I am having back surgery today. Two weeks ago I went to the Doctor’s office and received a “Rigid Panel Lower Back Brace” .
So I get a EOB for the brace. $3400 was list price. Insurance price $1600.(I paid it as part of my deductible.)
I found it on Amazon for $203.
Course, there was a woman who showed me how put it on and adjust it. Not a nurse. Spent maybe 15 minutes with her.
That is the problem with our healthcare system. The idea of a doctor marking up a back brace by 800% is insane. Figure if they paid the woman $100 an hour and the 15 minutes counted as an hour, they marked up the brace 700%.
Wait until you see what they charge for the price of screws and other items used in some back surgeries. The medical device industry is a primary source of ridiculous costs.
The appliance used in my hip replacement cost $8000. There’s no way it cost anywhere near that much to manufacture the thing and costs for things like FDA approval get amortized over a long life. Why did my new hip cost so much, well maybe it has to do with the fact that the salesman who works for the manufacturer makes $300,000 a year. Wonder what the CEO of the company makes.
Medical devices, whether it’s EM’s back brace, a walker, or my hip live in a land of perfect rent seeking.
I’m quite short and have small bones. What I hate is the “one size fits all” stuff they use to repair fractures. The screws in the rod that supports my left humerus (sp?) dig into my upper arm muscles and hurt quite a bit at times.
Where is the orthopedic surgeon who selected these devices? Off in the wilds of Texas after having closed his practice here. Convenient, yes? Cause I’d be tempted otherwise to ask him to take the steel out for free! Fat chance, but I’d just like to see the look on his face when I made my request. 😉 NancyO
Which is why the complicity of certain liberal Democratic Senators to reverse the Medical Device Tax under ACA makes we see red. And yest this includes Al Franken and for the FSM’s sake Elizabeth Warren, both of those states have big medical device manufacturers.
The polite term for much of the medical device industry is ‘rent seekers’ working to maximize their self-interest in a system that has little cost control, The more realistic term is vampire squids sucking the blood of the health care system resulting in obscene profits and that the LEAST we could do is recapture some of the blood, err rents, via a modest Medical Device Tax.
But nooooo!!! THIS is where we get to demonstrate bi-partisan kumbaya comity. All because certain manufacturers happen to set up in deep blue states. LIke Minnesota and Massachusetts.
i cut my thumb a few months ago. badly enough to need stitches. total bill for the “treatment” was four thousand dollars. i suggested to Medicare they were being overcharged. In fact they did reduce the charges by about 50% (I think, the various “providers” are not through finding ways to bill for their “services”… i put this in quotes because I am by no means sure any of these people provided services or that they are not all billing for the same service.
Moreover there was an efford to stampede me into getting an operation that i felt was not necessary, and now after three months it seems that i was right. What would the charges have been for the “operation”/
Point of all this is that it seems “medical care” is a license to steal, and “Medicare” is at least somewhat powerless to prevent it.
It could be that this is what someone here at AB was trying to tell us a few months ago… but her “solution” seemed to be “trust the free market insurance companies to control costs through competition.” I was pretty sure that’s how we got here in the first place.
Amen, Bruce.
What we really need, a la Dean Baker, is patent reform in these fields. We also need to understand that there’s no such thing as a competitive market for medical devices. There’s far too much collusion between large medical practices and the device companies.
Encouraging a system based on package pricing, e.g. a hip replacement costs x dollars rather than a la carte pricing with highly discretionary coding would be a start.
Unfortunately I think you’ve hit on the great failing in our political system, the ability of well heeled interests to control even the most progressive of politicians in my field I watched Tammy Baldwin, a rather progressive Democrat, go to bat for the paper industry and a large printing and mailing company to lower postal rates. She basically threw labor under the bus, costing many more jobs than the higher rates in order to placate two large industries in her state.
Although a number of years ago when my late mother needed an oxygen machine due to copd, the charge for 6 months for that device was about the same as the machine itself cost on the web. (I don’t recall the site). The machine on the web looked the same and had the same brand name as the machine provided by the medical equipment shop. Yes the shop included a backup oxygen cylinder if the power went out, as well as supplying small tanks for travel. So it was clear back then that there are some huge margins in the medical equipment business.
When I asked the device supplier about the discrepancy I got Duh!
Of course the same it true of lab tests but then the difference is you put the test on a credit card, versus the lab waiting for the bill to be paid thru the insurance in a couple of months.
maybe patent reform would help, but what we really need is a single payer with enough clout to say, “no. i won’t pay that much, and besides I think this treatment is unnecessary.”
that single payer could provide that there be competition among suppliers, and it would need to monitor results. moreover it needs to be paid for by a transparent dedicated tax apportioned as fairly as possible among the people. “fairly” does not mean “let the rich pay for my insurance.” it does mean that everyone pays a reasonable proportion of their income (how much is health worth to you?) up to a cap, with “the rich” paying more (because they have more income) on the theory that they are also insuring themselves against the possibility of becoming “poor” and needing the subsidy themselves.
for what it’s worth, i have been lucky enough to avoid doctors, and insurance, for all of my life. it would have been hard to sell me the idea of “universal coverage” under which i would be paying for what i regard as other people’s hypochondria and desperate need to have someone else pay for their routine costs. i mention this so you know i know it would be a hard sell, even if it is the most sensible approach.
Speaking of mystery bills–When I was hospitalized for a hip fracture (no surgery required) doctors I thought worked for the hospital showed up to check out my pain and mobility levels several times a day. There was a separate member of hospital staff (ID showed he was staff) who ran the rehab unit and prescribed pain meds, OT, and so on.
I was in the hospital only about 10 days and when released needed a home health aide on duty most of the day. Thereby parting with several thousand bucks since my insurance didn’t cover in-home care. One day I got a fat envelope in the mail with a bill from an unfamiliar billing company. It seems that the cheery young doctors who breezed in and out of my room were self-employed “hospitalists.” I didn’t know I could refuse their services and didn’t agree in writing to accept them or waive my insurance coverage. So, badabing, baddabang, here’s a bill that says I owe the three of them something like $1600.00.
I ended up paying one of them who hadn’t billed my insurance about $300.00 based on what the ones who had billed my insurance were paid. Never heard from them again. However, there’s no way to know if the matter is resolved. For all I know, they sold the paper and it’s floating around in the backlog of a crooked collection agency somewhere. This practice of letting self-employed people loose on uninformed patients is, in my view, an abuse. But, it happens as Coberly attests. NancyO
[reposted] Having been switched involuntarily from Medicare and Medicaid to a narrow network plan — and having been a few times in the ER and overnight in the hospital — I got 8 “out-of-network” bills, so far. How can I chose my ER physicians/ No huge total: only about $800 altogether. I’ve got no money but tons of credit.
Luckily I got good professional advice and found I can opt out of the narrow private network and back into what I had before.
I had to call the Client Enrollment Broker. 877-912-8880 No questions; no hassles — out 1st of next month. Don’t forget to call Medicare to re-enroll in the drug plan.
I’ve just been reading America’s Bitter Pill by Brill (who also wrote a book on the Teamsters — so I know he’s okay ;-]). Seems the whole mess was put together — very imaginatively I must credit — out of deals with every interest group to give up X amount with the promise to get as much or more back from the extra business. Don’t be at the table and they would be the meal — hanging over them.
Laws and sausages. What this process shows is that except for limited ability to manipulate the powers-that-shouldn’t-be — as long as they don’t suffer too much — the majoritarian mechanism (to use Tom Geoghegan’s phrase) is broken beyond immediate repair.
Only way back to majoritarian rule is to re-unionized (seemingly the perpetually invisible elephant in the progressive room).
EMichael, I recently broke my wrist and after a fiber cast, I was given a wrist brace that sells for $18 at Amazon. The doctor does not bill so I know his staff’s time was not included in the bill. The bill from a medical device distributor in Oregon was $80. This was not as big a markup as yours but is the approved Medicare price for this $12 brace. So in my case the markup occurred mainly at the retail distributor of the device. Unless, of course, it occurs at Medicare.
the last doctor i saw… to remove the stitches (i was told the cost of removing them was included in the cost of putting them in)… “gave” me a brace to replace the “cast”. it rubbed my thumb and it seemed to me that good circulation and lack of abrasion was more important than whatever support the brace gave, so i took it off and used a gauze wrap for support, (and reminder “do not bang”) which seemed to work much better. i should add that i had taken the cast off after it got wet and would not dry and used the same wrap for the same purpose, again with perfectly good results. but the cast people “gave” me the scissors which they were going to throw away anyway, so i got something for my four thousand dollars.
moral… if you are a “difficult patient” you may not reduce the bills, but you may avoid further injury.
Y’know Cob, sometimes I wonder about you. It seems you have a couple of thoughts that are absolutely etched in stone that you refuse to budge.
“most back pain responds well to exercise”
Really? Who’d thunk that? Course, in the four years of treatments I received(non surgical) every single one included rehab to combat the pain. I and my doctor tried every non surgical procedure from acupuncture(followed by excercise); to epidurals(followed by exercise) to radio frequency ablations(followed by exercise). All brought temporary relief at best, particularly the RFAs.
But the relief only lasted a couple of months before the pain became unbearable with any movement at all. That is when I decided to get surgery.
Curiously, Of the three surgeons I met with that were recommended to me by my orthopedist, not one guaranteed any kind of success. Every single one made sure I had tried every non surgical procedure before surgery. The problem was simply that I had no disk at all between L-5 and S-1. No exercise in the world can prevent pain when bone is on bone in your back.
So today I am home and I am now 13 millimeters taller than I was on Friday. That is the size of the disk they put in my back.
My complaint was that no physician should be allowed to mark up items to that extent, as I am assuming that they are buying that brace for $200 and charging $1600. Which brings me to another inane comments of yours about back braces.
Yeah, it is a bad idea when repairing the spine to make sure it receives support while the body accepts the repair. Just like a cast on a broken leg is a bad idea.
I hope that your surgery will be succssful. Maybe while you are recuperating you could find a tenth grade English teacher who will help you learn to read with your brain instead of your gonads.
Begin by rereading what I wrote. I did not say “never get surgery”, I said in most cases it was not a good idea. Your doctor appears to have agreed with me if he “tried everything else.” Are you calling him insane?
As for back braces… well, everything I have heard says that they also are generally a bad idea. Yours may have been, and is now, one of the exceptional cases. I could not know that in advance. I could only tell you that based on what I have heard, and what I know from my own back, both surgery and braces are a bad idea except in “some” cases. Perhaps yours is one of the “some.”
Meanwhile you and some other people here behave like chimpanzees throwing your used bananas at people you don’t like… mostly because they are different from you or disagree with you or simply say things you don’t understand. This is actually extremely common among humans as well as chimpanzees. There is really nothing that can be done about it. Sometimes psychotherapy helps, but not if there is no brain there to begin with.
I suppose if I couldn’t think for myself I’d have to adopt the tribal behavior that gets you through life, but knowing what i know now, i am sure glad i can get along without that.
but go back and read what i wrote and what your doctors said. they are the same thing. so you are calling me insane for agreeing with your doctors.
then ask yourself why you are going out of your way to make an enemy of someone who meant to save you money and pain.. in case you had one of those doctors who operate first, of which there are many.
you might want to think a little harder next time you set out to make an enemy.
Figure this one out.
I am having back surgery today. Two weeks ago I went to the Doctor’s office and received a “Rigid Panel Lower Back Brace” .
So I get a EOB for the brace. $3400 was list price. Insurance price $1600.(I paid it as part of my deductible.)
I found it on Amazon for $203.
Course, there was a woman who showed me how put it on and adjust it. Not a nurse. Spent maybe 15 minutes with her.
That is the problem with our healthcare system. The idea of a doctor marking up a back brace by 800% is insane. Figure if they paid the woman $100 an hour and the 15 minutes counted as an hour, they marked up the brace 700%.
Seems a medical license is a license to steal.
Wait until you see what they charge for the price of screws and other items used in some back surgeries. The medical device industry is a primary source of ridiculous costs.
The appliance used in my hip replacement cost $8000. There’s no way it cost anywhere near that much to manufacture the thing and costs for things like FDA approval get amortized over a long life. Why did my new hip cost so much, well maybe it has to do with the fact that the salesman who works for the manufacturer makes $300,000 a year. Wonder what the CEO of the company makes.
Medical devices, whether it’s EM’s back brace, a walker, or my hip live in a land of perfect rent seeking.
Chinese knockoff?
I’m quite short and have small bones. What I hate is the “one size fits all” stuff they use to repair fractures. The screws in the rod that supports my left humerus (sp?) dig into my upper arm muscles and hurt quite a bit at times.
Where is the orthopedic surgeon who selected these devices? Off in the wilds of Texas after having closed his practice here. Convenient, yes? Cause I’d be tempted otherwise to ask him to take the steel out for free! Fat chance, but I’d just like to see the look on his face when I made my request. 😉 NancyO
Which is why the complicity of certain liberal Democratic Senators to reverse the Medical Device Tax under ACA makes we see red. And yest this includes Al Franken and for the FSM’s sake Elizabeth Warren, both of those states have big medical device manufacturers.
The polite term for much of the medical device industry is ‘rent seekers’ working to maximize their self-interest in a system that has little cost control, The more realistic term is vampire squids sucking the blood of the health care system resulting in obscene profits and that the LEAST we could do is recapture some of the blood, err rents, via a modest Medical Device Tax.
But nooooo!!! THIS is where we get to demonstrate bi-partisan kumbaya comity. All because certain manufacturers happen to set up in deep blue states. LIke Minnesota and Massachusetts.
hmmm
i cut my thumb a few months ago. badly enough to need stitches. total bill for the “treatment” was four thousand dollars. i suggested to Medicare they were being overcharged. In fact they did reduce the charges by about 50% (I think, the various “providers” are not through finding ways to bill for their “services”… i put this in quotes because I am by no means sure any of these people provided services or that they are not all billing for the same service.
Moreover there was an efford to stampede me into getting an operation that i felt was not necessary, and now after three months it seems that i was right. What would the charges have been for the “operation”/
Point of all this is that it seems “medical care” is a license to steal, and “Medicare” is at least somewhat powerless to prevent it.
It could be that this is what someone here at AB was trying to tell us a few months ago… but her “solution” seemed to be “trust the free market insurance companies to control costs through competition.” I was pretty sure that’s how we got here in the first place.
Amen, Bruce.
What we really need, a la Dean Baker, is patent reform in these fields. We also need to understand that there’s no such thing as a competitive market for medical devices. There’s far too much collusion between large medical practices and the device companies.
Encouraging a system based on package pricing, e.g. a hip replacement costs x dollars rather than a la carte pricing with highly discretionary coding would be a start.
Unfortunately I think you’ve hit on the great failing in our political system, the ability of well heeled interests to control even the most progressive of politicians in my field I watched Tammy Baldwin, a rather progressive Democrat, go to bat for the paper industry and a large printing and mailing company to lower postal rates. She basically threw labor under the bus, costing many more jobs than the higher rates in order to placate two large industries in her state.
EMichael
this is probably too late to help you. and of course i don’t know if your back was one of the few cases where surgery really is the answer..
but in general surgery is a bad idea and so are back “braces.” most back pain responds well to exercise.
no. i am not a doctor. but i run screaming from anyone who says “I am a doctor. Trust me.”
Although a number of years ago when my late mother needed an oxygen machine due to copd, the charge for 6 months for that device was about the same as the machine itself cost on the web. (I don’t recall the site). The machine on the web looked the same and had the same brand name as the machine provided by the medical equipment shop. Yes the shop included a backup oxygen cylinder if the power went out, as well as supplying small tanks for travel. So it was clear back then that there are some huge margins in the medical equipment business.
When I asked the device supplier about the discrepancy I got Duh!
Of course the same it true of lab tests but then the difference is you put the test on a credit card, versus the lab waiting for the bill to be paid thru the insurance in a couple of months.
Jamison
maybe patent reform would help, but what we really need is a single payer with enough clout to say, “no. i won’t pay that much, and besides I think this treatment is unnecessary.”
that single payer could provide that there be competition among suppliers, and it would need to monitor results. moreover it needs to be paid for by a transparent dedicated tax apportioned as fairly as possible among the people. “fairly” does not mean “let the rich pay for my insurance.” it does mean that everyone pays a reasonable proportion of their income (how much is health worth to you?) up to a cap, with “the rich” paying more (because they have more income) on the theory that they are also insuring themselves against the possibility of becoming “poor” and needing the subsidy themselves.
for what it’s worth, i have been lucky enough to avoid doctors, and insurance, for all of my life. it would have been hard to sell me the idea of “universal coverage” under which i would be paying for what i regard as other people’s hypochondria and desperate need to have someone else pay for their routine costs. i mention this so you know i know it would be a hard sell, even if it is the most sensible approach.
Speaking of mystery bills–When I was hospitalized for a hip fracture (no surgery required) doctors I thought worked for the hospital showed up to check out my pain and mobility levels several times a day. There was a separate member of hospital staff (ID showed he was staff) who ran the rehab unit and prescribed pain meds, OT, and so on.
I was in the hospital only about 10 days and when released needed a home health aide on duty most of the day. Thereby parting with several thousand bucks since my insurance didn’t cover in-home care. One day I got a fat envelope in the mail with a bill from an unfamiliar billing company. It seems that the cheery young doctors who breezed in and out of my room were self-employed “hospitalists.” I didn’t know I could refuse their services and didn’t agree in writing to accept them or waive my insurance coverage. So, badabing, baddabang, here’s a bill that says I owe the three of them something like $1600.00.
I ended up paying one of them who hadn’t billed my insurance about $300.00 based on what the ones who had billed my insurance were paid. Never heard from them again. However, there’s no way to know if the matter is resolved. For all I know, they sold the paper and it’s floating around in the backlog of a crooked collection agency somewhere. This practice of letting self-employed people loose on uninformed patients is, in my view, an abuse. But, it happens as Coberly attests. NancyO
[reposted] Having been switched involuntarily from Medicare and Medicaid to a narrow network plan — and having been a few times in the ER and overnight in the hospital — I got 8 “out-of-network” bills, so far. How can I chose my ER physicians/ No huge total: only about $800 altogether. I’ve got no money but tons of credit.
Luckily I got good professional advice and found I can opt out of the narrow private network and back into what I had before.
I had to call the Client Enrollment Broker. 877-912-8880 No questions; no hassles — out 1st of next month. Don’t forget to call Medicare to re-enroll in the drug plan.
I’ve just been reading America’s Bitter Pill by Brill (who also wrote a book on the Teamsters — so I know he’s okay ;-]). Seems the whole mess was put together — very imaginatively I must credit — out of deals with every interest group to give up X amount with the promise to get as much or more back from the extra business. Don’t be at the table and they would be the meal — hanging over them.
Laws and sausages. What this process shows is that except for limited ability to manipulate the powers-that-shouldn’t-be — as long as they don’t suffer too much — the majoritarian mechanism (to use Tom Geoghegan’s phrase) is broken beyond immediate repair.
Only way back to majoritarian rule is to re-unionized (seemingly the perpetually invisible elephant in the progressive room).
EMichael, I recently broke my wrist and after a fiber cast, I was given a wrist brace that sells for $18 at Amazon. The doctor does not bill so I know his staff’s time was not included in the bill. The bill from a medical device distributor in Oregon was $80. This was not as big a markup as yours but is the approved Medicare price for this $12 brace. So in my case the markup occurred mainly at the retail distributor of the device. Unless, of course, it occurs at Medicare.
oops $12 should be $18.
Anna Lee
the last doctor i saw… to remove the stitches (i was told the cost of removing them was included in the cost of putting them in)… “gave” me a brace to replace the “cast”. it rubbed my thumb and it seemed to me that good circulation and lack of abrasion was more important than whatever support the brace gave, so i took it off and used a gauze wrap for support, (and reminder “do not bang”) which seemed to work much better. i should add that i had taken the cast off after it got wet and would not dry and used the same wrap for the same purpose, again with perfectly good results. but the cast people “gave” me the scissors which they were going to throw away anyway, so i got something for my four thousand dollars.
moral… if you are a “difficult patient” you may not reduce the bills, but you may avoid further injury.
oh, they sent me a bill for removing the stitches anyway.
Y’know Cob, sometimes I wonder about you. It seems you have a couple of thoughts that are absolutely etched in stone that you refuse to budge.
“most back pain responds well to exercise”
Really? Who’d thunk that? Course, in the four years of treatments I received(non surgical) every single one included rehab to combat the pain. I and my doctor tried every non surgical procedure from acupuncture(followed by excercise); to epidurals(followed by exercise) to radio frequency ablations(followed by exercise). All brought temporary relief at best, particularly the RFAs.
But the relief only lasted a couple of months before the pain became unbearable with any movement at all. That is when I decided to get surgery.
Curiously, Of the three surgeons I met with that were recommended to me by my orthopedist, not one guaranteed any kind of success. Every single one made sure I had tried every non surgical procedure before surgery. The problem was simply that I had no disk at all between L-5 and S-1. No exercise in the world can prevent pain when bone is on bone in your back.
So today I am home and I am now 13 millimeters taller than I was on Friday. That is the size of the disk they put in my back.
My complaint was that no physician should be allowed to mark up items to that extent, as I am assuming that they are buying that brace for $200 and charging $1600. Which brings me to another inane comments of yours about back braces.
Yeah, it is a bad idea when repairing the spine to make sure it receives support while the body accepts the repair. Just like a cast on a broken leg is a bad idea.
geez.
EMichael
I hope that your surgery will be succssful. Maybe while you are recuperating you could find a tenth grade English teacher who will help you learn to read with your brain instead of your gonads.
Begin by rereading what I wrote. I did not say “never get surgery”, I said in most cases it was not a good idea. Your doctor appears to have agreed with me if he “tried everything else.” Are you calling him insane?
As for back braces… well, everything I have heard says that they also are generally a bad idea. Yours may have been, and is now, one of the exceptional cases. I could not know that in advance. I could only tell you that based on what I have heard, and what I know from my own back, both surgery and braces are a bad idea except in “some” cases. Perhaps yours is one of the “some.”
Meanwhile you and some other people here behave like chimpanzees throwing your used bananas at people you don’t like… mostly because they are different from you or disagree with you or simply say things you don’t understand. This is actually extremely common among humans as well as chimpanzees. There is really nothing that can be done about it. Sometimes psychotherapy helps, but not if there is no brain there to begin with.
I suppose if I couldn’t think for myself I’d have to adopt the tribal behavior that gets you through life, but knowing what i know now, i am sure glad i can get along without that.
Yeah, it is the mark of an adult to apply set in stone beliefs on every situation while including “maybe not in this exceptional case”.
And of course, without providing any kind of numbers to back up those beliefs.
EMichael
if i had any sense i’d leave it there.
but go back and read what i wrote and what your doctors said. they are the same thing. so you are calling me insane for agreeing with your doctors.
then ask yourself why you are going out of your way to make an enemy of someone who meant to save you money and pain.. in case you had one of those doctors who operate first, of which there are many.
you might want to think a little harder next time you set out to make an enemy.