I live in Orange County, CA, and I had a multilevel lumbar fusion with pedicle screw fixation in January, at a hospital that closed (I was the last patient out). It is being sold and renovated. I was in the hospital for 5 days and the acute rehab hospital for 5 days. Here's the breakdown:
Pre-op chest x-ray: $15.00 - Insurance paid $12.85 as agreed by participating provider.
Hospital bill: $308,386.41. That's $61,000.00 per day. For that amount I would have expected gourmet food, belly dancers and massage, with a personal nurse to assist me at all times. But I digress. Insurance paid $40,485.54 as the maximum allowed as agreed by the participating provider. My portion is $3,014.45. So, what's in it for the hospital to create this massive bill, of which $265K is not going to be paid? Tax write off? Do they show it as a loss on the books or something?
Surgeon bill: $28,902.00. Insurance paid $6,438.82 as the maximum allowed as agreed by the participating provider. My portion was $0.00. So what does the surgeon do with the uncollectible $22K? Is it just another made-up loss that he can also write off his income tax?
Anesthesia: $3,690.00. Insurance paid $368.34 - my portion, including a $500.00 deductible applied to this bill, was $859.46. $1,100.00 seems like a pittance for the guy keeping me sedated but alive. Hell, I know hookers and drug dealers and other criminals who make more than that.
Rehab hospital: $6,862.95. Insurance paid $4,830.00 as the maximum allowed as agreed by the participating provider. That's a pretty good take for my semi-private room, three square meals a day, and daily PT and OT assistance. I became independent in walking with my walker and in taking a shower by myself there. (It was really my elderly mother who gave me all the assistance - where's her cut?).
A few doctors at the rehab charged a few hundred bucks each, for taking almost 4 days to get my pain controlled. If a nurse had not just come back from a training seminar about uncontrolled pain, I might still be lying there writing.
Bone Growth Stimulator: $5,890.00, for a little plastic gadget with two batteries and a charger and a few hundred electrode pads. Insurance paid $2,172.70 as the max allowed for this service.
I will have a long period of rehab and PT on an outpatient basis, and will soon spend my annual out-of-pocket max of $5,000.00, after which everything will be paid at 100%. This does not reflect pharmacy costs, which are a separate animal. $15.00 to $25.00 per bottle of pills is the usual for my policy, although there have been exceptions - $56.00 for some lidocaine patches and $118.00 for another scrip.
So, it is clear that somebody is cooking the books, and it is clear that someone is profiting from this mess. Who is it? What is really going on? Although I did have a rather radical 5-hour procedure, it sure as hell does not warrant a $308K hospital bill, especially in a hospital that was closing and that had non-skilled nurses in the ortho wing (who actually hurt me in a lifting incident, I might add). My employer pays the premium and I have no idea what the monthly premium is.
Help me understand WTF is going on here.