What a horrifying article. And they call themselves a hospital and not for profit no less.
These people and the system we call U.S. healthcare is despicable.
These people and the system we call U.S. healthcare is despicable.
33
Blaming the coding system for the high cost of health care is like blaming the English language for insults. The hospitals and physicians billing in this way, as arcane as it is, are following the rules (mostly) given to them. The fault is with the multi-payer, fee-for-service, mainly private system that encourages maximizing revenue no matter the circumstances of patients or society at large. I really do wish the media, academia, government and business would come together around a national payer system to guarantee coverage for all, simplify benefits and reduce cost-sharing. It seems like a lost cause. So let's just blame coding. It's a lot easier even if it won't lead to any change whatsoever. Maybe that's not your job, Elizabeth. But perhaps you could compare the US system with any other developed country in the world and it would be more informative and helpful. I'm just sayin....
18
Remarkable article. Real service to everyone getting these facts out.
Appears that hospitals and insurers are trying to make the most compelling argument they can for universal Govt healthcare with this behavior. Very unfortunate for everyone.
Appears that hospitals and insurers are trying to make the most compelling argument they can for universal Govt healthcare with this behavior. Very unfortunate for everyone.
8
Two points: 1) The California Public Employees' Retirement System (CalPERS) and California companies sued hospitals to disclose their medical-procedure prices and won in 2010 after a 10-year court battle. 2) Another way for doctors to earn extra money is to not use new medical technology. As an example, non-invasive MTWA was FDA approved in 2001 (16 years ago) to determine susceptibility to Sudden Cardiac Arrest (Carrie Fisher and Prince are recent victims); SCA kills an American every two minutes. Yet doctors and hospital continue to use invasive, and far more costly ($9,000 vs. hundreds of dollars for MTWA), electrophysiology to determine susceptibility. MTWA can also economically determine who needs a defibrillator implanted, saving $3.15 billion annually. Google "MTWA" for more information.
8
Clearly, regardless of what happens to Obamacare, American healthcare is completely broken when such lack of transparency, profit maximization and greed become the norm. Can the country free itself from the clutches of parties (doctors and hospitals) who see healthcare as a way to enrich themselves when families are most vulnerable and desperate, and focus on what is right for the citizens of the country? Seems like not. Patients are screwed. Canada ought to have a thriving medical tourism business by now!!
4
This article proves:
1. Private Healthcare solves nothing.
2. The ridiculous overhead of America's labyrinthine "system of choice".
The goal of the entire enterprise to generate revenue. Whether it cures anything at all is incidental. Whether the lives of Americans are improved is also incidental. Only morons would keep such a system in place.
1. Private Healthcare solves nothing.
2. The ridiculous overhead of America's labyrinthine "system of choice".
The goal of the entire enterprise to generate revenue. Whether it cures anything at all is incidental. Whether the lives of Americans are improved is also incidental. Only morons would keep such a system in place.
15
This is a frightening article however I haven't seen anyone mention what might be the most distressing item in the article -- prescribing a narcotic pain killer merely to increase their reimbursement rate. What about the patient?! How many unnecessary prescriptions like this have led to opiate addiction?
23
How about the massive prescription of statins for primary prevention? To control "bad" cholesterol, though not proven to prevent heart attacks or strokes.
Those who get bad reactions to statins (see statinvictims.com) then need pain relief. Look at photos if you are convinced. What do they get? Opioids, of course. And probably there is little else to do.
Statins sell $29 billion a year. Now that's big business!
Those who get bad reactions to statins (see statinvictims.com) then need pain relief. Look at photos if you are convinced. What do they get? Opioids, of course. And probably there is little else to do.
Statins sell $29 billion a year. Now that's big business!
8
"...hospitals charge patients who are uninsured or self-pay 2.5 times more than they charge those covered by health insurance (who are billed negotiated rates) and three times more than the amount allowed by Medicare. That gap has grown considerably since the 1980s..."
So those who can least afford the cost of the health care treatment costs and associated with recuperation/after the procedure, can be found asking for huge sums of money , without offering any details or able to be understood specifics on what charges relate to what cost , when and why...will instead encounter prices 200-250% or even more to those presented as without Health Coverage, or if not helped by or through other Go Covered by Medicaid..
Not only does such a practise make no sense whatsoever, it only ensures that more people will be unable to pay their Costs /Bills that for many could mean the loss of their financial security as well as assets and a secure future and better life.
That so many are put at risk through such a random opportunistic system that cares little for the needs or well being of their customers is criminal and such an alien concept to so many in more humane, superior Societies that have not and would not put any of their Citizens in such a situation and potential risk. Neither people's Health, nor their Care are obviously not the Only or most important considerations to the Industry in America where profit is the only thing that comes first.
So those who can least afford the cost of the health care treatment costs and associated with recuperation/after the procedure, can be found asking for huge sums of money , without offering any details or able to be understood specifics on what charges relate to what cost , when and why...will instead encounter prices 200-250% or even more to those presented as without Health Coverage, or if not helped by or through other Go Covered by Medicaid..
Not only does such a practise make no sense whatsoever, it only ensures that more people will be unable to pay their Costs /Bills that for many could mean the loss of their financial security as well as assets and a secure future and better life.
That so many are put at risk through such a random opportunistic system that cares little for the needs or well being of their customers is criminal and such an alien concept to so many in more humane, superior Societies that have not and would not put any of their Citizens in such a situation and potential risk. Neither people's Health, nor their Care are obviously not the Only or most important considerations to the Industry in America where profit is the only thing that comes first.
2
We can choose health, or we can choose profit.
Single payer please, now.
Single payer please, now.
34
What a terrific job by Elisabeth Rosenthal! Greed overtakes the Hippocratic Oath. What is a "fair profit"? The heroes are easy to identify. The antagonists, not so easy. We all would like to be "cured" at a fair price. Once government started to reimburse for care, the vultures descended. If administration accounts for 25% of our bills, what percentage is attributable to profit? Healthcare is obscene because it is necessary but we have no data that addresses results-oriented care. Reform, hopefully in my lifetime!
8
Everyone complains about the medical insurance industry but the problem is the health care providers and their obscene, unjustifiable charges. Finally, the New York Times is shedding light on the real problem. I have a friend who received insane bills like this after a car accident in the US. They rightly disputed the amounts. All of you should. It's nothing but extortion.
16
I can easily predict what will bring this country is the unaffordable Medical cost. It is getting so high that people have less disposal income to spend money which affects the entire consumer based economy. The way we address Medical in our country is almost laughable. No other country spends 20 to 30 % of their discussing Medical plans, Billings, repeal of existing laws etc.
we cannot be called a superpower where free Medical care is not a right.
we cannot be called a superpower where free Medical care is not a right.
8
To all the people who are asking for a single-payer system: make sure you know exactly what you're asking for. Once there is a single-payer system, there will officially be a two-tiered healthcare system in this country. There will be the services that the government will pay for, and then there will be the services that people with enough money will get that are leaps and bounds beyond what the average person will have access to.
3
This is not true in Canada. The homeless and unemployed get exactly the same health care as the rich and we don't want it any other way.
31
Clearly you have employment sponsored health insurance or a grandfathered plan.
First to no harm includes financial ruin. And this is coming from a not-for-profit institution. Imagine any other not-for-profit suing the people they are committed to serving. Despicable. We need real reform, and we need it now.
7
First do no harm, is a principle for the physicians, not for the government, health insurers, coders, lawyers, and administrators. I think there is a confusion here, physicians have little to do with how much our work is charged, in fact we are forced and reprimanded if we see less than 12-14 patients every day, not taking into consideration all the documentation we have to fill out, electronic medical records, etc. All this work takes half of the time that we should spend treating, counseling, comforting patients, that is the main reason why we are in this profession.
All these considerations lead to physician burning out, and its complications: increased suicide rate, depression, anxiety, divorce. I'm sorry about what happened to this patient because she suffered a horrible disease. But to blame doctors for what the "non-for-profit" hospitals charged her is unfair. We don't have any saying in how much is charged. On the contrary we tried to avoid charging patients more doing our own coding that a lot of times are challenged by the coders.
There has been lately the initiative of asking physicians about the health care law, I think that's a great idea, but I don't have any hope that it will happen any time soon.
All these considerations lead to physician burning out, and its complications: increased suicide rate, depression, anxiety, divorce. I'm sorry about what happened to this patient because she suffered a horrible disease. But to blame doctors for what the "non-for-profit" hospitals charged her is unfair. We don't have any saying in how much is charged. On the contrary we tried to avoid charging patients more doing our own coding that a lot of times are challenged by the coders.
There has been lately the initiative of asking physicians about the health care law, I think that's a great idea, but I don't have any hope that it will happen any time soon.
9
Has it not occurred to any medical oversight board that a a new (understandable) coding system is seriously required?
4
Most here seem to agree that we need a single payer system. Remember that when you vote. You are not going to get that from the Republicans, nor will you get it from the neoliberal Clinton wing of the Democratic party, such as "single payer will never happen" Hillary and "we're capitalist and that's just the way it is" Pelosi. The major power brokers in the DNC still say it would be a mistake to move left. We should have had Bernie.
22
I know an American who was in Israel when she fell from a broken 3rd story balcony. She suffered a severe traumatic brain injury. She was transported part way to the hospital in an ambulance and the rest of the way by military helicopter. On arrival, they thought she was going to die. She spent the next 3 weeks in the neurological intensive care unit, received physical and occupational therapy daily. She had surgery to put a titanium rod in her back. She was discharged after 4 weeks. The hospital billed her HMO for its and the doctors' services in one bill. The total was $64,000. I can't image that they could have upped any codes considering the severity of the injury. Where in the US could you get more than a few days in an ICU for $64,000? Her HMO must have been rejoicing that she wasn't in the US when this happened. Why is our healthcare the most expensive in the world? (BTW-she made a complete recovery.)
25
This makes me sick.
17
After my father died in a Roanoke, Virginia hospital in 2001 (covered by Medicare and a good medigap policy), I asked for a copy of the total bill. I wanted to be a good consumer, get an idea of what was being billed, how much Medicare paid, how much the insurance paid, how much we paid. It took one year for the hospital to produce a bill. Apparently the situation has not improved much in 15 years.
15
My deceased husband was chief of a department at a large medical center.
He had a fair amount of power, was on at least 18 different committees,but could NEVER get an accounting on how many administrators were in the hospital.As he said, each needs an office, a secretary, a phone, computer, expense account, etc., and pretty soon there will be more MBA's than doctors in the hospital. Retired administrators get $2,000,000, and some get that in a year.
And, as he said, all of this is based on the relationship/treatment of one doctor to one patient.
He had a fair amount of power, was on at least 18 different committees,but could NEVER get an accounting on how many administrators were in the hospital.As he said, each needs an office, a secretary, a phone, computer, expense account, etc., and pretty soon there will be more MBA's than doctors in the hospital. Retired administrators get $2,000,000, and some get that in a year.
And, as he said, all of this is based on the relationship/treatment of one doctor to one patient.
21
Thank God I don't live (and will never travel to) in America.
What a total disgrace, a health system driven by greed .. think about it .. it's greed.
If that happened to me in Australia, I would have gotten the best of care, air ambulance, hospital, surgeons, scans, etc and it would have cost me nothing even if I didn't have health insurance.
It seems in America, the fundamental rights of health, education and justice depend on how much money you have.
What a total disgrace, a health system driven by greed .. think about it .. it's greed.
If that happened to me in Australia, I would have gotten the best of care, air ambulance, hospital, surgeons, scans, etc and it would have cost me nothing even if I didn't have health insurance.
It seems in America, the fundamental rights of health, education and justice depend on how much money you have.
42
I'm a coder for a large hospital group. I am confident that not a single one of my colleagues is coding to maximize reimbursement. We don't even have access to the actual bills, or any detailed knowledge of how much the hospital is being reimbursed.
Furthermore, we have constant QC audits, which are looking for one thing only- that what we coded is an accurate depiction of the medical record, as documented by physicians and other staff.
Our health system has plenty of problems, but blaming any of them on hospital coders is a real stretch.
Furthermore, we have constant QC audits, which are looking for one thing only- that what we coded is an accurate depiction of the medical record, as documented by physicians and other staff.
Our health system has plenty of problems, but blaming any of them on hospital coders is a real stretch.
9
I also am a coder for an emergency department. We do our best to code accurately... upcoding is never in the picture and we are audited constantly. I am so sorry for the plight of these poor people but don't blame the coders. We code from the documentation we see.
7
You coders may not be personally responsible for distortion (extortion), but you are working in (and for) a system that distorts and extorts. I'm glad that this system and your role in it are being exposed.
I'm sorry to have to say this, but the whole idea of for-profit health insurance and health care should be shut down--NOW!
I'm sorry to have to say this, but the whole idea of for-profit health insurance and health care should be shut down--NOW!
5
Kathy, nobody is blaming the coders. The blame is on the AMA who creates the 150,000 plus codes, whom also have a major conflict of interest in setting the rates and complementary codes to each code. Of course a group of AMA "consultants" that are doctors are going to set each code with a major profit motive for their own industry. We have all seen this play out in medical bills. A code for basic physical therapy, but also a code for a deep hip stretch. A code for a basic dental cleaning, but then another code for a deep cleaning that was no different than the regular cleaning. Or a code for a basic Xray, and a code for the Xray technician's digital enhancement that looks like any other Xray file. It has become so impossible to actually know what code is associated with what level of service. That obfuscation is not an accident. The more you confuse, the more you can charge, an old business trick. So yes, as a code setter or a code processor, the blame may lie with your industry, but the issue rests with you folks. Time to speak up and further this article's main objective to clarify the problems and push for solutions at the AMA.
5
No wonder Americans have alarming health statistics, we must navigate a system built to do nothing more than to wring every single cent out of those who needs medical care, and at one time or the other, that will be all of us.
We are truly a land of the most alarmingly stupid people . . We actually are allowing the politicians we elect to do this to us. Why do we do this?
We are truly a land of the most alarmingly stupid people . . We actually are allowing the politicians we elect to do this to us. Why do we do this?
25
You ultimately have no choice but, to not even attempt to pay. Damned if you do, damned if you don't!
1
This also explains in part why the average back office cost for physicians to interface with insurance companies (not including Medicare) to get paid is about $84,000 per Doctor. See fixithealthcare.com
8
I received a bill from Swedish medical center, for my mother in law, one line
miscellaneous. $58,464.
Her responsibility $620.
I called 3 times to request a itemized bill... I finally received about 20 pages of nonsense. Each person I talked to gave a different reason. " required by Hipa..for privacy reasons. Someone might open your mail and they could gain information." " you are not paying the bill anyway..only the insurance co need to know." Ect. Pure ridiculousness, the reason is to hide cost from the person who would really know..the patient.
miscellaneous. $58,464.
Her responsibility $620.
I called 3 times to request a itemized bill... I finally received about 20 pages of nonsense. Each person I talked to gave a different reason. " required by Hipa..for privacy reasons. Someone might open your mail and they could gain information." " you are not paying the bill anyway..only the insurance co need to know." Ect. Pure ridiculousness, the reason is to hide cost from the person who would really know..the patient.
16
I'm having a diagnostic procedure at a major NYC hospital, and asked how long it would take to get results, as I have to make an appointment for a second opinion. After being talked at incessantly by the office manager, I learned it would take ten days for them to get results, and they would call to tell me when to come in so they could tell me about them.
When I asked if I could make an appointment now for ten days after the test to get the results, they said NO. When I asked why not, they gave me a long run around, and finally said that if I made the appointment before the procedure it would be billed one way, but if I made it only one day after the procedure, it would be billed differently, so I would have to wait until one day after the procedure to schedule an appointment to get the results.
I said, oh, you mean the CPT codes the NT Times just wrote about! I was told I was a smart person. What a corrupt system!
When I asked if I could make an appointment now for ten days after the test to get the results, they said NO. When I asked why not, they gave me a long run around, and finally said that if I made the appointment before the procedure it would be billed one way, but if I made it only one day after the procedure, it would be billed differently, so I would have to wait until one day after the procedure to schedule an appointment to get the results.
I said, oh, you mean the CPT codes the NT Times just wrote about! I was told I was a smart person. What a corrupt system!
12
1. In my opinion (and as other pointed this out already here) profit should never be part of the equation in any fashion when human lives are at stake. This is why we live in a society, and this is where we do need the government to control and regulate the prices (see Medicare).
2. I wonder what would happen if the entire insurance industry were erased and all the money spent there would be put into health care? We don't need health insurance, we need health care. Where was this point lost in the shuffle? University courses on "coding"? Scary. How about re-training coders to build ... solar panels? Coding is clearly a useful tool in global tracking of diseases and conditions. But coding to figure out how a rendered service can pull in more profit? Where has ethics gone when (again) people's lives are at stake?
2. I wonder what would happen if the entire insurance industry were erased and all the money spent there would be put into health care? We don't need health insurance, we need health care. Where was this point lost in the shuffle? University courses on "coding"? Scary. How about re-training coders to build ... solar panels? Coding is clearly a useful tool in global tracking of diseases and conditions. But coding to figure out how a rendered service can pull in more profit? Where has ethics gone when (again) people's lives are at stake?
9
The author says "For-profit colleges offered medical-coding degrees, and internships soon followed". Why call out the for profit colleges while ignoring the not for profit nature of the villain in this story? Amazingly, the villain (the UVA health system) is ignoring its mission to provide uncompensated care to the poor and driving the "patient" into bankruptcy. This is really grotesque.
8
Re: "In other countries, when patients recover..."
How dare you cite "other countries"?
This is the USA! This is America!
We are exceptional! We are not like those "other countries"!
We each pay our own way. We do not pay to solve each other's problems!
How dare you cite "other countries"?
This is the USA! This is America!
We are exceptional! We are not like those "other countries"!
We each pay our own way. We do not pay to solve each other's problems!
4
PLEASE tell me you're being sarcastic!!
9
Me thinks so
4
Having just taken 1/2 of day in several phone calls to understand a $989 bill for a procedure fully covered by the ACA because of a coding error from the OB/Gyn's billing company was ridiculously frustrating. I needed to be home on a day off to correct this mistake. I am a Physician Assistant with a decent grasp on coding, pity the patient who has no clue and just pays the bill not knowing any better.
15
In short: This is insanity, and disgustingly immoral into the bargain. That Congress and the Administration allows this to continue is beyond reprehensible. The American "Health Care" Industry is a terrorist organization that tortures anyone so misfortunate as to become seriously ill. Especially, virtually everyone who is not very secure financially.
5
My partner died in September, covered by Medicare and Kaiser Senior Advantage HMO insurance. By November, he was being dunned by a collections agency for past due medical charges.
I asked for a "final billing detail" and got those broad categories of charges over a date range. No specific costs and no specific dates. I paid the balance.
Four months later, my partner got another statement for unpaid charges that were not included on the "final bill."
When I complained, they said they would send the bill to collections. "And collect from whom?," I asked. No answer.
I asked for a "final billing detail" and got those broad categories of charges over a date range. No specific costs and no specific dates. I paid the balance.
Four months later, my partner got another statement for unpaid charges that were not included on the "final bill."
When I complained, they said they would send the bill to collections. "And collect from whom?," I asked. No answer.
13
I had a cortisone injection for a trigger finger condition --our area has a huge medical group called Orthopedic Associates. I got the EOB, which listed about 5 items, including an x-ray, which I did not have. When I called the billing dept. they said oh yes you did, it's an ultrasound machine, which shows the Doctor where to inject. Well no, he did not use any machine.
The " list " price was around $1,400.00 Since I had insurance I paid a copay at the time of visit, and on the bill I owed approx $136.
Three months later I needed another injection. My insurance had changed so I could see the doctor I preferred at another practice. he's a phenomenal hand surgeon. He gave. me the injection - no ultrasound machine needed - this was over a year ago and the finger is fine. The EOB stated a list price of $280. My portion was $7.61. Our health insurance system is a disaster.
I won't even tell you the horror story of what I've been going through for a year with MetLife and their so-called dental insurance. They are the worst liars and they obfuscate at every step of the process in order not to pay. There should be a special place in hell for them.
The " list " price was around $1,400.00 Since I had insurance I paid a copay at the time of visit, and on the bill I owed approx $136.
Three months later I needed another injection. My insurance had changed so I could see the doctor I preferred at another practice. he's a phenomenal hand surgeon. He gave. me the injection - no ultrasound machine needed - this was over a year ago and the finger is fine. The EOB stated a list price of $280. My portion was $7.61. Our health insurance system is a disaster.
I won't even tell you the horror story of what I've been going through for a year with MetLife and their so-called dental insurance. They are the worst liars and they obfuscate at every step of the process in order not to pay. There should be a special place in hell for them.
14
The favorite trick of some hospitals is to send bills to Medicare patients whose costs are fully covered by insurance. There must be plenty of seniors paying those bills, especially when they're followed up by calls from collection agencies within a few days after the stated "due date" (although nothing is actually due). It takes weeks to resolve these claims -- not a pleasant experience for someone with health issues.
19
What I have never understood is the dance between the insurance companies and the physicians/hospital that you have started to address here.
The "service provider" states that such and such procedure costs $1000 and one insurance company says we pay $800 for that and the provider says okay we'll take it and the extra $200 is never paid.
With a patient with a different insurance company, the "service provider" states that such and such procedure costs $1000, this company says we only pay $500 for that and the provider says okay and then demands $350 from the patient.
With patients with no insurance, the "service provider" states that such and such procedure costs $1000 and if begged will give a 20% discount (example presented in this article) and the patient is required to pay $800. In most, less expensive situations, the provider demands full recompense.
Add in this coding nonsense--which is clearly an esoteric "language" that no one else can decipher used by bureaucrats to extract more money from patients and insurance companies in order to cover up their possibly fraudulent behavior--there is clearly only one solution to the problem...
Single payer health insurance.
The "service provider" states that such and such procedure costs $1000 and one insurance company says we pay $800 for that and the provider says okay we'll take it and the extra $200 is never paid.
With a patient with a different insurance company, the "service provider" states that such and such procedure costs $1000, this company says we only pay $500 for that and the provider says okay and then demands $350 from the patient.
With patients with no insurance, the "service provider" states that such and such procedure costs $1000 and if begged will give a 20% discount (example presented in this article) and the patient is required to pay $800. In most, less expensive situations, the provider demands full recompense.
Add in this coding nonsense--which is clearly an esoteric "language" that no one else can decipher used by bureaucrats to extract more money from patients and insurance companies in order to cover up their possibly fraudulent behavior--there is clearly only one solution to the problem...
Single payer health insurance.
10
Thank you for this informative article. As a cardiologist/electrophysiologist (unbelievably) I had no idea that the American Medical Association owns the copyright to the CPT code book. Please know that I get called no less than three times per day by the coders requesting that I up code a procedure or diagnosis. Sometimes I can and will but often they have imagined a scenario which is not feasible and I refuse. Having a broken leg and being immobile does not constituent paralysis and I therefore refused to up code which cost me (the electrophysiologist) a long lecture from the head coder!! When someone looks into that CPT code book copyright and deems it illegal--patients will have a better chance of being billed fairly.
11
I am a psychologist specializing in treating persons with complex medical illnesses. I see every explanation of benefits issued for my work for patients and I am very familiar with their cases as health care consumers.
This is just another example of how our health care non-system is a shameless patchwork of entrepreneurs focused on maximizing profits while holding the health and lives of America's citizenry hostage. A single-payor system is effectively in place for the millions who have Medicare, Medicaid, and veterans benefits. Extending it to the rest of the country would be a start.
But health care is not like other services and products and should not be treated as such. Charge as much as you can for a BMW, but not for emergency surgery or chemotherapy. When populist health care consumerism is allowed to predominate over the lobbyists of the world's largest cash cow, we will have an ethical and effective system that rewards providers of these goods and services well, but not lavishly. And perhaps medical bills will no longer be the greatest cause of bankruptcy in America.
And, who knows. perhaps caring for the health of our fellow Americans will once again become a calling worthy of respect rather than a tawdry system of hustlers and extortionists.
This is just another example of how our health care non-system is a shameless patchwork of entrepreneurs focused on maximizing profits while holding the health and lives of America's citizenry hostage. A single-payor system is effectively in place for the millions who have Medicare, Medicaid, and veterans benefits. Extending it to the rest of the country would be a start.
But health care is not like other services and products and should not be treated as such. Charge as much as you can for a BMW, but not for emergency surgery or chemotherapy. When populist health care consumerism is allowed to predominate over the lobbyists of the world's largest cash cow, we will have an ethical and effective system that rewards providers of these goods and services well, but not lavishly. And perhaps medical bills will no longer be the greatest cause of bankruptcy in America.
And, who knows. perhaps caring for the health of our fellow Americans will once again become a calling worthy of respect rather than a tawdry system of hustlers and extortionists.
8
Any other part of the economy which would operate in such an intransparent way would be out of business very quickly, either because of consumers switching to alternatives or because of legal enforcement of better practices. Even the Financial industry would fall into that category. Unfortunately, there is no real alternative unless we would seriously pursue better models such as the single payer system in Canada or the equivalent that many European countries have in place. The painful fact of the matter is that even though the US spends about 20% of GDP on health care the outcome in terms of life expectancy and overall population fitness is inferior by a wide margin versus those much cheaper and more efficient models abroad. But, who wants to seriously go after cost cuts in 20% of the economy? The annual GDP growth would in fact be negative if the United States tried to reduce overall health care cost by, let's say, 20% over a 2 to 3 year period (and still be the most expensive scheme in the world)
8
It's been a well-known racket for many, many decades. No remedy on the horizon - our political system is completely broken. Probably things will have to get worse (a lot worse) before they get better. Or, more likely, they still won't get better.
3
Want to make a start in reducing medical costs for consumers? Let both houses of congress pass a bill, and have the president sign it, that would make medical bills as clear as bills from credit card companies.
4
Wanda Wickizer needs to file a complaint concerning her credit score rating to the Consumer Financial Protection Bureau before President Donald Trump and his hard right Republican buddies weakens the agency to a Virginia Knauer like condescending uselessness! I believe that the CFPB has reached an agreement with the credit agencies that Mrs Wickizer's black marks be removed from credit reports.
7
The items in reference are court cases that have been settled out of court, paid-off or settled collection agency debts and the like.
1
Hospitals now spend much time on training clinicians to code "correctly" i.e. putting down the code that brings the most reimbursement. The problem is aggravated by the fact that many hospital administrators see their job as making as much money as possible for the hospital, and incidentally for themselves. The same approach permeates all aspects of health care, so even the most basic item of equipment is seen as an opportunity to make inflated profits. The doctors and nurses are as much victims as anyone in this business, and will be until the profit motive is made illegal.
7
The crime here is not the coding. It is the fact that hospital and doctors can bill patients amounts that have about zero relation to the actual costs of their medical treatment. And that the codes are not translated into meaningful descriptions on the bills. In no other activity would that be allowed.
8
We need to end predatory healthcare pricing. When you ask for the price for a particular service, the response should not be "Who is your insurer?" Coders, compliance officers have to be paid along with doctors and nurses in the current scheme. Multiple layers of administration justify their salaries. Sign the Change.org petition proposed by Steven I. Weissman "End Preditory Healthcare Pricing." Hospitals should be forced to publish a uniform price charged to all patients.
5
As a provider, I am disgusted with the current model of healthcare. I am consistently being ordered by unqualified personnel to deliver care to patients out of medical guidelines only to produce profit. I have had patient's complain about not getting certain tests because "they demand them". When stating my case vis a vis CDC guidelines, USPTF, and general screening standards, I am told, "I have to give them what they want". This is not about patient care anymore; this is about large greedy hospital systems squeezing as much money out of people as possible often leaving them with bills they cannot pay. This is not only disgusting but it is unethical and should be illegal. There is also this horrible concept of "customer service" permeating healthcare. We are now being measured and graded by corrupt organizations for how well we please our customers as if healthcare is some sort of machine or television. When will this country ever understand that healthcare is not a commodity? We are people; we are not gadgets. I look forward to retirement so that I can travel to another country to deliver the right kind of healthcare. Shame on the large hospital systems, Big Pharma, and insurance companies. They have effectively ruined healthcare in this country.
9
It is shocking that not only are patients are hit with incomprehensible and artificially inflated bills, our lawmakers allow them to sue us for those bills, very few of which we freely choose beforehand, forcing us into bankruptcy, and undermining our financial futures by ruining our credit records. Congress ought to outlaw punitive billing tactics in medical collection.
5
I think an aspect of US healthcare which is not widely recognized is that the amount actually paid by insurers can vary enormously for a particular healthcare service. There may be a list price for a particular service (defined by the CPT code) but the actual price paid is actually up for negotiation, on a fee-for-service or fee-for-value (capitated contract) basis. Individuals, on their own, will have no negotiating power in this model and will be asked to pay the list price. Insurers can pay far less. In a nutshell, having insurance in the US is not just about managing risk, it is also about reducing prices paid.
6
In most industries, billing and recording revenue is done by a small group of people at a relatively small cost. In a hospital like the one where I now work, it's done by an army of people at many times the cost of what it would be in almost any other industry. Coding correctly means trying to get the most out of every interaction - but it also means being in compliance with rules and regulations. The health care industry pooh-poohed technology for years and still lags, even with all the Epic implementations in the news. (I work on a seven year old refurbed desktop.) So it's not that surprising to me that trying to understand any financial part of medical care is so difficult. It is a rare health care institution that fully understands its financial structure, and without that understanding, it is difficult at best to run efficiently. (And the cost of billing, collecting, and recording revenue is only the start of what makes health care so expensive. There aren't enough characters available to get into that.)
Medicare and Medicaid truly do not cover the full cost of providing care. Nearly all of the patients seen at my employer are on one or both of those, and we lose money. I can see why the UVA Medical Center wouldn't want to accept a Medicare/Medicaid level of payment, but to repeatedly insist on the billed amount (essentially list price) is pretty gross.
Medicare and Medicaid truly do not cover the full cost of providing care. Nearly all of the patients seen at my employer are on one or both of those, and we lose money. I can see why the UVA Medical Center wouldn't want to accept a Medicare/Medicaid level of payment, but to repeatedly insist on the billed amount (essentially list price) is pretty gross.
4
This is a case where Medicare for all would have taken care of this woman. Everyone belongs and pays premiums; the government can negotiate costs, and the patient has only a reasonable amount to pay. Of course, hospitals and doctors won't like it much because it pays less, but it could eliminate this type of traumatic experience for Americans.
I applaud Ms. Wickizer for sticking with it and I wish her well!
I applaud Ms. Wickizer for sticking with it and I wish her well!
8
Thank you for reporting this example. I found out that a 30 minute visit to an ER for a couple of staples & rinsing out a head wound after a hiking mishap would cost me over $5,000. The negotiated rates are the key phrase in the smoke & mirror of insurers. Even though the BCBS plan claims it is "accepted anywhere", this is not true. It only means the hospital will treat you. Your bill will be with any negotiated rates, so it means you are walking in as if you did not have insurance.
Yes, Barton Memorial in Lake Tahoe does take Blue Cross, but NOT a Blue Cross policy from MICHIGAN.
The lack of transparency is criminal. No posting of costs, no details on bills. (When I called to complain, they offered a 20% discount if I paid the entire amount by Credit Card). Patients must demand more transparency from all of the middle men in our health care - doctors, hospitals, insurers.
Yes, Barton Memorial in Lake Tahoe does take Blue Cross, but NOT a Blue Cross policy from MICHIGAN.
The lack of transparency is criminal. No posting of costs, no details on bills. (When I called to complain, they offered a 20% discount if I paid the entire amount by Credit Card). Patients must demand more transparency from all of the middle men in our health care - doctors, hospitals, insurers.
7
Fact check from a primary care doctor - my reimbursement for a level 3 office visit is $58 not $175. The accusations about doctors in the article, that we check weight and listen to lungs to upcode, are inaccurate and ridiculous. Checking a patient's weight is part of their vital signs, which we use to determine things such as the dosing of medications, not to upcode an office visit. The same goes for listening to lungs. Listening to heart and lungs is part of any basic assessment of a patient, not an evil plot doctors have to steal patients money. I too wish there was a safety net that provided health care for this country. I am happy to do my job and try to provide the best care to my patients in a medical system that is dysfunctional and difficult. However, I am pushing 50, still paying off my medical school debt, like many of my colleagues, and drive an aging Honda Civic. I do not mind and know I have it better than most, but these type of unsubstantiated claims do get tiresome.
10
A few years ago, I went to the ER after falling and hitting my head very hard on concrete. Before they ran me through the CAT scan machine, I had to take a pregnancy test. It was nothing fancy; just the EPT stick that tests urine and is available for around $8 at your local drugstore. I was fully insured at the time, so I paid my $100 co-pay and went on my merry way (dignosis: vertigo).
A few days later, I received the Explanation of Benefits from the insurance company. The amount billed or the pregnancy test was $250. I called the insurance company to ask if they were really going to overpay for it. I was told it was none of my business.
A few days later, I received the Explanation of Benefits from the insurance company. The amount billed or the pregnancy test was $250. I called the insurance company to ask if they were really going to overpay for it. I was told it was none of my business.
4
15 years ago one of my employees died of Non-Hodgkin's Lymphoma. He was only 31 years old.
A lot of effort was made medically because he was so young and had a two year old child and it was very expensive.
A few months after he'd passed I received a telephone call from the hospital asking if he still worked here. I said, "no" The person said that they'd tried to call him and had left messages and the calls weren't returned. Mail was coming back "Return To Sender" and they wanted to know if I had his new address. I proceeded to give her the address and added the plot and grave number There was a moment of silence and she asked me if I was kidding. I said no and told her to give it up. "You've been paid over $150,000 by our insurance company and now you're looking to harangue him for another $90,000? Why don't you call the insurance and find out why you aren't being paid?
I had an easier time with GMAC. Lee had a term policy on the loan and Once I sent GMAC a copy of his death certificate we heard nothing more fro them.
The reason for calling me was that his wife couldn't deal with all the collection calls any more. They'd sold everything even the parrot and lived in a single wide trailer. There wasn't any more to give.
A lot of effort was made medically because he was so young and had a two year old child and it was very expensive.
A few months after he'd passed I received a telephone call from the hospital asking if he still worked here. I said, "no" The person said that they'd tried to call him and had left messages and the calls weren't returned. Mail was coming back "Return To Sender" and they wanted to know if I had his new address. I proceeded to give her the address and added the plot and grave number There was a moment of silence and she asked me if I was kidding. I said no and told her to give it up. "You've been paid over $150,000 by our insurance company and now you're looking to harangue him for another $90,000? Why don't you call the insurance and find out why you aren't being paid?
I had an easier time with GMAC. Lee had a term policy on the loan and Once I sent GMAC a copy of his death certificate we heard nothing more fro them.
The reason for calling me was that his wife couldn't deal with all the collection calls any more. They'd sold everything even the parrot and lived in a single wide trailer. There wasn't any more to give.
9
My dentist retired and a younger dentist bought the practice. After the first time I saw him, I received an accounting from my dental insurer with a couple of charges that were rejected. I looked up the codes online and realized that I never received the two coded procedures. I emailed the dentist's office manager to ask why those two procedures were included and would I have to pay for them since they never happened. The office manager said it was a mistake and I wouldn't be charged.
But what I realize is that they probably add extra procedures as normal procedure (perhaps to pay for the new practice?) and if the insurance pays for them, there are usually no questions from the patient. I won't be returning to this dentist.
But what I realize is that they probably add extra procedures as normal procedure (perhaps to pay for the new practice?) and if the insurance pays for them, there are usually no questions from the patient. I won't be returning to this dentist.
7
After I found a coding error ~ non emergency instead of emergency ~ I told the hospital the insurance I had would not cover the non emergency and my hospital stay had been an emergency. The error was theirs and I would not be paying the mistake. Afterwards they stopped demanding payment. I was lucky.
2
It is despicable the way the medical business is allowed to abuse its customers. Even in a non-emergency situation, it is impossible to get a price quote on a test or treatment. Providers, even in the same practice, may not take the same insurance or they may one week but not the next. The biggest scam of all, a hospital may be in a network, but the doctors in the emergency room don't belong to it and can hold up their victims for unconscionable amounts of money. This is criminal. Until there is a one payer system which sets the prices there will never be affordable care in the U.S. Now, even with Medicare, the doctors can scam the system by deliberately billing for a more expensive diagnosis and as they have done for a long time, charge for procedures that are never done.
35
I'm really sorry, but you just don't understand how the system works. I'm a physician and it wasn't until I was 3 or 4 years into practicing that I began to understand it. Here is how it seems to me (a physician's perspective)
1) As an 18 or 19 yo I decided to become a doctor. I knew I was sacrificing the next ten years of my life to rigorous life of med school and 90 our work weeks in residency, but it would be a gratifying job and a stable, manageable income.
2) During medical school and residency, my wife and I worked obscene hours and accrued a combined $700,00 of debt.
3) I finished residency with said back-breaking debt and found out I had to fund my own retirement and pay for malpractice and expensive disability insurance so that I could pay back my debt in case I got injured or otherwise incapacitated.
4) I love my job! It's so satisfying to help take part in the care of sick children and adults. Unfortunately, I have to work around 80 hours a week to pay for my life and debt. I have innumerable compliance measures dictated by bureaucrats. The exceptionally profitable insurance and pharmaceutical companies pay for lobbyists and fund political campaigns and dictate the terms of the game. Physicians don't have the time or money to fight back so we learn to play the game as best we can. But we know we don't really have any control.
Two of my friends committed suicide in the last 6 months. I wish there was a way to undo the system.
1) As an 18 or 19 yo I decided to become a doctor. I knew I was sacrificing the next ten years of my life to rigorous life of med school and 90 our work weeks in residency, but it would be a gratifying job and a stable, manageable income.
2) During medical school and residency, my wife and I worked obscene hours and accrued a combined $700,00 of debt.
3) I finished residency with said back-breaking debt and found out I had to fund my own retirement and pay for malpractice and expensive disability insurance so that I could pay back my debt in case I got injured or otherwise incapacitated.
4) I love my job! It's so satisfying to help take part in the care of sick children and adults. Unfortunately, I have to work around 80 hours a week to pay for my life and debt. I have innumerable compliance measures dictated by bureaucrats. The exceptionally profitable insurance and pharmaceutical companies pay for lobbyists and fund political campaigns and dictate the terms of the game. Physicians don't have the time or money to fight back so we learn to play the game as best we can. But we know we don't really have any control.
Two of my friends committed suicide in the last 6 months. I wish there was a way to undo the system.
That is so true but please don't go after the providers. It is NOT the providers that do this; rather it is the hospital systems who vested interest is in making profits. We the providers do not do that- we are simply the low people on the totem pole seeing patients.
5
Thank you for this article. Healthcare reimbursement truly is a coding war, and it's not fun to be a part of as a physician. My colleagues and I joke about the intricacies of the system we have to navigate, where the solution is to higher some more billing experts.
The best part was when a colleague (and fellow physician) was told by the "compliance department" that his job was not to see patients, but to write notes--the notes being the documentation that supports the billing.
The best part was when a colleague (and fellow physician) was told by the "compliance department" that his job was not to see patients, but to write notes--the notes being the documentation that supports the billing.
19
A good solution would be to incorporate medical coding education into providers' education, thereby holding providers themselves accountable for miscoding. Adding one minute to a 90 min chemo treatment simply for profitability purposes should be cause for challenging a provider's license.
11
It is NOT the provider's that do this- it is the greedy hospital systems and coders that they hire. Please do not blame the providers- blame the right people
7
i am a Canadian and understand why a single paying system without intermediaries(insurance companies) is the only logical system for healthcare.
I am also a physician and even though people critic our system nobody her will be put in the poor house because they are sick.People get the best treatment when they need it.
Those who think that health care should be market driven are deadly wrong.Health care is and should not be a buisiness but a right.It is not a commodity.
I am also a physician and even though people critic our system nobody her will be put in the poor house because they are sick.People get the best treatment when they need it.
Those who think that health care should be market driven are deadly wrong.Health care is and should not be a buisiness but a right.It is not a commodity.
50
Anyone who believes the complexity and obscurity of the US medical billing system is an accident, is extremely naive. This mechanism to obscure our bills' ridiculous inflation is deliberate, and represents the worse type of collusion between our government and the medical industry. This system was devised to disguise outrageous over-charging by medical providers (principally hospitals) so that those providers could recoup the massive costs associated with "uncompensated care". In other words, those indigent patients who don't even qualify for Medicaid support, yet who can not pay for their services - for which the hospitals were mandated to provide care for , since the Reagan-era legislation was passed. Hence, back in the '60's when those mandates were fashioned, the average American health consumer would have some extra charges buried within their bills - by inflating the individual charges for the services that patients received. Those relatively small inflated charges could be assumed by most health consumers, along with their bills for actual care. This was the way our government decided to keep those hospitals making enough profit (for their huge CEO salaries along with all their other expenses) and yet force those hospitals to care for all comers. This seemed to work fairly smoothly, although American health consumers began to groan about their escalating medical costs by the 1980's. Then came "open borders", and the costs became insurmountable for US consumers.
13
We have health insurance. While my husband was still feeling the effects of anesthesia, someone at Memorial Medical Center in Las Cruces, NM called and demanded he pay approximately $1300.00. Not being able to think clearly, and he was told before he was discharged not to sign any legal papers or make any major decisions for at least 24 hours, he gave the person our credit card number. Fortunately, I'm an attorney. I contacted the HMO and discovered the hospital could not, under the terms of our health insurance, demand this payment. Meanwhile my husband needed additional surgery. The hospital again tried to demand money from us. I told the person who demanded payment that the hospital was acting outside of the contract with the HMO and that we didn't owe them any money. We didn't have to pay that charge.
I insisted the $1300.00 be returned to us. Reluctantly, the hospital did so. When we received the hospital bill, the $1300.00 charge and refund wasn't listed. That was 9 years ago. I still don't know what the charge was for.
Since then, I've gotten my HMO on the phone and on speaker while negotiating payment with the person handling my paperwork for a procedure. I've called my HMO when a doctor bill was sent to me rather than to the HMO and asked the customer service representative to intervene. She did so and the bill disappeared. Fight back. Demand an accounting. File complaints with your state's Attorney General.
I insisted the $1300.00 be returned to us. Reluctantly, the hospital did so. When we received the hospital bill, the $1300.00 charge and refund wasn't listed. That was 9 years ago. I still don't know what the charge was for.
Since then, I've gotten my HMO on the phone and on speaker while negotiating payment with the person handling my paperwork for a procedure. I've called my HMO when a doctor bill was sent to me rather than to the HMO and asked the customer service representative to intervene. She did so and the bill disappeared. Fight back. Demand an accounting. File complaints with your state's Attorney General.
24
yes. Fight back. but you shouldn't have to . That's the point.
3
How can we get this engrossing article onto the desk of our new President?
(But wait. He doesn’t read much, so this piece might be too challenging…)
Maybe call it to the attention of the cunningly cruel Paul Ryan or Mr. McConnell et al?
But no, they’re too deeply devoted to the fuzzy math of trickle down economics and magical thinking about privatizing everything, whereby all is for sale, including the education and healthcare of their constituencies.
So our only hope is for the moderates on both sides to pull up their big boy pants and compromise to forge a bi-partisan plan for a Single Payer - at the least to begin a public dialogue on same. Business is very likely to LOVE the idea, as they’d no longer have to deal with the provision of health care to their employees. Think of the money they’ll save! (Their only consideration.)
(But wait. He doesn’t read much, so this piece might be too challenging…)
Maybe call it to the attention of the cunningly cruel Paul Ryan or Mr. McConnell et al?
But no, they’re too deeply devoted to the fuzzy math of trickle down economics and magical thinking about privatizing everything, whereby all is for sale, including the education and healthcare of their constituencies.
So our only hope is for the moderates on both sides to pull up their big boy pants and compromise to forge a bi-partisan plan for a Single Payer - at the least to begin a public dialogue on same. Business is very likely to LOVE the idea, as they’d no longer have to deal with the provision of health care to their employees. Think of the money they’ll save! (Their only consideration.)
14
Barbara - You want to get this article on the desk of the president - for help I would imagine. Then you insult the very person you want to help! Welcome to half the population that should get nothing but insults in return. Elections have consequences especially for those who still don't know that they lost hugely.
2
Maybe if you start treating him with some respect he might be amenable to some input from you. If somebody or group constantly criticized you as not literate or competent, would you seek input from them? I wouldn't.
1
He would deny that this ever happened through a tweet and that the NY times is liberal lying media! Right?????
2
Our lawmakers (who oppose the ACA regulations )say we will benefit from a "market based" system. That implies that the patient can negotiate with the provider BEFORE receiving treatment. This is rarely possible as this article shows. The patient looses all leverage once the treatment is performed. The next time you go t the Dr. ask him/her to tell you how much everything he does will cost you before he does it, from saying hello and shaking your hand to saying good by. My guess is it will be a short visit.
10
1 year after my mother had died from leukemia the hospital were still sending me for bills unpaid by Medicare. I wrote back once and they still sent me another one. This was also done after balance-billings were prohibited by recent laws. The lay person might have not know that.
For those who have not realize it yet, hospitals, or hospital chains are big business nowadays, eating a large chunk of or disposable national income. There is a lot of automation involved, worse now that medical coding and electronic record have reduced the personal interactions to "auto billing." Walmart went through a transformation similarly in the 80's being a global high volume purchaser and sellers. Hospitals are trying to do the same thing. Education is also on the chopping block becoming more privatized.
The big difference here is that Walmart is selling Twinkies while hospitals are selling doctors' services.
Most other countries understood the difference. Their civilization has learned from thousands of years of hurting each others. We are still on a learning curve.
The healthcare issue will test the limits of our Constitution.
For those who have not realize it yet, hospitals, or hospital chains are big business nowadays, eating a large chunk of or disposable national income. There is a lot of automation involved, worse now that medical coding and electronic record have reduced the personal interactions to "auto billing." Walmart went through a transformation similarly in the 80's being a global high volume purchaser and sellers. Hospitals are trying to do the same thing. Education is also on the chopping block becoming more privatized.
The big difference here is that Walmart is selling Twinkies while hospitals are selling doctors' services.
Most other countries understood the difference. Their civilization has learned from thousands of years of hurting each others. We are still on a learning curve.
The healthcare issue will test the limits of our Constitution.
14
If, indeed, "the medical center spent less than $60,000 treating Wickizer," I wonder how much the CEO and the executives of that hospital group were paid. My guess is it was millions of dollars. Someone has to pay them. And their stockholders demand ever-increasing share value, right?
Healthcare coding has become a racket run by the hospital/provider Mafia. We complain about oil cartels and bemoan drug cartels in other countries. Well, we have our own cartel right here. Our system is so broken it is like a pane of glass that has fallen many floors to the concrete surface below. It is not repairable; it must be replaced. But being paid what they are, the greedy CEO's of these health care facilities will fight tooth and nail against anything that diminishes their cushy jobs and power.
Healthcare coding has become a racket run by the hospital/provider Mafia. We complain about oil cartels and bemoan drug cartels in other countries. Well, we have our own cartel right here. Our system is so broken it is like a pane of glass that has fallen many floors to the concrete surface below. It is not repairable; it must be replaced. But being paid what they are, the greedy CEO's of these health care facilities will fight tooth and nail against anything that diminishes their cushy jobs and power.
25
Sounds like a functional Congress interested in protecting it's people is in dire need . . . Now, where are we going to find that?
1
Unfortunately my wife and I are familiar with the "coding scam" that is at the heart of this market/profit based system of medicine that shatters the lives of countless Americans annually. But this very useful article reveals even more than we had expected. The American system of secret billing codes lurking behind every mystifying medical bill is nothing more than a cover for theft. That oft-quoted line from the Hippocratic Oath, "first, do no harm" has been rendered meaningless by the blind pursuit of profit. It should be updated to say "first, do no harm, then destroy them with absurd and mysterious billing." Every American should be ashamed of what we have become.
20
This is why we need single payer healthcare. Once profit is removed from healthcare, costs fall into line
27
" Once profit is removed from health care,..." medical innovation stops.
5
But lots of innovations happen without regard to whether they are profitable. Many innovations arise out of simple curiosity. Do not underestimate the equally powerful rewards of publicity, honor, and recognition.
Your old bromide is offered to stop debate and maintain the status quo. That dog won't hunt. It's time to admit that the current for profit system is broken and start working on a solution.
Your old bromide is offered to stop debate and maintain the status quo. That dog won't hunt. It's time to admit that the current for profit system is broken and start working on a solution.
It hasn't stopped outside the US
1
Please also write about the experiences of people with insurance. I have never received an accurate initial bill. Errors are rampant and can take more than a year to resolve. And you can still be left with substantial charges even the most informed consumer could not have foreseen or prudently avoided. Articles focused on the horrible experiences of the uninsured are necessary but invite a flood of comments about personal responsibility and consequences of actions and "why should I have to pay?" The systemic problems encompass far more than a story that some find easy to dismiss with: They can't save your life for free.
13
Exactly right. And also true is that most patients don't need to leave the country to get the best care in this world. Capitalism (greed is the reason).
3
More and more people do leave the U.S. for medical procedures abroad, where the quality is as good, and a lot cheaper.
3
An elephant in the room in this story is the revelation about what all this talk of "coding" is about. So many bright kids who don't know what to do with themsleves with a university liberal arts degree and much debt to show for it are being lured into a host of speedy-mart "coding schools." This work is like factory piece work and requires skills that are the equivalent of rats reacting to falshing lights, buzzers and electric shocks. What else—anything creative?—do coders do? Sorting people into categories was what obedient dummies did to new arrivals on trains to the death camps. Are we to understand this as the answer to "Where are the jobs?"
4
I cannot believe that Wanda is still alive after going through the ordeal she was inflicted, not by the disease but the billings. We live in France a country nearly bankrupted by poor management .....But we cannot take away from it that it has the best Medicare (Assurance Maladie) in the world.
Is there a happy medium to this crucial health care problem?
Is there a happy medium to this crucial health care problem?
7
Melinda, I agree with you that everyone should have a right to healthcare. It is true that there are groups that take advantage of the system. But understand that even in the midst of having people that don't work, illegal immigrants and people who work lower-paying jobs--the system is still a problem. You cannot relegate the problems with healthcare to a particular group. Greed is greed and it is indiscriminate. Be careful not to make broad sweeping statements to justify what you perceive to be one truth. Do you honestly think that if that bill were sent to someone who was a billionaire that it would have been less, or, for that matter, detailed for their benefit???!! Abuse abounds, and everyone--the government, big business, big pharma and us-- as health care consumers and citizens of this great nation-- are to blame.
2
Should be required reading for the Freedom Caucus. However I know that would be a waste of time , because they can afford to be in a system like this.
How can a system that can turn you into a serf be good?
How can a system that can turn you into a serf be good?
3
It is about time that Doctors and hospitals were paid by the hour and the coding wars were made obsolete.
3
cant wait for that overtime!!!
2
All of you talking about how healthcare isn't free: Obviously.
The article is discussing how the billing is often corrupt and unintelligible, giving lie to the idea that we should all "shop around" as consumers for our healthcare, and thus the totally free-market will will make everything cheaper and more efficient. It hasn't yet--before the ACA--and it never will.
The article is discussing how the billing is often corrupt and unintelligible, giving lie to the idea that we should all "shop around" as consumers for our healthcare, and thus the totally free-market will will make everything cheaper and more efficient. It hasn't yet--before the ACA--and it never will.
7
I have family in Italy and travel there a few times a year to visit. Occasionally my cousin's husband who is a teacher of Greek and Latin has asked me to speak with his high school class of seniors regarding the United States of America. I always tell them that America is a wonderful place to live if you're extremely wealthy but if you're poor and middle-class you're much better off in Europe.
I'm hoping that out unstable & mentally unbalanced President Trump will be so angry with the right wing Freedom Caucus that he will do an about-face and start working on national health for all.
Coders in hospitals are as useful as coal miners in Kentucky. Let's get rid of both.
I'm hoping that out unstable & mentally unbalanced President Trump will be so angry with the right wing Freedom Caucus that he will do an about-face and start working on national health for all.
Coders in hospitals are as useful as coal miners in Kentucky. Let's get rid of both.
14
As a doctor who is in private practice and as a former hospital chief of staff, I understand the bigger pictures in medical billing and its pertinence to the current health care debate. Since care rendered in medical emergencies is government-mandated, too many folks think they won't have to pay. This lady chose to go uninsured and chose to put her children on Medicaid, rather than even having catastrophic insurance, a choice that strongly implies she expected others to pay. Trying to dodge personal responsibility is why the personal mandate was written into ObamaCare by the Democrats.
The notion that coding more expensively than is reasonable is why healthcare costs too much is wrong. Overcoding is now criminal and is why current Florida Gov R Scott lost his job as a hospital chain CEO. The Feds onerously enforce coding regulations as part of the Democrat ObamaCare Act.
Charges are higher than expected payments, way above what Medicare and insurers would pay for a different reason: lawyers want them that way so that where a lawsuit can exist, they can keep 40% and still give the litigant something.
A single payer system would deliberately starve health care as Trump now proposes for the National Institute of Health.
The notion that coding more expensively than is reasonable is why healthcare costs too much is wrong. Overcoding is now criminal and is why current Florida Gov R Scott lost his job as a hospital chain CEO. The Feds onerously enforce coding regulations as part of the Democrat ObamaCare Act.
Charges are higher than expected payments, way above what Medicare and insurers would pay for a different reason: lawyers want them that way so that where a lawsuit can exist, they can keep 40% and still give the litigant something.
A single payer system would deliberately starve health care as Trump now proposes for the National Institute of Health.
8
Of course, under the ACA, she herself would have been on Medicaid, so your point makes the case for keeping it.
10
The hospital charged this patient nearly 600% more than a patient with a "negotiated rate". My experience is that even being insured with Blue Cross does not mean that you will receive a negotiated rate for services from the provider. I was treated out of state, and the billing total was as if I had walked in without any insurance.
The negotiated rates are not revealed to the consumer or the insurance agent that sells you the policy. This means that the policy you have may really only be valid at certain hospitals, and in certain states, despite the ads "Accepted everywhere in US).
The negotiated rates are not revealed to the consumer or the insurance agent that sells you the policy. This means that the policy you have may really only be valid at certain hospitals, and in certain states, despite the ads "Accepted everywhere in US).
Who knew healthcare was so complicated?
8
Everyone who ever got a hospital bill of any kind! That's why some high-up's didn't get it.
8
Canada just announced that it will include all insured Americans within its national health system. Unfortunately today is April fools and this should be a good joke but it's a tragedy instead.
9
This article should be required reading for Congress.
10
In 2004 I took my late husband to the ER because of chest pain (he was 83 at the time). Within 40 minutes he was in surgery and having 4 stents placed. He spent 24 hours in the hospital. The surgery was successful and he had great care and lived another 10 years. But here's the clinker: About a month after discharge we received the hospital statement for a total of a bit over $72,000!
Each stent was itemized at $12,000. Medicare paid $15,000, so we paid 0.
The surgeons fees were separate and not unreasonable - it was the hospital bill that was horrifying!
Each stent was itemized at $12,000. Medicare paid $15,000, so we paid 0.
The surgeons fees were separate and not unreasonable - it was the hospital bill that was horrifying!
9
Medical billing for the uninsured needs to be regulated. The piece is tilted toward the consumer and that side of the argument is hard to ignore. But she has two houses and 100k in the bank. There is a responsibility to society here from the inividual that is not covered. When she could not "afford" insurance was she paying for cellular? cable tv? . How many cars and personal property did she have. This story needs to be told but is incomplete and "heartstring pulley". In my practice we have clients that cant "afford" insurance and have boats, trucks, 4 wheelers, ect. She took a risk and suffered, no doubt , and she should have some better protections. But also the idea of going with out insurance has consequences, she may have to sell her second house.
7
The hospital charged this patient nearly 600% more than a patient with a "negotiated rate". My experience is that even being insured with Blue Cross does not mean that you will receive a negotiated rate for services from the provider. I was treated out of state, and the billing total was as if I had walked in without any insurance.
The negotiated rates are not very revealed to the consumer or the insurance agent that sells you the policy. This means that the policy you have may really only be valid at certain hospitals, and in certain states, despite the ads "Accepted everywhere in US).
The negotiated rates are not very revealed to the consumer or the insurance agent that sells you the policy. This means that the policy you have may really only be valid at certain hospitals, and in certain states, despite the ads "Accepted everywhere in US).
3
She owns one house, which is rented out to pay the rent of the apartment she lives in, which is in a different city. This was/is a pretty common situation when people move, and can't sell the first house because real estate values tanked in the past decade.
3
If her kids qualified for Medicaid, she couldn't afford much of anything. Do you think a person shouldn't be able to have a phone or TV in order to not be gouged for 8 times what their illness cost? The doctors and hospital charged her that much more than her services cost them: That is a scandalous practice, and you should be embarrassed by your callous suggestion. Of course, you do refer to your "practice", so we probably see your perspective.
Back in 1971 when I was a Hospital Care Investigator (basically finding out if a patient was insured or completing a Medicaid application), I would also enter the ICD code. This was a small part of my job and no one was trained for it. Now, it takes trained professionals and computer technology to determine which of the many code possibilities will be entered. The more complex the system, the harder it is to uncover overcharging.
8
there must be some mistake here.
we're assured by many americans`, ad nauseum, that the american system is the pick of the litter compared to all those crazy socialist democracies.
my father paid the price for a lifetime of smoking and drinking and died 10 years ago a few months before his 79th birthday. he went to his family doctor who examinied him. he went for tests within a week and was at a specialists a week after that. he was beyond saving. after a few final at home so he could smoke, he checked himself into st. joseph's hospital in hamilton, ontrio where he died 33 days later. he had good care.
medical cost was zero. we paid for parking when we visited, a phone and TV for his room before ditching the tv when was unable to focus on it.
there are more than a few reasons to be happy you're weren't born in the usa. this is one of them.
we're assured by many americans`, ad nauseum, that the american system is the pick of the litter compared to all those crazy socialist democracies.
my father paid the price for a lifetime of smoking and drinking and died 10 years ago a few months before his 79th birthday. he went to his family doctor who examinied him. he went for tests within a week and was at a specialists a week after that. he was beyond saving. after a few final at home so he could smoke, he checked himself into st. joseph's hospital in hamilton, ontrio where he died 33 days later. he had good care.
medical cost was zero. we paid for parking when we visited, a phone and TV for his room before ditching the tv when was unable to focus on it.
there are more than a few reasons to be happy you're weren't born in the usa. this is one of them.
22
the hospital as predator.
nice system.
nice system.
13
The battle between the Hedge Fund Managers who own the Hospitals and the Hedge Fund Managers who invested in the Insurance Companies will never be settled because they are both making big bucks and can afford the lobbyists and and their highly paid Congressmen. Did anybody ever investigate the collusion between these Industries?
My Health Insurance provider gets my bills reduced approximately 70% and both the hospital and Insurer are just doing fine financially.
My Health Insurance provider gets my bills reduced approximately 70% and both the hospital and Insurer are just doing fine financially.
3
This is not the free market. This is a market manipulated by forces that the average person has no chance of comprehending. It's time for single payer.
12
I see a lot of calls for radical changes. However in reading the article it appears that what need is an accurate and legitimate bill.
Simply pass a law that allows consumers to see the true price of care.
As it stands right now , and was compounded by the aca medical providers are no longer allowed to give you the true cash price
Simply pass a law that allows consumers to see the true price of care.
As it stands right now , and was compounded by the aca medical providers are no longer allowed to give you the true cash price
4
great story - detailing how outrageously offensive the American healthcare system is to those of who live in free healthcare countries like Australia - do we look like commies to you ? - I don't think so.
Time for Americans to step up and say Enough of this price-gouging the poor.
Hmm - pity about that new President of yours - trying to do the opposite -
making American Great again - for rich people ...
Time for Americans to step up and say Enough of this price-gouging the poor.
Hmm - pity about that new President of yours - trying to do the opposite -
making American Great again - for rich people ...
5
This article is predictably melodramatic and one-sided. The resulting reader comments are similarly predictable.
UVA did not ask this pt to never seek their care or see any doctor until a life threatening emergency occurred that people with lesser training (EMTs) missed as food poisoning. Routine BP checks and meds could have prevented the entire emergency. But Americans can't stand to force a pt to pay for health insurance so they can avoid expensive emergencies - that's "unAmerican"...unless ur a Chevy. Americans r ok with requiring everyone to b licensed, registered, inspected, and insured if ur a car - but not if ur a person who wants to stay alive. That's like allowing this woman to not get her oil changed, tires rotated, or brakes checked, but then drive uninsured and cause a huge pile up when her brakes fail almost totaling the car...then blame the mechanic who gets her back on the road for being callous enough to charge her for resurrecting her junker. What would u all think if her accident killed a bus full of kids? What if her poor self care caused a SDH while driving a school bus? What if I remind u ur premiums go up to make up for her not paying for her own costs? Instead of paying for health insurance like u did, she chose a $100K rental investment, because she knew she would b able to get out of paying for healthcare.
UVA did not ask this pt to never seek their care or see any doctor until a life threatening emergency occurred that people with lesser training (EMTs) missed as food poisoning. Routine BP checks and meds could have prevented the entire emergency. But Americans can't stand to force a pt to pay for health insurance so they can avoid expensive emergencies - that's "unAmerican"...unless ur a Chevy. Americans r ok with requiring everyone to b licensed, registered, inspected, and insured if ur a car - but not if ur a person who wants to stay alive. That's like allowing this woman to not get her oil changed, tires rotated, or brakes checked, but then drive uninsured and cause a huge pile up when her brakes fail almost totaling the car...then blame the mechanic who gets her back on the road for being callous enough to charge her for resurrecting her junker. What would u all think if her accident killed a bus full of kids? What if her poor self care caused a SDH while driving a school bus? What if I remind u ur premiums go up to make up for her not paying for her own costs? Instead of paying for health insurance like u did, she chose a $100K rental investment, because she knew she would b able to get out of paying for healthcare.
5
The point is that she was prepared to pay for the care. But the bills were outrageous, and the explanations nonexistent. Yes, she did not have insurance, but she was not avoiding paying!
When medicine has all this overhead, from coders, stockholders, big CEO salaries, etc, the cost of care balloons. As to having to treat all comers whether they can pay or have insurance, that is a separate question from what happened in this story.
When medicine has all this overhead, from coders, stockholders, big CEO salaries, etc, the cost of care balloons. As to having to treat all comers whether they can pay or have insurance, that is a separate question from what happened in this story.
So you are blaming the victim here? Really? You think the hospital system is the victim? That's ridiculous. Did you really read the article to understand how much this woman was charged? Would you have paid that bill? She had her insurance dropped because her husband died. Is that her fault? Give me a break. This country is so wrong on how healthcare is delivered. Do you think it is ethical to put a lien on her home to go after a medical bill?
4
$325,000 billed for the $60,000 spent for medical treatment. What a stinking rip-off!
7
It's vital that you request a detailed, itemized statement so that you can analyze your own medical bills for inaccurate charges and unreasonable prices. Medical Billing Advocates of America finds that more than 80% of the medical bills they see contain errors that are costly to the patient.
4
If someone does not agree to a medical procedure then they should not have to pay for it. Doubly so if they're incapacitated and unable to make decisions.
I pay privately for dental care and always know in advance what an office visit, cleaning, X-ray, crown etc is going to cost before I schedule an appointment. Should be the same for medical care.
Emergency care where the patient can't make decisions should be publicly paid. However with ever more expensive technology providing ever more expensive and sophisticated options, limits will have to be set somewhere on the low side of infinity.
The political right is more focused on those limits, and a desire for wealth to mean private access to the more expensive technology. It would help if there was more open discussion of that dilemma.
I pay privately for dental care and always know in advance what an office visit, cleaning, X-ray, crown etc is going to cost before I schedule an appointment. Should be the same for medical care.
Emergency care where the patient can't make decisions should be publicly paid. However with ever more expensive technology providing ever more expensive and sophisticated options, limits will have to be set somewhere on the low side of infinity.
The political right is more focused on those limits, and a desire for wealth to mean private access to the more expensive technology. It would help if there was more open discussion of that dilemma.
3
the problem is 3rd party payer. see also college education.
4
A C-section plus a preemie for three weeks at ICU. Covered fully by the general health insurance. Total 30.000USD.
Bill only gets paid when codes are adequately used.
Then the mom was not allowed to work for 12 weeks. Husband and mom could stay home each seven months (or one ten, the other four - even together) and both get paid by the state up to 2000USD monthly each. Then both of them could stay home (unpaid) until kid turns three. Parent at home and kid insured via the partner. Jobs need to be kept vacant.
Our economy is thriving and we are no communists.
Just speechless how this human right to general health care can ever be questioned.
Bill only gets paid when codes are adequately used.
Then the mom was not allowed to work for 12 weeks. Husband and mom could stay home each seven months (or one ten, the other four - even together) and both get paid by the state up to 2000USD monthly each. Then both of them could stay home (unpaid) until kid turns three. Parent at home and kid insured via the partner. Jobs need to be kept vacant.
Our economy is thriving and we are no communists.
Just speechless how this human right to general health care can ever be questioned.
11
finally someone who understands the ICD and drg system. this system is also used to price drugs. as more expensive a day in the hospital becomes, as more drug companies can charge for drugs that shave off a day or a few hours, as long as the drg doesn't change.
the system encourages a simple behavior: diagnose high and treat low.
the system encourages a simple behavior: diagnose high and treat low.
2
My first mammogram bill was rejected by insurance though it was supposed to be covered. I could not get through on the phone to the lab who did the test and my insurance company and gynecologist would not help me. After a year of bills arriving that I didn't know what to do with and hours spent trying to get a human on the phone, I finallu talked to someonr who looked at my bill and said oh, you have been charged for tests on two right breasts.
5
We spend a lot of money paying people to "shuffle paper" relevant to our nations health care costs. It would be interesting to know the total cost of paper shuffling on a percentile basis.
As the late, great former Senator Everett Dirksen once said " a million here, a million there, after a while it adds up to real money".
As the late, great former Senator Everett Dirksen once said " a million here, a million there, after a while it adds up to real money".
4
A system can be designed to maximize profits or to maximize helping people. it cannot do both. It's really that simple.
4
Despite all the advances of modern science, our hospitals still rely on traditional methods: applying leeches.
5
This article elucidates several inconvenient truths. First, the United States does not have a health care system. A health care system is designed (usually by government) to deliver health care to patients. What we have instead is a medical-industrial complex. In the absence of design, it has evolved to maximize the wealth of its executives and shareholders, too often at the expense of patients. It's focused on money rather than patients, to the point where providing health care is called "medical loss."
Second, the corporations in the complex devote inordinate resources to fighting battles over money, deploying an army of coders and clerks as foot soldiers. Patients often are casualties in the crossfire, and not just financially. As anyone unfortunate enough to have been hospitalized knows, nurses are so busy entering data to support their employers' side of the battle that they can no longer adequately care for patients. Even if a patient has a full-time volunteer caregiver/advocate, the outcome can still be devastating or fatal.
Third, a "market-based" health care system is impossible when providers treat the price information necessary for "shopping" as secret strategic battle plans, and actual charges are deliberately encrypted. Reforms like the ACA can fix a few of the industry's most egregious failings, but our medical-industrial complex remains unsustainable and untenable. It's no surprise that every other country has rejected "market-based" health care.
Second, the corporations in the complex devote inordinate resources to fighting battles over money, deploying an army of coders and clerks as foot soldiers. Patients often are casualties in the crossfire, and not just financially. As anyone unfortunate enough to have been hospitalized knows, nurses are so busy entering data to support their employers' side of the battle that they can no longer adequately care for patients. Even if a patient has a full-time volunteer caregiver/advocate, the outcome can still be devastating or fatal.
Third, a "market-based" health care system is impossible when providers treat the price information necessary for "shopping" as secret strategic battle plans, and actual charges are deliberately encrypted. Reforms like the ACA can fix a few of the industry's most egregious failings, but our medical-industrial complex remains unsustainable and untenable. It's no surprise that every other country has rejected "market-based" health care.
12
I was born and raised in Wisconsin, but have lived here in New Zealand for the last four decades. All of my family lives in the USA. Give me 'socialised medicine' any day please. Unlike my family members I have never had to worry about the cost of having an accident or becoming sick (from a financial or a care perspective).
To all of the politicians and their brain washed constituents who rail against the guaranteed form of health care that I enjoy I have a simple message: wake up and smell the coffee. As this article so clearly outlines once you make it all about money, actual health comes so far down the line that it frequently just disappears.
Anyone who has ever wondered how the 'greatest' and richest nation on the planet can produce such appalling health statistics (in life expectency, maternal and neonatal morbidity/mortality, child health, etc.) only needs to understand that putting the profit motive over the population's health will mean that real people miss out.
If you really believe that free market principles work for health care I hope your lucky charm works too.
To all of the politicians and their brain washed constituents who rail against the guaranteed form of health care that I enjoy I have a simple message: wake up and smell the coffee. As this article so clearly outlines once you make it all about money, actual health comes so far down the line that it frequently just disappears.
Anyone who has ever wondered how the 'greatest' and richest nation on the planet can produce such appalling health statistics (in life expectency, maternal and neonatal morbidity/mortality, child health, etc.) only needs to understand that putting the profit motive over the population's health will mean that real people miss out.
If you really believe that free market principles work for health care I hope your lucky charm works too.
11
Why wont they just blame what it the real problem. Obamacare! Healthcare costs are rising fast but deductibles are skyrocketing. All of this so the first black president can say hey look I sent America into the poor house because I got people to say lets pass it to see what is in it.
Politicians especially Democrats are trying to get you dependent on the government instead of earning for yourself. Do you know why they do that. Because as long as you are dependent on the government you will always vote for the group that gives you the most free things.
Do you know another government that did that. Union of Soviet Socialist Republics. Do you know where they are now. They are no more.
Politicians especially Democrats are trying to get you dependent on the government instead of earning for yourself. Do you know why they do that. Because as long as you are dependent on the government you will always vote for the group that gives you the most free things.
Do you know another government that did that. Union of Soviet Socialist Republics. Do you know where they are now. They are no more.
the incident described has nothing to do with "Obamacare." The circumstances described occurred prior to full implementation of the ACA, so please gate your facts right before posting nonsense.
3
Why don't you find out what you are talking about before you post this kind of thing? Too much work? Obamacare had good intentions but was thwarted by the GOP, which wanted no changes in the system Pre-existing conditions not covered...fine with them. Big sums spent by insurers on things other than healthcare...so what. And on and on. Then John Roberts on the Supreme Court made it financially unsound. Obamacare intended to be a single payer type system, but was forced into what we got instead.
This was not communism coming to our country. What we have now is robber barons instead. Unfettered capitalism can cause just as much damage to the people of this country as communism. How tiresome that those who support the former are usually the least informed. Since when has anything that helped the people of this country automatically been socialistic or Joe Stalin just around the corner? Since ignorant people got hold of computers I guess.
This was not communism coming to our country. What we have now is robber barons instead. Unfettered capitalism can cause just as much damage to the people of this country as communism. How tiresome that those who support the former are usually the least informed. Since when has anything that helped the people of this country automatically been socialistic or Joe Stalin just around the corner? Since ignorant people got hold of computers I guess.
2
So now we know where thw Mafia went. This could all be stopped if doctors decided enough was enough. So the Gospel of Jesus Christ has no effect in the USA? It appears so.
2
This entire medical system is corrupt to its core. There should be free, single payer insurance for all with options to pay for extra fancy care (like private hospital rooms etc). Doctors should also not be forced to pay 300k for schooling thereby enforcing high prices. I say this as someone who maybe benefits from current system (in that my taxes might go up under single payer and my insurance is already good). I remember when I started out as an entrepreneur, the key objection was that "I would lose insurance." I was not only risking my time, other people's money; I was also risking my life. This bad systems kills innovation and it kills people.
5
My bad cough cost Medicare and my secondary insurance well over $1000. I recall when I was uninsured between jobs and went to a local emergency room fearing a heart attack that turned out to be a panic attack. It's not free, as people assume. They charged me more out-of- pocket for the blood test than they would have charged an insurance company that has a contract price.
1
Excellent, thorough, investigative reporting! Was in Toulouse, France, earlier this week and a couple we visited were positively glowing about the medical treatment they receive there (and the cost). It's certainly not because they have better doctors in France (my child is an American doctor, thank you very much), its's the system! I can hardly wait to send them a link to this article (at least we can brag about our journalism).
3
"Wickizer’s team of experts dissected the bills and negotiated with the hospital and its representatives at the law firm over its charges and coding strategies — just as insurers do behind the scenes on patients’ behalf."
Ms. Rosenthal shines a light on our depraved health care system. But she can't help her biases. The insurers don't work on patient's behalf. They work on their own behalf. The patients are caught in between. Many doctors are caught in between as well merely as helpless cogwheels. Healthcare is increasingly run by the payers and administrators.
Ms. Rosenthal shines a light on our depraved health care system. But she can't help her biases. The insurers don't work on patient's behalf. They work on their own behalf. The patients are caught in between. Many doctors are caught in between as well merely as helpless cogwheels. Healthcare is increasingly run by the payers and administrators.
2
It's unfortunate that healthcare legislation only seems to focus on the insurance side yet does little to address the healthcare industry as a whole. Who is the real villain, the insurance industry that tries to reign in cost, or the hospital, pharmaceutical companies, etc..?
I lean conservative but I do support medicare for all. It is the only way to reign in these absurd abuses by industry. Healthcare is a human right, not a luxury.
I lean conservative but I do support medicare for all. It is the only way to reign in these absurd abuses by industry. Healthcare is a human right, not a luxury.
3
The columnist does describe some unethical coding practices that unfortunately do happen. For the most part- most coders are extremely ethical and would not upcode unless specifically pushed to do so. I do agree that the uninsured should be able to apply the federal Medicare rates if they want to pay a hospital bill. This is one of the reasons the unisured should potentially be covered by (or be able to purchase) a (new) Medicare Part E product. This would create healthy competition in the marketplace. Over the last few years, I have worked on bills / coding and helped negotiate fair outcomes for friends. It is a tough thing to understand without an indepth understanding. Ms. Rosenthal does not spare the AMA regarding CPT.. CPT codes, the modification and creation of said codes produce a HUGE cash crop. Thank you .
4
As someone who works with codes at a hospital, I found this interesting. However, I'm confused on if she ever had to pay them. All it says here is the case was dismissed. That doesn't tell us if the hospital was found to be in violation or not...and I think they should've been. I work in healthcare and I fight for patients and if I'd been working on this, I'd have wanted to go after them. Does anyone know if this horrid hospital got away with this? If she paid those creeps? Ugh. I work in healthcare but I despise the system so much.
2
Just more evidence we need a transparent single payer system covering everyone.
4
It really makes me sick to read these stories. Yes, it's great that there are good people willing to volunteer their time and effort to help with medical bills, but we shouldn't have to need their help! USA is the only industrialized nation where people go bankrupt from being sick or injured. People shouldn't have to worry about paying the bills when they're fighting for their lives. What happened to the Hippocratic oath?
This article makes the insurance company sound like the good guys, but aren't they the ones that are making "coding" so lucrative? Our doctor's group recently notified us that the insurance companies made them stop offering the out-of-pocket option. It used to be that any office visit was charged $120 per visit if patients skipped the insurance company (still expensive by global standards) and paid out of pocket. We found out that when we paid through our insurance, we had to pay over $300 for the same visit until deductibles were met. So, who's making the big bucks here?
ACA was a correct step in the right direction, but we desperately need a REAL healthcare overhaul that gets us closer to the care and prices offered in other industrial countries.
This article makes the insurance company sound like the good guys, but aren't they the ones that are making "coding" so lucrative? Our doctor's group recently notified us that the insurance companies made them stop offering the out-of-pocket option. It used to be that any office visit was charged $120 per visit if patients skipped the insurance company (still expensive by global standards) and paid out of pocket. We found out that when we paid through our insurance, we had to pay over $300 for the same visit until deductibles were met. So, who's making the big bucks here?
ACA was a correct step in the right direction, but we desperately need a REAL healthcare overhaul that gets us closer to the care and prices offered in other industrial countries.
2
After 22 years with the same dental clinic, I left. The periodontist ordered a deep cleaning of three teeth. Work was to have been done by a hygienist without supervision by the periodontist, who would not have been in the same building at the time. I had the good sense to ask how much the cost would be: about $275 per tooth. Why you ask. Two reasons: Each tooth was in a different quadrant of my mouth and according to the ADA for insurance purposes, each quadrant is charged separately or so I'm told. But here's the kicker: each tooth would have cost $100 more than if a general dentist had ordered the work rather than the periodontist, even though the hygienist would be performing the work. The clinic refused to budge on the charges. I'm looking for a new dentist and periodontist.
Hey, this is America. We have a choice. Pay or die.
5
I live in a rural area. I recently drove a very sick friend to a cardiologist for a stress test. She was also scheduled for an echo cardiogram the following week. We asked, since the drive was almost an hour each way, and the long drive was very hard on her, why couldn't both tests be done at one visit? The response was that the insurance wouldn't pay for both procedures in one visit. This isn't health care. There is no mercy in such a system.
7
Elisabeth Rosenthal has been doing outstanding reporting on healthcare costs for several years now. I don't understand why she hasn't won a Pulitzer.
6
I had the bad fortune to have cancer but the good fortune to have it in Prague. I never saw a bill, and on top of excellent treatment was given three weeks in a medical spa to recuperate. i truly think that had I had this illness in the US, the anxiety over the bills would have finished me. What is wrong with us? We are here to love each other, not grind each other into the dirt.
3
This breaks my heart.
I am all for the republican dictum of personal responsibility , but either provide the costs upfront transparently, or ensure that emergency care doesn't drive people into bankruptcy. This story makes me ashamed to state I practice medicine
I am all for the republican dictum of personal responsibility , but either provide the costs upfront transparently, or ensure that emergency care doesn't drive people into bankruptcy. This story makes me ashamed to state I practice medicine
1
For everyone suggesting single-payer as the solution to our woes: The single-payer system we have now - Medicare - is the SOURCE of all of these complicated bills, because it was the first insurer to use the CPT/ICD coding system. HIPAA, when it passed in 1996, required that all the private insurers use the same billing system.
So if you think that "Medicare for all" will solve this problem, unfortunately it will not.
So if you think that "Medicare for all" will solve this problem, unfortunately it will not.
1
Single payer wouldn't be concerned with billing anyone.
3
As referenced, it is a "cat and mouse game" between payer (either Medicare or private) and provider which seeks to maximize revenues via coding. The bigger issue is "unaligned financial incentives" between payers and providers. While Medicare and Medicaid dictate packaged price rates for hospitals, private insurers' ability to negotiate is a function of local market competition, which is sorely lacking in many markets. Hence, the enormous variation in health procedure (and private health insurance) cost by market.
The bigger scam is that "non for profit" health system cartels can dictate private insurer pricing and methodology (i.e. refusal to accept Medicare DRG pricing with a multiple) in many markets due to lack of competition caused by massive vertical and horizontal consolidation--- "cartelization". Once the cartels acquire the physician practices (and physicians must "order" any test or procedure offered in a hospital) they drive referrals to the much higher priced hospital cartel (often at 200-400% the price of independent providers). Then the independents are forced out of business or into acquisition by the cartel. Oh, and after acquiring the physician practices, the cartels add a new, separate "facility overhead fee" for each professional service! That's known as "patient centric" and "clinically integrated care".
Only price controls at the provider level or trust busting of the cartels will control prices/costs.
The bigger scam is that "non for profit" health system cartels can dictate private insurer pricing and methodology (i.e. refusal to accept Medicare DRG pricing with a multiple) in many markets due to lack of competition caused by massive vertical and horizontal consolidation--- "cartelization". Once the cartels acquire the physician practices (and physicians must "order" any test or procedure offered in a hospital) they drive referrals to the much higher priced hospital cartel (often at 200-400% the price of independent providers). Then the independents are forced out of business or into acquisition by the cartel. Oh, and after acquiring the physician practices, the cartels add a new, separate "facility overhead fee" for each professional service! That's known as "patient centric" and "clinically integrated care".
Only price controls at the provider level or trust busting of the cartels will control prices/costs.
1
Now I understand why Americans voted for President Trump. This medical system is utterly ill and must be taken down completely, bevor a new and cost effective system can be installed.
Thank you for publishing this piece. The University of Virginia, and its doctors group, need to be publicly shamed for their actions in this case. Since we cannot count on our elected representatives to ensure that this conduct is illegal, a front page article in the New York Times may be the best recourse we peons have of getting a fair hearing from the rapacious hospitals and doctors.
2
It makes no sense for a hospital to demand more money from an uninsured person than from an insurance company that negoiated a low reimbursement with that hospital. It is unconscionable.
It is time for Medicare for all. I applaud Bernie Sanders and Elizabeth Warren for moving on this. AND, who in the house will take this on? Why do most Republicans come across as uncaring about the health and safety of its residents? A healthy US is a safer US. It's an investment with a very good ROI!
It is time for Medicare for all. I applaud Bernie Sanders and Elizabeth Warren for moving on this. AND, who in the house will take this on? Why do most Republicans come across as uncaring about the health and safety of its residents? A healthy US is a safer US. It's an investment with a very good ROI!
5
How can I get my hands on this code book? Seems like everyone should have a copy of this bible. I would love to see the coder's in action. Maybe take a few charts and give them to a handful of random coders and see the differences side by side.
3
In 2011 I visited a well-known clinic for some out patient testing. I had good insurance at the time and provided my insurance info during the visits, but for some reason the hospital thought I was uninsured. I received a bill for over $75,000, of course, with vague numbers and terms that made no sense. I knew my insurance would cover it, but I had a feeling the bill was padded, so I contacted the hospital and demanded detailed information on the bill, as well as proof that any billed services were actually rendered (send me my charts, and no, I'm not paying for them). I figured this is what any insurance company would require. They initially sent one or two pages of useless info, until I told them I was an attorney. Magically, I received a revised bill a few months later for less than half of what was initially billed. Then they realized I had insurance and the bill became even smaller. It looks like my insurance paid about 1/4 of what I was billed for in the first bill. This took months of phone calls and correspondence back and forth, wasting my time and money, and causing me significant stress when I was ill. If I had not been a lawyer who was willing and capable of fighting for myself, I would have been seriously ripped off. All I could think about was, what about the millions of elderly or disabled people who may not have the ability to advocate for themselves, or someone advocating for them? Our system is horribly broken.
13
As a recently retired physician I can attest that there are many things wrong with our health care system. Better transparency regarding cost for elective procedures as well the complications encounter at the hospital or by the physician would allow for consumers to make better choices.
The ICD-10 coding system is one of the worst things that has ever happened in medicine! There is nothing that causes more headache than when the coder would call and tell me I gave the patient the wrong diagnosis and billing. I would wonder what medical training they had to come to such conclusion. It was usual based on semantics and had nothing to do with the true delivery ( quality or time) spent saving a patients life. Or a patient would call complaining that lab studies were covered because the diagnosis (ICD-10 code) it because pneumonia was listed instead of bacterial pneumonia. Doctors were told that changing to the new coding system would improve patient care. Based on my experience and this article it's clear that coding is not for the patient's benefit but to drive profit.
The ICD-10 coding system is one of the worst things that has ever happened in medicine! There is nothing that causes more headache than when the coder would call and tell me I gave the patient the wrong diagnosis and billing. I would wonder what medical training they had to come to such conclusion. It was usual based on semantics and had nothing to do with the true delivery ( quality or time) spent saving a patients life. Or a patient would call complaining that lab studies were covered because the diagnosis (ICD-10 code) it because pneumonia was listed instead of bacterial pneumonia. Doctors were told that changing to the new coding system would improve patient care. Based on my experience and this article it's clear that coding is not for the patient's benefit but to drive profit.
5
The healthcare "market" does not meet the conditions for being a typical sector within the capitalist market. Healthcare pricing is opaque; within the context of a healthcare crisis, it is close to impossible to compare the costs and benefits proposed by various providers; within a good number of regions, one or very few providers exert near monopolistic control of the market; what competition there is does not effectively establish economic equilibrium among costs, profits, wages, etc. These deviations from capitalist norms were already evident before Obamacare, and cannot be attributed to the ACA alone.
Healthcare, it seems to me, is analogous to thirstcare. Would we really prefer that public water utilities be abolished and be replaced by competitive private water providers who would charge whatever the market will bear? Would thirstcare needs be better met if a variety of for-profit entities competed for our thirstcare dollars? Would the quest for short-term profits and shareholder value inevitably drive thirstcare costs, for individual consumers, right through the ceiling?
Healthcare, like a well regulated public utility, should provide service to everyone at a reasonable cost to each customer. That minimal cost, of course, must be sufficient to assure the continued operation of the utility and its growth to meet expanding needs.
Healthcare, it seems to me, is analogous to thirstcare. Would we really prefer that public water utilities be abolished and be replaced by competitive private water providers who would charge whatever the market will bear? Would thirstcare needs be better met if a variety of for-profit entities competed for our thirstcare dollars? Would the quest for short-term profits and shareholder value inevitably drive thirstcare costs, for individual consumers, right through the ceiling?
Healthcare, like a well regulated public utility, should provide service to everyone at a reasonable cost to each customer. That minimal cost, of course, must be sufficient to assure the continued operation of the utility and its growth to meet expanding needs.
2
So. Hm. While I agree in general principle about costs, obscurity of the bill, etc., I will say there is some factually incorrect information in this article (Ex. Costs are connected to HCPC codes via a fee schedule distributed by CMS at the end of the previous year. You can view 2017's here: https://tinyurl.com/kzpwx88). Most insurance companies have a contract w/ a provider to provide a % of that (often 20-30% lower.), but self pay has no such thing and as hospitals are private companies, they can charge what they want. Doctors are only taught ICD coding, not HCPC coding, and most can't really do what you're describing here. Billers can't either because *it's fraud*. IDK I don't have the space here to get into the rest of it, but this article is factually incorrect in places and misrepresentative in others. I don't really think that falsehoods contribute anything good to the conversation. The bad guys in healthcare are not the individuals who work in it, it's the insurance companies and desperately needed torte reform (which is the real culprit behind over testing and over prescribing.). You don't even mention the clearing houses, nor that most of the handling of claims is actually automated. Source: I'm a support rep for a piece of EMR/coding software used largely for prosthetic & orthotic offices. I spend my days helping confused billers (BTW coders are people who do dx coding and billers do HCPC Coding /billing.) with this.
1
If you believe medical malpractice suits are behind escalating medical costs, I have a bridge you may be interested in buying.
As far software coding programs go, I believe part of the ACA incentivized medical practices to upgrade their software, and in specific instance when my HCP installed their "upgrade" it took longer to print out my lab results than the "old system."
In addition, the company rep was there at the time and instructed the operator on the correct sequence of inputs required to print my report. Needless to say, the operator reached one step where she was instructed to "manually" copy a specific reference number and where this number should be entered. I asked the Instructor why any manual input was required as this increased the possibility of error; the company representative did not answer my question and was visibly perturbed. My point is, it seems the medical software coding was not subject to any minimal requirements.
Finally, as I wrote previously, physician groups formed to even the playing field on negotiating reimbursement rates from insurance companies.
As far software coding programs go, I believe part of the ACA incentivized medical practices to upgrade their software, and in specific instance when my HCP installed their "upgrade" it took longer to print out my lab results than the "old system."
In addition, the company rep was there at the time and instructed the operator on the correct sequence of inputs required to print my report. Needless to say, the operator reached one step where she was instructed to "manually" copy a specific reference number and where this number should be entered. I asked the Instructor why any manual input was required as this increased the possibility of error; the company representative did not answer my question and was visibly perturbed. My point is, it seems the medical software coding was not subject to any minimal requirements.
Finally, as I wrote previously, physician groups formed to even the playing field on negotiating reimbursement rates from insurance companies.
1
Single payer (government provided Meficare for all) is the only solution.
Sad.
Take a grateful patient and turn them against you, for what? Nothing, in this case it seems. The sick epilogue is that UVA (and many other "non-profits") will write off this "$500,000.00" bill and then add that to the sum of "uncompensated care" provided over the last year - a number inflated 5-10x to brainwash the public & inoculate the organization from accusations of greed and malfeasance. I'm a physician, and this $h!t nauseates me.
This is THE health care "moon shot" for anyone wanting to do something meaningful in the next 50 years. What good is it to cure the body, but crush the soul with financial ruin? Figure out how to encourage organizations compete for business based on value (quality/price). Michael Porter is a good starting point.
We need to remember while we may not all be physicians, administrators, insurers or health care providers, we will eventually ALL be patients.
Take a grateful patient and turn them against you, for what? Nothing, in this case it seems. The sick epilogue is that UVA (and many other "non-profits") will write off this "$500,000.00" bill and then add that to the sum of "uncompensated care" provided over the last year - a number inflated 5-10x to brainwash the public & inoculate the organization from accusations of greed and malfeasance. I'm a physician, and this $h!t nauseates me.
This is THE health care "moon shot" for anyone wanting to do something meaningful in the next 50 years. What good is it to cure the body, but crush the soul with financial ruin? Figure out how to encourage organizations compete for business based on value (quality/price). Michael Porter is a good starting point.
We need to remember while we may not all be physicians, administrators, insurers or health care providers, we will eventually ALL be patients.
2
Some people rob you with a gun.
Some with a fountain pen.
Acolytes of the twin shibboleths of the "free market" and "sanctity of contracts" completely lose sight of the basics of both when they incessantly chant those mantras.
Nowhere is that more obvious than in health care.
Basic principles of both "free markets" and "sanctity of contracts" are premised on fully informed and fully capable participants who not not under fraud or duress.
There can be no "meeting of the minds" which is presumed by basic contract law when one of the parties has no information.
There can be no "bargaining" for price which is presumed by the basic so-called "laws" of "supply and demand" of classic economics when one of the parties is far less informed than the other party.
The relationship between health care providers and patients in no way resembles the relationship between commodity merchants in the "marketplace".
To assert that those relationships are equivalent -- or even halfway similar --
is absurd and outrageous.
Medical need puts ordinary people in severe duress.
Health care providers -- including not only physicians but also hospitals -- are classic cases of fiduciaries.
Fiduciaries always ought to be required to put their patients' needs first,
above their own.
Moreover treatment is a highly technical matter about which ordinary patients have very little knowledge.
Any supposed "contract" signed by any patient in medical need ought to be considered ipso facto null and void.
Some with a fountain pen.
Acolytes of the twin shibboleths of the "free market" and "sanctity of contracts" completely lose sight of the basics of both when they incessantly chant those mantras.
Nowhere is that more obvious than in health care.
Basic principles of both "free markets" and "sanctity of contracts" are premised on fully informed and fully capable participants who not not under fraud or duress.
There can be no "meeting of the minds" which is presumed by basic contract law when one of the parties has no information.
There can be no "bargaining" for price which is presumed by the basic so-called "laws" of "supply and demand" of classic economics when one of the parties is far less informed than the other party.
The relationship between health care providers and patients in no way resembles the relationship between commodity merchants in the "marketplace".
To assert that those relationships are equivalent -- or even halfway similar --
is absurd and outrageous.
Medical need puts ordinary people in severe duress.
Health care providers -- including not only physicians but also hospitals -- are classic cases of fiduciaries.
Fiduciaries always ought to be required to put their patients' needs first,
above their own.
Moreover treatment is a highly technical matter about which ordinary patients have very little knowledge.
Any supposed "contract" signed by any patient in medical need ought to be considered ipso facto null and void.
1
Single payer system is one possible solution to avoid these problems.
While we are dreaming about the single payer system, how about mandating all the hospitals / medical care providers to provide us with a side-by-side comparison of how much they are going to charge me (with or without insurance) and how much they would have charged me if I had medicare.
As more people are beginning to read the medical bills line-by-line (including me), a nominal baseline comparison would create more awareness and hopefully enable us to question the whole hospital/insurance pricing strategy.
While we are dreaming about the single payer system, how about mandating all the hospitals / medical care providers to provide us with a side-by-side comparison of how much they are going to charge me (with or without insurance) and how much they would have charged me if I had medicare.
As more people are beginning to read the medical bills line-by-line (including me), a nominal baseline comparison would create more awareness and hopefully enable us to question the whole hospital/insurance pricing strategy.
2
Problem is they have a whole method to confuse, obfuscate, deceive and overcharge on Medicare.
Dear Americans. Please join the rest of the Western world and fund your healthcare system through general taxation. It can be done, as every other Western county can demonstrate, more cheaply and more humanely, than your current approach.
Your stats, particularly for pre and postnatal care, rival third world countries - shame on you! You are currently making insurance and drug companies, along with all the other hangers-on, very rich at the expense of your health.
Your stats, particularly for pre and postnatal care, rival third world countries - shame on you! You are currently making insurance and drug companies, along with all the other hangers-on, very rich at the expense of your health.
4
This article only begins to scratch the surface of the what our coding/reimbursement method does to medical care. Medical procedures are generally reimbursed very well. It is relatively easy to then set up an assembly line for epidural steroid injections, colonoscopy, cardiac catheterization, name your procedure. Even ordering an expensive imaging study or procedure allows a physician to document more complex "medical decision making" and potentially charge more.
What is not well reimbursed? Talking to a patient about lifestyle modifications, the nature of their ailment, explaining why an expensive imagining study or procedure is not needed and may even be harmful.
Physicians are human and even the most upstanding will be at the very least tempted by the pull of reimbursement. This pull has an effect that is far and wide from specialty choice (shortage of primary care), to location of practice, to time allotment of patient visits, to the nature of problems and patients that a physician is willing to see (gravitating to problems likely need a procedure, and patients who are less medically complex).
The ONLY way to change system is to change the reimbursement method.
What is not well reimbursed? Talking to a patient about lifestyle modifications, the nature of their ailment, explaining why an expensive imagining study or procedure is not needed and may even be harmful.
Physicians are human and even the most upstanding will be at the very least tempted by the pull of reimbursement. This pull has an effect that is far and wide from specialty choice (shortage of primary care), to location of practice, to time allotment of patient visits, to the nature of problems and patients that a physician is willing to see (gravitating to problems likely need a procedure, and patients who are less medically complex).
The ONLY way to change system is to change the reimbursement method.
1
I did insurance coding for our clinic and different insurance companies used different codes for the same procedure. It was not uncommon for the patient to receive a bill stating 'not covered due to coding errors'. Staff would then erase the original billing and recode the insurance bill with its own particular codes and then insurance would pay. Often we had to call the insurance company to learn the new coding procedure because they didn't inform us a head of time.
This takes time, increases frustration and requires a whole department of coders for large health centers. It is just 1 of the many reasons our healthcare is the most expensive in the world.
I also have experience in the Canadian healthcare system. Everyone has equal access and treatment for their medical care, there are some waiting lists but if you need life saving care re: cancer treatment......you get it now. Its not perfect but it costs a lot less and has better overall healthcare outcomes than our country.
This takes time, increases frustration and requires a whole department of coders for large health centers. It is just 1 of the many reasons our healthcare is the most expensive in the world.
I also have experience in the Canadian healthcare system. Everyone has equal access and treatment for their medical care, there are some waiting lists but if you need life saving care re: cancer treatment......you get it now. Its not perfect but it costs a lot less and has better overall healthcare outcomes than our country.
4
This seems like an area that is a hot spot for pattern recognition software. To identify when up coding occurs and who does it. If up coding becomes universal that would show an unexplained epidemiologic change.
Pattern Recognition (PR) can be deployed against treatment records. A medical coder that is constructing phony treatment records will have a certain "tell". Physicians don't know a priori what they treating that leads to a certain randomness in treatment. That's hard to fake.
Pattern Recognition (PR) can be deployed against treatment records. A medical coder that is constructing phony treatment records will have a certain "tell". Physicians don't know a priori what they treating that leads to a certain randomness in treatment. That's hard to fake.
Thanks god I'm in UK, the NHS Universal care takes care of it. Even though there are queues to see consultants , end of the day you won't burn your pockets
4
My husband and I are planning on leaving the USA for Europe. This horrible and barbaric health care system is the main reason. We were deeply traumatized by seeing a friend die in the most inhuman way; doctors and hospitals left his grieving widow swamped in debt.
We are not sick and we purchase insurance every year and yet we are having to fight every single thing we do: the yearly blood test, a regular visit to the OBGYN, an annual check up with our PCP; invariably, there comes a bill for us to pay that should have been billed to our insurance company, not once but many times over; we have to send the bills back and correct errors almost every time we use a health care service. Paul Krugman wrote in an article once that he thought Americans are less productive now because we spend too much time on social media. I don't agree with that assessment. We spend too much time fighting and negotiating health care bills on the phone and writing claims.
We are not sick and we purchase insurance every year and yet we are having to fight every single thing we do: the yearly blood test, a regular visit to the OBGYN, an annual check up with our PCP; invariably, there comes a bill for us to pay that should have been billed to our insurance company, not once but many times over; we have to send the bills back and correct errors almost every time we use a health care service. Paul Krugman wrote in an article once that he thought Americans are less productive now because we spend too much time on social media. I don't agree with that assessment. We spend too much time fighting and negotiating health care bills on the phone and writing claims.
6
Dear Republicans,
Why not try fixing this unholy mess?
Why not try fixing this unholy mess?
Bravo for Wanda Wickizer and her legal team. Ms. Wickizer and her advocates are on the side of the angels.
As for U. Va: For shame.
As for U. Va: For shame.
50
This article needs to be required reading in high school so the new generation of Americans realize right out of the blocks that your friendly saintly doctor is no saint and certainly not your friend.
67
Do you actually believe this is something doctors want? We don't understand or endorse the coding or complex billing any more than you do. I worked 93 hours last week, because that is the only way I can afford to maintain my practice, my life, and pay off my medical school debt. Then I get to read more and more people bad-mouthing doctors. Meanwhile Anthem Blue Cross cleared a billion dollars in profits last year. I am going to start going to college campuses and discouraging any young person from becoming a physician. It is ABSOLUTELY not worth it.
1
Doctors unfortunately have no control over the billing.
2
Doctors hate this more than anyone else. And when you treat a doctor like a used car salesman instead of trusting our experience and judgment you imperil your own health
2
Disturbing and I am a practicing physician. There is a theory of the burning platform. That theory is that it has to be on fire before people realize there is a problem. This platform... medical care...has been on fire for sometime. We the people have to rise up and DEMAND "Medicare" for all. Then we have to pay for it. We went to the moon in less than 10 years. We liberated Europe twice. We can do anything we want. Wake up and VOTE
204
Medicare for All (single payer) will wring a lot of the administrative waste out of our system, but not the profit. For that we have to get rid of "fee for service." Doctors should be salaried.
1
No, you are misinformed, a victim of the constant brainwashing by misinformation of the American Way. You did not 'liberate Europe twice', don't fool yourselves. The second WW was 'won' by Russia, if anyone could claim that.
I voted for Clinton for president and Teachout for Congress. I gave more money than I could afford for them and for many other Democratic candidates who all lost. I will continue to vote Democratic but will only give money to food pantries, humane societies, and other charities, not to political parties, even my own.
I expect that the trade schools will be telling people that if they take courses in coding they can mint their own money. Then when they graduate there will be coders from coast to coast, and they will be lucky if they can all get jobs flipping hamburgers. Remember when the fad was paralegals?
I expect that the trade schools will be telling people that if they take courses in coding they can mint their own money. Then when they graduate there will be coders from coast to coast, and they will be lucky if they can all get jobs flipping hamburgers. Remember when the fad was paralegals?
to paraphrase Upton Sinclair: "it is very hard to get someone to work on simplifying things when their salaries depend on it not being simple"
96
The reason we don't have a Single Payer System is because we are a capitalistic country and our politicians are beholden to insurance companies, hospitals and pharmaceutical companies- all of whom want to profit at the expense of the patients. Describing it in our president's words , "very sad !"
71
This article makes me sick! Single payer and put in place best practices where there's universal health care at a third to half our cost. No one should fear bankruptcy due to medical care.
69
You bankrupt your sick at their most vulnerable point in their lives. You're all heart America. Thank God for the Canadian Single-Payer Health Care, where I went through a similar experience as Wandas and NEVER SAW A BILL, never had to fill out or read any paperwork and just had to use my energy on healing and getting better. You are the only advanced country that treats its sick this way. I knew it was bad down there, but whoa!
168
Oh, but didn't you go to the USA when you needed an operation to get away from the waiting lists? That's what the conservatives all say, the USA conservatives that is.
2
The diagnostic codes are not the problem. The whole world uses ICD-9 and ICD-10 codes. They have nothing to do with rising costs. The real problem is the insurance companies themselves. Europeans don't have to deal with this arcane middle tier of service, put in place only to make a profit. Clinical coding is a great way to ensure clean data and can be used for public health reporting and quality improvement initiatives. This article is way off.
12
No health insurance in "Europe"?
Maybe not in the UK and a few other countries.
Must most of "Europe" has some kind of insurance, and most insurance plays a role in how much is paid and for what.
As for the UK and a few others -- those have truly "socialized" medicine -- and the providers -- including physicians -- learn to deal with the requirements of the system that pays them -- i.e. the government.
Some -- maybe many -- maybe too many -- American physicians and other health care providers have found a sweet spot where they can simply bill and bill without challenge and someone else can pay and pay.
Well, let them bill and bill, but to get paid, they need to be forced to compete with each other to find very wealthy patients or otherwise, for less-than-wealthy patients -- to deal with insurance companies or with the government.
The law needs to change to prevent them from trying to collect anything from ordinary patients without insurance other than charges calculated at Medicaid reimbursement rates. And that ought to apply to all providers, including hospitals, and including university hospitals.
Maybe not in the UK and a few other countries.
Must most of "Europe" has some kind of insurance, and most insurance plays a role in how much is paid and for what.
As for the UK and a few others -- those have truly "socialized" medicine -- and the providers -- including physicians -- learn to deal with the requirements of the system that pays them -- i.e. the government.
Some -- maybe many -- maybe too many -- American physicians and other health care providers have found a sweet spot where they can simply bill and bill without challenge and someone else can pay and pay.
Well, let them bill and bill, but to get paid, they need to be forced to compete with each other to find very wealthy patients or otherwise, for less-than-wealthy patients -- to deal with insurance companies or with the government.
The law needs to change to prevent them from trying to collect anything from ordinary patients without insurance other than charges calculated at Medicaid reimbursement rates. And that ought to apply to all providers, including hospitals, and including university hospitals.
12
Absolutely false. I ended up in the hospital in Nepal for 5 days with HAPE and my bill had a total of 2 codes. My insurance company here refused to reimburse me for the charges until the codes were changed into the American system by the hospital in Nepal. The hospital had no idea what I was talking about and literally could not do that, so I had to get an advocate. It was eventually resolved, My point is, coding is not universal as you states.
1
yes, most of Europe has non-profit insurance companies. There is more than one way to solve this, if the U.S. had the will.
1
Let's all remember, as we read through this terrifying article and comments, that standing in the way of making any progress at making healthcare more affordable and less terror prone in this country is a doctor, Dr. Tom Price, appointed by Donald Trump and warmly welcomed into his role by the American Medical Association, the largest association of physicians in the United States. Let's also remember that medical bills are the largest cause of bankruptcies in the United States--a national shame. Hospitals and physicians have become a cabal of profiteers that makes the Sicilian mafia and the Mexican drug cartels look like amateurs. It's time to start holding these "providers" accountable, and the best way to do that is through a single-payer system.
67
Please explain how single payer system will bring costs down. It will simply shift costs, but will not re-orient us to value-based care.
At one time medical practices were at the mercy of the insurance companies who dictated reimbursement rates to their network of providers. This practice led to a backlash from the medical community, which resulted in the near extinction of sole practitioners and the creation of monopolistic healthcare consortiums.
26
If health care providers want to get paid enough to live better than the average patient, they better get used to competing with each other for patients who have more financial resources than they themselves have.
If they want to be considered good-guy "white hats", they either need to be satisfied with less for themselves or conform to the requirements of those -- either the private insurance companies or the government -- who have both the financial resources to pay and also the technical savvy to negotiate and bargain on equal terms.
Every medical school ought to be required to post notices to that effect in big bold letters for all would-be applicants to read before embarking on a career that they imagine to be win-win -- both comfortable life-style and self-image as do-gooders.
If they want to be considered good-guy "white hats", they either need to be satisfied with less for themselves or conform to the requirements of those -- either the private insurance companies or the government -- who have both the financial resources to pay and also the technical savvy to negotiate and bargain on equal terms.
Every medical school ought to be required to post notices to that effect in big bold letters for all would-be applicants to read before embarking on a career that they imagine to be win-win -- both comfortable life-style and self-image as do-gooders.
Incredibly comprehensive article. My experience matches several of the injustices cited.
I just e-mailed Tom Price, the Secretary of DHHS, Speaker Paul Ryan, and the chairmen of both the House and Senate committees on Health Care, urging them to read the article.
As I often say "We don't have health care in this country. We have Health Insurance.".
I just e-mailed Tom Price, the Secretary of DHHS, Speaker Paul Ryan, and the chairmen of both the House and Senate committees on Health Care, urging them to read the article.
As I often say "We don't have health care in this country. We have Health Insurance.".
32
Tom Price is a Physician. He knows how the Health care system works.
What's needed is not repeal but Cost Control.
What's needed is not repeal but Cost Control.
8
Actually, most physicians know very little about how the system works - by their own admission. They aren't coders or billers and generally are only taught how to use ICD codes, which they hate because they hate EMRs. They have no idea how billing works for the most part, unless they're at a smaller practice where they've had to undertake doing their own billing. Most of them don't want to anyway though because it takes away from patients.
25
I stopping working in private practice partially for this reason. Not to mention the prior auths.
1
The system is a nightmare. Having (unluckily) had several encounters with the system which involved intensive emergent care, I can assure you that health care is NOT a "marketplace" where a consumer can "shop" knowledgeably and "choose." Yet Republicans insist that the healthcare market is a free market in the Adam Smith model where buyers and seller BOTH have full knowledge to make rational choice. That is nonsense.
Then, the patient-victim is faced with life-ruining costs. Goodbye retirement, college savings, a lifetime of responsible saving for middle-to upper middle class people.
By the way, that 20%, even with Medicare, can be ruinously expensive. How many people have $70,000 just lying around?
Then, the patient-victim is faced with life-ruining costs. Goodbye retirement, college savings, a lifetime of responsible saving for middle-to upper middle class people.
By the way, that 20%, even with Medicare, can be ruinously expensive. How many people have $70,000 just lying around?
70
Hospitals manipulate billing codes for a lot of other reasons besides increasing the bill. A lot of hospital safety rankings and infection rates are based on billing codes, so they train the billing clerks how to avoid using those codes if possible.
37
The application of free market economics to medical care is a fantasy that violates the fundamentals of this school of economic thought. First,what does the purchaser of the service e.g., open heart surgery, Know about the provider? In the real world, few if any patients have the knowledge or he all-important time to research the outcomes of the. nearest qualified hospital AND whatever surgeon will be operating on them. So, we have a "consumer " , as likely as not ignorant of the "service" they are "purchasing " most likely paid for by a third party (their health insurance) from providers about whom they, the buyers, may know nothing other than that the hosptal is close by and the surgeon is available to operate.
Nothing could be farther from a well informed consumer making an informed choice from equally qualified, transparently competitive sellers.
Competitive markets in health care is an economists dream and nothing more.
Nothing could be farther from a well informed consumer making an informed choice from equally qualified, transparently competitive sellers.
Competitive markets in health care is an economists dream and nothing more.
56
I would add the GOP pushes this same "competitive markets" fallacy as the answer to curtailing rising healthcare costs. The irony is the ACA, was in part, premised on the idea of "competitive markets" through the healthcare exchanges, which due to weak enforcement of the individual mandate led to a significant number of individuals foregoing health insurance until they actually needed it, and the companies did not have enough "healthy" individuals to offset their medical costs.
Very cogent analysis!
This is exactly what drives me round the bend every time I hear folks like Paul Ryan and their cronies go on about the sacrosanct nature of unlimited, unregulated patient "choice!" Buying medical insurance, let alone choosing a course of treatment, ain't the same thing as buying a new laptop or set of tires.
And only the most fortunate in U.S. society can enjoy unfettered choice in the health care they receive, the rest of us are boxed in by all sorts of constraints and complexities created by the various players in our health care system...
This is exactly what drives me round the bend every time I hear folks like Paul Ryan and their cronies go on about the sacrosanct nature of unlimited, unregulated patient "choice!" Buying medical insurance, let alone choosing a course of treatment, ain't the same thing as buying a new laptop or set of tires.
And only the most fortunate in U.S. society can enjoy unfettered choice in the health care they receive, the rest of us are boxed in by all sorts of constraints and complexities created by the various players in our health care system...
1
I suppose that the Times finally got tired of bashing Trump every day so now they decided to take on another of their favorite targets--how lousy hospitals and medical services are.
Let me try this again. Hospitals are a business. The hospital provided crucial life saving services to save this woman's life. But now the hospital is being crucified because -- horror of horrors -- the hospital wants to be paid for rendering those life saving services. I also thought that Obama care was supposed to magically fix our health care crisis by requiring everyone to have insurance. How come this woman still has no insurance after Obama care became law??
Hospitals are a business and like any other business we're going to bill you for services rendered. Hospitals have their own expenses to meet such as payroll and ordering supplies. Health care isn't a freebie here.
Let me try this again. Hospitals are a business. The hospital provided crucial life saving services to save this woman's life. But now the hospital is being crucified because -- horror of horrors -- the hospital wants to be paid for rendering those life saving services. I also thought that Obama care was supposed to magically fix our health care crisis by requiring everyone to have insurance. How come this woman still has no insurance after Obama care became law??
Hospitals are a business and like any other business we're going to bill you for services rendered. Hospitals have their own expenses to meet such as payroll and ordering supplies. Health care isn't a freebie here.
18
You're correct, healthcare is a business. And just like any business, a customer is entitled to see an itemized bill and dispute any charges for services that were not received. Herein lies the problem (and the point of the article): Hospitals severely overcharge patients, especially those who lack the time and resources necessary to fully understand their bills. Wickizer seems like an anomaly here; most uninsured people are not even aware of the complex coding structure behind their bills, and are stripped of all possessions or file for bankruptcy in order to pay these unfair charges. The hospital is not being "crucified" for asking for payment; it is being criticized for taking advantage of a recovering patient by more than quadrupling its actual cost (estimated $60,000, versus almost $300,000). Healthcare is a business. In the U.S., it's unethical business.
93
Yes, in this country, hospitals ARE a business. That's the problem!
52
But you fail to mention the hospital, and other providers, together appear to be gouging the client, and possibly through fraud. We are headed in this direction again with the Republican non-plan to replace what we have.
34
The biggest obstacle preventing the U.S. from having national health care is the fact that people not making much, not working at all or the millions here illegally with their large extended families expect health care for free.
Health care is not free. It costs money and the middle and upper class are sick of footing the bill for a significant part of the population. Everyone should pay a percentage of their salaries or entitlements to cover costs, both premiums and co-pays, of their family's medical/health care.
Access to health care is a right but everyone should participate. Health care & drug costs should be regulated. Until that happens, the system will remain broken.
Health care is not free. It costs money and the middle and upper class are sick of footing the bill for a significant part of the population. Everyone should pay a percentage of their salaries or entitlements to cover costs, both premiums and co-pays, of their family's medical/health care.
Access to health care is a right but everyone should participate. Health care & drug costs should be regulated. Until that happens, the system will remain broken.
39
Melinda, your final paragraph is right on the mark. The middle paragraph is also correct, i.e., everyone should pay taxes into a single payer system. But your first paragraph is a bit flawed. Yes, a lot of people simply don't make much money, or maybe no money at all, and they will thus pay less into the system than others. The flaw is in the last part of your sentence, citing the "millions" of illegals and their "extended families." Please don't blame these people for the system's woes.
22
You haven't actually checked any of your numbers, have you? Because lower income people actually pay a disproportionate amount of their salaries to taxes. You first paragraph is just patently untrue all around.
1
I actually don't think the mythical "other people" expect health care for free. We just want it to be affordable, and we want paying for it NOT to be an additional stress when we are already sick or recovering.
and hospitals get yo add 15% if they get a judgement plus late fees.
2
A potential problem with this article is that people might say, "Well, I'm insured, so this won't happen to me." The injustice suffered by Ms. Wickizer is terrible, but the bigger point of the article is that this is a huge source of cost to our country. Your headline correctly points this out. I'm concerned that people might not absorb this if they write off Ms. Wickizer's situation as someone else's problem.
22
You came close to saying the obvious: are current "system" employs an unneeded number --perhaps 20 million or so--workers who otherwise would have no jobs. The system must be inefficient, ineffective, and predatory to employ as many people as it does.
1
Of course, her problem and costs raises insurance premiums for everybody.
Once upon a time, I was recommended to a top NYC physician. When you at a 10:30 appointment, he saw you at 10:30. Not at 10:29, and not at 10:31. He had one person in his office. He didn't accept insurance, and charged a multiple of insurance reimbursement.
BUT he knew what he was doing, lab tests merely confirmed what he already knew, and he didn't deal with insurance companies.
Now, he's semi retired, accepts insurance, and I believe he and his receptionist spend half time with patients and half with insurance. Is it any wonder that top people won't deal with insurance companies, except as a hobby?
BUT he knew what he was doing, lab tests merely confirmed what he already knew, and he didn't deal with insurance companies.
Now, he's semi retired, accepts insurance, and I believe he and his receptionist spend half time with patients and half with insurance. Is it any wonder that top people won't deal with insurance companies, except as a hobby?
12
Totally spot on !
1
So basically, buying health insurance means you're retaining the coders and lawyers. There's no care in health"care"... just caveat.
12
My hospital charged me $4,800 for two pills to cure my bad migraine.
10
Did the pills "cure" the migraine or merely provide short-term pain relief?
3
Doctors don't really cure people. They dispense pills at $4,800 a pop and complain it isn't $6,000.
How did they determine it was a migraine? There is an old joke about a computer salesman who repaired a computer by banging it with a hammer and billed them for $5,000. The owners of the computer wanted an itemized statement. They got one: banging on computer, $5. Knowing how and where to bang, $4,995.
3
The expense to the consumer for these armies of specialists is not so much the cause as a symptom of a for-profit system. Similarly, that the "insurance companies and government seem always to be one step behind the guerilla tactics of the providers' coders" should be no surprise. Providers are merely successfully exploiting the system to earn a profit, which is the primary imperative of the free market system. The expense and inefficiency added to the health care system by the necessity of this medical coding "war" is a clear refutation of the ideology that the system needs more free market solutions.
12
I am certain most people who received medical care and the resulting Explanation of Benefits (EOB) they receive from their health insurance provider are already fully cognizant of the fact that deciphering medical bills is a practice in futility.
Moreover, I am guessing, based on the complexity of the medical industry’s billing practices, these same people who ever attempted to decipher their EOB and the corresponding medical bills is cognizant of the fact that this “administrative” medical function is one reason for the inflated cost of healthcare.
The aforementioned, notwithstanding the fact that the author stated the ACA had rendered “catastrophic care” obsolete, belies the fact that Ms. Wickizer’s medical emergency occurred prior to the full implementation of the ACA on January 1, 2014.
While Ms. Wickizer stated she left her job to ensure that her children had coverage under Medicaid, had the ACA been in effect during her medical emergency there is the possibility she would have remained employed and received coverage under the guarantee issue provisions of the ACA and received ACA tax premium subsidies.
I understand this article is about the complexities of medical coding, but an analysis of pre and post ACA costs would have been informative.
Moreover, I am guessing, based on the complexity of the medical industry’s billing practices, these same people who ever attempted to decipher their EOB and the corresponding medical bills is cognizant of the fact that this “administrative” medical function is one reason for the inflated cost of healthcare.
The aforementioned, notwithstanding the fact that the author stated the ACA had rendered “catastrophic care” obsolete, belies the fact that Ms. Wickizer’s medical emergency occurred prior to the full implementation of the ACA on January 1, 2014.
While Ms. Wickizer stated she left her job to ensure that her children had coverage under Medicaid, had the ACA been in effect during her medical emergency there is the possibility she would have remained employed and received coverage under the guarantee issue provisions of the ACA and received ACA tax premium subsidies.
I understand this article is about the complexities of medical coding, but an analysis of pre and post ACA costs would have been informative.
21
Terrific article. I am a Physician and I am constantly dealing with coding issues. It is essentially a computer game and in the end even as physicians we end up "gaming" the system. My software provides most of the codes and counts up the justifications for each code. But we keep having billing meetings where professional coders come in and tell us how to squeeze more codes out of our documentation. They also tell us new key phrases to include in our notes to avoid claim denials. For example, in documenting a review of systems at an appointment, the phrase "a 12 point review of systems was performed and all were negative" will trigger a requirement to list which 12 systems. Usually all 12 are not documented and the whole claim can be denied or the code decreased. However, listing one or two systems (e.g. heart OK, lungs OK) followed by "all other systems negative" will get full payment for a complete review. This is of course, absurd. Imagine the money we could save by getting rid of both coders and insurance reviewers.
63
Thanks for your candor, Dr. Seldon!
1
It takes an sverage of 3 physician letters with records submissions to get approval for a number of selected medications, treatments and tests - that's 3-4 hours of telephone, fax and paperwork for a hospital caseworker, and/or medical office manager or biller. Sometimes patient's are forced to wait for weeks. Insurance companies bank on people giving up and either paying out-of-pocket or not getting care at all. It's just another corporate insurance industry delay, delay, delay to avoid payment. We need stricter regulation on the health insurance corporations - they exist to provide care for people, not pad their pockets with our monthly premiums and bonus their CEO's for denying care to us on the dollars they pocketed. It's time for insurance industry reform that serves We The People, and not corporations!
36
We all know that there is a simple, three-word solution to this problem. Say it with me, people.
Single payer system.
That wasn't so hard, was it?
Single payer system.
That wasn't so hard, was it?
28
Single payer will certainly address the issue of American's becoming bankrupt over health care services they might received, but the "coding war" that goes on between providers and payers will continue on. It may be even worse in a single payer environment if care is being reimbursement at an overall lower rate. This will only drive incentive to further "optimize" coding or even over-code. Even with single payer, health systems are still businesses that need to manage their bottom line.
And what would you do with the insurance industry? Do you think they would voluntarily go out of business. Under Citizens United, they would fund to get any single payer proposal stopped. Until you resolve Citizens United, I don't see how single payer is possible, regardless of how desirable it would be.
I hope that I'm wrong.
I hope that I'm wrong.
oh my - Europeans do have an advantage over American patients, yes our health insurance is mandatory and paid by taxes and/or employer and employee contributions. The health systems have a scale of charges similar to the US coding system that is negotiated by the government with the insurance providers & hospitals and medical professionals. Everyone makes money, but since the healthcare is not for profit everyone wins.
If you are loaded or your employer feels that you are worth it you can buy additional 'private insurance' which gets you (i.e. in Germany) a single bed or two bed room with en suite facilities and the attention of the 'head of department' medic, And perhaps a newspaper delivered to your oom in the morning. Other than that, nursing care, food, equipment are the same for everyone..
I live in the UK and I am using the very efficient healthcare system here. The only flaw we have is that some procedures are over subscribed and require a wait -knee or hip replacements-, urgent care is happening as needed and there are certainly no death panels.
Had to have surgery and did not want to wait so I went home to Germany as a self payer. In all I paid less for a 5 day hospital stay, abdominal surgery, flight to Frankfurt and back than Mrs. Wickizer paid for anesthesia alone...
Its time America entered the 21st century & looked at universal health care- UK and Germany pay roughly 12% of GDP vs. US paying 17%.... Crazy to pay more for less
If you are loaded or your employer feels that you are worth it you can buy additional 'private insurance' which gets you (i.e. in Germany) a single bed or two bed room with en suite facilities and the attention of the 'head of department' medic, And perhaps a newspaper delivered to your oom in the morning. Other than that, nursing care, food, equipment are the same for everyone..
I live in the UK and I am using the very efficient healthcare system here. The only flaw we have is that some procedures are over subscribed and require a wait -knee or hip replacements-, urgent care is happening as needed and there are certainly no death panels.
Had to have surgery and did not want to wait so I went home to Germany as a self payer. In all I paid less for a 5 day hospital stay, abdominal surgery, flight to Frankfurt and back than Mrs. Wickizer paid for anesthesia alone...
Its time America entered the 21st century & looked at universal health care- UK and Germany pay roughly 12% of GDP vs. US paying 17%.... Crazy to pay more for less
44
What Bettina reports is so obvious, and so useful. The key, among the many succinct, easy-to-understand and important statements about the European health systems is that "Everyone makes money, but since the healthcare is not for profit everyone wins." There's the real issue, pain and simple. In the U.S. the healthcare industry is "for profit" and tied to "market competition" and "individual choice" arguments ad nauseam. In the "not for profit'" model, providers and insurers do get paid a reasonable amount, at however pre-negotiated charges with the national (gasp) "government." Is that "socialized medicine?" Call it that if one wants to use that term, but please remember (if you are against such as system for the U.S.) that the actual direct health providers and intermediary insurance administrators in the European health systems are mostly private sector professionals, insurance companies, etc. Yes, the "losers" if we also move to such as system over here would appear to be these same private providers who will be limited to what they can charge by the rates negotiated with the government single payer, but they will still make a fair profit. And, if we do this as a nation, my bet is that over time the percentage of GDP spent on health care will go down by roughly 50% of what that percentage is today.
9
"pain and simple." Exquisite typo.
6
I got really sick while studying in Hamburg, Germany- I was hospitalized twice totaling over two weeks in the hospital and I had a surgery. I had a private room and saw had the chief of surgery perform my surgery and had other top specialist doctors as well. The total cost was about 14k in euros. The total cost for outpatient surgery for a minor arm surgery I had was three times that cost. Something is very wrong with our system.
6
This article shows the real problem with the Affordable Care Act. It was and is successful at getting insurance coverage for people who would otherwise be unable to do so. However, it passed only because it did not address the deeper problems of the health care and insurance industries, which affect all of us. IMHO, it would not have been hated by so many people if its core programs benefitted all of us. That was the original spirit of Social Security, but we are no longer that smart.
52
The incident described occurred prior to full implementation of the ACA.
6
this happened BEFORE the ACA, which would have covered Ms. WIckizer along with her children.
1
This article clearly underscores why we will never have a single payer system in this country; the current system is designed to guarantee the profit margins of the insurance company. Once again, another reason why business and government are not the same - one has profit as it's primary goal and the other is health, welfare and safety. Decisions will be made accordingly. In the case of health care, we are all paying the price to ensure fat bonuses, returns and profits at the cost of our health and welfare.
Other countries have made healthcare work for all, we can too, if Congress only had the courage.
Other countries have made healthcare work for all, we can too, if Congress only had the courage.
26
Strangely enough, government employees, elected public servants and political appointees have free health insurance for life.
I'm sure glad I live in England. You get ill, you get taken to hospital, you get all the necessary treatment for however long it takes and all the follow-up treatment in rehabilitation units and at home, etc, etc, etc … And the whole thing is paid for from taxation. Sure, we have private hospitals, too, but when disaster strikes as quickly as in the article EVERYONE in the UK - Brit, visitor, tourist, whoever - goes straight to the NHS and never gets hassled for money during recovery or anytime after it. "No man is an island … "
23
And do you remember how the British was pilloried during the healthcare debate in 2010?
Now I know why my optometrist's office suddenly announced last year, after 10 years of my going there, that they needed to measure weight and blood pressure with eye exams. They gave an indecipherable explanation about it being part of high-quality care, and required for insurance purposes, dentists were going to start doing it too, etc. That sounded like bunk so I refused the extras, and they didn't look happy. Now I know that they probably got a new coder and were trying to up-code an eye exam and get more money for the same service. Short term: I have a new optometrist, and my dentist never asked to weigh me (pretty sure my teeth, at least, aren't too fat). Long term: single payer, please!
27
Any eye doctor and/or dentist who asks me to step on a scale will lose my business, end of story. It's bad enough to get weighed every single doctor's appointment, even if I saw them a month ago. Enough with that nonsense excuse about needing my weight for medication purposes since none of my doctors have used my weight to determine proper medication doses to begin with.
4
Also because if they don't and you have a blood pressure related eye problem they will be sued for not checking ...
Read T.R. Reids Book "Sick around the World" or watch http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/ In most if not all (except USA) Democracies the Medical Price is set for everyone either by the Government (Canada, UK) or the Private sector , (Germany and Japan). In addition to covering everyone, Joe pays the same price as Jane does even though they have a different insurers or providers. It is illegal to price otherwise. This is the main reason every other country pays half in terms of pct. of GDP in Medical Costs.
8
It seems to me that the writer is describing subdural hemorrhage, and not subarachnoid hemorrhage, which is much more serious and often fatal.
1
I think "death was imminent" is clearly synonymous with "often fatal."
5
It was a subarachnoid hemorrhage. It was very nearly fatal.
1
Have you ever heard of "coding boot camp"? It is/was where office personnel learned to bill for every conceivable item, individually. Imagine a restaurant charging for every drop of olive oil or grain of salt instead of the entire meal. All this is now handled by big billing companies as the article explains. My physician once said a good coder could raise billings by 10%, and an incomprehensible mess for everyone else. The AMA makes many millions putting out the new codes every year.
5
The provider-side of the healthcare equation is where healthcare reform needs to happen -- NOT insurance!
The issue has never been people not having access to healthcare in the USA. Rather, the issue has been that people cannot afford to use healthcare services in America. Forcing everyone to buy insurance doesn't fix this fundamental fact & flaw in our system. Until we fix this, our healthcare system will only serve the providers and insurance companies and not the actual patients.
The issue has never been people not having access to healthcare in the USA. Rather, the issue has been that people cannot afford to use healthcare services in America. Forcing everyone to buy insurance doesn't fix this fundamental fact & flaw in our system. Until we fix this, our healthcare system will only serve the providers and insurance companies and not the actual patients.
16
Many with duel citizenship have an advantage over natural born Americans for they can always go back to the 'old country' for procedures or retirement.
I'd like to retire someplace like Canada or where ever but it's highly doubtful that any country will receive a US citizen without multi-millions of money.
It starting to look more and more that my retirement plan is to go to prison.
At least I'd get medical care there. And food.
I'd like to retire someplace like Canada or where ever but it's highly doubtful that any country will receive a US citizen without multi-millions of money.
It starting to look more and more that my retirement plan is to go to prison.
At least I'd get medical care there. And food.
13
I'm planning to start a two-year medical coding program this fall. What would be the best way for me to become part of the solution, rather than part of the problem? Maybe becoming an advocate for people who've been given the shaft should be my goal.
10
No country for old people
22
The medical/insurance industry should provide up front estimates which are accountable to accurate final billings " well before" finalizing the methods and means of administering remedies!
Similar to car repair! After all in this "Jiffy Lube" health care provider system of visitations with a doctor being limited to 15 minutes maximum with each visit!
Similar to car repair! After all in this "Jiffy Lube" health care provider system of visitations with a doctor being limited to 15 minutes maximum with each visit!
6
Even if you are and MD and call and ask what benefits your patient has they say "send us the bill after you did the service and we will see "
Impossible !
Impossible !
Hospitals can look to the Mayo clinic as an example for reform. I recently had surgery there. My medical bills came to me, not in code, but readily decipherable English, line-item by line-item. I was able to see how much every catheter and pill cost. And although my procedure was intensive--requiring the skills of a cardiothoracic surgeon and a 3 day stay in the Mayo hospital--my bill came out to a clearly defined $65,000.
19
Has it occurred to you that $65,000 for three days including the "intensive" procedure is obscene?
A whole month in the best heart center in Germany, including an "intensive" procedure costs about the same.
A whole month in the best heart center in Germany, including an "intensive" procedure costs about the same.
25
As an attorney leach feeding on the system for years, I can confirm there is some merit to all this. However, as the saying goes, never ascribe to malice that which can be adequately ascribed to incompetence. When I began doing this work, I, too, was impressed with the apparent difficulty of the job of coding, with the complexities of the various coding paradigms noted, etc.
However, over time, I realized this was certainly not being treated in the medical industry as a highly prized skill set. I began to question my assumptions. Coding is not a well-compensated profession. With all due respect, it does not take a 4-year college degree to become a certified coder. A high school diploma can get you a job in coding, and a few night classes will lead to certification. Think of other office jobs that do not require a college education, and realize that medical coding is comparable to them.
In sum, as one well-respected hospital recently offered in response to an audit from the HHS Office of Inspector General, "It is well known that coding professionals often disagree on the interpretation and application of the ICD-9-CM Official Coding Guidelines. Coding subjectivity is further evidenced by the difference in coding errors identified by the OIG and those identified by the independent contractor engaged by the OIG." (report and response available at HHS OIG website).
However, over time, I realized this was certainly not being treated in the medical industry as a highly prized skill set. I began to question my assumptions. Coding is not a well-compensated profession. With all due respect, it does not take a 4-year college degree to become a certified coder. A high school diploma can get you a job in coding, and a few night classes will lead to certification. Think of other office jobs that do not require a college education, and realize that medical coding is comparable to them.
In sum, as one well-respected hospital recently offered in response to an audit from the HHS Office of Inspector General, "It is well known that coding professionals often disagree on the interpretation and application of the ICD-9-CM Official Coding Guidelines. Coding subjectivity is further evidenced by the difference in coding errors identified by the OIG and those identified by the independent contractor engaged by the OIG." (report and response available at HHS OIG website).
6
Disagreements and quality in coding are part of the issue. Hiding data and refusing transparency by hospitals and insurers is unethical and should be illegal. We are told to be informed consumers yet don't have access to info to do that. And fundamentally it is not realistic that we can take the time during an emergency to "shop around". Also care givers don't assume any responsibility in hospitals to ensure professionals are in- network. Consumers are disadvantaged at every. Single. Step. Of. The. Way.
17
I was sickened by this story as I compared it to another patient in another country.
My mother, at 79, had the same kind of brain bleed in her home south of London, England. The ambulance arrived within 3 minutes. She was taken to the closest hospital, unconscious. They assessed her and immediately transferred her to a major London hospital. 3 weeks later she was discharged with a walker, a daily nurse visit, and helpful equipment was installed in her bathroom. She recovered completely and now at 84 lives completed independently in the same house she has lived in for 30 years. She never received a bill of any kind; not for the ambulances, not for the hospitals and doctors, not for the nurse, not even for the home modifications. This is medical care under the NHS.
When will we treat our citizens as human beings here in the US, and recognize that healthcare is a fundamental human right and patients should not be viewed as another business opportunity?
My mother, at 79, had the same kind of brain bleed in her home south of London, England. The ambulance arrived within 3 minutes. She was taken to the closest hospital, unconscious. They assessed her and immediately transferred her to a major London hospital. 3 weeks later she was discharged with a walker, a daily nurse visit, and helpful equipment was installed in her bathroom. She recovered completely and now at 84 lives completed independently in the same house she has lived in for 30 years. She never received a bill of any kind; not for the ambulances, not for the hospitals and doctors, not for the nurse, not even for the home modifications. This is medical care under the NHS.
When will we treat our citizens as human beings here in the US, and recognize that healthcare is a fundamental human right and patients should not be viewed as another business opportunity?
99
If this doesn't scare the hell out of you it should. I worked in a trauma ICU for 20 years and this woman's situation could happen to anyone at any time. We need a better healthcare program in this country and Obamacare was a good start!
49
Two characteristics of a competitive market are (i) large number of buyers and sellers and (ii) "perfect information". The ACA incented hosptials to merge, acquire private physician practices and extend their services because their reimbursement rates are better than for the small, decentralized compeittors. It was unbelievabely ill informed. The second, "perfect information" is even more fundamental. Consumers cannot negotiate in advance (they think they insurance companies do that for them), and when you need them you are constrained by time and pain. The provider hospital exploit this with "trust us" billing, and this is what we get. Detailed billing, including codes, should be mandatory. The Justice Dept should prosecute hosptials for bogus billing. Mail fraud, racketeering, antitrust. Example. I have Blue Cross under ACA and need a physical therapist for severe back pain. My doc referred me to a physical therapist. Wanted a week for the appointment (and relief) and 10 minutes before my appt the secretary called to advise that (i) I have not met my 15k deductible and (ii) the NEGOTIATED RATE with Bluecross for today is $525. I pay 100% Some negotiated rate. The facility is hospital owned. Ambush billing only works when its opaque. And there is massive cost shifting by insurers and state governments. States allow these predators to feast on a few of us so that the state gets a better rate on its deals with the same facilites. Its incestuous.
13
A few criminal prosecutions for mail fraud would help.
And the insurance companies are not blameless. United Healthcare REFUSES to obey NYS laws on filling prescriptions for heir insureds. And the NYS Department of Financial Services is worse than useless, exchanging e-mails for months and then accepting an apology for a "mistake" when the company then insists on repeating. Ad infinitum.
Jail is probably the only answer that will reform the system.
And the insurance companies are not blameless. United Healthcare REFUSES to obey NYS laws on filling prescriptions for heir insureds. And the NYS Department of Financial Services is worse than useless, exchanging e-mails for months and then accepting an apology for a "mistake" when the company then insists on repeating. Ad infinitum.
Jail is probably the only answer that will reform the system.
9
*their insureds.
1
This is obscene. American business ingenuity run amok.
19
The uninsured patient should be charged less because they are paying in cash. Without the middle-man, there are fewer people to pay.
American Healthcare is the one economic marketplace that makes little sense, mostly because of bloated administrative costs and the lack of transparency.
American Healthcare is the one economic marketplace that makes little sense, mostly because of bloated administrative costs and the lack of transparency.
16
Who knew health care was so complicated? Only people who open their bills.
Pay them? If I do, I can't buy food. Any doctor who invites himself into my hospital room, then bills me, is SOL. My internist actually prefers that I eat occasionally. I don't do fast food or carry-out, as that's too expensive.
I may start using 1600 Penn as my billing address.
Pay them? If I do, I can't buy food. Any doctor who invites himself into my hospital room, then bills me, is SOL. My internist actually prefers that I eat occasionally. I don't do fast food or carry-out, as that's too expensive.
I may start using 1600 Penn as my billing address.
20
In my opinion, New York State already has a bill in place that can serve as model for the country on how to really change administrative waste and provide more accountability -- the New York Health Act. It passed in the Assembly by a 2 to 1 majority and now needs only 2 votes in the Senate.
According to Prof. Gerald Friedman, chair of UMass/Amherst Economics Dept., the New York Health Act would save $45 billion for New York State businesses and taxpayers, and save billions for upstate and rural counties. It would make health coverage accountable to the people of New York, and eliminate the insane amount of administrative costs for doctors and patients, as well as equally outrageous co-pays and deductibles.
This bill would protect the freedom of private practice, let you choose the best doctor and drug for yourself, and gives doctors more time to spend with their patients. It has a long list of supporters, including the New York State Nurses Association.
As a nation, we pay close to twice the amount for drugs and health care than other high-income countries, and I am mystified as to why we have such a blind spot to the inevitable -- universal health insurance under a single payer system.
The absolutely number 1, most admired Canadian according to a 2001 CBC poll is a politician -- Tommy Douglas, the so-called Canadian "Father of Medicare." Imagine that!
According to Prof. Gerald Friedman, chair of UMass/Amherst Economics Dept., the New York Health Act would save $45 billion for New York State businesses and taxpayers, and save billions for upstate and rural counties. It would make health coverage accountable to the people of New York, and eliminate the insane amount of administrative costs for doctors and patients, as well as equally outrageous co-pays and deductibles.
This bill would protect the freedom of private practice, let you choose the best doctor and drug for yourself, and gives doctors more time to spend with their patients. It has a long list of supporters, including the New York State Nurses Association.
As a nation, we pay close to twice the amount for drugs and health care than other high-income countries, and I am mystified as to why we have such a blind spot to the inevitable -- universal health insurance under a single payer system.
The absolutely number 1, most admired Canadian according to a 2001 CBC poll is a politician -- Tommy Douglas, the so-called Canadian "Father of Medicare." Imagine that!
12
I challenged my bill and the non-profit hospital sued me. In court, the hospital did not have to prove anything. The hospital brought one witness...someone who worked in the billing department who wasn't even employed by the hospital at the time I received services. She confirmed the amount listed on the bill and the judge ruled that I must pay it. He did not even allow my attorneys to speak. Instead, he said, "Take it to the Appeals Court." We did but the appeal's judge stated that she was reluctant to overturn the first judge's decision.
21
I also tried to contest a $1000 medical bill for an X-ray in court but the case was decided in favor of the hospital out of court after I sent in my pre trial statement. I now think twice before signing on the dotted line any payment agreement which is like signing a blank check.
"Not for profit" hospitals are another scam. When a not for profit claims they "give" millions of dollars in community and charity care it is a lie. They artificially raise the cost of the care and then write it off as bad debt. They often forget to inform people that charity care is part of their not for profit status. Then if you look at their real assets you find millions of dollars hidden in funds and accounts. They find ways to profit which is why the executives have multimillion dollar salary packages. Those executives aren't interested in healing they are interested in running a profitable business. Just look at our new Secretary of Health and Human Services. He's a vampire. Beware to of religious hospitals with bible quotes artfully painted on hospitals walls -- it's all marketing,folks, to the disadvantage of the most vulnerable people in our country. It is stealing, it is shameful and it is a disgrace.
36
Nice article - about time we started pulling the shades back on the business of medicine in the US - but I'm afraid you've missed the forest for the trees. Coding per se, and the battles between payers and providers over coding details, are not the real issues. That's only providers and payers working to maximize revenue and minimize expense. What is it about the American health care markets that leads to pricing practices where the least able to pay - the uninsured - are billed 400% the charge to the best insured?
In normal markets, competition generally serves to drive total cost down. The US health care markets are distorted by the bureaucratic requirements of Medicare and Medicaid, the 2 largest insurance providers in the US, with the unintended consequence that CMS has emerged as a giant price fixing scheme that drives prices ever upward.
Comments calling for a single payer system are half correct. The market based option, adopted by many European countries, of competitive, regulated, private insurance with mandated, subsidized participation, would also restore normal market forces. In other words, Obamacare for all!
Ironic (or pathetic) that conservative Republicans are so opposed.
In normal markets, competition generally serves to drive total cost down. The US health care markets are distorted by the bureaucratic requirements of Medicare and Medicaid, the 2 largest insurance providers in the US, with the unintended consequence that CMS has emerged as a giant price fixing scheme that drives prices ever upward.
Comments calling for a single payer system are half correct. The market based option, adopted by many European countries, of competitive, regulated, private insurance with mandated, subsidized participation, would also restore normal market forces. In other words, Obamacare for all!
Ironic (or pathetic) that conservative Republicans are so opposed.
17
This reads like a list of criminal activities by hospitals, insurers, and doctors. Choosing one procedure vs. another -- or adding tests and procedures that might provide few benefits because they provide higher or additional billables -- is theft, plain and simple.
Insurers are using a blizzard of obfuscating information to hide truth. Healthcare delivery and billing for such services are, indeed, very complicated. But they are NOT impossibly complicated. Solve the problem instead of building (and sending billions to!) an industry that profits from complexity. Eliminate intermediaries.
Responsibility for providing unambiguous, easy-to-understand, and complete descriptions of (a) services and (b) contractual responsibilities must be placed squarely on providers and insurers ... by law. Then let the free market work. But if healthcare providers and insurers find new ways to pervert that market, go to a single-payer system.
Great article!
Insurers are using a blizzard of obfuscating information to hide truth. Healthcare delivery and billing for such services are, indeed, very complicated. But they are NOT impossibly complicated. Solve the problem instead of building (and sending billions to!) an industry that profits from complexity. Eliminate intermediaries.
Responsibility for providing unambiguous, easy-to-understand, and complete descriptions of (a) services and (b) contractual responsibilities must be placed squarely on providers and insurers ... by law. Then let the free market work. But if healthcare providers and insurers find new ways to pervert that market, go to a single-payer system.
Great article!
4
When will we stop killing ourselves for profit? This article explains why we need a single payer system. We must remove the profit motive from healthcare. As it is now, it is far cheaper to die from preventable causes than to be "saved".
8
The REAL solution for corrupt healthcare system - in 3 sentences: https://www.centerforhealthjournalism.org/2017/03/21/betrayal-corrupt-co...
1
Is the CEO of this hospital still employed? The legal and admin costs associated with trying to collect these funds probably outweigh the charges. For an institution of this size and revenue base to risk their reputation in a NYT article rather than accept the generous offer of most of this patient's life savings is absurd. As health care costs shift to consumers they are going to need to improve their strategy.
12
Only in America will your health insurer kill you if your medical problem doesn't.
21
iam a physician myself and i can tell you honestly the hospital billing and income is the most opaque piece of data. the hospital must be required to disclose their cashflow like the corporations are....
24
As a business, the billing practice constitutes an unconscionable commercial practice. The victim, here the patient, is entitled to treble damages and attorney's fees.
6
Insurance companies are the reason health care costs so much.
8
One thing might be misleading. The author says that to code for a certain higher paying code, you have to meet certain exact definitions, e.g. "the heart was pumping less than 25%." However, in MANY circumstances, these exact definitions are NOT so perfectly written down anywhere - and certaintly not in the Intl Classification of Disease ICD, which largely just names disorders and assigns numbers. Therefore, in MANY circumstances, it is much more argumentative which code applies. This is an equally critical aspect of the issue. The author focuses on Hospital codes. However, there are three or four slightly different ways to code for some molecular tests, such as one of the most common, BRCA, with different local Medicare billing rules, such as prices can vary from about $900 to about $2700 just for a lab test! http://www.discoveriesinhealthpolicy.com/2017/03/how-to-quickly-explain-...
6
This is so depressing I wasn't able to finish reading it.
12
The only way to stop the deceptive billing and claims practice is to mandate clear disclosure and transparency of all costs. Hospitals, insurers, facilities and doctors must publish what they must be paid and will bill for consumers to see. No more inflated UCR billings with a settling somewhere below that after back room deals and collusion. Let consumers see what the charges are so they can make informed choices and costs will decrease. The ACA and the AHCA failed to do that, they only continue to pander to the insurance industry.
21
It takes quite a stretch of one's thinking to call this system "health care." Neither of those two words are true.
The current medical establishment monster doesn't focus on heath - illness and disease are the driving forces.
Care? HAH! The only thing cared about is $$$$$.
How very sad. I know that somewhere in the smoldering mess there are dedicated medical professionals who desperately want REAL health care, but they're tilting against the giant windmills of mega-hospitals, big pharma, and the insurance lobby.
When the only thing that matters is money, we all lose.
The current medical establishment monster doesn't focus on heath - illness and disease are the driving forces.
Care? HAH! The only thing cared about is $$$$$.
How very sad. I know that somewhere in the smoldering mess there are dedicated medical professionals who desperately want REAL health care, but they're tilting against the giant windmills of mega-hospitals, big pharma, and the insurance lobby.
When the only thing that matters is money, we all lose.
11
My blood boils. Is there a code for that?
26
R45.4, "anger and irritability"
5
Thank you for writing this piece. I worked in medical billing for a large hospital system, and was a Chiropractic consultant for both insurance companies and patients for a portion of my career and have understood this for years. If more Americans had a ring-side seat at the circus that is health care billing, they would realize why we pay so much in administrative costs for our care vs CMS programs such as Medicare. It is the job of the billing department to maximize reimbursement, and the hospital systems usually have the right people in place at the top to accomplish this. Fail to do so, and you lose your job. On the other hand, as an insurance adjuster, your job is to minimize reimbursement for and limit the use of procedures. This ongoing, expensive battle is indeed one of the main reasons administrative costs are so high on insurance plans and that our healthcare is now out of reach for so many.
23
You think this is bad? Go investigate how much hospitals charge for transfusing DONATED blood. I've seen bills in the 10,000 range - for a single transfusion.
Please NYT, keep the pressure up with articles like this until enough people are outraged (or embarrassed) enough to take action.
To put it in Republican-speak, any resulting decrease in the size of our healthcare bills due to public outrage would be the perfect example of "the market" working "just as it's supposed to".
Please NYT, keep the pressure up with articles like this until enough people are outraged (or embarrassed) enough to take action.
To put it in Republican-speak, any resulting decrease in the size of our healthcare bills due to public outrage would be the perfect example of "the market" working "just as it's supposed to".
25
Her only choice is to declare bankruptcy. This is pretty obvious and is a perfect example of why we need to abolish our for profit health care system and adopt Universal Health Care immediately. I cannot believe she offered up her retirement account and they refused it. She needs an attorney to settle this.
8
If you get all your money in federal checks (usually direct deposits), as happens on some disability retirements, let them sue. No one but the IRS can touch your money. Local police? State police? FBI? No. No. No.
Secret Service, cause it's US Treasury disbursements. Several heavily armed Secret Service Agents get the attention of bill collectors and attorneys, who should know better! They don't show their weapons unless they have no choice.
Of course, we DC locals learn to spot "soft clothes" Secret Service agents early in life.
Let folks sue. They usually write the bill down to something sensible.
Secret Service, cause it's US Treasury disbursements. Several heavily armed Secret Service Agents get the attention of bill collectors and attorneys, who should know better! They don't show their weapons unless they have no choice.
Of course, we DC locals learn to spot "soft clothes" Secret Service agents early in life.
Let folks sue. They usually write the bill down to something sensible.
6
This lack of transparency issue doesn't only affect emergency situations like the incident detailed in this article. Prices for the most routine procedures, for the insured, are completely unknowable ahead of time.
My wife and I are currently covered under a high-deductible insurance plan. We benefit (financially) from the HSA tax savings and lower premiums. However my wife wanted to 'keep her doctor', a specialist out of network, and called their practice about a routine screening. They demanded a 'facility fee' of nearly $1000 and would not quote a price for a standard procedure as they were not certain how it would get 'coded'. How exactly are we supposed to shop around if we don't even know the procedure/price ahead of time?
I am deeply skeptical of any 'free market' medicine plans the Speaker of the House has bandied about. I suspect he's never even tried to schedule his own appointment at a medical practice, let alone learn 'the codes' for even the most routine procedure. Is he even on a HDHP?
We are graduate-educated (read: able to navigate and research) and in a relatively high tax bracket (read: high earnings and getting richer off the backs of unhealthy impoverished). But how the heck are regular Americans going to do better for themselves with this Ryancare idea for higher deductibles until they fix the competition / transparency plaguing the system? The R's should realize this problem is sending our country to single-payer if they don't fix it soon.
My wife and I are currently covered under a high-deductible insurance plan. We benefit (financially) from the HSA tax savings and lower premiums. However my wife wanted to 'keep her doctor', a specialist out of network, and called their practice about a routine screening. They demanded a 'facility fee' of nearly $1000 and would not quote a price for a standard procedure as they were not certain how it would get 'coded'. How exactly are we supposed to shop around if we don't even know the procedure/price ahead of time?
I am deeply skeptical of any 'free market' medicine plans the Speaker of the House has bandied about. I suspect he's never even tried to schedule his own appointment at a medical practice, let alone learn 'the codes' for even the most routine procedure. Is he even on a HDHP?
We are graduate-educated (read: able to navigate and research) and in a relatively high tax bracket (read: high earnings and getting richer off the backs of unhealthy impoverished). But how the heck are regular Americans going to do better for themselves with this Ryancare idea for higher deductibles until they fix the competition / transparency plaguing the system? The R's should realize this problem is sending our country to single-payer if they don't fix it soon.
24
Trying to deal with insurance companies is a nightmare for a small healthcare provider like me, a psychologist. I could give you many examples but here's just one. Regence Blue Cross forces me to choose between seeing a client for 55 minutes or 38 minutes for psychotherapy. They pay me a whopping $7 more for a 55 minute session. And if I still honor my patient and my profession with the 55 minute session I must be prepared to prove it "medically necessary." In spite of the fact that psychotherapy is not a drain on the profits of insurance companies, and even though research shows that insureds who use psychotherapy are physically healthier, insurance companies hack away at the providers who can't fight back. There are multiple ways for these private companies to win (and healthcare loses). . .unless we just dispense with them altogether
21
You know what would be useful? Names. The names of the people at the University of Virginia hospital, the names of the people who code, the names of the people who bill. Get us their names. And addresses. And phone numbers.
10
Block the folks who call looking for money. The last call I got I explained I thought we had a deal: the doctor would write off the copay and I wouldn't report her to the State Board of Medicine for ethics violations and being simply wrong. (She knew she'd screwed up medically & ethically, which I've found to be unusual.)
I don't want to sue anyone. Litigation is a pain in the rear.
I don't want to sue anyone. Litigation is a pain in the rear.
3
Thus the insurance companies achieve their goal of scaring us away from utilizing their services. Even with decent Silver Plan coverage under the ACA, I rarely seek medical attention because I never know what random charges I may incur. It's a complete spin of the roulette wheel every time I see a doctor. Is this visit covered by the copay? Or will some random series of codes result in my owing hundreds of dollars for a procedure I didn't realize I needed or was given? No wonder I stay home and wait out each minor illness. The flip side of this is that I now walk into a doctor's appointment with, say, my son's orthopedist and say, "tell me what billing code I need to qualify for the custom orthotics he needs." No more discussion about diagnosis and best treatment options. It's all about the code, and it's a racket. This country needs single payer yesterday.
28
This fear of finding a costly illness may be a reason for "white coat syndrome", when patient's blood pressure goes up uncontrollably upon seeing his doctor.
3
This is why they passed Obamacare. To avoid these catastrophic bills. It isn't perfect, but it does help.
Having been in healthcare for 37 years, on both sides, clinical and administrative, I have seen the billing issues firsthand. I have experienced some myself. We try to make sense of what things will finally cost; but, like this article so deftly articulates, we are stymied. We don't know and cannot know until we get those bills. It has never made sense to me. It is fee for service, but with all the unbundling that goes on, it is a algorithm that even the experts do not fully understand. And it is all about maximizing profit.
And there are many mistakes, incorrect billing, etc. It will never be properly vetted by our government. At least with Obamacare, there are some protections.
Having been in healthcare for 37 years, on both sides, clinical and administrative, I have seen the billing issues firsthand. I have experienced some myself. We try to make sense of what things will finally cost; but, like this article so deftly articulates, we are stymied. We don't know and cannot know until we get those bills. It has never made sense to me. It is fee for service, but with all the unbundling that goes on, it is a algorithm that even the experts do not fully understand. And it is all about maximizing profit.
And there are many mistakes, incorrect billing, etc. It will never be properly vetted by our government. At least with Obamacare, there are some protections.
15
None of this is new. The medical mentality seems twenty percent care and eighty percent big business. What is not surprising (and disappointing) is that no one has addressed medical charges in the current debate. Example: Why is the VA the only agency that can negotiate drug prices.
8
One other reason for increasing costs - hospital executives pay. There is just not just CEO, there are CFO , CMO , other directors of various departments enough to fill an entire wing of a hospital. They typically earn much more than doctors and do not provide direct patient care.
16
I know someone who works billing reviews in a large hospital system. Every bill can be easily challenged. Even the bill creators are at a loss to explain their method and system of billing.
6
I challenged my bill and the non-profit hospital sued me. In court, the hospital did not have to prove anything. The hospital brought one witness...someone who worked in the billing department who wasn't even employed by the hospital at the time I received services. She confirmed the amount listed on the bill and the judge ruled that I must pay it. He did not even allow my attorneys to speak. Instead he said, "Take it to the Appeals Court." We did but the appeals judge stated that she was reluctant to overturn the first judge's decision.
3
Rosenthal's narrative blows holes in the current "the consumer must have skin inn the game" rationale for a market place mechanism for distributing medical care and paying for medical services. In the first place when she was only 51 when she went from "healthy, energetic" to catastrophically ill - an unpredictable and unlikely occurance. Thus it was "rational that she chose not to have insurance with her budget constraints. In the second place, when she became ill, she was in no position to shop around or choose among alternative providers, nor make trade offs between say, a regular ambulance and a helicopter. In the third place, had she or her family been mentally capable or wanted to cost shop, there would have been no way to anticipate or evaluate the mountain of charges (or any discounts) that were to be incurred. Fourthly, this was such a devastating, scary event that no one involved could have been in an emotional state where they could make rational economic choices or trade offs. The story of her bill reflects the bizarre structure of our health care financing system in which no participant can be a "rational economic actor."
28
Coding for hospital corporations, PhRMA, and HMO's, is karma for chameleons like Congress. The less we know the bigger the profit, the better the lie.
5
My wife was ill ten years ago.
Bills from doctors and hospitals mounted.
I placed them in a binder (most recent one first).
I quickly learned to distinguish between an EOB (a.k.a. Explanation of Benefits) and an actual bill requesting payment.
LESSON #1: never, never, never send a check in response to your EOB. In fact, every EOB proclaims > THIS IS NOT A BILL.
LESSON # 2: when I received the actual "bill," I wrote the check and then photocopied it on my copy of the "bill."
BTW, in the memo line on the check is wrote down "DOS 2-13-13." DOS = date-of-service. You should easily be able to find the DOS on the bill.
WHY? Because you get lots and lots of bills, and sometimes you become confused about which one you paid and which one now required issuing a check.
LESSON # 3: If you find it necessary to call the vendor regarding a request for payment, if you have the bill-with-copy-of-the-check in your hand, you can
proceed to politely inform the representative to the effect > "I mailed you a check dated 6-22-13 in the amount of $290." That information usually will shutdown the conversation. If there is any pushback from the person on the other end of the line, offer to send them a copy of the paid bill (including the photocopied check).
Bills from doctors and hospitals mounted.
I placed them in a binder (most recent one first).
I quickly learned to distinguish between an EOB (a.k.a. Explanation of Benefits) and an actual bill requesting payment.
LESSON #1: never, never, never send a check in response to your EOB. In fact, every EOB proclaims > THIS IS NOT A BILL.
LESSON # 2: when I received the actual "bill," I wrote the check and then photocopied it on my copy of the "bill."
BTW, in the memo line on the check is wrote down "DOS 2-13-13." DOS = date-of-service. You should easily be able to find the DOS on the bill.
WHY? Because you get lots and lots of bills, and sometimes you become confused about which one you paid and which one now required issuing a check.
LESSON # 3: If you find it necessary to call the vendor regarding a request for payment, if you have the bill-with-copy-of-the-check in your hand, you can
proceed to politely inform the representative to the effect > "I mailed you a check dated 6-22-13 in the amount of $290." That information usually will shutdown the conversation. If there is any pushback from the person on the other end of the line, offer to send them a copy of the paid bill (including the photocopied check).
15
Gee .. another day and another article about the insane U.S. health care system ...
10
Fabulous reporting and writing. I want everyone I know to read this. Thank you!
9
EXACTLY TRUE
As the treating physician, I once decided to check a number of my patients' hospital bills in minute detail. I looked at more than 15 records, because I was so upset after the first two or three.
In EVERY case I found egregious over-charging (NEVER under-charging).
Do we need single-payer universal coverage with GREAT OVERSIGHT of charges and reimbursements? You bet we do.
A physician MD
As the treating physician, I once decided to check a number of my patients' hospital bills in minute detail. I looked at more than 15 records, because I was so upset after the first two or three.
In EVERY case I found egregious over-charging (NEVER under-charging).
Do we need single-payer universal coverage with GREAT OVERSIGHT of charges and reimbursements? You bet we do.
A physician MD
42
Congratulations to you, a medical provider, for this opinion. Many of us laypeople are concerned that the American medical establishment fears the financial consequences of a single-payer system.
BTW, do you approve generally of the way Medicare is administered?
BTW, do you approve generally of the way Medicare is administered?
1
This is the sort of article that makes me apoplectic with rage.
While the malicious titans of the medical industrial complex construct an inscrutable code system to con Americans out of billions of dollars, a patient in a hospital is often given blankets as thick as tissue papers, incurs a tremenedous risk of infection (100,000 Americans die every year from infections contracted in the hospital) and may often receive too much radiation (A Dr. from the Mayo clinic was quoted in this paper as saying that CT scans, which emit as much as 500 times as much radiation as chest x ray, will give us an extra 25,000 cancer deaths a year).
I do, however, suggest a new code:
A CODE THAT TAKES INTO ACOUNT THE OUTCOME OF THE PATIENT'S treatment. As medicine is practiced, doctors can tinker and toy with your tortured body and leave you dead, but for each medical procedure they will reap a ton of green backs. Whether you live or die should have some impact on the bill.
While the malicious titans of the medical industrial complex construct an inscrutable code system to con Americans out of billions of dollars, a patient in a hospital is often given blankets as thick as tissue papers, incurs a tremenedous risk of infection (100,000 Americans die every year from infections contracted in the hospital) and may often receive too much radiation (A Dr. from the Mayo clinic was quoted in this paper as saying that CT scans, which emit as much as 500 times as much radiation as chest x ray, will give us an extra 25,000 cancer deaths a year).
I do, however, suggest a new code:
A CODE THAT TAKES INTO ACOUNT THE OUTCOME OF THE PATIENT'S treatment. As medicine is practiced, doctors can tinker and toy with your tortured body and leave you dead, but for each medical procedure they will reap a ton of green backs. Whether you live or die should have some impact on the bill.
16
This is an obscenity and a racket.
9
OUTRAGEOUS. That's the word that describes medical costs in the U.S. today.
A solution? Pressure, suggest, request that CONGRESS have the same rates as
we mere mortals, and have the delights and frustrations of paying these bills. Readers are directed to the NCCN (National Cancer Comprehensive Network)
for cancer treatments. When public figures have cancer, the media rarely reveal
the medications bring used. Examples: Jimmy Carter,, brain/melanoma; Beau
Biden, brain. Trump met some BIG PHARMA CEOs about a month ago
and has promised to lower sky high drug prices. Don't hold your breath.
BIG PHARMA is part of Wall Street and profit is king,
A solution? Pressure, suggest, request that CONGRESS have the same rates as
we mere mortals, and have the delights and frustrations of paying these bills. Readers are directed to the NCCN (National Cancer Comprehensive Network)
for cancer treatments. When public figures have cancer, the media rarely reveal
the medications bring used. Examples: Jimmy Carter,, brain/melanoma; Beau
Biden, brain. Trump met some BIG PHARMA CEOs about a month ago
and has promised to lower sky high drug prices. Don't hold your breath.
BIG PHARMA is part of Wall Street and profit is king,
7
Bravo. Terrific article. Horrific system. Complexity rules. Confusion is a profit center (as you can see from your cellphone bill). Articles like this are why I'm happy to be a NYT subscriber, but these physicians have subverted "first, do no harm."
How rich is rich enough?
How rich is rich enough?
6
Ok, health care in the US is badly, ridiculously broken. And the government won't fix it. I challenge our big thinkers and courageous entrepreneurs (the next Gates, Zuck, Bezos, Brin, Musk et al) to find a creative workaround. There's a huge opportunity here - provide reasonable healthcare at reasonable, predictable cost. People would flock to it and love you for it. So let's figure it out! Time for disruptive ideas.
9
What a wonderful graphic! The pill bottle is clever and apropos.
2
As an Australian who moved here over 25 years ago I am still astounded by the term 'medical bankruptcy'. It's a term I never heard or knew about in my 30 years living in Australia. It's tragic. The sooner you guys switch to a single payer system the better. My medicare premiums came put of everyones pay check. You get a card. When you need treatment you present the card and sign one form. That's it.
18
That is just too simple in the good ole US of A. We need complexity here so corrupt politicians can buy vacation homes.
5
The question should be: which national sickness care system has the lowest admin costs, and why?
The first answer is Taiwan, at just 2%:
https://en.m.wikipedia.org/wiki/Healthcare_in_Taiwan
The second answer is Taiwan's unique system:
http://www.npr.org/templates/story/story.php?storyId=89651916
The first answer is Taiwan, at just 2%:
https://en.m.wikipedia.org/wiki/Healthcare_in_Taiwan
The second answer is Taiwan's unique system:
http://www.npr.org/templates/story/story.php?storyId=89651916
6
And the Republicans want "free market" solutions to health care! You can't have a free market without transparent pricing. Medicare for all!
20
Case in point-
I am a healthy 59 year old woman who had both hips replaced in the past year(9 months apart).
Same doctor,hospital,epidural vs general and a 24 hour stay in hospital the 2nd time vs 48 hours the first.
1st hip-$82,000
2nd hip-$185,000
I called the hospital to get a breakout of costs but never received it.
Insurance covered all but $4,000 of it BUT I am shocked by the disparity. Insane.
I am a healthy 59 year old woman who had both hips replaced in the past year(9 months apart).
Same doctor,hospital,epidural vs general and a 24 hour stay in hospital the 2nd time vs 48 hours the first.
1st hip-$82,000
2nd hip-$185,000
I called the hospital to get a breakout of costs but never received it.
Insurance covered all but $4,000 of it BUT I am shocked by the disparity. Insane.
146
That should be investigated. I would call a local news station to dig into the disparity in those bills.
3
from the article and deserves to be read again and again
Studies have shown that hospitals charge patients who are uninsured or self-pay 2.5 times more than they charge those covered by health insurance (who are billed negotiated rates) and three times more than the amount allowed by Medicare.
Dental even worse.
Studies have shown that hospitals charge patients who are uninsured or self-pay 2.5 times more than they charge those covered by health insurance (who are billed negotiated rates) and three times more than the amount allowed by Medicare.
Dental even worse.
5
That is wild! I have heard it is virtually impossible to get a breakdown of bills, even for people who work in the medical profession themselves. That's why all this talk of the "free market" and "shopping around" related to health care is meaningless. How can either work if you can't get any information about cost as it relates to what you receive?
3
Let's call this by its real name: racketeering. The disgraceful dishonesty of this hostage racket is enough to sink this society.
18
The EMTS didn't take her to the hospital? Negligence? Would she have required less expensive care and a shorter hospitalization if her condition had been diagnosed sooner? Law suit?
7
Two words. Single payer.
22
So there's still a whole bunch of people in this country who think anything in the NY Times is fake news, that's almost as sick as our medical system. Obamacare has at the very least brought light into this disease of our medical system. We need to get rid of our fake governemt that took power this year and get some people in Congress who will cure this disease.
7
Everyone should live in fear of the healthcare shakedown.
4
Another depressing article. Makes me glad I'm getting closer to retirement every day.
3
I've been a doctor for 25 years, and thought i understood how this worked. This system is so broken and dysfunctional I want to puke.
11
Not sure whether this commenter is serious or just serving up a softball, but ...
"So why can't the government negotiate prices for all of us? Why do so many Americans have to suffer?"
Because the previous administration agreed NOT to negotiate prices with drug companies, in exchange for their commitment to stop opposing Obamacare. It was heavily publicized at the time.
"So why can't the government negotiate prices for all of us? Why do so many Americans have to suffer?"
Because the previous administration agreed NOT to negotiate prices with drug companies, in exchange for their commitment to stop opposing Obamacare. It was heavily publicized at the time.
8
Well , thank you for the lucid article highlighting these monopolistic pricing practices . It is certainly not fair to our citizens who do not fully participate in employer or other group health insurance plans , in fact it seems abusive . With 18% of our GDP consumed by healthcare , one must assume this accounts for a significant unproductive 3-4 % . Perhaps a good " 60 Minutes" topic . I am becoming a fan of single payer / price reviewer for all .
7
This article has been written and replayed exactly the same over the last 50 years, if not more. It's one of the many "So it never happens again" happening again and again and again.
6
I'm a cardiologist in Australia. We have a single payer system, and also Health insurance as an extra. I find this sort of story astounding. We provide worlds best practice at no extra cost to a patient. You can have a heart transplant for free.Health care is considered an essential service just like you have the right to own a gun ;)
Reform your system. This is crazy. You pay twice what the rest of the world pays, but have worse outcomes and many uninsured.
Reform your system. This is crazy. You pay twice what the rest of the world pays, but have worse outcomes and many uninsured.
33
Most Americans agree with you. The reason why it doesn't happen is that we no longer have a government that represents most Americans. They represent their lobbyists.
And yet, incredibly, people continue to vote for Republicans.
3
Terrifying. That whole procedure is completely free anywhere else in the world, including the helicopter and later treatment for life, and for everyone. You just have to call 911 and that's it.
5
Not free - it is paid for by much higher tax rates.
4
Prescription drug advertising has the US media so strung out that stories like this are as rare as hen's teeth.
7
The disaster we are in right now is due to the fact that health care is for profit in the US. As it is for all companies the ultimate goal is maximizing of profit. Excellent halthcare and the patient care become the instruments but are not the end goal. Maximal profit can only be reached by minimizing cost in this case treatment and patient care. A for profit healthcare system will always be a disaster no matter in what shade it comes in. Does it have to be single payer? No, there are systems using non profit insurance companies with the government as the mediator between insurance, physicians/hospitals, and patients in other countries. We just need to keep an open mind.
3
An anecdote:
I was living in London when a friend of my girl friend showed up one Sunday night with a high fever. We rushed him to the local hospital. The ER was dark and dinghy and empty. There was a widow with a woman behind it. We were sent to an examining room and in a minute a doctor showed up. He treated my friend and handed us two prescriptions. He said the pharmacy was around the corner.
I handed the pharmacist the scripts and in five minutes had the drugs, I then asked, "Where do we pay?"
"Pay?" she said, "There's no money in this hospital."
"You don't understand, " I said. "We are not British citizens. We are just guests."
"No, YOU do do not understand, This is England. This is a hospital.. We treat sick people. We treat all sick people, Brits, Frenchmen, Chinese, even Americans. And that's all we do. We just treat sick people."
I was living in London when a friend of my girl friend showed up one Sunday night with a high fever. We rushed him to the local hospital. The ER was dark and dinghy and empty. There was a widow with a woman behind it. We were sent to an examining room and in a minute a doctor showed up. He treated my friend and handed us two prescriptions. He said the pharmacy was around the corner.
I handed the pharmacist the scripts and in five minutes had the drugs, I then asked, "Where do we pay?"
"Pay?" she said, "There's no money in this hospital."
"You don't understand, " I said. "We are not British citizens. We are just guests."
"No, YOU do do not understand, This is England. This is a hospital.. We treat sick people. We treat all sick people, Brits, Frenchmen, Chinese, even Americans. And that's all we do. We just treat sick people."
12
I spend a lot of time in Innsbruck Austria with my wife. We have had occasion to use the medical system there, both doctors and hospitals, and have received excellent care as private (uninsured) patients. What's amazing to me as a user of medical services in the USA, is that in Austria, there is one PRICE for all. It doesn't matter what kind of insurance you have or don't have; there is a single price for the procedure (and in our experience the price is much less than in the USA).
What's going on here? Are we crazy, or what?
What's going on here? Are we crazy, or what?
8
My niece's husband does medical coding & billing. When I wanted to find out what I was billed for emergency surgery, we went through it line-by-line & called out the items that were unnecessary or over-billed. Thank goodness for him
6
It's impossible to,list in a short space all the lies and misrepresentations that Rosenthal, once again, has managed to publish. One has to wonder if she ever actually practiced medicine. Or if anyone fact chests her writing. Most of this is completely wrong.
1
Why? Please do explain
5
It's a mistake to think of any of this as disorganized.
When Elizabeth Warren held up her credit card contract, and said that she couldn't make head or tail of it, she acknowledged that it's done to confuse us. But OK, those are banks. We know about them.
When a Hospital does the same thing, and that is why these bills are so complicated, it's truly an insult and should be regulated just like the dosage on a medication.The sick, and their families shouldn't have to play Three Card Monte when they're at their weakest.
When Elizabeth Warren held up her credit card contract, and said that she couldn't make head or tail of it, she acknowledged that it's done to confuse us. But OK, those are banks. We know about them.
When a Hospital does the same thing, and that is why these bills are so complicated, it's truly an insult and should be regulated just like the dosage on a medication.The sick, and their families shouldn't have to play Three Card Monte when they're at their weakest.
6
The health care industry has become utterly depraved.
4
Pre Obamacare going broke from illness and with pre existing cancer high risk insurance was something we hoped for. it meant she was living long enough to go broke. Imagine a doctor saying. " The stress from you not being able to work and your money hemorrhage really help your healing"
Health insurance is exactly that. Insurance for healthy people.
Health insurance is exactly that. Insurance for healthy people.
As sad as this story is, why was the victim uninsured, and lacking a subsidised policy from the exchange? She seems like the primary targeted beneficiary the ACA was designed to cover. This article needs to address this issue.
3
The article did address the issue: this occurred prior to the ACA.
1
Let's put a stop to this nonsense. We need single-payer universal health care. Now.
2
This is a most disturbing (nauseating, actually, for me) article, but I am so glad it was written. What gnaws at me constantly is how many of us have been, unwittingly, ensnared in this medical-industrial complex - capitalist dystopia through 401K, index funds, etc., investments that are laden with pharma/health care equities. You want your investments to do well so that you can send your kids to university, save for retirement, do all of the things we are being hammered to do by financial experts … and most often the best-performing investments are Big Pharma/ Medical-Industrial equities!?!
The last sentence in Dr. M. Curtin’s comment below captures perfectly what I have concluded, but could not express as well, now five years after my cancer and chemotherapy, and recent hernia surgery. It became crystal clear that the ‘providers’ were focused only on their next Porsche, next yacht, next year’s Ivy League tuition for their kid, and you were only the means to get there … and YOU were NOT entitled to the same.
The last sentence in Dr. M. Curtin’s comment below captures perfectly what I have concluded, but could not express as well, now five years after my cancer and chemotherapy, and recent hernia surgery. It became crystal clear that the ‘providers’ were focused only on their next Porsche, next yacht, next year’s Ivy League tuition for their kid, and you were only the means to get there … and YOU were NOT entitled to the same.
6
Do you think a guy like Dr. Tom Price thinks this is a problem? He's now in charge of HHS. In private practice he was maximizing profits with coding. He's on the side of the upcoders. He knows the game.
Do you think the current Congress cares?
Everyone needs health insurance. Insurance companies obviously provide a very valuable service to their customers. Scrutinizing these medical charges, challenging the upcoding and pricing, is something we're not trained to do. I have a new found respect for my insurance provider, and I won't complain about the premium costs in the future.
Do you think the current Congress cares?
Everyone needs health insurance. Insurance companies obviously provide a very valuable service to their customers. Scrutinizing these medical charges, challenging the upcoding and pricing, is something we're not trained to do. I have a new found respect for my insurance provider, and I won't complain about the premium costs in the future.
3
Her here in the U.K. We have the NhS we pay via our tax system so when you are in need of a Dr or hospital it is free at the point of contact . It is complex but it works. I have heard of people in the US going in for a routine hospital visit and say having a routine flu jab whilst there and then getting a bill for it which was much more than anticipated. When they complained the reply was to reduce the bill to another figure. So what was the original based on ? Another friend had a short stay in hospital and the toilet flushes were itemised...frankly this is madness.
5
Thank you for this article.
If a law were to be proposed that said a doctor, hospital, or other provider could not charge anyone more than three times the average payment received for a given medical procedure, I guarantee you the medical industry would scream bloody murder. But that is the answer.
If a law were to be proposed that said a doctor, hospital, or other provider could not charge anyone more than three times the average payment received for a given medical procedure, I guarantee you the medical industry would scream bloody murder. But that is the answer.
3
As long as US health care is considered an 'industry', profits will always come before people. And both the GOP and corporate Dems will ensure this never changes.
11
Why can't I call around and see what each entity charges for an MRI, like I can for my cable bill, and make an educated consumer choice as to where I want to get my MRI? I work for a major hospital, and have been there for 40 years, and I still had to pay 1000.00 up front before my MRI was even done for a non emergent scan. They would not do the scan until they had charged my credit card and it had gone through. Scans are another huge revenue source for hospitals. The scanners at my hospital run 24/7 and have done so for the 30 plus years we have had them, long after they have paid for themselves. The same scan in Japan costs 160.00. Why? Because the government controls the costs. Americans pay because our government decided in the 1920's that healthcare should be a business model not a human right. And Americans are good at business models....away we go!
16
You can call around and it is worth it. MRI pricing can vary by more than 50%. If done at a standalone facility it is much cheaper than a hospital. Consumers have the right to price transparency and we should take advantage. It is time facilities and doctors start competing on price, along with the quality of their outcomes.
1
If you are in a coma for three weeks, how do you even have a clue what services you received? I had surgery years ago at the hospital my "in plan" Doctor used. The doc used an anesthesiologist that was not covered by the insurance. I got billed for the entire cost of the anesthesiologist! Worse yet, my friend's husband was in ICU for three months before he died. At one point, they started bringing in all kinds of specialists. I asked her if the new docs were covered by her insurance. Wh she started asking the staff at the hospital, they all thought she had her priorities wrong, but they don't care if she has to declare bankruptcy after her husbands death. And the insurance company could care even less. Patient -- beware!
15
Thank you, thank you NYTimes! This is precisely the kind of investigative journalism we desperately need in an age of political theater and outright lies designed to distract us from the brazenly open collusion between the Federal and State governments and the healthcare industry. The billing system you describe is little different than a mafia run protection racket. It's time for hospital executives and other abusers of the system for profit to spend some time in prison on racketeering charges.
9
Have you ever wondered what those nice ladies at those desks just behind your doctor's reception counter do? Have you ever wondered what goes on in all those huge insurance company office buildings along the interstate? Now you know. And lucky us we get to pay for all this waste, which is an inevitable part of our third-party payer health insurance system. Its direct and indirect impacts figure importantly in explaining why US health care costs are so much higher than other countries', and note it contributes nothing to improving our health. It is beyond time to get rid of this ridiculous system.
7
But look at the "bright" side - all these coders and lawyers are working. If it weren't for these jobs, what would they be doing? Same thing as the unemployed miners? On the dole?
6
Let me offer an example of poor code documentation.
I am on Medicare with a supplemental add-on policy from Blue Shield. I had dual hernia surgery recently. The total charge for this laparoscopic surgery, which took about 60 minutes of time was ~$15k. Medicare + the supplemental insurance paid ~$3k total. My out of pocket was zero.
I have to see how to get the Medicare EOB but I do have the EOB from Blue Shield, where I see that the total claim was made up of 18 procedure codes as follows:
"Surgical Services" (0250, 0301, 0305, 0309, 0312, 0369, 0370, 0636, 0636, 0636, 0636, 0636, 0636, 0636, 0636, 0636, 0636, 0710).
That's the total EOB "explanation": "Surgical Services" with a four digit code spread over 18 codes. No detail, no real explanation.
More strangeness is that ALL the 0636 codes are for different amounts! I wonder what they could do that would fall under one code, that needed to be repeated 10 times for a variety of different charges ($276, $105, $75, $90, $75, $75, $75, $75, $90, $75)? Wiping saliva from my mouth?
The medical industrial complex in conjunction with politicians in their pockets have made healthcare in the USA so complicated that it is nigh impossible for anyone to figure out costs, let alone try to control them!
I am on Medicare with a supplemental add-on policy from Blue Shield. I had dual hernia surgery recently. The total charge for this laparoscopic surgery, which took about 60 minutes of time was ~$15k. Medicare + the supplemental insurance paid ~$3k total. My out of pocket was zero.
I have to see how to get the Medicare EOB but I do have the EOB from Blue Shield, where I see that the total claim was made up of 18 procedure codes as follows:
"Surgical Services" (0250, 0301, 0305, 0309, 0312, 0369, 0370, 0636, 0636, 0636, 0636, 0636, 0636, 0636, 0636, 0636, 0636, 0710).
That's the total EOB "explanation": "Surgical Services" with a four digit code spread over 18 codes. No detail, no real explanation.
More strangeness is that ALL the 0636 codes are for different amounts! I wonder what they could do that would fall under one code, that needed to be repeated 10 times for a variety of different charges ($276, $105, $75, $90, $75, $75, $75, $75, $90, $75)? Wiping saliva from my mouth?
The medical industrial complex in conjunction with politicians in their pockets have made healthcare in the USA so complicated that it is nigh impossible for anyone to figure out costs, let alone try to control them!
132
You're probably already aware of this, but the revenue code 0636 is basically a catchall code for each dose of each different prescription drug that was used as part of your procedure. Hospitals don't report inpatient prescription drugs individually, unless you have some separate prescription drug billing information. That's why they can have different costs associated with them. They're different drugs.
3
The codes you list are revenue codes (cost centers) for drugs needing a detailed description, not separate procedure codes. Different drugs would fall into the same category, 0636, hence different dollar amounts.
1
I don't know if this explanation will help, but here goes . . . separately payable drugs are paid under revenue code 0636. For example, if a drug’s code description is 50 mg and 50 mg was given to the patient, this would be billed once using 0636. However, if the drug code specifies a dose of 50 mg (as in previous example) but the MD gave you 200 mg, the coder needs to specify this by using code 0636 four times (i.e., 50 mg x 4 = 200 mg). Your listed charges of ($276, $105, $75, $90, $75, $75, $75, $75, $90, $75) could represent different drugs and dosages given during your surgery, hence the different charges. I know this sounds convoluted, but this may help as an explanation.
1
No need to change the parts of the healthcare system that insure that the patient is prey. That's the part that Republicans like best. It's not easy to create a 'buyer beware' market and still pretend that it is a "free and fair" market. For Republicans, "free and fair" is when the customer loses, and "free choice" is what the provider chooses. You can bet your bipi that Trumpcare will be preda-care; care that costs as much as possible, and delivers as little as possible with fine and invisible print designed to favor the survival of the business over the survival of the customer. It's not personal, its only business. They get paid to sell you out.
3
The lack of transparency of medical billing is mind boggling. The financial rape of patients unconscionable. If there is a God, the old saying that pigs get fat and hogs get slaughtered will come true when we have Medicare for all.
3
I've been fortunate to recently move to South Korea where they have a single-payer healthcare system.
Even with no insurance, I was charged around $20 US dollars after blood tests and an x-ray on my initial visit to a hospital.
I can never forget the horror of watching Michael Moore's 'Sicko.'
We have a broken system.
Even with no insurance, I was charged around $20 US dollars after blood tests and an x-ray on my initial visit to a hospital.
I can never forget the horror of watching Michael Moore's 'Sicko.'
We have a broken system.
3
This is horrible, but the Durable Medical Equipment (DME) industry isn't included in Ms. Wickizer's needs, so this story misses another huge source of huge bills, coding and rip-offs.
I received a re-supply of some replaceable for DME about 18 months after I last needed it. (Only used the equipment for 6 months). I called the supplier and the person actually said that they had gone down the list of customers for that equipment, and just sent everyone supplies!
I requested (and received) a shipping label to send the equipment back. USPS tracking info showed it was delivered to the company, but they insisted they never received it, and continued to bill me for it.
I pointed out that I didn't really owe ANYTHING for items sent to me that weren't ordered, but that fell on deaf ears.
Asked the BBB to investigate, but they got no reply. Just as I got the final demand before collections, I contacted the Attorney General's Office of Consumer Protection. One quick form-letter from their office to the company (cc to me), indicating that they had received my complaint and would investigate, and POOF! the company said I owed them nothing.
Look up the BBB ratings of various "Medical Supply" companies, and you'll see how low their ratings all are!
I received a re-supply of some replaceable for DME about 18 months after I last needed it. (Only used the equipment for 6 months). I called the supplier and the person actually said that they had gone down the list of customers for that equipment, and just sent everyone supplies!
I requested (and received) a shipping label to send the equipment back. USPS tracking info showed it was delivered to the company, but they insisted they never received it, and continued to bill me for it.
I pointed out that I didn't really owe ANYTHING for items sent to me that weren't ordered, but that fell on deaf ears.
Asked the BBB to investigate, but they got no reply. Just as I got the final demand before collections, I contacted the Attorney General's Office of Consumer Protection. One quick form-letter from their office to the company (cc to me), indicating that they had received my complaint and would investigate, and POOF! the company said I owed them nothing.
Look up the BBB ratings of various "Medical Supply" companies, and you'll see how low their ratings all are!
8
The health care system in the US is an institutionalized tiered pile of parasites sucking whatever grotesque levels of profit they can off of the misfortunes of helpless people.
3
I was overcharged 50 thousand dollars by a hospital, but, luckily, it was caught--but not by me. Someone who knows the rope, checked on my behalf. A frightening situation.
5
We have this for a health care system and we just elected an ignoramus President. The next time I hear someone call the U.S. "the greatest country in the world", I'm going to vomit on his shirt.
6
All I can say is I am glad I moved to Canada 12 years ago. Moving to Canada was for the opportunity to buy some land that was a reasonable price. Now I have stage 4 bone cancer and so far has cost me nothing. My prescription for my once a month shot was $500 each shot and it cost me $9 each. If you look around the world at countries that have full coverage the taxes are much higher as they are in Canada but you know where its coming from and where its going. In the states the ins companies are running the healthcare and until they are gone completely it will never be accomplished. This admin is all about money for themselves and heck with the rest of the country. We do need socialism to fight capitalism which has been the ruin of the country. This all comes from the profit margin which is way out of control. As it says hospitals have learned how to manipulate the medical codes and investors want a BIG return unlike the rest of us who are just trying to enjoy life.Not try to tear it apart because we are spoiled children like the clown in charge......
11
Few years ago there was a great article from TIME of a journalist's year-long investigation into the healthcare world of insurances, bills, expenses, etc.
http://content.time.com/time/subscriber/article/0,33009,2136864,00.html
There are many faults in the US healthcare system, it's not only one single problem. Overcharging is just one evident result of this broken system.
http://content.time.com/time/subscriber/article/0,33009,2136864,00.html
There are many faults in the US healthcare system, it's not only one single problem. Overcharging is just one evident result of this broken system.
2
Yes that was a terrific article. Hope it got a Pulitzer, every American should read it.
Doctors who treat patients without insurance usually never get paid, which is very unfair. Patients who attempt to pay something toward their bill should be should be commended.
2
There's a huge amount of cost-shifting. Medicare and many commercial plans have strict rules about allowable payments, so health care costs are shifted to those with less restrictive insurers or sadly to those who have no one to advocate for them--the uninsured. Doctors and hospitals have been forced to adopt crazy documentation rules for coding and billing or fail to survive.
You get the behavior you support and reward. If a hospital knows that an insurer will discount the bill by 75% why wouldn't it quadruple the initial "price"?
The answer is single payer.
You get the behavior you support and reward. If a hospital knows that an insurer will discount the bill by 75% why wouldn't it quadruple the initial "price"?
The answer is single payer.
6
The "invisible hand" of market forces in health care economics should be more correctly called legerdemain. Single payer, now, please.
2
I really enjoyed your article Ms. Rosenthal. I was in my doctor's office a few weeks ago and noticed five or six people working that I never see as medical techs or nurses. When I asked my doctor about them, he said that they were his billing staff. My doctor, a PA, NP, nurse, receptionist, and 3 medical techs comprised the rest of his staff.
This of course means that almost 50% of his staff is involved with our health care's arcane billing practices.
You mention in your article that a Commonwealth Fund study supplied you with the statistics on Health care billing costs in the US, Canada and England. Would you provide me a link to that study?
Thanks,
John Valine
This of course means that almost 50% of his staff is involved with our health care's arcane billing practices.
You mention in your article that a Commonwealth Fund study supplied you with the statistics on Health care billing costs in the US, Canada and England. Would you provide me a link to that study?
Thanks,
John Valine
3
The insurance coding has become the tail that wags the dog. It is no surprise that Bills are unimaginably difficult to interpret, explain or understand.
EMR/HIS systems have replaced the paper chart, and commonly have roadblocks that hold up everything until the all important ICD beast has been fed. In modern hospitals almost anything more sophisticated than a wheelchair is linked to the hospital's IT systems and most use it to very tightly control every aspect of care, testing and treatment.
The codes are way past arcane, obtuse and unwieldy. You cannot so much as scratch your nose in our EMR system without filling in any number of fields directly tied to the ICD coding beast. If you do not complete the EMR portion the data will not transfer to the machine you actually need to do what you need to for the patient, which opens up an even bigger can of worms. What was once simple has become burdensome- a voice order from a Physician has now become a spaghetti bowl of EMR data input with numerous chances to make subtle differentiations that impact how a chart is coded for billing.
Hospitals and Clinics used to treat the patient first. That seems to be commonly upended to treat the chart first and the patient second. Make no mistake, this is all about the money and the Suits in Administration will not hear any pleas about the straight-jacket many caregivers in the hospital have been put in. ICD codes have caregivers sorting Talcum Power from Confectioner's Sugar.
EMR/HIS systems have replaced the paper chart, and commonly have roadblocks that hold up everything until the all important ICD beast has been fed. In modern hospitals almost anything more sophisticated than a wheelchair is linked to the hospital's IT systems and most use it to very tightly control every aspect of care, testing and treatment.
The codes are way past arcane, obtuse and unwieldy. You cannot so much as scratch your nose in our EMR system without filling in any number of fields directly tied to the ICD coding beast. If you do not complete the EMR portion the data will not transfer to the machine you actually need to do what you need to for the patient, which opens up an even bigger can of worms. What was once simple has become burdensome- a voice order from a Physician has now become a spaghetti bowl of EMR data input with numerous chances to make subtle differentiations that impact how a chart is coded for billing.
Hospitals and Clinics used to treat the patient first. That seems to be commonly upended to treat the chart first and the patient second. Make no mistake, this is all about the money and the Suits in Administration will not hear any pleas about the straight-jacket many caregivers in the hospital have been put in. ICD codes have caregivers sorting Talcum Power from Confectioner's Sugar.
7
I think we can once again blame politicians for some of this. Aren't they behind mandated "cost control" measures requiring detailed coding and reimbursement tied to them?
1
American medical system is crony capitalism for the providers as well as socialism for the patients. It is unlikely Wanda Wickizer paid any of her bills. If she was insured or on Medicare/Medicaid, they would have whittled the bills down to a fraction on what was allowed/negotiated which would be still astronomical compared to what other countries pay the providers.
2
Makes sense. Fiance is a cardiologist. We are on the other side of this equation.
For recruitment, 4 or 5 day all expense paid trips, nice dinners, free car rentals, realtors driving us around, getting picked up at the airport in a luxury SUV, etc. I thought, who is paying for all this?
These hospitals are spending thousands and thousands of dollars recruiting doctors. It is all over the top.
For recruitment, 4 or 5 day all expense paid trips, nice dinners, free car rentals, realtors driving us around, getting picked up at the airport in a luxury SUV, etc. I thought, who is paying for all this?
These hospitals are spending thousands and thousands of dollars recruiting doctors. It is all over the top.
2
We all knew this already. But we do not want our Health Insurance to do the same either. One can be as bad as another. It's like working on your taxes. Why should anyone have to Pay someone to decipher taxes? Why waste time calling healthcare representatives, pharmaceutical companies and hospitals on these issues. The sick have enough problems.
1
Compare those "indecipherable medical bills" with a traditional Medicare bill (NOT a Medicare Advantage bill). There is no comparison. Medicare bills from Uncle Sam are much clearer and straight forward. Why is that? How does the federal government know how to present a bill more clearly than a hospital's or a private insurance company's bill?
Yes, hospitals, insurance companies and any other non-governmental bills are meant to be mind-boggling so you pay without understanding. Shouldn't indecipherable medical bills be illegal?
Companies mus write medical labels and product inserts to be understandable with an eighth grade reading level. Why not medical bills?
Yes, hospitals, insurance companies and any other non-governmental bills are meant to be mind-boggling so you pay without understanding. Shouldn't indecipherable medical bills be illegal?
Companies mus write medical labels and product inserts to be understandable with an eighth grade reading level. Why not medical bills?
2
Thank Heaven for Medicare. I have had two surgeries in the last two years although I am in good health. One was a broken ankle and the other an appendicitis. The bills were outrageous and as this article states unreadable. But I just waited for them to be sorted out with Medicare and my supplemental. All turn out well.I paid about $300.
In contrast, back in the 70's I was hospitalized for a back injury and was charged for catheters which I never had. When I protested I was told that "I must have had them after surgery". When I replied that I had no surgery they said they would have to "investigate".
People know whether or not they have had surgery for goodness sake.
This has been a problem for a long, long time. I hope it can be fixed.
In contrast, back in the 70's I was hospitalized for a back injury and was charged for catheters which I never had. When I protested I was told that "I must have had them after surgery". When I replied that I had no surgery they said they would have to "investigate".
People know whether or not they have had surgery for goodness sake.
This has been a problem for a long, long time. I hope it can be fixed.
2
Insurance companies and "non-profit" hospital like Baptist throughout the South are money machines. They've ruined medicine. Doctors don't make what they should and patients get lousy treatment for the money they pay. They're the two entities that have benefited the most from Obamacare and that would have benefited the most from the Trumpcare plan.
Insurance companies make the big banks look angelic.
Insurance companies make the big banks look angelic.
3
Excellent article. But, nothing will change as long as people try to do the "right" thing and pay the bill. Paying the unethically inflated bill is not the right thing to do, it is the wrong thing. Refuse to pay, be sued until there are so many lawsuits that someone will have to consider a reform to eliminate the profiteers once and for all.
1
Single. Payer.
I have health insurance which is very expensive and nearly useless due to the high deductible. Consequently I avoid going to the doctor or having any procedures done if I can help it. But I am 63 now and it is getting harder to play that game.
Last year I had a little surgery done for a hernia and the the bills kept coming and coming for months and months. this one from a hospital. this from some doctor. this from some other doctor. and this. and that. and this. and that.
Single. Payer.
Imagine if this happened when you last took your car in to the dealer for repair. A bill from the dealer. a separate bill from three different mechanics and from whoever hooked your car up to the diagnostic computer. several other bills from the parking facility that held your car until you picked it up. separate bills for parts from the suppliers.
To me, a hospital should be one-stop shopping, with a single, unified and clear bill that covers all procedures from the moment you enter an ambulance or cross the threshold of the facility until the moment you are discharged.
Single. Payer.
We should not have to live in fear of the medical system. We should be able to know it is there to help and protect us. In this country that is far from the case. It exists to taunt us. To bankrupt us.
Single. Payer.
Single. Payer.
Single. Payer.
I have health insurance which is very expensive and nearly useless due to the high deductible. Consequently I avoid going to the doctor or having any procedures done if I can help it. But I am 63 now and it is getting harder to play that game.
Last year I had a little surgery done for a hernia and the the bills kept coming and coming for months and months. this one from a hospital. this from some doctor. this from some other doctor. and this. and that. and this. and that.
Single. Payer.
Imagine if this happened when you last took your car in to the dealer for repair. A bill from the dealer. a separate bill from three different mechanics and from whoever hooked your car up to the diagnostic computer. several other bills from the parking facility that held your car until you picked it up. separate bills for parts from the suppliers.
To me, a hospital should be one-stop shopping, with a single, unified and clear bill that covers all procedures from the moment you enter an ambulance or cross the threshold of the facility until the moment you are discharged.
Single. Payer.
We should not have to live in fear of the medical system. We should be able to know it is there to help and protect us. In this country that is far from the case. It exists to taunt us. To bankrupt us.
Single. Payer.
Single. Payer.
Single. Payer.
6
This is the part about being a corporate-employed physician that sickens me most. It's a disgusting parasitic system, and I see no end to it. It makes me want to take my skills to another country that treats its citizens humanely.
2
This issue has hit me personally, where despite insurance I was hounded by some bill collector for a bill which I thought should have been paid by my insurance company. When I saw the bill, there were so many line items there was just no way to know which may have already been paid, or may have been duplicates or mistakes.
it's the equivalent of going to a restaurant, and getting a separate line item for every single vegetable and spice used to create the recipe. No one would put up with this in any other industry.
I don't know why we continue to put up with this in this country. It's insane.
it's the equivalent of going to a restaurant, and getting a separate line item for every single vegetable and spice used to create the recipe. No one would put up with this in any other industry.
I don't know why we continue to put up with this in this country. It's insane.
1
I tell anyone who listens that the problem isn't with insurance companies, it's with hospitals and pharmaceutical companies and their costs and people look at me with a blank stare.
Both those industries must love that the insurance companies are taking the heat for this problem.
I guess it's to be expected when they are the largest lobbying group in DC.
Both those industries must love that the insurance companies are taking the heat for this problem.
I guess it's to be expected when they are the largest lobbying group in DC.
2
Insurers should be required by law to provide access to both the billing codes and the costs that they contract with medical providers under the insurance contract with YOU, the payor of premiums. Employers should demand this, if they have a group plan and employees pay any portion of the premium. Where else would a consumer not know what they are purchasing? This is a racket and it needs to stop.
This is another example of why there can be no free market solutions in health care, exactly how is this women supposed to negotiate her care and prices charged while in a coma. Only Republicans can be so stupid not to recognise this.
3
Hospitals and doctors routinely lie to pad their bills. But this is a red herring that presumes that a for-profit health care system can be fixed by a minor tune-up. We don't pay twice as much per capita than other western countries because we have unintelligible bills.
Take profiteering out of the system and billing codes will become irrelevant.
Take profiteering out of the system and billing codes will become irrelevant.
3
I had three surgeries on a badly broken arm and after the second one I called the billing office because I could not decipher the bill, the codes, what the charges were for and like all bills I receive, I want to understand how and why I am charged for things. The lady I spoke with had no answers (and she was relatively high up the food chain) and thought I was a nut case for wanting to know these things. After all, she said, "the insurance is paying most of this." What a total farce our medical system is. Do you think this would improve with Single Payer? Not a chance. It will get only worse as the fraudulent schemes our medical system has created will suck the teats of the taxpayers 100 percent (Americans seem to forget that someone has to pay for this, and with SP, we that work that will be paying for it all).
4
"In a doctor’s office, a Level 3 visit (paid, say, at $175) might be legally transformed into a Level 4 (say, $225) by performing one extra maneuver, like weighing the patient or listening to the lungs"...
So that's why my bill varies from one visit to the next! As if being weighed at the Dr.'s office isn't traumatic enough already.
So that's why my bill varies from one visit to the next! As if being weighed at the Dr.'s office isn't traumatic enough already.
2
How about another scam? Hospitals buy physician groups, then bill patients for a hospital "facility charge" in addition to the doctor's visit charge! Insurers disallow it, but, if one is self-insured or the physician is outside the narrow network, they are free to try to extract (extort?) more from the patients.
3
This article exposes the foolishness of the right's two panacea's they claim are the solutions to our health care mess; "access to good health care for all" and "free market competition" to drive down costs. Clearly Ms Wickizer had "access" to good health care. Being self pay, she was the ultimate free market consumer, with the need to shop for the best pricing and avoid any unnecessary expense....so why didn't she check around for the lowest price medi-vac airlift to the hospital? Once in the hospital (and semi comatose), she should have asked about treatment costs, sought lower priced options, perhaps solicit bids from the doctors and hospital to evaluate her various options. Isn't this just like shopping for a car, or any other high ticket purchase? Absurd, absolutely absurd.
3
Good article. I had a heart procedure last year in the range of a few $100K. Any individual doctor office will tell you they have no idea what $$ they are charging for these codes (I accept that). HAving a VERY high deductible I repeatedly asked and drilled down for a reasonable full estimate beforehand from NYU and from Aetna. Of course I was given no reasonable detailed response from either. They are incapable to do so. The both said find out from the other.
NYU administration who should know pointed to different departments. The departments including hospital, surgery etc said not to worry – it depends on what insurance would pay for it complete run-around of incompetence. Ran out of time, had to have the procedure.
So the billing? The detail was insane as was discussed in article. Payments between insurance and negotiated amounts made no sense. It was a litany of nonsense.
Lets not put up with this billing war and ouija board billing any longer. Pay the doctors well because they usually deserve it, have a uniform system, and lets get to a single payer!
NYU administration who should know pointed to different departments. The departments including hospital, surgery etc said not to worry – it depends on what insurance would pay for it complete run-around of incompetence. Ran out of time, had to have the procedure.
So the billing? The detail was insane as was discussed in article. Payments between insurance and negotiated amounts made no sense. It was a litany of nonsense.
Lets not put up with this billing war and ouija board billing any longer. Pay the doctors well because they usually deserve it, have a uniform system, and lets get to a single payer!
13
I've noticed that when I see a physician, say for a flu, I am weighed even if I'd been there a short time before. One always measured height! BPs are also the norm even for a routine follow-up. Perhaps these are coded to increase payments.
BTW. nice piece of work UVA med center.
BTW. nice piece of work UVA med center.
4
until the system is fixed, this is why everyone needs Healthcare, even with a high rate and high deductible it's still cheaper than a $300,000 hospital bill. it seems she can pay tens of thousands of dollars for the bill but couldn't afford health insurance. Bad choice
1
I recommended a doctor to a friend. He saw the doc and, amonung other items, the doc said he had to have earwax removed. He is under Medicare so why sould he care what the cost is for the procedure. A few days later I went to see the same doc for a physical. Lo and behold, he recommended that I have earwax removed, And on and on it goes. Nurse does simple 10 minute procedure and the bill is increased by ????.
Many times I have been charged for long visit when, frankly, I was in the presence of a doctor for 10 minutes.
I cannot complain about the care I have received, it has been first class. But with Medicare and AARP supplement I have no reason to challange bills or coding. I am covered..
Many times I have been charged for long visit when, frankly, I was in the presence of a doctor for 10 minutes.
I cannot complain about the care I have received, it has been first class. But with Medicare and AARP supplement I have no reason to challange bills or coding. I am covered..
3
Medical costs are high for one reason - lots of middle managers to support. Rather than clean it up, we have to look at it for what it is - a jobs program for the middle class.
When cost cutting comes up, you'll see nursing staff laid off, physician's pay cut, college-educated lab techs replaced by high-school graduates. Those doing the work get the axe while the suits make all the decisions and, surprise!, don't fire themselves. That leaves us with a conundrum - single payer can clear out that middle-management bloat, but now you have thousands out of work. At the hospital, at the pharmaceutical companies, at the disposables companies, and on down the line.
Perhaps step one is to call it what it is - welfare for college-educated caucasians.
When cost cutting comes up, you'll see nursing staff laid off, physician's pay cut, college-educated lab techs replaced by high-school graduates. Those doing the work get the axe while the suits make all the decisions and, surprise!, don't fire themselves. That leaves us with a conundrum - single payer can clear out that middle-management bloat, but now you have thousands out of work. At the hospital, at the pharmaceutical companies, at the disposables companies, and on down the line.
Perhaps step one is to call it what it is - welfare for college-educated caucasians.
2
True story: My first daughter was born 21 years ago at the University of Chicago hospital. Everything went as expected. A month later I received the bill. I had great insurance and was only responsible for 10% of the total cost, which was something like $838 spread across 40 of so discrete procedures -- virtually none of which I witnessed while in the delivery room with my wife (and daughter a few hours later). So I went to the hospital, bill in hand, and got my number and waited to be called, just like at deli. When it was my turn, I showed the bill to the financial consultant, informed her how beautiful my daughter was, and then asked if we could go over each item on the bill. She took one look, said "wow, you have great insurance, we've already received more money for your daughter's birth than we do for most births. There's no need for you to pay any more." She handed me a new print out that said, "Paid in Full." We both smiled.
2
Every time I read one of Rosenthal's stories on the outrageous cost of medical care, I get both furious and sick to my stomach.
If the government won't give Medicare to everyone, which they should, then politicians should at least pass a law that requires hospitals to provide itemized bills (and medical records) on demand. Failure to do so within 72 hours of request should result in all rights to collect being automatically dissolved.
There's no excuse.
If the government won't give Medicare to everyone, which they should, then politicians should at least pass a law that requires hospitals to provide itemized bills (and medical records) on demand. Failure to do so within 72 hours of request should result in all rights to collect being automatically dissolved.
There's no excuse.
This article made me sick to the stomach. Our healthcare system has become one big extortion racket. How do the people who work in the system and make it what it is sleep at night? Clearly they have lost their sense of decency along the way trading morality for profits. We are fools to accept this system. It's time to move to single-payer.
1
Single payer! Single payer! The rest of the modern world provide heath care to all of their citizens and visiting guests. Perhaps the United States might wake up and finally realize that health care is a right, not another profit center. Let the undertakers make their money gouging the grieving. Doctors and nurses until recently have worked to help the suffering not fill their pockets. The insurance industry can offer policies to allow the wealthy to step out of line and get the care they need before anyone else.
1
We only have to thank ourselves. We created this system of profit and loss and every spiraling health care costs.
And the expectation is that if you enter the medical field, the compensation should be rewarding, not only for working long hours but saving lives.
So who gets the bills, typically the insurance providers who have no incentive to cut costs. And they get billed at the list price and so do we when we have no insurance.
Who will stand up and say this is not fair. And that our health insurance system has to include everybody. Just like Obamacare.
And the expectation is that if you enter the medical field, the compensation should be rewarding, not only for working long hours but saving lives.
So who gets the bills, typically the insurance providers who have no incentive to cut costs. And they get billed at the list price and so do we when we have no insurance.
Who will stand up and say this is not fair. And that our health insurance system has to include everybody. Just like Obamacare.
1
Personal tales of the way UVa Medical Center duns patients with their incomprehensible billing, regardless of insurance coverage, are commonplace in this area. Locals know they'll take your home if push comes to shove. They've also been fined several years in a row for infection rates after scoring at 7 on a scale of 10 where 10 is the worst. http://www.dailyprogress.com/news/local/uva-medical-center-penalized-ove...
3
"Twenty-five percent of United States hospital spending — the single most expensive sector in our health care system — is related to administrative costs, “including salaries for staff who handle coding and billing,” according to a study by the Commonwealth Fund. That compares with 16 percent in England and 12 percent in Canada."
I know. I know. Stay healthy. Oh, how sick I feel.
I know. I know. Stay healthy. Oh, how sick I feel.
Behind the bloated bureaucracy there is the profit reason, but another reason nobody talks about is the number of jobs in healthcare administration:
have we seen this number published ? In a "service" oriented economy the emphasis on delivering good healthcare fades as compared to the economic interest to multiply administrative jobs.
have we seen this number published ? In a "service" oriented economy the emphasis on delivering good healthcare fades as compared to the economic interest to multiply administrative jobs.
1
Without knowing all the particulars of her finances, I would think that a bankruptcy filing would have made a lot more sense from the outset. The funds in her IRA would be protected; she may have had an exemption for the rental property. It's admirable that she would wish to pay for these services but given her financial picture, bankruptcy laws were designed to protect individuals in her predicament.
1
The U.S. healthcare system is in fact a monopolistic cartel, which has made a few spectacularly rich through the exploitation of the desperate many. Its core operating principle is extortion, which hides behind an array of smoke and mirrors designed to confer legitimacy.
1
My son had a quick procedure done at a local hospital. We received a bill for $16,000. The insurance company paid $800 to the hospital. Case closed. If he hadn't had insurance, he would've been on the hook for $16,000. How do hospitals determined these arbitrary and capricious amounts?
4
You are lucky! You could have been seen 1 second by an "out of network" doctor you never met and didn't need. Who could then legally extort thousands from you, with the threat of sending you to a collection agency, where decades of good credit you've built up would be destroyed. All perfectly legal in most states. And if you have ERISA insurance not even states law trying to ban this extortion can protect you against these sharks.
A few critical things we need to all understand.
1. The AMA sets the prices for procedures and guarantees high prices for patients. CPT codes benefit the AMA itself by providing royalties from insurance companies. But the biggest beneficiary is the doctors who receive the highest billing amounts based on what the AMA thinks is "fair". In what other industry does the group providing the the services have a super team that controls prices?
2. When hospitals or doctors do not receive payment they can either partner with a collection agency to collect or sell the invoices to collection agencies. But in either case the hospital or doctor can then deduct unpaid invoices from their annual taxes. No wonder the poorest people receive the highest bills to assure high deductions when the tax forms are completed.
Tax reform to correct this needs to be looked at.
1. The AMA sets the prices for procedures and guarantees high prices for patients. CPT codes benefit the AMA itself by providing royalties from insurance companies. But the biggest beneficiary is the doctors who receive the highest billing amounts based on what the AMA thinks is "fair". In what other industry does the group providing the the services have a super team that controls prices?
2. When hospitals or doctors do not receive payment they can either partner with a collection agency to collect or sell the invoices to collection agencies. But in either case the hospital or doctor can then deduct unpaid invoices from their annual taxes. No wonder the poorest people receive the highest bills to assure high deductions when the tax forms are completed.
Tax reform to correct this needs to be looked at.
Medical care should really be considered a public utility, and everyone deserves access. It should be regulated in a way that preserves the public good. I have come to the conclusion that a single payer plan is really the only option that will achieve this end.
2
Medicare constantly reminds us that the first line of defense against fraud is the patient. I come from a medical family and am married to a retired registered nurse and I can't begin to decipher the Medicare claim documentation that we get in the mail. How in the world can the average Medicare patient spot fraud?
97
I have never been more terrified of getting sick or injured. The prospect of navigating the costs involved are paralyzing. There are those who do not believe insurance is mandatory, that each of us must be responsible for ourselves, but when the choices are so stark and limiting how is that not punishment and an abdication of protecting the least among us?
When profit is king even in non-profit institutions, the public will suffer. We incentivize the wrong things in our society; looking for "return on investment" instead of helping the people who most need help. Until we return to a time when it was a doctor's and hospital's highest purpose to heal people, an educational institution's highest purpose to educate, etc., and create a coding system that is patient-friendly, we will serve profit, not people.
Medical coding professionals are highly trained, credentialed professionals bound by ethics and law to code correctly. Their codes are used for medical research, public health, and quality control as well as for billing. Unless you blame quiet back-office scientists when their findings are abused by industry for profit motives, you should not blame the coders.
But I concur that a profit motive is inappropriate in healthcare is wrong, and I would welcome single-payer.
But I concur that a profit motive is inappropriate in healthcare is wrong, and I would welcome single-payer.
3
Many years ago I worked for a chiropractor in another state, doing admin work and billing. I was instructed to submit billing with codes that would get the highest level of reimbursement, and I spent at least half of my time wrangling insurance companies to get them to pay. To be fair, the doctor knew that she would not be fully reimbursed for her services, and that was part of her motivation to try to get the most for the bills they did pay. But I saw greed on her part, too. Let's get as much of the greed and profit motive out of the healthcare system as we can--for patients, for providers, for businesses, for our society. It's beyond time for a single-payer, improved Medicare for All, universal system!
127
Full disclosure: I am a coder and I work for a physician practice. I believe this article illustrates the need for a single payer system, Medicare for all. I don't believe profit should have a place in delivering healthcare. I may be oversimplifying but everyone deserves to get the healthcare they need when they need it.
Medicare has started moving toward pay for performance/Quality and away from pay for service. It is in its infancy but that is the direction we are moving in. Physicians and hospitals will get paid for providing quality care with good outcomes and will share in the savings. Providers will be penalized for re-admissions and excessive spending. At this stage there is a lot of room for improvement.
Medical coding has been around for a long time and beyond the usefulness for payment it is used for epidemiology reporting and data collection. It is a useful tool to determine the state of health for a population, what methods are used and the outcomes. It should be notes that medical systems worldwide use the ICD-10 diagnosis coding system but the US is unique in the CPT/procedure coding system. It can be incredibly confusing, especially when all the providers bill separately. There are Accountable Care Organizations that are starting to move away from that issue as well. One bill for a hospital stay, one payment distributed to all providers and done.
Bottom line: it is a hard industry to navigate if you are not experienced. Medicare for all!
Medicare has started moving toward pay for performance/Quality and away from pay for service. It is in its infancy but that is the direction we are moving in. Physicians and hospitals will get paid for providing quality care with good outcomes and will share in the savings. Providers will be penalized for re-admissions and excessive spending. At this stage there is a lot of room for improvement.
Medical coding has been around for a long time and beyond the usefulness for payment it is used for epidemiology reporting and data collection. It is a useful tool to determine the state of health for a population, what methods are used and the outcomes. It should be notes that medical systems worldwide use the ICD-10 diagnosis coding system but the US is unique in the CPT/procedure coding system. It can be incredibly confusing, especially when all the providers bill separately. There are Accountable Care Organizations that are starting to move away from that issue as well. One bill for a hospital stay, one payment distributed to all providers and done.
Bottom line: it is a hard industry to navigate if you are not experienced. Medicare for all!
277
Thank you for your comment. No one should be able to read this article and then find blame with the patients...good grief.
We can start the process of "medicare for all" by offering medicare as an option on the healthcare exchange since the insurance companies are all pulling out anyway.
What a complete waste of resources.
Wonder why the economy is growing slowly?
Resources diverted to such silliness.
Copy any other OECD nation's healthcare model and we will have more effective care at around half the cost (adjusting for worse demographics in most of the OECD).
Wonder why the economy is growing slowly?
Resources diverted to such silliness.
Copy any other OECD nation's healthcare model and we will have more effective care at around half the cost (adjusting for worse demographics in most of the OECD).
2
One of the great advantages of Medicare - which would be the big benefit in a Medicare-for-all / single-payer system - is that they negotiate the bill and take all that worry out of the process. It's huge. Until I started handling my elderly mother's health care it never occurred to me. Most people who are not receiving Medicare or are not involved in the care of someone on Medicare have no idea what a miracle program it is.
2
When will the American public wake up to this healthcare travesty rife with: exorbitant costs higher by far than in any other country; millions of uninsured citizens; thousands of personal bankruptcies caused by unpaid medical bills; extraordinarily high rates of chronic illnesses; high infant mortality rates because of inadequate prenatal care; thousands of citizens who are unable to pay for prescribed drugs; etc, etc. Obamacare is not perfect but it was a step in the direction of giving American citizens the healthcare that citizens of other developed countries expect and receive. Shameful doesn't cover it. It's criminal in the richest country in the word.
I once got the plastic flange of one of my earphones stuck deep in my ear canal. With no friends or family available to help get it out, I panicked and went to the emergency room. After waiting around for several hours, a doctor solved my problem easily with an enormous pair of tweezers. It took him about five seconds. I felt like an idiot, but was so thankful for his help.
Afterwards, a nice woman seemed to hesitate before asking me to fill out some paperwork. I suspect she wanted to let me slip away unnoticed, or was hoping I'd take the hint and run for it. But I was naive and gave them all my information and my signature.
When the bill arrived, with line after line of impressive medical jargon, it was for $945.
Afterwards, a nice woman seemed to hesitate before asking me to fill out some paperwork. I suspect she wanted to let me slip away unnoticed, or was hoping I'd take the hint and run for it. But I was naive and gave them all my information and my signature.
When the bill arrived, with line after line of impressive medical jargon, it was for $945.
1
Medical bills are voluminous and complex. They are that way for a reason...to confuse patients and families so that they cannot work out what is what. When someone is able to fathom the bills and identify the fraudulent and "mistaken charges" and raise them with the hospital often the questionable charges disappear! Wow.
Sometimes fraudulent bills just don't even get delivered to the patients but they do get sold to collection agents who the call the patient and engage in threats and pressure. I'll bet most patients are so scared they pay the fraudulent bills.
The likelihood is that only a small number of patients who their families will have the time to sort the fraud from the correct charges. As a result, the hospitals win big and fraud pays!
Sometimes fraudulent bills just don't even get delivered to the patients but they do get sold to collection agents who the call the patient and engage in threats and pressure. I'll bet most patients are so scared they pay the fraudulent bills.
The likelihood is that only a small number of patients who their families will have the time to sort the fraud from the correct charges. As a result, the hospitals win big and fraud pays!
2
Congress needs to be on the same insurance as the rest of America. We were wiped out from my cancer treatment 2 years ago. My AFLAC paid my $800 a month health insurance premium while I underwent treatment and couldn't work so I didn't lose my insurance. At 70 and 60 we have to start all over again. We will be working until we die. The USA has the worst health care in the civilized world. There are no words to describe the lack of morality in a government that would allow their citizens to go bankrupt to pay for medical care. The Christian Right who only care about business profits, and put them before people are anything but. People are what make America great and it a great responsibility to keep your citizens protected - and it's cheaper for all to keep them healthy. Medicare is a proven system that works. Why not use it for all Americans
1
So disgusted, had to read this article again. One hears the American Medical Association mentioned quite a bit. Somehow from their benign name, I assumed they were concerned with medical standards and patient care. Despite their mission statement “Our mission is to promote the art and science of medicine and the betterment of public health,” from their stance against single payer health insurance and the copyrights they hold and royalties they receive from medical coding, I guess now we know who the enemy is.
I hope The New York Times and Elisabeth Rosenthal win a Pulitizer Prize for this.
I hope The New York Times and Elisabeth Rosenthal win a Pulitizer Prize for this.
5
This should be required reading for anybody who wants to talk about healthcare solutions for the United States. I was born in Italy and lived there for many years; I have now been in the US for over 30 years. I have been exposed and have experienced both healthcare systems and, while the quality of care in some of the very best hospitals in the US might be a little better, there is no question that for the majority of the population the Italian system - single payer funded by tax revenues - is by far the better solution. Anybody who believes that the US system is "market driven" probably believes in the tooth fairy as well! What we now have in the US is a system for the insurance companies and the large hospital chains whose ONLY concern is to maximize profits! People wake up! Demand a single payer solution!
1
My healthcare experience was a nightmare. My husband fell off a ladder and crushed two vertebrae. We had good coverage so when surgery was recommended we met with the Physician and scheduled the procedure. Big mistake. The recommended surgery was in the list of 75 procedures not covered by our insurance. Long story but we wanted to know - could we afford to self pay? Many extensive calls revealed: 1). They did not know the cost, and 2) the surgeon fee alone was $50k. We walked out before surgery. It was outrageous that no one could say how much it cost. Because the cost differs - depending on who is paying the bill.
1
I am not sure I understand. I've often read that uninsured people who can't afford medical care pay being admitted to hospitals for emergency services and being provided those services regardless of their ability to pay. That is often cited as a source of "hidden costs" to taxpayers and society of people being uninsured. But Wickizer was on the hook for payment for all services, regardless of her ability to pay. So I'm confused.
2
If you have more than $3000 in the bank Medicare won't cover you.
Medical costs in the US are a big scam. I live in the Netherlands and have a health policy that more or less covers all medical costs. The price is $ 220 monthly for myself, my wife and two children under 18. Some extra's are not covered or limited, like some therapies or medication but those costs are relatively small. The first $350 on costs I have to pay myself. The insurance companies break-even or make a profit. The health insurance is mandatory, so everybody contributes to the system. Not a bad system if you ask me and if you read the horror stories about bills in the US. And btw, I am no socialist.
3
No other country treats it’s citizens like the way Wanda has been treated. The medically uninsured are a uniquely American phenomena. The homeless and unemployed in Canada receive the same excellent universal health care as everyone else and Canadians would not have it any other way.
I was operated on for a brain tumor in Canada and spent 11 days in the hospital. I received excellent follow-up care for many years after, including frequent MRIs, and visits with specialists. How much did this cost me? Not a dime. I never saw a bill. This is how it is outside of the United States. If you lived in any other advanced country in the world, you would be covered by a single payer universal health care system and most likely like Canada, you would never be billed for medical treatment. What Wanda went through in the United States is obscene. Americans deserve what the rest of the developed world enjoys… peace of mind from financial hardship due to illness or accident and I hope they start to seriously fight for it because I can assure you, it is worth fighting for.
I was operated on for a brain tumor in Canada and spent 11 days in the hospital. I received excellent follow-up care for many years after, including frequent MRIs, and visits with specialists. How much did this cost me? Not a dime. I never saw a bill. This is how it is outside of the United States. If you lived in any other advanced country in the world, you would be covered by a single payer universal health care system and most likely like Canada, you would never be billed for medical treatment. What Wanda went through in the United States is obscene. Americans deserve what the rest of the developed world enjoys… peace of mind from financial hardship due to illness or accident and I hope they start to seriously fight for it because I can assure you, it is worth fighting for.
3
Wow, what an awful system. I'm glad my government does the negotiating and paying for me, using trained experts and my (very reasonable) tax dollars. Highly recommended.
It seems that the lauded free-market innovation which health insurance creates is great new ways to make patients pay more for less.
It seems that the lauded free-market innovation which health insurance creates is great new ways to make patients pay more for less.
Someone needs to delve deeply into and investigate the Electronic Hospital Record systems health care providers are being forced to buy into. They are all designed to maximize billable hours and are definitely part of the problem.
1
Recently a local orthopedic practice suggested I wear a boot for a heel problem. They gave me the boot and a nurse explained in less than a minute how to buckle it. Medicare authorized payment of $850. I could buy exact boot on line for $62. Medicare and doc office said the coding was proper and the charge legit. (I wore the boot one day because of pain it caused.) Seems doc office could have suggested I buy online. Alas.
We all pay.
We all pay.
5
TO those who think that this article cries out for a single payer system, understand that the coding monster was created by government, not industry. ICD-10, with more than 100,000 diagnoses, was craeted by the government. CPT is licensed by Medicare and used by Medicaid. The complexity of government rules keeps piling up. Private insurers copy what the government is doing, not the other way around. Many private payers are trying to simplify the process by paying large doctor groups a single amount of money to cevoer everything (called pppm - per patient per month).
The more control that the government has over health care, the worse the rules become. Ask any doctor about this!
The more control that the government has over health care, the worse the rules become. Ask any doctor about this!
1
Several years ago I went to the emergency room with chest pains. After some tests that were negative, the doctor said he wanted to admit me just to be sure I was okay. I was handed a piece of paper that stated at the bottom that some insurers wouldn't cover this - it was explained to me that while I was going to be in the hospital it was billed as out-patient. I called my insurance company and they said that I wasn't covered. I declined to stay. A very nice, motherly woman from the hospital visited me and told me that "Of course your insurance will pay the bill." Astounded I said that they wouldn't. I was pressured to stay by the doctor as well, but I was finally released. It felt like being in a trap. If I'd really been sick, not sure what I would have done. The insurance people would only speak to me, not my husband - so we couldn't have even gotten information. My "solution" is to not be afraid to die, better to stay out of the clutches of medical pros and insurance companies!
3
Great article.
It is difficult to see America making informed policy decisions regarding a fair, effective healthcare system until we understand actual medical costs. The many levels of manipulating truth here - whether performed by hospitals recouping lost revenue from other (mandated and uncompensated) service areas, medical practitioners trying to get to fair compensation for their work, or insurers and pharmaceutical companies simply increasing their bottom line - is staggering.
Please...single payer system that allows vendors/suppliers a reasonable profit, rewards outcomes...an truthfulness.
It is difficult to see America making informed policy decisions regarding a fair, effective healthcare system until we understand actual medical costs. The many levels of manipulating truth here - whether performed by hospitals recouping lost revenue from other (mandated and uncompensated) service areas, medical practitioners trying to get to fair compensation for their work, or insurers and pharmaceutical companies simply increasing their bottom line - is staggering.
Please...single payer system that allows vendors/suppliers a reasonable profit, rewards outcomes...an truthfulness.
101
This article should be required reading for the entire Trump administration and Congress.
While the Trumpees rage about freeloaders, the real thieves exploit medical coding to pump profits. American health care needs to be re-built from the bottom up.
While the Trumpees rage about freeloaders, the real thieves exploit medical coding to pump profits. American health care needs to be re-built from the bottom up.
121
Healthcare is not a marketplace. Period.
Education is not a marketplace. Period.
To pervert these basic human rights in an advanced civilized society by trying to characterize either as a marketplace is, well, a perversion. As such it is indicative of the mindset that insists that these basic human rights somehow are contracts, ex or implicit, between two equal parties.
Any thinking, sentient adult human being knows this.
Education is not a marketplace. Period.
To pervert these basic human rights in an advanced civilized society by trying to characterize either as a marketplace is, well, a perversion. As such it is indicative of the mindset that insists that these basic human rights somehow are contracts, ex or implicit, between two equal parties.
Any thinking, sentient adult human being knows this.
1
People with insurance don't pay any attention to these bills. They only care about co-pays and meeting their deductibles. This is the reason all of our medical expenses are rising. The insurance companies pass these increased expenses directly to consumers in the form of higher premiums. And for Medicare and Medicaid the government picks up the tab. There needs to be serious oversight, of course. But under the Triump administration this will never happen. So we can decry these absurd expenses, but we must wait for four years for the chance to correct a problem that has been going on for years.
1
The medical coding business has taken the health industry underground, like its profiteers prefer it to be.
Out of sight, out of mind. It's the medical industries equivalent of what the financial algorithm writers did for the Bernie Madoffs of the financial industry. The whole coding industry hides the truth about the greed which drives the insane profits of the brokers.
It should make even the Russian hackers take notice.
Out of sight, out of mind. It's the medical industries equivalent of what the financial algorithm writers did for the Bernie Madoffs of the financial industry. The whole coding industry hides the truth about the greed which drives the insane profits of the brokers.
It should make even the Russian hackers take notice.
1
Consider the following story as an example of all that is wrong.
In January, I came down with a cold. Now, I am recovering from non-Hodkins Lymphoma, and my immune system is still funky.
So I went to my regular doctor. Only guess what? Regular doc quit or was let go. Saw her replacement. Explained my issues and my propensity to get way sicker because of my health history--all promptly dismissed. As the matter of fact, when I tried to bring up a third issue she instructed me to make another appointment and said "only one problem per time slot". I. Kid. You. Not.
So I left without antibiotics.
....and got sicker and sicker.
A week later, hacking up a lung, I went to the minute clinic thinking my hacking cough would surely qualify me for antibiotic. No cigar, sent home again.
Got even sicker. Ended up going to urgent care where they decided given my history, I needed a CT scan to rule out I don't know what. Had the CT scan, it was not pneumonia and was sent home. Without antibiotics. Again. Called lymphoma doc but he said stick with reg docs for cold.
By now, I was on week 3 of the plague and had to travel to Tel Aviv for business. Plane was hell. Dragged myself to dinner on night 1 and woke up the next day at deaths door. Hotel called doc. Doc prescribed antibiotics, steroids and 2 other pills--all bought for $25 at pharmacy without insurance. Doc cost $60. I felt better in 2 days.
How much do you think I spent in the US vs what I spent in Tel Aviv?
In January, I came down with a cold. Now, I am recovering from non-Hodkins Lymphoma, and my immune system is still funky.
So I went to my regular doctor. Only guess what? Regular doc quit or was let go. Saw her replacement. Explained my issues and my propensity to get way sicker because of my health history--all promptly dismissed. As the matter of fact, when I tried to bring up a third issue she instructed me to make another appointment and said "only one problem per time slot". I. Kid. You. Not.
So I left without antibiotics.
....and got sicker and sicker.
A week later, hacking up a lung, I went to the minute clinic thinking my hacking cough would surely qualify me for antibiotic. No cigar, sent home again.
Got even sicker. Ended up going to urgent care where they decided given my history, I needed a CT scan to rule out I don't know what. Had the CT scan, it was not pneumonia and was sent home. Without antibiotics. Again. Called lymphoma doc but he said stick with reg docs for cold.
By now, I was on week 3 of the plague and had to travel to Tel Aviv for business. Plane was hell. Dragged myself to dinner on night 1 and woke up the next day at deaths door. Hotel called doc. Doc prescribed antibiotics, steroids and 2 other pills--all bought for $25 at pharmacy without insurance. Doc cost $60. I felt better in 2 days.
How much do you think I spent in the US vs what I spent in Tel Aviv?
3
None of this is news.
Does anyone remember when CMS dropped the chargemaster data on the internet 2 or 3 years ago, showing that charges for the same procedure varied by orders of magnitude depending on location? There was about 36 hours of indignant editorials before it disappeared from the press.
There is too much for profit industry involved in this sorry state of affairs that there will always be more incentive to brainwash the American public into thinking that a single payer system is evil, rather than devoting resources to making a rational single payer work.
Does anyone remember when CMS dropped the chargemaster data on the internet 2 or 3 years ago, showing that charges for the same procedure varied by orders of magnitude depending on location? There was about 36 hours of indignant editorials before it disappeared from the press.
There is too much for profit industry involved in this sorry state of affairs that there will always be more incentive to brainwash the American public into thinking that a single payer system is evil, rather than devoting resources to making a rational single payer work.
1
The problem with our "health care" system is a misguided American delusion that we can escape our own mortality...on the cheap, no less.
Health care interventions that actually improve quality and quantity of life...vaccines, family planning, clean water, lifestyle interventions...are derided, ridiculed, and barely paid for.
Meanwhile interventions that extend older lives for mere months are designed by companies, marked on TV, and paid for with scarce health care dollars.
The fundamental problem with single payer in America is...Americans. We are not predisposed to think of the good of the whole over our own interests. Our systems are skewed to pay for things that make people money, not healthy. And the special interests are so entrenched it's impossible to imagine them changing.
Health care interventions that actually improve quality and quantity of life...vaccines, family planning, clean water, lifestyle interventions...are derided, ridiculed, and barely paid for.
Meanwhile interventions that extend older lives for mere months are designed by companies, marked on TV, and paid for with scarce health care dollars.
The fundamental problem with single payer in America is...Americans. We are not predisposed to think of the good of the whole over our own interests. Our systems are skewed to pay for things that make people money, not healthy. And the special interests are so entrenched it's impossible to imagine them changing.
My insurance company participates in this kind of nonsense. One year they'll pay a bill, then, coded slightly differently, pay nothing. When the provider recodes the bill, they're told that changing the coding will not change the refusal to pay.
Who can fault the biller: there are almost 11,000 separate codes. Medicare deals with the same system.
Since the Trump administration wants to deregulate, let's have them simplify medical billing. 90% fewer regulations translates into just 1,100 codes. That seems like enough to me.
Who can fault the biller: there are almost 11,000 separate codes. Medicare deals with the same system.
Since the Trump administration wants to deregulate, let's have them simplify medical billing. 90% fewer regulations translates into just 1,100 codes. That seems like enough to me.
It is the US National religion, greed, that afflicts the American health care system. The most successful union in America is the AMA, which artificially restricts the number of doctors. Meanwhile a sizable chunk of the legal industry lives off frivolous and exorbitant malpractice suits. Not to be left out are the health care insurers that want their pound of flesh even though they provide no tangible value as intermediaries. Look to other nations that have successfully implemented a single payer model, and who hold doctors in no higher esteem than their engineers.
1
The problems within this article are myriad and exist because we have a multi pronged for profit health care system. Upcoding has been going on my entire career as a nurse. The prices charged are whatever the insurers will pay. They have nothing to do with true costs. The rest of the world has figured out that health care costs do not respond to free market rules. This woman could not have compared prices, saved money and planned for her brain aneurism. The world recognizes this but we are "advanced" and do not. They set and cap prices with actual costs not artificial numbers. Believe me I do not get paid 68 dollars to give a tetanus shot but that is what you will pay. Take the profits out of medicine or things will get worse
1
As horrifying as this woman's experience is, I'm sure the providers are making a ton more on the lower cost routine tests billed at 6 or 10 times the rate of Medicare/Medicaid and the epidemic of over-testing. I've had two tests in the last few year that I disputed because I later learned that they were entirely medically unnecessary. Providers need to learn to do with less income and insurers need to go the way of the dinosaur. That is all there is to it. Time for single payer! Medicare already has so much in place to measure and detect fraudulent over-billing -- imagine if they could do that for everyone -- what a fantastic thing that would be. It will require a paradigm shift in how people think of doctor/hospital and other providers income -- you shouldn't be able to become a billionaire individual or institution by tending to mortal human suffering. You should do it for reasonable pay and because you want to be in a helping profession.
2
As sad as this story is l, why was the victim without a subsidised ACA exchange policy? it seems like she was the primary targeted beneficiary the ACA was designed to insure. This missing piece should be addressed. On the other hand, medical billing is an enigma. I found, after surgery, that insurance companies only pay what Medicaid, or Medicare pays plus about a 10% premium. My insurance paid 10 to 20 % of the amount of the stated bills. So, insurance companies have a great incentive to lobby the to keep the government payments low, it's a scam, everyone lose except for insurance company executives.
1
How about the medical bills you can read? Like the two times I had elective plastic surgery. It was my obligation to pay the entire bill up front which was exactly what I did only to find out months later that the anesthesiologist billed my insurance anyway and tried to collect a cool thousand dollars after I had been required to pay it in advance. I guess they thought my insurance company wouldn't catch the fact that I received these services for elective surgery. They almost pulled it off, not once but twice. And I called my insurance company to tell them they were double dipping. I wonder how many of those they pull off that fraud in a year?
3
I've worked in a hospital billing office for over 30 years and from my perspective a big part of the problem are uncooperative patients who really think hospital care should be some freebie that they shouldn't have to pay for What concerns hospitals most is the magic word--Reimbursement. I don't want to be responsible for any heart attacks out there but we actually want to be paid for our services. Hospitals also have financial aid departments where patients can go to make payment arrangements if there's going to be a problem. All we ask is that you work with us. Compounding our problem are the equally uncooperative major insurance companies who also don't want to reimburse us. Hospital billing offices now have to waste a great deal of time appealing cases to justify the medical necessity of many hospital admissions to the insurance companies Appeal is just another way deadbeat insurance companies try to stall payments to hospitals for as long as possible. Sooner or later they will either have to pay or face the consequences from the NY State Insurance authorities. Spare me the stories of how we need a single payer system. It's not happening.
Try walking in our shoes before heaping unfair criticism on the heads of those of us who toil in hospital billing!!! We're not the bad guys here!!!
Try walking in our shoes before heaping unfair criticism on the heads of those of us who toil in hospital billing!!! We're not the bad guys here!!!
I am a nurse and yes the hospital corporate system is the problem. A day in a hospital should not be 25000. That amount is ridiculous. The for profit vendors of DME and pharmaceuticals certainly add to the cost but get real no one expects free we just want fair. An RN takes care of 2 - 7 patients a shift and makes 75,000 a year. A 10 minute meeting with a doctor should not be 400 dollars. We will get to single payer because we must. The rest of the world sets and caps prices based on actual costs. We do nothing of the sort
1
So effectively the USA has no functional health care system. Please fellow USA citizens can we reign in insurance companies, ridiculous billing systems, insane medical school prices? It is quite possible. Here in México we have a multi-tiered system like Germany and Switzerland that offers universal coverage from private pay to private insurance to IMSS which is a system for large scale employers to Seguro Popular - a Medicare type of full coverage for whoever opts out of the other systems. A week in the hospital can come out to be about $500-$1000 USD. With highly trained multi-lingual doctors and nursing staff. One easy reason its so accessible is the excellent national University with branches in each state cap is free for top 20% and reasonable for the rest. Same for med school. My orthopedic doctor here did a long residency in Hahnemann in Philadelphia, was offered a position there but chose Mexico for lifestyle and professional reasons - here doctors can concentrate on health treatment of patients rather than billing systems and insurance qualifications. Please guys, it is so do-able.
3
Just a reminder your Republican members of congress see nothing wrong with this situation it's simply capitalism working as it should. If the far right had their way she would not have been treated to begin with.
As long as we have laws that require hospitals to treat a patient in this women's situation then healthcare is not a privilege but a right and we provide that right in the most expensive way possible. This simply stupid on so many levels it makes my head explode every time I try to have a rational discussion about the mess that the US healthcare system is with a conservative.
As long as we have laws that require hospitals to treat a patient in this women's situation then healthcare is not a privilege but a right and we provide that right in the most expensive way possible. This simply stupid on so many levels it makes my head explode every time I try to have a rational discussion about the mess that the US healthcare system is with a conservative.
2
The first adjustment to the ACA should be to prohibit providers from billing self-paying patients more than insured patients -- or at least no more than say 5% above the highest negotiated fee. Why should self-payers be punished so viciously?? Don't dismiss these people as responsible for their own situation. There are many, many reasons responsible people find themselves in these insurance gaps. People who change jobs, move across states or back home from abroad, encounter impossible financial situations like the poor woman in this story. Vistors to our country, including relatives. The system now makes any of these vulnerable people a sitting duck for every provider. I think the most repulsive one in this story is the doctor who hounded her after treating her. He was a human being who had laid his hands on this other human being and still saw her as.. a cash cow.
4
Medical care costs are out of control. Period. This coding nightmare is just another symptom of the problem. I just saw this with my son who had his wisdom teeth out. The billed amount was over $2000 but the amount my insurance paid was actually about $1000. So as you see, as the story says, if I did not have insurance I would have had to pay twice as much! Why? That is ridiculous? The huge insurance companies get to pay half or even less than an individual would have to pay? Our health system is going to collapse under it's own weight. I have always felt that urgent medical care should be a non-profit or low profit business and elective care should be high profit if they want. But to bill someone hundreds of thousands of dollars for procedures that really cost tens of thousands of dollars is simply criminal. Why are we not putting these hospital administrators in jail when they do this is beyond me.
3
Very nice article. And all of us feel the dread of this lady while reading the article. But I would mention a few salient facts. This lady had real assets (her home) that are risk of being lost due to a fire or health problem. And assuming that she had fire insurance, it is clear that Obamacare prevented her from being able to get inexpensive catastrophic health insurance. This is because Obamacare outlaws many inexpensive health care plans. The outcome has clearly been horrible
Way to blame the wrong thing. Before the ACA she couldn't get insurance. She could have paid 800 a month for an ACA plan but thought it was too expensive. The rate is not subsidized so she makes over 45000 a year. She chose not to become insured because she was healthy. This is the problem with the ACA, for insurance to work everyone needs to be insured. The ACA fines for not buying were set too low. If everyone uninsured was required to join the costs would have decreased. I do understand your desire for catastrophic insurance not offered by the ACA. I have looked into what the costs would be and it would be over 300 a month for insurance with a 25000 dollar deductible now. Remember the costs will be higher as there are no caps now
Several years ago, my father (87 years old at the time) suffered a subdural hematoma. He was initially attended at home by his family physician, who ordered an ambulance to take him to the local community hospital. He was given an MRI and a number of other tests and after a night's stay, transferred by ambulance to a major metropolitan hospital with a neurosurgical facility about 30 miles away. He was operated on successfully, spent three days in ICU, and was transferred by ambulance back to the community hospital for postoperative observation. After two days, he moved to a rehabilitation facility where he stayed for four weeks, receiving daily therapy. He was then moved back home, where a nurse visited regularly until his recovery was complete. Total cost of this care: zero. Of course, he lived in the UK where his treatment was provided by its "failing" National Health Service.
5
Thanks to Elizabeth Rosenthal for this revealing article about medical billing, and its impact on rising health care costs.
A story like this would be unimaginable in any country with universal health insurance. Only in the U.S. does this happen.
Ms. Wickizer was first a victim of a bad decision by EMS, then a stroke, and then an unconscionable multi-year effort by the University of Virginia Hospital system and its doctors to soak her of everything she had. They weren't content to charge her what they charge Medicare and insurers. No, they wanted her to pay 3 or 4 times that - money she obviously didn't have. They weren't content to take her entire retirement account or force her to sell her rental property. She did her best to be responsible and pay what she could, but they rejected it.
I'm amazed she handled it and recovered as well as she did. She was fortunate to get some much excellent pro bono help.
It is just appalling and unethical that medical providers try to collect more from uninsured patients, who obviously can't afford the huge medical bills and often go bankrupt. Healthcare providers fix the patient, and then try to destroy their lives.
Our healthcare "system" is diseased.
A story like this would be unimaginable in any country with universal health insurance. Only in the U.S. does this happen.
Ms. Wickizer was first a victim of a bad decision by EMS, then a stroke, and then an unconscionable multi-year effort by the University of Virginia Hospital system and its doctors to soak her of everything she had. They weren't content to charge her what they charge Medicare and insurers. No, they wanted her to pay 3 or 4 times that - money she obviously didn't have. They weren't content to take her entire retirement account or force her to sell her rental property. She did her best to be responsible and pay what she could, but they rejected it.
I'm amazed she handled it and recovered as well as she did. She was fortunate to get some much excellent pro bono help.
It is just appalling and unethical that medical providers try to collect more from uninsured patients, who obviously can't afford the huge medical bills and often go bankrupt. Healthcare providers fix the patient, and then try to destroy their lives.
Our healthcare "system" is diseased.
4
An industry that kicks you when you are down - part of the hypocritical oath they take, I am sure. A dollar and a dream perversely becomes a diagnosis and a financial nightmare for life - from the hospital to debtor's prison. Major side effects of getting medical treatment in America are financial PTSD, nausea, high blood pressure accompanied by rage, numbness, bankruptcy and death.
We're all just living slabs of meat to be exploited for financial gain by a massive medical and non-medical industrial complex contributing nothing to any real health outcome or consequence for us.
Perhaps uninsured patients should carry a tag around their neck stating you only pay the same rates as Medicare - not three times more! Or perhaps we need to be a "prepper" and Bring Our Own Medical Supplies and Drugs before entering a hospital to save money on that. Maybe you can take your own blood pressure and blood samples too.
Imagine if McDonalds considered their price list proprietary, we would never know how much the dollar meal actually cost until the cashier rung up the total.
The more money that goes into this racket through fees, premiums, deductibles, taxes, subsidies, etc., the greedier this "mammoth growth enterprise gets." Like college tuition - the more loans and government assistance there is, the higher the cost goes for essentially the same product.
American corporations race amongst each other to get the consumer into debt first - or be left out with debt burdened customers.
We're all just living slabs of meat to be exploited for financial gain by a massive medical and non-medical industrial complex contributing nothing to any real health outcome or consequence for us.
Perhaps uninsured patients should carry a tag around their neck stating you only pay the same rates as Medicare - not three times more! Or perhaps we need to be a "prepper" and Bring Our Own Medical Supplies and Drugs before entering a hospital to save money on that. Maybe you can take your own blood pressure and blood samples too.
Imagine if McDonalds considered their price list proprietary, we would never know how much the dollar meal actually cost until the cashier rung up the total.
The more money that goes into this racket through fees, premiums, deductibles, taxes, subsidies, etc., the greedier this "mammoth growth enterprise gets." Like college tuition - the more loans and government assistance there is, the higher the cost goes for essentially the same product.
American corporations race amongst each other to get the consumer into debt first - or be left out with debt burdened customers.
America. I got placed in the high risk pool for a similar reason. I took lorazepam for panic attacks during my husband's cancer illness and subsequent death. I, however, did purchase expensive open marketplace insurance. With the passage of the ACA, I actually received a subsidy (based on my income) which lowered my premium. Otherwise, I'd be paying $811 per month.
All I can say is, there must be a special place in hell for the people who dreamed up this indecipherable system with its cruel outcomes. Ms. Wickizer's problem is she has a few assets. (That's the only reason I keep paying premiums, to avoid medical bankruptcy.) What was the point of fixing her up to throw her out on the street?
One last thought, on top of this labyrinthine coding system are the intricacies of the insurance policy itself (if one has insurance). My B/C card lists various 'tiers' for providers, all ER visits are billed at $5,500 to walk in the door, and on a recent visit a physician's office insisted they were tier 2 while B/C insisted they were tier 3. Who needs a drink?
All I can say is, there must be a special place in hell for the people who dreamed up this indecipherable system with its cruel outcomes. Ms. Wickizer's problem is she has a few assets. (That's the only reason I keep paying premiums, to avoid medical bankruptcy.) What was the point of fixing her up to throw her out on the street?
One last thought, on top of this labyrinthine coding system are the intricacies of the insurance policy itself (if one has insurance). My B/C card lists various 'tiers' for providers, all ER visits are billed at $5,500 to walk in the door, and on a recent visit a physician's office insisted they were tier 2 while B/C insisted they were tier 3. Who needs a drink?
1
What a travesty.
The very persons who supposedly purport to alleviate suffering impose it in the form of severe financial distress on the very persons they supposedly claim to heal.
Balance billing should be made simply unenforceable.
Any provider who claims or alludes in its promotion or advertising or elsewhere to accept insurance should be prevented from balance billing over the rates allowed by the plan.
Any provider who treats uninsured patients should be required to limit its billing to the equivalent of the average of what Medicare, Medicaid and the five biggest private insurers would pay.
The very persons who supposedly purport to alleviate suffering impose it in the form of severe financial distress on the very persons they supposedly claim to heal.
Balance billing should be made simply unenforceable.
Any provider who claims or alludes in its promotion or advertising or elsewhere to accept insurance should be prevented from balance billing over the rates allowed by the plan.
Any provider who treats uninsured patients should be required to limit its billing to the equivalent of the average of what Medicare, Medicaid and the five biggest private insurers would pay.
Thank you Dr. Rosenthal for shining a light on this obscure but important topic. The health care financing system in the US is like going to a bazaar where prices are negotiated between two parties. Of course the seller (hospital) will set a high opening price for its services, while the buyer (insurer) will scoff and demand a much lower price. In the end, the negotiated price is somewhere in the middle. Same with drug prices between pharmaceutical companies and insurers. The uninsured individual without leverage at her most vulnerable moment loses out in the end. It's time to make healthcare prices transparent and fair, and end protection for "proprietary" charges and secret negotiated rates between hospitals and insurers. Single payer is one way forward but not the only way, but the health care marketplace will not fix itself.
The only descriptor required is "incompetence". The health care sector has been a runaway disaster for well over a decade, when medical bankruptcies began to spike.
Consider these atrocities:
Charging people money they can't possibly afford, and claiming it's a viable system.
Allowing ridiculous price increases for medication on a "whether it's affordable or not" basis.
On the case cited in this article, someone could buy a house and almost retire, based entirely on picking a number to charge for procedures. Does it sound like it could ever be a good pricing system?
Permitting a nation with a chronic, massive and increasing range of health issues to continue to suffer and go broke for no good business or economic reason is obscene. What use is it to charge prices nobody can afford, anyway? What use is it to turn the health sector in to one huge national debt collection agency trying to recover money that doesn't exist from very sick people?
Never mind the politics; the whole idea of galloping costs is nuts. "User pays" be damned. Cost viability beats user pays any day of the week. This isn't a free market or any other ideological issue, it's a business issue about a sector-wide case of total failure to recognize basic issues and pricing realities for so many years. The upshot will be corporate failures, loss of services, and more sick people on the scrapheap. End this system, ASAP.
Consider these atrocities:
Charging people money they can't possibly afford, and claiming it's a viable system.
Allowing ridiculous price increases for medication on a "whether it's affordable or not" basis.
On the case cited in this article, someone could buy a house and almost retire, based entirely on picking a number to charge for procedures. Does it sound like it could ever be a good pricing system?
Permitting a nation with a chronic, massive and increasing range of health issues to continue to suffer and go broke for no good business or economic reason is obscene. What use is it to charge prices nobody can afford, anyway? What use is it to turn the health sector in to one huge national debt collection agency trying to recover money that doesn't exist from very sick people?
Never mind the politics; the whole idea of galloping costs is nuts. "User pays" be damned. Cost viability beats user pays any day of the week. This isn't a free market or any other ideological issue, it's a business issue about a sector-wide case of total failure to recognize basic issues and pricing realities for so many years. The upshot will be corporate failures, loss of services, and more sick people on the scrapheap. End this system, ASAP.
These issues have been percolating for decades. It was impossible for me to price out a procedure 40 years ago and nothing has changed. Our first child cost us under $1,000, and included all prenatal and post office visits, plus labor/delivery and 8 hospital days for me as well as 10 days hospitalization for our baby. Understand now the average cost for a baby is about $22,000 with a hospital stay of no more than 3 days. The intervening years have wrought an enormous increase in cost AND it is still virtually impossible to find out the actual cost for a genetic testing during pregnancy.
So my question is in what way does a consumer have market based choice? And BTW, if pregnancy isn't required of all insurance plans, how exactly does the Trump plan figure ordinary Americans can cough up thousands of dollars to have a baby?
So my question is in what way does a consumer have market based choice? And BTW, if pregnancy isn't required of all insurance plans, how exactly does the Trump plan figure ordinary Americans can cough up thousands of dollars to have a baby?
1
I am fortunate, I have high-quality health insurance from my employer, backed up by Medicare. My wife and I both worked (and I still work) with computer systems. We are are both amazed at the both intentional and unintentional obfuscation of medical billing systems --- frequently the people who administer them cannot cannot answer simple questions about them. If any other line of business charged for goods and services in the manner that health care does, the perpetrators would be publicly castigated.
Before Congress embarks on another effort to reform health insurance, its members might be well advised to consider how badly free market principles operate when the product is ultimately one's survival and the price is deliberately hidden.
Before Congress embarks on another effort to reform health insurance, its members might be well advised to consider how badly free market principles operate when the product is ultimately one's survival and the price is deliberately hidden.
2
I've lived in Europe and Asia for nearly 20 years, in developed countries. The health care providers in these, yes, single-pay systems--which are supplemented by private insurance--make do with much less than their greedy counterparts in the U.S.
And the U.S. doctors and other health care providers have managed to convince Americans that they receive the best health care on the planet. Well, as we know, the health outcomes paint a different picture, even though the U.S. spends twice or more on its massive medical-industrial complex than other industrialized countries.
And the U.S. doctors and other health care providers have managed to convince Americans that they receive the best health care on the planet. Well, as we know, the health outcomes paint a different picture, even though the U.S. spends twice or more on its massive medical-industrial complex than other industrialized countries.
1
We have the best government money can buy. The medical industry makes about 20% of our GDP while delivering dismal services resulting in below average life expectancy and health. But this is our country. As long as the population swallows this insult, nothing will change. As long as people are happy to read about their favorite celebrity and their life styles while neglecting their own well being, nothing will change. We NYT readers might know about the state of the Union but can't change much, not unlike the citizens of the Soviet Union who mostly knew about the inefficiencies and corruption of the regime. The only difference is we can write and read about it. In front of our eyes a probe into the biggest election fraud evaporates, our best scientists receive death threats when pointing to a looming catastrophe.
We can't keep the narrative that this is the best place on earth while maintaining a feudal system that keeps 90% in serfdom, but alas whenever someone points out what a crap hole this country is, even the most ardent critics get back in line and support the system as if aliens are attacking it.
We can't keep the narrative that this is the best place on earth while maintaining a feudal system that keeps 90% in serfdom, but alas whenever someone points out what a crap hole this country is, even the most ardent critics get back in line and support the system as if aliens are attacking it.
1
As originally conceived, the "free market" is a place where the prices of goods & services are determined by what people are willing to pay. Competition is the driving force behind this: purchasers want to pay the least possible while sellers desire just the opposite; if I charge too much, someone else may very well come along and find a way to deliver that good or service for a lower price. If I'm not willing to pay a certain price, I either don't get that product or I find someone who will sell it for the price I want to pay.
That ideal system has been so deeply distorted that it is completely dysfunctional. If you can lie, cheat and obfuscate, you can short-circuit the basic laws of economics and get people to pay a great deal more for a good or service than the free market would dictate. And what better arena for this to play out than health care, where people are literally given the choice of life or death?
According to our Declaration of Independence, every human is endowed with an inalienable right to life. Why, then, do we as a society allow profit-seeking henchmen to rob us of that right in order to maximize profits? When will we say enough is enough?
That ideal system has been so deeply distorted that it is completely dysfunctional. If you can lie, cheat and obfuscate, you can short-circuit the basic laws of economics and get people to pay a great deal more for a good or service than the free market would dictate. And what better arena for this to play out than health care, where people are literally given the choice of life or death?
According to our Declaration of Independence, every human is endowed with an inalienable right to life. Why, then, do we as a society allow profit-seeking henchmen to rob us of that right in order to maximize profits? When will we say enough is enough?
1
Do not make any attempt to deal with this. The best course is to ignore it entirely, and do as little as posable to resolve anything - its all a waste of time. Certainly do not make any "good faith" payments. It the hospital tries a law suit, then fight it by challenging everything they did, claiming it is, in effect, entirely fraud, which it most is by any reasonable standards. Claim that every detail did not happen - that every charge was manufactured. The system is clearly an evil system, and should be opposed as an evil system. The fact that good people work with it, highly qualified doctors, does not change that. I got assessed several thousand dollars that insurance would not pay. I simply ignored everything entirely. I did not spend a minute looking over the material. You will take a credit hit, but its is nearly impossible to prevent that. I repeat - the system is pure evil, do not attempt to reconcile anything.
2
The problem comes from an unrestrained Orwellian, 1984-like bureaucracy that sits in place for decades and had no accountability. Only another powerful bureaucracy can oppose it - the insurance system, which is also corrupt. The solution - set up hospitals and insurance systems that are accountable. They might be publicly owned corporations that have regents or directors that are voted in or out, like public university regents. A government single payer system is somewhat accountable too, as a government can be voted out. Treating hospitals like public universities might provide the business model we need.
Several times I timed my visits to private family physician's office for routine exams & have been made to pay $140 for simple 3 minute routine doctor consultations. The insurance company, going by billing codes submitted by the doctor's office, agrees with the charges. Are there other professions that fleece their customers charging such high fees for routine stuff ($2800/hr)? By the way, those are the negotiated rates in my Midwest large metropolitan area.
It is time to get rid of so called "Free Market" healthcare. Bring on single payer government run clinics for the masses, and let the GOP purists pay out of their own pockets exorbitant rates for their treatment at "Free Market" healthcare centers.
It is time to get rid of so called "Free Market" healthcare. Bring on single payer government run clinics for the masses, and let the GOP purists pay out of their own pockets exorbitant rates for their treatment at "Free Market" healthcare centers.
2
Another issue is that most doctors are rarely sympathetic to patient concerns about costs. One doc told a relative of mine that he had to stay overnight at a very high cost to be available early in the morning for a test. Apparently there was no hour early enough to arrive in the morning that could prevent an overnight stay.
First thing in the morning a different doctor decided that the test wasn't necessary; that a simpler test that wouldn't have required the overnight stay was all that was needed. Too late of course, to save the cost of the expensive hospital stay. There's no other business that can get away with this kind of incompetence.
First thing in the morning a different doctor decided that the test wasn't necessary; that a simpler test that wouldn't have required the overnight stay was all that was needed. Too late of course, to save the cost of the expensive hospital stay. There's no other business that can get away with this kind of incompetence.
2
Imagine going to a GM dealership and picking out a new car. You will have no idea how much the price of that car will be. GM sends you a bill in the next couple of months. The bill might be $15,000 or $143,729. You are legally obligated to pay the bill that arrives. By that example, the American healthcare system more akin to a mafia shakedown than a free market transaction. There has been no vaunted intersection between supply and demand: at no time has the consumer and provider made a deal for the price of services rendered. What has really occurred is that the consumer signed away their rights to have any knowledge of price while retaining full obligation to pay. And this has likely occured while the patient is bleeding to death or beginning lifesaving chemotherapy. There is no "free" market and no capitalism in this system. It is an entrenched and legally sanctioned shakedown that accounts for about 17% of American GDP and employs 1 in 8 people in this country.
2
I would say that moist health care professionals do their best to accurately describe the services performed and why. They are trying to be paid fairly. The coding system is extremely complicated, and I am a biller and certified coder owning one of these billing companies. We do need a single payer system. We could then code for statistical purposes and not for payment.
Also, self pay patients can and should try to negotiate a lower rate. Providers know what their usual payment is and are most often open to accepting that from the patient. The problem is that the patient is unaware of that. Offering to pay $75.00 on a $200.00 bill will win you that discount most of the time.
Also, self pay patients can and should try to negotiate a lower rate. Providers know what their usual payment is and are most often open to accepting that from the patient. The problem is that the patient is unaware of that. Offering to pay $75.00 on a $200.00 bill will win you that discount most of the time.
3
Excellent amd timely article.
My wife's hip replacement billed out at over $114,000 and was paid in full at $12,000. Let's face it, at a minimum, the services should be priced at the amount willingly accepted?
If we want to bend the cost curve in health care down, a single price point should be mandated (eg. The amount Medicare will pay as it is calculated to pay actual cost plus a profit).
Health care has to be the only industry where its customers are never told the price of its services until after consumption.
My wife's hip replacement billed out at over $114,000 and was paid in full at $12,000. Let's face it, at a minimum, the services should be priced at the amount willingly accepted?
If we want to bend the cost curve in health care down, a single price point should be mandated (eg. The amount Medicare will pay as it is calculated to pay actual cost plus a profit).
Health care has to be the only industry where its customers are never told the price of its services until after consumption.
2
Like many Americans, I put the healthcare bills at the bottom of the pile and pay them last because they are often so hard to decipher and compare against the amounts my insurer has paid them. These delays must hurt the cash flows of the various providers, but that's their problem. It becomes ours when the providers raise their rates to compensate.
On multiple occasions, I've received bills from providers that fail to account for the money they've already been paid by my insurer. I am also not in a hurry to pay because our regional health system, for example, routinely resubmits claims to my insurer weeks or even months later, causing the amount I owe to decline. Pay too early and you will over-pay, and thus face the hassle of trying to get your money back.
This same regional provider is expert at sending out bills which say "pay this amount" and little more. When you ask for documentation, you get lengthy statements filled with medical jargon and acronyms, with amounts that still bear little resemblance to your insurer's records.
When people ask me to describe the most painful part of a medical procedure, I reply that it's usually the opening of the invoices a few weeks later. All of this is why so many Americans are relieved to go on Medicare. Our national health system for seniors isn't that cheap, but it does a great job of removing the stress at billing time. I add my name to the millions who advocate Medicare for all . . . and the firing of health system CFOs.
On multiple occasions, I've received bills from providers that fail to account for the money they've already been paid by my insurer. I am also not in a hurry to pay because our regional health system, for example, routinely resubmits claims to my insurer weeks or even months later, causing the amount I owe to decline. Pay too early and you will over-pay, and thus face the hassle of trying to get your money back.
This same regional provider is expert at sending out bills which say "pay this amount" and little more. When you ask for documentation, you get lengthy statements filled with medical jargon and acronyms, with amounts that still bear little resemblance to your insurer's records.
When people ask me to describe the most painful part of a medical procedure, I reply that it's usually the opening of the invoices a few weeks later. All of this is why so many Americans are relieved to go on Medicare. Our national health system for seniors isn't that cheap, but it does a great job of removing the stress at billing time. I add my name to the millions who advocate Medicare for all . . . and the firing of health system CFOs.
2
Patients without insurance suffer a triple whammy.
1. Insurers negotiate lower rates for their clients.
2. Insurance companies are equipped to effectively battle unfair billing including arcane coding practices.
3. Insurance companies pay a significant portion of their clients medical bills.
I am heartened that Ms. Wickizer has mostly recovered and is moving on with her life, thanks to a supportive cadre of friends, relatives, and former strangers.
1. Insurers negotiate lower rates for their clients.
2. Insurance companies are equipped to effectively battle unfair billing including arcane coding practices.
3. Insurance companies pay a significant portion of their clients medical bills.
I am heartened that Ms. Wickizer has mostly recovered and is moving on with her life, thanks to a supportive cadre of friends, relatives, and former strangers.
There are numerous problems with medical billing. Before I went into surgery. I asked the Dept. of Surgery that only participating providers be used over the 16 hours. Then the huge bills poured in from non-participant providers. I explained that since I was out, I had not hired them. Then there is the issue of bills for drugs; no research was done on conflicts that could have killed me. I rely on my pharmacist and NIH.gov (as I did for the surgery since the neurosurgeon spoke to me for a total of seven minutes pre- and post-op and now I can barely walk and lost much of my vision; NIH.gov being one of our greatest assets that Trump wants to shed). Billing departments want me to do their work: pay them, get a reimbursement. I told them no, it was their job to get reimbursement and leave only the co-pay. All remains a mess except for one item: I am a lawyer and the debt collectors receive 50 to 60% of recovery, or the cost of filing suit.
3
full disclosure: have spent over a decade working for a major hospital on electronic medical record systems.
Until we reform fee for service, our medical care woes will never improve. And for this to happen, congress has to repeal or replace (heh) HIPAA. This would involve changing the way that Medicare - the most utilized entitlement by the elderly, who disproportionately vote. HIPAA is what forces the private insurers to use the ICD/CPT coding system that creates all the complexity, and all the waste/fraud/abuse and unnecessary procedures that plague us. It is also what makes medical bills so hard to understand. The next time you are visiting your primary care physician ask to speak to someone in his back office and ask that person to explain medicare modifiers to you.
Ways in which fee for service destroys everything: It requires hordes of people working for both the insurance company and the hospital to negotiate reimbursement rates; it has spawned a whole industry of people known as medical coders whose only job it is to demand high salaries to know CPT/ICD and add zero to actual care; it incentivizes doctors to do additional procedures because that is how they can get more money; it permits fraud by billing for visits that never occurred, etc.
Unless and until we jettison fee for service, or massively simplify it, healthcare will continue to be a massive cost sink for our country.
Until we reform fee for service, our medical care woes will never improve. And for this to happen, congress has to repeal or replace (heh) HIPAA. This would involve changing the way that Medicare - the most utilized entitlement by the elderly, who disproportionately vote. HIPAA is what forces the private insurers to use the ICD/CPT coding system that creates all the complexity, and all the waste/fraud/abuse and unnecessary procedures that plague us. It is also what makes medical bills so hard to understand. The next time you are visiting your primary care physician ask to speak to someone in his back office and ask that person to explain medicare modifiers to you.
Ways in which fee for service destroys everything: It requires hordes of people working for both the insurance company and the hospital to negotiate reimbursement rates; it has spawned a whole industry of people known as medical coders whose only job it is to demand high salaries to know CPT/ICD and add zero to actual care; it incentivizes doctors to do additional procedures because that is how they can get more money; it permits fraud by billing for visits that never occurred, etc.
Unless and until we jettison fee for service, or massively simplify it, healthcare will continue to be a massive cost sink for our country.
4
In 2013 I had my "free" ACA physical at the UNC Hospitals system. After insurance paid the $189 for the physical the UNC system charged me another $850. They said I agreed to pay that because I signed a form saying I recognized that there might be additional charges.
It was creative billing all the way. For example, when I told the doctor I had high blood pressure I was billed for a "diagnosis of hypertension", and when I simply mentioned a painful wrist I was billed for an "orthopedic consultation".
The point is, that even if you have insurance as I did, the creative billing system can be used against you to charge you for things the insurance will not cover. Instead of the UNC Hospital suing me, I threatened to sue them and got all the charges canceled. After reading this wonderful article I realize I was very lucky.
It was creative billing all the way. For example, when I told the doctor I had high blood pressure I was billed for a "diagnosis of hypertension", and when I simply mentioned a painful wrist I was billed for an "orthopedic consultation".
The point is, that even if you have insurance as I did, the creative billing system can be used against you to charge you for things the insurance will not cover. Instead of the UNC Hospital suing me, I threatened to sue them and got all the charges canceled. After reading this wonderful article I realize I was very lucky.
6
1. Prior to the ACA, true catastrophic health policies were a very good thing. At any age, you could get a policy with a 25,000 deductible for about 200 dollars per year. So if you get hit with a 300,000 bill, you are only one the hook for 25,000. The ACA ended true catastrophic plans, and replaced it with something of the same name, available to people under 30, but because of a plan having to meet ACA provisions, eliminated the true catastrophic plan. I had one for 20 years.
2. yes self pay hospital billing is really really scary. No doubt about that.
3. Yes if we paid the same drug prices as the rest of there world, all parties in the US ( government, insurance companies, and citizens) would save a conservative estimate of 200 billion dollars per year. This could eliminate or reduce the scarcity mentality that is driving everything these days.
4. yes it is time to look at maybe 10 modern countries with reasonably effective health care systems and carefully look at advantages and disadvantages of each, throw in a few ideas of our own given who we are in the US and what we expect in healthcare - and come up with a handful of debatable options.
5. As a side note, England, Germany, Hong Kong, and Canada all have public health care - but none of these countries have identical systems. They are all different. However, we in the US are basically on the lunatic fringe right now, but there are interesting cost effective options evolving successfully too.
2. yes self pay hospital billing is really really scary. No doubt about that.
3. Yes if we paid the same drug prices as the rest of there world, all parties in the US ( government, insurance companies, and citizens) would save a conservative estimate of 200 billion dollars per year. This could eliminate or reduce the scarcity mentality that is driving everything these days.
4. yes it is time to look at maybe 10 modern countries with reasonably effective health care systems and carefully look at advantages and disadvantages of each, throw in a few ideas of our own given who we are in the US and what we expect in healthcare - and come up with a handful of debatable options.
5. As a side note, England, Germany, Hong Kong, and Canada all have public health care - but none of these countries have identical systems. They are all different. However, we in the US are basically on the lunatic fringe right now, but there are interesting cost effective options evolving successfully too.
1
Excessive billing from hospitals and other health care facilities is a common practice throughout the US. Unfortunately unpaid medical bills are the leading cause of personal bankruptcy. A simple law that can make illegal to charge any uninsured patient more than medicare rates. To me offering 20% discount on highly inflated charges is a highway robbery. No one should negotiate to pay the hyper- inflated hospital bills.
Hospitals are the only place where neither health care providers nor the patient have any clue about the cost of the services and treatment given in the hospital.
Our politicians are more focused on the ideology than solving health care issues in our country. I wish we can pull the health care insurance of all the elected congressmen and let them buy from open market. This way they will feel the pain of a common citizen that they feel every day.
Hospitals are the only place where neither health care providers nor the patient have any clue about the cost of the services and treatment given in the hospital.
Our politicians are more focused on the ideology than solving health care issues in our country. I wish we can pull the health care insurance of all the elected congressmen and let them buy from open market. This way they will feel the pain of a common citizen that they feel every day.
As a surgeon approaching retirement this article explains my and many other physicians' frustration with the corrupt American Health Care Financing System. I personally resent being an accomplice in what is becoming a criminal enterprise. I can't help but think this Tower of Babel will some collapse under it's own weight. Unfortunately the Affordable Care Act, aka Obamacare, has only added hundreds of stories to the Tower. The Republican alternative is a perfect example of going from the frying pan into the fire. Electronic Health Records and mega Data touted as saviors that will increase quality and efficiency are primarily concerned with documentation to maximize reimbursement and are not focused on patient care. Pointing out problems is easy, solutions are not. Unfortunately our political leaders have neither the intellect, backbone or other anatomic equipment necessary to design and execute solutions.
Let’s face it, the medical insurance industry in its current incarnation is a borderline fraudulent racketeering operation. In no other business would these practices be legal.
To solve some of the problems we need to (1) have the insurance purchase decision be made directly by the beneficiary/consumer (by removing the employer tax benefit), and (2) while keeping low income beneficiaries covered under medicaid, have the government step in to provide/subsidize also catastrophic coverage only to the middle and upper-middle class, so that people don’t go bankrupt from emergency high-cost medical care. This will be cheaper than Obamacare. Routine day-to-day medical costs will be covered directly by the consumer out-of-pocket or by an insurance company if the consumer chooses.
The result will be greater transparency, competition, rationality and efficiency in the insurance market (because they will cater directly to the customer), and in the market for a lot of of medical care (because they will also sell directly to the user). There will also be enormous cost savings and efficiency by dropping a lot of the heavy administrative and other insurance-driven burdens and costs, and by having much of catastrophic care costs covered by the government, which can more directly negotiate, address pricing concerns and make large lump payments.
To solve some of the problems we need to (1) have the insurance purchase decision be made directly by the beneficiary/consumer (by removing the employer tax benefit), and (2) while keeping low income beneficiaries covered under medicaid, have the government step in to provide/subsidize also catastrophic coverage only to the middle and upper-middle class, so that people don’t go bankrupt from emergency high-cost medical care. This will be cheaper than Obamacare. Routine day-to-day medical costs will be covered directly by the consumer out-of-pocket or by an insurance company if the consumer chooses.
The result will be greater transparency, competition, rationality and efficiency in the insurance market (because they will cater directly to the customer), and in the market for a lot of of medical care (because they will also sell directly to the user). There will also be enormous cost savings and efficiency by dropping a lot of the heavy administrative and other insurance-driven burdens and costs, and by having much of catastrophic care costs covered by the government, which can more directly negotiate, address pricing concerns and make large lump payments.
1
I'm a physician, and I know first-hand as both a patient and a doctor, how Byzantine our medical billing system is. Spending 25 percent of U.S. hospital spending on administrative costs is obscene. Just recently I was double billed for a procedure at a major medical center (not in Chapel Hill) and when the insurance company refused to pay for the duplicate billing, the medical center billed me for the full amount. It took more than two weeks for the medical center to reverse the bill. I wonder how many patients would not have spotted the error in the first place or not had the documentation to fight it. Bottom line is that our current healthcare system is a disaster. Trump is right. The system is broken, but the solution is not Trumpcare. That's an even bigger disaster. The solution is a single-payer system that will drive medical coders into a more productive line of work and get the insurance companies out of the medical system. Pay doctors a reasonable salary for their services. Have hospitals paid reasonable amounts to maintain their facilities and give patients care at a cost that's in line with what other advanced countries pay. With all the money the society would save, we might even have dollars to spend on public education.
1
Thank you for this well researched article. As our president said health care is so complicated . Unfortunately the recent health care debate regarding health care had almost exclusively focused on market based health insurance which may be only part of the problem. There are other reasons for health cost inflation in the US which include exorbitant price of pharmaceuticals and medical devices, expensive sometimes futile intensive care in the last few weeks of a patient's life ,procedure oriented specialists receiving the highest payment in the world. Add to this mix billing and coding, the complexity becomes more daunting. It is difficult to put all the blame on the hospitals which by law have to give care to any one without medical insurance like Ms Wickizer who walks into the emergency room. That includes patients from any part of the world who go straight from the airport to the ER.
This article should be a required reading for every congressman and for our president who appears to be more interested in marketing than health care policy details and solutions. Single payer anyone?
This article should be a required reading for every congressman and for our president who appears to be more interested in marketing than health care policy details and solutions. Single payer anyone?
An Easy Way To Lower Health Care Costs For All
When I retired early, my company continued to provide health insurance with a personal premium I paid plus an employer subsidy. However, I was required to enroll in Medicare at age 65. Interestingly, the premium cost (Medicare + my supplemental + employer subsidy) was essentially unchanged as was the coverage. What changed ? First of all, there were no more “preferred providers”, I could choose among all (not just a few) nearby clinics, doctors, and hospitals as well as bigger medical centers far away - all now in my network! But, most importantly Medicare established much lower allowed charges by hospitals and doctors. (Perhaps our president has heard that Medicare allowed fees are 40% to 60% of the absurd higher costs initially billed by medical providers. Large insurers don’t do quite as well but still pretty good, I’ve heard.) So just incorporate into pending health care laws the requirement that Medicare sets ALL fees. This would level the negotiated costs playing field and cut costs for all and dramatically for the uninsured. Then establish a single payer non-profit plan to administer these insurance for these costs.
When I retired early, my company continued to provide health insurance with a personal premium I paid plus an employer subsidy. However, I was required to enroll in Medicare at age 65. Interestingly, the premium cost (Medicare + my supplemental + employer subsidy) was essentially unchanged as was the coverage. What changed ? First of all, there were no more “preferred providers”, I could choose among all (not just a few) nearby clinics, doctors, and hospitals as well as bigger medical centers far away - all now in my network! But, most importantly Medicare established much lower allowed charges by hospitals and doctors. (Perhaps our president has heard that Medicare allowed fees are 40% to 60% of the absurd higher costs initially billed by medical providers. Large insurers don’t do quite as well but still pretty good, I’ve heard.) So just incorporate into pending health care laws the requirement that Medicare sets ALL fees. This would level the negotiated costs playing field and cut costs for all and dramatically for the uninsured. Then establish a single payer non-profit plan to administer these insurance for these costs.
2
My wife has Stage 3 endometrial cancer of the uterus. The hysterectomy and cancer treatment chemo, so far, has been billed at over $270,000. Alabama is relatively cheap for medical care. Medicare and Federal Blue Shield has "Paid" to hospitals, oncology center, labs, and doctors less than $35,000. Medicare has covered and paid about 10% and Blue cross about 2.5%. We owe Zero to hospital, labs, and doctors, so far! We have some medicines and extras for this cancer that we have paid, about $400. The full two year bill may reach $500,000 and the hospitals and doctors will get paid less than $65,000! We hope to pay less than $2000 in medicine, wigs, ect. and extra care for this cancer.
Note, we do pay $8,000 per year for all insurance, Medicare, Blue Cross/Blue Shield and Blue Cross Dental for two of us.
There are two lessons learned. First, yearly gynecological exams might have caught her cancer in time. Medicare does not pay for such exams if over 70. That is wrong. Second, make sure you get Medicare as early as possible and support medicare for all in the future . Think what we would have paid before the ACA or would have paid with Trump care.
We say Medicare for all.
Note, we do pay $8,000 per year for all insurance, Medicare, Blue Cross/Blue Shield and Blue Cross Dental for two of us.
There are two lessons learned. First, yearly gynecological exams might have caught her cancer in time. Medicare does not pay for such exams if over 70. That is wrong. Second, make sure you get Medicare as early as possible and support medicare for all in the future . Think what we would have paid before the ACA or would have paid with Trump care.
We say Medicare for all.
1
As a former medical biller, I am offended by this article. Medicare routinely
monitors over payments, the result is called a charge back, where the facility
must pay back erroneous payments.
ICD9 or ICD10 codes are determined by supporting documentation, and
are not manipulated, agreed, that is fraud. Codes are designed to reflect
an office visit, a wellness preventive care visit, and are specific to the date
of service. Billers who manipulate a DOS code will eventually be caught.
There are some charges patients should dispute, a $3.00-$7.00 charge
for the injection, the injection puncture, from a phlebotomist, for a blood test.
This article makes Coding and Billers sound like they are in it for the money,
and what they can get away with.
Hospitals have patient advocates, who will help a patient and their family,
dispute and correct erroneous billing.
Insist the hospital explain each and every charge on the bill, before a patient
or family member pays the bill, and with the help of a patient advocate, that
is a right, not a mystery.
We need more informed articles on billing and patients rights.
monitors over payments, the result is called a charge back, where the facility
must pay back erroneous payments.
ICD9 or ICD10 codes are determined by supporting documentation, and
are not manipulated, agreed, that is fraud. Codes are designed to reflect
an office visit, a wellness preventive care visit, and are specific to the date
of service. Billers who manipulate a DOS code will eventually be caught.
There are some charges patients should dispute, a $3.00-$7.00 charge
for the injection, the injection puncture, from a phlebotomist, for a blood test.
This article makes Coding and Billers sound like they are in it for the money,
and what they can get away with.
Hospitals have patient advocates, who will help a patient and their family,
dispute and correct erroneous billing.
Insist the hospital explain each and every charge on the bill, before a patient
or family member pays the bill, and with the help of a patient advocate, that
is a right, not a mystery.
We need more informed articles on billing and patients rights.
3
I suffer from type 2 diabetes and colon cancer ( in remission after major surgery) I get treated in Thailand at Bumrungrad hospital. You would not believe how efficient and respectful this place is towards patients. In America I would get bounced around from doctor to doctor and lab to lab navigating a labyrinth of arcane procedures and uncommunicative clinics, labs, and physicians while my Anthem Blue Cross insurance just informed me no more out-of- network coverage on a policy that I pay 1200 USD a month for with a 7000 dollar deductible. Medicine is obscenely expensive compared to the costs overseas. The so called ACA act has only mad things get more confused and overpriced for me because I am not eligible for the freebies Obama set up for people of lesser means. It is just another form of taxation and I get punished because I pay my taxes on income earned. The doctors get burned , the patients get ripped off , and big pharma and the Insurance companies make a fortune. I moving to Thailand permanently because of these reasons. Why Americans pay more for less is a real problem that leads to rotten health care without compassion.
A few thoughts: 1. What about paying providers a flat fee for ongoing care, rather than a fee for each service, an idea much touted in recent years? 2. How do other countries' systems deal with this problem? 3. What possible moral justification is there for charging the most vulnerable -- those without insurance or with inadequate insurance -- higher prices? Why shouldn't hospitals be required by law to charge the same prices to everyone? 4. As this excellent article illustrates, in our current healthcare environment, patients need as much protection from financial harm as from medical harm. Medical schools and professional organizations for hospitals and other providers must provide education on this issue, and encourage the adoption of higher ethical standards for the protection of patients. Medicine must return to the idea of being a profession dedicated to public service, not an industry dedicated to maximizing revenue.
I work in clinical commissioning in the NHS in the UK. Essentially, we are the single payer of the hospital, community services and ambulance bills, drawing our revenue from income tax and national insurance via the Treasury.
Coding errors are made here too but patients do not see or experience any of the confusion whilst recovering. We take care of that. They simply leave hospital and think about getting better. We find it so hard to understand the resistance in the USA to this system of healthcare. Everyone is covered. Care is evidence-based. Only necessary procedures are carried out as noone gains from excessive investigations.
I can't claim to really understand the nuances of the Affordable Care Act but I do wonder if Americans would prefer a nationalised health service when I read articles like these.
Very interesting indeed.
Coding errors are made here too but patients do not see or experience any of the confusion whilst recovering. We take care of that. They simply leave hospital and think about getting better. We find it so hard to understand the resistance in the USA to this system of healthcare. Everyone is covered. Care is evidence-based. Only necessary procedures are carried out as noone gains from excessive investigations.
I can't claim to really understand the nuances of the Affordable Care Act but I do wonder if Americans would prefer a nationalised health service when I read articles like these.
Very interesting indeed.
A catastrophe in health ought not create chaos in paperwork.
Canadian billing entails about 78% less paperwork than U.S. health care, a saving reflected in much lower accounting requirements and office staff employment for physicians.
Best of all, clients never have to read fine print while figuring out coverage.
The notion that several kinds of personal and public coverage must be duct-taped together to save you money seems ludicrous to us. And a crushing complication to serious illnesses.
Medical bankruptcy, like coverage-confusion, is almost unheard-of here, while hospitals save millions in accounting costs
.
Single-payer universal coverage even poorer folk access to and choice in doctors. It also frees ERs for real emergencies, saving more paper, reducing more non-medical staff, and saving time for staff and patients. Having brain-surgery should not result in new headaches, just recovery.
Canadian billing entails about 78% less paperwork than U.S. health care, a saving reflected in much lower accounting requirements and office staff employment for physicians.
Best of all, clients never have to read fine print while figuring out coverage.
The notion that several kinds of personal and public coverage must be duct-taped together to save you money seems ludicrous to us. And a crushing complication to serious illnesses.
Medical bankruptcy, like coverage-confusion, is almost unheard-of here, while hospitals save millions in accounting costs
.
Single-payer universal coverage even poorer folk access to and choice in doctors. It also frees ERs for real emergencies, saving more paper, reducing more non-medical staff, and saving time for staff and patients. Having brain-surgery should not result in new headaches, just recovery.
2
I recently had to have an echocardiogram done. This is a test that had been done at my cardiologist's office in the past for approximately $400.00 (before insurance.) The cardiologist has now moved their diagnostic testing equipment to a room at the local hospital. It is the same test, done by the same technician, results read by the same doctor. The only difference is that they have physically placed the machine in a room downstairs at the hospital and now bill for $1600 before insurance. As I pay a 25% copay, I called the billing department to try to understand why my new co-pay was as much as the entire cost of my previous echocardiograms. I was told that they moved the equipment into the hospital because they could bill more for the tests there as they use different codes. I paid the bill, and found a new doctor who continues to offer these tests in office for $400. The old cardiology center was bought out by a corporation, and these types of changes quickly followed. Our healthcare system is beyond repair, and is purely profit driven at this point. How anyone can think that this is better than a single payer system is beyond me.
240
This is the wrong discussion to be having.
The two biggest employers in my city are the University and Health Care. Both are very large, very complex operations. The University is split into Colleges and Departments with Faculty and Staff at the edges. Faculty are paid a yearly salary, not a set amount for each person education (or test given or student paper graded or after having a discussion with the student).
Our "Fee for Service" Health Care system is nonsense. Doctors should be hired and paid a salary. The Department they work in should determine services in collaboration with others (just like a University). Lazy Doctors should be shunned and not given tenure ala lazy Faculty. Supplies ordered on a budget.
Taxes and appropriations would determine the level of care to be delivered. Insurance companies would be gone, billing nonsense gone, with Doctors left to focus on care, not insurance.
I walked out of my clinic the other day seeing a couple of Doctors and Professional Staff. I walked by a long hallway of people crowded together, shoulder to shoulder, pecking at terminals and talking on the phone. This bank of 20 people were there simply to work on insurance issues arising from care delivery.
Fee for Service needs to go.
The two biggest employers in my city are the University and Health Care. Both are very large, very complex operations. The University is split into Colleges and Departments with Faculty and Staff at the edges. Faculty are paid a yearly salary, not a set amount for each person education (or test given or student paper graded or after having a discussion with the student).
Our "Fee for Service" Health Care system is nonsense. Doctors should be hired and paid a salary. The Department they work in should determine services in collaboration with others (just like a University). Lazy Doctors should be shunned and not given tenure ala lazy Faculty. Supplies ordered on a budget.
Taxes and appropriations would determine the level of care to be delivered. Insurance companies would be gone, billing nonsense gone, with Doctors left to focus on care, not insurance.
I walked out of my clinic the other day seeing a couple of Doctors and Professional Staff. I walked by a long hallway of people crowded together, shoulder to shoulder, pecking at terminals and talking on the phone. This bank of 20 people were there simply to work on insurance issues arising from care delivery.
Fee for Service needs to go.
The law needs to change big-time.
Absolutely no liability whatsoever for any medical bill unless the provider waives any and all rights to withhold any so-called "trade secret" or other "proprietary information" relevant to understanding the bill, and demonstrates that its charges are no more than the average of major government payers (Medicare, Veterans, Military) plus the biggest five private insurers' contracted in-network rates for the relevant geographic area (regardless whether the particular provider is a member of any of those networks).
Absolutely no right (by any provider or by any collection agency) to report any claim for any medical bill until it has been adjudicated in court and time for all appeals have expired.
Unlimited liability (without exception for "business" reasons) for libel and slander for any report to a credit agency of any liability which is not adjudicated in court and no longer appealable.
Absolutely no right to require any claim for any medical bill to be submitted to arbitration outside of court unless the defendant has agreed after presented with the bill after the procedure -- i.e. absolutely no right to enforce any so-called contract for arbitration signed in advance.
Raise the exemption limits on assets subject to levy for enforcement of judgements for medical bills to at least $100,000 in home equity and $50,000 of life insurance and $5000 in retirement assets for every year of age after age 35, up to a maximum exemption of $100,000.
Absolutely no liability whatsoever for any medical bill unless the provider waives any and all rights to withhold any so-called "trade secret" or other "proprietary information" relevant to understanding the bill, and demonstrates that its charges are no more than the average of major government payers (Medicare, Veterans, Military) plus the biggest five private insurers' contracted in-network rates for the relevant geographic area (regardless whether the particular provider is a member of any of those networks).
Absolutely no right (by any provider or by any collection agency) to report any claim for any medical bill until it has been adjudicated in court and time for all appeals have expired.
Unlimited liability (without exception for "business" reasons) for libel and slander for any report to a credit agency of any liability which is not adjudicated in court and no longer appealable.
Absolutely no right to require any claim for any medical bill to be submitted to arbitration outside of court unless the defendant has agreed after presented with the bill after the procedure -- i.e. absolutely no right to enforce any so-called contract for arbitration signed in advance.
Raise the exemption limits on assets subject to levy for enforcement of judgements for medical bills to at least $100,000 in home equity and $50,000 of life insurance and $5000 in retirement assets for every year of age after age 35, up to a maximum exemption of $100,000.
While the system is certainly broken your demonization of medical coders couldn't be further from the truth. I work for a very large health system in Philadelphia, as a medical coder. A point I think your article is truly missing is that these codes and modifiers and the whole nine are set into place by none other than our government. Major insurances and Medicare make it next to impossible to get appropriately reimbursed. If one simple thing is out of place, denied. Send an appeal, denied. Trying to get an explanation of your denial? Forget it. They don't give details. We, as medical coders, are held to the CMS standard. Fraudulent charges? Pay back CMS and other insurers. Because audits are rampant. Accurate coding is principal in this field. CMS lays down the rules and I do my best to abide by them. I, personally, am legally liable if charges are fraudulent. Do I find it absurd that the rate hospitals or doctors charge self pay patients? Absolutely. But my goal is never "entrepreneurial coding". Your article while relevant to the ever present issue of our mess of a health system is placing far too much blame on people simply doing their job and trying to find their way in this precarious world of coding. The only organization at fault here is the US government. I also would like to ask, if not the coding system(which has gotten more specific to prevent fraud), then what? How do we, as office staff or billers, convey to the myriad insurers what services were provided?
2
As a recipient of Medicare, I have the comfort and peace of mind that my medical bills will be paid, often in full, when my supplemental coverage is taken into account. Traditional Medicare reimbursements may be about one-third, but are generally much less than the billed amount, and often as little as 5-10%. So when providers are seen accepting 5,10 or 15-cents-on-the-dollar, it's safe to conclude that the amounts charged the uninsured are inflated, to say the least. Had I been the lawyer for the subject of this piece, I would have demanded the providers render the bill as if she had been a Medicare enrollee. That would reveal the reasonable charges. Oh yes, my supplemental policy premium is less than $200 monthly.
I suffer from glaucoma and need to take three kinds of drops a day, While on vacation in Italy last month i unexpectedly ran out of one product and went to see an ophthalmologist to get a prescription. The visit cost me 100 euro ($108) because i obviously have no medical coverage in Italy but when i went to the pharmacy to fill my prescription I found out that the full price was 14 euro ($15) and i bought two bottles of 5 ml. At home my copayment alone for the same prescription ( one bottle of 5ml.) is $280. I have a good medical insurance plan. We read every day of abuses by big pharma, big banks, big oil, big insurance and big everything and how they get away with it with no legislation to stop them. Where legislation is in place, it appears to be extremely difficult to have a case resolved because enforcement of the law is apparently hard to get. Are there any politicians left in this country who are not on the payroll of the industry? Single payer yes, but i don't see it happening in my lifetime, and certainly not under this administration.
1
On a much smaller basis I too have come up against the coding issue. My son had physical therapy after dislocating his shoulder playing sports. We were not billed for each office visit which would have been the simplest way of doing it. Instead we got a whopper of a bill at the end. I requested an explanation of charges and was sent a 20 page document filled with different billing codes and divided by dates of service but in a completely random order. I refused to pay the bill until someone explained it to me which no one could. I talked to the orthopedist who I knew well and he said he would take care of it. He started to then handed it over to the billing department which did nothing even after multiple conversations and requests for help. Then they got a collection agency involved and I asked again for an explanation of the bill. Got the same 20 page document again which they could not decipher at all. A year later my son needed shoulder surgery and I was put in a windowless room with a woman who stated that they would not treat him until I paid the bill. She literally left me there with my son in the waiting room for almost an hour coming back in once or twice with more documents that made no sense. I finally just paid the bill and he was seen. Luckily our insurance had paid most of it. Although I love my orthopedist his billing practices were a disgrace.
1
There are more than 70,000 ICD-10 codes, many of which are vague and really do not fit the actual problem treated. However, this is the system literally FORCED upon the medical community by ..... who? Actually, I'm a physician and to this day have no idea who and what is behind this coding garbage. What I do know is that insurance companies will deng payment for every bill sent until they are finally forced to pay the provider or reimburse their insured. For those who are uninsured, most hospitals and doctors will extend courtesy and often will work for next to nothing or, in some cases, pro bono. It is not unusual for hospital bills to inlude charges for ten dollar tubes of toothpaste and five dollar mini soap bars, and most hospital and physician payments are much lower than the actual submitted charges. It is the uninsured patient, however, who is left out in the cold with little recourse. Many are placed on emergency Medicaid on admission, but in over forty years of medical practice I have never seen a person treated as inhumanely as the lady in this article. Unless Trump and Ryan get their way, most Americans will be spared the cruelties of medical billing. Between the GOP and the Virginia medical community this story could be the rule rather than the exception. What has happened to the Hippocratic oath? Indeed, what has happened to decency and common sense?
5
There are a number of learnings in Ms. Wickizer's tragedy.
She couldn't afford a premium of $800 a month - Obamacare doesn't offer subsidies to people that make more than 400% of the Federal Poverty Level
She let her insurance lapse - Trump & Ryan's American Health Care Act would make her pay 30% more than the amount she couldn't afford
She quit work to take care of her children, which got them on Medicaid - but Medicaid in Virginia doesn't cover such a mother
Then because she wasn't covered by either Obamacare or Medicare, which would have paid a much reduced, flat all encompassing fee for most of her care, she was subjected to line-item billing.
Last, she didn't have before and couldn't understand after what the charges were for each service, so she couldn't act like a consumer.
There is an old saying of Russian workers - we pretend to work and they pretend to pay us - that describes the essence of U.S. medical billing practices. Hospital CFOs rather arbitrarily tweak the several thousand billing codes that their hospitals charge for in order to make their budget for next year, to pay for expansions of facilities, services & staff and to add to reserves (which would be called profits, but they are not-for-profit, which only means they do not pay taxes). Sure, Medicare makes hospitals relate charges to costs but only across broad departments. But hundreds of billing codes used within departments make little sense
These are things that must change in US health care
She couldn't afford a premium of $800 a month - Obamacare doesn't offer subsidies to people that make more than 400% of the Federal Poverty Level
She let her insurance lapse - Trump & Ryan's American Health Care Act would make her pay 30% more than the amount she couldn't afford
She quit work to take care of her children, which got them on Medicaid - but Medicaid in Virginia doesn't cover such a mother
Then because she wasn't covered by either Obamacare or Medicare, which would have paid a much reduced, flat all encompassing fee for most of her care, she was subjected to line-item billing.
Last, she didn't have before and couldn't understand after what the charges were for each service, so she couldn't act like a consumer.
There is an old saying of Russian workers - we pretend to work and they pretend to pay us - that describes the essence of U.S. medical billing practices. Hospital CFOs rather arbitrarily tweak the several thousand billing codes that their hospitals charge for in order to make their budget for next year, to pay for expansions of facilities, services & staff and to add to reserves (which would be called profits, but they are not-for-profit, which only means they do not pay taxes). Sure, Medicare makes hospitals relate charges to costs but only across broad departments. But hundreds of billing codes used within departments make little sense
These are things that must change in US health care
5
Every industry I deal with is required to post fees BEFORE engaging.
*Why not the medical field?*
When was the last time you walked into a doctor's office and saw a totally transparent fee schedule posted?
One should not need a doctorate in algorithms, logarithms, calculus, and trigonometry to figure out one's medical bills!
*Why not the medical field?*
When was the last time you walked into a doctor's office and saw a totally transparent fee schedule posted?
One should not need a doctorate in algorithms, logarithms, calculus, and trigonometry to figure out one's medical bills!
4
Have you ever asked how much a procedure will cost?
They can't come up with a figure or amount.
I did not have dental insurance and needed a root canal.
Having to pay out of pocket, I inquired about the price for the procedure.
Nobody, not one person in the office could give me an answer.
If you are paying out of pocket should not a patient be able to find out the exact amount beforehand? Then you could also shop around, like one would when purchasing a car or any other service. How much is this going to hurt, financially? It is all so painfully ridiculous. There has to be a better way.
They can't come up with a figure or amount.
I did not have dental insurance and needed a root canal.
Having to pay out of pocket, I inquired about the price for the procedure.
Nobody, not one person in the office could give me an answer.
If you are paying out of pocket should not a patient be able to find out the exact amount beforehand? Then you could also shop around, like one would when purchasing a car or any other service. How much is this going to hurt, financially? It is all so painfully ridiculous. There has to be a better way.
8
I have been in the health care field for -42- years . My husband and I are currently on health care advantage with Medicare and Kaiser (G-d bless them).
Although the bills/non bills are confusing I can only say......
Medicare for ALL.
Do our Congressmen/women have to jump through health insurance hoops?
I doubt it!
Although the bills/non bills are confusing I can only say......
Medicare for ALL.
Do our Congressmen/women have to jump through health insurance hoops?
I doubt it!
6
My general rule of thumb for dealing with incomprehesible medical bills is to keep shredding them until somebody knocks on my front door. So far nobody has. People are not sending us these things. Computers are. And thus far they haven't learned to drive cars and come to my house.
50
remember Waco. it might be a bit late when they come knocking, Buddy.
2
Please, don't get me wrong. I think you are morally in the right not to pay extortionists and loan sharks (otherwise known as hospitals and medical providers). However, their computers do not need to know how to drive to your house. They only need to know how to use the legal system to tap into your retirement funds and empty them.
5
When hospitals smelled ACA coming, they saw the opportunity to gouge patients by adding "facility fees." In my case, five minutes in the office for a liquid nitrogen spritz: $2000; ten minutes for an injection for an arthritic knee: $3000. Absolutely no excuse for such obscene charges. Mr. Trump, you want approval? Forget AHCA; go after these sharks.
3
We're having the same experience. Now that hospitals have bought up numerous doctor practices, we get myriad bills from the doctors, anesthesiologists, and then facilities fees. Impossible to decipher, so we just have to pay. We have insurance and college education. What on earth do people with no insurance and little education do in this world? Not being snotty about that but if we can't understand these bills, who can? Fix ACA, actually moving to single payer and we would all be better off.
1
What these providers are doing is basically organized crime. Isn't this kind of overcharging clearly one of the major factors contributing to the extreme stress on our healthcare system aside from the damage it is doing to individuals?
Isn't this something that liberals and conservatives can agree on and work on together?
Can we not assume that most people are against this kind of fraud and abuse? We know that this kind of scamming is the bread and butter of our con man huckster president and "freedom" caucus republicans. But certainly good people under all shades of the political spectrum realize how toxic this system is and that is must be reformed.
Isn't this something that liberals and conservatives can agree on and work on together?
Can we not assume that most people are against this kind of fraud and abuse? We know that this kind of scamming is the bread and butter of our con man huckster president and "freedom" caucus republicans. But certainly good people under all shades of the political spectrum realize how toxic this system is and that is must be reformed.
3
Wow. And the GOP just tried to feed us a "bitter bill" that would make it all just that much worse. I would say "Shame!", but they have none.
14
In other words, the medical industry has figured out a way to squeeze the patient for every possible cent. If you have a heart attack - WHAM! Big cost. BUT!!....if you have "acute systolic heart failure, it's WHAM, WHAM, WHAM! Because you needed a different kind of monitor or catheter or drug while you were in the hospital.
We have evolved from a society into a profit-making machine. Why does it cost $20 co-pay to see my regular doctor, but $175 co-pay to see a specialist? Where is the justification? Oh...there is none, other than the "specialist" tagged onto his Post-nominal letters. And like idiots, we pay the difference.
One day someone will drop a few bombs, wipe out most of the population and whomever is left will be able to start over from scratch. Let's hope they learn from our mistakes.
We have evolved from a society into a profit-making machine. Why does it cost $20 co-pay to see my regular doctor, but $175 co-pay to see a specialist? Where is the justification? Oh...there is none, other than the "specialist" tagged onto his Post-nominal letters. And like idiots, we pay the difference.
One day someone will drop a few bombs, wipe out most of the population and whomever is left will be able to start over from scratch. Let's hope they learn from our mistakes.
2
In 2011, I was laid off my job. I had been paying into health care for 27 years, through my employment and had always been healthy. I was offered COBRA, but the $1200 a month was too expensive and so I took a chance. A few months later, I fell and broke my leg and injured my knee. When the ambulance arrived they asked if I owned my house and advised me not to go to the hospital. They carried me to a friend's car, I went to an Immedicenter and was told that I indeed had a severe injury. They gave me pain killers and sent me home and told me to get an MRI. I got quotes that ranged from $350 in bad neighborhoods, to $3500 where I had my mammograms. The results were given by my othopedist (250 consult and for each follow up). Now I had a pre-existing condition. This was a $100,000 injury. After six months I got Obamacare (700 per month). My leg was not repaired in those months and I was in excruciating pain. I consulted Mexico (7800), Canada (15,000) and India (5500) for treatment. Under Obamacare and with the help of a very good surgeon, I was able to walk again. During this time, I almost never got a straight answer about what the costs were. 40 years ago I worked for a doctor in Canada, the codes were in a thin book and were very straight forward, but in the US, nothing made sense. I had paid taxes and premiums for years and never used them, but a small fall resulted in catastrophic bills. I sold my house and returned to Canada where I am lucky to live.
12
Some have an 'escape hatch' country they can go to for medical care but home grown Americans do not have this option. I know many older adults who intend to return to the old country when they retire. Nice if you have this option.
I wish I could just move back to Canada or where ever after I retire.
I wish I could just move back to Canada or where ever after I retire.
I was involved with the pharmaceutical industry from 1993 till 2013. What I can tell you is that during the mass confusion of 2008 and 2009 and crumbling of the banking system. The pharmaceutical industry finalized their "coup" against American public. Many patents on drugs had already expired and generics were pooing in at very low prices with only a narrow supply of new drugs in the pipeline the pharmaceutical industry needed a radical strategy to once and for all take control of the drug market. Some of you may even recall pharmacies running ads form a month supply of drugs for $8.99 and there was a lot of them!!! Pharmacies would still make money. So what happened?
Here are some of the deceptive strategies used the industry :
- Phony extended release products
- Adding two generic drugs together and giving it a brand name.
-Changing formulation of syrups and suspensions eye drops and giving it a brand name and of course brand name pricing.
- Adding an over the counter drug to a generic drug and calling it a brand name
- Changing preservative and the strength and asking for extension of an eye drops patent.
- Buying out competition and closing them and their suppliers.
- Making therapeutically equivalents of a certain generic unavailable (these are drugs that are in the same class) so you have fewer options
- Making sure that only one or two generics for a product is available and that is sold by their sister company with a price slightly sting below brand name.
Here are some of the deceptive strategies used the industry :
- Phony extended release products
- Adding two generic drugs together and giving it a brand name.
-Changing formulation of syrups and suspensions eye drops and giving it a brand name and of course brand name pricing.
- Adding an over the counter drug to a generic drug and calling it a brand name
- Changing preservative and the strength and asking for extension of an eye drops patent.
- Buying out competition and closing them and their suppliers.
- Making therapeutically equivalents of a certain generic unavailable (these are drugs that are in the same class) so you have fewer options
- Making sure that only one or two generics for a product is available and that is sold by their sister company with a price slightly sting below brand name.
14
I have been waiting for an article like this for years, hope the author keeps up
Next I would like to see a study on
1) what the AMA has "contributed" to support good medical care
2) the abuse of Medicaid, both from hospitals, physicians, patients, agencies for long term care etc
3) EMR contribution to GIGO (garbage in, garbage out), and what happened to the billions that the Obama administration invested in EMR companies
Next I would like to see a study on
1) what the AMA has "contributed" to support good medical care
2) the abuse of Medicaid, both from hospitals, physicians, patients, agencies for long term care etc
3) EMR contribution to GIGO (garbage in, garbage out), and what happened to the billions that the Obama administration invested in EMR companies
4
This article is spot on. The world of OCD coding is medicine today. It drives the entire flow of treatment and money.
3
I'm glad to see an article on this. For years we have been looking at our insurance statements (Blue Cross Blue Shield) that we receive after any medical bill has been paid, noting the difference, usually 100% plus, between what the "provider charged" and what "we (BCBS) paid" (also called "amount allowed"). We've always wondered what was going on. One assumption (who knows how true or false) is that the providers overly inflate their "charges" knowing full well that the game is to do such in expectation that the insurer will actually pay only half or less of the amount charged. Or, it could be the the amount charged by the provider is what someone without insurance will actually have to pay, which is more troubling and perhaps in fact the case given some of the other comments about patients having to "negotiate" down high prices billed by providers. Anyone out there able to explain this better?
9
This reporter is doing the Lord's work! Please, don't stop.
I once got a doctor's bill which had only a list of codes on it, but not what the codes stood for. I had gotten about 12 different blood tests, and the costs varied quite a bit. (Normally this doctor group would list the associated test, but apparently since I went to a satellite office rather than the main office that one time, the test names were not listed.) I called the billing department to find out what tests had been done on me. The person I talked to looked up each code and told me what is was, until she had reached 8 - and then her computer system locked her out and told her she couldn't do any more searches! (At least, that's what she told me.) I find it mindboggling that codes are so super-secret even employees of the billing department are deemed security risks and can't know more than 8 codes per patient per bill!
I once got a doctor's bill which had only a list of codes on it, but not what the codes stood for. I had gotten about 12 different blood tests, and the costs varied quite a bit. (Normally this doctor group would list the associated test, but apparently since I went to a satellite office rather than the main office that one time, the test names were not listed.) I called the billing department to find out what tests had been done on me. The person I talked to looked up each code and told me what is was, until she had reached 8 - and then her computer system locked her out and told her she couldn't do any more searches! (At least, that's what she told me.) I find it mindboggling that codes are so super-secret even employees of the billing department are deemed security risks and can't know more than 8 codes per patient per bill!
8
Medical care is not a "for profit" enterprise. Those blood-thirsty Republican legislators advocating repeal of the Affordable Care Act for the past 84 months apparently believe otherwise. Thanks so much to the New York Times for this brilliant piece of both descriptive and investigative reporting.
How we have arrived at this pathetic state of affairs presents the prima facie case for the disaster of so-callled "Trumpcare" presented to the least amongst us. At least President Obama's Affordable Care Act had ground rules. Any loss of political capital incurred by Ryan and Trump arising from promotion of the "American Health Care Act" is profound comeuppance.
How we have arrived at this pathetic state of affairs presents the prima facie case for the disaster of so-callled "Trumpcare" presented to the least amongst us. At least President Obama's Affordable Care Act had ground rules. Any loss of political capital incurred by Ryan and Trump arising from promotion of the "American Health Care Act" is profound comeuppance.
9
Politicians from both isles wants to cater to insurance companies and hospitals. Never they will fix this problem because they never look at it with the intention of solving it. Shame on these cowards who care more for their finances and re-elections. As others have pointed out, this is not free market capitalism, it is like getting hunted and eaten alive if you become unfortunately sick without insurance.
10
Although my case was no where near that expensive, I too received a slew of bills I couldn't identify. I had a nurse anesthetist during the procedure and was billed for her services but I also received a bill from the anesthesiologist whom I never saw. It's crazy. And I couldn't figure out the billing either.
We cannot let the GOP take us back to an era sans Medicaid, Medicare or ACA.
We cannot let the GOP take us back to an era sans Medicaid, Medicare or ACA.
2
Hospitals have many different prices depending on who is paying. The cash customer pays the most. Bill $300,000 + for a cash customer, when the hospital would take $60,000 from an insurance company. The right wing says that if you pay cash, you will watch your medical spending. Obviously this is backwards from the real world.
1
How did America governments become so unaccountable for the dire state of healthcare provision for the people? What an an abolute hellish and wasteful state of affairs.
1
Outrageous ! Outrageous!
We are not a civilized, compassinate country.
We are not a civilized, compassinate country.
1
My wife and I are two of the lucky ones. We both qualify for Medicare and hold policies to supplant Medicare A and B that, for the most part, take care of the rest of our medical, dental, vision, and audiology needs. It is very good healthcare coverage. I am very pleased.
But when I attempt to understand what policy is paying for what service given the co-pays, deductibles, and vague, overly complicated EOB's, I am instantly lost. Recently, I was foolish and changed my Medicare to electronic reports, thinking to save some paper. Then I lost my password. Should be a simple problem, but the toll free number is was directed to call, is never available, so I have no idea what is going on with that coverage. As for the Medicare plus policies, those statement are so confusing, I cannot even understand who they are paying for what service when. They seem to bill six months behind the service, and since we both are older and see medical providers numerous time each year, it would be a full time job just keeping track of when we had been to a particular doctor or clinic. Another issue is that some laboratories bill via doctors whose names are not even familiar to us.
In all, hospital billing codes and insurance EOB's make a patient's understanding of a bill impossible. We have basically given up attempting to make the effort. Once in a great while, when I get a direct billing I call my insurance company to inquire why they have not paid the bill. It's all I need to know.
But when I attempt to understand what policy is paying for what service given the co-pays, deductibles, and vague, overly complicated EOB's, I am instantly lost. Recently, I was foolish and changed my Medicare to electronic reports, thinking to save some paper. Then I lost my password. Should be a simple problem, but the toll free number is was directed to call, is never available, so I have no idea what is going on with that coverage. As for the Medicare plus policies, those statement are so confusing, I cannot even understand who they are paying for what service when. They seem to bill six months behind the service, and since we both are older and see medical providers numerous time each year, it would be a full time job just keeping track of when we had been to a particular doctor or clinic. Another issue is that some laboratories bill via doctors whose names are not even familiar to us.
In all, hospital billing codes and insurance EOB's make a patient's understanding of a bill impossible. We have basically given up attempting to make the effort. Once in a great while, when I get a direct billing I call my insurance company to inquire why they have not paid the bill. It's all I need to know.
2
I wonder if Ms. Wickizer is of that tribe of people who believe that they have a right to not buy insurance as a matter of personal freedom? And if they do choose, they get to choose their benefits, so a guy like me does not need to buy pregnancy coverage or for that matter coverage for type 2 diabetes since my weight is normal. Of course when the bills come in for the catastrophe of a subarachnoid hemorrhage, which I am sure she did not expect - at retail rates (which nobody but the uninsured are ever charged), she is upset and financially threatened, and asks for dispensation from others - namely the rest of us taxpayers and insured people who subsidize the uninsured regularly.
Not to say the system is not broken, but until it is fixed, the rules in place need to be followed, This means that one buys coverage any way they can, including the various subsidies for low income available at least today via the ACA. I wish her the best but wish she and others like her understood the stakes of being uninsured and did not turn to others when fate catches up to them.
Not to say the system is not broken, but until it is fixed, the rules in place need to be followed, This means that one buys coverage any way they can, including the various subsidies for low income available at least today via the ACA. I wish her the best but wish she and others like her understood the stakes of being uninsured and did not turn to others when fate catches up to them.
1
Heres a good one.
I was recently hospitalized in NJ for what was diagnosed as Gastritis. The hospital billed my insurance company approx 8 thousand dollars. The insurance company paid a little over 3k based on the fact it was an in-network hospital and my doctor is affiliated with the hospital.
So, all is good right? Nope. The hospital i guess was annoyed that they didnt get the full 8k they proceeded to send me a bill for the difference and when i refused based on what my insurance negotiated and paid, they sent the account to a collection agency, still claiming i owe them money.
I was recently hospitalized in NJ for what was diagnosed as Gastritis. The hospital billed my insurance company approx 8 thousand dollars. The insurance company paid a little over 3k based on the fact it was an in-network hospital and my doctor is affiliated with the hospital.
So, all is good right? Nope. The hospital i guess was annoyed that they didnt get the full 8k they proceeded to send me a bill for the difference and when i refused based on what my insurance negotiated and paid, they sent the account to a collection agency, still claiming i owe them money.
4
I've never had any difficulty understanding my medical bills. I don't even get a bill when I come out of the hospital. There must be a reason. Wait! I know why. I live in that ugly socialist country, Canada.
5
As a nurse, I have been hit by this coding sham. I have done coding and when my bill arrived I was shocked. Called the hospital and got the "big shuffle". I went in to talk and got the big shuffle. Finally got ahold of the head person in the billing office and I have never met anyone so rude. I finally drove in to meet her and explained the procedure and the billing. She relented. My insurance company saved hundreds of dollars. Who would know this but someone who actually knew the codes. We are being "had" folks.
7
Mind-boggling for the unsubsidized middle class...
If you're on Medicaid - free...
As your own story calls out - but in your usual circumspect way, when you want to ignore/bury the truth - the reason she didn't go on Medicaid was to hold on to assets...
Your use of words like "broke even" or "small rental property", or noble notions like "would help pay for her children's college" put your journalistic bias out in plain sight...
Find me the working middle-class person - currently having to buy unsubsidized insurance for themself and their family - who wouldn't like to own a rental property, or have a $100K in retirement savings...
But they don't make for good NYT anecdotal narrative...
She should have sold everything and bought lottery tickets...
It would've been a better bet than the one she took...
What you don't even address is why she didn't buy a bronze plan - probably would've disqualified he children for Medicaid...
Liberté, égalité, fraternité, subsidé...
Which is why Le Pen is in the hunt in France...
If you're on Medicaid - free...
As your own story calls out - but in your usual circumspect way, when you want to ignore/bury the truth - the reason she didn't go on Medicaid was to hold on to assets...
Your use of words like "broke even" or "small rental property", or noble notions like "would help pay for her children's college" put your journalistic bias out in plain sight...
Find me the working middle-class person - currently having to buy unsubsidized insurance for themself and their family - who wouldn't like to own a rental property, or have a $100K in retirement savings...
But they don't make for good NYT anecdotal narrative...
She should have sold everything and bought lottery tickets...
It would've been a better bet than the one she took...
What you don't even address is why she didn't buy a bronze plan - probably would've disqualified he children for Medicaid...
Liberté, égalité, fraternité, subsidé...
Which is why Le Pen is in the hunt in France...
4
In Missouri, if you make more than $400 a month, then you are too rich to get Medicaid. Your kids can get Healthcare, thanks to Hillary Clinton in the 1990s, but not adults.
The ACA tried to fix that by requiring states to cover adults up to $24,000 a year, but Repubs sued and the supreme court ruled that states could not be forced to raise the income level. Since MO is a red state, we didn't raise the income level. Retirement accounts don't count towards income.
Note that this story took place before the ACA, so she would not qualify for medicaid.
The ACA tried to fix that by requiring states to cover adults up to $24,000 a year, but Repubs sued and the supreme court ruled that states could not be forced to raise the income level. Since MO is a red state, we didn't raise the income level. Retirement accounts don't count towards income.
Note that this story took place before the ACA, so she would not qualify for medicaid.
1
Disgusting. What stands out:
1. Without decent health care insurance the health care providers are will charge you 2.5 times more
2. The comparison with Medicare is 3 times more.
It would seem to me that this mean that the insurance company is therefore costing those whom they insure 50% of the cost of their care. Out of that 50% they are running large businesses and still managing to make a profit if they are for-profit.
Then think about the decreased cost of getting your insurance from a medical group rather than an insurance company.
I have never read such a good justification of single payor.
1. Without decent health care insurance the health care providers are will charge you 2.5 times more
2. The comparison with Medicare is 3 times more.
It would seem to me that this mean that the insurance company is therefore costing those whom they insure 50% of the cost of their care. Out of that 50% they are running large businesses and still managing to make a profit if they are for-profit.
Then think about the decreased cost of getting your insurance from a medical group rather than an insurance company.
I have never read such a good justification of single payor.
5
The true cost of medical care is, and probably always has, shrouded by the use of obscure terms and breakdowns of services and materials. After staying in a hospital for 4 nights following a MI I was presented with a bill for more than $60,000. I had allowed my insurance to lapse, and I was a "self-pay" patient. On the day of my discharge I was told that for a single payment of $12,200 my bill would be cleared, but I had to pay that day. This was a for-profit hospital. I paid and that was that. But I still wonder why a for-profit hospital would accept just 20% of a bill. I was unemployed at the time, but I owned a home. They were either charitable or simply covering their nut. If the mark-up truly is $4 for each $1 cost, that goes a long way explaining why healthcare costs are skyrocketing. I remain conflicted about the billing.
6
I have excellent medical insurance which paid almost everything for several major surgeries and radiation treatment for cancer. However, the statements are beyond absurd including a long list of things like
hospital/doctor charged $413.12
insurance paid $75.96 and you owe a co-pay of $3.42
There should be one set fee for a full cycle of radiation treatment, instead of a separate charge for each of 25-30 treatments, plus various test before, after ,and during treatment and physician charges for weekly check-ups.
Similarly, for a joint replacements, there should be a set price with the hospital taking care of the surgeon, anesthesiologist, x-rays, etc.
I recently moved to a new city and found out that when I see a physician at the XXX Medical Center, Medicare pays for both a "clinic visit" and the doctor's fee. This is absurd.
There is another benefit for a *full-service* fee structure. I was kept an extra day in the hospital after a minor surgery because the surgeon nicked a blood vessel. It doesn't make sense that my insurance paid an extra day for the effect of what was essentially a medical error. (Probably the result of a resident doing the surgery. OK -- so they have to learn. I have no problem with that, but my insurance should not have to pay more for it.)
hospital/doctor charged $413.12
insurance paid $75.96 and you owe a co-pay of $3.42
There should be one set fee for a full cycle of radiation treatment, instead of a separate charge for each of 25-30 treatments, plus various test before, after ,and during treatment and physician charges for weekly check-ups.
Similarly, for a joint replacements, there should be a set price with the hospital taking care of the surgeon, anesthesiologist, x-rays, etc.
I recently moved to a new city and found out that when I see a physician at the XXX Medical Center, Medicare pays for both a "clinic visit" and the doctor's fee. This is absurd.
There is another benefit for a *full-service* fee structure. I was kept an extra day in the hospital after a minor surgery because the surgeon nicked a blood vessel. It doesn't make sense that my insurance paid an extra day for the effect of what was essentially a medical error. (Probably the result of a resident doing the surgery. OK -- so they have to learn. I have no problem with that, but my insurance should not have to pay more for it.)
2
I learned exactly how horrific our "system" of billing and coding is during the years that I dealt with my mother's significant medical problems and the resulting bills. Since she had an excellent Medicare Advantage plan with incredibly helpful representatives and since I was a lawyer, you would think that navigating her bills would be easy. Hardly.
For example, one provider's bill showed that he was using a billing code for an uninsured experimental procedure, not the usual procedure. The bills for three office-based procedures totaled $45,000. It took letters and conference calls among the Medicare plan rep, the doctor's unhelpful office staff and/or billing service, and myself to make clear that no one was going to pay those bills and that a complaint was being filed with state authorities and Medicare. Finally, an accurate bill for the procedures with the proper code was submitted. The Medicare Advantage plan paid in full.
This sort of thing happened to some degree every month. Apart from the fact that monitoring her bills (and trying to get her to switch to more ethical doctors) became my part-time job, I couldn't help but wonder what a vulnerable elderly person with no one helping them would do - simply try to pay the bill, not understanding their Medicare rights and plan coverage? Older Americans are sitting ducks for unscrupulous providers and billing services under our labyrinthine billing and coding practices. Universal coverage/single payer is the answer.
For example, one provider's bill showed that he was using a billing code for an uninsured experimental procedure, not the usual procedure. The bills for three office-based procedures totaled $45,000. It took letters and conference calls among the Medicare plan rep, the doctor's unhelpful office staff and/or billing service, and myself to make clear that no one was going to pay those bills and that a complaint was being filed with state authorities and Medicare. Finally, an accurate bill for the procedures with the proper code was submitted. The Medicare Advantage plan paid in full.
This sort of thing happened to some degree every month. Apart from the fact that monitoring her bills (and trying to get her to switch to more ethical doctors) became my part-time job, I couldn't help but wonder what a vulnerable elderly person with no one helping them would do - simply try to pay the bill, not understanding their Medicare rights and plan coverage? Older Americans are sitting ducks for unscrupulous providers and billing services under our labyrinthine billing and coding practices. Universal coverage/single payer is the answer.
5
Coding is not an issue. Pure greed of charging 10 times what you would charge a Medicare patient is. There need to be limits on what can be charged for a code. Doctors hardly spend any time with you. They keep you waiting for 2 hours and see you for five minutes and charge $100-$200 to the insurance company, and many times more if you are uninsured.
106
This is much more a system issue than you realize. Doctors are obligated by their contracts and by the administrators to see a set amount of patients per day or be considered not to meet their employment standards.
We physicians didn't go into Medicine to become this way, the system has forced us to continue to cut back on care and focus on billing and documenting to enhance revenue for the hospital. It is sickening.
We physicians didn't go into Medicine to become this way, the system has forced us to continue to cut back on care and focus on billing and documenting to enhance revenue for the hospital. It is sickening.
One more example showing that the US must, soon, move to a single payer health care health system. This is what almost all other wealthy developed nations use.
My son, an internist, and I, a family medicine doc, both belong to Physicians for a National Health Plan. This is a national group of doctors who advocate for a single payer system.
Maybe ten years ago the president of the Mayo Clinic was asked about the US health care system. His reply? " The US does not have a health care system. We have a non system."
My son, an internist, and I, a family medicine doc, both belong to Physicians for a National Health Plan. This is a national group of doctors who advocate for a single payer system.
Maybe ten years ago the president of the Mayo Clinic was asked about the US health care system. His reply? " The US does not have a health care system. We have a non system."
285
Here's a sort of flip-side to this story: I'm a retired neuropsychologist. The small, rural agency I worked for did *not* have one of those highly-trained billing coders.
While working 10-hour days assessing complex patients, examining and making notes on the thick stacks of their medical records, scoring and interpreting the results, writing their reports, and explaining to them and their families the practical implications of their neurological condition(s), I also had to make my best-guess at which of perhaps half a dozen quite similar ICD-9 codes my agency should bill.
About half the time, the insurer would refuse to reimburse us for my work. Wrong code!
The agency refused to get more training for the billing person, or hire a new one. They kept increasing the number of patients I saw each week to make up for the un-reimbursed hours.
By my mid-60s, I was working 11- and 12-hour days, desperate to keep providing excellent services to suffering people. There was no other agency or medical center in the area to hire me; to work solo I'd have had to buy many thousands of dollars of specialized tests... and hire a skilled billing specialist. I fell ill and retired early. No one took my place. People needing evals must now travel ~100 miles to obtain one. In fact, when one of my own adult children needed an eval, I had to drive 2-1/2 hours so she could get it!
Single payer. Please?
While working 10-hour days assessing complex patients, examining and making notes on the thick stacks of their medical records, scoring and interpreting the results, writing their reports, and explaining to them and their families the practical implications of their neurological condition(s), I also had to make my best-guess at which of perhaps half a dozen quite similar ICD-9 codes my agency should bill.
About half the time, the insurer would refuse to reimburse us for my work. Wrong code!
The agency refused to get more training for the billing person, or hire a new one. They kept increasing the number of patients I saw each week to make up for the un-reimbursed hours.
By my mid-60s, I was working 11- and 12-hour days, desperate to keep providing excellent services to suffering people. There was no other agency or medical center in the area to hire me; to work solo I'd have had to buy many thousands of dollars of specialized tests... and hire a skilled billing specialist. I fell ill and retired early. No one took my place. People needing evals must now travel ~100 miles to obtain one. In fact, when one of my own adult children needed an eval, I had to drive 2-1/2 hours so she could get it!
Single payer. Please?
485
I've become seriously and chronically ill to the point where I've had to "retire," aka go out on permanent disability and I owe it all to the stress of practicing primary care medicine. The environment has changed so drastically over the past 25 years that I was lucky to get paid pennies per patient visit or procedure, each year working harder and longer hours, while the hospital entity rolled in piles of money. I loved my patients and they loved me, but ultimately I had to decide to leave and hopefully go into some level of remission, or stay and work myself to death. If we all would refuse to participate in this insanity we could change it, but we are too fatigued, indoctrinated, and scared to take a stand. I am taking my stand but it is sadly one taken lying down, stuck in bed, hoping for recovery.
3
Here's what is even more infuriating - the EMTs and Medical Coders make less than $30K/yr!
1
Medical care has become a freebooter type of activity where the defenseless patient is at risk of being driven to bankruptcy. Consider this army of avaricious administrators and work for profit coders. Now, think of Republicans who want to deliver us into their arms. And think again of Republicans' incomprehensible assertion that we, as individuals, can understand, much less negotiate, the terms of our health insurance. If politicians don't bring about a single payer system, it will the medical industry (separate from medical profession) that will cause it to be inevitable. The medical industry has become as grasping as t he military procurement industry.
61
What happens when the coding company people get sick?
11
They have a special code to take care of their needs.
In my experience the studies that "have shown that hospitals charge patients who are uninsured or self-pay 2.5 times more than they charge those covered by health insurance (who are billed negotiated rates)" is way too optimistic. My husbands recent surgery was billed out at over $35,000. Negotiated rates with the insurance company brought that down to $6000. Without insurance it would have cost us almost 6x more.
The absurdity of our system and its perverse incentives leaves me speechless.
The absurdity of our system and its perverse incentives leaves me speechless.
161
Moved with my family last year to the UK. This article explains one of the primary reasons why. None of the machinations of our Congress matter if the ethos described in this article is not excised from the system.
1
I think the elites that work in these hospitals should be targeted.
Thank you for this important, elucidating and timely article. I have two words in response: Single Payer!
86
There was a presidential candidate that supported single payer. We were not allowed to vote for him, instead we were given a choice between the status quo or destruction of health care. We voted for the destruction of health care.
1
Just look to the VA as a shinning example if you wish for single payer.
1
This is one of the reasons why doctors have lost their reputation for being an honorable and ethical profession. Bought out by big business. Fortunately, women dominated professions, such as nurses, teachers, and librarians still hold true to their professional codes of ethics.
20
In truth, nurses are the last trusted people vin America. Trust in fellow citizens evaporates in countries with huge wealth gaps ( UK and US) while It thrives in social democracies ( Scandinavia and Japan) where wealth gaps are narrow.
1
My partner died in September and I'm still getting bills for services delivered last August. How do I know if we owe this money? The bills keep coming.
26
Start by requesting a fully itemized bill with all associated billing codes. At the same time, request all medical records for the dates of service in question. It's important to compare the two because the records will show what services were actually rendered, like IV's, therapies, drugs, xrays, labs, etc.. If they can't prove a charge, you shouldn't have to pay for it. Make a file. Document all communication with the hospital - dates, names, items discussed. Make monthly payments, however small. This shows a good faith effort to resolve the issue. Best of luck!
2
ask for help from a local coder specializing in that injury/illness your partner had. Perhaps an interview on the local news show, Face-book plea ( if you you're on social media), or via a local university health center.
Also, determine yourself what the procedures were that are billed --> go to google or other search engine, type in CPT 99473 or whatever the procedure code is, and self-determine whether or not that service was provided to the best of your ability.
ICD-10 codes are the diagnostic codes; if you have those listed, look up what they stand for on the CDC-website listing.
Advocate for yourself; the monies may be owed, but knowing that they are legitimate and that you are doing 'right' by your partner AND yourself on their behalf is important for you to be able to carry on . . in this grieving time.
Sincerely,
JKN
Also, determine yourself what the procedures were that are billed --> go to google or other search engine, type in CPT 99473 or whatever the procedure code is, and self-determine whether or not that service was provided to the best of your ability.
ICD-10 codes are the diagnostic codes; if you have those listed, look up what they stand for on the CDC-website listing.
Advocate for yourself; the monies may be owed, but knowing that they are legitimate and that you are doing 'right' by your partner AND yourself on their behalf is important for you to be able to carry on . . in this grieving time.
Sincerely,
JKN
Beyond the absurd medical bills that takes teams of experts to assist ONE person to sort through is the basic problem that the people least able to pay are charged the most. I had good insurance but they refused to pay for a test ordered by my doctor and I received a bill for $2020. The test WAS covered by my insurance but my doctor was supposed to get pre approval. Luckily I live in New York with all those heavy handed "regulations" to help patients. THREE appeals later ( the first two of which the insurer merely claimed generically the test was not needed without any explanation) the State of New York ruled in my favor ( after sending the dispute to a third party) and would you believe that $2020 cost my insurance company $375. So about six times what they wanted to charge an "uninsured" patient. Great how the "free market" works.
85
Slight correction. I had THREE "internal" appeals though my insurance company where again they provided no actual reason for refusing to pay until the final one, I then went through the New York State Dept of Finance ( odd) for my outside appeal which is sent to approved qualified neutral party and thanks to detailed support from my doctor ( and extra work of course) the outside expert ruled in my favor. Imagine what would have happened if insurance were sold between state lines which the Republicans claim will lower prices. New York State was very helpful to me on this but it took over a year of stress to resolve
1
How can anyone pretend that our free market healthcare system works? You can't figure out services and costs even after the fact! It's outrageous and cruel.
69
Perhaps the Republicans could offer a bill that would require medical bills to be printed in plain English. As more people with high deductibles pay cash, they need to know what they're being charged for so they can negotiate and shop around.
Another idea would be to outlaw different prices for different people. One procedure, one price.
While the insurance companies will object, It would make good sense.
Another idea would be to outlaw different prices for different people. One procedure, one price.
While the insurance companies will object, It would make good sense.
24
I can't imagine the administrative processes that go into generating such bills. A public system eliminates this craziness & allows medical staff to concentrate on their jobs. Many Canadians facing health episodes in the US are surprised by the "upsell" of unnecessary medical procedures tat are unsupported by medical best practices. No system is perfect but publicly funded systems overall are cheaper & produce better health outcomes.
34
Every medical procedure carries some risk. Upselling adds more risk.
Nothing will improve until fraud stops.
A friend had a tooth removed; she said that she paid $250.00, but Medicare was billed $3,200.00.
Serious money must go into cracking down on fraud with Medicare, Medicaid, and all private insurance companies.
A friend had a tooth removed; she said that she paid $250.00, but Medicare was billed $3,200.00.
Serious money must go into cracking down on fraud with Medicare, Medicaid, and all private insurance companies.
23
Curious as to why her tooth was removed and Medicare paid for it. Medicare does not cover dental work, with very very few exceptions. I agree with your conclusion, though.
1
This is a well-researched article, but it is about more than one thing. It is a strong argument for a national health service which covers the entire population. It is also about the confusing complexity of diagnostic and procedural codes. It is about how better paying codes can be used by tweaking the documentation. It is about the unfair practice of billing individuals without insurance far more than an insurance company would have to pay. And, it is about divorcing the coding and billing from the hospital and doctors and putting these in the hands of professionals whose job it is to maximize income regardless of the impact on the patient. Who knew health care could be so complicated? Ask anyone involved, either receiving or delivering.
58
Insurance companies won't let doctors negotiate prices. If your ear gets plugged with wax, you'll pay $200 for a five minute visit to have it suctioned, wherever you go.
An awesome article, which highlights the broken system. There really is no accountability. The hospital has random charges on anything and everything it is amazing. I agree that it is the only business, where there is no estimate or max. limit on charges. Whats worse is that most medical entities game the system and the end loser is always the patient.
35
It's all an absurd situation exacerbated not only by the very customized nature of medical treatment but also by the nearly complete uncertainty for providers about their ultimate reimbursement will be and how much money (in the form of labor and paperwork) they will have to spend to get that reimbursement.
Insurers think pricing transparency will make a difference. Sure it will -- for insurers....but the average medical consumer doesn't have the ability to decipher the nuances in a hospital's "average cost." Look back to the Pennsylvania heart care study in 1992 - while the study looked at quality factors -mortality, complications etc, the key takeaway was that quality data is easily skewed by the type of cases treated. The same can be said for costs.
Insurers think pricing transparency will make a difference. Sure it will -- for insurers....but the average medical consumer doesn't have the ability to decipher the nuances in a hospital's "average cost." Look back to the Pennsylvania heart care study in 1992 - while the study looked at quality factors -mortality, complications etc, the key takeaway was that quality data is easily skewed by the type of cases treated. The same can be said for costs.
4
"Non profit" does not mean no money. The CEOs of these health systems take home tens of millions yearly.
36
"Non-profits" exist for the personal profit of their executives.
We should go to a single payer system.
32
That really means a single-collector too: the government, via taxation.
The specificity of the codes complicate matters but they sure don't help the consumer shopping for health care.
I tried to compare apples to apples by calling different offices and asking them what they charged for certain specific codes that had to do with my general area of problem - I got them from my old bills with help from a friend who's a coder.
Not one office would tell me over the phone how much they would charge for that specific code. They said they couldn't diagnose over the phone. I told them I was not asking them to, explained what I was doing, said it was a hypothetical patient for whom they had already diagnosed and coded and what would the charge be?
They got huffy and said we were talking about your health here - medicine - not a consumer product and I told them we were indeed talking about a consumer service unless they were so intent on their higher mission that they would treat me for free.
I got hung up on a lot, and never got a dollar figure. How do we shop for medical or dental care when they won't tell us what they charge? Even those lawyers that people complain about - until they need one - tell you their fees.
I tried to compare apples to apples by calling different offices and asking them what they charged for certain specific codes that had to do with my general area of problem - I got them from my old bills with help from a friend who's a coder.
Not one office would tell me over the phone how much they would charge for that specific code. They said they couldn't diagnose over the phone. I told them I was not asking them to, explained what I was doing, said it was a hypothetical patient for whom they had already diagnosed and coded and what would the charge be?
They got huffy and said we were talking about your health here - medicine - not a consumer product and I told them we were indeed talking about a consumer service unless they were so intent on their higher mission that they would treat me for free.
I got hung up on a lot, and never got a dollar figure. How do we shop for medical or dental care when they won't tell us what they charge? Even those lawyers that people complain about - until they need one - tell you their fees.
99
I went through this same runaround, back in 2003, when two spine specialists said I needed a fusion to resolve numbness in my legs. I also discovered my Health Insurer had not "contracted" with any hospitals in my State. So I could be subject to the full "Rack Rates" with a 10% discount for Commercial Insurance.
I called the local Hospital billing office, and asked for the billing codes so I could try and determine what the procedure would cost, or what Medicare would pay for a similar procedure. Basically got nowhere, this is "confidential information" !
In exasperation, I had received a second Medical opinion in Montreal, at the Neuro, a World Class surgical facility, affiliated with McGill University.
The Neuro billing office, told me up front, what the fees would be for this procedure, (to be paid in advance) charging me a flat DAILY RATE of $2500 from the day I was admitted, with the CT scans pre-op to prepare for the robotic insertions of the stabilizing screws, the 8 hour operation, and then 5 days of recovery. No operating room charges, only an extra fee I paid directly to the Neurosurgeon.
So I had the surgery in Montreal, at the Neuro, after my US insurer agreed in writing to pay all my Canadian charges (less my deductible), and the surgery was a success.
Best of all, I had NO followup collection phone calls or bills. I did pay out-of-pocket for two post-op CT scans in Montreal for the Neurosurgeon to evaluate my recovery. Cost for each CT scan? $180 Cdn.
I called the local Hospital billing office, and asked for the billing codes so I could try and determine what the procedure would cost, or what Medicare would pay for a similar procedure. Basically got nowhere, this is "confidential information" !
In exasperation, I had received a second Medical opinion in Montreal, at the Neuro, a World Class surgical facility, affiliated with McGill University.
The Neuro billing office, told me up front, what the fees would be for this procedure, (to be paid in advance) charging me a flat DAILY RATE of $2500 from the day I was admitted, with the CT scans pre-op to prepare for the robotic insertions of the stabilizing screws, the 8 hour operation, and then 5 days of recovery. No operating room charges, only an extra fee I paid directly to the Neurosurgeon.
So I had the surgery in Montreal, at the Neuro, after my US insurer agreed in writing to pay all my Canadian charges (less my deductible), and the surgery was a success.
Best of all, I had NO followup collection phone calls or bills. I did pay out-of-pocket for two post-op CT scans in Montreal for the Neurosurgeon to evaluate my recovery. Cost for each CT scan? $180 Cdn.
2
When a hospital sends a bill to collections at dat 91 while it is under dispute from the outset and the insurance company is engaged (to better understand the cost), you know they are charging way too much. Even the collections agency hinted as such (which was quite sympathetic). When you are willing give away half the bill without even attempting to resolve an issue (which was resolved by the insurance company), you know something is wrong.
11
The answer starts with single payer health care. That seriously curtails Insurance company abuses, greatly reduces drug expense and disavows hospitals from abusing their billing systems.
33
I have had hundreds of thousands of dollars in claims payments all over the country, due to a rare disease. UVA is by far the most egregious, unreasonable and aggressive medical claims collector of any medical institution, hands down. They hounded me for payment of an MRI that was unreadable, per their own neurosurgeon, and paid for IN FULL by the insurer. All I can say is that I wish many subarachnoid hemorrhages, untreated, in their future.
8
When Steve Bannon talks about "deconstructing the administrative state", I hope he puts this scam right on top of the administrative nightmares we face as a public.
9
Don't hold your breath. No one in DT's circle has any intention of helping any non-billionaire. They're all about making the rich richer.
28
In addition to apparently "predatory" coding, there are cases of simply sloppy/erroneous coding.
For outpatient arthroscopic knee surgery last year on my right knee, the surgeon's office code was for cartilage repair of both knees, and the anesthesiologist's office billed for anesthesia for surgery one one knee and one shoulder!
Their bills went directly to Medicare, which paid them. I intervened to make sure that Medicare received corrected bills and paid only what was due.
For outpatient arthroscopic knee surgery last year on my right knee, the surgeon's office code was for cartilage repair of both knees, and the anesthesiologist's office billed for anesthesia for surgery one one knee and one shoulder!
Their bills went directly to Medicare, which paid them. I intervened to make sure that Medicare received corrected bills and paid only what was due.
18
I don't have a PhD in Economics or public health. However, after a simple number crunching using the following numbers (800 dollars/month for a health insurance plan, which covers 80% of the actual cost of care; average median household income in the U.S.: $56,000 )I found that an individual must be paying roughly 17% of their income on healthcare! Senator Sanders' Medicare For All requires a family of four to pay only half of this amount [8.4% including both employer (6.2%) and employee (2.2%)contributions]. Makes perfect economic sense to advocate for universal healthcare!
40
The whole US pays roughly 17% of its national income for its spotty health care.
This is example of what should be considered fraud, a violation of consumer laws and likely a case of racketeering. It is appalling that we allow the abuse of members of our society who are least able to pay. What system allows billing the maximum one could think of which no one really pays to those least able to pay. One reason people need insurance is that without it they are billed and expected to pay charges that are a substantial multiple of what insurance companies pay.
So, how to start fixing the system? Call out the big accounting firms that audit medical providers and hospitals and allow misleading accounting that has no economic relevance. Change the way un-insured patients and out-of-network patients are charged to no more than 120% of the average rate that the two lowest insurance firms have negotiated with the provider. This requirement would require greater transparency since few providers actually post actual expected prices (or reimbursements).
An additional requirement that would have a benefit would be to make every service, provider or drug be considered in-network as long as either the hospital or admitting physician is in network. STOP the gaming of the system where nameless and faceless out-of-network providers somehow get in the payment chain.
So, how to start fixing the system? Call out the big accounting firms that audit medical providers and hospitals and allow misleading accounting that has no economic relevance. Change the way un-insured patients and out-of-network patients are charged to no more than 120% of the average rate that the two lowest insurance firms have negotiated with the provider. This requirement would require greater transparency since few providers actually post actual expected prices (or reimbursements).
An additional requirement that would have a benefit would be to make every service, provider or drug be considered in-network as long as either the hospital or admitting physician is in network. STOP the gaming of the system where nameless and faceless out-of-network providers somehow get in the payment chain.
90
The only fix to this system is to do away with it through single payer healthcare!
3
After working in a university hospital as a bonded laborer under the all MBA "leadership team" finally quit and am trying to set up a solo practice.
To determine if I will be able to do so tried calling insurances including MEDICAID HMO's to find out how much they reimbursed for the services.
No one will reveal the rates.
The reason for my call was because I was been asked if I would see Medicaid patients as no one in the state of NJ took them. A quick online search showed only 40% of NJ physicians take Medicaid.
If published rates were to be believed I will be making 5 dollars/ patient (after overheads) for half an hour I will spend/ patient (of which 20 minutes will be spend documenting on EMR in medico legally correct format and meeting all the regulatory requirements.....for these btw, Medicaid doesn't pay. This time is on physician as per Medicaid). You also can't charge Medicaid for no shows the rate of which is about 50%.
Most of the small practices have been run into the ground due to cost of keeping up with regulations and mandates required by CMS that has been exacerbated by ACA. This has led to creation of behemoth health systems that are involved in price gouging.
BTW, if you are donating to any hospitals (anywhere) ask what percentage of your charity is going to go towards the new fancy building, CEO and "administrative overheads" and how much will go towards buying equipment and hiring more medical staff or attracting better medical staff.
To determine if I will be able to do so tried calling insurances including MEDICAID HMO's to find out how much they reimbursed for the services.
No one will reveal the rates.
The reason for my call was because I was been asked if I would see Medicaid patients as no one in the state of NJ took them. A quick online search showed only 40% of NJ physicians take Medicaid.
If published rates were to be believed I will be making 5 dollars/ patient (after overheads) for half an hour I will spend/ patient (of which 20 minutes will be spend documenting on EMR in medico legally correct format and meeting all the regulatory requirements.....for these btw, Medicaid doesn't pay. This time is on physician as per Medicaid). You also can't charge Medicaid for no shows the rate of which is about 50%.
Most of the small practices have been run into the ground due to cost of keeping up with regulations and mandates required by CMS that has been exacerbated by ACA. This has led to creation of behemoth health systems that are involved in price gouging.
BTW, if you are donating to any hospitals (anywhere) ask what percentage of your charity is going to go towards the new fancy building, CEO and "administrative overheads" and how much will go towards buying equipment and hiring more medical staff or attracting better medical staff.
11
Hospital emergency care is a well known racket that is protected by our government. Any other industry involved in such fraudulent practices and flagrant price gouging of the consumer would have been driven out of business with class action lawsuits.
This article makes my blood boil but Kudos to the NY Times for their work exposing our fraudulent Emergency Care system.
This article makes my blood boil but Kudos to the NY Times for their work exposing our fraudulent Emergency Care system.
21
Even with this patient being there multiple days, there is nothing they could have done that would cost that much. I know, it's not an hourly charge it pays for machines and what not. It's still outrageous and any standard business would have been shut down. The medical system is immune from oversight and ought to be treated as criminals for billing this way.
11
All patients should have the option of receiving all medical bills in a digital form that expands out in "plain English" what it is claimed was done for the patient under each of the codes and abbreviations used by such bills. That can all be done by software.
The same electronic form ought to include an option to protest a claim or protest a charge -- either to the medical provider or to the insurance entity or both. A checked box next to the disputed item would open up a window for the patient to provide such detail as deemed appropriate.
Patients should also have the option of filling out an electronic form that contains the kind of information all health care providers tend to request. That form would be available to all health care providers, authorised by the patient, and all insurance entities covering the patient. Each health care provider can thereafter request supplemental information that may be relevant to the particular specialty or malady.
The same electronic form ought to include an option to protest a claim or protest a charge -- either to the medical provider or to the insurance entity or both. A checked box next to the disputed item would open up a window for the patient to provide such detail as deemed appropriate.
Patients should also have the option of filling out an electronic form that contains the kind of information all health care providers tend to request. That form would be available to all health care providers, authorised by the patient, and all insurance entities covering the patient. Each health care provider can thereafter request supplemental information that may be relevant to the particular specialty or malady.
1
I'm part of this game, and it sickens me.
15
I was born in the United States and lived there till 1972. Since then, I've lived in Canada, in two different provinces. In one province, I was billed $54 a month for medical insurance. That covered pretty much everything except prescriptions: office visits, all indicated tests, hospitalizations and surgery. In the province where I now live, my insurance fees are included in my provincial taxes. I have not had to worry about the cost of any medical assessment or treatment since 1972.
And just in case you didn't know -- I choose my own doctor, I choose which of several specialists I prefer to see, and even in non-emergency situations, like cataract surgery, wait times are acceptable: I was referred to a Board-certified surgeon in November, had the necessary tests in January, and by April both eyes had been corrected. Urgent health needs are met immediately.
Canada's population health statistics in almost every area are much better than those for the United States. While the Canadian system isn't perfect, Canadians are simply gobsmacked that Americans object to a national health system (actually, each province runs its own system under Federal minimum standards, with Federal funding). We simply can't understand why health care in America is a market commodity .
From a personal perspective, America's system of paying for medical care destroys people's health and lives. From a national perspective, the country's appalling health status is an economic and social disaster.
And just in case you didn't know -- I choose my own doctor, I choose which of several specialists I prefer to see, and even in non-emergency situations, like cataract surgery, wait times are acceptable: I was referred to a Board-certified surgeon in November, had the necessary tests in January, and by April both eyes had been corrected. Urgent health needs are met immediately.
Canada's population health statistics in almost every area are much better than those for the United States. While the Canadian system isn't perfect, Canadians are simply gobsmacked that Americans object to a national health system (actually, each province runs its own system under Federal minimum standards, with Federal funding). We simply can't understand why health care in America is a market commodity .
From a personal perspective, America's system of paying for medical care destroys people's health and lives. From a national perspective, the country's appalling health status is an economic and social disaster.
79
When I moved to Australia in 1992 and had my third child in 1996, the first trip to the doctor's office for a newborn's examination was $50. My national health cover reimbursed about $20. Five years before, that same examination for my 2nd child, born in 1992, was just a bit under $300 in San Francisco. Our family health insurance policy had paid half of this. The cost of hospital delivery for the 3rd child in Australia was 25% of what was charged in San Francisco 4 years earlier. The quality of care was the same.
There are no artificial barriers in Australia that keep you from choosing a doctor. "Out of network" translates as "out of the country". There are no bills to be paid after a trip to the Hospital Emergency Room. Single payer systems have no reason not to post prices and reimbursements.
The American Healthcare Industry is ripe for disruption. If hospitals, service providers and insurance companies won't post their prices, payments and reimbursements, consumers should be able to them out and do it for them on the State Health Insurance Exchange sites.
There are no artificial barriers in Australia that keep you from choosing a doctor. "Out of network" translates as "out of the country". There are no bills to be paid after a trip to the Hospital Emergency Room. Single payer systems have no reason not to post prices and reimbursements.
The American Healthcare Industry is ripe for disruption. If hospitals, service providers and insurance companies won't post their prices, payments and reimbursements, consumers should be able to them out and do it for them on the State Health Insurance Exchange sites.
Susan,
Thank you for correcting misguided and misrepresented views of how healthcare is insured in Canada. The US market based system does not work !
Many of us - physicians included- have been asking/demanding national health insurance to cover all Americans for many years- even before 2009-2010 when ACA was born.
Physicians for a National Health Program explains how national health systems works in many countries and why health insurance in US is inferior in cost and equal delivery to all Americans. Canada's system is a beacon to us.
Must look up information at PNHP.org
Thank you for correcting misguided and misrepresented views of how healthcare is insured in Canada. The US market based system does not work !
Many of us - physicians included- have been asking/demanding national health insurance to cover all Americans for many years- even before 2009-2010 when ACA was born.
Physicians for a National Health Program explains how national health systems works in many countries and why health insurance in US is inferior in cost and equal delivery to all Americans. Canada's system is a beacon to us.
Must look up information at PNHP.org
2
I continue to believe that the medical/pharmaceutical industrial complex of this country is hands down the most malicious, egregiously cruel system known to humankind. They make the tobacco and oil industries look like hapless children and yet we, as Americans put up with this horrendous institution. The majority of us are just so numbed and grateful that we have employee health insurance and are not caught in the snares of this industry that we close our eyes, pay our co pays, and pray we remain healthy and above water. In this regard we are like the dwellers in Plato's cave who simply assume that this is the way things are and always will be.
13
Even for people with insurance medical billing is a mess at best and fraud at worst. On several occasions, I have prepaid co-pays and deductibles only to be sent another bill in the mail for these a month or two later. In one instance a bill was sent to a collections agency before it was sent to me. It takes multiple attempts to get the billing department to admit they made a "mistake" and then sometimes several more billing cycles to get them to actually fix it. I'm lucky to be young and in good enough health that I have recovered quickly to fight these battles. I can't imagine doing this while also recovering from a serious illness or injury! Insurance might make medical billing fraud less expensive to the consumer ("hey, you got the discounted rate TWICE!"), but it certainly isn't any less common.
3
Can anyone argue, after reading this article, that EVERY American should have health insurance as a matter of RIGHT from birth till death.
15
Medical care at the level we want it is simply too expensive for any individual. We need a single-payer system. I'm sure it's not an ideal solution, but it satisfies and relieves most of the rest of the civilized world. And I'm sure reduces overhead costs dramatically.
13
Good luck figuring out how many providers you dealt with - with separate hospital, equipment, specialist, generalist, and support bills, even if you know what procedure you got you dont know how many palms you need to grease until much much later. Just the way big med, big insurance, and big pharma like it.
TRY, just try to ask the doctor what will something cost.
14
You can't ask the doctor because we simply don't know. Most doctors work for large health care entities, they don't do their own billing, and have almost no control over what is charged or what each code provides. It is also different for every insurance and Medicare. As a doctor, I can choose to stay current and educated about medicine, or about billing. I chose the former. It is a mess, and a terrible burden on doctors too (nowhere near the emotional and financial toll it takes on our unfortunate patients). Single payer would be a better option.
2
Still paying off an emergency room bill from a year ago. When I was there, a financial manager came to my room and said I needed to pay 20% - about $300. I had no idea what that was 20% of, and I only wish that was 20% the final bill.
The worst part about it was that I blew through my deductible in one day - and then a month later started a new job and started from zero again.
The worst part about it was that I blew through my deductible in one day - and then a month later started a new job and started from zero again.
5
The coding problem can be solved by automation. Healthcare providers and hospitals are required to use electronic medical records by Medicare. Billing codes a physician uses must be supported by the medical record. It seems to me that it is fairly obvious that the medical billing should be done automatically by the software using an algorithm agreed upon by Medicare and the AMA. The software can then be validated by Medicare and be required to be accepted by all commercial insurers. This would eliminate the need for coders as well as many auditors. Medicare auditors could then concentrate on actual fraud rather than looking for someone making a mistake in this arcane coding system.
The second problem of the huge bills that someone who is uninsured can accumulate due to a catastrophic illness is somewhat separate. No matter how economically efficient a system of care becomes, the cost of treating a person who requires a helicopter flight, brain surgery and intensive hospital care is going to be more expensive than the average person can pay. There are three solutions: a single payer system, a mandatory system of private insurance with much harsher penalties than those under the ACA, or denying medical treatment to those who cannot pay. The last option should be unacceptable to any civilized country and personally I have come to believe single payer is the only reasonable option.
The second problem of the huge bills that someone who is uninsured can accumulate due to a catastrophic illness is somewhat separate. No matter how economically efficient a system of care becomes, the cost of treating a person who requires a helicopter flight, brain surgery and intensive hospital care is going to be more expensive than the average person can pay. There are three solutions: a single payer system, a mandatory system of private insurance with much harsher penalties than those under the ACA, or denying medical treatment to those who cannot pay. The last option should be unacceptable to any civilized country and personally I have come to believe single payer is the only reasonable option.
26
While Obamacare was not perfect, what this poor woman went through is what the Republicans will be bringing back if they manage to pass their Obamacare replacement bill - unlimited exposure to often undocumented and always excessive medical charges from everyone involved in your care. Before Obamacare, many were forced to declare bankruptcy. A significant of people who could not afford health insurance but became seriously ill lost their homes, college savings for their kids and retirement money to their healthcare providers lawsuits.
At least under Obamacare, the maximum out-of-pocket a single individual can be exposed to is $7,150. Who wants to trade that limit for unlimited exposure, including possible bankruptcy, under the Republican's health insurance version?
Republican's need to join with the Democrats to fix and repair Obamacare, not kill it because Republican Libertarians are upset that they are forced to participate.
At least under Obamacare, the maximum out-of-pocket a single individual can be exposed to is $7,150. Who wants to trade that limit for unlimited exposure, including possible bankruptcy, under the Republican's health insurance version?
Republican's need to join with the Democrats to fix and repair Obamacare, not kill it because Republican Libertarians are upset that they are forced to participate.
16
Thank you for this illuminating story. I wish everyone who chooses not to buy insurance would read this. I also wish Congress would pass laws that prevent this sort of abuse instead of favoring the medical and insurance businesses.
As you noted, this is a problem for more people when deductibles and co-pays keep going up.
Insurance is supposed to insure against financial disaster when illness or accident strikes.
As you noted, this is a problem for more people when deductibles and co-pays keep going up.
Insurance is supposed to insure against financial disaster when illness or accident strikes.
1
These hospital billing departments have become professionals at taking advantage of patients. It seems unethical for a healthcare provider to essentially up-charge a patient in order to increase their bottom line. This article reminds of the Seinfeld episode where Jerry attempts to buy a new car. The salesman gives Jerry a price, but then adds keys, floor mats, finder's fees and rust proofing, yet ultimately admits to Jerry that the dealers don't even know what rust proofing is. Hospitals have joined the ilk of used car dealers portrayed in Seinfeld.
5
I am an emergency physician in practice for 20 years. I hate this system of exorbitant charges. Even inside the system, I have no idea what a patient's medical bill will be because the hospital system hides this data from its physicians. My share of a patient's bill averages $150 and is never more than $400, so hearing my patients' stories of $20,000 ER bills makes me wonder where all this money is going. In this unfortunate woman's case, I cannot fathom how any hospital system would charge in excess of $300,000 for her care. In all other westernized nations, the same or better care would cost fraction of that amount. These fractional costs for care elsewhere are not ones I made up but are well documented and publicized throughout the developed world. The discrepancies are what motivate large US companies to outsource their elective employee medical care to hospitals outside the US: same care, better outcomes, at charges that are a fraction of US charges.
The bottom line is that our medical system is based first on profits, not patient care. This paradigm shift in our health system is not why I went into medicine. Shame on those who rationalize and promote it.
I only hope that those in power now will recognize how horrific and utterly shameful our system has become. My hope is that our system will someday return to its more noble roots and allow physicians to treat their patients in a system that does not bankrupt those it is supposed to serve.
The bottom line is that our medical system is based first on profits, not patient care. This paradigm shift in our health system is not why I went into medicine. Shame on those who rationalize and promote it.
I only hope that those in power now will recognize how horrific and utterly shameful our system has become. My hope is that our system will someday return to its more noble roots and allow physicians to treat their patients in a system that does not bankrupt those it is supposed to serve.
53
My wife is a two time cancer survivor, breast and lung. The whole process, starting with "can you pay?", not "how can we can help?", is sadly flawed and dispiriting.
And the bills that hospitals, and the myriad of affiliated services who use the hospital but bill separately, are designed to be confusing. The way providers bill is not the way insurance companies pay, so reconciling invoices is a long, slow and painful process that requires an honest and friendly customer service rep.
Having said this, the doctors and nurses who provide care are quite outstanding. My wife has been fortunate to be under the care of some amazing medical professionals at Rush University Medical Center here in Chicago
And the bills that hospitals, and the myriad of affiliated services who use the hospital but bill separately, are designed to be confusing. The way providers bill is not the way insurance companies pay, so reconciling invoices is a long, slow and painful process that requires an honest and friendly customer service rep.
Having said this, the doctors and nurses who provide care are quite outstanding. My wife has been fortunate to be under the care of some amazing medical professionals at Rush University Medical Center here in Chicago
2
Let's face it --- The "establishment" (Clinton) Corporate Machine Democrats are just as into that federal lobbyist money from the healthcare industry as the Republicans (maybe more!) which is why Obama did not have the votes to pass the Affordable Care Act with a public-option that 70% of voters said was right and fair! Until we move forward to a gradual expansion of Medicare/Medicaid for EVERYONE, we will not escape the illness-for-profit system we call "health care" in the USA that leaves out tens of millions of people, and diminishes health care for millions more due to high premiums and deductibles. But worse yet, a system that doesn't invest in prevention, early detection and cures, or focus on making drugs more affordable. If the Republicans put single-payer health care in place, I would become a Republican. I am fed up with both parties until that happens.
11
It was the insurance companies who refused to come to the table if the public option remained.
1
A liberal attempt in Sept. 2016 to revive the so-called public option — a government-run insurance plan most-likely based on an expansion of Medicare to shore up gaps in the Affordable Care Act — is opening old wounds between the Democratic Party’s liberal and moderate wings. For instance, Hillary Clinton's VP choice is not for it! (hint) and Sen. Jon Tester, a moderate Montana Democrat. Sen. Heidi Heitkamp (D-N.D.) calls the public-option debate a "distraction," in a mid-term election year. But #Progressives - the liberal wing of the Democratic Party says, many of the ACA’s flaws could be repaired with a public option, which would essentially be a new plan offered on the Obamacare insurance exchanges, some of which are down to only one or two private insurers. Elimination of 'public option' in the original ACA plan threw consumers to the insurance wolves and DINO Joe Lieberman was very instrumental in that decision. Fellow Democrats blamed the amount of federal lobbyist money available to any politician willing to help them fight off public option. When he was running for president, Obama regularly talked about the need for a public option. That was one reason why many health care reform advocates supported him instead of Hillary Clinton. Ditto in the match-up between Bernie Sanders and Hillary Clinton.
1
In 2016, a co-worker in my midwestern town had to take her son to the emergency room for a minor but painful cut on his hand. She went to the preferred provider, called her insurance company, and received the news that the procedure would be approved. Before leaving the emergency room, she paid around $100 co-pay, but expected other bills might show up.
What showed up, 2 weeks later, was a bill from the hospital charging her "facility's fees". The $800 charge would not be paid by her insurance company, as it didn't correspond to any medical care. The billing department could only tell her that they charge a fee for walking in the building.
No one could tell her how this fee was calculated. Based on the total cost of the procedure? Is it a fixed fee charged to anyone in the ER? Do other hospitals charge this fee? Would she have been better off going to another hospital out of network that didn't charge the fee?
We can't know what our charges are. I recently visited a local clinic for a cold, paid my $5 co-pay, got a breathing treatment, and received a bill for $50. No one told me I would be billed that, and I had never been billed so before.
The health care billing system is out of control. Only when people aren't profiting off the health of others will we be able to fix this.
What showed up, 2 weeks later, was a bill from the hospital charging her "facility's fees". The $800 charge would not be paid by her insurance company, as it didn't correspond to any medical care. The billing department could only tell her that they charge a fee for walking in the building.
No one could tell her how this fee was calculated. Based on the total cost of the procedure? Is it a fixed fee charged to anyone in the ER? Do other hospitals charge this fee? Would she have been better off going to another hospital out of network that didn't charge the fee?
We can't know what our charges are. I recently visited a local clinic for a cold, paid my $5 co-pay, got a breathing treatment, and received a bill for $50. No one told me I would be billed that, and I had never been billed so before.
The health care billing system is out of control. Only when people aren't profiting off the health of others will we be able to fix this.
Worked in the accounting medical field for almost 20 years for a private provider. My take is if we went to a single payer, thousands of claims adjusters and coders would be out of a job and insurance costs would go down. Personally loved Medicare, you follow the rules, you get paid. Otherwise, it was a wild west to try and get paid from Humana, UHC, BCBS, etc. Insurance companies are basically leeches, the only way they make money is not to pay claims. Healthcare is only complicated because of capitalism. Hospitals are complicit in not trying to be efficient, all in the name providing "great" healthcare. If you go personally bankrupt, what good is that health? I could go on for hours how America has ruined healthcare.
Ms. Wickizer is in the top 1% of patients in her competence and effort to figure out her billing. In my healthcare experience of a few years ago, an uninsured self-pay patient could go to billing and get an automatic 20 % discount. It might have changed or VA was especially aggressive.
When it comes to upcoding, you should talk to the Governor FL, Rick Scott, famous for his tens of millions in unearned charges when he was head of Columbia-HCA. This kind of pricing is dictated from the top.
When it comes to upcoding, you should talk to the Governor FL, Rick Scott, famous for his tens of millions in unearned charges when he was head of Columbia-HCA. This kind of pricing is dictated from the top.
12
If President Trump really meant and wants to MAGA, he must extend Medicare for all and take on the high prescription drug cost.
If he does that, I don't care if he tweets insults at 5 am or puts his face in a soup bowl and blows at White House dinners.
If he does that, I don't care if he tweets insults at 5 am or puts his face in a soup bowl and blows at White House dinners.
8
When my spouse was dying, he had medical insurance that paid for his care. Even though the "explanation of benefits" he would receive after insurance company payments to providers would state minimal or zero payment due from the patient, he would always be billed by the providers who would refer/sell these amounts to collection agencies. The threatening letters from the agencies would arrive with regularity and I would fax back a copy of the EOB with a cease and desist letter.
The supposed charity hospitals should be ashamed. The providers including the doctors should be ashamed. The insurance companies who declined to insure anyone who coughed before the ACA was adopted should ashamed. The Republican Party that believes healthcare should only be for the rich should be ashamed.
The supposed charity hospitals should be ashamed. The providers including the doctors should be ashamed. The insurance companies who declined to insure anyone who coughed before the ACA was adopted should ashamed. The Republican Party that believes healthcare should only be for the rich should be ashamed.
20
An employer-based healthcare system is a blight on this nation's purported egalitarian values. To pay so much for care which isn't even the best in the world compounds the injustice. I don't anticipate it getting any better in my lifetime.
For three years I have been fighting to get a proper billing from my HMO. I have always been told to call back in two weeks. Every day I check in to see my online balance it changed drastically over years. On one of my first phone calls to billing instead of correcting the problem the woman actually dropped me from my policy by mistake. I fought to be reinstated. Last week I got a large bill in which it stated that if I didn’t pay the full amount I would be terminated without explanation. I paid the bill out of fear. have two pre-existing conditions. I am told my bill was from three years ago but as they changed medical billing companies they did not have records to provide me with their version of billing. If I wasn’t disabled and didn’t have the time to spend eight hours a week on the phone with them I would most likely be uninsured due to their errors. It’s hard to fight your insurance company alone when your sick/disabled. They still have not provided me with a bill. I will be in contact with the State Commissioners office for insurance soon. Incompetence at it’s best and trying to take large sums of money away from me and many others without providing me and others with an actual bill. It’s not just coding it’s also not providing patients with a bill! And this is from the “best HMO’s out there” as they call themselves. Oh well, I guess I’m glad to still be alive which I guess now is the the best you can say about many insurance companies.
5
Thank you for highlighting the absurdity of the American way of healthcare, in which each and every American face the possibility of total financial devastation and bankruptcy due to an unexpected illness or accident. Hospitals (and doctors and drug firms) have no logical basis for the amounts that they charge, and they cannot tell you in advance what the payments will be. Prices for various standard procedures can vary by over 1,000%, with no basis for these differences.
And to add insult to injury, if you make a decision to go uninsured and pay cash for medical expenses, you end up paying the vastly inflated "list" price for services, rather than the much lower "wholesale" price negotiated with doctors and hospitals by insurers.
Good medical care is a human right. The current U.S. system is untenable, unsustainable, and needs to be totally revamped. Spend less money on administrative costs, and more on actual healthcare. The ACA has provisions for this. No American should have to worry themselves sick over absurd medical bills while trying to get physically better.
Single payer for all would minimize situations such as those described in this article.
And to add insult to injury, if you make a decision to go uninsured and pay cash for medical expenses, you end up paying the vastly inflated "list" price for services, rather than the much lower "wholesale" price negotiated with doctors and hospitals by insurers.
Good medical care is a human right. The current U.S. system is untenable, unsustainable, and needs to be totally revamped. Spend less money on administrative costs, and more on actual healthcare. The ACA has provisions for this. No American should have to worry themselves sick over absurd medical bills while trying to get physically better.
Single payer for all would minimize situations such as those described in this article.
12
It's about time the real cost of health care has been identified. It's not the health insurance companies and their premiums that determine the high cost of the health care system. It's the entire health care industry. E.g hospital costs, doctors charges, drugs, medical equipment costs. All the insurance companies do is pass on the medical costs and tack on their profit. Insurance companies aren't responsible when hospitals charge 3 bucks for 2 advil
1
The coding is hardly the major problem. "Health Insurance" is the problem. We need a system of "Health Care" NOT "Health Insurance". Between the insurers who do their best to make their money by not covering "some" procedures and "some" medications - as if patients should fight with their docs or hospitals before they begin any treatment to see if the insurance company thinks that what the doctor who examined them told them is appropriate care or not. Either doctors still deserve the special trust that their actions are in the best interests of the patient (which they've been afforded for generations), or they are just vendors looking to make money... If it is the latter, then we need to remove the profit motive from medicine by paying doctors a lot less (as they do in all the actually civilized countries in the world) or come up with some other scheme to reimburse doctors for their training, time, and expertise that does not encourage them to try to maximize the income from every patient encounter.
4
The real issue is not just lacking clarity in understanding the bill, it is that the hospitals and doctors can charge whatever they feel like. Even worse, they don't tell you what you might be charged. A doctor gets to decide how much work he/she did treating you, and charges what he/she feels like. Imagine walking into a food store and not seeing what a loaf of bread costs, and then after you took it home and consumed it, you get a bill for whatever amount the store feels like charging you and you have no choice but to pay it!
12
I do research in this area. It's not just the hospitals. About 1/3 of the physician offices I call won't even tell me what they bill for an office visit. And that's just for so many minutes of the doctor's time--tests and treatments are extra. Same is true for physical therapy clinics, etc. You can't find out what your bill is going to be in advance and of course that is especially true when you have an acute care situation. Meanwhile, politicians whose gold-plated health care is paid by our tax dollars cavalierly tell us to shop around.
11
Having been through the angst involved in a healthcare agency's recent government-mandated changeover from using ICD-9 codes to ICD-10 codes, I've been more alert re: the accuracy of the codes that I see on my billing statements. Twice I've questioned the codes documented on the summary statements of diagnoses and services that I reviewed at checkout. I've also expressed concern about specific discrepancies between what I've been told in the office versus what is documented in the medical record. While I understand the burdens of the whole documentation and billing systems on the nursing and medical staff members, I'm concerned at the blase attitudes that I've encountered about these issues.
When I received the bill for an emergency room visit, I noticed I was charged $150 for a urinalysis test, though I knew I had not had one. After several calls to the billing department and they insisting I did have one, I asked them to send me a copy of the test results.
Problem solved, charge removed.
Problem solved, charge removed.
Largely absent from this article is the technology, called 'Electronic Medical Records' (EMR), where coders and providers work to document clinical notes and the alphabet soup (CPT, HCPCS, and ICD) of codes outlined in the article.
Health systems have spent hundreds of millions of dollars implementing IT systems to store, transmitt, and report on the codes and associated clinical documentation required to receive reimbursement from insurers and patients. This task is almost impossible to do on paper and not much easier with IT.
Health IT systems have largely become vehicles which assist in billing at the maximum legal level, despite higher rhetoric that the technology can also support patient care and engagement.
One day, with the right incentives, EMR technology could be designed primarily around the patient and medicine rather than a means to ensure no penny is left on the table.
Health systems have spent hundreds of millions of dollars implementing IT systems to store, transmitt, and report on the codes and associated clinical documentation required to receive reimbursement from insurers and patients. This task is almost impossible to do on paper and not much easier with IT.
Health IT systems have largely become vehicles which assist in billing at the maximum legal level, despite higher rhetoric that the technology can also support patient care and engagement.
One day, with the right incentives, EMR technology could be designed primarily around the patient and medicine rather than a means to ensure no penny is left on the table.
Healthcare should not be a profit center.
4
If doctors don't exaggerate the evaluations they perform - like doing heart or lung exams on healthly patients with broken legs, then insurers will pay them so little for their work that their group or employer won't be able to afford paying them. The idea is that to get, say a reasonable $200 for providing care, a charge of, say, $1000 must be generated, then the insurance company or Medicare will pay the $200. Patients who don't have insurance get stuck with the $1000 bill. It's not legal to charge different amounts based on patients' insurance, and the uninsured have no one to negotiate reasonable payments for them. Now, the whole system is a tragic waste. Physician coders, billers and collectors and all the workers in the insurance companies, and their advertisers and headquarter skyscraper builders all make good livings. Insurers have many workers to deny claims and to harass doctors by seeking more information and delaying payments. Honestly, we'd be better of without insurance. What is now a $1000 charge - to be reduced by insurer and paid only after a long delay, maybe, would be $50 if paid out of the patient's pocket at the time of service. So much money goes to nonproductive people between the act of the patient paying money to his insurance company, and the doctor getting paid by the insurer. Such a waste.
7
We have higher admission standards to West Point Military Academy (aptitude test scores, etc) then to become the commander in chief of the whole army. Many federal agents have to also undergo personality tests, and so on. Think about Ronald Reagan, a former actor, and all the damage he has done (leaving the country with double digit unemployment, jobs going overseas, etc). How can we have this kind of people making our laws and critical decisions?
How do we make sure good competent people are in charge? Should IQ test scores be disclosed as part of election process? I think we have to evolve, try things only a little and see if it works, just like the nature does with evolution. We didn't become humans overnight, it took tens of thousands of years. Because if we don't evolve, we will be like bears.