One day, my friend and business partner Bill noticed a problem with his legs. And I said, well, you know, you're not the only person with tiresome health problems, I have a tingling in my arms.

"What!!!?!?! That might be a heart attack, let's take you to the hospital."

So to the hospital I went, and they took a look at me, found I had high choloresterol, adult onset diabetes and a mild bit of carpel tunnel, but no heart attack.

I stayed the night at the hospital and although service was mediocre at best - I never knew when I was going to be dragged to the next stage - I thought I had a good enough experience.

Then I saw the bill. It came to $8,500 for a single night in the hospital, with about five different tests done.

Blue Cross, my insurance company, had negotiated my day in the hospital down to about $2,800.

I thought it was a pretty miserable experience for $2,800. Surely they could treat me at least as well as a four-star hotel for that money? I felt more like Motel Six than Four Seasons when I was there.

Two questions for the audience.

Why was the bill so high? Is that what a person without health insurance would have been obligated to pay?

How was Blue Cross able to get it down, to well below 50% of the original charge?

D

Note: You will be prompted to set up an account once done with your message

Medical expenses are really outrageous. The initial bill will show the amount due if you had no insurance. Blue Cross negotiates rates with hospitals, based on the treatment, tests, diagnosis, and probably some other variables. Your stay was in whatever category that pays $2,800. You are lucky. If you had no insurance, you would be responsible for the entire $8,500.

Prices are continually going up to balance out the small payments from Medicare and managed care (what you have). It's all a bit of a mess, in my opinion.

It's good that it wasn't a heart attack. So what are you doing as a result of all these tests? I hope you do something and get all the numbers down...

Sue

Note: You will be prompted to set up an account once done with your message

One interesting point is that you hear a lot about hospitals having to write off the cost of care of illegal aliens. You get "Illegal aliens cost us $x billion!" But really, if you look at how this is computed, that's not making sense. They would have gotten 1/3 or less of that $x billion if the bills had been paid through insurance.

It makes me think that inherently, hospitals are very unfair places.

It's interesting that when I get insurance, it appears that I'm paying as much for the insurance company's negotiating power than anything else. Personally, I would rather pay for the care myself and regulate cost that way, but I have no negotiating power.

The problem is, I don't think I got $3,000 worth of care, let alone $8,000. Maybe $1,000 at most.

It costs about $1,000 a WEEK to stay in a hospital in the Philippines, by the way. And from what I can see, the quality of care is lower but far better than the cost difference would indicate.

I've changed my diet to limit carbohydrates to some extent. (I found low-carbohydrate popcorn, which is about half the carbohydrates of goldfish, which I no longer eat :-( ).

If you consider these wildly inflated bills and costs, it seems to me like hospitals should be making huge profits. Why are they so often insolvent? And frankly why should I have any sympathy for institutions that clearly abuse the poor and insolvent, by overcharging so blatantly?

Maybe if they could figure out a way to charge reasonable fees, the poor and middle class might be able to pay them.

D

Note: You will be prompted to set up an account once done with your message

Goldfish? But wouldn't they be protein???

Hospitals are not doing well financially. They are very expensive to run and maintain. The charges are mostly written off for people who have insurance and/or Medicare. Medicare, by the way, pays according to diagnosis. If you have a suspected heart attack and are in the hospital overnight, Medicare will mostly pay the same amount, no matter how many tests you have. I'm not sure if private insurance has gone there in general or not, but the private insurers do tend to follow Medicare's lead...

Note: You will be prompted to set up an account once done with your message

Well, I'm referring to Pepperidge Farm Goldfish, which are carbohydrates through and through.

How does Medicare determine how much to pay, if it knows nothing about the individual patient's situation? I would think that this would mean it would pay way too much in some situations and way too little in others.

D

Note: You will be prompted to set up an account once done with your message

You're right -- sometimes they pay more than the billed charges. However, the payment scale is fairly low, so most of the time they pay a lot less.

Note: You will be prompted to set up an account once done with your message

If Medicare pays less than the cost of care, I would think hospitals would simply refuse medicare patients until the issue is resolved.

There's no reason they should run at a loss, but at the same time there seems to be little excuse for the insane level of costs involved.

I'm not sure who to blame because I think $2,800-odd was still way too much for what the hospital did when I was there. They just ran a few tests; they did nothing to try and fix me at all.

I think they did give me some kind of patch to lower something but I'm sure that was inexpensive and that was the only real care I got.

D

Note: You will be prompted to set up an account once done with your message

Unfortunately, Medicare patients are the majority of sick people who wind up in the hospital to begin with. There are some doctors, btw, that refuse to treat Medicare patients because the payments to doctors are also very low.

I'm sorry that you are disappointed in the care that you got. Do you think your expectations might be a little high? After all, you didn't get sick or die while you were there, and those are very good things.

Do you still have the patch?

Note: You will be prompted to set up an account once done with your message

No, the patch was just a temporary thing they put on for a few hours and then took off and discarded.

I wouldn't say I'm terribly disappointed, I just think it flunks badly on the value per dollar ratio.

I think Bill was just paranoid and that paranoia cost Blue Cross $2,800. That seems like an awfully stiff price for paranoia. There has to be a way to be paranoid that doesn't cost quite that much ...

D

Note: You will be prompted to set up an account once done with your message

Well, arm tingling can be one of the symptoms of a heart attack. And it was good that you went after all, since you learned about a bunch of things that you can work on to make better. Probably not fun, though.

I haven't been in the hospital since Lisa was born. I did go to the Emergency Room a couple of years ago for asthma problems -- I was there for seven hours. It was a total nightmare. I was ever so much sicker by the time that I left...

Note: You will be prompted to set up an account once done with your message

I was rather annoyed that you don't even get a private room for your $2,800-odd. I mean, if you have to pay $2,800 a night for something, you should be entitlted to accomodations comparable to, say, a Hampton Inn, no?

I just don't understand where the money goes in hospitals. It seems like it's just vanishing - nobody's getting rich off them, but the money just disappears.

I know doctors are well paid but in my 18-odd hours in the hospital I don't think I even saw a doctor for more than an hour, total. So the doctor could make $300 an hour and hardly change the bill at all. The bill was just for hospital-related stuff.

D

Note: You will be prompted to set up an account once done with your message