I ruptured my quadricep tendon this summer. The hospital billed me $900 for a used leg brace that could be purchased new for $300.
39
And people wonder why their insurance premiums, deductibles and copays are so high. Ms. Rosenthal really makes a good case for government controlled universal health care.
114
I’m a physician who’s seen it all. My conclusion?
Single payer. ASAP!
189
Just speaking as an American born, raised, educated, and long lived in the USA, I'd say the country's as corrupt top to bottom as it gets. There's scarcely an area of human activity that isn't rife with serious funny business. "Do unto others as you would like them to do to you," is the national anthem of America.
41
This could be written by anyone who has gone to the hospital or engaged in any way more complex than an office visit. The so called "best" healthcare system in the world is a disaster.
88
I daresay my example is a simple mistake, but still... I received two bills for the same date, one for a scan which I had, the other for an OB US follow-up per fetus billed at 209 dollars. I'm pretty sure the latter did not take place as I am 80 years old.
(Wife of Richard)
58
You want this fixed? Take away the premium healthcare from our elected representatives in the U.S. Senate and House. For them, everything is fine and dandy. Make them share the pain.
128
Excellent article! This is exactly what is wrong with healthcare and how both political parties are ignoring the obvious. Instead of coming up with plans to pay for the high cost of healthcare there should be an in depth congressional investigation first on why medical costs are so high. Both the Democrats and Republicans are avoiding this obvious question. If there is fraud or if the rules are fast and loose due to lobbyists then lets drain this swamp and find out the real cost of healthcare first before pie in the sky healthcare programs are proposed that mask the real issues of healthcare costs. The cost of healthcare in this country is a national disgrace and the American public deserves better from both political parties.
57
While the writer makes some valid points her implication that “one trip” to the CT scanner for scans of the head, upper spine and maxillofacial should somehow be considered as just one exam is staggering in its ignorance, especially for a former ER physician. Those are 3 separate and distinct exams, each with dozens of images to interpret by a board certified Radiologist. Interpretation of these exams takes three times as long as interpretation of one exam as there are 3 times as many images.
I’m sure if the writer sat at her laptop and wrote three back to back to back articles, she would not accept payment for one.
35
1. Medical care is a basic human service, like education, not a 'product'.
2. Medical care should not be 'for profit'. Doctors should be paid appropriately but not outrageously. (I am a psychiatrist.)
3. There is no need for monstrous 3rd party (i.e., insurance industry) to stand between patient and health care providers.
4. = single party payer aka Medicare for all aka 'socialized' medicine!!!
78
Welcome to America. We have the worst health care system in the world and it is all because of one reason: greed. The tired trope that this is all the insurance companies fault needs to end. The hospitals are probably the worst culprits of all, but the doctors, PA's, nurses, are all in on this scam, and they know it. I highly recommend traveling overseas whenever possible for medical care, whether it is Asia or Latin America. You will be treated better, charged less, and end up with better care, in my personal experience. I tend to like lower taxes in general, but in this case, I have zero doubt. It's time for Medicare for all.
60
When you sue the hospital, where do you think the money comes from?
8
Hello fellow Americans,
Our health care system is broken broken broken. These fees are going to pay for multi million dollar salaries for health care executives that never see patients, advertising budgets and managers and more managers, billing departments, uninsured fellow Americans, big pharma companies and on and on. When are we going to stop this bleeding of our citizens and fix this mess? Believe me the physical therapists, nurses, technicians and most of the MDs you see are not raking in the bucks for this shameful state of affairs.
42
"Frauds Are All Legal" until you get caught or first get Congress to make them legal.
This is a foundational principle of capitalism in the USA.
This is not hyperbole— this is documented history of the nation.
To wit the CDO Home Mortgage fraud—largest global financial fraud to date—resulted in not one indictment against those who legalized the mechanisms required to pull it off and, more importantly, get away with it scot-free [Gramm-Leach-Bliley].
The billing practices of the Healthcare Industry over the past four decades make the mortgage fraud of the first decade of the 21st century look like a mere liquor store hold by comparison.
One would be hard to dispute the fact that the Hospital Industry's annual lobbying budget of half a billion dollars a year is money well spent.
33
Often, my american counterparts will refer to bad waiting times in the canadian public system, to argue against a similar one in the U.S.
Well, here is some food for thought.
As a primary care physician working here in Canada, and in the public system for 17 years, I can say that whenever I refer a patient for a screening colonoscopy (for ex. in an asymptomatic patient), the waiting time is of about 6 months. On the other hand, if a patient (say over 40 years old) presents on/off mild rectal bleeding, with no other "red flags" (very important point), he/she will undergo testing within about 1 month. (of course, he/she is told to go directly to the ER if the situation deteriorates). In case of a lower GI hemorrage, people go directly to the ER and undergo an emergent colonoscopy the same day.
With all due respect, wouldn't most americans rather wait a reasonable amount of time for these tests, rather than pay these vast amount of money?
69
Billed $775 for waiting for 3 hours in a patient room in ER.
19
I have been HOPPING mad since I had an eye exam a month ago.
So a long time ago, I concluded that vision insurance was an utter scam. For years, I had a system. Every so often I would go to one of those walk-in lens places. I would get an eye exam and then they would apply the cost of the eye exam towards glasses AND get me a discount. I might walk out having spent $400 but with glasses, contact lenses and a prescription.
Well.
My husband switched jobs and insisted that this time, I go through insurance. So I dutifully found a provider. I had to wait a month for the appointment. I went and was feeling pretty pleased with eveything until I got towers the end. Sitting there blind as a bat, I was asked to sign a form consenting to a $180 fee for a "contact lens fitting".
Well I was there specifically for contact lenses. Without it I would have to leave empty handed. So over the barrel, I signed. I walked out with a prescription and nothing else---and I paid $180. If I take my stupid worthless prescription somewhere I will have to pay full price for the glasses.
NEVER AGAIN.
But it goes to show you the difference of insurance without costs controls and legislation.
With Lens Crafter or Vision Works or any of those places, there is a bit of free market stuff going on so they have to compete. But these other people had me right where they wanted me--so they got paid my "doctors visit" fee and for a one minute contact lens exam I paid $180. Good thing I have it.
17
I've had this experience as well. So does everyone else. It seems to be "baked into" our healthcare system. Medical providers get to charge exorbitant prices, ins companies "cover" some part of those exorbitant prices as part of your "coverage" and then bill you likely the amount you *should* be paying for these things. This is how both providers and insurance companies can justify the system as it is, I'm sure.
I've seen medical providers charging me sr doc rates when I've seen a nurse practitioner (and questioned it with the ins. co. - they were very blasé about it). I've also had a vision doc's office charge the insurance company for a pair of frames I never received. Reported that as well, ins. co. also blasé about the whole thing.
This is the US healthcare system ... just one HUGE question mark in a bucket of question marks. The outrageous prices are probably also basis for the "retail" price hospitals and ERs routinely charge those who don't have insurance, and this is how they justify it (ie they charge insurance companies the same price). In order for everyone to make the kind of money they do from the system as it is, this inflation would seem necessary.
It's also why med bill collection is particularly onerous for those w.o insurance (and even those with - you can totally go bankrupt from one major medical incident, even with insurance!) ... these are the prices they're asked to pay.
15
The US medical/health care system has absolutely created a highly educated, and in so many cases still highly respected, den of thieves. Blame big pharma, blame the medical lobby, blame seriously overpaid hospital administrators, and blame the doctors themselves, especially the specialists, who when asked about billing practices claim ignorance, but still believe they need to earn their fair share of the bounty. It is so entrenched now, there probably is no way any political party can find a way out of it all for the patients.
15
And yet the great American Public s up in arms over any proposal to rectify this reeking corruption.
30
If you own a automotive shop and it’s visited for tire rotation by a someone who sets hospital pricing. 1. Transport fee ( into the garage). 2. Lifting fee. 3. Illumination fee for extra lighting. 4. Lugnut removal fee with a multiplier of twenty for all lugnuts. 5. Tire removal fee with multiplier of four. 6. Tire transport fee to move the four tires multiply by four. 7. Tire lifting fee times four. 8. Lugnut application fee times twenty. 9. Auto descend fee to bring the vehicle down. 10. Another transport fee to get it out of the garage. 11. Technical expert billing for the technicians work. 12. Key holding fee to keep the keys until owner pickup. Key holding is billable by the half hour. I am sure NYT readers can think up a few more here.
73
Transparency, a level playing field and free flow of information are key aspects of Adam Smith's "free market" and they are all completely absent from today's healthcare market.
19
But wait! Wouldn't "socialized medicine"run by the government be worse?
11
Ours is not a healthcare system. As I always say” it’s a giant billing system with elements of healthcare attached to it.” It’s all about the—.
22
Somehow I only see people attacking the so-calle system. And what about the physicians themselves? It would look that they take advantage of the system with gusto. Try to call them thieves they would be outraged.
7
Why do Americans continue to allow big medicine to rob them blind, all in the name of "freedom".
America under the AMA, etc. is the least free developed nation in the world.
Why doesn't the entire country wake up to the larceny that bleeds instead of heals?
Freedom to be fleeced?
Check out the NYT article on Finland this weekend's paper.
20
Sure, it's a bit of a play on words, but the theme of Ms. Rosenthal's criticism could be stated: Placing a higher value on human life means we should place a lower value on the medical means to save and support it.
3
massive objects in motion do not have their course altered easily. Simple starts help change course.
Consider "Ambulance Balance Billing"
I had arthritis compress my cervical spinal cord. In the week waiting for MRI to be delivered to neuro surgeon (never delivered) I sporadically lost gross motor control and took five falls to my padded rear. The sixth fall was mid-turn and I broke my right leg in four places below the knee.
I had neuro appointment for 8am next day so I asked ambulance to take me to that hospital. No problem they said. High speed, no siren and gratefully NO POTHOLES!
Cost was all my responsibility because despite the name "XXX County" it was private company, NOT affiliated with my insurance. I got a c-collar, a blanket, and transport.
When you call 911 perhaps you should ask the affiliation of the service they send? Is fire department covered by homeowners insurance?
I griped and with help of my insurance company (yes, they were on MY SIDE) the ambulance bill was reduced by 2/3.
Because I was not an "urgent patient" (very little pain) I didn't get to my room until about 4am from an 8pm admit time. At 7am my neuro surgeon popped into my room and quipped "I'd have seen you at 8, no need to break your leg! My people will be in to see you today." And they did. No less than half a dozen people arrived, took me to basement for MRI, poked, prodded, and next day I became part carbon fiber and titanium. My x-rays look like "The Terminator"!
4
Several months ago I did something dumb at home, banging up and cutting my nose. It was bloody and I was a bit afraid it was broken. As it was evening, I iced it and took myself to urgent care. Not broken, said the staff member (someone with a master's degree) after looking at my face. She put a fancy Band-Aid on the wound. This was billed as "surgery." My insurance paid for it. SURGERY? Normally, I have no idea what amounts are billed, and patients whose charges are covered have no incentive to complain or question. (
Many Republicans suggest that Americans love their insurance and their doctors. Who is it out there that loves the health-care system that we have now? Patients often have trouble getting appointments, wait too long, are rushed through appointments, may see a specialist for a couple of minutes at most, don't get records and images transferred to the right place without a hassle, and so on. We might love our doctors if we spent any time with them . . .
16
Two words: market failure.
9
When will people learn that hospitals are the bad actors in medical care.
They are not these benevolent institutions run by nuns.
13
As always, Elizabeth nails it.
5
Single payer is what must happen. Canada does a better job. Your trauma charge and a lot of those ER bills pay so the place stays open to take care of poor folks.
15
Wonderful article - write more like it.
Foreigners from non corrupt countries don't know the meaning of the words "medical bankruptcy". Ask a tourist, they won't know. D.A., J.D., NYC
10
Congress: for Pete's sake, if there's anything that brings us together in this country today, it's fear & loathing of our health-care "system." Speak plainly, as Elisabeth Rosenthal does in this article (or as Elizabeth Warren has, for years!) and you'll find there's bi-partisan support for ending this particularly American horror.
15
The conclusion of this very thorough account of medical billing fraud is that these practices must be reined in.
There is another section to be written on what has been done to date: what has Congress, the 2020 candidates done/proposed on this problem. Here, we need cite Elizabeth Warren; fighting fraudulent billing is what defines her mission as a lawyer, a senator and now also as a presidential candidate. As a Harvard law professor, Obama called her to Washington as an expert on bankruptcy laws. As an off shoot of her mission, she developed and pushed through her Consumer Financial Protection Bureau to examine fraudulent loan practices sending victims into bankruptcy. In it's first six years of operation, $12 billion (if memory serves) was returned to victims of deceptive loans.
As a senator, on 10/21/19, Warren along with two senators, confronted five private equity firms with their role in contributing to the sharply increasing surprise bills in emergency medical services. This is, in effect, an extension of the CFPB work, and which she further extends to low income housing firms and other private enterprises that collect exorbitant payments without equivalent services.
So now tell me what other Congress person or presidential candidate has been as dedicated and effective as Warren.
19
Funniest billing statement I received surprised me with references to heart surgery I never had. I called the listed number. When I got through to a live person, I cited the error, confirmed my name, identity, and age (66, with my employer's insurance in addition to Medicare). The rep refused to believe I hadn't had the surgery, ridiculously asked if I had a scar on my chest ("None!"), and asked to speak to a relative. It felt like a comedy sketch. Naturally, I countered with a firm request to speak to a higher up. At a later date, I was told a patient identity mix-up had occurred in a physician's office. None of it made sense. Nor does our profit-motivated medical care system.
17
I was billed $2000.00 for a simple x-ray, because the x-ray wasn't done at my doctor's office. It was done at an imaging center at the hospital--WHERE MY DOCTOR SENT ME. Insurance refused to cover it despite the fact that my doctor had no x-ray machine, the hospital had a contract with the insurer, and no one told me or my doctor that the location of the x-ray machine would affect their payment. Medicare for all!
21
About the bill from the doctor who never saw me and I never laid eyes on in the ER - the company refuses to submit the bill to Medicare or my secondary insurance!
4
This is exactly what I have been calling it for years, and why isn't there a coding list that the patient could check to see if the coding was correct and the billing amount accurate. One doctor was billed twice and when I called Blue Cross, I told them about the double billing said, they needed to have one payment returned or it would be fraudelent. Another billing Blue Cross ignored for almost 1 1/2 years. This, after multiple letters, emails, and telephone calls to no avail. I finally wrote to the CEO and got a next day response and within a month my billing problem was resolved. For a $2,000 approximate charge, the hospital was paid $126. My husband had blood work and when he saw what they were charging Medicare, he laughed, over $4,000. This is a health system gone awry and our politicians on both sides are doing nothing for the American people. We get billed for a doctor's visit and a nurse practitioner or physician's assistant sees you. Then bill the patient for their services, not a doctor's visit. Total craziness and it remains the status quo while our politician's pockets are being filled by the lobbyists.
11
Some of these services you may not have even received.
"There was also an administration fee of more than $350 each for four injections."
The only injections around a CT scan are for Iodinated contrast. The contrast has dose related nephrotoxicity and the standard of care is to wait 24 hours, in someone with normal kidney function, before giving another dose of contrast.
The 3 scans that were done in a single session used a single injection. The other injections, which were never given, were "bundled" in with the second and third scan.
The bundling is done by computerized algorithm. The medical industry has brought a computers efficiency to fraud
15
Just delivered a baby a few months ago, and with great coverage, my out of pocket expenses totaled about $2500 for a pretty normal delivery and 2 days of care. But it’s always shocking to see the “full price”- over 7k a day for hospital care. How do women without good coverage afford safe deliveries? Seems unfair to me. Additionally, the hospital billing center messed up and charge twice for services that would have cost an extra $900!! If I hadn’t read the bill carefully, which is confusing to say the least, and called my insurance to discuss out of pocket maximums, I may have missed it. These types of things should definitely be regulated, and not the job of tired new parents to scrutinize their bills to make sure everything is correct.
9
We must get this kind of wasteful spending out of healthcare, if we're ever to have any kind of single-payer system. Warren says she would pay for her plan partly by saving money on such expenses, but I'm sure she underestimates how easy to do that will be.
After all, politicians have been insisting for half a century that they're going to crack down on waste and fraud in defense spending...and they're still saying it. And defense spending isn't nearly as decentralized as medical spending throughout the country. I'm not hopeful.
4
Excellent reporting by Ms. Rosenthal.
Recently Caroline Lewis from The Gothamist reported similarly using my recent case with NYU Langone Hospital.
https://gothamist.com/news/medical-estimates-are-meaningless-providers-can-charge-thousands-more-you-expect
The numbers are not as outlandish as they are for Ms Rosenthal's husband, but the procedure involved (a simple nerve conduction study) is much more mundane as well.
We elect a government to serve The People. How can this principle be so upside-down?
5
I would really like to see this essay published on Fox News also. Then we could read all the nasty comments from Fox and other right wing media about how Dr. Rosenthal is making this whole episode up and it is fake news.
Perhaps if other patients and care givers started publishing their hospital and doctor billing in their local newspapers or FB pages maybe it would outrage more people....
13
Um, 7K for a “trauma activation fee”? God, I hope a miracle happens and Bernie Sanders is elected president.
10
I hear ya!! Recently went to the doctor for some leg pain and he immediately started suggesting tests that had NOTHING to do with my pain. Good thing in another life I worked on a surgery unit and was able to correctly point out why the tests he suggested made no sense. He lowered his head and agreed with me. I left after getting a shot of Motrin with not a lot of confidence in the medical industry. They pile on the tests because they know Medicare will pay for them. I cringe as I wait for the bill...
15
Absolutely disgusting. How do these people live with themselves?
7
.
It is the [capitalist] economy stupid!!
.
7
The flip side of this horror show is my wife’s situation. She fell, broke her elbow, and required surgery with plates, pins, and screws to repair the damage. When she’d healed sufficiently our insurance authorized PT, which she really needed. But the number of PT visits per calendar year was woefully inadequate to be meaningful. She is better, but will never be able to straighten her elbow fully ever again.
7
You identify an even bigger problem but ignore it. Hospitals are charging outrageous amounts and have been for many years and the insurance companies pay less yet still pay ridiculous amounts for clearly fabricated services. The amounts charged and the amount paid keep going up and the insurers pass the bill on to the insured. These payments have allowed hospitals to expand into huge enterprises that employ hundreds even in smaller cities with campuses that include multistory outbuildings for any and every service they can bill for.
A significant problem with MFA is that the reimbursement rates lock in Medicare rates which are no where close to those private insurance pays. Thus MFA is an existential threat to hospitals as they are now constituted and they will fight it with every resource they have. Unless private insurers can begin to wean hospitals off of this "fraudulent" (and I agree it is fraudulent) billing by reimbursing only reasonable charges health care costs will continue to rise as a result of this alliance between insurers and hospitals (and outpatient services owned by private proprietary interests).
9
Billing in Healthcare industry which includes doctors,insurance companies .mega corporate physician groups and hospitals is a racket .The racket is supported by political donations to legislators making any meaningful reform impossible. Hospitals also are hostage to escalating unreasonable demands by healthcare and nurses unions .Recent lawsuit In US Supreme Court by hospital lobby to prevent disclosure of negOtiated prices is not in the interest of public.Why is the healthcare insurance lobby silent and paying upfront the variable demand prices by the hospitals?Why are the political candidates not addressing the outrageous bills by the hospital?
In the area I live ,community hospital affiliated to no profit academic center charges$ 2000 for a CHem panel which is done for $200 in outpatient lab across the street.
There should be mandatory posting of prices by the hospital in its website accessible to consumer .It will make the consumer more savvy shopper instead of being ambushed by unjustifiable bills There should be legislative upper limits to charges in hospital pricing just like Medicare limits .
Variable pricing is discriminatory because it victimizes the consumer prefers self pay instead of going through contracted insurance carrier
7
Same thing happened to me after an auto accident. I SPOKE with a PA three times during the SEVEN HOURS it took to do a PET scan and one with contrast of my neck and head. First time I was taken to the lab, the nursing staff had not been told to insert an IV for the dye for the scan. It took SEVEN HOURS for a scan to be done and evaluated at the main hospital 10 miles away. The biggest surprise was an $842 bill from a doctor who never saw me and I never saw. The company that billed me is in Connecticut. I live in Atlanta, Georgia. When I called the hospital, they had no idea who this doctor was. I am NOT paying this bill. I go to Emory hospitals because all my doctors are with the Emory Health System and I expect to be treated by Emory doctors. I'm not paying some doctor who flew in on her broom to find patients to bill. This will probably ding my perfect credit score, but so be it.
11
Great article Ms. Rosenthal, thank you! But enough of the complaints and anecdotes--everybody has them. How can they be combined to present as the tsunami it is and put the brakes on this blatant travesty? What has to done and who needs to be contacted? Instructions please!
11
While I cannot be as detailed as Ms. Rosenthal, I have two brief stories about hospital fraud. In 1992 my 81 year old grandfather was operated on to place a pacemaker at a city hospital in Iowa. The surgeon placed the pacemaker ON THE WRONG SIDE OF HIS CHEST and the operation had to be redone. My poor grandmother was so stressed due to my grandfather's precarious health, that she overlooked the fact that their Medicare/insurance was billed for two operations. As it was the surgeons/hospitals fault, the second operation should have been gratis. The second story involves my grandmother's death in 2001 in a smaller hospital. While they took fairly good care of her in her last days, after her death the doctor strode through the office and tossed off the comment " Oh, and add $10,000. to L______ C___________'s bill." My cousin was one of the employees who worked there and heard this. No accounting, no itemizing, just add 10K to her bill.
15
A multi-tiered industry which exists entirely to profit off of our nation’s medical needs is just smart business practice.
The really devious part of it is how they get legislators to convince voters not to trust a system in which doctors get paid for doing what they were trained to do, while not having to bother with the extortionist middle-men.
But what good is political power if you’re forced to consider things like nuance?
8
I know all of this -in part because of professional experience in health care and in part because of reading articles like this.
My scheme for not being affected by the health care scam?
Stay healthy.
So far it's working.
4
What is the value of any given medical service? The answer is clearly not... 'what is charged'. The next logical guess would be, 'what the provider accepts for payment in full'. Unfortunately that produces no unitary figure, but a multitude of numbers depending on who the payer is.
What other industry...anywhere.. allows the answer to the question: "How much for this service?" to be, "Well, it depends..." ?
4
As a primary care physician working here in Canada, and in the public system for 17 years, I can say that whenever I refer a patient for a screening colonoscopy (for ex. in an asymptomatic patient), the waiting time is of about 6 months. On the other hand, if a patient (say over 40 years old) presents on/off mild rectal bleeding, with no other "red flags" (very important point), he/she will undergo testing within about 1 month. (of course, he/she is told to go directly to the ER if the situation deteriorates). In case of a lower GI hemorrage, people go directly to the ER and undergo an emergent colonoscopy the same day.
Many of my american counterparts will mention terrible waiting times in our canadian system to argue against medicare for all; with all due respect, wouldn't most americans rather wait a reasonable amount of time for these tests, rather than pay these vast amount of money?
12
The anecdotes in the comment section are sobering. Frankly, I have similar stories and I do not know a single person who does not have additional tales of woe. By nature I am a political moderate - I believe that compromise solutions are always superior if functional. I have decided, after the Republican attempts to denigrate Obamacare, that a compromise solution on healthcare is not viable. A single payer solution that covers everybody is the only stable solution. If the government takes in tax what my employer and I currently pay for private insurance (currently $31,476 per year for a family of four) from everybody I am sure this will cover the nations health expenses and cost no one any additional fees.
14
When Medicaid providers in New York state manpulate the system, the NYS state government refers to it as
"Over-utilization." How's that for a euphemism?
1
This is why proposals for Medicare for All, etc. seem to miss the point. Health insurance costs so much because the providers--docs, other med professionals, drug and equipment manufactures, etc.--charge too much, sometimes semi-fraudulently. It's not just or event mainly the insurance companies. Also, the government acting through Medicare can't police that any more than the private insurers. Most of this is due to the lobbyists and unions for the providers and there political clout with elected officials.
6
A few years before the ACA i had one of those high deductible plans that I paid for myself since my employer did not provide health benefits to part time workers. I became ill and was prescribed a CPAP machine. The hospital affiliated provider I saw issued me a $3000 machine that I had to pay the entire cost for out of pocket due to my high deductible. I found out I could have purchased the same machine from a reputable online supplier for under $600, less than a third. I refused to pay the bill, went to court with the debt collector and settled for $800. I don’t know what the debt collector’s attorney charged, but I am sure they must have lost money on the whole deal. Why didn’t they just charge a reasonable amount in the first place? I would have paid a reasonable markup.
9
Please read the article about living in Finland and connect the dots. To all of you Americans who deplore the perils of "socialised" medicine I say wake up. Civilised countries care about their citizens and don't expect them to die or go bankrupt to get standard, basic medical care. It is shameful that health is considered a free market, user pays service and not a basic human right.
17
This is a great article. Good expose of organized medical billing crime. Elisabeth Rosenthal seems to have the perfect credentials to write this article. Maybe some of the "economists" who are so bewildered as to why medical costs keep going up should talk to her.
The U.S. medical industrial complex is a profit making machine with actually providing medical treatment almost a sideline. Eventually we are going to replace this system with some kind of universal, taxpayer supported, no fee for services, national health system, either one entirely under government control, or as in, say, Germany, one run by highly regulated insurance companies in partnership with the German government. I don't think we will see this in the next election cycle or possibly in my lifetime but the medical industry is eventually going to kill the goose the laid the golden egg.
6
A glass shattered in my hand about five days before my wedding. It badly sliced my left ring finger and pinkie near the knuckle. Counting up in my head the cost of stitches, I briefly considered stitching it up with silk embroidery floss (my roommates talked me out of that) and then used butterfly bandages and bandaids to take care of it. I still have an obvious scar on my pinkie 2+ years later, and we didn't do any hands w/rings pictures, but I also didn't have a giant ER or urgent care bill. So I still think it was worth it.
6
Five years ago, I discovered a lump in my upper palate. I went to see a GP who referred me to an ENT specialist. No bill from the GP.
The ENT doctor did two biopsies, prescribed a CAT scan, diagnosed a benign tumor and referred me to a surgeon. No bill from the ENT specialist or from the medical lab.
Some weeks later, I underwent surgery and spent one night in the hospital. I saw the surgeon again twice over the next few months (to check the healing). The surgeon confirmed that the tumor was benign and wished me all the best. No bill from the surgeon or the hospital.
Oh, I forgot to mention, I live in Canada.
24
Passive Americans will keep on paying and elect politicians who preserve the status quo. Nothing will change. Why shouldn’t medical (and other) crooks take advantage of us when we are such easy marks?
15
As a physical therapist I am appalled at the behavior of the PT in the story. This behavior should be reported to the hospital and to the Physical Therapy director in particular. I don't know of any hospital that would tolerate fraud like that from an employee. The PT you mention should be promptly fired and probably would be if you reported him or her. Please do.
11
If you can only reduce this kind of spending by 20%, it is as much as eliminating the entire country's drug expenditure.
What the author does not mention is the amount of "over-billing" associated with claiming a higher degree of severity in patients. For example, stating that the nature of the emergency is higher than what it is in reality. There are published studies showing that the prevalence of this kind of overbilling has increased over time. The type of emergencies have stayed the same, but the billing shows them to have increased in severity.
7
I would add to this excellent article the issue that medical bills often appear many months after the treatment itself. It is often impossible to tie these delayed and sometimes confusing billing statements to what actually happened at the time of the treatment. This makes accountability even more difficult.
9
My province just dropped the monthly medical services fee, basically a health insurance premium. Used to be $50 a month, now I am fully covered with no monthly premium, no co-pay, no surprize bills, no paperwork.
If I am unfortunate enough to require an ambulance I would be billed $80.
I cannot fathom why every American is not in the streets protesting for universal coverage.
Editor’s note: This comment has been anonymized in accordance with applicable law(s).
25
In October I had an accident in Portugal. My total bill for ERT treatment, ambulance, CT scan (required by law because of my age), stitches and ER MD exam was ~$200. My bill was one page and my medical report was one page. I got both pieces of paper five hours after the accident when I was discharged. Our system in the U.S. is designed for corporations.
21
The awareness of incidents of black and brown people being treated badly by police and white people didn't change until the behavior was caught on cell phone videos.
Video each interaction with a healthcare worker--I realize there is sometimes a very long delay between treatment and billing but some of these "drive-by" incidents could possibly change the behavior.
Especially if egregious ones went viral.
Call it one aspect of "transparency in hospital billing"
7
My late father would always refuse such services (some perhaps to the detriment of his own health, though I think he knew better) -- he was adamant that he not make insurance even more expensive for everyone. Of course, once he was unconscious, it was impossible to refuse many services. We got billed for unbelievably ridiculous things, like a doctor evaluating his foot for some kind of a brace when my father was not mobile/could no longer walk. I wonder how much worse this kind of thing is for the elderly or folks who may never get to review their bills.
3
For years I went without medical insurance. I learned how to self treat minor ailments. Homeopathic medicine helped out a lot. Cayenne pepper with lemon and honey teas for strep throat ( it works). White or yellow onion for minor cuts ( a chemical in onions have clotting properties that rival pharmaceuticals), and so on. But, there are medical ailments for which no homeopathy or savvy knowledge will assist. I have insurance now, but will lose it due to making too much$$, but still not enough to afford the Bronze policy on the ACA. Our country needs to vote in badly needed change.
8
The Healthcare Industry has successfully created a planned economy in the alleged bastion of capitalism.
5
Today I got a bill for $6.90 from a place I never was. I got it once before thinking maybe I was somewhere I don't remember. I often pay small amounts and think of them as a nuisance tax. When it is more I fight it which involves hours of tracking people down. Double and triple billing happen often.
I hope your husband is okay. I am very glad you wrote this.
In terms of billing and outrageous charges. All of it for that matter should be free.
The whole thing is criminal. You are pounced on when you are most vulnerable. Someone like Elizabeth who is savvy, smart and can make sense out of things would be a good person to know. Which doesn't mean she won't be scammed, abused, taken advantage of. Someone like me has no idea what I am reading when it involves what I am agreeing to. And if I am upset this is compounded multi fold.
6
My wife is from a foreign country in Asia where I am a legal resident and am enrolled in their national health care plan. The cost is about $600-$700 per year. It's an additional $300-400 per year for nursing care insurance which is mandatory for anyone over the age of 40.
Each time you visit a doctor you present your national health care card, when you are finished they present you with a bill for that days services along with an itemized list of the services performed and a plastic card with the charges embedded in it. One places the card in machine along with your credit card, a receipt is printed out. End of transaction.
I visited a cardiologist there a few months ago. She ran a series of standard tests: Echo, EKG, blood test, etc. She had the results within a couple of hours and advised me to keep taking the meds I had been prescribed in the States, which is apixaban or Eliquis. The cost in the States was about $500 with insurance. I paid $100 for a 90-day supply.
Total cost for the visit not including meds: $180.00
5
My husband went over the handle bars on his bike, was transported to the ER in an ambulance but only had bruises. He spent 2 hours in the ER. For this they billed us $40,000....I am not joking. Thanks to my insurance company we will probably have the bills down to about $4000 (I have a high deductible plan and health savings account), but still outrageous. I was charged $75 for "smoking cessation counseling" because the ER doc asked if my husband smoked. I have an out of network charge from the ER doc for my in network hospital, and he keeps sending us bills for $2000, not happy with the $600 he got from the insurance company. If I didn't have insurance and was more middle income, we would be bankrupted by all of this. Don't want to get into politics here but those who want to see Trump repeal Obamacare so they don't need to buy insurance are complete nutjobs...thank goodness for the insurance company.
14
I discovered that if you write up your experience on Yelp with the out-of-network doctor you may get offers to help with the out-of-network bill from the hospital.
I also know from experience that if I hound my insurance company month after month, eventually they will process in network if I went to an in-network facility but got stuck with an out-of-network doctor.
5
I note several comments from the UK. Please note:
Conservatives in the UK are eager to "sell" at least part of their health care to the US. Boris Johnson is all for it.
You have an election in 4 days. Your National Health is failing.
Getting rid of those furriners has also gotten rid of a lot of the caring professions.
Conservatives are no longer conservative. Conservation is conservative.
5
I'm also a US physician and it is shocking how much fraud and profiteering there is in the US medical system. I'm currently working in New Zealand and the differences are huge and stark...except in outcomes which are excellent in New Zealand. We have to get price control into the US health system, it is completely out of control. The US spends about 18% of GDP on health care and doesn't even cover everyone! New Zealand spends about 7.4% and does (though NZ probably under-spends, 9-10% would be a good target). Transparency in billing, price controls, and some form of Universal coverage can all be done and actually reduce our cost at the same time. Literally every other advanced country in the world can manage it.
18
One of my doctors recently changed groups. I called for an appointment and arranged it at the new facility.
I was then seen not by him, who’s been treating me for a decade and knows my particulars, but by a PA.
On the way out, I asked the desk attendant if PAs are paid the same as physicians. She laughed so much it was a while before she could answer “of course not, are you kidding?”
To which I replied “Then why am I paying the same as when I get to see Dr. E?”
No answer.
13
How do we go about fixing the system? I’m too small to make any changes.
3
This excellent piece is spot on in its description of what is wrong with medical care in this country. Talking about health care insurance is not enough - we need to discuss the fraudulent practices as well. This is one aspect of the corruption Elizabeth Warren and other candidates allude to. But undoing this problem will be a long hard battle as there are powerful forces behind it - Pig Pharma, the AMA and the lobbies for the individual medical specialties. I wish I could be optimistic about the chances for reform.
9
I broke my foot at home and was transported by ambulance to my in-network Hospital ER. When I was at my most vulnerable, the hospital gives me an out-of-network ER doc to look at my foot. I’m was at their mercy.
Apparently the ER docs around our county in San Diego have formed a professional group and then refuse as a group to work in-network for the hospital.
I blame the hospital CEO for this situation who could easily recruit ER docs from around the country to sunny San Diego but instead doesn’t. I won’t speculate why, but I will say that in my research I discovered that my out-of-network doctor was once chief-of-staff at the hospital.
You cannot make the argument that somehow these are better doctors and wouldn’t you want the best doctor not just the in-network doctor. ALL of my other doctors at this hospital are in network and they are fabulous.
I fought for six months to get the bill processed in-network. I eventually won the battle but only after many contentious phone calls.
11
@Patricia Brown
Probably explains why there is a long line at the strip mall urgent care center, and why the big fancy new trauma center at the La Jolla hospital is deserted...
3
It has been said they do this to cover the people they MUST treat that can not pay. Universal health care would be more efficient and cost less overall like it is in other countries.
11
Terrific job itemizing for material in the first person. So true.
Sadly, we are "afraid" to open the door on all this cheating, and it is not only costing us a bundle but also threatening our future.
The people who refuse to work on improving this system are in many cases in the tank with wealthy and powerful donors who don't want the door pried open.
In the end, we all will suffer. Earth itself is taking a hand, as reality breaks in. My personal opinion based on years of observing pollution of multiple kinds is that billions will not survive, and humanity will have to start over in a world that resembles Mad Max too closely for comfort.
6
@Susan Anderson
I'm afraid you are right.
2
We all have experiences that could be added to this detailed account, provided by a medical doctor to boot. I was a medical social worker in acute and rehab hospitals for half of my career and not many physicians were happy with the system. It’s even worse now.
We should be skeptical of politicians who tell us most people love their private insurance.
9
"Medicare For All" is no fix—Medicare has been co-opted by the Healthcare Industry.
Medicare's byzantine structure created a market for the Healthcare Industry to supplant Medicare by marketing "Medicare Advantage Plans."
Plans that are an advantage only to the Healthecare Industry who are provided another revenue stream of taxpayers' dollars.
1
This is the best article on health care in the US that I've seen in a long time. So many of us have the exact same mind-boggling moments when opening bills from ER visits. This is what I would like politicians to be talking about. And a Pulitzer for Ms. Rosenthal!
16
At least the author, Elisabeth Rosenthal, is a physician and thus familiar with medical treatments and what's reasonable and what's not.
The rest of us, me included, are not -- which makes us prime marks for inflated billing, unnecessary treatment (I didn't know it was unnecessary!), and phantom charges.
After personal experience I've come to realize that hospitals and physicians are financial ghouls who are perfectly OK with helping us physically while harming us financially.
As a result I don't trust any of them.
14
We would all like to change our current medical system, however we live in a money oriented system where the goal is to squeez as much out of the consumer as possible. The health industry is no exception. Lobbyists will flood government offices if we'd like to change anything. We let money dictate all consumer related decisions by electing officials that want to enrich themselves while in government positions.
5
Health care providers, hospitals, and clinics must be required to show the charges for all services ( including labor) equipment use, room use, medications, administration costs, and any and all other fees for all to see. These charges should be available for all to see and judge and compare to actual costs to the provider. Importantly, We need people with expertise and no affiliation with the providers/institutions or with insurance companies to do the work of establishing reasonable costs for services provided and medical treatments administered. These reasonable costs should be published and available to the public.
Major insurance companies have done this type of work, but do not share it beyond what we see them actually reimburse providers. We need to see evidence that the charges billed to us are reasonable and we need to establish rules/laws against the kinds of fraudulent billing described in this opinion piece.
3
All so true, so typical, so endemic, and toxic to good social order. Just imagine what the bill will be when millions more have access to this parade of horrible. And not one candidate offer to expand the system denies its existance. Nor do they say this isn't merely the private insurance system at work, it is undergirded by the Mother of All such grand schemes: Medicare and Medicaid. Yes, our governments allow this and insurers merely go along with it. All in for all getting a cut?
1
The part you refer to “patient responsibility” is the true cost of the product or service availed. Rest all are system charges paid to keep random people in business.
2
And this is why there are so many people supporting Bernie Sanders and Elizabeth Warren. In a system as corrupt as this, it is a liability to be seen as part of or supporting that same broken system. Count me as one of those who refuses to back candidates that think the system, healthcare and otherwise, only needs a tuneup or a little tinkering around the edges.
10
@Mark Holmes well said! the medical system needs to be brought down. More Power to Bernie and Elizabeth! They fight relentlessly to educate us on the mess of the capitalism. I hope all americans fight this.
1
One more story.
My mother was prescribed a medication that costs $13,000 a month. Please explain to me what sort of magic elixir costs $13000 to make.
She is elderly and was told that there were foundations that would help her out. She called and immediately "found" the money. All sounded great until I dug a little.
Turns out these foundations are funded by the same Pharma companies that charge that much in the first place. They do it so that people on Medicare will have an option. My good friend in the know explained the reason. Without it, they will raise the issue to local legislators and they dont want that undue attention.
True? I dont know but my friend works in pharmaceuticals so he may know more than me.
It is fraud. It's all fraud.
17
This is a good article and course Ms. Rosenthal is correct that the medical billing world is fraudulent. But she has apparently yet to discover one underlying fraud: the idea that insurance companies "negotiate" rates with providers. That explanation and those words are not consistent with the reality of legal conspiracy that exists between insurers and providers. In any other field we would easily identify the situation and bring anti-trust actions against the corporate players for fixing prices. But we're conditioned to accept the fraudulent "negotiations" even though they are secret and inherently effect billings of the non-insured, not just the insured. The entire medical-financial business in the United States is based upon falsehoods, frauds and secret conspiracies, all conveniently disguised as "caregiving", but actually devoted only to profits.
9
My sister is an attending physician and director of ORs in a major hospital but has no control over billing. During surgery her resident administered a drug that the patient was not supposed to receive due to allergies. Luckily there were no negative consequences, but my sister was quite upset and followed up with the patient to express her regret and discuss what should have happened to prevent the situation. The patient suggested that she should not be billed for the antidote that was provided to her in case she experienced a reaction after discharge. My sister absolutely agreed, but was embarrassed to acknowledge that she has no influence over billing. My sister continued to lobby the billing department but was that she would not even be informed if the patient was billed for the antidote. It's frustrating that physicians have so little involvement in patient billing, and it's counter to what any patient would reasonably assume.
14
It would have been good to know if the author challenged the insurance company about the more bogus of the fees for services not rendered and devices not used.
Whether we really pay these fees or not out of our own pocket, we should all take a little time to comb the bills. The problem is that most of us don't ever pay the full price, so we don't really care.
And yet we complain about the high cost of healthcare.
And a note to those opposed to Medicare for All. Would you rather keep lining the pockets of insurance companies?
5
@Jane
Medicare has been co-opted by the Healthcare Industry.
Medicare's byzantine structure created a market for the Healthcare Industry to supplant medicare by marketing "Medicare Advantage Plans" that are an advantage only to the Healthecare Industry who are provided another revenue stream by taxpayers.
I don't disagree with your comments in general. However, there are "exigencies" built into the system that contribute to these excesses. If your mother had been sent home without a wheelchair/commode and had fallen, resulting in an injury and readmit, this would have been considered a significant lapse in quality of care, resulting in penalties against the hospital and staff for failure to provide durable medical equipment. Could have refused the equipment? 2) We need more physicians in certain specialties. Trauma surgeons, neurosurgeons can basically name their price for being "on call" nights and weekends. ie - not enough money, I don't take call. Patients can be shipped to another hospital or city. Not too many choices for hospitals in these circumstances. Don't blame medical billing or the hospital for this. Instead, sit down and have a little chat with the trauma surgeon asking why he/she feels it necessary to make that much money. If we had more of them, would fix the problem. Tax support for medical education in specialties with shortages. 3) Re. meeting in the lobby. You can blame this on HIPPA privacy laws. What if a neighbor wanders by and hears the physician say "I'm going to prescribe a much stronger narcotic for Joe." Then you get a call for another neighbor saying "I hear Joe needs narcotics. He must be in a lot of pain." You might not be too happy about all this information sharing.
4
This whole medical billing business is a scam as this article so perfectly illustrates. When the patient urgently needs something and they have a (virtually) unlimited ability to pay ethics and integrity go out the window.
I find it particularly galling when providers bill patients without health insurance the rack, read inflated, rate for various items or procedures and expect them to pay up. Why wouldn't the person with the least ability to pay be given the best, not the worst, pricing?
3
I agree that medical bills are sometimes infuriating. What this article doesn't address is the fact that a large percentage of patients seen in the ER pay nothing no matter what services they get, and that many surgeons and medical doctors get paid nothing for the services they provide to many of their patients. If a patient has no money and no insurance, they still get great medical care. Part of the solution would be to insure everyone.
5
Yes, it is fraud. But I don’t see change arriving any time soon. Even if Elizabeth Warren or Bernie Sanders were elected next November, we are assured that majorities in the House and Senate would oppose structural reform of healthcare, so the most we will get is some tinkering around the edges. Why? Because as Ms Rosenthal has pointed out in her previous column, hospitals are such an enormous fraction of most cities’ economies, employing so many people in the community, any suggestion that changes are coming that will reduce hospital budgets send shock waves through the community. Will I lose my job? Will my income be cut? How will I afford the mortgage on my 5000 sf house? My BMW car lease? Private school tuition for my kids? That’s at the top end, where cuts are never likely to be made. More likely, it will be the lower-salary employees who will feel the axe, and then when their buying power is lost to the community, we will see the inevitable recriminations about the ‘decline of health care’ and ‘socialized medicine’. Just like the military-industrial complex, when a sector of the economy is so large and dominant, significant cuts can never be contemplated because of the massive damage they will do to the economy. But the alternative — continuing on the same path — is the way of personal and national bankruptcy.
5
Health insurance is a total fraud. Here's another example. We pay about $15,000 a year in premiums for private insurance for a family of five. We are each covered for 30 physical therapy visits a year, which sounds great, right? But for each of those 30 visits, we are billed just over $250. Once the coverage runs out, each visit costs us $80. But not going through insurance at all, I was told, would be insurance fraud. It's like we've all fallen through the rabbit hole.
We don't have a health care system in this country. We have a doctor/hospital/insurance company care system, because it's all about them making money, not about patient health.
7
I'll add my story. 12 years ago, I had a double laminectomy. The accident insurance company told me to pay for it myself and they would reimburse me. So I negotiated with the surgeon and hospital (surgery center) for the total of less than $5000. All participants issued the medical form required by the insurance company and I got reimbursed. The hospital didn't/couldn't. So I told the insurance company to deal directly with the hospital and pay them. The hospital then billed them $50k for what was $2k. Insurance company ended up paying $20k, the remains of my eligibility, even after I told them the fee should be $2k.
Insurance companies don't have strong enough an impetus to negotiate hard with hospitals. They pay whatever the "discounted" price, and then they can turn around and raise your premium every year. This is why we need Medicare for All, because free market just doesn't work for healthcare.
3
The longer I work in healthcare (now over 20 years) the more convinced I am that those who are against universal care are violating the Hippocratic oath. The legalized scam that is our present healthcare system does harm to patients and their families that can last for generations. Financial harm may not be physical harm, but it can lead to both mental and physical harm. Even though I have good insurance, I fully realize that if anyone in my family has a major (or perhaps even minor) health issue it could bankrupt my family and make my children's future very difficult. All of us who actually care about people, need to share articles such as this one and fight back against those who are exploiting us in the present system. One idea is to ask: Are you humane (and support universal care) or inhumane?
11
Articles like this and the one Time published a while back, "Bitter Pill: Why Medical Bills Are Killing Us," are necessary to publicize the healthcare industry's outrageous practices.
Healthcare lobby is no different than the gun lobby. They have most members of Congress beholden to them.
Unless those of us who are affected by the healthcare industry's fraudulent practices spread the word and organize to elect individuals who would vote to change the system, there will be more articles like this but less action.
9
I think it's important to realize that insurance companies have no incentive to control costs. They take a percentage of what they process as corporate profit and pass the rest on the next year as higher premiums. The higher the bill, the better from their standpoint. Moral hazard anyone?
3
We are currently awaiting claim processing for a hospital bill of $38,000. This was for output surgery, 2 hernia repairs, that’s it, no complications or co-morbidities. Of course this does not include any of the MD fees, which total about $13,000 or Pre-op testing...We don’t know yet what the negotiated rates will be, imagine if you don’t have insurance, and are charged full rates!! As the author states, most of these absurd billing practices are “legal” , however some mentioned were not. In particular, the home therapy PT visits, if no service was provided. If the therapist entered the home and made a clinical assessment and provide some form of education, that is billable. I am a PT for over 30 yrs, and have been met with the pt refusal at the door, no likes it but you can’t bill for that.
2
@TS
You would be interested to know that Rand Paul, the politician who claimed universal single payer systems are "slavery" for the medical practitioners, recently came to Toronto, Canada to have a hernia operation conducted by doctors at the world renowned "Shouldice Hospital" a private/public clinic that specializes strictly in hernia operations.
Since he was not a Canadian he ended up paying $8000 for the operation, a procedure that when Canadians(who are the bulk of the patients) have it done at this clinic, they incur no expense whatsoever.
5
My daughter was 36 when she was diagnosed with breast cancer. Three years later her bill is well over one million dollars. What's really upsetting is the fact that she gets bills for treatment that occurred 3 years ago! How does that happen? After medical treatment, one really gets sick!
13
So not only has medical care turned into a mind bending shell game of financial fraud and corruption it has translated into one of largest drivers of bankruptcy. Tack on the ever complex and growing expense of co-pays, deductibles, spend down accounts and other insurance gimmicks and the denial of needed care & access & you have the reason Heath care is a number one concern for Americans. When someone points out the cost of addressing this using Medicare for all I have one response. Will that still be true when the shell game is ended? When the exaggerated bills, the drive by doctoring etc are addressed then talk about how to pay. What I want to know is why this clever “game” is allowed in the first place.
4
America overpays for hospital visits (like your husbands) and our life outcomes are worse than other countries citizens.
To be clear - we pay more for a worse outcome!
Only in America would you pay more to live a shorter life, have babies that die and have a quality of life that is lower than our friends in Europe.
I love having a local hospital. However, their billing practices are outrageous and must be regulated. Middle class families need medical care they can afford so they don't go bankrupt. America's hospitals need to have Congressional oversight till they charge our citizens a 'fair and honest' amount versus the fraud that occurs now.
2
@Jon Lower life expectancy and worst outcomes are not the fault of hospitals and doctors. We have insanely high rates of suicide and drug abuse, obesity, lack of education etc.
1
A Chicago hospital refused to give me information on billing for ER care - they said it violated HIPAA. But I was the patient.
How can Google and India get my medical information with no problems when I can't even get the costs?
Never did figure out who that doctor was that I never met. The one thing that these places are good at is stonewalling.
6
I need minor outpatient surgery and there are only two surgeons in my area who do it. My Principle Care Physician suggested I make an appointment with each to meet them before I made my choice. To make a long story short, $1,700 later, all but $100 paid by Medicare, I've met two doctors.
1
During your emergency, you’re glad that whole $100 million hospital was there and received you. But then you get the bill and now you’re outraged. Now how many times have you seen line items in your bill for: Land, building construction and maintenance, water, electricity, gas, backup power systems, medical grade HVAC equipment, cleaning staff and supplies, food and nutrition kitchen and management services, medical waste management, security, accounting staff, records management staff and equipment, compliance management, legal services, payroll, liability insurance, computer equipment and maintenance, IT infrastructure, communications and data resources management, high end medical imaging and analysis equipment, inventory management, procurement, payroll, human resources management, training, operations staff quarters, offices, medical consumables storage, etc. You don’t. But now, you see the list of all those other costs above. How was all that paid for and fully operational when you had your unforeseen emergency? Go through all your bills. You won’t see a charge for any of the above. Still angry?
7
Obviously, you think the bills were too low. The hospital has to decide whether it can recover its capital expenses in one year, ten years or 20 years. I believe the tax code provides some guidance in that area. If they have decided they have to charge $300 for a $15 item, they should at least offer the patient a choice of having a family member go to Walgreen's to get it.
In the late 1980's my father-in-law was hospitalized with a serious condition and developed a very bad cough. The nurse ordered "something" for it. Unfortunately, it was a weekend, and after six hours of listening to him cough, I went across the street and bought a package of cough drops for $1.25. After eight hours two cough drops arrived from the hospital pharmacy. The bill for those two cough drops was over $30. "Overhead".
No other business could get away with this kid off nonsense.
7
@P Meister Thank you. 100 % correct. And the writer, who is described as an ER physician, should know better.
1
You completely miss the point, unless you expect the same sort of itemized fees from the grocery store, bakery, auto shop, vet, beauty salon, etc.
5
I guess another reminder is in order here. The companies that make up the private healthcare industry in America, Medical practitioners, hospitals, pharmaceutical companies and insurance companies AND the CEO's that run them have as their main purpose and fiduciary responsibility to maximize profits for their shareholders, everything else is inconsequential. Healthcare in America is treated as just another commodity to be bought and sold.
All of the other countries who implemented some form of universal/healthcare system decades ago determined that because healthcare is not like any other commodity but it is "inelastic" in demand in which at some point in everyone's life they will need it, there won't be a choice, especially if they are in an emergency or chronic care situation.
In order to reign in costs and increase efficiencies the private sector must relinquish control and in order to accomplish that, Americans must also start electing politicians who are unencumbered by the "bribery" from an industry who wishes to maintain the "status quo".
5
As long as the cost of entering the field of medicine rises so too will medical billing prices.
Also don’t confuse the reasonable value of a service, which is the providers charge, with allowed amount, which is what insurance companies pay
2
And now I know why pediatricians will never make real doctor money...when I do a “procedure” like pulling something out of a kid’s nose, or resetting a dislocated elbow (common, often pretty easy), I and I think everyone else in my practice will waive or downgrade the visit charge and just bill for the procedure which at $200-300 dollars seems like enough. Oh well.
5
@Bonnie Good for doctors like you! Have a look at this: From our Bill of the Month Series. Some folks made big money pulling a doll's shoe out of a kid's nose. https://khn.org/news/nothing-to-sneeze-at-the-2659-bill-to-pluck-dolls-shoe-from-childs-nostril/
1
ditto for geriatricians. Podiatrists, however, can bill quite nicely for "debriding" each toenail. Must have something to do with lobbying. There is no other possible explanation.
1
A few years ago I had back surgery. I was very careful that my all docs involved and my preop clearance was by a Doc who took my insurance. I arrived that day and the doc was busy and they sent in someone who did not take my insurance. I said "Wait a minute, I am not going to be covered for this!". The new doc said take it easy it will be OK. As I got re-dressed, I said I will resched the surgery when a doc is available that takes my surgery. Funny, they found someone for the 5min exam in about 10 min. Problem 1 solved. After surgery some anesthesiologist wandered into my room to ask about my pain. I asked if he took my insurance. Nope! My comment was to please leave. I wanted my surgeon to mange my pain. The new guy also told me not to worry. I told him to leave. He left. My surgeon ordered the pain meds. All good. Right? Nope the anesthesiologist sent me a bill for $500 to cover the 30sec he spent in the room telling me to calm down. I would not pay it. Eventually he just stopped. I did have one surgeon who promised he took my insurance. He did not. He sent me a large bill for a consult. I paid him $5 each month for a few months until he just stopped. What a scam.
12
Until medical costs are reduced, Medicare for all will simply enable a broken system. Please don't misinterpret that statement as Medicare for all is a bad idea.
But ultimately Medicare is no different than any insurance plans, and all are doomed to failure unless our medical system is fixed.
Yes, there are problems with insurance, but It really makes zero sense that somehow insurance is supposed to be the lone savior for this dysfuntion.
3
As long as our so-called 'health care system' exists solely to enhance shareholder value the horrors described herein will only worsen. Is it any wonder that our infant mortality is increasing while our life-expectancy is decreasing.
4
Everyone commenting on this article about how Medicare-for-All can avoid insurance company costs is missing a key point. Medicare pays 20% of allowable charges. That means you must have a supplemental insurance policy or you pay out of pocket. 20% of medical expenses can still be a huge outlay without supplemental insurance.
5
That is true for Medicare right now. That doesn’t mean Medicare for All is stuck with that same percentage.
2
It is astounding that the United States is unwilling to bend when it comes to a universal health system that would eliminate the outrageous and needless billing practices; also to mention those who with all these exorbitant bills find themselves dealing with an "out of network doctor."
What has always dumfounded me about my fellow Americans is their almost instant recoil when universal health coverage is discussed. The response is always the same, "but that's socialized medicine." Why is this so scary? A progressive tax instead of monthly premiums, co-pays, and deductibles. A card that gets you into any hospital and to see any doctor; never mind whether or not he/she is in your "network."
Many countries throughout the world have had a universal health coverage system in place for many decades. These countries are not socialist in the true sense, many have a symbiotic relationship with capitalism and the working class.
Why the U.S. does not see the parallel of good education, good health care, along with capitalism with more of an equal partner with the working class as the foundation of a society that is more productive and less bent on lawlessness.What ever happened to for the "common good," aspect to a society we all wish to live.
10
Great article. As a retired physician, still too young for Medicare, I can attest for every single word written by Dr. Rosenthal.
One of the biggest frustrations while in practice was witnessing the financial and personal devastation families had to endure while dealing with chronic or life threatening illnesses.
The Healthcare "system" in the US is inhumane, unethical and criminal considering the number of people dying due to lack of affordable preventative care.
Nobody wants to admit that this fraudulent system is going to financially destroy us all - despite the "strong economy".
Go Warren, Go Sanders, Go anyone brave enough to grab this monster by the horns.
20
Medicare is a critical gatekeeper for the growing portion of US health care provided its recipients. Just check out the gap between their approved fees (lower) and the enraging fraud reported here. A public option for the Affordable Care Act will not alter this graft, nor will more controls on drug prices. Big Bad Government intrusion will -- as in Medicare for All.
2
I have been an expatriate for 35 years.
Medical checkups or whatever assistance required was always carried out in the country I was working at that time.
Obviously, if anything major, you would rather return to your country of origin to get it done. Make sense as you would be closer to your family and able to have prognosis explained in your mother tongue language.
Until I came to work in the USA, I was never confronted to such an opaque medical system.
My major gripe? you are completely unable to control who and what service is provided to you.
You cannot authenticate the providers and agree they can perform ahead of them doing so.
My only time in an hospital was for a gall bladder removal. My single stipulation, I only want in network medical providers. I was assured my wish would be respected.
Sure enough, I got bills from out of network providers, working for a in network outfit.
My insurance said that it it is unfortunately the case, and there is no way to control it.
If you are unconscious, anybody can just crack the door open on your room, and bill you for "checking on you"....
8
I work in health care it is a mess purely driven by profit. While there are countless caring and compassionate health care providers most are beaten down so hard by the system they all become cynical, and are just trying to survive their jobs as am I.
9
Two things. 1. Hospital prices make drug prices look like a pie fight. 2. 30,000,000 people do not have health insurance. They go to the ER when they get sick and the rest of us pay for it via higher prices.
6
and the money from all these "itemized" charges goes for what? What's the old line? "Follow the money!" Now that would be an interesting article to read.
2
The NYTimes should support Ms. Rosenthal through a lawsuit against this hospital for fraud and misleading business practices. This kind of abuse of the system needs to be brought to light but hospitals count on individual consumers being too intimidated to take them to court. Here is a perfect example of someone who could have the power to fight back. It would help all of us!
7
Too bad so many Americans (Even Democratic Candidates for public office) really don't understand how much fraud and sham is really involved with medical billing and private insurance. If you "really like your private insurance" it's because you really don't know how much private insurance is really taking out of your (and your employer's) premiums and putting into the pockets of lobbyists, insurance company investors and employees, instead of into actual health care delivery. We are all being scammed by the healthcare industry and the politicians they help get elected to maintain a system based on fraud and waste.
7
Bravo Elisabeth; no sugar-coating it - just simple (and at the same time) complex fraud. If you or I had the moxie to perpetuate similar in our own worlds we'd be investigated thoroughly, indicted and prosecuted. Free medical for all sounds great but until we can get control of the fraudulent monster in our midst now the concept should remain a fantasy
5
what is fraudulent billing and other malfeasance to us is profit to the healthcare industry and the GOP— the GOP, a wholly owned subsidiary of the healthcare industry.
3
If RICO were applied vigorously to the healthcare industry, thousands of people would go to prison.
5
The United States of Grifters' Paradise, where gotcha capitalism might as well be enshrined in the Constitution.
7
Insurance companies are not the only profiteers in healthcare- it’s the whole delivery machine, millionaire doctors, hospitals, suppliers, etc.. That’s why M4A makes so much sense: it cuts the profit motive out of healthcare totally. And that’s why the profiteer machine is spewing so much propaganda to defeat it!
4
@Robert M. Koretsky Fascinating how doctors should be the only ones who should not have a “profit motive”. Good luck finding people who get top grades, sacrifice 14 years of their life and go $ 400 K in debt to race in at 2 am to save your life for no profit, Bob
2
Happens in India too! Just pure scammers!
The insurers are making mega bucks. They put out propaganda that says, "don't allow medical care for all" and it works. Our government could pay reasonable fees like other countries and the providers would do just fine. The stupid wall or the parade or the golf trips of Trump or the million dollar bolts and screws for the Pentagon could easily pay for our health insurance.
The billing situation at the hospitals is made worse by the corporate bean counters. All the hospitals here in NYC have been bought by four corporate entities whose bottom line is profit. My last internist had 1,000 patients. I couldn't call her or reach her directly. She told me I would have to go to the Emergency Room if I needed immediate care. What's the point of having a doctor if they are almost unavailable because they have a thousand patients? No wonder they see you for 10 minutes and hustle you out the door!
Meanwhile, Medicare doesn't pay much for dental work and our dental insurance is paltry. $3,000 out of pocket to have a tooth removed and an implant placed. The tooth, later, will be another $2400. Good thing we have a savings account!!!! Insanity prices, but you can't do without teeth.
The whole system is corrupt and the two people, Bernie and Liz, who really want to change it, are mocked because they say so. "Socialism!" people scream. Yeah, right. Sign me up.
7
Health care in the United States is a racket.
6
Call your congressman and complain.
4
Won’t do any good. They listen to lobbyists not voters
1
Hospitals "cost-shift" i.e. the practice of tiering charges such that insured or well heeled self pay patients subsidize indigent care. The charges in no way reflect the actual collections health care entities get. As a surgeon, I can tell you that my charges and actually collections have no real basis for one another. They/I certainly hope you/your insurer will pay, but recognize they will receive a negotiated rate that can be up to 5 to 10 times less. This is where the type of insurance you have matters. Those that require you to pay a certain percentages of hospital charges will leave you vulnerable to this practice. Plans that limit your hospital fees to a certain amount will protect you to some degree. I consider this fact when selecting plans for me and my family each year during Open Enrollment. A capitated system such as Kaiser is one solution as hospitals receive a set fee for the admission and then deduct any and all charges from that thereby reducing the incentive for hospitals to engage this practice.
5
Great if you have that as an option. Not so great if it’s not offered where you live.
Now it can be told: The only thing wrong with the American medical system is that it's designed for PROFIT, not for HEALTH. Until that changes, all the politicans' "plans" in the universe won't fix our problems.
8
Replacing our system with a single payer government system will be the same or even worse. The article mentions how Medicare pays for all sorts of useless and questionable things. The only solution is to make insurance truly “insurance” again, and force people to make cost choices about their own healthcare.
4
So we can be pre existing conditions again and be denied insurance entirely? How will you shop around for the best price if no one can tell you what the prices are? How do you do that if you are unconscious or delirious?
4
@KJ McNichols
Oh I make those cost choices all the time. I don’t go to the doctor since I can’t afford it.
1
If you call your insurance company and dispute the charges, doesn't your insurance company contact the providers and challenge them? Most people don't challenge, so they get away with it.
Clearly, it is insurance fraud if someone bills you for 3 PT visits that didn't happen, etc.
Several years ago, I demanded an itemized bill for a outpatient procedure I had a hospital. I was billed an extra fee for "EXTRA LARGE GOWNS." When I contacted the hospital about the insurance fraud, I received a snide remark from the billing manager, "None of us likes to admit we are as big, as we really are."
My response was, "Next time, before you commit insurance fraud, check the weight of the patient I currently weigh 100 lbs."
I was also billed for pain medicine that I am allergic to, declined and did not receive.
When I threatened to go public, they removed the fake drug and extra large gowns charges.
She further explained that the hospital had a contract with United Healthcare and they were allowed to bill $10,000 per procedure, regardless of the actual costs, as part of my co-insurance. She then confessed the hospital selects various charges that equals 10k.
Why are people acting like our current healthcare system is so sacred. It is one big sham.
14
Bottom line: fee-for-service, third-party payer, profit-driven does not work. The problem isn't just the private health insurance companies; many of these same incentives will persist with single-payer.
2
I know you won't want to read this. The high costs of healthcare are a result of an increasing population of overweight, obese, and morbidly obese people, who should be weighed, periodically, and have their health insurance premiums adjusted for the increasing health risk they become for themselves, and financial burden they become for us as a result of increasing our health insurance premiums. I am done subsidizing sloth, laziness, poor eating habits, and skyrocketing BMI's. Why should I keep my BMI in the lower 20's, exercise daily, eat in moderation, when every where I look, the world is occupied by people who visibly don't care about their health? How many addicted to pain killers could have merely lost weight to reduce the pressure on the very joints they suffer pain from? How many doctors have the guts to confront their patients whose ailments are primarily as a result of their overweight condition? We are closer to Wall-e than you think. Healthcare costs will not reduce until we approach healthcare from a pro-active rather than a "throw a pill at it" reactive perspective. We pay twice the rate for worse outcomes as other developed countries. That is not the best healthcare system in this world, far from it.
5
@LaPine
NO!
Actual services being delivered literally have nothing to do with actual costs or honest charges made.
And what about the obesity being caused by medical care and the pharma industry?
5
@LaPine Dont blame the patients for being sick. That is no excuse for medical system to charge whatever heck they want.
4
I read your comments. I don’t disagree. However, the issue of obscure and fraudulent medical billing is completely tangential. Perhaps,You should write an article about this issue?
3
Great framing of a tjorny issue! The problem is not just who is paying, because this type of behavior, if unchecked, will continue under a single payer system and continue to escalate. The problem is under-regulation and the mentality that anything goes to take in money, as long as you can get away with it.
And although Obamacare has brought lots of relief, a little known side effect of requiring insurers to spend at least a certain percentage of proceeds on medical care is that now they have an incentive to drive up total costs too, since they get more when everything costs more.
Nobody except we the people has an incentive to control costs. Which means that we the people must take back control.
1
I don't believe you. Even though I'm still making payments to 3 different entities for my tonsillectomy back in June, my conservative family members insist that our healthcare system is the best in the world and people don't go into debt because of it. They tell me that everyone has great access to great care and that the evil Democrats want to destroy us by "fixing" the system.
3
I agree, a lot of this sounds like fraud. I suggest that the NY Times and other organizations that want to change the healthcare system should form a superpac to create ads and other content to educate Americans broadly on our healthcare system and how we can change it. We need to force the health insurers and providers to defend what they do when it comes to billing and billing scams. This needs to be exposed beyond the readers who already agree with this.
3
I am a physician and a former healthcare administrator at one of the nation's largest healthcare systems. What most people do not realize about healthcare spending is that physicians, especially surgeons and specialists (with a couple of exceptions) are paid vast sums of money by the so-called "not-for-profit" hospitals and academic medical centers. Just to give you an example: A few years ago two orthopedic surgeons made close to $20,000,000 at one of these academic medical centers in New York. It is possible they billed for operations during which they were barely present thanks to tax-payer funded residents (most people do not realize that the government actually pays for a large portion of residents' salaries). More importantly, their employer gave these guys a cut from the lucrative hospital fees it collected for the hospital stays following these operations. The money was funneled from one entity to another entity within the same healthcare system to get around the Stark Law that is supposed to prevent these types of kickbacks. Please do not assume that this was a unique instance of "fraud." This is how the healthcare industry operates in general. The solution is not simple because it requires significant cuts to physician and hospital fees as well as reigning in the drug prices. It is not easy, because no policymaker, politician, or expert wants to make an enemy of the most powerful and greedy industry in our country.
11
I am also a physician - a specialist. My specialty is neurology. As I do not perform any ‘procedures’ my income, for many years, has been about $150,000 or less. With the requirements of deciding the next course of action when one of numerous test results returns, in addition to explaining to the patient the need for this and reasoning behind it, and ordering the subsequent plan (possibly requiring notes to my staff), Additionally reading consults from other doctors I’ve referred my patient to and considering further action, And - typically Most time consuming - answering the several (20-40) daily emails from patients, I have 70 hour weeks. I can only bill for the 35 hours I am seeing a patient.
This system is not fair.
11
Another wonderful scam is the freezing of non-malignant, usually tiny, keratosis on the body - usually the face. The doctor. or more often the professional assistant, will go psssft, psssft, psssft with the freeze bottle for ten seconds or less and voila, you've got a bill for three $180 "surgeries" or $540. If he/she takes another 5 seconds and does two more psssfts, it hits $900. I did the numbers once and $900 per 15 seconds comes out to $216,000 per hour. Advice to young parents: tell your kids to study dermatology!
5
In addition to the frauds described by E Rosenthal, the underlying pricing system is also fraudulent. Why should any service, such as stitiching a finger, be billed by the provider at one rate to someone with health insurance but billed at a higher dollar cost to someone without health insurance? Health insurance companies should only involve how a bill gets paid -- NOT how much a provider charges for a service.
It does not actually cost an ER any more to stitch my finger than it costs the ER to stitch the finger of someone just like me, but who has private health insurance.
Step one in fixing our health care system should be requiring that every patient, regardless of who they are or what private contracts they've signed with insurers, MUST be charged the exact same amount for the same service.
5
@Mollie S. And this is why M4A is so vital and necessary: there’s only one price, and NO millionaire doctors.
2
@Mollie S. Absolutely agreed! The cost shifting is unacceptable, and it seems entrenched. Everyone to be charged the same amount for the same service regardless of payer.
1
Where is Congress? Where is the Consumer Financial Protection Bureau?
3
@Sherry
When he was in charge of the department, like many others, the Consumer Protection Bureau was systematically dismantled by Trump henchmen Mick Mulvaney. It is there in name only and it isn't protecting anyone.
2
@Sherry
Since it’s run by Mulvaney, don’t expect much.
It is a sad wake up call when many people are talking about being robbed by the "Medical Complex". This is the way people talk about police shakedowns in corrupt countries.
Every day more of us are refusing medical help because we fear that we will be robbed!
9
@Richard Fried
You can see from this large and continuous list of comments, that healthcare is not just another commodity and if one enters the hospital in an emergency situation they are at the mercy of that institution.
I will admit, as a a Canadian, that I do pay "moderately" more in taxes than my American counterparts, however, knowing that if and when I have to go to a hospital for an emergency situation, when I, hopefully, finally come home, it is rather comforting to know that I will not receive a bill in the mail from the hospital that might require me to either, exhaust my bank account, take a second mortgage on my house or like the HALF MILLION Americans who declare bankruptcy every year because they can't pay their medical expenses.
2
Excellent article, Elisabeth Rosenthal; I particularly appreciated your examples.
Last May my father, an army veteran who served at Iwo Jima, passed away at home after receiving excellent care from the VA for many years.
But during a prior brief excursion into the private sector he was first surprised, then appalled, at the outrageous invoices submitted to his insurer.
One thing that irked him in particular: the paperwork always arrived several months after any intervention, with the vaguest of descriptions making it hard to nail down exactly what was being billed.
Yet it was very clear that he was regularly subjected to spurious "tests" on all of this private medical group's expensive equipment, with semi-serious references to the need to establish a "benchmark".
As a trained accountant, he would call out the most egregious abuses, but ultimately gave in more often than not (when you're 101 you have other priorities).
But until his death he used every opportunity to remind anyone who would listen that the USA desperately needs universal single-payer healthcare.
8
@Chris Durban
AND the only way you will have a chance of achieving that is by electing representatives who are unencumbered by campaign donations from lobbyists(especially the healthcare industry)who have the commitment and will to do something about it. There is no other way.
4
The problem with US health care isn't whether we should have a single payer plan or private insurance: its the criminal enterprises that the pharmaceutical companies (my husband does R&D in pharmaceutical) and the hospital/medical industry has become. Monopoly power and pay for access is why we pay three times what other countries pay for worse health care.
8
@Sharon
Outside of the insurance companies who are basically just "middlemen" who skim BILLIONS off the top, excluding the actual medical practitioners themselves, the pharmaceutical companies and hospitals ARE the industry.
All the other countries that have some form of universal/single payer healthcare determined decades ago that in order to reign in costs and increase efficiencies, the private element must relinquish control, there is no other option.
3
When people consider who to vote for as the Democratic nominee, they should keep this article in mind--and the comments here. We need to address the profiteering of the big health care conglomerates.
Only Sanders and Warren would directly take them on. The moderates' plans, including the libertarian, misguided "Medicare for All Who Want It", would leave Big Pharm, major private insurance companies, and the big health care conglomerates in the driver's seat.
The "public option" would, in some cases, simply be another of those weak marketplace plans. Those who highlight an option to switch to Medicare do little to change its vast problems: HUGE gaps, burdensome paperwork, convoluted billing, premiums, deductibles, and need for PRIVATE supplemental insurance. They are peddling policies that sidestep the fundamental problems.
Let's start asking Biden why his plan leaves 10 million uninsured and millions more saddled with costly premiums.
Let's ask Buttigieg how he will achieve universal *quality* health care if he leaves things much as they are, and does not offer a vastly improved Medicare.
Pressure Klobuchar in the same way.
Ask them the tough questions about affordability, taxes, coverage, premiums, dental and vision care, hidden charges, convoluted billing, and achieving universality. How would they achieve health care justice rather than the mere tweaking of Obamacare or offering an illusory "choice"?
9
@Marsha Pembroke very true, and a profound argument for M4A!
@Marsha Pembroke
Biden, Buttigieg and Klobuchar are just another group within the corporate/establishment wing of the democratic party who "tinker" around the edges of healthcare because their corporate donors tell them to.
2
I still have the $146,000 hospital bill from my dad's hospitalization 16 years ago, and I saved it because the list of charges for non-events and nearly non-events was simply astounding. Ultimately, he was approved for Medicaid post-humously--his own insurance for which he paid $16,000/year didn't cover a dime because when he got sick he could no longer work.
But to answer the question--why do insurance companies pay? Because consumers pay the insurance companies more than enough to cover their share of expenses, their employees, handsome salaries for executives and nice payouts to shareholders.
As long as PEOPLE are paying for and then actually defending private health insurance, are willing to accept much higher costs with overall poorer outcomes than other competing nations, the insurance companies will continue to pay out these charges.
In fact, they'll use these situations to pad their profits even more calling it "risk."
6
Thank you, Dr. Rosenthal, for your meticulous analysis and your lucid, powerful writing.
I am going to send your article to my senators and representative, and I hope every reader does the same.
8
All American health care is fraud, often crime.
We have excellent doctors. My daughter's pediatrician is the best doctor in an international "hospital foundation" at providing care to children and families.
By 'good' I mean the whole package: patient, open, personally concerned, supremely able and up to date at the highest level, a delightful individual with whom to spend time.
As I say, she (like almost every other doctor in America) is embedded in a huge industrial service provision mechanism. When we want that American medical wonderfulness, we can make an appointment in January for June.
We have had miracles performed on my daughter's behalf. I will die one day believing I have not thanked these people enough.
But the business of medicine, the machine that sets standards, decides procedures, sets prices/collects payments, represents scamage of the highest order.
Collectors threaten, providers deny critical/emergency care, charges for nothing appear out of nowhere.
American medicine is a carnival barker's extravaganza of misdirection, deception, outright theft. Its a market created explicitly to cheat and confuse, and does it well.
Elizabeth cites bills her insurance pays. That's not what those are. Those are what your insurance charges you, many tens of times what they hand over to hospitals. Your premiums are based on that inflated number.
We know how to fix this. Examples galore around the world. Easy, affordable, medically superior. We refuse.
9
A friend in northern California with medical insurance cut her hand at home and went to the ER. The wound was flushed to prevent infection and stitched. The bill was $3,200. She paid $600 out of pocket.
5
Speaking of scams in the health care industry, I have an example of an inheritance scam involving an elderly man, E. W. Talbot who was suffering from dementia.
My grandmother, Grace Kittle, who lived in Cuyahoga Falls, Ohio, visited Arizona every winter and took along an acquaintance, E. W. Talcott from nearby Akron, Ohio.
Grace decided that since she had taken along Talcott every year she was owed something. Mr. Talcott’s dementia made it easy to get him to change his will in favor of Grace. Since he owned a number of apartment buildings there was a great deal of money involved.
When he died Grace asked for her money from the court. She discovered that a caretaking young couple had moved in to Talcott’s home and tried the same scam by getting him to change his will in their favor.
Grace litigated with the court and did receive a large amount of money making it possible to have her son, my father Ivan Kittle, retire at 58, buy new homes and move to Oregon.
All of this is perfectly legal but highly unethical. I lost all respect for my father and grandmother because of their dishonesty and never saw them again.
11
Thank - you for sharing this information about our sick care system. Interestingly, these same ( not for profit????). Facilities are also busy getting donations (charity? Really?) and suing patients who did not may these bills for the fraudulent services.
So , the patients go broke and the charities get rich.
The insurance companies are paying all of these fraudulent bills, while denying fda approved medications and treatments to these same patients who are paying them high premiums for the care they are being denied.
This system is in dire need . Broken does not even begin to address it. At the very least we can all request itemized copies of our bills and question them. Tell our insurance companies not to pay for fraud. Have government ( don’t laugh) actually do something to address these issues. Bringing this to light could be the start of something.
4
Consolidation of medical services has created monopolies. Large hospital systems can charge what they want because there is nowhere else to go. They now own all the hospitals, laboratories, clinics, and ancillary services. Doctors must work with (and increasingly for) them, and insurers, patients have no choice but accept these predatory business practices.
A lot of law making and lobbying went into elevating extortion into a business model. For anything to change, politicians would have to stop pretending they are defending free enterprise and customer choice when they facilitate the creation of health care behemoths.
1
Why do insurers pay? Because they don't care. They just raise premiums. In 2017 the US spent $3.5 trillion ( = $111,000 per second: 24/7/365) . The US government anticipates that will be $6 trillion by 2027 ( = $190,000 per second: 24/7/365.) Does anyone really believe the medical-pharmaceutical-medical device manufacturers-insurance industrial complex wants to "fix" this in any way?? It is a system that profits from illness. More sick and sicker people = more profits. At the systems level, human health and life barely matter. It is NO different than the fossil fuel industry's indifference to catastrophic global climate collapse...where melting in the Arctic represents an "opportunity." And, NO different than Big Banks scamming people into bankruptcy and debt.
5
One area not covered here is the fact that Big Pharma charges exorbitant prices for new, branded drugs still in beta test research with patients, not yet eligible for generic status, but now requiring patients to pay thousands for because the drug was prescribed by their physician. Entresto is such a drug, not yet fully tested or finally approved by the FDA and still in Beta test. It's the first new drug for some heart patients in 30 yrs., but no field trials have been completed. The one trial with the most publicity was paid for by Novartis, the manufacturer, and the doctors who tout it all over youtube and the WWW are all "consultants" on the Novartis payroll. Why should American patients pay thousands to have their health data passed along to a Billion $$$$$$ drug manufacturer while the product is still in beta test and not finally approved by the FDA? This business model is antiquated, and unfair to patients who may or may not be fully informed of the potential long term risks associated with beta tests. Patient health data is extremely valuable, particularly in this type of research situation, and patients who agree to test such a product should be given the drug at no personal cost to themselves.
2
One thing I do know about the healthcare system, the Republicans won't even try to fix it.
11
@Gone Coastal
To them it is not broken and they never have to see or deal with anyone affected by this intentional neglect.
3
What you get when your health is for profit, you know, like your Elected Employees who, out of compassion for lobbyists, barred Medicare from negotiating drug prices.
5
Someone has to cover the executive seven figure salary for the CEO at a charity hospital. Some one has to cover the salary of a sinecure like Michelle Obama, who was paid $175,000 per year for a part time gig as "director of outreach" for a charity hospital when Barack became an Illinois state legislator and her salary was doubled to $35,000 when he was elected to the Senate.
After an additional individuals were covered by Medicaid and Obamacare, why is it that prosperous charity hospitals raised their billing charges by 3.3 times the rate of inflation while urban clinics and rural hospitals that served a high proportion of Medicaid patients closed because Medicare supplemental payments were eliminated.
Americans pay two times per capita for medical services because it is not a free market. It is because the government regulated in order to favor big medicine. Hospitals charge $1,000 per day, minimum and yet mark-up a bag of saline from the $0.50 they paid for it to $500.
4
@ebmem , and yet other first world countries do just fine, usually better, with some sort of universal health care. In the US drug companies, hospitals and health insurance companies are RENT SEEKERS. Fraud and consumer manipulation are their game and they are playing the game very well, government regulations or lack there of.
3
Ms Rosenthal is a MD by training but hasn’t treated a patient in years. Has never run a medical practice or covered a payroll.
That said maximizing reimbursement is totally legal. All services and equipment provided mentioned in this article were provided. Billing for service not provided constitutes fraud not what Ms Rosenthal alleges. Medical boards have determined that high bills for services appropriately performed does not constitute fraud or misconduct. No services cited in this article were improper or unnecessary. Emergency rooms sometimes “over treat”because of fear of malpractice suits. Lastly, the insurance companies are the real culprits. They encourage high billing to justify high premiums then discount their reimbursement to hospitals and providers.
3
@Robert
and when did "medical boards" become the judiciary branch of our democratic republic?
4
@Robert This author clearly outlines services that were NOT provided, i.e. the several PT visits. Your claim that it states otherwise is disingenuous at best.
3
Why do insurers pay? Because they're making obscene profits...it would seem extremely cost-effective to investigate fraud, but maybe that would lead to their eventual demise.
4
It’s amazing how we hear about waste in government form the right all the time. Yet not a word about waste in the private sector of which this is a prime example. I guess it’s only waste if you are not making a profit from it.
6
The only answer is a single payer system.
4
"Why do insurers pay? Partly because insurers have no way to know whether you got a particular item or service. But also because it’s not worth their time to investigate the millions of medical interactions they write checks for each day."
This is all any legislator should need to know. Its the whole of the problem...lack of oversight. Its not simply inefficient oversight, its a complete lack of it. Which could easily be remedied, if not solved, by absolute transparency of itemized billing, that is not written in code, that is also provided to the patients upon their dismissal. A complete list of the Who's and Whats.
BUT - should we look at other forms of insurance, like auto, or home - should I make a claim (hit in a parking lot, cracked side rear view mirror, no note) - you can bet I will be scrutinized under a microscope. How dare I use my rarely used auto insurance. And be prepared for a rate hike!
The whole system of insurance no matter the type is completely broken and either set-up for no use, or when used to allow the abuses the author so perfectly exampled.
I'm lucky enough to have employer based (employer provided is a false term. they only facilitate!) but I always hesitate to use it, because of all the extras I wont know about till I'm stuck in a place of having to waste serious amounts of time fighting as my responsibility. I don't sit at a desk, so I cant spend my days on the phone being bounced around a broken system.
We need complete transparency.
3
It is called a "racket." All of this is used to mask the reality that in order to compensate for all the waste and legal bribery for the insurers profits and the incredible profits of equipment makers. Add to that ( some) doctors needlessly high incomes where they practice at for profit hospitals. Oh, did I mention the hostage taking of Big Pharma? What they do is truly criminal. All of this to support a few million jobs to push around the data to keep the con going. The great irony is that doctors and nurses of the world's great hospitals like Cleveland Clinic and Mayo Clinic ( the docs work for salaries), will tell you that they detest this system. Yet, due to the bought and paid for politicians in D.C, the caregivers are stuck in s maelstrom they cannot escape.
This is America. Not enough good productive jobs, so grifters and scammers can flourish.
5
A racket for sure. Corporate machinations and high paid consultants grease the wheels of this game. As a primary provider with a dental practice I can say that your friendly, private practice , honest, neighborhood docs are being eaten alive by this system. Honest billing is being downcoded and non-payed to death while the trickery in this article are being handsomely rewarded. Winner takes all but it is the patients who lose...
Our legislators, i.e. congress, should be arrested and charged with criminal activity under the RICO statutes. Congress is "a Racket Influenced and Corrupt Organization."
1
I believe the figure is 40 cents of every dollar spent on healthcare goes to fraudulent billing and other malfeasance. That estimate might be a little low.
2
@Mike
what is fraudulent billing and other malfeasance to you is profit to the healthcare industry and the GOP —a GOP that is a wholly owned subsidiary of the healthcare industry.
you say
1
I think you hit upon a key problem with doctors care. The question you failed to ask is why. Because doctors and hospitals and especially emergency care, are lousy at managing resources. They don't get to bid for your care: you're stuck with a sole-source provider --- and boy, do they stick it to you.
As an engineer, I worked with this situation all the time. When I went through the invoices I found that my project cost 3 times what I estimated. (I had to request them and wait for weeks, and send them back for more definition of what exactly we were paying for.) I was told, with a grin, "I guess you're not very good at estimating." (I've been doing this kind of work for 34 years.) At least, I got this contractor fired from future work after a 5+ years experience raping us.
I can't imagine how anyone could get these insurance companies to rein in costs. You need a code book to break down their charges. My mother managed it well with her cancer but she had a genius IQ and was an accountant. I saw her help many of her friends: confused, sick and old. Eventually, cancer killed her and some of the bills arrived. My sister an equally-skilled accountant dealt with it.
2
I guess Americans "like their private health insurance" and resist real change to the system because they know hings are as bad as this write descibesvadn are afraid of what will happen to them if this system of legal fraud is and theft is threatened.
essential health care is NOT a commodity and must be closely rergulated or it will only get much worse than this article reveals it to be. Democrats know this an propose to at least try to fix it. As paid stooges of the insurance industry, Republicans approve of the theft and fraud and lie about it.
1
Yes, it's fraud. That is why you should never pay your "patient responsibility" when you are billed dubiously. I assume that is why the prices are so inflated because many people don't pay. I prefer not to be stuck in the sucker's group.
1
God bless Elisabeth Rosenthal.
1
I was recently sent home from rehab with a walker. The supplier billie Medicare $138 for it. You can buy the very same walker from Amazon for $58.
3
Reality check: the business purpose of electronic records is to document every single condition or item that can be billed for. Computers are much more efficient than humans at generating bills and don't miss anything. Many of the "frauds" described are really artifacts of a system that is rule based and requires the inputting of information in a structure and context that is translated into a billing format. The system just uses a contracted price table to then generate a charge. There is no thinking involved, no mitigating context. That's our system!
3
@malabar
Yeah. THIS is the problem. Deliberate and intentional obtuseness. Confusion is profitable and emotional upset makes it more difficult to pay attention and deal with someone being dishonest without raising your voice. Notice how many guards there are in hospitals now and how all news focuses on people "attacking" staff but never mentions the adversarial abusive way that staff deals with the public?
The complexity of how well the apparent haphazardness has been created gives away the fact, if you did not already know it, this is not a necessary situation. It has been created for one reason, to funnel money to the creators of it. If medical care happens it is an accident.
Another consequence of unexpected bills is that people put off or choose not to have needed procedure. My wife works for a major airline and we have very good insurance but still have to pay 10% of whatever is billed. Her doctor recommended that she have surgery to clear her sinuses. We were informed that our portion would be $400 PLUS other charges (unspecified) for anethesiologist, facility charge, and possible other charges that may come up. She asked the doctor's office what those charges would come to and they were unable to tell her. Since the problem is not life threatening, merely uncomfortable, she chose not to have the surgery, rather than in effect signing a blank check to go forward. We have excellent insurance. What about people who don't?
Furthermore, over a year ago I had an MRI which was supposed to be 100% covered as a diagnostic procedure. I just got a letter from a collection agency saying that a charge of over $400 was put in for collection by the hospital, even though I had never received a bill for this. A call to the insurance company did not resolve the issue, rather resulting in a lot of beating around the bush about how the amount was our portion of the $10,000 cost, which the insurance company had negotiated down to $4,000. The fact that it was diagnostic and should be completely covered seemed not to matter a bit.
6
I once had an ENT doctor I liked very much. During one exam, while cleaning the wax out of my ears, he also removed the plastic cone of one of my hearing aids that had, unbeknownst to me, become detached and taken up lodging in my ear (much to my embarrassment).
When Medicare sent me the billing report, I noticed it had been billed for two different procedures at double the cost of a few hundred dollars. The cone was removed at the same time the wax was: The whole procedure took no more than 3 minutes.
Innocent mistake on the part of the office's billing department or deliberate? I considered a call to Medicare but was afraid that such action might negatively impact future treatments so I never did.
A sad quandary and one, however small its scale, points to another reality that may help to keep this onerous system in place.
3
I wouldn’t be so hasty getting outraged an opinion that completely omits a possible cost management explanation. It was convenient for the author of this opinion piece to have her injured husband’s private medical bills and very private medical history at hand to show the world when she has a book to sell.
A neck brace doesn't magically appear and install itself on the patient when the patient rolls into the ER unannounced as this author would have you believe. Get one at Walgreens, she argues. Well, I think I'd have a problem with a hospital that runs out to Wallgreens to get something every time a patient comes in . That they would make the drive there and back to the local pharmacy, and install whatever they bought from Wallgreens on the patient in emergent time for free is preposterous. This author would argue that an entire emergency unit, equipment and staff should be purchased, built and equipped only at the moment when the patient comes in because it's 'less wasteful'. I seriously doubt the cost management understanding this author has. But if you want to know why at $15 neck brace, for example, ends up costing $300, it's a total cost of having the neck brace and staff available to put it on when the patient comes in, while not having to make a run to Walgreens. I think everyone would appreciate that an emergency room should have equipment and trained staff ready to go when the patient comes in. This essay is purely agenda-driven and one-sided. Disappointed.
5
@P Meister Nonsense! Do you think this sort of extortion pricing happens in other countries with universal health care? Patients get the same care, drugs and equipment at 1/3 -1/2 the cost.
5
@P Meister The cost of having "trained staff ready to go" is covered by numerous other line items on the bill, and I would think a hospital, buying in bulk, should be able to get a better price than retail at Walgreens.
3
@P Meister
if the staff had not placed a hard collar given the mechanism of injury until a cervical spine injury was ruled out, the hospital would have been negligent-staff acted within the standard of care for a trauma
it requires training to place the hard collar correctly so the the patient does not suffer injury
the question should be, what is preventing a spinal cord injury worth?
I have cared for many spinal cord injuries that would have paid anything to prevent their tetraplegia over the past 38 years
Thank you, thank you, thank you, Ms. Rosenthal, for calling it what it is: fraud. I can remember a doctor waving good morning to my elderly father in the hospital and then billing Medicare for the gesture. I had to confront a psychologist who was allegedly “treating” my dad there when no one had asked for his services. He backed off quickly when I threatened to report his fraud to Medicare. Most recently, my wife was admitted overnight to an ER room in the hospital after a minor health incident. Medicare was charged a $3400 monitoring fee when barely anyone checked on her and she was not hooked up to any monitoring equipment. This was on top of a $2400 emergency room fee.
The real fraud is perpetrated by Republicans who insist: 1) American healthcare is the world’s greatest, 2) we are happy with our providers, and 3) we are happy with our insurers. We are being held hostage by a healthcare-insurance-industrial complex whose primary excellence is manifested in bribing our elected representatives.
4
Anyone with half a brain knows that this fraud is continually being perpetrated on the nation. But insurers and health care providers have a vested interest in maintaining it. This is perhaps the principal reason that our health care is so enormously bloated and expensive in comparison to every other industrialized nation. But who will reform it? The public clearly is not in favor of "Medicare for All," which might actually trim costs. They prefer to support this fraud for some absolutely incomprehensible reason.;
4
The insurers pay because they are part of the scam also, they just pass the costs down to the premium payers. It's time for universal healthcare so all these scammers can be put out of business.
5
Millions of dollars in fraud, but meanwhile the middle class is enraged by a few hundred a month of SNAP benefits by the "undeserving".
But, hey, those doctors have those student loans to pay off!
I once filed a fraud claim aainst a hospital who billed for a psych consult by a psychiatrist who never spoke to me. Apparently he was clairvoyant and could assess me via ESP. That got nowhere. The medical-industrial complex does not care as long as they get theirs.
3
This is how the "other half" loots, and legally. It just doesn't make for a good T.V./Cable news like a riot in a poor section of a city.
1
Clearly there are many fraudulent practices in medical billing.
At the same time, if you had to do research for 4 hours to address a medical issue, none of it is accounted for in billing.
My understanding is that split billing is a facility fee and a professional fee.
The medical extender collect that data. The clinician is the decision maker and should bill for cognitive services.
If you truly wants to address the cost of medical services, start by changing the structure of the notes. Regardless of the complexity of decision making, one cannot bill a level 4 visit without documenting useless information. Eliminate the useless information that is collected to justify a level of the billing and pay simply for the complexity of decision making. This would make medical communication clearer and would reduce the army of coders, billers, and compliance officers. It would also save countless hours that are spent documenting idiotic information.
And consider using clinicians and not providers. The provider designation came from corporate medicine.
My wife and I went to Italy on vacation,
She fell off a curb in Rome,
She fractured her ankle in 3 locations,
She was operated on,
Spent 5 days in the hospital,
The care was phenomenal,
Total cost?
0
PS- my wife has dual citizenship
5
THIS is what the GOP is protecting. It's all about the money and nothing to do with healthcare.
5
What an outstanding column as counterpoint to:
https://www.nytimes.com/2019/12/07/opinion/sunday/finland-socialism-capitalism.html
As we close on the season of choosing next year's options for health insurance and the arcane rules and intricacies thereof, we are presented with a tale everyone who had had a health incident has experienced. None of this even touches the cost, and the quality of care, just simply the paperwork plus the trolling for dollars. It is also another example of our leaders ignoring the public outrage.
I do not believe people are looking for health care without cost. I believe that people are looking for a rational system whose primary purpose is not to rip them off, and waste their time in the process. Fixing this when you are injured or ill is going to be too late.
4
Every time I get close to moving home from France I read something like this. Yikes! On the train last month I ran into a Québécoise who told me she'd had four kids and never paid a cent for the four pregnancies. I used to be rather libertarian, but the U.S. has a horrible mix of almost no socialist aid with a predatory, monopolizing medical system. People are squeezed in the middle.
5
I’m serious when I say this might be the most relevant and important op/ed column in any paper in the country this weekend. So called “community hospitals” have know-nothing local boards and overspend outrageously, passing the cost onto to the next local resident who needs an MRI. It’s a national disgrace.
4
As a retired physician, I fully agree with the author.
3
I wish some District Attorney's would start prosecuting these cases for what they are — flat out criminal fraud. Send people to jail. It’s the only thing that might change behavior.
3
One of my patients got a $7,000 bill for a psychiatric emergency room visit. She complained and the cost was reduced to $1,000. I was once talked into being admitted to the hospital when there was nothing wrong with me except mild anemia leading to shortness of breath. My copay I later learned was $500. I called the hospital and threatened to report them for fraud and my entire bill was canceled. You need to know how to advocate for yourself.
1
Sounds like a good case for class action against these fraudsters. I'm amazed that some smart lawyers have not risen to the occasion.
1
,
How about $165,000 (yes) for a 30 hour hospital stay including 3 hours in a cath L
lab? This, of course is bill that the hospital knows is ridiculous, is not owed, and is a large multiple of what is actually owed and will be paid. Whatever thel motive for this nonsense may be it certainly is not the patient's well being.
Elisabeth Rosenthal somewhat rhetorically asks, "Why do insurers pay?" The answer is simple and straight forward - They take a cut off the top. The bigger the pie, the bigger their slice of it.
4
America's healthcare system is where Americans go to get traumatized with killer bills. It is a free-for-all greed-fest designed to plunder our wealth when we are most vulnerable. Is gouging and fraud the capitalist innovation David Brooks doubled down his praise for?
Huge resources are squandered every time an insurance company and medical provider negotiate for every pill, service, mystery item on a bill, let alone the effort and cost to ferret out fraud that we-the-patient ultimately pay for. There's a randomness inherent in a scheme designed to confuse to maximize profits over a tragic predicament of a human in need of medical care.
Bottom-line, profiteers have no business being in the provision of healthcare when they have your life in their hands to exploit for profit. Intelligent, government run healthcare - free from private manipulation and corruption under the guise of "government incompetence" to benefit private interests.
I received many bills from doctors I never met that misdiagnosed an almost lethal spinal cord infection. Did I get my money back? No! Urgent care ordered me to the ER right away. The same ER doctor turned me away with pain killers - TWICE! - billed twice too. I had the temerity to demand admission which ended up saving my life.
“extenders” are how capitalism in America works - a pyramid scheme where those at the top reap all the benefits from all the “extenders” doing the actual work.
Like joblessness, America is a terrible place to get sick.
Where does all this money go? Why are hospitals and other providers evidently so greedy?
Some of the money surely goes to buy very expensive equipment that the hospital might not need on a regular basis but which it uses to attract patients and, at least in appearance, represent itself as on the cutting edge (no pun intended) of treatments. Some of it is probably used to cover the costs of emergency room treatments for those who have no insurance.
The whole business of adding fees on top of fees has spread across virtually all segments of America. We recently needed to register a matter with the state of Maryland. Well, the fee to do it online was more than three times doing by mail. Bad enough but then there was a $3+ "convenience fee". What a pile of....you name it. Gee, give me inconvenience and let me skip that fee? No way.
Our nation once had business people who gave honest prices. Now, "dynamic pricing" means you never know what you are going to pay for an airline ticket, a hotel room, a rental car. American corporations, and sometimes the government, too, are the every day enemies of citizens. Given any chance, I would show them no mercy in return,
2
I was charged over $2000.00 not for delivery of my son, but for him been here
An eye opening call to action. Luckily it took place outside the emergency room or I'd be getting a bill for surgery.
3
The grass is always greener... but...
I think it's a little naive of Dr Rosenthal to hold up law firms as models of better, less gouging billing. My parents had a lawyer who charged hundreds of dollars to read each >10-word email, however trivial the content — and I am told this is not unusual. And there are famous true cases of attorneys who've responded to their clients' complaints about excessive billing by offering to meet up and discuss it... and then, the lawyer charges the client (massively) for that conversation... about excessive billing!
2
I live in France & I'm married to a French man. I never have to worry about such outrageously corrupt medical bills.
French people ask me if I miss the USA. But when I tell them about the healthcare system, they are incredulous.
4
Elizabeth,
Most if not all of these costs appear on the Charge Master, a magical check off sheet created by the Hospital. Certainly it is ambiguous, that was the intent.
America in reality does not have access to healthcare for too many of its citizens. This was intentional as well with much meaningless jargon simply accepted by many. There are several examples: the “freedom” to get the healthcare you can afford, those “others” accessing our healthcare (freeloaders), universal coverage is that evil boogeyman’s “socialism, and my physician will be at my beck and call.
The bottom line is America’s healthcare is the most expensive in the world with worse outcomes. All that money is being absorbed by a feeding frenzy for Health Insurance Companies, Hospitals, Physicians, Pharmaceuticals and Medical Devices. But too many American die everyday because they have accepted the stupidity of no healthcare.
2
American exceptionalism at work. Best healthcare in the world.
Folks if you don't like this, vote more intelligently next time!
5
You tell the truth - which is so infuriating I couldn't read most of the article........
2
anyone who has a had a surgical procedure involving a stay in hospital knows what Ms. Rosenthal reports to be true and also know she is correct to call it fraud.
Similar accounts have been written up in medial outlets for decades:
"Outrageous E.R. Hospital Charges: What to Do" June 27, 2013 Fox Business
"The Cure for the $1,000 Toothbrush"
August 13, 2013 10:08 pm August 13, 2013, NYTs Opinionator
"OBSERVER; The Hospital Bill"
By Russell Baker, Aug. 16, 1989 NYTs
Confusion and Error Are Rife In Hospital Billing Practices; Elisabeth Rosenthal. Jan. 27, 1993
Point being the real fraud and criminality is—according to the Center for Responsive Politics— this year there are 2,701 lobbyists working Congress, spending $447,928,391 and 53% of them are former government employees.
You and I have—allegedly—535 lobbyists working Congress though clearly they aren't all on our payroll and one in the Oval Office—god knows whose payroll he is on.
2
Alas, without fraud American companies could never grow at the rate that is required to maintain their stock prices. And, ever since the time off the charlatan Reagan, business is only about stockholder value. The rest be damned.
4
I have Medicare and supplementary Blue Cross/ Blue Shield. The standard practice is to bill Medicare and then BC/BS. Stanford, STANFORD, has been billing me without billing BC/BS. PPOs, as I understand it, limit what they can charge me. It is left to me to determine if the billing is correct. I am trying to do that but it takes an inordinate amount of time. I am elderly but still compos mentis. What if I were more disabled? Why is the burden on me?
4
In 2005, I was admitted to the hospital for surgery. After being prepped, I was informed that the surgery had been canceled because there were not enough beds to accommodate me after the procedure. I had no choice but to leave.
Later, I got an Explanation of Benefits from Blue Cross/Blue Shield that they had paid the hospital $1,200 (Heaven only knows what the hospital actually charged.) for the "service" they had rendered me. I complained to BC/BS that the bill was fraudulent but never got a reply.
1
Amen! Just back from a visit to the ER for a cardiac arrest and the bill: a whopping $150K after spending 2 days in the hospital and a stent. If I didn't have insurance I would be bankrupt by now. This is the big problem with our medical system. This wholesale robbery has got to stop otherwise the US will turn into a third world country.
530
@TheniD
Turn into?
Where have you been? That happened in 1980.
68
@TheniD Same situation in Ontario cost $45 for ambulance ride. Also higher taxes but not compared to
the US lower taxes plus medical insurance cost. Medical care not merely medical insurance.
Unwilling to help others by paying higher taxes? Unchecked greed? A country built on myths?
Definitely sad.
103
@TheniD
Unreal. That's considerably more money than they charged for my teenage son's 7-hour surgery to correct a severe spinal curve, with nearly a week in the hospital. Only a nationwide, single payer program can fix this nonsense.
57
I often wonder if the staff who answer the phones and explain how these obscene charges are in fact not errors are able to sleep at night. Medicare for all in 2020. No more sickness industry criminals ripping us off when we are most vulnerable.
My husband got a colonoscopy and endoscopy in September. We got the bill today. Medicare is paying, we're paying $600, and some was "forgiven." But the actual bill for both brief, uncomplicated procedures was $40,000. It enrages me. People tell me I should get a Medigap policy. I know the reasons why these policies make sense for individuals, but one result would be more of a bill like this would be paid--by insurers and eventually you and me. It's all crookedness.
377
@Margaret
What did Medicare APPROVE for the procedures? Did they approve $40,000? What is "billed" is irrelevant. The insurance will only approve a certain amount for a certain procedure. If your cost share was $600 then Medicare only approved about $3,000.
9
@Margaret
$40,000?
Please tell me that's a type and it should have been $4,000!
10
@Margaret
One of teh things these medicos do to people without insurance is sell off that fake number to debt collectors. If you had no insurance and could not pay they abuse you for as much as they can for a year then get a tax write off for that 40K, then they sell your debt on to debt collectors who will abuse you for it for 7 years or more when you probably paid up the 3K they would have got from an insurer in that first year.
Oh and you are now a marked person in the credit system everything you buy with credit from then forward will cost you several hundred percent more.
48
I was in a minor car accident. I didn’t lose consciousness but the police officer could see I was kind of hurting. I refused the EMT and ER visit. The officer was very nice and asked again “are you sure?” I was quite sure. Despite having auto insurance and health insurance the ER would absolutely find a way to rob me. At the very least, there’d be the consults that are “out of network” to just about everybody. I told the officer I couldn’t afford it and as I came around suggested maybe if he’s looking for some criminals he should arrest the billing dept for the emergency room. I stand by that suggestion.
541
@Mike A perfect example of why "Medicare for All" should be enacted immediately.
46
Anyone in America who has used Any Medical services be they many Doctors, Hospitals, physical therapist or Insurance companies Knows that many if not all are nothing but Crooks protected by crooked politicians...
As long as so much money is available Nothing will change.. We need to change the entire system of health care to fix it...
1
Medicare for All with a robust fraud department is the answer.
2
I am reading this in Canada where I have never paid a single penny for treatment in a hospital.
I don't pay a single penny for visits to a doctor's office, or for any kind of blood or other type of test.
I pay a modest amount for prescription drugs.
I can't understand why you tolerate this, and the waste of time and resources of it all is mind numbing.
6
This behavior is fraud. The problem here is the hospital, that is taking advantage of vulnerable patients, generally avoids scrutiny, not that it’s behavior is not illegal.
The patterns are clear. Hospital CEOs need to be held “personally responsible” for this conduct. Personal fines that cannot be paid by the hospital or third party insurance and jail time commensurate with the level of income from the fair as well as the number of incidence would go a long way. Shame doesn’t work. They are shameless. I’d also suggest legislation that makes this kind of fraud a federal crime with mandatory jail time for CEOs. They will try and blame the “billing clerks”. But we all know they don’t decide these things.
The medical payments system is a pigs trough. We argue over who pays (government, insurers or recipients), but the real argument should be over the total lack of cost controls in the health delivery system.
2
The entire system is rotten in its very bones.
I recently had surgery to repair a hernia. Following a pre-op appointment, on the morning of the surgery I was given an "estimated" cost (after insurance was applied) and told I had to pay that in order to proceed.
A couple weeks after the surgery, we received a bill for an amount 30 times what I had paid the day of the surgery. Never mind, we were told, that's just what the various personnel and facilities had "charged" for all the various aspects of the procedure, from time to fluids to anesthesia, etc.
So, we waited. Eventually, we began receiving various bills from different entities for additional payment. Again, when we consulted the insurance, we were told to wait, and it would all be sorted out later, not to worry.
Finally, I received a bill from the surgeon's office saying that the insurance had been "resolved," and I now owed an additional payment, the same amount as what I paid the day of the surgery.
In other words, the "estimated" amount was anything but. Believing the surgeon's office, I paid the bill, assuming I was finished.
Nope. We continue to receive bills, which have now descended in some cases into threats of collections.
Here's my question: Why bother to "calculate" the patient's share prior to surgery, only to come back at him or her for additional payments far exceeding that amount? And remember, there is no comparison shopping; heck, you never even really know what's being charged.
Disgusting.
3
One crucial piece of this grotesque spectrum of graft is that consumers are not encouraged to complain when they see signs of fraud on bills which Medicare of their insurers will pay. Far from it. Complaint would take too much time -- waiting on the phone, etc -- and would almost certainly be useless. A Dermatologist can take a number of useless biopsies after a skin test but Medicare will pay for them all. Who picks this up? Who complains?
Corner office types extorting money from our society using our health care system.
1
I recall former Speaker of the House Paul Ryan pulling out a health insurance coverage card from his wallet and exclaiming that we have the best health care system in the world. Of course, he was referring to Congress' health insurance plan for their members, which they get to keep when they leave office, which I have no doubt have zero deductibles and no out of pocket costs. If you want to know how good Congress cares for itself, Google Dick Chaney's heart transplant on Wikipedia.
Congress is in no rush to change the current system because we all die one by one, and think the other guy's misfortune will never happen to us. Plus, we've been brainwashed to believe capitalism is always better than socialism, and any effort to involve more government in health care will only result in a Russian mess.
We've been played for fools.
2
I'd like to know--in the interest of disclosure--whether the author's husband is a Kaiser member, since the author works for Kaiser Health News. If so, then is the care that the author received, at least in this instance, a reflection of Kaiser's health care system?
@John Newton There is no connection between Kaiser Health Care News and the Kaiser health care system other than the Kaiser name. I have been a member of the Kaiser health care system since 1968 and have obtained all of my care there. Kaiser has seen me through two pregnancies and deliveries, and bouts with three different cancers. The care I have received as a Kaiser patient has been outstanding, and I have never experienced the billing fraud described in Dr. Rosenthal’s report.
1
A friend ended up in the hospital. He told me that all day long doctors he'd never met would stick their head in his room say hi and leave a business card on the nightstand and then leave. Sometimes he'd be sleeping and the pile of cards had grown quite a bit.
Later, when the bills started arriving each of those "doctors consultations" were in his bills and he was being charged whether he knew them or not..
4
Thank you for the detailed expose… unfortunately your piece exemplifies the electorate’s frustration w/our current political system… patronage, lobbying, and no one seemingly in charge who cares to change anything… while Warren calls out insurance companies for their “corporate greed”, Bernie touts “Medicare for all” and Trump vows to “reduce medical costs”, voters often just throw in the towel because not one politician of any stripe delves beyond bumper sticker slogans to slog through the quagmire of sludge you write about in order to actually fix the healthcare system… no wonder voter participation is so low when we have no leaders in any level of government w/the courage to spend political capital in righting the ship… you at least have the financial and intellectual resources to understand the “legal” medical billing scams … how many others do you conjecture just bow their heads in helplessness and hopelessness in the face of such a juggernaut… journalists can help by publishing investigative reports, such as yours, to call out the politicians for their lack of accountability and self-serving greed
This article makes it clear that this does not look like fraud it IS fraud. The health insurance industry as a whole has become a Racketeer Influenced Corrupt Organization. Time to abolish them.
3
Anyone reading this in America knows it is true.
European readers will refuse to believe it.
It is simply too absurd: Surely Dr. Rosenthal is spinning a dark fable.
But this is our profit driven American medical system.
The same system which defines as "fraud and abuse" a doctor who charges less than the amount regulations dictate for a given service, accepts the billing for a single CT scan as 3 separate studies which shows the head, the neck and the chest, because, well, each of those are anatomically different areas.
Why not charge a separate fee for reading the CT of the left ear and another for the right?
Non profit medical systems in Europe have their faults and are always a magnet for complaints, public protest and dissatisfaction.
Nobody is always happy with medical care.
But ask any European if he would trade his system for ours and, especially if he's read Dr. Rosenthal, he will howl with derisive laughter.
1
Just imagine if we had a Congress and a President who cared as much about legislating fair, affordable and transparent healthcare services for the American people.
Imagine there were no heavens ... well, you know the rest.
1
We had all kinds of dubious line items on the bills we started receiving after an easy unmedicated vaginal birth a few years ago (sticker price - $25K) I called 5 or 6 times to protest and each time, I received a long song and dance about why each was valid.
Finally, I found one that I knew I could protest! A $900 per night charge for 2 nights in the nursery. But this hospital only had a NICU, no nursery. They practiced “rooming-in” and I hadn’t gotten a minute’s sleep either of the nights with my newborn. “Oh,” the hospital said. “It’s for the sheets and crib we provided in the room.” I replied that next time I’d just put my baby in a room at the Ritz-Carlton for half the price. But that was my last call, I conceded defeat and resignedly paid all my bills. It’s ridiculous and there’s no winning as an individual.
4
It’s a criminal enterprise, alright, but at 18% of GDP, there are simply too many criminals involved. The chances of getting this rotten system “fixed” are nil. It will collapse under its own weight before that ever happens.
1
If only the "capitalism is efficient" crowd spent some time on planet Earth.
2
Oh, this brought back an unpleasant conversation with billing at my dermatologist office. I was being examined by a radiation tech, my skin squamous cell sites, measured and photographed to begin radiation. I had 3 small sites, but they could NOT do them in same visit!! Instead, I was to return several treatments 3 or 4 times a week for extended period of time. It added up to something like 36 visits into Spring 2020.
However, a physician walked down the hallway, turned in my direction at the open door and the tech introduced me to him. He did not look at my skin, no comment, just walked on. I was billed almost $100 for an exam( of at least 15 minutes, it said on bill) that I certainly did not have!!! Horrifed. Called and they said Medicare will pay and it is allowed. Allowed!!! Somethingthat did not happen. Explained to me that the tech works under his supervision and he is paid under that guideline. It is a scam and a shame this goes on. I plan to protest to Medicare.
2
Thanks, Elisabeth, I always read your pieces at the Times. I hope your husband is recovering well.
1
I recently spent a month in hospital following a collapsed lung. I was in a semi-private room. My total bill; $0. I was supposed to go to Florida this winter. I shared with hospital staff that "thank God I was not in the United States when this happened." Americans, wake up! This ONLY happens in the USA.
4
This level of legalized extortion and fraud is inevitable when a society accepts that "medicine is a business" - rather than a human right.
When the first rule of medicine is "maximize profits" rather than "do no harm" - the lords of medibiz will behave like any other monopoly (looked at your cable TV bill recently?) - squeezing as much profit as possible from "the customer".
The fact that "the customer" is frequently both an involuntary one and one in fear, pain or worse simply makes them more susceptible to being gouged, extorted and sometimes (600K times per year) bankrupted.
The fact that these medibiz ghouls sleep well at night should tell you everything you need to know about their humanity (or lack thereof).
As a Canadian father of 2 daughters I am endlessly amazed by the sham otherwise intelligent people call healthcare. If not for articles like this most Canadians give little thought to our universal coverage. It is not free. We all contribute as a single payer via our taxes.
With technology quickly removing entire job classes. Tying your families health care to your employer seems pretty fool hardy. Time to set yourself free.
3
And joe Biden is worried that a single payer system would put the medical billing departments out of work!
@English Stu
What does he care, he has a lifelong "gold plated" healthcare "government plan" paid for, of course, by the American taxpayer!
I know one thing for sure. Nothing will be done to fix this problem. And that's because any attempt to do so will be lambasted by Republicans as death-dealing socialism.
The other really confusing part of medical billing is that the actual amount paid by Medicare and most insurances is a flat rate based on the final diagnosis or DRG modified a little based on co mobidities. The itemized bill you see as a after the fact compilation but what really matters is the diagnoses, spelled out in excruciating detail in ICD 10 language," Mid shaft fracture of R 7th rib with lung injury initial encounter due to trauma"
Asking why the Tylenol is $20 is like being at an All Inclusive Resort and asking how much the Mojito is and complaining because is it's $15.
Imagine this bike accident happens when you’re riding to your restaurant busboy job. You’re not married to an ER physician, like Andrej, and your health benefits are the most minimal your employer can get away with. Not only are you crushed by 5 figure fraudulent out of pocket charges, but you don’t have an ER doc in the household who understands your medical treatment, the bills, and the fraud being perpetrated on you as well as your insurer.
If an experienced ER doc and investigative reporter is helpless to reverse this systemic theft, how is it possible for the average patient to even comprehend how they are being cheated, much less do anything about it.
And it’s little wonder many Americans do love their Cadillac private insurance. They’re barely aware of these sort of shakedowns, as their insurers and employers seem perfectly happy to pay the vig.
3
In addition to all the fraudulent billing in our healthcare system another gripe I have is that for every doctor or hospital visit the first thing they ask you in the US is how do you plan to pay for this visit? Providing healthcare is not their first concern. We need universal healthcare for all like the rest of first world countries!
Don’t you dare attempt to change the FREE MARKET otherwise it would be socialism or worse, it would be like FRANCE !
And then you add the part that most hospitals are “non-profits.” Meaning they are a 501c(3) and pay less taxes, get utility benefits, as well as get to fundraise from donors so the hospital can “cover” the bills for those that can’t pay. The whole system is such a scam. Something must be done!
4
This article is typical of misrepresentation of the circumstances that providers are forced to work in.
How about EMTALA? This means that the hospitals and all associated providers MUST care for anyone who shows up in their ED. Without regard for insurance or ability to pay. This long-standing law has merit to it. However, who is supposed to pay for the care that all (and there are many) these poor patients receive? They receive the same care that anyone else gets.
Take for example the trauma activation fee that the author mentions. Current practice in trauma medicine is incredibly successful in saving lives. However, it is really, really expensive to have all of the necessary equipment and personnel on hand 24/7/365 for every imaginable circumstance.
And the insurance companies. The unethical, avaricious conduct that is routine for insurance companies is outrageous! And Medicare and Medicaid pay rates that do not even cover costs.
The system is busted, but it is mostly the fault of medical economics, reimbursement, and regulations, which themselves are incredibly costly and often nonsensical.
This article has a lot of garbage in it.
1
@MHW Surely fraudulent overbilling of insured patients is not the proper strategy for covering costs of medical care for uninsured or indigent patients. What part of this news report specifically do you think is garbage?
@MHW
as to "This article has a lot of garbage in it."
Specifics please.
Facts appreciated.
@MHW
In your comments, you have stated everything that would justify the implementation of a universal healthcare system in America!
1
In America, medical billing is legal fraud, and medical insurance is legal extortion. I’m sick of being told that we “can’t afford” an efficient & logical health care system like those that function perfectly well in every other developed country. It’s the forms of organized crime that we call “health care” and “politics” that we can’t afford.
How did I know- just from the headline (not seeing the subhead on the NYT homepage) that you were talking about healthcare? I didn't know it was specifically billing- but given my exposure to the medical-industrial complex as I have aged (and so have my parents and in-laws), this had to be it.
1
This issue needs to be driven hard to do everything we can to cause change! Keep up the pressure and keep the story front and center.
This industry cannot and must not be allowed to get away with this.
Listen to the podcast An Arm & a Leg. It will make you sad and mad, but hopefully instigate change in the cost/billing side of our crooked healthcare industry.
Write and call your representatives, Democrat and Republican, and tell them you want truth, transparency and accountability in medical costs and billing.
Dear Dr Rosenthal,
Why won't the journalist-physician tell us at least the name of the hospital where this took place? Don't you have an obligation to do that? How can such "fraud" be fixed if the victim will not identify the transgressor?
@BD Because it doesn't matter. This is not some rogue billing operation, it's standard operating procedure at all hospitals.
2
Thanks, Ms. Rosenthal!!!!!
I've been going at their juggler every time I have tried.
However, some fraudulent behavior is deeply baked in, so I skip those. It often takes time to hit 'em where it hurts.
You are my hero!
You would not have this bother with a single payer system. Welcome to Canada!
Doesn't Ms Rosenthal and her husband have some kind of medical insurance so she wouldn't be saddled with all of these bills???? Wasn't Obamacare supposed to fix all of our healthcare problems once and for all???
In the interest of full disclosure I have been working in a hospital billing office for the last 36 years. We are not committing fraud--we just want to get paid like every other business. That's right healthcare is a business. Yet everyone feels insulted whenever they get a medical bill. Healthcare is not some grand freebie--hospitals also have expenses to meet from payroll to buying Band-Aids. If patients are having financial problems they are more than welcome to visit the Financial Aid Office where they can make payment arrangements. The billing department is not the bad guy but it would be nice if columnists like Ms Rosenthal didn't treat us like the enemy.
PS -- Try telling Master Card and Visa you don't feel like paying that huge bill after you maxed out the plastic and see where that gets you.
1
@sharon5101 She states very clearly in the article that she and her husband do, in fact, have insurance. She's not just questioning charges they paid, but also charges paid by their insurance. And no "Obamacare" was never supposed to fix all of our health care problems. It was a small step originally developed by a conservative think tank.
2
Which is why we want socialized medicine!
The lesson to be learned here is do not go to the doctor unless you are dying. Just don't.
1
Welcome to our de facto criminal health care system unique to our peer countries and many third world countries.
1
About 25 years ago I received a $600 bill for a nurse’s fee who attended my 6 year-old for 2 minutes in a Miami ER for suspected strep throat. (The single aspirin was another $8). I told the hospital billing department that I was sorry to have missed meeting Gloria Estefan during our visit to the ER as she must have been the attending nurse as she was the only woman in Miami who was earning $8,000 per hour. The hospital billing person laughed and told me I was really paying for all the Haitian immigrants who showed up and got treated for free.
131
@Richard Katz
There's obvious racism reflected in your hospital billing person's comments about Haitian immigrants being treated 'for free', since the same person didn't seem to mention the many, many, more uninsured American citizens who show up at emergency rooms expecting to be treated 'for free' as well. But the statement only reinforces the need for a nationwide single payer system that we ALL pay into (as we do to Medicare). Everyone would be covered, and for less expense overall. The only drawback would be that people like your hospital billing person would need to find another minority to scapegoat.
135
@Ronny Venable Agree totally. Our entire system is absurd. We should have at least a basic level of medical care (it doesn't have to be that great) for everyone within our borders, regardless of status. There should also be a better level of private or concierge care for those who want to pay extra. And there should definitely be some rationing of care (no knee replacements for 97 year olds.)
41
@Richard Katz FYI, hospitals are paid Disproportionate Share (DSH) payments for the uninsured to make up for the fact these people have no money.
So the hospital does get reimbursed but it is NEVER enough. I was in health insurance for 40 years and I never heard a provider say they got enough money to treat patients.
13
Thank you for writing this piece. We need to expose the terribly opaque medical billing industry.
I was once charged 600 dollars for a hand therapy visit to a facility connected to Alta Bates Hospital, where I was seen by a therapist that didn’t even touch my body, but just prescribed exercises. When I complained, I was told: “that’s the way we do business; pay up.”
My mother who lives in Japan got both her cataracts removed and stayed in the hospital for ten days, because under the Japanese system it was cheaper to stay in the hospital than to take a 15-minute taxi ride to and from the hospital everyday for ten days. The entire bill came to about $5000, and her out-of-pocket payment, after all the subsidies were paid, was less than $250. Japan does not have “socialized” medicine. Ambulance ride is free there, too. Isn’t that how it’s supposed to be?
2
Anyone who has used the American medical system, which means everyone, had a similar horror story.
I will share one. My physician referred me to a company that provided diabetic equipment. I received a "free" monitoring device and then my insurance company was charge $120 for 50 test strips. I paid my share, which was $15.00. I found the same strips on Amazon for $15. From then on I refused to go through my insurance company for this purchase and instead bought them on Amazon.
One way to lower the cost of health care is to avoid, when you can, getting your insurance company involved.
1
My one visit to an emergency room in recent decades was in a remote part of Scotland, when I slipped and cut my hand on a hike on the Isle of Skye. The doctor I saw in the small local hospital stitched me up, and even did the paperwork, if I remember right. There was NO charge to me : `all provided by the National Health Service' I was told. There was also no charge a couple of days later, when I went back to have the bandages changed. Meanwhile, back in the US, Tea Party activitists were raging against Mr. Obama's proposed health care bill. Ironic and sad.
2
Google how private, employer-based health insurance originated in the US.
The extremely profitable medical-insurance complex began, like a lot of private fortunes in the US, with an accident, then capitalized upon by some shrewd capitalists, then become a new normal.
Not at first Balzac's great crime, maybe, but eventually so.
1
I was stung by a bee this summer on my ring finger. It quickly became swollen and my ring needed to be cut off. I first went to urgent care thinking that they could give me a shot to stop the swelling, but no. They also said that the tool they had for cutting rings off would not do mine and I needed to go to the emergency room. It took two "kids" from the non-medical group to cut it off. It cost $1,300. Unbelievable.
120
@PA What a rip-off! I hope this doesn’t happen to you again, but just in case, try the fire department before you go to the ER. The tool is usually a standard part of their equipment, I was told, and they’ll cut the ring off for free.
33
@Dylaina That is exactly what I did a few years ago when my ring needed to be cut off. The firemen were eating dinner, but still jumped up and were so kind to me.
24
My father died in his sleep in his recliner at 80 years old. My shocked mother found him and, though she believed he was dead, called an ambulance in the vain hope that they could revive him. A month later, I opened a bill for TWENTY THREE THOUSAND DOLLARS. That's $23,000 to transport a dead body 3 miles to the hospital and have it declared dead. I called Medicare and they said, "don't worry, you don't have to pay." I told them I didn't care WHO paid, that this was tax money that shouldn't be spent. To be clear, the ETs were amazing -- and they're paid peanuts. Somebody else is making a lot of money for doing virtually nothing, and it's time we Americans stopped putting up with it.
693
@Emma Ess
Thank you for sharing. Another scam/sham that people need to know about.
43
Medicare pays hospitals fixed rates for treatment according to Diagnosis Related Groups and fixed rates for various defined services. Medicare for All would do the same. We might all benefit from a dramatic simplification of our medical payment system.
Lobbying dollars Spent by Health Industry in 2019—$447,928,39.00
1,282 clients funded the lobbying dollars spent by the Health Industry in 2019.
Of the 2,701 lobbyists on the Health Industry's payroll 53.28% are former government employees.
[as reported by the Center for Responsive Politics]
4
The stand-in doctor phenomenon is probably driven by the insurance companies themselves who will not reimburse services for lesser mortals.
1
Thank you for your article. If we don't make an effort to tame this beast, M4A will most certainly bankrupt the USA but the doctors, Big Pharma, the Medical Device folks, the CEOs and highly paid hospital administrators will be rich and won't care one bit. Fix this problem before we turn it over the USA to run!
Sadly, not a new story. The subtext to your tale is the difference between "charge" and "cost." The chicanery obscures what is a fair and reasonable cost. That is why we have public utility commissions, to keep power companies from gouging us with exorbitant rate hikes. When the people who benefit from escalating medical bills are left free to over-inflate their charges, the consumer -- and our insurance intermediaries -- are stuck with the bill. As provider institutions and their executives continue to pad their own pockets, the public is left with skyrocketing premiums, co-pays and deductibles. Who is minding the store? A couple of our presidential candidates clearly get this huge con, and have been bold enough to argue for complete overhaul. Listen to the whining from hospitals and drug companies about their "losses." But without a truly competitive marketplace, someone has to balance the scales before we all go bankrupt.
4
Unreal. Infuriating. As a Canadian who is a recipient of “Medicare for All” (we call it something different here) I can assure you that the type of financial abuse just laid out in the article would result in swift and punishing censure by the College of Physicians and Surgeons. How in God’s name does the average American cope (not to mention the poor) with this reality? I would be in a state of permanent anxiety. Sanders and Warren are offering the Canadian brand of coverage up on a silver platter and can’t find enough takers, or at least not enough to get them elected. The only conclusion that I can come to (and you’re going to hate my saying)is that Americans, deep down do not believe everyone merits equal health care. There’s really no other credible explanation. Apologies to whomever this offends. You’re a wonderful nation.
8
What you get when your health is for profit, like when your elected Employees, out of compassion for lobbyists, barred Medicare from negotiating drug prices.
1
Doesn’t sound like the author has “great” insurance; she shouldn’t put it like that. Maybe in comparison to others in the U.S., but not by a reasonable standard. Let’s not feed into this healthcare lobbyist talking point.
Hard to believe in far away Australia. We have universal health care with a few add - ons - works pretty well.
One solution is hold some hearings then IMPEACH the bloody lot of them.
1
It's called Capitalism. Get used to it.
1
@Paul Adams
"Croney"capitalism.
And this is the system many don't want to change. Oh well, have a nice day.
1
This is fraud, period. These people should be in prison, and that includes the hospital administrators.
Dr. Rosenthal—Why do you not complain about some of the “crazy high charges?” A few hundred here, a few hundred there, and pretty soon, we’re talking billions.
Most medicine is a complete scam as illustrated by this piece. And this is Dr. Rosenthal—reporter for The Times—presumably a sophisticated consumer of medical services. What about the rest of us? We are at their mercy, and they take no prisoners!
I’m not for Bernie or Liz, but how about massive training of more doctors—a moon shot—and let them practice medicine in the free market! Fee for services—no insurance. And please, no FMGs! We don’t need them and we can do this ourselves.
1
Yes it is. It's fraud and it's massive.
2
Non-wealthy people of the United States, know that the following individuals are your adversaries in life: Executives at private sector for-profit health insurance companies and major shareholders of private sector for-profit health insurance companies.
To these people, you are a form of revenue extraction. The moment you get sick and actually expect the premium payments you have made for years or decades to pay for your treatment, they are actively working against outcomes that are in your best interest. Their objective is to ration your health care to minimize payments insurance companies must make on behalf of patients. Try to understand this. Executives at Aetna, Cigna, and UnitedHealthcare make more money in a year than LeBron James (look it up). Do not worship at the altar of capitalism. Doing so may literally end up killing you.
Capitalism and health insurance just don't mix. Why are Americans in large numbers basically the only people on earth who have a hard time understanding this?
2
The whole system is a fraud. But hey, everyone loves their insurance company. That's the new mantra right? I swear the propaganda is worse than the lead up to the Iraq War.
5
I doubt if Dr. Rosenthal will be asked to join a medical practice in the near future.
She is correct.
1
It is highway robbery.
The author in her rant is complaining that her husband was provided a cervical collar--she calls it a "hard brace" and "piece of plastic" and "medical swag"--to prevent aggravation of a possible spinal injury. Maybe next time when he is out biking he can bring his own cervical collar. Or perhaps next time when he is injured he can roll the dice and decline to pay the reduced price of $215 for the cervical collar. Whatever he and his wife decide to do, her foolish nickel-and-diming of our health care industry, together with her shrill and intemperate accusations of fraud, put at risk the health and safety of all of us.
@Phillip Brantley Let me guess, which part of the medical industry are you part of (or is it just a big part of your portfolio)? And I'll bet that you've never called a man who made an argument you disagreed with "shrill".
2
When you decide to read the article, you will see that he did not need the cervical collar and it was removed after a short time. You seem to think that he should have been billed for the entire cost of the hospital having an MRI machine.
1
For the thousandth time, we must get rid of these parasitic Medical Insurance Companies. A very legal Scam, nothing more.
Medicare For All. 2020.
2
I work in an auto body shop fixing wrecked cars.
It's a similar job and somewhat like this Doctor / Journalist, Elisabeth Rosenthal, does in fixing wrecked bodies.
I have invited Elizabeth to our next convention in Orlando to give a presentation on how to ripoff auto insurers when somebody wrecks their car body as well as their own body. The law firm of Dewey Cheetam & Howe will also be giving a presentation right after that.
2
Vote progressive and let's try to bring the curtain down on this theft.
1
“For-profit” applies to certain pursuits and activities. It does not apply to others.
In the United States we do not have for-profit police departments, for-profit public schools or a for-profit postal system. The men and women who defend our country are not serving in a for-profit army, navy or air force. Air traffic controllers, food and drug inspectors, intelligence agents and parole officers are not employed by for-profit agencies. The interstate highway system, a marvel of engineering, is not a for-profit business.
Do Americans want corporate control of the public schools? Law enforcement agencies? The military?
The Food and Drug Administration? A corporation running the EPA? The CIA? The criminal courts?
No.
The fact that we put up with for-profit hospitals, pharmaceutical companies, for-profit health insurance companies is outrageous. Medical professionals, hospitals, etc. ruthlessly taking advantage of other’s medical misfortunes is immoral and unethical.
“How much will it cost to have the tumor removed from my daughter’s brain?”
$$$$$$$
Regular everyday business.
Can you imagine asking a police detective,
“What will it cost me to have my brother’s killer arrested, prosecuted, convicted and imprisoned?”
“Nothing, sir. Victims don’t pay for justice in America.”
Our twice-as-much-per-capita, for-profit health care system is a moral outrage and a financial swindle.
Politicians who protect and perpetrate this for-profit nightmare should be relieved of their offices
5
What Ms. Rosnthal describes is the "Mother of All Quid Pro Quos."
1
Two words - criminal fraud. It's past time to clean this up.
1
Thanks for this eye-popping exposé.
This makes my blood boil.
1
Profit. There’s that word.
Besides solving the problem of fraudulent billing practices, I think it should be pointed out that Medicare for All would increase the number of jobs for providers and support personnel in areas that need it the most: Rural areas that have experienced clinic and hospital closures in the last few decades.
Changing to a Medicare for All or a Single Payer type system removes **profit** as the driving force and replaces it with the proper government role of **service**. Just as the need to provide roads, postal services, law enforcement and education to less populated areas is necessary, so are health services. By balancing the load a little just as we do with roads, etc., clinics and mid level hospitals would re-open and improve the lives of so many people in these remote areas.
These closures happened because as the years went by they got deemed "not profitable" and so get bought out and consolidated into ever larger and more profitable centers farther away from remote areas, creating hardship for populations spread out over vast geographical areas of the country.
I believe that Bernie Sanders, Elizabeth Warren and other candidates with their teams of experts should do more to get this message out. They might win over some friends in geographical areas where they sorely need them.
1
The madness of it all, and the passivity of the American public in response to it, are exasperating. We should be manning barricades, but instead we whine together over coffee at the diner.
The odds are this ridiculous medical insurance "system" will waddle along until it people, en masse, simply stop paying their medical bills. What are they going to do? Throw everyone in jail?
I've seen an ambulance service bill for oxygen while transporting a corpse.
3
It's fraud sure - but it's really known as grifting. Also conniving.
In other words - medical billing is about lies and the liars making the lies.
1
Bravo!!!! This says it all.
1
It gets hard to understand how the people who perpetuate this system can look at themselves in the mirror. But no doubt tomorrow this industry will pump out some more garbage p.r. about how Americans want "choice", then bribe some more of our brave Congressmen with "campaign contributions", then hire a few more unnecessary employees to ensure that if anyone tries to change this stupid system, they will be threatening "American jobs". Not to mention, encourage a new flood of "thoughtful" articles and opinion pieces in the pages of major newspapers (like this one) questioning the wisdom of candidates who argue for a better, saner system.
Yes and Yes....This is the USA Medical System. Thank you for this article. Fraud and Corruption to the accounting core of the USA medical system. It is a "Fake" billing system and we allow it? Please let us hug and appreciate the health providers, and fight this accounting rot..........
The notion that doctors want to entrepreneurs is a fiction propagated by the entrepreneurs who converted the health care industry from non-profit to whatever the market will bear. The Frist family were pioneers.
https://en.wikipedia.org/wiki/Bill_Frist
1
I'm dying to meet those persons Joe Biden and Pete B. say want to keep their insurance as is.
Perhaps they've never used it or they are so stinking rich they don't deal with the paperwork.
2
I'm in favor of a single payer system. However, we need to revamp more than the way the money gets paid. Providers have gotten away with over-billing (fraud) for too long. Insurance companies pay -- and, thus, are complicit -- because insurers simply pass the high costs on to consumers and taxpayers.
The entire system needs to be revamped from the ground up.
Meanwhile, Dear Leader frets about toilet flushes. Sad and shameful.
1
The people of the US have repeatedly voted for politicians who don't want a system of medical insurance that is affordable for the people. So, quit your whining and go back to whatever it is that you serfs do. The people know that they do not deserve better and will help to elect the people who will continue punish them for their sins.
I had a good long stretch--most of my adult life in fact--avoiding hospitals. Only recently have I had to visit--once for a work injury trauma (fall from attic on a construction site), and twice more (in succession) for a lacerated kidney (also from a fall while chainsawing firewood).
My take away -- going to an Emergency ward is like going to an a la carte clip joint. There is no "market" since there are no prices posted, nor can you see prices (this despite NY State law that makes such visible prices a matter of law). Because of this, there is zero possibility of an informed decision by you, the patient about the care you will receive.
The second series of visits I received exemplary care, once I was moved from the local hospital to it's affiliate in the city; in the first I experienced many similar 'drive by' billings, excessive charges and treatment that I specifically stated that I did not want, and they simply refused to listen to me, and did extra treatments anyways. The charges for this single workplace accident basically wiped out my gypsy contractor income for the year--how could that be possible, and why is it allowed to continue?
(Husband of Susanne)
185
Another 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."
710
@Len Charlap
We had a similar situation in Finland. We accessed their "socialized medicine" at a clinic in a nearby mall. It wasn't fancy, bare bones; but we were in and out with a prescription in two hours for $12.
66
@Len Charlap
This is another example of the benefits of Universal medicine.
Warren 2020
77
@Len Charlap similar story when my son and his wife needed care visiting England. The National Health rules. We need it here- and people live longer there too!
55
The world's biggest fraud is the American student loan system.
1
"Socialized medicine is not the answer."...........Ronald Reagan
2
Instead of the usual format for the next Democratic debate, let's split this article up into bite-size pieces, and make every candidate read part of it aloud.
1
Too bad Obamacare did nothing to fix this. Time to stop asking “Who should pay for healthcare?” And start asking “Why does it cost so much?”
2
It isn't mere fraud. Since refusing to go along with their scams would result in compromised health, or even death, they are in effect threatening to injure or kill you if you don't hand over extravagant sums of cash.
They are thugs, thieves, and assassins. Enough!
2
yes, that is my experience - the drive-by - my insurance was billed $600 for a beautiful doctor who touched me for one second, as I was waiting to be released after two days in the hospital for kidney failure from stones.. I put my opinon on her heathgrades page - a doctor willing to bill for nothing! That is fraud!! My comment remains there to this day..Sometimes I feel guilly, but the effect of my comment on this high-paid billing fraud seems to be nothing..I have to go back for surgery again..You bet I am calling out every non- existent treatment or doc on their healthgrades site, with more enthusiasm than ever..
1
@grace thorsen
there is an apocryphal story about Nixon commenting on another apocryphal story about Kaiser healthcare.
The second one is that Kaiser works very hard at trying to do nothing since the vast majority of medical complaints "resolve themselves" if nothing is done.
The first one is that Nixon commented on this by saying something like "It's the perfect business you charge them for something and give them nothing".
Our mostly propaganda based system is somewhere in there.
Think of the scam as a game of “chicken” where the scammed are gaslighted by unlimited sums of “free speech”$, denial, projection, aggression and ad hominems.
Such tactics have a proven record of working.
The Trump Scaministration is banking on it...and doesn’t want to even give you a look at their “adminstrative” bilking records.
2
Shocking. Total fraud. Sounds like a Mafia protection racket. Not medical care.
4
This is the land of 50 states of duplication of everything.
2
A friend, who lives hand to mouth, tore ligaments in her ankle and needed surgery. Fortunately she is no longer a waitress but has an hourly factory job includes good health insurance. She had surgery at an in-network clinic. She couldn't work for a month she got behind on some bills. Just as she was starting to get caught up, she got a huge ($,$$$) SURPRISE bill from a PRIVATE EQUITY FIRM that owns the anesthesiologists who work at the clinic.
4
Perhaps the NYT should dedicate a nice lengthy article to the HEALTH CARE PRICE DISCLOSURE ACT.
I hope that Mr. Trump gets to sign it into law.
https://www.alec.org/model-policy/health-care-price-disclosure-act/
3
Next time Andrej wipes out on his bike, tell him to do it in Canada, or England, or France or just about any other place in the modern world besides here.
4
Be sure you have end of life documents because you have no idea how much being put on life support against your will can cost your family.
1
Thank you Dr Rosenthal.
1
Capitalism is best!
According to Mr Brooks, anyway. Perhaps he’s never been hurt or sick.
3
I thought this article was going to be about the Bidens.
@Daphne
indeed...in Trump's world fraud isn't just SOP, perpetrating fraud is a required condition of employment.
@Daphne
Oh so witty....
It's racketeering, pure and simple. Should be covered by RICO. Some of the executive suite dirtbags should be in the slammer.
1
I will not bore you with my story which mirrors Dr. Rosenthal's. What is wrong with this country which allows this type of fraud to continue year after year? Can't we do anything?
1
White coated crooks. Lying is easier than breathing for most of them. And, "the system" just shrugs at any complaints. It's how they're all getting rich - playing, "Find the peanut, smuck."
Rosenthal has only lifted a tiny corner of the carpet, exposing just a bit of the dirt underneath.
2
There is an eye-opening podcast featuring Keith Smith of the Oklahoma Surgery Center that runs an open, transparent pricing system.
This is a must listen for anyone who wants to understand why our health system is the way it is.
https://www.econtalk.org/keith-smith-on-free-market-health-care/
2
Thanks for this column. Hope it opens the minds and hearts oif all our elected officials. Sickness has no party affliation. Nor do accidents. Get rid of the lobbyists. That is the only way to fix american health cae or anything for tahty matter..
I was referred to a colo-rectal surgeon a couple of years ago. In the initial visit she used a lighted scope to look inside my rectum -- similar to a doctor looking in a patients's ear with an otoscope. Imagine my surprise when I received a bill for a $100 surgery copay (and of course, my insurance paid out much more). Only in the insane world of medical billing would that examination be considered "surgery." After some other tests done elsewhere I came back for a follow-up appointment.The surgeon said everything seemed fine, but she like to take another look with her scope. When I asked her why, she said there was no compelling reason, she was just being thorough. I then asked her if she realized that every "peek" was billed as if she had performed surgery, and she said said she had no idea. The doctors are often clueless when it comes to cost vs. value for their services.
3
"So what is the appropriate payment for swag I didn’t ask for, ...? In some cases, zero; in others, far less than was paid."
Unfortunately, nothing is ever free. Even though you had no co-pay your are, have been and will continue to be charged for those services in the form of increased premiums. One of the reasons for the current lack of increase in income is that your annual raise is going to pay for your medical insurance.
Yes, the system needs to be fixed. If it's not done then we will be stuck in economic stagnation as the cost of medical care sucks all of the Oxygen out of the room.
Emigrate!
1
Unfortunately, we now have an Elisabeth Rosenthal money extraction recipe book for overseas hospitals when an American walks though the doors. Around Bangkok, you find most hospitals are primarily used by local Thai people. And you also find large medical centers that gear their marketing to resident expats and medical tourists. The difference is usually a more opulent lobby in the foreigner oriented hospital, and prices typically six times as high. The American style marketers have learned to set prices far above local rates, but low enough to seem like a bargain by American standards. For anyone thinking of medical tourism, some of the less visible local focus hospitals deliver high quality care with English speaking MDs and pharmacists (English proficiency is required to get the degrees). Avoid the marketing machines that want to suck patients into American style scams. And enjoy the trip, knowing the money saved is more than the cost of travel in many cases.
I sliced deeply into my forefinger about the time Urgent Care closed for the evening. I bled for about an hour, and oozed after that. Hubby wanted me to go to the ER. I insisted he go to the pharmacy and get me some liquid bandage and super glue.
It was deep and in an earlier day I'd have gone in for stitches. But having had surprise billing I preferred to roll the dice with field self-care. Yes, we have insurance.
My finger healed very nicely for about $10. Still...is this really first-world medical care?
306
@SD
"Is this really a first-world country?"
38
@SD
Duct tape is your friend. :)
18
@all fear is rational
No, we have been a colony again since sometime n 1981.
24
I recently cut my finger, badly. Knowing what a trip to the hospital would entail, I cleaned the wound myself, without anything for the pain. I flushed it with something in the medicine cabinet, and bound it tightly, checking every day for signs of infection. It really should have had stitches and will leave an ugly scar. Why, do you reckon, did I do that?
234
@otto
I cut my finger badly, washing glasses.
My mother, a nurse, followed your protocol.
It left a scar, but she knew best.
13
This article overlooked the unpaid overage hospital billing that insurance or patient doesn't pay that becomes a bad debt tax expense for the hospital.
Thank you Dr. Rosenthal. Would you please write a follow-on piece about how to obtain the detailed charge lists for all the (myriad) procedures and "services" and the glossary that maps the codes to the actual activity? Is that what the new price transparency law is intended to do? My understanding is that it is still fiendishly difficult to find these "chargemaster" lists, much less interpret them.
You are entitles probably by law to see your detailed bill. That is the easy part. Interpreting Themis the problem.
In 2004 I spent a total of three weeks in hospital for a difficult to diagnose stomach condition. The doctor finally decided to have me take a capsule that had a camera which would travel through my intestines to find the problem. I had to go to Rhode Island Hospital for the procedure. Because I was feeling better, the plan was to have me swallow the "camera", wear the apparatus the picked up the images, then discharge from the original hospital that evening. I was taken by ambulance to RI hospital where I swallowed the capsule and put on the apparatus. I was taken by ambulance back to the first hospital where I was told I'd wait 6 or so hours, be taken by ambulance back to RI hospital so they could remove the vest. I suggested it would make most sense and save money for the hospital to discharge me and have my husband bring me back to RI hospital instead. "Really?" was their response, and with that I went home, waited the 6 hours got driven back to RI Hospital and probably a lot of money. Hospitals waste money with unfair billing, excessive use of equipment and carelessness that lands patients in their care of unneeded extra days. (Such as bringing me solid food when I was on a liquid diet. Luckily I was alert enough to tell them to take it away.) Until the system is drastically changed this kind of waste will continue.
The doctors are not being given enough credit for this system.
It could not exist if they were not 100% in on it.
After the last couple decades of iatrogenic injury related decline in health I can say this: Most doctors I have seen in the last 20 years are better at gaslighting than they are at medicine.
3
Trauma activation fees, allowed since 2002 to maintain readiness. Today’s companion article on the ‘Quiet Senate Halls’, there is mention of a bipartisan bill on surprise medical billing, high drug prices.
In between voting on partisan judges, some rated unqualified, maybe some doing-nothing Senator could attach an amendment to that bill- repealing the readiness doublespeak.
Senator McConnell, between giving us biased judges, keeping tabs on your family shipping company in China, maybe....try doing something, like allowing legislation to actually be, voted on. Or do we need to pay the Senate an activation fee, too?
6
Many of us afraid to complain about billing procedures or lack of service for fear our physicians, therapists, etc. will refuse to treat us or retaliate in other ways.
1
I have seen exactly the same thing with medical bills I have received -- a laundry list of inflated expenses. I know that they are inflated when I compare the billed amount to the amount negotiated by the insurance company. The negotiated amount is typically less than 1/2 the charged amount. Luckily I have insurance and the insurance company pays most of the negotiated charge. But what happens if you don't have insurance (or Medicare)? Those without insurance or Medicare do not have a third party to negotiate a vastly reduced, actual charge. You must pay the vastly inflated, billed amount.
2
I have become an eagle eye when it comes to medical billing to my Medicare supplement, but it is exhausting - and almost always futile - to fight the battle. One relatively minor example: I had been receiving physical therapy for knee surgery, billed for onr hour each time (in reality, closer to half an hour) by the PT arm owned by the orthopedic doctors who were treating me. Suddenly, scanning my online account, I noticed that the PT folks had begun billing for an hour and a half - when my "treatment" time, unchanged, remained about half that. I called my insurer, and the person I talked with just laughed. His response: "Oh, the doctors probably discovered that they could legally bill for this much time, so they did." While I stopped the PT and found another practice, my insurers - as this article confirms - just shrugged and happily paid the bill.
3
When my daughter was born, the hospital gave us a gift basket to take home donated as a promotional tool by a company that makes baby products (miniature samples of powder, wipes, a disposable diaper, etc.). When the hospital bill arrived, they had itemized each sample, deeply inflated the price, and billed us for what they had received for free. The bill for the basket came to over a couple of hundred dollars.
10
Thank you for publishing this. As a person living in a small town with a single major hospital I am afraid to push back on ridiculous billing procedures. It doesn’t take a rocket scientist to see that a five minute conversation between MDs as they talk about a patient (and never to the patient!) shouldn’t be billed at their full rate (that cost was $400). No hospital corporation is really interested in improving that model. The administrators stand to make just as much money as the doctors.
3
I have fought the good fight against "medical coding," where the doctor had three separate LP's, all of whom sent me their illegible billings, but refused to include the translation of terms. Nor would they send me a complete overview of charges for the entire procedure. I held my ground, for a year, refusing to pay their ridiculous attempt to charge me $15,000 for a PRP (platelet rich plasma) treatment, which took about 30 minutes. Each time I received a bill, it was under a different provider name, and for a different, unexplained service. (They took my blood, put it in a centrifuge, and injected it into my injury--WHAT other services could there be?) I asked and asked for a breakdown, but always received the same illogical copy of their "codes." I finally informed them that I would pay them $25 a month, in good faith, until they decided to sue me, and then they could explain it all to a judge, since they refused to explain it to me. It would cost them way more to fool around with me than to adjust the bill and explain it fully. The next billing was "$0." Never pay a bill until you fully understand it, and it can be justified by the provider. Pay a little each month, in good faith, and wait for them to do the right thing.
14
I am so happy you wrote this!
Even though I worked in hospitals for 10 years and enjoy plowing through technical documents, I could not understand my parent’s medical bills. After I read your An American Sickness I bought 12 copies and handed them out to family, friends, and strangers facing medical bills. God Bless.
5
If this kind of billing occurred in just about any other industry, the company or individual providing the service would not last long in business. Reform is overdue in healthcare. If single payor will solve this, I'm all for it.
7
Medicare For All. Medicare For All. Medicare For All.
Not a public option, which leaves the present morass of bureaucratic insurance companies in charge and saves nothing.
Not merely price transparency and drug price negotiations, which will be integral parts of Medicare For All.
Medicare For All. Medicare For All. Medicare For All.
The whole enchilada.
Keep demanding it until it happens.
5
This is rampant and very much part of the reason for our health insurance high costs.
Last year my son had a rash and went to an Urgent Care fearing it was Lyme. They looked at it, did no tests, and let him go. We were billed 430 dollars, of which my insurance paid approximately half.
I called the Urgent Care and told them I had a rash I wanted looked at, but said I had no insurance. She told me it would cost 150 dollars. If I ever have to go to a place like that, I will say I’m uninsured, it will save me money.
4
My daughter sprained her ankle and since it was after 10pm her only choice to receive medical attention was hospital emergency care. The total bill was $4000 of which she had to pay out of pocket $100. A boy on our soccer team sprained his ankle. It was daytime and we went to an urgent care clinic and since he had international insurance the total bill had to be paid up front. The insurance company reimbursed us a few weeks later. The up front total cost was “surprise surprise” $100. The US health care system as is and those who want to keep it so or just tweak it a bit or go back to yesteryear are only perpetuating fraud.
3
I read this piece after reading the article on capitalism in Finland. We have really failed ourselves in many ways here in the USA. It might be time to go. Soon our retirement funds will be worthless due to unsustainable government spending with dubious value received in return and what will we have to sustain ourselves?
5
This article, and similar articles I have read about medical billing, make me wonder whether we can successfully adopt single-payer, Medicare for All. In order to go from a system that generates bills like those described here, we must change the system. That is a tall order because healthcare accounts for about one-sixth of our economy. That means that about one out of six Americans derives an income from the system that generates such bills.
If you think that the employment decline in manufacturing was a big deal, just imagine the number of billing, insurance, and administrative jobs will be lost in going to single-payer and streamlining the payment of hospitals, clinics and other healthcare providers.
And then imagine the next Donald J. Trump.
3
This makes me so glad we moved to Italy 25 years ago. We don't miss the US healthcare system and would never move back to the USA unless Medicare for All became reality. This despite the fact that we are supposedly insured by my husband's former employer the University. That said the insurance company did not even answer the billings I submitted for a weak in the hospital here with stroke. But at least the bill was only $7,000 including the emergency room visit. I escaped intact and consider myself lucky to have only paid $7,000 for an infusion of a clot busting drug, two catscans,an MRI, a chest X-ray, two ultrasounds and eight days under observation in the stroke ward. The quality of care was excellent. Americans are getting thoroughly ripped off by a system that has absolutely run amok and it the shame of the developed world. Why they don't want Medicare for all and to kick the insurance companies out other lives, beats me. I am scared by stories like this one to set foot in the USA.
6
My wife worked in patient intake, insurance section, for awhile. There are many insurance companies, with most offering dozens and dozens of different coverages. The hospital wants to receive the biggest payment possible from insurance, so it automatically sets all of its billing prices for each item or service so high as to ensure that it will receive the maximum insurance payment what whatever coverage the patient has. It is completely impractical to think the hospital, or any medical provider, can be able to know what each policy provides as payment for each item or service.
The tragedy here has nothing to do with insurance. It is the fact that the uninsured get billed at these same stratospheric rates that nobody believes have any relationship to costs or fairness.
5
I repeat what I often say, which is that in successful universal systems - which describes all other advanced countries - the government basically sets prices, essentially in a bargaining process with providers. A "free market" just does not work, because of the incredible complication of difference insurance coverages, and because healthcare consumers just don't have the information or opportunity to shop on price.
4
This column is dead on correct. I have been beating this drum for years as a medical professional, patient advocate and later as a patient myself. The whole, very complicated, intricate system from the highest paid specialists and administrators down to the pay scale for housekeepers and food service workers in and out of the hospital needs to be carefully and fully examined. Fixes will be slow and tedious even before industry influencers enter the picture, but it is pasttime to begin.
8
As hospitals are scooped up by corporations and patients lack the time, energy or knowledge to fight this, it will continue. The most important question patients must asked a healthcare facility, hospital, doctor, P.T., etc. is "do you participate in my insurance"? PARTICIPATE IS THE KEY WORD. Then write down the name of person you spoke to, time , date. Also, keep track of what happened during your treatment. Pay for nothing until you call and make it clear you aren't falling for it. Best of luck!!
2
No question, there is no justification for medical billing practices; except:
1. Hospitals need to provide emergent, competent treatment 24/7.
2. Hospitals revenue stream has been "robbed" by all those out patient surgicenters. Orthopedics, Ophthalmologist, and even Dermatologist all now perform procedures in those attractive, modern temples to medical care. All those revenues used to go to your local hospital.
How much better would those emergent bills and critical bills be if hospitals wee the providers of those services?
Mark E. Boyken, M.D.
Wisconsin
1
I have A-fib. I recently bought a $100 app for my iPhone that lets me take my own EKG whenever I want to. It's a lot cheaper than the EKGs I've had in three ER visits.
2
I am a doctor. After my wife had back surgery, I asked for a copy of her hospital bill. She was charged twice for the same implanted equipment and I told the insurance company to not pay the charge. I give all patients the same advice: if hospitalized, always get the complete, itemized bill. If you have had surgery, always get the surgeon’s operative report, the pathology report from every tissue removed and for any hospital stay, the discharge summary. Keep these in a ring binder so every subsequent doctor can see what happened. You have paid dearly for these things and should at least have an understanding of what you paid for.
6
Shocking, but not surprising. Single-payer advocates are missing a bet by not publicizing more of this kind of information instead of debating how many billions or trillions of dollars can be saved. Personal beats general every time.
3
My son was born in a birthing room inside a hospital. We were told that if my wife wanted anesthetics, they would wheel her down the hall to a standard delivery room. No drugs were allowed in the birthing room. My wife had the baby naturally, with no drugs, and we were home within 24 hours. Weeks later, in reviewing the bills, I saw a $900 charge for an anesthesiologist. When I called the hospital for an explanation as to why we were charged for an anesthesiologist in a room where no anesthesia was allowed or given, I was passed up the chain of command to an administrator who explained that after the baby was born, one of the many people who had come into the room and shaken my hand was the anesthesiologist. By hospital policy, that handshake entitled the anesthesiologist to bill us for his not allowed and not used services, even though I knew for a fact that at the time of our delivery, the man was down the hall, attending a c-section. I told the insurance company all of this, yet they paid the bill without question. The real problem with costs in our health care system lies in the nature of our private insurance model. Costs are determined by two parties, the providers and insurers, whose interests are not served by reducing them. In fact, the more that is spent, the more both of them make. The consumers, who ultimately bear the burden of those costs, are kept completely out of the process.
7
What should emabarrass and shame Americans is what is and has been legal in America.
Black African American enslavement and separate and unequal was as lawful as the colonization and conquest of brown indigenous America and Americans.
What is the for- profit nature of the healthcare business?
The basic ethical obligation of the medical profession is to do no harm.
While the legal profession must avoid even the appearance of any impropriety.
Beyond the 'business' of both professions is the humble humane empathetic moral obligation of service without any regard to the ability of a patient or a client to pay for their services rendered.
But the fundamental question is whether or not access to quality affordable healthcare is a universal human right for the many or a privilege for the few.
2
The medical lobbyists are as powerful as the NRA and pharmaceutical companies unfortunately it’s not the doctors that are making the big money it’s the lobbyist and insurance companies which are owned by companies which are owned by corporations, owned by conglomerates, owned by some state/country. This is the game Risk being played out on a grand scale and I blame the internet. Unrest like people living in Russia still without plumbing or heat in there hovels but can look with there cell phone and see pictures of how other people live. Unrest for Guatemala’s being killed where they stand no plumbing or water to there homes nothing to look forward to so they turn on the phones and see how other people live. Unrest in Africa, India, France, Hong Kong and the internet is creating this Unrest.
I'm shocked by the number of comments looking to excuse physicians for their role in the breakdown of our medical system. There are many honest MDs, but almost every procedure or charge has to be sanctioned by a medical professional and those who generate the most income are rewarded handsomely. Revenue, not care, is what drives many decisions.
1
Sometimes the difference between what hospitals bill retail and what they collect at the wholesale rate from Medicare and private insurance is really amazing to see.
I wonder if the negotiated prices paid by Medicare and private insurance are sufficient to pay for the legitimate cost of the services provide. If not, this would provide an incentive for fraudulent billing.
Perhaps the fraudulent billing is driven by greed abetted by a strong lobby.
I suspect that for people with no insurance, a serious accident or illness is almost always the harbinger of bankruptcy or prolonged. grinding debt that forecloses any opportunity to advance economically.
Democrats are divided over whether to replace the entire system now or to address the problems incrementally.
The modest efforts of Republican to address health care problems, as they work assiduously to repeal the ACA, have been met with fierce resistance.
I don’t expect much to change soon.
Although everything Ms. Rosenthal wrote is accurate and many people “whine” about health care costs, there are too many interest groups lobbying for their piece of the pie. In health care, particularly, one person’s waste is another person’s income. Most hospital bills do not reflect costs, because the bills are “charges” which are sometimes arbitrary and shift costs to make hospitals financially solvent. Healthcare industry is $ 3.5 trillion cookie jar, and everybody, including patients, want to have their hand in the jar. USA spends 10-20% on administrative costs. Every doctor, patient, hospital, and other providers complain but resist change, if it involves their group. ACA (Obama Care) attempted to regulate some, but the interest groups are too powerful to make major changes. Incremental changes with shared “sacrifice” is probably the best way, but it will be difficult politically.
2
Every 10 months I have a lumbar block that allows me to live relatively pain-free. It's the exact same procedure every time. But the bills are always different, sometimes radically so: my copays, all-in-all, will range between 600 and 1100 dollars each time.
1
A small part, albeit not the most egregious part, of what keeps us stuck in this healthcare scam, is people who don't want to give up their "great" insurance. They are not too concerned about the oppressive nature of our healthcare. It is not until they are out of a job, hit with a health crisis, stiffed by their great insurance or can't afford their premiums, that they can see otherwise. It speaks to our capacity for empathy. Or lack thereof.
4
Think billing is tough to decipher? Try to get an accurate guesstimate of what your portion of the bill will be for a simple, elective, standardized outpatient procedure. The run around, stonewalling and downright deceit I got when trying to determine what costs I would incur for carpal tunnel surgery was totally exasperating! And I never did get a good answer. Our health care billing system is designed to work for everyone EXCEPT the patient.
6
The way I understand this is insurance companies are good at telling us what they don't cover of our care, even when they really do. But they are fine assuming everything charged is reasonable. And we get to pay for this service to, is it us?
All of this continues until it becomes too large to ignore. As the pendulum swings further in this direction, its reverse become more intense. This was the wisdom of Karl Marx, who observed this trend in human society. Should the administration succeed in its court battle to destroy the ACA, the demand for change will be too hard to resist.
2
I really appreciate this piece. I have had health care in nine different countries, and not only do we pay more in the United States, we get less. We need to end the bloat -- we don't need to have one in six workers in the health care industry when they don't provide medical services.
4
I’ve never understood why medical bills cannot and has not been standardized the way that banks use the ACH system. It is seamless and efficient.
1
I am afraid it is to logical solution and unfortunately it would lead to transparency. It is exactly why this is not going to be done unless, magic happens......
A trip to the ER 18 months ago that turned out to be unnecessary ran into tens of thousands in bills, some of which were high but understandable, others of which, like $23k for the ER overnight stay (and they couldn't even find me a pillow!) that didn't include anything but the bed and the nurses monitoring wasn't the worst.
The worst was the ambulance: It is about a mile from my provider to the hospital's ER. One Mile! That trip with a tech monitoring my EKG, cost nearly $4,500--only a few hundred covered by insurance. Ambulance companies typically REFUSE to have contracts with insurance companies so they can balance-bill such outrageous amounts against a person in deep distress when they show up. EVENTUALLY, my insurance covered all but a few hundred of it. Just the ambulance ride part was $930--the rest for the tech.
When my cardiologist looked at the suspect EKG he said "Your 62, active, fit, and an inverted right side T-wave is nothing to worry about." So why didn't they call across the hall to him, since he's in the same building, part of the same provider company (generally a good one, too)? His answer wasn't complimentary....
5
The idea that this type of fraud is limited to medical care is naive at best. My Lexus dealership told me that my 3 year old Lexus needed $980 of maintenance. Included was wiper blades for $99, cabin air filter for $149 and engine air filter for $149. These parts total around $40 at the auto parts retailer and take me around a total of 15 minutes to replace. They also insisted that I needed a fuel injector cleaning. By the way, the $980 was with an alleged 10% discount, and this was all 'scheduled maintenance,' recommended without inspecting or test driving the car)
And don't get me started about legal billing... It's everywhere. Education, finance, etc. This kind of corruption is rampant in the entire economy. Welcome to 21st century capitalism, where the capitalists make the rules.
4
@tanstaafl so true.
1
I imagine everyone who reads this column and spent any time within the American medical system has variations on your superbly detailed story. I went to a dermatologist to have some potential skin cancer spots checked. I was told they could only check three (3) spots per visit. OK, I responded. Here is the one that brought me in, find the other two. I am not a physician and can potentially miss one. They checked me, recorded some varicose veins and blemishes, for which I then received at least twenty emails and letters from various medical 'cosmetology' practices wishing to make money off predicted vanities. America, the land of hidden fees and inflated bills. Don't you love lobbied capitalism?
4
My father developed a progressive dementia which led to his incapacity and eventual death. Since my parents lived in the UK the NHS provided all sorts of equipment, wheelchair, hospital bed etc.at no charge, of course. A couple of days after he died, there was a knock on the door and a man politely informed us that he was here to collect the equipment. We were not left with a house full of expensive equipment we had had to buy and had no further use for. How efficient - and cost saving!
I would point out, though, that the cries for single payer in the US, especially medicare for all, miss the point in a way. As pointed out in these pages years ago, the problem is the fee-for-service model which allows medical facilities to nickel and dime until the bills reach astronomical numbers. The trouble is that getting rid of that would end the gravy train for too many people with too much influence over the political process.
5
$2000 admission for new born, which the insurance didn’t pay as the new born couldn’t be added, as he didn’t exist before. The $2000 fee didn’t cover pediatrician or nurse work, or his delivery. And this happened in 1994. At that time I had insurance through my university.
2
My experience with the medical system can be summed up more easily. A few months after a routine rotator cuff surgery I received a summary of the medical expenses. This summary would have been more appropriate in a Benny Hill script. The summary stated the "value" of my procedure at $39,000, the amount billed by the various insurers at $23,000 and the amount actually paid to the medical establishment at $13,000. I would assume that the med group did not actually lose $$$$ on this whole medical episode. So where do all these other inflated dollar amounts come from?
2
Tax write off.
$9282 for two days in ICU room sounds like a bargain.
Good reporting on important issue. Wish you would take on sleep centers and their suppliers, where this is common.
The first step to combating these abuses is for you, the consumer (particularly a consumer with detailed knowledge and experience in the field) to file formal, written complaints with the hospital, your insurer, and your state’s insurance regulators, letting all three know that you’ve notified the other two, and cc’ing any local, state or federal officials who have expressed concern about medical costs and waste. Real and lasting change will only be effective if consumers become actively involved and responsible for the costs of their care, even when they don’t pay out of pocket for most of those costs.
3
the American system supports giant paydays for those who do not deliver care and their profits are based on the denial of care. start there.
2
Most of the problems listed here can be solved with the creation of some simple bulling rules. They should be enacted by state legislatures. But if the political situation doesn't allow for that, it's a mystery to me why insurers don't do so.
1
Because chaos is good for business and transparency is not.
1
I had a half-aunt who was a registered nurse back when nurses weren't paid very much, but was taken out of the work force by an automobile accident that left her paralyzed from the neck down. She gradually regained the ability to walk short distances with a cane after many years of physical therapy.
For ten years I visited her once a week in her rented trailer and then in a nursing home for the final years of her life. Once when she lived in the trailer she shared with me the record of her medical expenses that were paid by Medicare. She was a nurse, so she knew that many of the charges were completely fraudulent, but I was too busy working 60 hours a week as a community college to do anything about it.
Most people don't look at the bills because they don't have to pay them and those who do for the most part could never understand them. But according to my aunt Billie the system was a complete rip-off.
4
Third party payers skew incentives. Patients don't pay out of pocket, and providers pad bills to compensate for insurers' shorting them on reimbursements creating an inflationary spiral.
But the problem is not insurance per se, but the underlying cost of care, which makes rick polling through insurance necessary.
Fraud is tolerated because all players are locked into codependency. Rock the boat and you're out.
1
This is what a for-profit insurance based health system creates; rampant fraud with no regulation or oversight. The key component here is regulation and oversight. These are dirty words to people and organizations that see the suffering of fellow humans as merely a way to make money for themselves.
5
American healthcare system has become a consumer driven industry instead of Art of healing. Pharmaceutical companies, hospital and corporate CEOs , unnecessary and unfair litigation issues, many unnecessary administrative staff whose main job is to find the least significant fault instead of looking at the whole picture, dysfunctional EHR systems, the glut of many physicians to bring in the maximum income at the expense of patient care and well being, patients demanding many unnecessary and unjustified labs and procedures , all contributed to the mess in the current system of healthcare in US.
3
Now the that fraud is in the first stage of being documented on the editorial page of a national news paper. The documentation needs to be carried on by reporters and by others who have time, research experience, and writing experience to make credible reports of how the business operation components of the health care industry carry out the regular practice of fraud.
Businesses use pyramiding(duplication) of time and of equipment to inflate costs that employees and consumers are never allowed to get away with when trying to get the best deal for themselves in any business transaction. Insurance companies have the best systems for inflating expense than any other business( except maybe in the financial industry) entity in the nation.
3
Thank you for calling out the medical industrial complex on these abusive practices. Beware however, your membership in the AMA is about to be revoked! ;-)
The fact is that the AMA and other medical and hospital associations systematically lobby for these abuses - and their enormous access to our legislators is a base cause.
3
Excellent article! I have had parallel experiences administering the bills for my husband's spinal surgery and managing my eldest son's care through a life of Crohn's disease. "It is easier for the insurers to pay" fraudulent charges without questioning because it"s all "too big" and complicated? Of course when the costs (inevitably) go up, insurance companies must charge us more -- to protect their profit centers.
We live in a vicious circle/cycle of costs, always spiraling UP.
There are many profit centers that will continue to be protected in the medical/medical health insurance racket as currently constructed.
And please understand: the profit centers are protected, not patients!
A nation of consumers -- yet we can never access medical costs up front, because those numbers are not available. When do you ever opt to buy a product you do not know the price of? This is easy to ask when it is for a scheduled and carefully planned for piece of surgery -- but in an emergency?
Our healthcare system is NOT the best in the world.
Our healthcare system has bought Congress.
We are all victims of this fraud.
6
When you hear the Democratic candidates say that you can join an expanded government plan or keep your private insurance, what that means is that insurance and the medical industry will be allowed to continue to perpetrate the scams you see in this article--only the government will be being scammed on your tax dollars. The only way to bring costs down and eliminate these bogus charges is to eliminate private insurance. You don't see any of this happening in the superior national health systems of other countries. They just don't allow them. Private insurance is in cahoots with providers to scam the public. Time to stop the madness.
6
But wait, there's more! Much more.
The Connecticut Health I-Team -- C-HIT.org -- uncovered $1 BILLION in "facility fees" that had been added to patient bills in our small state over two years.
Their reporting lead to a state regulation that required medical providers to at least notify patients there would be such a charge in their invoices. Yikes.
1
My cousin shattered his ankle. The hospital discharged him home with a wheel chair that was 4" too wide to go through any doorway in my home. It might have worked if he had been discharged to a nursing home or other facility. It took 5 days to get the DME company to pick it up. I am sure they were charging Medicare big time each day. We ordered a transport chair from Amazon for a little over $100 that served the purpose and was delivered to my door in 24 hours. There is a lot of waste in our system, we can afford Medicare for all if we cut out waste and the administrative costs of private insurance.
5
Two types of medical fraud worst than what is reported here and a proposed solution.
1) Opioids
Why does an article on medical fraud have not a word on opioids? Is it true as many articles reported that there was an incentive for doctors to prescribe opioids? Is it possible these incentives are still in place? In a recent visit to an orthopedic doctor may I was given two prescription for opioids for a very mild discomfort, oxycodone as well as prescription Tylenol with codeine. I needed neither and I did not fill either. I didn't even take over the counter Tylenol. Is the opioid scourge still with us?
2. I noticed some doctors hesitate to prescribe needed treatment for actual disease. I have read that insurance pressure may result in undertreatment or no treatment at all. While waste of medical dollars is reprehensible when disease is left untreated to save money is much worse.
3. One solution is to make a law to give 50% to a whistleblower patient who takes the time to review and report unnecessary charges. The 50% should not include only the amount the patient paid directly but also the amount the insurance paid in her or his name. Furthermore if proven that money was saved in denying necessary treatment there should be a punitive penalty 10 the money saved.
Given the difficulty of proving medical fraud it help to create a registry for suspected fraud. This would help flag repeated fraud and would generate a pool of witnesses corroborating each other's testimony.
Watch the YouTube video of Britons being asked on the street to guess the price of various health services in the U.S, like an ambulance ride, or giving birth. Americans have absolutely no idea just how dysfunctional our healthcare system is in comparison to the rest of the industrialized world. Thirty million without health insurance. Tens of millions more with deductibles so high and with co-pays, they might as well not even have insurance. A have million medical bankruptcies every year. We pay an insane amount for medications such as with insulin, which cost ten times what Canadians pay. This has to change. Single payer, Medicare for all, where you can see any private doctor or go to any private hospital (no in-network out-of-network shenanigans to rip you off or other surprise billing) is an obvious solution. What is so stunning is that we actually allow this to be perpetrated on us by this predatory healthcare system. We can change this and join the rest of the industrialized nations to have a functional and affordable healthcare system.
6
Americans have no idea of those costs either since, for the most part, they are insulated from it. Their employer or the government pays the cost and where there is a contribution from the insured, it is often via payroll deduction.
@FXQ
yet the New York Times and other publications treat Warren and Sanders as if they were the fraudsters. I say to them if you want to find fraudsters look in the mirror.
1
You know, I once had a job where I often quoted projects. When I was new at it, my procedure was to itemize everything that we would need to do in order to complete the project. Later, after I was involved in a number of completed projects, I compared my quotes the actual cost of the projects, and I found my quotes were always much higher than the actual cost. Why ? There are a number of reasons, but a simple one is that often three tasks, say, would be quoted as separate activities, but when the actual job came around the engineer performing the tasks would often find ways to perform all three tasks simultaneously, thus that part of the project would actually cost one-third of the quote. Later, I learned to quote projects based on the total cost of similar projects that we had one previously, thus much improving our competitiveness. The original method, I'll call it bottom-up quoting greatly over-estimates. Medical billing suffers from the same effect: everything is billed as a separate task, while in actuality the medical technician can take your blood pressure during the same visit that she gives you an injection.
2
As a recently retired home health physical therapist I'd like to point out that what is described in your article is actually fraud. Patients seen by home health care nurses and therapists must sign our electronic medical records (computer, cell phone) to confirm the visit. Billing for visits that did not happen is flat out fraud.
I agree that the system needs to change. Over 20 years of working for a large hospital based system as well as personal experiences similar to the ones described have allowed me to witness outrageous abuses in medical billing.
2
I have no problem with single payer but I don't see it as a solution to this problem. Fraud is fraud, and as long as all of the participants in the system view the fraud as an acceptable "feature" of the system nothing will change.
If we wanted to create a more inefficient, expensive and impenetrable network of healthcare with its obvious frauds and scams on purpose, we couldn't. That is my basic argument to people complaining about the possible negative consequences of any major reforms, whether it be single payer, public option, or just removing the requirement that large employers provide healthcare insurance.
We have gradually progressed from a culture in which doctors took care of patients as best they could with the resources that were available and closely guarded to one in which we get care from a system. The satisfaction and quality of our doctor patient relationships have been replaced with interactions with an impersonal healthcare system in which every interaction is monetized. The system diagnoses your coverage so as to develop whatever charges it may be able to attach to you and your insurer to maximize revenue. That we spend more on healthcare than any other country and yet our quality of healthcare as ranked by various methods, put us in the middle or low end of the distribution.
It is time to bite the bullet and join the rest of the industrialized world and do healthcare better and not for profit.
10
I am especially aware of physical therapy rip-offs. One outfit was double-billing. When caught, they were all apologetic as if it was some mistake. Recently, my 98-year old mother-in-law was evaluated, given a few exercises (she is incapable of doing them independently), and given suggestions about walker use and avoiding falls. There were several short visits apparently. The company billed Medicare $7000 . We’re reporting it.
5
I worked for an HMO when I first started in practice almost 40 years ago and they were all the rage as cost control vehicles despite how obvious it was to me that no industry wants to control its own costs just the individual companies controlling theirs.
That seems to be the main argument for government run health care. However in medicine as in the economic world around us things change so fast that the government will resort to the simplest unsophisticated method to control costs that won’t control costs.
Rather than control the medical care of 325 million people, try to control the insurance companies. If the Fed govt provides catastrophic insurance to prevent bankruptcy, the insurance companies can purchase that and the government can charge a supplemental premium for POST existing costs, then the insurance companies can fight EACH other and treat the patients better medically, non medically and financially. Let each state clearly indicate what is a standard policy and require the insurance company to, when they sell a policy give a clear indication of how their policy differs in writing, in a web site.
You might really see insurance companies help promote better diets, more exercise with financial backing.
I’m against single payer because the same inmates would run the asylum. No country is like ours, has a pure single payer system, and if they are all so great why are they not identical?
1
One of the most egregious faults in our reckoning of health care and health insurance is akin to calling social security an insurance too. Insurance is useful for perils that are probability driven with the occurrences being more like anomalies not longitudinally predictable. In other words, we all know that 95 out of 100 of us will get sick occasionally, have minor physical accidents requiring ER or clinic and need income at retirement. That is not the concept of insurance. Insurance is pooling the risk of many via reasonable premiums to cover the few catastrophes that befall some members of the insured group. I.e. early death, house fire, car totaled in accident or theft. Insurance is the expectation that we pay a minor premium but don’t hope or expect to collect on the policy because we don’t wish a tornado or cancer in our life. Actually Health Care, not this health insurance misnomer, is like groceries and rent. We all know we will have regular and significant expenses, so it is not a lottery to insure. It is a recurring path to properly manage for all with costs in line with services.
3
I especially love the medical bills that arrive, say, 18 months later - after you think you're all paid up. It's a system you just have to love. America is indeed the land of opportunity (or is that opportunism?)
1
Amen. THIS is the corruption in the system, vastly more than the health insurance companies (disclosure: I run a car insurance company). But, I see the bills from car accidents, and they work exactly the same way.
Medical billing of this nature is endemic. It’s also parasitic - hangers on want to milk each injured person (but only if they are covered!). As the author states, this should be criminal.
Before we get to criminal, a better solution is publishing the names and billing practices of egregious hospitals and providers. Stories like this will drive change, especially if linked to pressure on the leadership of nonprofits who run many of the health facilities.
4
I too was in a bike accident resulting in a coma and fractured ribs, clavicle, and other injuries. Two weeks later the insurance company called to tell me that they would not pay for the ambulance that the police called to take me to the hospital as it was not pre-authorized. Ultimately they had to agree that if I knew I'd be hit by a truck at a certain location at a certain time, I would have gone elsewhere, and they paid the bill. We must look at more than doctors if the system is to reach the level provided in less wealthy nations.
4
I recently had relatively minor hand surgery lasting about half an hour.
The hospital charged about $10,000, insurance agreed to pay $4,000, of which I paid $360 plus a $300 co-pay.
The surgeon charged about $4,000, insurance agreed to pay $600, of which I paid $600.
The anesthesiologist charged about $2,000 of which insurance agreed to pay $400, and I paid $100.
It’s clearly a game I don’t understand. But at the end of the day, I paid up to the amount of my deductible plus co-pays, and the doctors got paid less than they should be compensated. The hospital bill was probably too high, and the insurance company has always made more from our annual premiums than it pays out to cover our care.
I have no clue what the answer is - and I don’t really trust anyone who claims they do.
9
My daughter has high deductible insurance-as an adjunct professor she cannot afford good coverage. A recent doc visit led to multiple ultrasounds for possible cancer. The stress was more about the costs than the health issues. She called her insurance and the hospital- no one could tell her what the tests would ultimately cost- they kept sending her to others who also could not answer her questions. She could not get a clear answers on whether there would be a facility charge based on where the tests were performed. No one could tell her whether it was better to pay at the time of service or wait for her insurance to be billed. Health “care” induced financial stress is the opposite of preventative medicine!
4
I am a recently retired anesthesiologist. I used to work in a proctologist’s office providing sedation for colonoscopies. My wife went to said office for a colonoscopy shortly after I had stopped providing care there. By that time the proctologist had obtained coverage from an alternate anesthesia provider. My wife received sedation for the procedure which took no more than 45 minutes. This particular proctologist performs on average around 12 cases per day at his own office. I can tell you my anesthesia group collected roughly $400 per case when I worked there, having been in network with all providers. $5,000 per day in all. Not a bad haul.
You can imagine my astonishment when we received a bill for $3450 for anesthesia services. Our replacement anesthesia provider was out of network. Our medical insurance company sent us a check for $3450 which I sent to the billing company.
When I called the company to complain about the exorbitant charge, I mentioned that I used to perform the exact service at that particular office. The same woman who had been badgering my wife about forwarding the check beread from a script she readily had in front of her. In essence, everything done and billed was legal.
If I were to assume the anesthesiologist working there is out of network for ALL insurers, he could easily generate over $40,000 in collections (not billables) in a single day.
The insurance company paid this ridiculous charge without a second thought.
THE SYSTEM IS BROKEN.
13
A big part of the problem is also the passivity of the elderly who run up the bulk of the expenses without any real cost to them. I have seen both my parents get very large clusters of bills for a variety of ailments in terms of medicine, equipment and in-hospital stays over the past three years. In each case, the billing is quite high. But since they are on Medicare, why should they care when virtually less than two percent comes out of their own pocket ? Watch how a hospital wing works, visit a doctor’s office. Every little motion and unit of inventory supply is coded for a line item to be tacked onto a bill at an inflated rate. If you do the math, what today’s Medicare recipients contributed in paycheck deductions over their working lives is a pittance to the health care benefits the enjoy, even after provider-insurer discounts are applied. It is TODAY’s workers who pay into the system who are supporting the outrageous invoices. Hence, the lack of direct impact between and control between (tax) payers and current beneficiaries ( the patients and the health industry ). The disjointed distance between payer and receiver leaves so much room for systemic profit.
6
@Suburban Cowboy ... How about protest marches across the country...and forming nonprofits to fight?
I don't miss the healthcare system in the USA.
Every time I go home to see family in Texas, I am told how it is the best in the world.
Whatever quality it may purport to have, however, is buried and interred beneath bills and bills and more bills.
The patient in America is simply a slot machine.
461
@tom It is potentially the best but is also buried in bureaucracy and out-of-control costs. The quality of healthcare (in most cases) is excellent, and people are fearful that proposed changes, needed as they may be, will diminish that.
7
@tom About 25 years ago my wife's grandmother came from Sweden to visit her daughter's (my wife's mother) family. While here she had to be hospitalized. My in-laws plaid the bill, then later sent it to family in Sweden to get reimbursed. The Swedish family thought they were being swindled by my in-laws, because the bills were so incredibly high. They were being swindled; just not by my in-laws.
36
@wnhoke If the quality of care in the U.S. is excellent, why are our health outcomes so poor compared to those of other developed countries? Perhaps you mean the quality of care for affluent and wealthy Americans is excellent. But I would argue that even Americans who can afford to pay high prices for high tech, advanced care often experience poorly coordinated care that negatively affects their health. I witnessed this for years with my parents, and am currently witnessing it as I assist a friend who has a cancer diagnosis and is being treated by a prestigious university-affiliated medical system. Then there are the unnecessary procedures ordered because they generate profit, the infections contracted in sloppy hospitals. I could go on.
42
The health care managers are masterful businessmen, and they get more money per person from our economy than in any other country. This is called business success, and getting them to stop is like getting a cat to stop sharpening its claws on the furniture and drapes. Leaving money on the table is against a businessman's nature.
Controlling health care costs means being anti-business and against the ways and decisions of the marketplace. It means letting the government choose winning and losing strategies, and therefore winners and losers, rather than leaving it to competition and the market.
As long as American voters allow themselves to be frightened by cries of socialism and big government, we will continue to pay the highest per capita health care costs in the world.
514
@sdavidc9
I would phrase this differently:
Instead of saying "Controlling health care costs means . . . letting the government choose winning and losing strategies," I would say that it means "letting all of us, the rich and poor, the sick and healthy, through our government, choose winning and losing strategies."
Those who oppose Medicare for All confuse "government" with "bad government." And they find a way to turn a blind eye to business/marketplace failures, corruption, greed, and trickery. Both government and private business can be good or bad, efficient or inefficient. The only difference really is that business is exclusive in its aims (profits for some at the expense of others; a few looking out for themselves) while government is inclusive (all of us looking out for all of us). Neither will happen without effort. So let's put the effort into our common government, especially for things like health care, defense, criminal justice, and energy production. The rest can be done by private business.
31
@sdavidc9
What does "socialism" mean? Does capitalism mean that we always rob the poor to benefit the rich? BTW Medicare B & D has all kinds of charges that one pays, despite supplemental insurance. Never pay the first bill -- always wait for the 3rd. For a routine Tetanus etc. TDP (every ten years) vaccination I was billed initially 200$ not just for the vaccine but for the administration. (I had the same vaccination years earlier at a city clinic for 0$! My GP then did not administer the vaccine in his office but this was NYU Langone. I paid the bill at about 160$ but then the last bill was 140$!!! Do I get a credit?
What a fantastic article: fraud here there and everywhere. (Trump is a master of that - well documented.)
I have no idea hat my fellow Americans really think about what goes on here. Some are very happy having a good broker. Others are too stupid to understand any of it -- that may include myself.
But this "God is in the details" essay hit the problem of medical cost squarely on the head. BTW at a dental appointment (intake? but have been going there 20 years. X-rays including of the jawbone parts with no teeth at all -- I was told something looked funky - but only scheduled for the replacement of a buckle/veneer that fell off -- after 20 years I was told if saved it could be glued back on! ) PS. The radiology practice that had 35 years of mammograms from me changed ownerships and deleted the records!
Only Warren.
7
@sdavidc9,
Nonsense. You can get your cat to stop clawing a chair if you electrify the chair.
Allow police to go after these scammers. Write local laws (the federal government is bought-and-paid for) to permit these bounties to be collected from insurance companies who are culpable in the fraud if they pay for it with premiums.
Once attacked in one city or county, the idea will spread. Insurance companies, in a panic, will begin to police themselves.
Right now insurance companies are happy; they're excited about a democratic take-over because Obama care does nothing to protect patients and there is Hillary's mandate to squeeze tax payers into having insurance that covers nothing for high premiums.
3
I have SVT (supraventricular tachycardia). My heart rate goes from 68 bpm to 200. I show up at the emergency room and tell whoever will listen that I need a push of adenosine. They ignore me. Specialists come in with cool machines and give me tests that confirms what I've told them -- my heart rate is 200 bpm. Nurses ask If I've drunk coffee, smoked cigarettes, or taken street drugs. -- No [although by this time, I wish I'd gotten high before arriving]. I don't use coffee, drugs, or cigarettes.
Eventually the doctor on duty arrives, and confirms the information already given. He goes to his computer and after five or ten minutes returns, and announces profoundly to the assembled staff and me that he has determined I need a push of adenosine.
That is given. My heart instantly returns to its usual 68 bpm. They try to admit me overnight, which will get them extra money -- gobs of it. I decline, and usually end up signing out "against medical advice."
Before I leave, they give me 15 or 20 pages of printouts for what I should do as an SVT sufferer that haven't changed in 20 years, and that I recycle as soon as I get home.
The bill usually comes in around $6,000 plus $750 for the doctor who confirmed my diagnosis and treatment, and y'all pay it except about $50 because I'm on Medicare.
I could go on, but I'm over the Comment character limit.
714
@George Health care professionals should be paid well for doing good work and that is it. We should not be paying for all the nonsense. Everything you described cost in the real world less than 100. Who gets to keep the other $5900? Why?
44
@George Yup. I recognize this story. Makes me SO angry.
We are idiots in this country.
42
@George
I have worked (in Canada) as an ER physician. It is common to have SVT patients come for repeat visits, be treated with adenosine and be discharged home -- the easily obtained hospital record confirms past diagnoses. apart from the EKG whose diagnosis is immediately obvious.
I suggest you try a different hospital, they surely can't all be stupid and corrupt -- or can they?
63
Two points. First, I think that you shouldn't pay what you were billed. I believe that these amounts are calibrated to be high enough to generate real income but too low to make it worth the while of upper middle class and wealthier patients to fight. Hiring an attorney to fight will cost a lot, and you might lose. The health care system has calculated that they'll win almost every time.
Second, it's ridiculous that it's not worth the time of your insurance company to fight the fraudulent charges. The insurance company works for you, supposedly. It's not worth their time because they can just raise their rates to cover whatever the aggregate fraudulent charges are, and you and your employer will just pay the higher amount because it's too much trouble to change insurance companies (and they're all the same besides). This problem can be addressed: Make the consumer the sole beneficiary of contesting the bill with a triple damage award.
171
@David H.
Obamacare specified that insurers were limited to 15% for overhead and profit for group policies and 20% for individual policies. That applies to all policies, not just Obamacare policies from the individual or small group exchanges.
That created an incentive for insurers to agree to pay very high charges because they set their rates assuming they will get to add 15-20%. It is the equivalent of making them cost plus contractors.
Prior to Obamacare, insurers would estimate how much they were going to pay out in benefits, add a markup and then would have an incentive to negotiate lower reimbursement rates with hospitals and other providers.
If an insurer paid out more than reasonable amounts for services, it cut into their profits or caused them to have to raise premiums.
O'Care changed the dynamics. The powerful hospitals increased their charges. As long as all insurers were being charged around the same amount, they didn't care because they raised premiums along with co-pays and deductibles.
9
@ebmem, The problem could well be worse than it once was, but I doubt that it's new. (My own pre-ACA experience tells me that insurers wouldn't try to collect on obvious double billing fraud, where I'd done all the work to show them which charges were duplicates.) Allowing consumers to sue and collect for any overbilling might alter the incentives. Putting a few executives and underlings in jail for actual fraud would likewise change the way that people think about the potential outcomes.
35
Another solution, which would save patients (and they're what really matters here at the end of the day) thousands and tens of thousands, is of course to change over to a single payer system and cut out the middle-man (the insurance companies). First of all, it would stop the ridiculous practice of having to check whether someone is insured before treating them, and it would prevent insurance coverage issues, and it would stop the sharp practices hospitals engage in order to generate revenue.
35
I had to go to the ER a few years back because of a possible stroke. While waiting for the results of my MRI, I was told I needed to be moved to an actual room because my space in the ER was needed. Well aware of how hospitals game the billing and particularly attuned to my $6500 deductible, I refused, telling them to leave me in a gurney in a hallway or let me leave as I was not about to pay for a full-day hospital charge just to wait for test results. It took a vociferous argument, first with the attending doctor and finally with his supervisor, before I got my way and spared myself thousands of additional dollars in unnecessary "care."
7
This is unbelievable and infuriating! i ask myself what is an appropriate response to this dishonesty and waste. Is it possible to somehow engender honesty in all these individual players? Of course not. So we are left with a system problem. Some people believe that corruption is the inevitable result of a capitalist culture that is becoming more impersonal and corporate each year. Is that changeable? Probably not. So i ask myself, " what is changeable?" I think the way we finance healthcare is our only chance. Financing through a single-payer mechanism would not eliminate all fraud, but it would control costs better than our privatized, fragmented system currently does. It works in other countries and I think it is time to give it a shot.
318
@james binder, MD
Unfortunately, Dr. Binder, it is all too believable. And, yes, it is infuriating. It is infuriating to realize that the rest of the world figured this out a long time ago. It is infuriating to know that the American political and economic system has not a clue about how to change this outrageous situation. Most of all, it is infuriating to realize that the solutions are all there in plain sight.
33
@Jeff Laadt Yes the solutions are obvious. Corporate medicine is a fraud.
11
@james binder, MD ,
Yes, the best medical service in the world (They tell us). They mean it's a money-maker, a one-armed bandit.
8
It is surprising that Elizabeth Rosenthal says overcharging and outright fraud is "legal". Actually, it's not. The cases have just not yet resulted in written legal opinions. When patients countersue for overcharging and fraud hospitals settle quickly. I know of only one case out of Colorado where a patient counterclaimed on an outrageous bill, and there the jury returned a verdict that the patient only owed Medicare rates, i.e. actual cost.
The reason these charges are not legal (apart from the obvious illegality of fraud) is that these are unconscionable contracts. In contract law, if one party has all the power, and charges an exorbitant price, that contract is unconscionable and unenforceable. That's why hospitals, when pressed, settle; they know they will lose. All the rest of the time hospital officials insist on treating medical bills like regular consumer debt (as if your husband had chosen to have an accident) and they send patients to collection, sue them, and most don't know their legal rights.
Beyond fraud, and beyond unconscionability, is a blatant breach of fiduciary responsibility. This responsibility is recognized in Canada but not yet in the US. Breach of duty is also based on the extreme imbalance in power, where the hospital owes a duty to look out for the patient while he's scared, in pain, or unconscious on a gurney, which includes refraining from price-gouging.
Please let us all begin to more seriously question the legality of all this misconduct.
856
@Sherry
The credit reporting agencies and the rest of the monetary system are all in on these scams as well.
70
"The cases have just not yet resulted in written legal opinions."
As long as the stolen Court is not widened, to dilute and ultimately remove vile-GOP influence, we should be glad they haven't.
Fear every appeal that makes it to the nine.
38
@Sherry
I see your point.
And it is true that the hospitals and centers often back down when confronted with a knowledgeable person who has good legal advice.
Of course, first you have to be knowledgeable and be able to afford said legal advice. The system is certainly set up to deny easy access to information.
I think, in the end, this will continue on--possible changes to public options or single payer notwithstanding--until those who do it are identified personally--not as entities of organizations--and threatened with jail terms for such fraud. Not with fines, as these organizations have deep pockets and would look upon such fines as the cost of doing business, but with jail terms.
In this sense, the health care establishment is most like the banking industry--no one there goes behind bars for perpetrating fraud, either. This needs to change--in both realms.
51
We’re retired and now living in Spain. We have private healthcare insurance as a condition of our residence visa. We pay less for coverage than our employee share when we worked in the US for a good sized company, and it has only been raised by a modest amount as we have aged. We always thought we would go back to the US if either of us got sick. But when it happened, we realized how much better off we are here. My wife has Ovarian Cancer. Her care here has been professional and caring. She’s being treated with the same recommended platinum treatment as in the US, as confirmed with our oldest daughter, an Internal Medicine Doctor in the US. She’s had hospital stays twice, has had too many procedures to count, and we have yet to have any issues with authorizations, surprise charges or outrageous bills.
Our co-pays are reasonable and have been consistent. We pay about $15 per Oncologist or other Doctor visit. We paid about $30 as our co-pay for genetic testing. We have been to the hospital ER room a few times due fever, but have never been charged more than a modest co-pay. For every visit, every blood test, Chemotherapy, CAT Scan, X-Ray or other procedure, we get a medical report, yes, in Spanish, but we have had no trouble tracking co-pay charges, and we have yet to have any billing issues. A question or two, quickly answered, but without any contested issues. Our Spanish friends tell me they are happy with their national healthcare system. Our US health system is broken.
369
@Ron Adam Thank you, absolutely broken and mostly because of greed. Whatever happened to do no harm? That should be emphasized both as a medical and financial imperative.
28
@Ron Adam
Sounds quite similar to the system here. Had we been living in the US while my wife was fighting cancer, we would have been left homeless from the cost. That does not happen here, and everyone can get treatment if they have a national health card.
41
@Ron Adam I can imagine that stories like these strike fear in the hearts of the insurance and medical industries in this country. If only we could persuade the majority that there is indeed a better way!
31
I went to pick up a walker for my mother at the local drugstore. The price was $25. When I mentioned it was for my mother who was on Medicare, the drug store told me not to buy the walker at their store, but to go to the local medical supply store and it would be covered by Medicare. It was, which I thought was nice until I saw the fee that Medicare paid for the walker, which was the identical walker but now cost $200. Multiply that by every walker, cane, commode, shower chair, wheelchair, scooter, etc. that could easily be purchased at a Walmart or Amazon, but now the government is paying the medical supply store 5-10 times the price. Whenever I get a phone call asking if I need a back brace or see a commercial for something that “may be covered completely” by your insurance, I think of all the waste and abuse that goes on. The ACA, by mandating coverage for items and providing them at no cost to the patient, seems like a great idea, but when you look at the number of brand new breast pumps for sale on line that are automatically provided to nursing mothers (whether they want it or not) at a cost of 8-10 times what they would cost without insurance coverage, you have to wonder how a health care system can survive. It really is frightening.
264
@Debra Salman The bill show $200 for the walker but trust me the government is not paying $200 for that walker it is all negotiated down
16
But the government is not paying $25 either.
20
Yup. Way down.
Medicare knows exactly what an appropriate billing is for such equipment and doesn't easily fall for those scams.
7
Thank you, Elisabeth Rosenthal, for helping me organize my outrage that still roils in me 5 years after my daughter’s multiple breast cancer surgeries. We’re a college educated family, my late husband a physician, my daughter a contract attorney, and despite our best efforts, the tangle of insurance absurdities was the most stressful part of the ordeal we faced. Besides the unidentifiable and inexplicable costs, the double-speak and contradictory answers offered by billing offices at every level still haunts me today. How do people sleep at night, when their jobs are to convince others they’ll be cared for, yet knowing their “helping hand” is to overwhelm vulnerable patients with confusion and fear – all for the bucks that line corporate pockets. Face it, America – our health is a corporate commodity to be traded among shareholders, and the sicker we become, the more ‘robber barons’ will prosper. Blessings on those with the compassion to honestly care for patients despite the vicious fraud of the industry.
639
@Betka
And some are saying we should not have Medicare For All because these insurance company workers who design their trickery, who deny claims, who use intentionally confusing language, who produce inflated bills, might have to find another job.
I just thought of something. They can all work for a Trump business.
49
@Betka
They sleep at night because they need that low paid job and are doing what they have to do because its company policy.
The people who make the policy sleep at night because they are "good businessmen" who are making profits for the corporation. If they don't come up with ways to profit the company, they're out.
They sleep at night because they're major shareholders and executives of highly profitable corporations who believe their PR departments protestations that their goal is helping people.
21
@Just Thinking’
Have another thought. The billing described here is indistinguishable from the way traditional Medicare handles billings. They use the same process as the private insurers, although the price controlled prices are lower. Traditional Medicare keeps their overhead at a reported 3% because that is how much they pay the contractors to process the bills. But they pay for services never rendered because the contractor gets paid its 3% whether the charge is appropriate or not.
Those insurance processors aren't going to lose their jobs under Medicare for all.
9
I came home from the hospital after a nine day stay. Much of this column sounds familiar. I came to the conclusion that many of the staff were doing excellent work but no one was taking responsibility for the treatment. Like working on an assembly line, a worker installs a part but no one can take credit for the finished product. I was asked my name and where I was at least 20 times. Someone took blood 6 times. I was served kosher food though I've been an atheist for 50 years for all this. I can't for the life of me think of the reason. but I'm sure the cost of the action will appear on the bill. The hospital will submit that bill and the insurance company will negotiate and I'll pay a relative pittance but the whole system is broken.
The Affordable Care Act was a politically possible start at a solution. The Republicans seem to ignore the problem and the Democrats aren't offering anything that will see the light of day. We will continue with this broken healthcare system. As I like to say to anyone who will listen, The U.S. has the best healthcare in the world until you have to use it.
1
A candidate who promises to pay for my vote and includes a cash incentive to stay out of the hospital is long overdue. Democracy died a long time ago in this country.
2
My daughter did bloodwork at Chop and was billed $1,000 after discounts while the same tests at labcorp cost us $50
2
Everybody who underwent surgery or spent some time in an Emergency room for a life-threatening condition can tell the same stories: billing by physicians the patient never saw or who did never saw his/her medical records, pills charged hundred of dollars. After knee replacement surgery, an unknown doctor prescribed oxygen at home, which was totally unnecessary. It was a fight to get rid of this cumbersome equipment, that was never used, but was billed over $1000 for staying a few days in my home!
2
And as you and others below cite, what's billed is not what you pay. So, the patients do not get all worked up. This is the dark side of 3rd party reimbursements. And one of the reasons for the inexorable expansion of health care costs. No insurance scheme by itself, even Medicare for All will solve this. And there are reports out there that 16% or about 1/8th of the economy is health care related. Talk about an intractable situation.
4
Thanks for the excellent article Dr. Rosenthal.
I see it as an excellent example of what happens when we let capitalism run amok in our government, and how lobbyists work for medical professionals and how the medical industry works for lobbyists.
As you point out, no one is working for the patients. We are in a Kafkaesque nightmare of bureaucracy. Surely, if Kafka were alive today in America, he would write a novel titled Emergency Room, that creates the same surreal, unreasonable, inhumane, etc, ... narrative that Joseph K. underwent.
8
Medicare whistleblowers keep fraud in check and may receive 15 percent to 25 percent of whatever money the government recovers if the government joins the case and up to 30 percent if it doesn't.
If the medical provider scams its other patients the same way, the amounts can be substantial.
3
My partner was in amin for a major hospital. On a specific day of the week (let's say every Thursday) a certain department would have a mandatory lunch meeting attended by physicians, dietitians, physical therapists etc. Sandwiches and sushi would be provided. An employee would then arrive with a stack of patient files and each patient's name & profile would be quickly read. A question would be asked if there were any recommendations. At that point, whether or not there were any comments- each professional in the room (regardless of whether or not they'd ever seen the patient) would get to individually bill for a group consult. These files would often be reviewed at under 3 minutes each, and often there were no comments by professionals involved. The most scam part is that only patients who had Medicaid were in this group of patients who got this "group consult" service. Whistle Blower attempts to higher ups and governmental officials were not heeded. Nobody seemed to care.
14
Whoa!! Just goes to show that any system based primarily on profit, especially a vital one that people can;t do without, is prone to corruption at all levels, unless closely and properly regulated and observed. In most "civilized" countries, high-quality medical care is considered a) a right that every citizen should have, and b) something too important and too much in the interest of the public good, to be relegated to for-profit, private interests who may or may not put their clients' best interests anywhere near the top of their list of priorities. In the US, high-quality health care is viewed as just another commodity, like bread, biscuits or bicycles. This fact, combined with a political system that is wide open to bribes of all sorts, leads inevitably to the kind of dissaster described in this excellent article by a "health care consumer" (aka "patient" in most countries) who was actually paying attention.
19
@Joseph Ross Mayhew
This is not corruption. It is bidness.
"Nobody goes through a major medical intervention without all this." I did (see my comment below). I think the US health care system has been using the bleeding regimen on its patients far too long. A radical change of approach is needed. Just take wholesale anything from Europe -France, Germany,especially UK, and your costs will halve.
14
So sad and so true. At best one must hope they have an attorney in the family. I pay a fortune monthly on premiums and live in fear of needing to use it..
7
I'm not sure what the complaint about the neck brace is.
(1) Was the concern that it was not medically necessary/appropriate?
(2) Or, was it just too expensive?
(3) Or, was the concern that it was disposable (vs. cleaned/sterilized and used again) because that was cheaper even though it _might_ have a larger environmental impact.
(4) Or (less likely), that it didn't go home with the patient?
(5) Or, something else.
1
I think the good doctor was saying that the entire billing process, not just this one part, was a pain in the neck. You may have missed this point.
18
Ridiculous overcharging, if nothing else. Unbelievable that this can go on, when medicals is the primary cause for personal banktrupcies.
@Bob Richards
The hospital charged much more than the object was worth and much more than it paid for the neck brace. Similar to the charge of $40 for Tylenol [cost $0.10], $500 saline solution [$0.50], $10 small box of USSR grade facial tissue [$0.25] or $25 disposable water pitcher and drinking cup [$3].
Eighty percent of hospital supplies and materials are purchased by four group purchasing organization allowed only in the hospital industry. The monosomy practices drive down the priced hospitals pay for goods and services, which the hospital then marks up far in excess of any justification.
1
Been there, done that, and my bike crash resulted in much worse injuries.
Appalled by the fraudulent billing I recieved. Never would we, in a group medical practice (Saranac Lake, NY) have done anything like this. What an eye opener!
I even contacted my Medicare Advantage carrier to tell them not to pay the outrageous $800 bill from a hospitalist who barely entered the doorway (yet prescribed medicine which would have resulted in my death within 20 minutes had I not refused).
Thanks for this column.
37
@Richard P. Handler, M.D., Was the hospitalist charged with attempted murder?
2
And this is why most of the medical establishment, in addition to the insurance industry, is against single payer health insurance. Right now, hospitals can ply three-card monte with insurance companies and most fo the cost gets passed to employers. If the government is the only insurance company, these games get a lot tougher to play.
18
@Bill
Check out the hospital bill of a Medicare beneficiary and you will see the same excessive charges.
Hospitals claim that Medicare reimbursements only cover 90% of the cost of care. But the Medicare reimbursement rates are 150% of what a Canadian or IK hospital would be paid for the same services.
The hospitals use the "low reimbursement of Medicare" to justify cost shifting to the privately insured, who they bill prices that are 200-300% of what a Canadian or UK hospital would get as revenues.
Did you follow the news with respect to Senator Menendez and his ophthalmologist buddy? Menendez tried to get Medicare to "help" his buddy get higher reimbursements. And it wasn't even illegal for Menendez to accept gifts from his buddy, since there was no quid pro quo as defined by the laws passed by Congress.
It is an absurdity to even suggest that the big medicine cronies are going to get less money if the government becomes the single payor.
Think it through on a rational basis. When Delta Airlines buys an airplane from Boeing, do you believe they pay $50,000 for toilet seat or wrench? But the US military does when they buy a jet. That's because the government is the only payor for military equipment.
2
Insurance coverage is a loose term in this context. Most other countries of the world have single payer systems, and they're typically much less costly, fare more efficient and show better treatment outcome. Private enterprise and profit is indeed part of the problem.
3
Airlines buy their jets on a free market. Healthcare is nothing like a free market. You have no choice but to pay for it. No choice as to when you will get sick and what with. You can’t compare prices and shop around. You have to make decisions when you are sick and not thinking well. That’s if you are even conscious. People are scared for their lives. They have you stuck and they know it. So it operates nothing like a free market and will never operate that way. Single payer isn’t perfect ( nothing is) but right now we have a system with millions uninsured and underinsured and we pay more than anybody else. Something needs to be done.
1
I have 50 years experience in the auto repair business.
Charging for the least expensive part or service without prior customer authorization is strictly forbidden. Admittedly, there are many facilities that ignore that, but when challenged are forced to comply.
The medical industry needs to be forced into honest practices. Medicare for all would be really cheap if the fraud was eliminated. Handled correctly, it would be a net financial gain for most.
34
I have been a physician for over 40 years, serving as a clinician, researcher, teacher, administrator, and scholar. In the last year both I and my wife have undergone major surgeries, so I have seen this from all sides. This story is so typical as to be tedious, were it not so tragic. Nobody goes through a major medical intervention without all this.
So much money is being expropriated by so many powerful interests that repair by market forces, even if they existed, is impossible. We must necessarily pursue a gradual approach, if we are to have any reform at all. But know this full well: this fraud can only be abated from the top down. If not single payer, then a regulated utility model. Sorry, libertarians, but this is too big a war for private armies.
73
@Realist
It would be beneficial to introduce price and quality, essential to a free market. Most medical services are not emergency services. If most people paid for their routine and predictable care, out of pocket, they would be motivated to seek out quality providers who offered affordable services. And there would be providers of information like a Consumer Reports for Medical Care that would provide quality and price data.
For the unexpected emergency requirements, people would have high deductible low premium health insurance and the insurer would stand between the willing buyer and the potentially exploitive provider.
Intervention in regulating and financing of health care by the government has caused opacity of cost and quality to increase at the demand of the big medicine cronies. Every increase in involvement moves us further from a free market and increases inefficiency.
High deductible means those who can’t afford it will put off care until they are really, really sick
2
I am a retired family doc. I never charged for services that I did not provide. Guess I went into the wrong specialty.
21
I have received continuous treatment, now follow on treatment, for my stomach cancer over several years and which, in the early stages, resulted in a gastrectomy. I was treated in University College London and followed on at my local GP practice, with regular check ups by the head of the hospital gastro surgical department. I am now clear of cancer. I am well, but of course lack a stomach. I run several times a week, but having been a sportsperson (20 years of rugby took its toll) I do so gently.
Overall, I was overwhelmed by the quality of care I received and the attention by staff.
How much did this treatment cost for all the superspecialist to more mundane types of care, including drugs?
NOTHING. Thank you National Health Service. This is precisely why it is loved by the British public. Over more than 3 years I have never seen a bill not the hint of a bill. I have been treated with kindness, compassion and skill by all professionals.
I should say that I am very familiar with the US health care arrangements, having studied it (in New York) as part of my doctoral research. Over the years since, as this report shows, it has gotten worse for is billing and poor performance; it now appears more or less a money making scam.
And yet, it appears that anyone wanting to improve it is denounced as a wild eyed radical. The USA, I submit, is in a dark and difficult place. Dear Americans, who I regard as my friends, you have my deepest sympathy.
79
@G Rayns
Thank you, we need it.
4
These practices are not new either. Over 40 years ago I fell on the ice in NYC and went to the Bellevue ER with a comminuted (“pulverized “ —ack!) bimalleolar ankle fracture. I was in the hospital for 10 days, had surgery to fix the fracture, and received morphine injections every 4 hours for a week. I never saw a bill or statement of any kind and that horrified me. My insurance company could have been billed for brain surgery and I wouldn’t have known.
7
The cat had a blockage in its sinus causing us to seek vet care for it. The choice was scoping or an MRI. The MRI lab gave us an itemized estimate showing the cost of the procedure, plus the costs of some other procedures that might be used depending on what they found.
I've had several MRIs. To this day, I couldn't say what they cost. I paid a copay. The insurance company paid the rest.
Moral: if you want to know the true cost, tell them you don't have insurance.
Of course, that's impossible.
We're swindled by the insurance company and the medical providers, even as hospitals close and md pay decreases.
Just be rich and everything will work out./s
9
As if this weren't enough, medical providers have turned local courts into collection agencies to exact payment for these fraudulent charges. Once a court judgement is on the books, the patient's credit is ruined.
28
Thanks so much for writing this out in detail. I am right now trying to decipher all the flurry of bills from my mother's recent hospitalization (Medicare and supplemental). This article helps me through the minefield.
Also, it fills this lifelong single payer advocate with rage. Why do we Americans put up with this? This is our health at stake. We have falling life expectancy among many groups. I pay through the nose each month for insurance, only to be one of the "underinsured" who dare not actually seek actual treatment for fear of co-pays I cannot afford after paying through the nose each month for insurance. What a racket it all is.
44
@Duncan
Medicare is single payer. Medicare for all is not going to reduce the billings paid, it will just eliminate the 20% co-pay your mothers supplement is covering.
When I was overseeing my mother's Medicare plus supplement billings, she was billed three times for cataract surgery despite the fact she only has two eyes, She was billed for two office visits by a specialist, one for a comprehensive exam, one for treatment despite the fact that she spent ten minutes discussing her condition with the specialist. He never touched or treated her and his staff did not even take vital signs. When we protested the second visit treatment charge to Medicare, they said they'd already paid the bill and it was too much trouble to collect the excess $250 [discounted from the non-Medicare $350 charge.]
If she were a Medicare for all beneficiary, what are the odds the doctor wouldn't have billed for a third visit. And how many 85 year old Medicare beneficiaries are former welfare examiners and have a daughter who is an accountant.
2
@ebmem I favor expanding the VA healthcare system to create a US version of Britain's NHS -- not "Medicare for all". I realize you are arguing against the current healthcare proposals from the Democrats, but there is more than one kind of single-payer healthcare.
I don't favor expanding Medicare because it is a fee-for-service system that is riddled with fraud, and has learned how to co-exist within an ecosystem of massive profiteering and flim-flam (the private healthcare system). There is really no way to reform this; we need a clean slate.
Thank you Dr. Rosenthal. You are certainly among the most important medical journalists today.
One aspect of the health care system that is blatantly apparent from this article is the widespread ineffectiveness of health insurance companies in controlling costs. Many insurers have devolved largely into marketing operations that also happen to aggregate people into risk pools, passing along cost increases to the policy holders.
The fee for service reimbursement system is clearly too complex to effectively administer. Furthermore, with the consolidation of hospitals and physician practices in many markets, health insurers have little negotiating power.
16
@JAH
Why should insurance companies control costs? Their profit is derived from the costs--20% of the total.
6
@JAH
Obamacare improvements to the system increased costs. Medicare for all would not eliminate hospital billings that have no relationship to the cost of services.
1
Costs have been riding for years. I doubt increasing costs are solely because of Obamacare.
This experience mirrors my own. And I agree with ACA's suggestion that these outrageous billing practices have much to do with enriching the top handful of executives in these hospital corporations. They are often not to the patient's benefit and they don't benefit the nurses, aides and other people on the front lines who actually deliver most of the care.
The American health care system is legalized theft, not just fraud. And despite the enormous sums spent, Americans are less healthy than many of their developed-country peers. This is yet another urgent issue -- like climate change, gun violence, etc. -- that our government does nothing about, year after year. It's a pitiful state of affairs!
41
Despite being both relatively healthy and a physician, I have been through enough "Are you kidding???" billing episodes to appreciate the tale being told here.
I would note, however, that at least in Rhode Island, despite these billing practices, the largest hospital system just reported an operating loss of $35 million (https://www.providencejournal.com/news/20191204/lifespan-reports-35-million-loss-in-2019-ceo-says-layoffs-last-resort) and other systems are hardly pictures of financial health. Some of that is supporting fantastical salaries -- in 2917 the three highest paid executives made nearly $5.7 million; one surgeon made over $1 million. (https://www.rifuture.org/ri-nonprofits-paid-11-people-more-than-a-1-million/). For what it's worth, the median home price in RI is about $300,000; this is not about the cost of living.
However, I would re-direct the emphasis here. Even if insurance pays a fraction of these bills, it raises the price of insurance. To stay solvent an insurance company has to charge enough in premiums to cover the costs of care to the covered and its own overhead. Premium costs come out of everyone's pockets -- they are a de facto tax since everyone either has, or should have, health insurance. The costs ultimately become a cost to businesses paying insurance for employees and are often huge expenses for people on limited incomes, who if ill, can't afford to forego insurance.
Everyone pays for this, not just the sick and injured.
34
@ACA Your post begins to address the question foremost in my mind, which is, Where is all this money from fraudulent overbilling going? But even multi-million dollar salaries for top executives and physicians don’t seem as though they would account for all the money collected from overbilling on the massive scale Dr. Rosenthal reports.
6
Somebody somewhere is getting very rich off this.
1
As a physician and a patient, I completely empathize with your situation. You’re completely correct, almost every situation mentioned easily qualifies as outright fraud.
One point that I wish the general public would appreciate is that the physician is not the beneficiary of such immoral practice. Of the thousands of dollars charged to a patient in your husband’s circumstance, the physician will see far less than $1000.
Physician compensation has been cut year over year on two fronts. First, hospital systems have been negotiating successfully for a bigger piece of the pie, to the detriment of the individual physician. Secondly, local physician groups have been gobbled up by big national groups which in turn are owned by private equity firms. The Wall Street firms seek to earn a return on their investment which translates into a cut in physician pay.
This is precisely where physicians of all stripes especially their professional organizations have completely failed. Instead of advocating for their patients’ financial health and for better compensation for themselves, they are endorsing the position of the same hospital systems and private equity firms that are robbing physicians. We are being asked by our professional organizations to lobby against surprise billing. I myself and many of my colleagues have voluntarily withdrawn our membership to such organizations and I would urge others to follow suit. It’s immoral and tarnishes our field.
49
@A Doctor I don't understand your response. You state your professional organization is asking you to lobby against surprise billing. Isn't that a good thing? We don't want surprise billing, right?
But then you say you and others have voluntarily withdrawn your memberships in "such organizations."
So, I am not being hostile, am just learning here, but why would you withdraw from an organization that opposes surprise billing?
4
Thank you so much for carefully setting these problems out in straightforward language. Following surgery in 2016, I was bombarded with mystery bills my insurer would not pay. I panicked and put everything on my credit card--at 23% a.p.r. Now, I'm 33k in debt and shuffling that load from one 0% balance transfer offer to another. Add in being unemployed for a year as result of a medical condition, and I'm looking at bankruptcy within the next 3 months.
21
Believe it or not, in this instance, I feel bad for your credit card issuers. You should have left the bills with the hospital who ran them up. Since you live in Texas you have Homestead protection on your house. Filing a bankruptcy will wipe out the debts. Gives you a fresh start. If you struggle with the debts collecting in your name your credit standing and your cash flow will remain worse than if you get the burden relieved in the federal bankruptcy court once and for all you owe. Call an attorney, it may cost $1500 and it’ll be done.
3
@H.M.
It is unfortunate that you put the charges on your credit cards. When the debt is discharged in bankruptcy, the credit card company will take the hit and the hospital that may have overbilled you and/or the insurer that failed to pay charges that may have been legitimate get to skate.
2
Yet why can't the democrats communicate these severe issues clearly and concisely to moderates and those on the fence? Poor messaging, plus most of them are in bed with the medical industrial complex anyway.
16
@Joe Arena Elizabeth Warren and Bernie Sanders talk about health care abuses frequently and vehemently. Perhaps you think their message isn't compelling?
5
@Joe Arena what is the reason - or evidence - behind your statement "most of them are in bed ... "? If you have evidence, then please cite it. Otherwise it looks like lazy cynicism, of which we all have too much already. I'm not defending any party here - just reason, and the diligence to understand facts that is crucial to the democracy the founding fathers gave us.
Yup, the for-profit health care industry is a sham, a scam, a series of flim-flams. I mean, at this point, how many articles like this have we all read. The only folks supporting these practices are rich doctors and hospital execs. It really makes me wonder why people aren't ready for Medicare for All. So scared of change that they will take the abuse or is it Stockholm Syndrome? I can't tell.
26
@Doug The industry is very good at hiding the extent of their fraud from most Americans. It's only those of us who are actively dealing with the system (for ourselves or loved ones) who really see behind the veil.
12
Not just Doctors and Health Care Execs. What about all those people, usually ‘pink collar’ administrative workers, you see in doctors’ offices and hospitals and insurance companies who do the paperwork on inflated billings ? Their paychecks depend on it. And the entire set of insured persons who do not care that somebody else is picking up the tab.
2
@Doug The dirtiest word in the English language for conservatives, Republicans, Trumpistas, etc is "socialism." Anything they don't like gets called socialism and its then dead in the water. Apparently, somehow Christianity and socialism are at completely different ends of the socioeconomic spectrum to these same people. Socialist ideas are also anathema to them because they sometimes embrace the community over the individual which should never happen because that might bring about the end of the NRA. Finally, I think they think hypocrisy is a good thing and means intense love of Christ.
No, this type of fraud is not legal and if involves Medicare billing it is a serious federal crime. All of these types of charges should be contested if you have reason to believe they are fraudulent. Now charging more than what you might pay for a given medication is not fraud. But being billed for unprovoked services is fraud.
8
@T Smith People recovering from major medical episodes and the family members busy caring for them might understandably lack the energy and resources to contest fraudulent charges. Something more needs to be done.
8
I’m so not surprised. I worked for a major insurer for 32 years. Billing practices - and how insurers interpret, review and pay the bills - are mind boggling. So much fraud and waste.
20
One of the biggest rip-offs, which is only briefly mentioned here, is how hospitals bill outrageous prices to patients who don't have insurance companies to negotiate for them. I'm not talking about what insurance companies actually pay for, but rather the negotiated prices a patient benefits from just because he or she has insurance. Supposedly non-profit hospitals may bill unfortunate uninsured patients (the patients least able to afford their care) as much as 5 or more times what they negotiate with even the most generous insurance plans.
16
They do. Before the ACA I could not get insurance (preexisting condition) and I got gouged for my care. It’s really bad because usually the people who don’t get their insurance through work don’t have well paying jobs in the first place, so they have fewer resources to begin with.
18
Funny thing is the medical industry and hospitals have a euphemistic term for this greed and fraud...they call it "Revenue Management."
Find me another successful healthcare system that operates with teams of MBAs and Private Equity goons working in back offices determining how to overcharge patients...I'll wait.
11
As a retired R.N. who has worked in various venues, including UTILIZATION REVIEW and MDS, I can state with unequivocal confidence that insurance medical billing is a gigantic scam, with insurance companies being the beneficiary..
It is geared to :
1. Denying the patient benefits whenever possible, and
2. Creating financial barriers to effective treatment.
And when benefits are granted, the spigot opens wide for corruption and abuse by unscrupulous medical practices, especially billing for private insurance.
This is why Americans have undecipherable medical bills.
I can barely decipher them, and I am nurse!
What chance do the rest of us have?
47
@BJ Kapler "What chance do the rest of us have?" - No chance until those who know that such fraud is being committed, join together, and take a stand to stop it.
1
As a Orthopaedic surgeon, I think the trauma activation fees are a necessary evil. They don’t apply to me, but to the general surgeons, anesthesiologists, respiratory therapists and other allied staff who drop whatever they are doing during the day or night to go down to the ER when a “trauma activation” is called. Trauma care is often uncompensated and money losers for hospitals.
2
@Craig in Orygun The hospitals funding models are clearly flawed. Astonishing that Americans seem incapable at looking at systems in other first world countries, all with universal health care which is provided at a far lower percentage of GDP. In Australia medical health professionals are rostered on call for emergencies and are paid an extra amount per hour (a 'loading') only when they are called in. These costs are included in the universal health care provision of emergency medicine such that the 'trauma activation fee' is an unknown concept.
16
Just imagine what this does to somebody making $8/hr. There’s gotta be a better way of paying for this without bankrupting people.
1
I do wonder if we made the hospitals sue to get paid like that, would they be able to make the charges stick in front of a jury... I see no contract between the parties that authorizes those charges...
18
@abh You are right. A jury would not like this and would very likely find against the hospital for a money judgment.
However, it's not that simple. Your lawyer would need to file discovery motions to help obtain evidence; she would have to retain expert witnesses in medical billing, fraud, perhaps other areas; the hospital's insurance company's large law firm on retainer would file dozens of motions, employ delaying tactics, depose your experts, find experts of their own for your lawyer to depose, etc
Three or four years later, you will get your trial. It will be costly. If you win, the insurance company for the hospital will file an appeal. Appellate briefing moves slowly. More time will pass. You will or will not eventually win. And, of course, your lawyer(s), the experts, and the court costs, must be paid.
This is why so few people actually go to civil court for remedy. The hospital will provide a wall of lawyers. It will take years. Even if you prevail, you don't.
I know this because I am a trial lawyer who has seen it. I don't support it, but that is how it works. There is a reason why Shakespeare's quote, "First, let's kill all the lawyers," is so popular.
3
American corporations and the sociopaths on Wall Street - with the ignorant, stuck and/or willing participation of every one of us- have succeeded in monetizing every aspect of our lives: our education, our homes, our health and our well being. Life is not about Making the Most Money from Everything. Life is about caring for each other, raising the next generation and making sure nature survives- and creating an economic system that functions within those life affirming values, rather than destroying them. We love to think of ourselves as successful but we are actually very very sick. And the state of our “health care” shows it.
55
This piece strikes a responsive chord with my experience as an investigator of doctors in California. My tenure as a fact finder happened during two different administrations whose ethical policies and practices differed diametrically. One that emphasized no regulation of fraudsters and one that did. It brought home to me the importance of who’s at the top of the regulating body. And how their political beliefs can negatively impact patients and their families financially. It would improve the situation if the oversight of doctors by lawmakers was enhanced and the violating doctors were disciplined more swiftly and heavily than now. It would also help if doctors who served in government agencies were legally prohibited from being able to retire to private high level positions in insurance companies - a current reality that is unethical and may be a catalyst for fraud.
21
My head was nodding faster and faster as I muttered uh-huh, uh-huh to myself over and over and Over again to myself. The rage from hospital sticker shock is familiar to all of us.
We all dread the inevitable headaches and anger caused by each and every hospital visit, whether it's for delivering a baby, stitching up a cut, or dealing with a cancer or a heart attack.
I can't help but think that if Universal Healthcare was in place in the USA, such billing assaults would be significantly reduced.
Let's do it. Make healthcare an affordable right.
43
If you think this is back, you should see the fraud that takes place in mental/behavioral health. Someone should look into that.
No matter the condition of the patient, they are typically recycle in and out within a few days since admitting and discharge services are financially rewarded by insurance companies.
8
Where to begin....where to begin.
Thanks, Dr. Rosenthal, for this succinct, entertaining insight into what is probably the biggest problem with the delivery of medical/health(?) care in America today.
After nearly 20 years as an ER nurse, I wound down my career in healthcare as a hospice nurse, spending much of my time the last couple of years arguing with hospital and ambulance billing personnel over the charges for our patients. Probably my favorite fight was the bill of over $120K for a cardiac pacemaker. The lady had cancer, yes, but not of her heart (among the rarest of primary cancers). Turned out there was another patient with the same (first and last) name in the hospital at the same time who, I assume, did receive an implanted pacemaker,but didn't have cancer. (And this was in a community with a population of about 35,000. What are the odds?)
These billing notices are fired out willy-nilly, mostly without the input or interference of human thought, as is intimated at by the "auto-fill" feature of hospitals' billing software.
As a side note: The hospital where I was an ER nurse covered the weekend shifts (the busiest) with MDs from the Dallas area who were in residencies for things like cardiology or anesthesiology. I routinely followed behind one of the cardiology docs tightening and re-tying his sutures for minor lacerations. Great in a heart attack, but the guy couldn't tie a square knot, let alone any of the routine surgical closures to save his life.
20
A great article and overview of what should be regarded as systemic fraud.
My own experience was a surgeon billing for a second hernia procedure after cutting me open on the wrong site the first time. The doctor admitted his error to me, took full responsibility, but nevertheless billed for the do-over surgery—coding it as a follow up “correction” needed at the first surgery site.
I reported these false circumstances and the nearly $8,000 in bogus billings to my Medicare Advantage insurance carrier. The insurance company had already paid the bills and didn’t care. They said it was up to me to push back. So I sent the doctor a letter requesting full refund of all billings for the second surgery—or face a claim of malpractice for wrong-site surgery and Medicare fraud.
The doctor complied. It was gratifying. But none of this should have been necessary! Patients shouldn’t have to be the regulators. And the insurance companies shouldn’t be enablers, in the end profiting from their share of a healthcare industry that grows bloated in dollar volume via falsely inflated billings.
The millions of similar stories like this about specious medical billing paint a picture of a borderline criminal enterprise driven by unregulated greed. We must scrap our current healthcare “system” and go to single-payer universal healthcare—with regulation and accountability.
58
@Steve McNutt
If anything, Medicare and Medicaid have yet less QA checks than the private insurance companies. No matter how many years in jail people get for Medicare fraud, this fountain never dries...
7
I am not sure, my experience tells me that the private insurance just don't care - they will get paid through increase premiums and deductibles.
9
It is a mistake to think that insurance companies are in business to save money for the policy holders. Insurance companies are really finance agencies. Your bank lends you money for the things your need, like a home mortgage. But apart from (usually) wanting to be confident you can and will repay the loan, they don’t care how expensive your house is. Your insurance company (auto, home owner, health or life insurance) finances your cost of risks that are generally unlikely to occur, such as a car wreck, a house fire or even death If your car or house costs more your premium will probably reflect that. But your insurer has no real interest in reducing the cost of cars or houses or health care. Their concern is to price the risks correctly so as to make a profit. Of particular importance in health care insurance is the obligation to pay for medical services based on the prevailing prices. Of course there will be some who try to deny legitimate claims thereby putting some or all the insured loss back on you! I see that as a form of cheating.
So whether doctors or hospitals are charging too much or using billing practices that would strike ordinary people as either duplicative, deceptive or outright fraudulent the problem is too complex for simplistic solutions like single payer or Medicare for all. And needless to say, any crackdown on fatcat hospital systems and medical practices is bound to generate huge political opposition. But we certainly need a crackdown!
4
Thanks for this article. Insurance companies are the favorite targets for our rage. But the medical establishment is just as bad. But for some reason we are afraid to take them on.
19
I live in California and I am a member of Kaiser. I've had two major surgeries that cost me about $200 each, though Kaiser listed the actual cost as about $70,000 per surgery. Kaiser is the best health care I've ever received in my life - they are available 24/7 and I never see bills anywhere close to what this article relates. I don't understand why Kaiser isn't the model for health care in this country.
18
@J.Sutton
I’ve had Medicare Advantage with Kaiser for two years now. Fortunately no serious medical issues, and I’ve been quite happy with Kaiser so far.
4
@J.Sutton You must have an excellent policy. As do I (medicare and medigap coverage). Most of the working people I know have much inferior policies, with high deductibles.
4
And the worse your job, usually the worse your policy is, if you are lucky enough to get anything at all. High deductibles a low wage job = forget going to the doctor.
2
Then there is dental insurance, another scam. Allowable costs are limited to "usual and customary" rates, which sounds reasonable. But the insurance company's "usual and customary" is about half of what is actually usual and customary (this is in St. Louis, a low-cost area). If you ask what they think is usual and customary they refuse to tell you. You only find out after you or your dentist has submitted a claim and they underpay.
13
@Jonathan Katz
I would also include the outrageous charges many dentists charge for their services as compared to dental services in major European countries.
4
Yes, dental insurance is almost useless. I got a $90 bill for an extraction that they refused to cover a year after the fact. I dread going for the root canal I need because I know even with insurance it’s going to be more than I can afford. Trying to save up money for it but every time I get a little set aside I end up having to go to dr for something else, that wipes out my savings & I’m back to square 1.
1
United Health Care got sued by New York state for that legerdemain.
2
Ms. Rosenthal, if you haven't been showing up to vote in every single election, and to vote for whatever politician is calling for a single-payer system, you are now reaping the consequences. (Single-payer system is a highly efficient and effective way of delivering medical care, minus the thousands of for-profit middlemen. I know. I grew up with the truly brilliant NHS in the UK. My family still lives in the UK, and still continue to receive top notch care within that system--for major, advanced care as well as for snuffles and sprains.)
The same is true for every other reader on this thread currently expressing outrage over this fraudulent rubbish that passes for healthcare in this country.
17
@EB
Though the NHS is suffering under Tory cuts. It seems conservatives the world over hate having healthy people.
1
To whom was this article addressed? Is there anyone in charge of this system? Maybe the medical schools, which are creating the means to perpetuate this disaster, have to step in. Don't the schools teach the most basic son - do no harm?
3
My mother has lived all of her life in the UK. At the age of 80, she got breast and lung cancer, which spread to 2 ribs, her chest wall, and collar bone.
She was taken into hospital immediately. Her breast was removed, as was part of her lung. Her ribs, collar bone, and part of her chest wall was also removed and rebuilt with a medical concrete. After the surgery, she was in the hospital for 9 weeks, getting great care in a private room. After her discharge, visiting nurses came to her house twice a day for a couple of weeks and then, for another 3 months, aides came twice a day to help her bathe, dress, and cook. Her many medications were prepared, sorted, pre-packaged, and mailed to her, so she didn't have to figure out for herself what to take when. All of this was done on the National Health Service. How much did my mother have to pay for this? Not one penny, not even for the meds.
That was 2 years ago. She's now in relatively good health, although very breathless. A couple of weeks ago, the surgeon called her to ask how she is. She mentioned being very breathless still. He immediately enrolled her in a gym that specializes in people with breathing difficulties. She attends twice a week. How much does she have to pay? Not one penny.
All of her life, a small amount of money (relative to the huge sums Americans pay for health insurance premiums) came out of her and my dad's paycheck toward the NHS. Now that she's sick, money is the last thing she has to worry about.
94
Normally a free market will help prevent this sort of over-billing. A mechanic who was only open six hours a week, and demanded emergency rates for working any other time, would not last long in the marketplace.
But medicine is not, and never can be, a free market. Free markets exist when the purchaser can realistically refuse a good or service. But if you're wheeled into an ER still unconscious, you can't refuse whatever services they provide. If your insurance only works with one of the three providers in your area, you're cut out of the market.
The UK spends far less than we do per person. They live longer lives. America deserves lower costs and longer lives. A National Health Service would go a long way for that.
26
@John Schwartz And in fact we do have one of the largest UK-style systems in the world: Veterans Health Administration. I've long thought that, rather than trying to unpack all the fraud in the current system(s), we should simply expand on the VA system to become our very own NHS.
7
Thank you for hi-lighting this highway robbery. Real people like me are getting robbed during broad day light.
Recently, my wife had a minor surgery. I received a bill from an anesthesiologist (separate from the hospital), to pay my portion of the bill. It looked too high. I contacted the company that sent the bill, they refused to give me more details (how long the anesthesiologist was there etc.). I talked with the insurance co., they did give me the name of the doctor and the 28 min he spent (~$1,800). They told me that, I was also charged for his assistant for the exact 28 min duration (~ $1750). I was shocked to learn that both rates were very close, even though the assistant did not have a MD degree. I eventually, connected with the an Anesthesiology group who had sent the bill to insurance co. and me. It seems the anesthesiologist supervises multiple patients at the same time, while his assistant remains in the operating room. I protested that how can the anesthesiologist charge me, for the time he is not there in the room. And the fact he might be billing multiple patient for the same 28 min he was supervising. The Anesthesiology group told me that the insurance company paid it, and thus this is correct billing and I must pay my part.
20
@Cincinnati Incredible!!! No other profession would allow an individual—regardless of their title and years of experience— to bill for treating two or more unrelated clients simultaneously. Why should anyone receiving medical care from an intern be charged for that individual’s supervision? That must be paid by the hospital that is reaping the benefits of having interns to providing services.
That your insurance carrier did little on your behalf is not surprising either. I was once double billed by a cardiologist. She submitted two claims for one procedure; she billed for it on two separate dates. When I informed my insurance of the doctor’s error they said there was nothing they could do. I was stupefied! The cardiologist refused to refund my insurance for the monies she received too which made me suspect she double billed on purpose. Her office stated a few times that I should not be concerned because my insurance already paid and that it did not cost me a penny! The audacity!
I contacted the attorney general in my state. His office sent her a letter and she promptly cut a check that she mailed to me and I submitted to my health insurance. Health insurance companies tolerate doctor’s playing around with CPT codes and other forms of fraud.
I monitor all my statements of benefits like a hawk because we’re all being all circled by vultures who want to feast on us when we are sick or vulnerable!
13
@Cincinnati Free market could work - it's the hidden nature of what's being billed on the back end that causes this fraud and higher cost. It's the only industry where they're allowed to roll up charges after the fact and you had no idea what was going to be on the bill. It makes matters worse when in-network hospitals team up with contractors 'out of network' like an anesthesiologist operating independently that end up hitting you for huge rates since they're work is not covered. Here in Texas, we're fed up and trying to fix it, but even that falls a little short.
https://www.dallasnews.com/business/health-care/2019/08/19/texas-legislature-s-fix-to-surprise-health-care-bills-still-leaves-millions-vulnerable/
Up front disclosure of the costs of these procedures would put huge downward pressure on prices as providers compete, and insurance companies and patients alike can be a part of the voice of reason when a specific 'splint surgery' is listed for 300 bucks.
1
Free market will never work. You can’t just walk away if you are really sick. You aren’t going to be able to shop around while unconscious. That’s if there is any competition. Live in a rural area you might only have one provider within a reasonable distance.
2
It should be duly noted that corporate hospitals have systematically bought or competing with private physician offices with an army of administrators and managers - and ultimately what the administrators Say is what happens. You can blame the doctors all you want but in the end the doctor is the rich guy but the hospital system and administrators are wealthy. Not to mention a lot of hospital systems have stock options traded on Wall Street - so private investors and fund managers are also part of the deal.
14
@Anonymous Thanks. You have helped to answer my question about where all the money generated by this outrageous overbilling is going.
BCBS of IL paid for my broken ankle twice. I changed orthopedic surgeons after my first visit. The first doctor charged in full for 6 weeks of treatment that I didn't receive and I couldn't get his billing office to make a correction despite telling them that I would report fraud to the insurance company.
The insurance was billed $2,800 and I had a $1,000 deductible. I waited three weeks no correction was submitted. My insurance paid the first doctor's $2,800 bill, I didn't get billed my deductible, and the insurance was also paying the new doctor.
I call BCBS's fraud department and explained that they paid twice and I couldn't get the first doctor to refund the insurance. She said "There is nothing I can do about it"!! She told me that they had a contract with the doctor and were obligated to pay whatever he billed. I couldn't believe it.
15
So much of outrage when people don’t have a clue of what happens in the trenches of medicine. Everyday hundreds of American hospitals, mostly the academic ones treat thousands of extremely sick patients who don’t have insurance and don’t pay a cent into the system. As a surgeon I have done hundreds of procedures over the years where the patients or Medicaid has paid next to nothing. However, if there was an error we would have been sued for a million bucks. Additionally, we teach the next line of physicians and surgeons. People that will take care of your kids and your grandkids. Most importantly the bills that hospitals send out get reimbursed for 1/4 the amount that was billed. It’s a sort of a game which hospitals on one side and the insurers and the government on the other, play with each other. There are all kinds of intangibles that happen in hospitals that do not get billed like multiple phone calls from patients etc and valuable time is spent, teaching and mentoring the next generation of clinicians etc. These are people that devote a lifetime to learning.
Money has to be collected somewhere somehow to keep these hospitals running. Should waste be controlled?.yes. Should hospital administrator salaries be capped? Absolutely. But this animus needs to be restrained. Watch as hospitals shut down as the clueless rooftop screamers cuts their noses off to spite their faces when there are no hospitals and no quality doctors and no quality nurses in the trenches of medicine
7
@Purple is the new red and blue Ooooh, I am so sorry that you suffer the angst of the hard-done-by surgeon. Yes, there are all sorts of things wrong with the system. The greatest thing that is wrong is that it is based upon an expectation of "profit." That, and the notion that too many MDs are attracted to medicine because, to quote a famous bank robber, "that's where the money is." My Ophthalmologist once told me that the difference between most Canadian doctors and most U.S. doctors is that "we (Canadians) go into it to help people, not to make a lot of money."
17
@Purple is the new red and blue - sorry, but the rest of us don't want to be caught up in your "sort of game." If other complex industries can figure out how much to charge for things, surely you can too.
I get so tired of doctors trying to tell us how heroic they are (yes, it's great that you teach young doctors and that our kids will one day get treatment), something many of them do each time anyone dares to question their practice. Sorry, but there are lots of heroes out there, and most of them don't try to bankrupt us for necessary services. Nor do they subject us to what you yourself describe as your "game" of billing us anything you feel like billing us.
24
@Purple is the new red and blue
It is one thing to charge a lot. It is another to charge for services never provided or for services billed at a higher level than justified by the actual work done. Fraud is fraud.
The only solution to this problem is to eliminate fee for service billing by doctors and hospitals with a single payer reimbursing on a capitated basis. Otherwise billions of dollars will continue to be spent on overcharges, false charges, billing itself, and administrative costs.
I am a surgeon myself and I am appalled by the financial practices I have seen in private and university medicine.
33
I agree with Dr Rosenthal. Hospitals that absorb private practices are legally permitted to charge twice as much for primary care procedures as independent physicians They are reimbursed based on hospital costs which are not related to primary care. Furthermore they are gobbling up primary care and specality practices to control market share. We need complete transparency for hospital charges and a single payer system which will reduce those charges.
20
Let’s not forget “upcoding” where a 5 minute appointment mostly with a nurse for a minor problem becomes an in depth assessment and treatment of a severe problem requiring the doctors attention. The chart entries (pre EHR) were fiction. My insurance company did not care, nor did the State Board.
Billing staff are sent to classes to learn how to do this so it isn’t a secret.
We’re not patients to be served. We’re revenue sources to be monetized and maximized.
26
In the early 80s there was a big push by companies to cut their medical costs. One of the initiatives was to reduce billing errors. Employees at large corporations were encouraged to review their itemized medical bills and report errors.
I can't remember the last time I saw an itemized medical bill. It's been at least a decade. The insurance companies contract with the medical providers and billing goes directly to the insurance company.
7
Quite a few commenters are pointing out the illegality (fraud) of the practices described in this excellent article. Are any DAs or their staff reading this? Or anyone looking to run for DA or AG in some jurisdiction? Maybe corporate medical fraud should be the next target for progressive elected state attorneys.
18
Thank you for writing about these issues. It's completely absurd that any of this is legal here.
An additional frustration is that medical professionals, and hospitals in particular, generally will not tell patients how much a procedure, office visit, or test costs before asking the patient to agree to it. When considering knee surgery recently, I asked the surgeon whether the cost of the procedure would be closer to $1,000, $10,000, or $50,000. He replied he didn't have anything to do with billing and couldn't tell me anything at all about how much it would cost. It took me a month of calling numerous different offices in the hospital to ascertain that the implant the surgeon had recommended would cost $20,000, and would not be covered by insurance.
I believe most doctors are good people who care about their patients' health. But our health care system desperately needs improvement.
20
@Eric
You were lucky to be told what your surgery would cost.
I was in a similar situation years ago, when two different specialists told me I needed a spinal procedure, a fusion.
Our local hospital in Vermont would not tell me what this would cost me, and I had limited private insurance As it turned out my insurer hadn't "contracted" with any Vermont surgical centers either. So there would be no discounted price, just the full rack rate.
I had gone to Canada, to a top notch hospital in Montreal for a second opinion. The Neuro Surgeon I saw there was so alarmed by the numbness in my legs, that he wanted to schedule the surgery in a week. As it turned out, the US practice wouldn't move even my pre-op date up, and the Canadian hospital told me up front exactly what the cost would be.
I decided to have the surgery in Montreal, knowing the cost up front, and my private insurance paid all the costs less deductible.
6 months after the surgery, I had to return for a followup visit for a CT scan. The cost? $140 Cdn.
21
On 1 occasion, I was billed for an ENT consult. I chose not to have an invasive exam he suggested, and I had not asked to see him, but the hospital sent him in to see me
2. On another occasion, my insurance covered an xray for my daughter. I called to tell them she had not been xrayed, their response was basically, well, you dont have to pay anything, so why do you care.
Finally, my doctor, medicare and I went round and round for 2 years following a fall and severe sprain. They gave me a needed ankle brace Medicare fully cover 10 sessions of PT but decided the brace had been fraudulently billed. I would pay to protect my credit score, call Medicare to get them to pay, receive a refund from the provider, only to have Medicare withdraw them payment, prompting a new bill from doctor The third time around Medicare told me it was too late for me to appeal. I told them that if they wanted all the previous paperwork, a copy wwould also be going to my Congressman. They paid (for now)
9
Unfortunately, America has become the country of scams.
Amazon and who knows how many other big companies pay no taxes, toss off their employees on the public welfare system, and ask for more tax breaks.
Banks regularly scam their customers... why is Wells Fargo still in business and not prosecuted under RICO?
Internet companies spy on us and sell our personal information.
The list goes on.
So why are we surprised that doctors are scamming us?
It’s not a promising future we are creating...
33
America's medical pricing system is tantamount to the only restaurant in town serving mortally starved patrons and providing them with a menu with no pricing and when the exorbitant bill shows up it includes many items you never ordered, received or recognize while still expecting a tip in appreciation for saving one's life.
As the saying goes, "if you have to ask, you can't afford it." And there's the rub - only a tiny few can afford to live (be medically saved) in America's Republican healthcare plan, filled with profiteering lobbyist gouging plans - fraud and all - that are bound to make everyone sick.
23
I think one of the most unjust parts of this organized swindle is the exorbitant prices charged to those who can least afford it. Those without insurance, and the “negotiated rates,” pay the inflated list price costs with little hope of recovery.
41
Yes. I was shocked by this when I was uninsurable because I was a preexisting condition. Obamacare for all its faults at least fixed that.
4
Now I understand why Trump has not produced his health care plan yet. He's discovered that the one that we have has been made Great already !
7
I agree totally with the fraud and scam of the system, but I am confused--and a little frightened--when you detail all these excessive charges and yet still say you have "great insurance." If this nightmare happened even with "great insurance," then God help anyone who doesn't have it.
27
This article explains the real reason why the "we can't afford it" arguments against Medicare-for-All makes sense. It's because we are being ripped off. All other economically advanced countries can afford it, and spend much less than we do with our crazy system. It's a scam, and a fraudulent one at that!
It is time that Bernie and Elizabeth and the rest begin explaining why our healthcare system is so expensive and how this has to be changed- as your article does. No matter what system we have, without any financial controls we will still have a mess. Hospital administrators should be in jail, rather than in their corner offices.
The good news is that if we get one government regulated system, such as Medicare, the government can negotiate with providers from a position of strength. And if medical school is free (or costs are contained), doctors won't have to charge a gazillion dollars to pay off the exorbitant costs of their education.
Yes, we have the best system if your sick- and loaded. For the rest, let them go bankrupt.
24
A FRAUD IS A FRAUD IS A FRAUD! A FRAUD BY ANY OTHER NAME WOULD STINK AS BAD! If I were presented with such apparently fraudulent billings, I would contact my attorney first, then begin sending out form letters notifying each provider by name that I was making a complaint against his/her/their license for fraudulent billing. Along with making complaints against the medical consultants/employees of the insurance companies that sign off on such apparently fraudulent billing. The goal of such a strategy is to exert pressure on individual professionals by calling them to account for participating in apparently fraudulent activities. Using form letters and email would make the task less onerous than doing so using snail mail. But why should such steps be necessary when the top priorities for patients is to heal, not to fight fraudulent billing! It is hardly surprising that other advanced countries provide excellent care that is less costly. Because they're NOT permitted to engage in fraudulent billing
13
Most people don’t have the resources to do that. And the insurance companies know it.
3
It is fraud, and it's unconscionable.
Let's take a look at insurance company profits, the healthcare lobbyist community (and the politicians who cater to them), and the growing industry of health insurance billing.
Much as those parties might deny it, it's all about making money off the backs of those who are sick and suffering.
It's time -- or way past time -- for America to catch up with every other first world country and provide single payer healthcare.
Eliminating the middlemen will make healthcare cheaper for us all.
15
For profit healthcare is organized crime against people who are not well. HCA frequently is busted for coding fraud, denies and settles, repeats. Rick Scott as CEO presided over one of the largest Medicaid frauds in history, outdone only by subsequent crimes.
18
An example of chicken or egg here, but let's take this drug, Epidiolex, a CBD based medicine that helps prevent severe epileptic seizures in children. The amount of CBD in this drug is 100 mg per ml and the cost is $32,500 a year. Now the same amount of CBD one could purchase in that amount would cost around $150 or around $1,800 a year, depending on the weight of the child.
Why would the company who makes this drug charge that? Probably because they know they can get the insurance middle men to pay a good portion of it.
Bottom line, this country needs to wake up and go to single payor. Hospitals, pharmaceutical companies and other providers would be forced to negotiate with Uncle Sam. Imagine the buying power of the U.S. Government when negotiating with drug companies and hospitals. Let the private insurance companies compete or cease to exist, it's the free market after all.
16
The price is kept artificially high by the fact that cannabis is still illegal federally and in many states.
This article needs to be widely circulated. Send copies via certified mail, return receipt requested to all our Senators and Congressmen. I too am appalled at what I call "Ghost Billing". More and more private medical practices are affiliating with Hospital Chains. When I see my doctor and do not actually go to the affiliated hospital - I see charges to Medicare and to my Medicare Supplement by my doctor or specialist, then bills from the hospital sent to my insurance provider. To me, that appear to be double billing/ghost billing if you will. Insurance pays a vastly reduced amount, I pay the remainder. But, I suspect that the hospital writedowns are written off on earnings reports, and the hospitals continue to call themselves "non-profit" organizations.
13
There's a really simple solution to all of this - take the profit incentive out by adopting a federally mandated, single-payer system like the rest of the world has. A friend here recently had a lengthy surgical procedure followed by 10 days in hospital, 2 days of it in critical care, and follow up bloodwork and PT for the next several months. He's out of pocket less than $2000.
21
@expat That does not necessarily mean there is no fraud, it just makes the cost invisible. I am German, and while we don't have a single payer system we have something pretty close to it. My wife is disabled ever since some routine surgery went wrong. Health insurance rents her wheelchair for some 2000 Euros every two years. The same wheelchair costs some 850 Euro if I would buy it, but then I would have to pay myself. The speech synthesizer our previous speech therapist wanted to play with cost 8000 Euro( it's a Samsung tablet computer that retails for 350 Euro). I could buy software that does the same for 300 Euros, but then again I would have to pay myself. The humidifiers for her tracheostomy tube are seven Euro a piece - that's an inch of plastic tubing with a foam inlay. We don't see the prices until we ask explicitly. As long as everything is coded properly Health insurance coughs up for the weirdest things, and our copay is capped at 1% of our income per year (the only thing they have issues with are decent wages for nurses and, for some reason, adult diapers, which are capped at three pieces per day). I am still aware that somebody is paying for this and try to reject the more frivolous items that are prescribed, but that's work that comes with no reward, and the temptation not to give a fuck is always there (Disclaimer: our health system is mostly awesome, it's just the waste that annoys me. Also, long term care is a different system, which is less than awesome).
1
Recently I had my gall bladder removed. I received a bill for $35 from a radiologist, but my insurance company sent me a letter that the service (whatever it was) was not approved. After a few phone calls, I found that the doctor "read" my X-ray, which probably took him all of 5 minutes.
It wasn't much, considering the entire bill, but I finally got hold of that dr's office and told them I wasn't paying for something that wasn't authorized.
I won!
7
I hear and empathize with your troubles. I can assure you (whether this makes you feel better or not) that the actual doctors and nurses who cared for your husband didn’t benefit monetarily from the ridiculously-overpriced encounter (ie. They just earned their regular, fixed salary). Hospital and insurance administrators, however....
21
@GBR: that's certainly true for the nurses and house staff physicians. Plenty of the other docs, however, are deeply embedded in the scam and profiting mightily.
9
@Douglas
Well, I’m a sub-specialist physician ( > 10 years out of training) and have a fixed salary. So I guess I’m not part of the “embedded” in crowd; too bad for me and my colleagues, it sounds like.
5
@GBR: Good for you. I think that's how physicians should be paid. But surely (unless you live in a very sheltered corner of the American healthcare universe) you know that what I wrote is true: Lots of docs are participants in the inflated billing scams.
In fairness, I should note that most of the people who are really cleaning up are older than you are and were able to establish themselves in the more lucrative schemes before corporatized medicine figured out that physicians could be treated as "human capital" in the same was as any other employees.
7
This kind of thing has gone on for a long time. When I was a college student in the 1970’s, I had an IUD inserted at the University hospital. Because I was a student, I was told the cost would be minimal. When the bill arrived it was several pages long with many charges that made no sense to me. I called the hospital and no could explain the charges.
I paid the amount I was originally told and eventually I got a call from a bill collector. She said if I didn’t pay, they would come to my house and collect the IUD. I explained what an IUD was and she laughed and told me not to worry. The calls stopped and I notified the Better Business Bureau.
29
I had a similar (but less severe) event in Toronto. The ER service led to x-rays, careful examination, pain pill prescription and discharge. Under the Ontario universal single payer health care, no one sent me bill and no one made unnecessary visits. The hospital and staff are doing fine, as am I. Dr. Rosenthal shows that the alternative has little going for it.
22
@Harpo Been to Canada several times. Have made it a point to converse with locals and talk about/discuss their health care cost and their quality and efficiency of care. All love their single payer plan. None complained about waiting periods for non emergency surgeries. Yes, they pay taxes, but they also have services and meds charged at significantly lower prices. Thus the offers to consumers from companies that sell meds from Canada - at far lower prices. Something smells here.
6
As a Canadian, for decades I've had health services at "no cost" to me (I pay taxes)... eye surgery, a colon resection, ongoing stuff re: getting old. But the worst experience was on holiday in Florida. I self-diagnosed a DVT (Deep vein thrombosis) in my leg. The father-in-law's doctor sent me for diagnostic ultra-sound, then to Emergency. One hour in Emerg, 10 minutes of a doctor's attention, a round of anti-coagulant injections by a nurse, and a prescription. That was it. Total bill: $4,000. Prescription cost: $940 (in Canada, same drug, same dose and duration, $240). I said I wouldn't pay that much to the hospital: they replied that 50% would be o.k. if paid within 30 days. I sent the money.
The upshot is that the healthcare and pharmaceutical industry in the U.S. and their enablers in Congress have lied consistently to the people and have created a monster of a system.
Look to Canada. We're doing nicely, thank you, and don't listen to the people who complain that we have to wait too long for care. We get what we need: science, not privilege determines care. Our healthcare outcomes are far better on every meaningful metric.
99
It will take more than single payer. I recently had some medical issues under Medicare, and the doctors billed Medicare, and my supplemental insurer, handsomely for services I strongly suspect were not always delivered. Even though the amounts were knocked down, they were excessive, and counted on the beneficiary not to question them. It's an ongoing fraud that will only stop with a substantial number of doctors in jail.
15
But you *can* question them, and tell Medicare. I do. It works.
4
@Douglas
True,but hard to prove,I was too out of it to document each visit and what happened.
3