Another Racket

It is racket week and here’s another one. This racket inhabits our marvelous health-care system. I first read about it some time ago in the context of a clinic in the Bay area that was attracting doctors with high pay.

Basically the idea is to attract insured patients with PPO out-of-network coverage, and then bill huge amounts. In most cases the racketeer accepts whatever the insurer pays, usually 60% or so, and doesn’t charge the patient the balance. In some cases, if the patient asks about fees, they will be told that there will be no out-of-pocket cost. The idea is, if you charge, say, 5x the going rate, then at 60%, typical for out-of-network coverage, you are at 3x which is plenty good enough.

Here is one where the hospital got called on this. The patient was bitten by a scorpion and received two shots of antivenin and an $83,000 bill:

The poison control center advised Edmonds to go to a hospital, so she went to Chandler Regional Medical Center, where doctors administered two vials of a relatively new anti-venom called Anascorp, which was approved by the Federal Drug Administration last August and is distributed to hospitals for about $3,800 per vial, toxicologists say.

Edmonds left the hospital after a three hour stay, but the bill that arrived several weeks later came out to $83,046, or $39,652 per Anascorp vial, ABCNews.com confirmed. That’s about 10 times what the hospital paid for each vial.

“Everyone I talk to says, ‘You’ve got to be kidding,’ ” Edmonds said to the Arizona Republic.

Chandler Regional Medical Center released a statement apologizing for Edmond’s treatment costs, explaining that they are working to adjust the high “out-of-network” bill she received for the anti-venom.

The antivenin is made in Mexico, by the way, and costs about $100 per dose there. And Chandler Regional Medical Center is “not-for-profit.” Sure it is. Well, after the staff has split the takings, anyway.

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