The cost of inguinal hernia surgery!

[PSM]

The cost for 2 1/2 hours in the hospital and 45 minutes in surgery to repair an inguinal hernia was one 2017 CORVETTE STINGRAY RWD Coupe 1LT: 56,445. Oh joy!

Pat

[RichL025]

Originally Posted by PSM

The cost for 2 1/2 hours in the hospital and 45 minutes in surgery to repair an inguinal hernia was one 2017 CORVETTE STINGRAY RWD Coupe 1LT: 56,445. Oh joy!

Pat

No it's not.

That's what the CHARGES are, that's not the COST.

There are serious problems with the finance side of modern American health care, and one of them is the fact that consumers (patients) aren't told the costs (or actually, the charges) up front, and billing is notoriously random and unreliable.

Where did you get that number from? Is it part of your insurance paperwork? If so, don't worry about it, it reflects the hospital trying to stiff the insurance company to make up for all the times the insurance company stiffed the hospital. Those charges bear scant resemblance to actual costs.

Is this from a bill YOU got sent for a self-pay inguinal hernia repair? If so, that charge is out of line and easily fightable.

The actual COST of the hernia repair is around $5K: https://www.ncbi.nlm.nih.gov/pubmed/26874507

So instead of a Corvette Stingray it's more like a solid used Ford Escort.

[PSM]

Originally Posted by RichL025

No it's not.

That's what the CHARGES are, that's not the COST.

There are serious problems with the finance side of modern American health care, and one of them is the fact that consumers (patients) aren't told the costs (or actually, the charges) up front, and billing is notoriously random and unreliable.

Where did you get that number from? Is it part of your insurance paperwork? If so, don't worry about it, it reflects the hospital trying to stiff the insurance company to make up for all the times the insurance company stiffed the hospital. Those charges bear scant resemblance to actual costs.

Is this from a bill YOU got sent for a self-pay inguinal hernia repair? If so, that charge is out of line and easily fightable.

The actual COST of the hernia repair is around $5K: https://www.ncbi.nlm.nih.gov/pubmed/26874507

So instead of a Corvette Stingray it's more like a solid used Ford Escort.

Guess what my out-of-pocket share was: A solid used Ford Escort.

So I guess they get my premiums, then play ping-pong with the doctors and hospital, and I still foot the whole bill. Cool.

Pat

[RichL025]

Originally Posted by PSM

Guess what my out-of-pocket share was: A solid used Ford Escort.

So I guess they get my premiums, then play ping-pong with the doctors and hospital, and I still foot the whole bill. Cool.

Pat

Did you have insurance or was it fee for service?

[PSM]

Originally Posted by RichL025

Did you have insurance or was it fee for service?

I had Medicare and UHC supplemental. We had Etna for 15 years and had to switch to United Healtcare on 1 Jan (Etna pulled out of AZ). My surgery was 3 Jan.

It's no big deal, really. I just thought that it was funny that what I considered and simple and routine surgery would cost as much as a Corvette just after I went on Social Security. I'd rather they buy me the car, though.

Pat

[Kyobanim]

Here's a nice example of overcharging . . .

I have a genetic issue called Alpha 1 Antitrypsin deficiency. It keeps the liver from producing the enzymes that protect the lungs and liver from diseases. Kinda like an immunity boost. To remedy this, I get an infusion once a week of the enzymes that are taken from human blood plasma.

According to my insurance company: (I work for a hospital system, we are self insured).

The weekly cost for this is $25000.00. Yes, that is thousand. Billed from Glassia
The discounted cost for this is $21900.00. Discounted by Glassia
Actual billed cost to insurance is $3100.

So my average monthly cost of this would be $12400. per month, lucky that I am insured as it is costing me nothing.

[JJ_BPK]

Originally Posted by PSM

I had Medicare and UHC supplemental. We had Etna for 15 years and had to switch to United Healtcare on 1 Jan (Etna pulled out of AZ). My surgery was 3 Jan.

It's no big deal, really. I just thought that it was funny that what I considered and simple and routine surgery would cost as much as a Corvette just after I went on Social Security. I'd rather they buy me the car, though.

Pat

Pat

Look at plan F offerings(zero co-pay - zero out of pocket) next fall.

I have used plan F in Florida and now NOVA for about 10 yrs and the costs is not that much higher.

My $00.00002

[doctom54]

Originally Posted by PSM

Guess what my out-of-pocket share was: A solid used Ford Escort.

So I guess they get my premiums, then play ping-pong with the doctors and hospital, and I still foot the whole bill. Cool.

Pat

Now you understand how insurance works in the USA.

[frostfire]

Have you looked into medical tourism?
More Americans go overseas for single day, out pt procedure.
In some cases, the technology is better than here.
We may still be in the lead with cutting edge research, but not in cost-efficient advanced medical procedure

I plan to go to Malaysia/Singapore/Thailand for a stem cell orthopedics procedure. Something that have not cleared ethics committee here.

[PSM]

Originally Posted by Kyobanim

Here's a nice example of overcharging . . .

You diffidently win, Kyo! Too bad that you have to go through all of that, though.

Originally Posted by Oldrotorhead

If you get a chance ask you Surgeon how much his Malpractice ins. costs. Then consider that he was only one of several doctors attending your surgery. It could easily be 10% of his income.

The total was 100% of my income. But I would like to see tort reform to relieve that burden on her. That threat also led to having to see a cardiologist for an echo-cardiogram prior to surgery because of my age.

Originally Posted by doctom54

Now you understand how insurance works in the USA.

I always knew it. It's just that I've not encountered it. I did have the same, opposite side, surgery 25 years ago but I didn't get an itemized bill for it. Besides that surgery and the birth of our son, we've only used it for yearly exams.

I don't have dental insurance but have to get an implant next month. At the moment it's $4000 out-of-pocket but, knowing this, I can probably get it down about 25%. The GOP Congress didn't do us any favors today.

Pat

[Trapper John]

Originally Posted by RichL025

No it's not.

That's what the CHARGES are, that's not the COST.

There are serious problems with the finance side of modern American health care, and one of them is the fact that consumers (patients) aren't told the costs (or actually, the charges) up front, and billing is notoriously random and unreliable.

Where did you get that number from? Is it part of your insurance paperwork? If so, don't worry about it, it reflects the hospital trying to stiff the insurance company to make up for all the times the insurance company stiffed the hospital. Those charges bear scant resemblance to actual costs.

Is this from a bill YOU got sent for a self-pay inguinal hernia repair? If so, that charge is out of line and easily fightable.

The actual COST of the hernia repair is around $5K: https://www.ncbi.nlm.nih.gov/pubmed/26874507

So instead of a Corvette Stingray it's more like a solid used Ford Escort.

You silly goose you. don't you know healthcare is free? You can keep your Dr., you can keep your insurance plan, you can keep your hospital? Geez the gubment said so!

On a serious note, Michael Porter has promoted the novel idea of moving healthcare pricing from a fee for service basis to a cost and materials basis along with publication of pricing and success metrics such as recovery times and infection rates for common surgical procedures. Where these have been implemented the results have been significant increase in efficiencies and quality of healthcare.

[NurseTim]

Originally Posted by Trapper John

You silly goose you. don't you know healthcare is free? You can keep your Dr., you can keep your insurance plan, you can keep your hospital? Geez the gubment said so!

On a serious note, Michael Porter has promoted the novel idea of moving healthcare pricing from a fee for service basis to a cost and materials basis along with publication of pricing and success metrics such as recovery times and infection rates for common surgical procedures. Where these have been implemented the results have been significant increase in efficiencies and quality of healthcare.

It’s probably worth a try.
But, if I may. Recovery times are individualized, and infection rates have numerous variables. Bean counters already control medicine. The sons of the bean counters that prosecuted the Vietnam war.

The problem is multifaceted, economic, foods consumed by most everyone, medicine, middlemen in insurance. I saw bills for child birth from the 40’s and it was less than $100, and that was when they kept you in the hospital for days after the birth. But the dollar had much more purchasing power.
Monsanto didn’t have the grip on our foods then than they do now, etc.

I don’t have the answers.

[Badger52]

Originally Posted by Trapper John

On a serious note, Michael Porter has promoted the novel idea of moving healthcare pricing from a fee for service basis to a cost and materials basis along with publication of pricing and success metrics such as recovery times and infection rates for common surgical procedures. Where these have been implemented the results have been significant increase in efficiencies and quality of healthcare.

FWIW, Denninger over at the Market-Ticker proposed similar (with examples) about 4 years ago. You can read that article here. He is, as typical, rather exercised about government approaches to things.

Intro taste of The Bill To Permanently Fix Health Care For All:

Let's lay out the parameters for a bill, a fairly-modest update to my two previous missives on this point here and here (note the dates) and which can be easily turned into formal legislative language:

All providers must post, in their offices and on a public web site without any requirement to sign in or otherwise identify oneself to access it, a full and complete price list which shall apply to every person. This instantly allows customers to compare pricing between providers for services and products in the medical realm.

All customers must be billed for actual charges at the same price on a direct basis at the time the service or product is rendered to them. This immediately and permanently decouples "insurance" from the provision of care. The current system of an "explanation of benefits" that often features a "negotiated discount" of some 90% is nothing other than an extortion racket and is arguably felonious -- threatening to bankrupt someone if they don't buy your "insurance" through a threat to charge them ten times as much certainly appears to be a criminal enterprise and, given that more than one entity is involved, looks like it meets the definition of Racketeering. Insurance coverage may well cover some, part or none of a given bill, and nothing prevents an insurer from telling you in advance of your visit how much they will pay (if anything) for a given procedure or drug. Indeed you should demand that information from them and use it as part of choosing where to obtain treatment but the bill still has to be rendered to you, you have to be the one to file the claim and everyone must pay the same price to the same provider for the same kind and quantity of product or service.

For a bill to be valid and collectible it must be affirmatively consented to in writing, with a disclosure of the actual price to be charged from the above schedule for each item to be provided whether good or service, prior to the service being performed or the good furnished, subject only to the emergency exception below. A bill that is increased, has items added to it after consent is obtained, which contains any open-ended promise to pay without an actual price listed for each service or good prior to customer consent or is issued with no consent at all (including having a customer sign a consent form while under the influence of drugs the facility gave them as occurs in virtually every instance today while you're being wheeled into the OR) is deemed fraudulent and void. This instantly stops "drive-by" doctor charges in hospitals as just one example. It also prevents charging $20 for an aspirin; nobody would tolerate being billed by the square for toilet paper in a hotel! Hospitals will of course squawk that they cannot operate like this as they "can't" figure out what is required until after-the-fact but that's false; nothing prevents them from advertising "Appendectomy: $2,000" and that being the soup-to-nuts price. In fact that's exactly what the Surgery Center of Oklahoma does today so quite-clearly it both can and does work. In addition this change will permanently and immediately put a stop to the ridiculous practice of defensive medicine (read below for the explanation.) You would never accept a gas station that only displays the cost of your gasoline after you pumped it and varied that price based on who your car insurance was bought from or a grocery store that had no prices posted at all and only gave you a total after your groceries were taken out of the store and the transaction could not be refused.

No event caused by or a consequence of treatment, can be billed to the customer. This instantly aligns the interest of the customer in not having such an adverse complication (e.g. MRSA, etc) with the medical provider. As it stands right now hospitals actually have an incentive for you to have a complication since they make more money if you do. If you call me to fix your roof and I drop my ladder causing it to crash through your picture window I get to pay for the glass I broke through my ineptness. The same must apply to medical providers. For those who claim hospitals and similar can't adopt such a model I point to the OKC surgery center, which does exactly this -- and has a lower complication rate (gee, I wonder why when they have to eat it if they cause it....) The exception: A unavoidable and pure-chance side effect of a treatment or medication that (1) is less harmful than the disease or condition treated, (2) fairly and objectively disclosed in comparison to the original risk of the condition being treated and (3) thereby consented to with informed consent. In other words you can't give informed consent to an MRSA infection acquired in a hospital but you can give informed consent to the risk of taking a drug, if and only if you are in fact provided the truth about the treatment and it's scientifically-documented risks and rewards. Note that if those scientific facts are later proved to be bogus you have a cause of action against everyone so-involved in deceiving you.

There's a bunch more, and he bludgeons the billing system as well as those who won't make health decisions clearly in their own interest. But he's not railing simply to fill up his blog. There are some alternative approaches to the current kluge that exists, particularly in the disparity of who gets whose coin.