hoops902
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Post by hoops902 on Apr 27, 2020 10:52:27 GMT -5
Obama care does nothing to reduce medical bills I'm still waiting for both parties to present ideas on how to do this. The only one who did was Bernie. But abruptly making private insurance illegal would cause chaos in our economy - among other things. The problem with ideas like Bernie's is that it "reduces medical bills" for individuals...but increases them for the taxpayer. I'm not sure it's a win to say "the medical bill you get will be less, but your tax bill will go up accordingly". It would be like having a $1000 mortgage and having your county say "we're implementing free housing, you don't pay a mortgage at all anymore...on the flip side you'll need to pay an increased tax of $1500/month to cover this program". Oh, what a deal! Doing away with private insurance doesn't even make sense from a cost perspective. We'd still need the government to run efficiently which it isn't remotely close to doing with healthcare. I've pointed it out before, I'll do it again. The total government spending on healthcare is already equivalent to what other countries with national healthcare spend per capita. And that's without accounting for the fact that the government gets a lot of administrative work done for them without labeling it as healthcare, because the SSA does a bunch of their administrative work for them (which is nice use of being more efficient, but underplays how much they actually spend to administer healthcare to the level they currently do).
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pulmonarymd
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Post by pulmonarymd on Apr 27, 2020 11:01:53 GMT -5
I'm still waiting for both parties to present ideas on how to do this. The only one who did was Bernie. But abruptly making private insurance illegal would cause chaos in our economy - among other things. The problem with ideas like Bernie's is that it "reduces medical bills" for individuals...but increases them for the taxpayer. I'm not sure it's a win to say "the medical bill you get will be less, but your tax bill will go up accordingly". It would be like having a $1000 mortgage and having your county say "we're implementing free housing, you don't pay a mortgage at all anymore...on the flip side you'll need to pay an increased tax of $1500/month to cover this program". Oh, what a deal! Doing away with private insurance doesn't even make sense from a cost perspective. We'd still need the government to run efficiently which it isn't remotely close to doing with healthcare. I've pointed it out before, I'll do it again. The total government spending on healthcare is already equivalent to what other countries with national healthcare spend per capita. And that's without accounting for the fact that the government gets a lot of administrative work done for them without labeling it as healthcare, because the SSA does a bunch of their administrative work for them (which is nice use of being more efficient, but underplays how much they actually spend to administer healthcare to the level they currently do). There is a lot of stupid spending however. In an article on COVID in NYC in the NYT magazine 4/12, there was a patient in an nursing home with dementia and contractions. He was a DNR. Brought ot ED with COVID, and when faced with death, family opted to do everything. He will likely die, and even if he survives, his quality of life is no better. We could have more realistic policies in place to prevent these kind of cases. Here, in the US, there are patients in nursing homes who are on ventilators and dialysis. These sort of things are not done elsewhere. A tremendous amount of money is spent on these sort of cases. Those are the sort of discussions that need to take place if we are ever going to reduce costs in this country.
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Post by Deleted on Apr 27, 2020 11:40:58 GMT -5
After dealing with my late DH's dialysis for years, I happen to be of the belief it should be used a whole lot less than it is. It's horrible and doesn't leave many people with any sort of quality of life and I don't think the current system does a great job of explaining that to potential users.
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swamp
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Post by swamp on Apr 27, 2020 11:54:30 GMT -5
The problem with ideas like Bernie's is that it "reduces medical bills" for individuals...but increases them for the taxpayer. I'm not sure it's a win to say "the medical bill you get will be less, but your tax bill will go up accordingly". It would be like having a $1000 mortgage and having your county say "we're implementing free housing, you don't pay a mortgage at all anymore...on the flip side you'll need to pay an increased tax of $1500/month to cover this program". Oh, what a deal! Doing away with private insurance doesn't even make sense from a cost perspective. We'd still need the government to run efficiently which it isn't remotely close to doing with healthcare. I've pointed it out before, I'll do it again. The total government spending on healthcare is already equivalent to what other countries with national healthcare spend per capita. And that's without accounting for the fact that the government gets a lot of administrative work done for them without labeling it as healthcare, because the SSA does a bunch of their administrative work for them (which is nice use of being more efficient, but underplays how much they actually spend to administer healthcare to the level they currently do). There is a lot of stupid spending however. In an article on COVID in NYC in the NYT magazine 4/12, there was a patient in an nursing home with dementia and contractions. He was a DNR. Brought ot ED with COVID, and when faced with death, family opted to do everything. He will likely die, and even if he survives, his quality of life is no better. We could have more realistic policies in place to prevent these kind of cases. Here, in the US, there are patients in nursing homes who are on ventilators and dialysis. These sort of things are not done elsewhere. A tremendous amount of money is spent on these sort of cases. Those are the sort of discussions that need to take place if we are ever going to reduce costs in this country. OMG, you want death panels!!!!! ARGH! How could you, you're a doctor, you're supposed to save lives!!!!! How dare you play God?! You want to kill Gramma!!!!! And that's why we can't have a rational discussion about this.
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pulmonarymd
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Post by pulmonarymd on Apr 27, 2020 11:59:05 GMT -5
There is a lot of stupid spending however. In an article on COVID in NYC in the NYT magazine 4/12, there was a patient in an nursing home with dementia and contractions. He was a DNR. Brought ot ED with COVID, and when faced with death, family opted to do everything. He will likely die, and even if he survives, his quality of life is no better. We could have more realistic policies in place to prevent these kind of cases. Here, in the US, there are patients in nursing homes who are on ventilators and dialysis. These sort of things are not done elsewhere. A tremendous amount of money is spent on these sort of cases. Those are the sort of discussions that need to take place if we are ever going to reduce costs in this country. OMG, you want death panels!!!!! ARGH! How could you, you're a doctor, you're supposed to save lives!!!!! How dare you play God?! You want to kill Gramma!!!!! And that's why we can't have a rational discussion about this. I know, right. And the irony is, if we did this, I would make less money.
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Post by Deleted on Apr 27, 2020 12:04:07 GMT -5
OMG, you want death panels!!!!! ARGH! How could you, you're a doctor, you're supposed to save lives!!!!! How dare you play God?! You want to kill Gramma!!!!! And that's why we can't have a rational discussion about this. I know, right. And the irony is, if we did this, I would make less money. The doctors who work at Kaiser are well compensated but often make less money than they would on the open market. However, you would be hard pressed to find many of them who want to leave or complain about their income. Not having to deal with the healthcare "system" and instead getting to treat patients goes a long way towards job satisfaction.
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Blonde Granny
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Post by Blonde Granny on Apr 27, 2020 12:11:24 GMT -5
Yes, part of the reason it costs so much. In addition, we are criminally liable if we bill incorrectly, but the billing is so complicated that it is almost impossible to not make mistakes [ It’s a horrible system Does anyone know when it became so convoluted? I remember simple times. When I was first married (60s) we had insurance through my husband’s employer but it was called major medical. Really only covered hospital costs, doctors visits were out of pocket and maybe $25. No coding Then insurance started to cover doctor visits but people had to fill out insurance forms themselves (just cost of visit) and submit claim. Then the doctors office took over sending claims - disaster followed We went to family doctor who just had one nurse and I think she also made appointments and billed. Now a physician with a practice would probably need 5 people to deal with insurance It's not likely a physician would have anyone working in his/her office. Today is the day of Drs. being part of a large medical group and likely associated with a large hospital. My PC likely doesn't hire her own staff and there is also a lab (Quest actually) in her office as well. My PC is part of a large group, as in my cardio (same group) and my orthopedic surgeon. I saw a pulmonolgist last year who was all under the same umbrella and the dermatologist I see yearly is also part of it. What I like about this is my medical records are all in one place, and if cardiologist changes a med, my PC sees it in my record. My medicare bill is sent in, then after approval it is sent onto my supplement, which happens to be the VA, both pay the bills and I pay nothing. I've been on Medicare now for 10 years, and the total I have ever paid was $42. It was easier for me to pay it than fuss about it.
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bobosensei
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Post by bobosensei on Apr 27, 2020 16:50:05 GMT -5
That is more or less what I am arguing for. There should be a true price that you pay regardless of insurance. Medicare would pay it, Medicaid would pay it, BCBS would pay it, and the uninsured would pay it. It would no doubt be higher for everyone other than the uninsured. But that is what it actually costs just like a loaf of bread costs $3.99 at Publix. If you buy it with food stamps, it still costs $3.99. Publix isn't giving a negotiated price on bread depending on how you pay. Actually if one price was paid, Medicare and Medicaid would pay more, and private insurance would pay LESS, because they would not be subsidizing everyone else. Would be even better if everyone had insurance. Which is part of the reason the ACA was designed. Not sure why it is controversial. Otherwise we should just have the uninsured not get any care, but no one seems to have the stomach for that. As to pricing, it is an absolute mess. The charges depend on “intensity of service”. I get paid more for more complex cases. You don’t know how complex your case is, and I don’t know what.to charge until I see you. So, if you call as a new patient, we can give you a range of prices, but we do not know the charge until after we are done. Sort of like taking your car in. To do otherwise we required overhauling the billing system. One price for a service doesn’t work, unless you think someone with a cold paying the same as someone with a lung cancer What she is saying is the cost to remove a mole should be the same for everyone regardless of how you pay and the price to diagnose, test, and subscribe meds for strep throat should be the same for everyone. Of course if you have a new patient appointment the person wanting their mole looked at to see if it should be removed shouldn't be charged the exact same as the person with strep. But all people going to get a mole looked at should be charged the same. And yes, if you have to call in a consult that can be another charge, but again would be the same across the board for everyone. You would take a loss on medicaid, a break even for Blue Cross, and then charge out the wazoo for the uninsured patient just to see how much would/could be paid.
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bobosensei
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Post by bobosensei on Apr 27, 2020 17:04:03 GMT -5
Ok, but if you get rid of the health insurance companies and the paper pushers in the local hospitals' and doctors' offices, you are eliminating an entire industry. Our economy is a set of dominoes. Try to remember that. They can work in supplementary insurance.... or retrain for something else. We thought the same thing and it didn't happen. The providers and coders will always be audited for billing and compliance errors so medicare/medicaid would just be auditing all claims instead of the ones they do now if it was a single payor government system. And yes, as long as secondary and tertiary insurance is allowed then there will continue to be some level of commercial payors that also need paper pushing and auditing. I think it is more likely that software will cause job loss here as we are able to use machine learning to predict which claims will fall under audit and correct them and retrain offenders prior to losing money. It would also allow a hospital to say hey we were underpaid for this, lets check all trillion claims we have for similar diagnosis to see if we were underpaid elsewhere so we can get the money we are owed.
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pulmonarymd
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Post by pulmonarymd on Apr 27, 2020 17:09:23 GMT -5
Actually if one price was paid, Medicare and Medicaid would pay more, and private insurance would pay LESS, because they would not be subsidizing everyone else. Would be even better if everyone had insurance. Which is part of the reason the ACA was designed. Not sure why it is controversial. Otherwise we should just have the uninsured not get any care, but no one seems to have the stomach for that. As to pricing, it is an absolute mess. The charges depend on “intensity of service”. I get paid more for more complex cases. You don’t know how complex your case is, and I don’t know what.to charge until I see you. So, if you call as a new patient, we can give you a range of prices, but we do not know the charge until after we are done. Sort of like taking your car in. To do otherwise we required overhauling the billing system. One price for a service doesn’t work, unless you think someone with a cold paying the same as someone with a lung cancer What she is saying is the cost to remove a mole should be the same for everyone regardless of how you pay and the price to diagnose, test, and subscribe meds for strep throat should be the same for everyone. Of course if you have a new patient appointment the person wanting their mole looked at to see if it should be removed shouldn't be charged the exact same as the person with strep. But all people going to get a mole looked at should be charged the same. And yes, if you have to call in a consult that can be another charge, but again would be the same across the board for everyone. You would take a loss on medicaid, a break even for Blue Cross, and then charge out the wazoo for the uninsured patient just to see how much would/could be paid. So, removing a mole that takes 10 minutes, and one that takes 30 should have the same charge?. What if the removal leads to significant bleeding that doesn't stop? If you are someone who asks 100 questions, and takes up twice as much time as someone who understands things quickly, and does not need extra time, you get to be charged the same. Very few situations are exactly the same. And if we then say charge based on time, if you are more efficient, you get penalized? Sure, lab reports can be the same, but the time required for an interpretation of an x ray can vary widely? This is why billing is such a nightmare. Some people will pay more and some less under any system. And you can incentivize the wrong thing. Currently, it is actually better to see a bunch of simple problems then see a complicated patient from a financial standpoint. We do not want to worsen that, because complicated patients, such as those on Medicare/Medicaid could find even more issues getting care. In my office, what you pay for a code 99212,99213,99214 varies based on the payer. So, we cannot give you one price without knowing your insurance. The whole thing is a nightmare for everybody involved. The system also skews payments towards doing things, and away from talking/thinking, which can lead to overtreatment.
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bobosensei
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Post by bobosensei on Apr 27, 2020 17:12:54 GMT -5
No frozen order yesterday, spoke to the driver: 7 of them drove to the warehouse and only 2 had load ready. 80 people called out yesterday. Every shift the past week 50-100 people are calling out of the warehouse. Having similar issue on a lower scale at store level : 2 people quit, 2 stop coming because they cannot deal with the stress/worrying about catching COVID. The one case we had called last Monday, that is more than a month later; she cannot return to work yet because her Dr saw some lung damage. So would prefer her to be fuller recovered from that before letting her get back, been out since 3/17. I appreciate the sacrifice you are making having to stay away from your family. Between the extra hours you must be doing, and the added burden of having to clean after you touch all the shared areas of the home, I am sure you are at your wits end. I don't know if everyone appreciates the pressure. It is easy for us to say "these people should go get different job" but when you are in that position and the choice is keep the job that might add stress and danger so that you can continue to save and pay down debt that is what a lot of people would do.
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pulmonarymd
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Post by pulmonarymd on Apr 27, 2020 17:49:21 GMT -5
No frozen order yesterday, spoke to the driver: 7 of them drove to the warehouse and only 2 had load ready. 80 people called out yesterday. Every shift the past week 50-100 people are calling out of the warehouse. Having similar issue on a lower scale at store level : 2 people quit, 2 stop coming because they cannot deal with the stress/worrying about catching COVID. The one case we had called last Monday, that is more than a month later; she cannot return to work yet because her Dr saw some lung damage. So would prefer her to be fuller recovered from that before letting her get back, been out since 3/17. I appreciate the sacrifice you are making having to stay away from your family. Between the extra hours you must be doing, and the added burden of having to clean after you touch all the shared areas of the home, I am sure you are at your wits end. I don't know if everyone appreciates the pressure. It is easy for us to say "these people should go get different job" but when you are in that position and the choice is keep the job that might add stress and danger so that you can continue to save and pay down debt that is what a lot of people would do. I agree, people like the Haitian never asked for this. They should be commended for what they are doing. They are every bit as valuable as healthcare workers in this time of need, and are more important for the average person. I am eternally grateful for their hard work and sacrifice
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bobosensei
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Post by bobosensei on Apr 27, 2020 18:00:20 GMT -5
So, removing a mole that takes 10 minutes, and one that takes 30 should have the same charge?. What if the removal leads to significant bleeding that doesn't stop? If you are someone who asks 100 questions, and takes up twice as much time as someone who understands things quickly, and does not need extra time, you get to be charged the same. Very few situations are exactly the same. And if we then say charge based on time, if you are more efficient, you get penalized? Sure, lab reports can be the same, but the time required for an interpretation of an x ray can vary widely? This is why billing is such a nightmare. Some people will pay more and some less under any system. And you can incentivize the wrong thing. Currently, it is actually better to see a bunch of simple problems then see a complicated patient from a financial standpoint. We do not want to worsen that, because complicated patients, such as those on Medicare/Medicaid could find even more issues getting care. In my office, what you pay for a code 99212,99213,99214 varies based on the payer. So, we cannot give you one price without knowing your insurance. The whole thing is a nightmare for everybody involved. The system also skews payments towards doing things, and away from talking/thinking, which can lead to overtreatment. No, I get what you are saying. I understand the same mole might take less time to remove from someone's back as it would their face. Or it may take more time to remove on a kid than an adult because the kid won't stay still. But is time actually a factor in billing? I understand more complex = more time = more expensive, but if that is the case bill for the circumstances that create the complexity. If Dr Smith is dumber than the average doctor so takes longer to diagnose or if Dr Jones is newer and and has only cut 3 moles before so it takes him longer than the doctor that has done 10 thousand that should be on them, not the patient or insurance to subsidize. There is added waste if you have to document everything to defend your treatment and choices later. I had a dentist take a picture of my broken crown with his phone because he said insurance might not cover the replacement so he wanted to show it was medically necessary. I think insurance should trust what is deemed medically necessary by the provider unless they find the provider to be deliberately committing fraud by padding billing. Eventually they will be able to see who is an outlier and they can focus on specific offenders instead of making everyone else do more work to prove they are in compliance.
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pulmonarymd
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Post by pulmonarymd on Apr 27, 2020 18:14:12 GMT -5
So, removing a mole that takes 10 minutes, and one that takes 30 should have the same charge?. What if the removal leads to significant bleeding that doesn't stop? If you are someone who asks 100 questions, and takes up twice as much time as someone who understands things quickly, and does not need extra time, you get to be charged the same. Very few situations are exactly the same. And if we then say charge based on time, if you are more efficient, you get penalized? Sure, lab reports can be the same, but the time required for an interpretation of an x ray can vary widely? This is why billing is such a nightmare. Some people will pay more and some less under any system. And you can incentivize the wrong thing. Currently, it is actually better to see a bunch of simple problems then see a complicated patient from a financial standpoint. We do not want to worsen that, because complicated patients, such as those on Medicare/Medicaid could find even more issues getting care. In my office, what you pay for a code 99212,99213,99214 varies based on the payer. So, we cannot give you one price without knowing your insurance. The whole thing is a nightmare for everybody involved. The system also skews payments towards doing things, and away from talking/thinking, which can lead to overtreatment. No, I get what you are saying. I understand the same mole might take less time to remove from someone's back as it would their face. Or it may take more time to remove on a kid than an adult because the kid won't stay still. But is time actually a factor in billing? I understand more complex = more time = more expensive, but if that is the case bill for the circumstances that create the complexity. If Dr Smith is dumber than the average doctor so takes longer to diagnose or if Dr Jones is newer and and has only cut 3 moles before so it takes him longer than the doctor that has done 10 thousand that should be on them, not the patient or insurance to subsidize. There is added waste if you have to document everything to defend your treatment and choices later. I had a dentist take a picture of my broken crown with his phone because he said insurance might not cover the replacement so he wanted to show it was medically necessary. I think insurance should trust what is deemed medically necessary by the provider unless they find the provider to be deliberately committing fraud by padding billing. Eventually they will be able to see who is an outlier and they can focus on specific offenders instead of making everyone else do more work to prove they are in compliance. Yes, I agree in principle about efficiency, but a more complicated mole will take more time, and that should play a role in charges. If I an die 3 of something easy in the same time as something complicated, and make 3 times as much, that is the wrong incentive, don’t you think. Time can be a factor in chargers. Documentation requirements can be onerous
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Post by Deleted on Apr 27, 2020 18:28:02 GMT -5
No, I get what you are saying. I understand the same mole might take less time to remove from someone's back as it would their face. Or it may take more time to remove on a kid than an adult because the kid won't stay still. But is time actually a factor in billing? I understand more complex = more time = more expensive, but if that is the case bill for the circumstances that create the complexity. If Dr Smith is dumber than the average doctor so takes longer to diagnose or if Dr Jones is newer and and has only cut 3 moles before so it takes him longer than the doctor that has done 10 thousand that should be on them, not the patient or insurance to subsidize. There is added waste if you have to document everything to defend your treatment and choices later. I had a dentist take a picture of my broken crown with his phone because he said insurance might not cover the replacement so he wanted to show it was medically necessary. I think insurance should trust what is deemed medically necessary by the provider unless they find the provider to be deliberately committing fraud by padding billing. Eventually they will be able to see who is an outlier and they can focus on specific offenders instead of making everyone else do more work to prove they are in compliance. Yes, I agree in principle about efficiency, but a more complicated mole will take more time, and that should play a role in charges. If I an die 3 of something easy in the same time as something complicated, and make 3 times as much, that is the wrong incentive, don’t you think. Time can be a factor in chargers. Documentation requirements can be onerous But my primary care doctor already has a way to differentiate the length of visit. I laugh sometimes because I always am written up as an extended visit because he likes to talk a lot. I don't mean that he likes to talk about ME a lot. He will talk politics, the weather, what he's doing on the weekend, etc. There can be differentiations on how complex removing a mole is. But a complex removal should cost the same regardless of who is paying for it.
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pulmonarymd
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Post by pulmonarymd on Apr 27, 2020 18:34:00 GMT -5
Yes, I agree in principle about efficiency, but a more complicated mole will take more time, and that should play a role in charges. If I an die 3 of something easy in the same time as something complicated, and make 3 times as much, that is the wrong incentive, don’t you think. Time can be a factor in chargers. Documentation requirements can be onerous But my primary care doctor already has a way to differentiate the length of visit. I laugh sometimes because I always am written up as an extended visit because he likes to talk a lot. I don't mean that he likes to talk about ME a lot. He will talk politics, the weather, what he's doing on the weekend, etc. There can be differentiations on how complex removing a mole is. But a complex removal should cost the same regardless of who is paying for it. Why? Free market is how we run our economy, payment is based on negotiation between payers and providers. Who determines what the payment should be. And if the all pay the same, how is that different than a single payer
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Post by Deleted on Apr 27, 2020 19:11:34 GMT -5
But my primary care doctor already has a way to differentiate the length of visit. I laugh sometimes because I always am written up as an extended visit because he likes to talk a lot. I don't mean that he likes to talk about ME a lot. He will talk politics, the weather, what he's doing on the weekend, etc. There can be differentiations on how complex removing a mole is. But a complex removal should cost the same regardless of who is paying for it. Why? Free market is how we run our economy, payment is based on negotiation between payers and providers. Who determines what the payment should be. And if the all pay the same, how is that different than a single payer I know I was going to have to pay $4400 for physical therapy that ended up being paid for insurance after I appealed. Then it cost $400. It is not fair to take advantage of the uninsured. That is what the medical profession is doing with the "negotiation" bs. A loaf of bread costs what a loaf of bread costs, whether you buy it with food stamps, a credit card, or cash.
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pulmonarymd
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Post by pulmonarymd on Apr 27, 2020 19:15:14 GMT -5
Why? Free market is how we run our economy, payment is based on negotiation between payers and providers. Who determines what the payment should be. And if the all pay the same, how is that different than a single payer I know I was going to have to pay $4400 for physical therapy that ended up being paid for insurance after I appealed. Then it cost $400. It is not fair to take advantage of the uninsured. That is what the medical profession is doing with the "negotiation" bs. A loaf of bread costs what a loaf of bread costs, whether you buy it with food stamps, a credit card, or cash. We charge the uninsured Medicare rates. But if you look at what bills are not paid by people, we are at the top of the list. People who owe $500 think that paying $5 a month is ok. I do icu work, the amount that we write off is ridiculous, and we see everybody admitted to icu regardless of ability to pay or payment source. There is a lot wrong with the system and it is not only on the patient side
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pulmonarymd
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Post by pulmonarymd on Apr 27, 2020 19:19:48 GMT -5
Why? Free market is how we run our economy, payment is based on negotiation between payers and providers. Who determines what the payment should be. And if the all pay the same, how is that different than a single payer I know I was going to have to pay $4400 for physical therapy that ended up being paid for insurance after I appealed. Then it cost $400. It is not fair to take advantage of the uninsured. That is what the medical profession is doing with the "negotiation" bs. A loaf of bread costs what a loaf of bread costs, whether you buy it with food stamps, a credit card, or cash. In addition, who sets the price of bread. Reimbursement rates for Medicare and Medicaid are set by the government, no negotiation. Commercial rates are based on negotiations, but insurers have a few schedule, and each one pays at a different rate. I have no idea how they decide what they pay for each code, seems random at times. We collect between 55-60% of what we bill, and will frequently collect 20% of a bill for an Icu patient whose life we saved. Yet, if I screw up, I can be sued for a ridiculous amount. How is that fair?
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Post by The Walk of the Penguin Mich on Apr 27, 2020 19:37:37 GMT -5
So, removing a mole that takes 10 minutes, and one that takes 30 should have the same charge?. What if the removal leads to significant bleeding that doesn't stop? If you are someone who asks 100 questions, and takes up twice as much time as someone who understands things quickly, and does not need extra time, you get to be charged the same. Very few situations are exactly the same. And if we then say charge based on time, if you are more efficient, you get penalized? Sure, lab reports can be the same, but the time required for an interpretation of an x ray can vary widely? This is why billing is such a nightmare. Some people will pay more and some less under any system. And you can incentivize the wrong thing. Currently, it is actually better to see a bunch of simple problems then see a complicated patient from a financial standpoint. We do not want to worsen that, because complicated patients, such as those on Medicare/Medicaid could find even more issues getting care. In my office, what you pay for a code 99212,99213,99214 varies based on the payer. So, we cannot give you one price without knowing your insurance. The whole thing is a nightmare for everybody involved. The system also skews payments towards doing things, and away from talking/thinking, which can lead to overtreatment. No, I get what you are saying. I understand the same mole might take less time to remove from someone's back as it would their face. Or it may take more time to remove on a kid than an adult because the kid won't stay still. But is time actually a factor in billing? I understand more complex = more time = more expensive, but if that is the case bill for the circumstances that create the complexity. If Dr Smith is dumber than the average doctor so takes longer to diagnose or if Dr Jones is newer and and has only cut 3 moles before so it takes him longer than the doctor that has done 10 thousand that should be on them, not the patient or insurance to subsidize. There is added waste if you have to document everything to defend your treatment and choices later. I had a dentist take a picture of my broken crown with his phone because he said insurance might not cover the replacement so he wanted to show it was medically necessary. I think insurance should trust what is deemed medically necessary by the provider unless they find the provider to be deliberately committing fraud by padding billing. Eventually they will be able to see who is an outlier and they can focus on specific offenders instead of making everyone else do more work to prove they are in compliance. Let me throw some examples of costs at you to get you to see the difference. Back in Feb 2011, I had a hip replacement. My primary hip cost my insurance company about $80K. This was a surgery that took the surgeon less than an hour and he did about 8/day each day he did surgeries. Fast forward to Nov 2012, I was having that same hip replaced again after it had been removed 6 months previously. That surgery ran $265K. Why the difference? Isn't a hip replacement a hip replacement? In my case, no. I was the only surgery that my surgeon did that day and I was in surgery over 7 hours. That tied up a surgeon, his staff, an operating room, an anesthesiologist and a myriad of other people for a single surgery. So in the time that they did one surgery, in a normal day they could have done 8 x $80K surgeries (my surgeon accepts Medicare patients, but not Medicaid), or as much as $640K. My surgery didn't come close to covering what they'd normally get paid in an uncomplicated case. This was the same surgeon, same hospital, same anesthesiologist (I had my favorite by then), and many of the same nursing staff. Only difference was the 19 months between those 2 dates. Oh, and the truly ironic thing of this was that for that $80K surgery I was hospitalized 3 days. For the $265K surgery I was released in 22 hours.
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hoops902
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Post by hoops902 on Apr 27, 2020 20:01:16 GMT -5
But my primary care doctor already has a way to differentiate the length of visit. I laugh sometimes because I always am written up as an extended visit because he likes to talk a lot. I don't mean that he likes to talk about ME a lot. He will talk politics, the weather, what he's doing on the weekend, etc. There can be differentiations on how complex removing a mole is. But a complex removal should cost the same regardless of who is paying for it. Why? Free market is how we run our economy, payment is based on negotiation between payers and providers. Who determines what the payment should be. And if the all pay the same, how is that different than a single payer So I'm probably more "pro" free market than a lot of folks, but our economy could hardly be said to be really free market. There are all kinds of regulations which restrict pricing for certain goods and services, determine the kinds of products than can be offered, who can purchase them, etc. Heck, if you believe in free market, go try to sell your N95 masks at a 1000% markup right now and see how well that works out. There are all kinds of rules/laws which prevent free market, presumably this would be another in the long line of them. It would be different than single payer because it wouldn't be the government running it...which is usually what people are referring to when discussing single payer. I'll also point out that she said "regardless of who is paying for it" and not "regardless of who is doing it". At face value, that means you could set a price of $100 and someone next door could set a price of $200. But you couldn't pick and choose to charge some people $100 and some people $200.
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Post by Deleted on Apr 27, 2020 20:04:53 GMT -5
I know I was going to have to pay $4400 for physical therapy that ended up being paid for insurance after I appealed. Then it cost $400. It is not fair to take advantage of the uninsured. That is what the medical profession is doing with the "negotiation" bs. A loaf of bread costs what a loaf of bread costs, whether you buy it with food stamps, a credit card, or cash. We charge the uninsured Medicare rates. But if you look at what bills are not paid by people, we are at the top of the list. People who owe $500 think that paying $5 a month is ok. I do icu work, the amount that we write off is ridiculous, and we see everybody admitted to icu regardless of ability to pay or payment source. There is a lot wrong with the system and it is not only on the patient side If you say so. I don't think the physical therapy clinic, which was associated with the hospital, charged me the Medicare rate when they billed $4400. I saw Medicare rates when my husband was so sick last summer. It was very similar to the negotiated insurance rates . . . about 10%. And had BCBS not reversed their denial upon my appeal, I doubt it I could have paid $5 a month on my $4400 bill. But, hey, they did reverse it. So only $400! Lucky me to be one of the fortunate ones with insurance. That is so wrong. To charge the "uninsured" 10X more than BCBS.
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hoops902
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Post by hoops902 on Apr 27, 2020 20:06:37 GMT -5
Why? Free market is how we run our economy, payment is based on negotiation between payers and providers. Who determines what the payment should be. And if the all pay the same, how is that different than a single payer I know I was going to have to pay $4400 for physical therapy that ended up being paid for insurance after I appealed. Then it cost $400. It is not fair to take advantage of the uninsured. That is what the medical profession is doing with the "negotiation" bs. A loaf of bread costs what a loaf of bread costs, whether you buy it with food stamps, a credit card, or cash.But the reason that loaf of bread costs what it costs, is because the SELLER has decided to use that format. The seller chooses to do that out of convenience for themselves. The seller could just as easily stand there behind a counter and negotiate pricing for each loaf of bread available. It makes no sense for them to do so...but that loaf of bread is being sold wholesale...it won't have the same price to the retailers it is sold to. I work for a company that sells both unique goods and what would be considered commodities in a supplier environment...those commodities do not get priced the same way to all the customers. Fixed pricing is super advantageous to retailers of small goods...it's much simpler to handle. But doctors are not retailers of small goods...as a comparison...go try to have the same builder put up the exact same home for you on a comparable lot. They're going to negotiate the price based on what they think they can get. Negotiations are far more likely based on the good being sold, not because of "fairness".
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hoops902
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Post by hoops902 on Apr 27, 2020 20:10:01 GMT -5
We charge the uninsured Medicare rates. But if you look at what bills are not paid by people, we are at the top of the list. People who owe $500 think that paying $5 a month is ok. I do icu work, the amount that we write off is ridiculous, and we see everybody admitted to icu regardless of ability to pay or payment source. There is a lot wrong with the system and it is not only on the patient side If you say so. I don't think the physical therapy clinic, which was associated with the hospital, charged me the Medicare rate when they billed $4400. I saw Medicare rates when my husband was so sick last summer. It was very similar to the negotiated insurance rates . . . about 10%. And had BCBS not reversed their denial upon my appeal, I doubt it I could have paid $5 a month on my $4400 bill. But, hey, they did reverse it. So only $400! Lucky me to be one of the fortunate ones with insurance. That is so wrong. To charge the "uninsured" 10X more than BCBS.Why? BCBS is buying in bulk. And BCBS holds far less risk of never paying...so there's less reason to factor in nonpayment risk.
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Post by Deleted on Apr 27, 2020 20:19:54 GMT -5
If you say so. I don't think the physical therapy clinic, which was associated with the hospital, charged me the Medicare rate when they billed $4400. I saw Medicare rates when my husband was so sick last summer. It was very similar to the negotiated insurance rates . . . about 10%. And had BCBS not reversed their denial upon my appeal, I doubt it I could have paid $5 a month on my $4400 bill. But, hey, they did reverse it. So only $400! Lucky me to be one of the fortunate ones with insurance. That is so wrong. To charge the "uninsured" 10X more than BCBS.Why? BCBS is buying in bulk. And BCBS holds far less risk of never paying...so there's less reason to factor in nonpayment risk. Ok, double. triple. 10X? We aren't talking a few dollars. We are talking thousands. And I saw it over and over with Medicare. The hospital charged 10X (or more) what the Medicare Advantage plan would pay.
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Post by The Walk of the Penguin Mich on Apr 27, 2020 20:34:44 GMT -5
Why? BCBS is buying in bulk. And BCBS holds far less risk of never paying...so there's less reason to factor in nonpayment risk. Ok, double. triple. 10X? We aren't talking a few dollars. We are talking thousands. And I saw it over and over with Medicare. The hospital charged 10X (or more) what the Medicare Advantage plan would pay. OK, how many PT sessions are you talking for $4400? Under normal, self pay these would be anywhere from $100-200/session (yes, I have done self pay PT). That should have been about 22 sessions under self pay conditions.
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pulmonarymd
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Post by pulmonarymd on Apr 27, 2020 20:44:56 GMT -5
Why? Free market is how we run our economy, payment is based on negotiation between payers and providers. Who determines what the payment should be. And if the all pay the same, how is that different than a single payer So I'm probably more "pro" free market than a lot of folks, but our economy could hardly be said to be really free market. There are all kinds of regulations which restrict pricing for certain goods and services, determine the kinds of products than can be offered, who can purchase them, etc. Heck, if you believe in free market, go try to sell your N95 masks at a 1000% markup right now and see how well that works out. There are all kinds of rules/laws which prevent free market, presumably this would be another in the long line of them. It would be different than single payer because it wouldn't be the government running it...which is usually what people are referring to when discussing single payer. I'll also point out that she said "regardless of who is paying for it" and not "regardless of who is doing it". At face value, that means you could set a price of $100 and someone next door could set a price of $200. But you couldn't pick and choose to charge some people $100 and some people $200. Medicare and Medicaid set prices, so there is no free market for a large part of the market. So there are de facto price controls. We negotiate commercial rates. You are correct in that the risk of nonpayment does play a role in setting uninsured rates. But those are all negotiable. We cannot set our rates below Medicare, and since everyone accepts the same rate from Medicare, there is little incentive to charge a lower rate than someone else.
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pulmonarymd
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Post by pulmonarymd on Apr 27, 2020 20:49:37 GMT -5
We charge the uninsured Medicare rates. But if you look at what bills are not paid by people, we are at the top of the list. People who owe $500 think that paying $5 a month is ok. I do icu work, the amount that we write off is ridiculous, and we see everybody admitted to icu regardless of ability to pay or payment source. There is a lot wrong with the system and it is not only on the patient side If you say so. I don't think the physical therapy clinic, which was associated with the hospital, charged me the Medicare rate when they billed $4400. I saw Medicare rates when my husband was so sick last summer. It was very similar to the negotiated insurance rates . . . about 10%. And had BCBS not reversed their denial upon my appeal, I doubt it I could have paid $5 a month on my $4400 bill. But, hey, they did reverse it. So only $400! Lucky me to be one of the fortunate ones with insurance. That is so wrong. To charge the "uninsured" 10X more than BCBS. I was talking about my practice personally. If you are uninsured and prepared to pay quickly, we accept Medicare rates. We avoid the cost and waiting for payment, so it is advantageous to us. We cannot charge less than mediocre without someone proving hardship. But, we are also taken advantage of for being compassionate in this way, in that people don’t pay what they agreed to. Again, everyone should have a payment mechanism if they want care. Why should I work for free?
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Post by Deleted on Apr 27, 2020 21:05:45 GMT -5
Ok, double. triple. 10X? We aren't talking a few dollars. We are talking thousands. And I saw it over and over with Medicare. The hospital charged 10X (or more) what the Medicare Advantage plan would pay. OK, how many PT sessions are you talking for $4400? Under normal, self pay these would be anywhere from $100-200/session (yes, I have done self pay PT). That should have been about 22 sessions under self pay conditions. I think It was 2x a week for 6 weeks. It doesn't matter. I am insured. I should quit feeling outraged for those who aren't. Go Team Haves!
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Post by The Walk of the Penguin Mich on Apr 27, 2020 21:18:07 GMT -5
OK, how many PT sessions are you talking for $4400? Under normal, self pay these would be anywhere from $100-200/session (yes, I have done self pay PT). That should have been about 22 sessions under self pay conditions. I think It was 2x a week for 6 weeks. It doesn't matter. I am insured. I should quit feeling outraged for those who aren't. Go Team Haves! Huh? I thought those costs were high for ANY of the many rehabs I have done. Knowing that it was only 12 sessions makes it obscenely high. I’m just wondering what was so special about this? This isn’t a have or have not issue, just what they wanted to charge.
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