Way back in 2017, before we were on the Road to Nuremberg With Donald Trump, the Washington Post was outraged that hospitals were trying to make a profit. Like most stories involving reporters, economics and healthcare it was both wildly inaccurate and agenda–driven.
The story’s one useful service was it introduced the public to the slightly ominous term “Chargemaster.” At first glance, the term “Chargemaster” might be mistaken for the cause of the so–called epidemic of “mass incarceration.” A fiendish device district attorneys use to jail minorities captured during the government’s regular sweeps in low–income areas.
Even for those who haven’t been to jail, the term has unsavory associations bringing to mind arrogant, price–gouging, monopolies who look upon customers as rubes to be exploited. (Ticketmaster, come on down!)
In reality, the “Chargemaster” has more to do with pricing than policing. Theoretically, it’s a complete listing of all the services and procedures a hospital provides patients, followed by the cost for each item.
What the consumer doesn’t know is the price listed after any procedure is as hyperbolic as an entree description on a Trump restaurant menu. The cost paid by Medicare or a health insurance company often bears little relation to what’s listed on the Chargemaster. Just as the window sticker on a new car is only a starting place in the negotiation.
The US healthcare market is currently designed to guarantee high prices, encourage waste and discourage price shopping. That’s because consumers can get a binding estimate on building a house, but they can’t get any kind of estimate on removing a gall bladder. Requiring hospitals to post the Chargemaster on the web is supposed to give consumers this vital information, but in truth all it will give most of them is a headache.
I predict it will be easier to read the privacy agreement for Facebook victims than it is to comprehend the Chargemaster. If it were up to hospital administrators consumers wouldn’t even be able to find out what it cost to park until they tried to exit the lot. Instead of a simple procedure equals cost equation, the consumer will no doubt have to assemble the procedure himself, which is just how the hospitals want to keep it.
Maryland made a tentative effort to lift the cost veil. The Maryland Health Care Commission has a website with the inane name of “Wear the Cost,” which sounds like the surgery bill will be tattooed on your backside. Instead, it compares turnkey prices for common procedures affecting patients who are either women, old or both.
Consumers who fit within that medical straightjacket can finally see what hip replacement, knee replacement, hysterectomy and vaginal delivery prices are at 21 different hospitals. Unfortunately, hospital patients, like whiskey drinkers, tend to associate high cost with high quality. That’s not necessarily true as the medical complication and readmission rates for the procedures at various hospitals demonstrates.
Patients can have high–quality care for lower cost if they will only do their research among these limited options. more
Hospital bill to insurance item;
Box of Kleenex@ .50 insurance will not pay.
Call it a mucus recovery system@ 50.00 insurance pays full amount.
True story. They pay people to get paid and profit. Insurance was not reformed under bammy care…..it was put on steroids.
I have been in medicine for over 40 years. I can assure you that it is impossible to get a firm quote on a procedure or service. The reason is that Medicare sets the charge for all procedures and will change it at a minutes notice. Medicaid barely pay anything. All insurance is indexed on Medicare to one degree or more. Plus, it is against the law to give people free care or charge less than Medicare. Then there is variability of the extent of a procedure, lets say you want a gallbladder. The doctor is going to use a scope, in and out of the hospital in a short time. Except that the scope can not be used, so you have an open procedure and bang, one week in the hospital, if no complications. Now, if you don’t have insurance, you can negotiate with the hospital for Medicare rates. Now, at least 10% of the time a complication sets in and then, pricing goes out completely. The people that are ripping you off are the insurance companies. The deny a procedure recommended by your doctor, often after it has been done. Why do you put up with that, sue them. If they will not ok a procedure, sue them. If they require that your doctor talk to another doctor to get permission for a test, sue them. The person that your doctor is talking to is likely a drug addict that can not practice medicine and is instructed to block all request. Sue them. They say that you can’t sue as you signed a contract, was your lawyer in the room? Then you can sue.
The medical billing and charging system is so complicated and obscure in its workings, I don’t think even the people doing the charging and billing understand it.
I had to have some emergency surgery a couple years ago and it took practically a full year for all the bills to show up, most of them incomprehensible when trying to relate them to the services and care I received.
As it stands now, I’m still waiting to receive a bill for my annual physical from several months months ago. Because it usually shows up in a little over a week, I called the doctors billing office to find out where it was and if I just hadn’t received it after almost two months (I was concerned about it being past due, something I hate the very idea of). The response was they were still trying to figure it out and waiting on the insurance company to see how much they would charge me, that they would send it as soon as they figured it out.
The whole system, at least the financial part of it, is starting to become dysfunctional. At least the care I receive is still top notch, but that too may end up going down along with everything else when a financial lockup finally happens.
Just got called by a collection agency (TRUE STORY) trying to collect on a $ 21.50 co-pay they refused to take when I completed the office visit and I asked to pay it. Now 4 months later they call and want it paid.
I am current on all my bills and have never missed a payment – but now I’m a deadbeat. Oh Yeah – the Hospital was recently bought out by a huge conglomerate health care Wellspring. (I laughed at them and hung up and then went on line and paid it).
So get ready to get screwed folks.
@Hans
True story…just got a “we want our $$$$$$$$ back” notice from an insurer. A necessary procedure…skin cancer removal. This is coming three years after the surgery was done. Their reasoning is that they are only the administrator of the plan, I need to ask the company I worked for why they want the money back. And yeah, they will wreck anyone’s credit score for a dollar.
As obolacare wrecks the system into oblivion, no one is getting paid properly. My doc did the work. The insurance extortionists are no different than the mob. They want a cut whether they earned it or not.
I got a bad case of Deja vu reading those first 4 paragraphs; what will that cost to cure?
Uh….
ya know trump signed a law that hospitals now have to show prices…
started jan 1.
My wife was a medical coding auditor (contractor) for the Air Force and now retired. She now amuses herself by calling the billing departments of our doctors and explaining how their procedure codes were in error and hinting that medicare would not be forgiving of their processes. Sometimes they just apologize and write it off…..
“Hospitals Guard Prices Like the CIA Guards Secrets”
That mean we can get them off HRC’s secret server for a small donation?
izlamo delenda est …