Why Medical Bills Are Killing Us
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Topic: Why Medical Bills Are Killing Us
Posted By: 123Donna
Subject: Why Medical Bills Are Killing Us
Date Posted: Feb 22 2013 at 8:28pm
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This Time article is definitely an eye opener. A must read about what's wrong with our medical system today. Bitter Pill: Why Medical Bills Are Killing Us Read more: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2LgIopRip" rel="nofollow - http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/#ixzz2LgIopRip ------------- DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09) 11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15 |
Replies:
Posted By: debB
Date Posted: Feb 23 2013 at 1:52pm
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Donna, Thanks for posting this. A friend sent it to me and I read through it yesterday. It is a long read, and parts are too sadly familiar to me. I don't know where medicine is headed in this country but it sure is currently a mess! Deb ------------- Dx 4/29/11, 46 yrs old, 3.9 cm tumor, Stg 2 Grade 3 chemo 4 rounds DD AC, 12 weekly taxol, finish. Lumpectomy, 2mm residual tumor. 37 rounds rads completed. Cisplatin/PARP trial |
Posted By: tjm
Date Posted: Feb 23 2013 at 11:28pm
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Going to pick the magazine up tomorrow, as I have heard a lot of discussion about this article. Our medical bills have really been tough to handle, but feel blessed that we have health insurance though my husband's work.
This year our co-pays, deductibles, out of pocket and the amount they deduct for our insurance out of my husbands check has gone up.
Used some money from my 401K, in 2012, to get caught up, and this came back to hurt us when we did our taxes this year.
It is hard to win for loosing.
Wish there was a magic wand we could wave and everyone would have coverage and it would be the same for all.
Traci ------------- Dx.6~30~11~TNBC,Stage 4 mets to lungs, BRAC neg,Since Aug.2011, Taxol & Avastin,NED 3~1~2012,4~2~12 Mastectomy,5~17~12 New lesion lung, Taxol & Avastin, New Hilar LN lesion,starting Gemzar & Carbo |
Posted By: MsBliss
Date Posted: Feb 26 2013 at 2:24am
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Donna, Again, many thanks for posting this link. Eye opening, but not surprising. The Medical Industrial Complex dwarfs the Military Industrial Complex. That got my attention. Bliss ------------- Dx 3/09 stg1 BRCA neg, 1.4cm IDC + 7mm DCIS, ki67 70 -90%, lump w/re-ex for margin, no chemo/no rads due to delays from secondary health issues; SonoCine every 6 months plus CAM interventions |
Posted By: Charlene
Date Posted: Feb 26 2013 at 9:25am
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I was just about to post about this Time Magazine special report when I saw it was already here. Boy, have I learned a lot. For example:
1. The chargemaster that hospitals use to set prices has no relationship to what it actually costs the hospital to provide the service in question.
2. The president of M.D. Anderson makes 3 times what the president of the entire University of Texas system does, while also maintaining financial ties to pharmaceutical companies. Oh, and M.D. Anderson's operating profit for 2010 was $531 million.
3. Non-profit hospitals are not really non-profit--I actually made a $100 donation to one last year--never again!
4. And, worst of all, what we all knew and still allow to continue in this country, is that those least able to pay are the ones who pay the highest rates.
I'm only about halfway through, because the entire magazine is devoted to this topic, but I am totally disgusted with what I am reading.
Charlene ------------- DX 3/10 @59 ILC/TNBC Stage 1, Grade 2, Multifocal; Lumpectomy/re-excision SNB 0/4 nodes, BRCA-; Taxotere/Cytoxan X4, 30 rads 3/14:NED |
Posted By: 123Donna
Date Posted: Feb 26 2013 at 10:13am
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Charlene, Thanks for posting your comments. I'm going to get the Time magazine. It's definitely an eye opener. My husband, who hardly ever reads magazines, told me he wants to read it. Well this past weekend we were at the grocery story and while checking out I remember to look for it. The only magazines at the POS were the People, US, Tabloids. I couldn't find one Time or actual "news" magazine. What a sad reflection on our society (IMHO). All I could see were faces of the Kardashians or Angelina. I didn't have time to go to the magazine aisle and search for the Time magazine, but definitely will this week. I agree that what I find most sad is the people least able to pay for medical services are the ones without insurance. They aren't afforded the luxury of having their services negotiated down like others that have insurance. They get to pay the exorbitant fee, which they can't afford. This is just not right. Donna ------------- DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09) 11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15 |
Posted By: debB
Date Posted: Feb 26 2013 at 10:48am
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Donna and Charlene, I am one of those self-employed people who buy my own policy so I have NO bargaining power. We have a good BCBS policy, however, the doctors at the 'better' local hospital are not PPO. The year I was diagnosed, I had a hysterectomy two weeks prior to finding my lump so I also had those bills. I had chemo in a hospital room instead of the big beautiful cancer center. I went six hrs out of state when surgery when the hospital didn't want me to incur more bills and were going to want approx 6k up front for my lumpectomy. I had me pre-treatment MRI there before i knew better and it was a full 2k more than the same MRI I had post-treatment literally down the stret. I went across town for radiation to yet another facility and they nearly botched the focused rads. Now I go two and a half hrs out of state to get quality in-network care. Last summer when my son shattered his elbow we ended up an hour and a half away to get good in-network care and go there every three months for follow-up. Crazy. When it came to trying to negotiate down the hospital bill, they take the stance that you know you we're out of network, so you have to pay the full bill. Their own billing person tells me the average discount insurance companies get is 40%. When I look at discounts on my own in network billing, many times it is more than that. After hours of chasing my tail (and beating my head against the wall!), they offered a 20% one time discount if I paid the bill IN FULL. Not paid in full, pay the full freight. They have an assistance program but we are just barely over their limit. And as the article said, all the while, they put up new state of the art buildings. We rarely used our insurance before because we were afraid of increasing our premiums, but now we are stuck with it and the skyrocketing premiums forever! So, while the uninsured who can afford it least get socked, so do the so-called 'underinsured'. Very, very frustrating. I surely don't have the answers, but this system is broken. Stepping down from my soapbox now! Deb ------------- Dx 4/29/11, 46 yrs old, 3.9 cm tumor, Stg 2 Grade 3 chemo 4 rounds DD AC, 12 weekly taxol, finish. Lumpectomy, 2mm residual tumor. 37 rounds rads completed. Cisplatin/PARP trial |
Posted By: Charlene
Date Posted: Feb 26 2013 at 10:50am
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Steven Brill, the author, appeared on the Charlie Rose show last Thursday, Feb. 21. It is available online. I had to subscribe to Time Magazine because, several months ago, I wanted to read an article by Joe Klein on end-of-life care issues that he had faced while caring for his parents. I was not able to find the magazine even at Barnes and Noble, so I subscribed to get access to the article.
Charlene ------------- DX 3/10 @59 ILC/TNBC Stage 1, Grade 2, Multifocal; Lumpectomy/re-excision SNB 0/4 nodes, BRCA-; Taxotere/Cytoxan X4, 30 rads 3/14:NED |
Posted By: mainsailset
Date Posted: Feb 26 2013 at 11:14am
Deb, what you are describing is much like what I've gone through. I've been able to get some help through the Affordable Care Act that has been coming online gradually since  it was passed in '11. You can access it at HealthCare.gov and I've started several threads with updates here at the Forum. One of the things that it does is deny insurance companies from rate hiking so horrifically for us pre existing folks. It's unfortunately one of those things that until you are hit with an illness you have no idea how rotten it is to survive the bills much less the disease! Best of luck to you. Mainyps Here's a clip where Brill is on a discussion panel, it's a really great clip and then it's worthwhile looking at the commentary below http://crooksandliars.com/karoli/steve-brill-shows-george-will-who-health" rel="nofollow - http://crooksandliars.com/karoli/steve-brill-shows-george-will-who-health I agree with the author that it does not help the discussion to try and turn it on its ear to blame those who get sick! On the other hand, the comment Brill brings out that lowering Medicare to say age 60 would actually lower Medicare costs (much as a single payer system would) is something we should have a discussion about. pss Here's also a discussion with Ezra Klein on Brill's article, (Ezra is my go to analyst for Health Care) and the suggestion is that govt rate oversight is a good start http://www.washingtonpost.com/blogs/wonkblog/wp/2013/02/23/steven-brills-26000-word-health-care-story-in-one-sentence/" rel="nofollow - http://www.washingtonpost.com/blogs/wonkblog/wp/2013/02/23/steven-brills-26000-word-health-care-story-in-one-sentence/
------------- dx 7/08 TN 14x6.5x5.5 cm tumor 3 Lymph nodes involved, Taxol/Sunitab+AC, 5/09 dbl masectomy, path 2mm tumor removed, lymphs all clear, RAD 32 finished 9/11/09. 9/28 CT clear 10/18/10 CT clear |
Posted By: Charlene
Date Posted: Feb 26 2013 at 12:18pm
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Deb,
What you describe is exactly like what is communicated in the article. You can only get a discount if you pay in full upfront and if you are slightly over their income limits for assistance, you are SOL (excuse my acronym.) And, what I also learned from the article is, just as you say, the non-profits are putting their revenue into more buildings, etc. that are not needed. In addition, what we hear about the amounts that Medicare pays not being enough to cover the true costs is simply not true. It's just not the amount required to provide the profit margins that are desired.
Charlene ------------- DX 3/10 @59 ILC/TNBC Stage 1, Grade 2, Multifocal; Lumpectomy/re-excision SNB 0/4 nodes, BRCA-; Taxotere/Cytoxan X4, 30 rads 3/14:NED |
Posted By: Lee21
Date Posted: Feb 26 2013 at 1:26pm
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I am still plowing through the article; what I have read so far makes me very angry that the hospitals, drug companies and medical device companies are getting a free ride and there is no indication that they will ever get reined in. Last summer, I got a pathology review at a premier West coast medical facility -- I Fedex'ed the slides there and a pathologist reviewed them. The first indication that something was not right was when I received the "Estimate of Benefit" statement from BCBS showing that they received a claim for $2455 for hospital services and that they are denying the claim because the hospital filed the wrong forms. I didn't pay that much attention because previously that particular hospital had send claims to BCBS of Michigan rather than BCBS of California (who then sends the claim to BCBS Michigan) and it would be quickly settled. I was rather surprised by the total cost and the charge for hospital services (use of the microscope??). I thought perhaps pathology had done additional slide preps or new marker studies because I had asked my oncologist in California about them. It turns out that all that was done was review of the path slides that was sent to them. I had a similar pathology review done in a NCCN facility in Indiana and the total cost (chargemaster) was $660 but all covered since it was in-network. We called the hospital and said they must have made a mistake because it should have been coded for pathology consultation not hospital services. They said they will file it again. All they did was to file the same hospital services claim and needless to say the claim was denied. This happened another two times and every time billing said this is how they do it in California. Meantime I received a bill from the hospital that I owed them the full amount. I was in constant communication w/ BCBS of Michigan and they told me that if the hospital filed the proper claim forms, it would be completely covered. They also contacted BCBS of California to have them deal with the hospital there. But nothing seems to be happening. Finally in November, 3 months after the whole thing began, I wrote to the CEO of the hospital, the chairman of the Path department and someone in billing recounting the whole sorry story. I didn't hear anything from anyone until the end of January when someone from billing finally wrote and said that I was correct, it should be coded for path consultation, not hospital services and that I don't owe them anything. I am glad it turned out the way it did, it could have happened the way the Time article described and I would have no recourse but to cough up $2455 for something that should have been completely covered. With electronic billing, it is so easy for hospitals to over code and over charge. If others on the forum have similar encounters, don't cave in! Go to the top (email and contact information all public record). I am positive if I haven't taken the final step of writing to the top honchos, I would have to pay the 2+K, knowing full well that the hospital was just plain gouging hapless patients. ------------- 12/9/11 @59,IDC,grade3, TNBC,3cm(MRI),SLNB0,stage IIA, BRCA1 variant 1/30/12 DD AC-T, 6/7/12 Lumpectomy, ypT1b(0.8 cm), 7/9/12 Rads x 30 11/9/12, clinical trial cisplatin/rucaparib, cisplatin-only arm |
Posted By: tjm
Date Posted: Feb 26 2013 at 3:20pm
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Donna, thanks so much for posting this article. I had been hearing people talk about it, but the magazine was sold out in the 2 stores we went to. That tells you this is an important topic for a lot of people.
Even though I am a nurse and have worked as a care manager for cancer patients, when you are in the middle of the system, it can truly be a challenge.
I love it when I can read what others have tried, because this helps teach me what else I can check into. This is something I learned from a friend that saved us over $600.00 just this month.
Last year I had to have an upper and lower GI scopes. I checked and made sure that the doctor, facility and anesthesia they used were all in our network. Because of my previous chemo and surgery, our plan was paying at 100%. Everything went great and all the bills came in correctly, until we got the bill for lab/pathology. They were out of network and wanted to charge us over $600.00. I called the lab/pathology company and explained that everything else with my procedures was in network and that I did not understand why the lab wasn't. The doctors that owned the facility did not get along with the local hospital were the lab normally would have been done and covered at 100%. She said they would talk to my insurance and pay at the in network rate. I told her it should be paid at 100%. Well I got a bill for 20% of the charges. So i call back and remind them that the claim should have been paid at 100%. The next bill I received was for $0.
One other thing I learned as a care manager, is that at times insurance companies will negotiate your benefits. For example we had a patient that had no hospice benefits, but had skilled nursing benefits. The insurance company traded the skilled benefits in for the hospice benefits. Another time all the patient needed to go home was a hospital bed. She had no benefits through her insurance company. After discussion they decided it was a lot cheaper for them, for the patient to have a bed at home, than be in one at the hospital. A social worker or case manager is always available at the hospital to help folks out in these situations. ------------- Dx.6~30~11~TNBC,Stage 4 mets to lungs, BRAC neg,Since Aug.2011, Taxol & Avastin,NED 3~1~2012,4~2~12 Mastectomy,5~17~12 New lesion lung, Taxol & Avastin, New Hilar LN lesion,starting Gemzar & Carbo |