My wife had her gallbladder removed last week. They used the laproscopic method, she was out of the hospital a couple of hours after the surgery. The total cost is just over $18,000. I expected it to be expensive, but I was still guessing under $10k. Thankfully, our insurance will be covering it. But I’m still amazed at how expensive it is, and curious about why. The one line item I’m most curious about is “STERILE SUPPLY” at over $5000. What is that, and why would it cost so much?
I would guess that this includes all the sterile items needed ie scalpels, trocars, graspers, scissors, sutures, bandages, sponges, drapes, gowns, gloves, etc.
That’s what I thought, but $5k seemed ridiculous (even in hospital terms) for that…
If you haven’t done so, call up the hospital billing department and ask if they added a zero or two on that item, and just what that item is. And then get back to us!
Hospital billing is not to pay for your wife’s operation. It’s to pay for your wife’s operation AND for operations for people who are uninsured.
Former hospital collections worker here (and my Og, if that wasn’t a soul-sucking job…) – it’s for things like instruments, bandages, etc etc. 5K IS really high though – I agree with Lynn that you should call billing. My estimates from my work were that maybe 1% of bills had an error on them – and nearly always in the hospital’s favor, so call and get that straightened out.
*I saw a couple infant circumsicions billed to the mother or to a female baby – those were always pause for “durr, what?”. The most common errors were extra meds (billing for 4 pills when 2 were used).
Reading about hospital errors makes me wonder - why aren’t audit controls catching this stuff? I would think that if people are being given 2 pills and charged for 4, some accountant is going to raise an eyebrow when attempting to reconcile records when they see that the pharmacy was at 1000 percodan pills on 1/1/2010, received a shipment of 500 on 1/5/2010, and a total of 200 were billed during the month of Jan, according to billing records, but the pharmacy reports that there were 1400 percodan pills during end of the month inventory, leaving 100 surplus pills in the pharmacy. I would think they would have these controls in case of the opposite situation, if doctors were administering stuff and “forgetting” to bill it.
Do departments just not communicate?
Don’t just call the billing department and make a general inquiry about whether your bill is correct. Call them and demand a detailed, itemized bill with Current Procedural Terminology (CPT) codes. Once you get such a bill, you can go on the AMA website and compare the hospital’s CPT charges to the standard Medicare reimbursement rates for that procedure. There are even companies you can pay to do this for you (see the article i linked, at the bottom).
Now, the amount charged to an insurance company will almost always be higher than the Medicare rate (the Medicare rate is about the lowest there is), but it can give you an idea of whether you’ve been screwed. Also, you can request the hospital’s Chargemaster, which is an itemized list of procedures and prices.
Of course, if your insurance company is paying for all this, you might not want to spend too much time and effort on it. As RealityChuck suggests, hospital bills are designed to cover not only the procedure for people like you, but also for people who could not afford to pay. But many hospitals overstate the extent to which they lose money on uninsured patients, and many also inflate their billing beyond all reasonable levels.
The San Diego Reader had a good article last month on hospital billing practices. I highly recommend it.
Thanks all. I’ll have my wife call them and see what’s up (I assume she has to call, since it’s all in her name).
My gawd, what an article! Is it really like that? If so, it’s one more reason I cannot for the life of me fathom why so many Americans are resisting change, seemingly any change, to the US health care ‘system’.
That is absurd, isn’t it? It’s not even a matter of changing to UHC, it’s just a matter of actually paying for what you received and not being robbed by hospitals!
I was amazed at the idea of shopping for a hospital, and of asking for prices before receiving treatment and of keeping detailed notes on all services and medicine received. When you’re sick and/or injured I’m sure that’s exactly what you want to be focusing on!
Regarding the “Sterile Supply” billing item…aren’t most of those things single-use only and therefore already sterile when purchased by the hospital?
Yes, things on this line item are probably prepacked. They’re sterile and “disposable” or “single use”, but as a layperson, you’d probably doubt that. They are hefty and solid, made of surgical grade stainless steel, and you or I would reuse those scissors for 10 years at home. In a hospital setting, they must be sterile at the time of use, and once they’re opened, used or not, they’re no longer sterile for the next patient. Since hospitals don’t routinely re-sterilize things anymore, the patient is charged for each of those 12+ pairs of metal scissors and tweezers and hemostats and stuff, and then they’re thrown out after surgery. (Or taken home by the nursing staff, but you didn’t hear it from me.)
Some surgical scissors. Check out the McClures at the bottom: $268.20 for one pair if you buy more than 30 at a time. :eek:
But that page even specifically says you can autoclave those scissors “many times” before they start to corrode. Surely they don’t really just use a $270 pair of scissors once, do they? (Also, those scissors say they’re for micro-dissection work; maybe for most surgeries one of the cheaper $30 or $40 pairs above would work?)
I don’t know if it’s commonly done, but I bet some hospitals make the calculation that you can buy a lot of $270 scissors for the cost of one malpractice suit because someone forgot to autoclave a scissors.
Many laparoscopic instruments are truly single-use items, with complicated internal mechanisms (some including electronics) that can’t be broken down to be sterilized for re-use. Not all of them, certainly, but in general as the instruments get scaled down smaller and smaller so that they can be used through tinier incisions, they are more likely to become ‘disposably’ designed. An instrument meant to go through a 1/2" port has four times the cross-sectional area as an instrument meant to go through a 1/4" port, and all else being equal it will be four times ‘tougher’.
Consider the following hypothetical: if by using more expensive, smaller, disposable instruments, you are able to discharge patients in an average of 8 hours rather than 24 hours, you will save money over the long term.
Yes, you can, and a small medical clinic, a rural heathcare center or a private doctor’s office may do that. Most large US hospitals don’t, because autoclaving is an expense, and because of the fear of lawsuits previously mentioned. Since they’re passing on the expense to your insurance company, your pocket or their “charity care” tax exemptions, they don’t care much.
Don’t forget that your insurance company might be paying a flat amount for the procedure based on a contract with the hospital and the bill is not really meaningful.
There is also some concern that autoclaving does not destroy the prions responsible for a few very nasty, though rare, diseases - making hospitals uneasy about re-using potentially contaminated equipment.
Hospitals don’t use CPT codes; they use revenue codes and report charges to the insurance company as line items. You certainly can ask for an itemized bill that lists prices for each item, however. (Individual supplies may be listed as HCPCS codes, but there should still be a description.)
CPT codes are used by the physician to bill the insurance company for the specific procedures s/he performed. These do not include the hospital’s charges; those are reported separately, on a different form.
Just a point of contention.
They charge you for everything that goes into the room, whether they use it on you or not. But a lot of things are routine charges. For instance, I read over my hospital bill for kid #2 and they had a $250 charge for “labor room” along with a much higher charge for “delivery room” and another charge for “recovery room.” I called them up and pointed out that I bypassed the labor room and went straight into delivery; they removed the charge. But I had to argue about it, because they said stuff like, “Well, that labor room was there for you, it’s a routine maternity charge, we charge everybody,” blah blah blah.
It’s true. If you’re one of those people who give birth in the parking lot, then go into the hospital to get checked out, they will soak you for everything unless you protest.
Also, note that there is no specific breakout for the nurses’ time, even though there is for everybody else. Consider that there is a nurse assigned to count all the items going into the delivery room–not just say, “Oh, the standard tray” but to actually make sure the items are there. And then count the items coming out and make sure they’re all there again, used or otherwise. It wouldn’t be applicable for laparascopy (I don’t think) but one reason this is done is to assure that none of the implements have been left somewhere they shouldn’t, like inside the patient.