Jon forwarded me this recent New York Times article, Survey Finds High Fees Common in Medical Care, and I’ve finally gotten around to blogging it today.
A patient in Illinois was charged $12,712 for cataract surgery. Medicare pays $675 for the same procedure. In California, a patient was charged $20,120 for a knee operation that Medicare pays $584 for. And a New Jersey patient was charged $72,000 for a spinal fusion procedure that Medicare covers for $1,629
This is not unfamiliar to me. While being induced at Swedish Medical Center – Ballard, I was offered an epidural after nearly 30 hours of being there. Up to that point, I had been offered opiates for pain control, but I wasn’t liking it – and I’m sure they didn’t seem too keen to pony up to “whatever medication you want” that they had promised. (For a reference point, this was for a stillbirth, in case some of you are just tuning in.) The anesthesiologist was happy to help lay my fears to rest about the procedure, and I eventually relented – to the tune of $9000. Why do hospital births cost many thousands more than birth-center births (not that this was even an option for me at the time)? I’m guessing because of the epidural. I was told by some friends that their epidurals only cost in the $1500 range, and after some quick Googling, I found some that were even charged less. Luckily, insurance has covered much of the cost of my hospital stay, however, the cost of childbirth especially stings when you walk away with empty arms.
The health insurers, saying they felt unfairly vilified, gave the report to The New York Times before posting it online on Tuesday, explaining that they wanted to show that doctors’ fees are part of the health care problem.
This doesn’t surprise me. After my stillbirth I was seen days later in the Swedish Ballard ER for a Deep Vein Thrombosis, which turned out that I was at an in-network facility with then, out-of-network physicians serving the ER. Part of what I understand to have been the issue between the Ballard Emergency Physicians (the contracted ER physicians for Swedish Medical Center – Ballard) and Premera was that the BEP wanted more money, and Premera wasn’t having any of it. This meant that when the BEP dropped their agreement with Premera, they could charge unlucky people such as myself (and many others, being that Premera is the largest insurer in the state), whatever they saw fit. This meant, that in one case I’m personally aware of, two identical visits, for the same problem at the same time of day, had a $1000 difference in charges.
Premera is well within their right to write their contract as they see fit. They also have the goal of staying profitable, which means that they’ll draw the line as to what they’ll pay for and what they won’t.
But Dr. Robert M. Wah, a spokesman for the American Medical Association, said there was another side to the story: insurers’ low payments to doctors who enter into contracts with them and the doctors’ difficulties, in many cases, in getting paid at all. That is why, he said, doctors may simply abandon insurance plans. Then patients end up with extra fees because they have to go outside their networks.
I remember once having some issue with coverage of my naturopath’s services. It finally got settled, but one of the grumblings I heard from the office manager was that they had issues with one of the Blue Cross affiliated insurers paying them in a timely fashion, if at all. This can obviously be an issue, though I’m not sure the answer is completely over-charging others as they see fit to make up the difference.
I’ll let you go to the article to read the rest. The article lays out pretty much exactly what I’ve been talking about on this blog regarding my own experience between a hospital and an insurance company, even covering similar efforts by others to both individually and legislatively change the system to be more transparent, and offer some opportunities to regulate some of these high costs.
Health care reform matters. I’d prefer there not have to be legislation to change the status quo. I prefer that in just about every case it can be imagined. However, this madness has gone on long enough. No matter what loud people in town halls are saying.*
*see upcoming disclaimer on this.
See previously under the Ballard Emergency Physicians tag.
Tags: ballard emergency physicians, grief, health care, maternity, medical, premera, swedish medical center