How (and why) to Ramble on your goat sideways
09-07-2014, 07:54 PM
Whenever I see a mail carrier, they are chatting or playing on their cell phone.
Also, if I understand my most recent medical service statement correctly:
$1200 was billed, insurance paid $450, the medical service wrote off the other $750 as a loss, and I paid a $20 co-pay. Is that even legal (writing off what apparently appears to be a dramatical inflation of the cost of services)?
Also, if I understand my most recent medical service statement correctly:
$1200 was billed, insurance paid $450, the medical service wrote off the other $750 as a loss, and I paid a $20 co-pay. Is that even legal (writing off what apparently appears to be a dramatical inflation of the cost of services)?
Last edited by Enginerd; 09-07-2014 at 08:11 PM.
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09-07-2014, 09:44 PM
Boost Pope
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It's not not legal, and it's how the game is played. I should show you the bills from my recent OR / surgery / post-op care. Same basic write-down percentages, with an extra zero or two at the end.
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09-07-2014, 10:00 PM
Same experience here. I had one bill that was sent to me directly rather than being filed with the insurance. I called and asked if I was expected to pay it out of pocket, and they said, "Oh, no, just send it to your insurance, and then after we see how much of it they cover, we will waive the rest."
Among many other issues, the pricing model for healthcare is incredibly screwed up.
Among many other issues, the pricing model for healthcare is incredibly screwed up.
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09-08-2014, 01:15 AM
I hope most of u have seen the article about the 10k blood test?
That is the primary reason why our medical system is so fucked up.
Hospitals charging 10k for a basic 10 bucks blood test.
That is the primary reason why our medical system is so fucked up.
Hospitals charging 10k for a basic 10 bucks blood test.
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09-08-2014, 08:45 AM
Boost Czar
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kinda like how the price of schools keeps going up...
the problem is less about the "fucked up medical system" but more about the fucked up payer system.
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09-08-2014, 09:48 AM
My sinus fracture surgery was billed at over $40,000. I paid around $3200 out of pocket. My insurance paid another $10,000 or so I think. The rest was just waived.
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09-08-2014, 09:58 AM
Boost Pope
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The thing that perplexes me moth about the heathcare system in the US, in general, is why we have the expectation that health insurance can and should be used to cover routine, everyday needs.
If you need an oil change in your car, do you file a claim with your auto insurance?
If you have to call a plumber to un-clog a drain at home, do you file a claim with your homeowners insurance?
Why, then, is the very first question uttered aloud when I file a routine prescription, get a flu shot, or partake in any other non-emergent healthcare "insurance card?"
Health insurance used to be for the same purpose as car insurance- it was there to cover catastrophic events. If you get hit by a bus and land in the hospital with bills for surgical care and inpatient treatment, that's a health-insurance sort of event.
But what good does it do, I ask you, to involve health insurance in literally every single financial transaction related to routine healthcare? It adds cost for the healthcare provider, and it needlessly involves a third-party which expects to make a 20% profit on all transactions which pass through its hands.
Involving health insurance in routine care does nothing but raise the cost of healthcare for all involved. No one* benefits.
* = except for the employees and shareholders of companies which provide health insurance. This is not an bad / evil thing, just a fact of life.
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09-08-2014, 10:17 AM
2 Props,3 Dildos,& 1 Cat
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^ Truth.
The thing that perplexes me moth about the heathcare system in the US, in general, is why we have the expectation that health insurance can and should be used to cover routine, everyday needs.
If you need an oil change in your car, do you file a claim with your auto insurance?
If you have to call a plumber to un-clog a drain at home, do you file a claim with your homeowners insurance?
Why, then, is the very first question uttered aloud when I file a routine prescription, get a flu shot, or partake in any other non-emergent healthcare "insurance card?"
Health insurance used to be for the same purpose as car insurance- it was there to cover catastrophic events. If you get hit by a bus and land in the hospital with bills for surgical care and inpatient treatment, that's a health-insurance sort of event.
But what good does it do, I ask you, to involve health insurance in literally every single financial transaction related to routine healthcare? It adds cost for the healthcare provider, and it needlessly involves a third-party which expects to make a 20% profit on all transactions which pass through its hands.
Involving health insurance in routine care does nothing but raise the cost of healthcare for all involved. No one* benefits.
The thing that perplexes me moth about the heathcare system in the US, in general, is why we have the expectation that health insurance can and should be used to cover routine, everyday needs.
If you need an oil change in your car, do you file a claim with your auto insurance?
If you have to call a plumber to un-clog a drain at home, do you file a claim with your homeowners insurance?
Why, then, is the very first question uttered aloud when I file a routine prescription, get a flu shot, or partake in any other non-emergent healthcare "insurance card?"
Health insurance used to be for the same purpose as car insurance- it was there to cover catastrophic events. If you get hit by a bus and land in the hospital with bills for surgical care and inpatient treatment, that's a health-insurance sort of event.
But what good does it do, I ask you, to involve health insurance in literally every single financial transaction related to routine healthcare? It adds cost for the healthcare provider, and it needlessly involves a third-party which expects to make a 20% profit on all transactions which pass through its hands.
Involving health insurance in routine care does nothing but raise the cost of healthcare for all involved. No one* benefits.
* = except for the employees and shareholders of companies which provide health insurance. This is not an bad / evil thing, just a fact of life.
Incidentally, I had a routine dentist appointment but found out later that I forgot to get dental insurance when I dumped my company insurance for my wife's. They billed me. I called the dental office up and said "Last time the insurance company paid X. I would like to pay that amount instead of the higher amount on my bill". They agreed to it. Saved me about half.
MEANWHILE while I wait for open enrollment (lame!):
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09-08-2014, 10:41 AM
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^ Truth.
The thing that perplexes me moth about the heathcare system in the US, in general, is why we have the expectation that health insurance can and should be used to cover routine, everyday needs.
If you need an oil change in your car, do you file a claim with your auto insurance?
If you have to call a plumber to un-clog a drain at home, do you file a claim with your homeowners insurance?
Why, then, is the very first question uttered aloud when I file a routine prescription, get a flu shot, or partake in any other non-emergent healthcare "insurance card?"
Health insurance used to be for the same purpose as car insurance- it was there to cover catastrophic events. If you get hit by a bus and land in the hospital with bills for surgical care and inpatient treatment, that's a health-insurance sort of event.
But what good does it do, I ask you, to involve health insurance in literally every single financial transaction related to routine healthcare? It adds cost for the healthcare provider, and it needlessly involves a third-party which expects to make a 20% profit on all transactions which pass through its hands.
Involving health insurance in routine care does nothing but raise the cost of healthcare for all involved. No one* benefits.
The thing that perplexes me moth about the heathcare system in the US, in general, is why we have the expectation that health insurance can and should be used to cover routine, everyday needs.
If you need an oil change in your car, do you file a claim with your auto insurance?
If you have to call a plumber to un-clog a drain at home, do you file a claim with your homeowners insurance?
Why, then, is the very first question uttered aloud when I file a routine prescription, get a flu shot, or partake in any other non-emergent healthcare "insurance card?"
Health insurance used to be for the same purpose as car insurance- it was there to cover catastrophic events. If you get hit by a bus and land in the hospital with bills for surgical care and inpatient treatment, that's a health-insurance sort of event.
But what good does it do, I ask you, to involve health insurance in literally every single financial transaction related to routine healthcare? It adds cost for the healthcare provider, and it needlessly involves a third-party which expects to make a 20% profit on all transactions which pass through its hands.
Involving health insurance in routine care does nothing but raise the cost of healthcare for all involved. No one* benefits.
* = except for the employees and shareholders of companies which provide health insurance. This is not an bad / evil thing, just a fact of life.
They want to know what is going on with their customers.
If a routine and otherwise cheap bloodwork is ordered, that could be leveraged as some sort of a pre-existing condition to either deny claims in the future, or jack up premiums for the next billing cycle.
They do not want to miss out on any opportunity to ream the customer.
Also, any money spent on their part is collected - sometimes with ungodly "interest" - over time, in the form if raised premiums.
They are in this business to make money.
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09-08-2014, 11:03 AM
Boost Pope
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And, without going into Scott-like conspiracy theories and claims of corruption, this interest (making money) is also served by creating an atmosphere in which it is considered routine and commonplace to involve the health insurance company in literally every single healthcare transaction, be it an immunization, a health exam, an office visit for a minor complaint, a routine prescription, etc.
I mean, consider the case of a person who has a couple of chronic but commonplace health problems which require daily medication. We'll say high blood pressure and high cholesterol, just at random. This individual will take two prescription medications every single day.
This person goes to the pharmacy once a month to pick up their two bottles of pills, and once a month they hand over their insurance card. This isn't a catastrophic or unforeseen event, and it's not even preventative healthcare in the most genuine sense of the term, it's just a routine ongoing expense in which we have all decided that it's normal to involve a third-party.
How is it in the best interest of anybody other than the insurance company for health insurance to be used to pay for this monthly medication?
The individual isn't saving any money. Oh, sure- they see the price of the script go from $120 down to $10 at the register, but in the long term they're paying for it. They're paying more, in fact. If we assume that the insurance company has a negotiated reimbursement of $50 for those meds, then the individual winds up paying $72.50 out of pocket at the end of the day.
How is this? Well, insurance companies aren't in business to lose money. So when you involve them in a routine, ongoing monthly expense, you can rest assured that they're going to get their money back, from you, in the form of routine, ongoing premiums. So not only do you pay the insurance company back the $50 they paid for the medicine, you also pay them a 20% premium to cover their profits and expenses, plus the $10 out-of-pocket that you paid directly to the pharmacy.
So the pharmacy collected $60, and the insurance company pocketed $12.50 as an administrative cost. Everyone* loses.
How do you fix this? Simple**, just eliminate the double-standard in pricing, give everyone the "negotiated" rate, and go back to the original model wherein health insurance is there to cover unforeseen expenses.
Not that it'll ever happen, obviously. And it's got nothing to do with corporate greed, political corruption, or anything grandiose like that. It's because of individual stupidity. You try to implement a sane, rational system of healthcare funding and people*** will start screaming about how "they're trying to take away our health insurance!"
I mean, consider the case of a person who has a couple of chronic but commonplace health problems which require daily medication. We'll say high blood pressure and high cholesterol, just at random. This individual will take two prescription medications every single day.
This person goes to the pharmacy once a month to pick up their two bottles of pills, and once a month they hand over their insurance card. This isn't a catastrophic or unforeseen event, and it's not even preventative healthcare in the most genuine sense of the term, it's just a routine ongoing expense in which we have all decided that it's normal to involve a third-party.
How is it in the best interest of anybody other than the insurance company for health insurance to be used to pay for this monthly medication?
The individual isn't saving any money. Oh, sure- they see the price of the script go from $120 down to $10 at the register, but in the long term they're paying for it. They're paying more, in fact. If we assume that the insurance company has a negotiated reimbursement of $50 for those meds, then the individual winds up paying $72.50 out of pocket at the end of the day.
How is this? Well, insurance companies aren't in business to lose money. So when you involve them in a routine, ongoing monthly expense, you can rest assured that they're going to get their money back, from you, in the form of routine, ongoing premiums. So not only do you pay the insurance company back the $50 they paid for the medicine, you also pay them a 20% premium to cover their profits and expenses, plus the $10 out-of-pocket that you paid directly to the pharmacy.
So the pharmacy collected $60, and the insurance company pocketed $12.50 as an administrative cost. Everyone* loses.
* = again, except for the employees and shareholder of the insurance company, and the other businesses downstream of it and them.
How do you fix this? Simple**, just eliminate the double-standard in pricing, give everyone the "negotiated" rate, and go back to the original model wherein health insurance is there to cover unforeseen expenses.
** = not simple.
Not that it'll ever happen, obviously. And it's got nothing to do with corporate greed, political corruption, or anything grandiose like that. It's because of individual stupidity. You try to implement a sane, rational system of healthcare funding and people*** will start screaming about how "they're trying to take away our health insurance!"
*** = mindlessly parroting what they've seen on their favorite "news" outlet.
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09-08-2014, 11:26 AM
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In my mind, the real harm that is done by this system is that health care no longer benefits from free market competition. Consumers don't shop for the best deal when someone else is paying the bill. They just go ahead and get all the tests, all the procedures, consult with all the specialists. All of that costs money which ultimately we all end up paying even if we have insurance.
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09-08-2014, 11:38 AM
Boost Pope
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In my mind, the real harm that is done by this system is that health care no longer benefits from free market competition. Consumers don't shop for the best deal when someone else is paying the bill. They just go ahead and get all the tests, all the procedures, consult with all the specialists. All of that costs money which ultimately we all end up paying even if we have insurance.
I mean, the average person, myself included, is not capable of making informed decisions about what is and is not necessary when it comes to labwork, imaging, etc. The same basic conundrum, therefore, exists here as when a person who is not mechanically inclined takes their vehicle to a mechanic. The owner gives a vague description of the problem, and then trusts* the mechanic to diagnose the problem and give an accurate accounting of what parts and services are necessary to rectify it.
* = nobody actually trusts mechanics, but most people don't really have a choice in the matter.
Now, a car is a complex object, but it's nowhere near as complex as my body, nor do I really care as much about my car as I do, say, my right hand. So if I** can't even make a truly informed decision as to what it will take to make my car stop shaking when I am coming to a stop, how the hell am I supposed to make an informed decision about whether that MRI is really necessary after all?
** = someone other than myself who doesn't know jack sit about how brakes work. The woman, for instance.
If anything, the situation is even worse in the case of the doctor, since we*** have created a highly litigious environment in which healthcare professionals are hesitant to do anything less than everything humanly possible in the course of a diagnosis, for fear of a malpractice suit being files against them should they miss something exceedingly obscure.
*** = a small but statistically random sample of the population.
If you're ever bored one day, take a note of how many advertisements you see on billboards, in the subway, on the side of a bus, etc., from tort lawyers proudly proclaiming how much money they're recovered from doctors in malpractice cases. Then make the same observation about how many lawyers are offering to sue auto mechanics for malpractice.
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09-08-2014, 11:56 AM
It's that bad. Seriously horrifying to drive.
LOL. Well played.
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09-08-2014, 11:58 AM
Whenever I see a mail carrier, they are chatting or playing on their cell phone.
Also, if I understand my most recent medical service statement correctly:
$1200 was billed, insurance paid $450, the medical service wrote off the other $750 as a loss, and I paid a $20 co-pay. Is that even legal (writing off what apparently appears to be a dramatical inflation of the cost of services)?
Also, if I understand my most recent medical service statement correctly:
$1200 was billed, insurance paid $450, the medical service wrote off the other $750 as a loss, and I paid a $20 co-pay. Is that even legal (writing off what apparently appears to be a dramatical inflation of the cost of services)?
Same experience here. I had one bill that was sent to me directly rather than being filed with the insurance. I called and asked if I was expected to pay it out of pocket, and they said, "Oh, no, just send it to your insurance, and then after we see how much of it they cover, we will waive the rest."
Among many other issues, the pricing model for healthcare is incredibly screwed up.
Among many other issues, the pricing model for healthcare is incredibly screwed up.
That's kind of the point, though. Insurance companies don't pay the quoted prices. They end up paying somewhere between a tenth to a half of the quoted price.
My sinus fracture surgery was billed at over $40,000. I paid around $3200 out of pocket. My insurance paid another $10,000 or so I think. The rest was just waived.
My sinus fracture surgery was billed at over $40,000. I paid around $3200 out of pocket. My insurance paid another $10,000 or so I think. The rest was just waived.
Ah yes, back to my world.
Here's the deal: When the contract negotiations between insurance and providers are done, the amount that insurance will pay/apply benefits to is called "Usual and Customary," or "Contracted Rate" or "Allowed Amount."
What this has done is gone to the old "If you want $50, ask $100" tactic.
It's legal, though somewhat amounts to extortion.
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09-08-2014, 01:33 PM
I mean, consider the case of a person who has a couple of chronic but commonplace health problems which require daily medication. We'll say high blood pressure and high cholesterol, just at random. This individual will take two prescription medications every single day.
We have a couple large competing grocery chains (grocery chains look at the pharmacy as a profit center but also as a loss leader to get the shopper into the store to by milk & eggs, amongst other things).
One chain offers 90day 'generic' meds for 10$/fill
The other chain offers a name brand med (which my cardiologist insists on using) for free. Think 'loss leader'.
So, I ask them to price match the competitor which they gladly do and get the name brand for nada.
Oh, the generic 90 day/fill is less than my insurance copay so my insurance isn't involved at all.
Amazing what you can get by just asking.
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09-08-2014, 01:47 PM
Junior Member
Join Date: Sep 2011
Location: finger lakes NY
Posts: 433
Total Cats: 17
In my mind, the real harm that is done by this system is that health care no longer benefits from free market competition. Consumers don't shop for the best deal when someone else is paying the bill. They just go ahead and get all the tests, all the procedures, consult with all the specialists. All of that costs money which ultimately we all end up paying even if we have insurance.
I mean, the average person, myself included, is not capable of making informed decisions about what is and is not necessary when it comes to labwork, imaging, etc. The same basic conundrum, therefore, exists here as when a person who is not mechanically inclined takes their vehicle to a mechanic. The owner gives a vague description of the problem, and then trusts* the mechanic to diagnose the problem and give an accurate accounting of what parts and services are necessary to rectify it.
* = nobody actually trusts mechanics, but most people don't really have a choice in the matter.
Now, a car is a complex object, but it's nowhere near as complex as my body, nor do I really care as much about my car as I do, say, my right hand. So if I** can't even make a truly informed decision as to what it will take to make my car stop shaking when I am coming to a stop, how the hell am I supposed to make an informed decision about whether that MRI is really necessary after all?
** = someone other than myself who doesn't know jack sit about how brakes work. The woman, for instance.
If anything, the situation is even worse in the case of the doctor, since we*** have created a highly litigious environment in which healthcare professionals are hesitant to do anything less than everything humanly possible in the course of a diagnosis, for fear of a malpractice suit being files against them should they miss something exceedingly obscure.
*** = a small but statistically random sample of the population.
If you're ever bored one day, take a note of how many advertisements you see on billboards, in the subway, on the side of a bus, etc., from tort lawyers proudly proclaiming how much money they're recovered from doctors in malpractice cases. Then make the same observation about how many lawyers are offering to sue auto mechanics for malpractice.
Anyway, I do give more consideration before spending. A doctor's visit is $110, so I don't go as often. Obviously, If I don't see the doctor as often then she doesn't write as many prescriptions or order as many tests or make as many referrals. You might be skeptical, but I really believe that if everyone had this policy then the total amount of money that goes into the health care system would be significantly less. And, since that money ultimately comes from us (whether it goes through an insurance company or not) we all save.
Who knows, it might even motivate the industry to be more cost effective.
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