Health care costs are RIDICULOUS!!!!

dudette10, MSN, RN · Jun 16, 2011

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?

My interpretation of what I posted: once Medicare assignment is accepted, there can't be a "limiting charge." Limiting charges are only imposed when the facility/HCP does NOT accept Medicare assignment. In the original scenario, it looks like the facility did accept assignment.

dudette10, MSN, RN · Jun 16, 2011

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

Our health insurance for employee + spouse + 2 or more children is $527.40 q2wks. We pick up $200.80 of that cost, and the employer pays the rest. We have an HMO. Office visits are $50 each, and most things are covered at 100% with varying copayments, as long as we follow HMO procedures (getting referrals, approvals, etc.).

For example, a major trauma that involved three members of my family cost around $350,000 ten years ago. We paid a couple hundred dollars for co-pays.

Most of our out-of-pocket expenses yearly are related to dental, although we have dental insurance. We have two children, both of whom are orthodontic patients, and that comprises the majority of our OOP dental expenses. It's covered at only 50%, and a treatment plan can run more than $5000 with full compliance to instructions.

Mulan · Jun 16, 2011

Regarding the original post about medicare, there is so much misinformation posted on these sites.

KatieMI, BSN, MSN, RN · Jun 16, 2011

Do not forget to add costs of "defensive medicine". I'd broke my toe couple of weeks ago while rollerskating and then had 30-min. battle of the words in order to avoid stat MRI of the brain. The "diagnostic reasoning" (if it could be named so) was that there was some "hospital protocol" requiring ALL patients with acute trauma of whatever origin to undergo the said MRI, as well as several blood tests and ECG.

Well, I can imagine that sometime someone can sue an unfortunate doctor for "pain and suffering" inflicted by missing diabetes which "could" (and that's very much of "coulds") potentially lead to poor healing of the minor trauma or infection of some sort. But later on I'd calculated that the said protocol would add close to $5000 to my very own bill and I question that my insurance would pay for those diagnostic exercises.

eagle78 · Jun 16, 2011

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

Ok, but if they accept assignment according to this there is to be no additional charge other than the Medicare deductible and coinsurance. Did that combination make up the other $5000??

chellelynn25 · Jun 16, 2011

My boyfriend was recently in the hospital for almost 3 weeks. The total amount of his stay was almost $170,000!

Granted he spent the majority of his time in the MICU for 3,100 a day. Not to mention the stents that he had placed in his aorta we about 20,000 a pop and he had two of them. He also had a chest tube placed and those drainage systems are expensive! Not to mention numerous CT Scans, blood draws and chest x rays.. Plus for every 30 cc of Malox they gave him for his heartburn cost 4 dollars and some change a pop! It is craziness how hospitals can charge the patients that go them for help. Even if they do or dont have insurance.. Kinda scary!!

psu_213, BSN, RN · Jun 16, 2011

I'd broke my toe couple of weeks ago while rollerskating and then had 30-min. battle of the words in order to avoid stat MRI of the brain. The "diagnostic reasoning" (if it could be named so) was that there was some "hospital protocol" requiring ALL patients with acute trauma of whatever origin to undergo the said MRI, as well as several blood tests and ECG.

I think I would politely inform them that I would be going to a different hospital for a my future emergency needs. :smokin:

dudette10, MSN, RN · Jun 16, 2011

Ok, but if they accept assignment according to this there is to be no additional charge other than the Medicare deductible and coinsurance. Did that combination make up the other $5000??

From the Medicare handbook:

Emergency Department Services
When you have an injury, a sudden illness, or an illness that quickly gets much worse. You pay a specified copayment for the hospital emergency department visit, and you pay 20% of the Medicare-approved amount for the doctor’s services. The Part B deductible applies.

Part B had a $137.50 deductible (I think that amount is correct...it's close) in 2010. 2011 deductibles are a little bit higher, but not by much.

Supposing that the $10,000 ER visit was 1) accepted as a Medicare assignment and 2) the Medicare-approved amount was $5,000, then 3) the most that could have been charged to the patient is $1000 + $137.50.

If the patient had Part B supplemental through a private company, it would pick up the other 20% that Medicare Part B didn't cover. Therefore, the total bill would be only the $137.50 deductible for Medicare Part B.

ETA: The Medicare handbook is updated annually. It's fairly easy to read. Here's a link if anyone is interested.

http://www.medicare.gov/publications/pubs/pdf/10050.pdf

conroenurse · Jun 16, 2011

The thing that I wonder abt is how did hospitals cope BEFORE the insurance covered alot of us. I know that when I had my babies (so MANY yrs ago) we paid cash prior to admit. It was alot, but not unaffordable, and also had my Dr bill paid off, also in cash. Now days I don't believe a minimum wage earner (which was what my ex was at the time) could even come close to making enough pymt's to pay it out before hand. I believe INS. companies own us all, (the USA) and we all end up paying so they can be profittable...IMO of course.

I just think we created a monster and he is eating us!!

eagle78 · Jun 16, 2011

From the Medicare handbook:
Part B had a $137.50 deductible (I think that amount is correct...it's close) in 2010. 2011 deductibles are a little bit higher, but not by much.
Supposing that the $10,000 ER visit was 1) accepted as a Medicare assignment and 2) the Medicare-approved amount was $5,000, then 3) the most that could have been charged to the patient is $1000 + $137.50.
If the patient had Part B supplemental through a private company, it would pick up the other 20% that Medicare Part B didn't cover. Therefore, the total bill would be only the $137.50 deductible for Medicare Part B.
ETA: The Medicare handbook is updated annually. It's fairly easy to read. Here's a link if anyone is interested.
http://www.medicare.gov/publications/pubs/pdf/10050.pdf

Thank you for clearing that up for me and also for the link.

Anne36, LPN · Jun 16, 2011

Agreed, that has been my cheif complaint for a while now. Its not JUST the fact that my health insurance premiums have been 800/mo for the past 2years but the fact that after that, I cant even afford utilize my insurance and go to the Dr for anything because it is so expensive and then I will get hit with my 20-30% of the bill because insurance does not pay it all, + the deductibles.

I went to the Ear Dr because I was very sick with an acute ear infection and chronic fluid buildup, that visit alone was $500 and $175 was MY share!

It doesnt even matter if you do or dont have insurance anymore, either way its unaffordable to go to the Dr. Im not even taking thyroid meds anymore because of this.

TheCommuter, BSN, RN · 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?

I'm uninsured. I find it ironic that I provide care to patients, but I cannot even afford to receive the same care if I ever needed an inpatient or outpatient stay at my workplace.