When you realize that the hospital was charging $19,000 for a stent that cost $1,500, you realize that painting Calver as someone who is going to cost us all money is misdirected anger.
And, to be clear, they charged $19,000 for the stent, not "stent plus theater time to place it plus surgeon, anesthesiology, OR nurses", of course not. Those are all absolutely billed separately.
I believe there should be legal consequences for getting things this wrong. Wondering how they came up with the $19,000 number.
Also, in speaking with a vascular surgeon I know, their hourly rate is between 200-350/hr. The middlemen and hospitals have figured out how to milk this cow and they're feasting.
Absolutely, and it is this sort of practice that all Americans could get behind legislation that made it illegal. Unfortunately we can't seem to have a civil discussion on health care to find the issues we have in common.
>You could literally bill for breathing hospital air and people would have to pay.
Don't be ridiculous. You'd be billed for air and hospital odor separately!
Though I should note that a delivery is usually more complex than simply waiting there for the little one to fall out, there is some after care and such that is being performed plus the doctor is usually not that cheap either. (They have a lot of student debt to pay off after all)
Their liability insurance has to cover the costs of lifetime care for any babies that are injured during delivery (juries have made this clear enough). It's not strange that they pass this cost on to mothers.
Medical billing is a nightmare. I have HMO insurance (which means the process should be really streamlined - everything is in-house) and I once tried to figure out why certain rather simple bill item was billed certain cost. It took about three weeks, multiple calls and emails, and speaking to several people, to get to the stage where they said "this is probably because if it was classified as code X, though we can not give you rules why it is code X and not code Y, and there's no way to know upfront which it would be, we'll just send you the bill later and you pay whatever we say" and even then they couldn't answer why sometimes they billed certain percentage upfront and sometimes another, so that you end up getting different pre-payments and different bills for the same thing. This whole thing is an ungodly mess.
Hospitals should be required to publicly post prices, just like fast food restaurants are now required (in some places) to publicly post the calories for each dish.
This isn't just restricted to US. It has become very common even in a country like India for doctors and hospital owners to invite their doctor buddies for 'second opinions' and looking at non-issues and then billing the patients 'consulting fees'.
There is also a huge industry built along the lines of phony testing.
The term used for that think is called 'basin test', basically samples are flushed down the basin and made up numbers are put in reports. You can put in what you like as the doctors know the patient is healthy.
Hospitals should be legally mandated to accept replacement of materials in lieu of payment.
If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement.
It's not as if medical supplies are unavailable to the end consumer.
When I had a broken finger and was uninsured, I was charged ~$40 for a finger splint that costs $7 at Walgreens (yeah, the very basic one made out of aluminum and blue foam).
Also, a word of advice - never ever pay what you were sent from the hospital right away. I personally throw most medical bills in the trash and wait until they call me, then negotiate it down to a fraction of what was billed, offering to pay in cash.
> Hospitals should be legally mandated to accept replacement of materials in lieu of payment.
> If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement.
Meh. The only reason they inflate supply costs is because that's where insurance negotiations let them. Mandating supplies must be available at-cost to consumers is just a stupid cost-shifting game. Consumers shouldn't care in particular about the cost of supplies — overall cost is what matters.
Price-fixing in general does not really work. The difference is made up somewhere. Things that would actually reduce pricing stupidity and surprise bills are obvious things like: increased pricing transparency, consumer stake in reducing costs (HDHPs are a stab in this direction), and single payer.
Emergency care is not a great market to be a buyer in, but that does not change that market economics apply. And it is beside the point. The vast majority of healthcare is boring, predictable, non-emergency expenses that can be shopped around.
I agree that regulation makes sense, just not with the extremely specific proposal that medical devices be sold at cost (or whatever slightly higher unit cost is available to consumers).
> Mandating supplies must be available at-cost to consumers is just a stupid cost-shifting game.
That's not what I suggested in my post at all.
Also, if it reduces costs for the end consumer, what's the harm? Why should consumers subsidize hospitals with cutthroat billing departments who make up numbers out of thin air?
NHS is a single-payer system, which is one of the solutions I proposed.
Yes, mandating supplies be sold at-cost is exactly what you proposed:
> Hospitals should be legally mandated to accept replacement of materials in lieu of payment.
> If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement.
And to address:
> Also, if it reduces costs for the end consumer, what's the harm?
The problem is in the condition. At the end of the day, ineffective regulation increases costs for the consumer.
Are you suggesting that a sick person, recovering from an operation, be responsible for researching prices on the parts that were used in surgery? Most do not have the time or expertise for that, nor would anyone want to do it.
Have your spouse/relative shop around for replacement while you recover. Or be destitute for 10 years after being bankrupted by medical bills. I know which one I'd prefer.
> Most do not have the time or expertise for that, nor would anyone want to do it.
Is that a joke? You can find most of those things with a 30 second Google search. I thought this was a forum with technically apt people?
Is anyone working on an app that can do this? There were those parking ticket negotiating apps for a bit. I wonder if there is a way to systemize the negotiation process here. I bet you could charge people up to 10% of the money you save them.
People are surprised when I tell them I simply refused the 3k dollar (after insurance) couple hour hospital bill for having the flu. They couldn't tell me why two tylenols, a saline drip, and a prescription cost that much. (I was vomiting blood which is why I was taken in).
They ended up dropping the bill altogether as insurance had already paid them.
> They couldn't tell me why two tylenols, a saline drip, and a prescription cost that much
I know the US system is different to what I grew up with (UK NHS), but I have had similar "treatment" when ill as a tourist in 3rd world countries: couple of pills / drip.
I understand that the difference of systems in regards to extensive care, but a couple of pills and a drip - why on earth is such basic care just not free to all?
Have you been following the quality of people running our government?
I mean, I know this seems like just a snarky political comment. But it's just the honest answer. Our federal government is simply completely dysfunctional right now, incapable of solving anything.
For what it's worth, "Medicare for All" has been polling increasingly higher recently, due to more Americans being basically ready to give up on the current private system entirely.
Just now? It’s seemed dysfunctional to me since I was capable of understanding government, circa 15 years ago. My parents felt the same way 30 years ago, and their parents felt the same way 50 years ago.
Nope. No way. Have we learned nothing from "fulfilled by Amazon" counterfeits?
The supply chain has to be verifiable as genuine goods from the factory to the hospital floor. Trying to verify the authenticity of patient-supplied replacements would be a nightmare.
Then force hospitals to price match or force them to show YOU, the customer, how much the item actually cost when it was delivered to them for storage.
I wasn't actually seriously suggesting that patients be required to source the item physically, then physically deliver it to the hospital in person.
Honest question - does this really work? I have tried it once or twice without success. Are there particular 'magic phrases' you need to use, or is it jut a question of persistence? Does it impact your credit?
> Are there particular 'magic phrases' you need to use, or is it jut a question of persistence?
My situations varied, but when I had no insurance and was living off of savings, I found a generic "hardship" form and explained my situation to them - they waived 80% of the fee without much resistance. This is compared to the laughable discount of 2% they offered me on the spot if I paid in cash (at the moment of the visit)
In other situations, I'd imagine it's more a question of persistence, but I'd venture to say you can knock off at least 50% on _any_ hospital bill.
I recently bought a house, and my credit was 800+, so I don't think it does in any appreciable way.
That wasn't the gist of my post though. I was advocating more to resist the bullshit and to legislate something that allows the customer to replace materials instead of paying a hugely marked up item.
Same concept would be applicable, for example, for a car mechanic shop. Just because they billed me $600 for brake pads doesn't mean that they've actually provided me with a 10x markup of value on having bought brake pads myself for $60 - at some point this needs to be treated as "usury" (I don't know if there's a word for exorbitant markup on a regular good).
Another thing I would add - don't put your social security number on medical forms. I've never seen it enforced and there's no medical reason for them to have it.
Paying 300-500/mo for decades, as a chronic heart patient here. I've had multiple open heart surgeries and nothing sweeter than paying 6k for the recovery room and 0 for the surgery (along with sweet receipts for 1mil in aggregate surgery costs). The separate billing is a pointless red herring, in context of the article.
In the UK and paying a monthly National Insurance tax:
About 5 years ago, I had 6 weeks in hospital, a total of 3 angiograms, one MRI scan...and then 5 stents (should have been 4, but they tore something and had to put in a covered one!).
The wait was mainly down to an unfortunate series of events: One stent was needed in a 'tricky' place and so I was timetabled to be operated on by a specialist surgeon elsewhere, but his father fell seriously ill so he went on leave. My first op was rebooked for another hospital...and they had a 'flu outbreak so ops were postponed. Eventually I was booked in elsewhere had a one hour ambulance transport ride for 'third time lucky'.
The stents were fitted in two separate operations about two weeks apart. The most notable expense I incurred was for data top-ups on my cellphone because hospital wifi was still being setup and hadn't quite made it to my ward.
The NHS gets a lot of flak, and it's by no means perfect, but it's generally there for you when you really need it.
PS: I'm on a slew of meds for my heart condition and T2 diabetes - all free at the point of collection.
I had my surgeries in the middle of Los Angeles (Kaiser - 4867 W Sunset Blvd, Los Angeles, CA 90027). My insurance covered 7 days, but I paid for additional recovery time at about 2k a day.
In regard to your friend ... his 7 x 2 = $14k. That's a LOT for basically a bed, blood draws daily, limited TV and cafeteria food, but in the center of Los Angeles, that's what you get.
And, to be clear, they charged $19,000 for the stent, not "stent plus theater time to place it plus surgeon, anesthesiology, OR nurses", of course not. Those are all absolutely billed separately.