Medical stuff
May. 26th, 2005 01:20 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
pecuniumGot 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.
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.
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no subject
Date: 2005-05-26 09:18 pm (UTC)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.
no subject
Date: 2005-05-26 09:45 pm (UTC)C'est la guerre.
TK