99.74% off

I was snipped last month, and I’ve been getting a steady stream of explanation of benefits (EOB).  EOBs are the listing of what the medical provider did, what they charge, what the insurance company has as a contract rate, what the insurance company pays, and what the individual member who received the service is responsible for.  For the actual surgeon and anethesiologist, I was expecting to see a 70% to 80% reduction in charges from what the provider asked for and what the contract rate was.  And that was the basic discount. The pathologist saw an 87% discount. 

And then today, I received the facility charge explanation of benefits.  The entire ask for a five hour hospital stay was the equivilent of a new subcompact.  The contracted rate was the sales price of a 1984 Toyota Tercel that could not go over 66 miles an hour downhill with a favorable wind nor go in reverse (if you want cheap birth control, buying every 17 year old kid this car would work too). 

The most eye popping discrepency was the ask for a local topical anesthitic at $194.00 and the pay out of .56 cents.  I think I can buy a tube of generic version of the drug at my local mega-drugstore for $1.99.  That tube has been good to get Kid #2 through his last 6 teeth that have popped through.

This is asinine, and if the health policy push over the next decade is for people to become more cost concscious, hospital pricing has to be vaguely related to actual payouts.

65 replies
  1. 1
    Mathguy says:

    This is just insane. I wish the ACA required published prices to which they would actually adhere. Although not quite as bad, higher education, where I work, is similar, with the retail price, and a massive discounted (“Look, we’ve given you a $12,000 scholarship!”) actual price.

  2. 2
    Baud says:

    Better just to snip yourself at home.

  3. 3
    Waynski says:

    I know what you mean. My doctor put me in the hospital for observation for a day and a half. My EOB was north of $80,000. Un – fkg – believable.

  4. 4
    Chris T. says:

    Yep, I remember one recently that went something like: hospital X ray: $300 … negotiated down to: $7.35; we pay: $7.32; you owe: $0.03

  5. 5
    Richard Mayhew says:

    @Mathguy: Massachusetts is working on this:
    Boston Globe in December 2013:

    Many consumers may be unaware, but health insurers have been required since October to provide their members with cost estimates — within two working days — for specific tests, procedures, and office visits. That means, for example, insurers must tell members how much an MRI of the knee costs at an individual hospital, imaging center, or doctor’s office, so that patients can comparison shop. The quote will include how much of the total price members would pay based on their deductibles and co-payments.

    And by next October, insurers will have to provide this information instantaneously. By January, hospitals and doctors will be required to provide their own cost estimates to patients.

  6. 6
    tybee says:

    and if you go in as an individual, the hospital and staff expect those retail prices.

    it’s disgusting.

  7. 7
    raven says:

    I’m wondering about my decision to delay or cancel my shoulder surgery. I met with the pod, had the mri and then he diagnosed a torn labrum and recommended surgery. I said OIK but when I did research into the post-op recovery I decided to cancel next week’s procedure. I had already paid the co-pay to the hospital but I’m uncertain of the ramifications of canceling in terms of the BCBS approval?

  8. 8
    Ash Can says:

    This gives us an idea of the kind of bills people without insurance see.

  9. 9
    raven says:

    @Richard Mayhew: My wife and I have both gotten calls from BCBS telling us that we were approved for procedures but they only went into cost with my wife’s MRI. They suggested somewhere less expensive than at the orthopod but did not insist.

  10. 10
    Bobby Thomson says:

    What about the boilerplate the hospital always makes you sign that you agree to pay what the carrier won’t?

  11. 11
    Halcyan says:

    I have always sort of thought that the reason the “ask” was so high, was so that they could write off a huge amount of money that they were unable to collect from the indigent. And say “See? See how CHARITABLE we are?” Because the only folks who ultimately get that high of a bill without the “adjustment” are the folks who have no insurance and very little money.

  12. 12
    OzarkHillbilly says:

    Hospital bills are fun! I just received a bill from our local BJC affiliate for some outpatient surgery I had done…. in 2012. No kidding.

    And no, I’m not paying it.

  13. 13
    Chris T. says:

    @raven: Oh, fun (?) CT-scan thing: I had a potential spinal stenosis (confirmed by CT, alas, but still controllable with drugs for the next however many years, at least).

    The “prescription” for a CT scan was made while I was changing jobs, paying for COBRA on the old one. That was a very comprehensive Blue Cross (BCBS) plan with smallish deductibles and so on, where the negotiated price would have been taken from somewhere well north of $2k down to about $700 cost-to-me in the end: basically, using up all of a $500 deductible, plus passing on another $190ish of “you pay” costs.

    Being in Job Transition I figured I’d just wait and see how the new coverage came out. That was a much less comprehensive High Deductible Health Plan with $5k deductible. And yet … the cost to me was lower, because they negotiated the same scan with the same imaging place down to a bit over $500.

  14. 14
    azlib says:

    Yes, the EOB information is pretty insane. No wonder people are utterly confused about the actual cost of medical procedures.

  15. 15
    raven says:

    @Chris T.: Ugh. This hasn’t been bad so far but one thing that bothers me about this surgery is that the rehab is vital and the co-pay is now $25 a visit. From what I can gather the therapy will last from 4-8 months and, as Groucho said, ata runs into money!

  16. 16
    OzarkHillbilly says:

    @Bobby Thomson: Sue me.

    Seriously, in the above instance, I had 2 insurances, one of which was my Union Carpenters policy under which I NEVER had to pay more than my initial copay, including one instance of blood clots where I spent a week in ICU, with an ambulance transfer to a hospital in STL.

    If Carpenters didn’t pay, it’s because the hospital screwed up. Over the years, this has happened several times and they have never come after me. Whether they screw up in the OR or the billing dept, it is on them.

  17. 17
    OzarkHillbilly says:

    @raven: You are right to be cautious. When I was having PT on my arthritic shoulder, it was on only my wife’s insurance. Being used to Carpenters, I thought I only owed the co-pay. After 4 months of less than stellar results (it helped, but only to a point) I stopped. THEN I received a bill north of $600.

  18. 18
    shortstop says:

    @OzarkHillbilly: I’ve had this happen half a dozen times with various physicians (never for a hospital stay — yet). I’ve found that when I ask the providers for documentation of their timely submission to insurance, requests for my payment vaporize.

  19. 19
    maximiliano furtive, formerly known as dr. bloor says:

    This is asinine, and if the health policy push over the next decade is for people to become more cost concscious, hospital pricing has to be vaguely related to actual payouts.

    Actually, with more people getting insurance, you can make the case that people will become less aware of hospital charges, because hospital charges are a nothingburger if you’re protected by contract rates.

    I think the outrage over what a hospital bills for a procedure is pretty overblown and has little if nothing to do with healthcare cost increases at this point. I can bill a skazillion dollars for a 45 minute therapy session, but I’m never going to get more than $83 plus copay from one panel I’m on or more than $70 without copay from the other one I’m on, and I have no illusions about collecting a Skazillion minus $70 from any of those patients.

    It’s all about the contracted rates. What I charge on my HCFA1500 form doesn’t have anything to do with anything.

  20. 20
    MomSense says:

    You may be right about the birth control properties of an ’84 Toyota Tercel, but the ’85…now that was a verygood year.

    I really appreciate the pricing information that is now available to consumers and employees about how much our plans cost and how much procedures and treatments cost at our providers. Before this, it was really difficult to find out how much something would cost and I always felt that I was at the mercy of the providers. It meant that I would put off diagnostic testing because I had no idea whether or not I could afford to pay for it.

    I know that I have scheduled a number of things like lab work and physicals for everyone and I wouldn’t be surprised if there is a spike in services performed as many of us with new insurance try and catch up.

  21. 21
  22. 22
    raven says:

    @maximiliano furtive, formerly known as dr. bloor: So a $25 copay for a therapy session isn’t bad?

  23. 23
    Howard Beale IV says:

    Seems Healthcare learned from Hollywood when it comes to accounting.

  24. 24
    BGK says:

    I was stuck with the full-retail bill for a hospital stay when Aetna decided post-facto that the stay and treatment therein was unwarranted. This despite me having asked up and down that Aetna was OK with the treatment and them actually saying yes. The bill was $36000 for two days. The issue was the admitting doctor providing incomplete documentation, and Aetna did eventually, churlishly, pay their part. Still, it was quite the bucket of ice water down the shorts to get that bill two months later when I thought it was a settled issue.

    Also too, this is a public hospital, and most of the three page admission form is about your financial responsibilities. They make it clear insurance billing is a courtesy, and you the patient owe payment, and they’ll do everything up to and including harvesting your internal organs to collect. Also three, if your gross income is more than 150% of the federal poverty level, forget about any discounts off retail pricing. I’m not sure how that works in practice, but it’s not exactly light reading when one is already under stress from laying in an ER bed.

  25. 25
    SP says:

    Could people get together a crowdsourced list of the insurance payment schedule at most hospitals? Obviously ins cos and hospitals won’t share this, but enough people posting the numbers from their EOBs should be able to get together a reasonable list.
    Then when people without insurance go to get a procedure where they know how much the hospital will actually be paid, they can offer to pay that much (minus all the paperwork!) and maybe the hospitals will accept.

  26. 26
    Richard Mayhew says:

    @MomSense: Some people choose abstinence, and others have it chosen for them….

  27. 27
    hoodie says:

    This is asinine, and if the health policy push over the next decade is for people to become more cost concscious, hospital pricing has to be vaguely related to actual payouts.

    Maybe a push to make people more cost conscious by telling them what the price of the MRI they already had is what’s asinine. It seems like a push for cost visibility for patients vis a vis provider reimbursements is, at best, a pointless exercise and, at worst, a libertarian pipe dream. Disconnect between retail and wholesale pricing is not limited to healthcare. Electricity markets have the similar issues, e.g., you have sophisticated pricing for power flows between utilities, but not for individual consumers. The reason for that is that consumers really couldn’t do anything with the information the utilities had and, therefore, for that reason (and because of the geographic monopoly involved) it was better to just regulate the utilities. New technology may change that to some degree and such technology may include providing improved pricing signals to consumers through things like the internet, but a big part of that new technology is the ability of consumers to do something with the information in real time once they have it. For example, in energy consumption, a consumer can purchase digitally controlled appliances that act in response to real time energy pricing information to reduce cost. I doubt the equivalent will ever be true for healthcare, at least until we develop robots that can replace physicians and other providers. Moreover, a lot of healthcare is simply not that amenable to retail purchase by the typical consumer because of the cash flow requirements.

    Universal coverage, price transparency and proper regulation at the insurance level seem more important and what we should focus on is making sure insurers get accurate pricing info (maybe they already do and the master charge lists are just nonsense), are properly regulated and their financials made transparent so they don’t take advantage of their superior information or pull bullshit moves like not covering something they’re supposed to cover. That, and government entities that monitor things like the cost and utility of certain procedures. Oh, wait, the ACA does a bunch of that. Bitching about EOBs and the fairy tale numbers on them is supporting GOP pipe dreams about making healthcare like buying flat screen TVs.

  28. 28
    japa21 says:

    This is always a fun topic. So some degree maxililiano is correct, the amount billed doesn’t really matter, if the provider is in the patient’s provider network. One problem is a totally uneducated public (well, not the whole public, but a significant portion thereof). And, in fact, this problem may grow as more people have insurance for the first time and don’t fully understand the ins and outs.

    If I were to call a somewhat unscrupulous doctor’s office, or imaging center, and ask if they accept my insurance, they can say yes, even though they are not a preferred provider for that insurance, and they would be telling the truth. What they are not saying is that they will still bill the difference between what the insurance pays and their billed charges.

    There are few cost controls in place in terms of limiting what a medical provider can charge or capping payment to a provider. One of the exceptions is in the area of workers’ compensation, where most states have a maximum payment structure in place. This, of course, is the result of businesses and WC payers working together to force the state to create that system. The common person does not have that kind of bargaining power.

    Another factor is that there are certain states where, rather than a fixed dollar reimbursement in place for services, most providers will only contract as a preferred provider at a percent of charges reimbursement. This is specially true for larger hospitals and systems. An attempt is made, by insurance companies, to limit the impact of provider charge increases by limiting the amount a provider can raise their charges by a certain percent and then, if the provider increases charges by more than that, deepening the discount.

    However, to keep track of all the increases requires extra effort and money on the part of the insurance company, which has to be squeezed into that 15% of premiums that doesn’t have to go directly to cover actual care.

    Another issue, which flies under the radar a lot, is the issue of physicians actually dispensing drugs and charging for them. They up the cost tremendously, whcih increases insurance payouts, which increases premiums.

    Eventually, there will come a time when what happens in workers’ compensation will become the norm throughout the entire industry, but probably only when there is a single payer system.

  29. 29
    JasonF says:

    This is why I laugh at my right wing friends who insist that the best way to curb medical costs is to make patients shop around. If I’m incentivized to find the best rate on my vasectomy or liposuction, the theory goes, the competition for my business will drive prices down. As if a single patient trying to choose between two hospitals has better bargaining power than Blue Cross/Blue Shield.

  30. 30
    sal says:

    I recently went in for a prostate biopsy (doctor) & ultrasound.(technician). This was done in a plain exam room, and I was there a bit under an hour. No cutting. Total bill over $6000. Haven’t got the EOB yet, but $2500 of the bill was a ‘room fee’. I could take a vacation in Costa Rica for that amount. A plain exam room.

  31. 31
    CaseyL says:

    I think I’ve already mentioned the $11,000 for minor foot surgery (2.5 hours in the outpatient clinic), with $8,000 of that the “facility charge.” After discounting, and insurance payment, my share was $687. That’s, like, 6% of the initial quote.

    And, yes, the thing that struck me most forcibly was, “If I didn’t have insurance, how much of the initial $11,000 would I be on the hook for?”

    I think it’s safe to say that the douchenozzles who advocate shopping around for medical and surgical care have never, ever had to actually do that. I’m 100% percent certain they’ve never had to do so in an emergency situation.

  32. 32
    maximiliano furtive, formerly known as dr. bloor says:

    @raven:

    Well, that’s really your call. I mostly see $15 to $40 these days, and $25 isn’t likely to be an obvious rip-off. I know of some panels where the copay is now effectively 50% of the total charge, which doesn’t strike me as being “insurance” in the traditional sense.

  33. 33
    Marmot says:

    I love these posts, and read every single one.

    But to be pedantic once again, is “ask” — as a noun — the real term of art for this situation? Maybe short for “asking amount”?

    I only — uh — inquire because I see it employed a lot as douchey corporatese for “request.” Similar to “to parking lot,” the fake verb.

  34. 34
    Booger says:

    Hey, I loved my 84 Tercel. Of course it was the 4wd wagon. God, I still miss that car.

  35. 35
    maximiliano furtive, formerly known as dr. bloor says:

    @hoodie: @japa21:

    Universal coverage, price transparency and proper regulation at the insurance level seem more important and what we should focus on is making sure insurers get accurate pricing info (maybe they already do and the master charge lists are just nonsense), are properly regulated and their financials made transparent so they don’t take advantage of their superior information or pull bullshit moves like not covering something they’re supposed to cover. That, and government entities that monitor things like the cost and utility of certain procedures. Oh, wait, the ACA does a bunch of that. Bitching about EOBs and the fairy tale numbers on them is supporting GOP pipe dreams about making healthcare like buying flat screen TVs.

    Eventually, there will come a time when what happens in workers’ compensation will become the norm throughout the entire industry, but probably only when there is a single payer system.

    This is really the essence of it. The systemic problems and inequities–some of which are population-related (but some of which are the product of a free-market health insurance industry!)–aren’t going to be addressed by doing stuff like getting hospitals to change their line charges. That’s nothing more than making sure Buck can’t buy T-Bones and Cadillacs with his welfare benefits.

  36. 36
    RaflW says:

    The negotiated discounts are a key reason why I think people should at least have catastrophic coverage.

    I actually have had decent insurance, but rarely even met the $1,000 annual deductible. But one year I needed a CT scan urgently. The “price” was $4,000. The negotiated, insurance co. cost was $600. All of which I had to pay, as I was before deductible (barely, at that point).

    People w/o insurance are billed $4K. People with even a super-high deductible who might be paying in $80/mo in insurance get the $3,400 discount. There is value in that, which goes unnoticed most of the time.

  37. 37
    JoyfulA says:

    @raven: $25 copay is what my Medicare “Advantage” required last time around (so I had to pay $75/week to acquire a tendon snap on my knee that took more surgery and a longer and harsher recovery than the original knee replacement).

    I know I wasn’t paying that high a copay for PT on my pre-Medicare knee replacement 6 years ago, but I don’t know exactly what.

  38. 38
    RaflW says:

    @Waynski:

    My doctor put me in the hospital for observation for a day and a half. My EOB was north of $80,000. Un – fkg – believable.

    Serious, non-snarky question: Richard, when all the healthcare stats are published about spiraling costs of health care, are they based on billed amounts or net EOB amounts?

    Because, as Waynski says, $80K for 36 hours of hospitalization – sounds like no surgery, no code red crash cart – is utterly, mind-bogglingly disconnected from reality. But if that’s what gets reported as the ‘cost’ and then there’s some footnote about the negotiated discounts on appendix iii.3 then what nonsense are we dealing with in care costs??

  39. 39
    Rob in CT says:

    Hospital billing is utterly screwed up. It’ll take years of persistent effort to get it to resemble reality.

    My doctor put me in the hospital for observation for a day and a half. My EOB was north of $80,000.

    This is amazing, even in the context of a thread on ridiculous hospital bills. The full “ask” for my daughter’s 2-week stay in the NICU was ~$65k. Even that is massively inflated, but hey, it was two weeks and it was an intensive care unit. [she’s totally fine, btw]

    And of course there is the seperation of billing nowadays. You get dribs and drabs of billing over the course of months, with each service broken out. It’s absurd.

  40. 40
    Danton says:

    OT a bit, but a thought I’ve long had:

    It might be cost-saving and user friendly if all insurance companies developed a standard form for the EOB and other forms.

  41. 41
    HW3 says:

    Richard, I am curious about the origins of this now all too common practice. How did it get started, and why is it considered legal? I had heard at one time that a change to Medicare in the early ’70s was the driver to the pay fraction x of the total bill, but I am sceptical of the source.
    It’s all nice and good when you can find a medical provider who will work with a cash patient to give them a realistic discount (while still getting a lot more than most insurance will pay out), but most people aren’t all that aware of that possibility.
    BTW, my scalpelless procedure was an out patient thing and even the EOB costs seemed reasonable (still could but that ’84 Toyota instead).

  42. 42
    chopper says:

    @CaseyL:

    And, yes, the thing that struck me most forcibly was, “If I didn’t have insurance, how much of the initial $11,000 would I be on the hook for?”

    all of it, charlie.

    that’s the great thing about the facilities highballing their prices knowing insurance companies will lowball them. people with no insurance are stuck paying exorbitant amounts that make no fucking sense whatsoever.

  43. 43
    David in NY says:

    My wife had her hip replaced last May. I have quite good work insurance. I have no idea what any of it cost — don’t even recall getting much in the way of EOB’s (one, maybe two, for little stuff?). And ditto with my colonoscopy — no clue about the doctor’s charge or the facility’s (of which doc is a part owner) charge or the anesthesiologist or anything. I think this is nuts (though I do have reasons to think this doc is good, and thorough, which counts in this area).

  44. 44
    pseudonymous in nc says:

    So, how do you end the bullshit sticker prices that exist solely to a) bankrupt the uninsured; b) inflate the writeoffs on profit/loss statements; c) allow for an “80% discount” with insurers to something approaching a fair price?

    Well, you can do it by fixing the prices. That’s how the rest of the world does it.

    I’ve described it before as medical bistromaths, because the numbers operate in an entirely different realm of mathematics to the real world, designed solely for accountancy bullshit within the internal medical economy.

  45. 45
    Richard Mayhew says:

    @RaflW: Net paid

    As Dr. Boor and others have noted, it costs them nothing to ask for the moon, and hell it is a nice write-up in the local newspaper when they “donate” care at those prices. I’m not sure how the IRS prices out donated care for deductions –Yatsuno, any idea if they go off of list price or some price that is close to what they actually get paid on average?

  46. 46
    negative 1 says:

    @Richard Mayhew: I just got snipped one hour ago. How long until the Novocain wears off and it starts to hurt?

  47. 47
    Mark-NC says:

    @tybee: More to the point – they will chase you to the end of the Earth and take your house and everything you own to collect the full retail if you don’t have insurnace.

  48. 48
    Manyakitty says:

    @Richard Mayhew: @RaflW: I read somewhere (probably here) that “observation” was the hospital industry’s latest trick to jack up fees. When you’re admitted, there are more global charges, but when you’re observed, everything is a la carte. Is that accurate?

    I had a robotic procedure about two months ago, and they were desperate to keep me in observation. I said if they were worried, they should fully admit me, and if not, I wanted to go home. I REALLY wanted to go home, and pushed hard for it, but only because I have a fear of nosocomial infections. Had I known about the billing scheme, I don’t think I’d have even accepted the possibility of observation.

    Part of my exciting weekend plans involve combing through the EOBs and bills to see who’s playing games. I have employer-funded benefits (for now, at least) and even though I met all kinds of deductibles and out-of-pocket limits before the surgery, I’m still seeing some pretty serious bills. ugh.

  49. 49
    Richard Mayhew says:

    @negative 1: It never really bothered me — my toddler has done an excellent job of reminding me of snip-area sensitivity as his foot has an amazing abilty to find the cut point, but beyond that, it was nearly painless.

  50. 50
    Gretchen says:

    I went to the emergency room a couple of years ago and was admitted. The hospital bill was $22,000. The provider writeoff was $20,000. After insurance, my payment was a few hundred. A poor sucker with my symptoms who showed up uninsured on that holiday weekend would still be trying to pay off $22,000.

  51. 51
    Richard Mayhew says:

    @Manyakitty: Observation is more of a way to get around Center for Medicare Services (CMS) regulations and accountability measures. An admitted patient counts against the readimission criteria. An observed patient does not.

  52. 52
    aimai says:

    @sal: Well, I kind of get that. When you have a grant through a university the university takes “overhead” which is used to defray all the costs you can’t see and don’t care about of maintaining the building etc…You can’t know, a priori, what costs underlie the running of the entire building.

  53. 53
    aimai says:

    @sal: Well, I kind of get that. When you have a grant through a university the university takes “overhead” which is used to defray all the costs you can’t see and don’t care about of maintaining the building etc…You can’t know, a priori, what costs underlie the running of the entire building.

  54. 54
    HW3 says:

    @negative 1: Have those frozen peas and carrots handy, brother.

  55. 55
    Mnemosyne says:

    @CaseyL:

    And, yes, the thing that struck me most forcibly was, “If I didn’t have insurance, how much of the initial $11,000 would I be on the hook for?”

    If you lost your insurance partway through the process, pretty much all of it. If you went in without insurance and negotiated the price up front, you probably could have negotiated it down to at least half, but $5,500 is still way more than you paid with insurance.

    G works for a home infusion company and they run into the “how much if I self-pay?” question all the time. And nine times out of ten, the answer is, We have no idea. They have, like, three different “self-pay” scales that depend on different things, and that’s leaving aside the 15 or so different kinds of insurance they accept.

  56. 56
    dr. bloor says:

    @Richard Mayhew: If the IRS actually lets them write off retail prices on their balance sheets, then that’s a problem with the tax code more than anything else. Hard time believing that actually happens.

    The other thing to note is that to some extent high self-pay rates historically helped underwrite caring for the uninsured and having to provide services they incurred losses on solely because insurance companies demand comprehensive under-one-roof services–not sure how much of that is still true. Hospitals have taken a big hit in terms of how much they can hope to get reimbursed by state-level “angel funds” at the end of each year for providing treatment to anyone that shows up at their doors.

    The hospital I spent the first half of my career at routinely charged $15 for a Tylenol, $2500 for outpatient procedure rooms and four figures+ for ER services. They made so much money they went bankrupt and shut down a few years back. And they had the Catholic diocese underwriting some of the losses.

    “Dr. Boor,” huh? Good thing I’m not Freudian, or I’d have to interpret that. :)

  57. 57
    Manyakitty says:

    @Richard Mayhew: Fair enough. That seems less malevolent, though still self-serving.

  58. 58
    StringOnAStick says:

    Just to put all this is a more global perspective, the website for the Canadian newspaper The Globe and Mail recently had an article up titled “What if you received a bill when you went to hospital?“.

    How quaint. And humane. Seriously, the blinders most US citizens have because of our crappy media are why we have shit for social programs in this country, including our insane for-profit medical industry.

  59. 59
    Jackie says:

    The problem is Medicare now requires a doctor to certify that you will need two nights care to be a full admission and otherwise you must be an observation patient. Where Medicare treads the private insurers tend to follow. It’s a cost savings for Medicare not for the hospital because an observation admission is more out of pocket for the patient.

    Observation started as a way to get people out of the ER, into a more comfortable bed and less chaotic atmosphere, and free up ER space for the next patient while you received fluids or breathing treatments or enough time to exclude you were having a heart attack and not heartburn but were expected to be able to leave in less than 24 hours. It also does not count toward the idiotic rule that Medicare has that you need a 3 night inpatient stay to get rehab coverage.

  60. 60
    Fair Economist says:

    The medical pricing system for uninsured patients is extortion, and demonstrates why the free market can’t work for medicine. When you need treatment, your ability to negotiate is limited at best (by desperation) and totally absent in many case (unconciousness or limited mental function). Literally nobody has the time and ability to pre-negotiate treatment for all of thousands of possible conditions with the hundreds or even thousands of providers you might have to use. (Quite literally; with millions of needed negotiation, nobody has time, regardless of skills) Total market failure, exhibit A.

  61. 61
    Jim says:

    I had hoped that the ACA law might help us clarify some of the crazy billing issues that arise. But in practice, what it will probably do is to continue the opaqueness of what things cost, because the same insurance companies will continue to be involved.

  62. 62
    Mnemosyne says:

    @Jim:

    PPACA will help, in the medium term (next 3 to 5 years) once electronic record-keeping becomes the norm for everyone. But it will continue to be a PITA for at least a decade to come.

  63. 63
    wildweasels says:

    And all of this tells me why single payer is the best. I go to my doctor and ask why my belly button is getting red an sore. He refers me to a surgeon in the same network. It looks like an umbilical hernia. Oh, I had the inguinal kind so I better have this fixed. I diligently followed the instructions on handling referrals so I was safe. I made sure I had the referral in hand before continuing. It can be be bothersome at time but unless it is an emergency, I can wait a few days for the approval. The end result, a procedure that cost around $12,000 was only $30 out of pocket. OK I have Tricare but like Medicare, why should’nt everyone have this?

  64. 64
    Phoenician in a time of Romans says:

    @Waynski:

    I know what you mean. My doctor put me in the hospital for observation for a day and a half. My EOB was north of $80,000. Un – fkg – believable.

    The last time I was seriously sick (as some who might be on Pandagon might recall), I was in hospital for 21 days with a lot of support post-event.

    I paid nothing. Not a damn thing, save for a nominal amount for some drugs issued after I left. And the medical system itself paid the smallest price possible on my behalf because it negotiated hard as a single buyer on drugs and suppliers, and because my regional health board ran the hospital and radiological departments I used.

    I have no earthly clue why Americans haven’t responded with pitchforks and torches to their medical system by now.

  65. 65
    Andrew Lazarus says:

    A 1983 Toyota Tercel SR5 was my first car and a damn good one. So were the 1984 models. You must have abused yours.

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