I just went through $27k of hospital bills. Insurance is NOTHING but organized crime

[Horse with no Name]

I pay between $7-8k a year for insurance.
I pay $20 co-pay for PCP, $30 for specialists.

In going through these bills....this is the breakdown.


Billed amount: $27,483.47
Eligible charges: $4924.63

So, right off the bat...the insurance company gets to WRITE OFF $22,558.84 for contractual obligation.

So, that $4924.63 that is "eligible", I paid out of pocket $1730.48 and the insurance company paid a whopping $3194.
Now...the REAL fun comes if you DON'T have insurance. There is nobody to bargain these prices for you and you end up getting fucked and paying full price.

This is ridiculous.:mad:

[seeker4ever]

1. Sing it! I Just Got My $33k Bill!

Fuckin' BULLSHIT!

[JVS]

2. If Unions were to carry that kind of clout in the labor market, they'd be illegal.

[Mythsaje]

3. Oh, yeah...

I went into the ER with migraines a couple month back (after a week of dealing with them). My insurance company wrote me to ask if they were WORK related (to foist them off on L&I, I imagine). I was like "They're fucking MIGRAINES. Even if they WERE work-related, how in the hell would you prove it?"

Ugh. Gawd, I hate the insurance companies.

[Rosa Luxemburg]

5. yes I got one of those letters too

mine was a sore foot.

[sandnsea]

11. We got one about a car trailer

If the trailer had been connected to the car when he got his hernia, the auto insurance would have been liable. Mind you, he wasn't even sure he got it unloading the trailer and only mentioned it in passing along with a bunch of other things he had done that day, but somebody must have written it down and that was all it took.

:crazy:

[YewNork]

23. Did you expect anything else?

I guess they want you to come back when you can prove that they're not work related.

Like anything else, their job is to not pay, and they're going to check every option.

[smalll]

4. Um, you get PCP through your health plan?

Not a good idea. There's a thread in LBN right now about some guy on PCP out in California who chewed out one of his 4-year-old son's eyes.
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=102x3884130

[Godhumor]

12. PCP = Primary Care Physician

Not drugs.

[Dorian Gray]

24. Funniest

subthread I've seen in a thread in a long time!

[nadinbrzezinski]

6. When my dad broke his hip it was impressive

they don't have the insurance, another scam, involving another country. Regardless, we got a 20% ahem discount, because brother is a doctor at the cleveland clinic, and knew some of them damn tricks.

Suffice it to say I knew before we need the health care... but the companies, and the hospitals, are blood suckers. And as long as we have health care for profit...

[imdjh]

7. I paid cash not too long ago

I wanted to see a specialist outside my HMO. My primary wouldn't authorize it- so I called the specialist (at a hospital practice) to ask how that would work. The woman on the phone said, "No problem - if you pay AT TIME OF SERVICE it's about $30 for the visit." I was stunned. The practice normally billed my old PPO plan about $180 for the office visit. On both my PPO and my HMO, the copay for specialist was $25. So for three bucks more (it was actually $28) I saw the doctor without insurance.

[truedelphi]

14. That scenario varies. For instance, if the drs' office has negotiated with one of the local

HMO's, they might only charge that HMO's clients some $ 24 a visit - a deal that gets negotiated when the clinic is starting out and wants to be sure that there will be customers.

IF no one negotiates the deal, then, like you say, the insured might be paying more than the uninsured.

[Ms. Toad]

32. That is very unusual

We were headed for surgery a year out with my daughter. She needed her wisdom teeth out about a year before they could do jaw surgery so the bone had time to heal. The doc dropped my insurance company shortly after he took wisdom teeth were taken out, but didn't bother to tell us until we called to schedule the surgery.

His office wanted to charge about $10,000 for the surgery. The insurance was willing to pay about $2000. His office was willing to give us a slight discount, but nothing close to the $8000 discount he had negotiated with the insurance company.

Fortunately, we found another doc in plan.

Even more fortunate, he turned out to be a much more gifted surgeon. He had to operate in a hospital that was not his usual hospital because of our insurance restrictions, so the staff was not familiar with his work. He told us the surgery would take about two hours. The hospital staff (used to working with other surgeons) insisted it would be more like 6 hours - since that is how long the surgery typically lasts. He was back to us before the two hours was up. The staff who worked with him reported that he was the best they had ever seen. The original doc had told us that both upper and lower jaws would need surgery to make them align properly - the new doc only did surgery on the lower jaw (and they are perfectly aligned - her orthodontist was very impressed). My daughter went to school less than a week later and no one even noticed she had had surgery. Her friend (who used the surgeon we had planned to use) had a much rougher time when she had her surgery about six months later.

So - I'm glad you had a good experience with paying cash - but that is really atypical. With an in-plan doc, we ended up paying about $200. With the original surgeon, with a discount, we would have had to pay $6000-$8000 (we never got far enough in the negotiations to pin down a precise amount)

[HamdenRice]

33. I think I know why -- the risk of non-payment

I have a close family friend who is a doc, and she says that something like 1/3 of all billing gets written off either because the patient doesn't have the money or the insurance co stiffs them.

Another 1/3 is administrative cost -- a room full of people filling out forms, accountants, and managers.

If you pay cash, they can charge you the 1/3 that the service actually costs.

[Abecca]

8. Response to Insurance is organized crime

Sometimes there are companies that empathize with the plight of high insurance fees and they pick up the tab. In this economy, you should be thankful though that you can afford insurance- that is a blessing.

[tavalon]

20. It should be a right, not a blessing

[Jack Sprat]

9. Something new using PPOs.

PPOs are normally used to save you some money. But now I'm being billed from lab doctors I've never heard of. My insurance carrier doesn't pay a cent on those bills. They say they are out-of-network. WTF?

[Double T]

10. The medical and health care profession is a division of organized crime.

To make it even worse, these criminals are being supported by our congress and president.

[SammyWinstonJack]

39. Nice! Some great change there.

x( What do they care, really? They've got their health care plans, courtesy of the taxpayers, many of whom can't afford health care insurance. Why can't we, at the very least, have what they give themselves?

[sakabatou]

13. I'm under COBRA right now

I hope my family can cover me as a dependent due to brain damage or I can get covered by other means in the near future.

[philly_bob]

15. Dems lose in 2010 without REAL health care reform.

and that includes a public single-payer option available to everyone.

[WCGreen]

16. And then the whole working class will begin to unravel....

even more than they are now.

[TwilightZone]

43. No, they will not.

The Republican Party is shuffling off to irrelevancy. Unless you're aware of some other party that is going to come to power in 18 months, Dems will continue the '06/'08 trend and will make further gains in Congress in '10.

Health care reform is extremely important, but it is not the only issue at hand, and it is certainly not enough on its own to alter the decline of the Republican Party in the short term.

[philly_bob]

49. I discourage talk of a "permanent Democratic majority." Reminds me of Rove.

What happens if the hope of '08 is frustrated? A third party? Ron Paul takes over Republican shell? A split within Democratic ranks?

I just think politicians can not afford to alienate their base. On the health care issue, the American people are saying one thing, the insurance companies are saying another, and at least some Democrats seems to be listening to the insurance companies.

Here's hoping Obama gets health care reform right, and the Democratic Party adds seats in 2010.

[TwilightZone]

50. I said nothing about permanency.

I was specifically addressing the claim that we will lose in '10 because of health care.

Not going to happen. Not even the Republicans believe so. In fact, some of them are already talking about '12 being a lost cause: http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x5692881

Plus, the average voter is generally more patient than we are.

[philly_bob]

51. Correct, TZ, you did not say 'permanent'. I did.

Cuz I was quoting Rove to warn against complacency, and pointing to how Republican complacency preceded their fall.

I mean, how certain are we really of Democratic victories in '10 and '12, TZ?

I checked a Prediction Market site, and they have a 86% chance for Dems in '10 and a 67% chance for Dems in '12. http://www.intrade.com/jsp/intrade/contractSearch/#

I was surprised. I'm much less certain than that, giving Dems maybe 59% chance in '10 and 55% in '12. That's why I discourage complacency and pray that Dems keep their progressive base energized on issues like health care reform.

[TwilightZone]

53. Barring a complete meltdown, I'm very certain.

Granted, anything can happen, but there are simply no indications that the Republican Party is any threat whatsoever in '10. They're in complete disarray and the heads of the party at the moment are Rush, Palin, and Newt. Oh, and Cheney, who pretty much everyone detests, including most Republicans.

Their party affiliation is at the lowest level in decades, ours is at its highest, and independents are leaning more Dem than ever. Polls show that the public associates with us more, trusts us more, and Obama's approval ratings are solid. The pessimism shown on DU re: Democrats simply isn't shared by the public at large.

[philly_bob]

54. Hope you're right. Really do. But maybe it's just post election afterglow.

If I remember correctly, Bush's father had popularity in the 90's after Kuwait and then lost his base -- and the next election.

Incidentally, I don't limit threat to Dems to only the current Rush/Palin/Newt/Cheney Republican party, pathetic as it is.

I'm also looking at outcomes like a Republican Party taken over by Ron Paul Libertarians, or Democratic splits between corporatists and progressives.

I'm a "Glass is half empty" kind of guy, TZ. Just saying, everybody: let's not get complacent.

[eridani]

17. I hope everybody is contacting Obama and congressional representatives on this

At least weekly. Daily if you can.

[datasuspect]

25. they don't listen anyway

they laugh at us. all the way to the bank.

[SammyWinstonJack]

40. Exactly!

[MindPilot]

18. My dentist told me he could cut his fees by half, maybe more

if he didn't have the dealing-with-insurance overhead.

[Saphire]

30. Same thing my hospital told me about my 78K bill. They would

cut the bill by 45% because I don't have insurance. I see the scam. Unfortunatly, I don't see how I'm going to pay the balance.

[eridani]

46. PLEASE tell this to Obama at the White House hotline

Also congresscritters.

[Saphire]

48. Just tried to, but they wanted a credit card and donation. Screw them.

http://my.barackobama.com/HealthCareOrganizing

[eridani]

58. Then tell them why you aren't donating. Also

--the comment line is free, and so is the email contact.

[armyowalgreens]

19. I spent three days in the hospital and it cost 23,000.

Thank god our insurance covered the vast majority of it.

The medical and insurance industry is really nothing more than organized crime. I don't understand how a 72 hour stay in a hospital could cost most than a car.

[elleng]

21. A GROUP policy?

Groups have to be smart AND really negotiate on behalf of YOU/US. And when we have choice of policies, we have to be smart about which we choose.

If the group or we don't exercise our power and/or smarts, we're all screwed.

[YewNork]

22. Can't afford insurance but can't afford not to have it

People against universal health care are quick to point out that you can't be denied medical treatment even if you can't afford to pay for medical insurance or pay cash for the medical treatment.

But, they never bring up the fact that you will STILL BE SENT THE BILL even if you can't afford to pay for medical insurance or pay cash for the medical treatment.

The bill doesn't go away, and if you have to sell your house or deplete your retirement savings - too bad, so sad. You'll be told that you should have had insurance.

[RJ Connors]

26. No Kidding!

It is part of the middle class enslavement institution.

[rucky]

27. Now tally up all the premiums you've paid over the years...

plus interest you'd have earned if you kept that money in the bank.

[Pavulon]

28. OP READ THIS!

Insurance claims are always open to re-evaluation. I suggest taking the bills and EOB paperwork and going through it all LINE by LINE with a claims administrator. If you are unable to do this due to illness you can have a family member help, as long as you start the call.

I have done this with my parents and ended up having the insurance company pay thousands of dollars originally left off due to "error". How a procedure is coded impacts payment. Recoding can be done if the provider made an "error".

Insurance sucks but it should be predictably bad. You should be able to determine you exposure before any claim is made. Depending on how it was purchased your agent or plan administrator should be able to explain your liability in a way that is clear.

Glad you are still with us and hope the situation resolves its self.

[Wednesdays]

29. K&R

:kick:

[harun]

31. Looters, just like the banks.

[WolverineDG]

34. I almost had to declare bankruptcy for what Humana did to me a few years ago

They actually paid the claim (shock) but a year later, determined that my surgery wasn't "necessary," so asked for (and got!!!) their check back. So the hospital starts dunning ME! Well, that was $6000 I didn't have, so I didn't pay. Ignored all the warnings about my credit rating because my credit is shot anyways, then I get a call saying they'd settle for $600, which I had & so I paid.

Fuck Humana.

dg

[deaniac21]

35. They wrote 22,558.84 off your bill and you are unhappy....wtf

[nichomachus]

38. The point is

that someone without insurance would have had to pay the full amount -- not the "negotiated amount" that the corporations pay.

[Horse with no Name]

44. because these "built -in" discounts

are bullshit.
I've been on the other side of the coin without insurance before.
There are no discounts for uninsured comparable to the ones they give FOR insurance.
I care about the Ponzi scheme, not the fact that I am "fortunate" enough to have insurance at this time.

[dugaresa]

36. Oh I hear ya!

[nichomachus]

37. Three hours in outpatient dept. = $24,000

I had to have a lesion removed from my vocal cords.

I went in at 2 p.m. They put me in a johnny and stuck an IV in my arm. I waited about an hour. They wheeled me into the treatment room, gave me the anesthesia, snip-snip, wheeled me out. A nurse took my BP, gave me a cup of ice and a tissue. I was in the car in the parking lot at 5 p.m.

Total $24,000 -- and that didn't include the doctor. My insurance paid $17,000.

The really maddening thing is that this is a rip-off medical corporation (which owns both hospitals in our area). A good friend is a physician who works for a medical insurance company on the east coast (I'm on the west coast). He was appalled when I showed him the bill. He went through it item by item. He said that on the east coast, the charge for what I had had done would have been no more than $3,500.

[L0oniX]

41. The crime is that our gov spends the money on war and banksters rather than SPHC.

[chill_wind]

42. K & R. n/t

[pleah]

45. K&R Yes they are.

[Raster]

47. But remember, we can't have single payer health insurance...

...no, no, no! Those excruciatingly wealthy insurance executives need those multi-million dollar bonuses, multi-million dollar stock options and multi-million dollar golden parachutes.

Look at it this way, for every chronically ill patient that they can kill before they have to treat, they add thousands to their bonus pool.

[shadowknows69]

52. I'm into various emergency rooms for about 10K

for about 5 minor visits, routine blood work and one several day IV treatment. I keep just telling the bill collectors that when I can get on disability or SSI then they'll start getting paid. I suspect someone will pass a law letting them pillage my wife's paycheck for it eventually. Not saying I don't owe it, but as you said. I "technically" paid cash so I got billed top dollar.

[earth mom]

55. And Congress is talking about taxing our health care!

As far as I'm concerned they are ALL criminals! :grr:

[hfojvt]

56. Why do you say that insurance is organized crime?

It seems to me that the doctors and hospitals who are charging $27,000 for something they can do for $5,000 - those people are the criminals.

You also seem to be complaining about your costs, when it seems to me that the insurance saved you $25,752.99 from your bill.

I am surprised at the level of write-down too. My hospital bill was $13,900 and the insurance company paid $12,400 and I paid $400. So the hospital got $12,800 from a $13,900 bill.

My knee surgery was more unbalanced, since they billed something like $4,000 and the insurance company paid something like $1,200.

[OHDEM]

57. $10K for ONE NIGHT in Peds ICU

The prices are INSANE and worse still you have to try to weed thru the bills and figure out what they didn't cover and if they should have paid it. As KO would say - WTF??

It's so frustrating that I don't even know who to blame for it all!

[Stellabella]

59. Yes they are.

I just don't understand why nobody has 'gone postal' on an insurance company. They are thieves and murderers.