The Cost of Healthcare: Procedures are 80% Inflated

SMWHealthcarePetitionAccording to insurance companies, our healthcare providers have inflated surgical procedures by 80 percent over the same procedures paid for by Medicare, as the New York Times article below reports.

Talk about the pot calling the kettle black.

And what a great argument for a Single Payer health system.

if our health insurers weren’t controlling state oligopolies (yep, just like a Mafia territory), the argument would have sharper teeth..

All this tells us is that  our health providers are just as mercenary as the insurers who raise our rates each year— and do so to the point where the average American family’s insurance premium is $12,680: a 20 percent of the median family income of $62,019.

Our national, state and local governments provide fire, police, defense, education and mail services. Not to mention that, without our government, there would be no parks. The Grand Canyon would be a condominium development.

So, why shouldn’t our government also provide healthcare to its citizens? We are the only major country on Earth which does not.

Other countries see it as a human right, not a profit center. It’s not “of the corporation, by the corporation.” It’s “for the people, and by the people.”

Educate yourself. Read up on the healthcare reform issues.

You’ll see pretty quickly that you’re not getting what you’re paying for — that is, if you can afford to pay for anything at all.

And if makes you angry, sign the “Single Women for Single Payer Healthcare” petition, so that you’re voice is heard.

If you don’t speak up, you don’t count.

Josie Brown

Relationship Channel Editor –

August 12, 2009 / Reprinted from The New York Times

Survey Finds High Fees Common in Medical Care

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.

The charges are among a long list of high fees cited in a survey released online Tuesday by America’s Health Insurance Plans, which represents 1,300 health insurance companies. The group said it had used Medicare payments for comparison because Medicare was so familiar and payments are, on average, about 80 percent of what private insurers pay.

The survey, insurers and some economists say, shows the sort of irrational pricing of medical care that is an integral part of the nation’s health care problems and that is largely being ignored, some say, in the current debate.

“It’s the wild, wild West when it comes to prices of anything in the U.S. health care system, whether for a doctor visit or for hospital charges,” said Jonathan S. Skinner, a health economist at Dartmouth.

The situation is so irrational, said Uwe E. Reinhardt, a health economist at Princeton, that it simply cannot go on. “We will not emerge out of this decade with this lunacy,” Dr. Reinhardt said, adding, “You worry about credit card charges, you scream for consumer protection — why not scream for it here?”

But Dr. Robert M. Wah, a spokesman for the American Medical Association, says there is 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 to get the care they want.

The survey comes as health insurers are trying to defend themselves against recent efforts by the Obama administration to portray certain industry practices as a major part of the nation’s health care problems. The insurance group, which gave its report to The New York Times before posting it online, said it had contracted with an outside group to do the study in part because insurers felt unfairly vilified.

Karen Ignagni, president and chief executive of America’s Health Insurance Plans, explained: “As we think about the health care debate, what’s been talked about is, What are the cost sharing levels? What are the premium levels? How much do health plans pay? No politician has asked how much is being charged.”

In the survey, patients were insured but saw doctors who were out of their networks of medical care providers. When patients go outside their networks, doctors have no obligation to accept the out-of-network fee from insurers as payment in full. Patients may then be accountable for the balance.

“That is what generally happens,” said Susan Pisano, a spokeswoman for the health insurers’ group. “The consumer is responsible.”

The survey looked at 10 companies that insure patients in the 30 most populous states; the companies provided some of the highest bills from 2008. Researchers excluded two types of charges that were likely to be erroneous: those that were greater than 10,000 percent of Medicare’s fees for a procedure, or more than 2,000 percent of Medicare’s fees and also more than 50 percent higher than the next highest bill for the same procedure.

There are state laws to protect patients from getting stuck with medical bills in excess of their normal deductibles or co-payments to providers in their insurance networks, but they vary widely, said Betsy M. Pelovitz, the group’s vice president for state policy.

And, she said, the laws often offer little or no protection to patients who seek care outside their insurance networks.

In New York, patients with managed care insurers cannot be asked to pay more than the applicable co-payment, deductible or coinsurance for an ambulance regardless of whether the provider is in or out of their network. In New Jersey, hospital emergency rooms treating Medicaid managed-care patients must accept Medicaid payments as payment in full and cannot bill patients extra. In Connecticut, a state law says it is “unfair trade practice” for medical providers to ask patients to pay more than a deductible or co-payment for services covered by their insurance.

But, in general, patients hit with high bills from out-of-network doctors and hospitals may have little recourse, said Leslie Moran, senior vice president of the New York Health Plan Association. “When patients dig in their heels and say, ‘No, I’m not going to pay it,’ it sometimes goes to collection,” she said.

While there is no way of knowing how often doctors submit exorbitant bills, insurance companies tell American’s Health Insurance Plans that they see such bills “all the time, every day,” Ms. Pisano said.

The New York Health Plan Association provided additional examples. For example, in testimony at a state hearing last October, it told of a Long Island surgeon who charged $23,500 for an emergency appendectomy. The patient’s insurer paid its out-of-network fee of $4,629. The surgeon then demanded the balance or said he would force the patient to pay. In this case, the insurance company paid the rest of the bill.

Patients who receive unexpected bills may not know what to do. That happened to Charles Bacchi’s mother. Mr. Bacchi, executive vice president of the California Association of Health Plans, said his mother was admitted to a hospital that, unbeknownst to her, had just dropped its association with her insurer and was now out of her network.

Mr. Bacchi’s mother, who spent less than a week in the hospital, received a bill for nearly $90,000 and was told that her plan would pay only a small portion of it and that she was responsible for the rest. Mr. Bacchi said his mother was terrified and hid the bill. “She thought the entire family savings would go up in smoke,” Mr. Bacchi said.

When his mother finally told him about the bill, Mr. Bacchi intervened and, eventually, the matter was settled by the hospital and the insurance company “as it should it have been” Mr. Bacchi said.

No one intervened for Maria Davis, though, when her son fell and banged his mouth on her kitchen floor.

Ms. Davis, a respiratory therapist in Miller Place on Long Island, took 4-year-old Ryan to an emergency room. “He was bleeding a lot, and it looked like he had a bad cut on the inside of his mouth,” Ms. Davis said.

After a long wait, she said, a doctor said he would put in a couple of stitches but seemed uncomfortable treating the agitated child. When he said he could call a plastic surgeon, Ms. Davis agreed.

The plastic surgeon, Dr. Gregory J. Diehl of Port Jefferson, “was very nice, very gentle, very kind,” Ms. Davis said. He put in three stitches, and Ms. Davis assumed his bill would be fully covered by her insurer, United Healthcare.

It was not. The bill was $6,000 — $300 for the emergency room consultation and $5,700 for putting in the stitches. The Davises paid their deductible of $350 and waited to see what would happen.

After United Healthcare paid $2,024.80, Dr. Diehl reduced his bill by $2,100 and billed the Davises for the balance, $1,525.20. He did not return calls to his office.

So far, the Davises have not paid the balance.

“I told them I thought it was an unreasonable amount,” said Jonathan Davis, Ryan’s father, who is a police officer.

“We have gotten several letters, and they have gotten more than a little threatening,” Mr. Davis said.

Had he known that the doctor would charge $6,000, he said, “we may have looked for another doctor.”

Copyright 2009 The New York Times Company