Wednesday, November 25, 2009

Why doesn't the Times write about this?

This comment on the Times website uncovers another reason for the high cost of health insurance and details how to deal with it:

Why is the root cause of high cost not being addressed? Insurance companies just get a discount from whatever the hospitals charge. A hospital Charge Master List is 4, 5 sometimes 6 times cost, and these inflated charges are what the uninsured and underinsured have to pay. The gold standard for pricing is what Medicare pays the hospital, doctor etc., for a particular procedure as defined by the CPT code. Insurance companies pay about 124% of that, still providing a handsome profit for the providers, who are mainly non-profit, don't pay Federal Income Tax and don't have to produce books to prove what charity work they provide, what donations they receive or what they pay their officers (a lot!).When you think abou it, your premiums to insurance companies just provide you with membership in a group that has negotiated lower prices than the inflated charges on the hospital Charge Master list, typically a 65 to 70% discount. That still leaves the hospitals and doctors (usually supplied by a Management company, except for Kaiser and a few others) whopping profits.When my daughter spent a month in hospital and incurred a $265,000 bill, the first billing person I spoke to offered a 50% discount, later increased to 55%. Since the hospital cost was proven to be only around $60,000, they could easily offer huge disounts and still make 100 to 200% profit. After I unearthed $50,000 of completely fraudulent billing, the hospital finally settled for less than $20,000. Another hospital in the same chain had been fined $6.5 Million that same year for Medicare fraud but only after a whistle blower took action.It's no good just going after the Insurance companies (although their act does need cleaning up). The clean-up has to start with the organizations who charge ridiculous and unwarranted prices in the first place, and whose prices unfailingly rise every fiscal year by about 7% regardless of inflation. Publlic options, reining in Insurance companies - it's all hot air until the basic cause of high and increasing initial costs is fully addressed. Hospitals are abusing their non-profit status, and defrauding the tax payers of USA.Incidentally 2 courts in USA have approved uninsured patients paying only what insurance companies would pay, as the normal fee that hospital habitually accept. If you want to analyze your hospital bill, get a detailed bill with CPT codes and contact and fight, fight, fight! I got the doctors' bill reduced from $18,000 to $8,000 in this way also, as well as outside lab bills reduced from $7000 to $3000. (from Mike Walter of San Diego)

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