The cost of getting fixed....

[WheelyFixed]

I just got my 'Medicare payment summary' that included the costs for my surgery - I thought it might be interesting to share...

I am on Medicare as primary, and Mass. Health as secondary, so MY cost was zero, (Thank you taxpayers! )

There is a HUGE difference between "Amount charged" and "Amount Medicare Paid" plus "Maximum you may be billed" (which presumably is what Mass Health covered?). I have NO idea why the difference or how / by who it got paid, or if the provider ate it...

All costs are US Dollars

Description Billed Amt Mcare Paid Max Bill Tot MC+MB Date Notes

Phone call $542.00 $94.54 $0.00 $94.54 08/28/23 Pre-op consult w/ Dr's PA

Hospital $38,667.77 $2,961.19 $755.42 $3,716.61 09/28/23 Hospital charges

Anesthesia 1 $790.40 $119.48 $29.99 $149.47 09/28/23 anesthetist?

Anesthesia 2 $1,185.60 $117.56 $29.99 $147.55 09/28/23 anesthetist?

Pathology $1,343.00 $275.29 $70.22 $345.51 09/28/23 examine non-diseased bits

Surgeon $4,800.00 $635.86 $162.21 $798.07 09/28/23 Actual cutting

TOTAL $46,786.77 $4,109.38 $1,047.83 $5,157.21

Emergency $6,894.36 $791.68 $201.97 $993.65 10/05/23 ER visit due to swelling Hospital charges

doc1 $594.00 $119.54 $30.50 $150.04 Dr plus Ultrasound

doc2 $364.00 $73.87 $18.85 $92.72 CT scan prof. Charge

doc3 $366.00 $59.73 $15.24 $74.97 more doctor

TOTAL ER $8,218.36 $1,044.82 $266.56 $1,311.38

Post ER care $363.00 $69.51 $17.73 $87.24 10/16/23 Exam and pull Foley cath

TOTAL $55,910.13 $5,318.25 $1,332.12 $6,650.37 GRAND TOTAL FOR EVERYTHIN

Notice the HUGE difference between what was Billed, and what appears to have been PAID

As a quick reminder - on August 28th, I had the presurgery phone call w/ the Dr's PA (Physician's Assistant) for things like going over the prep instructions, drug restrictions, and so on...

On September 28th I had the actual surgery

I had to go to the ER on Oct 4 because I had swollen to the point where I couldn't catheterize to pee... Ended up staying all night so billed on the 5th, got sent home w/ a Foley catheter and a leg bag.

On Oct. 16 I had the followup visit with the Dr's PA that was primarily looking at the site and confirming that the swelling had gone down, and then pulling the Foley catheter out.

My take, is first that I''m glad I didn't have to pay anything Otherwise, if you can get away with what Medicare has for the maximum billed amount, it wouldn't be that bad.... If you can't, and are looking at the 'Billed' charge, then a trip to Mexico to see Dr. A. seems like a real bargain...

WheelyFixed

[Paolo]

As this is relevant (and we're not going to have a discussion over the US healthcare system or of the lack of it!) I'll allow Wheely to post an image here.

Normally we don't allow this, but I'm making an exception!

[Losethem (imported)]

Once could only imagine what this looks like when a nomodicktomy is included.

[WheelyFixed]

As this is relevant (and we're not going to have a discussion over the US healthcare system or of the lack of it!) I'll allow Wheely to post an image here.

Normally we don't allow this, but I'm making an exception!

Actually that was not an image, sort of... I just used the 'code' tags which are part of the Vbulletin editor when you go to the 'advanced' mode. I did create a spreadsheet in Libre Office first with the raw data and copied the text into the post, (and still had to fix a lot of the formatting). The tag is SUPPOSED to keep the text entered in it from getting reformatted when using different size browser windows... Unfortunately it still messed stuff up a bit, but it is still readable...

I see this tag used a lot in software forums when posting code samples, or command line outputs, it's pretty standard and I didn't think it would be pushing any rules... Thanks for letting it stay up Paolo... (And I agree, no discussions about healthcare systems please...)

WheelyFixed

[erikboy (imported)]

OMG! $55000 ??? Is that true?

[WheelyFixed]

OMG! $55000 ??? Is that true?

That is what Medicare said the hospital billed them for, but as I pointed out Medicare said they actually paid a lot less... What I've heard is that because Medicare covers effectively every person in the US over 65 (whether they want it or not BTW, as any other over 65 insurance assumes that you ARE on Medicare, and bases their coverage on that) medical providers basically have to take whatever Medicare gives them, even though they take a loss on it (medical ethics don't allow them to refuse care...) Other insurance companies then point at the Medicare payment rates and demand the same sort of deals for their insured... So they jack up the 'billed amount' in order to get a slightly bigger check from Medicare, etc... Supposedly the only folks that actually get stuck with paying those over inflated 'billed' prices are the very few patients that are not insured at all...

If you look at the approximately $6,700 total of what Medicare said they paid plus the maximum the hospital would be allowed to bill me (in my case covered by Mass. Health, aka Medicaid), THAT price isn't all that far off from what Dr. A. supposedly charges down in Mexico, especially if you figure in travel expenses....

WheelyFixed

[Losethem (imported)]

OMG! $55000 ??? Is that true?

Paolo has asked us to steer clear of the political or merit discussions around health care billing in the USA. I'll see if I can explain this to you without it going off the rails or otherwise making a case for or against anything.

Unless you pay out of pocket, or are on Medicare as WheelyFixed is, in the US all healthcare is provided by insurance usually obtained through your employer. From there, insurance companies will demand the lowest price they can negotiate for care on a whole variety of ailments/issues/procedures. Since Insurance will make a low offer to the provider, the provider will initially bill the insurance for some astronomical amount, then let the insurance company "negotiate" that down to something smaller. It's basically a weird way to get at a reasonable cost for something. I once had a bill for a hospital stay which came to US $75,000, I had VERY good coverage through my employer insurance and paid $75. That's unusual here, but it can happen.

I have my own opinions on this shell game, and it's one of the reasons I may leave the US one day, but that's a discussion to be had elsewhere.

[erikboy (imported)]

Unless you pay out of pocket, or are on Medicare as WheelyFixed is, in the US all healthcare is provided by insurance usually obtained through your employer. From there, insurance companies will demand the lowest price they can negotiate for care on a whole variety of ailments/issues/procedures. Since Insurance will make a low offer to the provider, the provider will initially bill the insurance for some astronomical amount, then let the insurance company "negotiate" that down to something smaller. It's basically a weird way to get at a reasonable cost for something. I once had a bill for a hospital stay which came to US $75,000, I had VERY good coverage through my employer insurance and paid $75. That's unusual here, but it can happen.

I have my own opinions on this shell game, and it's one of the reasons I may leave the US one day, but that's a discussion to be had elsewhere.

I had no idea how it works in US. I am kind of not used to such bargaining in medical sphere. You never know how much resolving your health problems are going to cost you. But probably there is a reason why it evolved this way.

[WheelyFixed]

I had no idea how it works in US. I am kind of not used to such bargaining in medical sphere. You never know how much resolving your health problems are going to cost you. But probably there is a reason why it evolved this way.

There is definite history of how this state of things has evolved, but I'm not sure it would be possible to discuss that history without venturing further into the political realm than is acceptable here, quite aside from the length of giving an adequately detailed account.... Suffice to say that much of it has revolved around the history of tax policies (particularly the income tax) and efforts on the part of taxpaying entities (both corporate and individual) to minimize the bite of those taxes...

WheelyFixed

[Losethem (imported)]

There is definite history of how this state of things has evolved, but I'm not sure it would be possible to discuss that history without venturing further into the political realm than is acceptable here, quite aside from the length of giving an adequately detailed account....

I'd agree with this assessment. Medical care in the US is interfered too much by politicians be it in favor of the care providers or the consumers. Frankly, it shouldn't be political in any country, but here we are.