Cigna, the worst insurer ever!

To make a long story short, in 1974 when I had an emergency appendectomy after several hours of the physicians diagnosing my symptoms in the emergency room.  It took several hours to diagnose the appendicitis as my symptoms were not classic and I did receive excellent care at a north shore hospital.  But one Doctor came to my bed before my operation, looked at the notes taken, felt my side and said, "if it's a hernia, it's the biggest gd hernia I've ever noticed."  He then left the room, never saw him again. He got $300 for what was listed as reported on my bill as "consultation."   1974 dollars.  Things haven't changed.  Thankfully I had an excellent BC/BS work policy.  The total cost was above $10,000.  

There is no financial oversight, either by the market or by the government, of hospitals. This is why hospitals are able to charge anything they want to. Even worse, there is also a chronic doctor shortage in the United States, despite the fact that the U.S. population spends more on healthcare they do on housing. This is also the work of hospitals which have direct control on the supply of doctors. In the absence of transparent pricing which would allow the market to exert control, there needs to be a thorough government investigation and regulation of the growing unchecked power of the Hospital industry. Instead we have Jack Connors of Partners Healthcare showing up at the Massachusetts Statehouse during the last round of healthcare cost containment legislation to tell the government that "Too much regulation,....referring to the health care industry, could hurt the golden goose," (“Hospitals Mobilize on Health Care Bill; Fearing ‘Overreach’ by state, they mount lobbying blitz”.Boston Globe 5/20/12) and in response the government obediently kills any provisions that might check Partners Healthcare.

Our healthcare industry is a shameful mess...another failure of capitalism.

This same type of thing happened to me 3 years ago. I went to a pain clinic that apprantly  belonged to Beverly Hospital. I was there for less than 30 minutes and was charged for an office visit for $320, a facility charge of $376, and a surgery charge for $1800. The doctor looked at the wound on my leg for about 1 minute, a nurse cleaned the wound and dressed it and gave me instructions. The doctor never touched me. I called my insurance company when I saw what the breakdown was and complained. There was never any surgery, how could there be if the doctor never did anything but look. I was told that charge was for the cleanning and dressing of the wound. I was stunned that the insurance company didn't have a problem with this. The whole experience didn't cost me a cent as the insurance benefits covered the entire cost but it showed me another example of why medical costs ar through the roof. Insurance companies aren't doing any cost control on their own. The system is broken

I left my physician at the Lahey Clinic after I was charged an extra hospital charge for the use of a room where an electrocardiogram was done I had paid for the ecg but they wanted more than that for the room. People should know that Lahey Clinic is owned by the physicians and they get a share of the profits.

The main issue is that a consumer was charged for a service he did not recieve. Is there no consumer protection service when it comes to medical provider charges and medical insurance? It seems to me the hospital and insurance company are in cahoots. The hospital is allowed to charge for something they didn't do, and the insurance company is happy to accept the charge because they pass this off to the consumer as increased premiums, and as a result, the insurance company gets a cut of the overcharge. This is free market capitalism? It just seems like run of the mill fraud. Can't the attorney general help?

The American public has been duped into believing that the healthcare system in the US is the greatest in the world, that it cannot bear oversight and regulation, that the "free market" rules it, and that it hardly ever needs improvement.  I agree that the quality of care is above average, even superlative in some instances, but the costs are way, way out of touch with the reality of the average citizen's finances, and the system, not the actual care, is severely out of whack.  Most citizens are too cowed to speak up or complain when something goes wrong with their bill or even with their individual care.  Remember that "Seinfeld" episode when Elaine was blackballed by dermatologists all over Manahattan for being a "difficult, complaining patient"?  Well, it was hilarious, but it did tap into a deep-rooted fear in the citizenry.  Elaine had to suffer because the doctors had banded together to not serve her sufficiently.  Americans worry that that will happen to them if they speak up, too -- that doctors literally hold their lives in their hands, so they better be nice to their doctors.  The huge "healthcare-industry complex", although listed primarily as "non-profit", needs to continually make profits and to increase its market share of the American economy.  Efforts by citizen representatives to control this expansion will continually get push-back by a large, well-financed healthcare system that doesn't hesitate to pay off representatives to keep control/regulatory efforts at bay.  And as soon as one loophole manages to be closed, they will find and exploit another one.  The prognosis for these control efforts is not encouraging.

It's almost a game.  Keep the costs down in one place, they go up in another to compensate.  Primary care physicians' salaries fall below the 250K some salesman recently posted here as "what's needed to live in the Boston area."  So they compensate.  My wife broke her foot, they charged the insurance company $600 for a boot that costs 70 to the "list price" of 130 on line.  My insurance picks up the copay for my yearly physical, but when the doctor tells me still no prostate up there (and General Franco's still dead)  and my zero psa means no new cancer, he can charge the insurance 160, get 70, and suddenly I'm liable for a copay.

This is a very common and unjustifiable practice. The major university-affiliated teaching hospital system in Worcester took over a community primary care facility in Ware, MA  and appended facility charges to each care visit which, at least in 2010, increased the cost of a family practice visit by about 50% give or take a little.  Doubtless the practice was in need of the deep pockets and extensive resources of its new owners howevder the way to support primary care practices is for payments for primary care services whether on a fee for service basis or via allocation from an ACO to be reflective of their value and of the true cost of their delivery. Slapping on an arbitrary hospital facility fee for a visit to a clinic 32 miles as the crow flies from the hospital campus makes no objective sense even though it is legal and insurers, bowing to the market clout of a major player, pay it. It wasn't long ago that this same health delivery system was charging $4300 and being paid $1800 for marrow-donor screening tests that objectively were worth $100. This business is far more egregious. The dollars per unit are relatively few however the number of units of service is high making this a significant drain on our health care dollars.

I had the exact same experience as Mr. Reed a few years ago when I had a liquid nitrogen treatment at a Brigham & Women's facility at 850 Boyleston Street. I had a high-deductible Harvard Pilgrim plan at the time, but never dreamed that my 5-minute office visit would incur "surgical" facility charges. I appealed to Harvard Pilgrim, B&W, and wrote letters to the Attorney General, my state reps, and anyone I could think of. It's just plain theft. Now I'm at Lahey, with a Tufts health plan, and I had the procedure done there last week. I made numerous phone calls beforehand to find out how much I'd be out of pocket, but Lahey acted as if I have no right to know what they are charging. And I think Tufts HMO  misinformed me--they said if I went to a dermatologist not affiliated with a hospital, the procecure would still be billed as a "surgery" and I would be subject to the same deductible as for a hospital day surgery.  Doctors, when questioned about costs, refer you to the billing department, as if they're above dealing with such mundane issues as how many days a week you're going to have to work to pay for your five-minute office visit. I do think, at the very least, doctors should know what procedures trigger "faclity fees," and should inform patients about them directly, not through a sign posted inconspicuously on a receptionist's window.  They all claim ignorance of costs because every health care plan is different and covers different amounts. THIS IS WHY WE NEED UNIVERSAL HEALTH CARE.