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Cohim - first off I am so sorry about your Son's broken nose and the damn frustration you're going through. Horrible, Horrible. My prayers are being sent to your family for a fast resolution to this situation. Seriously I got a pit in my stomach just hearing that.

I attribute the reasons for this as follows (VERY SAD in the USA that we are having these issues):

2 years ago my wife had surgery and the bill was $32k, luckily we had insurance and our portion was $3,200.. here is the kicker, I called to pay the bill in full when it was due and asked how much the insurance company paid for the surgery, hospital, etc and My insurance company under contract was only obligated to pay the hospital $4,600, so I guess the hospital and the doctors are at a loss?? Crazy how this works. No wonder why quality medical care is in the tank.... long lines, when we go to the doctors for a 10am appointment we don't get seen for 45mins-90minutes, yet if we are late or don't show they charge us a "no-show" fee.

I assume they have to overload their workflow and downsize their staff to remain profitable because the insurance companies only pay peanuts under contract. I believe this is the reason why so many doctors & hospitals are now being selective with insurance companies and dropping plans like flies. Most of these plans don't pay enough to cover the doctors and hospital expenses. The only way for them to remain profitable (and I'm pro-profit) is to herd people in like cattle.. The downside is the level of care decreases substantially, and their are long lines, and you have to schedule appointments way in advance to get seen.

Not sure how this will develop over the coming years... Sad for doctors and nurses, very sad for patients too...  So sorry Cohim, I hope this gets resolved - there is no excuse for this at all!

For the first time ever here, I actually agree with RNaka !  :cheers:

[quote author=tksamtec link=topic=31395.msg133665#msg133665 date=1420047226]
For the first time ever here, I actually agree with RNaka !   :cheers:
[/quote]

HAPPY NEW YEAR!!

My new years resolution is to try to get along.

Peace

[quote author=CoronaCigar link=topic=31395.msg133661#msg133661 date=1420045700]
Cohim - first off I am so sorry about your Son's broken nose and the damn frustration you're going through. Horrible, Horrible. My prayers are being sent to your family for a fast resolution to this situation. Seriously I got a pit in my stomach just hearing that.

I attribute the reasons for this as follows (VERY SAD in the USA that we are having these issues):

2 years ago my wife had surgery and the bill was $32k, luckily we had insurance and our portion was $3,200.. here is the kicker, I called to pay the bill in full when it was due and asked how much the insurance company paid for the surgery, hospital, etc and My insurance company under contract was only obligated to pay the hospital $4,600, so I guess the hospital and the doctors are at a loss?? Crazy how this works. No wonder why quality medical care is in the tank.... long lines, when we go to the doctors for a 10am appointment we don't get seen for 45mins-90minutes, yet if we are late or don't show they charge us a "no-show" fee.

I assume they have to overload their workflow and downsize their staff to remain profitable because the insurance companies only pay peanuts under contract. I believe this is the reason why so many doctors & hospitals are now being selective with insurance companies and dropping plans like flies. Most of these plans don't pay enough to cover the doctors and hospital expenses. The only way for them to remain profitable (and I'm pro-profit) is to herd people in like cattle.. The downside is the level of care decreases substantially, and their are long lines, and you have to schedule appointments way in advance to get seen.

Not sure how this will develop over the coming years... Sad for doctors and nurses, very sad for patients too...  So sorry Cohim, I hope this gets resolved - there is no excuse for this at all!
[/quote]

The one possible flaw with your breakdown is whether or not that 32k charge was actually a legit cost to the doctors.  They play games with regards to reimbursement as well.  There are a ton of confounding factors in the US medical market that makes it quite difficult to ascertain what the actual market values for things are.

For instance, if you get an MRI here, the cost on the bill the doctor sends to the insurance might be 2000-3000 dollars.  Your insurance might reimburse the doctor 800.  Go to Japan, and you can walk in and get an MRI for 200, off the street.

What's the value of the MRI?

speaking from experience. Cost of an MRI WITH insurance (amount billed to ins. company) here was $3200.

Cost to ME with no insurance. $800

With that said, Obama care, Obama, and all who voted for the POS suck.  :finger:

Happy New Year Reed and my resolution is, not to make resolutions.

[quote author=Gee-Man link=topic=31395.msg133677#msg133677 date=1420054159]
Happy New Year Reed and my resolution is, not to make resolutions.
[/quote]

Smart man.

[quote]
And somehow turning over 1/6 of our economy to the federal government is going to "fix" the system. I don't think so.
[/quote]

One of the problems with discussing health care in America is that it's impossible for some to divorce it from partisan politics.

I said I was in favor of mandated universal coverage.  There is nothing in there that requires a turnover of 1/6 of the economy to the federal government, unless you assume that the only way to do that is for us to implement the Canadian or British systems.

[quote]
I don't see people crossing the borders to Canada or Cuba or Poland seeking medical care.
[/quote]

That's a straw man argument.

[quote]
Universal coverage is not a system intended to provide better medical care just equal, which is the ultimate goal of the progressives.
[/quote]

So, yes, if you cannot divorce the concept of universal coverage from a specific proposed methodology, there's likely not room for a legitimate conversation on the topic.

[quote author=mrmagee link=topic=31395.msg133674#msg133674 date=1420053225]
The one possible flaw with your breakdown is whether or not that 32k charge was actually a legit cost to the doctors.  They play games with regards to reimbursement as well.  There are a ton of confounding factors in the US medical market that makes it quite difficult to ascertain what the actual market values for things are.

For instance, if you get an MRI here, the cost on the bill the doctor sends to the insurance might be 2000-3000 dollars.  Your insurance might reimburse the doctor 800.  Go to Japan, and you can walk in and get an MRI for 200, off the street.

What's the value of the MRI?
[/quote]

I've long felt the same way. Doctors/ hospitals aren't caught by surprise when insurance companies only pay a portion of the bill. They know how much they'll get paid, and charge accordingly.

The common line is "we have to charge so much to make up the loss for people who can't/ won't pay." But really, they're charging so much in order to make the REAL amount from insurance companies.

Let's say you run a business providing a unique service valued @$1000. The cost to you is $500.  If you know one out of every 10 customers won't pay, you'll raise your rates to $1050 to cover that $500 loss. But, if everyone is compelled to pay, but ONLY 20%, then you would raise your rates to $5000 to compensate. Maybe if you're lucky, you can get the occasional uninsured customer to pay the entire $5000, for the $1000 service.

That is why medical bills are so high. Requiring everybody to carry insurance doesn't help. What would help is requiring insurance companies to pay a fair rate to the providers, and requiring the providers to adjust rates accordingly.

[quote author=Treinenwj link=topic=31395.msg133683#msg133683 date=1420056726]
That is why medical bills are so high. Requiring everybody to carry insurance doesn't help. What would help is requiring insurance companies to pay a fair rate to the providers, and requiring the providers to adjust rates accordingly.
[/quote]

It's one of the reasons, for sure (and I agree with the rest of your post).

However, another reason the prices are high is that hospitals (or, perhaps, Doctors - who are bound by ethical obligations) are required to provide emergency treatment to people without first being able to assure themselves that they can pay for the treatment.

If a person without insurance is in a car accident, and they require a $30,000 surgery (real cost) to save their life, and they can't pay -- that cost gets pushed into the costs of everyone else who either has insurance or can pay that cost out of pocket.  The hospital, however, will do the surgery when the patient is brought in on a stretcher.

The only way to avoid this is to allow the hospital to either refuse treatment to people who cannot pay -- or to require everyone to carry some minimum level of catastrophic coverage.

It's just like owning a house -- the mortgage company requires you to have insurance if your LTV is over a certain amount.  Only in this case, the LTV is almost always over that amount, and the mortgage company (in this case, the hospital) cannot refuse to do business with you if you don't meet their terms.

As far as systems go, it's pretty broken, intrinsically, and has been for a very long time.