Medical Insurance cost

[Nevada Ed]

I think I may have stumbled on why the cost of going to a Hospital or EM , is so high?

Back in November I spent 1.8 hours in a ER waiting to see a Dr.
and getting some pills for a fall that I had, for the pain.

My insurance final payment to the ER unit was $155 with nothing owed by me.

When I opened the bill from the ER, they added a "Zero" and printed out.....
$1,266, as the toal cost for the visit.

They sure have learned to add up cost items, in todays times !!

 

[Yaworski]

As with many things, there's your cost without insurance and the cost for the insurance company.

Years ago there was an article in a car mag by a guy who discovered that a replacement windshield for insurance company X was more than for insurance company Y. He then started looking into the price for a number of insurance carriers and found that there was a huge range of prices. The bigger companies had more negotiating power. The same is true in health care.

 

[swsig]

In 2011, I spent a week in the hospital getting both knees replaced. In reviewing the looong list of charges paid by Medicare and my supplementary Blue Cross, I noticed an interesting pattern. The insurance only paid about 35% of what the doctors billed, but it paid 100% of what the hospitals billed, so the insurance money trail leads to the hospitals. That's why so many hospitals these days are owned by doctors.

 

[Tom S.]

In 2011, I spent a week in the hospital getting both knees replaced. In reviewing the looong list of charges paid by Medicare and my supplementary Blue Cross, I noticed an interesting pattern. The insurance only paid about 35% of what the doctors billed, but it paid 100% of what the hospitals billed, so the insurance money trail leads to the hospitals. That's why so many hospitals these days are owned by doctors.

What you aren't seeing is hospitals negotiate with the insurance company to establish what the company will pay and the hospital will accept. If your insurance company and the hospital both agree on a set amount, then you are right, the hospital bill is paid entirely by the insurance company.

In many cases, the two sides will agree, but the insurance company will have a deductible or co-pay you are responsible for. In this case, you may get a bill for some or all of the amount charged by the hospital. There are also some procedures that are not covered by the insurance company either because they are considered experimental or lacking proof that they are beneficial. A good rule of thumb is if Medicare covers it, most insurance companies will as well.

Last but certainly not least, comparing insurance coverage is like herding cats in a dark room while wearing a blindfold with one arm tied behind your back. In general, if a company is offering to save you tons of money, either with lower payments or by giving you an overly generous spending account, RUN!!! The old saying there are no free lunches applies in spades when it comes to insurance companies and they will find more loop holes or ways to deny your claim than you can shake a health card at.

 

[pharmer]

January 2017 I got my 1 st bout of pneumonia. 10:30 at night I told the wife "I'm going to the ER." Got there fast, bitter cold, sat on a gurney in the hallway for hours. 1st doc: "Xray says pneumonia." Walks away never to be seen again. Next doc: "You got pneumonia." Me: "Can I have a Z-Pak and Augmentin so I can go home?" About 5:30 am I get kicked out with RX for Z=Pak and Augmentin. A week later I got a bill for a little over $16,000; "my end" was $3K. I got a "payment plan" for $75 a month spread out in 40 payments. I called the accounting dept of the hospital and told them if'n they would have given me the price they sold the note for (to some Midwestern bank) I'd have wrote the check. Reply: "We don't operate that way."

At least when COVID almost killed me 4 years later I got a bill for $137,000 and paid exactly $0. System is a mess. Joe

 

[s&wchad]

Mrs Chad had shoulder surgery about 10 years ago. She was diagnosed and scheduled within a few months. It was outpatient and I drove her home the same day.

The hospital billed $22K. Insurance paid $1900. Our co-pay was under $1000.

Thank God for our health insurance. If we lived in a country with socialized medicine, she'd still be waiting.

What a provider bills and what an insurance company pays are apples and oranges...

 

[grover99]

"What a provider bills and what an insurance company pays are apples and oranges..". I saw a dermatologist to screen for skin cancer. No cancer but had three places on my face froze as could be precancerous. Total time in office 20 minutes. Later saw what they billed Medicare. $9000. Medicare of course didn't pay anything near that and I was not out any money but will never go to that office again. Will not deal with crooks like that.

 

[Onomea]

.. If we lived in a country with socialized medicine, she'd still be waiting....

Many Americans believe this about national healthcare/socialized medicine, but I can say unequivocally this is untrue of Japan, which has national health insurance.

When I moved back to the US a few years ago after several decades in Japan it was really brought home to me how lousy, and how expensive, healthcare is in the US, at least compared to Japan.

Seeing a doctor, and getting treatment, is far quicker, far easier, in Japan than in the US. And dental care is covered by national healthcare in Japan as well.

I believe that healthcare in the US is not designed with the primary goal of keeping people healthy. I believe that the primary purpose of the healthcare system in the US is to generate money. I think this explains why in the US we spend something like two and a half times as much per capita on healthcare as any other country, and are ranked something like 43rd in the world in terms of life expectancy.

 

[Rustyt1953]

Since 2004 my medical bills have eclipsed 7 figures with proportionally little out of pocket.

No complaints from me as I am still ambulatory and solvent.

 

[ladder13]

Many Americans believe this about national healthcare/socialized medicine, but I can say unequivocally this is untrue of Japan, which has national health insurance.

When I moved back to the US a few years ago after several decades in Japan it was really brought home to me how lousy, and how expensive, healthcare is in the US, at least compared to Japan.

Seeing a doctor, and getting treatment, is far quicker, far easier, in Japan than in the US. And dental care is covered by national healthcare in Japan as well.

I believe that healthcare in the US is not designed with the primary goal of keeping people healthy. I believe that the primary purpose of the healthcare system in the US is to generate money. I think this explains why in the US we spend something like two and a half times as much per capita on healthcare than any other country, and are ranked something like 43rd in the world in terms of life expectancy.

Could be specific to Japan. We will hear from others soon.
About 30 years ago we were up in Kittery ME. The lady wanted to jump into a store to browse. There was a bench outside with a guy sitting there. I always talk to people so I asked if he minded company and said to him "this looks like the men's waiting room", we both laughed.
So the conversation started "where you from"? I said NY and he said Canada. After a few pleasantries, I asked "so how is healthcare in Canada?" He said "if you have money it's great, if you don't you wait for a long time unless of course it's an emergency". He was the latter.
That was then, maybe different nowadays.

 

[Golddollar]

Since 2004 my medical bills have eclipsed 7 figures with proportionally little out of pocket.

No complaints from me as I am still ambulatory and solvent.

A few years ago I spent 3 days in the hospital because of a suspicion I might have been having a stroke. When I saw the Explanation of Benefits I was sure glad I had my supplemental insurance because just the 20% Medicare didn't cover seemed to be astronomical. I'm glad to be upright and walking around and solvent too.

 

[bearman49709]

Mrs Chad had shoulder surgery about 10 years ago. She was diagnosed and scheduled within a few months. It was outpatient and I drove her home the same day.

The hospital billed $22K. Insurance paid $1900. Our co-pay was under $1000.

Thank God for our health insurance. If we lived in a country with socialized medicine, she'd still be waiting.

What a provider bills and what an insurance company pays are apples and oranges...

I've had my right shoulder operated on four times so far, my total cost is $0.00.

 

[ladder13]

It's your fault, no it's yours.

UnitedHealthcare CEO killing: Why health insurance upsets Americans

I wonder if the American food choices have something to do with some illnesses. Having been in a few European countries they seem to eat more fresh and natural foods.

 

[CAJUNLAWYER]

Many Americans believe this about national healthcare/socialized medicine, but I can say unequivocally this is untrue of Japan, which has national health insurance.

When I moved back to the US a few years ago after several decades in Japan it was really brought home to me how lousy, and how expensive, healthcare is in the US, at least compared to Japan.

Seeing a doctor, and getting treatment, is far quicker, far easier, in Japan than in the US. And dental care is covered by national healthcare in Japan as well.

I believe that healthcare in the US is not designed with the primary goal of keeping people healthy. I believe that the primary purpose of the healthcare system in the US is to generate money. I think this explains why in the US we spend something like two and a half times as much per capita on healthcare as any other country, and are ranked something like 43rd in the world in terms of life expectancy.

Anyone who has studied Ecomomics and has read Adam Smith's "The Wealth of Nations" is familiar with his premise that people who provide services to help you are not acting out of a sense of altruism by any means, They are acting out of self-preservation (ie by making money off of their services to provide for themselves).
Always keep that in mind. A more modern way of looking at it is the currently in vogue statement "Follow the Money"

Two little noticed disciplines, Mathematics and Economics, provide most if not all the answers to this perplexing world-only problem is that these fields by them selves in the abstract are incredibly boring. But they provide the building blocks for understanding everything in commerce, finance, engineering as well as the providing of the humanitarian services like law, medicine and dentistry.

 

[mtgianni]

I recently saw the bill for a birth in 1959. A hospital stay for parts of 3 days and the attending doctors fee were included. Total cost was $73.58.

Something has changed.

 

[Mr. Vito]

When medical insurers negotiate with a provider, such as a hospital or hospital chain, they usually end up agreeing to pay a certain percentage of the charges. So the provider then is encouraged to raise the "normal" charges so that the agreed upon percentage gives them enough money to justify providing that service to that patient. The real crime involved is for the poor sucker that has no insurance and so is billed at the full "normal" amount. Ideally an uninsured person should negotiate with the hospital in advance, agreeing that they will pay what Medicare or Medicaid would actually pay for the care, but I doubt that many providers would agree to do this.

All of this reminds me of how fortunate I was to decide on staying in the military long enough to qualify for a military retirement. Not only is my pension, which I have now been receiving for almost 35 years, the main part of my retirement income, but health care for myself and my wife is essentially without any cost for us, other than a small co-pay for medications. Medicare pays for most of our care, and the government pays for the part not covered by Medicare, and typically even for gigantic bills I end up paying zero out of pocket.

 

[zeke]

When medical insurers negotiate with a provider, such as a hospital or hospital chain, they usually end up agreeing to pay a certain percentage of the charges. So the provider then is encouraged to raise the "normal" charges so that the agreed upon percentage gives them enough money to justify providing that service to that patient. The real crime involved is for the poor sucker that has no insurance and so is billed at the full "normal" amount. Ideally an uninsured person should negotiate with the hospital in advance, agreeing that they will pay what Medicare or Medicaid would actually pay for the care, but I doubt that many providers would agree to do this.

All of this reminds me of how fortunate I was to decide on staying in the military long enough to qualify for a military retirement. Not only is my pension, which I have now been receiving for almost 35 years, the main part of my retirement income, but health care for myself and my wife is essentially without any cost for us, other than a small co-pay for medications. Medicare pays for most of our care, and the government pays for the part not covered by Medicare, and typically even for gigantic bills I end up paying zero out of pocket.

as it should be

 

[Jon651]

The private health insurance system is a complete disaster. Period. I don't yet qualify for Medicare, so my health insurance for me alone costs a hair under $1300/month which is a ridiculous amount. And it ain't nothing special, that's for sure! That is $15,600 per year for middle-of-the-road health care coverage with more than its fair share of deductibles, co-payments, co-insurance costs, etc.

Add onto that, but the explanation of how it is all supposed to function is unworkably complex. The presentations the companies give before the next year's plan goes into effect make everything look so direct and easy - until you actually try to keep track of it during the following year. As haphazard as most of these companies and the care providers in general work, it's virtually impossible to keep track of remaining deductibles, co-pays, balances, etc. because the limits, costs and percentages paid are different for everything in nearly every different circumstance.

Plus I am almost certain that the hospitals and other care providers still send out bills to the patient for beyond what the insurance companies agree to pay. They do this because they know a certain percentage of people will pay it regardless because they can't keep track or are too confused about their coverage to know better.

Yes, healthcare is a huge endeavor but all I want is a simple system of "Receive service A, pay amount X" and to heck with everything else!

 

[swsig]

In 2011, I spent a week in the hospital getting both knees replaced. In reviewing the looong list of charges paid by Medicare and my supplementary Blue Cross, I noticed an interesting pattern. The insurance only paid about 35% of what the doctors billed, but it paid 100% of what the hospitals billed, so the insurance money trail leads to the hospitals. That's why so many hospitals these days are owned by doctors.

What you aren't seeing is hospitals negotiate with the insurance company to establish what the company will pay and the hospital will accept. If your insurance company and the hospital both agree on a set amount, then you are right, the hospital bill is paid entirely by the insurance company.

In many cases, the two sides will agree, but the insurance company will have a deductible or co-pay you are responsible for. In this case, you may get a bill for some or all of the amount charged by the hospital. There are also some procedures that are not covered by the insurance company either because they are considered experimental or lacking proof that they are beneficial. A good rule of thumb is if Medicare covers it, most insurance companies will as well. ...

That's what happened in my case. My ortho surgeon was one of the owners of the hospital, a specialized facility that only dealt with orthopedic, neurological, and plastic surgery. He told me in advance that they would accept whatever Medicare and BC/BS would pay, and that my out-of-pocket expenses would be zero, which they were. Insurance payments were just north of $125,000, so I guess he was satisfied with that.

 

[Bald1]

Could be specific to Japan. We will hear from others soon.
About 30 years ago we were up in Kittery ME. The lady wanted to jump into a store to browse. There was a bench outside with a guy sitting there. I always talk to people so I asked if he minded company and said to him "this looks like the men's waiting room", we both laughed.
So the conversation started "where you from"? I said NY and he said Canada. After a few pleasantries, I asked "so how is healthcare in Canada?" He said "if you have money it's great, if you don't you wait for a long time unless of course it's an emergency". He was the latter.
That was then, maybe different nowadays.

Nothing has changed. My good friend and hunting buddy lives in southern Ontario. North of Buffalo NY, south of Toronto. I hear lots of stories. Canadians living close to border often come to the US to see specialist. And often pay out of pocket