The Hospital Bill

I just got my "Explanation of Benefits" form from Blue Shield of California.  Now I paid $100 for my surgery.  That's it.  Everything else the insurance took care of.  So I'm looking at this form, and according to them, El Camino Hospital billed them $71,006.62 for my RNY with one-night stay.  The overnighter charge was $4,046.  There are lots of "Inpt Pharmacy" charges totaling to $362.80.  Okay, I can accept that.  There are three "Laboratory" charges totaling $968.63.  I'm not sure what tests they ran, but okay, I can accept that.  All other charges are coded "Hosp Misc".  There are for $383.22, $5,179.23, $36,368.65, $16,687.06, $5,277.04, and $1,533.99, for a grand total of $65,429.19!  Now maybe it's just me, but if you're going to bill $65,000, don't you think maybe a few words would be nice?  Yes, it has a code, but that doesn't mean anything to me.  But here is the real kicker.  My insurance paid them a flat fee of $2,700 for the operation.  Okay, I realize this is long and rambling, but why would a hospital bill $71K knowing they're only going to get a total of $2,800 from both the patient and the insurance?  Are they really charging uninsured patients $71K for this operation?  Is anyone out there paying $71K for a laproscropic RNY?  Somehow I don't think so... Anyway, thanks for letting me vent...  Carol

Wow that is shocking but not shocking if you know what I mean. I have seen those things in all my hospital days, but only really pay attention to what I really have to pay. There is something seriously wrong with the system!

my mother runs a financial services Dept for a big hopsital in So Cal adn they have flat rate prices for cash pay customers. While they are alot more than what the insurance companies pay, it is still far less than they "bill" for. They have to bill for these ridulous amounts in order to get what they get from the insurance. If they only only billed 6000 dollars they would only get 500 from the insurance

Hi Carol ~ Kaiser paid UC Davis to do my surgery, so I get statements on how much Kaiser has paid UC Davis, and so far the total is over $95,000.  Call your insurance and find out why you are getting these bills. ~ Annabelle

I just received a statement from Kaiser and my surgery w/4days in the hospital was $70,000. I only pay $800.00 of that, thank goodness! =)

I used to work for a very large insurance company.  If your coverage is HMO, the Medical Groups and contracted Hospitals have what's called a capitation contract where they are paid a certain amount monthly for each person covered by that insurance with that medical group.  So whether you're seen or not, they get paid.  In turn, when you are seen, the insurance company is not billed for the visit because they've already been paid.  The hospital also gets a certain amount in the same fashion and then agrees to a contracted amount to be paid for certain procedures.  So the lower amount is what they've been contracted to pay.  As far as the larger amount shown, I have no idea if that's what the hospital would actually charge or not. I am in no way defending how this works.  Just explaining the mechanics of it all.  To me, it seems, it would be in the medical group and hospital's best interest to try to do less for the patient so they can keep their profits up and this isn't in our best interest.  There has to be a better way of doing business and still taking the best care of the patient.

My surgery was 3 years ago with the worlds best surgeon - Dr. Zorn! LOL_and was just under 50k... I think my total contribution was around 40-60 bucks for office visit copays while going through approval. This was before the 6mo education program that they have now... I got under the wire with in a month or two of them implementing the program! When my explanation of beneifits I looked at the bottom like - didn't think too much about it. Kaiser was footing the bill - I was glad that I finally got to use the insurance that I'd been paying for for over 8 years! (it's a benefit, but it's still!_) C h e e r s, gene

I am a cash pay client, and the total for surgeon and hospital is $19,000.00.  So no, I don't think anyone really pays that much, and why they bill that much is just crazy! -D

I have Blue Shield HMO and had a preapproval and authorization number prior to surgery. Surgery went well with no complications. Imagine my surprise when a bill comes saying I was in ICU/CCU intensive care/critical care unit. There was also a note in very small print  on my benefits summary saying my surgery was not a covered benefit. Interesting as  I had preapproval and an authorization number and my surgeon would not schedule without these.  Called Blue Shield and "they missed the authorization and would reprocess."  Now I know I wasnt there because I was walking 4 hours post op and walked PAST  this unit all night long both nights of my stay.  Panicked about unknown complications I might have had I spoke to the surgeon and the insurance clerk for the surgeon who verified info from my chart and the hospital and  said I absolutely was not in ICU/CCU and my surgery was quicker than most due to my smaller liver.  The next day at my 1 month postop visit, the surgeon said he specifically remembered my surgery because he called me in early so he could make an earlier flight somewhere.  Asked them to investigate the "incorrect" or overbilling as I was not in ICU/CCU.  The person literally said, "Its being paid by Blue Shield, dont worry about it." No wonder our healthcare costs are sky high!