The vet who has treated my cat for the past six years
recently moved 40 miles closer.  That was the good
news.  The office visit that used to cost $50 is now $110.
I asked about it.  The receptionist told me that the new
prices "are consistant with other practices in the area."
Same vet, same exam.  New price.  He's still worth it, but
I'm growing weary of every price being set at all the market
will bear.

In February, I had oral surgery.  Half an hour of outpatient
surgery: $17,000.  I was tempted to ask for the details that
led to the pharmacy part ($800) ... dunno what I bought beyond
a liter of saline and an injection of dexamethasone on the way
out.  Past attempts at challenging bills like this taught me
that the hospital knows just what to write down on the insurance
claim.  Maybe this explains why my premium goes up 25-30% every
year.  As with the vet, the surgeon was top notch and I'm very
satisfied with the service.  Paying for it is the problem.

Does anybody hold up stage coaches anymore?

I am in the USA, and I am a health care provider.  The obligation to
bill fairly means not billing for procedures that were not done, not
billing for equipment that was not used, not billing for drugs not
given, not billing for lab tests that were not administered,
and not billing for patients that were not seen.  There are Fair
Practice
laws in all the fifty states that govern business practices and they
most certainly do apply to physicians as well as anybody else
who goes into private business of any other type.

And no, physicians do not bill what they think their services are
worth.
They bill what they feel is in order to make their private business
earn profit, knowing, however, that they will only get paid for what
either
private insurance, or Medicaid, etc will choose to reimburse them.....
they can charge all they want, but they will only receive what the
insurance company thinks their services are worth.  In most cases,
except for the ones who practice in neighborhoods that can support
whatever they choose to charge, and those neighborhoods are few
and far between, a physician who bills much beyond what the insurance
will pay is well aware that he is not likely to see that bill paid on
time,
if ever, and his practice is likely to shrink as patients seek other,
more appropriate providers.

The enormous account-crashing bills (>$25,000.00 plus) that one hears
about
which are so notorious in the American healthcare system are usually
generated by unexpected hospital stays and these are the main bills
I was referring to in my previous post, actually, because there is no
way it is reasonable to expect an average layperson to be able to
parse a sixteen page itemization of all the materials, drugs and
equipment that might have been used in an ICU stay, or in an OR visit,
for example.  It would be extremely easy for a hospital billing office
to charge ridiculous amounts (such as twelve fleet enemas) and fully
expect to get away with it given the hundred of items on that bill
surrounding
the questionable item and the fact that it's "only" the insurance
company
getting ripped off, if it weren't for the Fair Business Practices laws
that make it a criminal act.  And most insurance companies do NOT
send that itemization to the patient anyways....they send a summary
that looks something like this:
Emergency Room evaluation:     $600.00
ICU stay (three days) :           $9000.00
cardiology consult:                $550.00
anesthesia consult:  etc.
miscellaneous equipment, etc.

...numbers from a hat, btw.......they don't usually itemize
directly to the patient just how many IV tubings were changed
during their stay etc. etc.  Some do, but most don't.  What they
will itemize will be any extras such as private hospital room,
telephone charges, things incurred directly by patient request.

It's not just CAVEAT EMPTOR anymore.  How on earth could anyone
have won a class action lawsuit against the big tobacco companies
if that were true?

--tension