Many U.S. hospitals mark up prices 1,000 percent: study
Even the astronomical price markups that consumers regularly pay for, say, wine in restaurants pale beside those in some U.S. hospitals: The price for procedures is often 10 times the cost, according to a study published on Monday in the journal Health Affairs.
Of the 50 hospitals with the highest markups, 49 are for-profit, including 25 owned by Community Health Systems.
Community Health and other for-profits did not respond to requests for explain their markups, but in the past hospitals have said list prices, shown on a "chargemaster," are irrelevant because "no one" pays those.
In fact, out-of-network patients and the uninsured are often charged list prices, said Dr. Renee Hsia of the University of California, San Francisco, who has studied hospital charges but was not involved in this research. "People do get bills based on the chargemaster, and for out-of-network care insured patients pay a percentage" of chargemaster prices, she said.
Auto insurers, covering care after accidents, and workers' compensation also pay full freight. "That results in higher premiums for auto insurance and for employers who pay into workers' comp," said study co-author Ge Bai of Washington & Lee University. "That means we are all victims of these markups."
She and Gerard Anderson of Johns Hopkins Bloomberg School of Public Health blamed lack of regulation and transparency for 1,000 percent markups. Non-transparency means patients cannot learn what a procedure will cost before they get a bill, preventing comparison shopping.
Those bills can be eye-opening. Hsia, for instance, found that charges for a lipid panel blood test varied from $10 in one California hospital to $10,169 in another; opening blocked arteries cost $22,047 in one, $165,386 in another.
For their study, Anderson and Bai analyzed 2012 data, the latest available, from the Centers for Medicare and Medicaid Services to identify the 50 hospitals with the highest markup over Medicare's allowed charges, which Medicare considers a hospital's cost.
The 50 had an average markup of 1,010 percent (see Factbox), vs. 340 percent for the other 4,433.
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http://www.msn.com/en-us/money/markets/many-us-hospitals-mark-up-prices-1000-percent-study/ar-BBkQCmG
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Last edited Tue Jun 9, 2015, 10:03 AM - Edit history (1)
and so might your surgeon, but ...
Surprise Medical Bills: ER Is In Network, But Doctor Isn't, NPR Example: none of the Humana-taking hospitals have ANY ER doctors who are in that network. ### Another tidbit -- even when researching ahead, it is very doubtful that in an emergency situation would end up with an in-network ER doctor) , 11/11/14
http://www.npr.org/blogs/health/2014/11/11/363059517/surprise-medical-bills-er-is-in-network-but-doctor-isnt
Many of them don't. In those situations, the doctors can bill the patient for whatever the insurance company wouldn't cover ((balance billing I think its called)) — because the coverage took place within the approved hospital network, but outside the approved network of physicians.
The Center for Public Policy Priorities recently analyzed ER billing by the three biggest insurers in Texas — Humana, Blue Cross and United Healthcare.
The report found that in more than half of Humana's Texas hospitals, none of the ER doctors who see patients there were within Humana's network. ( http://forabettertexas.org/images/HC_2014_09_PP_BalanceBilling.pdf )
The same was true at just under half the Texas hospitals that take United Healthcare insurance, and at about a fifth of those that take Blue Cross.
In an emergency department we see everyone, and we're not even legally allowed to ask if they're going to pay their bill," Moskow says. "Large numbers of people pay nothing." (Dr. Bruce Moskow, president of the Texas College of Emergency Physicians)
There is a mediation process in Texas for some of these out-of-network bills, but it's only for certain types of insurance, and for certain situations.
Some other states have tried to tackle the problem. In California, ER doctors aren't allowed to send a separate bill to HMO patients. In New York, a newly passed law requires out-of-network doctors and insurers to hash out payment on their own, and leave patients out of it.
...((much more - mandatory reading))
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And those ACA out of pocket maxes only apply for in-network services. The sky is the limit for out of network stuff.
And then there are insurance company plans' list of in-network providers, but in actuality many of those providers aren't! So be sure to check with the providers in advance!
It is no wonder people are deathly afraid of the health care system and putting off medical procedures. This shit is a crime against humanity.
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Good luck with the surgery
