Medical Costs

Gov. Arnold Schwarzenegger's administration has moved to ban physicians and hospitals from billing patients for the cost of services above what their HMOs are willing to pay. Such bills, which patient advocates call a consumer abuse, are the product of a protracted feud between insurers and healthcare providers, principally emergency room doctors, radiologists and anesthesiologists.

As if escalating prices for food and gas weren't enough of a worry, most seniors in Medicare's prescription-drug program are paying considerably higher monthly premiums for coverage this year, according to a study to be released today. Those in the 10 largest plans -- which account for nearly three-fourths of seniors signed up for drug coverage -- are paying an average of $26.

DRUG AND alcohol abuse sets people on a path toward heart disease, cancer and other chronic illnesses. A study in the Journal of Substance Abuse Treatment reports that hospital costs for this medical fallout can be substantial -- and could be avoided with more drug and alcohol treatment. Lead author Patricia Santora of Johns Hopkins University School of Medicine and colleagues found that 14% of people admitted to Johns Hopkins Hospital from 1994 to 2002 were alcohol or drug abusers.

California regulators have moved to stop one of the state's biggest hospital operators from billing privately insured patients for unpaid medical services received at its facilities. The Department of Managed Health Care, in a lawsuit filed Friday in Orange County Superior Court, is seeking to bar Prime Healthcare Services Inc.

Mary Wusterbarth thought her toddler was struggling with an ear infection when she seemed sluggish. Instead, a virus had attacked the little girl's heart, damaging it beyond repair. Brea needed a transplant. Within three weeks of a 2007 doctor visit, the 20-month-old had exhausted the $1 million lifetime maximum on her health insurance. Her parents have scrambled ever since for ways to cover thousands of dollars in monthly medical costs.

Rapper DMX was arrested Saturday at a Phoenix mall on suspicion of giving a false name and Social Security number to a hospital to get out of paying for medical expenses. Maricopa County Sheriff Joe Arpaio said that when DMX, whose real name is Earl Simmons, went to Scottsdale's Mayo Clinic in April, he gave the name "Troy Jones" and failed to pay a $7,500 bill. DMX attorney Cameron Morgan of Scottsdale declined to comment.

Whenever I hear talk about universal healthcare in the U.S., I shudder. Don't get me wrong, I firmly believe that access to healthcare should be a right, not a privilege. What I fear is universal access to a system that, in my opinion, is fundamentally flawed. We spend more per capita on healthcare than any other country in the world. A lot more. Especially considering that nearly one-sixth of the population has no health insurance. And the costs keep rising.

The government is putting millions of Medicare dollars at risk by authorizing fictitious sellers of wheelchairs, prosthetics and other medical supplies to submit reimbursement claims with only limited review, congressional investigators say. A Government Accountability Office study, obtained by the Associated Press, sought to follow up on oversight gaps that have plagued the Centers for Medicare & Medicaid Services since at least 2005.

Emergency room patients can no longer be stuck with the bill when hospitals or physicians disagree with insurance companies on their fees. Under new state rules that take effect today, hospitals and physicians are barred from billing patients for the balance of emergency care not covered by insurers. But the relief for patients may not last long. Hospitals and physicians are protesting the rules in court.

In late 2007, Centinela Hospital in Inglewood was losing nearly $1 million a month and had piled up $15 million in debt. Among the causes of the crisis: $25 million in overdue bills. Collecting that money would have given Centinela a measure of relief. But the bills went unpaid, and the century-old medical center was sold. The new owners slashed services, closed half the operating rooms and laid off a third of the employees. Who owed Centinela that elusive $25 million?