Quote :

"No, he knew he would only get 20% of what he asked for, so he asked for quintuple of what he wanted to make sure he got it."

And there's more to it than just this. Your insurance company (and medicaid/medicare) negotiate and reimburse based on usual rates, and usually some percentage less. What this means is that even if your doctor could operate on the $40 or $60 he gets between you and the insurance company, he still has to charge you and everyone without insurance the $150 or $200 for his time, because every time he charges you less money, that gets held against him the next time rate negotiations come up. That's part of why places have X% discounts for paying your bill at once up front, rather than just charging you X% less in the first place.

I've mentioned before my experience doing work for a specialty pharmacy that was expanding into South Carolina, but I'll explain it again because it illustrates the issue perfectly. The pharmacy dealt with very sick patients, people on an absolute minimum of 8 regular medications per month, and averaging 14+. In South Carolina, medicaid will pay for somewhere between 6 and 12 medications based on certain criteria and disease states. After that, they pay nothing, and it is the patients responsibility to pay the rest. The customer base the pharmacy deals with is not likely to have the money to pay for the rest of their medications. However, the pharmacy crunched some numbers and discovered that they could still make money billing medicaid for the most expensive medications the patient was on, and simply writing the rest of them off as a loss. That's an important point, the pharmacy was going to bill what they could get paid on, and then give these people the rest of their medications for free. Unfortunately, if the pharmacy did that, their usual rate for those medications would have $0's factored in, and we all know what a $0 can do to an average. As a result, in about a year or two, the reimbursements would be so low, that they wouldn't actually be able to afford to give away those medications again.

It's little things like that the keep health care costs up, and keep driving them higher.

2/6/2011 9:29:56 AM

http://www.wral.com/bill-would-block-affordable-care-act-changes-in-nc/12042975/

Quote :

"Bill would block Affordable Care Act changes in NC RALEIGH, N.C. — Senate Republicans opened their session Wednesday with an effort to opt out of provisions of the federal Affordable Care Act set to take effect next year."

1/30/2013 3:27:38 PM

Wouldn't that effectively increase the number of North Carolina residents who will have to pay the federal tax for not having health insurance?

At the very least, won't it limit residents' options?

[Edited on January 30, 2013 at 5:46 PM. Reason : ]

1/30/2013 5:44:49 PM

^yes, but since when did basic human decency matter to Republicans? not since I was born, that's for sure



anyway this just showed up in my feed, and I think that's not the whole story

3/1/2013 1:30:22 PM

$4B is not what's driving up costs

3/1/2013 1:38:15 PM

Also driving up costs: Using bandaids for small scratches that don't even puncture the skin

3/1/2013 1:56:19 PM

Let me give you some anecdotal evidence about non-emergency visits to the ER and their costs.

I came back from an overseas trip with 104 degree fever, which recurred daily for five days. I immediately went to the nearest hospital (it was Sunday), looking for Urgent Care unit (my regular physician not open on weekends). They immediately put me into bed in the ER section instad, but no catheter hooked up or anything (mind you, it was a pretty high fever, but I have not died in 5 days prior). I spend 3 hours lounging around there, out of that 3 hours, the MD visits for about 15 minutes, talks to me about symptoms, then another 15 minutes for x-rays with technnician, another 10 minutes to get my blood drawn by another technician, another 15-20 minutes talking to the billing guy. I get a generic antibiotic prescription for tick-borne disease (as tick was a suspect) and some ibuprofein on the way out. A few days later, the test results come back and they still unable to diagnose the decease. I end up going to urgent care for another set of blood tests, which finally identify the disease.
A few weeks later, a hospital bill comes for the first visit, somewhere in the $3,000 range between the insurance payments and the co-payments.

Did it cost the hospital more money to hold me in the ER than have me come in the next day to see a regular doctor? Maybe from the overhead point of view, since ER has to be open 24/7. Although given enough people coming in over the weekend to keep the ER staff busy full time (which they were, seeing how it took them 2 hrs of waiting). From point of view of doctor's time and the cost of supplies, this was not any different than visiting urgent care or a regular physician. Was the $3,000 bill fair to me for 15 mins of doctor time, and x-ray and blood tests? Was it fair for me to pay premium rate for a generic prescription antibiotic and over-the-counter fever reducer? No wonder our Medicare and Medicaid can't keep up with the payments, and the health insurance costs are ridiculously expensive.

If you would take your car to a shop with an overheating and they could not diagnose it, would it be still fair for you to pay the diagnostic fee, and pay premium for a coolant top-off that you could have picked up in the parts store?

3/1/2013 2:04:58 PM

I don't think anyone is saying that doesn't happen too much, I am saying (and I think lewisje and Str8Foolish are) that a few tenths of a percent of the total cost of healthcare is not what is driving up the costs.

3/1/2013 2:21:32 PM

http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

Had that been posted yet? Absolutely incredible article.

Quote :

"Janice S. was also charged $157.61 for a CBC — the complete blood count that those of us who are ER aficionados remember George Clooney ordering several times a night. Medicare pays $11.02 for a CBC in Connecticut. Hospital finance people argue vehemently that Medicare doesn’t pay enough and that they lose as much as 10% on an average Medicare patient. But even if the Medicare price should be, say, 10% higher, it’s a long way from $11.02 plus 10% to $157.61. Yes, every hospital administrator grouses about Medicare’s payment rates — rates that are supervised by a Congress that is heavily lobbied by the American Hospital Association, which spent $1,859,041 on lobbyists in 2012. But an annual expense report that Stamford Hospital is required to file with the federal Department of Health and Human Services offers evidence that Medicare’s rates for the services Janice S. received are on the mark. According to the hospital’s latest filing (covering 2010), its total expenses for laboratory work (like Janice S.’s blood tests) in the 12 months covered by the report were $27.5 million. Its total charges were $293.2 million. That means it charged about 11 times its costs. As we examine other bills, we’ll see that like Medicare patients, the large portion of hospital patients who have private health insurance also get discounts off the listed chargemaster figures, assuming the hospital and insurance company have negotiated to include the hospital in the insurer’s network of providers that its customers can use. The insurance discounts are not nearly as steep as the Medicare markdowns, which means that even the discounted insurance-company rates fuel profits at these officially nonprofit hospitals. Those profits are further boosted by payments from the tens of millions of patients who, like the unemployed Janice S., have no insurance or whose insurance does not apply because the patient has exceeded the coverage limits. These patients are asked to pay the chargemaster list prices."

3/1/2013 2:32:25 PM

I agree that the whole system is fucked up in multiple ways. My sister is a nurse and she says the doctors and the staff get fucked over by insurance companies on their end as well. I don't have go to doctor very often, but this recent encounter definitely opened my eyes on how costs can get out of hand very quickly for something really basic (we are not talking complex surgery or latest prosthesis here). Also the billing system was out of control. For that one visit, I received four separate bills. One of those bills did not make it to my house due to the medical billing company using a wrong address (mind you, I only gave my address once to the hospital's billing guy) and was sent to collections without anyone checking with me by phone or e-mail. And these are all private businesses (except for possibly the hospital, which may be government-funded in part)! Where is the fucking efficiency promised to me by the great competitive marketplace system?

/rant

3/1/2013 2:33:36 PM

Quote :

"Where is the fucking efficiency promised to me by the great competitive marketplace system? "

That's the entire point. There isn't competition. No one shops around for an emergency room, and hardly anyone pays the "real" prices; a third party payer distorts the market. In the vast majority of cases, the recipient of health care services is not paying the provider of those services. The recipient pays the insurance company; the insurance company pays the provider. If the insurance company had to pay the amounts listed in the "chargemaster", it wouldn't be a viable business model.

A lot of health care you can shop around for, though, and I wonder why we insist on having that covered by insurance.

3/1/2013 2:41:03 PM

^^Not sure how accurate this is, but a young doctor friend of mine recommended people with no insurance to offer the doctor Medicare rates in cash. While list prices are much, much higher than the Medicaid rates (as the article above illustrates), many doctors would apparently rather take Medicaid amount on the spot in cash than to go through medical billing firms, insurance companies, and collection agencies. I've always had insurance and never tried this, so take it FWIW

3/1/2013 2:41:21 PM

For the average routine medical visit, doctors can probably be replaced by nurses with AI systems. In general: hospitals, doctors and insurance companies are all making a fortune for nothing. My regular doctor does nothing for me except give me a bill for hundreds of dollars when I need an obvious, life depending prescription refilled. The prescriptions I need on a regular basis are what a lab tech would be able to prescribe based on my bloodwork.

Now there are doctors who do miracle work and deserve the pay, but the average doc is overpaid for nothing... Just based my experience with several doctors...

3/3/2013 4:41:23 AM