Apr 27, 2012

Hospital Math: Emergency Room Outlandish Overcharges

The bizarre calculus of emergency room charges

Readers share their experiences about the bewildering fees charged by hospitals. Even medical professionals can be baffled by the way costs are determined.

By Steve Lopez, LA Times

March 31, 2012, 8:16 p.m.

Debbie Cassettari had outpatient foot surgery to remove a bone spur. She arrived at the surgery center at 8 a.m., left at 12:30 p.m., and the bill came to $37,000, not counting doctor fees. In recovery now from sticker shock, she's waiting for her insurance company to do the tango with the clinic and figure out who owes what to whom.

Gary Larson has a $5,000 deductible insurance plan, but has found that his medical bills are cheaper if he claims he's uninsured and pays cash. Using that strategy, an MRI scan of his shoulder cost him $350. His brother-in-law went to a nearby clinic for an MRI scan of his shoulder, was billed $13,000, and had to come up with $2,500.

Kaiser member Robert Merrilees had a colonoscopy at an affiliated surgery center, which charged $7,500. His co-pay was $15, Kaiser picked up $470, the rest of the bill "just went away." Merrillees was left scratching his head over the crazy math in medical billing.

There is lots of head-scratching out there, and stories like these have poured in from across Southern California and beyond since I wrote last week about an 11-year-old girl and her $5,000 trip to an emergency room with a stomachache.

I heard from medical professionals who said fear of lawsuits leads to lots of play-it-safe tests and procedures. And some doctors and nurses argued that emergency rooms have to charge high prices because it's extremely expensive to operate them 24 hours a day.

No doubt. But the larger point in last week's column was that the calculus for medical charges in general is beyond comprehension, with outrageously high fees used as a starting point in a bizarre game of bargaining. Glenn Melnick, who teaches hospital finance at USC, told me it's as crazy as if he asked to buy the TV in my living room, and I gave him a price of $1 million to start the conversation.

This is the kind of insanity that exists when medicine and medical insurance are about private profit rather than public health, when 50 million people are uninsured, when Medicare and Medicaid reimbursements don't always cover true costs and when polarized politics prevent the kind of reasonable discussions that could lead to solutions.

In the case of Ella Moser, her grandfather — a physician and Yale professor who has written about medical overcharging —questioned the procedures that were done and the fees that were charged when she was treated in October at Providence Tarzana Medical Center. You can't talk about rising healthcare costs and healthcare reform, he argued, without making both of those elements part of the discussion.

Ella's father, John Moser, had a $5,000 deductible plan with Cigna, and had taken Ella to the hospital to rule out appendicitis. Nothing serious was diagnosed, and Ella went home to a quick recovery. Her dad got a bill for nearly $5,000 from the hospital, as well as bills for $540 from a pathologist and $309 from the doctor who treated her.

Like Moser, lots of patients are surprised to get separate bills like that, unaware that a hospital's doctors can be independent contractors. It's like going to a Laker game, paying $150 for a ticket, and later getting an additional $75 bill in the mail from Kobe Bryant.

Because of Moser's deductible, Cigna paid no part of his bill. But the company's contract with the hospital includes agreed-upon discounts, and those were passed on to Moser.

Just entering the emergency room had been billed at $1,288, for instance, but Moser paid Cigna's negotiated rate of $682.64. The total charges, nearly $6,000, ended up costing him closer to $3,000.

But like his father, the doctor, Moser was left with lots of questions. How can you trust a business that bills you $1,288 but is happy to collect $682.64? Is the second number also arbitrary and perhaps artificially high? Hospitals argue that list prices are high to compensate for patients who don't pay, but how can any patient on that spectrum know whether he's getting a break or being ripped off?

A single-payer system would address some of this nonsense, but forget it. Even President Obama's watered-down healthcare reform act, which may well die on the Supreme Court's operating table, couldn't be passed if it came up for a vote now.

Joseph Mondy, a Cigna spokesman, had some tips for anyone trying to avoid medical bankruptcy from an emergency room visit. Contact your health plan's on-call nurse for advice on whether you need to visit an emergency room, consider a less expensive urgent care clinic if one is available, go to an in-network emergency room if possible and ask the doctor to explain why certain tests and procedures are necessary. Good advice I'm sure, but there's not always time for all that in a genuine emergency.

Dr. Phil Schwarzman, medical director of the emergency department at Providence St. Joseph Medical Center, said 15 million of the nation's uninsured people live in California, and he sees lots of them. From his front-line perspective, he finds it unconscionable that so many Americans have been driven into bankruptcy from medical costs, and he thinks mandated healthcare for everyone would restore some sanity to pricing.

And he speaks not just as a physician, but as a consumer.

Schwarzman has an insurance plan with a high deductible ($7,000). Like Gary Larson (the guy at the top of this column), Schwarzman also paid about $350 for a scan on himself that would have cost much more if he went with his insurance company's negotiated rate. A couple of years ago, his daughter needed an ultrasound for a possible gallstone. If he'd gone through his insurance company, he would have been charged $3,200, with insurance paying $1,500, leaving him a $1,700 bill. He chose instead to leave insurance out of the equation and pay cash instead. The price was $250.

"It's outrageous," Schwarzman said. "I don't know where they're coming up with these numbers. Are they picking them out of a hat?"

Mitt Romney: The Movie

Apr 18, 2012

How the Trickle Down Theory Works...

Dick Clark....dead at 82

Dick Clark, the music industry maverick, longtime TV host and powerhouse producer who changed the way we listened to pop music with American Bandstand, and whose trademark Rockin' Eve became a fixture of New Year's celebrations, died today at the age of 82, ABC News has learned.

Clark, who suffered a serious stroke in 2004 but returned to the airwaves, reportedly died from a heart attack.

Born in Mount Vernon, N.Y., on Nov. 30, 1929, Richard Wagstaff Clark began his lifelong career in show business began before he was even out of high school. He started working in the mailroom of WRUN, a radio station in upstate New York run by his father and uncle. It wasn't long before the teenager was on the air, filling in for the weatherman and the announcer.


Apr 13, 2012

Some Major Barack Obama Accomplishments During his First Term

Not counting THIS ONE: 
And assuring BP cleaned up the Gulf Spill...

And for 3 years, no major terrorist strikes tho several have been thwarted.

Guiding us out of a very stubborn recession by building jobs with no help from the obstructionist Republican Party of NO.

Remember THIS...

And vote REPUBLICANS OUT in 2012 because they've been bribed by the rich to reject all taxes on the rich even at the cost of destroying the US economy, and bringing US modernization, and new US energy development to a STANDSTILL! 

Today's Republican Party: Corp Profit before Patriotism!

Conan has Exclusive Video of North Korean Missile Launch

Apr 12, 2012

The Question to Ask to Shut All Republicans Up!

Couple other items for your shopping convenience...
ALEC...US corporations trying to rewrite our laws.  The LIST.

At What Point Do the GOP’s Shenanigans Become Treason?

Apr 9, 2012

Ronald Reagan meets with the Taliban

Just a clue what Republicans had in mind 25 years later!

Apr 7, 2012

The "Talk" -- black and white parents give different talks to their kids about race.

"The Talk".  White version
For non black parents, how whites avoid trouble with blacks.   
(be patient with loading...this is a controversial new site.)

"The Talk".  Black version

For black parents in Pasadena, shootings give fresh relevance to 'The Talk'


** The author of the "White Version" here was fired from his job for writing what many call hate speech.  Even so, this blogger sees a great deal from this treatise in the attitudes of a great many whites.  Here are some comments related to the article.



Interesting comment from TKC's blog this weekend on a thread about the PD, presumably by a KCPD officer.  

Anonymous Anonymous said...
Well.....when the neighborhood I patrol is 90% black, it makes it difficult to find anyone else to stop. When I see a white boy from Johnson County driving around 45th and Prospect, I'd stop him just on principle. He's looking for weed, or is lost and a potential victim for black on white crime. And look at the numbers in Kansas City. Who does 90% of the crime? This is why 90% of the officers in Kansas City work SOUTH of the river as opposed to north of the river. Not saying white people don't do crime, just saying they only do 10% of the crime in Kansas City. So yes, if your a young black male and are committing a simple law violation like walking in the street in a "hot spot", I'm going to stop said black male. Call it stereotyping if you want, but the Supreme Court calls it doing my job. Walk on sidewalks and be as shady as you want, drive your car with legal tags and obey the laws like everyone else, and you won't get fucked with by the police. People in the ghetto are just stupid is all.
4/7/12 5:14 PM


Apr 6, 2012

PATHOLOGICAL VIDEO: 7 Mitt Romney lies exposed in 84 seconds.

The Obama campaign takes seven of Mitt Romney's attacks on President Obama and exposes each one of them as transparent lies in this 84 second, must-watch video:

From time to time, all politicians stretch the truth, but Mitt Romney is in a league of his own. Whether he's talking about himself or his opponent, he's one of the most consistently dishonest politicians ever to seek the presidency. He spouts so much nonsense it's almost like he's delusional, but he's not.

He knows he's lying. He's not the kind of guy who actually believes in conspiracy theories. He's the kind of guy who, when it serves his own interest, creates conspiracy theories for others to believe.

And the great thing about this video is that it efficiently and persuasively exposes Romney for who he really is: an unscrupulous salesman. 



Alternet: Deciphering Right-Wing Code: What Conservatives Are Really Saying When They Seem to Spew Nonsense

Apr 5, 2012

Bill Maher Video: Even Jesus Can't Run on the Republican Ticket


ALTternet: Capitalism's Dirty Little Secret-- Corporations don't create jobs. They kill them.

Photo Credit: Shutterstock

Corporations are not working for the 99 percent. But this wasn't always the case.    In a special five-part series, William Lazonick, professor at UMass, president of the Academic-Industry Research Network, and a leading expert on the business corporation, along with journalist Ken Jacobson and AlterNet’s Lynn Parramore, will examine the foundations, history and purpose of the corporation to answer this vital question: How can the public take control of the business corporation and make it work for the real economy?
Read the Series on Capitalism's Dirty Little Secret from Alternet.

Apr 2, 2012

Should Universities Tell Students in Advance Which Majors Pay the Best, the Worst?



The chart shows that the pay and employment prospects for graduates of the UM system are different depending on what they majored in. Certain majors, like engineering and health professions, tend to earn more money and make it easier to get a job compared to journalism or psychology majors.

This raises several public policy questions:
  1. Is it or is it not the responsibility of the universities to explicitly inform students of the employment and pay outlook for various majors?
  2. Should the universities counsel students to consider majors more likely to lead to more and better jobs, or leave this life-defining decision up to the student?
  3. Is it ethical to accept tuition from students whose job and pay prospects are limited by what they major in?
  4. Is it ethical to allow or facilitate students going into debt to pay for these less valuable degrees?
  5. Who benefits from and who is harmed when students major in journalism, psychology, or liberal arts (411 graduates)? Students? Taxpayers who support the universities and student borrowing? Faculty? 
Many student loans are for life. They can’t be discharged in bankruptcy, so the life prospects of many graduates may be worse than when they started. Should it be mandatory in Missouri for state universities to affirmatively inform students how much they are borrowing, how much they will have to pay each month, and the job and pay outlook for their major? When the average debt of a graduate is $24,000, what happens to the argument that students should be able to major in whatever they like?

Do Missouri taxpayers want to be party to taking tuition from students whose job prospects are not good? Do faculty in these areas benefit from students continuing to major in these areas despite limited job prospects? Whose job situation gets better? Whose gets worse?

More from ForwardSTL

Very Bad Week for the Evil Conservative Koch Brothers

We are smiling because we can afford to.
An FBI investigation, a new documentary, and a court's overturning one of their pet politicians' pet laws: here's a look inside the Kochs' worst week in a while.
Were there a way for a few billion clams to wipe a week off the calendar, one imagines that Charles and David Koch, the multi-billionaire principals of Koch Industries, would like to see the final week of March 2012 vaporized, at least in the public mind. For the Kochs, it was a week of bad news.

Read 6 reasons from Alternet why it was a horrible week for the disgustingly rich and politically savvy Brothers Grim.