Medical Reform - questions - PeachParts Mercedes-Benz Forum

kknudson · #1 10-25-2009, 09:52 PM

No politics, just explain this.

the Wife had an MRI, so a Radiologist needs to read it.

Charge 295.00
paid by Insurance 85.5
Due by us 9.5
written off 200.

Ok not bad for us.
Here are the questions

Was the 295 charge an attempt at a royal rip off ?
please what industry gives a 67 % discount.

Or did they loose their shirt because of the 'Insurance group' discount ? Yea right.
Bet they made a VERY nice profit at the 95 bucks paid, that 295 would have yielded a ridiculous profit margin.

How do they book the 'Written off', is this a Loss ?

When they tell us cost go up by 10 % (whatever) / year are they using the 295 number or the 95 ?

This is just one example, the MRI bill was similiar.
She had a procedure at the hosptial recently, 8k billed 2k paid.

Why isn't anyone in the governmoent, even the press talking about these games.

MTI · #2 10-25-2009, 10:07 PM

The $295 is the "retail" price for the procedure code; the $95 is the rate paid when the patient is insured. Part of the savings is that the collection costs for the provider is lower and there is really no dispute over "reasonable charge" for the procedure.

In some states, workmen's comp and auto accidents also have discounted rates because insurance is also involved in the payment mechanism, which again lowers collection costs.

Pavka007 · #3 10-25-2009, 10:26 PM

Well...its called free market economy... In the same line of question:
Why one dental crown can cost from $199.00 to $750.00? I was amazed to discover that actually there is no a single piece of legislation in the US regarding the price limits in Medical Charges. So every MD can charge whatever they want. The same goes for the "Medical Services" including the MRI.
I have a neighbor who owns a dental lab. He is doing the same work for numbers of dentist in the area...His prices are different for different practices. As per his own words sometimes as high as 125% between one dentist to other.
No wonder the MD in the US are one of the richest in the WORLD.
Back in Europe they work for salaries and they are well look after by the government...here is every man for himself.

Pavka007 · #4 10-25-2009, 10:27 PM

Quote:

Originally Posted by MTI

The $295 is the "retail" price for the procedure code; the $95 is the rate paid when the patient is insured. Part of the savings is that the collection costs for the provider is lower and there is really no dispute over "reasonable charge" for the procedure.

Who is determining the RETAIL price??? Can you find a guidance book for medical prices?

kknudson · #5 10-25-2009, 11:03 PM

Quote:

Originally Posted by MTI

The $295 is the "retail" price for the procedure code; the $95 is the rate paid when the patient is insured. Part of the savings is that the collection costs for the provider is lower and there is really no dispute over "reasonable charge" for the procedure.

In some states, workmen's comp and auto accidents also have discounted rates because insurance is also involved in the payment mechanism, which again lowers collection costs.

By that ratio the "retail" price of a 60k MB s/b what 180k ??

It's the EXTREME psuedo markup that seems ridiculous.

So then too by that you are saying that the cost of collection, for the uninsured, is 70 % of the "retail" cost ???

tankdriver · #6 10-25-2009, 11:12 PM

Quote:

Originally Posted by Pavka007

Who is determining the RETAIL price??? Can you find a guidance book for medical prices?

It's determined by the person writing the bill.

The $295 charge is what someone without insurance would pay.
If the actual cost for the procedure + a decent profit for this procedure is in actuality around $100, then the retail or uninsured price will be jacked to reflect the negotiated rate. IOW, the insurance company makes a deal with the hospital to pay 50% of the billed rate. The hospital doubles the bill. But some insurance companies have a deal to pay 60%. Think the hospital will still double the bill? Of course. Some insurance companies will pay less than 50%, and make their customer pay more of the bill. Think the hospital will still bill the double? Of course.

Hatterasguy · #7 10-25-2009, 11:21 PM

Yeah its BS, the hospital bill for my broken foot was $3,500. My insurance company paid $600.

I wonder if you can bargin with them if you have to pay out of pocket.

I know with dentists if you pay cash you can get some better prices.

Brandon_SLC · #8 10-25-2009, 11:22 PM

One of the things that bugs me is the hospital or Dr. has sole discretion whether they bill you for the retail price or something lower. When they send a bill to collections they usually charge the higher number.

When my dad was in the hospital last spring his bill totaled $90k. Medicare allowed $28,6xx and his insurance paid $282.00 I have no idea how the insurance arrives at this formula.

My mom was hospitalized 8 years ago for a cat bite. (She took in a stray cat and it bit her.) Her bill was $35,000. Unfortunately it was just before she qualified for medicare. She is just finishing off paying the bill. They did not discount it.

When I saw my Father's hospital bill I was absolutely shocked at how little Medicare paid. The discrepancy didn't use to be this large. I have the feeling these for profit hospitals are using the amount of the discrepancy to lower their tax bill. I bet most hospitals don't pay any income taxes.

The whole situation is a mess! This is why when you ask people in a poll if they support medical reform, the majority answer yes. A much smaller number support the current bills in congress. An even smaller amount want the federal government taking control of the entire system.

Hatterasguy · #9 10-25-2009, 11:26 PM

My friend was just talking about this. He works in a research lab and he is like you should see what some of the equipment is sold for. Some of the stainless tools he gets are total crap, you can get nicer ones at West Marine for $20. But they pay $600 for them. Research rats are $1k each, etc. Anything medical related is priced ten times what it should cost.

They mark this crap up because they can. When you are sick are you going to shop around? Everyone involved is making a ton of money so no one wants the party to stop.

The more I see the more I like Canada's system.

Brandon_SLC · #10 10-25-2009, 11:28 PM

Quote:

Originally Posted by Hatterasguy

Yeah its BS, the hospital bill for my broken foot was $3,500. My insurance company paid $600.

I wonder if you can bargin with them if you have to pay out of pocket.

I know with dentists if you pay cash you can get some better prices.

My dentist gives a 20% discount for cash, supposedly. My last crown still cost $680. Now I'm wondering what he actually gets from insurance companies. I bet the "20% discount" is bogus. My guess is nobody pays that price.

Brandon_SLC · #11 10-25-2009, 11:35 PM

Quote:

Originally Posted by Hatterasguy

My friend was just talking about this. He works in a research lab and he is like you should see what some of the equipment is sold for. Some of the stainless tools he gets are total crap, you can get nicer ones at West Marine for $20. But they pay $600 for them. Research rats are $1k each, etc. Anything medical related is priced ten times what it should cost.

They mark this crap up because they can. When you are sick are you going to shop around? Everyone involved is making a ton of money so no one wants the party to stop.

The more I see the more I like Canada's system.

My dad spent most of the last 25 years living in Canada. On the way home from receiving his cancer diagnoses he said, "thank God I'm not in Canada". I thank God he has excellent insurance.

daveuz · #12 10-26-2009, 01:16 AM

My father just had a Spinal Cord MRI among other things. The bill shows a charge of 1662.00. When I get more time I will post the cost of each different service on this bill.

davidmash · #13 10-26-2009, 01:40 AM

Quote:

Originally Posted by Brandon_SLC

My dad spent most of the last 25 years living in Canada. On the way home from receiving his cancer diagnoses he said, "thank God I'm not in Canada". I thank God he has excellent insurance.

My mother broke her elbow in several places while in Berlin. Several screws, plates, 11 days in the hospital, physical therapy all for under $5,000. Thank god she was not in the US.

US care is great (some times) if you can afford it. For those who do not have insurance, not so great.

MTI · #14 10-26-2009, 02:42 AM

Quote:

Originally Posted by kknudson

By that ratio the "retail" price of a 60k MB s/b what 180k ??

It's the EXTREME psuedo markup that seems ridiculous.

So then too by that you are saying that the cost of collection, for the uninsured, is 70 % of the "retail" cost ???

Well, if you have a monopolistic control over the market, like say DeBeers does in diamonds, you can pretty much price as you please, then there's the mark up by the retailers.

Brian Carlton · #15 10-26-2009, 09:02 AM

Quote:

Originally Posted by kknudson

By that ratio the "retail" price of a 60k MB s/b what 180k ??

It's the EXTREME psuedo markup that seems ridiculous.

So then too by that you are saying that the cost of collection, for the uninsured, is 70 % of the "retail" cost ???

The extreme pseudo markup appears to be ridiculous, however, it's meaningless to all who have health insurance. The amount paid to the provider is dictated by the insurance company and the "retail" price really doesn't matter.

What's totally egregious is the fact that these SOB's will charge the retail price to the people who are least capable of paying for it...........those without any health insurance. Where a hospital will accept a total payment of $10K from an insurance company, they will not negotiate the $30K bill for the exact same procedure and treatment for a an uninsured patient.

In reality, this is blatantly illegal. The hospital is obligated to charge both the insurance company and the person walking in the door the same rate. However, this use of the BS "retail price" and "negotiated discount" allows them to evade the law.

If this health care bill does anything whatsoever, it should close this absolutely abominable situation that takes advantage of all people who need serious medical care and don't have insurance. Their only option is to declare bankruptcy.............and many have done it.