Why Your Health Insurance is Unaffordable

Three weeks ago tomorrow, i had a Cardiac Angiogram. My wife retired from teaching a couple of years ago and her union provides a benefit that pays reimbersument for, among other things, hospital deductibles. So this afternoon i went onto the Empire Blue Cross Website, to download an Explanation of Benefits to send them so i could get reimbursed.

My mouth dropped. I was in the hospital at 7AM, the procedure started at 8, and ended around 9. Then i was in recovery till about 3:30-4PM. The charge for the hospital and their services alone, was $97,000. And Blue Cross listed the "covered amount" and the "amount paid to provider" at $97,000. ARE YOU KIDDING ME? I only glanced briefly at the itemization, i noticed $482 for prescription drugs. They gave me 2 plavix, and some sedation. didnt put me to sleep.

This doesnt include the Dr, Anesthesiologist, or any of that. Just Hospital services.
Its insane. $97,000???
I'm going to call Blue Cross tomorrow just to get my rocks off.

Sorry to butt in, Prato, but since members frequently just read the first post in a thread and hit the comment button I will mention that this thread has been warned for veering into the forbidden realm of politics. Members new to the thread are cautioned. -- PeterDisAbelard

Post Edited By Moderator (PeterDisAbelard.) : 7/10/2015 8:05:50 AM (GMT-6)

It's a national embarrassment. The co-pays alone can bankrupt a person. I've been advocating medical tourism lately.

TA, well said. I am going to use that expression, a national embarrasment, tomorrow, when i call Blue Cross. I know I'll be talking to a clerk. But i am going to ask how i get my displeasure voiced to a higher up. $97,000. IT IS so ludicrous its beyond words. I still am in disbelief.

It would be very interesting to know what their actual cost is for taking care of me. And at what point they consider the cost of equipment fully amortized. You have talked about needless bone scans in the past, and i get it, although it does give many peace of mind.
This situation, that i have come across, is just beyond the beyond.

My wife gets a shot of Faslodex each month for long term treatment for breast cancer. She has been on for 4 years and the med onc says at least 10 years on it. Since the med onc practice is owned by a hospital they get $7,900 for each shot (they bill $9,ooo). Before the hospital bought the clinic the med onc received about $2,000 for the shot. Same doc, same nurse, same facility, etc, same needle for all we know.

Just because the hospital gets a preferred billing code this treatment goes from expensive to outrageous. Ten years of the shot is a cool million$$$$$$.

A very good friend runs a large high quality hospital in Thailand. More than half their business is people from Canada, England, and the USA. Med tourism as Allen points out. All the docs are US trained and certified and costs are a small fraction of what we pay here including airfare. For the social med countries they can get in for a hip replacement in a few weeks instead of a few years.

FOR PROFIT, not healthcare

My hyperbaric treatments last August was billed at 2,500 per 2 hour treatment. These were done as a precaution prior to my dental surgery because of radiation damage. So that alone, came to 75,000, to breath enriched oxygen. What a deal. However, and I thought this was interesting, the VA only paid the hospital (civilian) 500 per treatment, and the hospital had to eat the rest. There were no co-pays involved.

I remember in 2009 when I had the Suprapubic catheter inserted, a minor surgical procedure, the hospital side alone was over 15k for about a 15 minute procedure.

Not sure why nothing is ever said or done by the powers to be about all this excessive price gouging. Seems obvious to we on the patient side.

Profits over health care.

Recent read article about some doctors who are refusing ('going on strike') to use some medications because had recently tripled, or more, in price.

If any company owns a drug or procedure, essential for health, they set the cost.
IMHO Price is set by whatever the market will pay. Insurance companies ARE the market - paying what is charged which sets expectations. Right?? insurance co. Are saviours for many. But for me, w/out it, that means I have to come up w/price that was set for their deep pockets.

lives are at stake it. If it was just a business selling a product like software, this would sound like a monopoly. Or blackmail. It is a circle, as title of this post indicates.

This is main reason I am seriously wanting to sell my home - to avoid a lien beiing put on it sometime in the future IF I need medical care.
I am not alone in being soomeone who cannot pay housepayments + medical insurance . I'm can only pray no major illness or accident happens before I can sell house. (My disability income is too high for me to qualify for any subsidy.)

Last year, my yearly 'wellness check-up', which I pay for - in cash, & got a small discount for doing so, was less than half of what I was charged 2 months ago. Same doctor, same exam, no discount. My income was cut about 1/3 in same time period -this is a major chunk of change for me. Grateful I could afford to go.

Holy Guacamole! And I thought a Tesla car was expensive.

My nephew is a reporter for Crains NY Business, and he covers the healthcare industry. I think I've got a story for him.

It is just a matter of time before the medical care system of the U.S. collapses because of the costs. When only the 1% can afford medical care, there won't be a need for 99% of the medical care profession.

I hear what you guys are saying and often wonder how they come up with the figures. I was surprised that prato's insurance paid the whole 97,000 , though...but then I haven't a clue as to how billing/paying is calculated.
However, it has also become commonplace for patients to want every test under the sun , being "informed advocates"which adds to medical costs . For example, a guy has as PSA of 4.0 , PSAV 5 years had a biopsy, 1 core of less than 5% G6. TRUS He want's to have a MRI fusion biopsy, a second and third opinion on the pathology and probably the MRI, an oncotypeDX and prolaris test. He also wants to consult ROs, oncologists, surgeons in Seattle,LA, Houston,Florida, Baltimore, Boston, New York,Chicago and Cleveland.This in itself adds to medical costs much covered by insurance...all in the name of being an informed, proactive, knowledgeable patient...but is it necessary and more than the seemingly overpriced medical care?

That is the great point. That the hospitals and docs charge an amount so much higher than they have agreed to do the procedure for. I don't see how that helps anything.

So what is our actual health care cost estimate based on? The amount charged or the amount received? Would be a considerable difference.

This difference starts getting critical with the near universal move to very high deductible and co-pays in the current insurance situation under the PPACA. When I know that I will be stroking the check for a lot or all of the cost, I want to make sure I get a deal at least as good as the insurance company.

RCS,

Not sure it's "most" guys. We tend to be youngish compared to prostate cancer patients as a whole. I think the younger guys are more comfortable with online communities, at least statistically.

Quite a few of us feel nailed to our chairs at work by the need to keep our insurance in effect.