[bmc99]

Why do doctors almost exclusively use MRI's now to diagnose conditions that were done quite effectivly and far less expensivly with X-rays. It was done to my mother recently for a conditon that at best required an X-ray which used to be the precursor before an MRI.. Cost to our insurance provider$9500 + and of course they did not pay the full bill so an additional $15 was charged by the hospitle to my 94 yr old mother. Why am I complainlng about a lousy $15 dollars? Because every year the co-pays seem to get higher and higher and they shift more and more of the bill to the consumer, especially MRI's. And of course the hospital never tells you what the bill will be unlike other businesses that are required by law tell you what they are charging. You just get a letter from billing saying you owe us this much more and if not paid by this date it will be turned over to a collection agency. Over two months later when you think the whole incident is in the past.. They did not tell my mother an x-ray was an option they just shoved her in the MRI and that was that. Why am I asking you for help? Well this is not the first time this has happened to my family and the agencys that I thought were there to assist you or at least give you answers. Never once, replied to my complaints. Insurance company, medicare fraud, my congressman, even the local TV news consumer fraud watchdog. Do you know of any help from any agency that looks after the little guy and is not just into the headline getting massive fraud scandles? I am afraid in the future after having medical treatment and a couple of months down the road a knock will come at my door from a collection agency telling me to get out of my home it is needed to compensate the hospital for an insurance short on my bill. And please do not suggest lawyers, they want money up front just to breathe the air in there office.. Please; this is not a vent at the system it is fear of a future where a lifetime of saving and being careful with savings will vanish overnight in a system I neither understand nor have any control over. Sincerly; bmc99

[Fr_Chuck]

Because of law suits, if they did not do MRI and missed something, people are ready to sue at a drop of a hat, they come here daily wanting to know if they have a case.

They are protecting themselves since the government is refusing to put limits on liability of law suits for medical malpractice

[bmc99]

California passed a law limiting pain and suffering to no more than $250,000 in medical maipractice. We were told it would lower insurance rates and medical costs. Voted on and passed. Insurance rates and medical fees kept right on going up! So that argument does not hold up. Frivolus lawsuits are not as common for medicaj mal practice as lawyers do not take on such cases without clients signing retainers making them responsible for all incurred court costs and attorney fees. Medical mal cases are not winning the lottery like 25 years ago. Case in point a friend of mine had a hip replacement. It went bad a year after being done. In the year following it went out two more times/ Fourth time it Was totally replaced with qdifferent brand prosthetic. By accident while watching the discovery channel they had a program about a company that made a hip that had been contaminated with a lubricant in the manufacturing process and was coming out of it's socket in patients it was mplanted in; To m6ch coincidece for me so when the program was rebrodcast later that week I taped it and gave it to my friend. The nubers matched the unit that he had. Don't ask me why but his surgeon gave him the unit after he replaced it.
In the program it said after the defect was identified all units were recalled in 1995. A class action suit was settied in 2000 or. My friend's original surgery was in 1997 rwo years after it was recalled. His doctor admitted the mistake to him after I gave him the tape. Said it was provided by the hospital and should have been sent back when it was recalled but wasn't.
Open and shut case you woujd think. Friend called the attorney who settled the class suit. Nope sorry suit is settled . I asked my friend if he told him about the joint being put in him AFTER IT HAD BEEN RECALLED .He said yes and the man's answer was try someone else.He contacted 7 seven local attorneys. Every one wanted A minimum 5000 retainer to take on his case and a couple of them recited the party line , case is already settled. I have no legal background but is it not negligence to implant an acknowleged defective, government recalled part into a patient? And not a nationaly broadcast documentary not give such a negligence suit commanding credibility? Well apparently not .I encouraged him to pursue it more but he said why don't I do it for him. I just said if your going to be that lazy then I was done helping him. Long story qnd my dates may be a bitvoff but if you doubt the story I will give you his E address and he corroberate what I told you. Don't buy into the lawsuit answer the industry gives you. Most doctors and hospitals are under a corporate umbrella and they set 4he guidelines that they work under. And even if you do not agree, $9500 for 15 minutes in an MRI machine is ridiculous. *f you can't see a problem with that then it is obvious your part of the problem. bmc99

[MikeBear]

Hi,
You have brought up questions now being asked by many news people, doctors, and lawyers. Obama said last year that he has saved "millions" of dollars by exposing fraud in Medicare... But, none of that was on any of the network TV national news programs, including Fox News!
There is no major push to get rid of Medicare/Medicaid fraud in America. Some doctors do as they please, with no consequences. According to the AMA and Consumer Reports lately, there are more and more tests done that aren't necessary, and some are now being proven to be not so accurate, such as some cancer tests.
It will Never stop, until the President (whoever it is later) puts a "push" on the Senate and the House to do something about it. Now, they really don't seem to care. All most want to do is get re-elected!

[fredg]

Yes, every year co-pays get higher and higher. My own Medicare Supplement insurance went up 50% in the last 2 years. Doctors do things like you talk about because no one will stop them. There is no on-going checks on Doctors who treat medicare patients, and they do what will bring them in the most money (or at least, many do).
It won't stop until the public gets mad, and votes people out of government offices that let this happen, and keep happening.

[Fr_Chuck]

Yes, when I used to live in the US, insurance for my wife cost about 500 dollars per month, just for her. A better plan, that is valid in any country of the world except the US cost about 140 a month.

[JudyKayTee]

This is a rant. A poorly spelled rant, but a rant just the same.

I never believe "my friend told me that his Attorney told him" information.

Everyone thinks procedures are too expensive or unnecessary, right up until they or a loved one is seriously ill. Then it all changes.

[Wondergirl]

This is why the patient and his family have to do research and be proactive on procedures and tests and treatments promoted by hospitals and doctors. Internet and library research and knowing when and why to say no will save the patient and his insurance company tons of money.

[bmc99]

Tried to help insurance compnay ignored me

[bmc99]

This is a rant. A poorly spelled rant, but a rant just the same.

I never believe "my friend told me that his Attorney told him" information.

Everyone thinks procedures are too expensive or unnecessary, right up until they or a loved one is seriously ill. Then it all changes.

Yes, it is a poorly spelled rant, written tired, spell check not used before sending, and done at 2:00 am with on screen keyboard and probably loaded with grammatical errors. My apologies. But, the fact is nobody has been able to point me to a reliable agency that can answer my question. Maybe I am ignorant of how the system works and the charges are more than reasonable. You think I am wrong to ask and should be greatfull. It is your opinion and you have every right to it. And it is my opinion I have every right in this country to ask for an explanation of the amount charged to my mothers medicare account if only for educational enlightenment.
Now, if you know of an agency or citizens group that will answer my primary but badly written question I would be very greatfull. If not, why did you bother to vent at my vent? Just call me a loser under your breath and go on to a chat room that shares your beliefs. I am looking for answers not a Political Spanking from the righteous and holyier than thou people of the world. This is the United States and I do have the right to question what a business charges my government for the billing of a family member. And I am entitled to an answer from either my HM0, or medicare and not being ignored as they have done to me before. bmc99

[bmc99]

I apologize to all who have replied to my question which I sadly turned into as one put it a "vent "overloaded with spelling and grammatical errors, long winded and an obviously made up story.What I should have asked plainly; "Is there any agency or organization out there, { Not the medicare fraud, nor my Hmo, Nor AARP " all who I contacted before ,filed forms with over three years ago about another incident somewhat the same and was never contacted by them} who might be able to answer my original question about X-rays being out ln favor of MRI's for conditions that really don't need the highly expensive diagnostic tool. Yes I know the answer is money but is it really by any known group or is it just media hype lip service and no one really cares about an out of control medical and pharmacutical industry in this country? bmc99

[JudyKayTee]

Allow me to address your passive/aggressive “apology” first - you say, in quotes, that an AMHD member stated your story is “overloaded with spelling and grammatical errors, long winded and an obviously made up story.” I’d like to know what you’re quoting because I can’t find it. If this is your level of understanding when your question is answered I have no doubt at all that you are having difficulty getting anyone to address your concerns. If you are quoting me, please quote me - don’t add to what I said for your own purpose.

On the other hand if you are counting on people believing you and not reading past posts you are mistaken, and you have just made yourself look sad.

I believe your thinking is flawed because you are operating on the mistaken belief that “... no one cares” and that the “medical and pharmaceutical industry in this country” are out of control. First you have to convince people that both of these “facts” are true.

I’ll address the pharmaceutical industry first (and it is an industry). What is your specific problem with that industry? If you are given prescriptions and feel they are too expensive, you don’t need them, something else, then don’t get them filled. It’s as simple as that. If you believe the profit margin is too high, then look into it and come back with facts and figures. My late husband was a Doctor of Pharmacy, so this is a discussion I am well prepared to have. I am not mindlessly defending pharmaceutical companies, but I am also reminding you that Pharmacists get a salary, not a commission, nor do they set prices.

I hold stock in Pharmaceutical companies. If they are making money hand over fist it’s not indicated on their stock reports. Maybe you know something I don’t know.

As far as MRI/X-ray and any other problem you have with medical testing, again, I would need facts and figures. If you are alleging that you don’t need certain tests, then refuse them. Personally I only treat with Physicians I trust, so if they recommend tests, I get them. Certainly no Physician has ever forced me to undergo any tests I did not want - and that includes supervising the medical care of my late husband.

If you are talking about medical treatments, such as Dialysis, what is your suggested alternative?

I also work in the legal field, and I am aware of medical malpractice lawsuit after medical malpractice lawsuit. Very often mis-diagnosis or lack of treatment because of no diagnosis at all is involved.

A rant is one thing. A discussion is another.

[Fr_Chuck]

Charges for medicare services are done according to pre-approved rates set by the government for each service, those are decided and billed according to the billing code for the procedure. The doctors and hospitals approved by medicare will have to use those ratings and that is how they are paid.

So if this is medicare billing, unless there are serivices listed you did not get, not ones you don't agree with but received, the charges are the stardard rates approved for those services

[JudyKayTee]

"No one will stop them"?

The patient can "stop them."

I don't understand why people don't take charge of their own health care.

[Wondergirl]

I am looking for answers not a Political Spanking from the righteous and holyier than thou people of the world. This is the United States and I do have the right to question what a business charges my government for the billing of a family member. And I am entitled to an answer from either my HM0, or medicare and not being ignored as they have done to me before. bmc99

Every procedure done at a hospital has to have written permission from the patient or a person the patient has assigned to sign documents. NO tests/procedures are done without the patient's written permission. No patient is forced to have a certain test or procedure. Explanation should be given why the test is needed and what other choices are available -- OR the patient and responsible family members should ask, "Is this necessary? Can something else be done?" In fact, you even have to sign a document at admittance into a hospital, and that document says you will accept basic care of IVs, blood tests, etc. Read that document next time before you sign it.

You are supposed to question need and cost BEFORE the test or procedure is done, not try to wheel and deal afterwards. As Judy said, the patient can always say no. I have been in the hospital a number of times during the past ten years and I have said no to certain procedures. (and I heard back, "You're crazy! This procedure is the gold standard for cancer treatment!") The risk of making my "no" choice was explained to me, and I continued to say no. (I learned later that one of the procedures I said no to has since been changed and rewritten to reflect my specific objections, so my no actually did some good for future patients.)

Hospitals and doctors want to get patients better and moved on, but they also want to do tests and procedures to cover their butts and also to make money (after all, they have all this shiny, expensive, ultramodern equipment at their fingertips to play with and to pay for). The patient and his family MUST be informed and be able to do their own research about what is needed and also be willing to make hard decisions that might fly in the face of their doctors and hospital. I've done it for myself and for my husband and even with vets for my cats. You can do it too.

[bmc99]

To JudyKayTee :I am sorry this has got this far. I have been looking for an answer to a question and stirred up a hornets nest. And I do appologize for that.
Yes I do know procedures can be refused. I have refused them myself many times.. My mother at 94 is very independent and likes to feel she can handle decissions about herself. It is not like her treatment was substandard, it was not,
We are incurring no crippling financial obligation. She is fine. I understand you work in the field. I do not disbute your knowledge nor your ability to do excellent work.
. This is not a case of looking for a sympathetic ear to rally to a cause.
I have been disabled for 35 yrs now. I have underwent over 25 operations in that time. I have suffred unrelenting pain caused by an overzelous chief resident who wished to impress his surgeon mentor who started an operation on me without the ortopedic surgeon in attendance. He severed my cyatic nerve and paralyzed %60 percent of my left leg. The kicker is I have suffered from the nerve that is left wich continualy communicates pain to me ranging from the feeling molten lead is being poured down my leg to extremely painful electrical voltage going through me. I have learned to live with it and I am telling you this not for sympathy but to say I am very well acquainted with medical proceedures.
And all this really means nothing. The X-ray versus MRI is a curiosty to me as My first MRI was in 1993. It was done for my orthopedic surgeon who wanted it because the X-rays that were done on me were not giviing him a clear picture of what he was dealing with. This was done at Sharps Hospital in San Diego California. The insurance coverd it %100. I saw it and it was around three hundred dollars. Each MRI I have had in the last 20 yers has been more expensive. Well that is the way of the world, the price of things esculate. I may not like it but it is what it is. 2010 I have a bone infection in my left foot doctor wants MRI, which makes me grimmace because of the co-pay but what he heck. Iget the bill and pay my $185 dollars.Total bill was $2800. It's 17 yrs later , Hey it went up just like everything else has in our daily lives. Now , November 2012. My mother falls, hurts herself. Bleeding from th forehead and some scrpes on her face. She is mad she fell but I insist on taking her to get checked. Consent papers signed, insurance coverage verified. Doctor talks to her, asks questions looks at me and says she looks fine except for the gash in her forehead. Told me they would take her in , clean her up stitch the wound and she should be right as rain. But to be on the safe side they would get an x-ray to be sure nothing bad was going on inside her head. I nodded to him in agreement and asked only that she be made as comfortable as possible.. They take her in call mean hour later and say she is fine and ready to return home.
Two months later a bill for $15 is sent by the hospital to me for payment the insurance would not pay. Yes I saw the form at the hospital we signed that we were responsible for all payments not made by the insurance. My mother signed the agreement I explained to her what it was for. The bill lists what we paid what we owe and what the inurance was billed for. The overwhelming cost for the MRI floored me. Why such a dramatic increase in two years?
OK here we are, all I want is a rational answer that justifies the cost. Three years ago my stepfather was brought to the same hospital emergrncy ward for a fall. He cracked a rib. 2 months later after the incident I get billed for incedentles the insurance won't cover. Other than looking him over, and x-raying the rib yes x-ray and running blood panels they said he was in no distress so take him home and make him comfortable. Other than the eight hour wait in the waiting room he was admitted at 10;30 pm . I was called at home at 2:00 am to come and pick him up he wanted to go home. 3 1/2 hours total time. The bill was$11,800. But looking at the itemization of the bill they werer charging for a three day stay. I understand how businesses have minimum charges for time.It may have been a 3 1/2 hour stay but in on Wednesday out on Thursday. That is two days why a billing for three days? I info4rm the insurance company they mail me a form I fill it out and send it back. They ask me if I would like to be informed of there findings I say yes.. How long? 6 weeks. I call after 6 weeks for an update, there backlogged but will let me know there findings. Four months later, still backlogged but we will inform you. Contact medicare fill out forms and send them in. They will get back to me.9 months later still no contact from either of them so I file a form with AARP who is affiliated with secure horizons and am assured I will be informed of the outcome. My dad died a year after the incident not from his injurys but just advance age. And alzhiemers. That was two years ago. I still have not been contacted by any of them as they said they would.
If you were me would you even bother to contact anyone of them again to try to get answers about the MRI costs?
I looked up sites on the internet to see if there were more reliable organizations that could in a reasonable time provide me with answers to my inquirys. You might not agree with me and that is OK but these agencys promised me it would be looked into and I would be informed of the outcome. Possibly it takes more than three years for them to investigate. Maybe it was a clericle error, but the hospital won't talk to me about it in my dads case. I will not ask them to look into my Mom's billing. I just wanted to know if some organization was out there that could help and if anyone of you on this site knew and could recommend them.
There is nothing in this for me. Secure Horizons, Medicare AARP all say if you think there is a problem contact us and it will be looked into and you will updated about progress. Three years and no contact whatsoever.
You did say something about facts and figures I did keep my fathers admittance and discharge papers so I do have dates and times somewhere, but since he died and the amount of time that has gone by I have lost my interest in my Dads case anymore.My Mothers is a different story. I would just like to know,BMC99

[JudyKayTee]

I appreciate that you took the time and energy to respond at lengthy - and well.

I do understand your frustration.

My story? My husband was a dialysis patient. His health insurance company does not send paperwork to the insured BUT I subpoenaed his hospital records and got copies of the bills.

He was billed for dialysis on Wednesday.

He died the day before, Tuesday.

I notified his carrier. I never heard a word.

So, yes, I understand.

Have you tried your State Attorney General?

[LearningAsIGo]

This was very long-winded so I admit that I only read about 75% before posting my own response. I have to reiterate what Chuck has said. (For the record, I've worked in health care administration for 15 years)

Medicare/Medicaid IS the government program that mandates what is legally billed to each patient for every procedure and drug out there. "They" decide what each procedure (MRI, etc) is worth, therefore what can be billed and what percentage is the responsibility of each patient. As such, private insurance companies follow suit. Medicaid sets the standard. Part of that is based on the number of people nationally dependent on government health care. Part of it is based on lawsuits. Part is based on innovation and new technology. The exact formula and reasoning is not made totally public to any one outside their system.

As pointed out, lawsuits are a big reason behind the issue. Though legislation is developing and passing to limit medical lawsuits, that "fear of God" has been put into the hearts and minds of the healthcare system and insurance companies will still act in such a way to protect themselves in the long run. Not to mention the fact that MRI's are entirely different from X-rays. They are much more accurate and cannot accurately be compared to simple X-rays. Some conditions can not be diagnosed with x-rays and some patients cannot tolerate x-rays (radiation levels), etc. While it may be true that in your mother's case she could have had x-rays first, the simple truth to "the system" is that a patient (and family) are legally responsible to be their own advocate. Personally, I was given an order for a scan, but I insisted upon an X-ray first. Luckily, it was determined after the x-ray I didn't need to have further tests. I can understand your frustration, but the medical community is taught to do the best and be the most efficient they possibly can. Most are almost completely clueless toward the billing system and the monetary value of any procedure or J-code, not to mention what each patient's responsibility per their individual insurance would be.

The doctor who wrote the order for your mother to get the MRI would not see revenue for ordering the more expensive test, so there is no monetary gain for him to have done so. Only the facility who performed it would see the revenue from performing such a test.

Before each procedure (excluding emergencies) it is technically up to the patient or their advocate to determine what is covered by insurance and decide if they will consent to what is recommended.

All that said, Obama Care will change the landscape of healthcare as we know it, but this is the current situation we find ourselves in.

As to who is best to hear your complaint? Your politicians and heads-of-state. Government is the organization that sets the "standards" of operation, so they should know what you experienced. Unfortunately, Medicare is one of the hardest to get a response from, so I doubt you'll make much headway there. We employee 4 people just to deal with Medicare claims in this office and they sometimes spend hours on hold dealing with one case. When you do call, don't wait 6 weeks like they might recommend. Call weekly. Get names. Put the pressure on them the best you can, but always be as sweet as honey. For those answering the phones, you're just one more voice in the thousands of angry people they hear from daily. Trust me when I say in these situations, they will respond much quicker to a nice voice on the other end of the line.

[bmc99]

To LearningAsIiGo- thank you for your post. While I started to ask a question I guess I let my emotions go at the time and sounded cluless and mad at a system. I am aware of how the system works as I have been entrenched in it for 35 years stemming from an accident I had and an eager chief resident trying to impress is boss. His surgical error gave me a lifetime disability. I learned to live with it. But as I got older and had to deal with my elderly parents problems. I have never known a life with no health care. I know malpractice suits legitimate or frivolous have driven costs to the moon but the billing for services not rendered or double billing has escalated too. When I pointed specific instances out to agencys that basically said we are here to help they did nothing. In the case of my dad I pursued it for 9 months and received no response. He died a year later from old age complications not from anything the hospital did . I let go of it. The latest incident with my Mom just resurfaced my frustrations. As it turned out after calling the hospital billing office it turned out it was not an MRI they gave my mother but a cat scan. However the girl said they three procedures each one a separate billing and that's why it added up to $9000 + dollars or 90% of the total bill.
My mother is 94, which may have had something to do with it but she is not aware of a patients right to refuse. The out of pocket expenses to us are three decimal points removed from the total cost. I guess what bothers me is the agencys of the insurance and Government who tell us to let them know if you think there is a problem they will check it out, you fill out forms send them in and you never hear from them again. Even if you call " your case is pending". And the costs just keep rising. I have never been married and have no children so things can get really much worse before I see any direct problems for me. But I have friends without insurance because of cost, and with their grown children now entering society I can't help wondering how they will ever afford the costs they will incur. Obamacare is a step in the right direction. I hear people saying it is socialist and costly and bad for the country. Time may prove them right. But of the presidents that have tried before at least he succeeded I have no illusions it will be a beacon of light in a dark sky but they may be able to adjust it over time so it can be worked with. I believe in the 21st century in the richest country in the world health care should be a right and not just for those that can afford it. I am sure my disability is my reason for that Had I not been fortunate enough to have coverage all these years since my accident ,the debt, the depression and the never ending pain would have made me eat a bullit a very long time ago. An option I wish on no one. The president gave a good speech tonight.Trouble is I have heard great speeches from a lot of presidents and the one inevitability of this country is it is slow to change, and the only time the Government partys work togeher is usually after a great many deaths. Hope your not asleep from reading this. I appreciate all who replied weather I agreed with them or not. I am going to out of town for awhile so I will not be pursuing this anymore. My mom is fine and in the end that is what matters most to me. I wish all of you the best. Sincerely BMC99

[bmc99]

I appreciate that you took the time and energy to respond at lengthy - and well.

I do understand your frustration.

My story? My husband was a dialysis patient. His health insurance company does not send paperwork to the insured BUT I subpoenaed his hospital records and got copies of the bills.

He was billed for dialysis on Wednesday.

He died the day before, Tuesday.

I notified his carrier. I never heard a word.

So, yes, I understand.

Have you tried your State Attorney General?

Judy thank you for the reply and my deepest condolences for the lose of a loved one. I replied to you today but as is my luck hit the wrong key and my reply to you is floating in cyberspace somewhere and I could never recover it. Tried again tonight but just kept missing somethng and could not send it to you. I replied to LearnAsIGo's post and it is pretty much what I was going to send you. If I actually got it onto the sight you can read it. The one thing I did say but is not on there Is Don Quixote is tired of tilting at windmills I will be out of town for a while and will not be on this sight for the foreseeable future. When all is said and done , my Mom is fine and that is what matters the most.. I wish I could meet you in person sometime. I would welcome a stimulating intellectual conversation with you not as equals because I believe you are somewhat more learned than myself. But as I look like a cross between a Biker and a Bear you might not want me shedding on your rugs, LOL Take care, BMC99
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