On the absurdity of not having health insurance

As I mentioned about six weeks ago, I ended up going to the hospital while I was on vacation in California. Of course one of the hospitals lost my insurance info so they sent me an itemized bill instead. I’ve posted it here so we can all laugh together at how much they’ve charged me for a few things. I’ve not included a couple of things because they didn’t seem terribly unreasonable to me.

Promethazine 25AMP: $37.88
Sublimaze (fentanyl) 100mcg injection: $47.50
1000mL Normal Saline: $99.01
Contrast with Exam: $412.00

CT scan/body:
CT W/W/O Contrast: $2629.69
CT Pelvis W/W/O Contrast: $2355.70

Emergency Room
Level 3 w/ MD/Nurse procedure: $699.43
Admin of IV Injection: $184.71


Self-pay adjustment: -$1321.54

First off, Promethazine is cheap. Dirt cheap. I don’t have the AWP for the injectable form, because I forgot to look it up, but it’s very inexpensive. Probably less than $1 in the quantities hospitals buy it in.

Secondly, Sublimaze has an AWP of 45 cents. I’m all for charging more than AWP to people, but not 105.56x over cost. In fact, it’s likely that the hospital pays much less than 45 cents per dose for Sublimaze.

Normal Saline. One liter. $99? You’ve got to be kidding me. One liter of normal saline runs less than a dollar. I can’t check the AWP for this, because we don’t sell it at all. Anyway, I don’t appreciate being charged, once again, at least 100x what the actual cost is.

Contrast, AKA Barium Sulfate. I consumed two 473mL bottles: 946mL of the stuff, which has an AWP of ~$64. In the quantities that hospitals buy it, I’m sure they’re charged less than that. A 640% markup.

Administration of IV injection. I don’t know precisely what that means, but it seems incredibly expensive.

Of course I won’t actually be paying these prices, because they’ve been able to successfully bill my insurance company. My insurance company won’t be paying these prices either — the little “Self-Pay” discount that they gave me is hilarious because it’s not really much of a break at all. The reality is that if I were a big insurer, I’d be getting a much bigger break than that.

You’d probably see the price of the saline drop to zero. Not even a penny. You’d probably see the cost of the barium drop somewhere down to AWP, along with the cost of the Sublimaze. Promethazine would probably drop to around 10 cents. I’m sure the CT scans would be billed at a much lower rate as well, probably around $1000 a pop. I know this because I’ve seen what my insurer paid for these things when I had them done before back home in Boston.

Given US healthcare economics, I’m not really complaining. I work for the system, and being on that side of it, I don’t have a problem with it so much. But I do have a problem with this kind of obscene price gouging. I felt like I should have gotten prescriptions for the Fentanyl, Barium, and promethazine, and had them filled at a regular pharmacy and saved myself some serious money — even if I didn’t have prescription insurance. BYO prescription meds, as it were. (Of course that would have never worked because no normal retail pharmacy stocks those items regularly, but you get the idea.) Price gouging a captive audience to the degree that this hospital did seems VERY wrong to me. Morally and ethically wrong.

On a completely unrelated note, Sublimaze is a very aptly-named drug…

[tags]Medicine, pharmacy, economics, price gouging, healthcare, California[/tags]

9 thoughts on “On the absurdity of not having health insurance

  1. Not that I support price-gouging (I also agree that those prices are ridiculous), but I think the hospitals are doing it to recoup their losses from other money losses in the hospital: unpaid hospital bills, medicare reimbursement rates, etc.

    What needs to happen is hospitals/doctors/America in general needs to get their act together on how to keep health care costs down, so that there isn’t so much money to be lost (and therefore needing to be replaced by folks like you).

    Uninsured but working Americans are the ones who get screwed the worst: insurance co’s have enough clout to talk down the prices a lot, the really poor people either have medicaid or are written off of the books as “indigent care” and whatever is left over gets charged to the uninsured guy who they’ll come after to pay. Doesn’t really seem fair…

  2. You are exactly right, actually. It is my understanding that hospitals break even plus a tiny bit extra with the average reimbursement from health insurance companies. They often lose money on those that can’t pay, or with medicare/medicaid patients. What they lose is more than what they make on people who are insured. So it falls to those that can’t form any sort of economies of scale.

    Unfortunately there doesn’t seem to be an easy way for uninsured individuals to form the necessary scale. It almost seems like it’d be a good idea for a NPO to form for some small nominal fee to cover administrative costs that would give them a discount card on basic healthcare. Like $50/year, which would more than make up for itself. For instance AAA gives discounts on prescription medications, and I know several people who have made up for their yearly membership just buying one med, which is kind of cool.

    For all I know, such things exist. I’ve never not been insured so I’ve never had ocassion to look into it…

  3. Case in point: A woman goes to hospital for hysterectomy. The day she is brought back to her room from surgery, someone brings in one of those ubiquitous plastic tubs. In the tub (which we never touched) was a large sealed bag of “maternity maxipads”. The patient never had a speck of vaginal bleeding. The package was literally never touched. When we were leaving I told the “discharge counselor” that I didn’t want the hospital to bill the insurance company for this pristine package of pads. I was told that they WOULD be billed because the patient had been supplied with the product. I then picked up the package and gave it to the “counselor” and told her that she needed to return it to central supply, that it was in perfect condition. She refused. I took out my handy dandy digital camera. Took a picture that showed the “counselor” and the package sitting on the table in front of her. I told her I would be mailing it to the insurance company along with a letter requesting that they not pay for it, and I would include her name. Suddenly, she was willing to not bill for it. Oh, the cost that she was going to charge? $156! For a freaking bag of 10 maxipads! For shame.

  4. >>” It almost seems like it’d be a good idea for a NPO to form for some small nominal fee to cover administrative costs that would give them a discount card on basic healthcare. ”

    Oh, you mean like Blue Cross/Blue Shield was when they were first established. They were the affordable nonprofit insurer that wrote coverage for schoolteachers and nurses and other public employees that couldn’t afford insurance at the prevailing for-profit companies’ rates.

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