Insurance company fees are usually preset for certain procedures. They
can't bargain after the fact. Anyway, election over I'm done with this
discussion. On to something more productive.
David Love
www.davidlovepianos.com
From: pianotech-bounces at ptg.org [mailto:pianotech-bounces at ptg.org] On Behalf
Of Susan Kline
Sent: Tuesday, November 02, 2010 9:51 PM
To: pianotech at ptg.org
Subject: Re: [pianotech] Medical costs (OT!) was:billing dilemma
On 11/2/2010 8:29 PM, David Love wrote:
No I don't think the insurers are victims, I think we the consumers are. I
thought that was fairly clear. And as I mentioned before I believe the
health insurance industry should all be non-profit.
David Love
www.davidlovepianos.com
Well, David, just below here you said:
<<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.>>
But they do have the luxury of being able to bargain for lower fees. They do
it all the time. It's the individual patients who have no power except to
bankrupt themselves, which is a pretty high price to pay after they've been
billed for six times more than the insurance companies pay for the same
procedure.
I don't know if my hospital does the overbilling of self-pay patients which
is common elsewhere, or to what extent they do it (probably not as much as
elsewhere, would be my guess). I suspect that if all insurance companies and
hospitals had to open their books to the public, we would find some
astonishing things, very embarrassing for the insurance industry. After I
heard that NPR program it seemed to me that we need a law making it illegal
for a hospital to charge different rates for the same procedure. That would
give them some defense against the insurance industry pressure.
And I agree the insurance industry should all be non-profit. Even if it
were, I think we'd find executives fiddling their pay and other compensation
to egregious levels.
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 20:10:48 -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
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 <mailto:skline at peak.org> <skline at peak.org>
Sender: pianotech-bounces at ptg.org
Date: Tue, 02 Nov 2010 18:45:38 -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
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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