Miss Tequila
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Post by Miss Tequila on Feb 15, 2021 15:49:27 GMT -5
This still makes absolutely no sense. My insurance company negotiates a rate for a particular service, and I pay my deductible. If the negotiated service price encompasses my full deductible, then I pay my full deductible (assuming that I've not yet met this year's deductible). It doesn't matter if my medical service is a $40K surgery or a $400K surgery, if the surgeon and the hospital is covered by my insurance, I pay my deductible. Choosing someone less expensive doesn't mean my insurance company has negotiated the same rate with them. So I would not only have to know the price of the service, but what proportion my insurance company would pay. Half of that data is not on the table, so this is impossible to determine. Considering that insurance companies set their deductibles and copays, I know exactly how much I am on the hook for if I need to use my insurance to the max. When I got sick, my OOP costs were $13K. It was very easy to figure out where the costs came from. My infection ran pretty much my full, IRS fiscal year but my insurance plan fiscal year split the year in half as it was July to June). So I got to pay 2 x $1500 as in network deductibles. I paid 2 x $4500 as out of network deductibles. That is $12K. I had $13K in expenses, the balance was copays for drugs and PT. Publicizing the cost of the 4 surgeries, the 6 weeks in the hospital, the month in rehab wouldn't change a bit what I ultimately paid, and I'd posit that in many cases patients are going to look for the best person to do the job - not the cheapest. What you are describing is exactly what I was working with our insurance company to disclose to our employees. I don’t care if my share of an MRI was $100 no matter where I want, I wanted the employees to see that provider A had a total cost of $800, provider B had a cost of $900 and provider C had a cost of $1,200. And yes, the negotiated rates and different providers were different. I realize that my brain might work differently than others, but in union negotiations the biggest sticking point was always health insurance. I wanted the employees to understand how their choice of provider could have a direct impact on our premiums.
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Post by The Walk of the Penguin Mich on Feb 15, 2021 16:08:23 GMT -5
This still makes absolutely no sense. My insurance company negotiates a rate for a particular service, and I pay my deductible. If the negotiated service price encompasses my full deductible, then I pay my full deductible (assuming that I've not yet met this year's deductible). It doesn't matter if my medical service is a $40K surgery or a $400K surgery, if the surgeon and the hospital is covered by my insurance, I pay my deductible. Choosing someone less expensive doesn't mean my insurance company has negotiated the same rate with them. So I would not only have to know the price of the service, but what proportion my insurance company would pay. Half of that data is not on the table, so this is impossible to determine. Considering that insurance companies set their deductibles and copays, I know exactly how much I am on the hook for if I need to use my insurance to the max. When I got sick, my OOP costs were $13K. It was very easy to figure out where the costs came from. My infection ran pretty much my full, IRS fiscal year but my insurance plan fiscal year split the year in half as it was July to June). So I got to pay 2 x $1500 as in network deductibles. I paid 2 x $4500 as out of network deductibles. That is $12K. I had $13K in expenses, the balance was copays for drugs and PT. Publicizing the cost of the 4 surgeries, the 6 weeks in the hospital, the month in rehab wouldn't change a bit what I ultimately paid, and I'd posit that in many cases patients are going to look for the best person to do the job - not the cheapest. What you are describing is exactly what I was working with our insurance company to disclose to our employees. I don’t care if my share of an MRI was $100 no matter where I want, I wanted the employees to see that provider A had a total cost of $800, provider B had a cost of $900 and provider C had a cost of $1,200. And yes, the negotiated rates and different providers were different. I realize that my brain might work differently than others, but in union negotiations the biggest sticking point was always health insurance. I wanted the employees to understand how their choice of provider could have a direct impact on our premiums. So you think that not only should employees have to figure out who has the cheapest MRI, they need to figure out what the insurance company's negotiated rates are? Because ultimately that cost is what the insurance companies are paying, not the total cost.
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pulmonarymd
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Post by pulmonarymd on Feb 15, 2021 16:09:20 GMT -5
This still makes absolutely no sense. My insurance company negotiates a rate for a particular service, and I pay my deductible. If the negotiated service price encompasses my full deductible, then I pay my full deductible (assuming that I've not yet met this year's deductible). It doesn't matter if my medical service is a $40K surgery or a $400K surgery, if the surgeon and the hospital is covered by my insurance, I pay my deductible. Choosing someone less expensive doesn't mean my insurance company has negotiated the same rate with them. So I would not only have to know the price of the service, but what proportion my insurance company would pay. Half of that data is not on the table, so this is impossible to determine. Considering that insurance companies set their deductibles and copays, I know exactly how much I am on the hook for if I need to use my insurance to the max. When I got sick, my OOP costs were $13K. It was very easy to figure out where the costs came from. My infection ran pretty much my full, IRS fiscal year but my insurance plan fiscal year split the year in half as it was July to June). So I got to pay 2 x $1500 as in network deductibles. I paid 2 x $4500 as out of network deductibles. That is $12K. I had $13K in expenses, the balance was copays for drugs and PT. Publicizing the cost of the 4 surgeries, the 6 weeks in the hospital, the month in rehab wouldn't change a bit what I ultimately paid, and I'd posit that in many cases patients are going to look for the best person to do the job - not the cheapest. What you are describing is exactly what I was working with our insurance company to disclose to our employees. I don’t care if my share of an MRI was $100 no matter where I want, I wanted the employees to see that provider A had a total cost of $800, provider B had a cost of $900 and provider C had a cost of $1,200. And yes, the negotiated rates and different providers were different. I realize that my brain might work differently than others, but in union negotiations the biggest sticking point was always health insurance. I wanted the employees to understand how their choice of provider could have a direct impact on our premiums. I think that is admirable, but unfortunately, since most people are not financially savvy, is not going to work. Just look at what happened with ridiculously low copays of yesteryear. Some were as low as $2. People would come to see me for the sniffles. When asked why, they said why not, it on cost $2. Same thing with brand name vs drugs. People perceived them as inferior, even though they weren't. So they wanted them since their "insurance was paying for it". All efforts to change this are problematic. Put too much responsibility on the patient, and they skip necessary care. Put too little, and they overconsume. We, as a country, get too much and too much ineffective treatment. The solution requires goring many peoples hide, including the consumer. Not sure how we get there ETA: meant to say brand name vs generic drugs. People perceived generics to be inferior
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Miss Tequila
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Post by Miss Tequila on Feb 15, 2021 17:01:31 GMT -5
What you are describing is exactly what I was working with our insurance company to disclose to our employees. I don’t care if my share of an MRI was $100 no matter where I want, I wanted the employees to see that provider A had a total cost of $800, provider B had a cost of $900 and provider C had a cost of $1,200. And yes, the negotiated rates and different providers were different. I realize that my brain might work differently than others, but in union negotiations the biggest sticking point was always health insurance. I wanted the employees to understand how their choice of provider could have a direct impact on our premiums. So you think that not only should employees have to figure out who has the cheapest MRI, they need to figure out what the insurance company's negotiated rates are? Because ultimately that cost is what the insurance companies are paying, not the total cost. No, I wanted the insurance company to make this disclosure easy. A bucket list of services and the provider with the lowest negotiated rate in their area. Not too complex for the insurance company and very basic for the employee. The way I explained it to the employees was our bucket for increases is $xxx. The higher our insurance premiums go, the less your salary increases. We need to work together to keep our premiums from sky rocketing. I wish I could have seen that project through to see if it really would have made a difference. The insurance company had incentive and so did we. I directly the employees did to, it was getting them to understand that our premiums next year are based on how much we spend this year. But that company was sucking the life out of me so I quit
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Post by Deleted on Feb 15, 2021 18:20:04 GMT -5
No, I wanted the insurance company to make this disclosure easy. A bucket list of services and the provider with the lowest negotiated rate in their area. Not too complex for the insurance company and very basic for the employee. The way I explained it to the employees was our bucket for increases is $xxx. The higher our insurance premiums go, the less your salary increases. We need to work together to keep our premiums from sky rocketing. I wonder if the providers or insurance company would consider this proprietary information that they wouldn't want competitors to know. It certainly would have been useful to me when I had high-deductible plans since my actual cost would be the one negotiated between the insurance company and the provider. Put too much responsibility on the patient, and they skip necessary care. Put too little, and they overconsume. We, as a country, get too much and too much ineffective treatment. The solution requires goring many people's hides, including the consumer. I know- I bristle when I see clamoring for "free" healthcare. Most people really mean "I want it at zero cost to me and send someone else the bill". When I was with a Prudential sub eons ago (1985-1995) your deductible was a function of your salary. It wasn't perfect- an Admin making a modest income would have a low deductible even if she was married to someone with a very high income- but it was a start. I had the higher deductible - I think it was $1,500 at the time- and I was fine with that. When I had ACA coverage between my retirement at 61 and becoming eligible for Medicare, $6,000 deductibles were the norm. DH was on Medicare and died in 2016 so I had only one deductible to pick up and it was manageable given my finances. Apply that $6K per-person deductible to a middle-income family with 2 parents and 2 kids and depending on the max out-of-pocket provisions it quickly becomes scary. .
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Miss Tequila
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Post by Miss Tequila on Feb 15, 2021 18:27:16 GMT -5
No, I wanted the insurance company to make this disclosure easy. A bucket list of services and the provider with the lowest negotiated rate in their area. Not too complex for the insurance company and very basic for the employee. The way I explained it to the employees was our bucket for increases is $xxx. The higher our insurance premiums go, the less your salary increases. We need to work together to keep our premiums from sky rocketing. I wish I could have seen that project through to see if it really would have made a difference. The insurance company had incentive and so did we. Indirectly the employees did too, it was getting them to understand that our premiums next year are based on how much we spend this year. But that company was sucking the life out of me so I quit I wonder if the providers or insurance company would consider this proprietary information that they wouldn't want competitors to know. I guess I’m thinking “too bad”. How can we decrease healthcare costs if we don’t focus on the cost of healthcare? Since the company is ultimately paying the costs (we were 80% experience rated) I think the company had the right to know who is a cheaper provider and try to encourage employees to go there.
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pulmonarymd
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Post by pulmonarymd on Feb 15, 2021 19:29:40 GMT -5
The other thing to think about: someone who had type 1 diabetes as a child, now gets a job and their own insurance. They are just starting out. Make them pay too much for their care and they will skip needed care. There is inherent unfairness due to circumstances beyond the patient’s control in our system. Much to think about.
And insurance companies do not want their competitors or the providers to know what they pay others. So they do not want to publish their reimbursement. They are afraid it could lead to a competitive disadvantage
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Miss Tequila
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Post by Miss Tequila on Feb 15, 2021 19:39:19 GMT -5
The other thing to think about: someone who had type 1 diabetes as a child, now gets a job and their own insurance. They are just starting out. Make them pay too much for their care and they will skip needed care. There is inherent unfairness due to circumstances beyond the patient’s control in our system. Much to think about. And insurance companies do not want their competitors or the providers to know what they pay others. So they do not want to publish their reimbursement. They are afraid it could lead to a competitive disadvantage In my case, even though in my example I said provider A, B and C were paid x amount of dollars, that wasn’t really what I asked the insurance company. I wanted a list of the most common tests/procedures (MRI, X-ray, etc) and the provider with the lowest reimbursed cost. Even if we started at a list of 10 for a trial to see if there was any impact on cost. I have several places where I can get a mammogram all within minutes of each other. If I knew that once cost less I would go there. I truly believe if we empower people they will make a wise choice.
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Post by Deleted on Feb 15, 2021 19:48:26 GMT -5
I think the company had the right to know who is a cheaper provider and try to encourage employees to go there. I'm all for more transparency. My concern with actually encouraging employees to choose the cheapest provider is that if there's a bad outcome the employee may claim they were pressured to choose that provider because they were cheaper. I know there are sites to rate medical providers but I don't rely on them. Sure, I trust people's judgement in areas such as office waiting time, ease in getting an appointment, whether or not the doc listens to you and answers your questions... but how do you evaluate a report of a bad outcome? Some is "stuff happens". It's no one's fault. Some is lack of patient compliance or other health issue that made treatment a challenge and interfered with the healing and recovery. Or maybe the doc specializes in high-risk cases of whatever. Decades ago I read an autobiography of the Mayo doctors (2 brothers) and one made a point that's stuck with me to this day: sometimes the doctors that other doctors use because they're so good get sued because they're not warm and fuzzy and sometimes the warm and fuzzy ones are bumbling idiots but they're so likeable patients trust them. Long way of saying: as an employer I'd be wary of "encouraging" the selection of any particular provider.
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Miss Tequila
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Post by Miss Tequila on Feb 15, 2021 19:55:32 GMT -5
I think the company had the right to know who is a cheaper provider and try to encourage employees to go there. I'm all for more transparency. My concern with actually encouraging employees to choose the cheapest provider is that if there's a bad outcome the employee may claim they were pressured to choose that provider because they were cheaper. I know there are sites to rate medical providers but I don't rely on them. Sure, I trust people's judgement in areas such as office waiting time, ease in getting an appointment, whether or not the doc listens to you and answers your questions... but how do you evaluate a report of a bad outcome? Some is "stuff happens". It's no one's fault. Some is lack of patient compliance or other health issue that made treatment a challenge and interfered with the healing and recovery. Or maybe the doc specializes in high-risk cases of whatever. Decades ago I read an autobiography of the Mayo doctors (2 brothers) and one made a point that's stuck with me to this day: sometimes the doctors that other doctors use because they're so good get sued because they're not warm and fuzzy and sometimes the warm and fuzzy ones are bumbling idiots but they're so likeable patients trust them. Long way of saying: as an employer I'd be wary of "encouraging" the selection of any particular provider. Fair point. But we need to do something to control the costs. I actually don’t like that different providers get reimbursed different amounts for the same tests. This is healthcare. It costs X amount of dollars for a test. The fact that different providers in the same area get different reimbursement rates is ridiculous.
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taz157
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Post by taz157 on Feb 15, 2021 20:02:14 GMT -5
When I'm being billed, I would just like it if they could tell me what exactly the tests were done. I'm going through medical bills that I've received for 2021 so far and it's like pulling teeth to tell what it's for. The generic of "Laboratory Testing" from Quest Diagnostics isn't helpful...
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Post by Deleted on Feb 15, 2021 20:06:14 GMT -5
The fact that different providers in the same area get different reimbursement rates is ridiculous. I totally agree with you on that!
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pulmonarymd
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Post by pulmonarymd on Feb 15, 2021 20:31:54 GMT -5
The fact that different providers in the same area get different reimbursement rates is ridiculous. I totally agree with you on that! Why? Why should healthcare be different than any other commodity? There is nothing about medicine that demands everyone should be paid the same. And why shouldn’t someone who is recognized as the best get paid that way? I am not trying to be difficult. I am truly interested in the answer. Because if you believe everyone should be paid the same, why shouldn’t we just go to a single payer
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Miss Tequila
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Post by Miss Tequila on Feb 15, 2021 21:00:05 GMT -5
I totally agree with you on that! Why? Why should healthcare be different than any other commodity? There is nothing about medicine that demands everyone should be paid the same. And why shouldn’t someone who is recognized as the best get paid that way? I am not trying to be difficult. I am truly interested in the answer. Because if you believe everyone should be paid the same, why shouldn’t we just go to a single payer An MRI is a commodity. One place shouldn’t get paid more because they have a bigger share of the market I’m getting to the point that I don’t care if we go single payer. As long as we reign costs in like Canada and other national healthcare countries. No more obscene prices for medicine (we are covering the cost for other countries). Salaries and benefits are also lower in other countries. And stop the multi million dollar lawsuits.
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pulmonarymd
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Post by pulmonarymd on Feb 15, 2021 21:41:11 GMT -5
Why? Why should healthcare be different than any other commodity? There is nothing about medicine that demands everyone should be paid the same. And why shouldn’t someone who is recognized as the best get paid that way? I am not trying to be difficult. I am truly interested in the answer. Because if you believe everyone should be paid the same, why shouldn’t we just go to a single payer An MRI is a commodity. One place shouldn’t get paid more because they have a bigger share of the market I’m getting to the point that I don’t care if we go single payer. As long as we reign costs in like Canada and other national healthcare countries. No more obscene prices for medicine (we are covering the cost for other countries). Salaries and benefits are also lower in other countries. And stop the multi million dollar lawsuits. That is a start, but much more needs to be done to reign in costs. We need to control drug prices. We waste a lot of money on unnecessary and futile care. And we provide a tremendous amount of care on people with very poor quality of life, and are “alive”. Our knife and gun club also contributes a significant, in many cases unreimbursed, care. Finally, college and medical school costs significantly more here than in other countries. If we do not deal with that, we will drive new graduates into the higher paid specialties at a greater rate so they can pay back their school loans. So many things must be dealt with. With our dysfunctional and unwilling to compromise government, we will just continue to kick the can down the road without accomplishing anything’s
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Opti
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Post by Opti on Feb 16, 2021 0:08:50 GMT -5
Why? Why should healthcare be different than any other commodity? There is nothing about medicine that demands everyone should be paid the same. And why shouldn’t someone who is recognized as the best get paid that way? I am not trying to be difficult. I am truly interested in the answer. Because if you believe everyone should be paid the same, why shouldn’t we just go to a single payer An MRI is a commodity. One place shouldn’t get paid more because they have a bigger share of the market I’m getting to the point that I don’t care if we go single payer. As long as we reign costs in like Canada and other national healthcare countries. No more obscene prices for medicine (we are covering the cost for other countries). Salaries and benefits are also lower in other countries. And stop the multi million dollar lawsuits. I wouldn't call an MRI a commodity. Its not like they are so cheap that even doctor's offices have them. www.bing.com/search?q=cost+of+an+mri+machine&form=ANSPH1&refig=970b0d7d44504c9e97ac07cce448c889&mkt=en-us
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giramomma
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Post by giramomma on Feb 16, 2021 8:21:20 GMT -5
There's a lot of data out on why MRI prices vary. It has to do with the body part that's imaged, location (Alaska has high rates) and facility. Hospitals cost more than imaging centers. I'm not sure how insurance companies account for there factors. I think that would be an interesting discussion.
I also don't buy the argument that cheap or no copays drive medical use. I paid $0 for the births of my first two kids. That wasn't incentive enough for me to pop out babies every year.
Even now my copays are $15. We still use medical care sparingly. Between four children, the last time we had a sick kid visit was 3 years ago. If hormonal BC was OTC, I would have only needed medical services due to pregnancy and childbirth.
Surely, we can't be the only family.
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Post by Deleted on Feb 16, 2021 8:48:42 GMT -5
Why? Why should healthcare be different than any other commodity? There is nothing about medicine that demands everyone should be paid the same. And why shouldn’t someone who is recognized as the best get paid that way? I am not trying to be difficult. I am truly interested in the answer. Because if you believe everyone should be paid the same, why shouldn’t we just go to a single payer Two things: first of all, doctors and facilities are not all created equal. The places where I go for mammograms keep their appointment times, have coffee and Wi-Fi, and provide results promptly. My dentist and my oral surgeon are both brilliant (oral surgeon is a Ph.D. and and MD). I've had 5 dental implants. I doubt they're the cheapest provider but I don't care. I've watched "Botched-up Bodies" on Netflix and seen what happens when people go for cheap dental implants. It's a nightmare. I monitor my bloodwork quarterly through RequestaTest.com. I go to any LabCorp or Quest Lab and get what I want for $150. Minimal wait, the orders are always there (my last doc's office never could get them to the lab or to me and I'd end up waiting- and fasting- till her office opened and they could call). Results on-line the next day. I have no illusion that people on Medicaid are getting the same treatment I am. Good providers and facilities should be able to charge more. Why do you think we have so many excellent foreign-born doctors in the US, and the Ghanaian Minister of Finance is in the US right now being treated for lingering health issues following COVID last December? Europe would have been closer, right? Second- what happens when the single payer decides to cut their reimbursements? My sister ran into this as an OB-Gyn in SC. If you wanted OB patients you took BCBS. Their reimbursement rates were pitiful and every time she brought on a new doc the malpractice coverage cost $50K- for FIRST-year claims-made, meaning it went up in subsequent years. She eventually sold her practice and became a hospitalist. In the UK, you can buy "supplemental" policies that magically get you in the door for an appointment faster. I do agree that we need a basic level of medical care for everyone and our current system isn't doing that. ACA was a start but it still needs fixing.
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pulmonarymd
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Post by pulmonarymd on Feb 16, 2021 8:54:16 GMT -5
There's a lot of data out on why MRI prices vary. It has to do with the body part that's imaged, location (Alaska has high rates) and facility. Hospitals cost more than imaging centers. I'm not sure how insurance companies account for there factors. I think that would be an interesting discussion.
I also don't buy the argument that cheap or no copays drive medical use. I paid $0 for the births of my first two kids. That wasn't incentive enough for me to pop out babies every year.
Even now my copays are $15. We still use medical care sparingly. Between four children, the last time we had a sick kid visit was 3 years ago. If hormonal BC was OTC, I would have only needed medical services due to pregnancy and childbirth.
Surely, we can't be the only family.
You are the unicorn. Study after study shows that copays drive compliance. Higher copays and people put off care. Low or no copays allow the “worried well” and hypochondriacs to go to the doctor for “free”. 0 dollar copays for ER visits allow people to use the ER instead of paying to see their physician. It isn’t rational, but it happens. No copays for maternity care makes perfect sense, but many insurances do not operate like that
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Post by Deleted on Feb 16, 2021 9:30:30 GMT -5
You are the unicorn. Study after study shows that copays drive compliance. Higher copays and people put off care. Low or no copays allow the “worried well” and hypochondriacs to go to the doctor for “free”. 0 dollar copays for ER visits allow people to use the ER instead of paying to see their physician. It isn’t rational, but it happens. No copays for maternity care makes perfect sense, but many insurances do not operate like that My late grandmother was on Medicare and every time she got a headache she went in for a brain scan. Dad joked that she developed every disease she read about. I think she just liked the attention she got at doctors' offices. In a podcast I sorely miss called "Sound Medicine", one doc observed that for many people, healthcare meant "Wait till you can't stand it then go to the ER". That's an area we need to fix and, as usual, it's not a single cause. If you're on Medicaid and can't find a doc who accepts it, that may be your only option. Or you hope it will go away because you lose income if you take off work for a doctor's appointment. I guess I'm part of the "worried well" but also part-unicorn. I do the recommended preventative screenings but I'm very conservative when it comes to meds and prefer to keep my cholesterol and a1c at healthy levels through diet and exercise. I have good Medicare coverage but I have better things to do than sit in doctors' waiting rooms. My last non-routine visit of any kind was a nasty sinus infection in October, 2019. I caught it from one of my adorable granddaughters. The guilty party refused to confess. In the end I figure I'm saving the system beaucoup bucks.
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thyme4change
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Post by thyme4change on Feb 16, 2021 11:04:53 GMT -5
I'm all for more transparency. My concern with actually encouraging employees to choose the cheapest provider is that if there's a bad outcome the employee may claim they were pressured to choose that provider because they were cheaper. I know there are sites to rate medical providers but I don't rely on them. Sure, I trust people's judgement in areas such as office waiting time, ease in getting an appointment, whether or not the doc listens to you and answers your questions... but how do you evaluate a report of a bad outcome? Some is "stuff happens". It's no one's fault. Some is lack of patient compliance or other health issue that made treatment a challenge and interfered with the healing and recovery. Or maybe the doc specializes in high-risk cases of whatever. Decades ago I read an autobiography of the Mayo doctors (2 brothers) and one made a point that's stuck with me to this day: sometimes the doctors that other doctors use because they're so good get sued because they're not warm and fuzzy and sometimes the warm and fuzzy ones are bumbling idiots but they're so likeable patients trust them. Long way of saying: as an employer I'd be wary of "encouraging" the selection of any particular provider. Fair point. But we need to do something to control the costs. I actually don’t like that different providers get reimbursed different amounts for the same tests. This is healthcare. It costs X amount of dollars for a test. The fact that different providers in the same area get different reimbursement rates is ridiculous. Sounds like price fixing. Different providers cost different prices in all sorts of industries. Hair stylist, grocery stores, car dealerships, etc. If we force one industry to have set rates, who sets them? Is this government controlled, or do we trust the industry? How do we deal with providers that have higher rent because they are in a better building? Maybe it is just a Phoenix thing, but there are old shit shacks very close to new, luxury buildings. Same area - different rents. Also, how big is an area? Because, again maybe just Phoenix, but 2 blocks could make a difference in neighborhoods. The office on the main street, with a big parking lot and lots of people is different from the one that is down the alley with a few dirt parking spaces, and if they are full you find street parking. What about quality of care? Even a simple blood draw, you could be treated rudely or have someone pleasant. We all have had good phlebotomists and terrible ones. We have all seen some offices that are cleaner than others. If we fix rates, what is the motivation to get a new chair instead of just sitting patients in a broken chair, or a folding chair from Walmart? The real costs aren't medical care, but (a) covering people who don't pay - either uninsured, or people who have to BK out of their debt from an illness and (b) administration of paperwork. But, if we suddenly went to a socialized system, we would eliminate millions of jobs and crash both the economy and the stock market. There isn't a great answer for containing costs. I think transparency will likely be used by insurance companies to negotiate better rates, but I doubt they will pass them along to consumers. I expect to see increasing profits for insurance providers. As far as union negotiations - if we went to a European style health system, we could get healthcare out of the employer-employee relationship. I'm sure in the end, many companies would love to that burden.
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pulmonarymd
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Post by pulmonarymd on Feb 16, 2021 11:08:51 GMT -5
Yes, we have a problem with over and under consumption, both of which leads to an increase in costs. In addition, we have a more unhealthy population compared to other developed countries, which leads to increased costs. The problem is complex; thinking simple measures will bring costs down is a fantasy. We need to have adult conversations about what it is we want to accomplish. That requires us dealing with death and dying, the medicalization of social ills, our violent culture, pharmaceutical costs, and our individualistic nature. No solution will occur until we can actually talk to each other and wish to solve problems rather than score points. I am not optimistic in the short term. Long term, costs will eventually reach a point where the pain we experience from a budget standpoint makes us have to deal with them
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Miss Tequila
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Post by Miss Tequila on Feb 16, 2021 11:19:18 GMT -5
Fair point. But we need to do something to control the costs. I actually don’t like that different providers get reimbursed different amounts for the same tests. This is healthcare. It costs X amount of dollars for a test. The fact that different providers in the same area get different reimbursement rates is ridiculous. Sounds like price fixing. Different providers cost different prices in all sorts of industries. Hair stylist, grocery stores, car dealerships, etc. If we force one industry to have set rates, who sets them? Is this government controlled, or do we trust the industry? How do we deal with providers that have higher rent because they are in a better building? Maybe it is just a Phoenix thing, but there are old shit shacks very close to new, luxury buildings. Same area - different rents. Also, how big is an area? Because, again maybe just Phoenix, but 2 blocks could make a difference in neighborhoods. The office on the main street, with a big parking lot and lots of people is different from the one that is down the alley with a few dirt parking spaces, and if they are full you find street parking. What about quality of care? Even a simple blood draw, you could be treated rudely or have someone pleasant. We all have had good phlebotomists and terrible ones. We have all seen some offices that are cleaner than others. If we fix rates, what is the motivation to get a new chair instead of just sitting patients in a broken chair, or a folding chair from Walmart? The real costs aren't medical care, but (a) covering people who don't pay - either uninsured, or people who have to BK out of their debt from an illness and (b) administration of paperwork. But, if we suddenly went to a socialized system, we would eliminate millions of jobs and crash both the economy and the stock market. There isn't a great answer for containing costs. I think transparency will likely be used by insurance companies to negotiate better rates, but I doubt they will pass them along to consumers. I expect to see increasing profits for insurance providers. As far as union negotiations - if we went to a European style health system, we could get healthcare out of the employer-employee relationship. I'm sure in the end, many companies would love to that burden. I keep seeing that the savings will go to the insurance companies. I can’t speak to all insurance types but I came from an experience rated plan. I received copies of the cost runs, which showed in details the total of x procedures and the total cost. Our premium was driven by the last few years charges (with the older claiming having less weight). The insurance company was very transparent. It was claims experience plus a standard admin %. So in our case, the cost savings would be born by my company. The older I get, the more disgusted I am by what is happening with health care. It’s just that you and I disagree on where the issue is. Sure, we can eliminate the layer of insurance admin costs but I also audited that same insurance company years ago. We are talking 20 years so I can’t remember specifics but I do know that they have statutory filings and can’t have excess income on premiums. I also remember that they invested the float and that is where they made a lot on that. In the end, we need to reign in the costs or we are going to fail. Drugs cost significantly less in Canada. Healthcare providers get paid less in Canada. Insurance is less because they do not sue like Americans. I can go on and on about our inflated cost structure compared to Canada. But if we want lower healthcare costs like Canada has, we have to be willing to do what Canada does. In some ways, I’m ok with that. I don’t want Americans to carry the burden of drug profits. I want a law that says Americans will pay no more than Canadians. Take the stupid commercials off the air and let doctors decide what to prescribe. It is criminal that people are literally going without medication because they can’t afford it. I was 100% against the ACA because it didn’t jack shit to control costs. I’ve said that since day one. No party is willing to make the tough decisions to reign in our costs. All we do is shift the costs to others. It’s maddening I need to go back to work. I’m reading my words and realizing I’m losing my “staunch conservative” card...lol. But I do think seeing the pandemic through the eyes of the have nots has caused the shift. Not that I believe in “free” anything. But perhaps healthcare should be more of a right and less of a profit driven business. Please don’t take my Republican card from me...lol
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Miss Tequila
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Joined: Dec 19, 2010 10:13:45 GMT -5
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Post by Miss Tequila on Feb 16, 2021 11:24:38 GMT -5
Yes, we have a problem with over and under consumption, both of which leads to an increase in costs. In addition, we have a more unhealthy population compared to other developed countries, which leads to increased costs. The problem is complex; thinking simple measures will bring costs down is a fantasy. We need to have adult conversations about what it is we want to accomplish. That requires us dealing with death and dying, the medicalization of social ills, our violent culture, pharmaceutical costs, and our individualistic nature. No solution will occur until we can actually talk to each other and wish to solve problems rather than score points. I am not optimistic in the short term. Long term, costs will eventually reach a point where the pain we experience from a budget standpoint makes us have to deal with them I agree that overconsumption leads to increased costs. But the simple fact is almost every procedure costs more in the US. Why? One sleepless night I had I found a website that showed the average costs of procedures there and here. It was mind blowing. Why can’t we focus on that? Yes, reducing the insurance admin will also reduce costs but we have an underlying issue. It’s a damn free for all when it comes to the costs of medical care. I also agree that heroic measures should not be taken when there is almost zero chance of survival. Keeping a brain dead person hooked up to a machine for years is criminal.
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justme
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Post by justme on Feb 16, 2021 11:24:55 GMT -5
I'm all for more transparency. My concern with actually encouraging employees to choose the cheapest provider is that if there's a bad outcome the employee may claim they were pressured to choose that provider because they were cheaper. I know there are sites to rate medical providers but I don't rely on them. Sure, I trust people's judgement in areas such as office waiting time, ease in getting an appointment, whether or not the doc listens to you and answers your questions... but how do you evaluate a report of a bad outcome? Some is "stuff happens". It's no one's fault. Some is lack of patient compliance or other health issue that made treatment a challenge and interfered with the healing and recovery. Or maybe the doc specializes in high-risk cases of whatever. Decades ago I read an autobiography of the Mayo doctors (2 brothers) and one made a point that's stuck with me to this day: sometimes the doctors that other doctors use because they're so good get sued because they're not warm and fuzzy and sometimes the warm and fuzzy ones are bumbling idiots but they're so likeable patients trust them. Long way of saying: as an employer I'd be wary of "encouraging" the selection of any particular provider. Fair point. But we need to do something to control the costs. I actually don’t like that different providers get reimbursed different amounts for the same tests. This is healthcare. It costs X amount of dollars for a test. The fact that different providers in the same area get different reimbursement rates is ridiculous. It's not ridiculous - it's what happens when health care exists in a capital environment.
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Miss Tequila
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Post by Miss Tequila on Feb 16, 2021 11:30:24 GMT -5
Fair point. But we need to do something to control the costs. I actually don’t like that different providers get reimbursed different amounts for the same tests. This is healthcare. It costs X amount of dollars for a test. The fact that different providers in the same area get different reimbursement rates is ridiculous. It's not ridiculous - it's what happens when health care exists in a capital environment. Fair enough. But I can also get the cost of everything else I’m going to buy or service I’m going to consume. Why is it so difficult to find out the true cost that my insurance will pay for my procedure so I can make an informed decision of where I want to have the procedure done? Why are we ok with being ignorant of the true costs for medical care?
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pulmonarymd
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Post by pulmonarymd on Feb 16, 2021 11:30:28 GMT -5
Yes, we have a problem with over and under consumption, both of which leads to an increase in costs. In addition, we have a more unhealthy population compared to other developed countries, which leads to increased costs. The problem is complex; thinking simple measures will bring costs down is a fantasy. We need to have adult conversations about what it is we want to accomplish. That requires us dealing with death and dying, the medicalization of social ills, our violent culture, pharmaceutical costs, and our individualistic nature. No solution will occur until we can actually talk to each other and wish to solve problems rather than score points. I am not optimistic in the short term. Long term, costs will eventually reach a point where the pain we experience from a budget standpoint makes us have to deal with them I agree that overconsumption leads to increased costs. But the simple fact is almost every procedure costs more in the US. Why? One sleepless night I had I found a website that showed the average costs of procedures there and here. It was mind blowing. Why can’t we focus on that? Yes, reducing the insurance admin will also reduce costs but we have an underlying issue. It’s a damn free for all when it comes to the costs of medical care. I also agree that heroic measures should not be taken when there is almost zero chance of survival. Keeping a brain dead person hooked up to a machine for years is criminal. 1 Malpractice 2 Less regulation of what can be charged 3 Medical school costs multiple times what it does in other countries Again, conservatives believe in the free market. So, is medicine supposed to be a free market or not. Why are you willing to regulate this market, and not regulate costs in other parts, such as the financial world or legal world. Why do you feel the need to fix costs here?
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justme
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Joined: Feb 10, 2012 13:12:47 GMT -5
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Post by justme on Feb 16, 2021 11:31:18 GMT -5
Fair point. But we need to do something to control the costs. I actually don’t like that different providers get reimbursed different amounts for the same tests. This is healthcare. It costs X amount of dollars for a test. The fact that different providers in the same area get different reimbursement rates is ridiculous. Sounds like price fixing. Different providers cost different prices in all sorts of industries. Hair stylist, grocery stores, car dealerships, etc. If we force one industry to have set rates, who sets them? Is this government controlled, or do we trust the industry? How do we deal with providers that have higher rent because they are in a better building? Maybe it is just a Phoenix thing, but there are old shit shacks very close to new, luxury buildings. Same area - different rents. Also, how big is an area? Because, again maybe just Phoenix, but 2 blocks could make a difference in neighborhoods. The office on the main street, with a big parking lot and lots of people is different from the one that is down the alley with a few dirt parking spaces, and if they are full you find street parking. What about quality of care? Even a simple blood draw, you could be treated rudely or have someone pleasant. We all have had good phlebotomists and terrible ones. We have all seen some offices that are cleaner than others. If we fix rates, what is the motivation to get a new chair instead of just sitting patients in a broken chair, or a folding chair from Walmart? The real costs aren't medical care, but (a) covering people who don't pay - either uninsured, or people who have to BK out of their debt from an illness and (b) administration of paperwork. But, if we suddenly went to a socialized system, we would eliminate millions of jobs and crash both the economy and the stock market.
There isn't a great answer for containing costs. I think transparency will likely be used by insurance companies to negotiate better rates, but I doubt they will pass them along to consumers. I expect to see increasing profits for insurance providers. As far as union negotiations - if we went to a European style health system, we could get healthcare out of the employer-employee relationship. I'm sure in the end, many companies would love to that burden. I've wondered, but never took the time to research, what happened in other countries. They didn't start out with socialized medicine day 1 - so how did they handle the transition? Was it so long ago that it wasn't this behemoth that would eliminate a ton of jobs? Or what?
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Miss Tequila
Distinguished Associate
Joined: Dec 19, 2010 10:13:45 GMT -5
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Post by Miss Tequila on Feb 16, 2021 11:36:22 GMT -5
I agree that overconsumption leads to increased costs. But the simple fact is almost every procedure costs more in the US. Why? One sleepless night I had I found a website that showed the average costs of procedures there and here. It was mind blowing. Why can’t we focus on that? Yes, reducing the insurance admin will also reduce costs but we have an underlying issue. It’s a damn free for all when it comes to the costs of medical care. I also agree that heroic measures should not be taken when there is almost zero chance of survival. Keeping a brain dead person hooked up to a machine for years is criminal. 1 Malpractice 2 Less regulation of what can be charged 3 Medical school costs multiple times what it does in other countries Again, conservatives believe in the free market. So, is medicine supposed to be a free market or not. Why are you willing to regulate this market, and not regulate costs in other parts, such as the financial world or legal world. Why do you feel the need to fix costs here? We can’t have it both ways. If people want a national healthcare system like Canada, then we need to reign in costs like Canada does. Do you seriously not think we have a cost problem? I guess I don’t understand where you are coming from. Aren’t you in favor of single payor or national healthcare?
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justme
Senior Associate
Joined: Feb 10, 2012 13:12:47 GMT -5
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Post by justme on Feb 16, 2021 11:36:52 GMT -5
Sounds like price fixing. Different providers cost different prices in all sorts of industries. Hair stylist, grocery stores, car dealerships, etc. If we force one industry to have set rates, who sets them? Is this government controlled, or do we trust the industry? How do we deal with providers that have higher rent because they are in a better building? Maybe it is just a Phoenix thing, but there are old shit shacks very close to new, luxury buildings. Same area - different rents. Also, how big is an area? Because, again maybe just Phoenix, but 2 blocks could make a difference in neighborhoods. The office on the main street, with a big parking lot and lots of people is different from the one that is down the alley with a few dirt parking spaces, and if they are full you find street parking. What about quality of care? Even a simple blood draw, you could be treated rudely or have someone pleasant. We all have had good phlebotomists and terrible ones. We have all seen some offices that are cleaner than others. If we fix rates, what is the motivation to get a new chair instead of just sitting patients in a broken chair, or a folding chair from Walmart? The real costs aren't medical care, but (a) covering people who don't pay - either uninsured, or people who have to BK out of their debt from an illness and (b) administration of paperwork. But, if we suddenly went to a socialized system, we would eliminate millions of jobs and crash both the economy and the stock market. There isn't a great answer for containing costs. I think transparency will likely be used by insurance companies to negotiate better rates, but I doubt they will pass them along to consumers. I expect to see increasing profits for insurance providers. As far as union negotiations - if we went to a European style health system, we could get healthcare out of the employer-employee relationship. I'm sure in the end, many companies would love to that burden. I keep seeing that the savings will go to the insurance companies. I can’t speak to all insurance types but I came from an experience rated plan. I received copies of the cost runs, which showed in details the total of x procedures and the total cost. Our premium was driven by the last few years charges (with the older claiming having less weight). The insurance company was very transparent. It was claims experience plus a standard admin %. So in our case, the cost savings would be born by my company. The older I get, the more disgusted I am by what is happening with health care. It’s just that you and I disagree on where the issue is. Sure, we can eliminate the layer of insurance admin costs but I also audited that same insurance company years ago. We are talking 20 years so I can’t remember specifics but I do know that they have statutory filings and can’t have excess income on premiums. I also remember that they invested the float and that is where they made a lot on that. In the end, we need to reign in the costs or we are going to fail. Drugs cost significantly less in Canada. Healthcare providers get paid less in Canada. Insurance is less because they do not sue like Americans. I can go on and on about our inflated cost structure compared to Canada. But if we want lower healthcare costs like Canada has, we have to be willing to do what Canada does. In some ways, I’m ok with that. I don’t want Americans to carry the burden of drug profits. I want a law that says Americans will pay no more than Canadians. Take the stupid commercials off the air and let doctors decide what to prescribe. It is criminal that people are literally going without medication because they can’t afford it. I was 100% against the ACA because it didn’t jack shit to control costs. I’ve said that since day one. No party is willing to make the tough decisions to reign in our costs. All we do is shift the costs to others. It’s maddening I need to go back to work. I’m reading my words and realizing I’m losing my “staunch conservative” card...lol. But I do think seeing the pandemic through the eyes of the have nots has caused the shift. Not that I believe in “free” anything. But perhaps healthcare should be more of a right and less of a profit driven business. Please don’t take my Republican card from me...lol Except insurance companies found ways to pad the line anyways to add to the costs and get a bigger cut. Optum and Express Scripts didn't always exist and didn't start out with a stranglehold on prescriptions - but now they are. Guess who owns them? INSURANCE COMPANIES. So now they got to increase their costs by adding the managed prescription option (so they get more $ as their admin is % based) and then the companies that they own then get their own admin percent. Yay! More money! Or for some care they "outsource" it to other companies to decide whether or not people need that care (instead of just relying on doctors to do their job) - and surprise! Those companies are also owned by insurance companies and also add their own admin % to the pile.
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