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captainsblogContinuing my recent tradition of putting all of my wife's sensitive medical information out on the Internet: here. The first of the bills for her surgeries in February and March:
Bottom line's not bad; in fact, it's almost exactly what I expected it would be. But look at how the screws get turned on the uninsured.
Actually, you can't tell from this bill what, exactly, it's for, so I will tell you: it is not for her surgeon, nor for her anaesthesia. Those are still coming (and should be covered because this bill covers her entire 2014 out-of-pocket maximum). It is just for the "ambulatory surgery center," so, it's about two hours of rent- of a prep room, and an operating table, and some monitors, and a recovery room or two, and some wear and tear on some gurneys and wheelchairs that took her from one to the next to the next.
All of that? Over $3,000 an hour if you're uninsured. Nothing diagnosed, no admission, no treatment beyond exactly what the surgeon had you go there to do, and for which you are going to pay him or her separately.
Now if you are insured, watch those ugly dollars melt away before your eyes, as they shave more than 80 percent off the bill just because you have a card in your wallet. You and the owner of the card then split the other 20. But what a kick in the pants to those who can't, or won't, or don't. It's comparable to the bill Eleanor got when she burned her hands a few years ago and had to go to the ER to get fixed up. At least they don't add a specific line item for "uninsured patient surcharge" the way ECMC does.
What would it be on my higher-deductible plan? No idea. Maybe, not only would the out-of-pocket be more, but the total reduction of the bill might be less. There's no way to know until you incur the charge. And that's where you see the fallacy of the Big Repugnicant Talking Point about "replacing" Obamacare with "more and bigger health savings accounts." Because even for people who can afford to fund them, as we, barely, have been when we've had them? Just try to "shop around" to get the best price for your medical procedures. Hospitals have those lists; they're known as "chargemasters" and they're what get you stuck with hundred-dollar charges for an IV fluid bag that costs less than a buck, and $500 for a single stitch. But in most places, those lists are considered private, proprietary and confidential and the hospital won't tell you in advance what's on them, because, capitalism. One study found that hospitals were more than happy to tell you their comparative prices for valet parking but not a thing about what things cost once you got inside.
If you complain about these outrageousnesses- and people have been- the horsepital executives will tell you they're meaningless. They're merely a "starting point" for negotiating with insurers- comparable, if you will, to the exhorbitant rates that hoteliers are legally obligated to post inside your room door which are never what anybody actually pays. But the hotel doesn't put those "rack rates" on your bill unless you're actually dumb enough to pay that amount, and you'd better believe that somebody, somewhere, IS paying those "chargemaster" prices just because nobody told them not to.
Eventually, and regardless of whether the Obamacare tide turns or keeps coming in, this aspect of Big Health may well be the straw that breaks the back of this messed-up system. And just wait until you see the six bills you'll get for THAT surgery:P
Bottom line's not bad; in fact, it's almost exactly what I expected it would be. But look at how the screws get turned on the uninsured.
Actually, you can't tell from this bill what, exactly, it's for, so I will tell you: it is not for her surgeon, nor for her anaesthesia. Those are still coming (and should be covered because this bill covers her entire 2014 out-of-pocket maximum). It is just for the "ambulatory surgery center," so, it's about two hours of rent- of a prep room, and an operating table, and some monitors, and a recovery room or two, and some wear and tear on some gurneys and wheelchairs that took her from one to the next to the next.
All of that? Over $3,000 an hour if you're uninsured. Nothing diagnosed, no admission, no treatment beyond exactly what the surgeon had you go there to do, and for which you are going to pay him or her separately.
Now if you are insured, watch those ugly dollars melt away before your eyes, as they shave more than 80 percent off the bill just because you have a card in your wallet. You and the owner of the card then split the other 20. But what a kick in the pants to those who can't, or won't, or don't. It's comparable to the bill Eleanor got when she burned her hands a few years ago and had to go to the ER to get fixed up. At least they don't add a specific line item for "uninsured patient surcharge" the way ECMC does.
What would it be on my higher-deductible plan? No idea. Maybe, not only would the out-of-pocket be more, but the total reduction of the bill might be less. There's no way to know until you incur the charge. And that's where you see the fallacy of the Big Repugnicant Talking Point about "replacing" Obamacare with "more and bigger health savings accounts." Because even for people who can afford to fund them, as we, barely, have been when we've had them? Just try to "shop around" to get the best price for your medical procedures. Hospitals have those lists; they're known as "chargemasters" and they're what get you stuck with hundred-dollar charges for an IV fluid bag that costs less than a buck, and $500 for a single stitch. But in most places, those lists are considered private, proprietary and confidential and the hospital won't tell you in advance what's on them, because, capitalism. One study found that hospitals were more than happy to tell you their comparative prices for valet parking but not a thing about what things cost once you got inside.
If you complain about these outrageousnesses- and people have been- the horsepital executives will tell you they're meaningless. They're merely a "starting point" for negotiating with insurers- comparable, if you will, to the exhorbitant rates that hoteliers are legally obligated to post inside your room door which are never what anybody actually pays. But the hotel doesn't put those "rack rates" on your bill unless you're actually dumb enough to pay that amount, and you'd better believe that somebody, somewhere, IS paying those "chargemaster" prices just because nobody told them not to.
Eventually, and regardless of whether the Obamacare tide turns or keeps coming in, this aspect of Big Health may well be the straw that breaks the back of this messed-up system. And just wait until you see the six bills you'll get for THAT surgery:P
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Date: 2014-04-06 01:56 am (UTC)There was a Daily Show sometime last year with a guest who explained a lot of the charge master business. I think it corresponded with a TIME article.
We took a hospital tour last month to prepare for Baby's arrival (STILL not here and three days overdue), and the nurse showed us a kitchen with a stocked fridge and told us to help ourselves when we've checked in. But then I've heard stories that when the bill comes you see that you've been charged $40 for a cup of yogurt or juice or whatever.
I guess it would be easy enough to avoid those incidental charges, but yeah, I'm beginning to understand why medical care in other countries is so much more affordable.