Wellness

[SilleeMee]

I get outpatient drug infusions when needed and there is a facility fee for each visit. My insurance covers that fee.

[Puppy Lips]

My neighbor was in a car accident.  He was in the ER for 4 hours and got his arm stitched up.  The bill was $61,000.  That is insane.  They have insurance. 

The whole health care insurance industry is so messed up.

[granddi]

@Puppy Lips I don't think the insurance companies think that the system is messed up. It is working just fine for them.

If everyone had the same system the point of view might be more sympathetic. But corporate coverage, Federal Employees, Railroad Retirees, Military, all have different sets of coverage rules-esp drug coverage. 

[Carmie]

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@Puppy Lips wrote:

My neighbor was in a car accident.  He was in the ER for 4 hours and got his arm stitched up.  The bill was $61,000.  That is insane.  They have insurance. 

The whole health care insurance industry is so messed up.

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I am 100% sure, $61k wasn't paid.  Hospitals bill high amounts, but they don't receive anything close to the amount they bill.

Auto insurance would be primary in any and all car accidents, then medical insurance would be secondary.

He probably had X-rays done as well as blood work and someone had to read the X-rays and labs,plus the ER physicians who stitched him up who may or may not be employed by the hospital want paid too. It would not have been just stitches.

My best guess is that the hospital received a few thousand dollars and wrote off the rest.  

[conlt]

@ScrapHappy I saw a news piece on TV about hospitals etc. charging an facility charge. Even doctors offices. I hope insurance pays for those. I do not know but will educate myself on it. 

[ScrapHappy]

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@conlt wrote:

@ScrapHappy I saw a news piece on TV about hospitals etc. charging an facility charge. Even doctors offices. I hope insurance pays for those. I do not know but will educate myself on it. 

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My area local news has been running a series out health care.  Mostly about patients receiving denials for coverage (but then after it's on the news, they receive an approval).  Also about costs, etc.  One man was being charged $14,000 in facility charges alone and it wasn't for surfery.  It was, I think, for infusions (not chemo).  They interviews the spokeswoman for the hospital (she also represents hospitals) and said if hospitals don't charge a facility fee, that hospitals will go under.  

[gardenman]

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@cjm61 wrote:

@ScrapHappy That sounds crazy. I haven't heard of that kind of charge.

@Winkk No, the insurance company doesn't and isn't required to check the detailed charges. When my husband broke his back years ago he was bedridden for a few weeks. He had plenty of time to go through every detail of his medical charges. One in particular was an $1,800 charge for the drill used to do his surgery. He called the hospital and basically was told that is how much the drill costs. He said if he paid $1,800 for a drill he wanted that drill. They told him not to worry his insurance would pay it. He pushed and pushed, adamantly stating he would not allow insurance to pay if he did not receive this amazing drill. After all, a drill that expensive must be incredible. Well, that charge was ultimately removed and he never got the drill. 

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In general, any tool/device used for a neurological procedure (brain, spine, etc.) gets discarded after use due to the risk of contamination with prions associated with Creutzfeldt-Jakob disease. Prions can't be disinfected like bacteria or viruses, so tools used in those types of procedures tend to be one-use tools and then discarded. 

[Puppy Lips]

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@Carmie wrote:

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@Puppy Lips wrote:

My neighbor was in a car accident.  He was in the ER for 4 hours and got his arm stitched up.  The bill was $61,000.  That is insane.  They have insurance. 

The whole health care insurance industry is so messed up.

---

I am 100% sure, $61k wasn't paid.  Hospitals bill high amounts, but they don't receive anything close to the amount they bill.

Auto insurance would be primary in any and all car accidents, then medical insurance would be secondary.

He probably had X-rays done as well as blood work and someone had to read the X-rays and labs,plus the ER physicians who stitched him up who may or may not be employed by the hospital want paid too. It would not have been just stitches.

My best guess is that the hospital received a few thousand dollars and wrote off the rest.  

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@Carmie Yes, I know all that.  They of course did not pay the $61,000.  But that speaks to my previous comment that the whole industry is messed up.  The medical offices/hospitals/labs, etc. bill highly inflated amounts, get what they can and then have to cover the costs of people who have no insurance at all.

[Carmie]

@Puppy Lips   They actually write off the amount they didn't receive for tax purposes.  They are contracted to get a set amount from insurance companies.

Medicare reimbursements are what what insurance compnies use as their reasonable rates called UCR.