Medical insurance part 2

Remember some time ago I posted about how the medical profession decides what to charge and what insurance will actually pay and how it didn't seem to make any sense, at least to myself?

Well, finished up paying my bills for my back surgery.

Could someone explain this one to me?

Over night hopsital stay (in at 6am for surgery out by 1pm the following day), bill from the hospital, $26,000! I ended up paying $350 out of pocket.

Bill from surgeon with assistant, $12,000. I ended up paying $950 out of pocket.

Back brace bill, $1000. I ended up paying $125

"Sleep doctor" (because I'm not going to try and spell it) $975. Paid $125 out of pocket.

What I'm scratching my head over is how the heck the hospital bill came out to over twice the amount of the surgeons bill, but I only had to pay the hopstial about 1/3 out of pocket than what I had to pay the surgeon?

You were paying the share of our indigent, uninsured, other-people-who think-healthcare-should-be-free, etc., population. Somebody has to pay the difference for the non-pays, because in the United States, as we all know, anyone can walk into any emergency room and recieve care and cannot be turned away. So your $26,000 bill for your 31 hour stay helped pick up their bill too.

Cityboy said:

as we all know, anyone can walk into any emergency room and recieve care and cannot be turned away. So your $26,000 bill for your 31 hour stay helped pick up their bill too.

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Ok, I'm dumb, I didn't know this.

I will however be asking for a detailed breakdown on the charges from the hospital just out of curiosity. I realize (or think) that there are "codes" for the breakdown of charges. What code is used for "picking up the tab for others"

Or do they just mark it up that much more to cover their losses elsewhere?

dzalphakilo said:

Or do they just mark it up that much more to cover their losses elsewhere?

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I think someone here has already mentioned this but I'm pretty sure the price the Hospital declares as their "cost" is not what they will most likely get paid. They will get paid according to what the insurance industry has defined as a "standard rate". The price you are shown is in case your insurance company won't pay the bill and then the hospital has to come after you. Then the price is bloated since they will now have to cover legal expenses and may only get the "true cost" in a court of law.

Basically, they are jacking their rates up to these astronomical levels in order to insure that even if the cost is reduced in court or by the insurance company that they are still making a profit.

But that is just my read on the situation - I may be wrong.