Post by Deleted on Aug 13, 2013 22:59:37 GMT -5
Remember my deal about a $36,000 appendectomy for my daughter and the hospital didn't even bother to bill insurance? Here is how it works.
Info from here: dailyreckoning.com/why-you-should-take-your-health-into-your-own-hands/
But, how is this reconciled??
Her story matches mine nearly exactly
This total lack of price transparency allows for this.
That is not all of the story, though.
And I benefitted unwittingly, unknowingly and without any possibility for choice. I don't believe in handouts, I'd never ask for a handout & I don't want to receive them, but got one anyways. And the hospital scammed the taxpayers.
What?? The employer pays?? Well... if you really think about it, NO.
I know how to solve this problem, but Obamacare ain't it.
Info from here: dailyreckoning.com/why-you-should-take-your-health-into-your-own-hands/
We’ll expose the scams that make U.S. health care the costliest in the world.
New Yorker Beverly Weintraub is one of the “lucky” ones. She has employer-provided insurance.
Last year, her teenage son choked on a piece of turkey. He spent four hours in the emergency room — a physical exam, sedation, endoscopy and removal of the offending poultry.
For these services, the hospital billed her insurance company, Aetna, $22,214.92.
Aetna agreed to pay only $2,885.67. And the hospital cheerfully settled for that amount. Ms. Weintraub was out of pocket about $800.
New Yorker Beverly Weintraub is one of the “lucky” ones. She has employer-provided insurance.
Last year, her teenage son choked on a piece of turkey. He spent four hours in the emergency room — a physical exam, sedation, endoscopy and removal of the offending poultry.
For these services, the hospital billed her insurance company, Aetna, $22,214.92.
Aetna agreed to pay only $2,885.67. And the hospital cheerfully settled for that amount. Ms. Weintraub was out of pocket about $800.
But, how is this reconciled??
Being employed as a reporter for the New York Daily News, she set out to find answers.
Her story matches mine nearly exactly
“There are the sky-high costs that a hospital will claim reflect its expenses, and the much-lower fees it accepts under contract with insurance companies.”
“What’s missing from this complex web,” Weintraub writes, “is any hint of what the services a patient received actually cost.”
That’s by design. For the U.S. health care system is yet another mechanism of “extraction.” “Washington’s empire,” economist Paul Craig Roberts reminds us, “extracts resources from the American people for the benefit of the few powerful interest groups that rule America.”
“What’s missing from this complex web,” Weintraub writes, “is any hint of what the services a patient received actually cost.”
That’s by design. For the U.S. health care system is yet another mechanism of “extraction.” “Washington’s empire,” economist Paul Craig Roberts reminds us, “extracts resources from the American people for the benefit of the few powerful interest groups that rule America.”
This total lack of price transparency allows for this.
“The rates that insurance companies pay,” Weintraub writes, “are negotiated based on what they believe a hospital’s true costs are. But then those rates are jacked up an average of 30-50% to make up for money that hospitals lose in treating patients who don’t have private insurance — which is the majority of them. So to make up the difference, they overcharge patients who are insured. This practice is called cost-shifting.”
That is not all of the story, though.
Cost-shifting takes place in the form of two insidious scams, patiently described to us by Dr. G. Keith Smith, an Oklahoma City MD who’s doing his level best to undermine the practice.
The first scam is called “uncompensated care.” To understand how it works, it helps to know a rough breakdown of who is treated in a typical hospital:
About 50% are covered by either Medicare or Medicaid… which don’t pay for the full cost of treatment
About 10% have no insurance at all. For obvious reasons, they too typically don’t pay full freight
About 40% have private insurance. They carry the burden for the other 60%.
At the end of each year, many hospitals collect money from an “uncompensated care pool” — funded by federal and state taxes and typically administered by a state government. “That creates the perverse incentive for hospitals to issue fictitiously insane bills,” says Dr. Smith.
“Let’s say they charge $100 for an aspirin for which they pay a penny. They collect $5 [from insurance], and claim they lost $95. That $95 goes into the ‘uncompensated care’ pool and helps them get this rebate at the end of the year.” It also, Smith explains, helps many hospitals maintain the fiction of not-for-profit status.
If you’re a taxpayer, you pay for this.
The first scam is called “uncompensated care.” To understand how it works, it helps to know a rough breakdown of who is treated in a typical hospital:
About 50% are covered by either Medicare or Medicaid… which don’t pay for the full cost of treatment
About 10% have no insurance at all. For obvious reasons, they too typically don’t pay full freight
About 40% have private insurance. They carry the burden for the other 60%.
At the end of each year, many hospitals collect money from an “uncompensated care pool” — funded by federal and state taxes and typically administered by a state government. “That creates the perverse incentive for hospitals to issue fictitiously insane bills,” says Dr. Smith.
“Let’s say they charge $100 for an aspirin for which they pay a penny. They collect $5 [from insurance], and claim they lost $95. That $95 goes into the ‘uncompensated care’ pool and helps them get this rebate at the end of the year.” It also, Smith explains, helps many hospitals maintain the fiction of not-for-profit status.
If you’re a taxpayer, you pay for this.
And I benefitted unwittingly, unknowingly and without any possibility for choice. I don't believe in handouts, I'd never ask for a handout & I don't want to receive them, but got one anyways. And the hospital scammed the taxpayers.
The second scam involves the insurance scheme known as preferred provider organizations, and is called “PPO re-pricing.” Here too there are perverse incentives: Insurance companies, contrary to popular belief, have zero desire to keep costs to a minimum. “The bigger the bill the insurance company receives, the more money they make,” says Dr. Smith.
“If a large hospital submits a bill to an insurance company for, say, $100,000, and the insurance company pays $22,000 of it, the insurance company then goes back to the employer who provides this insurance product to the employee and says, ‘Look what we did for you; we saved you $78,000.’ The employer, as part of his contract, pays the insurance company a percentage of that fictitious savings.”
“If a large hospital submits a bill to an insurance company for, say, $100,000, and the insurance company pays $22,000 of it, the insurance company then goes back to the employer who provides this insurance product to the employee and says, ‘Look what we did for you; we saved you $78,000.’ The employer, as part of his contract, pays the insurance company a percentage of that fictitious savings.”
What?? The employer pays?? Well... if you really think about it, NO.
If you have employer-provided health insurance, you pay for this. Were it not for the insurance company’s cut, you’d have a bigger paycheck.
I know how to solve this problem, but Obamacare ain't it.