Quote from hope3456
I know this is a complicated subject - but just one example of problems w/ hosp gouging uninsured patients. I just started a new job about the same time I became pregnant. I went to the dr w/o having my insurance card - I hadn't gotten it yet. I got the routine OB lab workup done - which was sent to the hospital lab. I even asked how much this would cost - not knowing for sure if it would be covered by my ins. The phleb. estimated $220. I got a bill in the mail for these labs - $398! However, I was able to send it to my ins and they took care of it. This particular ins. sends a statement including the cost that THEY paid for the services.
They paid the hosp. $77 for the labs.
This country definately needs a single payor health delivery system.
What the public and most nurses fail to realize, is that most providers have negotiared the payment. By providers, I mean physicians, labs, OT, PT, hospitals. I leave out nurses because we do not value our labor enough to negotiate a fair payment. So, the estimate of $220, the bill of $398 and the actual payment of $77, was something that was negotiated long before your lab work was done.
DRGs were the attempt to control cost in Medicare and Medicaid back in the 70s. The insurance companies attempted to use them to control their ever increasing costs. If one were to examine the rising cost, of health care, one would notice that a great deal is spent on capital improvements, i.e. the newest, latest MRI or scanner. And physicians are in on the grab, as well, telling the facility they will not admit, unless xyz is offered. And of course there is always the salaries of upper management. Adding to cost is the different codes and forms that each insurance company demands be used.
Quite simply, you are going to pay more for your heath insurance, you are going to see a continous rise in your co-payment and deductables, and there is little you can do about it. I worked as one of the initial individuals, charged with trying to bring NYS Medicaid cost under control, in 1976. In 2003, they were still attempting to do the same thing. I reviewed hospital charges for concurrent and retrospective reviews, here in Florida, during the 80s. I've spent the last 15 years reviewing my own Medicare bills and have drawn attention several times to errors. Without my knowledge of how the system functions, I would be p----- in the wind.