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Medical billing - a newspaper column


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  • Medical billing - a newspaper column

    Here's a link to a column in today's paper about medical billing. I think she's right on the mark about how incomprehensible it can be (and how meaningless some of the numbers can be). I don't know if it's often more confusing than she describes, but I do know that it would be even more overwhelming if, for example, she'd had to stay in the hospital for a week, as many myectomy patients do.


    Myectomy on Feb. 5, 2007.

  • #2
    Re: Medical billing - a newspaper column

    I was in the hospital 12 days following my sudden cardiac arrest and I never understood the billing. I looked at the bottom line and just thanked God that my friends had talked me into keeping my insurance when I turned 55 and it doubled (I'm self employed) I never understood any of it. My medical records can now be accessed securely online and I have a better idea of what happened the first five days I was in the hospital.
    Sister diagnosed with HCM 1987, died April 2012 of "unknown causes" as her family did not want autopsy
    My testing: 1987 and 1988 misdiagnosed with mitral valve prolapse
    Asthma diagnosis 1991
    Nephew diagnosed with HCM 1999
    Previous misdiagnosis "confirmed" 1999
    Cardiac arrest: 10/4/2010
    Induced hypothermic coma 10/4/2010
    ICD implanted 10/13/2010


    • #3
      Re: Medical billing - a newspaper column

      Since my dx in Oct 2010 to date with all testing, mri's, icd implant, heart caths and so on and so on My out of pocket expence is now over 50k. Due to my HCM I have lost my job and I am having no luck with finding another because I am told I am a liability risk. As almost all of you here know I have stacks of bills to try to figure out just what they mean. Just as in the article that Gordon posted What I am finding is it is impossible to understand these bills and to get an actual explanation of what they are. There is also 2 billing prices......insured and uninsured. Since I have insurance I am charged the inflated price and my out of pocket expence still ends up around the same price as the uninsured price.
      Can this really be explained?
      Diagnosed HCM @ 44 Nov.2010
      Daughter diagnosed HOCM Dec. 2010
      ICD Implanted 1-24-11
      Knowledge Saves Lives


      • #4
        Re: Medical billing - a newspaper column

        Why are you telling potential employers that you have HCM? It's none of their business. And those that have told you that they can't hire you because of you HCM are opening themselves up to EOE law suits.

        The insured price is always lower than the uninsured. It's like wholesale for insurance providers, and retail for those without insurance. Because the insurance providers are buying in bulk. So even if you have a crappy policy with a huge provider like say Aetna or Cigna, you'll still save money rather than not having insurance at all. Put it this way, at Stanford, an Echocardiogram for an individual without insurance is around $1000, my insurance got a bill for $550, my share was the office co-pay for a specialist $45.

        BTW... I'm unemployed and paying for my own policy, and since Cobra ran out and I had to go out and get a HIPPA policy, I'm even more exposed. Obamacare does squat for me. I've decided to just stay unemployed until Obama is out of the Whitehouse, no sense in paying taxes and having him spend it on stupid stuff.


        • #5
          Re: Medical billing - a newspaper column

          I'm certainly a neophyte when it comes to insurance and "what's behind" the billing and settling process. Many hospitals and center's of excellence are set up as not-for-profit organizations / foundations. Using the example given in this thread, the facility bills $1000, settles for the $550 + individual copay of $45 -- then they must turn around and "write off" the balance as a loss. That's my only explanation. Sometimes BCBS "settles" with the provider at 10-20% of the bill! The unfortunate folks that are really in a pickle are the ones without insurance at all -- I think we have the best healthcare system in the world -- someone needs to put some sanity into the billing / settling process! Health care reform should focus on establishing the value of services and what should reasonability be charged to the patient / insurance carrier - regardless of whether or not the individual has insurance. I don't buy the wholesale / retail argument at all...

          My 2 cents!

          A/V Heart Block 2009
          Permanent Pacer 2009
          Dx non-obs HCM CCF 2011
          CRT-D 2011
          Listed for H/T UAB 2011
          Dx Cardiac Sarcoidosis 2012
          Heart Transplant UAB 2012


          • #6
            Re: Medical billing - a newspaper column

            I have had hospital administrators tell me that they have to maintain the "retail" (aka uninsured) verse the "wholesale" (aka the insurance carrier negotiated rate) price structure because of Medicare/Medicaid regulations dealing with reimbursement rates. Because actually there is a third and fourth tier of pricing--a Medicare price that is probably a little less than the BCBS/Aetna rate and a Medicaid price that is well below that. I am told those rates depend on a complicated formula and one element of that forumula includes the "retail" price. Way too complicated for me. Could you imagine going to a grocery store that had a four tiered price structure where the price depends on who you are. Could we also maybe imagine how many fewer people who are uninsured would not have to go into bankruptcy if they could get even the BCBS/Aetna price?

            Diagnosed with unobstructed HCM in 2004 after a bad experience playing tennis
            Graduated to obstructed HCM by Dec, 2008.

            Life outside of HCM: Law, Photography, Tennis, Music, raising kids and camping