I was hospitalized overnight a few months ago for the removal of a small skin cancer tumor on my forehead. For most patients this procedure is accomplished in a doctor's office, but because of an arrhythmia issue, my cardiologist suggested a precautionary short stay and that the procedure be performed in the hospital. As I left the hospital, my ride home and I stopped in at the cashier's office to verify his free parking for patient pick up. I also requested a copy of my hospitalization bill, an item few of us see when they are remitted directly to medicare or another insurer, and then we see a consolidated explanation of benefits.
One of the first items which caught my eye was a charge for 18 disposable paper bath towels at $14 each. The same towels sell 6 for $8 on Amazon and at Walmarts. I had showered that morning before leaving, and I did use one of those towels. When I finally reached someone within the hospital billing department for justification of this charge and those for other unused items and procedures (notice the multiple on the latter), I was told these are standardized charges for every hospital bill. After requesting a bill correction, I was told that could not be done as the bill had already been approved by Medicare and my supplementary insurer. I started speaking about fraud, embezzlement, a few other crimes and pressing criminal charges, the individual to whom I spoke hung up on me. I followed up with letters to the head of the billing department for the hospital, the president of the hospital, both NYS Senators, NYS Justice Department, the NYC District Attorney's Office, and appropriate officers of the Federal Justice Department.
Small potatoes, but 2 months later I received a corrected bill, showing an almost $3,200 reduction in charges, and proof of refunds to both Medicare and my supplemental insurer. I was never sent a bill for my coinsurance responsibilities. I still thought my bill was excessive for a one night hospital stay. I had checked in at 9PM, after dinner had been served, received one oral dose of an antibiotic at 4am, the procedure was performed at 6am, and I checked out of the hospital at 9:30am. During the procedure I received an intravenous dose of stronger antibiotics I would not have received in a doctor's office. I was sent home with a prescription for a three day supply or oral antibiotics as precautionary preventative medication. The 21 stitches were removed a week later in a doctor's office by a physician's assistant. I earned another minor scar.
I've read estimates that fraudulent practices in the medical fields is almost 40% greater for private insurers than all of the governmental programs combined. I don't know how accurate those estimates are.
You can easily extrapolate and multiply my billing experience by the many hospital stays covered by Medicare and Medicaid, and derive your own questions about why our medical bills are excessive. Then do the same for those covered through private insurers. The numbers for the amount of those procedures can be found in multiple sources on the internet. Accuracy is always questionable, but that's why we give our equations ranges of variance. You can do the same with thousands of other procedural billings from both hospitals and doctors, billings covered by both governmental and private insurers. The problem is not one of fraud, it is a problem with our healthcare system being based on procedural remuneration. Try giving that some thought before jumping to conclusions.
I am also aware that when budgets are proposed, each item is a starting point in negotiations. Try giving that some thought before jumping to conclusions.
