Originally Posted by Mom of Franz
Well it's not really shock, but I'm really mad. Just got a bill from my recent stay at NYU Medical Center...well as they say "This is not a bill", and it isn't since my insurance will pick up 100%. But of course I DO PAY. However, for 6 days in the hospital, on a psych unit, meaning no fancy tests, IVs or special care, the bill is $19,000.00. Now if I didn't have insurance I guess I would be suicidal, huh? I've only been in the hospital once before for minor hand surgery and never saw a bill as I was an employee there, so I don't know how much that was. But I am sick and tired of the ever increasing cost of health care.
I pay our of pocket $130.00/month for meds, my Dr gives me samples when he can. However if I did not have insurance it would cost me $920.00/month. I'm not just mad for me, but for those worse off than me, the poor and the elderly. The poor, who aren't "poor enough" to qualify for medicaid.
And I'm sorry to make this political, and I am NOT an isolationist by any means, but we are traipsing through a country now (Iraq) without much of a plan in a culture that in my view, will not accept democracy and spending billions. Yet here at home, we have thousands upon thousands of homeless and poor. NYC has 17,000 homeless children alone, what is wrong with this country. I am sick of the insurance companies, the pharmaceuticals, the lobbyists and the politicians. Okay sermon over.
This is a bit more convoluted than it seems as well. The $19,000
very likely represents "gross charges", which are in the hospital's billing system for every single thing that they do. They are there to some degree to show resource use among different types of hospitalizations. If you have insurance, at least in NYS, they don't represent what the insurance company pays, at all. I would be surprised if they paid the hospital much more than $1,000 a day. Most insurances companies in NYC (other than Medicare and Medicaid) negotiate per diem rates, which are all inclusive of everything done, with the exception of things like expensive implants, get added onto the bill. Insurance companies however, as well as the Medicare program which pays on its on system, will still tell you that they 'covered' the high charge number on your explanation of benefits. "Covered", not paid.
Prior to the late 1990's, NYS did not allow insurance companies to negotiate rates for inpatient care. Blue Cross & Medicaid paid a calculated cost-based rate, which varied by hospital based on its costs not its charges. Commercial insurance companies (Prudential, Aetna etc) paid 113% of the Blue Cross rate. Uninsured patients were charged 120% of the commercial insurance rate, or charges, if they were lower. When the insurance companies were allowed to 'discount', beginning in the late 1990's, they paid less (and still generally do) than Medicaid does to hospitals here. (I'm not referring to physician fees here, just hospital payments.)
That was bad enough, in terms of the uninsured patients, but nowadays, patients with no insurance are simply billed 'charges' which generally bear no strong relationship to cost, because they are an artifact of an old system, where charges were not used for billing purposes. I was curious to read recently that Eliot Spitzer was looking into these practices (similar to a class-action lawsuit which has just been filed in the midwest) since at least in the not-too-distance past, the higher amounts billed to uninsured patients were legislated by state law.
Way back when, before so many people became working-uninsured, as well as people who lost insurance because they lost their jobs, the 'theory' behind charging a 'self-pay' patient more was that if you were poor, you qualified for Medicaid, so otherwise, you were just opting to take the risk of not paying for insurance today, which you might not regularly use. That of course was before it cost more to insure a family than many of the working uninsured make, and the 'self-pay' person was viewed as more likely to be someone from South America flying (legally) to NYC for specialized care. It was also before many states made significant changes in Medicaid eligibility, which either eliminated recipients or reduced the period of eligibility.
My personal view is that we are not likely to have universal healthcare in the US for a long time because no one wants to take on the insurance industries. There is a large amount of money which stays in the insurance companies when premiums are made, for payments to shareholders and bottom-line profits. In addition to the politicians who don't give a rats-patootie about the uninsured, I think they are also afraid of what will happen in the financial markets.
Reining in the pharmaceutical companies is another matter. The other day, I was in an MDs office listening to an insurance rep invite his office staff out to dinner (not the MD) at a local steakhouse. I paid almost $1,000 in drug co-pays last year. I'm glad to know that people are at least eating well on that.
Sorry to be so long winded!