Why hospitals charge so much

Show Search Search Query. Play Live Radio. Next Up:. Available On Air Stations. All Streams. The Price We Pay. The Price We Pay will explore the reasons for that and possible solutions to our health care crisis. Also, we'll go deeper on some of the issues in this series on Charlotte Talks with Mike Collins. Facebook Twitter LinkedIn Email. Courtesy Joan Malloch. Sign up for our daily headlines newsletter Email Address. Select Your Email Format html text. The pharmaceutical industry?

TMRW talked to experts on different aspects of the health care system who pointed to five overall reasons. The most salient reason is that U. In the U. In contrast, "lots of other countries have some element of private something, but there is that baseline understanding that health care is a right, not a privilege," Balber said.

The underlying motive to make money has a ripple effect that increases prices, she continued. For example, insurance companies spend an "enormous amount of money on utilization review," the process that determines whether a medical service is covered under a given plan, adding that the goal is "to not pay consumers for the care they thought they were insured for. Similarly, Dr. Georges Benjamin, executive director of the American Public Health Association, pointed to a lack of universal health care, where everyone is guaranteed access without undergoing financial hardship , as a primary reason for high costs.

During check out, your medical report will be generated and then sent to a medical coder. This will be translated into actual medical billing code and a superbill is generated that is sent to the medical biller. Billers are responsible for meeting the standards of billing compliance when sending bills.

The process of adjudication requires a payer to evaluate a medical claim and decide whether or not it is compliant. This typically is done by the insurance company. During this stage, a claim may be accepted, denied or rejected. After this lengthy process, the statement is then sent to you, the patient. In some instances, an Explanation of Benefits will also be sent to you. Once the bill is sent, it is up to the patient to pay any remainder an insurance company may not have.

IF the bill goes delinquent, it will be sent to a collections agency for further follow-up. While the above breaks down the process of billing, the costs associated with your medical bills and coverage can look quite different.

Providers, for example, assign costs to patients based on what they charge, rather than the costs associated with providing care. These include:. In what other industry would you do this? Would you use your car insurance to buy windshield wiper fluid or replace a burned-out headlight? Would you use your homeowners insurance to replace a screen? Many small community hospitals are currently in deep financial trouble.

Rather than trying to collect a fair amount for each affordable service directly from patients, hospitals go through the insurance companies for even the most mundane fees. And, since each patient only brings in a small profit, each denial puts them in a financial hole.

Their answer: lean harder on the patients who owe them money. How many ways is this system broken? As I said at the very beginning, one of the biggest problems with medical costs is that the real costs are so well hidden in all these games that almost no one even knows what they are, let alone what to do with them. This applies to doctors as much as patients. We saw how patients can easily be confused into buying drugs for far more than they cost, just because they have insurance. Doctors are run around just as much by the absurd system of insurance reimbursement.

Now, we find that even the biggest players; the hospitals, are playing the same crazy games by the same crazy rules. But now it begins to really hurt the patients.