Bite Me! You Say to the Cat. Okay! Says the Cat! $55K! Says the Hospital (Basically)

LAT columnist David Lazarus got bit by a cat (his cat) and when he added up all the expenses, the cost was $55,000. But he didn’t pay all that, and neither did his insurance company.

Marketplace did the math: “Luckily for Lazarus, he has health insurance. Blue Cross Blue Shield of Illinois covered $38,448. His co-pay was a little over $1,500. That leaves some $14,000 unaccounted for. Lazarus went to talk to the head of the hospital where he says he received excellent treatment. He says Dr. Feinberg of UCLA Medical Center told him the extra $14,000 was ‘funny money.’ It simply disappears.” Because that makes sense.

In other bite news: A dog bite in Europe, a not-bite from a bat in Montauk.

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8 Comments / Post A Comment

NeenerNeener (#156)

Clearly I don’t understand insurance. At the end of the article, a solution is proposed where the insurance company gives the doctor $8,000 per patient, and if the patient requires less, the doctor can pocket the difference (an effort to reward preventative care measures). But if the insurance company collects less than that per year in premiums for that member, how does that work?

KittyConner (#3,108)

It’s not ‘funny money’, that was poor word choice and I should think that a physician should know better.

It is the ‘contractual adjustment’. The hospital sets their charges (usually on a yearly basis). Separately, the hospital negotiates contracts with insurance companies. These contracts allow a facility to be considered in-network and the contract sets terms of payment, be it a set percent of charges or a specific negotiated rate for each type of service.

So a patient is treated, the services are billed to the insurance company at the rates initially set by the hospital. The insurer then examines the claim, pays the rate previously negotiated and as required by the terms in the contract, the hospital writes off the balance as a contractual adjustment.

Yes it is unfair and baroque(and broken!), but its how the system works at this point. Which is why no one should EVER EVER EVER pay full price for healthcare. EVER. No insurer is ever going to, so if you are a self-pay patient, you should request a discount EVERY TIME. Hospitals, doctors, and it’s even worth a shot at pharmacies. You’re never going to get as good of a deal as, say, Medicare, but a 20%, 30% discount is not off the table.

(Fun Facts And The More You Know Addendum: At my practice, Medicare pays significantly less than 40-50% of the charges billed.)

sunflowernut (#1,638)

@Ash@Work So since you seem to know about this, I have a question. I was recently switched to a high deductible insurance plan. Which fucking sucks. Until the deductible is payed in full (something I doubt will happen) can I ask for a discount from my doctor? Or is that like, a no-no, since I do technically have health insurance?

KittyConner (#3,108)

@sunflowernut You can always ask!

Here’s how it will go down: Your doctor’s office is going to run your claim through your insurance, regardless of your high deductible, the insurer is still going to reprice your claim at the approved rate and the doctor is going to write off the contractual adjustment. The amount the insurance WOULD have paid your doctor is what will get applied to your deductible, which will then be your responsibility.

So, technically, there is already a ‘discount’ on those charges. Which is good (cheaper is better) and bad (takes longer to meet your deductible).

In a perfect world, your doctor should, per the terms of the contract with the insurer, collect every penny from you the insurer says you owe. In the REAL world, however, once the EOB is posted to your account and sent to you as a statement, the average billing clerk is going to focus on you and not the ins. co and might be willing to provide a discount anyway, depending.

Also, HSA? Do you have one?

sunflowernut (#1,638)

@Ash@Work I do not have an HSA, and frankly, I don’t really make enough money that I think it makes sense for me? I’m on my parents health insurance plan, but since I’m not a dependent, they aren’t allowed to use their HSA on me. My mom says she will gladly help me out with the cost, but that’s not ideal for a variety of reasons, the main one being that I’m afraid it’s going to feel like she’s some sort of health care gatekeeper.

kellyography (#250)

Brilliant photo pairing for this piece.

I once stabbed my finger with an epipen when I was uninsured. thank ALL higher power my boss at the time was friends with a doctor who saw me, told me to soak it in hot water, and called around to other ER docs he knew to be sure this was protocol. I got to listen to the sound of physicians making health and finger-saving analyses, I got to watch my thumb (which looked dead…yellow, corpse-y) slowly get back to normal, and I got to eat a really good italian sandwich from the deli down the road from the doc’s office. but if I hadn’t had this friend of a friend, that stupid mistake would have cost me thousands of dollars I did not have. money to the uninsured is not “funny money”.

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