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Old 09-04-2012, 06:33 PM  
vailpass vailpass is offline
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Hospital Overcharge Really Stings

I realize hospitals have to make a profit in some areas to cover shortfalls in others but this one seems like an extreme case...


Scorpion sting leaves Ahwatukee woman with a big bill

by Ken Alltucker - Sept. 4, 2012 11:50 AM
The Republic | azcentral.com

Marcie Edmonds was tearing open a box of air-conditioner filters in her garage last June when she felt a sharp sting in her abdomen.

The 52-year-old Ahwatukee Foothills woman had never felt a scorpion sting before that day. She had no intention of seeking medical help, but within an hour of the sting, Edmonds' mild tingling sensation worsened with throat tightness, blurry vision, darting eyes and tense muscles. She could not walk and had trouble breathing.

With the help of a friend, she called Poison Control and was advised to go to the nearest hospital that had scorpion antivenom, Chandler Regional Medical Center. At the hospital, an emergency room doctor told her about the antivenom, called Anascorp, that could quickly relieve her symptoms. Edmonds said the physician never talked with her about the cost of the drug or treatment alternatives.

Her symptoms subsided after she received two doses of the drug Anascorp through an IV, and she was discharged from the hospital in about three hours.

Weeks later, she received a bill for $83,046 from Chandler Regional Medical Center. The hospital, owned by Dignity Health, charged her $39,652 per dose of Anascorp.

The Arizona Republic reported last year about the pricey markup Arizona hospitals were charging for the antivenom made in Mexico. Pharmacies in Mexico charge about $100 per dose.

After the Food and Drug Administration approved the drug last year, Tennessee-based Rare Disease Therapeutics sold the drug to a distributor for $3,500 per dose. The distributor charged hospitals about $3,780 per dose.

The Republic polled several hospitals in November, finding that hospital charges for the serum ranged from $7,900 to $12,467 per vial. At the time, Chandler Regional declined to tell The Republic how much it charged for Anascorp.

Edmonds' insurer, Humana, has paid Chandler Regional $57,509 for the bill. The hospital has asked Edmonds for the balance of $25,537.

Chandler Regional issued a statement indicating that Edmonds' charges represented the out-of-network costs for her treatment. Chandler Regional is not part of Humana's network, so she was charged the hospital's full billing rate.

"We believe no one should delay seeking needed medical care because they lack insurance or have high medical costs," the hospital's statement said.

Edmonds, who is a counselor, knows the intricacies of health-care billing, but she believes the hospital's wholesale charges should be explained to the public.

She was astonished to see the amount she was charged. "Everyone I talk to says, 'You've got to be kidding,' " when she explains her bill.

Read more: http://www.azcentral.com/business/ar...#ixzz25XxnIWnO
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Old 09-04-2012, 06:46 PM   #2
qabbaan qabbaan is offline
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I'm guessing that 1 payer to 5 non-payers for scorpion stings in Arizona might not be out of the question.
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Old 09-04-2012, 07:37 PM   #3
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Originally Posted by qabbaan View Post
I'm guessing that 1 payer to 5 non-payers for scorpion stings in Arizona might not be out of the question.
I'm not sure they give the uninsured the anti-venom. There isn't that much of it available. Hardly anyone that gets stung needs it anyway.
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Old 09-05-2012, 08:26 AM   #4
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I'll take the $100 dose please.
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Old 09-05-2012, 08:35 AM   #5
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Quote:
Originally Posted by vailpass View Post
I'm not sure they give the uninsured the anti-venom. There isn't that much of it available. Hardly anyone that gets stung needs it anyway.
Never got stung but everyone I talked to that has said it was like an intense bee sting. Sucks, stings like hell for several minutes then just goes away and leaves a welt.
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Old 09-05-2012, 09:14 AM   #6
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my wife's once a month, 1 hour treatment with the drug Tysabri is $7500.

retarded.

FWIW, this country is ****ed.
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Old 09-05-2012, 09:53 AM   #7
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Basically had it been an insurer they negotiated with they would have accepted the payment in full from Humana and not billed the patient further. Had this been an uninsured they would have gotten the whole bill.

Studies of this practice estimate that patients who are either self-insured or uninsured pay as much as 10 times what that areas monopoly dictates. I have witnessed this first hand. You can usually offer to pay in cash and get the total reduced by half with a lot of hospitals, but that still is as much as twice as much as who they are in bed with locally for negotiated rates.

It isn't hard to see why close to a third of what goes into a bill is administrative costs (either on the provider or insurer side). We need some major reform, personally I would love to see the middle man cut out or reduced in some way. It is the biggest reason I can't wrap around Ryan's plan. I would be all for vouchers if there was coverage assurances. Of course if there are coverage assurances, what private company is going to want to start insuring people in their late 60's at best?
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Old 09-05-2012, 11:32 AM   #8
vailpass vailpass is offline
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Quote:
Originally Posted by Radar Chief View Post
Never got stung but everyone I talked to that has said it was like an intense bee sting. Sucks, stings like hell for several minutes then just goes away and leaves a welt.
Yep. The small ones are worse as they haven't yet learned to inject their venom in doses so they give you the whole load. Uncomfortable, painful for a while, then done.
Obviously the frail and the young are at a higher risk for more serious complications.
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Old 09-05-2012, 11:33 AM   #9
vailpass vailpass is offline
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Quote:
Originally Posted by VAChief View Post
Basically had it been an insurer they negotiated with they would have accepted the payment in full from Humana and not billed the patient further. Had this been an uninsured they would have gotten the whole bill.

Studies of this practice estimate that patients who are either self-insured or uninsured pay as much as 10 times what that areas monopoly dictates. I have witnessed this first hand. You can usually offer to pay in cash and get the total reduced by half with a lot of hospitals, but that still is as much as twice as much as who they are in bed with locally for negotiated rates.

It isn't hard to see why close to a third of what goes into a bill is administrative costs (either on the provider or insurer side). We need some major reform, personally I would love to see the middle man cut out or reduced in some way. It is the biggest reason I can't wrap around Ryan's plan. I would be all for vouchers if there was coverage assurances. Of course if there are coverage assurances, what private company is going to want to start insuring people in their late 60's at best?
Some very good insight here, thanks.
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Old 09-05-2012, 11:33 AM   #10
vailpass vailpass is offline
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Quote:
Originally Posted by Dayze View Post
my wife's once a month, 1 hour treatment with the drug Tysabri is $7500.

retarded.

FWIW, this country is ****ed.
Best wishes for your wife's continued health.
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Old 09-05-2012, 12:23 PM   #11
qabbaan qabbaan is offline
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I would question if this was really the charge for the med only. If she had breathing issues she would have been in the ICU and depending on the care level she could have racked up a five figure bill without much of a problem. It sounds like the reporter got it right but we don't really know.
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