Transparency rule fails to shed light on costs for IU Health Bloomington patients

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In the dark: Transparency rule fails to shed light on costs for IU Health Bloomington patients

The rule is intended to help patients predict the cost of care. It isn’t working.

specials.idsnews.com

 

[hoosierdoc]

I would be thrilled if we collected 20% of what we billed. Like, jumping for joy thrilled. Guess what would happen to our bills as percent collected improved? They would drop dramatically.

What sucks is they are trying to pass laws that force any doc working at a hospital to be in network with an insurer if the hopsital is. So guess what happens to my ability to negotiate with an insurer for fair payment for services when i am forced to sign whatever contract they give me? zero arbitration. Just sign or lose your job insurer will make better deal with hospital and then screw over the doc contract. So then the doc just gives up and tries to get hired by hospital with zero leverage.


And IU health is not your friend.

 

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How did they put it, back when they were passing Obamacare?

"You think healthcare is expensive now? Just wait until it's free."

 

[bwframe]

I would be thrilled if we collected 20% of what we billed. Like, jumping for joy thrilled. Guess what would happen to our bills as percent collected improved? They would drop dramatically.

What sucks is they are trying to pass laws that force any doc working at a hospital to be in network with an insurer if the hopsital is. So guess what happens to my ability to negotiate with an insurer for fair payment for services when i am forced to sign whatever contract they give me? zero arbitration. Just sign or lose your job insurer will make better deal with hospital and then screw over the doc contract. So then the doc just gives up and tries to get hired by hospital with zero leverage.


And IU health is not your friend.

As always doc, thank you for your professional insider input. It is invaluable.

 

[HoughMade]

And IU health is not your friend.

All I know is that they pay their bills....a lot more than 20%.

 

[Leo]

I know everyone has a story. I think mine proves the system is dishonest. I had angioplasty and a stent twice in early 2020, 7 days apart at IU

Same prep room, same nurse, same Cardiologist, same anesthesiologist. One of the Nurses was the same. The procedure was in the same room. They snaked it through he same artery in my groin. Same recovery room nurse in the same recovery room. I was sent home at 4:00 both times. The first procedure was $99,000. the second was $140,000. I had to make a monthly payment for what the Insurance refused. I kept trying to find out why the second was $41,000 extra, as I could not see it. No one could answer, even the Insurance company said they could not find out and "it just goes that way". Where I come from, $41K is a lot of money.

I just made the last $990 payment. I know I should be glad, but it is hard not to stew about obscene billing practices.

It is not just at IU Med. The Franciscan Hospital echo of my heart was $2100, and 6 months later the next one was $4400. Of course the Insurance says that is way beyond usual and customary, and want me to pick up the double charge.

It is like they are double billing to make up for cancelling all non critical surgery. No one can convince me that what is going on is legitimate. Even if I can survive the next surgery, I will not survive the next bill.

 

[KittySlayer]

Scheduled a physician consult with an urologist outside my insurance network. Asked how much the cost would be without insurance and the scheduler could not tell me. She had absolutely no idea.

 

[CHCRandy]

Damn, these stories make me cringe. I swear you are sometimes better off telling them you don't have any money, no insurance, no address, no phone number, no job and maybe even that you are homeless and can't speak English.

One of my roofing guys hurt his knee and could not hardly walk. He went to St. Vincent clinic and they asked him how he was gonna pay, he said cash. Nurse got him right back. Doctor looked at his knee, did an xray and ultrasound and said he had an infection in his knee. Dr. told him you can have pills or shot. Felipe asked which was best. Dr. said pills are cheaper but shot may work faster, Felipe asked "Can I have both" and Dr said yes but it will cost you more. Felipe said he didn't care about cost, he just wanted to be better. Felipe got shot and walked to counter to pay. Cost him under $500.

Same guys brother comes to US to work in Tobacco fields 8 months every year then goes home to Mexico. He got sick late summer and needed a small outpatient procedure. He talked to his old Dr in Mexico and the Dr. told him the surgery would be 35-40,000 Pesos and they could do it when he got back home. That's like $2000 USD. Well Felipe told him to check with an American hospital and tell them he would pay cash, he got it done for less here than what it was gonna cost in Mexico.

How can this possibly be?

Tonight we was at CVS picking up medicine. The guy in front of us was told his insurance didnt cover the medicine Dr prescribed, he said...well no big deal, how much for me to just pay for it? The lady came back and said $1,091.00!! The guy about fainted. He laughed and said you can keep em.....I wont be paying that.

I don't understand how this is sustainable......insurance premiums are out of sight, out of pocket out of sight, charges out of sight.

Doc, honest question.......does a patient paying cash get a better price than an insurance company?

 

[2in1evtime]

I know in our local area all the doctors joined up with the local hospital {had to to use the hospital] Prices more than tripled, testing is very expensive also, had a few doctors leave the area because of the forced sign with us or lose your hospital privilege, some doctors were shut down if they didn't see a certain amount of patients a day, i know of one very good doctor that this was done too!!!!

 

[4sarge]

And IU health is not your friend.

AGREED IU Health is NOT Your Friend.
Personal Horror Story here and I should have SUED :-(

 

[Twangbanger]

Providers can't publish their prices.

They need cover, to figure out who they can "nail."

The providers don't want to turn anybody away. That is bad for business, and that turned-away person may eventually get coverage, and come back able to pay more. So it's in your interest to work with them.

But the insurance companies (and their clients) don't want to pay for anyone who doesn't have coverage.

The dilemma of the provider, is figuring out how to get insurance companies with their Great Big Pool of Money to pay for people who aren't covered - without knowing they're paying for people who aren't covered?

The solution according to insurance companies, is for everyone to have coverage - by government fiat, or whatever. They want the whole world to be their customer.

The shtty deal here, is that we've arrived at a situation where unfortunately, the c*suckers in the government and ins. cos. are basically right: once _anyone_ has coverage, the situation must continue to evolve until _everyone_ has coverage. Otherwise, the providers have to keep figuring out clever ways to make insurance companies pay for people who aren't covered, and you get situations like the ones listed above, where two people walk off the car lot paying $10k different for the same car.

Can the car lot occasionally afford to "dust off" $5k of the price of the car, for an individual customer? Sure, as long as everybody doesn't start figuring that out.

(The Doc can't afford to have an MRI and surgical suite in his garage, so, he's an "employee" along for the ride).

But the kicker will be: when you finally get everybody "in the pool," and get transparency, it doesn't mean it will get more affordable. It will just mean everybody gets "nailed" the same amount.

 

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...

One of my roofing guys hurt his knee and could not hardly walk. He went to St. Vincent clinic and they asked him how he was gonna pay, he said cash. Nurse got him right back. Doctor looked at his knee, did an xray and ultrasound and said he had an infection in his knee. Dr. told him you can have pills or shot. Felipe asked which was best. Dr. said pills are cheaper but shot may work faster, Felipe asked "Can I have both" and Dr said yes but it will cost you more. Felipe said he didn't care about cost, he just wanted to be better. Felipe got shot and walked to counter to pay. Cost him under $500.

Same guys brother comes to US to work in Tobacco fields 8 months every year then goes home to Mexico. He got sick late summer and needed a small outpatient procedure. He talked to his old Dr in Mexico and the Dr. told him the surgery would be 35-40,000 Pesos and they could do it when he got back home. That's like $2000 USD. Well Felipe told him to check with an American hospital and tell them he would pay cash, he got it done for less here than what it was gonna cost in Mexico.

...

It this an immigrant thing or would it work for an American citizen?

 

[hoosierdoc]

The laws governing it are messed up. Stark laws and anti-kickback laws. Used to be, and still may be, illegal for a doc to own a hospital he works in. But it's also illegal for a corporation to hold a contract to provide care in some places, the "corporate practice of medicine" statutes.

Hough probably understands it way better.

Medicare forces economic change on people. For radiology they reduce payment for hospital-affiliated imaging and encourage outpatient centers. But for cardiology, they slash funding for outpatient independeng testing by 30%,essentially forcing all independent cardiology groups to sell to hospitals in order to get fair compensation.

I hate it all. Should be a cash system as much as possible.

 

[tim87tr]

Health issues are stressful enough, then there's the agony of dealing with employer provided insurance systems. I'm glad direct pay is cost effective and helpful to people.

My story....family member has top tier Blue Cross, $300 copay and $1500 total annual out of pocket. Has a wellness system that's a setup and paperwork nightmare for the healthiest of people to get the 100%, not 90/10.

Heathy individual has a medical emergency, 14 days ICU. Bill around a half million. Paying bills as they come in as the insurance adjustments are made. Ideally would like to just give $1500 to them and forget about it, but these payments go to different medical entities as they are billed.

$200 from $1500 limit and family was turned into collections. Children running admin billing systems at IU Health said your supposed to set up payment plan. Ummm you just got a half mil and $200 away from full payment. Collection agency gets chewed out badly, along with IU Health, no responsibility was accepted, total disaster over nothing.

Individual soon gets $600 refund check from IU health and cashes it, calls them back and says you got a problem giving us refund and turning us into collections. Individual went ahead and paid the $200 to settle by phone and still got bills for it the next few months. They called them each time, and was told it was a mistake.

Can't make this stuff up, but how will this improve? I don't have any idea.
SNAFU...situation normal all f'd up
FUBAR..f'd up beyond all recognition

 

[spencer rifle]

SWMBO needed a shoulder x-ray a few years ago. Our insurance sucks, so she was trying to find alternatives paying cash which could be the same or less than our deductible. She called 9 places, with answers ranging from $2000 to $60. By far the most common answer was "We don't know." What, you've never done this before? How could you not know? WTF! Maybe it depends on who's paying? We tried to make it easy and tell them we would be paying cash. They still didn't know.

 

[phylodog]

I would be thrilled if we collected 20% of what we billed. Like, jumping for joy thrilled. Guess what would happen to our bills as percent collected improved? They would drop dramatically.

What sucks is they are trying to pass laws that force any doc working at a hospital to be in network with an insurer if the hopsital is. So guess what happens to my ability to negotiate with an insurer for fair payment for services when i am forced to sign whatever contract they give me? zero arbitration. Just sign or lose your job insurer will make better deal with hospital and then screw over the doc contract. So then the doc just gives up and tries to get hired by hospital with zero leverage.


And IU health is not your friend.

Sounds like a great system which will undoubtedly attract the best and brightest our nation has to offer in coming years.

 

[phylodog]

Can't make this stuff up, but how will this improve? I don't have any idea.
SNAFU...situation normal all f'd up
FUBAR..f'd up beyond all recognition

I'm sure more government involvement will help the situation.

 

[CHCRandy]

It this an immigrant thing or would it work for an American citizen?

I honestly have no idea.......but I know I have a buddy who is an American, dont work and lives in his sisters house. He got some kind of bone infection last year, was in St. V for 5 months while they removed bones from his body, let infection subside and put his bones back in. He was billed ZERO! Now he may have got Medicare/Medicaid, but he has never paid taxes....so not sure he is allowed to get it.

Then again, my wife had a tumor removed from her brain in 2013. The Bill was over $300,000. Neurosurgeon bill alone was $65,000 for an hour or 2 of surgery....my insurance paid a "pre approved" amount of $20-22K to surgeon. I am assuming Anthem negotiates this cost before signing with Goodman Campbell? I didnt get a bill for the unpaid amount. Maybe this is the stuff Doc was talking about.

One more example and then I will stop blabbing. My daughter, before she had insurance or a decent job...had to go to Hospital and was in for like 2-3 days. She got a bill and it was 10K or more. Her and my wife went to hospital and a case worker helped her get 95% of the bill wrote off, we then paid the balance in cash and it was only like $800. Now she has a good job and insurance and she pays more in premiums and out of pocket than that.

Almost makes you wonder if insurance is even worth it.....but you get sick and you own anything, you better have it or they will take your assets or you will be filing bankruptcy.

 

[hoosierdoc]

SWMBO needed a shoulder x-ray a few years ago. Our insurance sucks, so she was trying to find alternatives paying cash which could be the same or less than our deductible. She called 9 places, with answers ranging from $2000 to $60. By far the most common answer was "We don't know." What, you've never done this before? How could you not know? WTF! Maybe it depends on who's paying? We tried to make it easy and tell them we would be paying cash. They still didn't know.

Northwest radiology or CDI.

I called and got same day quotes and scheduled two CT scans for $1100 cash a few months ago. Including the radiologist report.

What Happens When Doctors Only Take Cash

Fixed-price clinics offer a glimpse at the post-Obamacare world

time.com

Procedures Archive - Surgery Center of Oklahoma

surgerycenterok.com

 

[phylodog]

I honestly have no idea.......but I know I have a buddy who is an American, dont work and lives in his sisters house. He got some kind of bone infection last year, was in St. V for 5 months while they removed bones from his body, let infection subside and put his bones back in. He was billed ZERO! Now he may have got Medicare/Medicaid, but he has never paid taxes....so not sure he is allowed to get it.

Then again, my wife had a tumor removed from her brain in 2013. The Bill was over $300,000. Neurosurgeon bill alone was $65,000 for an hour or 2 of surgery....my insurance paid a "pre approved" amount of $20-22K to surgeon. I am assuming Anthem negotiates this cost before signing with Goodman Campbell? I didnt get a bill for the unpaid amount. Maybe this is the stuff Doc was talking about.

One more example and then I will stop blabbing. My daughter, before she had insurance or a decent job...had to go to Hospital and was in for like 2-3 days. She got a bill and it was 10K or more. Her and my wife went to hospital and a case worker helped her get 95% of the bill wrote off, we then paid the balance in cash and it was only like $800. Now she has a good job and insurance and she pays more in premiums and out of pocket than that.

Almost makes you wonder if insurance is even worth it.....but you get sick and you own anything, you better have it or they will take your assets or you will be filing bankruptcy.

The system as it stands is irreparably broken. When it became law that those without the means to pay for treatment could not be turned away it was all over. The system is now just a bunch of throwing **** at the wall to see what sticks.

I'm not exactly sure why there needs to be 37 people making money off of the business handled between myself and my Doctor but it doesn't appear anyone feels the need to justify it, let alone change it.

Walk in and claim not to have a pot to **** in and the world is your oyster. Walk in with an insurance card and get bled dry. Like most thing the government has involved itself in, the system is ****ed beyond recognition.