Flippy - I Rant, You Read
Wednesday, May 17, 2006
And MORE Medical Bills
This should really be in the “Idiot of the Day” category. Today, I got my itemized bill from the hospital. * $13 for each of two Percocets. What I paid for 120 Percocets before I went in for surgery, $10. Each Percocet cost me less than TEN CENTS. What do you think they cost the hospital? OVERCHARGED * Celestone Soluspan 3mg (Schering) - hospital charged $497.00. I found a pack of TEN 6mg (double my dose) for $56.97. Even forgetting about the fact that what I was given was half the dose, I was still OVERCHARGED $491.30. * Vancomycin Hcl 500mg inj - hospital charged $783.00. Medicare reimburses $3.25. Retail price - $167. OVERCHARGED $616 * Cefazolin Sodium 500mg - hospital charged $143.00. Actual cost - $17.36. OVERCHARGED $125.64 * Midazolam Inj per 1mg - hospital charged $70.00. Actual cost for 5mg (five times what I got) - $13.41. OVERCHARGED $56.59 * Thrombin 20,000 unit kit - hospital charged $1,361.00. Actual cost - $268.15. OVERCHARGED $1092.85 * Charged for two different kinds of anti-embolism stockings, $116.00 & $378. Actual cost - $17 for one pair, $12 for another. OVERCHARGED $465 * Diazepam 10mg tab - hospital charged $6.00. Actual cost 35 CENTS. OVERCHARGED $5.65 * Metoclopramide 10mg tab - hospital charged $3.00. Actual cost 14 CENTS. OVERCHARGED $2.86 * 1 Gelatin Sponge Size 100 - hospital charged $346. Actual cost - $269…for a SIX pack. OVERCHARGED $301 * Bipolar Forcep Disposable - hospital charged $179. Actual cost (don’t know the type, but picked the most expensive one) $106. OVERCHARGED $73 * 2 Electrolytes PH7.4 1000ml bags - hospital charged $522. Actual cost - can’t find it for people, but for pets, it’s less than $10/bag. OVERCHARGED $500 * ZEMURON 10 MG/ML VIAL (Rocuronium Brm) - hospital charged $268. Actual cost - $16.64. OVERCHARGED $251.36
Next entry: I Give Up Previous entry: Medical Bills Rolling In
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I have received bills like this and understand the reasoning. It is called cost shifting. For instance: Hospital bill $25,000. Insurance discount $975. Insurance paid $800. Your share $175.
It is a game the insurance companies play with hospitals. The only people who pay in full are those without insurance and who are very very rich, maybe one out of a thousand admissions.
Hospital costs have skyrocketed in the last 30 years. And insurance reimbusments are getting skimpier each year. Most hospitals have a lot of difficulty breaking even, even those with a tax exempt status.
Yes, on the itemized bill the charges look rediculous. But you do understand that federal and state regulations mean that Vicodin you got had to be a written prescription by and MD, filled by a pharmacist, carried upstairs by a courier, and administered by a licensed nurse, and each of them had to spend ten minutes documenting why they did what they did and what your response was. These are the direct direct costs. Then there are the indirect directs, like housekeeping, dietary, ancillary people, contaminated waste disposal, etc. After that come the direct indirects, administrative salaries, liability insurance (huge item), benefits and so on. Last and not least are the indirect indirect costs: servicing mortgages, capital improvements, research and teaching if if is a teaching hospital, long term brick and mortar maintenance, and more.
And with a not for profit, all this is zero based budgeting.
Medicare and medicaid are losing propositions. The hospital literally spends more than its reimbursement, and the longer the stay, the bigger the deficit.
There is also the advent of the DRGs, back in the eighties. If for instance you go in for an appendectomy and have a heart attack while there, the hospital still gets paid for the appendectomy only. A huge amount of bills are just written off at the end of the year.
I know this because I managed hospital units for years.
As for malpractice, it rarely gets correctly addressed. Every single bad outcome, well almost every one, generates a law suit, whether there was any bad practice or not, any grounds. And yet gross malpractice, which does not result in visible harm, goes unnoticed. The only ones who come out ahead on this stuff are the lawyers.
No matter what we seem to do in the country to control health care costs, we seem to get it wrong.
You can think of it as almost analagous to going out for dinner, steak and lobster say, and paying $50 to $80 bucks for the meal. Obviously the ingredients cost way less than that. You are paying for the prep, the service, the ambience, and if you are stupid like me, for the Birthday Girl’s Manhattans!
Or what about paying 5 bucks for a designer coffee at Starbucks, actual cost about 35 cents?
The devil is in the details.
(Up in the midddle of the night to catch a 6:40 flight to Texas, doesn’t often happen.)
Me on 05/18 at 02:01 AM -
The problem with that is that my insurance already paid the hospital the ridiculous amount of $16,729.00…and *I* owe $2000.00, although as far as I know, I haven’t been billed for the surgeon OR the anesthesiologist. Not to mention the ridiculous selective nerve root block injections that were billed at $7000 each.
The anti-embolism stockings - they came out of a package that I ripped open myself and then, I put them on myself.
The hospital is an old dump. The outpatient surgery prep room looked like it was from 1960.
Leigh-Ann’s whole hysterectomy bill was $8000, and she spent the night. I should’ve negotiated a cash price for everything, because with the hospital overbilling the insurance company, they’re screwing me right along with the insurance company. I am NOT paying almost $500 for anti-embolism stockings that cost $12. I’m just NOT.
You know, if I felt great, this might not piss me off so much (especially the injections), but I don’t. The nurses can keep the almost $2000 I was charged for being in recovery. The rest, I’m arguing. Oh, and priceless…I got the bill today and they say it’s due in a week. LOL. ROFL. HAHAHAHAHAHAHA!
Flippy on 05/18 at 02:15 AM -
In all my dealings with hospitals and doctors since I moved to the US, I’m always offered a very large discount for paying cash. The hospital sent me a bill for $10000 after my surgery—I called them, gave them a credit card number to pay, and was given a payment discount of 50%. Did the hospital seriously not need that extra $5000, or does that prove there’s an element of randomness when it comes to what they decide to charge?
I get the same treatment at doctors’ offices as well. My last doctor charged me $60 total for an office visit, whereas some clients in her waiting room were paying a $40 co-pay and then the insurance company was getting billed another $160. I don’t begrudge the doctor any price she decides to charge, but the game played between providers and insurers is tainted and unfair to everyone. Perhaps doctors feel sorry for me when I say I have no insurance, and they balance out what they don’t charge me with what they do charge insurance companies, and that’s certainly not fair either.
I’d much rather see the a hospital charge an honest, flat “handling fee” to cover their expenses. If they need to come up with $8000 in extra charges to cover their operating costs, they should just add a segment to the bill which says, “overhead costs, $8000”. At least that would be honest, and it would allow patients to shop around.
Btw, my surgery estimates varied greatly from hospital to hospital—it was estimated to cost $24000 at a rundown hospital in a bad part of town, but just $14000 in a new hospital in an upscale neighbourhood. If I had insurance, I might have been forced to go the $24000 hospital, thus running up my costs unnecessarily.
I love the US health care system because if I find an expert I want to see, like my endocrinologist, I just call his office and make an appointment, snap, snap. In Canada, I’d need a referral, and then I might not get to see the endo I want to see, and I’d probably have to wait six months to see him. But you know, at least everyone is treated the same way, and there’s never a surprise bill waiting in the mailbox.
Leigh-Ann on 05/18 at 03:52 AM -
Oh Flippy. Bills like that can’t possibly make recovery any easier. I’m really sorry that the whole back pain nightmare hasn’t gone easier.
How is your back now? Is the bladder problem better? You are way too young to have all this happening. I go to the pain management clinic today for a follow up…which is annoying because each appt can only focus on one thing, either neck or low back. They are both obviously connected, but the ins. won’t allow such a silly idea as looking at me as a whole person!
I’m still sending healing thoughts your way!
moonandsun03 on 05/18 at 08:38 AM -
Came over from Leigh-Ann’s blog.
Holy moly. The first post really helped understand some of the reasoning behind these unbelievably high costs. And, my ex was (still is, I guess) a (sociopathic, klepto, control freak who stole all my stuff but I digress!) doctor so I know that malpractice insurance typically runs well into six figures annually, with the cost usually being borne by the doc.
But, still. What a difficulty for you to deal with on top of surgery!
I remember back in the 80s, Blue Cross running ads for insurance, saying “did you know a hospital stay can cost $700 PER DAY OR MORE?” Haha! Seems like that barely covers a couple of pain pills now.
A good friend of mine is doing the round of specialists and may be looking at back surgery in the foreseeable future. That’s scary. I’m going to read your previous entries to get some background (pun not intended.)Carina on 05/18 at 11:01 AM -
Carina, our absolutely fabulous gynecologist stopped doing obstetrics because of the cost of malpractice insurance. I can’t recall if it happened to him personally or if it was just an example, but he told us the story of a woman who took drugs during her pregnancy, drank, and got no prenatal care, and then sued the ob/gyn when her baby was born with some brain damage after a difficult birth in the emergency room. Maybe the doctor was partially to blame, but how could a person ever know? He also told us that most cases are just settled by the insurance company without a trial, because it’s cheaper for them to just pay out something than to spend years in the court system. It’s crazy. Here in Las Vegas we barely have any ob/gyns at all, because we’ve got some of the highest malpractice costs in the country.
My own surgery was in 2003, I think, and the hospital charged me $800 per day for the room. I remember seeing the itemized bill. That was before my discount, too, so I guess I ultimately paid only $400. That makes Flippy’s charges of thousands of dollars per HOUR for a room seem insane.
Leigh-Ann on 05/18 at 03:01 PM
