Survey Finds High Fees Common in Medical Care

[Zeno Swijtink]

August 12, 2009

Survey Finds High Fees Common in Medical Care
By GINA KOLATA

A patient in Illinois was charged $12,712 for cataract surgery. Medicare pays $675 for the same procedure. In California, a patient was charged $20,120 for a knee operation that Medicare pays $584 for. And a New Jersey patient was charged $72,000 for a spinal fusion procedure that Medicare covers for $1,629.

The charges came out of a survey sponsored by America’s Health Insurance Plans in which insurers were asked for some of the highest bills submitted to them in 2008.

The group, which represents 1,300 health insurance companies, said it had no data on the frequency of such high fees, saying that to its knowledge no one had studied that. But it said it did the survey in part to defend against efforts by the Obama administration to portray certain industry practices as a major part of the nation’s health care problems.

The health insurers, saying they felt unfairly vilified, gave the report to The New York Times before posting it online on Tuesday, explaining that they wanted to show that doctors’ fees are part of the health care problem.

The group said it had used Medicare payments for comparison because Medicare was so familiar and payments are, on average, about 80 percent of what private insurers pay.

“It’s the wild, wild West when it comes to prices of anything in the U.S. health care system, whether for a doctor visit or for hospital charges,” said Jonathan S. Skinner, a health economist at Dartmouth.

The situation is so irrational, said Uwe E. Reinhardt, a health economist at Princeton, that it simply cannot go on. “We will not emerge out of this decade with this lunacy,” Dr. Reinhardt said, adding, “You worry about credit card charges, you scream for consumer protection — why not scream for it here?”

But Dr. Robert M. Wah, a spokesman for the American Medical Association, said there was another side to the story: insurers’ low payments to doctors who enter into contracts with them and the doctors’ difficulties, in many cases, in getting paid at all. That is why, he said, doctors may simply abandon insurance plans. Then patients end up with extra fees because they have to go outside their networks.

Karen M. Ignagni, president and chief executive of America’s Health Insurance Plans, had a different view, saying: “As we think about the health care debate, what’s been talked about is, What are the cost-sharing levels? What are the premium levels? How much do health plans pay? No politician has asked how much is being charged.”

Some of the health care legislation being considered by Congress would require insurers to increase their disclosure to patients of possible out-of-network costs. And President Obama has proposed changing how Medicare sets its payments to doctors and hospitals. But there are no specific proposals to control prices for out-of-network medical services.

In the survey, patients were insured but saw doctors who were out of their networks of care providers. Those doctors have no obligation to accept the out-of-network fee from insurers as payment in full. Patients may then be accountable for the balance.

“That is what generally happens,” said Susan Pisano, a spokeswoman for the health insurers’ group. “The consumer is responsible.”

The survey looked at 10 companies that insure patients in the 30 most populous states; the companies provided some of the highest bills from 2008. Researchers excluded two types of charges that were likely to be erroneous: those that were greater than 10,000 percent of Medicare’s fees for a procedure, or more than 2,000 percent of Medicare’s fees and also more than 50 percent higher than the next-highest bill for the same procedure.

State laws protecting patients from getting stuck with medical bills in excess of their normal deductibles or co-payments vary widely, said Betsy M. Pelovitz, the group’s vice president for state policy. And, she said, the laws often offer little or no protection to patients who seek care outside their insurance networks.

In New York, patients with managed-care insurers cannot be asked to pay more than the applicable co-payment, deductible or co-insurance for an ambulance regardless of whether the provider is in or out of their network. In New Jersey, hospital emergency rooms treating Medicaid managed-care patients must accept Medicaid payments as payment in full and cannot bill patients extra. In Connecticut, a state law says it is “unfair trade practice” for medical providers to ask patients to pay more than a deductible or co-payment for services covered by their insurance.

But in general, patients hit with high bills from out-of-network doctors and hospitals may have little recourse, said Leslie Moran, senior vice president of the New York Health Plan Association. “When patients dig in their heels and say, ‘No, I’m not going to pay it,’ it sometimes goes to collection,” she said.

While there is no way of knowing how often doctors submit exorbitant bills, insurers tell America’s Health Insurance Plans that they see such bills “all the time, every day,” Ms. Pisano said.

The New York Health Plan Association provided more examples. In testimony at a state hearing in October, it told of a Long Island surgeon who charged $23,500 for an emergency appendectomy. The patient’s insurer paid its out-of-network fee of $4,629. The surgeon demanded the balance or said he would force the patient to pay. The insurance company paid the bill.

Patients who receive unexpected bills may not know what to do. That happened to Charles Bacchi’s mother. Mr. Bacchi, executive vice president of the California Association of Health Plans, said his mother was admitted to a hospital that had just dropped its association with her insurer.

Mr. Bacchi’s mother, who spent less than a week in the hospital, received a bill for nearly $90,000 and was told that her plan would pay only a small part of it. Mr. Bacchi said she was terrified and hid the bill. “She thought the entire family savings would go up in smoke,” Mr. Bacchi said.

When his mother finally told him about the bill, Mr. Bacchi intervened, and eventually the matter was settled by the hospital and the insurance company.

No one intervened for Maria Davis, though, when her son fell and banged his mouth. Ms. Davis, a respiratory therapist in Miller Place on Long Island, took 4-year-old Ryan to an emergency room. “He was bleeding a lot, and it looked like he had a bad cut on the inside of his mouth,” she said.

After a long wait, she said, a doctor said he would put in stitches but seemed uncomfortable treating the agitated child. When he said he could call a plastic surgeon, Ms. Davis agreed.

The plastic surgeon, Dr. Gregory J. Diehl of Port Jefferson, “was very nice, very gentle, very kind,” Ms. Davis said. He put in three stitches, and Ms. Davis assumed her insurer, UnitedHealthcare, would cover the bill.

It did not. The bill was $6,000 — $300 for the emergency room consultation and $5,700 for putting in the stitches. The Davises paid their deductible of $350 and waited.

After the insurer paid $2,024.80, Dr. Diehl cut his bill by $2,100 and billed the Davises for the balance, $1,525.20. He did not return calls to his office.

So far, the Davises have not paid. “I told them I thought it was an unreasonable amount,” said Jonathan Davis, Ryan’s father.

“We have gotten several letters, and they have gotten more than a little threatening,” Mr. Davis said. Had he known the doctor would charge $6,000, he said, “we may have looked for another doctor.”

[Toxic Reverend]

The L.A. Times article and the study I am referring to are:

Medical bills play a role in 62% of bankruptcies, study says
By Lisa Girion, June 4, 2009 Los Angeles Times
Articles about Bankruptcy - Los Angeles Times
The article appears to have been moved to their archives.
A copy is posted at: Physicians for a National Health Program,
Medical bills play a role in 62% of bankruptcies, study says | Physicians for a National Health Program
The article can also be found with the Google search terms;
"Medical bills play a role in 62% of bankruptcies, study says By Lisa Girion, June 4, 2009 Los Angeles Times"

Excerpts:

The study found that medical bills, plus related problems
such as lost wages for the ill and their caregivers,
contributed to 62% of all bankruptcies filed in 2007.

Medical insurance isn't much help, either. About 78% of
bankruptcy filers burdened by healthcare expenses were
insured, according to the survey, to be published in the
August issue of the American Journal of Medicine.

End of excerpts from:

Medical bills play a role in 62% of bankruptcies, study says
By Lisa Girion, June 4, 2009 Los Angeles Times
https://www.latimes.com/business/la-fi-medical-bankruptcy4-2009jun04,1,4411773.story
The article appears to have been moved to their archives.
Google search terms to find a copy:
Medical bills play a role in 62% of bankruptcies study says
By Lisa Girion June 4, 2009 Los Angeles Times
A copy is posted at: Physicians for a National Health Program,
Medical bills play a role in 62% of bankruptcies, study says | Physicians for a National Health Program

The entire study can be downloaded from:

Physicians for a National Health Program,
Physicians for a National Health Program - Health Care is a Human Right
at
Physicians for a National Health Program

___________________________________________


End of excerpt from:
Realities and tacit conspiracies of today's health care and political system

Posted at the Blog
Toxic Reverend - Toxic Revelations

The above blog also exposes the money trail of a corrupted health care
system. Connecting the following dots is proving to be a bit of a
challenge.

The blog will be updated soon, to include some of the aspects and
documentation mention in a movie titled "Under Our Skin",
about Lyme Disease and an infectious agent called borrelia burgdorferi.

The film documents that a proper diagnosis and treatment is dramatically
cheaper to the patient and health care system ww w. underourskin. com/

Documented is the manner in which the researcher, medical
information and treatment have been corrupted for profit. The movie
also included a segment on a researcher that found "borrelia burgdorferi" (an infectious agent) in 7 out ot 10 brains of alzheimer's patients.

The documentary "Under Our Skin" also mentions some of the other
very common misdiagnosis of Lyme Disease with such conditions as
"Chronic Fatigue Syndrome", Fibromyalgia" and many others.
The researchers interviewed also make mention of finding a known
non-lethal biological weapon called
"Mycoplasma Fermentans" in many Lymes Disease victims that
has also been found in many "Gulf War Syndrome" victims.
See the Gulf War Vets web page www.gulfwarvets.com

While watching the documentary, I realized that this has all of
the markings of a class of non-lethal biological weapon known
as "Incapacitating Agents".

YouTube - Under Our Skin - Lyme Disease Documentary Trailer

Written report
Bioterrorism and Biological Warfare Agents

Video posted at my profile with permission from Garth Nicolson PhD:



Chronic Illnesses and Biological War on Americans


Description: Garth Nicolson PhD has taught medicine for over 25 years, written hundreds of published peer reviewed medical journal articles and his bio is posted in the "About Us" section of his web page The Institute For Molecular Medicine www.immed.org In the video, he mentions the more accurate numbers of Veterans that have died of their illnesses, since serving in our armed forces. The military and government only count deaths that are in the theater of operations. And the Veterans that die after leaving the Middle East are not counted in the "official" death counts. The neurological effects are also discussed as are the association of vaccines and "other" illnesses.. Over 70% of spouses and over 60% of the children of Gulf War Veterans have shown the same signs and symptoms as the sick Veterans. They also have the same infectious agent detected in their blood. Professor Nicolson also makes mention of the health care workers that become ill from this and much more ..... watch the video. The simple facts are that chemical companies developed chemical and biological weapons for our country. Back in World War One and Two, they made things like nerve gas. At some point, the watered down the nerve gas and started calling them "pesticides". The "organic mycoplasma's" have been around for thousands of years. Predisposing factors were parasitic infections and malnutrition. Today we also have the Low Dose Cumulative Effects of Toxic Chemical and or radiation Exposures. It appears to me (The Toxic Reverend) that these "factors" are more of an influence in various illnesses than genetics. How ever, some "infectious agents" have been genetically modified and were tested on Texas inmates during the 1980's. And then sold to other countries. For details, see:


Project Day Lily https://www.projectdaylil y.com/


Note: The Gulf War Vets have posted a DVD movie about this, titled


"Beyond Treason" at https://www.gulfwarvets.c om


Toxic Revelations; Censored information on biological weapons and the health care industry The censored rough draft had been reposted, but has been censored again and some versions are even censored at the archives An incomplete version is Archived at:

https://web.archive.org/w eb/20050527092338/https://w ww.angelfire.com/in/sickbu ildingsyndrome/tr.html


Editing and updating of research is in progress


Toxic Revelations
Editing, link updating and research in progress
Toxic Revelations and Censored Military Information
Toxic Revelations
Home - Over View (Toxic Revelations)

Blessings,

The Toxic Reverend
MySpace - Toxic Reverend an Environmental Technologist - 50 - Male - Santa Rosa, Sonoma County, California - myspace.com/toxicreverend
aka
Tom Krohmer - Environmental Technologist


No "known" relationship to Jon Krohmer MD from


Homeland Security Department of Biological Terrorism


But I will tell you what "they" will not.

August 12, 2009

Survey Finds High Fees Common in Medical Care
By GINA KOLATA

A patient in Illinois was charged $12,712 for cataract surgery. Medicare pays $675 for the same procedure. In California, a patient was charged $20,120 for a knee operation that Medicare pays $584 for. And a New Jersey patient was charged $72,000 for a spinal fusion procedure that Medicare covers for $1,629.

The charges came out of a survey sponsored by America’s Health Insurance Plans in which insurers were asked for some of the highest bills submitted to them in 2008.

The group, which represents 1,300 health insurance companies, said it had no data on the frequency of such high fees, saying that to its knowledge no one had studied that. But it said it did the survey in part to defend against efforts by the Obama administration to portray certain industry practices as a major part of the nation’s health care problems.

The health insurers, saying they felt unfairly vilified, gave the report to The New York Times before posting it online on Tuesday, explaining that they wanted to show that doctors’ fees are part of the health care problem.

The group said it had used Medicare payments for comparison because Medicare was so familiar and payments are, on average, about 80 percent of what private insurers pay.

“It’s the wild, wild West when it comes to prices of anything in the U.S. health care system, whether for a doctor visit or for hospital charges,” said Jonathan S. Skinner, a health economist at Dartmouth.

The situation is so irrational, said Uwe E. Reinhardt, a health economist at Princeton, that it simply cannot go on. “We will not emerge out of this decade with this lunacy,” Dr. Reinhardt said, adding, “You worry about credit card charges, you scream for consumer protection — why not scream for it here?”

But Dr. Robert M. Wah, a spokesman for the American Medical Association, said there was another side to the story: insurers’ low payments to doctors who enter into contracts with them and the doctors’ difficulties, in many cases, in getting paid at all. That is why, he said, doctors may simply abandon insurance plans. Then patients end up with extra fees because they have to go outside their networks.

Karen M. Ignagni, president and chief executive of America’s Health Insurance Plans, had a different view, saying: “As we think about the health care debate, what’s been talked about is, What are the cost-sharing levels? What are the premium levels? How much do health plans pay? No politician has asked how much is being charged.”

Some of the health care legislation being considered by Congress would require insurers to increase their disclosure to patients of possible out-of-network costs. And President Obama has proposed changing how Medicare sets its payments to doctors and hospitals. But there are no specific proposals to control prices for out-of-network medical services.

In the survey, patients were insured but saw doctors who were out of their networks of care providers. Those doctors have no obligation to accept the out-of-network fee from insurers as payment in full. Patients may then be accountable for the balance.

“That is what generally happens,” said Susan Pisano, a spokeswoman for the health insurers’ group. “The consumer is responsible.”

The survey looked at 10 companies that insure patients in the 30 most populous states; the companies provided some of the highest bills from 2008. Researchers excluded two types of charges that were likely to be erroneous: those that were greater than 10,000 percent of Medicare’s fees for a procedure, or more than 2,000 percent of Medicare’s fees and also more than 50 percent higher than the next-highest bill for the same procedure.

State laws protecting patients from getting stuck with medical bills in excess of their normal deductibles or co-payments vary widely, said Betsy M. Pelovitz, the group’s vice president for state policy. And, she said, the laws often offer little or no protection to patients who seek care outside their insurance networks.

In New York, patients with managed-care insurers cannot be asked to pay more than the applicable co-payment, deductible or co-insurance for an ambulance regardless of whether the provider is in or out of their network. In New Jersey, hospital emergency rooms treating Medicaid managed-care patients must accept Medicaid payments as payment in full and cannot bill patients extra. In Connecticut, a state law says it is “unfair trade practice” for medical providers to ask patients to pay more than a deductible or co-payment for services covered by their insurance.

But in general, patients hit with high bills from out-of-network doctors and hospitals may have little recourse, said Leslie Moran, senior vice president of the New York Health Plan Association. “When patients dig in their heels and say, ‘No, I’m not going to pay it,’ it sometimes goes to collection,” she said.

While there is no way of knowing how often doctors submit exorbitant bills, insurers tell America’s Health Insurance Plans that they see such bills “all the time, every day,” Ms. Pisano said.

The New York Health Plan Association provided more examples. In testimony at a state hearing in October, it told of a Long Island surgeon who charged $23,500 for an emergency appendectomy. The patient’s insurer paid its out-of-network fee of $4,629. The surgeon demanded the balance or said he would force the patient to pay. The insurance company paid the bill.

Patients who receive unexpected bills may not know what to do. That happened to Charles Bacchi’s mother. Mr. Bacchi, executive vice president of the California Association of Health Plans, said his mother was admitted to a hospital that had just dropped its association with her insurer.

Mr. Bacchi’s mother, who spent less than a week in the hospital, received a bill for nearly $90,000 and was told that her plan would pay only a small part of it. Mr. Bacchi said she was terrified and hid the bill. “She thought the entire family savings would go up in smoke,” Mr. Bacchi said.

When his mother finally told him about the bill, Mr. Bacchi intervened, and eventually the matter was settled by the hospital and the insurance company.

No one intervened for Maria Davis, though, when her son fell and banged his mouth. Ms. Davis, a respiratory therapist in Miller Place on Long Island, took 4-year-old Ryan to an emergency room. “He was bleeding a lot, and it looked like he had a bad cut on the inside of his mouth,” she said.

After a long wait, she said, a doctor said he would put in stitches but seemed uncomfortable treating the agitated child. When he said he could call a plastic surgeon, Ms. Davis agreed.

The plastic surgeon, Dr. Gregory J. Diehl of Port Jefferson, “was very nice, very gentle, very kind,” Ms. Davis said. He put in three stitches, and Ms. Davis assumed her insurer, UnitedHealthcare, would cover the bill.

It did not. The bill was $6,000 — $300 for the emergency room consultation and $5,700 for putting in the stitches. The Davises paid their deductible of $350 and waited.

After the insurer paid $2,024.80, Dr. Diehl cut his bill by $2,100 and billed the Davises for the balance, $1,525.20. He did not return calls to his office.

So far, the Davises have not paid. “I told them I thought it was an unreasonable amount,” said Jonathan Davis, Ryan’s father.

“We have gotten several letters, and they have gotten more than a little threatening,” Mr. Davis said. Had he known the doctor would charge $6,000, he said, “we may have looked for another doctor.”