Friday, December 14, 2007

Review of Medical Expenses

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 BilledInsurance AllowedPatient Responsibility
ALS Emergency
Mileage ALS
Pulse Oximetry
IV Supplies
Disposable Supplies

* Still waiting* Still Waiting
Hospital ER $836.32$459.98$459.98
X-Ray Reading $28.00$12.18$12.18
Generic Pain Med $4.06$4.06$4.06
Wound Closure (done in office)
$650not 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 $2,302.69$862.28*$862.28*

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).


Alex Stoker said...

Interesting to see the breakdown; in the UK EDs get between 35 and 105 pounds per pt, depending on severity of case. I'm guessing this case would have netted our dept 70 pounds ($140), all in. Good deal, eh?

rlbates said...

Drshroom, not sure how the other expenses compare between UK and US (cost of supplies and staff salaries for example). The ER charge listed here covers all that. My friend didn't have a breakdown charge list.