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Re: Hidden Hospital Costs Leave Some Patients With Sticker Shock
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It does appear that way, but I deal with senior insurance people all the time, and they are almost always well-intentioned folks who want to do right by their customers. Maybe I'm just not seeing what's behind the veil.

Posted on: 12/6 13:56
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Re: Hidden Hospital Costs Leave Some Patients With Sticker Shock
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JCishome wrote:
In the last few years the major carriers (Aetna/Cigna/UHC/most Blues plans) have quietly adjusted their reimbursements to address this - in other words, they pay the radiologists and anesthesiologists as if they were in-network. It's a sloppy system, and sometimes you need to push the carrier to do it, but it works. Here's the sequence to follow:
- call the carrier's customer assistance line.
- if that doesn't work, call your HR department.
- insist that they call their broker to get it fixed.

The system is totally dysfunctional, but most people just give up too soon. That's understandable because they or a family member have medical issues to deal with, but in this stuff the squeaky wheel gets the grease.


This aggressive bullshit is why people hate insurance co's. I believe they screw with people deliberately no matter how good their claim, on the theory that if even a fraction of those give up and pay more than they should, that's profit. It can baffle the educated and native english speaker, imagine if you are neither?

I heard an interview where the president of an insurance corp was presented with the interviewer's bill and asked to explain what the charges etc meant. He was unable.

Posted on: 12/6 12:22
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Re: Hidden Hospital Costs Leave Some Patients With Sticker Shock
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In the last few years the major carriers (Aetna/Cigna/UHC/most Blues plans) have quietly adjusted their reimbursements to address this - in other words, they pay the radiologists and anesthesiologists as if they were in-network. It's a sloppy system, and sometimes you need to push the carrier to do it, but it works. Here's the sequence to follow:
- call the carrier's customer assistance line.
- if that doesn't work, call your HR department.
- insist that they call their broker to get it fixed.

The system is totally dysfunctional, but most people just give up too soon. That's understandable because they or a family member have medical issues to deal with, but in this stuff the squeaky wheel gets the grease.

Posted on: 12/6 11:14
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Re: Hidden Hospital Costs Leave Some Patients With Sticker Shock
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Dolomiti wrote:
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If I was an inpatient again I would post a sign on my bed instructing all personnel to either sign a waiver agreeing to abide by my insurers rates or walk away.

Yeah, that'll work... not


My points about the anesthesiologist etc is how little control we have over this currently. And your strategy for being treated ONLY by people on your insurance plan is....what?

Posted on: 12/5 12:03
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Re: Hidden Hospital Costs Leave Some Patients With Sticker Shock
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brewster wrote:
My youngest was 2002, and there wasn't the same nonsense.

This was definitely happening in 2002; people have been complaining about the "$5 Tylenol pill" for a long, long time. It's only recently gotten any attention.


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I don't know how you protect yourself as an inpatient, someone will peek into your room, and send you a bill!!

I never had that happen when I was in the hospital. Every hospital staffer who entered my room had a legitimate medical reason to do so.


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If you get surgery you often never even meet the anesthesiologist but you get their bill.

Meaning what, they didn't actually put you under and supervise your health while you were unconscious, because they didn't shake your hand first?


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If I was an inpatient again I would post a sign on my bed instructing all personnel to either sign a waiver agreeing to abide by my insurers rates or walk away.

Yeah, that'll work... not

The hospital employees don't decide the amount to charge patients. That's up to the hospital, who negotiates the rates with the insurers long before you were admitted to the hospital.

I mean, really. What are you going to do, sit there with a stack of blank waivers? Demand that the nurses who are wheeling you into surgery sign those documents, when they have no control over what the hospital charges you? Are you going to demand that your doctor sign the waiver before treating you?

The bottom line is that medical costs are raging out of control because we treat health care like we do any other good or service, which is a massive mistake. Health care is not like clothing or food or gas; the profit motive ultimately does not make it more efficient. This will become even more obvious over the next few years, as the ACA gets dismantled and replaced with an even worse private system.

Posted on: 12/5 11:05
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Re: Hidden Hospital Costs Leave Some Patients With Sticker Shock
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One thing to keep in mind is that those hospital prices are insane because they aren't the real price.

Hospitals set high rates because they are starting points for negotiations with insurers, who counter with significantly lower prices they are willing to pay. Unfortunately, those without insurance usually get hit with the full bill, though they can negotiate on their own (something few people know).

The ACA did not target that particular mechanism. On a fundamental level, the ACA is a conservative approach that keeps the current private system in place, covers more people, and keeps costs down by spreading the risk over larger (and hopefully healthier) pools of ratepayers.

IIRC it had some disclosure requirements -- I believe hospitals have to publish costs for certain common procedures. A few states are starting to require that hospitals publish their full chargemaster rate list.

Posted on: 12/5 10:50
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Re: Hidden Hospital Costs Leave Some Patients With Sticker Shock
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Get the best holiday / travel medical insurance (2 weeks worth) and travel to Niagara Falls and make your way to a Canadian Hospital for that 'unexpected' treatment !

Posted on: 12/4 2:27
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Re: Hidden Hospital Costs Leave Some Patients With Sticker Shock
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Very good advice Brewster. I would say everyone should write this on their inpatient paperwork just to see their faces! I personally will record my next conservation next time I sign something.

Posted on: 12/3 19:59
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Re: Hidden Hospital Costs Leave Some Patients With Sticker Shock
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My youngest was 2002, and there wasn't the same nonsense. I don't know how you protect yourself as an inpatient, someone will peek into your room, and send you a bill!! If you get surgery you often never even meet the anesthesiologist but you get their bill.

If I was an inpatient again I would post a sign on my bed instructing all personnel to either sign a waiver agreeing to abide by my insurers rates or walk away.

Posted on: 12/3 18:33
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Re: Hidden Hospital Costs Leave Some Patients With Sticker Shock
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Quote:

brewster wrote:
Quote:

bodhipooh wrote:
Quote:

brewster wrote:
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Monroe wrote:
Wasn't Obamacare supposed to fix things like this??


Obamacare is about insurance, and has absolutely nothing to do with it. Bayonne, Christ & Hoboken Hospitals are "for profit", and don't have contracts with most insurers. They can charge whatever they want, and they want a lot. Their business plan consists of Medicaid and overcharging for ER. Why would anyone seeking elective surgery or other sophisticated care go to them instead of one of the world class hospitals across the river?

I know someone who works for one of these places and went to get a sebaceous cyst removed, usually a simple outpatient procedure. They did it in a operating room with an anesthesiologist and everything! The bill for many thousands was absurd, but their own insurance plan "negotiated" and paid it.


I know someone who is planning to deliver her baby at Hoboken, and I almost choked when she shared that information. I cautioned her to make sure her insurance company will cover the crazy bill that will surely follow. While I don't believe in government intrusion in private businesses, I do think there should be some sort of limits imposed on these type of situations: hospitals provide a public service and the recipients of these services don't always have a choice in where they end up. I certainly wouldn't be happy to be taken to Christ, Bayonne or Hoboken if I happen to find myself in an accident and need emergency care.


If you have insurance you'll be ok in the ER, for emergencies the insurers have to negotiate and pay. It's the utterly uninsured that are screwed, though rumor has it they don't ever use collection agents.

My daughter was born in "St Mary's", now Hoboken University Medical Center. It was a great experience for a low risk birth, far better than St Vincent's for my son. Funny both are no longer, as least as they were. As for your friend, I fear she would not only have to check on the hospital, but on every person that pokes their head in her door. Sadly, this is true for ANY hospital these days, there are attendings etc who may not be on the same insurance as the hospital.


Thanks. I will pass along the information about checking on the various people who may be involved. Her ob-gyn is associated with Hoboken, hence the reason why she is planning to go there for the delivery.

I had recently heard of another situation such as what you describe of a woman delivering a baby and learning after the fact that the anesthesiologist was not associated with the hospital (or, not really part of the hospital staff?) and his bill was therefore not covered. I can't remember the details very well, but the end result was getting a huge, unexpected bill. I'm grateful that my daughter was born long enough ago that so much of this was simper and easier. Out of the total 20K bill, we only had to pay $50. This was back in 2001, at Hackensack University Medical Center.

Posted on: 12/3 18:08
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Re: Hidden Hospital Costs Leave Some Patients With Sticker Shock
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Quote:

bodhipooh wrote:
Quote:

brewster wrote:
Quote:

Monroe wrote:
Wasn't Obamacare supposed to fix things like this??


Obamacare is about insurance, and has absolutely nothing to do with it. Bayonne, Christ & Hoboken Hospitals are "for profit", and don't have contracts with most insurers. They can charge whatever they want, and they want a lot. Their business plan consists of Medicaid and overcharging for ER. Why would anyone seeking elective surgery or other sophisticated care go to them instead of one of the world class hospitals across the river?

I know someone who works for one of these places and went to get a sebaceous cyst removed, usually a simple outpatient procedure. They did it in a operating room with an anesthesiologist and everything! The bill for many thousands was absurd, but their own insurance plan "negotiated" and paid it.


I know someone who is planning to deliver her baby at Hoboken, and I almost choked when she shared that information. I cautioned her to make sure her insurance company will cover the crazy bill that will surely follow. While I don't believe in government intrusion in private businesses, I do think there should be some sort of limits imposed on these type of situations: hospitals provide a public service and the recipients of these services don't always have a choice in where they end up. I certainly wouldn't be happy to be taken to Christ, Bayonne or Hoboken if I happen to find myself in an accident and need emergency care.


If you have insurance you'll be ok in the ER, for emergencies the insurers have to negotiate and pay. It's the utterly uninsured that are screwed, though rumor has it they don't ever use collection agents.

My daughter was born in "St Mary's", now Hoboken University Medical Center. It was a great experience for a low risk birth, far better than St Vincent's for my son. Funny both are no longer, as least as they were. As for your friend, I fear she would not only have to check on the hospital, but on every person that pokes their head in her door. Sadly, this is true for ANY hospital these days, there are attendings etc who may not be on the same insurance as the hospital.

Posted on: 12/3 15:57
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Re: Hidden Hospital Costs Leave Some Patients With Sticker Shock
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brewster wrote:
Quote:

Monroe wrote:
Wasn't Obamacare supposed to fix things like this??


Obamacare is about insurance, and has absolutely nothing to do with it. Bayonne, Christ & Hoboken Hospitals are "for profit", and don't have contracts with most insurers. They can charge whatever they want, and they want a lot. Their business plan consists of Medicaid and overcharging for ER. Why would anyone seeking elective surgery or other sophisticated care go to them instead of one of the world class hospitals across the river?

I know someone who works for one of these places and went to get a sebaceous cyst removed, usually a simple outpatient procedure. They did it in a operating room with an anesthesiologist and everything! The bill for many thousands was absurd, but their own insurance plan "negotiated" and paid it.


I know someone who is planning to deliver her baby at Hoboken, and I almost choked when she shared that information. I cautioned her to make sure her insurance company will cover the crazy bill that will surely follow. While I don't believe in government intrusion in private businesses, I do think there should be some sort of limits imposed on these type of situations: hospitals provide a public service and the recipients of these services don't always have a choice in where they end up. I certainly wouldn't be happy to be taken to Christ, Bayonne or Hoboken if I happen to find myself in an accident and need emergency care.

Posted on: 12/3 13:52
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Re: Hidden Hospital Costs Leave Some Patients With Sticker Shock
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Monroe wrote:
Wasn't Obamacare supposed to fix things like this??


Obamacare is about insurance, and has absolutely nothing to do with it. Bayonne, Christ & Hoboken Hospitals are "for profit", and don't have contracts with most insurers. They can charge whatever they want, and they want a lot. Their business plan consists of Medicaid and overcharging for ER. Why would anyone seeking elective surgery or other sophisticated care go to them instead of one of the world class hospitals across the river?

I know someone who works for one of these places and went to get a sebaceous cyst removed, usually a simple outpatient procedure. They did it in a operating room with an anesthesiologist and everything! The bill for many thousands was absurd, but their own insurance plan "negotiated" and paid it.

Posted on: 12/3 13:14
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Re: Hidden Hospital Costs Leave Some Patients With Sticker Shock
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Wasn't Obamacare supposed to fix things like this??

Posted on: 12/3 12:31
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Re: Hidden Hospital Costs Leave Some Patients With Sticker Shock
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Somehow, I just KNEW before I clicked on this thread, that Bayonne Medical Center would be involved. I'd rather risk death going to a different hospital than go there.

Posted on: 12/3 11:19
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Hidden Hospital Costs Leave Some Patients With Sticker Shock
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Hidden Hospital Costs Leave Some Patients With Sticker Shock

December 2, 2016 11:30 PM


NEW YORK (CBSNewYork) — Can you imagine paying $15 for one Tylenol, $8 for a tissue or $50 for a tongue depressor?

If a store charged those prices, you’d probably find somewhere else to shop. But as CBS2’s Dr. Max Gomez reported, those are actual hidden hospital fees.

“Seventeen thousand dollars is roughly what you would pay for a decent used car,” Ryan Edgerton said.

It’s also the cost of a handful of stitches and a tetanus shot at Bayonne Medical Center, according to a medical bill he received.

His sticker shock is not all that uncommon.

Baer Hanusz-Rajkowski was equally shocked by a bill from Bayonne for a cut to his finger that didn’t require any stitches at all.

“Nine thousand dollars is a lot to eat for a band-aid,” he said.

“That’s why we are in the crisis that we are in with health care,” said Pat Palmer, who runs a company that negotiates health care costs on behalf of patients.

She said she’s seen it all.

“Fifty-three thousand for the trauma team that never performed one thing,” Palmer said.

You might recall hearing about the $39 “skin to skin” fee for a nurse to hand a newborn to his mother at a Utah hospital. Palmer said that’s just another way to pad a patient’s bill.

She also takes issue with the wording of some hospital bills. For example, would you know what a “mucus recovery system” is?

“That would be a box of Kleenex,” Palmer said.

Martin Gaynor, an economist who specializes in health care costs, said hospitals, just like any other business, need to turn a profit to pay for overhead like salaries, equipment and regulatory compliance.

“Hospitals live and die on sales revenues,” he said. “The total charges, which are like a sticker price on a car, that’s what the hospital asks but not what they actually get paid.”

Gaynor said typically insurance companies will negotiate with hospitals over these “list prices” or “aspirational charges,” as they’re called.

“They get paid what are often called allowed amounts,” he said. “Usually a fraction of the charges.”

Additionally, a spokesperson for Carepoint Health System, which oversees Bayonne Medical Center, told CBS2 that when hospitals have a lot of uninsured or under-insured patients, some costs shift to the private payers.

At the end of the day, both Edgerton and Hanusz-Rajkowski were billed less than $1,000 out of pocket for their care, but still say it was too much.

http://newyork.cbslocal.com/2016/12/02/hidden-hospital-costs/

Posted on: 12/3 0:58
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