Outrageous or Acceptable Medical Bill? I want to hear your thoughts

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Recently, I broke my hand (specifically the 4th metacarpal causing the 5th metacarpal to become dislocated as well.)

Being a recent college graduate, and going back to school this fall to finish up some prereqs to pursue a career in the medical field, I am without medical insurance.

I was referred to by my immediate care provider to an orthopedic center. Here are my resulting self-pay medical bills:

Medical Center(doctor consult and progress monitoring):
http://home.comcast.net/~hkou/medicalbill.JPG

Surgery Center:
http://home.comcast.net/~hkou/surgerybill.JPG


Are these prices normal? Am I getting fleeced?
I'd love to hear your thoughts.

That sounds about right. Its what happens after years of price inflation without any market control.

Originally Posted by Coldfusion079

Are these prices normal? Am I getting fleeced?
I'd love to hear your thoughts.

Yup. That's why, especially as a student, you should have insurance.

See, the thing is, they never gave me a full estimate of the costs. The pricing just seems so arbitrary and no one can explain to me what each dollar is going toward. I asked them to explain the costs a little more specifically and they told me they just follow AMA CPT codes.

If I had known how much it was going to cost me, I would have shopped around for a day before electing to have my surgery performed by this private practice.

(I understand, I SHOULD have insurance. And believe me, were it within my power to obtain insurance I would. The billing office is going to have a fun time getting 16 grand paid back 100USD/mo at a time.)

Originally Posted by Coldfusion079

See, the thing is, they never gave me a full estimate of the costs. The pricing just seems so arbitrary and no one can explain to me what each dollar is going toward. I asked them to explain the costs a little more specifically and they told me they just follow AMA CPT codes.

If I had known how much it was going to cost me, I would have shopped around for a day before electing to have my surgery performed by this private practice.

Welcome to the world of medicine with their price fixing. There is no other industry where they are able to hide their prices from you until after services.

The problem with our industry is there is no transparency of cost. These high prices are a result of consumers (i.e. you) not being able to shop for services as well as the cost shifting from those that are receiving free care. It is ridiculous that prices are set by an outside entity. Prices should be set by those providing the service, just as a lawyer charges whatever fees he/she sets prior to providing the service. It will then become a supply/demand market and drive down these ridiculous costs. In a system where the consumer is not the direct payer, we have no control over the ultimate price. Insurance should be a contract between the patient and the ins. company. The doctors should bill the patient and the patient should be reimbursed by the insurance company. Insurance would change and prices would become transparent to the consumer.

The consumer is just as much to blame for this. All expectations are placed on the hospitals. You want your benadryl to sleep? did you use to take it at home? How come you want it in the hospital? You also want to hold the hospital accountable if you didnt sleep and recover so well? How much is the cost of accountability? 10+ million dollar lawsuit?

What I am trying to say is that hospitals have become a monsterous defense system of service. You come in and get serviced and discharged with the least liability. If something increases liability then the hospital will transfer that liability cost to YOU... it will just be spread amonst payers that's all.

Nobody knows what this stuff costs. I have no idea. Sometimes people ask me for estimates, I just tell them I don't have a clue.

Originally Posted by Tired

Nobody knows what this stuff costs. I have no idea. Sometimes people ask me for estimates, I just tell them I don't have a clue.

Not true. I know, generally within $10, what >95% of the services that I provide cost. I believe that it is our duty to know these things.

As to the OP question -- to some extent, yes, you are getting the shaft. Everyone involved in medicine should know that our charges are out of line with what is fair and just payment. This is for a variety of reasons, but it is largely because some payers continue to reimburse base upon a percentage of charges up to a maximum amount, which mathematically necessitates inflated charges in order to collect what is due us. Another reason is the paltry reimbursement of Medicare, Medicaid, and even private insurers who have developed a monopolistic market share in a given region, resulting in cost shifting efforts....

If you look at the CPT codes (which are the five digit codes listed on the bill), you can then go to the Medicare fee schedule website and find out what Medicare says those services are worth. What private insurance pays varies according to region, but they generally pay better than Medicare (and rightfully so).

Talk to the group's financial person -- they will probably work with you on this.

Best of luck...

Originally Posted by MOHS_01

Not true. I know, generally within $10, what >95% of the services that I provide cost. I believe that it is our duty to know these things.

You are familiar with the facility charges? The cost of other consultants on your patients? You can estimate the total bill?

Originally Posted by Tired

You are familiar with the facility charges? The cost of other consultants on your patients? You can estimate the total bill?

Facility charges -- I currently operate only out of my office, so there are no facility fees -- but yes, if I operated out of an ASC I do know what the facility fee would be (it is a set fee based upon pay class schedules dependent upon the actual CPT service being provided).

I do not consult others on my patients as a general rule, but yes, I also know what the E&M and any fees associated with familiar procedural codes would be as well. The question at hand concerns the charges (and expected payments) associated with the services that I, as an individual, provided, which is what I believe is our duty to know well enough to be able to discuss.

Mine is an outpatient practice; if I operated out of a hospital I would take the time to know what their general fees were. Patients are becoming "consumers" more and more; if we wish to remain the leaders and authorities in the healthcare arena we will ultimately have to embrace this new role of cost educators as well.

As you said, pay $100 per month to each account. And, don't ever get injured or sick again without insurance.

If you are uninsured, it means you don't have an agreed fee schedule. That means that you might as well walk in with a blank check and hand it to the billing dept.

In your situation, I would go to:

https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp

This will let you research the medicare allowed reimbursement. Then go to the hospital and try to negotiate paying 2-3 times that amount. That would place you somewhere around what an insurance "allows"

As you can see from the above link, you are being asked to pay about 5 times what they would have to accept if they take medicare patients.

Our company will soon be moving to an HSA type plan. I will likely be the biggest pain in the butt patient any hospital ever had.

I plan on recording every Dr. visit with one of those little MP3 players ($10 at staples) and make a verbal record of my own as to what is done during visits.

The problem I'm running into is that the billing departments can't answer a simple question, like, "hey, why was this coded as 12041 instead of 12001?, I don't remember it being dirty and I doubt it was a layered closure done only with dermabond".

Prepare to be nationalized, which, will make things worse in some ways.

You could declare bankruptcy and have it discharged as you probably aren't planning to buy anything for awhile. Both of my parents have had to do this because of medical bills.

Also, Looking at the bills, there is a question as to whether they "unbundled" services that are normally bundled together.

i.e. postop care as part of the "surgical package". The problem is that without a prior agreement (such as the insurance companies have) your only argument is that the way they billed you is not Usual, customary OR reasonable.

#1 reason for filing bankrupcty.

i agree with renegotiating the price. you should have that hacked in half.

Originally Posted by MOHS_01

...if we wish to remain the leaders and authorities in the healthcare arena we will ultimately have to embrace this new role of cost educators as well.

Right on. It bothers me to no end that many physicians don't know how much their patients are going to pay out of pocket. I don't think there's much more that will have an impact on reducing healthcare costs than transparency.

Is it surprising that a lot of elective procedures such as LASIK, the prices are plastered everywhere? Not to me. Because when it comes out of a patient's pocket directly - they shop around and becoming informed; a task that is often impossible in many aspects of our healthcare system.

Originally Posted by Coldfusion079

(I understand, I SHOULD have insurance. And believe me, were it within my power to obtain insurance I would. The billing office is going to have a fun time getting 16 grand paid back 100USD/mo at a time.)

I personally have a super high deductible plan that costs me $50/mo. I don't use it to pay for anything, but just bringing in my insurance card means I get the network discount, then pay that MUCH reduced price out of pocket. Some cream I got cost over $100 but only $20 with insurance. However, for those with a chronic illness, I imagine their insurance price would be much higher and possibly unaffordable, hence our accessibility issue.

A lot of people successfully negotiate hospital and medical bills, either independently hoping for the staff's goodwill, or by bringing in a negotiator if the bill is high enough. Because many uninsured don't (or can't) pay their bills, the office benefits from at least locking in SOME payment, especially if you can do it up front. They often say it cuts the payment by a ton, maybe in half or even two-thirds off, say 25% above what medicare would reimburse. I personally feel annoyed at paying much more than someone else pays for the same treatment, especially when I feel like I'm saving the billing office trouble by paying out of pocket rather than them having to fight insurances. I've done some insurance billing and it can be quite a pain.

Originally Posted by AFSmiley

Right on. It bothers me to no end that many physicians don't know how much their patients are going to pay out of pocket. I don't think there's much more that will have an impact on reducing healthcare costs than transparency.

Is it surprising that a lot of elective procedures such as LASIK, the prices are plastered everywhere? Not to me. Because when it comes out of a patient's pocket directly - they shop around and becoming informed; a task that is often impossible in many aspects of our healthcare system.

where do you as the provider draw the line? we're already letting people who have no knowledge of medicine (beyond google) essentially dictate how care is delivered through litigious threats. you're going to let them pick and choose which tests or medicines they want based on costs? so that outcomes can be even worse and providers can get blamed (read: sued) more? get real.

Originally Posted by dodobird13

where do you as the provider draw the line? we're already letting people who have no knowledge of medicine (beyond google) essentially dictate how care is delivered through litigious threats. you're going to let them pick and choose which tests or medicines they want based on costs? so that outcomes can be even worse and providers can get blamed (read: sued) more? get real.

Uh, yeah. It doesn't matter what you prescribe, if they can't afford it, they won't take it. At our free clinic we make medication decisions all the time based on cost, what donated meds are in our free formulary, what's on the 4-dollar med list. Cost is an extremely important factor for a lot of patients.

Originally Posted by cpants

Uh, yeah. It doesn't matter what you prescribe, if they can't afford it, they won't take it. At our free clinic we make medication decisions all the time based on cost, what donated meds are in our free formulary, what's on the 4-dollar med list. Cost is an extremely important factor for a lot of patients.

Exactly, if metformin were $10/pill, most people wouldn't take it -- regardless of whether they need it or not.

About a month ago, I switched to Androgel 1% for TRT instead of shots (belonephobia) -- $268/month vs. the previous $50/month. My NP's office has some sort of agreement with a compounder so that I can get a 5% solution compounded for $40/month. Same stuff, I just take 0.5 ml instead of 2.5ml. Compounder's rule!

Had it been someone else that said "I hate compounders, they suck! You have to use the Androgel or nothing!" then I would have just went to another provider or ordered form overseas (Androgel 1% 30x5g = $130 instead of $268). How's that for compliance?

To the OP: It looks about average, a friend of mine got saddled with $14K over a kidney stone (no surgery).

I used to do some light insurance and billing. Talk to the folks at that office, you can often get a cash-only discount.

Originally Posted by cpants

Uh, yeah. It doesn't matter what you prescribe, if they can't afford it, they won't take it. At our free clinic we make medication decisions all the time based on cost, what donated meds are in our free formulary, what's on the 4-dollar med list. Cost is an extremely important factor for a lot of patients.

absolutely. and there's nothing wrong with that. we all have financial restraints. however i don't think it's up to the patients to decide which tests/medicines they will or will not take based solely on cost, because they don't have the medical knowledge behind them to make the best overall decision... that is why they go to physicians... who in my opinion have an ethical obligation to patients and the system as a whole to consider cost in their decision making. however concern over cost becomes a distant memory when docs feel threatened and order the kitchen sink of esoterica in defensive strategy.... and who can blame them?

the system is jacked and it is in dire need of reconstruction on everyone's part... but the root of the issue lies with lack of education, unrealistic expectations, and our absurdly litigious society, all which may nicely be summed up by "a complete and utter lack of sense of personal responsibility".

Originally Posted by Neuronix

You could declare bankruptcy and have it discharged as you probably aren't planning to buy anything for awhile. Both of my parents have had to do this because of medical bills.

This is the problem with society...I provide a service and if a patient can't pay the bill they can simply file bankruptcy and avoid it. I don't see anyone allowing me to do that for my student loans. Before someone gets on my case about health care...I pose you this question. If I walk into a restaurant and order a meal and eat that meal and then decide I can't afford it there are legal ramifications. Eating is just as much a necessity as health care so where's the difference.

It's people like you Neuronix who suggest that people just absolve themselves of individual culpability that are the root of the health care problem. Good luck in your pursuits as a physician..I hope you see what it's like when you put hours into patient care and get zip back for renumeration.

Originally Posted by wagy27

Good luck in your pursuits as a physician..I hope you see what it's like when you put hours into patient care and get zip back for renumeration.

When my dad needed a liver transplant and his insurance refused to pay because it was then "experimental surgery", should he have just died when I was a small child because we could have never come up with that kind of money as a poor family?

My mom is a schizophrenic who spends a lot of her time living on the streets or in her car. How exactly do you expect her to pay her psychiatric hopsitalization bills?

Good work on the Lee Burnett's law. Universal health care should be provided to all citizens of the USA, and you're going to have to deal with people being unable to pay for their care until that happens regardless of whether you think that is right.

Originally Posted by Neuronix

Good work on the Lee Burnett's law. Universal health care should be provided to all citizens of the USA, and you're going to have to deal with people being unable to pay for their care until that happens regardless of whether you think that is right.

Please save your liberal bleeding-heart ideology for somewhere else.

Health care is not a right. It is a commodity that you can purchase.

And guess what, some cars are better than others, just like some drugs are better than others, just like some doctors are better than others.

There is a reason why doctors and middle class/wealthy people from socialized medicine countries come to the U.S. for any medical problem that is remotely complicated.

Originally Posted by roflcakes887

Please save your liberal bleeding-heart ideology for somewhere else.

Why should I? I may post whatever I like, wherever I like as long as it conforms with the SDN terms of service. This is a forum specifically for topics in healthcare, and thus, you have no right nor standing to tell me not to post my opinion.

You never did bother to answer the questions I specifically asked in my post.

Originally Posted by wagy27

This is the problem with society...I provide a service and if a patient can't pay the bill they can simply file bankruptcy and avoid it. I don't see anyone allowing me to do that for my student loans. Before someone gets on my case about health care...I pose you this question. If I walk into a restaurant and order a meal and eat that meal and then decide I can't afford it there are legal ramifications. Eating is just as much a necessity as health care so where's the difference.

It's people like you Neuronix who suggest that people just absolve themselves of individual culpability that are the root of the health care problem. Good luck in your pursuits as a physician..I hope you see what it's like when you put hours into patient care and get zip back for renumeration.

The big difference is that in the ops case he didn't know the price before he got the services. In the counterpoints you mentioned, you already know the price of the meal before you buy it and you already know the amount of loans you need before you take one.

Originally Posted by Neuronix

When my dad needed a liver transplant and his insurance refused to pay because it was then "experimental surgery", should he have just died when I was a small child because we could have never come up with that kind of money as a poor family?

My mom is a schizophrenic who spends a lot of her time living on the streets or in her car. How exactly do you expect her to pay her psychiatric hopsitalization bills?

Good work on the Lee Burnett's law. Universal health care should be provided to all citizens of the USA, and you're going to have to deal with people being unable to pay for their care until that happens regardless of whether you think that is right.

I think that before we provide universal healthcare, we would have to provide universal food (which is why i'm against universal healthcare). Food is certainly more important to a poor person than a dr.'s appt.

Originally Posted by roflcakes887

Please save your liberal bleeding-heart ideology for somewhere else.

Puh-leese You know, I hear the same "liberal bleeding-heart" complaints day-in day-out from conservatives receiving welfare in my county.

Welfare? Liberal. Medicaid? Liberal. Free treatment for vets with PTSD? Liberal. Food Stamps? Conservative, but called "Liberal" by neo-cons.


"The lady doth protest too much, methinks."

No offense Neuronix but on whose shoulders should the cost of a liver transplant be placed? Why mine or our fellow taxpayers? Should I expect to be taxed to pay for everyone's health care. Get serious, what about individual responsibility? Either get a job, or find a way to pay for your care. If you can't, well Medicare and Medicaid are available. If you don't qualify, well that's too bad for you. No one gurantees food or shelter which I view as being much more important so why health care? The reason that hospitals are struggling at this time is because of all the bad debt they have to write off. You and your family are just adding to the problem that is the US health care system.

Originally Posted by rmbd2b12

I think that before we provide universal healthcare, we would have to provide universal food (which is why i'm against universal healthcare). Food is certainly more important to a poor person than a dr.'s appt.

Food stamps. [/discussion]

No offense Neuronix but on whose shoulders should the cost of a liver transplant be placed? Why mine or our fellow taxpayers? Should I expect to be taxed to pay for everyone's health care. Get serious, what about individual responsibility? Either get a job, or find a way to pay for your care. If you can't, well Medicare and Medicaid are available. If you don't qualify, well that's too bad for you. No one gurantees food or shelter which I view as being much more important so why health care? The reason that hospitals are struggling at this time is because of all the bad debt they have to write off. You and your family are just adding to the problem that is the US health care system.

Thank you for your intellectually honest and morally bankrupt statement. It's easy to feel that way if you are born into or are lucky enough to have the opportunities to get into decent circumstances and surroundings. I hope none of your family members are ever in the situation my family had--working very hard for many years only to lose everything due to medical illness insurance refused to cover.

It's funny...I want to agree and say "the world needs ditch diggers too" Neuronix, and I agree in most part with wagy, but damned if I wouldn't share your opinion if my insurance wouldn't cover the cost of a life saving procedure. Note, though, that I have insurance.

As long as I get paid for my work I don't care so much where the $ comes from. I understand some of my tax dollars go to care for the poor and underserved and that's fine with me.

What you fail to realize is that by you stating it's okay not to pay your medical bills or to file bankruptcy you're screwing over the physician who took the time to work on your family member. What about the plans they had for their income..how about their family members who might need financial support? Why should they get the shaft because you and patients like you decide they'll just discharge their bills by filing bankruptcy.

Further, it's probable that the physician may still get paid but it's the hospital that takes a hit. Why should the hospital be taking that hit...out of the their benevolence, get real. This just leads to the hospital taking it out on paying customers, raising the cost of health care further.

Originally Posted by wagy27

This is the problem with society...I provide a service and if a patient can't pay the bill they can simply file bankruptcy and avoid it. I don't see anyone allowing me to do that for my student loans. Before someone gets on my case about health care...I pose you this question. If I walk into a restaurant and order a meal and eat that meal and then decide I can't afford it there are legal ramifications. Eating is just as much a necessity as health care so where's the difference.

This is a lousy analogy.

You can't honestly compare a life-saving liver transplant or Whipple to CHOOSING to walk into a RESTAURANT and eating a meal that, honestly, you probably don't need to survive.

In the analogy you provide (that of eating at a restaurant and then deciding that you can't afford that meal that you've just eaten), choosing to eat a meal at that particular place is an option. There are other options that, while they might not taste as good, are cheaper and are still enough to offer you sustenance. The bottom line is, though, that you have choices.

In real life, though, the choice often comes down to choosing between a liver transplant that you can't afford and dying a horrible death from ESLD. What kind of choice is that?

(And before you start in on how people have a choice to drink alcohol or do IV drugs, I'm sure that you know as well as I do that many people need liver transplants secondary to things like PSC or alpha-1-antitrypsin deficiency.)

Originally Posted by wagy27

Either get a job, or find a way to pay for your care. If you can't, well Medicare and Medicaid are available. If you don't qualify, well that's too bad for you. No one gurantees food or shelter which I view as being much more important so why health care?

This is a remarkably ingenuous post that shows an incredible distance from reality.

The people who are MOST likely to be uninsured are the working middle-class. The upper class are likely to get insurance through their high-paying executive jobs, and the lower class qualify for government insurance. It's hard working people like my parents, and like Neuronix's parents, who worked INCREDIBLY hard (both parents held down full time jobs and worked overtime every weekend, AND raised a small child - all without knowing English), and are unable to afford insurance.

I am a hard working medical student. I have had, basically, catastrophic insurance for the last few years because I didn't qualify for my parents' insurance (which was equally s**tty, by the way), because it would have cost me over $1000 per month for anything better. And I wouldn't have even bought insurance, except that my school would have kicked me out otherwise.

It's not quite as simple as "get a job." I am literally floored at how little you seem to understand as to how expensive private health insurance is.

Originally Posted by wagy27

Why should they get the shaft because you and patients like you decide they'll just discharge their bills by filing bankruptcy.

Why is it so hard for you to understand?

It's not a question of, "Oh, I'm lazy and I got this expensive liver transplant....so I'll just decide to declare bankruptcy! What an easy option!" It's that, honestly, what else could they have done? What other option would YOU have proposed? Not take the liver transplant and just die?

As I see it, the reason why health care premiums and such are so expensive is b/c of the government intervention. And I'm not just talking about medicare (which actually wasn't started before the 1960s and before then, we had charity hospitals established), but more about EMTALA. This is a government mandate without funding and is causing a lot of hospitals to close down. It's a proven fact that approximately 50% of ER care is either chalked up to bad debt (meaning hospitals won't get paid) or to charity care.

And also, since when did the federal government become the answer to all our problems? The government is just a middleman that takes a percentage of the taxes we pay before disbursing it to other people. For every dollar paid to medicare only about 66 cents goes to paying for someone's health care. Wouldn't it be better if we could just go around the middleman and save some money?

And to neuronix who said a food stamp was equivalent to universal food, go tell that to the homeless people and the impoverished and see what they think.

Smq123;

With regards to the analogy, it was simply an example of far more basic tenets of life, namely food, that are not considered a right in this country. Food and shelter are 2 of the greatest necessities for survival, yet I have not seen a mandate to provide these to all citizens. Food stamps, please. Do those really go out to all the homeless who can’t fill out the requisite paperwork and have no address? While I understand some medical care is essential, I question how are we going to pay for it. With a growing population of unemployed, or those who have lost their benefits, the knee jerk reflex is to hit those with jobs, especially jobs that pay well, harder. I see this as draconian. Why keep taxing those that have to take care of those that don’t. Seems pretty socialist to me and at some point it goes to far. I already between state, federal, etc. give up nearly 40% of my income. How much more should I have to give up?

Regarding the insurance argument, I made it through medical school and paid for health insurance that the school offered. It wasn’t great coverage but it wasn’t a emergency policy either. I made a choice to forgo other things to ensure that I had coverage. So please, don’t feed me the line that you as a student could not anything but castastrophe insurance because I’ve been in that boat and seen the options available. With regards to your parents, I too am the child of immigrants who worked their tails off. My parents made sure though that education and health were the 2 most important things taken care of.

With regards to options for paying off medical bills…well I have several. How bout arranging a payment schedule, just like I have on my loans. The cost of a liver transplant is probably in the range of or close to my loan tab. Allowing for a repayment schedule may never get you all the money but at least it’s a sign of good faith and an attempt to pay back for the care delivered to you.
Further, as someone who has had family rack up health bills, I would definitely stress that in times of need family is supposed to be there to help. I’m not expecting them to pony up a check for the whole bill but assistance does help and my family has done this for other family members that needed help with health care bills. There are always options, whether they are palatable or not is another question.

You state that your parents are hard working middle class who busted their butts to provide. How would you like it if the people they worked for decided not to pay them because one of their clients decided not to pay. You wouldn’t be very happy either.

Originally Posted by wagy27

The cost of a liver transplant is probably in the range of or close to my loan tab.

The bill was well over $1 Million including subsequent care rendered in the following year. Of course this neglects that my father is a truck driver and you will come out as a physician and able to pay those loans and afford other costs of living.

Originally Posted by wagy27

With regards to options for paying off medical bills…well I have several. How bout arranging a payment schedule, just like I have on my loans. The cost of a liver transplant is probably in the range of or close to my loan tab. Allowing for a repayment schedule may never get you all the money but at least it’s a sign of good faith and an attempt to pay back for the care delivered to you.

For someone who's been a student and a resident, you're pretty far removed from your patient's realities. Since when has a solid organ transplant EVER cost "in the range of [your] loan tab"? Unless you went to an extremely expensive school, bought a penthouse, AND drove a Rolls Royce during school, there's no way that that's possible. Transplant patients are frequently kept in the hospital for months, were often racking up the medical bills BEFORE they got their transplant, and need tons of care afterwards. Especially liver transplants, who often times end up temporarily taking out their kidneys as well, and have to end up on either CVVHD or dialysis.

Did they not take care of transplant patients at the hospital where you did your internship? I'm a med student, and I could have told you that transplants cost way more than the average med student's debt. Even a simple c-section with one night in the hospital can cost more than one year's cost of attendance.

If you honestly think that a liver transplant would cost about the same as your loan debt, then no wonder you think that it's a simple matter for people to pay their own medical bills...

Originally Posted by wagy27

Further, as someone who has had family rack up health bills, I would definitely stress that in times of need family is supposed to be there to help. I’m not expecting them to pony up a check for the whole bill but assistance does help and my family has done this for other family members that needed help with health care bills. There are always options, whether they are palatable or not is another question.

Well, whoopee for your family.

a) Did it EVER occur to you that some people have family members that are equally as poor as they are?

b) What if you DON'T have living family?

That point of view is kind of narrow-minded, and ignores the fact that MANY people don't have a life anywhere nearly as privileged as yours has been.

I am quite cognizant of the cost of a transplant. Maybe what you are naive about is the cost of education. i have many friends with student loan tabs near or exceeding 500,000 since they were taking out loans for undergrad or and medical school so please do not get into that with me.

While I agree that my future income will allow me to discharge my debts much easier than others it still doesn't answer the question of why should a doctor have to accept not being reimbursed because a patient just files bankruptcy or refuses to pay. I am a firm believer in garnishing pay if necessary to extract as much as feasible to pay these bills.

Those of you that keep chiming in are mostly students and have not seen attendings devote endless hours to the care of a patient only to be told they would not be reimbursed for one reason or another. That will never register as acceptable to me. what you are saying is since doctors make a lot anyway they should be able to let one go and not worry about it because of "Insert sob story here." Why should I or any other physician be short changed for the work I did.

Originally Posted by wagy27

Those of you that keep chiming in are mostly students and have not seen attendings devote endless hours to the care of a patient only to be told they would not be reimbursed for one reason or another. That will never register as acceptable to me. what you are saying is since doctors make a lot anyway they should be able to let one go and not worry about it because of "Insert sob story here." Why should I or any other physician be short changed for the work I did.

I'm an attending, does that mean my opinion counts?

I am grateful every day that I practice medicine for the opportunity to care for critically ill infants who are not responsible in any way for their financial or health status. When I started decades and decades ago, families with no insurance would not have their babies be transferred to the highest level of care in some cases if they couldn't pay. I thought that was outrageous and am glad that era is long gone.

I would like to get paid for all of my patients so I support a universal coverage system for children whether they have a family {who are functional, etc} or not. I'm pretty sure the overwhelming majority of pediatricians do, although we may differ on the details of how it should be done. However, until such time, it is of not the slightest concern to me whether I get paid for 80%, 90% or 100% of my patients. I am blessed by the ability to take care of sick babies and a few non-paying patients do not cause me any concern, regardless of how many hours I spend taking care of them. I'm a professional and medicine is a profession, not just a job. Sometimes you get paid and sometimes you don't.As long as I "mostly" get paid (and we do...), the details for an individual are meaningless to me.

There are other rewards. Of course, YMMV, but, at least you've heard now from an attending.

Originally Posted by oldbearprofessor

I'm an attending, does that mean my opinion counts?

I am grateful every day that I practice medicine for the opportunity to care for critically ill infants who are not responsible in any way for their financial or health status. When I started decades and decades ago, families with no insurance would not have their babies be transferred to the highest level of care in some cases if they couldn't pay. I thought that was outrageous and am glad that era is long gone.

I would like to get paid for all of my patients so I support a universal coverage system for children whether they have a family {who are functional, etc} or not. I'm pretty sure the overwhelming majority of pediatricians do, although we may differ on the details of how it should be done. However, until such time, it is of not the slightest concern to me whether I get paid for 80%, 90% or 100% of my patients. I am blessed by the ability to take care of sick babies and a few non-paying patients do not cause me any concern, regardless of how many hours I spend taking care of them. I'm a professional and medicine is a profession, not just a job. Sometimes you get paid and sometimes you don't.As long as I "mostly" get paid (and we do...), the details for an individual are meaningless to me.

There are other rewards. Of course, YMMV, but, at least you've heard now from an attending.

I appreciate your input and sentiment and wished I could have the same attitude, I just don't. Medicine was a profession but with patients often suing for absurd claims, insurance companies and the government cutting reimbursement, medicine is not what it used to be. While it still carries to some degree a level of distinction there are large parts of what I do that i consider to be a job. And because of that, I am concerned about getting paid. Does that mean I won't see a patient who can't pay. Of course not, I am not devoid of compassion. But at the same token, I would hope that the patient would find a way to pay me for the services I am providing and not try to short change me in the same way I would not short change them by offering them less therapeutic options based on their financial status.

Originally Posted by wagy27

And because of that, I am concerned about getting paid. Does that mean I won't see a patient who can't pay. Of course not, I am not devoid of compassion. But at the same token, I would hope that the patient would find a way to pay me for the services I am providing and not try to short change me in the same way I would not short change them by offering them less therapeutic options based on their financial status.

Hoping to get paid, and being concerned about getting paid, is perfectly normal.

But what strikes me as unfair about your posts is your consistent labeling of people who canNOT afford to pay as unemployed deadbeats who file for bankruptcy as an easy out.

Medical care is extremely expensive. While it's true that medical education is also expensive, many loan companies will work with residents to figure out a manageable pay schedule, and most students don't have loans that approach the cost of a serious operation like a transplant or a Whipple (or neonatal care, etc). Banks and loan companies don't always pay the same consideration to patients.

My point is just that not all patients who cannot afford to pay for their medical care are lazy, deadbeats, unemployed, and irresponsible. And labeling them as such is unfair and not compassionate.

Originally Posted by Neuronix

My mom is a schizophrenic who spends a lot of her time living on the streets or in her car. How exactly do you expect her to pay her psychiatric hopsitalization bills?

.

The treatment of soome health conditions are more appropriately paid for by the government than others. I would include certain infectious diseases, such as TB and syphilis in this category. Also severe mental illness, which can lead to violence (I'm not saying this applies to your mother). It's a legitimate government function to protect the public health.

Originally Posted by oldbearprofessor

I'm an attending, does that mean my opinion counts?

I am grateful every day that I practice medicine for the opportunity to care for critically ill infants who are not responsible in any way for their financial or health status. When I started decades and decades ago, families with no insurance would not have their babies be transferred to the highest level of care in some cases if they couldn't pay. I thought that was outrageous and am glad that era is long gone.

I would like to get paid for all of my patients so I support a universal coverage system for children whether they have a family {who are functional, etc} or not. I'm pretty sure the overwhelming majority of pediatricians do, although we may differ on the details of how it should be done. However, until such time, it is of not the slightest concern to me whether I get paid for 80%, 90% or 100% of my patients. I am blessed by the ability to take care of sick babies and a few non-paying patients do not cause me any concern, regardless of how many hours I spend taking care of them. I'm a professional and medicine is a profession, not just a job. Sometimes you get paid and sometimes you don't.As long as I "mostly" get paid (and we do...), the details for an individual are meaningless to me.

There are other rewards. Of course, YMMV, but, at least you've heard now from an attending.

I'm not sure I understand why you would want universal coverage for your patients if you don't have the slightest concern about getting paid or not. It seems to me that universal coverage would get you 100% reimbursement. As the medical system stands now, if you didn't want to charge someone for healthcare you wouldn't have to, which is actually one of the pluses of the current health care system. Would that be true in the universal coverage model? Who would pay for that universal coverage? If you say the government, then you might as well throw 30% of what you pay for the tax to give universal coverage down the drain.

And also, just because you don't have any concern for getting paid does not mean that everyone else is so philanthropic. Even if the large majority of pediatricians were in favor of universal coverage, does that mean that the majority of patients are in favor of universal coverage? Of course if you were to find out you couldn't just ask them if they were in favor of universal coverage. You would also have to explain to them that the government would have to raise taxes. And it's very possible that someone who's making 40k a year and pays taxes subsidizes someone making 200k a year. Heck, I only made 4k last year and I still had to pay social security/medicare.

To the original poster,
You have found out what happens when you do not have insurance. You are paying inflated charges because the insurance companies and Medicare and Medicaid are able to negotiate low prices, but then the folks without insurance end up with an inflated bill. Hospitals and surgical centers inflate their charges because they know that insurance companies are only going to pay a certain %age of the total bill/charges.

I believe you are responsible for paying your bills, but you should go to the business office and negotiate that bill down. Tell them you cannot possibly afford to pay this much, but try to get them to cut the bill down by 25-50%. I know there are services/programs (probably can google this on the web) that will help you negotiate to lower medical bills...you may have to pay them something for their services, but if they can get the bill lowered that would be worth it. Work out a payment schedule where you are paying them a couple hundred/month or something. I hope your hand is feeling better. Yes, perhaps you should have shopped around with different ortho folks, but likely without insurance you would have gotten screwed over pretty much everywhere, unless perhaps there is a public hospital nearby with orthopedic surgeons on staff.

Originally Posted by dragonfly99

To the original poster,
You have found out what happens when you do not have insurance. You are paying inflated charges because the insurance companies and Medicare and Medicaid are able to negotiate low prices, but then the folks without insurance end up with an inflated bill. Hospitals and surgical centers inflate their charges because they know that insurance companies are only going to pay a certain %age of the total bill/charges

This strikes me as a rather odd argument. What percentage of patients who get a full charge, self-pay bill end up paying that amount in full? I bet it's far less than those who end up paying none of it. Thus these people are not at all subsidizing lower reimbursements than desired by certain payors.

Originally Posted by smq123

But what strikes me as unfair about your posts is your consistent labeling of people who canNOT afford to pay as unemployed deadbeats who file for bankruptcy as an easy out.

Medical care is extremely expensive. While it's true that medical education is also expensive, many loan companies will work with residents to figure out a manageable pay schedule, and most students don't have loans that approach the cost of a serious operation like a transplant or a Whipple (or neonatal care, etc). Banks and loan companies don't always pay the same consideration to patients.

My point is just that not all patients who cannot afford to pay for their medical care are lazy, deadbeats, unemployed, and irresponsible. And labeling them as such is unfair and not compassionate.

I have not once used the words lazy, deadbeat, or unemployed. My commentary has been directed at any patient who gets care and thinks that they can discharge their debt to physicians by not paying, bankruptcy, etc. They are being irresponsible in my opinion. If anything I get more angry at those that come in with their newest cell phone, 100 dollar shoes, etc and tell me they can't afford my bill because they obviously have the cash for other things. Maybe you need to reread my posts before you jump to conclusions like that.

Originally Posted by michaelrack

The treatment of soome health conditions are more appropriately paid for by the government than others. I would include certain infectious diseases, such as TB and syphilis in this category. Also severe mental illness, which can lead to violence (I'm not saying this applies to your mother). It's a legitimate government function to protect the public health.

That is the only constitutionally defensible position for federal involvement in health care.... contrary to any "progressive's" opinion.

Originally Posted by wagy27

I have not once used the words lazy, deadbeat, or unemployed. My commentary has been directed at any patient who gets care and thinks that they can discharge their debt to physicians by not paying, bankruptcy, etc. They are being irresponsible in my opinion. If anything I get more angry at those that come in with their newest cell phone, 100 dollar shoes, etc and tell me they can't afford my bill because they obviously have the cash for other things. Maybe you need to reread my posts before you jump to conclusions like that.

When you post things like this....

Originally Posted by wagy27

Either get a job, or find a way to pay for your care. If you can't, well Medicare and Medicaid are available. If you don't qualify, well that's too bad for you.

then, yes, I am going to think that you're assuming that all patients who cannot pay do not have jobs and are irresponsible. If that's not what you meant, don't post things like that.

Sure, some patients ARE irresponsible and waste money on things that they don't need. But not all patients are like that, and lumping all patients together is unfair.