The cover story, “Why Medical Bills Are Killing Us,” by Steven Brill in the March 4 issue of “Time” details astronomical medical charges.
Hospitals use a “chargemaster” list to bill patients for supplies and procedures. The prices often seem to have little relation to actual costs.
Examples included: $1.50 for one generic Tylenol pill; $77 for a box of gauze pads; $108 for a common antibiotic ointment; a stress test using radioactive dye for $7,997.54 (Medicare would have reimbursed $554); three CT scans for $6,538 (Medicare would have reimbursed $825).
Insurance companies and Medicare sometimes negotiate 80 percent or more off chargemaster rates.
Ironically, those without insurance or Medicare pay the most.
Brill says indigent or charity care that many hospitals report in their annual reports is based on chargemaster rates.
James Ybarra, business office director of Roosevelt General Hospital in Portales, says, “We do have a chargemaster, which allows us to manage and charge everyone … the same price.
“However, this does not mean that all will pay the same amount.
“Negotiations with various insurance companies have allowed the companies to negotiate different reimbursement amounts based on volumes and procedures.”
Based on their financial circumstances, according to Ybarra, RGH offers charity and indigent programs that may reduce or waive entire bills for some patients.
He says, “Hospitals normally do not share or advertise their chargemaster.”
Hoyt Skabelund, administrator for Plains Regional Medical Center in Clovis, says, “PRMC believes that financial resources should not prevent people from seeking or receiving needed medical care. PRMC provides free or discounted medically necessary care to patients who are uninsured, underinsured or otherwise unable to pay. PRMC also helps patients apply for government healthcare programs.
“PRMC uses a master charge list to bill all patient encounters. These charges reflect all of the costs of operating a healthcare system, not simply the cost of an individual item. The list is not available to the public due to competitive business reasons.”
He says bills to uninsured individuals reflect a 30-percent discount, and that financial assistance is available to those who qualify based on family income or catastrophic circumstances.
Patients whose annual family income is at or below 200 percent of federal poverty guidelines are eligible to receive care from PRMC at no charge; “patients whose family income is between 200 and 300 percent of FPG are eligible for significant discounts on a sliding scale. Catastrophic situations are reviewed on an individual basis,” Skabelund reports.
“In 2012, PRMC provided nearly $3 million in free care at our cost to patients who couldn’t afford it and $8 million in uncompensated care where the payment we received was less than the cost of the care we provided.”
Brill recommends those without insurance or Medicare find a medical billing advocate to assist them in disputing or negotiating chargemaster rates.
Contact Wendel Sloan at: email@example.com