Scorpion sting leaves Arizona woman with huge bill

[Nine]

Source: Associated Press

PHOENIX (AP) — An Arizona woman is wondering what hurt more: getting stung by a scorpion or seeing her hospital bill after treatment.

Marcie Edmonds says the bill from Chandler Regional Medical Center was more than $83,000. That includes two doses of anti-venom at nearly $40,000 per dose.

The Arizona Republic (http://bit.ly/RD6bX8) says Edmonds' insurer has paid more than $57,000 and the suburban Phoenix hospital is asking Edmonds for the balance of about $25,000.

Chandler Regional says Edmonds' bill represents the out-of-network costs for her treatment.

Read more: http://news.yahoo.com/scorpion-sting-leaves-arizona-woman-huge-bill-225717487.html

---

This was an insured American. Pharmacies in Mexico charge $100 for a dose of the antivenom. Tell me there's nothing wrong with healthcare in this country.

Read the original AZCentral article for more information: http://www.azcentral.com/business/articles/20120831scorpion-sting-leaves-woman-big-bill.html

[snappyturtle]

1. Why do the politicians keep ignoring this elephant in the room?

Seems to me that tptb only makes efforts to construct programs to satisfy the extortion our medical dollars. Although, maybe, with the recent refunds of insurance companies to customers is at least a small symbol of recognitiion of this problem.

[Blue_Tires]

7. Because politicians already get the best free care

and most of them are multi-millionaires anyway, so they could scratch out $80,000 checks like it's nothing...

[Selatius]

2. Not sure about hospitals in Mexico, but in the United States, hospitals exist to make a profit.

Because her insurer Humana did not have an agreement with that hospital as far as being in Humana's network, the hospital was free to charge as much as the market can bear in her case.

The hospital has shareholders seeking profit and executives to pay, after all.

[Mrs. Ted Nancy]

5. The hospital is non-profit

She went to Chandler Regional Medical Center. From their website:

"Chandler Regional Medical Center, a Dignity Health Member, is a 243-bed, acute care, not-for-profit community hospital providing innovative and exceptional healthcare to East Valley residents."

The poison control center told her to go to the nearest hospital with scorpion anti-venom. If you have ever been bitten by a scorpion, you don't weigh the cost/benefits of going to an out-ot-network provider....you just go to the hospital.

[Pat Riot]

10. Don't be so sure

Our biggest system here in Pittsburgh, UPMC, claims to be nonprofit, even though their CEO makes over 200 million a year. Our public schools and transit problems would be "cured" if they'd pay their fair share. I mean just because they say they are...40 grand vs. a hundred bucks?

[hughee99]

22. The CEO of UPMC makes $200 million a year? HOLY SHIT!!!

That's almost twice as much as the guy who topped Forbes list of highest paid CEO's in the US.

http://www.therichest.org/business/highest-paid-ceos-in-united-states/

#1 Stephen J Hemsley - UnitedHealth Group
Salary and bonus: $3.3 million
Stock gains: $ $98.6 million
One-year total compensation: $102.0 million

[PA Democrat]

23. UPMC spent a lot of money to build their newest hospital in Monroeville

less than a mile from Forbes Regional Hospital. That area does not need another hospital and UPMC did this for no other reason than to work toward their goal of a monopoly on health care in this region. They have been buying up doctors' practices in droves as well and soon your only choice will be UPMC.

As someone with Highmark insurance and a preexisting condition, I was really angry with the prospect of UPMC and Highmark's contract negotiation impasse. I guess we have a temporary solution, but UPMC needs to be reined in. UPMC set rates for hospitals and doctors' charges and are one of the region's two largest health insurers as well. Gee, what could go wrong? All UPMC has to do is raise their rates for medical CARE to justify raising the rates for their health insurance plans. Refuse to negotiate rates with your largest insurance competitor and you have a nice little monopoly.

[sendero]

18. Non-profit..

... means NOTHING. It means only that there are no shareholders collecting profits. "non-profits" ROUTINELY pay their executive exhorbitant salaries and waste money in many other ways.

Just so you know, non-profit DOES NOT MEAN charitable, not at all.

I heard that the supplier of the antivenom said they charge $400 a dose for this medicine. This is just another example of the ridiculous and indefensible billing practices of hospitals, who enter into contracts to charge $1000 to an insurance company for a procedure and then charge the uninsured $20000. It is bullshit and it has to stop.

[xxqqqzme]

43. Poison control

didn't tell her to 'shop around'? The rethugs always suggest this is the best way to cut costs.

The cost of the anti-venom is hard to grasp. Scorpion stings are not all that uncommon in the southwest.

[Hassin Bin Sober]

25. Apparently, the market can bear a lot when your respiratory system is failing.

[bad sofa king]

3. I wonder what the bill would have been if she were uninsured? I'm guessing less.

so long as there's someone willing to pay ridiculous prices like this, there will be someone willing to charge ridiculous prices like this. The entire industry is built up around this principle unfortunately and changing it, at this point, is probably not possible as hospitals would end up going out of business and that would just exacerbate the problem.

[yardwork]

11. The bill would have been the same if she were uninsured.

The hospital would have had to write off a lot of the bill as uncollectible, but not before ruining the woman's credit.

You're exactly correct that the for-profit insurance industry has created this problem.

[hedgehog]

26. I suspect the bill would have been HIGHER!

Hospitals set their charges unreasonably high for those who pay cash. This gives them a starting point when insurance companies come in to negotiate lower fees. One more example of how screwy our system is!

Come to think of it - that may be why ER charges are so high - who stops to get pre-certified when they have a heart attack?

[The Wizard]

4. America's failed health care

exposed. Until and unless the shysters who impose this kind of extortion are indicted, convicted, incarcerated and injected......
And then again we have the Affordable Health Care Act (Obamacare) to curb these kinds of abuses.

[wilt the stilt]

6. was this considered out of network?

because if it was here is the law.


4. Coverage of Emergency Room Services

Effective for plan years beginning on or after September 23, 2010, a group health plan or health insurance issuer that, with respect to non-grandfathered coverage, covers emergency room services is required to cover such services when provided by an out-of-network provider without the need for prior authorization and without regard to any term or condition of the coverage (other than (i) a permitted waiting period or (ii) applicable cost-sharing requirements). Administrative requirements or limitations on coverage for out-of-network emergency room services may be no more restrictive than the requirements that apply to in-network services. Furthermore, cost-sharing cannot exceed the cost-sharing that would apply if the services were received in-network. (PHSA § 2719A). This mandate is subject to the excepted benefits exclusion, retiree-only exclusion, and Code section 4980D penalty, all described at Section IV.A. above.

http://www.lexology.com/library/detail.aspx?g=e874b2e3-0b65-44eb-8472-e6bebd4a600c

[dixiegrrrrl]

19. That applies to ER services...

I am wondering if the woman was inpatient when she got the anti-venom
and
it appears the exhorbitant cost of the 2 anti venom doses was most of the bill.

[Nine]

20. So who decides what gets treated in the ER and who is considered "in-patient"?

If a patient goes in with a scorpion bite, that, to me, is an emergency service. Why should a hospital or any medical facility be allowed to define that as anything else?

[dixiegrrrrl]

28. Your question has 2 answers, I believe.

"So who decides what gets treated in the ER and who is considered "in-patient"?"

Generally, for a "walk in" patient, one goes to the ER for evaluation and stabilization.
ER is considered "outpatient" for many insurance companies.
The ER docs determine if inpatient treatment is needed.

Put another way, the bite is considered an emergency, requiring evaluation, patient stabilization, and treatment determination.
Once a course of treatment is determined ( and this can be done rather quickly in some cases)
inpatient treatment may be necessary.

Insurance companies usually define what constitutes ER services and what constitues inpatient services.
I know Medicare does.

[Liberal Veteran]

8. The whole "out of network" thing is so bizarre.

Like your first thought when you get bitten by a venomous critter, have a traumatic injury, or sudden life-threatening illness like a heart attack or stroke, your first thought should be "is the hospital in my network"?

[Richard_uk]

9. Glad I left Arizona

I lived in Arizona for 20 years, the hospital in question is run by Catholic Healthcare of the West, it is a non-profit, I have worked there it is a great hospital. When I lived in Arizona I was paying for family health insurance, prescriptions a co pay every time I wanted service and uncovered costs like the one above.

I now live in England, I pay 7% of my salary on National Insurance. For that I get free access to my doctor, free hospital visits regardless of the treatment required, health check ups (free), prescriptions again free (not everyone gets this otherwise they would cost about $12 a month) and a state pension!!! Also, my student son is covered for no extra cost (so free again) as he would have been covered if he were simply unemployed. While the British national health service is not perfect, it makes the US system look like a cruel joke. Luckily there a no scorpions here, but should I be so unlucky to be stung by something very nasty, the last thing that I would have to worry about is money.

I still find it strange to walk out of my very nice doctors surgery without anyone asking me for money. God bless the British socialists of the 50's (yes we have had this for over half a century) for coming up with the NHS.

[Tikki]

12. HI Richard_uk Welcome to DU..

We are working at it. Someday future generations of Americans
will shake their heads in disbelief of our past health insurance coverages.


Tikki

[janlyn]

13. Hear,Hear

Thank you sir,
I agree with you whole heartedly! I did the exact opposite as you and was born in Cambridge UK,lived there for 6 yrs. and then we moved to Arizona. Culture shock LOL!!

The one thing I truly wish we had here was a health system where people either get access to health care in a tax similar to the UK or at least Insurance that would cover expenses!!!

I am in need of a joint replacement surgery on my jaw that my current insurance provider does not cover, and even the ones I found that would, have a premium of 700 dollars and leave me with 30,000 out of pocket!!!



I am one of millions and that is truly a crime against the american people!!

[slackmaster]

14. It could have been MUCH worse. Look at what a scorpion sting did to this poor little dog...

[otohara]

15. Comment on FB - A Lear Jet to Mexico

would have been cheaper.

http://www.facebook.com/ChandlerRegionalMC?ref=ts

[otohara]

16. If It Weren't For Social Media

they'd get away with this shit!!

They are now revising the bill:

http://www.azcentral.com/arizonarepublic/business/articles/2012/09/05/20120905bill-scorpion-bite-reduced.html#ixzz25fJfoVVU

[lonestarnot]

17. Damn, someone needs to warn that woman to keep her distance from R Pie Hole!

[Uncle Joe]

21. Kicked and recommended.

Thanks for the thread, Nine.

[SoapBox]

24. K & R

[Rider3]

27. No more "For Profit" Healthcare

My title says it all. We need to take the profit out of healthcare.

[StarryNite]

29. Scorpions are all over the Phx Metro area.

I had one on my patio last week. I've had them in the house. It's not as a scorpion encounter is a rare thing. I don't see how they can charge anywhere near that much money...it's criminal.

[surrealAmerican]

30. $40,000 per dose?

I wonder how much the hospital is paying for anti-venom.

[Posteritatis]

31. If Mexico's charging $100 that implies something about the scale of the markup. (nt)

[surrealAmerican]

33. I'm kind of curious just who's doing the mark up.

Is it the hospital, or their supplier?

[Posteritatis]

34. Almost certainly both.

A lot of pharmaceutical companies will sell medication in poorer or more developing countries at prices which are high locally but still (mostly) affordable; the nature of those companies means they wouldn't be doing that if they couldn't turn a profit from it. Well, maybe exceptions for something media-friendly like HIV medication, but antivenin is pretty mundane by comparison.

Ridiculous hospital markups go without saying, of course. Don't three or four digit charges for tylenol happen there now and then?

[Nine]

36. from the Arizona Republic (azcentral.com) article:

http://www.azcentral.com/business/articles/20120831scorpion-sting-leaves-woman-big-bill.html

The hospital, owned by Dignity Health, charged her $39,652 per dose of Anascorp.

The Arizona Republic reported last year about the pricey markup Arizona hospitals were charging for the antivenom made in Mexico. Pharmacies in Mexico charge about $100 per dose.

After the Food and Drug Administration approved the drug last year, Tennessee-based Rare Disease Therapeutics sold the drug to a distributor for $3,500 per dose. The distributor charged hospitals about $3,780 per dose.

The Republic polled several hospitals in November, finding that hospital charges for the serum ranged from $7,900 to $12,467 per vial. At the time, Chandler Regional declined to tell The Republic how much it charged for Anascorp.

So...

$100 per dose in Mexico
$3,500 per dose by Tennessee-based Rare Disease Therapeutics
$3,780 per dose by unnamed middle-man distributor
$39,652 per dose by this hospital

$7,900 to $12,467 per vial at other Arizona hospitals but I don't know how a vial relates to a dose

[JustABozoOnThisBus]

39. Based on the link in otohara's post above, $3780

Why? Do you think a markup of 1100% is exhorbitant?

[L0oniX]

32. Vampires! ...sucking the life blood out of our people!

[Kali]

35. why the fuck did she even need that?

I get stung at least a couple of times a year - and by centruroides no less. WTF?

[phantom power]

37. different people react differently to the venom

[StarryNite]

38. Yup...

some people even die from the sting.

[Kali]

40. not very many

if she was a healthy adult there was no reason to get antivenin

at the most she could have been watched for a few hours.

OK I read the article, she had pretty severe symptoms. I wonder how much was just panic because of inexperience.

That is a hell of a mark-up on the part of the hospital, if they are giving much out it must be making up for some major losses elsewhere. jeebus!

maybe I should start catching scorpions and go into business. anybody got the recipe?

[StarryNite]

41. I don't get the impression she was

panicking. She said she hadn't even intended on going to the doctor until the severe symptoms began.

[Nine]

42. Why do you assume they are making up for losses elsewhere?

See the upthread discussion about "not-for-profit" hospitals and how much their CEOs make.

Meanwhile, plenty of good-hearted, well-intentioned people volunteer at hospitals, not realizing they are just padding the wallets of CEOs.

[raccoon]

44. I never thought of that...you have a point. "plenty of good-hearted, well-intentioned people

volunteer at hospitals, not realizing they are just padding the wallets of CEOs."