# Why are some medical bills so high? **URL:** \ **Category:** The BBQ Pit\ **Created:** [September 21, 2014, 4:06pm UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091 "2014-09-21T16:06:56Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [September 22, 2014, 2:00pm UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091/21 "2014-09-22T14:00:59Z")
> [@JesterX](#): > > What confuses me about this case is why the insurer sent the payment check to the patient instead of the doctor. My insurer has never sent me a check to pass along to the doctor. Is that normal for some plans? Because the doctor is out of network, and I imagine the patient didn’t sign a benefits assignment statement to the surgeon. ---
**Author:** ![YogSothoth](https://avatars.discourse-cdn.com/v4/letter/y/8edcca/32.png) [@YogSothoth](https://boards.straightdope.com/u/YogSothoth)\ **Post date:** [September 22, 2014, 6:23pm UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091/22 "2014-09-22T18:23:44Z")
Why is it that we can’t make sure prices are clearly marked for all medical issues? Like for example: Surgery, brain: $500 per hour (covers anathesia, nurses, extra blood, etc.) Surgery, appendix: $300 per hour, or $1000 flat fee Skin graft: $100 per square inch Kidney transplant: $10000 per 4 months on the waiting list, covers all surgery expenses. 10% off if you wait more than 1 year! Seriously, I’d like to know how much I’m paying for if I’m going in for anything, even if its life and death, knowing in advance at least allows me to plan ahead on payment Other industries will eat the cost if something goes wrong with the service. If you get a laptop fixed at Best Buy, and it breaks down the next day, they’ll fix it again for free. Why can’t the medical industry do that? ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [September 22, 2014, 6:39pm UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091/23 "2014-09-22T18:39:51Z")
In some cases, the hospital will “fix it again for free.” If a Medicare patient acquires an infection during his/her hospital stay (“hospital acquired conditions”), Medicare won’t pay for continued treatment, or will pay less for such treatment. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [September 22, 2014, 7:41pm UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091/24 "2014-09-22T19:41:48Z")
> [@GrumpyBunny](#): > > I think the insurance company here should be asking why the hell an assistant-at-surgery was necessary at all, and what that second physician DID. And deny all payment, put him on 100% pre-payment medical claims review, and go after him for fraudulent or abusive billing if necessary. The article said that his practice is being sued by another insurance company. Another set of hands was required - just not such an expensive set of hands. The article mentions that the insurance companies are trying to get laws passed to limit this kind of thing but are often blocked by the doctors lobby. This happened in Jamaica Hospital in Queens. My grandmother went there about 50 years ago. Anyone in New York see follow up on the local news about this story? ---
**Author:** ![JesterX](https://avatars.discourse-cdn.com/v4/letter/j/439d5e/32.png) [@JesterX](https://boards.straightdope.com/u/JesterX)\ **Post date:** [September 23, 2014, 4:49am UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091/25 "2014-09-23T04:49:55Z")
> [@YogSosoth](#): > > Why is it that we can’t make sure prices are clearly marked for all medical issues? Like for example: > > Surgery, brain: $500 per hour (covers anathesia, nurses, extra blood, etc.) > Surgery, appendix: $300 per hour, or $1000 flat fee > Skin graft: $100 per square inch > Kidney transplant: $10000 per 4 months on the waiting list, covers all surgery expenses. 10% off if you wait more than 1 year! > > Seriously, I’d like to know how much I’m paying for if I’m going in for anything, even if its life and death, knowing in advance at least allows me to plan ahead on payment > > Other industries will eat the cost if something goes wrong with the service. If you get a laptop fixed at Best Buy, and it breaks down the next day, they’ll fix it again for free. Why can’t the medical industry do that? I had an idea of developing a site to look up just what you’re asking but turned out there is one already . . . [Estimate Costs Step 2 / Medical | FAIR Health](http://fairhealthconsumer.org/medical_cost.php) ---
**Author:** ![Foxy40](https://avatars.discourse-cdn.com/v4/letter/f/a9a28c/32.png) [@Foxy40](https://boards.straightdope.com/u/Foxy40)\ **Post date:** [September 23, 2014, 4:16pm UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091/26 "2014-09-23T16:16:17Z")
> [@GrumpyBunny](#): > > I think the insurance company here should be asking why the hell an assistant-at-surgery was necessary at all, and what that second physician DID. And deny all payment, put him on 100% pre-payment medical claims review, and go after him for fraudulent or abusive billing if necessary. I can’t access the link. Perhaps it is not available any longer. On most surgeries, particularly spine surgeries, yes, an assistant surgeon is needed. In teaching hospitals they will use a resident, sometime a PA, sometimes they need another board certified surgeon. That isn’t the odd part. The odd part is what kind of surgery does the surgeon bill over 100K for? Unless this includes the OR, hospital and instrumentation charge, it sounds like a rip off to me. In my practice the cost of a two level anterior cervical fusion with instrumentation, is a little under $14,000, the assistant is 25% of that. A scoliosis repair doesn’t even cost more than $20,000. I wish I could see the article and figure out what the heck they are billing for? Saw it. The surgeon and the assistant are thieves. I’ve had to testify on reasonable and customary rates as an expert witness and I would destroy these doctors. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [September 23, 2014, 5:16pm UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091/27 "2014-09-23T17:16:48Z")
What Foxy said. I’m pretty sure Florida is not known for its low reasonable and customary medical charges but even if billed as a self pay $133,000 more than covers _every single normal charge_ even for a cervical fusion. That is, the hospital’s bill, the hospital radiology bill, the surgeon, the assistant and the anesthesia. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [September 23, 2014, 6:21pm UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091/28 "2014-09-23T18:21:30Z")
I am sooo glad I live north of the 49th. I pay my health care once a year in my taxes and never have to think about any of the stuff in this thread at all. It’s almost like you’re talking a foreign language! ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [September 23, 2014, 6:36pm UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091/29 "2014-09-23T18:36:50Z")
_Y u no speakee American?_ ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [September 24, 2014, 2:41pm UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091/30 "2014-09-24T14:41:13Z")
It looks like English, but it sounds American. 🙂 ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [September 24, 2014, 7:25pm UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091/31 "2014-09-24T19:25:11Z")
> [@Really\_Not\_All\_That\_Bright](#): > > What Foxy said. I’m pretty sure Florida is not known for its low reasonable and customary medical charges but even if billed as a self pay $133,000 more than covers _every single normal charge_ even for a cervical fusion. That is, the hospital’s bill, the hospital radiology bill, the surgeon, the assistant and the anesthesia. Well, exactly, and that’s the point. It’s the newest ways that some surgeons are upcoding, now that there are some strict FFS rules in place for reimbursement. I really think that we need to have some additional legislation passed in this country to protect consumers from this. If a patient goes in to a participating hospital and has a participating doctor, that should be proof that the patient only wants care from in-network providers. It should then be illegal for random doctors to stroll into the patient’s room, say hi to the patient, look at the chart, and bill for a “consultation”. Helping put a patient’s socks on is not physical therapy. And knock it off with the out of network anesthesiologists and “physical therapy” that consists of walking the patient to the bathroom. I swear, some of the stuff I’ve run into makes me want to bring back public flogging and the stocks. :mad: ---
**Author:** ![Guinastasia](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/guinastasia/32/5751_2.png) [@Guinastasia](https://boards.straightdope.com/u/Guinastasia)\ **Post date:** [September 24, 2014, 8:21pm UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091/32 "2014-09-24T20:21:52Z")
Don’t forget charging for individual q-tips and alcohol swabs. ---
**Author:** ![sweat209](https://avatars.discourse-cdn.com/v4/letter/s/9fc348/32.png) [@sweat209](https://boards.straightdope.com/u/sweat209)\ **Post date:** [October 3, 2014, 7:39am UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091/33 "2014-10-03T07:39:16Z")
> [@GrumpyBunny](#): > > _snerk_ > > Everyone – providers, pharmaceutical companies, and insurance companies – is getting more and more creative WRT squeezing more money out of the patients. > > I recently read of a creative method insurance companies are using to screw over members now that they are essentially forced to provide coverage to people with chronic medical conditions. I plan to Pit it once I pull all of the links together on my home computer. Like I said before in other threads that the US spends more on healthcare than any country in the world and large chunk of GDP. Yet healthcare is extremely high and no signs staying the same or slowing down.It is out of control cost. The cost are all artificial price well above the real cost. ---
**Author:** ![Doughbag](https://avatars.discourse-cdn.com/v4/letter/d/aeb1de/32.png) [@Doughbag](https://boards.straightdope.com/u/Doughbag)\ **Post date:** [October 3, 2014, 5:13pm UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091/34 "2014-10-03T17:13:55Z")
> [@Mr.Greenjeans](#): > > I guess that’s the price we pay for the best healthcare system in the world. You mean the [38th](http://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems_in_2000), right? Or are you from France? Or this… [US ranked 10th](http://www.forbes.com/sites/danmunro/2014/06/16/u-s-healthcare-ranked-dead-last-compared-to-10-other-countries/) …and the Times has [this](http://time.com/2888403/u-s-health-care-ranked-worst-in-the-developed-world/) to say about it. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [October 3, 2014, 5:19pm UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091/35 "2014-10-03T17:19:56Z")
Whoosh. Though by _one_ particular metric - life expectancy for patients diagnosed with life-threatening illnesses - we do have the best system in the world. ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [October 3, 2014, 5:44pm UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091/36 "2014-10-03T17:44:16Z")
I work in the healthcare analytics field. We spend a lot of time crunching data. The biggest trend lately that the entire industry has to get its hands around is the high cost of treating people with multiple chronic conditions (MCCs). Around 32% of Americans live with multiple chronic conditions such as asthma, COPD, cancer, arthritis, heart disease, ESRD, high blood pressure, chronic pain, high cholesterol, and so on. 7% live with 3 or more, 5% live with 4 or more, and nearly 9% live with 5 or more chronic conditions. The rates are up a couple of percentage points since the 2008, in part because of the aging of Baby Boomers, and in part (honestly) because healthcare is so good at keeping people alive who might not have survived a decade ago. But here’s what you might not know – more than 70% of all healthcare spending goes toward people with multiple chronic conditions. That’s over 2/3 of our spending, which is already the highest in the world. There aren’t currently any standards of care for people with MCCs, which is partly why they cost so much. Patients with MCCs often get incomplete or conflicting advice from different physicians, and they have to juggle multiple prescriptions and treatments. It can be a full-time job, even without looking at figuring out what a patient really owes a provider. It’s crazy, and until we get some standards in use, it’s going to get more costly. There is some great information [here](http://www.ahrq.gov/professionals/prevention-chronic-care/decision/mcc/mccchartbook.pdf)if anyone is interested. And now I have to go write some SQL queries. Blah. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [October 3, 2014, 7:10pm UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091/37 "2014-10-03T19:10:13Z")
> [@GrumpyBunny](#): > > I’m not an accountant, AFAIK they can write it off as uncollected from the patients. > > The other practice that annoys me, is having surgery in an in-network facility, with an in-network surgeon, and the damned anesthesiologist is out of network! Like people get to choose the anesthesiologist. Here’s your intro, as you’re on the gurney in the OR: “Hi, I’m Dr. Sleepy, your anesthesiologist. I see that you’re asthmatic, so we will keep a close eye on your oxygen saturation. [_dr puts mask on you_] Now breathe the oxygen…” Me: “That’s not oxygen!” Doc: [_doctor does something involving your IV_] “Okay, count ba…” and then you pass out. And when you wake you don’t remember anything after the preop IV was put in. So the bill is a surprise every damned time. This happened to a friend: her daughter had a procedure requiring sedation. The doctor and facility were in-network. The anesthesiologist was NOT - and asked for 4,000 dollars. Having had the same procedure myself, the “rack rate” from my anesthesiologist was more like 1,300 dollars - and the in-network rate was knocked down to 300 or so. Yes, that anesthesiologist was trying to get TEN TIMES the going rate for the work. As it happens, they wrote most of it it off. When my gallbladder got yanked, the “rack rate” for the hospital was 45,000. The in-network rate was more like 4,500. 1. These bullshit bills have to stop. 2. If the facility and doctor are in a network, all professionals involved must be required to be treated as in-network.The hospitals and facilities need to enforce this. The insurers need to agree to pay them as in-network, e.g. if your plan offers NO coverage for out-of-network, they need to treat those providers as in-network. ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [October 4, 2014, 4:44am UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091/38 "2014-10-04T04:44:41Z")
> [@Mama\_Zappa](#): > > This happened to a friend: her daughter had a procedure requiring sedation. The doctor and facility were in-network. The anesthesiologist was NOT - and asked for 4,000 dollars. > > Having had the same procedure myself, the “rack rate” from my anesthesiologist was more like 1,300 dollars - and the in-network rate was knocked down to 300 or so. > > Yes, that anesthesiologist was trying to get TEN TIMES the going rate for the work. > > As it happens, they wrote most of it it off. > > When my gallbladder got yanked, the “rack rate” for the hospital was 45,000. The in-network rate was more like 4,500. > > 1. These bullshit bills have to stop. > 2. If the facility and doctor are in a network, all professionals involved must be required to be treated as in-network.The hospitals and facilities need to enforce this. The insurers need to agree to pay them as in-network, e.g. if your plan offers NO coverage for out-of-network, they need to treat those providers as in-network. I wonder what would happen if every healthcare consumer started fighting back before this crap happens. What would happen if we all, before having a procedure performed, told the facility and surgeon that we want an in-network anesthesiologist. And that we will NOT PAY for an out-of-network one. Hell, we could write it on the form that you sign to assign the payment to the facility and doctor. It’s worth thinking about. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [October 4, 2014, 10:29am UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091/39 "2014-10-04T10:29:20Z")
> [@GrumpyBunny](#): > > Around 32% of Americans live with multiple chronic conditions such as asthma, COPD, cancer, arthritis, heart disease, ESRD, high blood pressure, chronic pain, high cholesterol, and so on. 7% live with 3 or more, 5% live with 4 or more, and nearly 9% live with 5 or more chronic conditions. The rates are up a couple of percentage points since the 2008, in part because of the aging of Baby Boomers, and in part (honestly) because healthcare is so good at keeping people alive who might not have survived a decade ago. > > But here’s what you might not know – more than 70% of all healthcare spending goes toward people with multiple chronic conditions. But that’s true in any country with a decent life expectancy; in fact, and although I don’t have data, I’ve heard so many times that line about “in the US people don’t get diagnosed from small things until they become big enough to go to the ER”, that if it’s true I’d expect countries with UHC to have higher rates of people diagnosed with MCCs. Part of the issue is communication: my mother is one of those patients, but so long as she’s in the regional healthcare system\* all of her doctors look at the exact same history, all are under the same protocols, all are part of the same system. She gets some of her care from a private clinic; those records are separate, but luckily the doctors from both systems have no problem calling each other up to confirm a detail or give a heads-up. There’s morons who think that the Ley de Protección de Datos (think HIPAA, only this one affects any data held on a person by any organization) means they can’t give a clinical history to a patient or that patient’s doctors, but all the ones I’ve encountered or heard of were in private clinics. Compare with a system where most records are on paper, each new doctor means a new history, you’re not allowed to get a copy of your own analytical results without paying extra (as if it was the doctor’s information, rather than yours) and it’s a lot easier for a person’s doctors to be missing critical information. In turn, this is likely to mean double-treatments, or giving to a patient a medication that he should not be taking. For example, my mother can’t take the most common oral diabetic medication because it gives her a side effect that was detected by the gastro: when she got assigned a new GP who wanted to put her on that pill, it wasn’t “the patient’s word” that “I don’t think I should be taking that”, it was in the computer with threats of hell and damnation on any GP that gives my mother that particular active principle (some of those medical histories get pretty colorful). Since doctors tend to believe their colleagues more easily than the patients, that computer system saved my mother several months of gastrointestinal distress. - Spain’s healthcare got shuffled over to the regions, in what may have been one of our politicians’ stupidest moments of the last 40 years. Now each region has different computers, some of which can’t talk to each other, each has different protocols for how to deal with “temporary patients”, and in some regions there are different local networks with different computer systems. Joy. ---
**Author:** ![Doughbag](https://avatars.discourse-cdn.com/v4/letter/d/aeb1de/32.png) [@Doughbag](https://boards.straightdope.com/u/Doughbag)\ **Post date:** [October 4, 2014, 12:54pm UTC](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091/40 "2014-10-04T12:54:59Z")
> [@Really\_Not\_All\_That\_Bright](#): > > Whoosh. Though by _one_ particular metric - life expectancy for patients diagnosed with life-threatening illnesses - we do have the best system in the world. If you’re lucky enough to have the money to pay for it … or remortgage your house … or suck up to your boss to keep you job and hope s/he has the treatment you need included in the health insurance package. [Previous page](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091.md?page=1) [Next page](https://boards.straightdope.com/t/why-are-some-medical-bills-so-high/699091.md?page=3)