Sunday, March 25, 2007

Hospital Bill: Appendix Addendum

Well, my weekend got away from me, so I'll settle for blogging the hospital bill I just received regarding my recent day trip to the local Emergency Room, as chronicled in Appendix Addendum.

In case you missed the first post, I went to one ER, bailed, and went to a second one the next day. In all fairness, I haven't seen a claim made on my first, failed visit, which I'd be cool with if they billed for the labs they more than likely ordered before I left.

So, Hospital B.

In short summary, I had a blood and urine workup, one CAT scan, and was seen by an ER doc and a surgeon.

The bill goes like this:

Eight, count them, eight lab charges.

$101.00, $125.00, $28.20, $89.00, $89.00 again, $96.00, $50.00 and $62.00

Total lab charges: $640.20

Total amount covered by my insurance company? $62.41

All lab charges were covered to the tune of 9.75% exactly, each individual charge was paid at 9.75%.

Now, if this had been ten years ago and I was starting my little business and was scraping by uninsured - which is exactly the situation I used to be in - I would have been expected to pay $640.20, even though the hospital is perfectly willing to accept 9.75% of their bill as adequate payment.

Weird, huh?

So, what else. Ah yes. The CAT scan.

For some unfathomable reason I have two CAT scans listed. The first one was $1,022.00 and the second one was $1,043.00

I'm pretty sure I only had one CAT scan, I mean, I was there. Maybe one of these charges is a radiologist charge, which would explain the two items, but man, that's a nice paycheck for an hour's work.

Total bill for the CAT scan: $2065.00
Total covered? $201.29

There's that 9.75% again.

There's then a general Emergency Room charge of $516.00, covered at the increasingly-familiar rate of 9.75%, the hospital getting paid $50.30 of the bill.

Finally, the "service charge", $28.10, covered in its entirety. "Service Charge". It's labelled "State Claim Surcharge".

So, the entire bill was $3,249.30, the insurance company covers $342.10, of which $25.00 is apparently a copay I was supposed to cough up, which no-one asked for. Therefore, of the entire bill, the hospital received a check for $317.10, less than 10% of the billed amount.

Here's the rub. An uninsured person would be expected to pay ten times the accepted reimbursement. But of course, if an uninsured person could afford the bill, they could afford insurance.

According to various studies, medical bills account for up to half of all personal bankruptcies. These people have jobs, albeit low-paid and not offering health insurance.

29% of Brooklyn residents have no health insurance, and are not eligible for Medicaid. Those people without insurance have lower access to health care, and will put off seeing the doctor, get sicker, and end up in the Emergency Room, where they find themselves now with an unpayable bill of thousands of dollars, which the hospital has to write off, leading to higher prices etc etc.

I don't claim to have the answer, but market forces are certainly not working at this particular hospital, which filed for bankruptcy in 2006. I grew up in a single-payer society, and while we certainly don't have the best care in the world, we have better outcomes in many areas over the USA and no-one is scared to go see the doctor regularly simply because of cost.

The richest country in the world owes its citizens better than this. Whether it be government or private charity, somehow we should be providing for basic health care for all. The richest country in the world also has one of the widest wealth gaps, the haves are getting way ahead of the have-nots.

In the meantime, if you do get a hospital bill and can't afford to pay it, bear in mind that it's as negotiable as any other bill.


soyne said...

Here's an interesting study, Price Check: The Mystery of Hospital Pricing , in which "mystery shoppers" attempted to get pricing and financial assistance information from hospitals. As you can probably guess, they weren't very successful.

The link also includes tips for consumers on more successfully obtaining this and other information from their health care providers.

sgress said...

Hospital bills aren't just as negotiable as other bills. They're more negotiable than other bills. In my experience, a hospital (or private practice) will settle for 50%, 25%, even 10% of a bill. And why not? In many cases (such as yours) 10% is still more than they'd get from insurance. Plus, they get to write off the rest of the inflated price as charity, even though they never expected anyone to pay it.

Where I come from they call that a racket, and it's the middle class that gets fleeced as usual. If you're poor enough (as I was "lucky" enough to be), you end up getting your bills mostly written off, even if it costs you eighteen months, 20 pounds, your significant other and a slight drug-dependency problem. If you're rich enough, you can have the lawyers fight it out when your insurance won't pay. But those 100 million+ Americans in the middle? They get it all-- the sleepless nights, the drug problems, the lawyers (maybe), and, best of all, what is now possibly the shittiest bankruptcy law in the civilized world. It's enough to make your appendix vomit.

But to be fair, we only have the time to be righteously indignant because we're not busy dying in the street, like some places I can think of-- I'm looking at you, sub-Saharan Africa...

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