Thursday, December 27, 2007

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
ALS Emergency
Mileage ALS
Pulse Oximetry
IV Supplies
Disposable Supplies

$     9.00
$ 27.00
$ 39.00
$ 16.00
EMT service has no contract with insurance company, so no reduction--
Hospital Charges
Emergency Room
$ 68.00
(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
X-Ray Reading   $28.00 $12.18 $12.18
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)
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. 


DrWes said...

Out of interest, what are your friend's monthly or annual insurance premiums? How much do they exceed the cost of this ER visit?

Might be an interesting tidbit, as people might decide to pay themselves some day rather than an insurance company.

rlbates said...

The insurance policy portion (family)is $462.88 plus $100 to savings each month--health savings account.

Vinai said...

I had colonoscopy done at Surgery
Center a few months ago,the bill for the procedure
Surgery Center $2843-allow $549
Surgeon $1200-allow $345
Anesthesia $504-allow $124
Path. $124.30 allow $16.76
my share $75

rlbates said...

Vinai--what type of insurance do you have? My friend's is a high deductible HSA (health savings account) and he had not used any of his deductible for the year until this accident.

Hope your colonoscopy / path was benign.