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I may have a little input on the topic of how hospitals charge and even more about reimbursement. I am a retired operating room nurse and I was responsible for maintaining charges for O.R. supplies based on their costs. We marked items up considerably with really a bigger mark-up for lower cost items than for the most expensive ones. That being said we are a non profit facility and what that means is we must make up the losses for those who cannot and/or do not pay by charging these big mark-ups to those who can and /or do pay.
Example: implants used for spinal fusions might cost us as much as $10,000 and Medicare reimburses us only $4400 for the entire hospitalization. I am on Medicare and TriCare for Life. I receive an explanation of benefits from them on what they have approved. The hospital charged $5290.14 for Herceptin alone. (This was for the first dose) and Medicare reimbursed them $670.43. Tricare for Life paid $711.28. Without knowing for certain what the hospital pays for the drug I think it is safe to say it was more than $1381.71. Hope this adds some insight into the mechanism that goes into what hospital charges versus what it costs them.
Marlys
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