This is NOT from Publisher's Clearinghouse..

Thursday, June 28, 2007

The lawyer for a deceased client in LA was a little surprised when she opened her client's bill and found a $1 million .... bill.

The hospital bill for $962,120 was 20 times what the lawyer had been told her client owed for her four-day stay at the Glendale Adventist Medical Center falling and suffering minor injuries last year, according to an LA Times story today.

That's right. The bill was 20 times higher than what the hospital quoted as $46,106. And what the hospital quoted was 10 times higher than what the insurance company's rate, which was $4,350.

These numbers, while imposing, are typical -- if you're uninsured. The client HAD insurance, and only had to pay $150.

But uninsured? If you're lucky, you'd get the $46,106 bill. Not? You'd better hope Ed McMahon comes knocking on your door with sweepstakes prizes.

Labels: Affordability, HospitalCharges, InTheNews

posted by Hanh Kim Quach | Permalink | 5:53 PM


 

The health debate goes multimedia...

Sunday, May 20, 2007

After a big week, it's time to take a quick check of other blogs and media:

TEXT: There's another edition of Health Wonk Review at Health Care Policy and Marketplace Review blog, which links to several articles of interest, including a conservative critique of the Massachusetts reform, an assessment that highlights the good and the bas about "retail" health clinics, and a detailing of the most recent bad acts by insurance companies.

Of most interest to me was the two links commenting on the new study about the uninsured getting charged multiple times what insurers get charged for the same service. On is at Health Affairs. InsureBlog has a critique that totally misses the point: I would imagine that if hospitals didn't charge such outrageous prices, maybe a few more of the uninsured might actually be able to pay the bill. And regardless, the charged amount--the inflated rate--is the bill that goes to collections and court. The price matters to the person getting the bill.

AUDIO: Back to California politics, KQED's Capitol Notes has now started a weekly podcast of analysis of Sacramento happenings. This week's features the health care, along with the budget and whales(!)

The health care section is amusing. It starts with a negative tone, led by Anthony York playing Eeyore, suggesting all the reasons health reform won't happen this year. But then after ten minutes of conversation, they all seem to come around to the notion that something might happen. (Will business accept a 7.5% minimum employer contribution? Don't most do a lot more now? Aren't some businesses signalling they would support such a standard?... Won't somebody simply put anything that passes on the ballot to kill it? But didn't it come very close time? And wouldn't Schwarzenegger be on the other side of the issue this time?...


VIDEO: Finally, Michael Moore's new film Sicko premiered at Cannes this weekend. It's a comparison of the American health care system with that of other countries. The reports suggests it focus on not just the uninsured but the insured who have issues with our private insurance companies.

Health Access was contacted for stories for the feature, although I hear we were not the only ones: one rumour was that they had hundreds of stories to choose from by the time they were done.

The movie comes out June 29th. It should be interesting to see how it impacts the debate in California and around the nation.

Labels: HospitalCharges, InTheNews, OtherBlogs, OtherStates

posted by Anthony Wright | Permalink | 10:50 PM


 

Now, is there a return policy on that kidney too?

Friday, May 18, 2007

I always thought it was really screwy that medical professionals could bill patients to correct medical mistakes that the professionals -- not the patients -- made.

Really, we all make mistakes. So the issue really isn't that doctors are making mistakes; it's what they do to make up for them. For most of us, making a mistake is mortifying and often means fixing it -- even if we have to eat the cost.

Unfortunately, that's not always the case in the medical profession. If a mistake is made and a patient ends up back in the hospital/doctor's office, then it means a second or third chance to charge for what should have been done right the first time.

So it really seems like a no-brainer that a Pennsylvania hospital system is providing a warranty for medical care, according to this story in the NY Times.

Already, the Geisinger Health System in Pennsylvania has seen results. Last year, patients who received heart bypass surgeries could return back to the hospital if they had complications -- at no cost to the insurance company.

Well, duh. That seems reasonable. I'd be mad if I had to pay twice.

Since they implemented that policy, the system has found that patients don't return as often, and spend fewer days in the hospital.

Seems like this kind of policy could be a good deal for everyone. No one likes being sick and getting sicker, after you thought you were taken care of, is the worst. And...it's cheaper.

Labels: HospitalCharges, Hospitals, InTheNews, OtherStates

posted by Hanh Kim Quach | Permalink | 1:27 PM


 

Spins a web...

Tuesday, May 08, 2007

The Health Affairs study on hospital overcharging that Hanh describes got national attention, including in the blogosphere from everybody from Juls Rosen to Ezra Klein.


The issue has been a focus and passion of Health Access California for five years, and its not a surprise that California, with one of the biggest problems, was one of the first and most ambitious in passing a law to solve it. AB774(Chan) was a big victory that will help many people avoid bankruptcy, but there's more work to do: hospital charges need to become transparent to relate to actual cost; and nobody should be left alone without group coverage.


While with Ezra, check out his review of Spider-Man 3. He gives it thumbs down for dialogue, but manages to see the movie as a message for universal health care. Given how many people saw it, hopefully others see it that way as well...

Labels: HospitalCharges, Hospitals, InTheNews, MedicalDebt, OtherBlogs

posted by Anthony Wright | Permalink | 4:06 PM


 

Soaking the poor...

Health Affairs' new issue, today, contains an excellent examination of hospital overcharging practices nationwide. (The study is summarized in these LA Times and SF Chronicle articles).

Essentially, it confirms what we advocates already knew: that hospital are routinely charging uninsured patients at least 2.5 times what Medicare and insurance companies pay for the same exact procedures.

In California, it's worse, with hospitals charging 4 times what Medicare allows, making it the third most egregious state in hospital overcharging. The results are similar to a Health Access investigation in 2004 called "Your Money or Your Health", that examined one hospital chain's pricing practices by looking at bankruptcy records.

What really blows is this: When the hospitals increase what they "charge'' it means that insurers can negotiate bigger discounts -- so insurers aren't paying higher rates.

"When the hospital increases its charges,...only self-pay (uninsured or
underinsured) patients are expected to pay the higher charges.''

And really, if someone is uninsured, it's most likely because they can't afford insurance in the first place. So how on earth could they afford the highest rates? The study finds that the collection rate from the uninsured is only about 10 percent.

Basically, this practice just means huge amounts of stress for patients who must deal with their illnesses, bills, and aggressive, name-calling debt collectors banging on their doors.

Now, the Health Affairs study looks at 2004 rates. That's two years before California passed AB774(Chan), sponsored by Health Access California, which took effect on January 1 of this year. It prevents this sort of overcharging for patients who are underinsured or earn less than 350% of poverty ($35,735 for an individual). Things should be a bit better for uninsured and underinsured patients now, as Anthony said in the SF Chronicle article:

"The ER visit that might have cost thousands of dollars may now cost several
hundred or a thousand dollars, which is still a lot of money, especially for
lower-income patient," he said. "But the patient at least has a fighting chance
to pay."

Labels: HospitalCharges, Hospitals, InTheNews, MedicalDebt, Research

posted by Hanh Kim Quach | Permalink | 11:25 AM


 

Fair is fair. Not charity.

Thursday, April 19, 2007

California enacted landmark legislation this year that would allow uninsured -- and underinsured -- hospital patients negotiate fair rates from hospitals.

As many are well aware, if you're uninsured and end up in the emergency room, you're often charged many times what insurance companies pay for the same procedures. Patients have reported visits that cost thousands of dollars per minute. Others have gone into bankruptcy as a result of needing health care at a time they were not insured.

As a result of these unfair and aggressive billing practices by hospitals, the Legislature passed (and governor signed) AB774 (Chan) last year, which would allow uninsured and underinsured patients to pay the same rates at Medicare.

Sen. George Runner, R-Antelope Valley, this year, is authoring a bill to clarify that law. Health Access is working with Sen. Runner's office to ensure that this effort is a technical clean-up. We appreciated his public commitment at Senate Health Committee yesterday to not move the bill unless it is something that stakeholders like us agree to. We want to ensure the hard-won consumer protections stay strong and that patients are not overcharged and thrown into financial turmoil because they had the misfortune to get sick.

But one clarification of our own: in yesterday's hearing, Runner repeatedly referred to the practice of "fair hospital pricing'' as "charity care.''

The law that Senator Runner is attempting to amend is not about "charity care.'' It shouldn't be considered "charity'' if you are simply paying the same price as public programs and big insurer.

Labels: HospitalCharges, Legislation, MedicalDebt, Sacramento

posted by Hanh Kim Quach | Permalink | 2:59 PM


 

Band-Aids don't stop the bleeding

Thursday, February 01, 2007

Gov. Schwarzenegger sat down and talked to real people yesterday about their experiences with the insurance industry. (Click the link to read a transcript of his press conference with California consumers.) Two people were considered "uninsureable.''

Another young couple had to file for for bankruptcy after they incurred a $150,000 debt in the two-month window that they had been between jobs and uninsured.

Here is their story, in Mrs. O'Hagan's words:

"We had always depended on my husband for the insurance; I worked for a
small company, I didn’t have insurance with them. So he was changing jobs,
and we were given the typical 60-day period before your benefits kicked in, and
our benefits were due to start on July 1st.

And it was like the middle of June, and he started having some stomach
pains. We put off going to the doctor, trying to make it to that July 1st
date. And he had to go to the emergency room, ultimately. His
appendix had ruptured, resulting in an appendectomy, and then he also had a
second surgery because there were so many complications.

He was in the hospital for 19 days. And when we got out, finally
home, recovery, the next month we received bills totaling to over $150,000 from
the hospitals, the physicians, and all the other bills that come along with
that.

We were kind of dumbfounded; we didn’t know what to do. So we
started with some of the help, the county-level, state and federal. And
after all of that, we basically over-qualified. Both of us were working
full-time, making roughly like $50,000 together, and we do have a small
child. We just kind of felt helpless, and we ended up struggling for about
6 months to kind of beat it.

And in January of ‘06 we filed for bankruptcy. All of our medical
debt was cleared, but we just felt that we under-qualified for paying for it,
and we were over-qualified for getting assistance. We just kind of fell
between the cracks, and I wouldn’t wish it upon anyone.

The O'Hagan's combined income puts them -- in wonk-speak -- at about 300% of poverty. As Mrs. O'Hagan said, they couldn't qualify for anything. With child care costs of $1,120 a month, and rent (then in Antelope, a suburb of Sacramento) there was less than $1,000 left afterward for food, gas and other life necessities. They decided to take a chance, in the intervening 2 months, rather than spend the extra $400 a month for COBRA.

Gov. Schwarzenegger was very sympathetic to the O'Hagan's plight. As an advocate, I was happy to seem him balance out his week of health care discussions by talking with real consumers who are affected by the convoluted rules and regulations in the industry.

But I want to point out a couple of things.

1. The governor's current proposal would not help the O'Hagans. Mrs. O'Hagan's company is still too small and would be exempt from the employer mandate. And there is nothing in the governor's current plan that would compel Mr. O'Hagan's employer (a nationwide bank chain) to begin providing insurance right away. They would still make too much to benefit from the subsidized insurance pool, yet, would have been required to pay for coverage.
2. Gov. Schwarzenegger was asked to respond to criticism that high-deductible plans (which he has established as the minimum amount of coverage) would leave consumers -- like the O'Hagans no better off.

In short, the governor said a $5,000 bill is a heck of a lot better than a $150,000 bill.

It's true, $5,000 is a much smaller number. A couple points, though. High-deductible plans often have loopholes. The $5,000 deductible is a consumer's liability on "qualified'' medical expenditures. I have spoken to many consumers who have discovered that not all of their hospital bills were covered. The reasons are many. Certain tests weren't approved. They were taken (by ambulance and no fault of their own) to an out-of-network ER, they needed special equipment because of a special condition and that ended up not getting covered (you get the picture).

Secondly, even if all the expenses are "qualified,'' you don't stop paying after the $5,000 deductible. High Deductible plans typically require co-insurance (20% to 30% of the procedure) after the deductible is met.

I do want to give the governor credit, here, for capping a family's TOTAL ANNUAL out-of-pocket liability at $10,000.

But in truth, if you step into the shoes of a family -- like the O'Hagan's -- with the combined income of $50,000 -- could you really afford to even pay off the debt of $10,000?

For families, even $10,000 could be enough to tip them into bankruptcy.

Labels: Affordability, Employers, HospitalCharges, Schwarzenegger, Uninsured, YearOfReform

posted by Hanh Kim Quach | Permalink | 5:48 PM


 

A compromise on kids...

 

Funny and sad...

 

It's Time for Standards...

 

Kicking kids off coverage...

 

Eyes wide open

 

More than you think...

 

A nudge/shove to get something done...

 

Next step in negotiations...

 

Stepping back for a moment...

 

Creeping Costs....