My insurance did ‘pay’. Since Sutter’s full rate what the negotiated rate the full rate got applied toward my 2.5K deductible.
We have a Sutter Surgery center. I don’t know how the docs work today but at the time the Sutter doc could perform procedure at either the Sutter Surgery center or the non-Sutter center. The base rate for the room between the two was obviously very large. And, at the time if a poly was found the whole thing got billed as diagnostic…so it would have been largely out of pocket.
We have avoided Sutter docs whenever possible. D recently had some female stuff to address and went to a Sutter office. The experience was NOT good. Very disorganized.
So if Sutter’s rate is the negotiated rate, and it’s higher than you might pay under some other plan, at some other facility, with some other doc, I can see the stress. Especially, when what you pay comes out of your pocket until deductible is met.
But I found it hard to do such an apples to apples comparison with those other options. Put another way, it wasn’t as simple as calling another doc and asking, what do you charge for code 12345.
And yes, charges for the hospital procedure room itself are much higher than when using an ambulatory center. Different overheads. For a procedure I had, the hospital would charge $X per 15 minutes, while the surgi-center would be a flat rate.
I’d just add, watch how you compare pre-ACA to now or how you project procedures that can have addl charges versus something more contained. For what I had done, there were “ifs.” If they see something and need another view, if they decide it needs a biopsy, then do that, then lab charges and pathologist.
Several years after becoming aware of the Sutter pricing structure, S broke his arm after normal hours. It looked quite bad and the choice was Sutter urgent care or the ER. We went to Sutter. They x-rayed him and told me that the regular doc was not comfortable resetting the bone. But, their orthopedist was seeing someone at the non-Sutter ER (Sutter refuses to put an ER into our county…IMO…they’d get to many non-pays) and we could go there and have S treated. So off we went.
I took son to a non-Sutter Ortho for all followup stuff. The cost of the Sutter office appointment (not including any ER associated fees) was as much as TWO followup appointments combined. In those follow up appointments my S was re-casted twice, had several X-rays and was told we could simply purchase any needed slings* at the local medical supply pharmacy. All that for less than the one Sutter visit.
Oh..and Sutter insisted S needed a sling before going to the ER. A completely separate invoice from a company I had never heard of charging $!50 for that thing came in the mail! Turns out, no reduction because Sutter was using a non approved vendor for their medical supplies. Sutter's response..well..we aren't required to either use an in network vendor, nor do we have to tell you about it. You signed a form stating just that. Yup, while I was trying to calm a child with an offset compound fracture one of the forms I signed basically said...any medical equipment they provide was my financial responsibility. So Sutter knew exactly what they were doing.
A little blurb in MORE magazine stated 44% of all hacks/information theft occurred via medical data records. There are horror stories of people having their health insurance used by stranger…and it’s very very difficult to recover from that particular situation. More so than if Home Depot or Target has an issue. The retailers and financial institutions have more robust systems and recovery mechanisms in place. Health care providers and health insurance companies…not so much.
@dstark - I hope the new guidelines mentioned in #363 go into effect quickly.
I fully expect such things to continue. Since the ACA requires that 85% of each premium dollar go to medical payments, the overhead will always be cut somewhere. It’s a standard balancing/budgeting act that all companies partake in.
And, of course, the hackers are always ahead of security.
You’re right, @arabrab, ACA has nothing to do with Anthem’s sloppy storage of our data. Home Depot also had a huge hack earlier this year, with no apparent involvement with ACA. In fact, 9 out of 10 of the [worst data breaches of all time](Security Articles | Tom's Guide) did NOT involve companies that have anything to do with ACA. So weird.
@bluebayou Anthem CEO Joseph Swedish gets paid $16 million a year. ACA didn’t force him to take that obscene compensation. But it strikes me that if some of that money had gone into encrypting the data, we wouldn’t have this mess.
Note that Anthem isn’t providing us with any of this information. You’re right @dstark , it’s a horrible company. Just horrible. I feel like a Special Enrollment Period ought to be instituted for people who just signed up with Anthem and don’t want to spend the rest of the year with them.
The ACA had nothing to do with the hacking directly. The ACA is rapidly increasing the number of people whose health care information is stored electronically (DOB, SSN, Carrier etc).
My insurance co had me stored electronically, too. For over a decade or more. If that’s a downside to having med coverage, I’ll still take the coverage. Just saying.
Yeah, cuz it’s rapidly increasing the number of people who have health care coverage. If you don’t get insurance, you won’t be vulnerable to criminals hacking your data, but you also won’t have insurance.
Dietz, we had this discussion some time ago but I can’t remember where you came down on the subject. Were you one of those who feels that medical record keeping should be done with paper and pen?
Digital records are always going to be vulnerable. Always. Yes, even at companies which have nothing to do with Obamacare. It is the duty of those companies to do everything possible to protect us. Anthem could have encrypted our data and chose not to. How is that ACA’s fault?
I’d imagine that his salary is not even a rounding error relative to the cost of Anthem’s IT budget.
Should Sony, Target, Home Depot, and others wish that they had spend more on IT security? Absolutely. Could they have spent more? Sure, lots more. And I have no doubt that they are doing so now. As is every other producer in Hollywood (based on Sony’s expreience), and retailers (thanks to HD and Target). Hindsight is 20:20, and their IT security budgets will grow exponentially.
But that is my point. Medical carriers are capped by law on what they can spend on infrastructure (unless they can tie it to “medical payments”.) Any expense limitation will be a contributing factor to future fraud and other problems.
Digital records are necessary, here to stay and have large advantages over pencil and paper. Medical records data is of as great an interest as is HD, Target etc data. Maybe it is even more attractive because it could take the victim much longer to discover their identity has been hacked. Most responsible consumers check their bank statement and CC statements on at least a monthly basis. Those statements are either USPS or electronically generated automatically. If a problem is discovered a card is shut down immediately, all charges stopped and put into dispute and a new card issued. Who checks their insurance records? They really only come up if an EOB raises a question. Now if you are receiving a heavy subsidy and co-pay/deductible assistance there is even less incentive to check your account status…it’s not your $$ (THAT is just human nature and applies to anything which comes free to the consumer…not just ACA stuff).
Also, credit card merchants have had to deal with electronic security from the get go…docs offices health insurance companies …meh…not so much. There was enough info about the specific vulnerabilities of Healthcare.gov to make one wonder why the system was so susceptible to breaches.
But it wasn’t Healthcare.gov data; it had nothing to do with healthcare.gov. It was the internal data of Anthem, including for customers of group plans like me.
Bluebayou – setting up a system which encrypts data is not expensive. There are powerful and widely used encryption technologies that are open source – meaning the cost of the software package itself can be -0–.Everything doesn’t need to be encrypted --just the social security numbers, credit card data, and user passwords. Maybe a few other fields-- but the only “cost” is in server-time. It takes a teensy bit longer for the computer to serve up encrypted data, but hardly noticeable to the end user. So basically that is simply paying IT people costs to do what is routine for IT people to do. Mostly it’s a matter of installing software and upgrading regularly.
Just as it’s easier to install updated and code compliant electrical, plumbing and alarm systems into a home just being built, it is It is easier to design a new data collection system, from the ground up, with robust security measures. It’s harder to go back patch things you missed in the first place. But as we all remember Healthcare.gov was so vastly over budget and running out of time that it is short cuts had to be taken.
So my point, while the Anthem issues is not ACA related, we are in the process of establishing a brand new massive health info data base. A data base which will take in a larger number of less sophisticated users (if you don’t have a credit card or numerous bank accounts…you don’t worry about misuse). It is alarming that this has the vulnerabilities it does.
