Saturday, November 26, 2011

Fantastical Bullshit

I finally received the statement I had been waiting for.

One day plus a few hours totals up to $53,628. This is just the bill from the hospital.

There are a few other smaller ones from The Lab Guy (less than $200) and the Anesthesia Guy ($2700).

I don't normally recieve an actual itemized statement.

I imagine that I have the right to them if I requested it, which I think I will do, if for no other reason than my personal amusement.

There are some questions:
Why am I being charged for Intensive Care. I was never in Intensive Care (not this time, anyway? Three years ago I was ICU for seven days.)

What drugs did I take that costed $3,070? I don't remember shooting up that many times.

I was in the Recovery Room for several hours. This was not my issue but theirs because they didn't have a regular room available yet. Am I being charged for all of that time?

The big kick in the ass: Operating Room... $29,900. I was in O.R. for about 4 hours. I would really like to know how they came up with this figure.

There was a team of about seven people (that I can remember) when they wheeled me in and put me to sleep. At least two of those were the Anesthesia Guy (who billed separately) and his sidekick (and I made both of them promise not to call their girlfreinds while they were supposed to be watching my monitor.)

Even more puzzling... why the 90% discount, negotiated by CIGNA. I can see insurers negotiating discounts with service providers of say maybe 10% or so.

But shit... 90%? I ain't buyin into that.

No way.

There is a shell game going on here.

I don't know what it is, but it's plain to see to any thoughtful observer how the medical industry in this country is fucked-up crooked by a simple reading of what is being admitted to.


John said...

If you can figure out your hospital bill you could make a fortune publishing a rosetta stone for the rest of us. The massive discounts for insurance always confuse the heck out of me too.

Bike Bubba said...

Medical billing and insurance have made liars out of more doctors than the game of golf, I'm sad to say.

What's going on; your bill is paying for a lot of emergency room and other care for the destitute. The insurance companies are on to this and have produced estimates of the actual cost of care minus the emergency room tax. The rest of us who do not have medical cost accountants at our disposal.....yeah, you got it right.

And thus we have the bizaare spectre of doctors being willing to get paid less because they're dealing with the insurance company adjusters.

Gino said...

i think you nailed that 'cost' thing bubba. or maybe part of it anyway.

people like to dog the insurance providers, but only they have the resources to apply downward pressure on costs.

$150 to see a doc for 10 minutes: i get that. he has a staff to pay, insurance premiums, etc... and that only comes to $450 an hour.

Brian said...

Stuff that drives high health care costs (in no particular order):

-overutilization of ER as primary care (largely a function of a lack of other viable options)

-(incredibly) high overhead of administrative costs (intrinsic to any third-party pays system)

-doctors/hospitals incentivized to bill for procedures rather than time or outcomes. More and more expensive procedures = more billing.

-increasing costs of producing the latest and greatest devices and pharmaceuticals (R&D ain't cheap...and you've got to pay for all the failures on the way to success)

-an expectation that the moment the latest and greatest comes on the market, it is the only acceptable standard of care

-an incredibly large amount of healthcare spending at the end of life

-artificial barriers to entry into health care professions

I don't pretend to have a comprehensive solution to all of this (it is a VERY complex set of problems) but it seems that there needs to be some combination of bringing fees for service in line with actual costs (and lessening the displacement of costs from the person receiving the service), dispensing with regulatory burdens that increase costs, diversification of provider types (i.e., a multi-tiered system with yes, different standards of care), and a certain minimal social safety net that is rigorously means-tested.

The problem with any type of reform of something this complex is that the half-measures produced by the political process tend to be as messy (or more so) than the status quo.

Night Writer said...

I'm starting to see the bills on my own treatment now (I'm also with Cigna) and they're startling, even though I've worked on the edges of the industry for nearly 20 years and I'm familiar with how the system works.

I also remember when I had my last knee surgery back in the late 90s. It was almost completely paid by my health plan, but I noted that the cost came to about $3000. My orthopedist, though, told me that if I hadn't had insurance the cost would have been closer to $18k!

Once the government gets its thumb on the scale you see all kinds of strange distortions. We need a healthcare system with no third-party payer; you simply(!) purchase high deductible "major med" coverage for big items and start a portable Health Savings Account for out of pocket expenses. The insurers (and reinsurers) and providers will adjust and the market forces will keep the premiums low. You also won't get unpredictable price swings on care. The body shop, for example, doesn't charge you a different price to fix your car after a wreck based on whether you have auto insurance or not.

Vanesa Littlecrow W. said...

That kind of bullshit is a perfect example of why I remained in debt for most of my nine years of marriage, until my birthday this year. Medical bills are crafted by Mephistopheles.