<p>I know the other side of the argument which is it keeps costs down and puts pressure on higher cost providers to lower costs. That is a good thing, but it is really tough on the patients. </p>
<p>Also, the patients don’t get to decide what the insurance company’s maximum payout is so this situation is open to abuse.</p>
<p>My understanding is that when they tell you you can’t spend more than $30K for a knee replacement, they also give a list of hospitals who charge that. It’s another way to squeeze hospitals, to be sure, but hospitals need to be squeezed when they overcharge for these common procedures with no improvement in quality.</p>
<p>It is just wrong to put more burden on insured patients. Period!</p>
<p>Today has been quite instructive for me. You might remember I had a bike accident and 2-night hospitalization in June. I had no procedures, and in fact no treatment besides oxygen. It was just monitoring.</p>
<p>I spent most of the day today paying my bills from that hospital stay. This required EIGHT separate transactions. The eight transactions, which could not be combined, and which required calls to SEVEN different billing entities, were for the hospital, the ER doctor, the inpatient doctor, the pulomonogy practice, the ECG provider, radiology, pathology, and the follow-up visit. All except the last were services provided to me in the hospital, which was in-network.</p>
<p>What do these layers of bureaucracy cost? The bills came to just over $15,000. Blue Cross paid over $11,000 and I paid almost $4000. (I have a $3k deductible on a dirt-cheap Obamacare plan.) Two nights, no procedures, no ICU. Insanity!</p>
<p>Oh my goodness, Hanna, that is, indeed, insanity. </p>
<p>Hanna, wow! Thanks for the update. </p>
<p>Costs we pay in the US are insane but at the same time everyone goes to the doctor for every tiny ailment so as a whole we bring it on ourselves. 80 year old granny does not necessarily need a knee replacement…</p>
<p>Do you know an 80 year old granny that received an unwanted knee replacement?</p>
<p>You can call and negotiate. I can’t remember what happened but I called and got one bill reduced by almost and the other 5%. But I think you have to ask for it.</p>
<p>I did call and negotiate, with the carrot that I was offering to pay in full there and then. One provider knocked 20% off of a $200 bill. But most of them said that because they’d already adjusted the charges to reflect their contract with BCBS, further discounts were not available.</p>
<p>I probably didn’t need to be in the hospital for two nights. But it’s a catch-22: if they say you need to be there, and you leave against medical advice, then the insurer won’t pay for ANYTHING that comes up later related to that illness or injury. So I couldn’t take the risk of taking some oxygen and going home, because if God forbid my condition got worse and I had to come back, I’d be effectively uninsured and on the hook for everything.</p>
<p>It was such an illustration of how markets/choices don’t really work in this context. I called 911 from a forest preserve and was taken to the closest ER, which admitted me. Doctors just show up in my hospital room at random intervals and examine me. I can’t imagine negotiating with them from my bed: “Are you in-network? Are you board-certified? What will you charge me today? Why do I need a pulmonologist for this examination vs. a less expensive internist? What’s the price for this saline drip? Is there a cheaper alternative?”</p>
<p>Yep Hanna, you are right.</p>
<p>For some insurance if it’s an emergency the bills are paid. But I did threaten to walk out on a hospital once after waiting for 7 hours, they finally had to do some quick stitching. I figure after 7 hours and nothing bad happened, ie nobody died, and nothing was done at the hospital then I had to take action.</p>
<p>I did call insurer today and they said it was undercoded and they’d resubmit it with a diagnosis code from the treating MD. They said should be paid as reprocessed within about 30 days and call if I had any problems with provider and billing. </p>
<p>When I had problems with in and out of network anesthesiologist for S, I fought with insurer and anesthesiologist practice and they compromised and had me pay LESS than I would have if they were in network and insurer paid some and practice reduced its bill. Whew!</p>
<p>I used to have these issues fairly often with insurer but not as often recently, thankfully! ;)</p>
<p>I did have to fight with my insurer on one occasion, different insurance that the one I currently have .They were arguing it was not accidental. I think I came out on the winning side. </p>
<p>i’ve challenged my insurer many times over the past 14 years. I lost twice and won all the other challenges, so I’m pleased. The two things I had to pay out of pocket for totaled less than $600, and I was OK with paying out of pocket for them. The rest I was able to convince them to pay out per the insurance contract, with my paying just my co-pays. I’ve had the same insurer nearly all my life and really have no major complaints, other than the irritating hoops they make docs have to jump thru and all the paperwork they make them file and the time they make providers wait for reimbursement.</p>
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<p>Wow, I had no idea that that was the case. Every time there’s a thread like this, I learn something that is even more ridiculous about the U.S. system of healthcare and makes me ever more grateful for universal care in Canada. </p>
<p>p.s. Come on, dstark. I’m still waiting for you and your wife to move. 
There are three houses for sale on my street!</p>
<p>Alwaysamom, Lol…you dont live in Vancouver. My oldest daughter doesn’t either. ;)</p>
<p>Anthem just raised premiums 8 to 12 percent on small businesses in Cal. The insurance commissioner says an increase of a little over 2 percent is warranted. </p>
<p>If the US had similar health care costs as Canada, we could visit Canada more often. :)</p>
<p><a href=“List of countries by total health expenditure per capita - Wikipedia”>http://en.m.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_(PPP)_per_capita</a></p>
<p>We have subsidized health care for many employees in the United States. Understandably, employees dont want to give the subsidies up. Makes it hard to move the needle towards an overall cheaper health care system. People don’t want or like change. Freaks them out.</p>
<p>The first time I went to Vancouver (I was playing in a hockey tournament) I called my husband and jokingly said, “Sell the house, I’ll meet you here.” If we had to move outside the US, that’s where we’d go. But would I have to become a Canucks fan?</p>
<p>We have a system where ten different entities like hospitals, insurance companies, lawyers, physicians, pharma and other suppliers, etc. all have huge established markets. And each of these groups looks at their income and growth as paramount even though there are individuals within who may think otherwise. Any attempt to cut costs is always at someone’s expense and since the latter party usually is far more aggressive, it’s naive to think that there’s a straightforward fix. </p>
<p>As long as there is money that’s available and it’s controlled by politicians who can be bought, nothing is straightforward. And for every cost cutting measure, it’s not difficult to come up with a “John, the loving grandfather with those gorgeous little grandkids needs this $100,000 drug that you dare not ration” scenario. That’s why it’s far easier to keep everyone happy and keep charging on our kids’ credit cards. </p>
<p>And it’s not any one entity that’s at fault - this is our system; if money is freely available, how many schools will find ways of spending it and keep increasing their tuitions versus voluntarily deciding to be frugal and leave money on the table? </p>