Comments on: Hospital charges and the uninsured

By: geoatwhgi@aol.com

geoatwhgi@aol.com — Sun, 17 May 2009 05:23:00 +0000

someone doesn’t know what in hell they are talking about. Of course, the world is full of know-it-alls. Here’s my story: i’d lost my job, and my benefits. I’d worked for the same company for 35 years. All during that time, I had medical insurance for my family.Prior to that, I was in the military and had coverage there. In 2006, my wife had a fall at home. I rushed her to the closest hospital, OVMC in Wheeling, WV. Barb was 64 years old at the time, a year short of being eligible for Medicaire. She was diagnosed with a broken hip, a broken shoulder, and a severe head injury. the inexperienced techs in Radiology forced her to stand up for x-rays even tho she was in agony. while a patient at the above facility, she went into a coma because of an overdose of drugs. She was found by a nurse to be “non-responsive” and transferred to the hospital’s ICU where she developed pneumonia and placed on a respirator. Because the hospital staff could not find a vein, she was sent to surgery to have a port implanted through wich vital drugs could be administered to her. Several days later, my daughter, who was a lab tech noticed that her pillow was soaked with the meds. Evidently, her port had become dislodged. God only knows how she must have suffered. Back to Surgery and another shunt implant. During that time, Barb had a stroke. As soon as she was stabllized, Barb was discharged from the hospital to an “Extended Care” facility which accepted her as a “charity” patient. She spent two weeks there and was, eventually discharged. The following day, I got a bill for $116,500 from the hospital and $38,000 from the “Extended Care” facility. This did not include the cost of the surgeons, the anesthesiologists, the guys who read her x-rays, the guys who read her EKGs or a host of other “referrals”. I called the hospital and explained that we did not have insurance and could we make some sort of deal? They flat out refused. So, I sent them $100/mo. Same was true of all the other physicians/surgeons and hangers ons. The hospital eventually turned me over to an out-of-state collection agency which demanded the total amount now. I also called the “Rehab Center”. that CFO laughed when I called. He said…..”We thought she waas a charity case.” I said..my wife is not a charity case…give me a cash price. He said “$13,700 if you pay now.” I wrote the guy a check. So, Mr Expert, you are full of shit. Oh, by the way, for the hospital, I wrote a letter to my state senator. Miraculously, the hospital somehow agreed to accept my $100/mo payments. Oh, by the way…I checked some web sites and found that Barb would have recieved better care, might have avoided all that pain and suffering and a stroke had she been lucky enough to recieve treatment from Johns Hopkins University……..and for a thrd of the cost.

By: mitch

mitch — Sat, 12 May 2007 02:25:00 +0000

“Get sick, loose your job, lose your insurance, get left with a chronic condition that costs $400/mo, get part time job with no insurance cause that is what you can do. Granted I can get insurance for about 800/mo.”

Thing is, if you lose your job and are working part time, you’d possibly qualify within a few months. If you lose your job, you’re covered under COBRA for two months from your past employer. Add one month to that, and you’ll then qualify for charity care if your income isn’t sufficient. There are always outs. Now, if you live in an area where you only have for profit hospitals,… I can’t answer those questions, since here in New York we don’t have for profit hospitals.

By: gibbon1

gibbon1 — Fri, 11 May 2007 10:29:00 +0000

“Those who don’t qualify, and also don’t have insurance,… I have no sympathy for.”

Get sick, loose your job, lose your insurance, get left with a chronic condition that costs $400/mo, get part time job with no insurance cause that is what you can do. Granted I can get insurance for about 800/mo.

By: mitch

mitch — Fri, 11 May 2007 01:53:00 +0000

As someone who knows, since I’m a consultant who concentrates on the revenue side of things these days, I can honestly say that the main reason hospitals have charge masters is to simplify the charge capture process for their revenue generating departments. Putting the blame on a charge master for what patients may ultimately end up owing is like putting the blame on butter for what cake does to you later on. Many hospitals across the country are now setting up plans for self pay patients that will actually discount their bills down to the amount of their best payer, which means that off the top some patients will get a 50% discount. Now, after that, there are many charity care programs at most hospitals that those who really don’t have the cash will end up with some nice discounts. Those who don’t qualify, and also don’t have insurance,… I have no sympathy for. But I’d also said for years that I didn’t think it was fair to put the fiscal viability on the backs of patients who ended up having to pay 100% of hospital charges; that’s pretty much been rectified after the Oregon lawsuit of 2 1/2 years ago.

By: lfjlkdjflsdkf

lfjlkdjflsdkf — Thu, 10 May 2007 22:03:00 +0000

Fact #3: Hospitals write off a large % of an insured patient's bill.

I know, because I've spent years doing just that for 40 hours a week.

The indigent get write offs, the insured get right offs, and the people who pay their own way get screwed.

By: Elliott

Elliott — Thu, 10 May 2007 21:36:00 +0000

David, you’re a dishonest hack and after this post, I’ll give you the last word (which is likely to be even more BS). I’m not the one conflating two different things. You have tried to argue that a price is the same for all patients because the charge master is the same for all patients. The truth is that the charge master no longer has any validity when it comes to the price that customers actually see. (You said as much) In other words, I was trying to point out that your conflation does not represent reality. At one time it did when there was cost-plus or % of charges type of contracts, then the charge master had some relationship to price. Then there was the use of the charge master to justify exceptional reimbursement to CMS but that got so abused that it stopped so, in that sense in that circumstance, the charge master had some passing relationship to price. Finally there are only two items left currently where the charge master has any relationship to price and that is in the write-off of charity care where it makes the hospital look better because an inflated number is written off (although regulations are cracking down on this use as well) and in the billing of the uninsured. Your argument that reimbursement does not equal price is ludicrous. If I agree to buy something then the price paid and the dollars received are the price (not some bogus number that noone pays). You claim to have an MBA and should know this. Price = contracted reimbursement and there is no conflation going on there. There are different prices for different customers and that is a fact no matter how much you try to muddy the water by talking about the charge master. The charge master has little to do with anything in modern hospital accounting except as an inventory/cost accounting mechanism that needs to be massaged a 1001 ways before it can actually be used for anything.

By: Happyman

Happyman — Thu, 10 May 2007 21:29:00 +0000

catron is right. the same rules apply to individual doctors' offices as well.

It's very simple, actually: let's say that for an office visit (CPT 99204) the highest-paying insurer e.g. aetna pays $145 as their "maximum allowable rate". Then, of course to maximize reimbursement the office will bill $150 to aetna for that patient, to be sure to get the maximum. Then, by law, the office must "charge" EVERYONE the same amount for the same service. Otherwise it'd be like discriminating against some patients at the expense of others.

The same rules apply to collection of copays - paying copays pisses people off, but not charging copays is illegal, and seen by medicare & other insurers as conspiring with patients to commit insurance fraud.

I don't know why this concept is so hard for some to understand.

I'm no fan of hospitals in general, but it's a myth that they're getting rich off the uninsured. Here's an option: If you're uninsured don't go to the hospital! Most patients in the ER aren't truly emergent anyway.

By: Catron

Catron — Thu, 10 May 2007 20:52:00 +0000

Elliott, since you are so fond of the words “disingenuous” and “lie,” what would you say about someone who continues to knowingly conflate two different concepts in order to support a fallacious argument? That is what you are doing when you discuss reimbursement and charges as if they are they same thing. It is not a serious (or honest) position.

By: Anonymous

Anonymous — Thu, 10 May 2007 19:55:00 +0000

And if you have REALLY good ins. they may get charged twice for everything. I had an arthoscopic knee surgery once that ended up costing my ins over 20,000.00. It was billed as though I had 2 complete separate surgeries. I had chondroplasty (billed as one complete surgery) I had catliage(sp) removed, billed as one complete surgery. In addition the hospital also billed twice considering (this 1 small surgery) as though I had been there twice and underwent two surgeries. In reality this surgery consisted of passing a punch and shaver through there. Hell, when I had my total knee replacement it wasn’t as expensive as what this surgery had been. This was at a very large orthopedic institute and there were bills submitted, by every doctor who works there (14), even though I never once seen any of these Doc’s except my surgeon. 20,000.00 for a small 15 minute surgery….Give me a break. And you wonder why medicine is in such a state.

By: Elliott

Elliott — Thu, 10 May 2007 18:41:00 +0000

Current hospital charge masters are an anachronism left over from the days of insurance reimbursement as a % of charges (and less ancient from CMS paying for outliers). Before that they were intended to provide cost-plus accounting for charges. In those circumstances, you could raise your prices and get revenue enhancement without being subject to the normal elasticity of demand. Once CMS went to DRG’s and insurance adopted similar measures, the charge master is a wierd amalgam of conversion factors. The only current reason that a charge master exists in its current form is because it increases the amount of write off for charity care.

Finally, I have yet to see a charge master where the numbers don’t represent at least 2X net patient revenue and most are in the 3 – 3.5X range. The whole charge master thing is misleading enough, but then to argue that the uninsured patient who is billed directly against the charge master isn’t getting screwed is disingenuous if you’re being nice and a lie if you’re accurate.