with a one-pill minimum.
I certainly don’t want to defend hospitals and their gross overcharges. Whatever their excuse, insurance, deadbeat patients, poor price control, whatever, they are still charging $64 for a pill that costs next to nothing to make. Whatever their reasons that is a huge markup.
That said, in the hospital your pills are individually delivered by hand by a highly educated and certified medical professional. For the 4 cent pills you have to drive yourself to the store and buy in bulk. The makeup is for the service.
Ah, yes, those people are certainly worth 1,600 times as much as all the people involved in getting that pill on the shelf at CVS.
Because it’s not a lie. The doctors’ portion of the bill is the same if they see you, write a Rx and you go and fill it or you get your first dose in the ER and then go and fill it.
Medication administration is a portion of the bill that covers the system and people used to dispense a large quantity, and wide variety of medications as safely as possible.
The first doctor was right. Antibiotics aren’t recommended after a venomous snakebite, if I remember correctly.
Next time don’t go to the emergency room; just buy the pill yourself. Think of the money you’ll save.
Regards,
Shodan
Too bad that, when the insurance company actually does pay a more legit amount, they then stick you with the rest of the bill, then.
And the $64 is not the cost of the visit. The price of pill is the cost of, at most, the pill itself, the pharmacist who deals with it, and the person who brings the pills to you. Everything else is on the bill separately.
But what people neglect is that the CVS pharmacy has all of that, too, yet they can somehow get the cost down. There is absolutely no way this isn’t just pure markup preying on people who can’t choose not to pay it. The most it should cost is the cost of going to that same CVS themselves, stocking up ahead of time, and then covering the cost of the person who brings it to you.
There is no way to defend a 160,000% markup. It doesn’t matter that the cost is low to you guys who can apparently afford to drop $64 dollars unnecessarily. (I sure as hell can’t.)
They need to charge actual costs and then labor like a mechanic does.
That’s why when I go to the ER I make sure to steal a shit ton of stuff. Like tongue depressors, those things can be sharpened into neat-o steak knives.
And that fiberglass cast-making wrap? Great party gag.
Didn’t edit in time:
See what I mean?
I.e., the same job that is already handled by a pharmacy plus one nurse who brings you the pills. Let’s be generous and give him $50 per hour. And let’s say it’s a big hospital and it took him 12 minutes to do it. And that he had nothing else to do at the time. So $10 worth of work, plus the costs that CVS already handles.
That’s still a 640% markup. Way more than would acceptable in any other situation. And, believe me, I’m being so generous it hurts. Even the highest paid nurses average only $40 an hour or so, and the one giving you your pills is probably making more like $25 an hour. And it probably takes less than five minutes to get you your pill. A more realistic cost is closer to $2. So a 3200% markup is more like it.
Except for the fact that they do ATTEMPT to get the absurdly high fees paid utilizing lawyers and collection agencies These tactics drive good working families made of real people into poverty and bankruptcy.
Something very cool and interesting happened yesterday that may help change this. Our government released a database of the fee schedules for all the hospitals in the country for all procedures. This will enable patients to actually shop for the best prices for their procedures and surgeries and will bring some competiveness into the marketplace.
The discrepancies revealed by this study are mind-boggling and it is clear that there can be no real basis for the differences other than some hospitals are price gouging. For example, the price range for the same joint replacement procedure in the NYC area ranges from $15,000.00 to over $150,000.00
My own story was a prescription for an eardrop that cost $250 for a half ounce bottle. The ONLY ingredients in this small bottle were acetic acid (white vinegar) and hydrocortisone. NOTHING ELSE.
Once I found out the price I went out and bought a small bottle of white vinegar and a tube of hydrocortisone cream, mixed them up and instantly had 8 grand worth of eardrops for less than 5 bucks. My doctor’s response was a big smile and “good for you”.
Everyone should read the article that Meatros linked to:
(here it is again)
http://www.time.com/time/magazine/article/0,9171,2136864,00.html
Once you read this you will realize that a lot of these charges such as the one the OP complained about are unfair and consist of double billing…room charges are an example – the daily charge for the room is supposed to include such items as the bedding and the lamp shades but some hospitals charge a rental fee for everything in the room including the lampshades on top of the daily room charges. So while you may try to justify the $64 pill as the cost of “bringing it to you”…there are probably dozens of other line items on that bill that reimburse the hospital for the cost of" bringing you the pill" and it shouldn’t be double-billed.
That’s interesting, as I spent much of yesterday morning in ER with my son. Based on his reaction when he hit his funnybone on the moulding around the door to his room, I wanted him to get an x-ray to make sure he hadn’t broken anything when he hurt his arm at Brazilian Jiu-Jitsu the night before. He got a tylenol, an x-ray and a sling after about 3 hours - nothing’s broken, he just hyper-extended his elbow.
I have no idea what it cost, because the Ontario Health Insurance Plan covered all of it out of my taxes.
Have you ever had a hospital allow you to take your own medications? I haven’t, and I always ask. Even if they’re maintenance meds, they order them from pharmacy if you need them while you’re inside their walls, or you go without. Even when the doctor’s entered an order for the med and you have it on you. Last month my mom was at Lutheran General for a cardiac cath procedure and developed back pain 6/10 from being flat on her back for 8 hours. Doctor ordered two Tylenol PRN or PRN Fentanyl. She chose the Tylenol and asked if she couldn’t just take them out of her purse. Absolutely not, she was told.
And, really, I understand why. She grabs what she thinks are two Tylenol and they end up being two something else and suddenly I’m suing the hospital for a medication error that killed my mom. (I mean, I wouldn’t, but some people would.)
But it makes it extra frustrating to read the itemized bill, where the Tylenol are billed for many times what she paid for the bottle in her purse. A patient really is a captive customer.
I could almost beat that, except an ER nurse took pity on me and decided I’d never been there so it didn’t cost me anything.
I had a contact lens stuck to my eye. What I needed was one of those little suction cups (tiny little things) to unstick it. But I didn’t have one. And it was Sunday afternoon. (Later, Sunday night.)
I had called every eye place that was open–24-hour optical, etc. It being Sunday my regular place was not open. I went to numerous drug stores. In the old days, when more people wore hard lenses, these things were easy to come by and any 24-hour Walgreens would have had them, but in this day & age, nope.
I had also tried various things like flooding my eye with water using an eye cup and, later, a vegetable sprayer.
I debated whether to try to sleep with the thing in my eye and go in to my dr. the next morning and decided I didn’t want to do that so I went to the nearest ER and asked if they had one. They did! But they said I’d have to go through the whole admission thing if they so much as touched me. So I asked, in a somewhat quavery voice (probably), what the minimum ER charge would be, as I have crappy insurance that no longer does a copay but just adds everything up until I’ve hit some maximum, I think $5000. I said I could manipulate the suction cup myself. The nurse thought about it, told me to wait, then set down three of the things in front of me and told me, “I didn’t touch you…” I said, “Right, 'cause I was never here,” but it was kinda hard not to just HUG her.
(These things cost probably cost about five cents to make; they are still only a couple of bucks, when you can find them. The ER visit minimum was $450.)
Also bear in mind that the people who handle your insurance plan have executives they have to report to, and those executives need large salaries. The head of the hospital, who probably has no medical degree but a PhD in Public Health Management or something, also needs those big bucks.
If someone told you that what goes on behind the counter in a CVS pharmacy, and what goes on behind the counter at a hospital pharmacy are the same then you were badly mis-informed.
Because it isn’t just the doctor. It’s the pharmacist that reads the order, the pharmacy tech that fills it, the other pharmacist that checks it, the delivery person that takes it from the pharmacy to the ER, and the nurse that administers it. None of those people are on your bill.
So it’s still a lie. The pill did not cost 64.
The hospital could have a standard billing price for "daily pharmacy use", just like there is a standard charge for use of a bed in a semi-private room.
Say, 50 per day-- for what you describe as “pharmacist reading the order, pharmacy tech filling it , another pharmacist checking it, delivery person, plus nurse to administer it.” Each one of those activities takes about 90 seconds, except for the nurse who may take 2 minutes at the bedside.
This is the same as any chain drugstore, where there exact same procedures are done by the pharmacists and technicians, except that the procedure ends with the patient spending 2 minutes with a cashier, not a nurse. And CVS still makes a profit selling the pill for 4 cents, not $64.
There’s no such thing as a “daily pharmacy charge”, al least not that would be reported on a bill to insurance, nor is it 4 cents for the pill and $64.00 for the doctor. The doctor is already paid, normally on a separate professional bill.
There’s the actual cost of the items, there’s the cost of running the ER (liability insurance, lights, make up losses from the uninsured and Medicare and Medicaid patients, salaries of the people etc, and there’s the markup just in the hopes that someone will come in and pay list price and for, as Tom Tildrum noted, for accounting fantasy.
There’s always a base ER charge on the institutional bill to cover some of the overhead, but the rest is tacked on to all the other services, in ways that can seen ludicrous if you pull an example out of the hat (or a pill out of a bottle).
So what exactly is the point of an itemized bill, then?