Inflated Health Care Costs Add to the Debate
True Stories of Billing Fiascos Demonstrate the Need for Reform
One reason real health care reform in the United States is needed is due to the inflated costs of medical procedures billed to insurance providers. This becomes more prevalent when the provider is Medicare. Seniors that meticulously go over the amounts billed and paid are generally reluctant to raise questions out of fears that their doctors might stop treating them.
Inflated Costs are Everyday Occurrences
A patient walks into an office that specializes in drawing and analyzing blood. After presenting the paperwork, the patient discloses that he is a self-payer, a person without any health care coverage. The patient is listed in the computer data base as having had insurance, but this ended with the termination of employment.
An initial computer receipt, stamped “Paid,” lists the cost of the procedure at $58.00. The receptionist, however, overrides the default payment amount and presents a bill of $20.75. If the patient had qualifying coverage, the provider would have been billed three times the amount of the actual cost of the procedure.
An 83 year old patient visits his urologist for an out-patient procedure in order to remove benign polyps from his bladder. It is a procedure the patient has experienced several times over the last ten years. In reviewing the bill for the procedure, however, the patient notes that Medicare and his secondary health insurance provider, AARP, was billed for “surgery.” The term is a play on words and the amounts listed suggest hospitalization.
Like most elderly citizens, the patient refuses to bring it up with his doctor or to call Medicare. His hesitancy is motivated by the fear that in acting as a “whistle-blower,” he might be blacklisted in some medical computer data base.
Life and Death Decisions
A severely ill patient admitted to a major medical center has been in the cardiac unit for almost two weeks. Although the patient has a long history of heart problems, arrhythmia was not one of them. A team of cardiologists, however, convinces the family to agree to the implantation of a pacemaker, even though the patient’s cardiologist had stated many times that this procedure would not work.
The patient’s family agrees. The pacemaker is implanted and the patient dies four months later. Medicare was billed tens of thousands of dollars for the procedure and the remaining, unpaid balance depleted the family’s financial reserves.
How Practices Benefit from Deficit Payments
A healthy patient in his 50s goes for his annual medical checkup. The primary care physician is part of a large city practice tied to the local medical center. The physician meets with the patient for 15 minutes. Basic procedures like blood pressure have already been completed by a nurse. The 25 minute visit is billed at $180.00 but the insurance provider only pays $120.00. The $60.00 discrepancy is written off and recouped on tax filings by the practice. It should be noted that the patient paid a co-payment of $50.00 which was not part of the billing.
Any meaningful health care reform must address inflated costs of procedures by health care providers. As more practices become part of large, often nationwide medical organizations, the incentive to inflate costs becomes an even greater temptation to improve bottom line profits. Little wonder insurance providers have become highly selective in whom they will insure.
Sources:
All examples in this article came from interviews with actual patients or patient families willing to share their stories.
Costs of Medical Procedures are Often Inflated
|
What do you think about this article?
More in Health & Wellness
Latest Articles