I am pleased to read that it turned out well for you in the end, Susan.
Best wishes for continued good health.
Will Truitt
From: pianotech-bounces at ptg.org [mailto:pianotech-bounces at ptg.org] On Behalf
Of Susan Kline
Sent: Tuesday, November 02, 2010 9:46 PM
To: pianotech at ptg.org
Subject: Re: [pianotech] Medical costs (OT!) was:billing dilemma
On 11/2/2010 2:05 PM, David Love wrote:
Susan:
Just one question. When you negotiated that hospital bill down to 30k who
paid the part you couldn't pay?
David Love
www.davidlovepianos.com
David, it was not a matter of someone paying for what I didn't pay. You need
to look at this from their standpoint. They are a nonprofit hospital, but
still they have to use some realism in their billing.
So, they bill an uninsured person. They may have to make a payment plan by
installment, at a rate that the patient can manage, more or less. And
sometimes even that isn't enough. The person has been seriously ill,
remember, and their income may be diminished. And the bills are very high.
So, what the hospital knows will often happen is that someone starts out,
pays installments for awhile, and then either dies or goes bankrupt. Or they
just stop paying, and it all has to be handed to a collection agency, which
of course takes their cut. When the hospital bills an uninsured ("self-pay")
person, they can expect that a lot of them will never finish paying. So they
pad the bill to try to get at least some of the money before it becomes
uncollectable.
I'm really impressed by how my local hospital handled this. It's full of
good and very sympathetic people. They started right in, with huge long
MRI's, a spinal tap, the expensive immunoglobulin treatment, just what I
needed, and no one said a single word about money. About my third day there,
a very pleasant woman came to my room and explored (in a tactful manner) how
I was going to pay for this. I told her exactly what my financial situation
was. After discussing it all for a few minutes, she told me, "If you are in
a position to make a lump-sum payment, you should wait till the main
hospital bill arrives, and then negotiate for a lower price."
So, that was exactly what I did.
The main bill came several weeks after I got home. I swear they send it out
late so that the patient pays off the individual doctor bills first. They
came a lot sooner! And they showed that all these people are (ahem ....)
quite generously paid. The hospital bill (roughly $40,000) was even higher
than I had predicted. I sat there, reading the details ($25 for two tylenol
at night from a big bottle, on a little plastic tray??), for four days,
gathering my courage, marshalling my arguments, knowing that the lady had
been right, I needed to negotiate it. It was scary, but I told myself that
the very worst thing I could do was dither till they sent the whole thing to
a collection agency.
I phoned the customer service number. I got a real dear heart on the other
end! She got my customer number, looked at her screen, and said, "Oh, my,
that's SO MUCH! I'm SO SORRY!" She sounded like she really was! I explained
how someone with my condition could expect improvement, but sometimes
elderly people didn't get over it all, and I hoped to be able to work later
on, but there were no guarantees I could, and I had some savings, but they
were also my retirement. She sounded sad, and started talking about setting
up an installment program. And she asked if I had filled out the financial
disclosure form. I thought I hadn't received it, but I found it later in the
pack of *stuff* which had arrived and was by then a tangled mess in my
computer room.
So, I told her, "the lady who visited me at the hospital said that if I were
in a position to make a lump-sum payment, I should negotiate the price." She
gave a gusty sigh of relief, and said, "OH YES! You SHOULD!!" There was a
moment of silence on the phone, while she looked over the itemized bill on
her computer screen. Then she said, somewhat tentatively, "$30,500?" And I
said, "I ACCEPT!" Then she got my credit union checking account data and a
check number, and we set up a date for them to withdraw the amount. I had to
sell some stock first and get the proceeds into my account.
And that is how I left the realm of fear and debt and uncertainty, and
reentered the calm light of solvency.
I think that gusty sigh of relief was partly for me, that I wouldn't have to
struggle with the bill, and partly for the hospital, since it meant they
could get enough from me to pay their true expenses, with a very short
waiting period, much shorter than if it had had to go through an insurance
company, and with no added office expense negotiating with an insurer.
Altogether, aside from getting the damned Miller Fisher Syndrome in the
first place, I think I was very lucky how it all turned out.
Susan Kline
_____
From: Susan Kline <mailto:skline at peak.org> <skline at peak.org>
Sender: pianotech-bounces at ptg.org
Date: Tue, 02 Nov 2010 13:36:35 -0700
To: <mailto:pianotech at ptg.org> <pianotech at ptg.org>
ReplyTo: pianotech at ptg.org
Subject: Re: [pianotech] Medical costs (OT!) was:billing dilemma
Will, you bring up one of the fatal errors in how conventional health
insurance worked before the health care bill passed (flawed as it is by
corporate pressures from all sides).
An insurance pool, to work right, has to have the largest possible number of
people in it. It should be affordable enough that many people pay in, but
the catastrophes happen to only a few of them, so the system stays in the
black. Insuring for a routine and expected expense is madness, because it
balloons the costs to several times what they would be if people just paid
out of pocket. I remember when dental insurance became common. Suddenly the
fees for my dental care tripled, though I didn't do a single thing to cost
the dentist a penny more than before.
What we need is not more insurance. We need more health, so that major
medical costs only happen to a few people, instead of almost all of them.
Plus we need efficiency, with doctors on salary. They should be forbidden to
take kickbacks for prescribing drugs, as many now do. They should not be
paid by the procedure, since this multiplies procedures, some of which are
dangerous and most of which are expensive. They should be protected from
needing expensive malpractice insurance. Instead of victims getting huge
money settlements paid for by malpractice insurance, doctors who are truly
incompetent should have their licenses revoked. There could be a public fund
to reimburse victims, so that half the proceeds wouldn't line lawyers'
pockets.
The "pre-existing condition" cherry picking just dumps huge segments of the
population to fend for themselves. Often this is absolutely not their fault.
Many of them work and take reasonable care of themselves and have money and
are willing to fund their medical coverage, if it could be made efficient
enough that the premiums weren't an invitation to bankruptcy. In the present
situation, they can't find a way into the system.
What we have now is a hodge-podge of exceptions and ad-hoc ways of getting
people treated when they are not in the shrinking pool of those privileged
enough to be insured (through work for major companies, extreme wealth, or
being young healthy and employed). You see the disconnect? Those who most
need health care are the very ones closed out from obtaining it.
This is why every industrialized country (EVEN BRAZIL!!) has some form of
universal coverage or a hybrid public-private setup. Adults were in charge.
They saw that leaving people with no access to routine health care led to
much higher expenses when they were in the final stages of fatal but
preventable diseases. It was a lot cheaper and more humane just to be sure
that everyone could get a certain basic amount of care.
We needed the public option really badly. But people fuming from Fox News
"entertainment" (read "tissue of lies") brought guns to public meetings,
screamed at the top of their lungs, and all the rest of it. Obama and the
Democrats blinked.
Okay, one more point and I'll shut up about politics. I see people saying
with fervor that they don't want to pay for the health care of people who
have all sorts of bad habits, eat junk food, smoke, etc. Might I point out
that they are already paying for it in the present system? Anyone can go to
an emergency room and they have to be treated, though they have to go
through the gauntlet of waiting in terrible conditions in the major city
hospitals crowded with other uninsured people. (What are you advocating?
Sending someone having a heart attack out to die on the sidewalk?) A
universal system would provide a way that everyone would pay something,
means-tested for the poorest, so that those people now crowding and
stressing the system could be treated early in a civilized uncrowded
non-emergency setting, and they could help pay for their treatment.
On the other hand, people complain that no one should be forced to buy
insurance. I am one of those who didn't buy insurance for thirty years, but
if the system had been fair and equitable and efficient, I would have rushed
to buy in. I don't imagine those who avoid being insured also avoid using
the hospital when they have a medical crisis. If they had paid a little in
for years before the crisis, the system might have been able to take care of
them and still stay in the black.
We heard all these arguments before Medicare was passed. But then last year
Fox News's campaign to derail the health care bill inspired the elderly at
town hall meetings to shout that Obama "should keep his hands off our
Medicare!!" You can't really have it both ways.
Susan Kline
On 11/2/2010 2:52 AM, William Truitt wrote:
You make me ashamed of myself, Terry. You are, of course, correct. Health
insurance is for 18 to 24 year old young women with no prior medically
disqualifying history (we'll overlook the medical crime of being born just
this once) (not for men in that age group, they get drunk and fall off
buildings) and the very wealthy.
My prediction is that when the wealthy can't afford health insurance either,
they will become Nazi-Facist-Commie-Socialists too.
Will
From: pianotech-bounces at ptg.org [mailto:pianotech-bounces at ptg.org] On Behalf
Of Terry Farrell
Sent: Monday, November 01, 2010 10:58 PM
To: pianotech at ptg.org
Subject: Re: [pianotech] Medical costs (OT!) was:billing dilemmawith pitch
raises
Nice comments Will, but one glaring error:
On Nov 1, 2010, at 10:16 PM, William Truitt wrote: "...this is how private
health insurance works also. Everybody pays into a pool so that the
individuals who need to take from the system can get the care they need when
they need it, at least in theory."
I would argue against this Will. In universal health insurance, everybody
pays into the pool via taxes. In private health insurance only those who are
healthy pay into the pool, unless of course, the odd situation arises that
the insurance company can't find a way to disqualify someone who has a
medical issue........
Terry Farrell
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