We had a similar experience this spring. A 21 minute outpatient surgery in a hospital setting that required general. Bill was $43k.

I asked one of my best friends who is a physician at the same hospital. She said the insane prices are because physician owned surgery centers have been outlawed with rare exceptions of some grandfathered in. She said the procedure should been more like $5k all in.

I used to work in medical software until I couldn't take it anymore. It's the only business I have ever seen where one party says "I'll bill you X amount", the other party says "Ok I'll pay Y amount" and everyone is fine with it.

In theory, I'm fine with that model.

However, I don't understand how accepting only 2% of the amount billed is sustainable or even makes sense!

Why don't they just bill something closer to what insurance actually pays?

the American health industry is absolutely a broken model.

That's not true at all.

Physician owned clinics are as popular as ever.

Would love to know more. Just confirmed with my friend that Obamacare made it illegal. Also this article seems to confirm, too. Again, I am referring to physician owned surgery centers. Would love to be pointed in the right direction for more affordable treatment options!

https://www.aei.org/op-eds/end-obamacares-ban-on-physician-owned-hospitals/

amymc72 said:

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Would love to know more. Just confirmed with my friend that Obamacare made it illegal. Also this article seems to confirm, too. Again, I am referring to physician owned surgery centers. Would love to be pointed in the right direction for more affordable treatment options!

https://www.aei.org/op-eds/end-obamacares-ban-on-physician-owned-hospitals/

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Your article specifies physician owned hospitals.

Ambulatory Surgery Centers are not hospitals, but they are a popular alternative to hospitals for outpatient procedures.

Send every bill you don't agree to up front to collections.

My original post stated physician owned, too.

Those ambulatory surgery centers are often owned by hospitals (they are where I live), so they're still allowed to charge a facility fee, which is what jacks up the price to ridiculous amounts, because the government allows it. That's why a CT or MRI at a hospital facility costs much more than going to independent imaging facilities. It's total BS.

I'm not sure what point you're trying to make.

All I have said is that physicians can (and do) own interest in surgery centers. Sometimes they have hospital/PE partners. Sometimes not.

Quote:

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the American health industry is absolutely a broken model.

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This is all you need to know. The whole thing needs to be blown up & reset. (Along with the tax code, VA system, USPS, etc.)

It is a really messed up model. Physicians and consumers have basically given up control to the government and insurance companies. It isn't like you are sending your health care premium to the local doc or hospital, those are going to big insurance then the locals have to fight like hell to get it back.

They charge what they do because sometimes they get it. The big insurance fights with big systems to get the agreed upon rate for every single charge (see the current dispute with S&W and BCBS). That is where you see "allowables" on the bill. This amount is usually some percentage close to the medicare rate which is set by the feds. If you are cash pay they love quoting the stupid high bill then offering huge discounts if you pay right away, a typical hard sale gimmick.

If the insurance doesn't have a contract with that entity then they are charged the full amount and pay. Thus you charge a huge amount because sometimes you actually get it. Auto insurance is like this as are legal type cases where medical costs are paid by whomever lost the case.

It is a big mess. I would have much preferred a open and simple free market with prices listed openly but this is what Obamacare promised and delivered.

Just got an email today that over 700 rural hospitals are at risk of closing. If you aren't part of a mega-big group then the insurance companies can bend you over and have at your hospital or just cut you out.

Dec 31st I had a hemmorhagic stroke. Symptoms started as a headache that became unbearable as the day progressed. Wife took me to ER at St Joes College Station. Taken back immediately and the did a CT scan. Loaded me in helicopter and flew me to Scott and White Temple. That flight was billed at $80,000. Fortunately I am a veteran and the VA paid all costs associated with stroke. $750,000 including 8 hour brain surgery, hospital stay, rehab hospital stay , PT and OT.