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WHY Hospital Sleep Studies So Much More Expensive
'Facility Fees' Are Surprise Cost For Many Patients.
Called "provider-based billing," it allows hospitals that own physician practices and outpatient clinics that meet certain federal requirements to bill separately for the facility as well as for physician services. Because hospitals that bill Medicare beneficiaries this way must do so for all other patients, facility fees affect patients of all ages. Doctors' offices owned by physicians and freestanding clinics are not permitted to charge them.
NOW I know WHY our local hospitals are building outpatient clinics all over town and the area! NOW I know WHY my husband's family doctor's office calls went from $35 to $85 over night!
http://blog.cleveland.com/metro/2009/06/patients_fume_over_clevelan..." target="_blank">
http://www.kaiserhealthnews.org/Stories/2009/October/06/fees.aspx" target="_blank">
Called "provider-based billing," it allows hospitals that own physician practices and outpatient clinics that meet certain federal requirements to bill separately for the facility as well as for physician services. Because hospitals that bill Medicare beneficiaries this way must do so for all other patients, facility fees affect patients of all ages. Doctors' offices owned by physicians and freestanding clinics are not permitted to charge them.
NOW I know WHY our local hospitals are building outpatient clinics all over town and the area! NOW I know WHY my husband's family doctor's office calls went from $35 to $85 over night!
http://blog.cleveland.com/metro/2009/06/patients_fume_over_clevelan..." target="_blank">
http://www.kaiserhealthnews.org/Stories/2009/October/06/fees.aspx" target="_blank">
Views: 123
Replies to This Discussion
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Permalink Reply by Andy on
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Oh, right. I said what I didn't do, but never said what I do do!
I'm a self-employed consultant to businesses.
Believe it or not, I used to consult to doctors, specifically on how to collect the maximum return on their billing!
Unfortunately, since many doctors seem to think that their medical degrees somehow qualified them to make detailed business, technical, and strategic decisions, I had to drop that part of the business.
And also, while they were grossing obscene amounts of money per hour (due to stacking of patients and 6 minute enounters), they didn't think that anyone else deserved charging a decent rate.
Even though every time I walked into their office, I made them far more money than they paid me.
But I'm not bitter.
;)
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Permalink Reply by sleepycarol on
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Yes, it is crazy. I must pay for my own insurance because:
I'm not a city worker.
I'm not a state worker.
I'm not a federal worker.
I'm not a congressman.
I'm not a senator.
And I don't work for one.
I'm not a state rep.
I'm not a mayor.
I'm not a city councillor.
I'm not a policeman.
I'm not a fireman.
I'm not a rescue worker.
I don't work for the railroad.
I'm not in a union.
I'm not in the military.
I'm not a veteran.
I'm not an immigrant, legal or otherwise.
I'm not an unwed mother.
I'm not an addict.
I have a social security number. And it's mine.
I'm not disabled.
I'm not on welfare.
I'm not on Medicaire, Medicaid, or Medi-Cal.
I'm not a teacher.
I don't work for Fannie Mae or Freddie Mac.
I'm over 18, but under 60.
I'm not a priest, minister, or nun.
I'm not an air traffic controller.
I don't work for a bank.
I'm a natural-born US citizen.
HOWEVER I have to pay for the health insurance for ALL OF THE ABOVE, through taxes and higher prices on everything I buy with what little money I have left over after paying for my own health insurance.
And for all of my co-pays.
I don't get a discount on my insurance because I'm not a member of a "group."
I'm just one of the minority of people that has to take care of themselves.
But I'm not bitter....
_____________________________________________________________________________________________
I must say your list is fairly long. Hmmm, around here I can tell you why there is a large turn over in some of the very jobs you mention.
I am a teacher. Many schools in the rural areas do not have great benefits. Most school boards only pay a small percentage of our health care with the rest being paid for by us. Typically families can not insure the whole family under these “group” plans due to the cost. My son and his wife, both teach, neither could afford to add their new baby to their policies due to the costs. They went with a high deductible, catastrophic plan for their newborn for him on an individual policy not connected to the schools. Let’s pray he doesn’t get sick!! Often times it is difficult to find “in-network” doctors on the policies that are offered due to low reimbursement rates paid by the insurance companies. So that means more out of pocket expenses for medical care. So yep, that is why there is an influx of people waiting for teaching jobs is due to the great benefits. NOT!!
My husband worked for the county government a few years ago. He was barely over minimum wage, although he had 27 years experience on the road crews. The benefits were laughable. They were virtually nonexistent. After two years we could no longer afford for him to continue working for the government. So yep, county works have good benefits, NOT!!
As far as our policemen and firemen, in our community they qualify for food stamps. A friend of mine has a daughter married to a policeman. She is going to school full time to become an RN. She continues to work full time at the local hospital in the evenings in order to have medical coverage on her family. She is pregnant and having a difficult pregnancy. She would love to quit work to concentrate on her schooling and the pregnancy. If she quits, they will have no insurance. So yep, policeman have good benefits!! NOT!!
In our rural area, councilmen and mayors, get a very small stipend. No benefits associated with the job. So yep, benefits are the reason many run for office!! NOT!!
The list goes on and on. I do agree that in larger states/cities the above may not apply and these types of jobs may provide great benefits, but not in our area!!
Anytime you want to help pay for our benefits let me know.
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In our local newspaper yesterday our Congressman states he does NOT stand behind Obama's health care plan as it would hurt the rural areas the greatest. The article states it will force many health care providers to close their doors and hospital and clinic closures in our rural area.
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Permalink Reply by RockRpsgt on
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Maybe Andy you could come help me stretch my dollar further. As I said before my insurance is great as long as I go through the hospital network that I work for. If I go out of network I am highly penalized. For my wife, myself and my 2 year old this is not a problem. My daughter's mom (the ex) works for the "other" hospital in our area. She refuses to go through our network. So I pay the difference as I am required to be responsible for all of Kylie's medical expenses by the state. This lately has been our only arguement so for that I am blessed. It could be worse.
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Permalink Reply by 99 on
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try bananas
99 said:try pearl barley water
Tim said:I went to the hospital ER last Monday morning because of severe pain that turned out to be a kidney stone. In the ER, I got Vicodin, an injectable pain med, Flomax, and Bactrim, a CAT scan, uraine labs, and some prescriptions. Last Friday I saw a urologist who did some more urine labs and gave me a script for for an x-ray, Flomax samples, and a script for Dilaudid (he also told me that to stop taking the Bactrim). I also have another follow up appointment with the urologist in a couple of weeks. I am lucky that I have insurance and my out of pocket expense should be less than $300. I don't even want to speculate what the rack price would be for the ER visit, CAT scan, prescriptions, x-ray, and 2 urologist visits. With any luck, the stone will resolve (pass) on its own. If it doesn't pass on it's own, I can expect to nearly double the current cost!
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Do not get sick
sorry is should have read the other posts
Rock Hinkle said:So Andy now I have to ask what do you do?
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Hi Carol,
Sorry if I sounded out of line with my long post. I did warn early on that a rant was coming on!
But, to be clear, I do not mean to put down anyone on my long list, nor do I feel any resentment towards them. Anyone with a job on that list that provides health care is getting a good benefit. One that we all deserve.
I only meant the list to point out all of the people in my area who do get their health care subsidized in some way. And to dramatize the point that I, and many people like me, do not.
In this area, most of the jobs I listed are union, and the unions fight hard for their health care benefits, even to the extent of demanding a certain insurance company, and not budging on copays and amounts that the employee pays.
Teachers here are not the highest paid, but their health insurance and retirement programs are generous.
Police, fire, rescue in this area vary in terms of pay. In the city and state police, it's not uncommon to see incomes over $150,000, after overtime. Most firemen in this area have a second full-time job, so their income is high too. Now granted, they're working for what they get. And what they do get is subsidized health care.
Our town council and selectmen are part-time, low-paying elected positions, but they do come with full health insurance. I often wondered why people would spend lots of energy and money to get elected to these positions, until I found out about the health care and retirement pay they get.
Unfortunately, in many areas of the country, such as yours, teachers and county workers get paid far less than average, and get few benefits. Clearly teachers such as yourself and county workers such as your husband are dedicated people, who are willig to work for the greater good. It's too bad that you can't get paid what you deserve.
All of this illustrates my underlying point-- that there are many hard-working, deserving people who should be able to have low-cost or no-cost (or at the very least, affordable) health insurance.
My real complaint is that everyone deserves it, but many, such as you and I, do not get it.
Again, I did not mean to disparage any individual, nor any profession.
I apologize if I did so unintentionally.
From now on I'll stick to posting about CPAP...
:-|
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Okay today I was sitting at lunch and thought I would open up the can of worms. LOL!!
Our congressman's son works at school. He is super smart and doesn't know how to have a good laugh -- you know the type, all business. He is our IT person. He has some good ideas, and then some that are way over most people's heads.
I asked him what he thought of Obama's health care plan. With 2000 pages, I wonder how many have actually read it AND understand it. I didn’t ask if him or his dad had actually read it (we only have a little over 15 minutes to eat).
He said there is a quota on the number of doctor's that graduate every year. He said this law was put on the books back at the turn of the 20th century because there were too many doctors and the pay was low. In order to drive up doctor's wages the put a quota on the number of doctor's graduating. He claims the law is still on the books and needs to be repealed. The more doctors we have, the cheaper the care in theory.
He said that states regulate the insurance industries. In any given state, the number of companies allowed to do business is limited in each state according the states regs. Over all the United States there are many insurance companies, but they are limited to certain states. He said many of the regulations needs changed or deregulated in order to broaden the pool of available insurance companies in each state. Competition should be a good thing.
His theory is that with the advent of a government backed plan premiums will be more affordable, at the expense of additional taxes since the cost will have to be covered some how. An example used is that the government will provide a $600.00 plan, the consumer will pay $300.00 for this $600.00 policy. At this point, we do not factor in the additional taxes needed to pay for the $300.00 the government is subsidizing. The private insurance companies cannot afford to cut their premiums and thus their premium is still at $600.00. Well who wants to pay $600.00 when they can get the same policy for $300.00. Consumers will decide to go with the government plan, leaving the private company in a bind with the losses of revenue this backlash as created. So in order to stay solvent, their premiums will possibly go up. When the private company raises their premium, more will sign up for the government backed plan. Thus is creates a cycle. At some point, the government will have to bail out the insurance companies or let them sink. His theory is that for the first five years, there will be a honeymoon phase. The next five years will see the tug of war start between private insurance and the government plan. By the time 20 years have went by, consumers will wish that they had a choice of private plans to choose from as our choices will be controlled by the government.
I think he has some very valid points.
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Permalink Reply by Jan on
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Hi Carol-- you got an awful lot of ground covered in just a 15 minute lunch!! If you have an opportunity to get his (or presumably his dad's) thoughts-- what would they suggest for fixing the health care situation? Or do they think it is OK as it is?
sleepycarol said:Okay today I was sitting at lunch and thought I would open up the can of worms. LOL!!
Our congressman's son works at school. He is super smart and doesn't know how to have a good laugh -- you know the type, all business. He is our IT person. He has some good ideas, and then some that are way over most people's heads.
I asked him what he thought of Obama's health care plan. With 2000 pages, I wonder how many have actually read it AND understand it. I didn’t ask if him or his dad had actually read it (we only have a little over 15 minutes to eat).
He said there is a quota on the number of doctor's that graduate every year. He said this law was put on the books back at the turn of the 20th century because there were too many doctors and the pay was low. In order to drive up doctor's wages the put a quota on the number of doctor's graduating. He claims the law is still on the books and needs to be repealed. The more doctors we have, the cheaper the care in theory.
He said that states regulate the insurance industries. In any given state, the number of companies allowed to do business is limited in each state according the states regs. Over all the United States there are many insurance companies, but they are limited to certain states. He said many of the regulations needs changed or deregulated in order to broaden the pool of available insurance companies in each state. Competition should be a good thing.
His theory is that with the advent of a government backed plan premiums will be more affordable, at the expense of additional taxes since the cost will have to be covered some how. An example used is that the government will provide a $600.00 plan, the consumer will pay $300.00 for this $600.00 policy. At this point, we do not factor in the additional taxes needed to pay for the $300.00 the government is subsidizing. The private insurance companies cannot afford to cut their premiums and thus their premium is still at $600.00. Well who wants to pay $600.00 when they can get the same policy for $300.00. Consumers will decide to go with the government plan, leaving the private company in a bind with the losses of revenue this backlash as created. So in order to stay solvent, their premiums will possibly go up. When the private company raises their premium, more will sign up for the government backed plan. Thus is creates a cycle. At some point, the government will have to bail out the insurance companies or let them sink. His theory is that for the first five years, there will be a honeymoon phase. The next five years will see the tug of war start between private insurance and the government plan. By the time 20 years have went by, consumers will wish that they had a choice of private plans to choose from as our choices will be controlled by the government.
I think he has some very valid points.
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He doesn't think the plan, as written is a good idea. Of course we are in the conservative Mid-West.
His thoughts were to lift the quota on the number of doctors allowed to graduate each year. His theory is that the more doctors there are the more competition and it will drive the cost down.
The only thing I question on this theory is that wouldn't Medicare and insurance companies have to allow doctors to set their own rates. It seems that in today's markets the costs are driven, not by the doctors, but by the insurance and government.
His other idea is to open up and allow more companies into each state so that there are more options through the various companies available to them. He doesn't see why consumers can not choose and pick their coverage – if you are young and healthy you may want to exclude certain conditions, or if you are older exclude other conditions. Example would be pregnancy coverage, if you are a single male without a partner exclude pregnancy or if you are older and past the age of having kids. If you aren’t on prescription drugs, exclude that coverage and pay out of pocket if and when you need a script filled. Of course you may end up in a catch 22, if you exclude certain conditions and then have the unfortunate happened and end up with one of the excluded conditions you are going to get hit with the pre-existing clause probably.
Hey, we have learned we can get quite a debate going on. We are a group of educators and so most of us don’t know what we would do if we had a “normal” lunch break of 30 minutes or heaven forbid a whole hour!! We would be absolutely lost.
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