Health Care and the Hospitals. A rip-off no one seems to address

[rpannier]

A few years ago my mother passed away from cancer.
She had insurance through Blue Cross -- my father recently retired after 40 years as a federal judge and Blue Cross paid all her bills -- Because they had to.

My father was telling me how they received the statements from Blue Cross (Not the bills, Blue Cross paid all those)
The statements were just to let my parents know what the bill was and what they paid.
He pointed out on the statements the hospital would list a treatment as being 3,439 dollars.
Blue Cross then would list paid 3,106 dollars.
My parents were never billed for the 333 dollars -- no one paid it.
The hospitals were either over-charging or too afraid to challenge Blue Cross.

The same thing happened last Spring.
My father was in the hospital for two weeks for an abscess on his lung.
The hospital sent all the bills to Blue Cross.
Blue Cross listed what they would pay the hospital for his care and that was the end of it.

The question/concern I have is...Who is protecting the uninsured???
Blue Cross is a billion dollar company with a fleet of attorneys and accountants that are skilled in dealing with hospitals and know how much the care really costs.
The average person is not.
If the hospital sent that same bill to Mr and Mrs Uninsured, would they be able to get away with sending them back a statement saying they were only paying 3,000 dollars and some change?
I doubt it.

Why isn't this being addressed?
I live in a country with National Health Care -- Korea.
No hospital/doctor would dare send an inflated bill to the government, because they're administrators and accountants would all go to jail.

[MarjorieG]

1. We need more primary care and county hospitals, which the bill addressed.

[quiller4]

2. You can make an offer to pay a lower amount just as the insurance

companies do. Almost nobody pays the full amount although different insurance companies negotiate different discounts. When hospitals know they are dealing with somebody without insurance, they usually offer a payment plan at the Medicare rate.

You posed this question:

If the hospital sent that same bill to Mr and Mrs Uninsured, would they be able to get away with sending them back a statement saying they were only paying 3,000 dollars and some change?
I doubt it.

The answer is YES. Hospitals expect it.

[TreasonousBastard]

3. Blue Cross negotiates payments with hospitals...

and the hospital sent statements with their "standard" rates but BC paid what its contract said it would.

We've just been through a local problem here where the only three hospitals within 50 miles decided they wanted Blue Cross to pay 60% more. Blue Cross wanted a reduction in its payments. Nobody published just what either side wanted the payments to be, but BC took the three hospitals out of its network for a while, and refused to pay anything but ER bills.

It's been dealt with, but only after several thousand people came close to heart failure over the thought of no local hospitals.

This whole thing is a structural problem that no other civilized country has. France and other countries without a British-style plan strictly control pricing and what insurance companies will charge and pay.

It is, btw, being addressed in the background, with experiments in salaried doctors, clinics with set pricing, and some other decent ideas, but politicians and activists aren't doctors or hospital administrators and don't really know how it actually works in the real world.

We are at the mercy of policy being driven by fear, ignorance, and anecdote.

[Coyote_Bandit]

4. Most states

have statutes that require health care providers to charge all patients the identical fee for the same services. Of course that doesn't happen. And the fuckers responsible for enforcing those laws don't.

[madrchsod]

5. blue cross pays the hospital close to the same as medicare does.

hospitals can take tax deductions for unpaid hospitals. one can apply for charity payment.

i spent less than 24 hours in icu because of chest pain (i had a heart attack several years before) the bill was 25,000. the nurse checked on me once every two hours and that was it. i had chest wall tear. the bill was paid by hospital charity fund.

what is hasppening now is the insurance companies are not paying every 30 days. they are delaying payments as long as they can and in my case almost 90 days. they claimed the paper work was`t right. the hospital,my doctor ,and i spent those 90 days fighting with the insurance company. my doctor and his staff hate insurance companies!

[Blue Diadem]

6. Our insurance pays much less on the billed amount.

I have two recent insurance notices of amounts paid. I have met my deductible after a short hospital stay this year so I owe nothing on these.

One is $71.49 billed, insurance allowed and paid $25.66
2nd is $557.00 billed, insurance allowed and paid $247.40.

I had a deductible of $2400 for my overnight hospital stay. The hospital did send us a letter saying if we paid in cash or by credit card by a certain date that they would accept $1600. Since my husband had been laid off from his job, we qualified and were able to apply for some assistance through the state which reduced it even more to roughly $450. I don't think all states have that available.

My insurance notice says the amounts they allow represents the usual, customary, and reasonable charges for the service.

and yes, if you have no insurance you don't have anyone to negotiate usual, customary and reasonable charges with the providers. Sometimes you can do it for yourself. When my son was without insurance and under a Dr's care, he talked to the Dr., explained his situation and the Dr. billed him what he'd actually get from insurance. $40 a visit.

[subterranean]

7. It's common for hospitals to charge the uninsured 2 to 5 times more.

I've even heard of cases of uninsured patients being charged almost TEN times more than what the hospital would have accepted from an insurance company. Some states have instituted laws against this practice, and many hospitals will offer a discount for prompt pay or work out a payment plan with you. But when the bill is $60,000 or $70,000 or more, in most cases it is just not going to get paid.

60 Minutes did a program about this a few years ago. You can watch it here:
http://www.cbsnews.com/stories/2006/03/02/60minutes/main1362808.shtml

[rpannier]

8. Thanks for sharing the link

I will watch it when I get the chance