Robbie ------> inside please
 

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.

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.

Robbie is the OG Schwtchhhhhhhhhhhhhhhhhhhhhhhhhhaaaaaaaaaaaa

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.

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.

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

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

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.

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.

:1orglaugh

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?

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.


.

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.

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

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

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.

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."

Let's not be dissin' the fountains! :winkwink:

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.

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.

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

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.

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.

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.

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.....

Bankruptcy
 

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

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.

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.

Yes.

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!

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.

http://i.imgur.com/d64i1IG.jpg

http://i.imgur.com/s6s6un1.jpg

http://i.imgur.com/sxKUkqg.jpg

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.

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

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)

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...

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??

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. :(