David, I agree that the whole situation is a disgrace, but I don't agree
that I didn't pay my full share.
I didn't "game" the system. I was just lucky enough to be solvent so I
could pay my bills.
I heard a radio segment (NPR) which said that the common practice of
hospitals is to bill the uninsured at a rate six or seven times what
they charge the big insurance companies for the same procedures. The big
insurance companies have a lot of clout and they pressure the hospitals
to provide services for less than their costs. Those who are defenseless
individuals then have to pick up the slack for both those who are
insured and for those who are indigent. Which is why so many routine
medical events can generate fees into six figures at the drop of a hat.
I'm sure that the insurance companies, who make lots and lots of money
(some pay out only 30% of what they take in in premiums) are delighted
that you think they are being victimized by the uninsured.
Susan Kline
On 11/2/2010 7:48 PM, David Love wrote:
> That's all fine and I'm glad it worked out for you but the elevated
> costs are, in fact, to offset the inability of the uninsured to pay
> combined with the hospital's obligation to treat the uninsured.
> Insurance companies do not have the luxury of being able to bargain
> for lower fees so they pass that on in the form of higher premiums to
> those who are responsible enough to carry insurance. Your bargaining
> combined with others who pay even less, or nothing at all, results in
> higher premiums for those who do carry insurance. Those higher costs
> are also what prevents many people from seeking care because they
> simply can't afford even a negotiated price. Those same higher costs
> are part of the reason insurers put lifetime caps on care and drop
> people or refuse to insure them for preexisting conditions. The
> requirement to carry insurance is to create an economy of scale such
> that the costs are spread to a greater number of people not unlike the
> auto insurance system which ultimately lowers costs. I'm my view if
> you don't want to carry health insurance you should then be required
> to demonstrate financial responsibility just like with a car. Whether
> you want to see it or not there is a social cost for your refusal and
> the costs of an unforeseen surgery or extended treatment out of your
> control can be far greater than you could ever negotiate even a
> fraction of.
>
> The notion, as others have mentioned, that services will be less
> readily available in a socialized system (more myth than reality)
> pales in comparison to those who die untreated because they can't
> afford premiums, care, medications or haven't figured out how to work
> the system as you did. In a country that prides itself on its
> humanitarian missions, doesn't blink at spending billions to kill tens
> if not hundreds of thousands of Iraqi civilians or fight useless,
> unwinable wars, it's a disgrace.
>
>
>
> David Love
> www.davidlovepianos.com
>
> ------------------------------------------------------------------------
> *From: * Susan Kline <skline at peak.org>
> *Sender: * pianotech-bounces at ptg.org
> *Date: *Tue, 02 Nov 2010 18:45:38 -0700
> *To: *<pianotech at ptg.org>
> *ReplyTo: * 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
>
>
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