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Unified Serenity
27th June 2012, 17:59
I posted a detailed article on my blog and will share a portion of it. You can read the whole post here. (http://unifiedserenity.wordpress.com/2012/06/27/how-hospitals-screw-the-uninsured-know-how-to-use-the-fair-trade-act-to-your-benefit/)

The High Cost of Health Care

Americans without health insurance are suffering through lack of knowledge. As a licensed health insurance agent a few years ago, I learned some of the industry secrets, and often shared them with my clients who were having problems that developed while they were uninsured. I had my own personal experience back in the early 90′s when my then husband injured his wrist and needed 2 stitches. The doctors did their job, and when I went to pay the bill it was over $400.00 dollars for a shot to numb the area and two stitches! Needless to say, I was aghast.


I asked why the bill was so high and the lady said, because people without insurance do not pay their bills, it increases the costs. I said, well, I know for a fact that if we had major medical insurance that the bill they sent to the insurance provider would only be about $80.00, and if you gave me an $80.00 bill, I will pay it right now! She failed to understand what I was saying, and as I did not have an extra $400.00 at that moment, I became a statistic that had an unpaid bill until we eventually paid it.


The fact of the matter is, doctors are not making the ungodly profits off of the uninsured, it’s the hospitals that are raking in the bucks, even with insurance. As a health insurance agent I had the information of what doctors were paid for various procedures and surgeries and it was shocking at how low that amount really was. I can’t give you an exact number from 2008, but a close example would be if a doctor did an emergency appendectomy, they got about $3500.00. Yep, a kings ransom for all their years of experience and saving your life right? Of course it’s not, but the total hospital bill would be well over $10,000.00 in many cases. Now, if you did not have insurance, that bill could easily be $20,000.00 and they will happily set you up on a payment plan of $200 to $300.00 per month until you pay it off which you will on time if you want your credit to stay in the excellent category. Here is the little secret they do NOT want you ignorant uninsured peons to know about. The fair trade act says that you cannot be overcharged for services in comparison to comparable care say with insurance. Meaning, they don’t have the right to charge you 5 or 10 times the amount they accept from insurance companies! I mean lets’ face it, when you find yourself or a loved on in an emergency say a car wreck, heart attack, stroke, ruptured organ you don’t have time to let your fingers do the walking and call hospitals and doctors to work out a reasonable cost for their services. You need help NOW, and you rush to the hospital to be fixed. When I almost lost my right leg in an auto accident in 2000, I did not get into the emergency room with my leg nearly severed and say, “Hey wait a minute Doctor Smith, how much are you going to charge me to re-attach my leg?”


Now, at the time I did have major medical coverage and my bill was $100.00 co-pay in my hmo. But what if I hadn’t had that coverage? I can guarantee you that for all the care I received, my bill would have been over $40,000.00! Who has that kind of money laying around? Now, I am not saying we should not pay our bills, but the bills must be fair, and yes, there is a way to find out if your bill is fair. One of the best hospitals in the world is John Hopkins. A non-profit group has compared all other hospitals in America against the charges for similar care of John Hopkins which is viewed as a hospital that charges people fairly according to this group. The organization is called Hospitalvictims.com.


The end of the article I shared:


Why am I putting so much effort to share this with you? I have witnessed countless families destroyed and lives ruined by credit problems and health care bills. We have a health care crisis in America, and the solution has already be provided. We do NOT need socialized medicine. What we need is an informed consumer market that exercises their rights! If you are struggling with this problem go to the site and avail yourself of the information therein. They even have a program to help you fight this and analyze your situation for free. They also offer other solutions but are not tied to that entity which will charge some fees.




Last but certainly not least:



You may qualify for Charity care. Go to this page (http://www.hospitalvictims.com/hv_defend10.asp) at Hospital Victims to see the charts and register to find out if you do qualify.


Many of the nation’s hospitals have charity care or financial assistance programs for which you may qualify. Some of the hospitals offer assistance up to 400% of the HHS Federal Poverty Guidelines.

scarletfire
28th June 2012, 15:03
Just watched a documentary about how financial institutions prey on those without dental insurance and set up situations in which care is provided and payed for with a credit line that often charges up to 30% interest. Many are without dental coverage and patient's are told to sign on the dotted line so that interest can start piling up before treatment has even started. This allows practitioners to be payed by financial corporations and patients left in a sort of indentured servitude like situation with huge bills hanging over their heads and repayment plans that they often can't afford.

http://www.pbs.org/wgbh/pages/frontline/dollars-and-dentists/rd.

I'm an RN at a nonprofit catholic hospital and the profits made by this place is jaw dropping. The nonprofit label simply means you have to reinvest profits back into the hospital which allows this money to be spent in ways such as expansive construction projects, huge CEO and specialist salaries, and marketing. My workplace actually has a bigger marketing budget than employee salaries. Another frustrating loophole is the creation of jobs that are in existence for the single purpose of maximizing reimbursement. I went into my job thinking that I would be contributing to the greater good and be surrounded by like minded individuals. In reality, only those working on the front lines seem to have a genuine grasp of the problems at hand and everybody else walks around in a sort of blissful ignorance bubble and have convinced themselves that they are not leeches. Very frustrating to be able to see through the BS while, it seems so many are unable and unwilling.

Unified Serenity
28th June 2012, 15:49
Well, now you know some more info on how to help those who are being emotionally, financially, and spiritually abused by this system. It's important for people to know how to work within the system and to demand their rights under the Fair Trade Act. Thanks for sharing.

hardrock
28th June 2012, 16:05
The problem is money...... Family practitioners make very low wages comparable to most surgeons and high throughput physicians. From the Insurance companies, to the Fed to they Hospitals to the physicians. Their main oath is to the dollar now, not some hyppocratic idealism. I could write a book on it and I don't have time, too busy working....much like most of the people I know and why you don't see much usage of the assistance out there. There is no time to research.

The very second we allowed healthcare to be corporatized it went down the crapper. Greed, avarice, dirty politics, and dog eat dog are the name of the game. There are still a few good family practice docs out there who will help people and work with the poor, but not many.

The hospitals are a lost cause. Go look at the NY Jets training facility and what do you see? Atlantic Health sponsored the naming of it. Why does a healthcare company need to sponsor a football facility? Healthcare should be renamed, because "health" and "care" are way down on the priority list.

For the most part, no ER in the US will refuse you care. They may not give you "star treatment", but they will try to fix you up and send you to the indigent care hospital asap. Physicians might or might not refuse you care. If its a non medical emergency, they have every right to refuse you care if you cannot pay up front and most of them have these policies. State Laws differ from region to region, but for the most part that is the case.

The charges that a healthcare facility or practitioner has on your EOB or Claim are just that - charges or what we call Billed Charges. Every healthcare practice or facility has a "charge master", which lists all of their charges for each code. This is not for public consumption and good luck getting it. This is because a lot of contracts with health insurers are set up to pay them a % of their charges. Rates are all over the place, but insurers get a "discount" from these "billed charges" and that is what is listed on your EOB.

Most hospitals and providers would rather have some money rather than none, and most of them send your unpaid bills off to collection agencies that buy up the unpaid bills at a % on the $ and try to collect directly from you, ruin your credit, etc etc just like any other business.

Unified Serenity
28th June 2012, 16:13
The problem is money...... Family practitioners make very low wages comparable to most surgeons and high throughput physicians. From the Insurance companies, to the Fed to they Hospitals to the physicians. Their main oath is to the dollar now, not some hyppocratic idealism. I could write a book on it and I don't have time, too busy working....much like most of the people I know and why you don't see much usage of the assistance out there. There is no time to research.

The very second we allowed healthcare to be corporatized it went down the crapper. Greed, avarice, dirty politics, and dog eat dog are the name of the game. There are still a few good family practice docs out there who will help people and work with the poor, but not many.

The hospitals are a lost cause. Go look at the NY Jets training facility and what do you see? Atlantic Health sponsored the naming of it. Why does a healthcare company need to sponsor a football facility? Healthcare should be renamed, because "health" and "care" are way down on the priority list.

For the most part, no ER in the US will refuse you care. They may not give you "star treatment", but they will try to fix you up and send you to the indigent care hospital asap. Physicians might or might not refuse you care. If its a non medical emergency, they have every right to refuse you care if you cannot pay up front and most of them have these policies. State Laws differ from region to region, but for the most part that is the case.

The charges that a healthcare facility or practitioner has on your EOB or Claim are just that - charges or what we call Billed Charges. Every healthcare practice or facility has a "charge master", which lists all of their charges for each code. This is not for public consumption and good luck getting it. This is because a lot of contracts with health insurers are set up to pay them a % of their charges. Rates are all over the place, but insurers get a "discount" from these "billed charges" and that is what is listed on your EOB.

Most hospitals and providers would rather have some money rather than none, and most of them send your unpaid bills off to collection agencies that buy up the unpaid bills at a % on the $ and try to collect directly from you, ruin your credit, etc etc just like any other business.

Thanks for sharing, but I am curious if you read my whole article. There are easy solutions to outrageous charges, and the fair trade act is your reason for asking for the UB 92 and UB 04. There is no reason to be over billed by a medical provider. I know people are busy working, but many are also busy working until 5 pm, come home and sit around for a few hours then go to bed. They have the time if it's important enough to them to write a letter such as the one in my article and reduce the charges to a reasonable amount or they can sit and watch "American Idol".

13th Warrior
28th June 2012, 16:40
This discussion is incomplete without the RUC being involved...

What is the RUC?


While many people are not familiar with the RUC, it has a direct affect on anyone that has ever gone to a doctor. The full name of the RUC is Specialty Society Relative Value Scale Update Committee and this group of doctors advises the Centers for Medicare and Medicaid Services (CMS) on reimbursement rates for medical procedures. As most insurance companies follow these guidelines pretty closely the RUC basically sets the rates for most medical costs.

Learn more here:

http://www.replacetheruc.org/

Unified Serenity
28th June 2012, 17:05
Please read my whole article at:

http://unifiedserenity.wordpress.com/2012/06/27/how-hospitals-screw-the-uninsured-know-how-to-use-the-fair-trade-act-to-your-benefit/

The UB 92 and UB 04 give you the charges which a hospital sends to medicare. The SCOTUS has already upheld they have to charge you a reasonable rate which has been found to be about a few percentage higher than medicare pays. I have seen some suggest even 25% more, but it goes down as low as 4% more.

hardrock
28th June 2012, 17:05
Sorry, Serenity, didn't mean to contradict you. I was more just ranting in general from my overall dissatisfaction with the way things are. Your recommendation to gain more knowledge of the system is admirable. Also, the ability to pre-negotiate the charges before your procedures is a great tool to have. Also, there is nothing wrong in asking for a copy of the UB or hcfa to be faxed or emailed to you. You will have to sign a release form, but it is your information and you can do so. You can compare the claim form with your EOB to make sure the charges match.

Warrior, RUC is layman's term for "Reasonable, Usual, and Customary". Very political organization that gets pulled in many different directions.

As a general rule of thumb.......Medicare rates are 15-40% of a facilitie's charges. Facilities charges differ wildly among codes and among regions. As a general rule of thumb, non profits usually have lower charges than corporatized facilities.

Facilities MAKE MONEY (just not that much) on medicare patients, so most private insurance and PPR contracts are pure profit margin. Facilities usually break even or lose money (but not that much) on Medicaid patients.

Unified Serenity
28th June 2012, 17:17
I understand hardrock. You can't per-negotiate in an emergency, and that was one reason for the ruling. You are a captive in that case and most think they just have to pay the bill, but the bill must be reasonable. When a hospital only charges insurance $100.00 for something and then tries to charge you $2000.00 dollars that is not reasonable. The Medicare rates are the known ones and therefore considered reasonable. I was a health insurance agent and it made me sick when I saw the differences in what doctors are actually paid verses what facilities and axillary fees were. The Hospitalvictims.com site says it all.

CdnSirian
29th June 2012, 02:48
Deleted post.

ghostrider
29th June 2012, 04:01
I hate paying a premium every month but I don't get sick every month, pay car insurance every month I don't have a wreck every month. the entire thing is a scam. health insurance, home insurance, renters insurance , life insurance, food insurance, flood insurance, you pay you pay you pay , when you need them they pay a PARTIAL, and you pay again then they raise your rates and drop you and you go to another company and it's the same dam thing all over again. toss the whole thing. there's no trouble getting health insurance for politicians, military and such, whats the dang big deal , it should be the same for everyone. insurance premiums for years, you may need it once, let me share in the profit of the investment of my own money if I don't get sick or have an accident. this obamacare ****e lets me know the NWO plans are still on track.

Mulder
29th June 2012, 04:33
I'm shocked at the number of people buying into this as a "good thing" e.g.

FZKhyFvkxAo

Unified Serenity
29th June 2012, 04:40
I hate paying a premium every month but I don't get sick every month, pay car insurance every month I don't have a wreck every month. the entire thing is a scam. health insurance, home insurance, renters insurance , life insurance, food insurance, flood insurance, you pay you pay you pay , when you need them they pay a PARTIAL, and you pay again then they raise your rates and drop you and you go to another company and it's the same dam thing all over again. toss the whole thing. there's no trouble getting health insurance for politicians, military and such, whats the dang big deal , it should be the same for everyone. insurance premiums for years, you may need it once, let me share in the profit of the investment of my own money if I don't get sick or have an accident. this obamacare ****e lets me know the NWO plans are still on track.

I have a problem with it because we are warned in scripture to not strike your hand in surety with another. Surety is exactly what insurance is, and we see what comes with this business. Of course many see benefits of it, but in the end we have unnecessarily high prices and people act irresponsible.

13th Warrior
29th June 2012, 16:12
Sorry, Serenity, didn't mean to contradict you. I was more just ranting in general from my overall dissatisfaction with the way things are. Your recommendation to gain more knowledge of the system is admirable. Also, the ability to pre-negotiate the charges before your procedures is a great tool to have. Also, there is nothing wrong in asking for a copy of the UB or hcfa to be faxed or emailed to you. You will have to sign a release form, but it is your information and you can do so. You can compare the claim form with your EOB to make sure the charges match.

Warrior, RUC is layman's term for "Reasonable, Usual, and Customary". Very political organization that gets pulled in many different directions.

As a general rule of thumb.......Medicare rates are 15-40% of a facilitie's charges. Facilities charges differ wildly among codes and among regions. As a general rule of thumb, non profits usually have lower charges than corporatized facilities.

Facilities MAKE MONEY (just not that much) on medicare patients, so most private insurance and PPR contracts are pure profit margin. Facilities usually break even or lose money (but not that much) on Medicaid patients.

I guess i have to cut and paste from the link i posted:

The full name of the RUC is Specialty Society Relative Value Scale Update Committee and this group of doctors advises the Centers for Medicare and Medicaid Services (CMS) on reimbursement rates for medical procedures.