Priceless: Getting a peek at my hospital bill
Listen, I have a hard enough time explaining to my older son why he is left handed and his parents are right handed. The last thing I want to do is tell my sons why they have foreskin and I don’t. That is to say, even if insurance wasn’t paying for it, we weren’t going to skimp on the circumcision.
“You can’t put a price on your son’s penis,” my wife said. She’s really wise sometimes.
If you read my blog post on health care reform, you know I’ve been having a tough time with the hospital since Dos was born. Our Blue Cross/Blue Shield insurance didn’t cover maternity, we knew that going in, and we saved up our pennies until we had enough to cover the birth of a child in America. We were given a pre-pay, self-pay rate and paid off the birth four months before my wife climbed into the stirrups. Then somebody at the hospital business office thought it would be a fun game to bill our insurance anyway. Then the insurance company mistakenly paid part of the bill, and then wanted the money back.
That began a Kafkaesque three months of bureaucratic red tape, misapplied bills, and multiple accounts in which we were being told we owed more money than we paid last winter. The business office supervisor wouldn’t return our calls. Bills kept coming. The insurance company–the one that doesn’t pay for immunizations or Well Baby visits–wanted its damned money. The hospital wanted its damned money. My baby wondered what in the hell we had done to his penis. It was a tough time. The stress to me and the wife was a little too much and it probably would have been beneficial to look into getting aid from the likes of GoFundMe for our medical bill costs, but should we have to pay them?
Finally, we had enough. We took the morning off and marched to the hospital with a manila folder full of proof we were right. We made sure we walked out of the office with a receipt showing a zero balance and a digital voice recording of the supervisor saying the same thing. Finally, the long Mt. Otis nightmare was over.
“Mommy put off stripping another day,” she told Dos. “I don’t have to work the pole today.”
That should’ve been it. Unfortunately, during the process of hugging it out with the hospital business office, we happened to get a glimpse of one page of our itemized bill. As you’re probably aware, hospitals don’t routinely hand out itemized bills (although I have since learned I should be able to get one just by asking). Even the business office worker seemed shocked when she was reviewing it.
“What is this for?” she asked, mouth hanging open.
“That was the ointment he received after his…” The supervisor lowered her voice. “Circumcision.”
Now, as a child’s circumcision is a moment every father dreads, I happen to remember every detail of that day, including the size and chemical make-up of the tube of ointment I had to spread on the poor kid’s wanger. These are things a daddy just doesn’t forget. What the nurse brought us was a very small tube of generic Neosporin. It lasted about three days.
The hospital charge for that little tube of generic triple antibiotic ointment: $166.
One hundred sixty-six dollars.
“One hundred sixty-six dollars.” I kept saying it out loud on the drive home. I was so flummoxed, I pulled into a pharmacy and walked directly to the first aid aisle. I snapped an iPhone picture of the same medicine we got at the hospital.
If for some reason you can’t read, that’s $4.49 for the exact same thing I got at the hospital for $166.
Back in the hospital, I couldn’t control myself. I knew the lady behind the desk didn’t have any control over it, but I couldn’t help asking, “Isn’t that a little ridiculous?”
She didn’t even smile. She looked up and said, “Be glad you didn’t get any Lortab.”
Funny thing about that. The doctors and nurses couldn’t have been pushing the Lortab any harder on my wife after the birth. I wouldn’t have been surprised if the nurse had whispered, “Listen, I’ll give you a taste for free, and you can tell me if you want more.” The wife, again a wise woman (who doesn’t mind a cool buzz), declined every time in favor of OTC pain killers.
“The Lortabs are $14 a pill,” the business office supervisor told us.
Now, I’ve never bought Lortab for recreational use, but I know some people familiar with street prices as they are able to view the latest Prices For Prescription Drugs using certain websites online. I couldn’t help but wonder who charged more, hospitals or drug dealers.
One reputable source told me today, “I would sling those for two for $10 or five for $20.” And that would be at a very big mark-up. That’s right. Had my wife needed Lortab, I could’ve picked up the drugs cheaper on the street than in the hospital.
Let me repeat: Hospitals charge 3.5 times more for drugs than drug dealers do!
Thank you, American health care system.
There are a thousand explanations excuses for why hospitals do this, but there are two reasons that stand out. One is obvious: profit. Second, it’s to make up for the people who need medical assistance but can’t pay for it. And that makes me wonder…all of the people who say they don’t want their tax money to pay for other people under a reformed health care system, do they prefer to pay $166 for generic Neosporin and above illegal street prices for drugs? The money is still coming out of your pocket.
Many smart people have said one good health care reform would be to force hospitals to publish a services menu and stick to the prices on that sheet. Then customers could pick and choose their health care based on the cost. If I had even guessed the hospital was going to charge me $166 for a $4.49 product, I would’ve walked to CVS and bought it myself. But, because it was handed to me with my kid and his bleeding schlong, I didn’t ask, and they certainly didn’t tell.
You can hate President Obama if you want. You can say private industry can handle health care better than government. You can defend the cost of medical procedures until you’re blue in the face. But don’t try to tell me the American health care system isn’t broken. I respect you, I think you’re pretty smart, but if you think there is anything right about a $166 tube of ointment, you’re a damned fool. It’s not an anomaly. It’s one example and it’s as cut and dry as a well-healed circumscision.
Rub some ointment on that.
Just remember the reports on what the government pays for things.
In Ghana the doctor in the hospital writes a script and the family runs to the corner pharmacy and gets it filled. So in your scenario, Lortab, anti-biotic ointment, whatever would have been had at Walgreen’s prices. This keeps the hospital from having an inventory and cash flow issue by selling you meds on credit and lets the family choose the supplier.
I assume that the big part of the snafu was the billing by the hospital to the insurance co. The hospital prolly billed the insurance co rate, to the insurance co, not the self pay rate to the insurance co, meaning now you had a bill with your name on it that was for much more than you’d been told originally. It really is your fault for telling the hospital that you had insurance in the first place.
I really like the published menu of services and prices idea.
“Mommy put off stripping another day,” she told Dos. “I don’t have to work the pole today.” I would have loved to see someone passing by and hearing that comment, not knowing its context.
No one is saying the health care system is perfect. Some of us believe we should not screw over the 87% who have health care they like in order to provide for the 13% who do not, especially when that number includes people who choose not to have health care. The bill they wanted to pass would have made it worse for everyone. The town halls across the country are showing people vehemently against what they are offering.
Now is the time for Obama to act out his campaign rhetoric and invite both parties to be part of the solution. This is not a crisis situation that needs to be solved in a matter of days. Take the time necessary to come out with a practical solution that pleases everyone. Learn from Massachusetts and Hawaii. Look at what is working in Utah. This will have an impact on people for years to come.
Brilliant. I wonder how quickly you’d get kicked out if you went to the hospital with 166 dollars worth of generic antibiotic ointment and handed it out for free?
Some of the fear-mongering when it comes to anti-government-paid health care makes me laugh. Most of the common warnings (you won’t be able to choose your doctor, there’s a bureaucrat in your way, you’ll have to wait until the government deems you can get treatment, etc.) are already realities with the private system in America. If people think the government will charge more than a 3700% markup on RETAIL prices, then they’re already medicated.
Last I checked, our drugs in Canada were cheaper…
Wow. Very well written, sorry to hear this.
@STB
It’s not so much the ~50 million without Health Insurance, as the ~200 million WITH Health Insurance–WHO THINK THEY ARE COVERED.
As a younger guy, I have gone with a Health Savings Account (HSA), therefore responsible for my expenses. You should see the look on the faces of my Doctor, my Dentist, my Pharmacist…when I question these expenses, and deny some of their “services.”
:FUBAR:
Nitpicky perhaps, but I have to say it. There is a problem with our health insurance and our healthcare billing, but not so much with our healthcare delivery. We’re doing pretty good medicine here in America and I’m proud to be a part of it. It’s the reason people from all over the world (mostly from Canada) come here for care.
-DrC
It’s a shame that hospitals are not bound to give an itemized list every time. That would be a good start for reform right there. Next, Congresspersons should actually have to read the bill before they vote on it. That would help too.
Unfortunately, $166 ointment is not going to get any “cheaper” with the government running some national health care system. Sure the price of the tube itself might come down, but the taxes out of pocket we’ll all pay to get to the hospital to get that ointment will be more than what you are paying now. Just having government run it is not a fix.
The system is broken, for sure. There is a fix out there, and there is a win-win situation for all of us, rich and poor everyone in between. It just hasn’t been proposed yet.
And the Doctor is right…we have the best health care professionals in the world. We also have some of the worst administrators & politicians too.
A long time ago, my dad had arthroscopic knee surgery. This was back when Reagan was in the White House, so this has been an issue for some time. They shaved his knee with a Bic safety razor, identical to the ones that I still shave with to this day. They cost $.99 for a pack of 10. So a 9.9 cent razor showed up on my dad’s bill as a $40 razor.
Good points across the board, most notably from Chako.
Chako, I don’t deny our care was first rate. Both doctors and nurses were fantastic. I just wish there was some way the health care professionals could help regular folks like us avoid getting charged, say, $166 for ointment. Like, I dunno, maybe mention, “This is going to cost either you or your insurance company $166. If you wanna run out to the pharmacy, we’ll put this back in the trunk with the gold, silver, and bearer bonds.”
The system is broken, but the problem is nothing that is being proposed will fix WHAT is broken, such as the problem you identified. Government oversight is nonexistent, so they arent the answer.
Taking a little bit from everyone, whether taxes, insurance however WOULD be way to do if not for the drug companies, politicians, lobbyist etc all jumping in to bed together all nice and cozy to see how much of your money they can take.
And while you are at it, throw tort reform in the mix. Focus on the problem, not who administers the robbery of America
Some things you need to think about. First, when congress made the prescription drug program for seniors, they specifically wrote that they could not negotiate a lower price for the drugs. Yeah drug lobby, great job looking out for the Tax payer and the budget. I do not know if there is this provision or not in this bill, but seldom does congress (any congress) and the Pres (any Pres) seem to look at the true cost of a program. Second, the published hospital rates are jack up so they can get a higher contract price from the insurance companies and Medicare. The “insurance company” price you keep talking about is actually lower (about 50%) because Medicare and the companies negotiate with the hospitals and especially Medicare will only pay about half the rate. That is why the rates are so high. Third, the jack up on drugs is the result of all the overhead required to give you that drug, and that you have little options to just go down the street once you are there. The same thing happens with anything that is sold, or resold. It just so happens that health care people cost more than factory or sales people, and once you are at the “store” you can’t leave and they know it. Four, you keep saying you won’t mind if your taxes paying for this, but right now your taxes aren’t really paying for the government, so what are you going to cut from the budget to pay for this, because eventually China is going to stop paying for our goverenment. Oh, and for all the people that don’t want a “bureaucrat” between them and their health care, unless they pay for it themselves, the insurance company is already between them and their healthcare. The big difference is that if they say no you get a big bill. Also, for every horror story in socialized med there is one here, despite the fact that we really do the best health available here in the US. You can’t look at the outliers and judge a system.
“The last thing I want to do is tell my sons why they have foreskin and I don’t.”
I like to tell mine that Grandma and Grandpa didn’t understand about nerve endings and Daddy’s future enjoyment of such endings, but that I am looking out for them. Then, I high five ’em.
I’m amused by the idea that health care will get better when the government runs it.
Does anyone else see the folly in that statement?
Reform is one thing… but too many of our politicians believe reform must include a new government run program. If there’s one thing the U.S. Government has proven time and time again… they shouldn’t be running anything!
We had our first child at Kaiser Permanente and I really think they have it figured out. With Blue Cross or any PPO plan, the insurance companies don’t trust the doctors and clients / patients often have to act as the middle man between the two. With Kaiser, the doctors are employed by the insurance company which also owns the hospitals. It seems to really help control the costs of everything.
We had our regular ob/gyn check ups once a month and then more frequently later in the 3rd trimester. Each time we got an ultrasound and a printed sonogram to take home. The cost of each visit? $0. Yes, they were free. On the day of the c-section (required due to minor complications) we had to pay a co-pay of $100.
I’ve gone in for regular check ups. I saw a sports medicine doctor and a physical therapist for pain I was getting after running 30min per day. I had severe abdominal pain and saw a doctor at urgent care and then was referred to a G.I. specialist and had an endoscopy. My wife has asthma and has doctor appointments for an allergy specialist as well as inhalers and other medications. The majority of our prescriptions cost $10 while I believe the rest cost $30. Each and every appointment, including the endoscopy, only cost us the co-pay amount.
All said and done, I have to say that I have had an extensive experience with our medical system over the past 10 months, moreso than most people. I have absolutely nothing to complain about and I hope that it doesn’t change any time soon because I don’t see any way it can change for the better for me and my family.
A-MFing-MEN
People can write all the paragraphs they want about how awesome their healthcare is and how they don’t want to fix something for the minority of blah blah blah. Screw them. It’s broken, it needs to be fixed, and hospitals charging that kind of money for generic crap should be punishable by an adult circumcision of the dude in charge
that is all.
“The last thing I want to do is tell my sons why they have foreskin and I don’t.”
So if your daughters had had their prepuce cut off, you’d have them snipped too?
How about if some other part of your body was missing – you’d have that cut off your children too?
Stop trying to kid yourself this was for your son’s benefit rather than yours.
I’d have paid a year’s salary just for my son to be left alone. If he wants to be circumcised when he’s 18 (16 if he knows what he’s doing), I’ll pay for it and help him find the best surgeon. Until then, he stays intact. His body – his decision.
If there is one soapbox I will gladly stand on, it’s the one labeled health care. I’m in total agreement that something has to change. There is a fundamental problem with any system when a life or death decision is made on profit.
For those that say they don’t want to pay for those who choose not to have healthcare, look at the CNN news report from June of this year. “A new study suggests that more than 60 percent of people who go bankrupt are actually capsized by medical bills… most of those who filed for bankruptcy were middle-class, well-educated homeowners. Overall, three-quarters of the people with a medically-related bankruptcy had health insurance”
I don’t want to live in constant fear that one illness could destroy my whole family financially.
1. Sadly, hospitals are not getting rich by charging you these insane fees. In fact, most hospitals barely break even. That tells you how much it actually costs to run those places. The overhead is crazy and the government regulations cost them a fortune.
2. I don’t know the answer to this question, but is healthcare a RIGHT of citizenship? Does our constitution mention drugs, CT scans, blood work, or surgery? If it is not a RIGHT, then the conversation is over. If you don’t like to pay $166 for some neosporin, then don’t go to the hospital. Eventually that price will drop as market forces work their magic. If it IS a RIGHT, then what degree of care is sufficient? Do we need to do EVERYTHING possible to keep EVERYONE alive for as long as possible, no matter what resources are required? Where do we stop? Where does healthcare rank in comparison to other public services, national defense, etc.
There is no simple solution to the complex problem. No matter what your opinions are on this issue, I think we can all agree that hastily written bills by Pelosi and company are not the best solution.
“Conservatives” like to talk about our “free market” when it is nothing of the sort. Free market in no way, shape, or form describes this system. Those using that term to describe our health system (to say nothing of the larger Economic System) are only parroting the opinion given them (typically) by the delivery of their favorite talking head on the the teevee, who, staying on narrative/message twists the term with the PR du jour they are given to repeat.
“Liberals/Progressives” are of course trotting out their own message/narrative, also given them by their favored mass media outlet (or group of them), same as above. The idea that gov’t is a solution represents a fundamental ignorance of both history and how the current system functions. I was 8 or 9 years old when I first heard of the $700 toilet seats at the Pentagon and got acquainted with gov’t malfeasance in general. You’re a few years older than I, and should be able to answer this question: Have things changed for the better at since then (in general), or are they worse? (I know the question is laughably rhetorical, but that’s my point)
Funny thing about “Conservative” vs. “Liberal/Progressive”. The two wings are attached to the same bird, the body of which is always obscured by a Stars n Stripes shield. No one ever wants to talk about the body, the unelected technocrats that manage the mass man through their “elected” proxies.
The Public/Private Partnership and The Great Revolving Industry/Gov’t/Philanthropic Foundation Door is the key to the beginnings of understanding. The game is rigged. The masses have been trained to discuss checkers strategy while the true rulers play multi-dimensional chess all over their asses.
“Fascism should more appropriately be called Corporatism because it is a merger of state and corporate power”–Benito Mussolini
You’re right, the current system is broken. Irretrievably so. In point of fact, it is collapsing. But then again, it was never meant to work. How could it when the system itself is predatory, and its high-functioning members so completely corrupted and co-opted? And so, we have The Problem.
Of course, the proposal to give it all to big benevolent daddy gov’t is The Predetermined Solution, given by the same interests (the “private” and “free-market”) that have effectively captured not just our gov’t, but governments worldwide.
So, after some spirited WWE-style wrangling for teevee and print, there will be another “bi-partisan compromise”, and The Solution will be achieved, which is where you were meant to go from the outset: Private Corporate Interests, using the full coercive force and power of the captured mechanism that is The State, will bring the true meaning of Health Management to fruition in order to keep the profits (and more importantly, the control) expanding unto infinity as demanded by The Economy.
And so it goes. Another round of The Hegelian Dialectic completed. Thesis, Antithesis, Synthesis.
I know it’s cliche as all hell to reference The Matrix, but that should in no way take away from the following:
Boy: Do not try to bend the spoon; that’s impossible. Instead, only try to realize the truth.
Neo: What truth?
Boy: There is no spoon.
Neo: There is no spoon?
Boy: Then you will see, it is not the spoon that bends, it is only yourself.
That’s long-winded enough for now. Your frustration is apparent, and not unjustified. I completely empathize. However, you must dig deeper. The problems are much more fundamental and widespread, and the “proposed” (pushed) solutions will only lead to further bondage and misery.
All the best to you and the family.
A small correction, since I was typing in a hurry due to losing it the first time I tried (your commenting system is quite unforgiving of typos :))
“Of course, the proposal to give it all to big benevolent daddy gov’t is The Predetermined Solution, given by the same interests (the “private” and “free-market”) that have effectively captured not just our gov’t, but governments worldwide.
So, after some spirited WWE-style wrangling for teevee and print, there will be another “bi-partisan compromise”, and The Solution will be achieved, which is where you were meant to go from the outset: Private Corporate Interests, using the full coercive force and power of the captured mechanism that is The State, will bring the true meaning of Health Management to fruition in order to keep the profits (and more importantly, the control) expanding unto infinity as demanded by The Economy.”
First paragraph in the above excerpt should be The Reaction. Second is The Predetermined Solution.
That’s it. Sorry to take up even more commenting space 🙂
Remind me to bring my itemized bill from the week-long hospital stay I had after my head injury.
I’d suggest not drinking before hand. Then, again the prices might actually seem sane to after a handle of SoCo.
While a $166 tube of neosporin may seem like a neccessity (sp?) in an accounting sense to defer some costs of hospital general operations, perhaps there needs to be an overhaul to bring those cost in line with any other place of business. Its akin to paying $9 for a pack of smokes in say an airport, but the gas station three blocks away has them for $3.
The only problem is, you’re not paying a premium on the place of business or having the freedom of walking a few more blocks to save a couple of bucks, its more like “here’s your choice, pay the $166 or enjoy some flesh-eating bacteria around those nether-parts”.
We’re all about choices in this country, lets hope the choice between paying for overpriced ointment and a shriveled dick or amputation never has to be considered and the fine doctors/nurses in this country get their dues for their hard work to learn these skills without having to resort to loan-shark type mark up.
Somewhere there’s a happy medium, I wish I smart enough to figure it out.
Say it this way and see if it makes any sense: “I want a healthcare system designed by lobbyists in Washington.”
Still think Congress’s plan will be better?
I’m a nurse and I have two things to contribute here (neither one here will really help since it’s after the fact…)
You could have saved a ton of money had you just skipped the circumcision altogether. It’s not a “mandatory” surgical procedure. Plus, your kid would have probably been a lot happier that day! Many hospitals are no longer performing them and only about half of the boys get them now so for the next baby, you don’t have to get him the snippity-snip (I didn’t have my newborn circed fwiw)!
About the meds – I hear people, including my own family, complain about the cost of drugs in the hospital. It’s true they cost a small fortune but you’re paying for more than just the drug. You’re also paying for the pharmacist, the pharmacy tech who ordered and retrieved that med, the TON of legal paper trail the hospital has to keep to prevent drugs getting stolen or traded, the lock-boxes and alarms the hospital pharmacy has to keep for the drugs, the lawyers who review the pharmacy paperwork, the insurance the hospital has to carry in case the pharmacist actually gives you the wrong med or dose, etc., etc. etc.
So…if you keep all that in mind, a $7 aspirin makes sense. $166 for a tube of ointment still seems pretty high. Maybe your kiddo convinced them to overcharge as a payback for his procedure??? Not sure but congratulations on the new baby!
“Reform is one thing… but too many of our politicians believe reform must include a new government run program. If there’s one thing the U.S. Government has proven time and time again… they shouldn’t be running anything!”
I agree CJ! The military SUCKS! They can’t do anything right!
Yawn. Tired arguments make me sleepy.
Ha… if G-Rob thinks the military is run by the U.S. Government then he’s never met anyone in the military! In fact, there’s a reason why such pains are taken to *not* politicize the general operation of the military.
But I’m happy to hear more of your strawmen…
For all against the snipage, especially those who happen to be female…you’re crazy! Not a day goes by where I’m not thankful for mine!
Plus, remember, chicks dig the drop-top.
After spending 40 minutes with my back surgeon discussing this very issue, Otis, I can tell you this:
We will soon have fewer doctors and nurses if this plan is put into action without some serious overhaul. Doctors and nurses want patients to get well and most refuse to shortcut care. This plan will tie our hands and result in a reduction of quality of care. Without tort reform, doctors can expect more lawsuits for not doing enough for their patients even though the feds say it’s okay.
My back surgery would not have been approved. My weight alone would have been enough for them to deny me. (Oh, go lose weight, you say? Without the surgery, exercise wasn’t an option because, well…there were times when I couldn’t even walk. So, explain to me how this would benefit me to be denied surgery and live a life in extreme pain at a relatively youngish age. Explain this to my children. Explain this to everyone else who would have to pay for me to be on welfare, food stamps, be put up in public housing. Someone always pays.) My mom’s upcoming surgery would not be approved under the new plan because she has more than two comorbidities. She’s 74, but she’s a vibrant 74. Take away her ability to walk or to get around independently and what do you have? A shell of a woman. And dare I say that your own father’s care would have been much different a few years ago if we had this new plan in place. (I know, not fair…but it is…because that’s how the plan works — everyone is equal, right?)
Regarding Dr. Chako’s statement: He’s 100% right.
Regarding Julia’s explanation of the cost of medication in the hospital: she left out the cost of us nurses knowing if the medication is the right medication for the right patient, in the right dose, given the right way at the right time, etc.
It’s so easy to complain about what’s wrong and demand something different, but it’s another thing completely to just hand over a very complex system to a bunch of people who don’t know a thing about it and hope they can fix it. For doctors and nurses, it’s an insult to the time and effort we put into education and the time and effort we put into the care we provide.
wrt Dr. Chako-
I respect your service history, and have followed your blog, but perhaps your experience in the military has not been representitive of a clinician in private practice. You say “There is a problem with our health insurance and our healthcare billing, but not so much with our healthcare delivery We’re doing pretty good medicine here in America…”
While I agree that overall, there IS a big problem with the way most physicians are forced to deliver care. The problem is that the majority of MD’s in the US practice medicine very defensively, which increases costs exponentially. My wife (an internist) often describes the rationale behind her needing to order tests she knows will come back negative, but orders them none-the-less because on the slight chance there is a poor outcome, the lawyers will jump all over her.
She’s never been sued, but she’s seen her partners loose significant office time over frivolous lawsuits brought by patients families. You know, their multi-organ failure demented father whose life could have been extended by a month if not for this *error*. Sadly, a case can be made that settling the lawsuit is cheaper in the long run because of lost productivity in the office due to wasted time in court defending a meritless claim which was not dismissed pretrial.
In my opinion, tort reform is an absolute requirement for any rational health care reform effort in this country.
Are there bad doctors, sure, and do we need to protect patients? of course, but the threat of lawsuit is a significant factor in the exponential increase in health care costs.
(full disclosure, as mentioned, my wife is an internist in private practice, and I work in clinical research in the pharmaceutical industry).
Champ, not a day goes by that I’m not thankful for my husband’s foreskin. Any “chick” that knows the difference most certainly would NOT “dig the drop-top”.