Hospitals Charging the uninsured MORE than the insured

[Left Turn]

Not a new story, but I'm surprised this issue never got discussed. Apparently a lot of hospitals, including a lot of Catholic hospitals charge uninsured people--those least able to afford it, double or triple what they accept from insurance companies for the exact same services. That doesn't seem fair, and I wonder why we don't hear more about this issue.

http://www.allheadlinenews.com/articles/7001036160 (Click for the full story)

Despite Huge Profits, Catholic Hospitals Gouge Uninsured
November 15, 2005 2:00 p.m. EST
Ayinde O. Chase - All Headline News Staff Writer

Washington, D.C. (AHN) - A Latino advocacy group released an eye-opening report Tuesday showing that the top 7 Catholic hospital systems raked in over $2 billion in profits in 2004, while continuing to price gouge uninsured Hispanics, 9 of 10 of whom are Catholic.

Consejo de Latinos Unidos, a national non-profit consumer advocacy organization which educates and assists Latinos and others, says the abuses happened while the group sat on over $20 billion in cash and investments.

"The $2 billion in profits are after all the charity care, all the losses on Medicaid, all the capital improvements. This is money sitting in the bank, made in part off the backs of uninsured Hispanics," says K.B. Forbes, Executive Director of the Consejo.

He adds, "The capital thievery of overcharging middle-class uninsured families, many whom happen to be Hispanic, three or four times more than what a hospital would accept as payment in full from an insurance company is a direct slap in the face of faithful church-goers." One in three Latinos is uninsured.

[kurth]

1. This has been going on for years!!!

And the bean counters always have an answer: It's federal regulations!!!

[Angry Girl]

8. the war on the poor and uneducated

The Amerikan government believes in the Phillip Morris way of cutting costs:

Philip Morris Cos. officials in the Czech Republic have been distributing an economic analysis concluding that cigarette consumption isn't a drag on the country's budget, in part because smokers' early deaths help offset medical expenses.

The report, commissioned by the cigarette maker and produced by consulting firm Arthur D. Little International, totes up smoking's "positive effects" on national finances, including revenue from excise and other taxes on cigarettes and "health-care cost savings due to early mortality."

http://www.mindfully.org/Industry/Philip-Morris-Czech.htm

[benburch]

2. That's because, in theory, insurance companies get a discount...

You do not get a discount, because there has to be an inflated price base that the fictional insurance discount is based upon.

[libodem]

3. Real nice

[Tonya]

4. Not so fast..

Actually, this is not true. I head a charity program for Providence Hospitals and this doesn't even come close to the truth.

First off, uninsured patients are automatically given a 30% discount and are also sent a charity application.

I write off millions a month to charity. Primarily to "undocumented workers I might add.

They are barking up the wrong tree..

[Warpy]

7. No hospital in NM gives the uninsured a writeoff

In fact, the last time I had to go to an ER and got the bill, I caught them upcoding, unbundling labs, and charging for phantom services. I complained. They sent it to collection. I put in a formal complaint to the state Attorney General. They crumpled faster than a cheap suit. I'm a nurse, and I know what to do in these cases. The average uninsured person is not only paying 300%-500% more than what an insurance company is charged, he's also blindly accepting any billing fraud that goes along with it. These people are gouging the uninsured, and there's no way to weasel around it.

Hospitals have also become the most aggressive bill collectors in the country, putting liens on property, garnishing wages, and even jailing patients in some cases as their way of "reposession" of their work.

I'm glad Providence Hospitals is such an enlightened outfit. However, please don't think what you're experiencing in New England is the norm for the rest of the country, especially in areas where the bulk of the hospitals are now rabidly for-profit. I'm afraid the hospital industry as a whole is going to have to change a lot of policies and procedures if it ever wants to get the trust it earned from the 40s through the 70s back, because too many people out here in workaday land have been badly burned by these bastards.

[FM Arouet666]

10. Yes and no.

I would agree that the current system is a mess, but why the uninsured are charged the way they are has to do with billing, insurance companies etc.

As an example, my traditional fee for an appendectomy might be 100xY, Y being the base fee for medicare. For insurance companies I negotiate a rate for the procedure, much less that 100x, but I charge the traditional rate to insurance companies I do not contract with, say in the case of an emergency. I never actually get paid that rate, just a haggling point.

For the uninsured, and yes I see a huge number of uninsured every year. I will bill the patient a fraction of what I would bill the insurance company, big cash discounts, and you can pay what you can. I have one patient that has sent me 10$ a month for the last few years for an emergency surgery that saved her life.

Do hospitals negotiate with patients. Some do, I have a few patients that needed very complicated surgery and the hospital gave them a greatly reduced rate. Sadly, some don't, some go for the max, the "traditional rate" a rate which is artificially high used as a bargaining chip to negotiate a contract with insurance companies. To charge a patient this rate should be a crime. But again, I agree the system is a mess.

[Warpy]

12. Notice I didn't lump the docs in with the hospitals

I've been without health insurance for 18 years, and docs have been the greatest, offering breaks on straight fees and downcoding if they're part of HMO nets. They're really not the problem here, and have been part of my solution to obtaining care for a serious chronic illness, an illness that has disqualified me from obtaining coverage and from obtaining any job that offers it.

For profit hospitals are the worst offenders, with nonprofit hospitals that own for profit health plans a very close second. Nonprofit hospitals will negotiate bills when they realize they're not going to get blood out of a stone and want to make a patient think he's getting a bargain so he'll be more motivated to start paying the bill off, but usually the bargain doesn't come down to what an insurance company is charged. For profit hospitals are rigid when it comes to negotiations, and will generally shift an indigent patient to a nonprofit or county hospital as soon as s/he is capable of surviving the ambulance ride.

More and more, the cost shifting that is occurring is away from the insurance plans and onto the backs of the elderly and uninsured. That is why hospitals have become so incredibly aggressive in their bill collecting procedures. Medicare was originally designed to come in slightly under the standard fee for care, but those fees have been jacked up so far above the Medicare and insurance company reimbursement levels that yes, they do constitute gouging.

[FM Arouet666]

9. Your going to get slammed

The health forum is for alt medicine and collective hatred of modern medicine. Oh, and welcome to DU.

[Denver Dave]

5. How do we find out health care prices?

Some hospitals do charge more and from the sounds of one post here, some may not. Where do we go to comparison shop for health care costs? Its much easier to find good information about what kind of toaster to buy than how to get the best deal on health care.

As a start to address these issues, I have helped start two websites:

www.ColoradoHealth.info - if we ever figure out some good information about good health care strategies - we can sare the information here.

www.HCTalk.com - discussion about access to health care issues. How to determine the best place to purchase health care services would make a good discussion topic.

[Sgent]

6. All you can do is call

and even then you will need to know the procedure codes and the like.

If you want to negotiate on an elective admission (birthing, ortho surgery, etc), offer them a prepaid payment the same as they get from Medicare based on DRG (Diagnostic Related Group). A DRG charge is based on your admitting diagnosis -- not individual services recieved, and you should be able to comparison shop once you get the DRG for your related issue.

After the fact, I would still offer a percentage of DRG. Just because they "list" a certain amount, doesn't mean they won't discount significantly especially if they are assured of quick payment. For Doctors I would offer the Medicare reimbursement amount.

[FM Arouet666]

11. Catholic hospitals?

What? Are you shocked that a religious hospital would gouge a patient? I work at a Catholic hospital and it is the most political, most corrupt institution in town.

If you are uninsured and have an emergency the hospital must treat you, it is the law. However, what you get charged is up to the hospital. Some go for the fictional "traditional rate" a figure used to negotiate with insurance companies, the high ball number. The insurance company will contract for a substantially lower rate. If you can't pay, they will send you to collections, some will negotiate, some will not.

If have a condition that needs treatment, but not an emergency, seek out a doc which will work with you. I had a patient with a AAA, abdominal aortic aneurysm, a serious condition which frequently results in death if untreated. He was too young for medicare, self employed with a modest income, and no health insurance. With our current health care system, for lack of a better word, he is fucked. I negotiated with the hospital for a reduced rate, greatly discounted my rate, and fixed his aneurysm. If you have the opportunity to negotiate up front, rates can become manageable and payment plans flexible.

My partner had a patient, an artist, with a very meager income, his charge? A painting. We donated the painting to the local hospital, and it sits in the lobby. Popular interest in the artist was born out of the viewing, his gallery is now full and he has a loyal following. Not the norm, but I think many docs have a heart and will work with patients.

Yes, the system sucks, universal health care is needed. The "greatest nation on earth," if you believe the propaganda, and 40 million Americans without health insurance. Now the administration is cutting Medicaid and simultaneously wants more money for the futile war in Iraq. What a fucking joke.

[Mayberry Machiavelli]

13. FM, doctors might not, but hospitals sure do charge uninsured WAY more

than what insured patients get, at least around where I am. I understand it's been this way for some time. Among doctors, I don't know any of us who think this is right.

[Sgent]

14. A lot of that depends on your area

In this area -- the hospitals still list bill using procedure codes all insurance companies except for Medicare & Medicaid (which requrie DRG's).

They got into a fight with BC/BS a couple of years ago -- BC/BS wanted 15% off list, and the hospital refused to give them more than 12%. They actually delisted with BC/BS for 2 years.

[FM Arouet666]

15. Your right, I got off the topic with my post

I was a bit tired. My experience is that smaller hospitals will work with patients who lack insurance, but larger institutions bill the maximum. The maximum charge is used as a bargaining chip when dealing with insurance companies, the hospital starts with 'x', insurance bargains for a much smaller percentage. At least that is my impression, that is how docs deal with insurance companies. 'X' is a really big number, I would never charge a patient this artificial charge, yet hospitals frequently do.

I wonder how the recent bankruptcy law affects patients facing ridiculous hospital charges? The system is broken and I can honestly admit, had I known this before hand I would have done something other than medicine.

[Left Turn]

16. Troubling

One of the things I find troubling about this article I posted, is the idea that we have just come to accept Catholic Hospital's as a corporate institution like every other aspect of health care. If they are raking in big profits, don't they have an obligation to their mission of providing health assistance for the less fortunate, rather than sticking it to uninsured people?