Why a patient paid a $285 copay for a $40 drug


WellRithms reviewed Calver’s bill in detail at the request of Kaiser Health News and determined that a reasonable reimbursement would have been $26,985. That’s less than half what Aetna paid.

Healthcare Bluebook, which offers cost estimates for medical tests and treatments, arrived at a similar conclusion. It said a fair price for a hospitalization in Austin involving four heart stents would be about $36,800. St. David’s Medical Center charged four times that amount.

Hospitals should not be allowed to rob patients while they are fighting for their lives. Just like insurance companies should not be allowed to charge copay 7 times what a drug costs. That these kinds of highway robberies are still allowed today is sickening.


It’s the cost of people without insurance abusing the ER room. I thought any good policy has an out-of-pocket max for the year. Every policy I’ve had has one.


Out of policy max doesn’t protect you from balance billing because that’s the healthcare provider holding you responsible for money outside the insurance contract. This is a loophole and should be closed.


WaPo picked up the story. No, it has nothing to do with “abusing” ER’s. The guy had a heart attack. That’s exactly what ER’s are meant to be used.

Our health care system is corrupt.


How do you think the hospital covers the bills of peoole it’s forced to treat that don’t pay? They know what the rate of non-collection is and factor it into the price of all services.


How do all the other hospitals cover their bills? What’s so special about St David it has to charge 4x the normal?


It all depends on their rate of people that don’t pay. It’s different for every hospital. I’ve known people that work at hospitals where less than 20% of patients have insurance or pay a bill. They get most of their finding from the state and by charging the few with insurance a lot.


there must be a dataset somewhere to figure all this out at the national level :confused:


But, if we continue to have a conversation where an individual here is always deflecting the moral issue to a boring conversation, we won’t get anywhere. Amoral people never see anything wrong with their fellow amoral people. The end.


you just made the argument for universal healthcare :slight_smile:
It’s going to be paid for anyway (somehow). Why don’t we just formalize it so you can rid the system of inefficiency


he’s not a commie that’s why :stuck_out_tongue: he’d just let the uninsured go sick. if people can’t plan for their own emergencies, maybe they should die.


Universal healthcare will undoubtedly be worse for a pretty large percent of people. I’m completely against forcing people into a system that’s worse. Even countries with universal care are starting to see more and more people opt-in and pay for private care. To me, it’s idiotic that we’d want to go to universal care when countries with it are moving more towards out model.

Also, just look at the UK where anyone that’s a smoker or obese is denied surgery. Even in our country Medicaid and Medicare reject claims at 2x the rate of private insurance. People assume universal care means nothing would be rejected. Odds are even more would be rejected than with private care. Then there’s the issue of wait times for care. Canada publishes theirs. They are horrible.

We could have put everyone without insurance on medicaid for far cheaper then the Obamacare bill. That way everyone is covered, but people still have the option to buy a private plan.


I actually think that is a great idea. Provide a base line plan that covers everyone and gets a lot of cost out of the system by providing preventive care (medicaid does that). and let people buy in to higher levels of service with private insurance.

The current system is not tenable. We are bearing all the costs in a very inefficient mechanism. We need some baseline coverage. And a barebones medicaid for all makes a lot of sense.


The other thing we need is a mechanism to encourage people to live healthier. Our obesity rates are far higher than other countries. Our rates of chronic illnesses are 2-4x higher than other countries. Just the preventable percent of chronic illness is driving 40% of the spending. That’s insane. All of the healthcare debate centers on who’s going to pay the bill. We never focus on the consumption side.


That’s the effect rather than the cause of our broken healthcare system. If the only healthcare people can get is the ER how can they get healthy?

What’s your plan to cure obesity? Ban soft drinks? Mandatory exercises? Have a “weight tax”?


how did smoking go down in the us?


Crazy high taxes and lots and lots of education. Kids are programmed in schools to go ewww on cigarettes.


I don’t drink any soft drinks at all. I am for putting a 500% tax on it. See if anyone still like coke enough to pay 5 bucks for a can. :smiling_imp:


i don’t believe coke is the only reason for unhealthy stuff. lack of exercise is also significant…


Coke tax + weight tax = winning.

$10K tax for every BMI above obesity level. Tax them til they die off naturally.