Health care costs are RIDICULOUS!!!!

CrunchRN, ADN, RN · Jun 16, 2011

I thought that part of the Medicare rules was that providers aren't allowed to bill clients for additional fees beyond what Medicare pays for a particular procedure -- that that was what providers agree to when they agree to accept Medicare coverage -- i.e., that, if a hospital usually charges $10k for a heart cath but Medicare only pays $5k, the hospital or physician isn't allowed to bill the client for the additional $5k. Does someone here know if I'm wrong about that? (I try so hard to keep up with all this stuff ... :))

I would love clarification of this also.

OhioCCRN, MSN, NP · Jun 16, 2011

i think why i was soooo shocked, is that when i had to get my health requirements for Nursing school, a CXR cost me $60 and a complete physical $100 at the local urgicare.... btw... that was before i bought the required insurance.... 2 years ago....

Im simply stunned that health care costs have risen exponentially in just 2 years...

dudette10, MSN, RN · Jun 16, 2011

I thought that part of the Medicare rules was that providers aren't allowed to bill clients for additional fees beyond what Medicare pays for a particular procedure -- that that was what providers agree to when they agree to accept Medicare coverage -- i.e., that, if a hospital usually charges $10k for a heart cath but Medicare only pays $5k, the hospital or physician isn't allowed to bill the client for the additional $5k. Does someone here know if I'm wrong about that? (I try so hard to keep up with all this stuff ... :))

From the most recent version of the Medicare handbook published by the US government:

Depending on the service or supply, actual amounts you pay may be higher if doctors, other health care providers, or suppliers don't accept assignment. Assignment is an agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance (if applicable). Doctors that don't accept assignment may charge you more than the Medicare-approved amount, but they can't charge more than 15% over the Medicare-approved amount. This is called "the limiting charge." The limiting charge applies only to certain services and doesn't apply to some supplies and durable medical equipment.

TheCommuter, BSN, RN · Jun 16, 2011

i think why i was soooo shocked is that when i had to get my health requirements for Nursing school, a CXR cost me $60 and a complete physical $100 at the local urgicare.... btw... that was before i bought the required insurance.... 2 years ago....[/quote']You paid less for your chest xray and physical because you received these services at an urgent care center. If you had received the exact same services at your local ER two years ago, I can almost guarantee that your bill would exceed $1000+. The bottom line is that everything is much more expensive at a hospital.
Many patients come to ERs for nonemergent issues that do not truly qualify as emergencies when they would have been treated in a more affordable, speedier, and appropriate manner if they had visited a doctors' office, public health clinic, or urgent care center in the first place.

psu_213, BSN, RN · Jun 16, 2011

Since certain departments (nursing, environmental services, dietary, maintenance, laboratory, etc.) cannot bill the patient directly for all of the services rendered, the hospital must charge an exorbitant amount for diagnostic tests, supplies, and procedures. The nurses, lab technicians, housekeepers, dietary workers, maintenance people, and transporters are not able to directly bill patients even though they must be paid somehow.
Physicians, physical therapists, speech pathologists, and other professionals provide services that are directly billable to patients. Nursing care is not billable, so where do you think the money to pay us comes from?
Nursing Care = supposedly 'free' and included in the bill
Housekeeping = supposedly 'free' and rolled into the bill
Dietary / Meals = 'complimentary' and rolled into the bill
Maintenance for when your TV breaks or toilet clogs = don't worry, it's included
Phlebotomy / Lab = another supposedly 'free' service that is included
To keep these services 'free,' the patient will be billed $20 for every Tylenol that they take, $50 for each pair of nonskid socks, $100 for every lab draw, $2000 for every XRay, $5000 for every MRI, and so forth. These high costs cover our salaries and wages since we cannot bill patients. The high costs also cover the operating costs of the hospital.

Don't forget the cost of malpractice insurance....

psu_213, BSN, RN · Jun 16, 2011

You paid less for your chest xray and physical because you received these services at an urgent care center. If you had received the exact same services at your local ER two years ago, I can almost guarantee that your bill would exceed $1000+. The bottom line is that everything is much more expensive at a hospital.
Many patients come to ERs for nonemergent issues that do not truly qualify as emergencies when they would have been treated in a more affordable, speedier, and appropriate manner if they had visited a doctors' office, public health clinic, or urgent care center in the first place.

At the rist of getting off topic...young man came to the ED with a "CC" of "drivers license physical." The MD went in to eval him, and told him that we didn't do those exams in the ED, that he would have to go to his PCP. Pt said "I can't get there. I don't have a car or license." When asked why he could not take the bus: "I don't have any money ride the bus." Last I checked, drivers licenses were not free. Talk about a broken system...

irishmama721 · Jun 16, 2011

My son broke his arm on Memorial Day and my ER bill was $3800. Thank heaven for insurance which knocked my out of pocket down to $1600. After almost $26000 in bills last time I had to go to the ER, I was thankful it was so low!

elkpark · Jun 16, 2011

From the most recent version of the Medicare handbook published by the US government:
"Depending on the service or supply, actual amounts you pay may be higher if doctors, other health care providers, or suppliers don't accept assignment. Assignment is an agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance (if applicable). Doctors that don't accept assignment may charge you more than the Medicare-approved amount, but they can't charge more than 15% over the Medicare-approved amount. This is called "the limiting charge." The limiting charge applies only to certain services and doesn't apply to some supplies and durable medical equipment."

Thanks for posting this -- I don't work with Medicare or billing stuff directly, but, as I said, I do try to keep up with at least the most basic, general stuff. :)

Unless I'm reading this wrong, in the scenario posted to which I originally replied, the hospital still wouldn't be able to charge the client the additional $5k, right? Just the 15% "limiting charge," which, in this case would be $750 (15% of $5k), not the additional $5k?

tewdles, RN · Jun 16, 2011

yup health care is ridiculous...

I recently went to ER...had emergency appy...which led to all sort of things like CTs, PETs, and am now waiting for another surgery...

will be filing bankruptcy post op, all because of medical expenses...

but it is good to be alive!

rnay312 · Jun 16, 2011

A total of 100 minutes of radiation to my orbital muscles cost $36,000. Thank goodness for decent insurance. It is absolutely ridiculous. I could have bought a car or two with that money. But I'm thankful my eyes aren't popping out of my head and that I can close my eyes when I sleep! :) (Exopthalmos from Grave's.)

GHGoonette, BSN, RN · Jun 16, 2011

Ok, this is a local story, but it's an amusing one; middle aged lady has a fall out cycling, sustains a cut on her forehead. Family takes her to a nearby private hospital emergency room. Dr comes in, takes one look at her, orders ECG, MRI scan, labs, can't remember what else, until the patient says, "stop, stop, I don't have a medical aid!" Dr does a double take, tells nurse to dress the wound and discharge with paracetamol....

itsmejuli · Jun 16, 2011

The cost of health insurance is ridiculous too with out of pocket costs rising every year.

What are you paying for health insurance, for how many people, and what is your total out of pocket expenses for the year?