A good example of why people are screaming for HC reform.

Superfreak said:
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I know it does. My sister went through it and it was a massive ordeal. But that didn't stop us from getting the estimate on costs ahead of time. She did not have anywhere near the money nor the insurance coverage to cover the total costs. But in knowing up front the estimate, my brother and I were able to start setting money aside to help her. No one should ever make a decision based on emotion if it can be helped. In an emergency situation, you don't always have the time and you do what you must. But in most cases, you have time... and if you feel overwhelmed, you can turn to family and friends to help in the decision.
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If you and your brother hadn't chipped in, would she have been denied treatment?
 
christiefan915 said:
I think it's highly relevant. In fact, I think there wouldn't have been a thread had he not been charged $250 a minute for walking on an effing treadmill.
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The thread was in regard to him not finding out ahead of time what the cost estimate was. There was no reason he could not have found that out. That was what we have been discussing.

I don't think you will find much disagreement that health care costs are out of control.
 
Superfreak said:
The thread was in regard to him not finding out ahead of time what the cost estimate was. There was no reason he could not have found that out. That was what we have been discussing.

I don't think you will find much disagreement that health care costs are out of control.
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Actually it's quite a bit more difficult than you think. The lack of transparency in medical billing is one of the areas of much needed reform. Keep in mind to that in a lot of cases, it's not like you have a choice. Then read your bill and see if you don't get more confused. I know when my wife had her bike accident. The billing went like this. Total billing was $10,000. Insurance paid $2,000 to radiology (MRI & Xray), $3,000 to emergency services and another $800 to the physician and another $500 for meds. So that's $6300.....Paid out. $1500 was paid by us and $4800 by the insurance company and the billing was considered paid but what the hell happened to the other $5700?
 
Mott the Hoople said:
Actually it's quite a bit more difficult than you think. The lack of transparency in medical billing is one of the areas of much needed reform. Keep in mind to that in a lot of cases, it's not like you have a choice. Then read your bill and see if you don't get more confused. I know when my wife had her bike accident. The billing went like this. Total billing was $10,000. Insurance paid $2,000 to radiology (MRI & Xray), $3,000 to emergency services and another $800 to the physician and another $500 for meds. So that's $6300.....Paid out. $1500 was paid by us and $4800 by the insurance company and the billing was considered paid but what the hell happened to the other $5700?
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You can thank your friendly neighborhood federal gobblement for this lack of transparency and here is why.

It all goes back to the advent of Medicare. Physicians at first resisted (and rightfully so). But, then it passed, and physicians soon discovered that nobody was watching the cookie store. They would bill and the gobblement would pay. No questions asked. Surprised?

It became clear very quickly that the system was unsustainable. So the gobblement had a fix. It would only pay physicians 80% of what they billed. That will show em. Also, I should add that if you are a physician and you accept medicare, you cannot by law charge anyone less than you charge medicare (this is important). So to get around the 80% decrease in reimbursement, physicians who know how to do math just started charging 20% more. Oooops. The gobblement didn't fix it and it also created the problem of now physicians had to increase prices to private payers and private insurance companies because the gobblement deemed it so.

In the face of the gobblement fix of the gobblement created problem, it was time for a new gobblement fix. In comes DRGs which basically assigns a price based on severity and condition. See here

http://www.hcup-us.ahrq.gov/db/nation/nis/APR-DRGsV20MethodologyOverviewandBibliography.pdf

and here

http://www.findacode.com/code-set.php?set=DRG

Now why is this important to the story you describe? Because of gobblement interference in the market place of healthcare, pricing has become a huge game. Providers try to "charge" as much as they can knowing that the payor isn't going to pay the full freight. It is one big fucking game. That other $5700 just goes into nothingness. That is why I say charges don't matter. They mean nothing. Sure they get the uninformed all fired up, but in the morass that has become payment of healthcare services they are irrelevant.

It will only get worse
 
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