Leaked Scripps Memorial Hospital records reveal huge, automated markups for health care

[Zorro]

Screenshots of a system used by the Encinitas hospital show markups of as much as 675% being imposed automatically during treatment



Ridiculous, seemingly arbitrary price markups are a defining characteristic of the $4-trillion U.S. healthcare system — and a key reason Americans pay more for treatment than anyone else in the world.

But to see price hikes of as much as 675% being imposed in real time, automatically, by a hospital’s computer system still takes your breath away.

I got to view this for myself after a former operating-room nurse at Scripps Memorial Hospital in Encinitas shared with me screenshots of the facility’s electronic health record system.

The nurse asked that I not use her name because she’s now working at a different Southern California medical facility and worries that her job could be endangered.

https://www.sandiegouniontribune.com/business/story/2021-12-10/column-healthcare-billing-markups

[leftieNanner]

1. This explains why

hospitals will accept a smaller payment from the insurance companies and still make a (disgusting) profit.

We got the Medicare report on my husband's hip replacement and the doctor and hip charge was $45,000!

[bucolic_frolic]

2. I got news for you

This goes on with everything. Food, auto parts, repairmen, mechanics, retail stores, manufacturers, professional services. It seems more unjust with health care.

[exboyfil]

4. Those other things give you a price sheet or estimate

In some cases the estimate is legally binding.

Health care does not work in a capitalistic system because you face an almost perfect inelastic demand curve.

I asked how much my pneumonia shot would be if insurance didn't cover it (doctor thought I should have it even though I am not 65 because of my general health condition). The nurse couldn't tell me so I passed on the shot and am going to research it with my health insurance provider.

When you go into surgery (especially emergency surgery) you don't get a price sheet. For the most part you hand over your credit card to cover the copay and deductible and get treatment (this is Medicare). Often the other bills keep coming in including the out of network doctors who just happen to show up. The system is insane. It is designed to bleed middle class people of all their assets. This after spending a lifetime of participating in your employer's insurance plan and paying into Medicare.

[mitch96]

3. Not to defend hospitals but in the end it's a business. No income no hospital

It was explained to me that it was necessary to account for not income labor and running the "plant". Housekeeping? they don't generate income, cafeteria workers? nope. All the facilities management team? just to name a few. Now with out oversight these "charges" get totally out of hand. It's even worse in private hospitals.. When asked they will always claim they are broke... Granted hospitals in low population areas are closing.. No way to make a profit...
YMMV
m

[ret5hd]

6. Go to a hotel...

that won’t:
tell you the price of the room
charge you separately for the bed
charge you separately for the elevator
charge you separately for the toilet
charge you separately for sheets

Yeah…I’ll go somewhere else.
But where are you going to go for that heart stent or emergency appendectomy?

[Hoyt]

5. Fortunately, payers -- Medicare, Medicaid, private insurers-- don't pay

anywhere near what hospitals, physicians, etc., charge.

Theoretically, uninsured could be billed the charge amount. But providers know the won’t get it.

[ret5hd]

7. Then who do they get it from?

Nobody?
Then why do it?

[Hoyt]

8. No one. They write off the difference between the fake charge and

what the payer allows (there may be coinsurance, but it’s part of the payer allowable).

This goes back to first few years of Medicare and private insurance where future payments to providers were based on charges a year or two earlier. Medicare and other payers quickly changed how they determined allowables because providers caught on and started raising their charges 20% or more every year.

So, in example above a payer probably allows $140 or so, and the provider has to write off the difference between $796 and $140. And, no, the provider does not get to deduct that amount on taxes unless they recorded income as $796, which very few do. Of course, many hospitals are tax exempt for most services.

It’s a stupid game.

[mitch96]

10. A very stupid game... And don't get me started on price vs quality.. we are down around #8

Most expensive and not the best... KInd of a ripoff... Want to beat the system? don't get sick.
Do what ever you can to stay healty.. After I moved I needed a new GP. After all the tests came in his comment was "well I'm not gonna make any money off of you, eh?"
DON'T GET SICK, it will cost 'ya...
ymmv
m

[mitch96]

9. Thats why hospitals "pad the bill" to cover non payment.... Make a small profit or die...nt