$180,955.40

That’s the FIRST Charge we have seen from my wife’s lumbar laminectomy http://www.spine-health.com/treatment/back-surgery/lumbar-laminectomy-open-decompression.

I suppose I should start by saying that it has now been a month since the surgery and she is walking and doing normal little things that we all take for granted until we have to have someone else do them for us. i. e. dressing, bathing, primping, light household functions like folding clothes, taking the dog for a short yard walk. The prognosis is very good, 70% improvement in the spinal column. We are thankful & hopeful for the procedure at this juncture. It is too soon to tell yet about the level of recurring pain but we are hopeful now, whereas before there was no longer hope of a pain free life.

I look at the bill, which is just the hospital bill, not the surgeons nor the anesthesiologist, nor other specialist that will pop up along the way and I wonder exactly what it means in terms of who gets what. Medicare has paid $19,969.83, we have paid $283.00  and our insurance has been billed. This bill shows a patient balance of $817.00 but of course no one pays the first bill until the insurance company pays what they pay and there’s a bit more time to figure out exactly what we absolutely have to pay. I’m betting it isn’t much more than we have paid because that’s what the doctors and hospital told us when we very pointedly asked for numbers.

So what really happens to the “adjustment” of $158,168.28? Is that a total write off or how does the hospital recover anything and what portion do they recover? What are the true costs of the hospital and how is their billing regulated and validated? Are there standards and measures that hospitals and Doctors are required to follow? Does our newly created health care reform deal with any or all of these issues? Do the politicians who have prostituted their votes for reform know the answers to these questions or are they only concerned with anecdotal sound bites that helped sway the emotions of their electorate?

See, when we talk about healthcare there is so much that is not understood by so many it is clear that most of us don’t have a clue how the system really works, so intelligent argument is almost an oxymoron. I know my wife and I paid for Medicare for decades and also made intelligent and judicious employment decisions to assure a lifetime family insurance package with a premium covered through pension.

So when I hear smart people tell me we need reform I say, why man, why?  How will this reform affect what just happened in our lives? Is it gonna change the insurance we have in anyway and how do you know? If you can answer my question about what happens to every penny of the adjustment then I will listen to your theory, if you can’t then you don’t understand anymore than I do.

I believe in Newton’s Law of Motion that every action has an equal and opposite reaction. I am watching with considerable interest/concern to see what happens next.

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5 Responses

  1. I think these “charges” are not much different than “MSRP.” In other words, a fabrication without basis in reality, other than to make someone think that they ‘saved” a ton of money. You “saved”; Medicare “saved” and insurance “saved.”

    I was at a medical place with my wife this week. I overheard another patient being told the owed $25 for a procedure. He said he thought it was covered by insurance. They said it is covered; that the $25 is the co-pay. The “full” price, for some sort of injection, is $1,000. Riiiight….

  2. I am happy to hear that your wife is feeling better. All I can say is that the health care industry is similar to defense. Everything is over priced and nobody knows where the money goes.

  3. OK after several days of (boring) research I think I get it now, kinda sorta understand what the hospital bill means in the total scope of it all. But one should be aware that my personality testing reveals that I deal very well with ambiguity, right off the charts.

    Hospital pricing is about as ambiguous a practice that man has ever devised. There is such a thing as a chargemaster, which is best defined as a price list of services. How chargemaster prices are determined is more art than science. It is done through a strategic analysis of all the services for all the stakeholders for every hospital. It does not reflect the actual cost of service nor recovery of cost, but instead positions the hospital to deal with all payers and meet their mission’s goals (hospital). The hospital uses this chargemaster to negotiate pricing to all payers which includes medicare, medicade, insurance providers, insured and uninsured patients. These costs are subjected to government sanction on a general basis. They are seldom available for the consumer to see, and now I understand why. They make no sense at all to the consumer, just like my initial reaction was stunned amazement at such an overwhelming “adjustment.” So medicare pays a low %, insurers pay a higher %, uninsured are billed with the idea to charge what they can reasonably pay and the wealthy take a hit if they’re not on medicare.

    This model is unique to healthcare in the US it seems. It does seem to work, but it also has a lot of undisclosed transactions occurring which is a little disconcerting after what we have all lived through. Just imagine walking onto a car lot and the salesman tells you he has a lot of different prices for the same auto, depending on what your situation is. So don’t be upset that the MLP is $250,000 that’s only if you are rich. If you are middle class you can have it for $35,000, and if you are destitute, you can have it for mmmmmm “how much you got?’ Except if your dealership is “quotad out” this month, then you might have to go to a lot that has less overhead and uses cheaper technicians. Or you just might have to wait a while.

    I don’t know how or if healthcare deform ( I didn’t even get red line on that) addresses this nor do I have a clue if it will help or hinder this process but as long as I can have a $250,000 car for a small deductible I ain’t gonna squawk any more.

    So it’s kinda sorta working and it is ambiguity personified, but I get it.

  4. I meant to respond before your reply above, and so you take much of the wind out of my sails 🙂 But I really wasn’t going to say much political anyway. The whole health care billing system is bewildering. You get a bill from the hospital and the surgeon and think you have it all under control, and then the bill comes in from the lab, the anesthesiologist, the radiologist, the cook, and the gardener. You get dizzy. I tried very hard in the beginning to sort it all out–I made different files for each provider and how much I had paid each, etc. but it was hopeless. It made me crazy that I had to sort through all that when I was least able to focus.
    Reform will certainly not address simplification…I imagine it will get even more complicated. At least when you buy a car, you don’t get bills from the company that made the tires, the company who made the battery, the company who made the…well you get my point.

  5. >At least when you buy a car, you don’t get bills from the
    > company that made the tires, the company who made the
    > battery, the company who made the…

    If the auto industry follows the airline industry…who knows?

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