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Snake-bite victim socked with $55K bill

maryland two fang marks emergency medical tech anti-venom treatment insurance

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#1 Hum

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Posted 12 August 2013 - 21:15

A Maryland woman treated for a snake bite received another shocker: a $55,000 medical bill.

Jules Weiss had stopped to take a photo at an overlook along the George Washington Parkway. On the way back to her car, she felt something bite her.

"It felt just like a bee sting," Weiss told local station NBC4. "There were two fang marks with liquid coming out."

The former emergency medical technician had suffered a copperhead snake bite. Within an hour, she said, her foot turned “grayish” and started to swell.

She went to Suburban Hospital in Bethesda, Maryland, where she received three IV bags of anti-venom over 18 hours. Then, the scary part: a whopping $55,000 bill for treatment. :o

“It’s not a number I can really wrap my head around,” Weiss said. Health insurance would bring the cost down to a few hundred dollars, according to NBC4. But the woman’s insurance had just lapsed. Anti-venom involves milking individual snakes and is a costly treatment.

The Bethesda Hospital told NBC4 it can cost as much as $40,000 to get the anti-venom.

That’s not the only pricey treatment for an animal attack: Last year, a woman in Arizona stung by a scorpion received a bill of $83,000 for the anti-venom treatment — a staggering cost of $40,000 a dose. Even after insurance, Marcie Edmonds still owed the hospital $25,000.

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#2 Growled

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Posted 13 August 2013 - 14:17


But the woman’s insurance had just lapsed.

 

Oh no! Things like this is why I keep insurance. You can't afford to be without it.



#3 ILikeTobacco

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Posted 13 August 2013 - 14:26

Oh no! Things like this is why I keep insurance. You can't afford to be without it.

Wouldn't have helped much in this case. Insurance would only cover the first bag in most cases because its the standard dose. After that, shes going above and beyond and has to pay the remaining 2 bags out of pocket. According to law, insurance only has to cover standard care and medications, anything beyond that is on the patient.



#4 +LogicalApex

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Posted 13 August 2013 - 14:32

Oh no! Things like this is why I keep insurance. You can't afford to be without it.

Very true.

 

Basic plans aren't excessive and could serve as very good catastrophic care gap plans when needed. I used to pay ~$120/m for a very good catastrophic level plan for my wife because it was cheaper than adding her to my healthcare at work (remember preventative care is free on all plans).

 

$120/m seems expensive, but it is about the same as people tend to spend on their cell phone or cable tv bills.

Wouldn't have helped much in this case. Insurance would only cover the first bag in most cases because its the standard dose. After that, shes going above and beyond and has to pay the remaining 2 bags out of pocket. According to law, insurance only has to cover standard care and medications, anything beyond that is on the patient.

Not true, the insurance will cover whatever the doctor says she needs and is allowed on her specific plan. The patient isn't forced to tell the doctor "you can only give me one pain pill because two is excessive and they won't pay for the second one."...

 

At least this is how it works in the US...



#5 theyarecomingforyou

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Posted 13 August 2013 - 14:34

Yet another reminder of how broken the US healthcare system is.



#6 +LogicalApex

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Posted 13 August 2013 - 14:38

Yet another reminder of how broken the US healthcare system is.

I think the government needs to do more to hold the feet of hospitals to the fire. Fortunately, here in Philadelphia charity care is very common and good. My wife had to go to the ER for an issue a couple of years ago and due to some messes with the health insurance company she didn't have coverage. The hospital waived almost all the charges and allowed us to pay a flat $99 for the ER visit. People shouldn't be murdered financially over medical issues, but it is a hard chestnut to crack.



#7 ILikeTobacco

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Posted 13 August 2013 - 14:38

 

Not true, the insurance will cover whatever the doctor says she needs and is allowed on her specific plan. The patient isn't forced to tell the doctor "you can only give me one pain pill because two is excessive and they won't pay for the second one."...

 

At least this is how it works in the US...

What you described is not how it works in the US. In the US, the insurance company decides what your treatment can be that they will cover and you choose from that. Anything outside of that treatment they won't cover. For instance, medicare will give you no preventative treatment for crowns on your teeth that are caused by grinding your teeth at night. A night guard is the treatment for that. Hence, you pay out of pocket for that. Now that medicare is the national standard, that is what insurance companies are saying is what they will cover. Insurance companies decide what they will cover and what treatment options you have. Not you, not your doctor. If you choose anything other than what your insurance companies says, you pay 100% of the cost.



#8 vetneufuse

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Posted 13 August 2013 - 14:44

I think the government needs to do more to hold the feet of hospitals to the fire. Fortunately, here in Philadelphia charity care is very common and good. My wife had to go to the ER for an issue a couple of years ago and due to some messes with the health insurance company she didn't have coverage. The hospital waived almost all the charges and allowed us to pay a flat $99 for the ER visit. People shouldn't be murdered financially over medical issues, but it is a hard chestnut to crack.

 

I've worked in data mining insurance claims for years now, and one thing I've always found is hospitals overcharge for ER visits like nuts when it gets sent to insurance... heck they will change your carrier $1,000 for an ER visit, that an uninsured person can get for $50... we've had doctor offices charge $250 to insurance for a patient to "fill our paperwork".... some of their claims are just ridiculous... including $500 for a box of gloves when you know they used a couple pair at most! Then they probably charged the next 100 people for that same box of gloves that costs $20 to buy at medical wholesale



#9 +LogicalApex

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Posted 13 August 2013 - 14:48

What you described is not how it works in the US. In the US, the insurance company decides what your treatment can be that they will cover and you choose from that. Anything outside of that treatment they won't cover. For instance, medicare will give you no preventative treatment for crowns on your teeth that are caused by grinding your teeth at night. A night guard is the treatment for that. Hence, you pay out of pocket for that. Now that medicare is the national standard, that is what insurance companies are saying is what they will cover. Insurance companies decide what they will cover and what treatment options you have. Not you, not your doctor. If you choose anything other than what your insurance companies says, you pay 100% of the cost.

Dental coverage falls into a separate category. Yes, in dental they typically say yes or no to individual things and the coverage is separate from medical coverage.

 

Medical coverage in the US has dollar value limits (which will mostly disappear next year) and not individual treatment limits. So, your plan would, for instance, cover $1M in medical care in a year, but it wouldn't say anything about what the doctor could spend that $1M on while you're admitted to a hospital.



#10 Growled

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Posted 13 August 2013 - 14:53

Yet another reminder of how broken the US healthcare system is.

Not many here know this but I was sick in January and I was in the hospital for nearly a week. My medical bill was over $40,000. I ended up owning around $3500 out of pocket. Still paying on some of these bills. I pay some every month. I'm still not sure it's broken, maybe just in need of some work.



#11 ILikeTobacco

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Posted 13 August 2013 - 14:53

Dental coverage falls into a separate category. Yes, in dental they typically say yes or no to individual things and the coverage is separate from medical coverage.

 

Medical coverage in the US has dollar value limits (which will mostly disappear next year) and not individual treatment limits. So, your plan would, for instance, cover $1M in medical care in a year, but it wouldn't say anything about what the doctor could spend that $1M on while you're admitted to a hospital.

You haven't read your contract have you? Read the coverage limits. Yes you have a $1M limit but that is a limit on your approved coverage. If you receive anything that is not approved by your insurance company, you pay out of pocket.



#12 ILikeTobacco

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Posted 13 August 2013 - 14:55

Not many here know this but I was sick in January and I was in the hospital for nearly a week. My medical bill was over $40,000. I ended up owning around $3500 out of pocket. Still paying on some of these bills. I pay some every month. I'm still not sure it's broken, maybe just in need of some work.

Whats crazy is that some hospitals will run credit checks and tell people to come up with the money now from other sources because they don't want to take up the credit risk. People are dumb enough to do it and if they default on an outside loan to pay this bill, they can no longer file for medical bankruptcy.



#13 +LogicalApex

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Posted 13 August 2013 - 15:09

I've worked in data mining insurance claims for years now, and one thing I've always found is hospitals overcharge for ER visits like nuts when it gets sent to insurance... heck they will change your carrier $1,000 for an ER visit, that an uninsured person can get for $50... we've had doctor offices charge $250 to insurance for a patient to "fill our paperwork".... some of their claims are just ridiculous... including $500 for a box of gloves when you know they used a couple pair at most! Then they probably charged the next 100 people for that same box of gloves that costs $20 to buy at medical wholesale

Yeah this is just part of the system's structure. Not saying it is good, but the reality is the US healthcare system has an middle man who argues down prices (insurance companies) and medical providers do their best to find ways to not have to lower those prices. The end result is they might agree to take a loss on regular office visits, but make it up by over billing for things like gloves.

 

 

You haven't read your contract have you? Read the coverage limits. Yes you have a $1M limit but that is a limit on your approved coverage. If you receive anything that is not approved by your insurance company, you pay out of pocket.

I have read every health insurance insurance contract I have ever had. They do not tell me how many gloves a doctor can use when I'm in the hospital or how many pills of morphine I can have is. The requirement that I obtain any per-approval, or contact and deal with the insurance company at all, is only if I go to an out of network hospital.

 

To make this a little clearer this is a snippet from my current insurance plan. Notice how much it says they pay for "In-Network" and that it mentions nothing about me being limited to one pain killer or two...

 

There are a lot of problems with the US healthcare system. Don't mistake my statements as some blanket support for the status quo, but I also think it is important that we're dealing with reality and not conjecture here.

 

Medical Snippet.PNG



#14 ILikeTobacco

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Posted 13 August 2013 - 15:11

Yeah this is just part of the system's structure. Not saying it is good, but the reality is the US healthcare system has an middle man who argues down prices (insurance companies) and medical providers do their best to find ways to not have to lower those prices. The end result is they might agree to take a loss on regular office visits, but make it up by over billing for things like gloves.

 

 

I have read every health insurance insurance contract I have ever had. They do not tell me how many gloves a doctor can use when I'm in the hospital or how many pills of morphine I can have is. The requirement that I obtain any per-approval, or contact and deal with the insurance company at all, is only if I go to an out of network hospital.

 

To make this a little clearer this is a snippet from my current insurance plan. Notice how much it says they pay for "In-Network" and that it mentions nothing about me being limited to one pain killer or two...

 

There are a lot of problems with the US healthcare system. Don't mistake my statements as some blanket support for the status quo, but I also think it is important that we're dealing with reality and not conjecture here.

 

attachicon.gifMedical Snippet.PNG

Again, you are looking at the amount covered of treatments actually covered. You can't just get whatever treatment you want and then bill insurance companies. Read the ENTIRE contract, not just the marketing tables.

 

Easy example. I have to test my blood multiple times a day to control my Type 1 diabetes. Insurance coverages materials for 3 tests a day. Doctor wants me to test 6 times a day and my pump manufacturer wants me to test 9 times a days. Because insurance only covers 3 times a day, they pay 80% of the cost of those supplies. For the other 3 tests, I pay 100% of the cost. I can't afford pay 100% for 6 more times a day so I had to go with 3 times a day.

 

If your insurance covers 80% of your in network costs, that means 80% of your approved in network costs, not 80% of 100% of costs.



#15 Rohdekill

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Posted 13 August 2013 - 15:14

 

Not true, the insurance will cover whatever the doctor says she needs and is allowed on her specific plan. The patient isn't forced to tell the doctor "you can only give me one pain pill because two is excessive and they won't pay for the second one."...

 

At least this is how it works in the US...

Tell that to my wife, who's insurance claim came back with a ton of "not medically necessary" refusal to cover.  And, she didn't ask for anything; it was all standard procedure or directly instructed by the doctor.