES DIDN\’T GET WHERE THEY ARE BECAUSE THEY TAKE BAD BETS. I HAVE BEEN DIAGNOSED WITH CARDIOMYOPATHY. I WELCOME ANYONE TO LOCATE THE A COMPANY THAT WILL WRITE A HEALTH POLICY FOR ANYONE WITH THIS CONDITION. THIS IS NOT CAUSED BY SMOKING, DRINKING OR OTHERWISE. IT IS A RESULT OF AN ERROR FROM A DENTAL EXTRACTION. IT HAS BEEN 13 YEARS SINCE WE WERE DROPPED FOR A PRE-EXISTING CONDITION AND IT HAS BEEN IMPOSSIBLE TO OBTAIN INSURANCE. HOSPITALS HAVE ONCE BEFORE WIPED US OUT YET WE KEEP ON GOING. WHAT OTHER CHOICE DO WE HAVE IF THE SYSTEM IS NOT PROPERLY HANDLED.SOMEONE NEEDS TO PUT EVERYONE ON THE SAME PLAYING FIELD. MY RECENT TWO DAY STAY COST 50K FOR AN APPENDECTOMY.
GHEINECKE,
I take it that you will get declined because of medical underwriting on an individual plan? Are you in business? Do you have your own agency? What is you roll in the insurance business or did you happen to stumble across this by doing a web search? If you check out the following website, it gives you a choice of coverage options, even for those who cannot get insurance due to medical condition. Please keep in mind, a for profit insurance company loses big time if they take an individual who has pre-existing conditions for $5k a year, then turn around and pay 50k in medical costs. However, some special programs that force a company by law to take the uninsurable. The bottom line is, the healthy people in such a pool pay more in order to cover those with cronic conditions, thus we much be appreciate of these options. Here is the link of your options: http://www.coverageforall.org/
Yes, IndAgent there are a lot of irresponsible people out there. I have been so responsible all of my life that Real Estate Bankers have to check my FIFO twice to make sure it is real. Some of them even say they didn\’t know they went that high. Until a few years ago I had never had a speeding ticket. I have never been locked up in jail, even overnight, that is if you don\’t count the Navy brig in Yokosuka.
Now all of this does not make me an example of an outstanding person. It makes me a lucky person. I just happened to have enough money to always pay my bills. True I didn\’t byte off more commitments than I could afford. I was lucky there too. I had a wife that kept me in line. I didn\’t get speeding tickets because I was very very lucky when I was young. My closest friends would tell you that I rarely drove my Mach 1, 428 cid Mustang under the speed limit. There were also times in my life when I rarely drove home sober, but I never collected a DWI. I could also believe that I was more than lucky there. Not getting a DWI or being involved in a crash driving while so inebriated that I could not remember most of the night would be enough to make anyone believe in a divine being.
I could go on and on with this. Oh, yes I have insurance too. That makes me responsible. The truth is that is mostly luck too. I retired from the Navy, and have Tricare. I am 65 years old so I am on Medicare. Just before he left office President Clinton signed a decree that gave retired military people Tricare for life when they became 65 and went on Medicare. That means Tricare became my secondary insurance and picked up the costs that Medicare did not. More important it also pays for all of my drug costs, after small co-pay. Now you might say I deserve all of that, but I really think I was just awful lucky.
What I am trying to say is that I could have very easily not have been so lucky. I could have not ended up with enough money to pay my bills. I could have easily lost my driver’s license. It would have been very easy to get in trouble in the Navy, and I would not have been able to retire after twenty years, with a twenty-year record of good conduct.
The system worked for me. It sounds like it worked for you too. There is no denying that the system for providing medical care does not work for everyone. Because it does not work for everyone, our emergency rooms are in gridlock. Because it does not work, we have hospitals issuing these bills that mean if you have insurance your insurer pays one fourth of it, but if you don\’t you pay it all. We have situations where they may go after the person for the whole thing, or give them a small discount, or not pursue them at all and write it off on their taxes. With this kind of mixed signals how can we blame people for not being responsible.
Our system for paying for medical care has to work for everyone. Before WW II most people paid their own medical bills. Two of my wife\’s prized possessions were two hand written hospital bills. One was the bill when her mother gave birth to her in the hospital. It totaled $61.85. She was in the hospital for five days. My wife\’s father had to pay it off in two payments. The other bill was when my wife\’s appendix was removed. That cost $52.55.
I don\’t think anyone realized what making insurance available to the employees of their company would eventually make our entire medical care system unworkable. The problem is that it never was designed as a system. There were little parts here and there that were all kind of collected together. It is a little like the horse that was designed by a committee. It turned out to be a camel.
I guess what I am trying to say is that IndAgent and I are doing well in this system, if you can call it that, but I thing we must admit that many others are not. We must put a real system together soon, or it will destroy medical care for everyone.
IndAgent I hope this helps you understand why this is not just a case of personal responsibility. By the way what the heck is an IndAgent anyway?
I have personal experience with a lab and hospital committing what can only be described as fraudulent billing. I\’m sure it goes on all the time since insurers aren\’t likely to notice, but could explain some unreasonably high bills.
1) Girlfriend needed a simple blood titre. Lab runs the titre and then 2 blots at $100 each. The blots aren\’t on the order and she didn\’t ask for them. Response #1: the blots were ordered (which she proved a lie by getting a copy of the order) Response #2: we always do the blots if the titre is positive. Her question at that point was, \”how can you charge me for tests that weren\’t ordered or authorized? Response #3: we don\’t do a titre by itself (i.e., we don\’t have the capability to do just what was ordered). That bill was paid to avoid collections, but they will be taken to small claims court to recover the $200.
2) Girlfriend is a nursing student (so she knows what she\’s talking about). We had to go to an ER on a Sunday morning on vacation b/c she was having an obvious reaction to a med she was on. The triage nurse didn\’t even have to ask, it was so obvious. There were no records to review. The doc might have taken 2 minutes to look up the common drug in a PDR, but spent literally 3 minutes w/ my girlfriend and never even LOOKED at her skin. Also said she couldn\’t change meds. (Fortunately, doc at home was perfectly capable of doing so and called in a new rx from 1000 miles away.) When the bill came, it was for a Level III ER Eval & mgmt. After disputing the coding of the bill over the last 7 months, they have given us a BS explanation about how they\’re right, but because they\’re nice, they\’ll cut the bill in half. The charge is reasonable now, but she\’s still tempted not to pay until they admit they coded it wrong, whether by \”mistake\” or not.
Like I said, if she were insured, I\’m sure these bills would have been paid w/o question.
Laws should not be based on one person\’s experience and how they think they got ripped off, law should be based on what is best for the common good of society. It is amazing how people think they know the macro economic impact based on their visit to the ER. Get over your own personal $10 loss and let\’s talk the real issues. The real issue is that if nobody paid doctors and nobody has insurance, these services would not be available. Lipitor was not invented in 5 minutes, it took a huge investment and dedication from fine individuals. The net result is that it did not only make life better for millions, it helped them extend their life. Quit crying about the small stuff and look at the big picture.
IndAgent, you are either the meanest person in the world or really really uninformed. Has it not occured to you that people may not have health insurance due to no fault of their own? People have lost their jobs to outsourcing, aquisitions, mergers, accidents at work, becoming ill with a chronic disease and many other reasons that a person has no control over. All uninsured people are not deadbeats or illegal immigrants. What would happen to you if you lost your job or became too ill to work? Do you see my point here or are you just too ignorant to understand? Man, your karma is bad.
First of all, I am not important compared to the common good of society, if society is not stable, then I am not stable. A sound economic structure and policies that return only the highest standard of living for all the American people is of the most important to me. I high standard of living means that we have an adundance of doctors who are very good at what they do. A standard of living the promotes irresponsibility and allowing people to choose vacations over health insurance is destined to be a society that will not return a high quality of life to it\’s people.
The fact that you are economically challenged is where your problem lies. If you took a macro viewpoint of society, you would understand what I am saying. If you take a self centered, me me me and me aproach, then you are destined to not only fail yourself, but to contribute to societies failure. Communist and socialist only think about themselves and they live in a society that returns and awful standard of living to it\’s people, let alone an awful medical system.
I have been ill and I had the appriate insurance in place to keep me going, so I know exactly what it is like. Also, I keep a reserve of three years salary in savings, not to mention a disability plan. Because of this, I cannot take as many vacations, but I have the peace of mind that I am not going to cry mommy too keep me financially above water.
Well said. I agree whether you have insurance or not is largely a matter of circumstance, luck, age, health, past decisions, ability to pay premiums and so on. However, the pricing end of our medical system is crooked and dishonest. The providers hire pricing contractors to \”game\” the system to keep pushing up the acceptable costs. They need patients who can or will pay the higher level tier of costs in order to legitimize those costs. God help you if you have to be one of those patients. That lies somewhere between outright theft and extortion. There are people who used to run a company named ENRON who are on trial today for much less.
What did I ever do to you? to treat me or my son in the way you have?
But, I can see that hour relationship is on the mend, and for that! You will be invited to my next milk party.
I hope you like pins your tails.
[HCA] Good Samaritan Hospital, San Jose, CA., this really is a beautiful silver left radial-ulna wrist-pin set.
The Appraisal Foundation say\’s it will Increase\’s in value from disuse. I admit it is not the best position possible, but I am kind of stuck with it. …now aint I?
Ernie,
I am not as fortunate as you, you have it all wrong. For half of my adult life, I did everything irresponsibly. Eventually things hit home that life was more of a hassle and a challenged doing things irresponsibly than responsibly. It was easier not taking those extra vacations, not buying the real nice car, and prioritizing my spending on things that I need, not things that I want. I know realize the huge dividends from this. I am no longer embarrassed by stupid things anymore, bad credit, not paying bills, etc. I have a huge sense of pride and people treat me with respect. Before, they would say \”you clown,\” now I get the royal treatment and they say \”It is a pleasure doing business with you.\” Businesses, Doctors, and others don\’t want to deal with flakes, they will blow you off. But when they know you are responsible, they will do everything possible to see that you are welcome back again.
Try prose next time. Shame on Healthnet for not taking your inebriated complaint posted to insurance journal seriously. They should have cut a nice 7 figure check by now. Complain to your state insurance commissioner. Demand justice, damnit!
It occurs even with insurance!
The other day I received in the mail, a statement, revealing the balance I owed from my recent surgery. My insurance had already covered plenty of the costs resulting from having a small piece of torn meniscus removed from my knee.
As I deciphered the statement however, my rage built inside me. Charges had been added to this statement to cover a particular incident and the result revealed pettiness and absolute gouging by the doctor himself.
My rage wasn’t a result of being charged for something, it came from being overcharged, for a simple task.
The incident involved filling out a form provided by my employer seeking advice from the Physician to determine my capabilities upon return to work. I deduct that the Physician was “put out” that my employer wouldn’t accept the widely used 5″ by 8 ” quickly scribed, doctors note. The charge indicated on the statement shows “pending ins”, this means the insurance was billed for the incident. Well, we all know how unlikely it is that insurance will cover this. I called the insurance and found they hadn’t received a claim for this.
Is my outrage in this incident unprecedented?
Was the Physician merely trying to make a statement in regards to my employer not accepting the popular “doctors note”? Well, we can be sure that my employer won’t be paying for this. The insurance has already stated that this sort of charge is not covered. So, I will pay my remaining patient balance and then will surely be billed for this subsequent, ridiculous, outrageous charge.
I’ve dealt with and have known many people who have had excellent experiences with Physicians, Dentists, Surgeons, etc, who run their practice with high integrity, who truly take care of and look out for the patient. This person however clearly lives only for himself.
When are we going to stand up for what’s right and do or say something about these unethical practices. Well, I for one will not just stand by and let them gouge me.
Oh yes, I’ll pay for it, but, will be adding another busines to my list of “Unethical business practice”.
I have seen doctors bill for completing insurance forms or responding to insurance documentation requests for 40 years. It used to be $5 or $10; now it is in the hundreds.
Just had my first sample. Got a $38,000 bill for what medicare would have paid $7,200 and private insurance would have paid $9,300.00. Why are hospitals allowed to put a higher financial burden on the middle-class and charge whatever they want. Example, stent cost the hospital no more than $3,000; the hospital charged me $16,910.00. OUTRAGEOUS! And I\’m not going down without a fight! The hospital is so arrogant that they haven\’t even responded to my certified letters.
There once was a time in our history when the government had to intervent in the marketplace and no one outside of the vested interests complained. What the government did then was called \”Trust Busting\” I am in principal against Government Intervention, but we have come to another point in time where it is needed.
We have arguably the best medical system in the world. Because of the issue of pricing, it has become, arguably, one of the most unfairly delivered systems in the world.
The seeds of the problem were sewn when Medicare and Medicade began keeping tract of what was charged for which proceedures in which portions of the company. Our National government decided to pay, I believe, on something called the 60th percentile. Now that does not mean 60% of what the provider charges. What it means is they will pay no more than what 60% of the providers in that group charge for that proceedure. They assigned computer codes covering every possible proceedure. These were called \”CPT Codes\”. Then they tracked what was charged in that geographical zone for that CPT code. Now, you can buy a book as thick as the largest dictionary you have ever seen that will give the most current CPT codes for that region. Guess what, it is updated periodically based on what the providers actually \”charged\”.
There arose a whole industry providing the latest revisions to the pricing basis. More importantly, there arose another industry dedicated to expanding that pricing basis. Today, most medical providers have a medical pricing subcontractor dedicated to capturing the maximimum for what was done to the patient and to escalating the cost basis.
We have an economy where inflation is around 2 to 3 percent. Why has medical cost inflated 18 to 20 percent annually?
Is it because of unbelivable costs associated with some minor breakthroughs? I think not.
The reason is that the pricing of our medical service delivery system is finally reflective of a decade of intentional inflation. Now we are handling a seven tiered pricing system as follows:
Tier one — No insurance, no PPO — pay full retail
Tier Two — Insurance, If no PPO involved, pay level one premiums
Tier Three — Have insurance associated with PPO, pay premium and a co , pay deductible and co- pay — Pay level Two premiums
Tier Four — have some PPO probably marketed as medical insurance. Pay amount chaged by provider subject to review by PPO
Tier Five — Have nothing, and try to pay the bill you are given
Tier Six — Have nothing and declare Bankruptcy
Tier Seven, — Have Nothing and get the welfare system to handle it.
I submit the entire pricing system is unfair and requires a complet overhaul.
I submit the entire payment system is unfair and requires a complete overhaul.
Ernest M. Holmes
Some people claim that they cannot get insurance because of their health history. Do not be fooled by that. The real truth is that these people at some point and time elected not to take Cobra coverage. Even is Cobra runs out after 18 months (36 months is some cases) then their is another continuation option called \”HIPAA.\” Also, by law, small group application cannot be declined by an insurance company due to health history. This applied to groups with a minimum of 2 employees (5 in some states). Finally, nearly every state has options for those who cannot get insurance because of health history. Folks, the bottom line is, nearly everyone can get insurance, but they don\’t because they know me and you will pay their health care bills. These people are snakes, they would take a vacation, go out to dinner, buy a nice car, but they will not buy their own health insurance. Yes, there are a very few select mentally ill people who cannot get coverage because they do not know how to, let alone pay for it and this does not include anyone on this board. For those of you in California who cannot get insurance, please click the link below and find out how good you have it!
http://www.coverageforall.org/
2 years ago my wife went in the hospital for 2 days.
Since we had a high deductible health plan the hospital sent us the bill for $11,820.
After our insurance company had it adjusted to what it would pay it went down to $980
As the first comment refers to, look at what the hospitals, doctors, labs, etc. send you a bill for and then look at what the insurance actually pays. If you are uninsured, you should not be required to make up for the difference which is basically what those entities are trying to make you do. IF they can make it on what the insurance companies are willing to pay, why are they charging/billing so much in the first place? To make their write offs look \”good\” which benefits hospitals in many ways? That is part of what is causing the crisis of people being uninsured with the other part being ambulance chasing/perfection requiring attorneys.
My brother (uninsured)suffered a broken clavicle and went to the hospital. X-rays and sling cost $1200. Seems kind of pricy to me.
I know what you mean, Phil. I spent one night in the hospital last Labor Day.
Fortunately (?) I have an HMO – my co-pay was $1,000. The hospital felt the need to send me a copy of a \”bill\” showing what the hospital fees were ($34,000) what the insurance company actually paid ($5,600)
and that the balance of $28,400. was being \”written off\”. Are they trying to give me some sort of guilt complex because I\’m not paying my \”fair share\”? Should I succumb to private insurance at triple the rates and half the coverage? What is one to do? Can\’t wait to see the piece on \”60 Minutes\”.
How about when hospitals don\’t properly diagnose a patient because he\’s uninsured? It happened to my brother. He injured his foot went to the ER & was told by the attending dr. he had a sprained ankle, given care instructions, meds & released. After 3 mos. his ankle still wasn\’t healed; he went to a county hospital where an XRay tech took a look at his Xrays and told him he had a broken foot!!!
Insurance negotiates the price because they send such a large block to the hospital. The uninsured do not have negotiating power and are not efficient for hospitals as many do not even pay their bills. The uninsured are flipping off soceity, they don\’t want to pay for their insurance nor do they want to pay their hospital bills. The bottom line is, me and you are paying for these fools health care and this is dead wrong!
Why would the waste time with your brother when he probably is not going to pay the bill? Would you show up to work if your employer didn\’t pay you?
There is a large piece missing here. It is NOT as easy or clear cut as this article or probably the 60 Minutes piece would have you believe. Self pay & uninsured pay the published hospital charges. Right or wrong insurance carriers negotiate rates with the hospitals based on the strength of the size of their insured population. IN MANY CASES THEY THREATEN TO PULL THE AFFILIATION WITH A PARTICULAR HOSPITAL IF THEY DON\’T GET THE RATE STRUCTURE (DISCOUNT OFF OF PUBLISHED RATES) THAT THEY WANT. In many cases, what this means is that hospitals loss money on every insured admission – in essence their costs are higher than the reimbusement an insurer gives them.
The only way a hospital can survive (and many are not going to survive under the present system) is to have their self pay rates high enough to offset the losses the insured population generate.
In New York State, 2/3 of all hospitals operate at a loss, despite decades of paying attention to costs. In New York State,those few not for profit hospitals who do manage a surplus of revenue over expense have a margin of 1%. Imagine if the operating profit of YOUR business was $100,000 on 100,000,000 in sales? If you sneeze – the margin could be gone. In New York State, in the aggregate, hospitals lost $3 Billion dollars last year and gee do you know what the profits of the health insurers were in New York State – $3 Billion dollars – amazing.
The legislature of NY State will not address this obvious imbalance because of the insurance company lobby – but will have to eventually. Probably when some state senator goes to his local emergency room and finds it closed – because the hospital can no longer afford to stay open.
The statesmenship of many elected officials is lacking in this day and age – and unless they address the imbalances – and there are many – in the healthcare system, we will have a disaster sooner than later.
Maybe because the uninsured medical bill takes about 20-30 years to be paid off by the patient, perhaps hospitals are building inflation costs into the bill because they aren\’t going to get paid right away or even anytime soon? Also there are so very many people uninsured using these services it has really severly hurts the economy of hospitals and their employees who are looking for their paychecks. Talk to an ex-employee of a hospital who got laid off because the hospital closed due to lack of money.
Hospitals need money and so does their employees to stay opened the money has to come from somewhere. Change the law to force employers to give their employees health care coverage, California had a chance to do this but the voters voted it down.
Just because a person does not have health insurance does not mean they are \”flipping off\” society. I am one of the health uninsured, not because I don\’t want to secure insurance, but because I cannot secure health insurance; due to uninsurablility issues. And because I work for a living (for a small business owner, so group insurance would not apply to me) I cannot rely upon government based welfare insurance, which I wouldn\’t do even if I had the opportunity. It\’s people like \”IndAgent\” that make me \”MsAnThropic\”
My friend Carrie was laid off in a company reorganization, is now working fulltime but considered a contractor so she does not qualify for benefits. Since she took an antidepressent briefly years ago, she now cannot find a health insurance company that will accept her as a customer, for any price – and look at the high doctor/hospital prices she is now subject to should she get sick or hurt. That\’s just one example of many as to why there\’s health uninsureds in this country.
The issue real issue is getting folks access to affordable health care, not access to insurance.
And don\’t tell me $20 per Tylenol tablet is just retail vs. an insuance company\’s discounted rates, when I can go to Walgreens and get two whole bottles for the same price. That argument does not fly.
The medical community, excluding electives, should be regulated. They charge to much for services which cost to much to insure.
If doctors didn\’t make $800,000 a year, I bet those hospitals would make more money.
Hospitals are not alone in this practice. It is widespread in the medical community from doctors to clinics to outpatient surgery centers. If you are uninsured, you don\’t get a discount and are expected to pay more than an insured person pays. A form of discrimination and trying to collect from those that can\’t pay.
The supposed losses incurred by hospitals in NYS are designed that way by the hospitals themselves. Their administrators pay themselves a fortune; they provide first class benefits to all employees; they don\’t charge rents or expenses to their physicians who all make a fortune. In short, the hospitals excess revenues are sure to be scoffed up each year by those who are \”in charge\”. This way they can cry to Albany and Washington and the insurance companies for more money! What a system. I do agree that the insurance companies are gougers too – look at the Empire Blue Cross going private in exchange for $1 billion to NYS a few years ago and now being sold to a larger for-profit carrier from Indiana, Wellcare, I think, with the Empire Board Chairman being given a $45 \”bonus\” late in 2005!! Outrageous. I\’d socialize the whole mess!
Socialization is not the answer! I was married to a military man for 10 years, and that is socialized medicine at its best, or shall I say worst! You have to wait months for an appointment, and while it is a service that is provided free of charage, it is not free. The health care is not the greatest, and forget about seeing the same doctor more than once. And forget about getting the newest prescription medications, or surgical proceedures. You work with what you are offered, and when it isn\’t offered, you don\’t get it. I am for regulation, not socialization.
The correct way to change health insurance in this country is not to socialize coverage. Health insurance shouldn\’t be paid by employers but my individuals. It should be guaranteed issue or a basic high deductible and insurers can compete on cost. Insurers can offer more expensive plans which they can underwrite. Then everyone would have some basic coverage you wouldn\’t have to risk losing coverage if you lose a job and you can still have some subsidies for poorer people.
The issue, alluded to by several of my fellow agents is simply: the system is broken, and until our legislators are no longer beholden to hospital, and for that matter, insurance lobbyists, the system is unlikely to change. And unlike \”indAgent\”, I agonize daily for businesses, individuals and families, who want to buy insurance, but are denied, or offered waivers or multi-year pre-existing condition exclusions because of various of health problems. I represent 5 top-of-the-line health insurance carriers, and have underwriters who earnestly try to help, but with current system, there will be more, not fewer uninsured. And we\’ll all pay the consequenses.
Curt got it right – but it is complex
All good points BUT many have missed the mark. Our parents had insurance and when the bill from the doctors or hospital came they usually ended up paying half of it. It\’s come full circle and it\’s our turn. Personally I have a HSA and provide the same for my employees (Retail Insurance Agency). We STRONGLY recommend them to all of our individual and group accounts. Simply…they work. NY has a problem with them as do other states. When our good legislators stop trying to legislate what a free enterprize market can do then you will see some return to competition and price reductions.
This is a very complex issue but hospitals do win with large write offs. Consumers do lose with insurance companies (think of the HMO\’s and the NO HEALTH consideration of the client…in other words, bring me your aids, your cancer, your fill in the blank) and try to make a profit from that. Personally I don\’t sell nor recommend HMO\’s except in cases were underwriting issues are so extreme that they are the last bastion of coverage.
Medical Malpractise Insurance, Law Suits, Outragous Settlements…all contributors to a system in need of an over haul. Can anyone explain to me why at the point of sale the pharmacy can apply my discount for my drugs but my doctor or hospital can only ask me for a co-pay and do I need a referral? Better yet my doctor\’s receptionist asked in shock \”I see you DON\’T have a co-pay…Is THAT RIGHT?\” Yes dear that\’s right… HSA\’s have been the future, are here today and will be with us for the rest of our lives…get knowledgable now….
Unfortunately here in the state of Iowa, in order to establish a HSA, you need to have health insurance in the first place with a high deductible.
Not so in the real world: If Ilose my job and somehow manage to pay $600+ a month cobra premiums for 18 months, but have failed to find another job and group plan I will be one of the uninsured you so belittle – by edict of the industry itself. I had a potentially serious health problem fixed four years ago so that I would be healthy and live longer. Now I am a \”high risk\” to – and rejected by – the industry.
There are hundreds of thousands of us out here – uninsurable because we had a health problem sometime in the past. Wonder what the premium is for someone who is perfectly healthy?
I am a semi-healthy 44 year old male in NC. I own my own biz. I pay $214 a month to BCBS Blue Advantage. It is full HMO coverage. I pay $15 for office visits. If I choose generic drugs they are free. This is an individual plan with $250 deductible. Try them. I am not a BCBS employee or agent. I had heard that I would never be able to get insurance, but I have it for a great price.
Patty,
I somewhat agree with your statement concerning the length of time it takes for some patients to pay off their bills. People should be more responsible in paying their debts, and medical providers should be able to bill for minimum monthly payments to avoid repayment being prolonged indefinitely. A fair interest rate on past due balances would also encourage timely repayment.
But, why should the state FORCE employers to provide health insurance to their employees? Health insurance is not a RIGHT; especially employer provided health insurance. Employers provide health benefits to attract and maintain good employees, the cost of which is passed along to consumers in the price of goods and services a company provides. This means you and I are paying for their employees\’ benefits. It\’s just simple economics; and there is nothing wrong, irresponsible, or immoral about it.
Why not have the state FORCE all individuals to buy their own health insurance? Would you vote for that?
(the last post by Mark to Patty should have been Mark2, not the first Mark)
\”When our good legislators stop trying to legislate what a free enterprize market can do then you will see some return to competition and price reductions.\”
This one comment says it all. The hidden problem in the health \”care\” issue is the various statutory requirements placed on health insurers by state legislatures. From rating to required benefits, the insurance industry is the most widely regulated in the country.
Excessive regulation destroys any possible benefit of competition.
P.S.
If you want a look into how the government would do with socialized health care, just look how \”well\” they did with the Medicare prescription drug benefit.
Government is not even capable of running out healthcare system, just ask anyone who is on medicare. The medicare system is so incompitent, it is incredible. Try calling medicare, good luck! When you call a private health insurance company, no the service is never perfect, but it does get done. Medicare is just downright broken, I was trying to get something done for somebody on medicare and every person I talked to gave me a completely different story and little did they do it with any enthusiasm. It was a nighmare! Also look at the service you get at the post office, what a joke! I have more and more of my small business clients just staying on their group health plan because they are frightened as hell to go on medicare. Only a fool would want government to run out healthcare system.
This is where many of you are wrong. Gov. run \”optional\” health care is the only solution. The premiums would be based on you annual income, and the deductible/co-pay would also reflect the individuals income. If you make something totally free people will always abuse it. I know people with full coverage that visit there doctor once a week for minor symptoms. Why do they do this? Because it cost $5 to see the doctor and $0 for drugs. It just does not make sense to offer medicare and Medicaid for FREE we need to make seniors/low-income/middle class pay initial cost of seeing a doctor and brand name prescription drugs and costs related to Health care will go down.
It is a simple solution. Instead of $5 doctor visits make them pay 30.00. When think with their wallets in this country.
The government is NOT the solution! This has not yet become a socialist government; although we are well on our way.
Don\’t forget that insurers and medical service providers are all private businesses (excluding state run charity hospitals, and the like), and government regulation of these businesses has caused many of the problems with the system today. Lawmakers try to \”fix\” every little issue that comes up with a new regulation which just causes problems somewhere else.
People who think the government is the cure-all have no clue what this great country was founded on… INDIVIDUAL FREEDOM, not the gimmee, gimmee, gimmee, society we have become. If we turn to the government to solve all of our problems, we are simply slaves of the state.
Work hard, be responsible, and take charge of your life. Don\’t rely on someone else to make things better; you will always be disappointed.
So what do we do now? We have a large bill pending with a hospital and we feel we are being over charged by 3 to 4 times.
I had my appendix removed and get $15,000 in bills – my insurance (Blue Cross) settled it for around $5,000.
I have an old indemnity policy the same as was in effect 50 years ago They pay 100% of the bill and up to the usual and customary and pay what 90% of doctors in my zip code do.
It goes like this. For an appendix operation a ppo or managed care policy would be charged say 25000.00. My insurence pays $50,000. The problem is because I have indemnity and it is not managed care, I am charged a bill of $75,000.00 or full sticker price. Even after being paid 100% more then the best managed care plan pays from my insurance, they then want another $25000 from me out of pocket.
Billing people say 75000.00 is not an over charge in spite of the fact they usually receive $25000.00. As billing agents always tell me, We can charge you anything we want, you are not under managed care. I tell them I can go anywhere I want and I do. You would think a hospital or doctor who has 85% of his patients under a managed care product would welcome a patient under the fullpaying indemnity. NOt true, I can actually prove doctors and hospitals like the managed care patients whose insurance discount there rates over those patents whose insrance pays 100% more. This because they shove the indemnity patient away by balance billing after having been paid so well. Now if this isn\’t greed, I don\’t know what is.
I don\’t believe hospitals (or any medical provider) are the losers when they negotiate contracts with insurers (or goverments on behalf of the military and goverment employees). A contract is a negotiation. Both parties give up something in return for something else. Hospital and medical providers negotiate fees in order to assure access to a large number of patients. It is a business deal. No party would sign a contract if it was a lose-lose one sided contract.
I watched 60 minutes, and read, many of your readers comments. The 60 minutes segment pointed out that hospitals have a license to steal. They have twisted so many arms in Washington that they now have almost everything they could dream of, but they still want more. They want the state and national governments to make them immune to lawsuits. That is why you keep hearing their appeals to lawmakers to limit medical malpractice awards, and this year in Florida it is do away with joint and several liability. They will not be satisfied until they have every advantage possible over the people that they are suppose to serve. I feel exactly like the person testifying before Senator Joseph McCarthy\’s subcommittee. I just want to address the hospital associations by saying \”Sir, Do you have no shame?\”
The fact remains that hospitals charge the least able to pay four or more times what they charge anyone else. It\’s all about the hospitals showing large writeoffs on paper – would you rather write off $20,000 or $5,000 if you are trying to justify your non-profit (pays no taxes) status and to try to increase their Medicare payout from the government. It is not about the cost of the services – the hospitals still make money on what they charge insurance companies. Many \”non-profit\” hospitals show healthy profits even after all the writeoffs.
Here is the rality of the hospital financing situation and why there are set charges that the self pay and uninsured are charged – and why they end up being higher than what insurers pay:
1- Medicaid emergency room rates have NOT INCREASED since the early 90\’s
2- Medicaid fee for service pays 24 cents of every $1.00 of the cost to treat a patient in an emergency room
3- Medicare pays 82 % of patient costs
4- In 2004 New York Hospitals provided a documented $1.6 billion in health care to people who could not/would not pay – a relatively small portion of which comes back to the hospital
5- Overall 2/3 of hospitals in NY are either losing money or at less than 1% gross margin. The only way they continue to operate or enhance their plant or services is through donations.
I know for many of you involved in this conversation, think that this can\’t be correct and somehow the hospitals are gaming the system. I can assure you it is not the case.
I would agree that there are hospitals in other parts of the country that are doing well – with 4% to 6% margins – which are adequate to maintain and grown their services – but that is not the case in NY where labor costs are so much higher.
There were very valid arguments being made for better access to healthcare.
The reality of hospital operation is that this is where the rubber meets the road for many of us and if the overall system is not repaired, we are facing a significant health crises as we move forward.
If you are so worked up about this – instead of *****ing about the docs making money and complaining about how the hospitals have it so good – GET INVOLVED. Call you local community hospital – ask if there is an opportunity to serve on the Board of Directors (if it is a non profit). I believe you will understand the true picture then
THE PRICE? Well paid in full by the current and past healthcare systems run by HMO corporate Executive\’s and their quest for profit position\’s. They and their counterparts (Mega Hospital Chains) cut the throats of everyone else but their selective group of player\’s.
Tenet is a major player along with HCA who had convinced localities to buy into the Royal Screw.
I personally know full well how far they will go to deduct and add to gain control, Health Net belongs to club med, and when I say club med, it\’s the full range on the NFL Player\’s Association too.
In my case SF #8 is the selective player on their rooster. Stats off these trading cards is all apart of their accounting process. Number\’s, Number\’s…..I have your calling cards.
Health Net if your are reading this, does card number 510 Indianapolis Colts 1989 Team Leader\’s.
Topps, TRUDEAU BEGINS A REVERSE.
Health Net, HCA & Tenet How well do you do under fire in your \”now\” REVERSE position?
Your rushing yardage of my medical records, now total down\’s is in a loss.
I\’m your friend NFL, HealthNet is drafting much more than that…sorry to say it can manage.
Rushing Eric Dickerson
c 1990
NFLPA and other markings offer up you any clue\’s? Health Net HMO?
Health Nets legal team and their coaching team wants you to enroll in their health plan. What you will get is rolled.
and it also has points to Saudi Arabia $$$$$ & Malik Hasan, M.D., Neurologist.
Is there any signs of problems with these two above Royalties having total control of the U.S. Healthcare systems and beyound with the health minds of corrupt individuals?
I have nothing nice to say about these hospital mega corporations and what they did. The State of California, where I live is not the sunshine state. It\’s a dirt bag for Corporate Pigs who have no spine! feed off from Delaware Incorporator\’s along with the Department of Health & Human Services.
Sacracmento, State Capital of California:
Get on this…
One last card for you healthnet, any dimonds or points off,Topps 40 years of baseball Yankee\’s card, P Dave LaPoint, that you could not have set the record straight with in the first place?
Healthnet Corp, it\’s was your desire to be deceitful and totally disreguarded my son\’s position, other than (A) major player to your accounting\’s, manipulative practices.
See this HealthNet, how does it feel to make decisions on healthcare you don\’t produce?
Are your Royalties 911 Stock?
First of all, I no longer watch 60 minutes regardless of that the subject is. When they got caught doing a story on the forged Bush military documents, that was the end for me, they have no credibility.
Seconly, I agree with you 100%, people will spend $$$$ on cars, going out to dinner, vacations, but they will not spend it on health insurance. When something happens and they get a real bill, they go cry mommy! Then they don\’t pay their medical bills because they don\’t think they have to and end flipping off society by going BK.
These people are who they are, they have no pride, the have no shame. These very people will go to the labor board if their paycheck is a day late, yet they don\’t pay their doctor\’s share of his or her salary that they owe. Yes, it is not okay for them to get their paycheck a day late, but how dare a doctor ask for their deserving salary!
Do we want to flip off doctors to the point where there will be no more doctors? For those of you who play this game, it is time to quit paying these kind of games and get some dignity into your life! Unless someone is mentally ill or disabled beyond the point of help, I do not feel sorry for anyone else one iota!
There is the California Nurses Association released just two months ago. This site is the study:
http://www.calnurses.org/research/pdfs/IHSP_Hospital_200_2005.pdf
Pretty clear when you read that some of these hospitals are non-profit and charging 900% above cost such as in New Jersey.
People can point to medicare as the reason, pricing discounts, what ever the reason. Bottom line though everyone in this country should have equal access to health care and equal access means access to hospitals excepting as payment in full the same charge for everyone. This is about preserving life, not any business arrangement.
The easy solution is pay the hospitals cost (and verify those costs are vaild and correct) – plus 4% so they can reinvest in the physical plant – and add new technology.
The question I have for you all is – in doing that, your health insurance premiums will go up 15 to 20%. That will put this on a level playing field. I assume all of you are comfortable with that.
This is the same concept a s the implications of a flat tax – you will have winners and losers.
There is a famous saying in Washington DC – \”Don\’t tax you, don\’t tax me, tax that fellow behind the tree\”
It\’s not about Insurance companies negotiating for better prices, which they no doubt do, it\’s simply a win / win situation for the hospitals. If they collect from a non-insured they get 3 times their normal rate; if they don\’t collect they can write off a great deal.
Other Honored Inductee\’s Include: \”The Much Obliged.\”
Top of the deck.
1. Service Employees International Union (SEIU) Accounting and Payroll Service\’s.
2. Industrial Medical Council, Anne Searcy, MD..Department of Industrial Relations. Industrial Medical Council. 395 Oyster Point Blvd.
3. SSI/SDI http://www.social-security-facts.org/
Can\’t say enough about the California State of Social Service\’s and the need to exceed the limits of information provided for the profits of HMO\’s and the Insurance Carrier\’s hell bent on denying claims.
Those fools are \”myself & my son\”. Yes, I stayed on the straight and narrow of providing necessary information so that corrupt insurance dodger\’s can gleam vital static\’s, and create false ML-104 reports with mega files to riffle through. I\’d thought I\’d throw that in too, Health Net.
4. The Department of Managed Health Care\’s? My Point
http://www.bizjournals.com/sacramento/stories/2006/02/20/story8.html
Another HMO on the horizon, Will it help? Who? Are your medical records files safe?
My Point: If the security of medical information is in the hands of turning? Where do they eventually end up?
Ans: Eventually Clever way of denying claims. The milage is great!
This is a situation that has actually occured to myself and son.
1. Another Patients records are inserted into my medical records history.
2. 3 traceable medical records of myself are the redistributed as an historical event, which were ensembled falsely.
My point: When will the turning point happen, that health care is not the golden soap bar for the elite membership of cooperation?
Sorry – Gingy has it wrong.
I have been on our community hospital board for 14 years – get involved and find out for yourself
I guess I am one of those people who have no pride. I still owe a doctor ten-dollar co-pay. I have owed it to him for nine years this March 15th. He was the doctor that should have performed an operation for my wife, but choose to go on vacation instead. He assured her there would be no problem. She died the day after he left for his vacation.
I filed a lawsuit, and reported him to the Board of medicine. Two years later and two weeks before going to trial his insurance company paid off to the limit of his insurance policy. Five years after my wife died I found out that the Board of Medicine had found him guilty of malpractice. I had to dig that information out of their database, no one informed me. Five years is about the average amount of time the Board of Medicine takes to make a decision. I think they do that so there is no way their finding can be used in a lawsuit. A lawsuit must be filed within two years of the incident, or maybe I should say crime. But, then there is no way you would ever get local law enforcement to look into that.
We are talking about money, so here is the money part of it. This doctor saw my wife twice. They were twenty-minute appointments two weeks apart. He billed my insurance company over a thousand dollars, and that last time we left his office I forgot to stop at the desk and pay our ten dollar co-payment. After my wife died he had the nerve to send me a bill for the ten-dollar co-payment. You are right IndAgent I am a bad person, and I will fight that doctor in hell before I pay him that ten dollars.
Ernie, you didn\’t pay the $10 not because you were irresponsible in life, but you didn\’t pay it because you had an issue with the doctor, a big issue.
You were responsible, you had insurance, you felt the doctor did your wife wrong and either his malpractice insurance company or a jury agreed with you and settled.
My gripe certainly is not with people like you, it is with people who do not have insurance and don\’t pay their bills (and for pete sakes, I am not talking about $10!!!).
You complain that the doctor only spent 20 minutes with you wife. Well with people not paying the medical bills,with malpractice lawsuits, as well as malpractice premiums, how can a doctor afford to be in business nowadays. There are so few doctors left who put up with all the nonsense, that they only have 20 minutes because there is a line outside of their door due to the lack of Doctors!
lormit,
I re-read the comments I posted on Government Run just to be sure, and I was right. No where did I say that working hard, being responsible, and taking charge of your life was easy. In fact, these are difficult to achieve, and impossible if you don\’t put forth some effort.
Yet, so many like you think that difficulties in achieving an education or opportunity are your excuse for demanding the government hand you whatever you want. If you feel it was the government that put you in the situtuation you are in, what makes you think they care about getting you out.
The government did not create \”unequal schools and unequal opportunity\”. It is most likely the government\’s incompetance which allowed these conditions to exist. Now, how would the government fair if called upon to \”fix\” the health care problems we face today?
Stop looking to the past, and work HARD for the future!
So after watching the show how do you feel? I was left wondering why a two person household making 50K a year could not afford at least an HMO plan for the husband (HMO\’s MUST TAKE EVERYONE). Then I got to thinking and that can be dangerous. See I have alot of clients and they all have two cars, dinners out 3 or 4 nights a week, new clothes, in short \”lifestyles\”. Perhaps if a car was sold \”POOF\” health insurance for the hubby (equals NO BURDEN on society). Oh you mean they made a \”Choice\” to maintain a lifestyle vs. paying for health insurance because \”it\’ll never happen to me!\” Roll the dice, sometimes you pay the price.
What ever happened to personal responsibility for ones own actions and living with the consequences of our choices? I see and hear these tails all day long in my insurance practise and frankly I\’m not surprised. People create most of their own problems and then they want someone to clean up their mess. It must be someone else\’s fault. The system is broke but so are our ethics in this country. FREEDOM doesn\’t mean FREE RIDE!
Kinsey said: HMO\’s MUST TAKE EVERYONE
Not true. The guy on 60 minutes had been turned down for health insurance.
I buy my own policy and the cost is $1400.00 per month for a comprehensive policy.But even the very low end policy is $600 per month for someone making $1400 per month. And that\’s if they will take you. So not eveyone can afford insurance because of the cost and then if you can buy the lowest price policy, only about half of a catistrophic hospital bill will be paid. Because of the full sticker price, and after insurance paid half, the individual is left filing bankrupsy. It is the same as walking onto a car lot and being told you will pay the full sticker price for this car. This while you know that 90% of the customers are given discounts.
The fact that so many of you commented on this article tells me something, our medical care is something we are passionate about. So I will let you in on a little secret, as long as the medical professionals can blame the insurance companies, and vis versa, this will never, ever be solved. I am so anti big government it is silly, but I think this is an area where we will soon have no choice but to have government regulation. These children will not play nice until dad comes home and lays down the law. I am not advocating socialized medicine, I have Canadian friends, it does not work. If you are passionate about your helth care contact your legislator, not for a hand out, but to tell him you want the system fixed. Hospital bills are only a symptom of the greater disease that could eventually bring down the best healtcare system in the world today.
Gene the fact of the matter is you made a choice to be responsible for yourself and not a burden to society. Thank You. Yes it is expensive…no the guy on TV said he was turned down for health insurance BUT did not say he could NOT GET HEALTH INSURANCE which I GUARANTEE he could have BUT choose NOT TOO because of PRICE. That\’s the back story that no one wants to talk about when airing a show like 60 minutes. It plays well to the un-educated public but for folks in the industry we KNOW BETTER. He made a choice…period.
The system is broke and needs to be fixed. Assuming everyone bought a individual health care policy, works hard, sacrifices second cars, eating out and does everything possible to satisfy society\’s requirements of appropriate suffering. Guess what? You\’ll still over-pay the medical community. They have us over a barrel and are laughing themselves silly all the way to the bank. How else are you planning to stay alive or to end you or your loved one\’s suffering? Until you take the money card off the table, you\’ll have this continued lopsided issue. Human life is being bartered for a Mercedes. Regulate the medical community.
I think many of you are forgetting about another large drain on the medical system in this country. Many in California and Texas are already accutely aware of it. Many of the millions and millions of illegal immigrants in this country use the hospital emergency room as their personal physician because anyone who walks into that door and is in need of medical care is treated (without regard to ability to pay and the illegals usually can\’t). There are numerous emergency rooms in Southern California that have been shut down because the hospital couldn\’t afford to keep them open because of these non-paying \”guests\”.
If you want to do something about the medical crisis, start there. Kick the illegals out or change the law so that hospitals don\’t have to treat people who can\’t prove they are citizens or that they are here legally.
No, the individuals shown on the show were not really given a fair choice. First, the individuals in the show never chose to pay 3X the value of the services. They chose to pay a fair price in the event they got sick. The fact that they are paying 3X the value of the services received is proven by the fact that the hospital accepts 1/3 of the billed amount when an insurance company is involved.
This is further complicated by the fact that when you have an emergency, you have no bargaining power. What the hospitals are doing is exactly what an efficient player would do in this situation: Clean out anyone who has assets and did not have the ability to do prior price bargaining.
The real solution: require all uninsured paitents be charged the lowest rate given to any bulk payer plus a reasonable fee of 10-20% to cover potential administrative burdens they escape by not buying insurance.
Who likes the current system: The insurance companies–this pressures people to pay through inefficient insurance companies. Also the liberal wing — it creates obvious injustice and an opportunity to fix it with socialized medicine. And of course the hospitals, which get the money.
The costs of \”illegal\” immigrants on the medical community is just the tip of the iceberg. The drain is also noted in un-insured motorist claims in personal lines as well. Until we secure our borders, nothing will change.
IndAgent – It would seem that you have never experienced \”hard times\”.
Years ago, when I had been laid off from a job, the COBRA offer came and it was twice my rent per month – half of the salary I had been making. I had no chronic conditions or other issues making me uninsurable. THIS is NOT an ability to get insurance. Sure, I made a choice – no insurance, but I could still afford to maintain the address where my medical bills would come, eat, and pay for the transportation to find a new job.
Now, as an underwriter, rather than refuse coverage for an undesirable risk, we\’ll \”price them out\” – surcharge to a point that the coverage offer is not really an offer at all, and either the risk will go uninsured or seek coverage elsewhere.
So, IndAgent, sometimes when people say that they \”cannot get insurance\”, it may just mean that by buying insurance from the one company that will offer it at an extreme price, they will not be able to pay their modest rent or buy auto insurance or any number of basic needs. Not living lavishly, but just adequately. They take the gamble, hoping that they won\’t get sick or that an accident won\’t happen.
The SYSTEM is broken.
I honestly believe much of it (not all) stems from personal injury lawyers suing frivolously and then hospitals and physicians order extra tests and must buy malpractice insurance at higher and higher prices, which drives up the cost of care. The uninsured are also more likely to file malpractice claims simply because they cannot pay.
The SYSTEM sucks and needs to be fixed.
Dear IndAgent: I am \”one of those\” who does not currently have health insurance. YOu want to know why? BECAUSE WE CAN\’T AFFORD COBRA @ 1,000 per month. Why am I not working? I took a FMLA November 2005 because my spouse\’s health. 2005, brain surgery, now 100% DISABLED. What\’s wrong with you? We went from six digitis a year in income to less than $50,000 last year! You explain to me how my spouse and I can afford to pay for health insurance (since I left my job) SINCE HIS WC CARRIER – A FLORIDA BASED PEO hasn\’t paid us a dime! $7,000 for the year 2005. That\’s it! SSI $1500 permonth? 3 sons, two in college, one left in high school? ON the flip side. You and I who are TAXPAYERS are paying for people whose income is extremely low. They need some help right? Well, I happen to be a ex. legal secretary. Worked for EVP of a large health care company. Know why we both left our firm? THE ALMIGHTY $$$ He\’s making about 4 mill a year? IT\’S THE MEN IN SUITS WHO OWN THE HEALTHCARE COMPANIES WHO ARE COSTING THE WHOLE NATION OUR HEALTH INSURANCE AND ANY SORT OF INSURANCE PERIOD. THEY OWN US. WE DON\’T OWN THEM. IF WE ARE LATE ON A PAYMENT – DONE. If they are Late? What to do? After almost 2 years, I just FINALLY RECEIVED A LOUSY $79.99 REIMBURSEMENT FROM AETNA that was submittted November, 2004! What do you have to say about that? That 80 bucks was spent in the supermarket on daily essentials! That\’s it. Yes. My son\’s work and work hard.
Well said. I should have read all before I started to write! YOu are so dead right. If you went to your stock broker and asked \”what type of fund/stock should I invest in?\” HEALTHCARE is what they tell you. I saw myself, my stock grow and couldn\’t believe it – but I know who is making the money. I have been there, done it, saw it, counted it!!! BED COUNTS That\’s what counts to the healthcare indusry.
Just because the couple didn\’t have health insurance is no justification for charging them 3 times more than anyone else pays. At most, the insurance companies should only get a 10-15% discount.
Doctor\’s don\’t make $800,000 per year. Where did you get that? a newspaper from the 70\’s? I have an ulcer from NAPROXEN. took for 14 years for cramps. Twice a month! When I finally realized something was wrong, I made an appt. with a gastro. 3 weeks! I was scared. When we finally met – I had to ask him – Why so long for me to see you? His reply: \”med mal is very high in my field and there are no medical students interested becuase ultimately – no money.\” You know what? When I received my nsurer\’s invoice? They paid him $45 dollars FOR 10 YEARS OF COLLEGE AND POST GRAD? I wouldn\’t go neither.
I posted earlier saying I pay $1400 per month for comprehensive insurance. You see, I don\’t have a PPO or an HMO. I have the old fashion indemnity policy which pays at 100%. What I face though is that while the PPO and HMO pays a hospital $5000 for such an operation, my insurance works off the full sticker price so the hospital is paid $15000. The problem is I am still stuck paying $10,000 out of pocket because the hospital billed me a total of $25000. So, from $5000(HMO,PPO) to $15000 (my Insurance payment), to $25000 (the overcharge).
I tell the hospital they usually get $5000 for this surgery, My insurance paid you $15000. Why ask me for another $10,000. They say that\’s our price. Pay it or go to collections. I now go to John Hopkins as they do not over charge me.
When Government creates unequal schools and unequal opportunity, people do not have the same opportunity to \”Work hard, be responsible, and take charge of your life\”. If it were only that easy, we would all be doing that.
People seem to hospitals and doctors are going to go broke from treating the uninsured. Personally I think they will go broke from providing deep discounts to 90% of there patients through there carrier.
What many people do not know is that 20 years ago the state of Maryland began to set the amount everyone is charged for health care. The state sets the fee which is charged. The results after 20 years appear to be a rising model of the new health care system. This because no hospital and very few doctors have gone under with the 20 year system. What happened is the discounting was cut out providing an evening out of fees paid for service. From what I read the hospitals are not operating on margin either but are in middle of the road America which profit. There is no problem with treating the uninsured there either as the system is far more stable and they can see those with out insurance, charge a reasonable amount, and still maintain a business. While I come from another part of the country, I use the medical facilities in Maryland because I know my insurance will cover at 100%. By the way, oddly Maryland is the very lowest for medical charges in the country yet have some of the best medical care there. This is a system which works and it is not a Canadian system. It has only price control which has shown to be reasonable.
I am not familiar with the Maryland system – but based on what you are describing, it seems to be a reasoned approach. You are correct, whatever the charges presented to the patient – outrageously high for self pay and stupidly discounted for insured, the system must be adjusted to provide balance. I say again – the carges should be based on verafiable cost plus 4% – and everyone should pay the same. The insurers will have the money because they collect the premiums – the hard part is the self pay and uninsured who don\’t have the money or refuse to pay. Dan Rather\’s comment \”and here is the outrageous part – they send the bill to a collections company\” is designed simply to be either inflamatory, without considering the implications of not trying to collect – or totally naiive. I am voting for the former.
While there certainly are some hospitals having financial trouble, more typically they have big profits. Check out http://www.wherethemoneygoes.com for more details about hospital finances. The tax returns of non-profits are public record so it is easy to follow the money.
I HAVE BEEN DIAGNOSED WITH CARDIO MYOPATHY AND UNABLE TO OBTAIN INSURANCE FOR 13 YEARS.WE WERE ONCE BEFORE WIPED OUT WHEN I HAD OPEN HEAART SURGERY AND WAS IN THE HOSPITAL FOR 30 DAYS. NO COMPANY WILL COVER US. SHAME ON ANYONE WHO TALKS ABOUT THE COSTS OF LIPITOR AND COMPARES THIS TO THE INABILITY TO WRITE EVEN CATASTROPHIC INSURANCE. MY MOST RECENT TWO DAY STAY FOR APPENDICITIS RAN 50K. WE PAY FOR MANY OF THOSE THAT INVADE OUR BORDERS AND ASSIMILATE AS CITIZENS THROUGH BIRTH BY ILLEGAL ALIENS . WAKE UP THE SYSTEM NEEDS SERIOUS FIXING. OUR COUNTRY SHOULD STOP FIGHTING IN A COUNTRY THAT COULD CARE LESS. BRING BACK OUR KIDS, CUT THE DEFICIT AND DO SOMETHING FOR THOSE THAT CONTRIBUTE TO THE ECONOMY AND ARE PREVENTED THE PEACE OF MIND AS EVERYTHING COULD BE GONE IN A SECOND.
INSURANCE COMPANIES DIDN\’T GET WHERE THEY ARE BECAUSE THEY TAKE BAD BETS. I HAVE BEEN DIAGNOSED WITH CARDIOMYOPATHY. I WELCOME ANYONE TO LOCATE THE A COMPANY THAT WILL WRITE A HEALTH POLICY FOR ANYONE WITH THIS CONDITION. THIS IS NOT CAUSED BY SMOKING, DRINKING OR OTHERWISE. IT IS A RESULT OF AN ERROR FROM A DENTAL EXTRACTION. IT HAS BEEN 13 YEARS SINCE WE WERE DROPPED FOR A PRE-EXISTING CONDITION AND IT HAS BEEN IMPOSSIBLE TO OBTAIN INSURANCE. HOSPITALS HAVE ONCE BEFORE WIPED US OUT YET WE KEEP ON GOING. WHAT OTHER CHOICE DO WE HAVE IF THE SYSTEM IS NOT PROPERLY HANDLED.SOMEONE NEEDS TO PUT EVERYONE ON THE SAME PLAYING FIELD. MY RECENT TWO DAY STAY COST 50K FOR AN APPENDECTOMY.
GHEINECKE,
I take it that you will get declined because of medical underwriting on an individual plan? Are you in business? Do you have your own agency? What is you roll in the insurance business or did you happen to stumble across this by doing a web search? If you check out the following website, it gives you a choice of coverage options, even for those who cannot get insurance due to medical condition. Please keep in mind, a for profit insurance company loses big time if they take an individual who has pre-existing conditions for $5k a year, then turn around and pay 50k in medical costs. However, some special programs that force a company by law to take the uninsurable. The bottom line is, the healthy people in such a pool pay more in order to cover those with cronic conditions, thus we much be appreciate of these options. Here is the link of your options:
http://www.coverageforall.org/
Yes, IndAgent there are a lot of irresponsible people out there. I have been so responsible all of my life that Real Estate Bankers have to check my FIFO twice to make sure it is real. Some of them even say they didn\’t know they went that high. Until a few years ago I had never had a speeding ticket. I have never been locked up in jail, even overnight, that is if you don\’t count the Navy brig in Yokosuka.
Now all of this does not make me an example of an outstanding person. It makes me a lucky person. I just happened to have enough money to always pay my bills. True I didn\’t byte off more commitments than I could afford. I was lucky there too. I had a wife that kept me in line. I didn\’t get speeding tickets because I was very very lucky when I was young. My closest friends would tell you that I rarely drove my Mach 1, 428 cid Mustang under the speed limit. There were also times in my life when I rarely drove home sober, but I never collected a DWI. I could also believe that I was more than lucky there. Not getting a DWI or being involved in a crash driving while so inebriated that I could not remember most of the night would be enough to make anyone believe in a divine being.
I could go on and on with this. Oh, yes I have insurance too. That makes me responsible. The truth is that is mostly luck too. I retired from the Navy, and have Tricare. I am 65 years old so I am on Medicare. Just before he left office President Clinton signed a decree that gave retired military people Tricare for life when they became 65 and went on Medicare. That means Tricare became my secondary insurance and picked up the costs that Medicare did not. More important it also pays for all of my drug costs, after small co-pay. Now you might say I deserve all of that, but I really think I was just awful lucky.
What I am trying to say is that I could have very easily not have been so lucky. I could have not ended up with enough money to pay my bills. I could have easily lost my driver’s license. It would have been very easy to get in trouble in the Navy, and I would not have been able to retire after twenty years, with a twenty-year record of good conduct.
The system worked for me. It sounds like it worked for you too. There is no denying that the system for providing medical care does not work for everyone. Because it does not work for everyone, our emergency rooms are in gridlock. Because it does not work, we have hospitals issuing these bills that mean if you have insurance your insurer pays one fourth of it, but if you don\’t you pay it all. We have situations where they may go after the person for the whole thing, or give them a small discount, or not pursue them at all and write it off on their taxes. With this kind of mixed signals how can we blame people for not being responsible.
Our system for paying for medical care has to work for everyone. Before WW II most people paid their own medical bills. Two of my wife\’s prized possessions were two hand written hospital bills. One was the bill when her mother gave birth to her in the hospital. It totaled $61.85. She was in the hospital for five days. My wife\’s father had to pay it off in two payments. The other bill was when my wife\’s appendix was removed. That cost $52.55.
I don\’t think anyone realized what making insurance available to the employees of their company would eventually make our entire medical care system unworkable. The problem is that it never was designed as a system. There were little parts here and there that were all kind of collected together. It is a little like the horse that was designed by a committee. It turned out to be a camel.
I guess what I am trying to say is that IndAgent and I are doing well in this system, if you can call it that, but I thing we must admit that many others are not. We must put a real system together soon, or it will destroy medical care for everyone.
IndAgent I hope this helps you understand why this is not just a case of personal responsibility. By the way what the heck is an IndAgent anyway?
I have personal experience with a lab and hospital committing what can only be described as fraudulent billing. I\’m sure it goes on all the time since insurers aren\’t likely to notice, but could explain some unreasonably high bills.
1) Girlfriend needed a simple blood titre. Lab runs the titre and then 2 blots at $100 each. The blots aren\’t on the order and she didn\’t ask for them. Response #1: the blots were ordered (which she proved a lie by getting a copy of the order) Response #2: we always do the blots if the titre is positive. Her question at that point was, \”how can you charge me for tests that weren\’t ordered or authorized? Response #3: we don\’t do a titre by itself (i.e., we don\’t have the capability to do just what was ordered). That bill was paid to avoid collections, but they will be taken to small claims court to recover the $200.
2) Girlfriend is a nursing student (so she knows what she\’s talking about). We had to go to an ER on a Sunday morning on vacation b/c she was having an obvious reaction to a med she was on. The triage nurse didn\’t even have to ask, it was so obvious. There were no records to review. The doc might have taken 2 minutes to look up the common drug in a PDR, but spent literally 3 minutes w/ my girlfriend and never even LOOKED at her skin. Also said she couldn\’t change meds. (Fortunately, doc at home was perfectly capable of doing so and called in a new rx from 1000 miles away.) When the bill came, it was for a Level III ER Eval & mgmt. After disputing the coding of the bill over the last 7 months, they have given us a BS explanation about how they\’re right, but because they\’re nice, they\’ll cut the bill in half. The charge is reasonable now, but she\’s still tempted not to pay until they admit they coded it wrong, whether by \”mistake\” or not.
Like I said, if she were insured, I\’m sure these bills would have been paid w/o question.
Laws should not be based on one person\’s experience and how they think they got ripped off, law should be based on what is best for the common good of society. It is amazing how people think they know the macro economic impact based on their visit to the ER. Get over your own personal $10 loss and let\’s talk the real issues. The real issue is that if nobody paid doctors and nobody has insurance, these services would not be available. Lipitor was not invented in 5 minutes, it took a huge investment and dedication from fine individuals. The net result is that it did not only make life better for millions, it helped them extend their life. Quit crying about the small stuff and look at the big picture.
IndAgent, you are either the meanest person in the world or really really uninformed. Has it not occured to you that people may not have health insurance due to no fault of their own? People have lost their jobs to outsourcing, aquisitions, mergers, accidents at work, becoming ill with a chronic disease and many other reasons that a person has no control over. All uninsured people are not deadbeats or illegal immigrants. What would happen to you if you lost your job or became too ill to work? Do you see my point here or are you just too ignorant to understand? Man, your karma is bad.
First of all, I am not important compared to the common good of society, if society is not stable, then I am not stable. A sound economic structure and policies that return only the highest standard of living for all the American people is of the most important to me. I high standard of living means that we have an adundance of doctors who are very good at what they do. A standard of living the promotes irresponsibility and allowing people to choose vacations over health insurance is destined to be a society that will not return a high quality of life to it\’s people.
The fact that you are economically challenged is where your problem lies. If you took a macro viewpoint of society, you would understand what I am saying. If you take a self centered, me me me and me aproach, then you are destined to not only fail yourself, but to contribute to societies failure. Communist and socialist only think about themselves and they live in a society that returns and awful standard of living to it\’s people, let alone an awful medical system.
I have been ill and I had the appriate insurance in place to keep me going, so I know exactly what it is like. Also, I keep a reserve of three years salary in savings, not to mention a disability plan. Because of this, I cannot take as many vacations, but I have the peace of mind that I am not going to cry mommy too keep me financially above water.
Well said. I agree whether you have insurance or not is largely a matter of circumstance, luck, age, health, past decisions, ability to pay premiums and so on. However, the pricing end of our medical system is crooked and dishonest. The providers hire pricing contractors to \”game\” the system to keep pushing up the acceptable costs. They need patients who can or will pay the higher level tier of costs in order to legitimize those costs. God help you if you have to be one of those patients. That lies somewhere between outright theft and extortion. There are people who used to run a company named ENRON who are on trial today for much less.
Health Net, Why can\’t we be friends?
A few of my qualities match up somewhat to yours.
What did I ever do to you? to treat me or my son in the way you have?
But, I can see that hour relationship is on the mend, and for that! You will be invited to my next milk party.
I hope you like pins your tails.
[HCA] Good Samaritan Hospital, San Jose, CA., this really is a beautiful silver left radial-ulna wrist-pin set.
The Appraisal Foundation say\’s it will Increase\’s in value from disuse. I admit it is not the best position possible, but I am kind of stuck with it. …now aint I?
But, what the heck…like a stuck record jamed.
Ernie,
I am not as fortunate as you, you have it all wrong. For half of my adult life, I did everything irresponsibly. Eventually things hit home that life was more of a hassle and a challenged doing things irresponsibly than responsibly. It was easier not taking those extra vacations, not buying the real nice car, and prioritizing my spending on things that I need, not things that I want. I know realize the huge dividends from this. I am no longer embarrassed by stupid things anymore, bad credit, not paying bills, etc. I have a huge sense of pride and people treat me with respect. Before, they would say \”you clown,\” now I get the royal treatment and they say \”It is a pleasure doing business with you.\” Businesses, Doctors, and others don\’t want to deal with flakes, they will blow you off. But when they know you are responsible, they will do everything possible to see that you are welcome back again.
How come nobody is listening to me. I posted two days ago and I demand a response. I am tired of people ignoring me.
Try prose next time. Shame on Healthnet for not taking your inebriated complaint posted to insurance journal seriously. They should have cut a nice 7 figure check by now. Complain to your state insurance commissioner. Demand justice, damnit!
It occurs even with insurance!
The other day I received in the mail, a statement, revealing the balance I owed from my recent surgery. My insurance had already covered plenty of the costs resulting from having a small piece of torn meniscus removed from my knee.
As I deciphered the statement however, my rage built inside me. Charges had been added to this statement to cover a particular incident and the result revealed pettiness and absolute gouging by the doctor himself.
My rage wasn’t a result of being charged for something, it came from being overcharged, for a simple task.
The incident involved filling out a form provided by my employer seeking advice from the Physician to determine my capabilities upon return to work. I deduct that the Physician was “put out” that my employer wouldn’t accept the widely used 5″ by 8 ” quickly scribed, doctors note. The charge indicated on the statement shows “pending ins”, this means the insurance was billed for the incident. Well, we all know how unlikely it is that insurance will cover this. I called the insurance and found they hadn’t received a claim for this.
Is my outrage in this incident unprecedented?
Was the Physician merely trying to make a statement in regards to my employer not accepting the popular “doctors note”? Well, we can be sure that my employer won’t be paying for this. The insurance has already stated that this sort of charge is not covered. So, I will pay my remaining patient balance and then will surely be billed for this subsequent, ridiculous, outrageous charge.
I’ve dealt with and have known many people who have had excellent experiences with Physicians, Dentists, Surgeons, etc, who run their practice with high integrity, who truly take care of and look out for the patient. This person however clearly lives only for himself.
When are we going to stand up for what’s right and do or say something about these unethical practices. Well, I for one will not just stand by and let them gouge me.
Oh yes, I’ll pay for it, but, will be adding another busines to my list of “Unethical business practice”.
I have seen doctors bill for completing insurance forms or responding to insurance documentation requests for 40 years. It used to be $5 or $10; now it is in the hundreds.
whoa, i got my appendix out last may (may 2005) and my name is jackie amato….how crazy
Just had my first sample. Got a $38,000 bill for what medicare would have paid $7,200 and private insurance would have paid $9,300.00. Why are hospitals allowed to put a higher financial burden on the middle-class and charge whatever they want. Example, stent cost the hospital no more than $3,000; the hospital charged me $16,910.00. OUTRAGEOUS! And I\’m not going down without a fight! The hospital is so arrogant that they haven\’t even responded to my certified letters.