# The Medical Bill Arrived . . . .



## Kevin (May 5, 2013)

My wife just showed me the medical bill from my little one night stand hospital stay. Get this, since I am married to her, I got the employee discount. I was liking that news. But before she even told me the total we owe, she said we got an employee discount of $11,000! :yikes: 

At this point, I asked her not to tell me anything else. I didn't wanna know. Cause I'm thinking if that was our DISCOUNT, what the heck was the bill? Turns out we only owe $600 and something. Not bad at all. But I noticed on the bill, my CT alone was nearly 9 grand! The CT scan didn't take very long, the MRI was longer but only cost $7 grand. 

We've already paid the various doctors off, but I won't go into their bills for obvious reasons.


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## JonLanier (May 5, 2013)

Wow, the cost of medical help. It just boggles the mind. I really don't know what to say to such a thing.


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## jimmyjames (May 5, 2013)

When my daughter was born there was a $695 charge on the bill for a "dismissal fee", I called around and nobody at the hospital even knew what it was....


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## AustinTom (May 5, 2013)

Kevin said:


> My wife just showed me the medical bill from my little one night stand hospital stay. Get this, since I am married to her, I got the employee discount. I was liking that news. But before she even told me the total we owe, she said we got an employee discount of $11,000! :yikes:
> 
> At this point, I asked her not to tell me anything else. I didn't wanna know. Cause I'm thinking if that was our DISCOUNT, what the heck was the bill? Turns out we only owe $600 and something. Not bad at all. But I noticed on the bill, my CT alone was nearly 9 grand! The CT scan didn't take very long, the MRI was longer but only cost $7 grand.
> 
> We've already paid the various doctors off, but I won't go into their bills for obvious reasons.


The reason to have medical insurance is for the "discount". The insurance company negotiates with a medical provider to establish a price they will pay for a procedure. This price may be pennies on the dollar. For example, I have an insurance EOB where the bill was $3766 but the negotiated amount was $315. It is hard to believe but that is not an unusual discount. If I didn't have insurance I would owe the whole amount. An obvious question is if $315 is adequate in one case then why isn't it adequate in all cases? Why wasn't the billed amount just $315? It is insane.


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## Kevin (May 5, 2013)

jimmyjames said:


> When my daughter was born there was a $695 charge on the bill for a "dismissal fee", I called around and nobody at the hospital even knew what it was....



I am looking for a "fee fee" on my bill. You know, the one where they charge you for charging you. 

:wacko2:


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## Mike1950 (May 5, 2013)

Kathie had back surgery- I think fused 2-3 and 4 with a titanium cage and 6 screws. That hardware was 35K + The bill- Unbelievable- we had insurance but our part was nearly 10K- No matter though -it was worth it......................


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## Kevin (May 5, 2013)

Mike1950 said:


> ... our part was nearly 10K- No matter though -it was worth it......................



:no dice. more please: 

Every last penny. A healthy Kathie is a happy Kathie. A happy Kathie is a happy Mike. A happy Mike is a happy Wood Barter. 

:gigglesign:


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## Kenbo (May 5, 2013)

All I can say is HOLY CRAP!!!!!!!!!!!!

I never realized how expensive it was.


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## davduckman2010 (May 5, 2013)

kevin i went to the emergency room 2 weeks ago for a severe sinus infection the said it was an impacted molar no xrays just looked at me sent me on my way go see a oral surgon with antbiotics and some pain pills. my insurance is 20.000 dollars a year and they didnt cover the bills they said it was dentestry one bill 307.00 the other 456.00 . what a %^&&*%^&& joke.:dash2::dash2::dash2: there getting a call tomorrow someones getting :karate: :diablo:  :ireful: :smack:  oh ya i was in there 45 fricken minutes hmmmm good thing it wasnt an hour


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## Mike1950 (May 5, 2013)

not to get political but we in the US get screwed. we passed on getting pharm coverage. We buy our Pharms out of Canada- same stuff- 25% of the cost- we pay less then the insurance coverage cost.................. :dash2::dash2::dash2::dash2:


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## Mike1950 (May 5, 2013)

Kevin said:


> Mike1950 said:
> 
> 
> > ... our part was nearly 10K- No matter though -it was worth it......................
> ...



Thanks Kevin- She is tough- but the back pain was horrible- They said she would regret surgery for 3 or 4 months and she did. Also told her it would take a year to heal and it did. If you need back surgery get the absolute best surgeon you can find...............


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## SENC (May 5, 2013)

The short explanation is that every payer (Medicare, Medicaid, Blue Cross, other managed care, other commercial insurers) each have their own rules for billing (more accurately for paying, or more accurately yet for trying to avoid paying). For ezample, Medicare may "bundle" supplies and certain other things into a procedure charge whereas Blue Cross may pay MUCH less for the procedure charge and pay separately for the components. When I say they each do it differently, I'm understating it... sometimes the payment rules are different even within a payer depending on the plan. Hospitals and doctors can't setup totally different billing structures for each payer and plan, so have a uniform chargemaster with fees for everything. Part two of the explanation is that Medicare and Medicaid consider it fraudulent to bill anyone less than them - and Blue Cross and many other payers right rules in their contracts with similar prohibitions. In the example above, Medicare might pay $1k for the procedure all-inclusive, whereas Aetna might pay $800 for the procedure and another $800 for the various supplies, drugs, etc. Assuming (for the sake of argument) that the hospital charge $1,600 for the procedure and $1,600 for the other stuf (way oversimplified), it will get paid a little less than 30% of charges by Medicare and 50% of charges by Aetna... but trying to reduce the "charges" to the reimbursement level would result in lower reimbursements because of the way the cockamamie system works.

As a general rule, hospitals' overall margin is <2.5% (more than you would believe lose money). Payer mix makes a big difference. While the following differs dramatically region to region and hospital to hospital (and even more so procedure to procedure within a hospital), it is pretty typical. Medicare pays about 40-50% of charges, which is about 90% of cost of providing the care. Medicaid pays 30-40% of charges, which is about 70-75% of cost of providing care. The uninsured (as a group) pays about 7% of charges (many pay zero, some pay as much as 70% based on ability, most <20%). As you can see, rural or inner city hospitals where a majority if patients fit these groups are struggling. Though Blue Cross, United, and the big insurers in any market are lower, on the avg commercial and managed car pay about 20% higher than Medicare. A hospital with all commercial payers could probably run close to a 20% margin... but for most hospitals the margin on commercial payers makes up for Medicare, Medicaid, and uninsured losses. This is the cost shifting you hear about, and the increasing need due to lowering gov't payments and increasing uninsured/gov't covered lives contributes heavily to hospital pricing.

I reckon that is all about clear as mud, but that is the convoluted mess we have... and expect it to get worse.



AustinTom said:


> Kevin said:
> 
> 
> > My wife just showed me the medical bill from my little one night stand hospital stay. Get this, since I am married to her, I got the employee discount. I was liking that news. But before she even told me the total we owe, she said we got an employee discount of $11,000! :yikes:
> ...


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## DKMD (May 5, 2013)

I could go on for days about how screwed up out healthcare system is... I'll spare you all the misery of reading my rant. 

Kevin, don't spare the details on th doctor bills... I won't get my feelings hurt, and I'd be the first to admit that my bills are as screwed up as any other. I can summarize the entire problem in two words... Government involvement.


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## Mandolin (May 5, 2013)

My bill for breaking my ankle and my tailbone was $8000 plus $1000 to the surgeon for putting three screws in my ankle. My insurance (Blue Cross) paid eighty percent. THAT is the reason I went back to work after I retired from the Police Department. My insurance was going to cost me $1100 per month. I now get it through my job for $50 a month.


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## shadetree_1 (May 5, 2013)

I guess I better not get into the cost of my Linda's bilateral lung transplant. It's flat scary!


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## davidgiul (May 6, 2013)

davduckman2010 said:


> kevin i went to the emergency room 2 weeks ago for a severe sinus infection the said it was an impacted molar no xrays just looked at me sent me on my way go see a oral surgon with antbiotics and some pain pills. my insurance is 20.000 dollars a year and they didnt cover the bills they said it was dentestry one bill 307.00 the other 456.00 . what a %^&&*%^&& joke.:dash2::dash2::dash2: there getting a call tomorrow someones getting :karate: :diablo:  :ireful: :smack:  oh ya i was in there 45 fricken minutes hmmmm good thing it wasnt an hour


Your use of smileys makes me think of the ole Cougar


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## healeydays (May 6, 2013)

DKMD said:


> I could go on for days about how screwed up out healthcare system is... I'll spare you all the misery of reading my rant.
> 
> Kevin, don't spare the details on th doctor bills... I won't get my feelings hurt, and I'd be the first to admit that my bills are as screwed up as any other. I can summarize the entire problem in two words... Government involvement.



Keller,

You forgot the other pieces. Lawyers, and frivolous malpractice suits.

Mike B

p.s. As for Obamacare, this year I like it as I am working for a dental insurance company reworking their systems to work in an Obamacare environment. So it's putting food on my family's table...


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## BarbS (May 6, 2013)

Compared to all you guys' problems, mine are trivial, but just have to add, two weeks ago I went to my dr. for my 6-mo. blood pressure check and labs. One year ago he charged me (uninsured) $130 for a 15-min. consultation and blood pressure reading. This time they were charging over $300, giving me a 'cash discount' down to $282. I was literally in shock, and sent the nurse back in to ask the dr. if he'd coded my billing correctly. He then lowered the code to "level 3 instead of 4" and I only owed $190 for him to read my blood pressure and a nurse to draw a blood sample. The lab work will be billed separately. Last time it was $136, making the total procedure $266 just to check on how my blood pressure medications are doing. This time, the lab work may be hundreds, if the same formula applies. I live on Social Security now, and am 63; will probably end up on gov't. exchange or Medicaid (hateful idea) for two years. Many doctors here are refusing Medicaid patients. The only solution I can see is, "Don't get sick in America!" They sure know how to Raise my Blood Pressure!


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## Mike1950 (May 6, 2013)

BarbS said:


> Compared to all you guys' problems, mine are trivial, but just have to add, two weeks ago I went to my dr. for my 6-mo. blood pressure check and labs. One year ago he charged me (uninsured) $130 for a 15-min. consultation and blood pressure reading. This time they were charging over $300, giving me a 'cash discount' down to $282. I was literally in shock, and sent the nurse back in to ask the dr. if he'd coded my billing correctly. He then lowered the code to "level 3 instead of 4" and I only owed $190 for him to read my blood pressure and a nurse to draw a blood sample. The lab work will be billed separately. Last time it was $136, making the total procedure $266 just to check on how my blood pressure medications are doing. This time, the lab work may be hundreds, if the same formula applies. I live on Social Security now, and am 63; will probably end up on gov't. exchange or Medicaid (hateful idea) for two years. Many doctors here are refusing Medicaid patients. The only solution I can see is, "Don't get sick in America!" They sure know how to Raise my Blood Pressure!



Barb do you get prescriptions out of Canada? It is worth the effort. Northwest Pharmacy.


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## Kevin (May 6, 2013)

Heck Barb get your own BP machine they are not expensive. Even if I wasn't married to a nurse even I can do that. And you can have your own lab work done without a doctor. You also don't need a doctor to read it. The lab gives you the normal parameters for each test. If something is out of whack and you don't know how to address it then you can go see the doc if you choose. 

Lab Work

That's not the company I used several years ago, I used this one to do a prostate cancer profile. Only reason I linked Direct Labs is because I just found them in a search and their prices look really good. But Private Labs MD has a ton of different tests you can use for very specific things you might want to check out. The report you get from PLMD is so detailed and informative, you never get such detail from a doctor. It even gave my likelihood of getting prostate cancer based on a battery of questions I filled out online. 

You can take control of your own health care to a large degree.


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## DKMD (May 6, 2013)

Kevin said:


> Heck Barb get your own BP machine they are not expensive. Even if I wasn't married to a nurse even I can do that. And you can have your own lab work done without a doctor. You also don't need a doctor to read it. The lab gives you the normal parameters for each test. If something is out of whack and you don't know how to address it then you can go see the doc if you choose.
> 
> Lab Work
> 
> ...



Those are interesting web sites, Kevin. I'm going to write those down at the office for folks who might be interested. I don't order much lab work, but it's always nice to know how to save a few bucks. I see that there are affiliated labs where you can have blood drawn, but there's not one in my area... I wonder if they'll accept mail order stuff.

Barb, one other way to get labs done... For free... Donate blood. At least locally, the blood banks offer free lab work with donations. You can help yourself while helping someone else!


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## Kevin (May 6, 2013)

When I had my tests done with PLMD they have an affiliate in Sherman and I just had it drawn when I had to go over there one day to Lowes. I didn't know that about blood banks giving free lab work with a donation David that's good info.


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## EricJS (May 6, 2013)

Kevin said:


> My wife just showed me the medical bill from my little one night stand hospital stay. Get this, since I am married to her, I got the employee discount. I was liking that news. But before she even told me the total we owe, she said we got an employee discount of $11,000! :yikes:
> 
> At this point, I asked her not to tell me anything else. I didn't wanna know. Cause I'm thinking if that was our DISCOUNT, what the heck was the bill? Turns out we only owe $600 and something. Not bad at all. But I noticed on the bill, *my CT alone was nearly 9 grand! The CT scan didn't take very long, the MRI was longer but only cost $7 grand.*
> 
> We've already paid the various doctors off, but I won't go into their bills for obvious reasons.



Kevin, I'm surprised nobody picked up on this - do you think maybe they hit metal?


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## Kevin (May 6, 2013)

EricJS said:


> Kevin said:
> 
> 
> > My wife just showed me the medical bill from my little one night stand hospital stay. Get this, since I am married to her, I got the employee discount. I was liking that news. But before she even told me the total we owe, she said we got an employee discount of $11,000! :yikes:
> ...



:teethlaugh::teethlaugh::teethlaugh:


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## brown down (May 6, 2013)

amazing the prices they charge! when i had bone fusion in my neck, just the room for one night, cost my insurance $60,000, can't even imagine what the whole deal cost and what my neck is worth 

glad you are only dealing with bills kevin and the metal joke was kinda funny as well!!


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## BarbS (May 6, 2013)

Wow, I had no idea those options existed! I'll check it out. And Kevin, I do take BP readings at home, and go to my dr. for the 6-mo. exam and testing because he writes the prescrips for the blood pressure meds. I need to keep updating my med prescrips, so just buying from Canada isn't really the problem. Actually, being uninsured, my Walgreens gives me a very decent price from a special program 'for the poor' I guess. I may go looking for a retired MD who might be practicing out of his home just for such light things. I'm hearing locally there are some leaving the clinics and doing this. And, the blood donation is a Great idea. Thanks!


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## Molokai (May 7, 2013)

Here in Croatia, you pay aproxx 15 dollars a month, and everything is covered, from bed in hospital to all kind of test. 
but only problem, there is always a line for something, like waiting for specialist etc. It can be one month to 6 months. Only in emergency you dont have to wait. 
The hospital and everything is run by government, not private corporations and i hope will stay that forever. Yes, the hospitals are not state of the art, latest technology but... its "free"


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