Thursday, September 01, 2011

Performing major surgery...on our wallets. To be continued.

This will be something of a teaser post, assuming anyone cares enough about this to feel teased, but it concerns an "explanation of benefits" I received yesterday in connection with my mother-in-law's recent hospital stay. Dreamboat, as we call her (it's a long story), resides in an assisted-living facility up the road, after five years of staying with us, but my wife sees her daily and, these days, basically manages her affairs. Hence the "explanation" came here.

Dreamboat was in the hospital for seven consecutive days and part of an eighth. During that time, doctors performed a minor surgical procedure, intended to relieve a bile-duct blockage. Nowadays this is a relatively simple and straightforward proposition in which the surgeon threads a tube down the esophagus; no actual incisions are required. They also gave her some diagnostic tests, including an MRI, and took a few X-rays. The procedure was unsuccessful but her symptoms remitted anyway, so they sent her home and told her to check back with her family doctor in a few weeks.

The final bill came to $76,557.79. For the math-impaired, and/or products of the California educational system, that calculates to about $10,000 a day. Actually a bit more, since she was back in her usual chair in the assisted-living facility by noon of the eighth day. Notable among the subtotaled charges was an entry of $7356.78 for "prescription medicine." (I guess they were giving her pills made of enriched uranium.) Also, under the generic heading of "medical care," there are four separate entries, which total just under $20,000. None of the charges is really explained in this "explanation." There are just a bunch of codes.

My mother-in-law owes nothing on the bill
Medicare and Blue Cross split 100% of the costs. But that's not the point. The point is that something is rotten at Lehigh Valley Hospital Network. The point is that I perceive in Dreamboat's recent hospital stay an object lesson in the way the medical establishment screws Medicare. Meaning you and me.

I'm going to look into this. I'm going to demand a full accounting, day by day, procedure by procedure, pill by pill. I will report back.

And by the way, inasmuch as it's sort of relevant again, if anyone wants to read or re-read my nine-part series on "placebo medicine," click here.


Dimension Skipper said...

I always hate, hate, hate it when the medical personnel tell you, "Oh, don't worry, your insurance will pay for it." Of course, they'll say that even before they've asked if you HAVE insurance. Apparently insurance is "FREE MONEY!" readily available.

My understanding (from parental experience) is that for numerous procedures and treatments Medicare only allows Drs to bill certain set max amounts and they're not allowed to bill the patients or their insurances for the difference. Is that total you're citing the full tally (as if Medicare was not involved) or is that the Medicare allowable charges and they would have been much MORE had just regular insurance been involved? I've heard that the medicare allowable fees are all extremely low-ball and unrealistic and I feel that's probably true, but that doesn't mean the "normal" billable fees aren't still outrageous (possibly to make up for what they may lose on Medicare patients?).

Good luck with the investigation. I'll be curious what you find out, but to be honest I foresee much frustration and/or aggravation in your future as you pursue this.

Dimension Skipper said...

P.S. Meant to say tht yes, those "Explanations of benefits" are always aggravating in that they usually explain nothing.

Voltaire said...

This ought to be an interesting series of blog posts. When I had an appendectomy, one of the items on the hospital bill was a pregnancy test. My mother called the hospital and had them take the item off the bill because I'm the type of human being who can't have babies.

Another reason why I'm interested in this is I work for a software company that makes medial record software for hospitals. In fact I might mention this to some people I work with; they might be even able to help out with the investigation.

Rational Thinking said...

That's an astonishing total, Steve. Definitely a good idea to go through it with a fine toothcomb. Coincidentally enough, I had this procedure done (privately) a few years ago here in the UK, and the total wasn't even a tenth of that amount. Okay, I was only in hospital for one night, but even so ...

I look forward to hearing how this goes.