Robbie ------> inside please

[Mutt]

I was trying to tell somebody your explanation of how the American medical insurance racket runs but I don't think I totally understood it. You were in a major car accident, had no medical insurance and at the end of your hospitalization you were stuck with one of these crazy bills where aspirins are billed at 10 bucks apiece so your bill was well into six figures - right? And then you made a deal with them for a fraction of the bill and they explained that's how the racket works, that nobody really pays these huge bills. Right?

So what I don't understand is what's the point of the wildly inflated bills? I think you said the insurance company writes off the difference between what the bill was and what you actually paid as a loss.

I just can't believe that is standard operating procedure, if it was so I'd expect there'd be a ton of liberal politicians and media exposing this.

[Barefootsies]

I've had the same experience as Robbie before I had health insurance.

Example.... I go to the DR's office now (with insurance), and the very same DR visit will cost me $125.00+ with the average around $150.00. Before when I paid cash for my visits, I would only pay $65.00 for the same office visit. I would have to dig up old bills for some other examples from ER and immediate care, but that one was most fresh simply because of the frequency.

If you pay cash, they give you a decent sized discount. They did not give me the 'racket' explanation they gave Robbie.

[Juicy D. Links]

Robbie is the OG Schwtchhhhhhhhhhhhhhhhhhhhhhhhhhaaaaaaaaaaaa

[fuzebox]

My limited experience with the american medical system and no insurance has been similar. Cash price for my doctor is $65 vs $100, and when I had a knee problem two years ago I was given a 50% cash discount on my ortho visits and MRI.

[johnnyloadproductions]

Originally Posted by Mutt

I was trying to tell somebody your explanation of how the American medical insurance racket runs but I don't think I totally understood it. You were in a major car accident, had no medical insurance and at the end of your hospitalization you were stuck with one of these crazy bills where aspirins are billed at 10 bucks apiece so your bill was well into six figures - right? And then you made a deal with them for a fraction of the bill and they explained that's how the racket works, that nobody really pays these huge bills. Right?

So what I don't understand is what's the point of the wildly inflated bills? I think you said the insurance company writes off the difference between what the bill was and what you actually paid as a loss.

I just can't believe that is standard operating procedure, if it was so I'd expect there'd be a ton of liberal politicians and media exposing this.

They paint targets on the back of people that don't have insurance, I believe it was this podcast: http://www.econtalk.org/archives/_fe.../arnold_kling/
Have a listen as it's enlightening.

[Grapesoda]

Originally Posted by Mutt

I was trying to tell somebody your explanation of how the American medical insurance racket runs but I don't think I totally understood it. You were in a major car accident, had no medical insurance and at the end of your hospitalization you were stuck with one of these crazy bills where aspirins are billed at 10 bucks apiece so your bill was well into six figures - right? And then you made a deal with them for a fraction of the bill and they explained that's how the racket works, that nobody really pays these huge bills. Right?

So what I don't understand is what's the point of the wildly inflated bills? I think you said the insurance company writes off the difference between what the bill was and what you actually paid as a loss.

I just can't believe that is standard operating procedure, if it was so I'd expect there'd be a ton of liberal politicians and media exposing this.

example: I was in the hospital 5-6 days earlier this year... cost 60K, insurance discount brought the bill down to 10.5K, I had to pay a bit over 5K out of pocket

[Grapesoda]

Originally Posted by Barefootsies

I've had the same experience as Robbie before I had health insurance.

Example.... I go to the DR's office now (with insurance), and the very same DR visit will cost me $125.00+ with the average around $150.00. Before when I paid cash for my visits, I would only pay $65.00 for the same office visit. I would have to dig up old bills for some other examples from ER and immediate care, but that one was most fresh simply because of the frequency.

If you pay cash, they give you a decent sized discount. They did not give me the 'racket' explanation they gave Robbie.

I go to a dr with a lab across the hall... he told me to tell the lab I had no health ins, tell the lab to bill the dr. and he would charge me what the lab charges him. full panel blood test was about $240 or thereabouts if I remember correctly... when I had the same test though my health insurance at another lab it was close to $1000

[k0nr4d]

I think the whole thing is psychological to make it seem like you are getting a huge discount so you aren't upset about the huge bill. $60k bill discounted to $5k sounds like a fucking steal whereas if they just charged you $5k you'd feel ripped off.

[artwilliams]

Here is one angle as told to me by an American doctor I once met on vacation.

Doctors pay huge malpractice insurance fees because ambulance chasing lawyers are suing them all the time. As a result, they've become overly cautious and send patients for any and all tests that might be related to their condition in order to help defend themselves should they get sued. This results in higher than needed health care costs and insurance premiums.

[Mutt]

Originally Posted by Juicy D. Links

Robbie is the OG Schwtchhhhhhhhhhhhhhhhhhhhhhhhhhaaaaaaaaaaaa

[Mutt]

I still don't get it - if they're targeting the uninsured with inflated prices it makes no sense, they know they can't blood from a stone and will never collect much.

and grapesoda says the opposite, that they give the insured a big discount.

so is anybody actually paying these 200K bills we hear so much about?

[L-Pink]

An old g/f has a Masters in Hospital Administration, basically a specialized MBA. She works for the University of Kentucky Medical Center. Her only job is to argue with insurance companies about billing issues.

Actually her job is to supervise the 5 story office building and the 5 story office building next to hers full of people doing the back and forth settlement of patients bills. She said the insurance companies will challenge even agreed upon pricing levels from patient to patient.

There are 4 office buildings in an office park setting doing nothing but administrative, non-medical work. This is in addition to the people working in the hospital itself doing other non-medical administrative work like her supervisors.

Spend 2 minutes talking with her and you'll know why our health care costs are so bloated … And it's not because the actual cost of patient treatment is high.

Add in non-medical employees, palatial hospitals with fountains and their own transportation systems, renting entire office complexes, etc. Then you have the insurance side of things with well paid executives, share holders and countless employees to argue and deny payments with hospitals, doctors and their own customers.

Now add the government into the mix with their fondness for bureaucratic expansion and prices will go even higher.


.

[Minte]

Originally Posted by Mutt

I still don't get it - if they're targeting the uninsured with inflated prices it makes no sense, they know they can't blood from a stone and will never collect much.

and grapesoda says the opposite, that they give the insured a big discount.

so is anybody actually paying these 200K bills we hear so much about?

Probably more of an accounting maneuver. They can put the debt on the books which pumps up their receivables. Gives them more borrowing power at the bank when they want to put on an addition or go out an buy up some smaller clinics. As long as they can collect something every 90 days the bank doesn't look at it like it's uncollectable.

[Grapesoda]

Originally Posted by artwilliams

Here is one angle as told to me by an American doctor I once met on vacation.

Doctors pay huge malpractice insurance fees because ambulance chasing lawyers are suing them all the time. As a result, they've become overly cautious and send patients for any and all tests that might be related to their condition in order to help defend themselves should they get sued. This results in higher than needed health care costs and insurance premiums.

very true indeed... malpractice ins goes up every year...

[Grapesoda]

Originally Posted by Mutt

I still don't get it - if they're targeting the uninsured with inflated prices it makes no sense, they know they can't blood from a stone and will never collect much.

and grapesoda says the opposite, that they give the insured a big discount.

so is anybody actually paying these 200K bills we hear so much about?

I didn't get a discount on the blood test Mutt.... or at least the ins didn't

[tony286]

Originally Posted by Mutt

I still don't get it - if they're targeting the uninsured with inflated prices it makes no sense, they know they can't blood from a stone and will never collect much.

and grapesoda says the opposite, that they give the insured a big discount.

so is anybody actually paying these 200K bills we hear so much about?

http://www.cnbc.com/id/100840148
No they go bankrupt. I can tell you my experiences, never got a discount for cash. Had to get an eye exam, I wanted a thorough one. I went to my Dad's eye doctor, this was 10 yrs ago. The exam cost me $150 they knew I was paying cash. I have no complaints he was thorough.
So my dad asks me, did you see the dr ? How much did he charge you? When I told him, he said want to know what the health insurance company he worked for paid him for that same exam? $35 so not everyone is giving cash deals.

[tony286]

Originally Posted by artwilliams

Here is one angle as told to me by an American doctor I once met on vacation.

Doctors pay huge malpractice insurance fees because ambulance chasing lawyers are suing them all the time. As a result, they've become overly cautious and send patients for any and all tests that might be related to their condition in order to help defend themselves should they get sued. This results in higher than needed health care costs and insurance premiums.

Thats insurance companies fucking them up the ass not actual law suits. In Tx they capped it all and it hasnt made a different of healthcare costs.


http://www.upi.com/Health_News/2013/...3391367349367/

"Some argue malpractice lawsuits are a big driver of U.S. healthcare costs, but researchers suggest these assertions are wrong.
Dr. Marty Makary, an associate professor of surgery and health policy at the Johns Hopkins University School of Medicine, and colleagues found in their review that U.S. malpractice payouts of more than $1 million added up to roughly $1.4 billion a year -- making up far less than 1 percent of national medical expenditures in the United States. The cost of U.S. healthcare was $2.6 trillion in 2010."

[Minte]

Originally Posted by L-Pink

An old g/f has a Masters in Hospital Administration, basically a specialized MBA. She works for the University of Kentucky Medical Center. Her only job is to argue with insurance companies about billing issues.

Actually her job is to supervise the 5 story office building and the 5 story office building next to hers full of people doing the back and forth settlement of patients bills. She said the insurance companies will challenge even agreed upon pricing levels from patient to patient.

There are 4 office buildings in an office park setting doing nothing but administrative, non-medical work. This is in addition to the people working in the hospital itself doing other non-medical administrative work like her supervisors.

Spend 2 minutes talking with her and you'll know why our health care costs are so bloated ? And it's not because the actual cost of patient treatment is high.

Add in non-medical employees, palatial hospitals with fountains and their own transportation systems, renting entire office complexes, etc. Then you have the insurance side of things with well paid executives, share holders and countless employees to argue and deny payments with hospitals, doctors and their own customers.

Now add the government into the mix with their fondness for bureaucratic expansion and prices will go even higher.


.

Let's not be dissin' the fountains!

[dyna mo]

my experience is the cash discounts happen on services and tests. especially lab work.

when i was in the er 6 months ago, my bill came to me with the fees in 2 columns, my price without insurance, and the insurance price.

also, speciaized doctors do not lower their fees, when i go to see the endocronologist, the cash fee is $350 per visit and the insured fee is the same. that endo will order a full blood panel for me, if i go through his office to get it at labcorp, the bill will be $1000, they don't accept cash paying customers.

www.labcorp.com

however, i can go to econolab directly and go there the bill is closer to $250

https://www.econolabs.com/category_s/20.htm

here's more:::::::::

Budget gaps at hospitals have forced many institutions to raise prices, even as new government rules have placed some limits on what they can charge the patients without insurance, according to the LAT. Ultimately the cost to underwrite the uninsured is passed on to insurance companies and insured patients -- who can end up paying up to 10 times as much as cash-pay patients do for the same procedure.

The California Hospital Assn. says that discounted cash prices are intended for the uninsured, not those who have coverage. Jan Emerson-Shea, a vice president at the industry group, said most hospitals offer a separate discount to insured patients who are willing to pay their portion upfront.
"If you have insurance, you are under that insurance plan's negotiated rate with the hospital," she said.

Robert Berenson, a senior fellow at the Urban Institute and vice chairman of the Medicare Payment Advisory Commission, big hospitals are exerting their market power to charge ever-increasing rates and major insurers go along with it because they can pass along the costs to employers and consumers. Insurance industry officials say that health plans negotiate the lowest prices they can, but that they also need to include prominent hospitals favored by customers in the network, and those institutions can command higher prices.

A Long Beach hospital charged Jo Ann Snyder $6,707 for a CT scan of her abdomen and pelvis after colon surgery. But because she had health insurance with Blue Shield of California, her share was much less: $2,336.
Then Snyder tripped across one of the little-known secrets of healthcare: If she hadn't used her insurance, her bill would have been even lower, just $1,054.


At Long Beach Memorial Medical Center, where Snyder got her CT scan, the hospital's chief financial officer said insured patients like her pay more to subsidize the uncompensated care given to the uninsured and low reimbursements for Medicaid patients.
"We end up being forced to charge a premium to health plans to make the books balance," said John Bishop, the hospital's finance chief. "It's a backdoor tax on employers and consumers."


http://www.latimes.com/business/heal...#ixzz2oggQFRgN

[Mutt]

Originally Posted by dyna mo

A Long Beach hospital charged Jo Ann Snyder $6,707 for a CT scan of her abdomen and pelvis after colon surgery. But because she had health insurance with Blue Shield of California, her share was much less: $2,336.
Then Snyder tripped across one of the little-known secrets of healthcare: If she hadn't used her insurance, her bill would have been even lower, just $1,054.


At Long Beach Memorial Medical Center, where Snyder got her CT scan, the hospital's chief financial officer said insured patients like her pay more to subsidize the uncompensated care given to the uninsured and low reimbursements for Medicaid patients.
"We end up being forced to charge a premium to health plans to make the books balance," said John Bishop, the hospital's finance chief. "It's a backdoor tax on employers and consumers."


http://www.latimes.com/business/heal...#ixzz2oggQFRgN

interesting - this refutes Robbie's claim that the lower cost to the uninsured is some type of shady deal between the hospitals and the insurance companies.

[dyna mo]

a big change that's been happening right now is the price fluctuation on my prescription meds. i buy a shiton of insulin and have (had) bought it for years from a canadian pharmacy, getcanadiandrugs.com. 1 vial of regular insulin there used to cost $60, the very same vial, branding, everything, eli lilly, cost 4x more here at walgreen's, $240.

then, several months ago, the canadian pharmacies all ran out of that insulin, they could not get it, so for several months, i had to pay usa pricing for it. the canadian pharmacy finally got it back and all the sudden it's even more than it is in the u.s.- $270

http://getcanadiandrugs.com/ProductS...nsulin%20Vials

but also at the same time, the price dropped at walgreens! that very same vial is now $80 at walgreen's

[pornguy]

Look in the news papers or where ever and see how much doctors pay the insurance billers they have in their offices. That will explain a major portion of it.

[Atticus]

According to the doctors I visit and my health care agent (that takes care of setting up my company health care) it works like this?

Insurance companies have a set rate that they will pay out for certain things. This can be different depending on the insurance company. These rates are 'discounted' compared to the 'rack' rate. For example United Healthcare might pay $850 for a scan, Blue Cross might pay $800. The cash rate may be $1300. Dr's agree to these rates if they want to stay in that carriers network.

The rack rate for individuals without insurance is higher then the discounted insurance rate. This is because for the most part individuals without insurance cannot afford to pay the bill. So the Dr and Hospital know that it doesn't matter if the bill is $200 or $2,000, 90% of these people can't pay it. But the 10% that do pay help to cover the cost of the majority that cannot. As someone posted above, it also helps with receivables. As long as they are collecting something every month ($5 whatever) they can show the high amount as a collectible debt on their books.

If you have a good relationship with your Dr you can usually negotiate an even lower cash rate, depending on your insurance deductible. My eye Dr does this for me routinely since my primary insurance doesn't have very good eye coverage.

[kane]

Originally Posted by Mutt

interesting - this refutes Robbie's claim that the lower cost to the uninsured is some type of shady deal between the hospitals and the insurance companies.

A lot of it depends on what kind of service you were there for and if you actively negotiated. If I remember correctly Robbie said he had a lawyer help him negotiate his bill (I may be remembering that incorrectly though).

Here are some basics:

There are roughly 30 million people in the US with no insurance. I have no idea how many millions of illegals there are here that also have no insurance. These people still get sick, hurt, pregnant etc. They just go to the ER and urgent care centers to get treated because those places won't turn them away.

Many of these people end up unable to pay their bill so the hospital either forgives the debt or they go after them legally and the people often end up declaring bankruptcy to avoid paying the debt. This saddles the hospital with all the cost of that person's care. So, in an effort to make up for those who don't pay they overcharge those who do pay. Most people who have health insurance don't really care or they might be a little outraged at the high prices of everything, but they do nothing about it because the money to pay the bill isn't coming out of their pocket.

If you don't have insurance you will still get one of these inflated bills where they charge you $25 for an aspirin or $15 for a blanket etc. You can choose to dispute it and they will often work with you to lower the bill.

Pharmacies, however, are often a different story. There is a maximum dollar amount insurance companies will pay for certain medications. Say for example an insurance company will pay $150 for a 30 day supply of a medication and you have a $15 co-pay. The pharmacy will charge you $165 for the med. You pay your $15 and the insurance pays the rest. Now, if you go in and want to pay cash for that medication they might charge you $200. They can charge you whatever they want because there is no insurance company telling them how much to bill for it. Many pharmacies will use cash paying customers to make up for lower profits from those who have insurance.

It can be an eye opening experience. Just call around to several local pharmacies and ask them for the cash price of a medication. You will likely get many very different answers and a potentially wide variety of medication.

Here is the kicker. All of those prices are grossly inflated. For example. I have asthma and use an inhaler. The cost of that inhaler ranges between $45-$65 depending on where I go to buy it. I can buy the exact same medicine from the exact same manufacturer online for $10.

[EddyTheDog]

I think its pretty much the same here with all types of insurance - There is a cash price and a price that's paid if it is invoiced to insurance - Mechanics do it and so do builders...

Even our vet has a 'cash' price.....

[Sunny Day]

Al lot of uninsured don't realize you can bargain and think they have to pay the whole bill.
A lot of uninsured don't realize that drug companies will give free or discounted meds based on income.

But over 60% of all U.S. bankruptcies are due to medical bills. Many are people with insurance.

http://beforeitsnews.com/economy/201...e-2500492.html

[Robbie]

Mutt, the way I analyzed what happened with me and what the suit from the corporation that owned the hospital I was in explained was this:

You go for medical care. They price it through the roof.
The insurance company pays out.
But the insurance company does NOT pay those inflated prices. They pay the "real" price (which is what I finally ended up paying myself).

BUT...the insurance company paperwork that YOU see shows that they paid that overinflated bill.
And they take those cooked books and adjust premiums accordingly.

In other words, the hospital bill shows you $100,000
Let's say you've already covered your deductible for the year and the insurance is paying it all.

The insurance company now "negotiates" (but not in any form of what we would define a "negotiation") and actually pays out $15,000 (which is really what your hospital stay was).

But you don't know that. All you ever see is what the hospital billed you. And then the insurance company sends you a "Explanation of Benefits" and that shows you what the hospital billed you and that the insurance "covered" it.

Now at the end of the year, the insurance company takes the set of figures from the hospitals original bill and uses those figures to adjust (raise) your premium.

THAT is the scam. And that is the real reason we are all paying exponentially more for our insurance premiums.

The rich get richer...

[Barry-xlovecam]

I have deduced how this works ...

First of all, Disproportionate Share Hospital (DSH) payments (a Federal subsidy) for the indigent (read: uninsured {noncollectable}) are reimbursed to Hospitals that receive Federal Payments (read: Medicare, Federally subsidized Medicaid) for their requirement of providing limited services to the uninsured.

The second part of the equation: The uninsured are billed at the "retail rate (not at the contracted rate given to insurers)'' because maybe one out of fifteen of the uninsured will actually pay that bill -- maybe a few will negotiate a settlement price and pay it or make payments on that settlement.

So bottom line, the hospitals may receive less than 25% of what they bill out to the uninsured from all payment and reimbursement sources.

Of course, the worst part is that they try to pass on some of their actual losses on unpaid care provided to the uninsured to the private insured patient.

[kane]

Originally Posted by Robbie

Mutt, the way I analyzed what happened with me and what the suit from the corporation that owned the hospital I was in explained was this:

You go for medical care. They price it through the roof.
The insurance company pays out.
But the insurance company does NOT pay those inflated prices. They pay the "real" price (which is what I finally ended up paying myself).

BUT...the insurance company paperwork that YOU see shows that they paid that overinflated bill.
And they take those cooked books and adjust premiums accordingly.

In other words, the hospital bill shows you $100,000
Let's say you've already covered your deductible for the year and the insurance is paying it all.

The insurance company now "negotiates" (but not in any form of what we would define a "negotiation") and actually pays out $15,000 (which is really what your hospital stay was).

But you don't know that. All you ever see is what the hospital billed you. And then the insurance company sends you a "Explanation of Benefits" and that shows you what the hospital billed you and that the insurance "covered" it.

Now at the end of the year, the insurance company takes the set of figures from the hospitals original bill and uses those figures to adjust (raise) your premium.

THAT is the scam. And that is the real reason we are all paying exponentially more for our insurance premiums.

The rich get richer...

So in essence the insurance companies and hospitals make it appear that the insurance companies are paying out more as a way for the insurance companies to rationalize raising your rates?

That is wild.

[fitzmulti]

I had a similar situation, when 2 years ago, I almost died from extreme high blood pressure / near kidney failure.
I was in the hospital for two weeks, had two surgeries, etc...and the tab was nearly $125,000.
No insurance, etc...and they negotiated that down to $38,000...basically saying that if it was w/ insurance the insurance company "ate" the difference, or some such crap.
Even my follow up stuff, and meds each month have been "negotiated" way lower, since I don't have insurance. (Example $218 in meds monthly, I get direct from the hospital pharmacy for about $40)...
Overinflated insurance pricing is a total scam...

Robbie's assessment is spot on.

Originally Posted by kane

So in essence the insurance companies and hospitals make it appear that the insurance companies are paying out more as a way for the insurance companies to rationalize raising your rates?

That is wild.

Yes.

[Robbie]

Originally Posted by kane

So in essence the insurance companies and hospitals make it appear that the insurance companies are paying out more as a way for the insurance companies to rationalize raising your rates?

That is wild.

And not only that...they use it to justify raising EVERYONE'S rates!

And then we get handed the argument that all of a sudden, magically in the last couple of decades that people using the emergency room with no money is responsible for medical costs and high insurance.

Yeah...because that never happened before.
It's pretty much the way they milk it for money.

I don't know about you, but in my experience I've found that there is always some milking going on.

I mean look at car dealerships and the whole scam there where people pay literally thousands more than they have to and think they got a "good deal".

Or retail furniture sales. They do 300% markups on product!

[dyna mo]

people like me are the ones getting fucked over, i make more than the poverty level, but do not have medical insurance.

although, in 4 days i will be taking full advantage of my new insurance policy.

[kane]

Originally Posted by Robbie

And not only that...they use it to justify raising EVERYONE'S rates!

And then we get handed the argument that all of a sudden, magically in the last couple of decades that people using the emergency room with no money is responsible for medical costs and high insurance.

Yeah...because that never happened before.
It's pretty much the way they milk it for money.

I don't know about you, but in my experience I've found that there is always some milking going on.

I mean look at car dealerships and the whole scam there where people pay literally thousands more than they have to and think they got a "good deal".

Or retail furniture sales. They do 300% markups on product!

One of my favorite car dealership tricks is when they tell people that they are giving them a good deal because that particular dealership is a wholesaler. Anyone can be a wholesaler. Calling yourself that doesn't mean it is so.

I used to work in the auto insurance industry on the side that set values of lost or totaled cars. What most people don't know is that many insurance companies hire companies to tell them how much to pay you for their car. They choose which company to go with by sending over the same info on a car to several different companies and having them all do a valuation. Whoever comes back with the lowest price gets the business. They will do everything they can to lowball you when it is time to make a payoff.

[dyna mo]

y'all know 2.5 is a typical retail mark-up, right?

if my cost to buy & sell a widget is .33c, i'm going to put it up for sale at .99c

furniture, clothing, sporting goods, etc. add a brand name on there and the sky's the limit. roche-bobois, kiton, rolex. etc. the markup there can be 100x

[PornoMonster]

Originally Posted by Mutt

I was trying to tell somebody your explanation of how the American medical insurance racket runs but I don't think I totally understood it. You were in a major car accident, had no medical insurance and at the end of your hospitalization you were stuck with one of these crazy bills where aspirins are billed at 10 bucks apiece so your bill was well into six figures - right? And then you made a deal with them for a fraction of the bill and they explained that's how the racket works, that nobody really pays these huge bills. Right?

So what I don't understand is what's the point of the wildly inflated bills? I think you said the insurance company writes off the difference between what the bill was and what you actually paid as a loss.

I just can't believe that is standard operating procedure, if it was so I'd expect there'd be a ton of liberal politicians and media exposing this.

There is an Insurance Price and a Cash Price.
But, with more of this coming out in the last few years, you now have to find more of a cash place (office)

Another reason they charge so much, is if they do not collect, it is a TAX write off.

I wont have these numbers exactly correct, but
I went in for a Blood Iron test, they charge my insurance $68-$88 I can't remember.
A Friend of mine got the exact same test in the same testing lab, said No Insurance and paid $18 Cash... this year (2013)

[PornoMonster]

Oh Forgot to say this part.
The bills are like Selling Cars, No one should pay the sticker Price, HAHA.

Say my medical bill is 100K, my insurance covers 80% so I am stuck with 20K and my insurance is stuck with 80K.... NOT so fast.. The insurance Companies have Huge Buildings of people who negotiate their part ($80K) down. I do not know how much they will get that 80K down to, but they employ hundreds upon hundreds of workers for just this...

[PornoMonster]

Originally Posted by kane

So in essence the insurance companies and hospitals make it appear that the insurance companies are paying out more as a way for the insurance companies to rationalize raising your rates?

That is wild.

AND,
Making you pay your 10% or 20% of the Inflated Price, while the insurance company pays prob half of the 80%, thus you might be close to 50/50 Ehh??

[dyna mo]

Originally Posted by PornoMonster

Oh Forgot to say this part.
The bills are like Selling Cars, No one should pay the sticker Price, HAHA.

Say my medical bill is 100K, my insurance covers 80% so I am stuck with 20K and my insurance is stuck with 80K.... NOT so fast.. The insurance Companies have Huge Buildings of people who negotiate their part ($80K) down. I do not know how much they will get that 80K down to, but they employ hundreds upon hundreds of workers for just this...

what's your bargaining tool to compel the hospital to negotiate your bill?

[Barry-xlovecam]

Originally Posted by dyna mo

what's your bargaining tool to compel the hospital to negotiate your bill?

The bargaining tool is the quantity of persons insured and the insurance company's management of the payment of medical benefits for those customers.

Hospitals, clinics, labs and doctors want to be approved providers to be able to sell their services to that insurance company's customers (like 30,000 customers in that county, 200,000 in that state -- that idea). So the insurance company can negotiate bulk rate flat contract prices.

But PornoMonster you are wrong on the allocation of the contract price for the person insured will pay if I understand you correctly.

You say the ''retail bill'' is $100K your share is $20K
If the $100K bill is contracted down to $80K the insured would pay his deductibles and the remaining 80% of the $80K contract price would be paid by the insurer.

A better example is a $10K bill.
That bill's services are negotiated to a contract price of $8K

The insured has already paid his 100% deductible costs.
The insured has a 80%/20% co-pay deductible to pay still.
This co-pay amounts are capped by the out of pocket maximum of the policy -- $13,900 per policy year by law now. This amount includes policy premiums and all deductibles as well as copays.
The insured would be liable for 20% of the $8K contracted rate that was negotiated.
Bottom line he owes $1,600 to the billing provider (the hospital, etc)
The insurer pays the hospital $6,400
$2K of the $10K is just 'air'.

This complex mess will lead to a tax supported mandatory universal health care at some point in time.

[Robbie]

Originally Posted by dyna mo

what's your bargaining tool to compel the hospital to negotiate your bill?

There is no "negotiating", at least in the sense that the word has always been defined.

The prices are fake. They are only there for Medicare, Medicaid, and insurance.
Once the hospital understands that you have none of those...then they will give you the "real" price.

That is exactly what happened to me.

And it is exactly what will never happen again once ObamaCare/Handout To The Insurance Companies is complete.
The more I think about it the more the whole "health care" (which has nothing to do with actual "health care) bill is one of the biggest moves by any industry in history. The insurance companies went from being something that wasn't really needed except for catastrophic care just a couple of decades ago, into being something that EVERYBODY must have and the costs are now through the roof and rising.

[dyna mo]

Originally Posted by Barry-xlovecam

[INDENT]The bargaining tool is the quantity of persons insured and the insurance company's management of the payment of medical benefits for those customers.

no, it's not.

Originally Posted by Robbie

There is no "negotiating", at least in the sense that the word has always been defined.

The prices are fake. They are only there for Medicare, Medicaid, and insurance.
Once the hospital understands that you have none of those...then they will give you the "real" price.

That is exactly what happened to me.

And it is exactly what will never happen again once ObamaCare/Handout To The Insurance Companies is complete.
The more I think about it the more the whole "health care" (which has nothing to do with actual "health care) bill is one of the biggest moves by any industry in history. The insurance companies went from being something that wasn't really needed except for catastrophic care just a couple of decades ago, into being something that EVERYBODY must have and the costs are now through the roof and rising.

again, my experience is entirely different, and as the post i made shows, people that are not near the federal poverty level and are uninsured do not get a break on price.

we have no bargaining tool. that's my point. if i don't pay the price, the hospital sells my account to a bill collector and my credit gets wiped out and i still have the bill.

[dyna mo]

Originally Posted by PornoMonster

Oh Forgot to say this part.
The bills are like Selling Cars, No one should pay the sticker Price, HAHA.

again, my question still stands, what is the bargaining tool you use to not pay the sticker price?

[dyna mo]

read the part about uninsured.

Originally Posted by dyna mo

[Brad Mitchell]

None of these explanations are actually true. This is where I wish I had a real keyboard on my iPhone to make giving everyone the real explanation easier.. Before being in this business, I spent eight years in charge of medical billing, accounts receivables and physician insurance enrollment. I was trained by a retired Medicare adjucary judge and during this part of my life was on the Medicare Advisory Board for the State of Michigan as I with my own hands or oversight billed a "gross" over a hundred million dollars for physician, diagnostic and laboratory services.

I'll explain by practical example as if I am a board certified Internal Medicine doctor who treats patients 18 to senior citizen. I do office visits, small procedures, have some limited diagnostic testing equipment in my office and a small in-office laboratory for processing limited bloodwork chemistries.

I participate with with Medicare, Blue Cross Blue Shield and my states Medicaid program. A small number of patients come to me with one off insurances that I do not "participate" with and from time to time I see patients whose bills are billed to an auto or other such insurance due to an accident and I also do not participate with them as they have no such option, even if they did it would be impractical to credential and include myself in their directories because almost none of my volume would result from this.

I'm an average physician and not a hospital, therefore I am my practice and I know my patients. It's my job to run a viable business, not easy as a small practice. If I don't have sound billing practices, I lose my patients and it affects my community reputation.

Because I participate with Medicare, Blue Cross and Medicaid I can only have ONE prevailing gross charge for any service, procedure, diagnostic or laboratory test. My agreement with the insurers requires this, also that I discount to their fee schedule regardless of what my gross charge is. I am not allowed to bill this difference to any patient. I am only allowed to further bill to my patients according to their insurance payment schedule and amounts determined by their explanation of benefits to be co insurance or deductible due from my patient.

Here is my example:
Service, my gross charge, Medicare pays BCBS pays, Medicaid pays, non-participating (like auto accident) insurer pays:

New patient office visit, $150, $115, $123, $77, $150
EKG, $50, $36, $28, $18, $50
Blood chemistry panel, $60, $18, $39, $8, $60

The difference between my charge and each carriers rate schedule is called a contractual write off. Unlike on our personal taxes, this is NOT a deduction or anything beneficial of the sort. It's just money I am not entitled to collect from the insurer or my patient. I'd be happy to charge less to cash pay patients but if i do so on any routine basis and get caught, I'll get kicked out of participation and be subject to fines and criminal charges. I don't have much cash pay business anyways, less than a few percent. I have about 15% of my patients whose insurers are auto, miscellaneous or that I otherwise don't participate with (out of state, etc) and those are my best paying clients. I need the extra revenue, malpractice insurance is high and it's expensive running a practice. I take some Medicaid patients to give back and help fill my days, but basically on top of being a slow payor, we lose money and need the averaging of the low revenue with our highest private payors to be viable. I have two people in the front office, two doctors that work for me, a full time medical biller for the sea of paperwork, claims and patient questions.. Three medical assistants, a full time lab tech and once a week an echocardiography technician whom we can fill a full day of ordered studies... And I pay a remote radiologist to interpret each and every study.

/end example

In short, whether I'm a hospital or a doctor I can only have one fee for any service rendered. 70% of my patients have one of three insurances and I have to bill at least as much as they will approve to pay, otherwise I'm leaving money on the table. I would just set my fees right above Medicare or Blue Cross approved amounts, but with the number of claims they deny and the amount of co insurance and deductible we are unable to collect from patients, we especially rely on the smaller number of patients with premium insurances who help average up our collections.. And we need that, especially because we are willing to treat the senior population and some of the indigent who only have Medicaid, state insurance with low fees that are 50-70% less than Medicare. And Medicare fees differ by region and geography, taking into consideration the cost of living index.

I can negotiate on balances due me farther down the road after sincere collection efforts. The money I don't collect doesn't provide any tax benefit or write off. In fact, if my business is >10 million a year or if I do accrual based accounting, I need to be very careful to avoid paying income taxes on uncollectable receivables.

Hospitalization is the same in terms of fee schedule rules and regulations. Difference is, you can hate a hospital but you will still go there. Other primary difference is that most are not for profit, what they get paid is different than physicians and often cost plus, also often not for profit. They're not rewarded for efficiency, quite the opposite. Their gross fees are usually offensive. It's not hard to understand why- it's where you go when you get in an accident and auto insurances (etc) pay whatever is billed to them.

I don't think a single payor system could ever work. However, the way things are right now, it's broken. I'm not presenting any solutions here, just wanted to inform everyone what's REAL about billed and collected amounts.

Sincerely,

Brad Mitchell

[kane]

Originally Posted by Brad Mitchell

None of these explanations are actually true. This is where I wish I had a real keyboard on my iPhone to make giving everyone the real explanation easier.. Before being in this business, I spent eight years in charge of medical billing, accounts receivables and physician insurance enrollment. I was trained by a retired Medicare adjucary judge and during this part of my life was on the Medicare Advisory Board for the State of Michigan as I with my own hands or oversight billed a "gross" over a hundred million dollars for physician, diagnostic and laboratory services.

I'll explain by practical example as if I am a board certified Internal Medicine doctor who treats patients 18 to senior citizen. I do office visits, small procedures, have some limited diagnostic testing equipment in my office and a small in-office laboratory for processing limited bloodwork chemistries.

I participate with with Medicare, Blue Cross Blue Shield and my states Medicaid program. A small number of patients come to me with one off insurances that I do not "participate" with and from time to time I see patients whose bills are billed to an auto or other such insurance due to an accident and I also do not participate with them as they have no such option, even if they did it would be impractical to credential and include myself in their directories because almost none of my volume would result from this.

I'm an average physician and not a hospital, therefore I am my practice and I know my patients. It's my job to run a viable business, not easy as a small practice. If I don't have sound billing practices, I lose my patients and it affects my community reputation.

Because I participate with Medicare, Blue Cross and Medicaid I can only have ONE prevailing gross charge for any service, procedure, diagnostic or laboratory test. My agreement with the insurers requires this, also that I discount to their fee schedule regardless of what my gross charge is. I am not allowed to bill this difference to any patient. I am only allowed to further bill to my patients according to their insurance payment schedule and amounts determined by their explanation of benefits to be co insurance or deductible due from my patient.

Here is my example:
Service, my gross charge, Medicare pays BCBS pays, Medicaid pays, non-participating (like auto accident) insurer pays:

New patient office visit, $150, $115, $123, $77, $150
EKG, $50, $36, $28, $18, $50
Blood chemistry panel, $60, $18, $39, $8, $60

The difference between my charge and each carriers rate schedule is called a contractual write off. Unlike on our personal taxes, this is NOT a deduction or anything beneficial of the sort. It's just money I am not entitled to collect from the insurer or my patient. I'd be happy to charge less to cash pay patients but if i do so on any routine basis and get caught, I'll get kicked out of participation and be subject to fines and criminal charges. I don't have much cash pay business anyways, less than a few percent. I have about 15% of my patients whose insurers are auto, miscellaneous or that I otherwise don't participate with (out of state, etc) and those are my best paying clients. I need the extra revenue, malpractice insurance is high and it's expensive running a practice. I take some Medicaid patients to give back and help fill my days, but basically on top of being a slow payor, we lose money and need the averaging of the low revenue with our highest private payors to be viable. I have two people in the front office, two doctors that work for me, a full time medical biller for the sea of paperwork, claims and patient questions.. Three medical assistants, a full time lab tech and once a week an echocardiography technician whom we can fill a full day of ordered studies... And I pay a remote radiologist to interpret each and every study.

/end example

In short, whether I'm a hospital or a doctor I can only have one fee for any service rendered. 70% of my patients have one of three insurances and I have to bill at least as much as they will approve to pay, otherwise I'm leaving money on the table. I would just set my fees right above Medicare or Blue Cross approved amounts, but with the number of claims they deny and the amount of co insurance and deductible we are unable to collect from patients, we especially rely on the smaller number of patients with premium insurances who help average up our collections.. And we need that, especially because we are willing to treat the senior population and some of the indigent who only have Medicaid, state insurance with low fees that are 50-70% less than Medicare. And Medicare fees differ by region and geography, taking into consideration the cost of living index.

I can negotiate on balances due me farther down the road after sincere collection efforts. The money I don't collect doesn't provide any tax benefit or write off. In fact, if my business is >10 million a year or if I do accrual based accounting, I need to be very careful to avoid paying income taxes on uncollectable receivables.

Hospitalization is the same in terms of fee schedule rules and regulations. Difference is, you can hate a hospital but you will still go there. Other primary difference is that most are not for profit, what they get paid is different than physicians and often cost plus, also often not for profit. They're not rewarded for efficiency, quite the opposite. Their gross fees are usually offensive. It's not hard to understand why- it's where you go when you get in an accident and auto insurances (etc) pay whatever is billed to them.

I don't think a single payor system could ever work. However, the way things are right now, it's broken. I'm not presenting any solutions here, just wanted to inform everyone what's REAL about billed and collected amounts.

Sincerely,

Brad Mitchell

Very informative.

If I understand you correctly, what you are saying is that if I have no insurance and end up in the hospital and the bill is $10,000 the hospital won't negotiate with me to lower the price by very much right at the start. They will try to collect as much as possible and only if they realize they may end up with little or nothing will the negotiate with me. Correct?

[dyna mo]

it's completely bizarre to me that some think generalized examples trumps actual personal experience.

[dyna mo]

Originally Posted by kane

Very informative.

If I understand you correctly, what you are saying is that if I have no insurance and end up in the hospital and the bill is $10,000 the hospital won't negotiate with me to lower the price by very much right at the start. They will try to collect as much as possible and only if they realize they may end up with little or nothing will the negotiate with me. Correct?

the hospital will start on day 1 working with you. they send a financial advisor to meet beginning on the 1st day of admission. i had the financial advisor meet me the last time before the physician intake. they want money up front if at all possible. this is how it's happened for me more than twice.

[Brad Mitchell]

Originally Posted by dyna mo

it's completely bizarre to me that some think generalized examples trumps actual personal experience.

I presume you're referring to my example.. While an example, it's entirely from my hands on personal experience and a completely accurate explanation of fee rationale, state and federal laws and participation regulations of the largest insurers. Maybe you missed the facts I presented because my example reads as if I'm empathetic to physician and practice owners. I'm not.

My take away from my personal experience is that health care is F'd. As a result, it's a core company value of ours to purchase the best health insurance benefits for our employees and their family members. We pay the full premium, about 2-2.5X the benefit of the average employer. Total out of pocket for our average employee with physician services, lab, diagnostics, hospitalization, prescription, dental and vision for them and their whole family averages is only $10-$20 per visit and max $20 copay on prescriptions with no other deductibles or copays.

Cheers,

Brad

[kane]

Originally Posted by dyna mo

the hospital will start on day 1 working with you. they send a financial advisor to meet beginning on the 1st day of admission. i had the financial advisor meet me the last time before the physician intake. they want money up front if at all possible. this is how it's happened for me more than twice.

When I was in the hospital a few years ago they sent someone in and we talked. I had insurance, but it was a catastrophic only policy. They actually laughed when they told me that the insurance should cover this because it was something I couldn't get treatment at home or in a regular docs office for and left untreated it would kill me. Therefore it qualified, but she said they will reject the claim and it will be a fight.

She was right. The insurance rejected the claim, but my doctor was a champ. It pissed him off and her personally took it upon himself to educate them and get them to pay for it. Had he not stepped in it could have been a huge headache and very expensive for me.

[dyna mo]

i' m referring to all the generalized examples, actually, there's been several. none of which mimic real world dealings.

mine and Robbie's comments show that 2 different people have 2 vastly different experiences dealing with it irl. Robbie is not wrong, that's what happened to him. i'm not wrong either, even though what's happened for me is different than him, or all the examples.