?

Log in

No account? Create an account
[cancer] More on the weird billing, and costs of healthcare - Lakeshore
An author of no particular popularity

Jay Lake
Date: 2010-02-23 05:48
Subject: [cancer] More on the weird billing, and costs of healthcare
Security: Public
Tags:cancer, health, healthcare, politics
Dad came over yesterday evening and read through the insurance paperwork. He pointed out that what the insurance company allows is by contract with the provider, and if they disallow 91% of the cost of my chemo, that's between the insurance company and the provider.

I still don't get that, as one of my chemo drugs is under patent and costs $10,000 per dose. Where did the $10,000 go? Let alone the other $4,500 the insurance disallowed? As Dad points out, what counts is the bill I get from the hospital, not the benefits statement I get from the carrier. Which I haven't seen that bill yet.

I understand about how contracted services work. One of the reasons for a crying need for healthcare reform is specifically because everything in American healthcare is drastically overpriced, then negotiated back down only by parties with the power to do such negotiation. In other words, if I walked in off the street and paid for chemo 100% out of pocket, I would be paying this $16,100 bill. Apparently my insurance company can pay the same bill off for $1,500.

Kind of rough on the uninsured, the underinsured and the self-funded, who don't have the negotiating power to have 90% of their bills waived away like my carrier apparently does. Our premiums and copays go up ahead of inflation every year, and have all my life. Apparently the problem of American recreational abuse of the medical system is so great that we must be forced to pay more to ensure good choices. That was certainly the conservative rhetoric around HSAs a few years ago.

But how the hell do we know what we're paying when there's a 90% differential between the list price and the insider price? What constitutes informed choice on my part?

I still don't think this is over. I'm used to seeing downward adjustments on insurance payouts, and the $2,000 I'll be paying over the next few months for my out-of-pocket and deductibles are just part of my penalty for being ill, despite all the premiums I've paid over the years. This is the "best in the world" system, after all, and I have to pay to play. But where the hell did $14,500 go? And who's paying for it?

The healthcare system's financial transparency is even worse than Wall Street's.

Post A Comment | 20 Comments | | Link






cathshaffer
User: cathshaffer
Date: 2010-02-23 14:44 (UTC)
Subject: (no subject)
Your Dad is right. The hospital can't bill you the difference between the insurance company's usual and customer allowed fee and their "retail price," whatever that is. Possibly the reason they price it that high is that some other insurance companies may allow it, letting them get as much as possible. Or perhaps they have deliberately priced it above the highest usual and customary payment to make sure they max out every possible insurance company price point. (Hmmm, interesting.)

What is ironic is that uninsured people don't pay that, either. A couple of things happen if you don't have insurance. One is that you become eligible for drug cost assistance programs through the drug company, the hospital, and certain nonprofit groups, and these can bring the cost of medicines into the zone of affordability. The hospital can't cut you a bargain on your care or medicines if you are insured, but they frequently have a sliding scale for the uninsured. Even so, it's a tough financial hit for anyone who isn't independently wealthy. :-)

We got screwed by that particular fine print last year when my husband was prescribed a treatment that was only covered 50% by insurance. We were told if we'd had no insurance at all, it would have been cheaper than paying the 50% out of pocket.

A good rule I've formed for my own sanity is not to worry about anything on the EOB until I see it on my bill. If my bill is wrong, I call the hospital billing office once and tell them to rebill the insurance company because something got screwed up, and then I wait for the next bill to come. You may also be interested to know that if the hospital fails to bill the insurance for a certain period of time--I think it's around a year--then the insurance company doesn't have to pay the bill and neither do you. This came up a while back with my mother when a doctor's office was persistently billing the wrong insurance company. They were given the correct information, but never sent the bill to the right place. When they finally did, it was rejected because too much time had passed, and the clinic had to write it off.

There was a time when we had insurance that paid for nearly everything. Prescription copayments were $5, office visits were $10. My entire cost for delivering my son in the hospital, with 57 hours of labor, umpteen ultrasounds, fetal monitoring, an army of doctors and nurses, an epidural, and a locksmith was about $20. That was 11 years ago. Every year, we've seen our costs increase and our coverage drop. Now we have something like a $200 copayment on hospital admissions, and the insurance only pays 90% after that. We have a $5000 family out-of-pocket maximum. So when my son burned his foot last year, taking him to the ER, getting it looked at, bandaged up, and three followup visits cost us over $300, more than ten times as much as the entire cost of giving birth to the same child. Trust me, if health care reform fizzles this time around, it won't be long before *everyone* is feeling the pain. Just the other day, I heard that health insurance companies want to raise premiums by 30% because, supposedly, so many people are unemployed and only the sick ones are making COBRA payments on their insurance. I think this is stupid and evil, because with 15% unemployment (here in Michigan) that means that 85% of the work force still has their usual employer-provided health insurance, I don't see how their costs could be up that much.
Reply | Thread | Link



cathshaffer
User: cathshaffer
Date: 2010-02-23 14:49 (UTC)
Subject: (no subject)
Actually, Jay, I just realized you might benefit from some of the patient assistance programs since your copayments have been really high. Here is some information on the Genentech patient access program: http://www.gene.com/gene/products/access/

And here is a document that has a pretty comprehensive list of copayment assistance programs on it. You don't have to be poor to qualify for all of them, and a cursory review indicates that a number of them serve colon cancer patients:
http://www.cancercare.org/pdf/fact_sheets/fs_financial_en.pdf
Reply | Parent | Thread | Link



Jay Lake
User: jaylake
Date: 2010-02-23 15:57 (UTC)
Subject: (no subject)
Thank you. I will look into this.

As tough as this for me to deal with, I have a friend with TBI who has to deal with this stuff while going through cognitive therapy. That is just *insane*.
Reply | Parent | Thread | Link



zellandyne
User: zellandyne
Date: 2010-02-23 19:22 (UTC)
Subject: (no subject)
When we were traveling in Estonia and my then boyfriend's father had a heart arrhythmia that landed him in the hospital, he was only charged a few hundred dollars for his care. They did tests and procedures on him that, in the US, would have easily been 10 times the cost.
Reply | Parent | Thread | Link



cathshaffer
User: cathshaffer
Date: 2010-02-23 19:27 (UTC)
Subject: (no subject)
Isn't it interesting, too, that you can get some of the same tests from a veterinarian, for your dog or cat, for a fraction of the cost that they are offered in a human hospital.
Reply | Parent | Thread | Link



zellandyne
User: zellandyne
Date: 2010-02-23 19:39 (UTC)
Subject: (no subject)
*laughter* I remember when I got sick once, and my father was treating me at home before taking me in to see his partner (he's a pediatrician) he gave me the dog's prednisone. It was exactly the same stuff as we got later at the pharmacy.
Reply | Parent | Thread | Link



Msconduct
User: msconduct
Date: 2010-02-23 21:12 (UTC)
Subject: (no subject)
How ironic! Here in New Zealand, where we have no-cost public hospitals and highly subsidised doctors' visits and prescription fees, we frequently complain about how expensive vet care is compared to human healthcare.
Reply | Parent | Thread | Link



(no subject) - (Anonymous)
cathshaffer
User: cathshaffer
Date: 2010-03-10 15:45 (UTC)
Subject: Re: Can you elaborate on this?
Ugh! The first thing I would do is contact the TN attorney general's office and find out who regulates this sort of thing. They can probably give you some resources, people to contact. If the bill is very large, it might be worthwhile to hire a lawyer to inform them of what the law says about "timely billing." The other issue is that they are billing someone who is deceased and there is probably also a time limit on when claims can be made against the estate. Good luck!
Reply | Parent | Thread | Link



Rachel Swirsky
User: rachel_swirsky
Date: 2010-02-23 15:16 (UTC)
Subject: (no subject)
No mitigation to the evil--but some of my wealthy relatives refuse to carry socialist insurance at all, and they pay all their medical bills in full at the hospital. They get massive--30-50%?--reductions when they offer to pay immediately in cash.

Still fucks over everyone who isn't a lawyer married to a contractor with lots of investments and rental properties.
Reply | Thread | Link



cathshaffer
User: cathshaffer
Date: 2010-02-23 15:24 (UTC)
Subject: (no subject)
Yeah, it doesn't make sense to carry insurance for something if you can afford to pay for it outright. What I've been told by people who do this is that often you can't get information about how much services cost at the point of care. So if you need an MRI and want to save money by comparing prices, the clinic can't tell you how much your MRI costs. It has to be processed through the Mysterious Hospital Billing Department after you've had the procedure. I'm surprised your relatives have been able to pay on the spot in order to negotiate a discount.
Reply | Parent | Thread | Link



Rachel Swirsky
User: rachel_swirsky
Date: 2010-02-23 15:29 (UTC)
Subject: (no subject)
Well, that's coming from them. Maybe they're exaggerating.

However, they don't seek out routine care, which they don't believe in. (They've even helpfully attempted to get my immediate family members to stop taking medicines for chronic conditions because they don't work anyway, apparently.) They believe chiropractry can cure everything--you know, I've nothing against chiropractry as a cure for back pain, but claims like my relatives' are silly. What's that Eddie Izzard routine? Whatever's wrong with you, I'll crack yer bones.

So the only time they've been to the hospital in recent memory was after a near-death experience with blood poisoning and a several-month hospital stay. That, along with all attendant emergency procedures, they paid the tens of thousands of dollars for (off of a much larger bill) on site--according to the story.
Reply | Parent | Thread | Link



cathshaffer
User: cathshaffer
Date: 2010-02-23 15:31 (UTC)
Subject: (no subject)
Wow! Quite eccentric!
Reply | Parent | Thread | Link



Paul
User: horrorofitall
Date: 2010-02-23 16:14 (UTC)
Subject: (no subject)
That seems about right. You can negotiate self pay discounts for everything from yoru Primary Care Physician to the hospital. Hosptials are working on tight budgets nad lean profit margins for the for profit hospitals, and or non profit hospitals retaining operating capital is tight. So they would rather discount a proceedure for a self pay patient that can get paid than right off the non discounted price as a loss.

Reply | Parent | Thread | Link



threeoutside
User: threeoutside
Date: 2010-02-23 15:37 (UTC)
Subject: (no subject)
I dont' have the expertise your other commenters do, but I have the experience of seeing my husband's billings and paperwork (about a bale or so) through his last, 4 1/2-month illness. I learned to be VERY rigid about opening those envelopes when they arrived, and matching all the papers pertaining to each procedure, test, whatever, together and clipping them together. I learned NOT to panic upon reading those cute little "This is not a bill" things - to wait before paying anybody anything until the biller had passed their bill at least twice through my provider - and twice I hand-carried papers to my provider which they took one look at and said, "Nope, don't worry about that. Give it here and we'll take care of it," and they did.

I waited a bit too long for one service provider (an imaging company populated solely by assholes, I'm convinced) and they turned it over to a whatchmacallit, collection agency. I made short work of THEM, myself. (This was when Bob was still in the hospital and I had HAD it - poor collection agent, heh heh.) Anyway, diligent paper-organizing and tracking is required. And don't get too upset over the ridiculous didoes the system goes through, right at first anyway. Some of it does get worked through. Though why it has to be so Byzantine and occult, I can only believe somebody's making extra money out of it that way.
Reply | Thread | Link



smoking catnip and chasing my tail
User: jettcat
Date: 2010-02-23 19:25 (UTC)
Subject: (no subject)
Ah the demonized yet very handy, contractual write-off.
The built in escape clause that HMO/big med writes in so they're not on the hook.
Watch carefully the wording used on both the explanation of benefits from the insurance company versus what the hospital might send.

I used to bill this stuff for years when I worked for a major clinical laboratory, give a shout if you'd like help figuring out what the medicalease means.
Reply | Thread | Link



Jay Lake
User: jaylake
Date: 2010-02-23 19:33 (UTC)
Subject: (no subject)
Thank you.
Reply | Parent | Thread | Link



martianmooncrab
User: martianmooncrab
Date: 2010-02-23 19:29 (UTC)
Subject: (no subject)
read through the insurance paperwork

which is why you spreadsheet the bills, they also tend to send two or three copies of the same bill, not just hoping that you pay the full amount, but you do it a couple of times.
Reply | Thread | Link



shelly_rae: Elephant Poop!
User: shelly_rae
Date: 2010-02-23 20:17 (UTC)
Subject: (no subject)
Keyword:Elephant Poop!
Not only is dealing with the illness stressful but then trying to understand the paperwork, the insurance company's billing vs. the hospital billing and what the heck this all means is just crazy making. I need a Patient Advocate just to attempt to understand this stuff.
ouch.
Now I do want a cookie.
Anon
Reply | Thread | Link



e_bourne
User: e_bourne
Date: 2010-02-23 20:37 (UTC)
Subject: (no subject)
Anyone can negotiate with a hospital. It takes determination, true, but it is doable. People tend not to question, and that's really our own fault. Hopsitals will negotiate.

Read your insurance. From not until the end of time, amen. They are getting more and more unscrupulous and they are putting things in small print and hard to find clauses. Read those suckers. Complain to your employer if you don't like it. Complain to your insurance company. Make yourself heard.

Health Net Oregon do not have a maximum life time payout. Not so far. Something to consider if you're someone that worries about that.

If you can afford it, get secondary insurance. AFLAC or one of its peers. They are worth it.

Do not be passive. Be polite. Be firm. Be demanding. Get what you want.
Reply | Parent | Thread | Link



(no subject) - (Anonymous)
shaolingrrl
User: shaolingrrl
Date: 2010-02-24 05:18 (UTC)
Subject: (no subject)
Ditto. Dozens and dozens of frosted cookies.
Reply | Parent | Thread | Link



browse
my journal
links
January 2014
2012 appearances