More overcharges

Hold the phone: another part of my hospital bill for sinus surgery has just arrived.  As you recall, my previous bill (which I posted here) was $32,094.84, not including the anesthesiologists’s fee and the dozen or so pre- and post-operative visits, including two expensive MRIs.  That would have brought the total to well over $40,000.  But the charges keep on coming: here’s another portion—for God knows what—that came yesterday.  It adds another $6044 to the bite.

Again, I pay only about 5% of this, but, I swear, when this is all over the total bill for my sinus surgery will be in the vicinity of fifty thousand dollars.  And that’s what an uninsured American would have to pay.

On a lighter note, we once discussed the disparity of pricing between men’s and women’s haircuts. I believe someone maintained that in a real barber shop (and not a salon or “unisex parlor”) there is no differential.  Sadly, at least in Hyde Park, there is.  Here’s a sign in the window of the local barbershop—a real barbershop.

Apparently, in this shop women’s haircuts include a shampoo and men’s do not.  But if a man had both a crop and a shampoo, it would cost him $20.  The same for a woman would be $4 more.  If I were a woman, particularly one with short hair or a simple hairstyle, I’d be peeved.

41 thoughts on “More overcharges

  1. The same for a woman would be $4 more. If I were a woman, particularly one with short hair or a simple hairstyle, I’d be peeved.

    Fact is, women’s haircuts tend to take longer to complete. Even if the hair is shorter, there’s still (usually) more work to be done. My understanding is that salons that do both have their stylists allot more time for women’s haircuts.

    I suppose the truly fair way to do it would be to move to a per-minute system of billing, however then you can’t really quote a fixed price up-front.

  2. Let them know that the charges are affecting your well-being in regards to the post-operative landscape.

    BTW, during our fiasco in 2009, the hospital charged $5 for each aspirin.

  3. For me, the basic idea of insurance is to assist in budgeting. That is, you should be able to know, with a good deal of certainty, “It will cost me at least $X, probably about $Y, and up to $Z for ______ over the next year.”

    The percentage deductibles and per-incident copays don’t really do that. Pay 5% of a quadruple bypass…and you could still be out-of-pocket almost as much as the typical person earns in a year. Do something that requires twice-weekly visits to a doctor with a $50 copay and you’ll be spending as much per month as you would on a luxury car lease.

    It took some searching, but I was able to find health insurance (through Golden Rule) that’s predictable. Monthly premiums total a bit over $2k / year, so I know I’ll be spending at least that much. The other half of the equation is a $2,500 per-year deductible. Even if I have a quadruple-bypass (which would be unheard-of for my state of health), it’ll cost me no more than about $4500 / year. If I only get routine care, it’ll cost about $2200 / year.

    Of course, the fact that I have to purchase private health insurance in the first place is exactly as insane as if I had to purchase private police or fire insurance. Civilized societies share the burden of providing services where the lack of service has far-reaching consequences. If only those who can afford insurance get police protection, crime runs rampant. If only those who can afford insurance get fire protection, fires spread like…well, wildfire. And, as we see here in America today, if only those who can afford insurance get health care, illness runs rampant.

    Not even the Tea Partiers have a problem with “socialized” military protection, and they seem to be pretty happy with out “socialization” of food and drug safety and of transportation infrastructure. Many are even wildly in support of actual real-life socialized medicine in the form of Medicare. How these people can be so blithely idiotic to oppose single-payer universal health care really does astound me, the influence of the Koch brothers notwithstanding.

    Cheers,

    b&

  4. Some time ago, I received a medical device that cost $10,000. My doctor told me if I had been on Medicare, it would have only cost $6,000. Why the difference? It realty cost more than $6,000, so they have to make up the costs somehow.

  5. The thing that really gets me about health care in the US is that it’s not provided anywhere close to at-cost. When my father had his pulminary embolism, he was in ICU for over a week. Total cost: $5,000 (he lives in Switzerland and insurance paid for most of it).

    In the US, the final bill would have been at least 5 figures… Not because the care actually costs that much, but because that’s just where the market has priced it.

    Another example – when I first moved to Canada, I was here on a visa so I had to buy my own insurance. My mother, living in the states, paid for her insurance as well. We both paid about $400 – she paid that amount per month, I paid it per year. Our coverage was pretty much identical.

    You guys are getting ripped off.

  6. Yeah, so you still have to pay like $2500, though, right? Plus any deductible you have?

    That will wreck a lot of people, if they don’t have time to plan ahead for it.

    1. I’ll assume you’re replying to me.

      First, the $2500 is the deductible. When I go for my annual physical, the office bills my insurance company for their standard rate; the insurance company replies with a “repriced” amount that’s generally a quarter of what the doctor billed them; and the doctor sends that bill to me. I pay the entire “repriced” amount.

      Second, I keep $2500 in a special bank account just for the deductible. I have a spreadsheet that I keep track of my finances with; it includes “current amount,” “target amount,” and “target date”; it calculates how much I need set aside from every paycheck to reach the target amount by the target date. I haven’t had any medical expenses yet this year, but if something big happened to me tomorrow, I’d empty the account and hand it over to the doctors, and put about $50 / week back into that account. Every other medical expense for the rest of the year would be free for me.

      More likely, I’ll only spend a hundred bucks or so on my annual physical in the spring and all the associated bloodwork and the like. The spreadsheet would tell me that I should replenish the account at a few dollars / week for the rest of the year, but I’ll probably just take the money out of checking and forget about it.

      Cheers,

      b&

      1. Ben, I would be curious to know your age?
        I’m asking because I am 53, I also have GR, and I am paying >$1,000 per month with $4K deductible each calendar year.

  7. This should also be a lesson to all those of us in countries where we have got free health care – the true cost of that care is massive, so do not use it needlessly, lest we reach a point when it ends.

    1. It is, but not nearly as massive as people are being charged in the US. The US health care industry is largely for-profit (and even those institutions that aren’t still depend on services and equipment provided by for-profit companies). They are not charging patients anywhere close to at-cost levels.

      This has been found over and over again – the US spends far more on health care, with a great deal more waste, than almost any other country in the world. Countries with socialized medicine do not generally tolerate a for-profit mindset, so they keep the billing close to at-cost levels (Switzerland, for example, has explicit laws banning for-profit business models for health insurance companies, for example).

      That’s not to say that it’s cheap! Using one’s healthcare wisely is always a good idea. What bothers me, however, is when people here in Canada – who truly cannot fathom what it’s like in the US: the high insurance premiums, the lack of coverage, the stress of “what if I get sick?” – see only the fancier hospitals and shorter wait times offered to the wealthy and push for a privatisation of our health care.

      I think these people really truly imagine that if we privatise, we’ll get all the nice stuff *and* all the current availability. The idea of not having access to medical care is just so far from their reality…

      1. I wonder if the difference in medical expenses is also due to the enourmous tuition fees that US universities charge compared to European universities. I often hear that US MD’s need their high paychecks to pay off their six-figure student loans.

        1. That’s actually an interesting question, because it probably isn’t been looked at when considering the total cost of a country’s medical care. Your universities are overpriced too, but European/Canadian universities are pretty heavily subsidized. So at least some of the money is still being put into the equation without necessarily being counted…

          I’d be very interested in seeing if this point changes the cost/value analysis in any significant way…

  8. Well … regarding haircuts, I used to have really short hair and used to mention the fact that really, I was getting a mens hair cut. Most of the time I was charged the mens price. If it’s the same amount of effort, say something and they might change the price.

    1. Whereas I (as MrPopularSentiment, who knows me in RL, can attest) who have longer hair than many/most women wear these days, can pay the men’s rate without question. Of course, since I only get a cut about twice a year, it hardly matters….

  9. As a guy, I can accept that women have to pay more to get their hair cut. I’d also be OK if all-you-can-buffets had two different prices for men and women.

  10. When some friends first let me know how healthcare functions in the States (it just popped up during a discussion), I really had to double check to make sure they weren’t making fun of me.

    Some (other) friends kept buggering me to move to USA instead of France (initially) or Italy (where I currently live). I’m glad I didn’t — I’m pretty sure I’d be a little dead at this point in time.

        1. Erm… Ok. Buggering means – to a native speaker of British english – that your friends were anally penetrating you in order to make you move to the USA. Is that what you meant? “Buggered” means that something is ruined or messed up, just like “fuck”.

          Maybe your default assumption shouldn’t be that you are are right when corrected?

            1. The verb “bugger”, isn’t directly related to verb form of “bug”, and despite the superficial similarity, are derived from very different words. I’ve never seen an -er suffix (or -ering) used as a tense on an english verb, though. The -er suffix is typically only added to adjectives and adverbs.

  11. Again, I pay only about 5% of this

    Well, 5% of $50,000 is still a good $2,500. For most people, that’s still more than a month’s pay (after taxes). Clearly, even if you do have insurance, health care in the US is still frightingly expensive. Here in the Netherlands, we only have to pay the first €150 or so in a year. My girlfriend’s acute appendicitis last year therefore only cost us about €130, as she had already used up about €20.

    About the hairdresser sign: what use is a listed price of “$15 & up”? Up by how much? Depending on what? Is that even legal?

  12. Those line items on Jerry’s bill are surgical procedural codes. They are added to the total surgical charge list, but are paid by the insurance company at a reduced rate, usually 25-50% of what is listed. The upper code is an otolaryngeal code, for the exploratory look around the sinus before the balloon was inserted. The lower code is a neurosurgical code, and refers to a computer estimation of the volume of the sinus, generated by a program in the machine used for guiding the balloon insertion and inflation – in other words, $3560 for the machine to tell the surgeon that he’s inflated the balloon sufficiently. The point is, still, that an uninsured or self-insured patient could be billed the entire amount. Not too shabby, what?

  13. Have any of you considered that women get cuts are usually more intricate?

    It seems that liberals are always looking for pseudo issues to show everyone how “sensative” they are.

    1. Hmmm, sudden leap from a light-hearted topic to a vitriolic blanket criticism there…

      As it happens this liberal does agree that women’s haircuts do, on average, tend to take more skill and time than men’s, and I’m really not sure why people don’t get this. Obviously there are exceptions with either gender and a certain flexibility from hairdressers is very sensible, but it’s really not an issue to my mind.

      That said I can imagine that women’s prices are partly dictated by the fact that women are prepared to pay more for a good haircut, so hairdressers can get away with higher pricing, whereas conversely men expect to get one fairly cheaply, and hairdressers know their male customers would go elsewhere if their men’s prices were higher.

    2. The issue is that pricing is made based on gender, not on the intricacy of the cut. I would have no problem with cut-based pricing, or hair-length pricing, or even time-based pricing. But in this case, it’s based solely on gender, regardless of how intricate (or not) the cut may be.

    3. By the way, if you’re ever wondering if something is truly discrimination or just “liberal whining,” try rephrasing the issue in different terms.

      For example, let’s say that kinky hair is harder to cut (I have no idea if this is the case or not, but let’s imagine it is). People with kinky hair therefore spend more time in the dresser’s chair than people with non-kinky hair.

      What should our reaction be if the default signage outside barber shops were:
      “Haircuts for black people – $25
      Haircuts for white people – $15”?

      If a brown paper bag test wouldn’t be appropriate, a genital check isn’t appropriate either.

      1. I’m assuming your comment about liberal whining is directed at Michael rather than myself, but the other bit regarding the gender basis for haircuts is actually a good clarification for me, I get your point.

  14. It’s also worth noting that the ‘final’ 50K figure is probably LESS than an uninsured American would pay: the costs you’re being shown are the rates that the insurance company has negotiated with the providers. Rest assured that out-of-pocket payers would be charged much more.

    1. Not necessarily. The surgical codes carry charges set by custom or by the surgeon, and are maximum amounts. When several surgical codes are submitted for one procedure, one will receive 100% payment, the next one 50%, the next one 25%, and so on. There are actually very stiff penalties for fraudulent billing, and oversight by CMS or the private companies is thorough, in most states. What is more serious is the charges allowed for certain procedures, such as mentioned above.

  15. Women’s haircuts are usually more time consuming? Long hair is more time consuming? Are you people bald or something? I used to have hair down to my hips. Every 6weeks I would get a trim that consisted of the stylist cutting a straight line. I would have paid more for a shampoo or blow-dry, but for that cut? Right now I have very short hair. So does my husband. His takes longer than mine to cut. I should have to pay more?

    That’s the reason that when my hair was hip length I got my dad, a retired barber, to cut it. It took longer to clean up than it did to cut!

    Don’t get me started on dry-cleaning & laundry…

    And as a Canadian, the US health system shocks me. I have to have carpal tunnel surgery and I don’t expect any bill at all, other than a prescription for pain killers and parking fees. Sure I pay more in taxes, but not THAT much more.

    1. As a general statement, this is manifestly untrue. In that bill of Jerry’s, the physician charges, while higher than they should be, IMO, are less than 20% of the entire bill. I agree that certain specialties are reimbursed at exorbitant levels for certain procedures, but the substantial majority of physicians are not surgeons or procedural people such as interventional cardiologists/radiologists and gastroenterologists. I assure you that primary care providers, including pediatricians, are not over-compensated. Very many of them barely hold their practices together, and more each year are forced into employed-physician status. Retained income for most primary care docs in this country is far, far less than the yearly salary of any utility infielder in the major leagues.

      1. I should add that health care plan and large hospital administrators, docs or not, very often are compensated at levels of seven figures, an obscenity in my opinion.

        1. I don’t think comparing doctors to the lowest paid utility infielder in MLB is going to make your case considering the major league minumum last season was $380,000.

  16. A real barbershop wouldn’t do a woman’s hair at all.

    Barbers are not stylists, and stylists are not barbers.

  17. Trying to get my head round the figures, with the fear that as governments lurch to the right in response to doing what the bankers tell them to we are going to have this sort of idiocy in the UK.

    The £/$ has been fluctuating around $1.50 for years now (market rates as of now us $1.60), so I’ll use 1.50 as an easy calulation tool(with rounding) (feel free to add/subtract 10% for fluctuation.

    Wage £1957 – Approx $3000 pcm
    Tax and National Insurance total £409 – Approx $600. (My employer also pays approx £150 emploeyers contributions)
    My take home (after pension contribution) £1480 – approx $2250). If I was an earlier poster, HALF MY TAKE HOME would go on health insurance.

    If I was to spend all of my take home on VAT (basically a sales tax) rated goods (I don’t) the Treasury would get approximately another £250.

    Total to the exchequer
    409
    150
    250
    £800 (approx rounded)
    About $1200.

    So, under my nasty socialist system I get to pay for my Health insurance, no deductable (caveat, eyes and teeth I pay for, also prescription -though these are subsidised so I pay £10 per prescription).

    ALL the other stuff the state does I get for ‘free’. Although I pay local taxed to the town and district, remember approx 75% of their money comes from National Government (so I’ve already paid).

    Tell Sarah Palin my dad got a Stent in his mid 60’s. My Nan was diagnosed with stomach cancer when she was 89, and was still treated until she died a few months later – any delay in diagnoses was because she didn’t see the doctor for months – she kept taking ant-acids.

    My mother in law is in long term care for dementia, my wife who has diabetes and an underactive thyroid gets all her prescriptions free – I would imagine in the US she would be ‘uninsurable’ (no matter how the new law is worded- you have to be able to afford the premiums).

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