Personal Injury and Social Security Disability Blog

Medical Bills Need Reconstructive Surgery

"Prices are almost always inflated before being routinely discounted. Amid such financial flimflammery, it's virtually impossible for a patient to be a well-informed consumer of healthcare."

That was the subtitle of an article in the Los Angeles Times recently. The gist of the article is that medical bills, especially hospital bills, are almost impossible for patients to decipher because there are so many different prices for the same services, depending on the insurance status of the patient. Please click the link to read the full article — it's an eye-opener. Here are the opening paragraphs:

Susan Kovinsky underwent outpatient surgery recently at Cedars-Sinai Medical Center. The procedure, a hysterectomy, began at 10:40 a.m. By 3 p.m., she was on her way home.

The hospital bill: $65,514.97.

"When I saw that number, I was sure it couldn't be right," Kovinsky, 44, of North Hollywood told me. "How could just a few hours in the hospital cost that much?"

Yet this is a story of the healthcare system working as it's intended to. Cedars-Sinai did its job. Kovinsky's insurer, Blue Shield of California, did its job. Kovinsky has no complaints about either.

But if we ever intend to get our healthcare spending under control, clearly there's much to be done to reform a system in which a relatively common procedure and less than a day in the hospital costs more than a fully loaded 535i BMW sedan.

Kovinsky's case is illustrative of the problem. Medical bills are almost always inflated before being routinely discounted. This is done by hospitals and doctors to boost their reimbursement from insurers.

The upshot, though, is that amid such financial flimflammery, it's virtually impossible for a patient to be a well-informed consumer of healthcare.

 

 

 

Why Your Kid Might Not Get Vaccinated

CNNMoney has published a disturbing article explaining why more and more family physicians are refusing to give vaccine shots. The answer is that the health insurance companies won't reimburse the doctors for the full cost of administering the vaccines. If a doctor is going to lose money on every vaccination, that doctor is eventually going to quit doing vaccinations. And while there are alternatives, such as free clinics and public hospitals, the sad truth is that many parents will just skip the vaccination rather than go to the extra trouble. This is bad news for the children. Here are excerpts from the article:

Parents who bring their kids to Dr. G. Andrew McIntosh for the chicken pox vaccine are out of luck. The family physician, who has a solo practice in Uniontown, Ohio, doesn't offer that shot because he can't afford it. Most insurers won't sufficiently cover the cost.

"It doesn't do me any good. I am losing money on [them]," he said. The chicken pox vaccine runs about $115, but insurers only cover between $68 to $83 of that. McIntosh has also cut back on a handful of other critical childhood vaccines for the same reason -- including the measles, mumps and rubella, known as the MMR vaccine.

It costs him about $58 to buy an MMR shot, he said, while insurers pay about about $40. So McIntosh keeps a lot less of the MMR on hand. If a patient needs the shot and he doesn't have it, he sends them to a nearby public health clinic.

"I'm not happy to do that," he said. "The clinic is far, the service isn't great and my patients aren't happy to go there." "I've lost a fair number of kids [at the practice] because I've had to send them elsewhere for their shots," he said.

It's not clear exactly how widespread vaccine cutbacks are, but in a recent industry survey, 5% of pediatricians and 11% of physicians indicated that they're seriously considering no longer offering immunizations. Currently there are about 350,000 pediatricians and family physicians in the U.S.

"These are fantastically alarming numbers," said Dr. Richard Lander, a Livingston N.J.-based pediatrician who chairs a committee on administration and practices at the American Academy of Pediatricians. "It's an example of how health care is being driven by managed care in the United States," Lander said.

Doctors have to absorb any costs that insurance doesn't cover because in most states insurance contracts prohibit providers from charging patients the difference.

Public health experts are particularly worried about doctors dropping vaccinations. Dr. Lance Rodewald, head of the Immunization Services Division at the Centers for Disease Control and Prevention, points to the consequences this trend has had on public health in the past.

"Between 1989 to 1991, a number of doctors stopped providing vaccinations to children because of financing issues," he said. Instead, doctors referred patients to public health clinics for shots like the MMR. But many parents failed to follow up on those shots, Rodewald said, and their toddlers were never immunized. The result: The situation led to 55,000 cases of measles, 11,000 hospitalizations and 123 toddler deaths. The CDC found that more than half of the children who had contracted the measles had not been vaccinated, even though many of them had seen a health care provider.

Doctors Groups Sue Aetna and Cigna, Alleging Rigged Database Underpaid Physicians

The Dallas Morning News reports that the American Medical Association has joined doctors associations from Texas and other states in suing health insurers Aetna Inc. and Cigna Corp. over a database they say was rigged to underpay physicians for more than a decade. Here are excerpts from the article:

The lawsuits heap more criticism on Ingenix Inc. data that already has cost UnitedHealth Group Inc. $350 million to settle a separate lawsuit involving the AMA. Ingenix is a UnitedHealth subsidiary.

The latest complaints accuse Aetna of deleting valid high charges from figures contributed to an Ingenix database. They also accuse Cigna of hiding "serious, systemic flaws" in the data.

Insurers use the data to determine "usual and customary rates" for care received outside their networks.

But Aetna and Ingenix "cooked the books" and corrupted the database, according to a complaint filed Monday in U.S. District Court in New Jersey. That led to skewed data, which lowered the reimbursement doctors received.

"It's time for Aetna and Cigna to stop this unethical business practice that shocks our patients with unexpectedly high bills for health care they thought they'd already paid for," said Dr. Josie Williams, president of the Texas Medical Association and assistant professor at Texas A&M University System Health Science Center College of Medicine. "It's time for them to stop cheating physicians and patients just to pad their own profits."

The insurer said prices charged by doctors are part of the problem.

It noted, for instance, that doctors in the expensive New York City market charge on average $214 for a 15-minute, out-of-network office visit. Health plans reimburse as much as $160 using the Ingenix database. Medicare pays doctors $77 for the same visit.

Aetna has already agreed to pay $20 million to help set up a new database that will replace the one run by Ingenix. UnitedHealth also pledged last month to give $50 million toward the database's creation.

Link of the Day - Possible Link Between Diabetes Drug Byetta And Acute Pancreatitis

The U.S. Food & Drug Administration has issued a warning regarding the use of the diabetes drug Byetta. There have been reports of acute pancreatitis in patients taking this drug. Here is the text of the FDA notice:

FDA ALERT [10/2007]:  FDA has reviewed 30 postmarketing reports of acute pancreatitis in patients taking Byetta, a drug used to treat adults with type 2 diabetes.  An association between Byetta and acute pancreatitis is suspected in some of these cases. 

Healthcare professionals should instruct patients taking Byetta to seek prompt medical care if they experience unexplained persistent severe abdominal pain which may or may not be accompanied by vomiting.  If pancreatitis is suspected, Byetta should be discontinued.  If pancreatitis is confirmed, Byetta should not be restarted unless an alternative etiology is identified.

FDA has asked and the maker of Byetta, Amylin Pharmaceuticals, Inc. has agreed to include information about acute pancreatitis in the PRECAUTIONS section of the product label.

Stronger Warning Ordered For Ketek Antibiotic

A few days ago, the Food and Drug Administration ordered stronger warnings of potentially deadly liver failure with the antibiotic Ketek (telithromycin).

Ketek is approved to treat acute bacterial sinusitis, pneumonia, and chronic bronchitis.

The stronger warning is based on the FDA's review of Ketek's postmarketing adverse event reports. Those records show 12 cases of acute liver failure -- four of which were fatal; a fifth required a liver transplant. There were also an additional 23 cases of acute liver injury.

Ketek's new label will advise doctors and patients to watch carefully for signs and symptoms of liver injury while taking Ketek and to discontinue the drug promptly if any signs or symptoms of liver injury are to develop.

When the FDA approved Ketek in April 2004, the drug's labeling included precautions about liver injury and possible worsening of myasthenia gravis, as with other drugs in its class.