Some one I know who only has begun to acquire significant medical bills since he had a heart attack a few years ago now is involved constantly in absurd battles with the hospitals and doctors over the costs of every procedure. He only discovered the truth after he questioned a bill related to the heart attack that seemed utterly exorbitant, and it required hours on the telephone with many different agents both of the hospital and of the insurance carriers before he was able to uncover the mechanisms that control the cost of any procedure or hospital visit. Now he questions all the bills he receives but the cost in time and energy is tremendous. How many other patients even realise how corrupt the system is?
Here is an example of the way HMOs and insurance companies operate in tandem with the hospitals and big medical practices in the States:
The patient had a regularly scheduled 'stress test' in October. Now, months later, he received a bill from the Hospital demanding $105.00 as HIS financial responsibility.
On the bill, the total cost of the procedure was given as $2100.00. Of this, Medicare was the first insurance company/carrier to pay and Aetna the second. The actual amounts paid by each respectively were not shown on the bill.
The patient rang the hospital to discover why he was being charged $105.00 when evidently, his two insurance carriers had paid over two thousand dollars for a simple stress test.
The first hospital agent gave him no specifics whatsoever, telling him he would have to ring Aetna for information. He insisted that she should tell him the actual figures as the bill was from the hospital where she worked. She first asked: 'Is there some one else in the house to whom I could speak?'
He retorted: 'You mean some one more intelligent?'
Ultimately, she fetched a supervisor who was more forthcoming. Here are the actual facts:
Although the purported cost of the procedure was given as $2100.00, Medicare and the hospital worked out a different total that was about $510.00. Of this, Medicare paid almost $400.00. The bill of the remainder of $110.00 was then sent to Aetna as the secondary insurance carrier. Aetna paid a princely total of $5.00. The patient pays $300.00 per month to Aetna, incidentally. As Aetna was unwilling to pay more than $5.00, a bill for the balance of $105.00 was sent to the patient.
This is not unusual at all. Hospital procedures and visits are given outrageous costs officially THAT NEVER ARE PAID BY ANY ONE. When Medicare receives the bill, a new total is negotiated or accepted by both parties. The patient, however, never sees the TRUE cost of the procedure but receives a bill that declares the original outrageous cost to be the actual cost. The percentages paid by his/her insurance carriers never are itemised either. Only the balance due AFTER all insurance payments have been made is shown to the patient.
This is only one small example of the way an entire Nation is being held hostage by the medical profession, insurance companies and HMOs.
A wonderful book was written on the subject of 'Formularies' and how corrupt the HMOs are with respect to the pharmaceuticals actually covered... The agents often make deals with one pharmaceutical company accepting ALL the drugs made by that firm and rejecting those made by competitors. This is why one insurance carrier or HMO may cover a product like the Lidoderm patch, for example, and another will not cover it. The book was fiction in the form of a murder mystery by John Lescroart but the information with respect to the common practices of the HMOs in the States was factual in nature.
'The Oath' by John Lescroart is a book that any one in the States with any desire to know how his/her insurance works would do well to read:
The Oath by John Lescroart
Once upon a time, doctors charged reasonable fees for their services and hospitals were not huge corporations. Now the patient seldom ever even knows the actual cost of services rendered or prescriptions filled. There are so many layers of deceit and so many negotiations between third parties involved in even the most simple office visit that it is almost impossible for an individual to discover what anything will cost in advance.
It is past time for this corrupt system to be overturned. Sweeping reforms need to be made in the field of medicine.
About Me
- Valkyrie Hawk
- My name is Eugenia-Maria Martino de Conde. Freyashawk is the name under which I write game guides and play many games. I specialise in Northern mythology but my original academic background is in History and British Law. Mine is the view of an exile, a Swan-Maiden rather than a god. Not an exile from heaven (that would be arrogant), but an exile nonetheless. I have lived in La Jolla, Nepal, London, Southampton, Manhattan, Roma, Pennsylvania et alia but spiritually belong to no land. Thus the affiliation with the air, hawk and swan. A Valkyrie chooses heroes from the slain. Walking among the dead is disconcerting. My greatest loves are my daughter and my Puttikins, my Himalayan cat clan. As Freyashawk, I write strategy guides for games. Time to write another novel for a writer can be a Valkyrie, creating warriors from her imagination that inspire people in the eternal battle between good and evil. Therein is the power I desire.
