Astonishing hospital costs

In My Humble Opinion (IMHO)
#1

A couple of months ago went into the hospital for some major back surgery, and went home on the third day. Fortunately, Medicare and my secondary insurance will pay for almost all of it.

I received a statement from the hospital today listing all the charges, and I see why Medicare is in trouble, as well as everybody who has or does not have insurance when I peruse some of the charges. The total was $23,881.77.

I understand that most hospitals are making only a minimal profit, if any at all, and are in financial difficulties. However, even so, some of these are outrageous.

The room charge is understandable, i guess, at $2,310 as is the cost for the OR and some other things. However, I shudder at some others. I was in the Recovery Room for about an hour, and the very attentive nurses kept checking me, but nothing really was done until I was taken up to my room. The cost: $892.

Radiology, I don’t understand, as had all the CT scans and X-rays done before, but I suppose they did some during the surgery, but the cost was $1,303.

Here’s a good one, Physical Therapy. The afternoon after the surgery, a PT came and had me do a few exercises, and walk around the room. Total time was about ten minutes. The next day she came back after I had done the exercises myself, and walked me around the halls for about another ten minutes. That cost $823!

“Supplies,” whatever that was other than the dressings on the incision, was $1,077. Huh?

Drugs. OK, they had me on several painkillers day and night for two days (I went home on the third day before taking any). Unbelievable total for that: $2565!

The service was excellent, even the food was good, and everybody was outstanding in their help, concern and treatment. However, I can see now why the health care system is in some serious trouble. I have to wonder if Medicare ever peruses these charges and questions any before just going ahead and paying them. Certainly, there is some room for wonder about many of these.

Ah, well, I am fortunate that it was all paid and that I’m recovering on schedule.

#2

Your OP makes me wonder how these same items are priced in the UK and Canada. Not what the specific prices are, but what market forces are at work to “force” prices to stay lower.

#3

I work a radiology clinic billing office.

If that’s a bill from the hospital that $1,303 might represent the entire radiology bill — both the technical portion (the technician, the use of the machine, etc) and the professional portion (the reading of the film). If you’re looking at the EOB or Medicare Summary, that might only represent the portion which your insurance was billed for.

A CAT scan might be about $500-$800 or so, and an X-ray about $50-$100.

Of that $1,303, I expect Medicare would pay only about $250.

#4

Hospitals aren’t shy about admitting that they mark these items up. They do it because when an uninsured person needs treatment, they have to treat him too even though they’re not going to get any money from him. Your bill is based on the fact that you are subsidizing the care of the uninsured that hospitals are legally required to perform. Sen. Obama made this point in the most recent debate.

Put another way, the mere existence of uninsured people makes health care costs go up for those of us who have some ability to pay.

–Cliffy

#5

Well presumably when the physical therapist, for instance, came in, she explained what services she provided, and that they cost $823, and asked KlondikeGeoff whether or not he (she?) would like her to proceed. So one can’t really complain about the price, when it’s stated up front… Right?
Right?

#6

**Fish **touched on this, but Medicare has set amounts it will reimburse for various things. What the hospital bills for and what Medicare (or private insurance) pay are two different things. So they don’t so much scrutinize individual bills as set caps for procedures. Here is a link with some examples: http://www.fernoperformancepools.com/reimbursement.html

In addition to indigent care, the hospital also has to roll malpractice insurance and all other adminsitrative costs into all of its billing somewhere.

#7

FWIW, I had major back surgery in 1990 and my total from ONE doctor (I had 2 doing the actual cutting and fusions) was $80, 0000. For one. The other was something like $25,000 and that doesn’t count tons of other charges. I still breathe a sigh of relief that I had just started working at a job with insurance. How could I have even paid 1/4 of that as a 20 year old? Crazy.

#8

My edit timed out, but I wanted to add that Medicare is not generally considered to even cover the hospital’s full cost. Hospitals need to find someone else to bill to make up for low reimbursement from Medicare/Medicaid patients: “In 2005, Medicare paid Wisconsin hospitals only 78% of the cost of caring for its beneficiaries.” http://findarticles.com/p/articles/mi_qa5426/is_/ai_n21398442

#9

KidScruffy, in theory that might be admirable, but in practice it’s much more complex.

The physical therapist would have know the ins and outs of every patient’s insurance coverage. “My services are $844, and your insurance will cover 80% of the allowable amount, which is 80% of $680, and you have met $192 of your $500 deductible, so you will have to pay $136 of the $544 which they would have covered in addition to the $164 which they don’t cover, not counting the contracted adjustment of $408 for the hospital being a preferred provider, assuming of course that your insurance agrees that the exam was medically necessary.”

Furthermore, the last thing most people want is for their doctors to be sitting around in their offices going, “What’s the most expensive exam we can do that their insurance will cover?”

In a perfect world, the doctor would recommend only the exam that he thinks is necessary and right and the insurance company would agree. That doesn’t happen.

#10

Huh? That’s some presumption.

None of the services I received, or I ever heard of anybody receiving in a hospital, are optional, or are the costs given to the patient. The therapist came in, told me she was going to have me do some exercises, and proceeded. Perhaps you misunderstood and thought I was talking about outpatient PT afterward, but this was during my post-surgery stay in the hospital.

The only choice I had during the stay was what to order on the food menus. :smiley:

#11

I’m going to further refine this answer to point out that the physical therapist may often have no idea the extent of the work she is about to do, how well the patient will respond to treatment, how often (or how long) she must assist the patient, for how many days, or whether there will be any additional costs. (For instance, a physical therapist may need to provide you with weights, stretchy bands for exercise, orthopaedic insoles, or whatever.)

Asking them to walk into a room cold and, before seeing the patient’s condition, to quote a price? I don’t see how. Hospital ≠ McDonald’s.

#12

Back in '04 , I was in a near fatal accident. 2 months in the hospital, Massive blood use (89 units), induced coma,ventilator,8 surgeries, etc.

$850,000

That was just the main hospital, I did not see the cost of the rehab hospital or the cost of the surgeries, doctor visits and such post-hospital.

#13

If we’re gonna compare medical bills you should hear about my kidney-liver transplant.

#14

The worst part of all this is that insurance companies and hospitals both have a major stake in keeping prices high, at least on the surface. Insurance companies know that the higher the prices of hospital care, the more people will demand health insurance and the greater amount they can charge for the insurance. The more people have insurance, the less important it becomes to them how much each procedure is going to cost. I’ve never seen a price list for various surgeries (other than cosmetic surgery) so who knows how much it costs for an appendectomy? I’m also pretty sure that hospitals own stock in insurance companies and vice-versa, so the money we pay to hospitals or insurance companies is just moving around a little bit.:slight_smile: Sort of like a shell game.

#15

No they don’t. They just have to say what they charge. How much, if any, is covered by insurance is the patient’s concern.

#16

As I have pointed out, “how much they charge” is not a flat up-front fee. All kinds of caveats are involved.

#17

Sometimes it’s the other way around

hosp: the bills 100$
medicare: We’ll pay you 75 cents on the dollar, and we’re >60% of your income stream, so you’ll take it and like it.

fastforward

hosp: the bills 125$

lather rinse repeat. Careful documentation in order to justify ourselves to Medicare is a constant thorn in our side

#18

I got an itemized bill from my chemo doctor with a $25 charge my insurance didn’t cover. I was going to pitch a fit about it, until I started reviewing the bill.

My Neulasta shot, which is 6mg, costs $7300!

I thanked Og for full time employment and insurance and wrote my $25 check with nary a peep.

#19

I know what you mean. I had emergency surgery back in March to fix a sudden-onset incarcerated inguinal hernia. I was a little irritated at the $720 that was made my responsibility, until I compared it to the $18,000 I wasn’t paying.

#20

I live in Alaska & had to travel to Illinois for four days of training. I developed a SEVERE case of too-much-earwax-in-both-ears … couldn’t hardly hear a thing & was obviously walking around in a fog. had to be taken to the emergency room to get my ears cleaned out. (If I couldn’t hear the lectures, what good would the training have done???)

I was billed $821 !!! Yikes!!! OTOH, the doc said it was the worst case of wax buildup he’d ever seen & it took quite a lot of irrigation & probing. Painful.

The bill is being disputed.