I do not even want to think how much I have cost insurance..Medicare with supplement. With significant back surgeries, it must be huge.
Now, my left hip needs to be redone. It has lasted over 20 years but parts are loose.
Contributor
I do not even want to think how much I have cost insurance..Medicare with supplement. With significant back surgeries, it must be huge.
Now, my left hip needs to be redone. It has lasted over 20 years but parts are loose.
Contributor
A few years back, heart patients without insurance were going to India for procedures. Total cost, including airfare for both patient,and another were less than 1/4 costs in US. In Dec 2021, I had a heart attack. Total bill before insurance buy downs was over $150,000. After buy downs, my share was around $450. One thing hospitals here do, and most likely elsewhere, is put Medicare patient in hospital under observation, not admitted. This way if patient shows back up in three days after discharge, hospital doesn't take a reduction from Medicare. This creates a hardship on patient if they need to go to rehab, as Medicare only pays if you were hospitalized for three days. Always ask, am I admitted, or under observation? What is done for patient is the same in either case, but it's a CYA for hospital
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The Commonwealth Fund has a lot of data about comparative costs and outcomes in many countries. Spending on healthcare in the US has grown disproportionately compared to other high-income countries. Quality of care in most areas is either no better than, or not as good as, the other countries.
HealthcareSpendingVsGDP.jpg
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Healthcare in the US is like many other systems (energy, land use planning, water rights and usage) that have morphed over many decades. The thing they all have in common is the answer to the question, “If you were starting from scratch, is this the system you would build?”
And that answer, in most cases, is an emphatic no.
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My wife had a subacrachnoid brain hemorrhage a few years ago, spent the morning in the ER of one hospital getting several brain scans and enough pain killers pumped into her veins to float a battleship. Hospital #1 didn't have the necessary equipment to treat her so an ambulance took her to hospital #2. She spent 11 days there in ICU getting many scans and angiograms, and 2 more days in recovery. After all that time they never found the source of the bleed. They presented us with a bill for just shy of $115k. The ER trip was just shy of $20k. Our total out of pocket -- the ER at #1, ambulance ride and 13 days at #2-- was $1830.00. I was expecting well into the $20-$30k range out of pocket, so we were pretty elated about our Medicare plus a Humana kicker insurance coverage!
--For about 15 minutes...
As we were finally checking out of hospital #2, they had us sign a statement, agreeing that we understood that if her problem re-appeared anytime in the future, her insurance coverage was persona non grata at their hospital and she would be welcome ONLY if willing to pay 100% out of pocket.
So, that ordeal aside, we're still happy with our medical coverage. But alas, IMHO, it seems that NO Virginia, there ain't no Santa Claus...
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ELEVEN - rotary cutter tool machines
FOUR - CO2 lasers
THREE- make that FOUR now- fiber lasers
ONE - vinyl cutter
CASmate, Corel, Gravostyle
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I don't understand....Originally Posted by Kev Williams
If you have medicare and the medigap supplement (Humana) how can a hospital refuse you service?
Medicare A pays for hospital visits if the person is admitted. Period. (Or so I thought)
Last edited by Patty Hann; 03-07-2023 at 1:59 AM.
"What you see and what you hear depends a great deal on where you are standing.
It also depends on what sort of person you are.”
Contributor
Doesn't Medicare have some sort of thing now where if a patient gets readmitted for the same thing within a certain period of time that the medical provider gets no additional money? That might explain why a hospital would say not to come back unless you are willing to pay out of pocket.I don't understand....
If you have medicare and the medigap supplement (Humana) how can a hospital refuse you service?
Medicare A pays for hospital visits if the person is admitted. Period. (Or so I thought
Contributor
Yes, readmit penalties were initiated in 2013 for certain patient types. But they should not result in a limitation of benefits to the patient, the only effect should be on the hospital. The thought process behind them is to penalize a hospital for discharging a patient too early (which many times is in their financial interest to do). The penalty is on the first hospital that provided care in the episode of illness, and it applies even if the patient is readmitted to a completely different hospital. IMO the readmit penalties are a good mechanism for quality of patient care because premature discharge is a serious safety issue.
I don't fully understand the story about hospital #2 telling the patient they weren't welcome back unless paying out of pocket.
Best I can tell, it sounds like an out of network issue. When beneficiaries sign on to Medicare Advantage plans, often times, they are limited to that plan's provider network, at least for non-emergent care, not to mention other limitations.
If this was a traditional Medicare (non-Advantage) patient, then I don't understand why they would say that.
One thing you can count on - if there is any opportunity for an insurance company to deny a claim, they (their software) will.
If it is a hospital that is part of a large system that the insurer cannot live without in a given market, then they'll duke it out on the denied claims but ultimately pay them. If it is a smaller independent hospital that doesn't have that kind of leverage, then that hospital will probably have to take the hit.
This is why there is so much consolidation in the industry and so few independent hospitals. Survival of the biggest. You will find most major metropolitan markets have one or two dominant hospital systems for this reason.
Last edited by Edwin Santos; 03-07-2023 at 6:52 PM.
Contributor
Fascinating info....thank you Mr Santos for taking the time to explain how all this works (or why it might not work).
"What you see and what you hear depends a great deal on where you are standing.
It also depends on what sort of person you are.”
Contributor
I for one thought that problem was addressed in 2010.The problem becomes the significant number of Americans who have no coverage. Those people are billed the full charges, and many are driven into bankruptcy as a result of the collections process.
Moderator
While the number of folks in the US that have health insurance is substantially higher today, there is still a very large number of people who do not have coverage. Any further comment on my part about that would not be permitted here.
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The most expensive tool is the one you buy "cheaply" and often...
Contributor
It was addressed, and the situation was significantly improved insofar as access to insurance was improved, especially for those with pre-existing conditions. But it's still a private system in the sense that the insurers in the health exchanges are still private companies that have to attach a price to coverage. Some tiers are more affordable than others based on the benefit/premium mix. The problem of affordability still keeps many people out.
ACA was insurance reform, not health care reform. So as the underlying costs continue to escalate at a rapid rate, and the premiums escalate along with them.
Don't get me wrong, ACA took a bad situation and made it less bad, and it has been a positive game changer for many people.
Contributor
Patty, I notice you live in Arizona, and so do I. You will understand when I say it is simply not possible for any insurer to have a complete network without Banner Health. So guess who has the leverage in a contract negotiation? The insurer will have to pay the piper, and then make it up in the premiums. If the insurer refuses to play ball and walks away, their commercial business will quickly dry up because employer HR departments will howl at the idea that Banner is no longer in-network and they'll cancel coverage, take their group elsewhere.
So when a small (or not so small) employer comes up for renewal and learns their premiums are going up by 40%, often times it is by product of the contract negotiation between their insurer and indispensable (dare I say monopoly) providers, although there can be other contributing factors too.
Could you imagine running a millwork shop or contractor business where you didn't have to care about your costs because you could charge pretty much whatever you want, and if your customer didn't pay it, they would be harming their own business?
BTW, Banner is an excellent provider. I just use them as an example of market leverage and how it affects health care cost for the whole system. And I picked a hospital system, but just as easily could have picked an insurance company, ancillary service provider, medical device manufacturer or pharmaceutical company.
Contributor
Yep, Banner, Osborne, Mercy (Don't know if I've got the affiliations right) but, yep....used them all at one time or another (not Mayo, tho').
ANd now I'm on Medicare so I can use most any of them with no restrictions.
Last edited by Patty Hann; 03-08-2023 at 4:13 PM.
"What you see and what you hear depends a great deal on where you are standing.
It also depends on what sort of person you are.”
Contributor
The other day I read that the average monthly premiums for medical insurance in the US was about $1000. Thats twelve thousand a year and you can wonder how sustainable that is.
< insert spurious quote here >
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