darkoshi | Entries tagged with medical bills

Medicare Provider Utilization and Payment Data - a government site. It has spreadsheets which let you compare the amounts that hospitals charged for various procedures.

I downloaded the inpatient & outpatient spreadsheets, and used the Excel filter options to show data for 3 hospitals in my area - Palmetto Richland, Palmetto Baptist, and Providence.

The inpatient data is surprising to me. In nearly all cases where there is data for all 3 hospitals, Providence shows the lowest charges (Average Covered Charges - this is the amount an uninsured person would have to pay). Their charges are generally way less; in many cases less than half that charged by the other hospitals.

The outpatient data shows more variance - in some cases, Providence has higher charges (Average Estimated Submitted Charges), in some cases lower.

As for hospital ratings/quality of care, these pages provide some comparisons:
Medicare Hospital Compare
LeapFrogGroup Hospital Ratings

In general, Providence has good ratings, though in some cases, Palmetto Richland has better ratings.

I wonder why Providence is able to have lower inpatient charges. Palmetto Richland is the largest one, by number of beds. Maybe fewer uninsured people use Providence, compared to the others? Based on the below articles, that doesn't sound like the case, although it could change as the hospital was just sold this year (which I hadn't heard about til now).

Providence to be sold to for-profit hospital company
Providence will maintain its ties to the Catholic church through the bishop in Charleston and uphold church ethics and religious directives, including its ban on abortions, said Sister Judith Ann Karam, a congregational leader.

Trends, finances drove Providence Hospital sale

Crossposts: http://darkoshi.livejournal.com/664677.html

( cut for possible TMI )

Crossposts: http://darkoshi.livejournal.com/564523.html

This is somewhat related to the last post.

I thought I had previously posted about the new high-deductible (HD) health care plan I switched to last year, but I had actually only written a comment on someone else's post. So I'm posting it to my journal now.

The HD plan includes a Health Savings Account (HSA) as mentioned in the prior post. The low-deductible (LD) plan instead includes a Healthcare Flexible Spending Account (FSA). HSAs should not be confused with FSAs, as they are different in several regards. HSA's are much better - unused funds roll over each year, earn tax-free interest, and can be used tax-free for qualified medical expenses in retirement. FSAs do not allow unused funds to roll over each year.

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I was surprised last year when I calculated the costs of going with the new HD plan versus the LD plan of my employer's health insurance.

Both plans have a deductible and a yearly out-of-pocket maximum amount, as well as biweekly premiums you have to pay. The amounts differ per plan. The benefits are pretty much the same.

I thought that the HD plan would make more sense for someone who had fewer medical bills, and that the LD plan would make sense for someone who had higher bills. However, that wasn't exactly true.

Supposing I didn't have any health care costs during the whole year, the HD plan would cost me less, as its premiums are much smaller. The HD plan would cost me only $260 while the LD plan would cost $2184.

Supposing I had just enough costs to meet the high deductible ($2500)... then I'd end up paying about $200 more for that year compared to the low deductible ($400) plan. The LD plan's biweekly premiums are so much higher ($84 versus $10), that by the end of the year, you pay nearly as much in premiums as the higher deductible amount would have been.

Supposing I had high enough bills to reach the yearly out of pocket maximum, the total amount I'd have to pay on the HD plan would actually be $500 less than the total amount that I'd pay to reach it on the LD plan.

Based on all that, it seemed that whether or not I were to have a lot of medical bills, the HD plan was likely to cost me less.

The LD plan seems like it would only possibly be the better option for people who don't have enough savings at the beginning of the year to cover the higher deductible.

Not all HD and LD plans are the same. The deductibles, premiums, and benefits can be very different than my own situation. Anyone who is considering them needs to do their own comparisons. One shouldn't assume however, that one is better than the other without researching them first.

Another good thing with last year's changes to my company's health care plans was that the contributions were made variable based on salary bands. Employees with higher salaries pay higher premiums now than employees with lower salaries.

Crossposts: http://darkoshi.livejournal.com/536555.html

As part of my employment, I have a Health Savings Account to which I contribute a portion of my salary during the year. The contributions are not taxed and may be used for paying medical expenses.

IRS publication 969 provides information on "Health Savings Accounts and Other Tax-Favored Health Plans".

This publication states: Qualified medical expenses are those expenses that would generally qualify for the medical and dental expenses deduction. These are explained in Publication 502, Medical and Dental Expenses.

IRS publication 502 has a long list of "includable" medical expenses, as well as a smaller list of "not includable" expenses. But nowhere in the publication can I find any mention of emergency room care, urgent care, or doctor's office visits (other than an annual physical exam). It seems inconceivable that they wouldn't be considered qualified expenses, but why aren't they listed?

Update - 2013/10/20
Publication 502 includes the following section titled "What are Medical Expenses?", before the lists of includable and non-includable expenses.

Medical expenses are the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and the costs for treatments affecting any part or function of the body. These expenses include payments for legal medical services rendered by physicians, surgeons, dentists, and other medical practitioners. They include the costs of equipment, supplies, and diagnostic devices needed for these purposes.

The publication also states:
Pub. 502 covers many common medical expenses but not every possible medical expense. If you cannot find the expense you are looking for, refer to the definition of medical expenses under "What Are Medical Expenses".

I still don't understand why emergency room care, urgent care, and doctor's visits aren't specifically listed when so many other things are, but perhaps the above is meant to imply that any medical expense not specifically listed is an "includable" expense rather than an "not includable" one.

Crossposts: http://darkoshi.livejournal.com/536185.html

American healthcare was already socialized by Reagan, we’re just fighting about how to pay for it - somewhat misleading title, but interesting. Till now, I wasn't sure what the laws were regarding whether hospitals can refuse to provide treatment or not.

The Law That Changed Everything—and It Isn't the One You Think - more info on EMTALA

Wikipedia entry on EMTALA

Crossposts: http://darkoshi.livejournal.com/534129.html

What life under a socialized medical system is actually like. Interesting comments too.

via

andrewducker

Crossposts: http://darkoshi.livejournal.com/392127.html

I had to pay $50 for a 30-day supply of 10mg Lexapro tablets. The price without insurance would have been $105. The insurance-agreed (Aetna) pricing is $87.02.

Apparently Lexapro is a "Non-preferred brand copay" type medication (where I pay 20% of the cost of the drug with a $50 minimum).
If it were "Preferred brand copay", it would be 20% of the cost of the drug with a $30 minimum.
If it were "Preferred generic copay", it would be 20% of the cost of the drug with a $10 minimum.

Apparently Lexapro is non-preferred, because it is considered "step therapy", and I would have to try "one or more 'pre-requisite'** medications before the step-therapy medication will be covered".

So if the doctor had prescribed one of the others first, and then Lexapro, it would have been cheaper. If the doctor had prescribed one of the others first, it probably would have been a generic one which would have been even cheaper. And it might have even been one of the ones you could get at Walmart for $4.

I wonder if the drug companies and the doctors have some kind of deal, where the doctor gets a kick-back for prescribing drugs which don't have generic equivalents.

** The pre-requisites are listed as:
Any one of: budeprion sr QL , budeprion xl QL , bupropion hcl QL , bupropion hcl sr QL , citalopram hydrobromide QL , fluoxetine hcl QL , fluvoxamine maleate QL , mirtazapine QL , mirtazapine odt QL , paroxetine hcl QL , sertraline hcl QL , venlafaxine hcl QL

With my insurance plan, the copay for office visits is $30. The chiropractor's office I've gone to the last few years always charges me $30, because that is my co-pay. (I pay right away, before leaving). The amount they charge for the services is over $30. However, the allowable/negotiated amounts for the services I've received has always been closer to $20, as shown on my insurance's Explanation of Benefits forms.

Last year, I brought the EOB form with me and pointed out that I had overpaid the previous times, and that I therefore should have credit on my account. Due to this, they didn't charge me for that visit. But for the 2 visits earlier this year, they again charged me $30 each time. I'm sure if I pointed it out again, they'd give me a refund, but they don't do so automatically. I wonder if they are doing this knowingly with all their patients, and whether it could be considered fraud.

Is it normal for a doctor's office to charge you your co-pay amount, and to not automatically send you a refund if the allowed charge ends up being less than the co-pay?

eh. words not forming well. thoughts not. not for replies. but for my own incogniz... inconceiv... inconstrue... contemplative non-sensical... yeah whatever, post, yeah. makeup is a pain. putting nail polish on is a pain. waiting for it to dry... lipstick gets ingested, doesn't it? you eat something, and it ends up swallowed. got some blue stick for tomorrow i guess. seems an odd idea to wear it. wanted black really. but you put it on, and it will end up some where else. in the food. or smudged off. and the polish will scrape off. a pain, not being able to use one's nails like normal. blech. and all this stuff for no good reason. novelty novelty difference whatever. poor little doggy. poor little me. this is what i do when i should get ready for bed. scope creep! scope creep! yee-haw, not mission creep, no.

i don't have a face yet. and i need two. for the jackolantern and the waterlantern. tiny jack. oh dearie. hmmm. shoo-bop, dippity do-bop. hmmmmtired. this is what i do. because. the fumes. my eyes. i can't cope. scope creep! my eyes can't cope. my poor little eyes and me and the world. the cost of health coverage has risen 15% each year for the last 4 years. ain't that a thought. 60 percent in 4 years. blech. friggin doctors. and insurance companies. i write programs for ins. co.'s. yep. i make lotsa money. yep. but my eyes can't take it. i'll end up with glasses. or whatever. maybe. whatever.

this is what i do. when it is easier not to get up. it's not warm.the lights are pretty. i have a hollow watermelon and a hollow little pumpkin. waiting for their faces. any i don't have any. yet. maybe i'll find some from last year's over...ideas.

i had a dream... i'm sure. yo yo. i had a yo-yo. i still do. green butterfly. and my glow-in-the-dark frisbee.
MOONLIGHTER 110 G. MODEL FRISBEE BRAND FLYING DISK.
1975 Wham-O Mfg. Co. San Gabriel, Calif. U.S.Pat.No.3359678.
yeah. who else got one of them? "For night time play"!

mhmmm. thank you for your attention. good night.