Yeah, the $2200 for one saline bag really stood out. Crazy system. I still remember a case that Brill outlined in his Time article where a woman just shy of Medicare eligibility went to the ER with chest pain. The bill was $21,000 and he outlined her struggles in getting it paid as the hospital 'threw the book' (er Chargemaster) at her. Here is an excerpt from her experience.
Edit - I just looked at the billing for my wife's claim and Janice S got off easy <ggg>, as I see a charge for Troponin protein analysis for significantly more that the $199.50 they charged Janice.
The $21,000 Heartburn Bill
One night last summer at her home near Stamford, Conn., a 64-year-old former sales clerk whom I’ll call Janice S. felt chest pains. She was taken four miles by ambulance to the emergency room at Stamford Hospital, officially a nonprofit institution. After about three hours of tests and some brief encounters with a doctor, she was told she had indigestion and sent home. That was the good news.
The bad news was the bill: $995 for the ambulance ride, $3,000 for the doctors and $17,000 for the hospital — in sum, $21,000 for a false alarm.
Out of work for a year, Janice S. had no insurance. Among the hospital’s charges were three “TROPONIN I” tests for $199.50 each. According to a National Institutes of Health website, a troponin test “measures the levels of certain proteins in the blood” whose release from the heart is a strong indicator of a heart attack. Some labs like to have the test done at intervals, so the fact that Janice S. got three of them is not necessarily an issue. The price is the problem. Stamford Hospital spokesman Scott Orstad told me that the $199.50 figure for the troponin test was taken from what he called the hospital’s chargemaster. The chargemaster, I learned, is every hospital’s internal price list. Decades ago it was a document the size of a phone book; now it’s a massive computer file, thousands of items long, maintained by every hospital.
Stamford Hospital’s chargemaster assigns prices to everything, including Janice S.’s blood tests. It would seem to be an important document. However, I quickly found that although every hospital has a chargemaster, officials treat it as if it were an eccentric uncle living in the attic. Whenever I asked, they deflected all conversation away from it. They even argued that it is irrelevant. I soon found that they have good reason to hope that outsiders pay no attention to the chargemaster or the process that produces it. For there seems to be no process, no rationale, behind the core document that is the basis for hundreds of billions of dollars in health care bills.
(VIDEO: The Exorbitant Prices of Health Care)
Because she was 64, not 65, Janice S. was not on Medicare. But seeing what Medicare would have paid Stamford Hospital for the troponin test if she had been a year older shines a bright light on the role the chargemaster plays in our national medical crisis — and helps us understand the illegitimacy of that $199.50 charge. That’s because Medicare collects troves of data on what every type of treatment, test and other service costs hospitals to deliver. Medicare takes seriously the notion that nonprofit hospitals should be paid for all their costs but actually be nonprofit after their calculation. Thus, under the law, Medicare is supposed to reimburse hospitals for any given service, factoring in not only direct costs but also allocated expenses such as overhead, capital expenses, executive salaries, insurance, differences in regional costs of living and even the education of medical students.
It turns out that Medicare would have paid Stamford $13.94 for each troponin test rather than the $199.50 Janice S. was charged.
Janice S. was also charged $157.61 for a CBC — the complete blood count that those of us who are ER aficionados remember George Clooney ordering several times a night. Medicare pays $11.02 for a CBC in Connecticut. Hospital finance people argue vehemently that Medicare doesn’t pay enough and that they lose as much as 10% on an average Medicare patient. But even if the Medicare price should be, say, 10% higher, it’s a long way from $11.02 plus 10% to $157.61. Yes, every hospital administrator grouses about Medicare’s payment rates — rates that are supervised by a Congress that is heavily lobbied by the American Hospital Association, which spent $1,859,041 on lobbyists in 2012. But an annual expense report that Stamford Hospital is required to file with the federal Department of Health and Human Services offers evidence that Medicare’s rates for the services Janice S. received are on the mark. According to the hospital’s latest filing (covering 2010), its total expenses for laboratory work (like Janice S.’s blood tests) in the 12 months covered by the report were $27.5 million. Its total charges were $293.2 million. That means it charged about 11 times its costs. As we examine other bills, we’ll see that like Medicare patients, the large portion of hospital patients who have private health insurance also get discounts off the listed chargemaster figures, assuming the hospital and insurance company have negotiated to include the hospital in the insurer’s network of providers that its customers can use. The insurance discounts are not nearly as steep as the Medicare markdowns, which means that even the discounted insurance-company rates fuel profits at these officially nonprofit hospitals. Those profits are further boosted by payments from the tens of millions of patients who, like the unemployed Janice S., have no insurance or whose insurance does not apply because the patient has exceeded the coverage limits. These patients are asked to pay the chargemaster list prices.
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Average family premiums for employer-based health insurance have jumped 47% in the last decade, outpacing wage growth and inflation
PUBLISHED THU, NOV 11 202111:35 AM EST
Sarah O’Brien @SARAHTGOBRIEN
While average premiums are up 4% from 2020, they’re 47% more than they were in 2011.Deductibles have surged 68.4% over the last decade to an average $1,669 from $991.Roughly 155 million people rely on employer-sponsored coverage.
ronnachaipark | iStock | Getty Images
You’re not imagining the growing pinch to your budget from the cost of your workplace health insurance.
Over the last decade, family premiums for employer-sponsored coverage have jumped 47%, according to a report from the Kaiser Family Foundation. That rate outpaces both wage growth (31%) and inflation (23%) over the same time period.
Annual premiums for family coverage this year reached an average $22,221, with workers contributing an average $5,969 toward the cost and employers paying the rest, the report says. The amount is 4% more than 2020.
Deductibles — amounts that you pay out of pocket for services before your insurance starts paying — also have jumped 68.4% since 2011, to an average $1,669 from $991.
This year, 85% of covered workers have a deductible in their plan, up from 74% a decade ago. At companies with under 200 employees, average deductibles are 70% higher than those at larger firms ($2,379 vs. $1,397).
Roughly 155 million people rely on employer-sponsored coverage, according to Kaiser’s research. The share of employers offering health benefits — 59% — has remained largely unchanged since 2011. However, the larger the company, the more likely it is to offer a health plan.
If you lack coverage through your job, be aware that you may qualify for affordable private insurance through the federal health exchange ( healthcare.gov) or your state’s marketplace. Open enrollment is currently underway for these health plans through Jan. 15.
Most enrollees qualify for subsidies to help cover the cost of premiums or, depending on your income, help with other cost-sharing like copays.
Additionally, the subsidies have been expanded for 2021 and 2022 so that more families can qualify. |
