Article: He and his wife both got cataract surgery. His bill was 20 times higher than hers

[triplets_93]

https://www.npr.org/sections/health...urgery-his-bill-was-20-times-higher-than-hers

Danilo Manimtim's vision was cloudy and blurred — and it was growing worse.

The 73-year-old retired orthopedic surgeon in Fresno, Calif., knew it was time for cataract surgery. "It's like car tires wearing out because you drive on them so much," he said.

In December 2021, he went to the outpatient department of the local hospital to undergo the common procedure that usually replaces the natural eye lens with an artificial one and is designed to restore vision. The outpatient procedure went smoothly, and Manimtim healed over the next few weeks.

Manimtim, who has a job evaluating disability claims for the state of California, knows the health care system and keeps tabs on his health benefits. He knew he already had met his health insurance deductible for the year, so he expected a manageable out-of-pocket expense for the surgery. He calculated his coinsurance would be about $750.

Then the bills came.

 

[CalPolyTechnique]

This wasn’t the news article we needed or asked for, but what we deserved.

 

[Reality]

Based on what I read skimming over the article it looks like he went to a hospital and she went to a surgical center.

Hospitals are well-known to charge a lot more for things than clinics and medical centers so it is no surprise at all that the hospital charged a lot more.

To be clear, I am not saying it is right, fair or his fault, but rather it is not a surprise that the bills were higher.

It's like taking you car to a dealer versus a locally-owned repair shop. The dealer will sometimes charge 4-5 times more for the same work than the repair shop despite both using the same parts and providing the same level of service.

As I said, it's not right, especially when you have no real choice (ex: emergency or need help that only a hospital can provide), but it is not surprising.

Personally, I think if you have health insurance and are having work done that is covered, any "overage" charges should be on the insurance company to negotiate and pay or not pay to the medical provider. In fact, a lot of the large health insurance companies and hospitals regularly negotiate contracts that define procedure rates and how additional charges are handled when/if they happen.

 

[Creeper]

Always check with the hospital and insurance company before hand to find out how much you will owe.

 

[Denim Chicken]

Always check with the hospital and insurance company before hand to find out how much you will owe.

Lol, sometimes they can even tell you.

I had shoulder surgery and estimated all the costs with my insurance company. After it was all said and done, surprise bill from a out-of-network surgeon's assistant that I had no idea would be used. $5k. More than the surgery itself.

Luckily for me, my state passed a law about this and I told her to kick rocks.

 

[Robbieac]

Hospitals are forced to charge a lot for services because there are many many many patients who do not pay their bills at all.

Trust me, I know.

My job (running a hospital lab) puts this front and center for me every day.

In many other countries if you need something medically done, you have to swipe a credit card or form of payment before they will proceed with anything. If you can’t pay for it, they won’t help you at all.

In the US, we don’t do that. We allow patients to rack up ER bills and hospital bills with little to no repercussions. Because of that, we have to overcharge those who can pay to make up for it.

I’m not saying it is right or wrong. But that’s how we as a society decided to keep things running since we’ve chosen not to deny healthcare to those who can’t afford it.

 

[Reverend Conehead]

Numerous times I've gone in for some procedure and asked how much it would cost, and they couldn't even tell me. They couldn't even tell me what 100% of the costs were so that I could calculate knowing that my insurance pays 80%. You would think we had a right to know in advance how much something is going to cost. This #$%^ wouldn't fly in any other business.

 

[visionary]

Hospitals are forced to charge a lot for services because there are many many many patients who do not pay their bills at all.

Trust me, I know.

My job (running a hospital lab) puts this front and center for me every day.

In many other countries if you need something medically done, you have to swipe a credit card or form of payment before they will proceed with anything. If you can’t pay for it, they won’t help you at all.

In the US, we don’t do that. We allow patients to rack up ER bills and hospital bills with little to no repercussions. Because of that, we have to overcharge those who can pay to make up for it.

I’m not saying it is right or wrong. But that’s how we as a society decided to keep things running since we’ve chosen not to deny healthcare to those who can’t afford it.

Very true, this is a societal decision. We as a society expect (not ask) our hospitals and health care providers to take care of the uninsured out if a humanitarian spirit. Believe it or not the hospital and the health care providers can be (and are) sued by the patient for that free care if there is an issue. But those are the choices we have made.

If someone would rather everyone pay out of pocket they can move to South America and those who want everything covered can move to Canada

 

[kskboys]

Always check with the hospital and insurance company before hand to find out how much you will owe.

And ask for what a cash discount. It's huge.