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|
|EMT service has no contract with insurance company, so no reduction--|
|Hospital Charges |
(insurance didn't break it down on their statement)
|ER Doctor Charges||$273.00||just received (12-22-07) & sent to insurance||Paid $273 while waiting for insurance|
|Generic Pain Med||$4.06||$4.06||$4.06|
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 |
|not covered by insurance |
|not covered |
|$30.06 (Coban, guaze, etc)|
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).
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.