How a $109K heart attack bill was slashed to $332

Northern Light · Sep 2, 2018

It's greed, plain and simple.... people at all levels of bureaucracy inflating their obscene profits at the cost of patients.

Health care is an inflexible good/service just like food is. What if food companies colluded and started raising their prices to $50 for a loaf a bread? There would be an uprising. Yet with medical care it's OK even though everyone needs it at some point in their lives.

jmotivator · Sep 2, 2018

AsI have said many times, the US spends as much PUBLICLY (without even counting private healthcare expenses) as all but two countries spend on healthcare in total. If the US were to reform Medicare and Medicaid they could offer a full service national health care system, or insurance system, without ever touching private insurance policies. If it is run well and provides good service then the competition would no doubt have an effect on private insurance. What I can't tolerate is the process instituted every time that reforms are discussed or implemented that artificially kill private insurance to boost a public options. If the public option is indeed the best option then it would end private insurance without even regulating it.

My proposal is for the Medicare and Medicaid systems to be abolished, and a "single payer" plan be started that covers wellness and catastrophic coverage but does nothing to interfere with private insurers. This would no doubt mean that those with the means could in theory get more treatment than those who rely only on the state provisions, but we have to resign to the fact that people with more money have more money and nothing will ever change that.

EMNofSeattle · Sep 2, 2018

Deuce said:
The problem with healthcare is that it's fundamentally incapable of operating as a healthy free market. The basic market principles a free market depends on are not present or crippled.

Actually it is perfectly capable of operating as a free market, if the leftists would get out of the way. It’s funny they refuse to apply any regulation at all on abortion clinics because doing so limits access.

I mean breast augmentation and eye surgery are not covered by government insurance and low and behold it’s cheap, safe, and lots of competition.

What you really mean is healthcare can’t operate in a free market as a parachute for irresponsible people who make bad decisions involvong their health, as most health ailments prevalent in our society are preventable

Sent from my iPhone using Tapatalk

jmotivator · Sep 2, 2018

Northern Light said:
It's greed, plain and simple.... people at all levels of bureaucracy inflating their obscene profits at the cost of patients.

Health care is an inflexible good/service just like food is. What if food companies colluded and started raising their prices to $50 for a loaf a bread? There would be an uprising. Yet with medical care it's OK even though everyone needs it at some point in their lives.

Health insurance companies don't make obscene profits. Eliminating Insurer CEO salaries wouldn't change health care costs. Some interesting trends in healthcare spending based on a Kaiser Foundation study from 2012:

So the biggest growth in healthcare payment source has been Medicare and Medicaid, and the biggest change in commodity spending is on pharmaceuticals ... which themselves are covered increasingly by insurance rather than OOP. This likely driven in part by the aging US population, and in large part by the pharmaceutical revolution.

jmotivator · Sep 2, 2018

TU Curmudgeon said:
The FULL DIRECT cost of one month's (unlimited) medical insurance in BC is

False. Canadian healthcare is indeed limited. The only selling point for single payer over private market is that it is more evenly limited.

Northern Light · Sep 3, 2018

jmotivator said:
Health insurance companies don't make obscene profits. Eliminating Insurer CEO salaries wouldn't change health care costs. Some interesting trends in healthcare spending based on a Kaiser Foundation study from 2012:

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So the biggest growth in healthcare payment source has been Medicare and Medicaid, and the biggest change in commodity spending is on pharmaceuticals ... which themselves are covered increasingly by insurance rather than OOP. This likely driven in part by the aging US population, and in large part by the pharmaceutical revolution.

I never said anything about insurance companies specifically. I said bureaucracy.

Greenbeard · Sep 3, 2018

jmotivator said:
AsI have said many times, the US spends as much PUBLICLY (without even counting private healthcare expenses) as all but two countries spend on healthcare in total. If the US were to reform Medicare and Medicaid they could offer a full service national health care system, or insurance system, without ever touching private insurance policies. If it is run well and provides good service then the competition would no doubt have an effect on private insurance. What I can't tolerate is the process instituted every time that reforms are discussed or implemented that artificially kill private insurance to boost a public options. If the public option is indeed the best option then it would end private insurance without even regulating it.

A public option in direct competition with commercial insurers was already floated nine years ago. A version of it even passed the House. Conservatives were too afraid of it and made sure the idea died.

EMNofSeattle said:
I mean breast augmentation and eye surgery are not covered by government insurance and low and behold it’s cheap, safe, and lots of competition.

You can't think of any differences in the market for emergency coronary angioplasties and the market for breast augmentation surgery?

holbritter · Sep 3, 2018

TU Curmudgeon said:
From ABC News

How a $109K heart attack bill was slashed to $332

A Texas hospital that charged a teacher $108,951 [NOTE - That should be "nearly $164,951".] for care after a heart attack slashed the bill to $332.29 [NOTE - That should be "nearly $56,332.29".] Thursday — but not before the huge charge sparked a national conversation over what should be done to combat surprise medical bills that afflict a growing number of Americans.

The story of Drew Calver was first reported by Kaiser Health News and NPR on Monday as part of the “Bill of the Month” series, which examines U.S. health care prices and the troubles patients run up against in the $3.5 trillion industry.

In Calver’s case, the 44-year-old father of two had suffered a heart attack in April 2017 and a neighbor rushed him to the nearest emergency room, which was an out-of-network hospital under his school district health plan. His insurance paid the hospital nearly $56,000 for his four-day hospitalization and procedures to clear his blocked “widow-maker” artery.

But the hospital, St. David’s Medical Center in Austin, wasn’t satisfied with that amount and went after the high school history teacher and swim coach for an additional $109,000 in a practice known as “balance billing.”

COMMENT:-

The Non-Resident per diem rate in BC's most expensive hospital's ICU is CDN$13,665 (roughly US$10,522.05) and in the least expensive it is CDN$8,120 (roughly US$6,252.40. The average over eight hospitals is CDN$10,420 (roughly US$8,023.40). At that average rate, the "nearly $56,000" that the insurance company paid out would have been enough to pay for "nearly 6.979 days" in a BC ICU. However, in BC doctors bill separately from hospitals, so the US bill that the insurance company paid is roughly the same as the BC bill would have been AND there would have been no "balance billing".

So, that leaves me with the question "What was the other $109,000 for?".

PS - The insurance broker that I linked to for the BC rates, recommends carrying at least US$50,000 in medical coverage if visiting BC. They also recommend that BC residents carry at least $5,000,000 in medical coverage if visiting the US. Ever wonder why the difference in cost for the same treatment?

Additional saline bags.

paprclip · Sep 3, 2018

Captain Adverse said:
To be fair, a lot of factors go into hospital patient billing beyond the basic costs of any medical procedure provided.

1. The cost of required "free" services for indigent patients coming in via the Emergency room. This will vary on whether the facility only has to give enough care to stabilize the patient in preparation for transfer to a city or county facility, or if they have to provide full care because there is no public facility within reasonable commuting distance.

2. The salaries of all hospital support staff. That's those medical assistant's who do intake and filing, billing clerks, pharmacists, janitors, security staff, administrative assistants, legal staff, etc. Those wages/salaries have to come from somewhere.

3. Equipment purchases and maintenance. All that High- and Low-tech gadgetry they use to rapidly diagnose your ills and help treat them. Often they are leased as opposed to being owned outright. Money has to come from somewhere, and donations don't always cut it.

4. Medical supplies stocking. All those tubes, needles, swabs, surgical tools, etc. that are used to treat you with. Money has to come from somewhere too.

5. Facility maintenance. When you go to and sometimes stay in a hospital you are in a building, which has to be maintained and provided with utilities. Money has to come from somewhere too.

These are all part of the costs accrued when someone comes to the hospital for treatment. The money comes from charges and fees for treatment and visitations.

So it is disingenuous to look at a bill and say "The heart operation should only cost this much, and no more." This totally ignores the fact that you are getting treatment in a facility fully staffed and maintained in order to provide such treatment on demand.

Could the costs be lower? Perhaps. Or perhaps as some people urge we should just go to social welfare hospitalization and tax everyone under a single-payer plan controlled and regulated by the central government?

I don't know, but at least try to take the cost of doing business into consideration.

I worked in healthcare billing for years, so I'll speak to this. A healthcare facility has what's known as the "chargemaster" (charge sheet) which is basically a listing of all services and products "retail" cost. As far as paying "retail" the only ones who pay it are those without insurance. Medicare sets a national pay schedule that takes into account local costs. So, let's take a CT scan for example: the chargemaster rate would be (as an example) $23,000. This $23k would include incidentals such as IV kits, blankets, contrasting dye, etc. Now, if you're a Medicare patient, Medicare will probably only pay $2,300 (of which you pay 20%) since that's what CMSS has determined to be the "value" of the procedure. If you have a commericial insurance policy (Aetna, Travelers, etc.) the discount is probably somewhere between 30% and 60% (and you pay whatever copay your policy calls for). However, if you're a "self-pay" not only do you get to pay the full retail rate you're going to get double and triple billed. The bill will be padded with items that should be (and are) included in the base charge. So you're going to get an extra charge for, let's say, IV admin sets, contrasting dye, misc. bandages, etc.

So to say that the extra costs are to pay for overhead is disingenuous; those costs are already figured into the base charge.

Another fun fact: hospitals, generally, have a 45.7% profit margin. That's higher than most industries, including tech (such as Apple and Google).

Captain Adverse · Sep 3, 2018

paprclip said:
I worked in healthcare billing for years, so I'll speak to this. A healthcare facility has what's known as the "chargemaster" (charge sheet) which is basically a listing of all services and products "retail" cost. As far as paying "retail" the only ones who pay it are those without insurance. Medicare sets a national pay schedule that takes into account local costs. So, let's take a CT scan for example: the chargemaster rate would be (as an example) $23,000. This $23k would include incidentals such as IV kits, blankets, contrasting dye, etc. Now, if you're a Medicare patient, Medicare will probably only pay $2,300 (of which you pay 20%) since that's what CMSS has determined to be the "value" of the procedure. If you have a commericial insurance policy (Aetna, Travelers, etc.) the discount is probably somewhere between 30% and 60% (and you pay whatever copay your policy calls for). However, if you're a "self-pay" not only do you get to pay the full retail rate you're going to get double and triple billed. The bill will be padded with items that should be (and are) included in the base charge. So you're going to get an extra charge for, let's say, IV admin sets, contrasting dye, misc. bandages, etc.

So to say that the extra costs are to pay for overhead is disingenuous; those costs are already figured into the base charge.

Another fun fact: hospitals, generally, have a 45.7% profit margin. That's higher than most industries, including tech (such as Apple and Google).

I see you missed this post:

Captain Adverse said:
I have to agree with you there:

I believe I posted this video in the Forum some time last year.

I never said the billing was "fair," just that the bill needs to include a share of all those expenses to run the hospital.

"Fun fact:" fact-checking before responding based on assumption bias is fundamental. :coffeepap:

RabidAlpaca · Sep 3, 2018

jmotivator said:
AsI have said many times, the US spends as much PUBLICLY (without even counting private healthcare expenses) as all but two countries spend on healthcare in total. If the US were to reform Medicare and Medicaid they could offer a full service national health care system, or insurance system, without ever touching private insurance policies. If it is run well and provides good service then the competition would no doubt have an effect on private insurance. What I can't tolerate is the process instituted every time that reforms are discussed or implemented that artificially kill private insurance to boost a public options. If the public option is indeed the best option then it would end private insurance without even regulating it.

My proposal is for the Medicare and Medicaid systems to be abolished, and a "single payer" plan be started that covers wellness and catastrophic coverage but does nothing to interfere with private insurers. This would no doubt mean that those with the means could in theory get more treatment than those who rely only on the state provisions, but we have to resign to the fact that people with more money have more money and nothing will ever change that.

You'd probably like Germany's system. If you don't want to take part in the public system you can opt-out and take 100% of your money with you to a private insurance company. It'll be cheaper when you're young, but will balloon as you age. The public system is based purely on income (7%) and doesn't increase as you age or get expensive conditions.

jmotivator said:
False. Canadian healthcare is indeed limited. The only selling point for single payer over private market is that it is more evenly limited.

Limited in the sense that all things are limited, like grains of sand at the beach. People are not cut off after their benefits are used up, as is the case in America. America has literal death panels at private insurance companies that decide who lives and who dies. If they deem you too expensive, they'll deny you coverage and you'll be up **** creek. In most of the UHC world, there are none.

jmotivator · Sep 3, 2018

RabidAlpaca said:
You'd probably like Germany's system. If you don't want to take part in the public system you can opt-out and take 100% of your money with you to a private insurance company. It'll be cheaper when you're young, but will balloon as you age. The public system is based purely on income (7%) and doesn't increase as you age or get expensive conditions.

If the German system nationalized, or single payer? Do the privately insured have a different pool of doctors?

Limited in the sense that all things are limited, like grains of sand at the beach. People are not cut off after their benefits are used up, as is the case in America.

People aren't "cut off" when their insurance is used up in America either.

America has literal death panels at private insurance companies that decide who lives and who dies.

Do you believe that Germany doesn't make decisions on who will and won't get treatment? Excuse me while I roll my eyes in your direction. :roll:

The problem with a national health care system is that when those death panels tell you you will not get treatment anymore you don't have recourse. In fact, in places like the UK they actively prevent you from seeking treatment outside of their system.

If they deem you too expensive, they'll deny you coverage and you'll be up **** creek.

Again, you honestly think Germany is better at that? Your state formularies choose what medications you can and can't have based on cost just like the US does, but in the US you have options.

In most of the UHC world, there are none.

False. You are just never given the options that the state refuses to pay for.

OscarLevant · Sep 3, 2018

TU Curmudgeon said:
From ABC News

How a $109K heart attack bill was slashed to $332

A Texas hospital that charged a teacher $108,951 [NOTE - That should be "nearly $164,951".] for care after a heart attack slashed the bill to $332.29 [NOTE - That should be "nearly $56,332.29".] Thursday — but not before the huge charge sparked a national conversation over what should be done to combat surprise medical bills that afflict a growing number of Americans.

The story of Drew Calver was first reported by Kaiser Health News and NPR on Monday as part of the “Bill of the Month” series, which examines U.S. health care prices and the troubles patients run up against in the $3.5 trillion industry.

In Calver’s case, the 44-year-old father of two had suffered a heart attack in April 2017 and a neighbor rushed him to the nearest emergency room, which was an out-of-network hospital under his school district health plan. His insurance paid the hospital nearly $56,000 for his four-day hospitalization and procedures to clear his blocked “widow-maker” artery.

But the hospital, St. David’s Medical Center in Austin, wasn’t satisfied with that amount and went after the high school history teacher and swim coach for an additional $109,000 in a practice known as “balance billing.”

COMMENT:-

The Non-Resident per diem rate in BC's most expensive hospital's ICU is CDN$13,665 (roughly US$10,522.05) and in the least expensive it is CDN$8,120 (roughly US$6,252.40. The average over eight hospitals is CDN$10,420 (roughly US$8,023.40). At that average rate, the "nearly $56,000" that the insurance company paid out would have been enough to pay for "nearly 6.979 days" in a BC ICU. However, in BC doctors bill separately from hospitals, so the US bill that the insurance company paid is roughly the same as the BC bill would have been AND there would have been no "balance billing".

So, that leaves me with the question "What was the other $109,000 for?".

PS - The insurance broker that I linked to for the BC rates, recommends carrying at least US$50,000 in medical coverage if visiting BC. They also recommend that BC residents carry at least $5,000,000 in medical coverage if visiting the US. Ever wonder why the difference in cost for the same treatment?

California unlike Texas embraces the ACA. I had an $8,000 operation with costed me only $300 and they allowed me to pay it in two installments

TU Curmudgeon · Sep 4, 2018

jmotivator said:
If the German system nationalized, or single payer?

The German system is that of a state run, single payer system, with the option of withdrawing and purchasing private medical insurance.

It is what is known as a "mixed" system however most people chose to participate in the largest insurance pool (which is the state run one).

jmotivator said:
Do the privately insured have a different pool of doctors?

No.

jmotivator said:
People aren't "cut off" when their insurance is used up in America either.

Quite right, only when all of their assets have been exhausted and the hospital can find some excuse to discharge them.

jmotivator said:
Do you believe that Germany doesn't make decisions on who will and won't get treatment?

Germany makes decisions on WHAT treatment modalities will be available under the state paid regime.

jmotivator said:
Excuse me while I roll my eyes in your direction.

A situation which generally arises when someone doesn't know what they are talking about.:

jmotivator said:
The problem with a national health care system is that when those death panels tell you you will not get treatment anymore you don't have recourse.

Which, of course, is completely different from when the private insurance company tells you that you have reached the limit of your coverage.

jmotivator said:
In fact, in places like the UK they actively prevent you from seeking treatment outside of their system.

You do realize that the UK has a parallel health care system to the NHS, don't you? Possibly you aren't aware of it because it is horrendously expensive.

jmotivator said:
Again, you honestly think Germany is better at that? Your state formularies choose what medications you can and can't have based on cost just like the US does, but in the US you have options.

Indeed, provided that you can pay for them.

jmotivator said:
False. You are just never given the options that the state refuses to pay for.

Sort of like when your insurance coverage runs out?

You do know that the treatment modalities offered in most of the Universal Health Care world are the same treatment modalities offered in the United States of America, don't you?

Or are you of the opinion that health care outside of the United States of America is still at the "bleeding and surgery without anaesthetic" level?

How a $109K heart attack bill was slashed to $332

Northern Light

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