Hospital bill $2500, insurance pays $290

[midnight armadillo]

This was for an ER visit I made in February which resulted in a diagnosis of pneumonia. It involved an X-Ray and a few hours hanging around the ER while they tested breathing etc.

The hospital billed the insurance for $2500, and the insurance paid them $290.

How the crap is this system remotely sane? If I had no insurance, I'd be out the full $2500, but yet somehow the service I received was only worth $290?! I have never understood this, and never will.

Single payer is the only way. Obama's bill will maybe plug some holes in the shit-filled dam that is the US health care system, but eventually the corrupt, ridiculous, insane system will come crashing down drowning us all in its rotted sewage.

[Echo In Light]

1. Fantastic system, eh?

[CurtEastPoint]

2. Mine... appendectomy billed at $29K, insur paid $5600

What gives, seriously? What is the real cost? How could you figure it out?

[droidamus2]

3. Sometimes

Sometimes I think the Hospitals/Doctors bill the insurance companies at a ridiculously high rate figuring the insurance companies have big pockets and they will pay it. Of course, over the years the insurance companies figured this out and realized how much it was cutting into their profits and bonuses so they decided to create their own 'cost' for the procedures (yes much lower than what the hospitals/doctors charge) and then base their payments on their 'cost'. Health insurance companies don't give a damn about you or your health they are only interested in the almighty dollar. As a caveat I think there are probably a lot of good people in the health insurance industry that sincerely believe they are helping people. It is the fat cats at the top that think the world revolves around them and their bank accounts that are screwing everybody.

[tavalon]

24. I assure you there are plenty of people in the trenches who care*

but, yeah, the fat cats don't care a bit.

*I know because I'm one of them. I've been a nurse for over 20 years and I still care.

[WCGreen]

4. I think the hospitals charge the premium price in order to write off the

difference against their profits...

At least some of that.

It's even worse with Medicare and Medicaid.

It's an escalating game, I believe, to scare the people about health care.

I think they also do this to determine people's life time caps.

I'm an accountant and have pondered this very issue many times over the last ten years or so. During that time, I have been in the hospital for over two(2) months of days and nights. A lot of that in intensive care. The bills were astronomical. But they settled for less in every situation. I paid over ten thousand over those years in out of pocket costs as well as about 30 thousand in deducted insurance premiums. This doesn't count the companies contribution.

Something is wrong with this whole picture. I wish I could understand what is going on. Just guessing but I think their is something behind that curtain beside an MRI machine.

[nebenaube]

9. typically,

There is a contract between the insurance agency and the provider. The provider subscribes to the insurer and must pay monthly fees to be a part of the provider network and to receive referrals from the network. In turn, the insurer offers a standardized rate for the procedure code, which is about 60-70% of the rate the provider normally charges. Of course, every insurer has their little tricks for delaying or denying payment so the provider loses another 20% to the billing process. The move to permit out of state competition of insurers only increases the collection costs of the provider.

Single payer would seriously streamline this process and cut health care costs by at least 20$ just by signing the bill.

[raccoon]

10. Do you happen to know the last time people's life time caps were raised?

I betcha for any ins. co., it's been a long, long time.

[WCGreen]

18. No I don't...

since I have seen the health care up close and personal and then had to deal with not only private insurance but also with medicare, I have started to think this is a cat and mouse game. Medicare says they will pay this much so the hospitals raise fees in order to recoup what is lost when Medicare cut % of cost payments.

[SoCalNative]

5. Mine: angiogram

hospital billed insurance over $18k. Insurance paid hospital their contracted rate of $1800.

[heli]

6. The plan is to impoverish as many people as possible

Drain their savings so they're kept in their place.

[Lorien]

13. And desperate to do anything for minimum wage

it's the new feudalism.

[stray cat]

7. Medicaid would pay even less as likely would even Medicare

thats why doctors are refusing patients with either one. Single payer is the way to go - but it will cost real money to enroll if you want it viable

[ThomWV]

8. And I'll bet your monthly premium was $1,000

[midnight armadillo]

23. More or less

My company has a slightly weird policy of not billing us for insurance - their rationalization is that it's the same if they pay us a touch less or we pay out of pocket part of the costs post-paycheck. This somewhat penalizes those that don't take family coverage but that's a handful of employees and they don't mind the system.

That said -the premiums are gigantic and definitely impaact the company's ability to do things like fund R&D projects, acquire capital equipment, pay us more $, etc etc. Every two years or so they're forced to roll back the coverage - our co-pays are 2-3x higher than when I started at the company 6 years ago. Out-of-pocket co-pay costs run us around $6-8k/year.

[Lorien]

11. My last visit to the ER: $8,500.00. Insurance paid ZERO

because they said that the ER was "out of network" (it's the only ER in our city). I pay for my own insurance, and I suspect those people forced to purchase the insurance they can afford via the mandate will find themselves in the same situation; paying out and getting zip in return for it.

[Lurks Often]

16. Then a file a complaint with your state DOI

You should contact your state Department of Insurance (or whatever your state calls it) and file a complaint.

[Odin2005]

12. K&R. Healthcare is a FUNDAMNETAL HUMAN RIGHT.

[Lurks Often]

14. It's simple

The $290 that your insurance company paid is the negotiated amount that the insurance company and the hospital agreed upon. Depending on the hospital and the insurance company, every year or every couple of years the hospital and the insurance company get together and renegotiate how much a procedure will cost, how much a standard room costs per day, how much a ICU room costs per day, etc.

And the reason I know this is because I spent about 5 years loading hospital contracts into the computers for one of the major insurance companies.

I still see hospital contracts on a regular basis and one of the things nobody ever seems to address is the ever rising costs of what the hospitals and the doctors charge.

[Vinca]

15. This is exactly why health care costs have skyrocketed.

Next time, in an effort to get more from big insurance, the hospital will up the ER fee substantially. Of course, they'll bill the uninsured for the full cost even though it is a ruse to get big insurance to pay.

[babyblonde]

17. same thing happened

to my friend who pays 500 bucks a month,for that kaka!:mad:

[ericinne]

19. guess that means

I guess that means when your policy says 80/20 coverage, it means you pay 80%, they pay 20%. ;(

[grahamhgreen]

20. It will be WORSE if the Senate bill passes!

[Bryn]

21. Maybe they should regulate hospitals as well

I've seen, I've heard ... hospitals overcharge. Many of them outrageous. I've heard that they charge $5.00 for a couple of aspirin tabs they give you while you're in hospital.

[Celebration]

22. here is how it works

The insurance companies try to rip off the hospitals and doctors by paying low rates. The hospitals and doctors have to make up for this by ripping off the patients. End of story.

Edited to add: Now that we don't produce much in the USA, most of the money made is by scamming each other, whether it is Comcast nickle and diming its customers, making billing "mistakes", or banks charging exorbitant amounts for various things, or hospitals jacking up fees for the uninsured.

[Cal Carpenter]

25. Second hand anecdote

Birth control pills (I'm doing this from memory of a rant I heard a few years ago so I could be off but the point is still made) cost something like $33 for a month's supply, her insurance gave her a $30 co-pay and wouldn't allow more than one month filled at a time.

So they paid $3 of the $33.

That's messed up.

[Change Happens]

26. My example: Hospital bills $27,000.00, the insurance company pay $4700.00. All this without me

not even being admitted to the hospital, not even one night...I was there for hours, not 24 hours, actually less than 12 (emergency room), they ran a bunch of tests...etc. All came out negative, there was nothing wrong with me!

We now have a different insurance company, recently I had blood work done, billed amount was $169.00, insurance company said it is $17.63 AND they charged it to me/towards my deductible!!! I called and started yelling at them for making me pay the $17.63, the lady's response was look how much we saved you, then I said you take my $763.00 a month premium and now you pay NOTHING/zero...etc. You fucked me and the lab and kept the money, she had no answer!!!!

Bottom line: they squeeze the hospitals, labs, and doctors, they charge me the rest toward my deductible, yet they keep all the premiums as PURE profits!!!

Last year, they increased my rate by 27%!!! I called them, brought up the HC debate, told them that's why I hope President Obama puts all of you mother fuckers out of business! Explained to them why I support his efforts, the best day for ALL Americans is when they all health insurance companies are gone. I told the young lady I will be voting in every election for people who want to take them on...etc. I kept her on the phone for an hour...

PASS THE DAMN BILL!!!