Medical stuff

[pecunium]

Got the bills for the kidney stone today.

Yeesh.

Total invoiced bills, rounded off, $8,000.

Five hundred of that is to the radiology lab for the CT scans, which are also billed on the hospital invoice to the tune of $3,700. I guess I wasn't kidding when I told the nurse at Walter Reed that, had I been paying for what they gave me, I'd have been filing bankruptcy after about 48 hours.

The mark-up for the saline, (which I know the rough cost of, because vets use it, and I worked at at vet) was about 14 times the cost of the bags ($222, rounded), the IV catheter cost $325, the tubing for it was, thankfully only $250. The morphine, a bargain at $50, for 10mg. Each time a nurse pushed some drugs, add a hundred bucks for the treatment, so for the bags and the drugs, $700 labor. Not bad for a grand total of 30 minutes worth of work (and I'm including the time spent getting the bags and drugs).

The worst part is the sanskrit billing. I don't recall getting a pair of injections, separately from the stuff pushed IV, but the bill seems to have them.

On the up side, if there is, I think I'd have agreed to most of that, and at that price (certainly the drugs, etc, I'm not so sure about the CT Scans) for the privilege of not screaming myself mute while the stone passed.


And the note on the back, that's the kicker. If we pay promptly (i.e. withing 30 days of today, though I might have to argue the date of reciept, were we to be on the line) we get a 50 percent discount for prompt payment, because I have no insurance.

Which feels like a scam.

I have to confess, even knowing that medical treament in the states is expensive, the sheer speed with which a huge bill gets racked up is astonishing (I made the comment at Walter Reed because I'd gotten lots of treatment in a short time. Fluids, doctors, ER, Spinal Tap, more bloodwork than I know how to describe, CT Scans, 14 doctors, on a total of four teams, plus my attending and the rheumatology team (who basically stopped by to see how I was doing; since it was their regimen of treatment which put me in hospital to begin with), three kinds of antibiotics, some potassium (ow, ow, ow!... not good, and worse the second time, after you've been getting IV Fluids for a week) and other things, I no longer recall. That was the first 2 1/2 days... I was there for almost two-weeks).

If it had been bad, say I'd needed a stent, or had mmore stones and they worried about complications, I'd be filing for bankruptcy. For some shots, a bit of blood work and some fluids. That makes up half the bill. The other half is for 10 minutes of scanning, and the expertise to read the results (I'm assuming the 500 to the radiology lab is for the person who shot the film).

Six hours, $8,000, for non-dedicated treatment (whatever nurse was handy, and the doctor on call).

On the other hand, if one can find the money (all of it) quickly, the bill is far less. Which makes me wonder at the real cost of things. It also means those who rack up really huge bills (say a heart attack, and a $25,000 tab) are screwed. They can't find the money to close the account, so they have to pay the really huge markup.

Comments

[electricland.livejournal.com]

I find it hard to comment on this issue without screaming and saying rude things, so I will just say:

Yikes.
I'm glad you won't be filing bankruptcy.
I hope this is the end of healthcare system interactions for you for a while.

[ckd]

Yeah, but don't you know that the bankruptcy law changes were only meant to punish people for buying plasma TVs they couldn't afford? I mean, really, did the credit card companies ever say word one about the fact that a large proportion of bankruptcies are caused by medical bills?

[pecunium.livejournal.com]

I read that, and I believed it, it just didn't sink in how quickly a, relatively minor, problem could become a huge liability.

[katedid1120.livejournal.com]

Hospital Bills are outrageous these days! i'm right up there with you. i have a few thousand in hospital bills from a serious case of mono. Health insurance in Canada is free... maybe i'll go there!

[flameamongcoals.livejournal.com]

Sounds about right. The hospital legally can't take more than a few dollars every month...and at that rate, they'll never get paid. I mean, god, think about inflation rates versus people who pay a hospital bill over 40 years. : ) By the time people pay it back, the money's worth half what it once was. : )

[pecunium.livejournal.com]

But can they sell the bill to a collections agency?

TK

[flameamongcoals.livejournal.com]

If you're concerned I'll confirm it with my lawyers, but to my knowledge, no. That's the kicker with medical bills; as long as you throw them some measly payment (I think it's $10/$20 a month), they can never come ask for more. Unless there's a lapse. Then it can become due in full. But I would imagine that it's the reason they'd be willing to settle for such a loss.

[texaslawchick.livejournal.com]

Yes, they can send bills to collections. Or they file a lein against your property. Usually they'll work with you though to come up with a payment plan.

I've worked in healthcare my entire life, and I find it amazing how the costs can add up. Part of it is that the hospital likely has to give deals to the insurance companies under various managed care plans, so the costs are still there but they're capped at a certain rate. The real "cost" of treating you was probably more in the range of $4500 or so, and my bet is that reimbursement for a kindey stone emergency room visit in a PPO plan is around $3500. So the hospital makes up the difference with uninsured and out-of-network patients. The hospital has to bill you at the (higher)usual and customary rate, or else they've breached their contract with the managed care plan, who will just take their thousands of patients down the street to the next hosptial over after suing the hospital for breach.

I and the expenses that I incur are also incorporated into that bill. Health care is one of the most highly regulated industries in the country, so people like me are essential to keep any hospital's doors open. But they can't bill for "legal services" or "regulatory assistance" so they figure my "cost" into the administration of your IV. People who do billing, auditing, house keeping, financial accounting, physician credentialling, and all of the other administrative types in healthcare are also incorporated into there.

The fact that it was an emergency also drove up the cost. Not that any kidney stone isn't expensive, but walking through the ER door instead of the front door of a hospital ratchets up the costs. Again for administrative purposes, but also because the professionals in ER cost a lot more. No one in private practice* wants to take ER coverage, and the hospitals pay a massive premium for that coverage. The premium is passed on to your bill. And in emergency rooms, the cost is additionally driven up because the emergency room is the only place in the country that we have a "right" to healthcare. You show up in an emergency room and they have to evaluate you and stabalize you, regardless of whether or not you can pay. So a lot of people get very expensive care in emergency rooms (that should be obtained elsewhere, but can't be because they can't pay for it) and then can't afford to pay for it. Hospital eats the bill, but some of those costs are passed on to the next person who walks through the door.


*They dont' want to take the coverage because it's more likely that they'll end up taking care of people for free, not to mention they'll get called in on their off time to take care of a little old lady with a cough. My dad has bitched about that one on more than one occassion.

[pecunium.livejournal.com]

And were it not a Sunday, we'd have looked for a doctor.

C'est la guerre.

TK

[moropus.livejournal.com]

OK, medical bills just don't make sense. Especially since vet bills are so reasonable for the same procedure. My dog stayed overnight, got a nail removed, had a dislocated toe set, got a slew of tests and annual shots, got all nails trimmed, and also annual shots and tests for another dog, $165.

Chopping the toenail and setting the toe, drugs and bandages included, $30.
Overnight stay with 24 hour monitoring and care, $6.
Nail trim while drugged, $6.
Amoxicillin caps 500 mg, 40 each, $20.
Breakfast, free.

I'm not really willing to stay in a metal cage and eat dog chow, but damn.

[electricland.livejournal.com]

you know what's funny? I distinctly remember a humour column in a Canadian medical publication a few years ago that advised doctors to take up veterinary science, 'cause the markups were so much higher for pets than for people.

Hmmmm.

[pecunium.livejournal.com]

They aren't, though usapfa seems to have gotten a deal.

When I was working at the vet the basic markup for things (drugs, labwork, etc.) was 100 percent.

Film was less, kennelling was $15 a day ($10 for day stay only, we had a number of people who kept pets at doggie day care) $60 if we had to have someone stay in all night to monitor the animal.

Surgeries ran from about $60 (dental cleaning, no anathesia) to a couple of grand (amputations, etc.).

Some things we didn't have the means to do (serious internal bone work, e.g. pinning a hip).

And deals could be made. Working there is probably the only reason we didn't have to put Token down when his pelvis was broken. I got everything at cost, and the doctor's time was gratis (which cut out a couple of hundred, when all was said and done, at $45 an office call, and a number of office calls) so the total was about $500.

The mark-up is less, but the overhead is less too.

TK

[texaslawchick.livejournal.com]

It's harder to get into vet school than medical school in the United States.

The other thing is, when my sister took her dog to the emergency vet clinic a few years ago, they demanded payment before they'd even look at the dog. She saw a very badly hurt dog be carried away from the clinic because the owner couldn't pay for emergency care.

[pecunium.livejournal.com]

We very rarely denied treatment. We did try to get payment.

People are, sadly, more willing to stiff a vet than a doctor. Many are also unwilling to spend what it costs. The vets I worked for were very unwilling to not help.

Hell, I recall one case, where the dog (a rottweiler), who was gravely; terminally, ill, and owned by a woman who didn't really care for it properly, but cared for it a great deal, coded out on the table, and Dr. Domotor got it going again.

She didn't think about it, and (with that grim humor one gets in hospitals, newspapers and armies... I've worked in all three, no wonder I've got a twisted sense of the funny and absurd, but I digress) said; with only half a dash of jest, "What was I thinking, I should have let the poor thing die."

But those are rare.

Almost as rare as the woman whose conyer was sick, and spent $600 for tests to see if it was curable. A coworker (at the L.A. County Zoo) was shocked to hear this was not a cure, but a diagnostic. The response, "I've had it for 16 years. I won't have to send her to college and this is the first big bill I've had, of course I'm going to pay for it."

TK

[texaslawchick.livejournal.com]

The response, "I've had it for 16 years. I won't have to send her to college and this is the first big bill I've had, of course I'm going to pay for it."

That's sort of how I feel about Relampago and Crianza. They bring me so much joy, why on earth wouldn't I do everything in my power to ensure that they're taken care of? On the balance, they get better healthcare than I do.

[skeetermonkey.livejournal.com]

In the legal field, we'd get a bill for our client that was, say, $1000. We'd tell the insurance company, "Look, our client racked up a grand of charges at this hospital." Then we'd use that to get a bottom line of what the ins. co. should pay.

Once we did that, we'd turn around and call the hospital and tell them we wanted to negotiate the lien. We'd usually get a drop in price of about 33%, or our client would pay about $666 (66 cents on the dollar). The remainder would go to the law office (it's how we made some of our overhead).

You might try calling and seeing if they'd knock off another few hundred for prompt payment, maybe a 3rd off the 50% price (or $3000 total?). They want to be paid, and sending things to collections means they only see half of it (if at all) anyway.

[goshawk.livejournal.com]

::wince:: Jeez. That's like adding a whole 'nother sort of pain to your recovery. I knew it was lucky we have HealthCare, but I confess I never really stopped and thought about it.


Well, here's to hoping this is your last dealing with the medical profession for a good long, healthy while.

[annathepiper]

*shiver* I had to shell out several thousand for my broken arm and my thyroid surgery, and this was with insurance. I don't want to think about what it would have been like had I not been insured.

[intelligentrix.livejournal.com]

It is a difficult thing to deal with--being unable to afford, and yet desperately need, medical services. I am one of the uninsured. In fact, I can't even get insurance privately, and as an independant contractor of sorts there's no employer to offer a health care plan. My only option, if I don't want to go into debt for the rest of my life, is to go to the emergency room at Charity Hospital. If you want an idea of what limbo is like, spend 8 hours in the Charity waiting room. Hard plastic chairs, glaring overhead flourescents, always-on TV, a variety of suffering and often unwashed humanity.... In Madison they at least had urgent care centers where you could go for relatively minor, but needing treatment, problems such as a deep cut or possible broken bone or high fever. You'd be seen quickly and efficiently, not made to feel like a wuss because you don't have bone protruding from your flesh and also not made to feel as if your trivial problem is taking time away from truly deserving emergencies. The fees were quite reasonable, too, as I recall. I went to one when I gashed my thumb open when a glass I was washing broke.

Lots of nattering to say what everyone already knows: the system doesn't work for most people, and those at the bottom of the economic ladder get the worst of it: they often get poor treatment and pay the most. Canada looks good, but the paperwork involved in emigrating!

[cluefairy-j.livejournal.com]

waitasecond. You don't have health insurance? Aren't you in the military?

[pecunium.livejournal.com]

I am covered, completely, when I'm on duty.

The funny/painful part of this is, I was supposed to be on duty, but because someone was needed to go to a change of command, not too far from me, I was moved to being on duty on different days.

So, I could have done all this at Huntington Memorial, and had it paid for.

On the up side (heh) there is a whole lot less paperwork, and I don't have to fight with State to get the bill covered.

TK

[cluefairy-j.livejournal.com]

But...but....you should be covered all the time. :-)

[pecunium.livejournal.com]

Yeah, but some stupid (republican) congressman decided it would be too much to ask to let me pay $75 a month to join Tri-care.

That, you see, would break the DoD's bank (an estimated $770 million), and there are more important things to spend that money on (which doesn't seem to include body, or HUMMVEE, armor, but pointing that out makes me sound bitter), and send the wrong sort of message.

But he supports the troops, for he's an honorable man, yea, as are they all honorable men.

TK

[lisajulie.livejournal.com]

Most of what I had to say has been said by other people - having to fold in the cost of administration, etc. Another cost to factor in is the cost of disposing of medical waste which is significant.

One reason they offer you a discount for paying promptly is the cost of collecting from people who are uninsured is pretty high. People who are uninsured are more likely to be poor (although this is changing) and might well move frequently if they have a fixed address at all. So, if the hospital isn't paid immediately, they are highly unlikely to get a significant amount of the bill paid at all. Collection agencies take their commission, and that's only on what is collected. So, they figure 50% of the bill quickly, is better than some small percentage way down the line. And they have the money quickly and don't have to wait for it.

[ourika.livejournal.com]

Do they have any kind of charity state aid in CA? In NJ, I racked up some extensive medical bills that were not covered by insurance. NJ State Charity Aid was very helpful in this matter.