How do health care providers get away with it?

Leatherneck · Post by **Leatherneck** » Mon Dec 08, 2008 2:41 pm

I just got a bill for my CPAP machine and humidifier and it's always like deciphering high level math. I saw the breakdown of costs and it astounds me. $32 for the filter? it's a 1x1" piece of high quality furnace filter. $1895.00 for a ResMed S8 Elite and $475 for the humidifier. About $200 for hoses, $300 for a mask (billed in pieces), X amount for the case and so on...All in all it is arounf $3200+ dollars. I have insurance of course and it will be about $400 out of my pocket, but my Lord how they rape the insurance companies. No wonder healthcare is ruined in this country. These folks are robbing them! I could get the same equipment on cpap.com for $599. Is there a rationale for the exorbitant markup? I understand overhead, service and such which is an understandable cost, but 5x as much?

O.K. rant over..

jnk · Post by **jnk** » Mon Dec 08, 2008 2:46 pm

It is my understanding that the amount "billed" may differ from the amount insurance actually pays, or "allows."

But either way, I agree with your general assessment.

Leatherneck · Post by **Leatherneck** » Mon Dec 08, 2008 3:02 pm

Yes, amount billable to my insurance is $1450 which is still a ripoff.

Gerald · Post by **Gerald** » Mon Dec 08, 2008 3:22 pm

Leatherneck.......

Here's the "rationale"....as I see it.

Doctors are the "elite"....they're smarter than the average citizen.....they get through a very stringent "filter"....Medical School.

They have a wonderful lobbying system....they know how to buy the votes of politicians.......and they know that politicians use force to control us....the citizens.

The doctors really dislike having to chase their "customers" (patients) for payment. They'd much rather bill an "insurance company" (pre-payment system) for their services.

In order to con the public into going along with the "insurance" (pre-payment) scheme, they mark up all services and equipment to "quadruple list price"....so that if a "patient" (victim) doesn't have "insurance" (a pre-payment system), he makes every effort to get one before he's "raped" again.

This drives the herd (us) into an ever tighter system of control and wealth transfer.

Welcome to Socialism.

jnk · Post by **jnk** » Mon Dec 08, 2008 3:50 pm

I don't mind people getting paid for what they do. All I ask is that they actually DO something!

nosbig17 · Post by **nosbig17** » Mon Dec 08, 2008 4:27 pm

Gerald pretty much has it nailed.

The Doctors also have a strong Union (AKA - American Medical Association). The AMA may not be a union, but they sure act like a union, where limiting trade is concerned. Essentially, there is NO market when it comes to medical treatment.

ziggytosh · Post by **ziggytosh** » Mon Dec 08, 2008 5:35 pm

I was wondering the same thing. The amount my insurance is going to pay with their "lease" agreement over the course of 12 months is roughly double the amount it would cost for someone to buy a machine directly from my brick-and-mortar DME (let alone what it would cost from an online DME). I understand the lease period represents increased risk to the DME, but is it really twice the risk to justify twice the price? I have mixed feelings about it. On the one hand, I LOVE to see my insurance company pay anything. Just love it. It makes my heart feel happy. On the other hand, all their stupid overpayments mean is higher premiums for me and everyone else.

jrt · Post by **jrt** » Mon Dec 08, 2008 6:07 pm

Union with kickbacks says it all. Recently I had a test got 3 bills one for the test,one for the radiologist who "read" the test and a kickback to a doctor(another radiologist) who neither ordered or was present during the test but got money because I was in the department. The insurance company paid the kickback doctor and when I questioned this was told this billling is common practice. This third bill is something new this year to me. I wonder if the next time I get my blood drawn will get 4 bills one for the test,one for the tech who draws it , one for a pathologist for time I spent in lab and another for a pathologist to "read" the computerized results. None of the above include the provider bills who ordered the test in the lst place.
The plan the administors the self-funded employer insurance loves those added charges so they can increase the premiums for their "services".

The providers will charge more to the insured/privatepays to make up for the discounts other insurances/people get. Plus someone has to pay for the nice facilities. In some countrys the local church is the community masterpiece to be admired. If you are looking to oh and ah a fancy buliding in the US just go to the local hospital/clinic but dont expect fine service.

georgepds · Post by **georgepds** » Mon Dec 08, 2008 6:16 pm

I'm not so sure that doctors are in cahoots with the insurance companies. Most articles I've read suggest GP's are leaving their practices because of frustration with insurance billing and collection.

Also, tax treatment is important, the leased items are an expense and deducted totally from the tax bill, purchased items are capital improvements, and the cost is not completely deductible. So, favorable tax treatment might govern the lease/buy decision.

ziggytosh · Post by **ziggytosh** » Mon Dec 08, 2008 6:19 pm

georgepds wrote:Also, tax treatment is important, the leased items are an expense and deducted totally from the tax bill, purchased items are capital improvements, and the cost is not completely deductible. So, favorable tax treatment might govern the lease/buy decision.

Fine, but all that means is tax dollars (or more specifically, uncollected tax dollars) are being wasted too. Since the set of "taxpayers" overlaps pretty thoroughly with the set of "people who use the medical system," the net loser in this wacked out system is one and the same.

BeanMeScot · Post by **BeanMeScot** » Mon Dec 08, 2008 7:24 pm

jnk wrote:It is my understanding that the amount "billed" may differ from the amount insurance actually pays, or "allows."

But either way, I agree with your general assessment.

This. I just got my bill back from the DME after it went through insurance. After the discount the insurance gets, several items were actually CHEAPER than they would be at CPAP.com. I found that surprising. They do have a huge mark up on the humidifier and machine. They charged $715 for the M series humidifier, my insurance approved $450 and I could get it for $149 at CPAP.com.

BeanMeScot · Post by **BeanMeScot** » Mon Dec 08, 2008 7:28 pm

By the way, I did notice that the DME had their math wrong. They gave me 2 filters and put 2 filters in the breakdown but the money breakdown says they only charged for one.

Guest · Post by **Guest** » Mon Dec 08, 2008 9:24 pm

you morons have no idea what it takes to run a DME - get a life.

sleepytexan · Post by **sleepytexan** » Mon Dec 08, 2008 9:51 pm

Guest wrote:you morons have no idea what it takes to run a DME - get a life.

Now that is funny

Wulfman · Post by **Wulfman** » Mon Dec 08, 2008 10:07 pm

Guest wrote:you morons have no idea what it takes to run a DME - get a life.

Apparently a lot of DMEs don't, either.....

http://www.hmenews.com/article/hm200812 ... ghts%20DME

http://www.hmetoday.com/search.asp?qu=fraud

Den

How do health care providers get away with it?

How do health care providers get away with it?

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