{"id":4833,"date":"2005-11-22T00:16:33","date_gmt":"2005-11-22T00:16:33","guid":{"rendered":"https:\/\/tomfarandasfolly.com\/?p=4833"},"modified":"2025-09-24T00:26:57","modified_gmt":"2025-09-24T00:26:57","slug":"i_got_two_bills","status":"publish","type":"post","link":"https:\/\/tomfarandasfolly.com\/?p=4833","title":{"rendered":"Medical care and medical costs"},"content":{"rendered":"

I got two bills today. One was for almost $22,000 from Memorial Sloan Kettering for my six day stay there. That was in July, for Nephrotic Syndrome. (Digression: this was caused by my lymphoma, and the triggering event for my current chemotherapy.) <\/span><\/p>\n

\n<\/p>\n

The letter with the three page bill said \u201cyour insurance carrier has paid $0.00.\u201d And then, please send us a check, we take mastercard, etc, etc.<\/span><\/p>\n

\n<\/p>\n

I called Aetna to see what was up \u2013 I knew payments had been delayed, because I\u2019d neglected to send them an update confirming that they were our only medical insurance.  <\/span><\/span><\/p>\n

\n<\/p>\n

I got through to a customer service rep quite quickly (at lunchtime on a Monday, that is quite miraculous!) and told \u201cDenise\u201d what I\u2019d received. She laughed and then said, \u201cWe sent out a check on 11\/17. You owe $500.\u201d I asked her how much Aetna had paid and she said \u201c$10,200.\u201d <\/span><\/p>\n

\n<\/p>\n

So while Memorial Sloan Kettering is not in the Aetna network they do have some sort of \u201cpreferred discount\u201d arrangement, which is evidently about 50% of what MSK bills. <\/span><\/p>\n

\n<\/p>\n

This is called \u201cManaged Care.\u201d I always presumed that the in-network cost discount to the insurers was about 40%, so I wasn\u2019t far off on that. <\/span><\/p>\n

\n<\/p>\n

And Aetna had been (very rightly in my opinion) arguing that the sixth day in MSK was unnecessary and they shouldn\u2019t have to pay for it.  <\/span>I don\u2019t know who won that argument. Itwill be interesting to find out.<\/span><\/p>\n

\n<\/p>\n

The second bill was for my recent PET scan at White Plains hospital, which is a member of the Aetna network.  <\/span>I had received an earlier bill for $3,300, but it said \u201cwe are submitting this to your insurer.\u201d<\/span><\/p>\n

\n<\/p>\n

On the second bill, it said Aetna paid $900, the Aetna \u201ccontract discount\u201d was $2,300, and I owed $100.<\/span><\/p>\n

\n<\/p>\n

A reduction from $3,300 to $1,000. That\u2019s a 70% reduction. More \u201cManaged Care.\u201d<\/span><\/p>\n

\n<\/p>\n

This is how providers (hospitals, etc) are currently pricing their \u201cproduct.\u201d There is a high \u201cretail\u201d price and a lower \u201cwholesale\u201d price, and it seems that very few people pay \u201cretail.\u201d The insurance carriers negotiate their arrangements. If you are poor, the hospitals accept medicaid. The only people who pay \u201cretail\u201d to MSK are wealthy people and celebrities who go there because of it\u2019s worldwide reputation.  <\/span>In fact the 19th<\/sup> floor at Sloan Kettering is the \u201ccelebrity\u201d floor, with special arrangements for security, privacy, etc. <\/span><\/p>\n

\n<\/p>\n

This is very interesting to me because under the category of \u201cfinancial advice for business owners\u201d, I am an insurance broker providing medical coverage and employee benefit plans for about two dozen different companies. For several of these client companies we use Aetna. <\/span><\/p>\n

\n<\/p>\n

By the way, the \u201cretail\u201d price for a semi-private room at Sloan Kettering is $1,940 a day. That\u2019s just for the bed and spaghettioes (and the nurses; can\u2019t forget them!). Everything else (Dr\u2019s, medicine, tests, bloodwork, etc, etc, etc) is extra. <\/span><\/p>\n

\n<\/p>\n

But nobody pays \u201cretail\u201d.<\/span><\/p>\n<\/p>\n<\/p>\n<\/p>\n<\/p>\n<\/p>\n<\/p>\n<\/p>\n<\/p>\n<\/p>\n<\/p>\n<\/p>\n<\/p><\/p>\n","protected":false},"excerpt":{"rendered":"

I got two bills today. One was for almost $22,000 from Memorial Sloan Kettering for my six day stay there. That was in July, for Nephrotic Syndrome. (Digression: this was caused by my lymphoma, and the triggering event for my current chemotherapy.) The letter with the three page bill said \u201cyour insurance carrier has paid […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-4833","post","type-post","status-publish","format-standard","hentry","category-my-lymphoma-and-related-medical-stuff"],"_links":{"self":[{"href":"https:\/\/tomfarandasfolly.com\/index.php?rest_route=\/wp\/v2\/posts\/4833","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tomfarandasfolly.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tomfarandasfolly.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tomfarandasfolly.com\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/tomfarandasfolly.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=4833"}],"version-history":[{"count":1,"href":"https:\/\/tomfarandasfolly.com\/index.php?rest_route=\/wp\/v2\/posts\/4833\/revisions"}],"predecessor-version":[{"id":9873,"href":"https:\/\/tomfarandasfolly.com\/index.php?rest_route=\/wp\/v2\/posts\/4833\/revisions\/9873"}],"wp:attachment":[{"href":"https:\/\/tomfarandasfolly.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4833"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tomfarandasfolly.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=4833"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tomfarandasfolly.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=4833"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}