Wednesday, May 10, 2017

Battling with doctors again


It looks (and feels) like I'm having a recurrence of my kidney stone problems.  Trouble is, the local doctor is dragging his feet.  He tells me my kidney stone (the existence of which has been confirmed by CAT scan) should not be hurting, because it's not in a position where it can block any drainage channel from the kidney.  However, when asked what it is that's doubling me over in pain sometimes, he can't suggest any other answer.  Neither can extensive online research, talking about it with other medical people of my acquaintance, etc.  Next thing you know, he'll tell me I'm imagining the pain!

I'm getting very fed up with the cover-our-asses-at-all-costs approach of the US medical profession in general.  No-one seems willing to provide a clear, categorical answer.  It's always hedged about with "but this..." or "perhaps that..." or "on the other hand..."  I suppose it's the fear of being sued for malpractice that does it, but it's intensely frustrating when you're hurting badly and wanting a solution.  Where does one go for a plain, unambiguous explanation?

I'm also beginning to think that medical tourism might become more and more an option for any expensive procedure, because the cost of getting to another country is more than offset by the much lower prices for procedures there.  (For example, the local list price for the latest CAT scan, with and without contrast dye, that I underwent yesterday, was over $6,000.  The insurance price was lower, of course, and I paid 15% of the reduced price, but I was still out of pocket to the tune of several hundred dollars.  For the list price, Miss D. and I could both fly to Japan, have the scan done there, spend a weekend in a decent hotel, indulge in some shopping, eat at good restaurants, and fly home again - and still have money in the bank!)  The US medical industry is slowly but surely pricing itself out of reach of even those with insurance.  It's frightening.

Peter

22 comments:

Old NFO said...

Those prices ARE truly outrageous! Sigh... Get better Peter!

Roger said...

US healthcare is so expensive to cover all the Lawyers beach homes and for all the folks that don't pay.

Anonymous said...

Recently had a conversation with independent provider of various scanning procedures - CAT scan is $300 cashier protocol with discount for multiple protocols in one session.

Suz said...

Tell your doc you are looking for straight answers, not a bunch of mumbo-jumbo, and you are not lawsuit happy. Grumpy/Cranky with pain, sure, frustrated cause this keeps coming back...yup, not calling up a lawyer on speed dial. Tell him you need him to speak in English, not medical-ease. Use those exact words.

Take along your wife as 2 sets of ears hear twice as much, and can ask the appropriate questions.

One question should be what can you do to prevent these from coming back. They can do an analysis of the stone/sludge/whatever so you know what it is made of, and what you need to avoid to prevent reoccurrences. And drink LOTS of water. Walk around with a water bottle attached to your hand.

Jon said...

https://surgerycenterok.com/ may be the wave of the future. Note that those prices (say for a hernia repair of $3060) includes EVERYTHING.

Fees for the surgeon, anesthesiologist and facility are all included in one low price. There are no hidden costs, charges or surprises.

Well Seasoned Fool said...

Sometime talk to the back room person doing billing about the Byzantine world of insurance company requirements. One suspects the over complicated procedures are designed to deny claims. Plus, each insurance company has their own protocol.

Forget single payer. Focus on a single billing system and watch costs go down. IMO

taminator013 said...

Hope you get it figured out soon. I know what that pain is like. I had the same problem for years. The best tip about prevention that I got was from a doctor after my one and only trip to the ER. He said to drink a lot of lemonade or limeade. Lime is supposed to be the better of the two, but I don't care for the taste of straight limeade. What I make is 67/33 lemon/lime. After suffering for decades I haven't had one in the last five years since I started swilling that stuff. Hope this helps..............

Unknown said...

This fiction of a list price is the real reason why we have a health care problem in the US

nobody with insurance pays the list price, even if they have a $6000 deductible to meet first, they instead pay the 'discount' price negotiated by the insurance company

and since the insurance company negotiators want to look good about how much money they have saved, and the doctors want the negotiators to be happy, the 'list price' keeps ratcheting up so that the 'discount percentage' also increases and the negotiators can be get good reviews and consumers are happy at how much money they 'save'

I've been saying for years that if I could pay the same amounts that the insurance companies pay, I would not need insurance except for a catastrophic coverage policy (say $10K deductible or something like that), especially when coupled with a HSA so that I can pay with pre-tax dollars.

I am out of work right now and paying >$500/month for a pretty useless policy. If I could bank the money and pay the insurance rates, I would only need a policy to cover major things (accidents, etc)

David Lang

Will said...

The major reason that small clinics exist, and you seldom see a single doctor office, is the high cost of the paper shuffling needed for dealing with insurance. That back office can have as many workers as there are medical types. Spreading that cost makes it practical for a doctor to deal with insurance billing. It's not the only reason, of course.

Kristophr said...

Talk to the folks at Bumrungrad Hospital in Bangkok.

They specialize in medical tourists. Top quality care and cheap.

John Cunningham said...

Karl Denninger at www.market-ticker.org has great essays on the foulups in our medical system.

Phillip said...

Well, as one of those professionals you seem to be unhappy with, allow me the latitude for some commentary. Are you seeing a reputable urologist, or a primary care provider? If not with an experienced urologist, find one. Make sure you don't have a reversible cause of stones, like drinking too much tea, hyperparathyroidism or other metabolic syndromes. Maybe it's time for a second opinion. The legal climate is really not a reason to forego providing appropriate care.
The system of billing and reimbursement we are burdened with is largely a result of, in my opinion, two major factors. The first is government. All payors tee off as a percentage of Medicare reimbursement, some higher, others actually lower. The system of allowable charges and reimbursement as a percentage of the allowable creates a perverse rate schedule in reaction to what is "allowed". Some private payors, though increasingly uncommon, reimburse as a percentage of "usual and customary" charges, which incentivizes raising charges to what the market will bear. Contractual write-offs in individual contracts with payors vary from practice to practice, location to location, and payor to payor. Time to payment can range from 30 days to 60 days or more. It's absolutely byzantine.
Your doctor is likely less fearful of medicolegal consequences than he is simply overwhelmed. With electronic records, prior authorizations, home health forms, continuing education and recertification requirements, returning calls, rounds....it's endless. Without making excuses or rationalizing, getting him to focus long enough on deciphering your problem may get increasingly difficult. You are your own best advocate. Medical tourism sounds great, until you have a complication and need followup or, more significantly, accountability.
Unless you plan to abandon your insurance policy, the only way to make a bargain with a provider, whether for care or testing, is to go all in for cash, and unless your deductible is astronomical or you are using an HSA,your cash price will likely not be much more favorable than your copayment and will not apply to your deductible.
I wish my profession, and healthcare, were market-based. It would solve a lot of problems, because the current system is contrived, artificial and dysfunctional.

Phillip said...

Aaah, the second factor: patient expectations. That one is fairly self-explanatory.

Dan said...

I remember discussing g costs with an MD. Am ER MD and professor at UC Davis (CA) Medical Center a good 15 or more years ago. He told me at that time that the ER
collected only 12 cents of EVERY DOLLAR they billed....and had to write off the balance.
WHY? Because the vast majority of their patients DO NOT PAY. WHY? Because of the
law called The Emergency Treatment and Labor Act. Which means any hospital turning away a patient in need of immediate care for lack of funds WILL BE PUNISHED. This opened the floodgates and EVERY ER IN AMERICA LOSES MONEY because people use R as a private doctor they don't have to pay for. And that means to keep the doors open EVERY hospital must pass those costs along to those who DO pay. Add in the fact that shysters are always looking for a payday and costs for those who PAY are ridiculous. Don't blame hospitals and healthcare for doing what is required to keep the doors open. Blame politics and the legal system.

Unknown said...

@dan

Yep, that's why every hospital with an ER recorded record profits once obamacare went into place, they were able to bill medicare for a lot of the patients that they would have otherwise had to treat for free.

I am automatically skeptical of any "X cents on the dollar" claims, both because they tend to be based on the highly inflated 'list prices' I mentioned above, but also because I've personally been in a situation where I was slowly paying off a hospital bill, and they ended up turning it over to a collection agency who ended up demanding higher payments or else, and the result was that they would no longer accept the payments I could afford and collected nothing further on the account.

David Lang

Anonymous said...

Yes sir, that. "Optimized Health Care" cost is becoming completely ridiculous. I'm sure its the cost of legal litigation, as well as the number of office personnel that deal with the insurance companies that is behind it.

Borepatch said...

+500 to Suz' comment.

wheels said...

Several years ago, I had to let a broken ankle heal the old-fashioned way - put a cast on it and wait. It's never been the same since.

The specialist I was seeing wanted to put pins in it and reposition the bones properly (the bones being slightly out of position is my ongoing problem with the ankle), but I couldn't afford it. At the time, I had no medical insurance. The doctor was going to charge $600 for his work during the operation, and the anesthesiologist would have been about the same or a little more, as I recall. The hospital, though, was going to charge $17k-$22k for the use of the operating room, and that's with a 40% discount for not using insurance.

0007 said...

True story.
Before my wife passed away, she spent two weeks in the hospital,(and one week in Hospice) moving between ICU and CCU. 24 doctors worked on her case(only on her last day there did one of the late-comers figure out what was wrong with her - too late).
Long story short, the hospital bill for her TWO WEEKS was $378,000 + doctors. I got/saw all the bills. Medicare had paid a bit of it, and my private insurance had paid ~$31K. I paid the difference of the insurance allowable to the various doctors. This ranged from $54.00 to ~$650. Not saying she didn't get excellent care, just saying I 'spect if she wasn't white and insured the billing would have been a bit different.

Anonymous said...

ok,
I've read about 20 blogs a day for years and have never commented...until now. This writing should have gotten answers about your problem - the pain from the stones. Instead you got 19 responses and only one actually addressed your real problem. A kidney stone's (calcium) enemy is citric acid. The one writer who actually offered good advice was the lemon/lime comment. Okay, so what? Go to walmart and get some powdered gatorade and citric acid (canning). Get a few quart sized lemon/lime gatorades (the bottles are indestructable). Add a 1/4 tsp of citric acid to the gatorade and pound the whole bottle. Don't care if you're not thirsty. Do it again later in the day. Remember that if the stone is shaped like a pickup jack, it's gonna hurt like hell and can cause bleeding. When you have empty bottles, now make your own stronger gatorade while still adding as much citric acid as you can stand. No downside and cheap.....and anytime you feel that pain in your right side back.....reach for the gatorade! Good luck!

Peter B said...

Here's an interesting link discussing vitamins A and D, and kidney stones. And the citric acid thing is good - if you have oxalate stones.

For more info, see Murray and Pizzorno's Encyclopedia of Natural Medicine. They also suggest (for oxalate stones) magnesium citrate (to bowel tolerance) and probably better add yet some potassium citrate to the mix. Magnesium and potassium citrate are cheap.


I realize I'm talking to an author, but you can get most of the relevant content if you go to Look Inside, select Print Edition and search for "kidney stone." I'm just sayin'.

Brigid said...

I got lifeflighted once when the time of ground transport would have been death. The insurance tried to bill me $15,000 as I didn't pick a transport service "in network". I was like "they had to resuscitate me, I wasn't in a position to start calling around!"