An absolute travesty. Look what they do to contractors in a disaster zone when their prices go up as a result of supply and demand and lot's of folks are looking to jump to the front of the repair queue.

How can we refuse to be governed by TPTB? So far most folks still don't take notice because inside their little box everything is still OK. I can only hope that starts to change...

I will have to say in fairness that Hershey Medical Center did not play games with me when I was admitted for surgery. I did have the luxury of a few months to review costs and procedures. They quoted me a total price.

When the insurance company sent me the statement it was the same price and amount paid as what the was quoted to me. No games for me on that occasion. Seems like a rarity.

Quote:

COBRA is another ripoff. The insurance companies and the hospitals are busy giving each other the reach around. In the meantime, parties that leave their jobs are stuck with the fear of catastrophic losses if they don't pay the extreme price hikes for Cobra.

There is no price hike for COBRA. COBRA requires that if you leave your job, you can keep your insurance for a time, by paying exactly what your employer was paying or would pay for that coverage, no more no less.

-Uwe-

@Euphorian ALL countries (at least in the first world) have much lower per capita health care expenditures than the US.

According to the OECD statistics the per capita expenditure in 2009 (the most recent year for all OECD country data) for the US was $7960. For Canada it was $4363 (45% less) and for France it was $3978 (50% less).

Out of pocket expenditures (not covered by insurance) per capita was $635.60 (14.6% of total expenditures) in Canada and $290.90 (7.3% of total expenditures) for France while in the US it is $976.20 (12.3% of total expenditures).

For pharmaceuticals per capita Canada is $638.20 (17% of total expenditures) and France is $640.20 (16.1% of total expenditures) while the US is $956 (12% of expenditures).

As a percent of GDP Canada is 11.4% and France is 11.8% while the US is 17.4%.

So health care costs are much higher in the US than elsewhere.

Same here - and I didn't even know who might be interested in my story:

I had an accident with facial fractures and required plastic surgery.
Months later I looked online at my Anthem BlueCross claims.
Overall:
billed $136,006.17
paid $67,138.76 of which $6,904.03 by me (high deductible)

Most extreme billed/payed
Hospital services 2.2x
Plastic surgeon 6.1x
Lab diagnostics 8.5x

Quote:

Cobra, how does that work if you are paying out of pocket? Your insurance company is not even involved until you meet your deductible or copay is it?

They submit the bill to the insurance company. Insurance company "negotiates" the rate and then sends it back to them with a note that the amount is subject to my deductible. I get a bill from the doctor or whomever and I pay it. I also get a notice from my insurance company telling me the details of the "negotiation" so I don't get scammed.

If I rack up enough billing in the year the insurance company then picks up the tab. That usually requires a hospital stay, otherwise for normal yearly doctors visits, etc, it's all under the deductible. Yet I still pay my $200/mo in protection money... :)

Quads - in 2005 I had outpatient sinus surgery. My insurance (PPO) had a $500 deductible and an 20% copay. (they paid 80, I paid 20) up to $5,000 I think and then they paid 100%. I met with the hospital, they calculated what I would owe and I paid them up front. They ended up reimbursing me about $80 some 5 months late for an overpay.

If I have an HSA policy (PPO) or just a high deductible - say $5,000 and need surgery are they not going to ask for $5,000 up front? What if I don't have it? That does not even include the copay. If there is an adjustment needed for the contracted rate for under the PPO seems like that would be done afterwards and not before.

Psquared - High deductible plans are for the entire year's expenses. A service provider can't know the amount of your co-pay and deductible by itself. The service company must contact the insurance company to learn the remaining deductible for the year. (And if you have exceeded the maximum out-of-pocket expense for the year.)

-BigCowboy

Psquared,

Interesting. I never heard of that. You could probably complain to your Insurance Company about that and they might penalize or drop that provider entirely.

Just to clear up another confusion. You did not pay a "co-pay" (a specific dollar amount) usually associated with HMOs. You paid your share of coinsurance (a percentage of the charge). Here is the difference...

Definition of 'Co-pay'
"A type of insurance policy where the insured pays a specified amount of out-of-pocket expenses for health-care services such as doctor visits and prescriptions drugs at the time the service is rendered, with the insurer paying the remaining costs. However, unlike COINSURANCE, where the insured is required to pay a certain percentage of the covered costs, co-pay plans require the insured to pay a specified dollar amount."

Again, we have been using high deductible PPO plans for years and have NEVER been asked to pay anything up front, That included outpatient surgeries (like yours), doctors visits and full blown hospital care.

Thanks. I have been mixing the two "phrases" and did not realize the difference between co-pay and co-insurance. But what you said makes sense.

Just about anytime I (or a family member) have been to the hospital over the last 10 years the first question they ask at admission is, "have you met your deductible." They will then usually call the insurance company, get a number and ask for payment. Before 2006 I could usually dodge it by saying, "bill me." This last time I asked them to bill me and they said, "no" we have to have payment before we will schedule the procedure.

I also remember stories about people who settled with hospitals. The hospital was getting 90% from the insurance company and so I've heard of people who would just say to the admissions clerk, I can pay you $250 now but that's all I have.

We have no bargaining power any more. Hospitals will just say, "nope, full payment or you don't get treated" because they know you can't go down the street and get a better deal from a different hospital for which your doctor does not have privileges.

Psquared,

Call your insurance co and see what they have to say about providers billing services in advance.

It is my understanding that providers sign agreements with insurance companies that bind them to follow strict billing procedures as well as to accept the agreed upon amounts for each and every procedure.

I would be very interested in what they say.

Anecdotal:
Ex Governor killed people on the roads ignoring stop signs
and speed limits driving drunk just kicked the bucket.

<Flags at half staff till they bury this douche?
Give me a break!>

But not before several trips to Ill. Mayo clinic and $900k + spent to
arrest his irreversible brain cancer diagnosed a week or two into
November.
Die with dignity bitches!
Dope me up and drop me on EXPY's lawn.
Set me/him loose into the wilderness.

PS 4 days ago he went into some kind of home care hospice
since we pay for it I bet THE PEOPLE are being billed for a half year
stay.

That scumbag
Janklow had produced maybe $240k in economic productivity
thru his entire .gov life if you don't count kickbacks and scams.

Quads, I was speaking hypthetically. I don't have health insurance of any kind right now. I'm looking at some quotes for HSAs and HDPs with BCBS, Coventry, and one other company, but I have not signed up yet. I'm leaning towards the HSA because I can do a one-time rollover from my IRA, but I can't find one with drug coverage which covers 100% after the deductible.

I'm a hospital accountant.

I'm not going to defend, nor deny this ticker.

The bottom line is that the only crisis in healthcare is figuring out who's going to pay for it.


The pricing difference is the whole point of insurance. I agree it's a racket. If you don't pay the insurance man, you're exposed to lose your ass if something bad happens to you.

Hospitals rob patients, but patients rob the hospital too. At my facility alone with average over 100 people a month that utilize services and don't pay a single penny. Plug that into the gas station reference.....every single customer that fills up their car PAYS.

It's a complex mess that really does need to be overhaul'd and simplified. I think letting people know the prices up front would be a good thing because it would stop people going to the ER for a head cold.