Snake Bite Costs North Carolina Couple $89,000 Hospital Bill

[MechAg94]

http://healthland.time.com/2014/01/29/north-carolina-hospital-bill-snake-bite/

I wasn't sure if this was politics, but I figured it would end up that way.
I guess I am not really all that shocked by the Hospital charging an outrageous bill, however, I was shocked to see a hospital spokesperson essentially state the truth:

The hospital, Lake Norman Regional, defended their pricing in a statement to the newspaper:  ”Hospitals only collect a small percentage of our charges, or ‘list prices.’ We are required to give Medicare one level of discount from list price, Medicaid another, and private insurers negotiate for still others. … If we did not start with the list prices we have, we would not end up with enough revenue to remain in operation. … Our costs for providing uncompensated care are partially covered by higher bills for other patients.”
Read more: SnakeBite Causes $89,000 Hospital Bill for North Carolina Couple | TIME.com http://healthland.time.com/2014/01/29/north-carolina-hospital-bill-snake-bite/#ixzz2rtQyNHlG

What?  They overcharge others to pay for those who either don't pay or to cover what the govt doesn't pay?  I am not really surpised, just shocked I that I am seeing it in print.   

Wasn't all that costs for people who couldn't pay supposed to be picked up by govt when they first told hospitals they couldn't turn people away?

[MillCreek]

http://healthland.time.com/2014/01/29/north-carolina-hospital-bill-snake-bite/

I wasn't sure if this was politics, but I figured it would end up that way.
I guess I am not really all that shocked by the Hospital charging an outrageous bill, however, I was shocked to see a hospital spokesperson essentially state the truth:What?  They overcharge others to pay for those who either don't pay or to cover what the govt doesn't pay?  I am not really surpised, just shocked I that I am seeing it in print.  

Wasn't all that costs for people who couldn't pay supposed to be picked up by govt when they first told hospitals they couldn't turn people away?

Absofrickinglutely not.  You are referring to EMTALA: the Emergency Medical Treatment and Active Labor Act, designed to prevent patient dumping of people requiring emergency treatment or who are about to give birth and who cannot pay.  It is an unfunded Federal mandate that shifts the costs of the care to the hospital.  It is a substantial portion of the typical hospital's bad debt write-off.  And since you still need money to keep the doors open, you have to make it up somehow.  And most places are pretty candid about the cost-shifting that goes on.

[MillCreek]

Double post

[roo_ster]

EMTALA is part of it and it is mostly an uncompensated requirement.  Now you see why so many hospitals have closed their ERs.  Entire hospitals have closed down to this sort of thing.  It is exacerbated by the millions of illegal aliens who are also covered under EMTALA in addition to home-grown poor folks.

Some hospitals also allow illegals and others to stick around beyond EMTALA, especially the taxpayer-funded hospitals.

[MillCreek]

In Rooster's area of the country, illegal aliens do make up a significant percentage of uncompensated care.  In my area, for example, the majority of uncompensated care is incurred by the natives and illegal aliens make up only a small part.

[roo_ster]

In Rooster's area of the country, illegal aliens do make up a significant percentage of uncompensated care.  In my area, for example, the majority of uncompensated care is incurred by the natives and illegal aliens make up only a small part.

We have three Level 1 trauma centers, one on either side of downtown and one the next county over(1).  What is interesting is that it is not 100%, but many of the illegals hit one and many of the native poor hit the other on either side of downtown.  And the natives will hop from one county's public hospital to the other one the next county over, because they have joined up the public transportation systems.  (Gaming the system?  Surely you jest...)  The illegals stay at the one because the other county will not go beyond the minimum to comply with  EMTALA.

What makes things really interesting is when the native & illegal gangs get frisky and shoot each other up in earnest, the shootee sometimes ends up in the "wrong" hospital.  This is one of the reasons why the hospitals have their own police forces.  No SWAT, but they have zero problem issuing out carbines to each and every officer if the threat level goes from "ho-hum" to "sporty."  All in all, they keep good order and are well-trained.  It is poor decision-making to get violent with the trauma staff, no matter how tiny the nurses might be.  

(1) Might just be a Level 2.  I can't recall. Will check later.

[tokugawa]

Karl Denninger has gone on about the cost of medical care for quite some time- he maintains that if the anti-trust acts were enforced, cost would drop radically.

 http://market-ticker.org/akcs-www?singlepost=3334904

[MechAg94]

It just shows that free stuff is never a good idea in the long run, no matter how emotionally good is makes voters/politicians feel. 

[Headless Thompson Gunner]

Karl Denninger has gone on about the cost of medical care for quite some time- he maintains that if the anti-trust acts were enforced, cost would drop radically.

 http://market-ticker.org/akcs-www?singlepost=3334904

So where does he think all of this illicit money is going?  Hospitals are not exactly gold mines of profit, ya know.

The problem in this instance is pretty clear:  the hospital has to pad their bill severely just to break even after the bills are negotiated down and then spread around to cover several other patients.

The problem is bureaucracy and regulation, not monopoly.

[tokugawa]

So where does he think all of this illicit money is going?  Hospitals are not exactly gold mines of profit, ya know.

The problem in this instance is pretty clear:  the hospital has to pad their bill severely just to break even after the bills are negotiated down and then spread around to cover several other patients.

The problem is bureaucracy and regulation, not monopoly.

 The problem is no free market exists in medical care, and has not for a very long time.
 

[Tallpine]

The problem is no free market exists in medical care, and has not for a very long time.
 

Plus the customer has very little discretion once he/she walks through the door.

You go in for an oil change and they rebuild the engine too.

[Cliffh]

And it's nigh impossible to find out how much the "oil change" is going to cost in the first place.

[Boomhauer]

And it's nigh impossible to find out how much the "oil change" is going to cost in the first place.

My last runaround with a hospital system

"So what's the bill gonna be?"

"I don't know, we have to submit it to your insurance"

"But I don't HAVE insurance, so what's the cash price, here, today, now, so I can pay it?"

"I don't know, we have to submit it to your insurance"


AAARRRGGGGGHHHHHH. Kind of like "We have to pass it to find out what's in it", hmm?

[Firethorn]

"But I don't HAVE insurance, so what's the cash price, here, today, now, so I can pay it?"

"I don't know, we have to submit it to your insurance"

I wonder if there's some sort of law against hidden charges/billing/deciding what to charge you AFTER the fact that you might be able to use to say 'They refused to tell me the amount, so I don't owe them anything'.

Personally, I see most of the excess cost for medical care in the USA, what's above what it costs the Europeans, coming down to 3 factors.
1.  Insurance company profit
2.  Paperwork/billing expenses due to the 'game' of providers paying personnel to try to extract payment from insurance companies even as insurance companies pay money to personnel/systems to try to avoid paying providers.
3.  Regulatory expense due to hospitals having to comply with a complex mess of laws that increases costs and limits people trying to enter the market.

[Pharmacology]

I wonder if there's some sort of law against hidden charges/billing/deciding what to charge you AFTER the fact that you might be able to use to say 'They refused to tell me the amount, so I don't owe them anything'.

Personally, I see most of the excess cost for medical care in the USA, what's above what it costs the Europeans, coming down to 3 factors.
1.  Insurance company profit
2.  Paperwork/billing expenses due to the 'game' of providers paying personnel to try to extract payment from insurance companies even as insurance companies pay money to personnel/systems to try to avoid paying providers.
3.  Regulatory expense due to hospitals having to comply with a complex mess of laws that increases costs and limits people trying to enter the market.

That, and doctors having to comply with shitloads of medi_____ requirements, lest they not get reimbursed.

Also, must doctors do a lot of unnecessary stuff/procedures simply to create a papertrail for CYA malpractice prophylaxis purposes

[Firethorn]

That, and doctors having to comply with shitloads of medi_____ requirements, lest they not get reimbursed.

I worded it poorly, using 'hospital' when I meant 'provider', but this comes under #3.

Also, must doctors do a lot of unnecessary stuff/procedures simply to create a papertrail for CYA malpractice prophylaxis purposes

Minor compared to the other 3 reasons.  Malpractice reform didn't actually save that much money, though one could argue that the perception of said liability still colors the actions of doctors who practice in states that limit malpractice awards.

[Pharmacology]

In the case of a snakebite, though, all of the stuff we're talking about is mostly inconsequential.

Crofab  is eeeexxpeeeeensssiiiiive

Especially since, given the dose they received, it was a very weak bite.
Some people receive more than twice that amount.

[tokugawa]

 Hmmmm
 http://market-ticker.org/akcs-www?singlepost=3334904

[KD5NRH]

I wonder if there's some sort of law against hidden charges/billing/deciding what to charge you AFTER the fact that you might be able to use to say 'They refused to tell me the amount, so I don't owe them anything'.

If not, then one needs to be passed ASAP.  You could package it with some anti-discrimination language about unmarked prices in retail, which would, after all, allow the staff to charge blacks more for the product, after all.  Healthcare providers could be doing the same thing.

Require all charges to be explained in full beforehand, or in the case of emergency treatment, as soon as the patient is stable and lucid, or the provider doesn't get to charge anything.  Given the amount of intake paperwork for an abscessed tooth, they could easily have included a price sheet with a signature line.

[Pharmacology]

Hmmmm
 http://market-ticker.org/akcs-www?singlepost=3334904

That's not really accurate. He probably googled Antivenin Crofab is at cost to hospitals is >$2k.
Yes, that's much cheaper than what they charge.  Yes,  they probably charge waaaay too much.
BUT that's what they pay for powder in a vial.
It doesn't cover the cost to have it prepared using aseptic technique by a pharmacy technician/pharmacist, the nurse who must administer it, and the MD who has to dose it.   They're also  not taking into account that one is much more likely to have very adverse reactions to antivenin  than other medications.

Now, I don't know if I'm correct here, but I'm just trying to logically figure out how a hospital charges $20k  for something that costs them $2k.
Because,  unlike Mr. Denninger seems to believe, hospitals are not usually gigantic profit machines.

[KD5NRH]

Hospitals are not exactly gold mines of profit, ya know.

Name a hospital administrator who is homeless or severely malnourished from eating nothing but ramen.

[tokugawa]

It is not just the hospital- the entire industry is a cartel- in what other industry are they legally allowed to charge different people different sums for the same product?  The federal government has sold favors to the medical industry allowing them to by-pass the anti trust acts.

[cassandra and sara's daddy]

It is not just the hospital- the entire industry is a cartel- in what other industry are they legally allowed to charge different people different sums for the same product?  The federal government has sold favors to the medical industry allowing them to by-pass the anti trust acts.

almost all businesses charge different rates to different classes of folks

[AZRedhawk44]

It doesn't cover the cost to have it prepared using aseptic technique by a pharmacy technician/pharmacist, the nurse who must administer it, and the MD who has to dose it.   

OK, add another $100 per stage for that.  It's certainly not something that takes entire days, or involves compounding other extremely rare or costly chemicals into the antivenom, right?  Another $300 total for the pharma prep, the nurse to pull it into a syringe, and the doctor to put it in the right vein.

They're also  not taking into account that one is much more likely to have very adverse reactions to antivenin  than other medications.

Which are then logged as new IDC9 codes, and treated with new CPT4 codes.  Which have their own reimbursement rate for that treatment, separate from the initial antivenom treatment.  No need to charge EVERY snakebite patient with heart attack procedure codes, just because 1% of snakebite patients have heart attacks.

Now, I don't know if I'm correct here, but I'm just trying to logically figure out how a hospital charges $20k  for something that costs them $2k.
Because,  unlike Mr. Denninger seems to believe, hospitals are not usually gigantic profit machines.

When the cost is not up for negotiation, you pad the profits where you can.

[tokugawa]

almost all businesses charge different rates to different classes of folks

sure- based on volume -

 It is not legal to conspire to form a cartel to keep your prices up, or to inflict a bill of several orders of magnitude higher on one customer than another for the exact same order , without telling them up front what the cost will be- .  Joe, your hamburger is $3,000. Mike, your hamburger is $8.50. 

 boomhauers example above is a perfect example- well, we can't tell you a price till we figure out how bad we can screw you.