Review of Medical Expenses--Update

This review was first posted on December 14, 2007.  I have added a couple of paragraphs at the end, as well as some (blue ink) changes in the chart.

My friend who incurred the self-inflicted gun shot wound to his right forearm has gotten his medical bills. I ask him to allow me to review them. I was interested in what was billed and what the insurance company actually allowed. Notice how long it has taken to get everything (well not everything--ambulance services still pending review) through insurance review (late August until today). Here is the breakdown.

Service Rendered		Billed	Insurance Allowed	Patient Responsibility
Ambulance-- ALS Emergency Mileage ALS Pulse Oximetry IV Supplies Disposable Supplies		$488.00 $146.25 $36.00 $42.00 $42.00	$463.00 $     9.00 $ 27.00 $ 39.00 $ 16.00	EMT service has no contract with insurance company, so no reduction-- $754.25
Hospital Charges Radiology- Emergency Room Drugs		$836.32 $213.93 $554.39 $ 68.00	$459.98 (insurance didn't break it down on their statement)	$459.98
ER Doctor Charges		$273.00	just received (12-22-07) & sent to insurance	Paid $273 while waiting for insurance
X-Ray Reading		$28.00	$12.18	$12.18
Generic Pain Med		$4.06	$4.06	$4.06
Secondary Wound Closure (done in office)		$650	not actually billed (maybe $356 on hosp % reimburse)	not actually charged (maybe $356 as based on ER reimbursement)
At home dressing supplies		not covered by insurance $30.06	not covered $30.06	$30.06 (Coban, guaze, etc)
Total Expenses		$2,575.69	$1,416.28*	$1,889.53*

My friend has a Medical Savings Account so has a high deductible ($5700). The insurance coverage did decrease his actual out-of-pocket responsibility by "not allowing" $392.16 (more depending on the ambulance bill outcome). This is also money that the hospital and ambulance service did not receive. I know he is grateful for the savings. I, however, also see the other side. A reduction of nearly 50% seems absurd. Is the medical community really overcharging that much? Or are we charging fairly to cover the expenses of the hospital/office? Just as Wal-Mart has a built in "padding for loses" for each item sold (covers losses due to theft /shop lifting), the hospitals/offices need to be able to have the same "padding" to cover the services that aren't paid for by the patient (under-payment by Medicare/Medicaid, no insurance, simply doesn't pay, etc).

 

Update 12-27-2007

My friend received a bill from the ER doctor which is (apparently) separate from the hospital charge.  This bill arrived on December 22, 2007, nearly 4 months after the injury!  It had not even been sent to the insurance company first, even though I am sure the ER doctor had access to this information. 

Turns out the EMT (ambulance service) does not have a contract with his insurance so they balance bill for the entire amount.