The Key to Healthcare Reform Is a Business Decision
The hope of a nation won’t reside in a healthcare bill in the end. The key to healthcare reform will come from a system where regulations restrict billing codes and pharmaceutical costs for the average American.
Take a Look at the Facts Behind a Legitimate Key to Healthcare Reform:
I am nearly seventy-years-old. In the past year, I had a hip replacement, two trips to the ER, and roughly nine medical appointments before and after the surgery. Those visits included blood tests and x-rays. The total amount billed to me was $72,298.12.
The staggering cost of my care would put those Americans without adequate insurance into the bankruptcy courts. The collection efforts by the medical facilities would force an uninsured citizen to their knees. Any hope they might have had for safety during retirement would be destroyed.
Since I’m over 65, the Medicare system becomes my personal watchdog against unreasonable costs for procedures they see as standard throughout the United States.
The Final Breakdown
As a senior citizen, Medicare looked at all the charges and came back to my medical teams with a determination. They determined the average cost of my care last year should have been $28,855.45. That’s a reduction in my costs of roughly $43,000. Compare my cost to someone who falls and breaks a hip before they reach retirement age. Unfortunately, they will pay the entire $72,000+.
Twenty-eight thousand dollars plus is still an enormous amount of money for most people. From my standpoint, I have an excellent supplemental policy. When my policy combined with Medicare, they paid for $27,102.77 of the remaining balance. That left $1,200.00 which came from my pocket. That’s a significant amount of money. But it’s not something that would cripple us or cause us to lose our home.
Let’s take a look at Jack, a friend of ours on the coast during our winter escape. Jack also comes from ‘up north.’ He had a bad heart valve which was surgically replaced by a mechanical device. That means Jack is forced to take blood thinners and have his blood checked every four to six weeks, depending on the results.
Jack lives in a community with a small hospital. This hospital has set aside a suite of rooms they have named the Anticoagulation Unit. When Jack has his blood tested at there, the charge is $101 for the test and an additional $52 for an office visit because he goes to an ‘office’ instead of simply going down to the lab like he did in years past. Jack’s co-pay under his current insurance is ten dollars. That’s a total of $143.00 Medicare and his Medicare Supplemental Insurance Company pay.
When Jack comes to the coast and goes to a 450-bed hospital for the same test, they charge him $3.00. (Three Dollars) Jack tells us they don’t even charge for the $10 co-pay he readily pays up north.
How could the billing systems differ between a twenty-five-bed hospital in a small town compared to a five-hundred-bed hospital in a large city by so much for a simple blood test?
Does it all come down to some fanciful algebraic formula that spreads overhead, profits, and costs differently between two institutions? Wouldn’t the larger facility have more traffic and therefore more profit to spread the overhead?
I believe an INR blood test should be a standard charge nationwide. One of the poorest states in the union charges only $3 for a test done up north for $153? What value does Jack receive up north for an additional $150?
The Key to Healthcare Reform Resides in Citizen Outrage
As a nation, we should all be encouraged by Jack’s story to do our investigations into pricing.
Why can one hospital lab determine how long it takes for Jack’s blood to clot for only $3 when another hospital in a different state charges $153? The labor should be identical. That brings it down to the overhead.
Since the blood test itself costs $101 up north, that would indicate a need to spread the overhead of a small hospital rather than the labor involved in running such a simple test.
Jack’s hospital up north has a full-service lab. That’s where he used to go for his test until about a year ago when the new office suite called the Anticoagulation Unit opened. That’s when the charge for an office visit of $52 first appeared and was added to the $101 cost for the blood test.
For my money, just send me down to the hospital lab. Those gals know how to extract a tube of blood quickly and efficiently.
Who Will Become Our Watchdog?
We need a system similar to Medicare for all citizens. Legitimate costs may vary from place to place, but Jack’s example is simply an inappropriate attempt to juggle billing codes for a more positive outcome for the provider.
That is unacceptable.
We have tried to solve this problem through enacting legislative changes in a market system without the controls and safeguards we built into the Medicare system to protect citizens against exorbitant costs.
Medicare has mostly worked, but in Jack’s case, they haven’t caught the inconsistencies in blood testing up north versus the same test down on the southern coastline.
Gaming the System
The solution must begin with a consistent coding system nationwide and a method to discover inconsistencies in treatment. The solution must include regulation on everything involved in patient care, from the doctors to the pharmaceuticals and durable medical equipment prescribed for them.
Once we have a national system of regulations to control costs, we can look at an open market insurance system. Without standardization, it can’t work efficiently. Someone will always find a way to “game the system.”
Even with standardization as we find it in today’s Medicare system, someone will always find a way to work around the intent of the regulations to charge more money.
It’s no wonder the insurance companies continue to scream “Foul!”
The first real job I had was working for a doctor in his billing department. My instructions were very clear: He didn’t care what billing codes I used as long as I found a way to get the maximum amount possible out of the insurance companies for each procedure.
Once I figured out that they charged different people different prices based on what I considered to be random factors, I quit. The sense of integrity my grandfather taught me wouldn’t allow me to continue working there.
We Are The Solution
It’s time we all stand together and stop feeding off exaggeration and fear-mongering. We have a responsibility to ourselves to shop medical services with the same vigor we shop the specials at the mall.
Until we begin to check the price for services and pharmaceuticals at other facilities, we throw the responsibility for monitoring our health to the insurance companies. Their goal is to keep costs down and deny coverage to high-risk customers. The best advocate you have is your determination to protect your money and health through logical investigation into charges.
The risk is in doing nothing and in accepting whatever the box at the bottom of the statement says we owe. Fight for consistency and fairness in medical coverage by fighting for your rights and by protecting your insurance company from questionable activities associated with the bills you receive.
Jack fully intends to bring the discrepancy to the attention of his insurance company as soon as possible. Will you? Click here to begin your research and ensure you’re paying a fair price for services. Here is just one example of what that website can tell you before you agree to schedule a test before comparing prices:
Sedimentation Rate – $8
- Lab tests can cost 3 to 5 times too much depending on the location of your test.
- You can receive lab tests at various locations:
- Hospital labs (often the most expensive)
- Physician’s Office
- Independent lab setting (often the best value)
- In some cases, you will also be charged for an office visit if you go to the doctor to have your labs drawn.
- Always ask your physician to help you find the lab location that will provide you the best value.
- In many cases, you may be able to save several hundred dollars.
You are in charge of your medical planning. The fastest way to control costs is to stop blindly agreeing to services without shopping the marketplace first. Once we all begin doing this, healthcare legislation will finally move in a direction that will help more people at manageable prices.
It’s time we all partner with our insurance companies to help them provide all the services we need at prices we can afford.
The hope of enjoying the medical services we require rests in our ability to demand fairness or go somewhere else.