Central Florida Regional Hospital

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Unfair hospital billing for the uninsured
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SANFORD, FLORIDA -- Permit me to introduce myself. I am a 57-year-old male with a heart condition. 13 years ago I had a triple bypass. I have recently had two procedures done at Central Florida regional Hospital, Sanford Florida. Inasmuch as I have a pre-existing illness. I am uninsurable therefore, I am self-insured as a self-insured person. I am asking the hospital for the same pricing and courtesy. They would extend to any other insurance company.

This of course will reduce my bill by thousands of dollars. More importantly, should I succeed in my quest. It will open the door for other uninsured individuals to receive the same pricing, as shall we say Blue Cross and Blue Shield or United Healthcare, or better yet, Medicaid. Medicaid is state funded health insurance, why should we the people, which obviously have less money than any of our good states; paying more for medical procedures at the hospital than your state. I propose that medical billing for hospital and doctor procedures to uninsured individuals be at the Medicaid rates. Large insurance companies have had their thumb on the working-class people for decades. They lobby in Washington to suppress national healthcare. Therefore, national healthcare will never be viable, at least in my lifetime. However, with a little help from the people, we may be able to open a new avenue for the middle and poor classes an avenue of self-insured. A method by which our hospitals would be obligated to charge the same pricing as they would an insurance company or Medicaid, example, I was charged for one of my procedures $21,495.25 for a self-paid person Blue Cross and Blue Shield would pay the hospital. A meager $3,166.00, United Healthcare would pay only $3,500.00 Medicaid would have paid approximately $2,149.53. You must agree the people who are least likely to be able to pay a $22,000 bill would be the middle to poor classes you and me. Yet we are charged enormous fees. Ask yourself why; my guess, the enormous tax write-offs. I ask you to help me fight the hospitals the large for-profit as well as the not-for-profit corporations to obtain better health care at affordable pricing for all uninsured Americans. My proposal is this. I personally am willing to assist any and all Americans that have been charged enormous medical bills from any hospital to contact me with their billing procedure codes. I will be processed the codes determine the correct Medicaid billing price, write the appropriate negotiation letter to which ever hospital it may be and suggests that we be charged Medicaid pricing. The more people involved in this procedure. The sooner we Shall prevail.
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chemman on 11/29/2006:
I couldn't agree more. I fortunately have never been in your position, but I have always felt that the whole healthcare system in the country is very messed up. I do not understand why hospitals allow Medicare and giant insurance companies to negotiate lower rates (I know the reason is the bulk business and possibly some shadier reasons, like kickbacks), but feel it ridiculous to make the individuals pay through the nose, since they can least afford it. I applaude you for trying to do something about it. An organization should be formed, with minimal fees (say $50 a year to cover costs) that would group all uninsured people together so they could use their collective bargining power to gain access to lower cost medical treatment. I would be willing to volunteer my services if anyone can come up with a feasible way of doing this!
Nohandle on 11/29/2006:

Billthis, I enjoyed your review. Many times I've wondered the same thing. Why the large difference in payment expected from those with no insurance?

My company provides and pays the Blue Cross premiums in full for the Health Insurance to the tune of over $425.00 per month per employee, single coverage. The only option we don't have is dental coverage and when I wrote a check several months ago for $1200.00 for some dental work knew other patients with dental coverage had no problem. The dentist was accepting the check from the insurance company for probably $400.00 as payment in full for the same procedure.

I, in no manner, endorse socialized medicine. I also don't believe it is the employer or government's responsibility to provide me with healthcare. I DO support what you have stated in expecting the same charges applied to all. The truly poor have healthcare provided for them at no charge. As usual, it's the middle class being stuck with the bill.

You have your numbers right in front of you and I don't. I had surgery approx 3 years ago and the hospital bill was some outlandish sum for outpatient surgery...something like $14,000. The hospital accepted as payment in full some 1/4 of those charges from Blue Cross. I remember thinking at the time that wasn't fair. Understand I didn't want to pay anything other than the $100.00 for outpatient surgery but clearly recall wondering what those without insurance were to do. Pay the bill in full, I suppose, or have their home taken from them if that's their only option to come up with some funds.

I've gathered from your post you don't expect any free lunch from anyone..least of all the taxpayers, only fair treatment for all. I truly wish you luck in what you are trying to accomplish.
billthis on 11/29/2006:
Chemman, I'd like to thank you for your support you most FLA have the correct approach and the right ideas. This is the main purpose of my publication. With comments as yours perhaps we can rally the uninsured Americans to stand up and be counted once we have established an enough people that are tryed of being financially abused. We can then perform the organization you suggested. In fact I already have the plans all I need is the people. Again thank you for volunteering and don't be surprised if I ask.

Bill This
billthis on 11/29/2006:
Nohandle, I like to thank you for your comment and the like to give you some food for thought. Your health insurance payment is $425 a month, do you have a 401(k)? If so let's do a little math, what if used making your health insurance premiums. Instead you pager $425 a month into your 401(k) on your side that would be $5,100 a year remember your employer matches your amount giving you $10,200 a year or $102,000 a decade. I do not know what each is, but with the help of the American people I can get my concept moving forward and you followed my 401(k) plan please calculate your retirement. Now let's consider you had a hospital stay and the Medicaid pricing for that stay was $4500 how much would it hurt you to withdraw $4500 from your 401(k) pay your hospital bill in full and continue your retirement plan. This is my ultimate goal today's publishing is the beginning of what is yet to come.

Bill This
Slimjim on 11/29/2006:
Couldn't agree more also. If an insurance company will only pay "x" for a procedure, can't we assume that it is a fair price since the doctor/hospital accept it? Why can't patients with cash get that price instead of being soaked?
Nohandle on 11/29/2006:
Billthis, thanks for your response. Remember, I am NOT paying for my insurance, my employer is. You have some really good points and my reply to you was in support of those with no insurance and expected to pay the full cost rather than the prices afforded the insurance companies and Uncle Sam. The uninsured should be provided the same courtesy. That was all I wanted to add.
David on 11/30/2006:
I don't think it matters what they bill you if they can't collect it. Perhaps showing a larger loss or write-off provides them some tax advantages. Have you offered to pay them cash at the insurance negotiated rate to settle the debt? I have heard stories of this working. Nothing first hand, but what is the worst they could do?
billthis on 11/30/2006:
David, thank you so much for your comment, your question or
billthis on 11/30/2006:
David, thank you so much for your
billthis on 11/30/2006:
David, thank you so much for your co
billthis on 11/30/2006:
David, thank you so much for your comment. It does matter what they bill you they know they cannot collect any use it for usage tax write-offs. There is one huge problem with this, they make enormous amounts of money and you and I wind up with a bad credit rating. Isn't life tough enough without having a medical issue and be rewarded by the hospital with a bad credit rating for not paying a bill they knew you couldn't afford to pay in the beginning. Yes I have offered to pay the bill at the insurance negotiated rate. Had they accepted that we would not be talking now. Offering to pay the insurance negotiated rate is what brought me to the realization that the hospitals do not want to pay your bill as a self-pay. If they did they would price it realistically. People of America that are uninsured and need to stop being the scapegoat for big business. I hope this answers your question I invite more like perhaps questions as these will bring the uninsured to an eye opening experience.
chemman on 11/30/2006:
Billthis, by all means please feel free to contact me if you think I can help. You can email me by clicking on my user name and going to my profile, there is a link there to contact me. Affordable health care is something I feel strongly about. It is a very complex issue and there is no one best way to handle it but I think your approach is a very good one. Best of luck to you nad I hope to hear from you in the future so we can move this issue forward!
Noneill on 11/30/2006:
I guess I am the only one with this point of view. I have been a medical insurance biller for 25 years for various doctors, hospitals, pharmacies, etc. The reason medical providers agree to accept a lower fee for medicaid and insurance companies is volume and fast payment. An average payment for a claim in general runs about 45 days from the time the claim is filed. That means no continuous monthly statements, and no losing it all when it has to go to collections. Uninsured individuals are not reliable payers. So they in fact are costing the medical providers the most. So given that point of view, you still think they should be given a discount? As a rule I would say no, however, I do believe that each patient should be given individual consideration. If they are open and honest about their ability to pay off a debt, I was always willing to put them on an affordable payment plan. A discount was offered only after the balance was brought down to a certain amount. A lot of patients wanted the discount given even before their first payment but that (in my experience) never worked. We would give the discount, then we never saw a dime afterward. We ended up putting the credit back onto the account and off it would go to collections. I don't know how things work in Floride, but in California if you cannot afford health insurance and you have to go to a hospital, you can always go to a County hospital. They bill on a sliding scale, and if you are truly indigent and can prove it, the bill is written off in full. In Virginia there are non-profit hospitals that will also reduce a bill after proof of income is determined. So help is available. And if you do not qualify for help, ask yourself how much is your health/life worth?
Nohandle on 11/30/2006:
Noneill, very interesting addition and most informative from another viewpoint.

Speaking for myself only, when a patient expected the same price charged him as the insurance company it was with the assumption the bill would be settled at that time. Negotiating the price and then monthly payments to the hospital sometimes over a period of many years, was not what I had in mind. We all realize the cost involved in carrying accounts on the books.

My question to you, with years in the business, if a patient had made his own prior arrangements and was able to take care of the bill at time of discharge or shortly thereafter...would a hospital then be willing to accept the same rate of payment as from an insurance company?
billthis on 11/30/2006:
Noneill, thank you for your input, you are correct hospitals negotiate contracts with the insurance companies for volume. I have a question how many millions of uninsured Americans are out there, what is the number of that volume. You mentioned indigence that's not what this post is all about. I am not indigent I am not able to get insurance to cover my heart condition. I am quite certain that there is a vast number of well intended people in my situation, I also must agree with you that there is a certain percentage of people that will never pay their bill, again these are not the folks I am referring to. I mentioned Medicaid inasmuch is that is the amount the states are willing to pay why should any individual pay more than their given state. Nohandle, is correct the basis of this post is that a Bill shall be paid within the same time. As an insurance company or the state would pay. The outlandish amounts that are charged to individuals is appalling. How much more money do you think the hospitals would gain if they priced everyone at fair pricing, I think their collection factor would be less than 2%. However inasmuch as I believe they want high collections for enormous tax write-offs and then their kind enough to give those individuals that they charge outlandish pricing bad credit how fair is that.

Bill this
chemman on 12/01/2006:
Noneill, I agree with the others, our discussion here involves the people who would be willing/able to pay the bill in a timely manner. I for one would be happy to pay $3100 for a medical procedure within 45 days of service if the alternative was $21,000 over a period of 5 to 6 years. That's a heck of a lot of interst to pay for spreading out the payments. What is wrong with the scenario you stated, give the patient the discounted insurance price with the understanding that it is to be paid off in 45 days, otherwise the bill will adjusted back to the nondiscounted price and billed to the customer (although I still think the discrepacies between what an insurance company pays and an individual pays is outrageous). It couldn't create that much more work, items are rebilled all the time to insurance comapnies and they don't get stuck with ridiculous bills. My current doctor just resent my billing to my insurance for the 4th time for some office visits (which are clearly covered by my policy) that occurred 18 months ago, so should the insurance company be forced to pay $3500 (which are normally $150)for those office visits since they didn't pay right away?
MikeJones on 12/07/2006:
While I think we all can agree that our health care system is broken, there are several statements here that are not correct. I am a CFO at a small rural hospital. In that role, it is my responsibility to manage all of the hospital's finances and negotiate insurance contracts. But, before you jump to conclusions, I too have been uninsured during my adult life. I see daily the outrageous number of uninsured and underinsured individuals in this country. However, hospitals are not rolling in the money. I see, read and hear about hospitals having to close their doors daily. That scares me for all of the individuals who will have an even more difficult time getting needed health care. In addition, the state of our current health care system is not the fault of hospitals. All hospital functions (from finances to most operations) are regulated by various federal governmental agencies. In addition, if you take a small hospital, such as mine, trying to negotiate with a monstrosity like Blue Cross or some of the other large insurance companies...there is not a lot of negotiating. They tell me what they will pay and I decide if the loss I'll take is worth the volume they will provide. And the government payors......they don't even sit at a table to talk to about it. You get a notice in the mail of what your rates will be. They are not going up...they are going down. So, billthis, I hate what you are going through. But, it seems as if you are blaming the hospital for the state of health care in our country. If it were up to the hospitals, insurance companies would pay for everything as they did 25 years ago and they would never have to bill a patient or send them to a collection agency. I truly wish you best and hope that you can make a difference in this country...but, in my opinion, targeting one hospital will not do it. Good luck!
billthis on 12/08/2006:
Mike, thank you so much for your post, a wise man once said old battles must be given somewhere. I most certainly agree with you our healthcare system is broken. However it is well past time that we the people do something about it inasmuch as our government is not going to. The feds would rather sit back take their fat grafts from the insurance companies and let people suffer. Actually the hospitals should embrace my position, inasmuch as there is no negotiating with a large conglomerates Blue Cross Blue Shield United healthcare etc. my position is clear at this point no self-insured individual should have to pay more than the federal government or any of our 50 states would pay for any particular procedure at hospital. This would do a couple of things first people would have fair pricing, second people which are insurable. Paying medical premiums and put that money into their 401(k) and when they need procedures they simply remove the fair pricing from their 401(k) and pay their bill. In fact a small modification and in the existing 401(k) policy to allow for direct hospital billing and automatic pay from the 401(k) would be the direction I would take. That said you me and the hospitals of America although the hospitals do not realize it yet are on the same side they just need to wake up and smell reality.
MikeJones on 12/08/2006:
Billthis, I think the 401(k) plan is an excellent idea and could likely work. However, if hospitals only make Medicare/Medicaid rates for every service they provide, we will have no hospitals. At that point the government will be forced to step in to provide health care for Americans. Then, we have socialized medicine. And that does not really work either. The government has made health care so extremely complex. Therefore, I really believe it can only be corrected by the government (due to the regulations and constraints they have placed on hospitals). Our broken health care system is such a hot topic right now and our government is working very hard to hide the issues. If there is going to be change in this country, I do believe the time to make it happen is now. Best of luck!!
billthis on 12/08/2006:
Mike, you are trying to tell me that Medicare pricing is so low that the hospitals could not sustain themselves. Okay, let's discuss it what would be a fair price to pay? Blue Cross and Blue Shield for example in my area for a left heart catheterization pays $3166.00. Now if I'm not mistaken the balance of the Bill becomes a tax write off that being the case the hospitals in gain that financial advantage. At this moment for my plan to work at all I have to choose a price that we all know is fixed such as Medicare. Inasmuch as the insurance companies negotiate their own terms payment from one company can even be plus or minus from another company. When the hospitals decide to finally embrace my concept is nothing saying we can't sit down at the table and negotiate a price we can all live with. Don't ever plan on the government providing health care those good old boys in Washington are real fond of the pork. And truly how bad is socialized medicine? Remember this my goal is not to put the hospitals out of business my intention is to work with the hospitals and provide each and every American affordable pricing.
MikeJones on 12/08/2006:
billthis, Yes, that's exactly what I am saying. Hospitals lose money treating Medicare and Medicaid patients. However, most of them opt for the volume and hope to recover the lost revenue in another way. The contractual adjustments that are taken do not provide tax benefits for the hospital. The only true government benefit is called disproportionate share. The government knows that hospitals lose money on treating Medicare and Medicaid patients (more Medicaid). Therefore, if a particular hospital treats more Medicaid patients than the national average, they can provide reports, documentation, etc to receive additional funds (not a lot, mind you) for the increased loss it suffered. So, if your trying to get a hospital to agree to those rates, I can assure it will not happen. Managed care contracts typically are where a hospital can make a little profit. The larger market share the company has, the less it is willing to pay. Of course the number of health care facilities in the area also come into play. The more competition that is in the area, the less the insurance company needs to make a particular hospital happy. In those cases the hospital needs to have a contract with that particular insurer. They know this and use it to their benefit. As far as contracts, they vary greatly in rates and payment methods. Many contracts pay by diagnosis. We'll pay you $5000 to treat a patient who has hernia repair. Others pay % of charges (especially stop loss riders). These typically pay 60% of the hospital's charges for services over a certain dollar amount. Hope this helps.
billthis on 12/08/2006:
Mike, thank you for your input it does help and I really appreciate it. As I said this morning this effort requires a pricing platform to start, I have no problem with renegotiating dollar amounts with hospitals. It seems to be some backwoods thinking on the part of the hospital, you charge an uninsured patient retail and you may give them a small discount. The major problem that I see by trying to make big profits on the uninsured all you wind up doing is writing off the debt no one pays. With my concept coming to a reasonable price for all I would predict about 60% of total settles rather than 100% right off. Generally people have no problem paying a reasonable price for anything, I personally wouldn't mind paying Blue Cross Blue Shield price for my left heart catheterization which is $3166 I think that's reasonable. If the hospitals would stop having a severe case of tunneled vision and what I mean by that is we been doing it all these years this way why should we change. This is a large mistake, there is now and never has been a perfect system modification of the existing system is needed. As you and I have already agreed we cannot rely on Uncle Sam, why not rely on ourselves let's put our collective heads together and come up with a workable solution
MikeJones on 12/08/2006:
I really enjoyed talking about this with you. Even though I disagreed with some of the items you mentioned, I do believe you are on to something and the time to get attention is now. However, I would like to see you take this more globally. I will be checking back from time to time, so, if you have questions about hospital operations or finances, let me know. Best of luck!!
billthis on 12/09/2006:
Mike, globally, I'm open to suggestions I've always believed that when starting a new endeavor use your own backyard. You mentioned in one of your earlier posts that the insurance companies for the most part reimbursed 60% of the Bill. I'm afraid I have to disagree with that, allow me to give you an example CPT code 93510, left heart catheterization hospital retail charge $21,495 they say they are offering a discount of 40% bring it down to $12,897 however Blue Cross and Blue Shield PPC pays the hospital for this procedure $3166 in less my math is seriously wrong Blue Cross and Blue Shield is not anyway near 60% of the Bill shed little light on this would you Mike.
MikeJones on 12/11/2006:
I was talking about different types of contracts. The 60% I was referring to is typically a stop loss clause.
billthis on 12/14/2006:

Update: this bit of information going to get your real upset . Did you know that both the states and the federal government pay the hospitals for charity case? A charity case is considered an uninsured individuals. The state program is called (Disproportionate share program) some hospitals are reimbursed millions of dollars every quarter. There's an article published through the Federal Trade Commission entitled hospital compensation and charity care. This actually indicates the hospitals compete for uninsured business. This bit of information means that our state and federal government are a large problem they encourage the hospitals to take financial advantage of people as well as ruining the American public's credit.
disturbedconsumer on 01/08/2010:
They want to charge $20,000.00 for a pet scan! The average cost is around $5-$7,000.00. I have two family members who have had them elsewhere (two completely different hospitals in other states)and I know how much it cost their insurance companies, it certainly was not $20,000.00. As it is we were given what they call a discount of 40% for the hospital stay but still owe the hospital upwards of $40,000.00 -one bill being %400.00 for an in-patient doctors visit who came in the room for about 2 minutes asked a couple of questions and left never to be seen again. They have even been awful about telling us exactly what they're even looking for and why. Oh and did I mention they operated and removed an organ on my loved one unnecessarily on top of it? At least that surgeon was smart enough to give an insurance discount for that one but then he knew they had made a big error. I have several friends in the medical field who are hoping for reform themselves, they work in it and know how screwed up our healthcare system really is.
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