A patient in southern California was charged $97,000 for a gallbladder removal. Medicare paid the hospital less than $4,000 and his supplement covered only $900 of it. Any claim submitted affects the financial integrity of the whole program.
The massive hospital bill had three pages of individual charges, each simply listed as “surgical services”. There is no way of knowing what they are for. Sure, you could look up the billing code for each online, but you will usually find a vague description. Medical billing is not useful to the patient.
Most healthcare finance goes on behind closed doors between insurance companies and providers, where the patient is merely an afterthought. This non-transparent system was established before the rise of high-deductible plans and co-pays, leaving patients with more out-of-pocket costs. Hospital fees are out of control because the patient has no idea what the actual costs are.
The costs should be made clear to patients on their explanation of benefits. The EOB lists fictional numbers that mean nothing in regards to real costs. The insurer receives a detailed receipt for all services rendered, but they do not share this information with the patient. It is industry standard to deny this detailed information to patients, although a proper explanation can be requested from the hospital.
Hospitals often lose money on Medicare cases, receiving 95 cents for every dollar spent treating a Medicare patient. They make up the losses by charging private insurers more, and charging uninsured patients sometimes three times what Medicare allows. EOBs should clearly explain benefits with complete transparency.
Take the guesswork out of what your medical costs will be by using MediBid. The total cost and all fees that are included will be provided by the physician or facility prior to your procedure being performed. MediBid uses complete price transparency and competition to get you the best deal for your medical need while saving you money.
Lazarus, David. “Deciphering your hospital bill — good luck with that.” Business. Los Angeles Times, 16 Aug 2016. Web. 16 Aug 2016.