Old Strokey Brownlee Ponders HMO Billing Obfuscation

We raised the hue and cry for insurance horror stories. My mommy answered.

Not quite a horror story, per se, but good old Sally B. wondered why the bill for a brain-debilitating stroke was 2/3rds less than her bill for an upset stomach.

The HMO told my mother not to worry about it, that it wasn’t any of her concern, since it wasn’t coming out of her pocket. But oh, allow her to retort: what about rising premiums? “Trust us,” the HMO cooed.

I’m particularly proud of my mother’s closing money shot: “Then people and politicians talk about “rising costs” of medicine, and how healthcare is so high we will need to go into a national universal rationing system. As long as no one is checking the bills, little wonder.”

Full email after the jump.

This isn’t a horror story, per se, but I find it disturbing for a variety of reasons.

I’ve had 2 hospitalizations in the past 18 months, I have very good health insurance and I knew that it would cover whatever the costs were. In that I am extremely fortunate.

I spent 4 days hospitalized after having a stroke. Services ER, CAT, MRI, IV, standard Blood, etc). Hospital was a small local one, run by a “for profit” healthcare organization that is part of my BC/BS HMO Blue.

About 10 months later, I had a bout of such incredibly intense stomach pain that I went straight to the ER, different hospital but local and the same “for profit” healthcare organization. Services ER, CAT, IV, standard blood, etc. Only difference was a morphine drip in the IV. I was “released” about 30 hours after I had shown up at the ER. Went home with antibiotics, codeine, and a 6-week diet of Jell-O.

One bill was for $5,000. The other was for $14,000. Yes, the stroke cost less than the gastric problem. I saw the bills by happenstance, since they get sent straight to the HMO. But the HMO is on the web, and I saw a link to my account, and there were the bills. No itemized charges on either, just a listing on “Medical Services $300, Medical Services $219.75, Room Charge $???.??).

I called the HMO, said “look, how do you know that I actually incurred these charges?, It’s ridiculous that 4 days for a stroke costs $5K, and 30 hours for a gastric complaint is $14K”. They told me not to worry about it. I persisted, told them that the bill wasn’t even readable, even the codes for the services seemed to be the same. They told me it was a matter of “TRUST”.

Well TRUST be Damned, I know I’m not paying for it directly (except with my steadily rising premium), but this is stupid, and when you try to tell BC/BS that you think they are being scammed, they don’t seem to care. Then people and politicians talk about “rising costs” of medicine, and how healthcare is so high we will need to go into a national universal rationing system. As long as no one is checking the bills, little wonder.

sincerely,
either John’s Mom or Mom

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  1. Drinker Nisti says:

    I ran up ~$15K for <24 hours in the ER/hospital for a broken leg. That’s what an uninsured person would be expected to pay– Because the hospital was “in network” for my PPO, the bill was immediately reduced by 2/3. That makes for $10K of bill padding, far as I can tell…

  2. ckilgore says:

    Gkad to hear your mom is doing ok after a stroke. Keep kicking ass John’s Mom.