This seems awfully dismissive considering the fact that hospitals pursue payment of these absurd “list” prices using the full force of the courts and the law.
I just got the itemized bill from my 93-year old grandmother’s most recent hospital visit. She is diabetic and takes long-acting insulin every night which a caregiver (that would be me) administers from an insulin “pen”. The pen contains 300 units/mL and she gets 30 units daily at bedtime, so each pen lasts for 10 days. The pens come in a box of five and each box retails for approximately $300. So the retail cost per pen is $60.
The hospital refuses to allow us to bring a sealed box of the pens from home to give her when she is hospitalized. Instead, they charge $384 per pen (which contains 10 days worth of insulin), BUT they administer the 30 units each day then discard the pen 90% full!!! She was in the hospital for four days and there were three charges for $384 each for the freakin’ insulin!
Medicare and her supplemental/Part D insurance refused to pay for them…and so did I! I sent them an invoice from my local pharmacy with a letter from the co-owner/pharmacist stating that the retail cost is $60 and since they chose to only use 10% and then waste the rest, my grandmother only received $6 worth of insulin per day. I told them if they wanted their $18 for it, they should try to rebill the insurance companies…
If they want to pursue it legally, let 'em go for it! Her SS check is barely enough to cover utilitiues, prescription costs, doctor co-pays and the premium on her Medicare supplement policy. My parents and I pay for her groceries, home insurance, home repairs (new roof & new A/C last year), property taxes and anything else that comes up. We spent almost $23k out of pocket just in 2012…
Her house legally belongs to me and my parents and she has no other assets or savings, so there’s nowhere for them to collect the money from, even if they could…
In a market economy, the true cost of anything is whatever the market will pay.
Now, what is the result of that when the consequences of not buying that good or service is a slow, painful death?
If you want to move healthcare outside of the market economy, that is the discussion you should be having. Not one arguing about markup on a pill.
Hospital billing needs to be a lot more transparent, is what I’m getting out of this. And agreeing with.
The thing is, the requirements for safety and infection control make this a totally false equivalencey.
I got to work today and there’s a new sign posted on the suture cart to remind the physicians not to multi-dose the vials of lidocaine they numb you with because doing so is a 10,000$ fine.
Beelzebubba, would they let you take the other 90% home if you asked? How long does the pen last once it’s been used once?
I’m thinking the OP had a line item bill that listed the pill at 64 dollars and I’m pretty sure there are other charges that cover all those people.
So 64 dollars FOR THE PILL. Plus $$$$$ for all those other people.
Don’t forget the waiting for two or three hours. I mean, that musak you are hearing isn’t free either.
Once the insulin pen is removed from refrigeration and opened, it is good for up to 28 days. But I just realized they were doing this when I got the bill.
My grandmother also has glaucoma and macular degeneration. She uses two different prescription eye drops that are also very expensive. They used the same bottle of those for for the several days that she was there, unlike the insulin pen. They left them in her room on the counter. When we checked out, I casually dropped them into my messenger bag and brought them home rather than leaving them to be thrown in the trash.
As they were getting her into the wheelchair to roll down to the patient pick-up area, I was rushing out the door. The car was parked in Siberia and I knew it would take me several minutes to get out there and drive back to the pick-up area. The discharge nurse called out to me as I went down the hall and asked if I knew where the ‘prescriptions’ on the counter went…I just locked eyes with her, tried to fight back a grin and said, “It beats the hell out of me, it’s not my job to keep up with that stuff…”
Her insurance paid for it, I’m taking it home! And I dare anyone to try and stop me!
In the words of dearly departed Whitney Houston, “I can be GHETTO when I want to! You KNOW that NOW!” :dubious:
It’s also ridiculous that they bill $64, but Medicare would only ‘approve’ $8 or less and the rest would be adjusted off the bill. Other insurance would pay a similar amount to Medicare and the balance would also be adjusted off. But an uninsured person could actually end up paying that entire $64 for it!
I need to rant for a few moments (I apologize in advance to the OP for thread-jacking, but I’ll try to make it brief)…
As I stated earlier, my grandmother was in the hospital for just a few hours shy of four complete days. But the hospital considered her an “Outpatient” claiming she was under “Observation”??? We were in a private room, had nurses attending to her, doctors making rounds, shitty food from the cafeteria three times daily…just as it has always been in the past for Inpatient stays. No one bothered to mention that anything was different this time.
Again, I only learned this when we got the bill and Medicare denied coverage for over $6000 of the $23,642 charges billed. Her secondary coverage refused to pay on the charges because Medicare denied payment on them.
Inpatient hospitalization is covered by Medicare Part A and it pays 100% after an annual deductible (a few hundred bucks) is met. Her secondary BCBS policy pays 90% of what Medicare doesn’t, so it covers all but a $50 or less of the deductible.
But Outpatient hospital treatment is paid by Medicare Part B. It has a higher deductible and then it only pays 80% of the charges. Her secondary doesn’t pay ANY on Outpatient. Medicare also refuses to pay for Insulin and certain other drugs they consider to be “self-administered” if you are considered an Outpatient!
Why would they code the claim as Outpatient and get paid less than they would for Inpatient? It defied logic, which is the norm for medical billing and insurance claims! It took days of research and countless phone calls to finally figure it out.
Medicare started reviewing Inpatient hospitalization claims much more closely over the last few years. They started kicking back claims that they didn’t consider ‘medically necessary’ and hospitals got paid $0. So any claims that aren’t CERTAIN to be paid as Inpatient (medically necessary), they submit as Outpatient to at least get some payment! But they also leave the patient with a balance of 20% plus a higher deductible and other unpaid line items! Even worse, if the patient required treatment in a skilled nursing facility after leaving the hospital, Medicare wouldn’t pay if it was considered an Outpatient stay!
Medicare refuses to define a specific time limit for an Outpatient “Observation” period. They say it should only be no more than 48-72 hours, but that’s all the do…say it but don’t make it legal!!!
Luckily, I have a friend who is an Elder Care Attorney and she deals with Medicare, SS and unethical medical billing practices all the time. She sent a letter on my behalf (since I am grandma’s Power of Attorney) and suddenly the entire balance was gone! She also told me how to make certain that it doesn’t happen to us again, but most people aren’t as persistent as me (once I sink my teeth in, I’m not letting go until the problem is resolved or one of us is dead) and they don’t have a great legal mind at their disposal.
Almost 30 years ago I told anyone who would listen: “You really want to help the uninsured? Start by passing a law that they get the same prices insurance companies get.”
An answer was “That would be restraint of trade.”
– 
:smack: Almost any health insurance or pricing-related legislation is restraint of trade.
It amazes me how different Health Insurance and Property & Casualty Insurance are from one another! I am actually a licensed P&C Insurance Agent in the state of Georgia, but Health insurance is a mystery to me…and that’s the way they want it!
But the baffling thing is how tightly regulated P&C insurers are, at least in Georgia, but Health insurance companies have free reign…
I’m lucky to have an excellent PP0 and I don’t even have a co-pay for doctor visits. But I just have one company to deal with (and most bills are from my PCP who I’ve been seeing for over 10 years).
But with grandma’s stuff I’m dealing with Medicare (government, yeah!), Blue Cross Blue Shield and Massive Hospital Bills…
Hopefully they realize now that I won’t just sit back and take their bullshit! I dealt with my other grandma’s medical and hospital bills for several years up until she passed away last year (Feb 2012). It was a different hospital and, thankfully, Medicare and her supplemental policy paid the bills correctly (because they were billed/coded correctly) and she only had to pay her deductibles. One 18-day hospitalization was billed at $140k and all we ever paid was a few hundred dollars and the insurance companies took care of the rest…
But I did have a few major issues with the quality of care and negligence at that other hospital. The worst was when the gave her Ambien (86yrs old, barely 80lbs) and then took her to the bathroom 15 minutes later! The nurse looked away for a second and let my (other) grandma fall as she was getting up from the toilet! It was nothing short of a miracle that she fell into the shower curtain and it supported her tiny body and prevented any serious injuries.
But I was mad as HELL and I made it VERY clear! This occured around midnight and I demanded to see the highest ranking employee in the hospital immediately. I was so angry that I was shaking. I didn’t curse or yell at anyone, except when she fell and I screamed for HELP down the hall! But they still called security and two dumbass wanna-be security guards glared at me from the nurses station the entire time this was going on!
I had my dad, step-mom and sister there in less than 15 minutes. I also called my Elder Care Attorney friend (at almost 1am) and she insisted on coming right then also, almost a 50 mile drive for her. She dealt with the head nurse, hospitalist (doctor) on duty and waited all night with me so we could be waiting for Hospital Administrator outside of his office at 8am the next morning! She also disbanded those slack-jawed security fuckers who were staring at me like they thought they could intimidate me or something…
As Sandra Bullock said in “The Blind Side”, “I’m in a prayer group with the DA, I’m a member of the NRA and I’m ALWAYS PACKIN!”…the latter two apply to me! 
I have a permit to carry and that hospital parking lot was known for muggings and car-jackings for a while…so I packed my overnight back with a change of clothes, some magazines, a toothbrush and my Glock 19!
The attentiveness and quality of care was never an issue after that! They even tried to pay us off, offering $10k then upped it to $25k if we’d promise not to sue for the fall incident. I told them that she wasn’t injured and my family doesn’t take money that doesn’t legitimately belong to us. Instead, I asked him to invest some of that money to provide additional training to the nursing staff on fall prevention. The bathroom also didn’t have a bar/support on the wall that someone in my grandma’s condition could use (rheumatoid arthritis, worst case her rheumatologist had ever seen). They did invest in the new assist-bars/handles, but I doubt it went beyond that…
In any case, I put the fear of God in them and I really hope I don’t have to do it with this hospital also…at least not any more than I already have…
Why should someone get a negotiated benefit that I am paying for? I get that that might seem “fairer” to you, but it’s not any fairer than expecting anything else you didn’t pay for just because everyone should get the same price. If my insurance company is acting as my agent, there is no really to extend the benefits of said agency to everyone else.
More importantly, you are forgetting that many, if not most uninsired don’t pay their bill, don’t pay it in full, or don’t pay it on time. Giving some destitute homeless guy a bill at Medicare rates might as well be a million dollars considering he will likely never pay it. One study in California found the net average amount paid by the uninsired was lower than Medicare rates. That is, even if uninsured person A pays more than anyone else, she is covering multiple other non-paying uninsired, and the average rate paid by the group is lower than even Medicare rates. If you mandated everyone get the insured rate (and by the way, there is no one insured rate), hospitals would lose a lot of money.
“I’ve got mine, screw the uninsured.” You’ll fit in real well in greed-oriented America.
BTW, you omitted part of my post from your quote:
An answer was “That would be restraint of trade.”
– Almost any health insurance or pricing-related legislation is restraint of trade.
I’ve been uninsured my entire life, but have paid every bill in full, and on time.
A close relative was absolved of the residual portion of a surgery bill … after turning over all bank accounts to the hospital.
It’s greedy now to expect to get a unique benefit from something I am paying for? :dubious: Rather than attacking me, plea explain why what you are suggesting us far to the insured, or how it won’t result in hospitals losing tons of money?
More importantly, why would any insurance company bother to negotiate, set rates, etc if they could just piggyback on the work of others?
AND? I not sure why you think that’s relevant to my question.
You are atypical.
12% of $64 is $7.68. So it is still much more that the 4 cents the pill costs. (to purchase at CVS)
Only 32 cents short of what medicare or insurance would pay.
I don’t think the hospitals are suffering too much from the uninsured.