Health Insurance fuckery

[locodos 5334]

One other piece to advice directly from the nice lady at UHC.   Never pay the deductible or anything if you can help it at the hospital.  Make them bill the insurance  and wait till all the charges come through. (you won't know how many there will be so wait a bit)

I paid the deductible to the hospital ($2000) when they asked for it prior to surgery.  But the anesthesiologist was a smart cookie and had his office file a claim at @1am on a Friday night presumably minutes after my son's surgery.  So he was entitled to the deductible, not the hospital.   So I had to go back to the hospital and collect the $2000 that was paid to them "in error".  So that's just as fun as you might imagine.

[locodos 5334]

4 minutes ago, Anastasis said:

Told her to file away any bills that come in for the next couple months and don't send them shit until the adjudication process work out. 

This ^

5 minutes ago, Anastasis said:

What we need is a system that requires pricing transparency, incentivize price competition, and backstops against catastrophic events. There are relatively straightforward ways to get there, at least conceptually. Too many interests vested in the current system though. 

Not this ^  This is horse shit.  It's 1am on a friday night and your loved is writhing in pain one need emergency surgery.   What are you going to do?  Fire up the ole internet to look for bargains?  You know make a few calls.  Fuck that!

 

[Anastasis 23394]

Just now, locodos said:

Not this ^  This is horse shit.  It's 1am on a friday night and your loved is writhing in pain one need emergency surgery.   What are you going to do?  Fire up the ole internet to look for bargains?  You know make a few calls.  Fuck that!

Emergency situations are clearly different scenarios, but if you have to shop an non-emergent outpatient MRI for example, some gd pricing transparency would be nice. 

[locodos 5334]

1 minute ago, Anastasis said:

Emergency situations are clearly different scenarios, but if you have to shop an non-emergent outpatient MRI for example, some gd pricing transparency would be nice. 

Agreed.   But I think that's the bare assed minimum we should expect.  For profit medicine is ghoulish, and most people find out once it's too late.

[Brisketexan 104628]

Wackadoo lucky coincidence of my life: after multiple years of doing the ordinary health plan, HSA accounts, all of that, one year my wife threw up her hands and said "I'M SICK OF THIS SHT.  I'M SICKING OF TRACKING EVERY EXPENSE AND SUBMITTING IT. ALL OF IT."  So, she demanded that this year -- at least for one year, let's do the full "buy-up" health plan.  It was the "we cover pretty much everything, $1,000 deductible" plan.  So, I signed up.  It was fucking expensive, relatively speaking.

And in January of that year, my daughter came down with a serious illness that put her in the hospital for the week.  I think the total billing on her treatment was $200k.  I wrote a check for $1k, and never had to look at another medical bill again.  Maybe the best timing of my entire life.

We went back to a sane plan after that year, though.  Because fuckin' A, the buy-up was expensive.

[DigglerontheHoof 21065]

1 hour ago, Neonmoon said:

No shit? Well I know these 3 million Americans and they owe over 10,000 in medical debt they can’t afford. I also heard that Humira was 427% more expensive in the US than the UK. 

It sucks about your colleagues kid, but they can buy private insurance if they are not satisfied with the single payer 

No argument from me. 

[HRSchenker 2259]

Health care billing is mostly bullshit. Medical billing isn't as fucked up as pharmacy billing from my experience. It doesn't help that these scumbag vultures like GoodRx exist. But then again, if our system wasn't fucked up they probably wouldn't exist in the first place. I can't blame them for taking advantage of consumers while the feds look the other way for the most part.

[Anastasis 23394]

31 minutes ago, HRSchenker said:

It doesn't help that these scumbag vultures like GoodRx exist.

Man, I really want to hate GoodRx because I understand how they work, but got to admit that they have saved me hundreds and hundreds of dollars on my kids fluticasone inhaler. The pricing on that shit is fucking criminal. 

[Anastasis 23394]

5 minutes ago, BeardIP said:

Why are they bad guys? I assumed GoodRx walked so Mark Cuban's discount pharma company could run.

Pharmacies run at some of the slimmests margins in healthcare, and GoodRx makes a good bit of their money by fucking around in the spread and taking money out of the pockets of the pharmacies. Now a company like CVS or Walgreens probably don't give a shit, but that independent pharmacy sure as hell feels the pinch. 

[SimonBolivar 10932]

On 10/12/2023 at 9:02 AM, Hawndoh said:

The whole industry makes no sense.

My wife has a prescription for migraines. It has always been free under our insurance.

One day she goes to get a refill and they say "that will be 400 dollars"

Long story short, they had tried to fill it for 20 pills when it had always been 19 pills. 19 pills is free, but 20 pills is 400 bucks.

Not exactly the same but in a similar vein...

 

My wife's birth control pills are free through her health insurance. I went to go fill her prescription once and it happen to be on the last day of the month, and they asked for $100 at the pharmacy because we had picked up previously on the 1st day of that month. So, we had to wait a day to pick it up or pay the extra $100. Annoying BS for nothing.

[HRSchenker 2259]

30 minutes ago, Anastasis said:

Man, I really want to hate GoodRx because I understand how they work, but got to admit that they have saved me hundreds and hundreds of dollars on my kids fluticasone inhaler. The pricing on that shit is fucking criminal. 

 

3 minutes ago, BeardIP said:

 

To the layperson, like myself, I thought GoodRX was disrupting the legacy rx business that gouged customers. I'd heard anecdotal stories of folks getting great prices for meds that were 3-10x higher otherwise.

Why are they bad guys? I assumed GoodRx walked so Mark Cuban's discount pharma company could run.

Oh man yall are about to learn today. Buckle up for this.

So pharmacy billing is based around a concept called usual and customary pricing. This is set as the price you would pay if you didn't have insurance. The U&C is set high because insurance companies won't pay you more than that set figure. Imagine Optum pays $40 for a drug, Express Scripts pays $50, and United pays $70. You want to set your U&C at $70 so you can capture that revenue. If you set it at $40 then Express Scripts won't pay you $50 and United won't pay you $70. State and federal plans base their pricing on U&C as well which is where things get tricky. Let's say a patient comes in and their copay is really high, like $100. The drug they want is a slow mover and it would be nice to get it off your shelf before it expires. You cut the patient a deal at $35. Per HHS and court precedent, that is Medicare fraud. Because you sold that prescription at a price below your U&C, you overcharged the feds for any previous prescription set at that higher U&C. Doesn't matter if you made none to little net margin on that prescription, it's not allowed.

What GoodRx does is bill through the same processor as Optum, Express Scripts, United, etc so the price being transmitted at the point of sale is still based on the U&C but they can set whatever terms they want. If they want to pay me $10 for a drug that costs me $50 from my wholesaler, they can do it. GoodRx makes their money on fees transmitted by the billing pharmacy. Some of yall are lawyers. Imagine you charge $1,000 to create an LLC. I come into the equation and say "hey you're gonna charge the customer $450 and pay me $50 for the privilege of lowering your price". That's the business model of GoodRx but I also sell the personal information of your clients on the side. I get that some people save money at pharmacies using those cards but it's all fake. You know the roofer that repaired the leak in your bedroom? You wouldn't be praising him if he was the one who caused the leak in the first place. GoodRx is nothing but a different side to the same corrupt coin.

Cost Plus is different in that their U&C can be whatever they want it to be at any moment since they don't bill insurance. They also don't have any brick and mortar pharmacies.

[Anastasis 23394]

3 minutes ago, HRSchenker said:

GoodRx is nothing but a different side to the same corrupt coin.

Yeah, I understand. Our inhaler is $300 if we bill it through our HDHCP, $120 through GoodRx. We fill most of our scripts through our local independent, but move this one over to Walgreens so they don't have to eat the shit on that one. It's all a fucking scam. I mean it's fucking fluticasone for christ's sake. 

[Anastasis 23394]

5 minutes ago, BeardIP said:

I appreciate the attempt here, but since it's not my domain and I'm never the smartest guy in any room I am in, I think I only grasped about 75% of this. I'll marry what I did understand with taking your word for it.

Here's a good link that tackles the issue as well.

https://www.drugchannels.net/2020/08/how-goodrx-profits-from-our-broken.html

 

[TwiceHorn 31283]

On 10/12/2023 at 3:35 PM, BeardIP said:

Do you not have insurance? Hard to believe that you'd get a $2500 bill with insurance.

Most insurance doesn't cover ambulances.  My parent had Medicare plus a BC/BS "supplement" that was actually the remnant of Dad's insurance from a Fortune 500 company, when they extended that past retirement (don't think many do).  It was gold standard, most of their healthcare cost almost nothing, including some hospital stays, extended diagnostic work and several days in the ICU for mom.

And a couple of ambulance trips, that cost about $600/throw, maybe a little more when a private one was dispatched.  That was almost 20 years ago.

[Gap03 3287]

I can beat that shit.  My wife recently had to get transferred from the ICU in Austin (in-network) to an ICU in Dallas that could do ECMO (also, in-network). They transported her by helicopter (air ambulance, which is generally covered by my insurance).  Nothing was mentioned to me at the time, but lo and behold, the service that they used was out-of-network.  Price tag?  $47,600.  I had already hit my out-of-pocket in-network cap, so I had thought I was good.  Instead, I now get to deal with an extra 5 figures of medical expense because of the classic in-network/out-of-network shenanigans (unless I can shame them into covering it as in-network ...).  ''

Yep - our medical system is just absolutely fucked.

[TwiceHorn 31283]

Question:

Has anyone ever been sued for medical debt?  Heard of such a thing?  

I know hospitals aggressively collect "liens" in certain situations, as where there is an injury lawsuit or other insurance settlement (from other than a health insurer), but I have never seen nor heard of a hospital suing to collect a debt.

Well, check that, recently I read that the University of Arkansas-Little Rock's hospital sued a bunch of people, including its own employees, but other than that  . . . .

The point being, I tend to assume that most medical debt can kind of be ignored, especially if it doesn't make it onto a credit report.

[G650 14108]

15 minutes ago, TwiceHorn said:

The point being, I tend to assume that most medical debt can kind of be ignored, especially if it doesn't make it onto a credit report.

 

Definitely not, I have several employees getting garnishments over medical debt.

[LCHorn 2585]

10 minutes ago, TwiceHorn said:

The point being, I tend to assume that most medical debt can kind of be ignored, especially if it doesn't make it onto a credit report.

But it does make it onto a credit report.  
 

Happy to find it for you but do you recall the Austin teacher that was harassed for $100k by St David’s back in 2018?  It was a big story at the time.  My sister has worked for both Seton and St David’s and mentioned that St David’s was known for aggressive collecting medical bills in spite of the inaccuracy frequently inherent in our messy system.  
 

It makes me a little embarrassed every time I see their commercials on Longhorn games-how much of that marketing budget came at the expense of patients browbeaten into paying a bill they thought would or should have been covered by insurance?

[Captainant 27467]

14 minutes ago, TwiceHorn said:

The point being, I tend to assume that most medical debt can kind of be ignored, especially if it doesn't make it onto a credit report.

Just seems like needless cruelty to inflict that stress on people as they are convalescing from a major medical procedure. 

[Al Bundy's Napoleon Hand 13547]

21 minutes ago, TwiceHorn said:

Question:

Has anyone ever been sued for medical debt?  Heard of such a thing?  

I know hospitals aggressively collect "liens" in certain situations, as where there is an injury lawsuit or other insurance settlement (from other than a health insurer), but I have never seen nor heard of a hospital suing to collect a debt.

Well, check that, recently I read that the University of Arkansas-Little Rock's hospital sued a bunch of people, including its own employees, but other than that  . . . .

The point being, I tend to assume that most medical debt can kind of be ignored, especially if it doesn't make it onto a credit report.

https://features.propublica.org/medical-debt/when-medical-debt-collectors-decide-who-gets-arrested-coffeyville-kansas/

[Celery Man 20886]

On 10/13/2023 at 3:51 PM, HRSchenker said:

 

Oh man yall are about to learn today. Buckle up for this.

So pharmacy billing is based around a concept called usual and customary pricing. This is set as the price you would pay if you didn't have insurance. The U&C is set high because insurance companies won't pay you more than that set figure. Imagine Optum pays $40 for a drug, Express Scripts pays $50, and United pays $70. You want to set your U&C at $70 so you can capture that revenue. If you set it at $40 then Express Scripts won't pay you $50 and United won't pay you $70. State and federal plans base their pricing on U&C as well which is where things get tricky. Let's say a patient comes in and their copay is really high, like $100. The drug they want is a slow mover and it would be nice to get it off your shelf before it expires. You cut the patient a deal at $35. Per HHS and court precedent, that is Medicare fraud. Because you sold that prescription at a price below your U&C, you overcharged the feds for any previous prescription set at that higher U&C. Doesn't matter if you made none to little net margin on that prescription, it's not allowed.

What GoodRx does is bill through the same processor as Optum, Express Scripts, United, etc so the price being transmitted at the point of sale is still based on the U&C but they can set whatever terms they want. If they want to pay me $10 for a drug that costs me $50 from my wholesaler, they can do it. GoodRx makes their money on fees transmitted by the billing pharmacy. Some of yall are lawyers. Imagine you charge $1,000 to create an LLC. I come into the equation and say "hey you're gonna charge the customer $450 and pay me $50 for the privilege of lowering your price". That's the business model of GoodRx but I also sell the personal information of your clients on the side. I get that some people save money at pharmacies using those cards but it's all fake. You know the roofer that repaired the leak in your bedroom? You wouldn't be praising him if he was the one who caused the leak in the first place. GoodRx is nothing but a different side to the same corrupt coin.

Cost Plus is different in that their U&C can be whatever they want it to be at any moment since they don't bill insurance. They also don't have any brick and mortar pharmacies.

ok and I'm a complete moron when it comes to all of this stuff, I just max out my hsa and try not to get hit by cars or inhale carcinogens, but this is the free market at work protecting us from socialism?

[TwiceHorn 31283]

36 minutes ago, LCHorn said:

But it does make it onto a credit report.  
 

Happy to find it for you but do you recall the Austin teacher that was harassed for $100k by St David’s back in 2018?  It was a big story at the time.  My sister has worked for both Seton and St David’s and mentioned that St David’s was known for aggressive collecting medical bills in spite of the inaccuracy frequently inherent in our messy system.  
 

It makes me a little embarrassed every time I see their commercials on Longhorn games-how much of that marketing budget came at the expense of patients browbeaten into paying a bill they thought would or should have been covered by insurance?

Sometimes it does and sometimes it doesn't, apparently.  And, of course, Biden has a proposal on the table somewhere to keep medical debt off credit reports.

Texas may be somewhat unique in that its exemption schemes make collection suits an often worthless endeavor and having no pre-judgment collection remedies to speak of.

[Bozo_Casanova 26285]

On 10/13/2023 at 2:39 PM, SimonBolivar said:

My wife's birth control pills are free through her health insurance.

No. Your wife's birth control pills are a prepaid service provided by her employer under contract in barter exchange for her labor. IT'S NON CASH COMPENSATION, and every time benefits are reduced or premiums are raised, it should be understood to be a pay cut.  This is the MOST important thing for all Americans to understand about our system. The word "free" needs to be eliminated from our vocabulary. 

On 10/13/2023 at 2:51 PM, HRSchenker said:

What GoodRx does is bill through the same processor as Optum, Express Scripts, United, etc so the price being transmitted at the point of sale is still based on the U&C but they can set whatever terms they want. If they want to pay me $10 for a drug that costs me $50 from my wholesaler, they can do it. GoodRx makes their money on fees transmitted by the billing pharmacy. Some of yall are lawyers. Imagine you charge $1,000 to create an LLC. I come into the equation and say "hey you're gonna charge the customer $450 and pay me $50 for the privilege of lowering your price". That's the business model of GoodRx but I also sell the personal information of your clients on the side. I get that some people save money at pharmacies using those cards but it's all fake. You know the roofer that repaired the leak in your bedroom? You wouldn't be praising him if he was the one who caused the leak in the first place. GoodRx is nothing but a different side to the same corrupt coin.

I'm not defending the nature of their their income, but they are cleaning up the market It's right there in the URL below:

On 10/13/2023 at 3:03 PM, Anastasis said:

https://www.drugchannels.net/2020/08/how-goodrx-profits-from-our-broken.html

"How GoodRX Profits from our Broken". I don't like the fact the the opportunity exists, but the fact is that the system created a problem that people need solutions for and they provide it.  Don't hate they player, hate the game. 

BTW, you know what would have solved this? Wyden-Bennett, you motherfuckers.*

33 minutes ago, Celery Man said:

ok and I'm a complete moron when it comes to all of this stuff, I just max out my hsa and try not to get hit by cars or inhale carcinogens, but this is the free market at work protecting us from socialism?

Actually, yes. 

 

 

 

 

*Or maybe not but still

Edited October 16, 2023 by Bozo_Casanova

[4th&Five 41461]

1 hour ago, Captainant said:

Just seems like needless cruelty to inflict that stress on people as they are convalescing from a major medical procedure. 

[horn4life 3755]

1) we spend more per capita than any other industrialized country

2) We have more uninsured than any industrialized country.

3) Republicans believe that there is actually some sort of tax cut solution involving millionaires that will create better health outcomes!

4) Republicans actually have a fantastic healthcare plan they are going to let us know about very soon!  It should be wonderful as it has been in development for roughly Half a Century.

[Celery Man 20886]

When I bottomed out with alcohol I was totally off the grid for several months and moved a few times and etc etc. I definitely paid the full deductible and insurance chipped in a lot but some bills got in there that I didn’t even know about until I started getting collections calls. Like 10k of knick knack collections bullshit that probably started at 1k. It’s embarrassing because I should have just taken care of it at any point, but I did not.

Anyways, that shit dinged up my credit a bit and I got annoying phone calls but that was it, and I’ve been sober for over 7 years now so hooray.

[Nice Guy Eddie 13414]

On 10/13/2023 at 4:34 PM, BeardIP said:

Not sure I agree with that. Every insurance I've ever had covers it if it's "in network". I just looked up my plan and it's a $100 copay:

 

Further my 90 year old grandfather had an ambulance ride to the ER last month and with the supplemental insurance he has through BCBS I think it is, it was $250.

A quick search tells me that Medicare Part B covers ambulance. They have different criteria if it's emergency vs non-emergency.  In some cases you may need a doctor's verifying that it was necessary to transport via ambulance and you need that note within a couple of days.

[washparkhorn 9935]

Example of our broken system. 

>We have an obesity epidemic in the United States.  
>Preventive or curative obesity treatment would save Americans trillions in costs associated with obesity.
>New drugs that curb overeating are so effective that we now see food-associated enterprises revising revenue numbers to reflect a reduction in US obesity. 

Our broken system—charge overweight Americans more for the drugs:

 

Edited October 16, 2023 by washparkhorn

[Captainant 27467]

Just now, washparkhorn said:

Example of our broken system. 

>We have an obesity epidemic in the United States.  
>Preventive or curative obesity treatment would save Americans trillions in costs associated with obesity. >New drugs that curb overeating are so effective that we now see food-associated enterprises revising revenue numbers to reflect a reduction in US obesity. 

Our broken system—charge overweight Americans more for the drugs:

 

Well regulating how much profit healthcare firms are allowed to extract from their customers would be COMMUNISM, or something 

[AUinHsv 576]

On 10/13/2023 at 4:34 PM, BeardIP said:

Not sure I agree with that. Every insurance I've ever had covers it if it's "in network". I just looked up my plan and it's a $100 copay:

 

Further my 90 year old grandfather had an ambulance ride to the ER last month and with the supplemental insurance he has through BCBS I think it is, it was $250.

No idea why but Mom had BCBS Federal which must have been golden. In 4 years at nursing home she took ambulance to hospital probably 6-7 times. Never saw bill. Never saw a bill for anything from the hospital either.

[pyrohornIII 4809]

The healthcare system is layers of corporations upon more layers all taking a piece of the pie, and we keep voting in people who not only allow this stuff, but actually pass laws that make it easier.  

To me the fleecing of the middle and lower classes by corporate greed (in all areas) is criminal and the protection of the average citizen from them should be top priority. 

Democrats should make consumer protection one of their standards.

You know there are rich fuckers who are in your misery from cradle to grave, every phase of your life.  Selling you the shit that makes you obese, then owning the healthcare and drugs that supposedly treat you, even the assholes who own the funeral homes that dispose of your body.    All the while they keep you distracted from how they are picking your pocket with all these diversions about race, gender, age, religion, etc.   

Harkening back to the conspiracy thread, I don't know if those rich assholes at the top orchestrated it starting centuries ago, or just are living large off the stupidity of humans, but I bet the answer is somewhere in the middle.    

On the funeral stuff, if you haven't watched The Burial yet, I'd suggest it.  

 

[Leeroy Jenkins 2393]

As an aside.

EMS services make their money on hospital to hospital transfers.

Also our fucked up health system has fucked EMS since the uninsured use the ER and 911 as their doctor.

[Brisketexan 104628]

As an aside.

EMS services make their money on hospital to hospital transfers.

Also our fucked up health system has fucked EMS since the uninsured use the ER and 911 as their doctor.

It’s been a truly fascinating (and discouraging) experience working with some lower income folks and seeing how they look to the ER as just a basic Dr visit. My ear hurts…I should go to the ER. I’m having a reaction to something (but the worst has passed, and I’m slowly improving) - I’m going to the ER.

Shit, I remember 10 years ago when my daughter had to go to the Children’s ER (and she really did - was hospitalized for a week). The ER waiting area was full. Almost all appeared to be lower income. A handful looked to really need an ER visit. The rest just looked like…sick kids. Like, go to a PCP or a minute clinic, and get some antibiotics for that strep. But that’s not what they’re doing.

nobody has ever explained to them how the healthcare system and their insurance (believe it or not, many poor folks have a health plan of some sort) works. I’m not sure where we start.

[Gatorubet 30117]

On 10/12/2023 at 4:49 PM, Brisketexan said:

Wackadoo lucky coincidence of my life: after multiple years of doing the ordinary health plan, HSA accounts, all of that, one year my wife threw up her hands and said "I'M SICK OF THIS SHT.  I'M SICKING OF TRACKING EVERY EXPENSE AND SUBMITTING IT. ALL OF IT."  So, she demanded that this year -- at least for one year, let's do the full "buy-up" health plan.  It was the "we cover pretty much everything, $1,000 deductible" plan.  So, I signed up.  It was fucking expensive, relatively speaking.

And in January of that year, my daughter came down with a serious illness that put her in the hospital for the week.  I think the total billing on her treatment was $200k.  I wrote a check for $1k, and never had to look at another medical bill again.  Maybe the best timing of my entire life.

We went back to a sane plan after that year, though.  Because fuckin' A, the buy-up was expensive.

I signed up for the cancer insurance policy at work which was $16 a month, two months before I was diagnosed with stage three colon cancer.  So far I’ve had about 300 K worth of billing between surgery snd chemo and many CT, MRI and PET scans. That second policy insured that I didn’t have to pay a penny of deductibles or co-pays when the final account was tallied, including my travel to MDA. 

Best $32 of all time for me. 

[Fudge Nuggets 19151]

On 10/12/2023 at 8:07 AM, pacman said:

America, leading the world in health innovation so that non-Americans can live long, healthy lives while Americans suffer.

Who would ever want to live in a society that can cure but elects not to because of money?

That’s one of many reasons I’m bailing out as soon as the youngest is out of the house. 

[Texas Jeff 1932]

How much of the cost in our health care system is simply related to billing and collecting? Anyone know?

It seems like a significant part of our current system is just figuring out who owes what and trying to collect.

[Captainant 27467]

5 minutes ago, Texas Jeff said:

It seems like a significant part of our current system is just figuring out who owes what and trying to collect.

Nevermind that the medical billing apparatus is designed to be opaque and abstract prices as far away from the point of decision as possible.

 

"We need to do this test for your wife."
 

"OK, how much will it cost?"

"Lol idk, we send this 10 digit code to insurance, they sacrifice a goat, and decide how many thousands you'll be out of pocket for on top of your monthly premiums"

[SilasCoade 2620]

The highest paid individuals in our healthcare system are hospital system CEOs and insurance executives. Anyone not in favor of single payor socialized medicine is either an abject moron or has never interfaced with the idiocy of our current system.

I just found this information which is relevant to me b/c I deal with Molina's fuckery every single day:

Joseph Zubretsky
President and CEO, Molina Healthcare
Total compensation: $22,131,256

 

The guy running the company that is providing coverage for a ton of poor people is taking home $22 million American dollars every year for the great feat of denying, delaying, and complicating care for thousands of lower income, lower education patients. You could pay for a hundred internal medicine doctors for that.

Edited October 18, 2023 by SilasCoade

[elfenix 34172]

How much of the cost in our health care system is simply related to billing and collecting? Anyone know?

It seems like a significant part of our current system is just figuring out who owes what and trying to collect.

I had an ER trip in July and have still not seen an actual bill. Not sure wtf is going on.

[tx 3 putt 76404]

Great idea 

[4th&Five 41461]

My wife got some blood work done a couple weeks ago and it turns out it wasn’t covered by our shitty insurance so we got a bill for $100. She called the lab to see what the out of pocket cost would have been and it was $15. Great system we got. 

[TwiceHorn 31283]

On 10/18/2023 at 10:59 AM, Texas Jeff said:

How much of the cost in our health care system is simply related to billing and collecting? Anyone know?

It seems like a significant part of our current system is just figuring out who owes what and trying to collect.

I'll give you a hint.  There are two Dallas biilionaires, Ross Perot and Darwin Deason, who became billionaires by selling computers and software to Medicare/CMS and state Medicaid/HHS systems, respectively, for billing (both to patients and from providers).

[Dnaguy 11777]

On 11/2/2023 at 4:22 PM, tx 3 putt said:

Great idea 

Need to have any all pregnant woman as well.

A judo move to have republicans put their money where their mouth seeing as they’re the party that loves / protects kids & the unborn.

[Snake Diggity 4614]

Sure seems like between profit margins and inefficiency due to lack of uniformity inherent in our current system, a single payer system would be better and more affordable.  It also seems like office visits, prescriptions, and hospital visits are 3 wildly different animals that are getting muddied up but should be treated totally separately (with preventative care a 4th crucial component that really doesn’t even exist in our current system).

Edited November 4, 2023 by Snake Diggity

[Bozo_Casanova 26285]

On 10/16/2023 at 11:18 PM, Brisketexan said:

nobody has ever explained to them how the healthcare system and their insurance (believe it or not, many poor folks have a health plan of some sort) works. I’m not sure where we start.

Let’s talk about the ones who are using the ER because they don’t have the ability to pay because they know they ER will see them.

1) If they are uninsured, they are billed at the full list price for services- usually a multiple of the negotiated rate your insurer pays for the same services.

2) The are presented with a bill when they do not pay.

3) This debt is ultimately charged off as a loss and acquired by someone who attempts of collect at pennies on the dollar, and a larger fraction of what insurance would have paid. It also ruins somebody‘s credit, insuring that they stay poor by raising the cost of housing, limiting job opportunities and increasing the price of financial services.

4) The provider takes a tax loss on the unpaid amount of the bill, and builds that loss into the price structure of services to be paid by insured patients, and premiums go up.

in sum:

the ER patient who cannot pay is served according to his need. The insured patient pays to his ability. The hospital, insurers and doctors all profit. 
Marx for us, Friedman for them.
 

Edited November 4, 2023 by Bozo_Casanova

[Captainant 27467]

13 hours ago, Bozo_Casanova said:

the ER patient who cannot pay is served according to his need. The insured patient pays to his ability. The hospital, insurers and doctors all profit. 
Marx for us, Friedman for them.

And the punchline is that we still do have long waits for appointments and death panels, as all the republicans said we'd get with single payer. Except we're paying a fucking arm and a leg for the privilege of letting some business ghouls dictate what level of care we deserve. 

[TwiceHorn 31283]

5 minutes ago, Captainant said:

And the punchline is that we still do have long waits for appointments and death panels, as all the republicans said we'd get with single payer. Except we're paying a fucking arm and a leg for the privilege of letting some business ghouls dictate what level of care we deserve. 

Yeah, "death panels" are inherent to any system that makes "institutional" (meaning not solely patient-driven) healthcare/treatment decisions.

One thing I have come to appreciate about government bureaucracies that seem ponderous and inefficient:  they do a better job of assessing and accounting for multiple stakeholders in any system than a corporate bureaucracy.  The only stakeholder in a corporate bureaucracy is the profit of the corporation.

Edited November 5, 2023 by TwiceHorn

[Nice Guy Eddie 13414]

Stop with the Sarah Palin rhetoric. It’s not a good look. Every healthcare system has resource limitations and therefore has to ration it out at some level.

[topochico 1049]

21 hours ago, Bozo_Casanova said:

Let’s talk about the ones who are using the ER because they don’t have the ability to pay because they know they ER will see them

4) The provider takes a tax loss on the unpaid amount of the bill, and builds that loss into the price structure of services to be paid by insured patients, and premiums go up.

in sum:

the ER patient who cannot pay is served according to his need. The insured patient pays to his ability. The hospital, insurers and doctors all profit. 
Marx for us, Friedman for them.
 

Am I misunderstanding this comment? I don't know about hospitals, but individual physicians cannot take a tax loss on an unpaid bill. 

Edited November 5, 2023 by topochico

[Bozo_Casanova 26285]

2 hours ago, topochico said:

Am I misunderstanding this comment? I don't know about hospitals, but individual physicians cannot take a tax loss on an unpaid bill. 

I’m not an expert on healthcare accounting, but maybe I don’t understand what your question means. When I say they take a tax loss, what I mean is that they have bad debt they write off along with charity care, and incur costs providing that care which yields negative value. How they account for that loss has some variation from business to business but it’s a loss any way you cut it. So in case of bad debt would that not be bad debt expense?

Are you saying that doctors don’t account for the cost of services rendered? Wouldn’t that be bad debt expense?