From: turnera@hubcap.clemson.edu (Allen Turner)
Newsgroups: misc.consumers
Subject: Re: Complaining about a hospital billMy son recently had some very minor surgery, he was a little tongue tied
Date: 9 Apr 92 14:39:13 GMT
Organization: Clemson University, Clemson SC

I agree with you that your son's hospital bill was unreasonable.  The recent
experience I had with my 2.5 week old son's hospitalization may lend you
some insight into the problem.

My son was hospitalized for 10 days, 2 in intensive care, with viral pneumonia.
The bill first presented to me was slightly over $17,000 and I was required to
provide 15% of that up to a maximum $1500 after a $200 deductible was met.  
My insurance would pay the balance.  I paid $1500 and my son was released 
from the hospital.

A few weeks later we received a notice from our insurance about our claim 
including the amount that they would cover.  The information was not
thorough in that the bill was itemized only in large general areas; i.e.
pharmacy, room, xray, etc. with only grand totals provided for each area.
The total requested by the hospital added up to the $17,000 that I had been
quoted but my insurance indicated that they would only cover about 60% of
each of the area totals.  The grand total covered by my insurance was slightly
more than $9000 (my deductible and up to $1500 would reduce the $9000+ that
my insurance would provide the hospital).  The uncovered total, almost $8000,
had an asterisk by it.  The asterisk comment stated that the medi-call
portion of my insurance had prenegotiated prices with the hospital and that
the $9000 was going to be the total cost.  It went on to state that I didn't
have to pay any of the difference between the covered amount and the 
original bill.  

The long and the short of it all is the hospital was willing to accept
roughly 60% of their usual billing rate because my insurance had prenegotiated
costs with them.  This wasn't 40% off on tootsie roll, it was 40% off on
a Honda Accord!  I was stunned.  Of course the hospital, knowing full well
about the actual billing rate quoted me the $17,000 which caused me pay
the full $1500.  At $9,000 my $1500 maximum would not have been met but
they took the full $1500 anyway.  

My son is now almost 3 months old, is healthy and thriving.  I am thankful
about the miracle of modern medical care that saved my little boy.  However,
there's something wrong in medicine today.  The costs associated with
health care are often a subtle form of extortion...'pay this amount' no
'pay this big amount' no 'pay this BIG amount' or your health will suffer.
In the case of my son we didn't have the luxury of time to check out our
health care alternatives...we had to pay whatever the hospital charged. In
my son's case they were willing to accept 60% of 'pay this BIG amount'
but they wouldn't tell me so, they would only tell my insurance so.  I
feel sorry for the people who don't have professionals who are experienced
in negotiating with medical care services.

I have no doubt that the hospital made money at the 60% rate they utimately
accepted.  It's no wonder that health care is sapping our economy when 40%
of routine billings and more is profit.

Allen Turner
Xref: sparky misc.consumers:10248 rec.autos:10999