IT TOOK MONEY to resolve my recent health issue—on the surface, a lot of money. But figuring out what it really cost is difficult. Actually, I found it impossible. Still, being a health benefits nerd, I couldn’t resist looking at the claims processed by Medicare and my Medigap insurance. Trying to understand billed charges, allowable charges and the resulting payments is daunting. I’m guessing most patients wouldn’t even try. Why should they?
My surgery was in the outpatient department but required an overnight stay. I walked into the hospital at 11:30 a.m. on day one and was out at 11 a.m. on the second day. The hospital billed Medicare $43,294, which covered scores of services, each billed separately. Medicare approved the entire amount. Pharmacy costs totaled $936.71, which is a lot of drugs. The only non-intravenous drugs I had were Tylenol and one Oxycodone. I can attest to how good the latter makes you feel.
My favorite individual service charge was $109 for “insertion of needle into vein for collection of blood sample”—twice. Each collection resulted in seven separate billings for different blood tests, at a total cost of $1,567.10. Interestingly, the same tests were done two days in a row.
Could my blood cell count change in 12 hours? Not being a doctor, who knows?
Pathology was $900. The operating room charge was a whopping $20,000. I’m thinking the robot used in the surgery got a piece of that $20,000. Anesthesia was another $5,000. I’m certainly thankful for anesthesia, but the $5,000 wasn’t for the administration of the anesthesia. Instead, the anesthesiologist’s charge was a separate bill.
Six assorted injections added another $358.81 to the total. Is all this itemization necessary? Or does it create an incentive to provide more services? Why is it important to know, for example, that an injection of an antibiotic cost $5.08? The Medicare explanation of benefits says it was a drug “requiring detailed coding.” Administrative requirements, it seems, are not limited to private insurance.
Now for the really interesting stuff: the doctor’s charges. Back in January, I had several rather unpleasant tests and procedures in the doctor’s office. The first test was billed at $1,737. Medicare’s allowed benefit—in other words, what it paid—was $447.04. Another procedure was $1,275 and Medicare allowed $240.82. The insertion of a catheter was described as “complicated” and billed at $400. Medicare paid $88.76. I’m not sure “complicated” is the right word to describe that procedure. All the services were billed as rendered on a single date, which they weren’t.
READ THE REST OF MY STORY at the link below:
Source: My $233 Surgery – HumbleDollar
I have been trying to figure out the true cost of my medical care for years. I have a spreadsheet that tracks what was billed and what the provider accepts. Sometimes it is as low as 10%. If the providers are willing to accept 10% of what they bill then why don’t they bill the uninsured at the reduced rate?
I had this discussion with one of my specialists. I was in his office for 30 minutes, interacted with a receptionist, a nurse, the doctor, another clerk for billing and to set up my next appointment. Then there are all the people I didn’t see. The accountant, lawyer, office administrator, cleaning staff, billing staff who file the claims, IT staff who keep their computers running, all the costs for building overhead, benefits for employees, taxes, etc. The wages of the people I did see for that 30 minutes had had to be the total amount that they accepted. I asked my doctor how they stayed in business. The have some smart MBA who figures all that out.
Now what would happen if my doctor demanded a little more from my insurance company and stopped cost shifting his cost to others and people with no insurance?
Another problem is you usually are not treated twice for the same major medical problem in the same way. It is not like if you over pay the next you’ll be wiser and not buy that service again. You don’t even for months after the fact that you over paid and hopefully you’ll never need that treatment again.