Cost of Lupron and Billing by Hospitals

In 2017, I had Lupron shots in an URO's office. Medicare was billed around $2000 and Medicare paid about a quarter of that. This time I had the shot in a hospital. Medicare was billed about $16000 and medicare paid the same amount it paid urologist in 2017. Why hospitals bill absurdly high amounts but accept whatever medicare pays? Can someone throw some light on why hospitals do things this way?

The entire medical costs billing system is little more than a racket...If you turned out to be an uninsured patient they would not accept the lower Medicare figure but would demand the $16,000 they originally billed..The leading cause for bankruptcy in the U.S. is the inability to pay medical bills....Once you reach that point, Medicaid will step in and cover all your medical costs after a fashion..

Going for brachy said...
In 2017, I had Lupron shots in an URO's office. Medicare was billed around $2000 and Medicare paid about a quarter of that. This time I had the shot in a hospital. Medicare was billed about $16000 and medicare paid the same amount it paid urologist in 2017. Why hospitals bill absurdly high amounts but accept whatever medicare pays? Can someone throw some light on why hospitals do things this way?

What a huge difference in pricing between the USA and Canada. I have coverage, but see the billed amount to the insurance company as $ 1250.00

If the billing amount means nothing, then why bill insane amounts.

Remember the number uninsured self paying patients is very very small compared to the insured patients. The low income uninsured patient gets indignant care and never pays. They have no assets so they don’t need to use bankruptcy. The providers have legal protection in setting rates for the Payors so the provider doesn’t go broke providing uninsured indigent care.

Each provider sets a billing schedule and then works with each third party payor to establish reimbursement agreements. The billing schedule starts higher than the provider expects to get and the negotiations start from there. Kind of like buying a new car. No one pays or is charged the MSRP. The dealer has the amount they need to meet their cost and then tries to get as much as possible above that. The buyer is not guided by the MSRP because 99.9% of buyers know the MSRP means nothing. The buyer also knows about what the dealer cost is and tries to get very close to that amount.

Due to Medicaid and Medicare setting reimbursement rates at or below the true provider cost of delivering care, non governmental payers know they must make up the difference or the provider will not be available. Obviously the third party payor with the most potential patients get the best deal due to the volume of patients they bring to the providers in their network.

Simple economic rules of supply and demand and in no way a racket.

I had my last Lupron (4 month) on 12/19/2017. The amount billed was $2917.91 and the in network discount was $1955.00 so my insurance paid the MO at the cancer center $962.91.

this has been discussed endlessly here. over and over. sometimes the threads end locked as people start arguing, ranting and otherwise behaving badly.

so every so often folks feel the need to drag out this horse and beat it again.

as dr. mccoy said, "he's dead jim."

i've decided to stop using capital letters as i see no reason why some letters should be superior to others. all letters should be equal so i'm no longer going to engage in the unjust behavior of making some letters uppercase and some lowercase.

andrew

oh no - you found me out!!!

bbqdude said...
...
is it possible we can go without punctuation too ...

i think that is something worth exploring
punctuation just limits the freedom of words

Andrew

Well, punctuation does have it's value. Consider this quote: "Let him who stole steal no longer, let him work." vs "let him who stole steal, no longer let him work."

chains chains chains
restricting meaning
and forcing words to a single meaning
when a multiverse possibilities exist
i choose infinity
over the dungeon of conformity

well u can tell that we are a bunch of old fogies on here otherwise as my granddaughter tells me when I text her is quit spelling out all words to much to read takes to much time. just abbreviate everything. mmmmm was just thinking if the medical system and insurance companies tried this method cutting out 90% of the paper work and just paid the darn bill how much that would reduce costs? oops I forgot lots of good paying jobs creating all the paper work, computer techs, printer sales, etc.!!

Just curious if anyone has checked out the prices for these meds in Mexico or the Caribbean?