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SKY
2005-Mar-09, 10:59 PM
For those that don't know or don't remember, I was admitted to the hospital the day before Christmas Eve (here is the link to the topic (http://www.badastronomy.com/phpBB/viewtopic.php?t=18590&postdays=0&postorder=asc&sta rt=0)). I was in the hospital no more than 36 hours with not much more done than some blood tests and a lot of saline solution administered via IV. I did have a CAT scan done of my abdomin, and I had a total of two bags of antibiotics in my IV. That was about it. I found out my bill...$13,877.00!!! http://img117.exs.cx/img117/5601/n1qshok.gif

I was told in the ER that because I didn't have insurance they would have to send me to the county hospital a couples hours away. I was against it. It was the day before Christmas Eve, I didn't want to be admitted much less hours away. The nurse told me that if the county hospital was full, they would have to admit me there but at the county rate. Both my mother and my wife were sitting at my bedside when a nurse and administrator both came and told us this. I (as well as my mother) wanted to release myself, but they were dead set against it and told my mother "we strongly urge you not to do that", we were then reassured that if the county was full, they would admit me there (closer to home) at the county rate. Then they came back a while later and said "Good news, the county hospital is full". This was the deciding factor, it was closer to home, it would be at the county rate, and I can find out if something is seriously wrong (at the time it sure felt like it). So we allowed them to admit me.

So can you guess what happened when I asked them "What happened to the county rate"? They answered "What county rate?".

Them: "We don't have a contract with the county so we don't do that."

Me: "But, your ER nurse and an Administrator both told me it would be at the county rate!"

Them: "They are misinformed."

:evil:

So, I got an itemized statement from them and had my personal doctor and his billing person take a look at it, and apparently they were in awe over the charges. Yesterday he told me "Just to give you an example, they charged you $400.00 for saline solution (which is just water with salt)...It costs him $5.00.

He also mentioned that this isn't the first case of Tenet Health Services overcharging people (and insurance companies). I did a search on the internet for "Lawsuits - Tenet Health" and found they are consistently being sued for anything from "Kickbacks" to "Overcharging". They are even being (or have been) investigated by the government for overcharging Medi-cal.

I called the customer service number today and spoke with a rep there concerning my bill. The person immediately had an attitude about why I was calling. I told him the charges were ridiculous and I was not going to pay almost $14,000 for what I was seen for, I even told him my wife gave birth for less than $11,000. He of course explained that it is what they charge. I explained the Saline Solution being $400.00 on the bill and you could buy it for $5.00. He stated that hospital charges are different that over counter charges (:evil: ). So I then explained, bottom line, I had my personal doctor and his medical biller look at the itemized bill and they were outraged at the prices you are charging me! He then said "What do you think would be a fair price"?!?! This coming from someone who was just adamantly defending the charges. I admitted that I am not a medical biller and I will fight this until the bill amount is reduced and even then I would have my personal doctor look at it to make sure it was fair. He then asked me to hold on.

When he came back to the phone, he stated that he spoke with a supervisor and they would offer me 65% off the bill to make the bill $4,856.95!!! Obviously, this is a lot better than the previous bill, but it seemed fishy to me being that he was able to drop the price almost effortlessly at just the mention that had someone with medical knowledge look at the bill. I told him that I would take the new figure to my personal doctor and see if he thinks it's fair, and I would call and let them know the answer. He didn't like this answer and said "I am offering a savings of over $9,000, what is not to like about it. I again reiterated the fact that I am not a medical biller and I don't know if it was fair, and also that I was told that this wasn't the first time that Tenet was accused of overcharging and I apologized, but I didn't trust him. He obviously didn't like that because he said "Fine, thank you" and he hung up. Which is weird, because I didn't think it was company policy to hang up on customers when trying to resolve an issue.http://img116.exs.cx/img116/934/z0tdntknw.gif The price may be fair, but I want to make sure it is before I commit to make the payments for them.

So anyway, I guess I'm trying to say that if you happen to be admitted to the hospital, beware of the billing, because it seems that Tenet has and is currently in the practice of overcharging people for the services provided. I personally plan to fight this until it is at a fair price and even then they will have to set up a payment plan.

I have a feeling I have a long fight ahead of me.

Swift
2005-Mar-09, 11:08 PM
I believe you are right (you have a long fight ahead of you). The whole situation of health care costs are completely out of control in the US and I feel sorry for even people with insurance. My out of pocket expenses jump every year at a rate well above inflation and that increase usually exceeds any pay raise I get (so effectively my pay drops each year). And I'm lucky, because at least I have insurance.

IMHO, anyone who has THE single magic solution, such as limit lawsuits, is kidding themselves. This is a very complex, but very serious problem, and virtually no politician wants to deal with it. I suspect there will be mass protests and riots about this (equivalent to the equal rights movement of the 60s) before something is done about this.

Good luck Sky.

Laser Jock
2005-Mar-09, 11:17 PM
I'm glad your feeling better SKY.

Yes, you do still have a long fight ahead of you, but it sounds like you are handling it very wisely. Having your own doctor look at the bill was an excellent idea. It gives you leverage so you may not even have to take it to court. $4800 may be a reasonable price, but I don't know either. Keep on the pressure; you're doing great so far!

[Edit to add]

See if you can find out what the county rate was. You have two witnesses that you could use in court to verify that they offered you that rate.

Nicolas
2005-Mar-09, 11:21 PM
11000$ for childbirth??? :o :o :o

Anyone got info what a normal childbirth costs overhere?

I don't see how my parents would have paid 55000$ for the 5 of us. 8-[

TriangleMan
2005-Mar-09, 11:24 PM
IMHO, anyone who has THE single magic solution, such as limit lawsuits, is kidding themselves.
Well a Universal Health Care system (UHC) would have solved Sky's particular problem but such systems have their downsides as well (in Canada, Sky may have waited a loooong time for that scan). I feel that UHC is not tenable in the US as the costs of implementing such a system are incredible - it is a huge component of government spending in Canada. The US would have to bump up taxes and severly cut spending in all other areas (such as military) to fund UHC.

I agree with Swift in that while lawsuit caps will do a decent job of reducing medical malpractice insurance rates for doctors and hospitals it will have only a minimal impact on health insurance rates. I'd expect health insurance to decrease slightly since doctors and hospitals will be paying significantly less for insurance, but it is more likely that a hospital will use the extra savings to fund further development (and doctors will hang on to the extra profit).

Has FP posted here recently? He's a physician so he could likely give a more detailed assessment of this issue.

Back to the main topic. Sky, if the health service was so ready to drop the bill charges by 65% with only a bit of fuss from you then something is really fishy here. Any chance you could ask the county hospital how much your procedure would have cost? If you have witnesses to the people claiming that you would get 'county rates' then you may have grounds for a court challenge to get the bill reduced to the 'county rate' (but if you're thinking of going that route absolutely consult with a lawyer first).

teddyv
2005-Mar-09, 11:26 PM
Stories like this initially make me glad I live in Canada. That said, nobody in the our universal health care system seems to actually know what any particular service costs, so costs could easily be inflated to ridiculous proportions. The only difference is the taxpayers on the whole take it in the rear, instead of the the individual.

Laser Jock
2005-Mar-09, 11:28 PM
11000$ for childbirth??? :o :o :o

Anyone got info what a normal childbirth costs overhere?

I don't see how my parents would have paid 55000$ for the 5 of us. 8-[

Before we got insurance that would cover childbirth, that was roughly the number that my wife and I were looking at should she get pregnant. Outrageously high? Yes. Close to average? I think so.

Nicolas
2005-Mar-09, 11:40 PM
What a quick Google search brought up, is that we have some obligatory health insurance, and that the costs of childbirth are fully paid back. In reality, I assume things still will cost something, but far, far from 11000$ I assume.

It's rather late now, tomorrow when somebody from this side of the Atlantic wakes up I might get some info from personal experiences.

SKY
2005-Mar-09, 11:41 PM
Back to the main topic. Sky, if the health service was so ready to drop the bill charges by 65% with only a bit of fuss from you then something is really fishy here. Any chance you could ask the county hospital how much your procedure would have cost? If you have witnesses to the people claiming that you would get 'county rates' then you may have grounds for a court challenge to get the bill reduced to the 'county rate' (but if you're thinking of going that route absolutely consult with a lawyer first).

My mother asked a lawyer friend of hers (I don't think he specialized in medical practice though) what I should do to fight this. He said to let it go to court, then ask the judge for an Arbitraitor. The Arbitraitor will be appointed by the court and will go over the bill with a fine tooth comb, picking out anything that would be overcharged and reducing it to actual cost. He would also be the one to research the county charge and apply that if the court saw fit to pursue that. That's the way it was explained to me anyway. I personally would like to avoid court, but if I have no other choice I will.

W.F. Tomba
2005-Mar-10, 12:20 AM
Well a Universal Health Care system (UHC) would have solved Sky's particular problem but such systems have their downsides as well (in Canada, Sky may have waited a loooong time for that scan). I feel that UHC is not tenable in the US as the costs of implementing such a system are incredible - it is a huge component of government spending in Canada. The US would have to bump up taxes and severly cut spending in all other areas (such as military) to fund UHC.
I thought I heard somewhere that the U.S. government already spends more money per capita on healthcare than any other nation in the world.

paulie jay
2005-Mar-10, 12:27 AM
Wow - I was aware that there were rorts going on but to this extent I did not know!

In Australia we have a public health system (called "Medicare", every person contibutes 1.5% of their taxable income) that runs in parallel with a private health system. I'm not saying that it's a perfect setup but at the same time I'm not seeing people refused treatment because of lack of insurance. Depending on which government wields power, the empahsis will either be on people using either public or private - but the choice is always there.

teddyv
2005-Mar-10, 12:32 AM
Wow - I was aware that there were rorts going on but to this extent I did not know!

In Australia we have a public health system (called "Medicare", every person contibutes 1.5% of their taxable income) that runs in parallel with a private health system. I'm not saying that it's a perfect setup but at the same time I'm not seeing people refused treatment because of lack of insurance. Depending on which government wields power, the empahsis will either be on people using either public or private - but the choice is always there.

Now, if only we can get the Canadian system to do the same. There are actually radio ads playing locally to go to the US for treatment of certain problems so you don't wait as long.

tmosher
2005-Mar-10, 12:37 AM
Based on personal experience, who gets charged what in the US medical system varies considerably.

Before my dad passed away a couple of years ago, he was in two different nursing homes. The first one in east Texas and the second one in Tulsa, Oklahoma.

I would get the billing notices that the Texas nursing home would send to Medicare and Blue Cross/Blue Shield. I was shocked when they tried three different times (with different billing codes) to charge either Medicare or Blue Cross $8,000 for 28 days of nursing home care. Mind you, this was for a semi-private room with no special medical needs. That's close to $300 per day.

After I moved him to a nursing home in Tulsa to be closer to me, I was pay ing roughly $80 per day out of my own pocket for the same level of care.

I asked a couple of people about this "practice" of grossly overcharging the insurance companies and Medicare. I was told it was SOP - they overcharged knowing that they would be able to get at least better than cost for their services after the insurance company or Medicare negotiated a rate.

It's also common practice, as I've been told, that uninsured patients are usually overcharged to compensate for the negotiated rates that the insurance companies pay.

paulie jay
2005-Mar-10, 12:39 AM
Now, if only we can get the Canadian system to do the same. There are actually radio ads playing locally to go to the US for treatment of certain problems so you don't wait as long.


Well, we certainly do have waiting lists for elective surgery in the public health system, but if you just can't wait you can then use private. Generally the people who want elective sugery are already in health care funds so it all seems to work out in the wash.


edited to add quote

frogesque
2005-Mar-10, 12:50 AM
Hmmm. There are problems with our National Health Service and I don't want to start a debate on it but critical treament is there, free at point of issue and given without favour.

A lot of years ago one of my children was born 3 month's premature, wife had 2 weeks treatment trying to delay the birth then little'n had 10 weeks in an intensive baby care unit, bill: £0.00. I cannot understand health care in the US. It's so simple, pay a tax (National Insurance in the UK) when you are well and working, free health care when you are ill and least able to afford it.

Glad to hear you are feeling better SKY and I hope that evil bill didn't give you a coronary :lol:

SKY
2005-Mar-10, 03:33 AM
Glad to hear you are feeling better SKY and I hope that evil bill didn't give you a coronary :lol:

I tried hard to keep my eyeballs in my head...I can't afford another $14,000.00 bill. :D

At first I thought that they were charging so much because they were trying to get me Medi-Cal, and they were trying to squeeze as much out of Medi-Cal as they could, but my doctor said the only problem with that is that Medi-Cal would narrow my $13,000 bill down to about $1,500.00, and that's all they would pay. :o

Gillianren
2005-Mar-10, 03:54 AM
was just watching the news a few minutes ago, and our governor just signed a bill into law requiring mental health parity. (the insurance companies have to cover mental illness just like any other disease.)

when I still had a job, you got "benefits" after a year. they were supposed to be supplemental insurance, but no one working there could afford insurance to supplement. they paid up to $300 a year, and up to$75 a visit. they also didn't cover mental health--though they will now. (they also told me that I had to be in regular treatment before my mental health got coverage under the Americans w/Disabilities Act, and never mind that I couldn't afford it.)

I'm manic depressive, and I haven't been in therapy since I graduated from college (where campus health provided it for free). there's something wrong w/this system.

and if it's any consolation, you're not the only one who has to bring lawyers into a health situation--I'm in the process of hiring a lawyer to push through my disability claim.

tmosher
2005-Mar-10, 04:26 AM
Even when covered under the company's insurance plan, mental health coverage tends to be a joke (at least with two of my ex-employers' plans it was). Generally, they refer to it as an employee assistance plan (EAP) that involves a set number of visits to a therapist (I believe it was only six). If you want to go to the next level, you have to go to one of their recommended psychiatrists - well, that didn't work out too well either because it was entirely drug based - when I asked about therapy they said "What? We don't do therapy" - take your prescription and leave. I ended up paying for my own visits to a psychiatrist that I trusted - no mood altering drugs were involved.

I just read in today's Dallas Boring News that Tenet's loss for the whole year has exceeded $2.64 billion.

Sky and Gillian I wish you both good luck and take care.

Jpax2003
2005-Mar-10, 06:51 AM
was just watching the news a few minutes ago, and our governor just signed a bill into law requiring mental health parity. (the insurance companies have to cover mental illness just like any other disease.)

when I still had a job, you got "benefits" after a year. they were supposed to be supplemental insurance, but no one working there could afford insurance to supplement. they paid up to $300 a year, and up to$75 a visit. they also didn't cover mental health--though they will now. (they also told me that I had to be in regular treatment before my mental health got coverage under the Americans w/Disabilities Act, and never mind that I couldn't afford it.)

I'm manic depressive, and I haven't been in therapy since I graduated from college (where campus health provided it for free). there's something wrong w/this system.

and if it's any consolation, you're not the only one who has to bring lawyers into a health situation--I'm in the process of hiring a lawyer to push through my disability claim.Does your area have any free or low-price clinics? When I was unemployed I got assistance from a local clinic where I paid $0. It was partially funded by grants and donations and a sliding scale for patients. I think it was paid for in part by medicaid. (In case people are confused Medicaid is for low-income individuals while Medicare is for seniors specifically.) It may be possible to receive help from your local state, county, township, and city governments.

I'm not sure what your issue is with supplemental insurance. It is optional insurance meant to cover your own expenses over and above that of major medical insurance. Many, if not most, Supplemental Insurance pays a flat fee to the policy holder to be used however they want, such as for travel expenses, household utilities when out of work, or to pay a deductible, or anything. It is generally paid upon verification of a diagnosis and not based after and upon services rendered or charges accrued. However, supplemental insurance is not a replacement or substitute for major medical insurance.

kucharek
2005-Mar-10, 07:21 AM
$14,000, that's exorbitant. I hope you get it cut down at least to the level you got through the phonecall.
WRT $11,000 for birth, I just have the 10 years old "pricelist" of the hospital at hand, where my kids were born.
The basic rate per day, just because you're there, occupie a room and are nursed, was some $300 per day. An normal birth up to 8 hours were some $1,700 (I guess they made some profits with my kids as both were delivered within a few minutes. Paperworks always took up more time than time in the delivery room).
These are charges when you're in the public health insurance. If you're privately insured (which you can if you're above some income level), these rates are easily doubled.
I guess, in most developed countries, currently the health systems are the hot potato of politics.

TriangleMan
2005-Mar-10, 12:10 PM
I thought I heard somewhere that the U.S. government already spends more money per capita on healthcare than any other nation in the world.
I took a look at the Historical spending for the US Gov't (http://www.gpoaccess.gov/usbudget/fy06/sheets/hist03z2.xls) to see spending in 2004. Going by just Medicare spending, health care made up 11.75% of spending. If you include "Health Care Services", which I guess is something different, the spending percentage becomes 20.92%.

The combined spending for Canadian federal and provincial governments on health is in 2003-04 is 19.34% (sorry, lost the link). The two results are not entirely comparable since the US numbers do not include state, and what US & Canada consider "Health Care Services" may differ but I'm still somewhat surprised, I expected the US spending % to be lower.

I was also surprised at the level of education spending, but that's another thread.

captain swoop
2005-Mar-10, 12:25 PM
Well, good old British NHS I say, there may be some creaky bits but it's free at the point of service and you still have the option of going private if you want.

My dad fell on some Ice last year and was in the Captain Cook Memorial and had a new hip in about 18 hours.
My friend Peter had a heart attack before Xmas, he was hooked up to the machines in Caprain Cook and they had Stents in him in no time.

Swift
2005-Mar-10, 02:30 PM
It's also common practice, as I've been told, that uninsured patients are usually overcharged to compensate for the negotiated rates that the insurance companies pay.
There was a lawsuit going on in the Cleveland area, where an uninsured man was suing a hospital and an insurance company. He was charged something like 5x or 10x the price for some procedure, that insured patients were charged, because the hospital and the insurance company had some sort of deal. He was suing on the grounds that this was against anti-trust laws. It's an interesting idea; last I heard the case was still in the courts.

Captain Kidd
2005-Mar-10, 02:49 PM
It's also common practice, as I've been told, that uninsured patients are usually overcharged to compensate for the negotiated rates that the insurance companies pay.
There was a lawsuit going on in the Cleveland area, where an uninsured man was suing a hospital and an insurance company. He was charged something like 5x or 10x the price for some procedure, that insured patients were charged, because the hospital and the insurance company had some sort of deal. He was suing on the grounds that this was against anti-trust laws. It's an interesting idea; last I heard the case was still in the courts.
It's my understanding that's SOP. The doctor/hospital/practice has a given rate for procedure X. Each insurance company then negotiates with the doctor/hospital/practice for a set discount on procedure X.

Itís similar to volume discounts retailers get from manufacturers. The more people the insurance company represents (i.e. leverage), the greater the discount. If youíre going to buy one widget youíre probably not going to get a discount. If youíre buying a few thousand widgets, youíre going to get a better deal. One person isnít going to get the same deal that a company representing thousands will.

W.F. Tomba
2005-Mar-10, 04:56 PM
I thought I heard somewhere that the U.S. government already spends more money per capita on healthcare than any other nation in the world.
I took a look at the Historical spending for the US Gov't (http://www.gpoaccess.gov/usbudget/fy06/sheets/hist03z2.xls) to see spending in 2004. Going by just Medicare spending, health care made up 11.75% of spending. If you include "Health Care Services", which I guess is something different, the spending percentage becomes 20.92%.

The combined spending for Canadian federal and provincial governments on health is in 2003-04 is 19.34% (sorry, lost the link). The two results are not entirely comparable since the US numbers do not include state, and what US & Canada consider "Health Care Services" may differ but I'm still somewhat surprised, I expected the US spending % to be lower.
Going by the numbers in that table, I calculated that the U.S. government's expenditures for health care services + Medicare amounted to over $1,600 for every person in the United States last year.

TriangleMan
2005-Mar-10, 06:25 PM
Going by the numbers in that table, I calculated that the U.S. government's expenditures for health care services + Medicare amounted to over $1,600 for every person in the United States last year.
I found the Canadian stats (http://www40.statcan.ca/cgi-bin/getcans/cstshowfin1.cgi?squote=&searchstr=&searchstrdisabl ed=&lan=eng&dtype=fina&filename=govt01b.htm) that I used. Assuming a population of 32 million the per capita expenditure is Cdn$2,800 , which is higher than the US but the stats include the provinces as well as the federal gov't.

W.F. Tomba
2005-Mar-10, 06:49 PM
I found the Canadian stats (http://www40.statcan.ca/cgi-bin/getcans/cstshowfin1.cgi?squote=&searchstr=&searchstrdisabl ed=&lan=eng&dtype=fina&filename=govt01b.htm) that I used. Assuming a population of 32 million the per capita expenditure is Cdn$2,800 , which is higher than the US but the stats include the provinces as well as the federal gov't.
:-k Hmm. We'll also have to take into account the difference in value between US and Canadian dollars. I am not sure how to determine this. (Currency exchange rates are not a reliable way to do it.)

TriangleMan
2005-Mar-10, 07:34 PM
I found the Canadian stats (http://www40.statcan.ca/cgi-bin/getcans/cstshowfin1.cgi?squote=&searchstr=&searchstrdisabl ed=&lan=eng&dtype=fina&filename=govt01b.htm) that I used. Assuming a population of 32 million the per capita expenditure is Cdn$2,800 , which is higher than the US but the stats include the provinces as well as the federal gov't.
:-k Hmm. We'll also have to take into account the difference in value between US and Canadian dollars. I am not sure how to determine this. (Currency exchange rates are not a reliable way to do it.)
2004 saw huge fluctutation in Cdn$ currency prices vs US$ but during the year it ranged from 1.17 to 1.40 so at the extremes of range:

US 1,600 x 1.17 = 1,872 Cdn
US 1,600 x 1.40 = 2,240 Cdn

W.F. Tomba
2005-Mar-10, 08:29 PM
It's not just that the exchange rates fluctuate, though. I believe Canadian currency is generally undervalued relative to US currency. That is to say, the price of any given goods or services in Canada, if converted to US dollars via the exchange rate, would yield an amount lower than what those same goods or services would cost in the United States. How much lower, I have no idea.

Gillianren
2005-Mar-10, 10:12 PM
except, to my understanding, books, which are outrageously overpriced.

my problem w/supplemental insurance was that it was the only "benefit" my former employer provided, and they assumed that meant you could go see a doctor to get a note every time you missed work for being sick.

all our local low/no cost psych care requires a referral, and I've never worked out from whom. the larger problem I'm having seems to be that practically all the disability lawyers in Western Washington live in Seattle and expect me to travel to them--a several hours' bus ride.