The High Cost of Health Care

Americans without health insurance are suffering through lack of knowledge.  As a licensed health insurance agent a few years ago, I learned some of the industry secrets, and often shared them with my clients who were having problems that developed while they were uninsured.  I had my own personal experience back in the early 90′s when my then husband injured his wrist and needed 2 stitches.  The doctors did their job, and when I went to pay the bill it was over $400.00 dollars for a shot to numb the area and two stitches!  Needless to say, I was aghast.

I asked why the bill was so high and the lady said, because people without insurance do not pay their bills, it increases the costs.  I said, well, I know for a fact that if we had major medical insurance that the bill they sent to the insurance provider would only be about $80.00, and if you gave me an $80.00 bill, I will pay it right now!  She failed to understand what I was saying, and as I did not have an extra $400.00 at that moment, I became a statistic that had an unpaid bill until we eventually paid it.

The fact of the matter is, doctors are not making the ungodly profits off of the uninsured, it’s the hospitals that are raking in the bucks, even with insurance.  As a health insurance agent I had the information of what doctors were paid for various procedures and surgeries and it was shocking at how low that amount really was.  I can’t give you an exact number from 2008, but a close example would be if a doctor did an emergency appendectomy, they got about $3500.00. Yep, a kings ransom for all their years of experience and saving your life right?  Of course it’s not, but the total hospital bill would be well over $10,000.00 in many cases. Now, if you did not have insurance, that bill could easily be $20,000.00 and they will happily set you up on a payment plan of $200 to $300.00 per month until you pay it off which you will on time if you want your credit to stay in the excellent category.  Here is the little secret they do NOT want you ignorant uninsured peons to know about.  The fair trade act says that you cannot be overcharged for services in comparison to comparable care say with insurance.  Meaning, they don’t have the right to charge you 5 or 10 times the amount they accept from insurance companies!  I mean lets’ face it, when you find yourself or a loved on in an emergency say a car wreck, heart attack, stroke, ruptured organ you don’t have time to let your fingers do the walking and call hospitals and doctors to work out a reasonable cost for their services.  You need help NOW, and you rush to the hospital to be fixed.  When I almost lost my right leg in an auto accident in 2000, I did not get into the emergency room with my leg nearly severed and say, “Hey wait a minute Doctor Smith, how much are you going to charge me to re-attach my leg?”

Now, at the time I did have major medical coverage and my bill was $100.00 co-pay in my hmo.  But what if I hadn’t had that coverage? I can guarantee you that for all the care I received, my bill would have been over $40,000.00! Who has that kind of money laying around?  Now, I am not saying we should not pay our bills, but the bills must be fair, and yes, there is a way to find out if your bill is fair.  One of the best hospitals in the world is John Hopkins.  A non-profit group has compared all other hospitals in America against the charges for similar care of John Hopkins which is viewed as a hospital that charges people fairly according to this group.  The organization is called Hospitalvictims.com.

You can find your hospital and compare their rates to theirs for a sundry of health care costs.  Then, if you feel you have been over-charged you can download two forms from the site.  I recommend before you talk to the finance department of any hospital to work out any arrangements that you get an itemized bill so you know exactly what you were charged for to have a fair comparison.  Was that pill really worth $20.00?  Did that X-ray really cost $600.00?  Was that EEG really worth 1000 times what John Hopkins charges? If you think I am exaggerating investigate it for yourself.  Where I live, there is a monopoly on radiology and they overcharge here to the tune of a 548% mark-up of costs!

Let me break it down :

Tallahassee Memorial Hospital (Tallahassee, FL)
charges 297% times its costs.
That is 254% times what Johns Hopkins charges!

Data for the period ending: 9/30/2006

Service                                          Mark-up

Anesthesiology                           1,228%

Operating Room                        299%

Radiology-Diagnostic             548%

Laboratory                                  716%

Electrocardiology                     551%

Those numbers show you how much higher of a mark-up as compared to a reasonable mark-up by John Hopkins:

Service                                            Mark-Up

Anesthesiology                             245%

Operating Room                          299%

Radiology-Diagnostic                103%

Laboratory                                     115%

Electrocardiology                        138%

Of course there is a mark-up.  Nothing is free, but there is reasonable and then there is unreasonable.  You can use this information to push your case with your hospital in fair trade.  What you need is a detailed bill, and you need to know your rights:

Plan to Fight to Protect Your Assets:

The courts say hospitals can collect only what is reasonable. Yes, all patients are required to sign a commitment to pay whatever is charged for treatment. But the courts have consistently ruled that hospital charges must be REASONABLE.

What’s a reasonable charge?

That depends on the procedure, any complications, and in what area of the country you are hospitalized. What Medicare pays is a benchmark. Insurance companies usually pay 5% to 10 % more than medicare, but not 3 to 4 times more! Hosptial Victims site can help you find out what is reasonable.

Don’t let your credit be destroyed!

It’s important for you to take action. Write the hospital and credit agencies. Collection agencies, working on behalf of hospitals, have ruined the credit of many uninsured families in attempting to collect unreasonable bills. Writing a simple letter can protect you and your credit. They’ve posted a letter that you should fill out and send to the hospital, collection agency, and national credit bureaus. Keep a copy for yourself.

First Step – Request the Medicare Treatment Codes:

Use this letter ONLY if you have not been sent to collections, and are dealing only with the hospital. If the hospital has sent you to collections, or is threatening to do so, please use choose from the next set of letters.

Here is a sample letter from Hospital Victims if you have not gone to collections or been threatened with collections:

[date]

[Institution Name]
[Institution Address]
[Institution City, State, ZIP]
[CFO Name]

Re: [Patient Name], Account [Patient Account Number], Date Admitted [Admittance Date]

Dear Mr. [CFO Name]:

I am writing to request your full and thorough review of my account. I received your balance due notice indicating I owe $[Amount Due] on the account. Please be advised that I do not believe the charges to be a reasonable price for the services rendered.

I am exercising my rights under HIPAA and demand that you provide me with a copy of the UB-92 or UB-04 used to make decisions on my behalf and made part of my designated record set. Under federal law (HIPAA), I am entitled to, and I am demanding a copy of the financial responsibility agreement and principle admitting, diagnosis, and treatment codes within 30 days of receipt of this letter. If you fail to provide either document, I will file a complaint with the Office of Civil Rights of the U.S. Department of Health and Human Services and forward my complaint to the U.S. House Oversight and Investigations Subcommittee.

I personally have a right by law to receive this information from you. I expect you to comply. The requested information should be sent to my attention at the address below. I will pay for any reasonable copy cost associated with this request. Thank you for your prompt assistance with this matter.

I recently was informed of my rights and now will use all legal avenues to protect myself from your unreasonable charges.

Please govern yourself accordingly.

signed

[Victim Name]
[Victim Address]
[Victim City, State, ZIP]

cc: The Consejo de Latinos Unidos
5835 West 74th Street
Indianapolis, IN 46278

Why am I putting so much effort to share this with you? I have witnessed countless families destroyed and lives ruined by credit problems and health care bills.  We have a health care crisis in America, and the solution has already be provided. We do NOT need socialized medicine.  What we need is an informed consumer market that exercises their rights!  If you are struggling with this problem go to the site and avail yourself of the information therein.  They even have a program to help you fight this and analyze your situation for free.  They also offer other solutions but are not tied to that entity which will charge some fees. 

Last but certainly not least

You may qualify for Charity care.  Go to this page at Hospital Victims to see the charts and register to find out if you do qualify.

Many of the nation’s hospitals have charity care or financial assistance programs for which you may qualify. Some of the hospitals offer assistance up to 400% of the HHS Federal Poverty Guidelines.

*When it comes to finances, legal, medical information one can find themselves in hot water easily.  So, I am not promising you any change to your situation. I share this for informational purposes only, and it is up to you to educate yourself and whatever action or non-action you choose to take is your responsibility.  Know your rights.  Know how to protect yourself, and don’t be a victim.