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Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsRecent hospital stay
An old problem reared its ugly head and a trip to the ER was called for. I ended up being admitted and staying for about 40 hours. CT Scan, treatment, intubation. No surgery required (that was nice).
Bill just came. $13,200.
Insurance subtracted almost $8100, they paid $4800 and I pay $350 as co-pay.
With the premiums we pay, the system recovers the $4800 in 8 months, assuming no other charges. That won't happen, but it won't be much.
So if you have no coverage, you're on the hook for 13 grand. People who do not want health insurance because ObamaCare, are screwed. Not by the gubmint, but by the healthcare system.
If the hospital can function on $4800 then that's what they should charge, not $13,000. We're doing this backwards. People who have no insurance should get basic (but proper) care and pay the lower fare, people who have insurance should get better accommodations and pay more.
Rorey
(8,445 posts)When my ex-husband and I were still trying to save our so-called marriage, we went to a counselor. It went on my insurance because his didn't work on this particular counselor. Her full fee per hour is $125. My insurance had a $57 discount, so the balance was $68 (of which I paid my $30 co-pay). I opted to discontinue seeing her, but my ex-husband continues and pays full price.
I would think that she would prefer seeing patients who did not have insurance over those who did because she then makes more per hour.
I agree with you. The system is backwards, IMO.
JustABozoOnThisBus
(23,343 posts)... she also might sit, growing cobwebs, waiting for some rich customer to show up. Might as well help some insured people while waiting.
Rorey
(8,445 posts)My ex-husband. He's not rich, but now that he has thrown all of us away, he's got more expendable income. (Ours was his first marriage, so he gained a family and eventually grandchildren.) Perhaps if he had gone to counseling a whole lotta years ago, he would be in better emotional health today.
He voted for -45, which should sufficiently speak to how messed up he is.
JustABozoOnThisBus
(23,343 posts)This one's not doing him any good.
(just kidding. sorta)
Rorey
(8,445 posts)The fact that he voted for -45 was when the decline of our marriage went into overdrive. At one session, she said she was able to help people get through their political differences. The thing is, it's a deal breaker for me. I can't set aside my morals and ideology.
I'm almost thankful, in an odd way, that he cheated so I could use that for my reason for the divorce.
Brainstormy
(2,380 posts)neither accept insurance.
Rorey
(8,445 posts)Therapists seem to be in high demand.
I only went a few times. When it became apparent that all my husband wanted to do in our joint sessions was bash me, I decided that it wasn't productive for me. I already knew all of his gripes about me. I mean, I could listen to that crap at home for free.
wasupaloopa
(4,516 posts)What a provider bills to someone with insurance is meaningless.
Providers contract with insurance companies and agree on reimbursement for each possible procedure code. The rate is somewhere above or below what Medicare pays, depending on the insurance company.
You can buy cheap coverage which has a low reimbursement rate and a provider my chose to not contract with them.
The payer decides what the reimbursement will be not the provider for a patient with insurance.
Turbineguy
(37,337 posts)So you're having a heart attack, so you call various hospitals to negotiate a rate. This would be the free-market system in a republican paradise.
wasupaloopa
(4,516 posts)Basically you decide what is paid when you sign up for coverage. A provider does not take all insurance plans.
They like PPOs
My shrink charges $135 per half hour. My Medicare and supplemental pay it. I have no idea what they pay but I dont pay anything other than my premiums.
Rorey
(8,445 posts)I remember that I went in during the afternoon when I thought I was having another TIA. In the late afternoon they talked me into being admitted so I could have an MRI that evening. I was put into a room with a patient from hell. She had long LOUD phone conversations and kept her tv volume loud too. Around 10:00, when I was awakened by the commotion of her getting help to go to the restroom, I said to the nurse, "I'm not getting that MRI tonight, am I." She answered that none had been ordered. I told her I was going home. She asked if I would wait until she talked to the Nurse Practitioner in charge and I said ok, but then I decided I didn't feel like enduring the whole attempt at them trying to convince me to stay, so I pulled off the electrodes and got dressed and went downstairs to wait for my (then) husband to pick me up. Before my (then) husband got there, the nurse came out and asked if I'd go back up with her so she could remove my IV port thing. I forgot I even had it.
Anyhoo, my bill for the roughly eight hours there was $12,085. The Cigna adjustments were $8,839 and they paid $2,197 so my bill was $1,049. So an uninsured patient would be billed over $12,000, but they accepted approximately $3,250 for my "treatment".
That's messed up.
FakeNoose
(32,639 posts)Sounds like you made the right decision. The doctor who admitted you didn't even order the MRI? WTF?
Rorey
(8,445 posts)I complained about it when the hospital called to do the follow up, and I also wrote an email, but I got the usual song and dance that one expects. The whole experience left me with a bad taste in my mouth and I'll probably resist going to the hospital if another situation like that arises. Then I'll probably just have the massive stroke at home.
I did have follow-up care with a whole lot of tests, and I'm apparently fine.
Rorey
(8,445 posts)I seem to recall them saying that the doctor in charge of me after admission had to order it. However, no doctor ever came in to see me after I was admitted. I was told one would come in, but by 10:00 I didn't figure that was happening. All I could see were the $ signs flashing before my eyes as I waited endlessly for the promised actions to happen.
FakeNoose
(32,639 posts)At least your insurance company was looking out for the rest of it. I guess that's the best part of the story.
Rorey
(8,445 posts)The monthly premiums are just a shade under $600 per month and I very rarely go to a doctor. Fourteen years ago I had a TIA and went to the ER and subsequently went through four months of quite a few appointments and tests. After that I went for my yearly checkups for a few years and then dropped off on those. So I went about a decade without costing my insurance company a penny. I figure they made well over $70,000 during those years.
Now I'll be on COBRA at a little over $700 per month (which my ex-husband is going to be paying for ) until I get to be on Medicare in the fall.
mokawanis
(4,441 posts)I had good insurance at the time (employer provided, before I retired) and my out-of-pocket expense, after 8 days in the hospital, was $1,200.
Now I'm on ObamaCare and the same surgery if I had it done today would cost me $6,500. Facing that kind of deductible puts me in the uncomfortable position of only going in for medical care when I absolutely have to, but of course it's much, much better than having no insurance at all.
Totally Tunsie
(10,885 posts)An even worse scenario is if you're placed in the hospital "UNDER OBSERVATION'. If you hear those words, insist that they instead admit you. Your insurance will reject many expenses occurring under observation than if you're actually admitted, and you will be billed promptly. It may be as small as the medications issued to you (Think $100. per aspirin) or as large as some of the exploratory procedures they perform. It'll be on YOUR dime!
Turbineguy
(37,337 posts)as much as possible. Almost any visit would bankrupt the average family and they would have to wait months to get paid, if at all.
Totally Tunsie
(10,885 posts)creates the order. You can try to debate/negotiate it at that time...some docs will be more amenable to changing the order. The hospital creates your status according to the doc's orders, but once you're in place, it's too late. If not sure of your status, be sure to clarify before putting on those hospital gowns!
I had vaguely heard of all this long ago, but it didn't surface in my brain when my doc told me she was putting me in "just for observation" for an evening. Lesson learned and seared into my brain once the bills started arriving!
Rorey
(8,445 posts)Now I'm even more sure that I made the right decision when I walked out of the hospital against medical advice after they admitted me for observation. I'm guessing that if I had stayed past midnight, I'd have been charged for another day.
snpsmom
(680 posts)Unless you are admitted, most insurance doesn't pay. for hospital expenses. ALWAYS ask to be admitted.
BSdetect
(8,998 posts)Vinca
(50,273 posts)procedures can vary by the tens of thousands from hospital to hospital in the same general area.
Hortensis
(58,785 posts)On the plus side, uninsured people can almost always negotiate bills way down. On the negative side, this is a college grad world, well functioning types, and a lot of people just arent. Plus, the bills left her off and dreadfully high.
We once had 100 grand unpaid after insurance Was exhausted. Happily, we were able to negotiate that down to only 50 grand and take out a mortgage to pay it.
for that happily. But nice how even the numbers were. Helped us with the math.
Turbineguy
(37,337 posts)and don't use the benefits, I'm better off than those who pay premiums or don't pay premiums but need the benefits.
Hortensis
(58,785 posts)all right.
For the era in which we raised our children insurance paid enough that I took them to the doctor often as needed and cheerfully. We had to make time payments a few times when things happened, but basically insurance did its job. Most of today's younger people have never seen this.
Then as empty nesters, like most people we paid increasingly heavy premiums with such high deductibles, etcetera, that the insurance never kicked in. We paid many tens of thousands in premiums over another two decades that literally never paid a single bill; we paid our medical bills out of our pockets, which meant that in spite of being insured we avoided physicals, tests, anything that maybe would go away on its own, etc.
But as you say, we were among the lucky ones. One cancer would have changed all that. The ACA now requires those premium collectors to cover annual health maintenance tests and exams, and that alone is a great thing.