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American Insurance

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Frans

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Here is what my sister is fighting:
The American Health Care system. She is a nurse and union rep.

It is a long read, but speaks plainly about what we, as Arborists and self employed Americans, can expect from our health care system.

Vote! Is about all I can say.


The article below speaks for itself. The passion I feel is why I do what I do: To become the spoke of the wheel of change for medical care and access for all, where the only burden is on the individual to care for themselves, their family, and ultimately the Earth.
Peace to you all,
Jonica
P.S. We put those stockings, otherwise know as TED hose, on just about every patient.

Last night RNs at CPMC joined St Luke’s, Alta Bates-Summit, Mills-Peninsula, Sutter Novato, Marin General, Sutter Delta, and Sutter Solano in voting to authorize a second Sutter-wide strike and REJECT CPMC’s contract offer. RNs at Cal voted yesterday to reject management's proposal by 3 to 1.

The Federal Mediator set up a negotiating session on Monday, 12/3, with CPMC in response to a request for help from CNA. We hope they will keep the meeting, agree to change their position and begin finally to compromise on significant issues, and respect the nurses’ vote.

Nato Green, Labor Representative
California Nurses Association
National Nurses Organizing Committee
2000 Franklin St., Oakland, CA 94612
Tel: (510) 273-2269 l Fax: (510) 663-5712
www.calnurses.org
www.singlepayer.com
This message (including any attachments) contains confidential information intended for a specific individual and purpose, and is protected by law. If you are not the intended recipient, you should delete this message. If you are not the intended recipient, any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited.






November 29, 2007




PAGE ONE




MAXED OUT
As Medical Costs Soar,
The Insured Face Huge Tab
Jim Dawson Hit Cap
After Hospital Padding;
The $1.2 Million Bill
By JOHN CARREYROU
November 29, 2007; Page A1
MERCED, Calif. -- One day in late July, Jim Dawson happily returned home. He had spent the previous five months in the hospital battling an infection that nearly killed him. The phone rang shortly after Mr. Dawson and his wife, Loretta, entered their house.

It was the hospital. California Pacific Medical Center was calling to remind the Dawsons that they owed it $1.2 million.



Jim Dawson survived a catastrophic illness only to face a $1.2 million medical bill.
Mr. Dawson, 61 years old, had health insurance through his employer, but had maxed out his plan's $1.5 million lifetime cap halfway through his long hospital stay. In addition to the bill from CPMC, Mr. Dawson owed tens of thousands of dollars more to scores of doctors who were involved in his care. Mr. Dawson and his wife's combined assets totaled a fraction of their medical debt.

"I had never thought in a million years that anything like that could ever happen," says Mrs. Dawson.

As spending on health care has climbed to almost $2 trillion a year, or 16% of the U.S. economy, the number of Americans burdened with massive medical bills has soared as well. According to a 2005 survey by the Commonwealth Fund, an estimated 34% of adults aged 19 to 64 face problems with medical bills or have accrued medical debt. A majority of those people -- 62% -- had health insurance, the survey found.

Million-dollar medical bills like Mr. Dawson's, while still unusual, are becoming more common as insurance policies once thought to provide catastrophic coverage prove inadequate when it comes to high-cost illnesses.

Part of the problem: Even as medical progress and new technologies raise health-care costs, health plans have been slow to raise their caps. Mr. Dawson's $1.5 million cap was relatively generous by today's standards. The Segal Company, an employee-benefits consulting firm, says the average health-plan cap among companies it advises is $1 million a person -- the same as it was in the 1970s, when the purchasing power of $1 million was the equivalent of nearly $6 million today.

MEDICAL LIABILITIES

• Million-Dollar Bills: As health-care spending soars, so has the number of Americans with huge health-care tabs.
• Funny Money: Many hospitals heavily pad their bills by marking up items and services.
• The Bottom Line: Hospitals say bill padding is their only defense against government and insurer cost cutting, but the practice can leave individuals with wildly inflated bills.
Another issue is the widespread practice of bill padding by hospitals and other health providers. While hospitals say bill padding is their only defense against the aggressive cost-reduction efforts of insurers and government programs, the end result is that individuals can, with little warning, be left stuck with wildly inflated medical bills.

For instance, CPMC charged Mr. Dawson $791 for stockings designed to improve blood circulation. The same pair can be purchased on the Internet for as little as $12.

Allan Pont, CPMC's chief medical officer, acknowledges that the charges on Mr. Dawson's bill are "Disneyland numbers" that health insurers and government programs like Medicare and Medicaid never pay. But he says they reflect the hospital's operating costs, such as paying for doctors, nurses and medical equipment, as well as markups to compensate for the fact that CPMC collects only a fraction of what it bills every year.

Mr. Dawson's health calamity, and the resulting $3 million in health-care bills it generated, was due to a staph infection, a bacterial skin infection that is usually easily cured if caught early. But Mr. Dawson's condition was missed by various doctors and spread throughout his body.

For 15 years, Mr. Dawson worked for oil refiner Valero Energy Corp. and its predecessor companies, selling gasoline products to gas stations across California. Big and burly -- and with a deadpan sense of humor -- Mr. Dawson spent much of his work life on the road.

In late 2005, Mr. Dawson noticed strange dry spots on his right arm. Over the course of the next nine months, they grew into big calluses and Mr. Dawson took to hiding them under bandages. He felt OK, but the calluses were unsightly.

In September 2006, Mr. Dawson went to see his primary-care physician, Patrick Golden, in Fresno, Calif. Dr. Golden referred him to a dermatologist, who gave Mr. Dawson an injection. The calluses disappeared within days.

But Mr. Dawson's health began to sharply deteriorate. In mid-November 2006, he was on a business trip in Victorville, Calif., when excruciating back pain woke him in the middle of the night. He checked out of his hotel in his pajamas and drove home to Merced, a small middle-class city 110 miles southeast of San Francisco.

THE COST OF CARE

• See a page1 from Mr. Dawson's $1.2 million CPMC bill, with explainers.
• Read the July 2 letter2 the Dawsons received from Health Care Legal Services.
• Read the October 5 donation solicitation3 the Dawsons received from CPMC's foundation.
After lying in bed for two days, Mr. Dawson didn't feel any better and couldn't move his right arm. Worried, Mrs. Dawson decided to take her husband to the emergency room at Emanuel Medical Center in Turlock, 30 minutes away. Mr. Dawson was hospitalized there, but his wife checked him out after three days because she says the hospital seemed unable to determine what was wrong and she felt he wasn't being properly cared for.

John Gilbert, a spokesman for Emanuel Medical Center, says Mr. Dawson was examined by an internist, who consulted with four other specialists. He says the hospital diagnosed Mr. Dawson with cellulitis of the hand, disintegrating back discs, chronic kidney disease, acute renal failure and gout, a form of arthritis characterized by sudden attacks of pain and tenderness in joints. No one realized it at the time, but all were likely consequences of the staph.

"We feel that he was provided good care," Mr. Gilbert says. Emanuel billed Valero's health plan $31,159.75 for the three-day stay. Using its bargaining leverage as a large plan, Valero's health plan negotiated the amount it paid down to $20,339.74.

Mr. Dawson returned to see Dr. Golden, who only diagnosed him with gout. Dr. Golden gave him painkillers for his back and an anti-inflammatory drug to reduce swelling in his arm. But Mr. Dawson continued to feel ill and lost his appetite. In just a few months, he went from 305 pounds to 223 pounds, his skin turned grayish and he continued to experience terrible back pain.

In February 2007, Mr. Dawson collapsed at a convention in Las Vegas. Mrs. Dawson and their 25-year-old son, Noel, drove 450 miles from Merced to pick him up. Mr. Dawson went back to see Dr. Golden, but he says Dr. Golden continued to maintain that his condition wasn't serious and told him to return for a checkup in 90 days. Reached at his office in Fresno, Dr. Golden declined to comment.

With her husband looking sicker by the day, Mrs. Dawson grew frantic. Thinking Mr. Dawson was suffering from a spine infection, she called her dentist, who she knew had back problems. He recommended going to the spine center at Seton Medical Center inDaly City.

On March 6, Mr. Dawson was admitted to Seton delirious and screaming. It was there doctors realized he had a staph infection that had spread through his bloodstream and invaded his entire body. His organs were failing and he was going into septic shock. A nurse told Mrs. Dawson her husband was very sick and might die.

Doctors at Seton began treating Mr. Dawson with massive doses of antibiotics but surmised they wouldn't be able to cure him unless they removed Mr. Dawson's pacemaker, which was encased in bacteria. Mr. Dawson had been carrying the device in his chest since 1995.

The surgery didn't go well. One of the pacemaker's two leads, wires that connect the device to the heart, broke off as it was being extracted and remained stuck in Mr. Dawson's right ventricle. On April 20, Mr. Dawson was transferred to CPMC in San Francisco, a leading cardiac hospital in the region.

The Dawsons wouldn't find out until later, but the six-week stay at Seton was costly. The hospital billed Valero's health plan $1,135,633.84. After negotiating a $283,908.46 discount, Valero's plan paid $851,725.38. More than half of Mr. Dawson's insurance had been used up. A spokeswoman for Seton declined to comment about Mr. Dawson's case, citing the hospital's patient-privacy policy.

At CPMC, Mr. Dawson was operated on again. The plan was to remove the broken pacemaker lead and replace part of Mr. Dawson's infected aortic valve with the valve of a pig. Doctors also needed to repair another heart valve that had been damaged by the infection. Mrs. Dawson was told the odds were very low that her husband would survive the extremely complex operation.

But the surgery was a success, and Mr. Dawson pulled through.

Over the next few weeks, Mr. Dawson fought through various other complications and began to recover. Then on June 18, he went into cardiac arrest during a rehabilitation session. He was rushed into intensive care and revived. Doctors decided he would need another heart operation to implant a defibrillator.

On June 29, Mrs. Dawson says she was leaving the hospital when she was ushered into a small conference room by Ema Beronilla, an employee from CPMC's financial office. She says Ms. Beronilla told her that her husband's insurance had run out and showed her a sheet of paper indicating that they owed the hospital more than $1 million. Valero's health plan had just paid CPMC $553,727.12 for Mr. Dawson's care through May 19 and informed the hospital that he had maxed out his policy. Any additional bills were Mr. Dawson's responsibility.

A spokesman for CPMC, Kevin McCormack, confirms the meeting but says Ms. Beronilla was merely trying to help Mrs. Dawson understand her financial options, not pressuring her to pay the bill.

Ms. Beronilla handed Mrs. Dawson forms for hospital financial assistance and for Medi-Cal, California's Medicaid program. The hospital bill was equivalent to several times the Dawsons' assets, which consisted of equity in their house and a retirement-savings plan. Mrs. Dawson implored Ms. Beronilla not to tell her husband about the bill because she worried it would affect his still-fragile health.

Three days later, while Mrs. Dawson was away, a man came by Mr. Dawson's room and briefed him on the financial situation. Mr. McCormack, the hospital spokesman, says that Ms. Beronilla relayed Mrs. Dawson's request to her supervisor and that she doesn't know who informed Mr. Dawson. "We regret that this happened," he says. Mr. Dawson, always good-humored, took the news in stride.

Later that day, a representative for Health Care Legal Services, an organization CPMC employs to coach uninsured patients on their financial options, called Mr. Dawson's room to enroll him in Medi-Cal. Mrs. Dawson answered the phone and declined, thinking her husband's income was too high to qualify him. She also wanted to review their options with an attorney.

HCLS sent the Dawsons a letter stating that it was returning their account to CPMC "so that they can initiate their collection efforts." Under intense emotional stress, Mrs. Dawson says she interpreted the letter as a threat. An official for HCLS says it wasn't trying to intimidate the Dawsons but merely to educate them about available assistance programs and help them apply for them.

On July 9, a defibrillator was successfully implanted in Mr. Dawson's chest. While her husband resumed his rehabilitation, Mrs. Dawson drove to Palo Alto to see Michael Gilfix, a lawyer who specializes in estate planning. Mr. Gilfix told her Medi-Cal might be willing to cover the hospital bill retroactively. But to qualify, their assets, excluding their home, had to be less than $3,000. That meant they would either have to spend down their retirement-savings plan or donate the money in it to their son, giving up their retirement cushion.

In addition, Medi-Cal would require that the Dawsons contribute any monthly income beyond $900 to their medical bills. Mrs. Dawson decided to rule out Medi-Cal because, with a mortgage on their house, she says there was no way they could live on that small an income.

Valero continued to pay Mr. Dawson his full-time salary until state disability kicked in -- beyond the period it was obligated to, according to the Dawsons. Mr. Dawson was also told his job would be waiting for him, even though Valero could hire someone to replace him after six months, he says. Valero declined to comment on the case, citing its employees' privacy.

CPMC discharged Mr. Dawson on July 26, and Mrs. Dawson drove her husband home. As they entered their house, Mr. Dawson lost his balance and fell. Mrs. Dawson was trying to help him up when the phone rang.

It was Ms. Beronilla, the hospital's financial counselor. Mrs. Dawson says Ms. Beronilla reproached her for declining to meet with HCLS and fill out the Medi-Cal enrollment forms, and told her the hospital would start billing immediately. With her husband still splayed out on the floor, Mrs. Dawson remembers replying: "Do what you have to do."

Ms. Beronilla declined to comment. Mr. McCormack, the CPMC spokesman, confirms the phone call. He says Ms. Beronilla called the Dawsons at home only because she had unsuccessfully tried to get in touch with them before they left the hospital. The purpose of the call, Mr. McCormack adds, was merely to see whether the Dawsons had filled out the hospital's financial-assistance forms.

Effectively uninsured with his Valero coverage exhausted, Mr. Dawson still needed close medical attention. Fortunately, he had served in Vietnam so he was eligible for care from the Department of Veterans Affairs. Mr. Dawson enrolled in the VA system and began attending physical-therapy sessions at a VA hospital in Fresno three times a week. But the VA wasn't obliged to cover his previous medical bills.

Hoping to stall CPMC, Mrs. Dawson sent the hospital two checks for $30. Bills were also piling up from doctors, so Mrs. Dawson also sent them small sums to keep them at bay. The Dawsons weighed whether to declare personal bankruptcy.

Before they made any decision, Mrs. Dawson asked to see an itemized bill from CPMC. When she received it, she was shocked by how much the hospital had marked up inexpensive items like the stockings. CPMC charged Mr. Dawson between $2,225 and $6,675 a night for an oxygen mask to help him breathe while he slept. After he was discharged from the hospital, the Dawsonsrented one from a medical-supply store for $250 a month. Mrs. Dawson resolved to try to negotiate the bill drastically down.

"I do not deny that our charges look insane," says Dr. Pont, CPMC's chief medical officer. But all hospitals operate the same way, he says. "It's the reality of the industry."

Once its operating costs are factored into an item's charge price, Dr. Pont says the hospital marks up that price by threefold to account for the fact that it only collects on average a third of what it bills in any given year. Although the nonprofit hospital reported $123.7 million in operating income last year, Dr. Pont says the money goes to charity care, cutting-edge medical equipment and new facilities to comply with the state's stringent earthquake-safety guidelines. CPMC says it dispensed $5 million in charity care last year and gave another $6 million to community clinics and health centers.

In her quest to know exactly what she was being billed for, Mrs. Dawson also asked the hospital for copies of all her husband's medical records. A copy service used by the hospital called to say the copies would cost $1,030. Mrs. Dawson was outraged. Further angering her, a letter from CPMC's foundation soliciting a donation came in the mail.

Earlier this week, Mrs. Dawson was contacted by a CPMC official with surprising news. The hospital said Mr. Dawson had qualified for financial assistance under its charity-care policy and wrote off his entire bill. Asked why the Dawsons hadn't been told they could qualify for charity care before a reporter contacted the hospital, CPMC said Mrs. Dawson never gave it the opportunity to explain its policy to her.

Told at one point that he would never walk again, Mr. Dawson is looking forward to going back to work at Valero in January. An avid car-racing fan, he recently went to see his son officiate at a race.

Write to John Carreyrou at john.carreyrou@wsj.com4


URL for this article:
http://online.wsj.com/article/SB119610495315004214.html

Hyperlinks in this Article:
(1) http://online.wsj.com/public/resources/documents/info-enlargePic07.html
(2)http://online.wsj.com/public/resources/documents/James_Dawson_medicalletter.pdf
(3) http://online.wsj.com/public/resources/documents/James_Dawson_donation.pdf
(4) mailto:john.carreyrou@wsj.com
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J

JonnyHart

Guest
I'm a little confused, what is the connection between Mr. Dawson's unfortunate mishap and the nurses wanting to strike?
 
F

Frans

Guest
I'm a little confused, what is the connection between Mr. Dawson's unfortunate mishap and the nurses wanting to strike?
IF, and I say IF, the insurance companies are allowed to continue, then folks will continue to receive, or not, minimal health care.

The nurses are just the tip of the iceburg. They are the ones who have to negotiate between folks with health care, and the insurance industries desire to limit health care. Or, to wheel folks out to the street if their health care insurance does not pay.

The nurses are striking to expand the amount of nurses per shift, and to increase their wages.
 

Old Monkey

Treehouser
Joined
Mar 9, 2005
Messages
8,764
We have Blue Shield and are one long hospital stay away from being ruined.
 
N

Newfie

Guest
They are the ones who have to negotiate between folks with health care, and the insurance industries desire to limit health care. Or, to wheel folks out to the street if their health care insurance does not pay.

The nurses are striking to expand the amount of nurses per shift, and to increase their wages.
I'd beg to differ with the first part. Doctors are the ones that fight to get things covered. Nurses are simply the ones that page doctors in the middle of the night to administer care.

Nurses are pretty well compensated as a whole for the job they do. In most instances though, there is definitely a need for more nurses on duty at any given time.

As for hospitals padding bills, that is the same old crock of shit that it has always been. Can you buy the special support stockings for less? Absolutley! But for you $12 did someone put them on you, check on you,
every hour, change them blah ,blah,blah, all on down the line. It goes along with the $8 tylenol or the $200 room charge ( which most people pay at a hotel for far less service).The fact of the matter is that most hospitals and health care delivery systems are in danger of going bankrupt because the government requires the uninsured to be treated and insurance companies pay far less than the services rendered cost. They can't magically pull money out of their ass.

Seems like the nurses in this case have taken the low road in their tactics to get paid. Poor compensation from insurance companies definitely makes it difficult for facilties to staff properly, but lets lplace the blame appropriately.


Too bad Mr. Dawson hid his "calluses" under band-aids for 9 months instead of acting like an adult and seeking educated professional help. No better than the jackass homeowner ignoring his dying tree and then trying to fix it with his Wildthing and then getting in over his head when it was almost too late.
 
N

Newfie

Guest
I know how to fix it.... lets sue someone and make it all their fault.
 

Old Monkey

Treehouser
Joined
Mar 9, 2005
Messages
8,764
The cost of healthcare is rising faster than the rate of inflation. Our insurance is due to go up 25% this year. If you are a small business that is an unsupportable rate of increase.
 
N

Newfie

Guest
The cost of healthcare is rising faster than the rate of inflation. Our insurance is due to go up 25% this year. If you are a small business that is an unsupportable rate of increase.
And my last post is the greatest contributor to that dilemna next to the uninsured drain on the system. More drains open than taps filling the tub, with most of the drains contributing nothing to the sytem other than draining dollars.
 

Old Monkey

Treehouser
Joined
Mar 9, 2005
Messages
8,764
I think there are many factors influencing the cost. None are easy fixes. Something needs to be done.
 

No_Bivy

Treehouser
Joined
Sep 2, 2006
Messages
5,910
I hate health insurance, they deny a lot of stuff. Make you sound like you are scamming when you make a claim. Who is the best canindate for health care reform,.....Obama?
 

Old Monkey

Treehouser
Joined
Mar 9, 2005
Messages
8,764
I don't think any of their plans are realistic. No one person can fix the problem. They need to get the whole group together, insurers, health care providers, pharmaceutical companies, etc, and work as a group to bring some balance back to things.
 
R

RIVERRAT

Guest
I don't think any of their plans are realistic. No one person can fix the problem. They need to get the whole group together, insurers, health care providers, pharmaceutical companies, etc, and work as a group to bring some balance back to things.
Darin my liberal friend, I agree!!
It is a tuff thing.It wont get fixed overnight & goverment provided healthcare is not a workable answer.
 

stehansen

Climbing Up
Joined
Aug 25, 2005
Messages
9,187
Location
Ceres, CA
The hospitals are getting a little more aggressive about collecting. My neighbor has a buddy who lost his job and his insurance then had some kidney stone thing and owed 20 K and the hospital put a lein on his home.
 

TC3

Headache !
Joined
Aug 12, 2006
Messages
1,505
Location
Michigan
I applied for state aide for medical. My children are already covered by BCBS & do not need addtional help.
I was forced by the state to apply for ALL of us, though I clearly stated that it was only me I wanted coverage for ???
I got denied coverage >>> we already had BCBS ???
Frustrating beyond belief.
Purchasing my own insurance was quoted at $480 a month... for a policy that read like Greek & covered virtually nothing.
Thanks.
 
F

Frans

Guest
TC3 is a single mom, who works trees for a living. AND she is an American. So why does she get less coverage than your local congressman?


Just curious why all the talk about the 'best' way to have health coverage, when it is clear to see that an American, does not have the same coverage as an American government employee...








It sickens me when I hear all this patriotic noise from our elected members, THEY have the best health care in the world!

so any discussion is academic to them, as they are not involved.
 

Old Monkey

Treehouser
Joined
Mar 9, 2005
Messages
8,764
I don't think everyone is entitled to good health care by the accident of birth. I think providing health care up front is cheaper than paying for emergency care of the uninsured, which we all end up footing the bill for anyway. Its that old saying "an ounce of prevention is worth a pound of cure.
 

Skwerl

TreeHouser
Joined
Sep 6, 2006
Messages
15,951
That might work if health care needs remained constant regardless of payment method. But we're talking about humans, not widgets. 'Free' health care paid for by taxes will equate to an enormous increase in demand from those who want to be sure and get their 'fair share'. A runny nose or scratched elbow all of a sudden turn into medical emergencies requiring immediate attention by a doctor since "It's free anyway". And how will the healthcare system handle this increased demand, especially considering that these formerly free market employees (doctors and nurses) will now be getting paid by the government? Do you think their pay will increase or decrease? And will that result in more doctors or less doctors to care for all of us?
 

No_Bivy

Treehouser
Joined
Sep 2, 2006
Messages
5,910
one war = billlions = could have been health insurance= fock

Why don't we wage war on this issue?:/:
 

Old Monkey

Treehouser
Joined
Mar 9, 2005
Messages
8,764
OK then what solutions do you see. I know that torte reform is needed but that won't reduce cost as much as a lot of folks think.


edit: The war billions shouldn't have been spent in the first place. Its that darn Chinese credit card that will get us into trouble.
 

No_Bivy

Treehouser
Joined
Sep 2, 2006
Messages
5,910
heck if I know......higher taxes? I aint blaming, but I get pissed about docs/hospitals/pharm co. fees, they are all making a killing. Including BCBS....
 

Old Monkey

Treehouser
Joined
Mar 9, 2005
Messages
8,764
I know what you mean. I feel your pain monthly. If I made more money I would drop my health insurance, get a cataclysmic policy and establish a health savings account.
 

gf beranek

Old Schooler
Joined
Apr 18, 2007
Messages
9,799
Location
God's country, North Coast
Frans, Sole Man

Thanks for keeping these posts about medical costs up and running wild. Like the "Sicko" Thread. It's realitly baby. right now I'm being taken to the collections for not paying the med bills for my injury that the defendents lawyers claim I'm liable for. Haven't worked for 7 months.

Shitty thing is, if I try and go back to work they will have video cameras on me and it will bolster their side. It's all "F" up.
 
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