Joe Biden promises to "provide health care for all"

[Captain_Falcon]

It was billed completely out of proportion to the cost of what was provided to try to make as much money as possible based on insurance rejections. We have a deeply immoral healthcare system with the poorest outcomes in the developed world.

Explain how it was billed out of proportion to the cost of what was provided. Specifics please

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[DrNotaDr]

Explain how it was billed out of proportion to the cost of what was provided. Specifics please

I’m not sharing my medical bills with a stranger on a online forum. If you don’t think Americans have the highest healthcare costs and some of the poorest outcomes of all developed countries than you’re education isn’t doing you any favors.

Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care

In the United States—more than in 11 other wealthy countries—the health care you receive varies with your level of income, according to a new Commonwealth Fund report.

interactives.commonwealthfund.org

 

[VA Hopeful Dr]

I’m not sharing my medical bills with a stranger on a online forum. If you don’t think Americans have the highest healthcare costs and some of the poorest outcomes of all developed countries than you’re education isn’t doing you any favors.

Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care

In the United States—more than in 11 other wealthy countries—the health care you receive varies with your level of income, according to a new Commonwealth Fund report.

interactives.commonwealthfund.org

Jesus Christ, SDN should start paying given how often someone posts that study and I have to show why it doesn't say what they think it does. Luckily I've saved the post where I address every single point in that study. Tl;dr, we are not even close to having the poorest outcomes. Cost though absolutely is an issue.

First category I don't care what patients think about anything, the only objective measures are in regards to diabetes, asthma, and CHF and preventative measures.

The preventative measures were easy - we rocked those:

Talked with provider about things in life that cause worry or stress in the past two years, among those with a history of mental illness - 4th place but only 10% behind first place which was 74%
Talked with provider about healthy diet, exercise and physical activity in the past two years - 1st place by a lot, we hit 59%, next best was 41%.
Talked with provider about health risks of smoking and ways to quit in the past two years, among smokers - 1st place
Talked with provider about alcohol use in the past two years - 1st place at 33%, next best was 25%
Women age 50-69 with mammography screening in the past year - 1st place
Older adults (age 65 plus) with influenza vaccination in the past year - 4th place, 1st place was 75%, we were 68% so very close


Diabetes we have the most of in the OECD by a pretty large margin (OECD iLibrary | Diabetes prevalence) so its not a shock we have more complications with diabetes. Our CAD burden, the leading cause of CHF, is significantly higher than most of the OECD so not surprise we're worse off their (and we have more CAD because of aforementioned diabetes and obesity). Our worse asthma outcomes are almost entirely due to cost of inhalers which were cheap before the EPA made them reformulate which re-earned their patents. That one does piss me off on both ends. Interestingly, German is worse on the DM and CHF measures. I can't figure out why but that's worth noting I"m sure.

Second category the only objective measure is whether PCPs use electronic clinical decision tools to improve safety. It doesn't say if those tools actually improve safety, just whether they are used. My EMR has them, I don't think they help.

Third category is more an indictment on our lack of EMR inter-operability (which was promised during the Obama years). Even hospitals on the same system often can't communicate (because Epic charges more for that to happen). That should be an easy fix, not sure why its not.

Fourth category is fluff.



Affordability is obviously a problem for us. A large part of it is that our patients do demand the best and newest of everything. American's don't do well with rationing. Its more complicated of course, but basically stuff is more expensive here. No one denies that. Its the why that we do.

Timeliness is a whole other issue:

-Have a regular doctor or place of care - Last place. As a PCP this is 100% a patient-drive issue. I have people come in all the time saying "I never get sick so why would I go see a doctor" or "I haven't seen a doctor in 15 years", both from people with very good insurance.

-Regular doctor always or often answers the same day when contacted with question - Middle of the pack, and that's fair.

-Saw a doctor or nurse on the same or next day, last time they needed medical care - Middle of the pack here as well and that is a problem but not the way you think. We have urgent care on every corner, if you need a same day or next day doctor, its easy to manage. Might be a cost issue (doesn't say why) which goes back to the first point.

-Somewhat or very difficult to obtain after-hours care - Middle of the pack again. Same as above

-Waited two hours or more for care in emergency room - Middle of the pack. Given how much non-emergency stuff goes there, no surprise. The 2 times I took my kids in, we had a room in under 20 minutes. Y'know, cause they were actually sick.

-Doctors report patients often experience difficulty getting specialized tests (e.g., CT, MRI) - Middle of the pack but overshadowed quite a bit by NZ, Canada, and France. Wouldn't have called that.

-Doctors report patients often experience long wait times to receive treatment after diagnosis - 2nd best, Switzerland apparently is awesome.

-Waited two months or longer for specialist appointment - 3rd place, I'll take it.

-Waited four month or longer for elective/non-emergency surgery - Tied for 2nd place

-Practice has arrangement for patients to see doctor or nurse after hours without going to ED - Last place, no surprise there as many/most places in Europe require their doctors to work nights/weekends. See the recent doctors strike in the UK.

So basically in this category we did great in Time but bad on Price so we got put in last place.

-I'm skipping administrative efficiency for the obvious reasons except to note that France did worse than us in every category there but one and the Dutch were similar. Not sure why that is.

-Also skipping equity measures because that's ridiculous.

Now outcomes, that's an important one:

-30 day in-hospital mortality rate following acute myocardial infarction, deaths per 100 patients - 3rd place, I'll take that

-30 day in-hospital mortality rate following ischemic stroke, deaths per 100 patients - 1st place

-Breast cancer five-year relative survival rate - 1st place

-Colon cancer five-year relative survival rate - 3rd place, likely due to our lower rates of screening and thus more advanced cancer.

We fail both Mortality Amenable to Health Care and decline in that same number.

-Infant mortality, deaths per 1,000 live births - Last place, but that's almost entirely due to how these things are reported. Our birth-30 day mortality is right in the middle of the pack. What gets us is that infant mortality is defined in this study as birth to 1 year. Our SIDS rate and abuse rates are much higher than most of OECD countries.

-Adults age 18 to 64 with at least two of five common chronic conditions - Last, see diabetes and obesity rates in this country compared to everyone else

-Life expectancy at age 60 in years - Middle of the pack.






So we came in last in most categories, I think unfairly.

We do well at fixing acute problems, timeliness, and prevention. We don't do well on cost, inter-operability in most forms, and anything relating to lifestyle issues. If we did something about our obesity epidemic, lots of these numbers would get better on their own (see @Nutmeg 's diabetes thread for that).

The biggest reason we score poorly is cost. That's a very complicated issue for a variety of reasons, but if that's taken out as a metric our system is at worst middle of the pack and actually quite good at a number of things.

 

[Captain_Falcon]

I’m not sharing my medical bills with a stranger on a online forum. If you don’t think Americans have the highest healthcare costs and some of the poorest outcomes of all developed countries than you’re education isn’t doing you any favors.

Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care

In the United States—more than in 11 other wealthy countries—the health care you receive varies with your level of income, according to a new Commonwealth Fund report.

interactives.commonwealthfund.org

I dont need you to post an actual medical bill lol. I was asking for you to explain specifics like "I required neck surgery and have regular PT appts, pain specialist with appropriate pharmacology costs"

It's not like people are paying 5k for their vitamin D and biyearly physical plus a statin

 

[VA Hopeful Dr]

I dont need you to post an actual medical bill lol. I was asking for you to explain specifics like "I required neck surgery and have regular PT appts, pain specialist with appropriate pharmacology costs"

It's not like people are paying 5k for their vitamin D and biyearly physical plus a statin

Exactly. We hit our deductible last year between my wife's Graves' disease diagnosis and one of my kids breaking her arm.

Only time we've ever hit the OOP max was when she gave birth to them. C-section plus 2 nursery bills adds up nicely.

 

[DrNotaDr]

I dont need you to post an actual medical bill lol. I was asking for you to explain specifics like "I required neck surgery and have regular PT appts, pain specialist with appropriate pharmacology costs"

It's not like people are paying 5k for their vitamin D and biyearly physical plus a statin

Charged 14k for a outpatient PICC line. It maybe, being very generous, costs 3k, allowing 1k for profit, they overbilled by 10,000. They did that because I have insurance and because they could, no other reason. It’s a sick system that needs to change.

 

[DrNotaDr]

Jesus Christ, SDN should start paying given how often someone posts that study and I have to show why it doesn't say what they think it does. Luckily I've saved the post where I address every single point in that study. Tl;dr, we are not even close to having the poorest outcomes. Cost though absolutely is an issue.

You say we do fine if it wasn’t for cost; in a country without socialized medicine that’s like saying if the titanic hadn’t hit the iceberg it wouldn’t have sunk. Except as cost keeps going up faster than inflation, every year that ship sinks faster and the life boats are less full.

 

[VA Hopeful Dr]

You say we do fine if it wasn’t for cost; in a country without socialized medicine that’s like saying if the titanic hadn’t hit the iceberg it wouldn’t have sunk. Except as cost keeps going up faster than inflation, every year that ship sinks faster and the life boats are less full.

OK, maybe you should be paying closer attention. I was responding to this post of yours (emphasis mine):

I’m not sharing my medical bills with a stranger on a online forum. If you don’t think Americans have the highest healthcare costs and some of the poorest outcomes of all developed countries than you’re education isn’t doing you any favors.

Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care

In the United States—more than in 11 other wealthy countries—the health care you receive varies with your level of income, according to a new Commonwealth Fund report.

interactives.commonwealthfund.org

That's the part I was addressing. Cost is absolutely a problem here, no one that I've ever heard has denied that.

 

[VA Hopeful Dr]

Charged 14k for a outpatient PICC line. It maybe, being very generous, costs 3k, allowing 1k for profit, they overbilled by 10,000. They did that because I have insurance and because they could, no other reason. It’s a sick system that needs to change.

They charged that, what was the insurance allowable fee?

 

[DrNotaDr]

They charged that, what was the insurance allowable fee?

It doesn’t matter. The fact that this system exists at all; hospitals charging extortionately, insurance paying as little as possible, will only lead to spiraling higher costs out of proportion to actual expenses, which is what we’ve seen for decades. It’s unsustainable.

 

[DrNotaDr]

OK, maybe you should be paying closer attention. I was responding to this post of yours (emphasis mine):


That's the part I was addressing. Cost is absolutely a problem here, no one that I've ever heard has denied that.

I’m just not sure I agree with your points over all the public healthcare experts. But let’s just say I do; we spend twice as much per capita, there’s no excuse for not being number one in all categories for the amount of money we spend, unless, of course, it’s all about profit and not about healthcare.

For instance, my healthcare organization choose to insert a outpatient PICC in the most expensive way it possibly could. It would have been cheaper to get admitted for a night, have an RT do the PICC line for 2k instead of a interventional rad in a surgical suite who was ridiculously overqualified to be doing a procedure like that in the first place, and discharged in the morning. A one night hospital stay would have costed less than a outpatient PICC line that took exactly 9 minutes to place.

 

[VA Hopeful Dr]

I’m just not sure I agree with your points over all the public healthcare experts. But let’s just say I do; we spend twice as much per capita, there’s no excuse for not being number one in all categories for the amount of money we spend, unless, of course, it’s all about profit and not about healthcare.

Or because we can't control what people do to their bodies?

We lead OECD countries by huge amounts in our obesity and diabetes rates. The vast majority of the measures where we aren't #1 or 2 are a direct result of that.

I would say our results being as good as their are is a result of how much we spend. If we had, say, Germany's obesity/diabetes rates I'd bet we'd get way more bang for our buck. Oh, and death panels. Those would help a great deal.

 

[VA Hopeful Dr]

It doesn’t matter. The fact that this system exists at all; hospitals charging extortionately, insurance paying as little as possible, will only lead to spiraling higher costs out of proportion to actual expenses, which is what we’ve seen for decades. It’s unsustainable.

Of course it does. My office could charge eleventy billion dollars for an office visit, but if Blue Cross only allows us to charge $110 that's what matters.

Besides, you do know the history of why charges are so high right? Its not for the reason you think.

 

[DrNotaDr]

Of course it does. My office could charge eleventy billion dollars for an office visit, but if Blue Cross only allows us to charge $110 that's what matters.

Besides, you do know the history of why charges are so high right? Its not for the reason you think.

If you charge 1 billion dollars to order a A1C today and insurance pays 1 million, next time you’ll charge 2 billion in the hopes insurance will now pay 2 million this time. That’s the game and it’s obscene.

 

[Captain_Falcon]

I’m just not sure I agree with your points over all the public healthcare experts. But let’s just say I do; we spend twice as much per capita, there’s no excuse for not being number one in all categories for the amount of money we spend, unless, of course, it’s all about profit and not about healthcare.

Isnt part of it the fact that our country is fatter, lazier, and able to live longer than most other countries too? I'm sure I agree with you that things can and should be better considering this is America. But considering the public eats like crap, doesn't exercise, have physically demanding labor jobs or desk jobs... I dont think the ultimate outcome of (more) expensive (than necessary) is only because of BigPharm bad BigHospital bad Wallstreetinvestors bad

 

[Captain_Falcon]

If you charge 1 billion dollars to order a A1C today and insurance pays 1 million, next time you’ll charge 2 billion in the hopes insurance will now pay 2 million this time. That’s the game and it’s obscene.

That's not really how insurance payouts work. They dont go "well last time we paid out 1 mill so let's give DrSmart 2 mill for using a CD24 code"

 

[DrNotaDr]

Or because we can't control what people do to their bodies?

We lead OECD countries by huge amounts in our obesity and diabetes rates. The vast majority of the measures where we aren't #1 or 2 are a direct result of that.

I would say our results being as good as their are is a result of how much we spend. If we had, say, Germany's obesity/diabetes rates I'd bet we'd get way more bang for our buck. Oh, and death panels. Those would help a great deal.

We could fix much of our healthcare costs if we stopped offering futile care we completely agree there.

 

[VA Hopeful Dr]

If you charge 1 billion dollars to order a A1C today and insurance pays 1 million, next time you’ll charge 2 billion in the hopes insurance will now pay 2 million this time. That’s the game and it’s obscene.

That's not at all how this works.

 

[DrNotaDr]

That's not really how insurance payouts work. They dont go "well last time we paid out 1 mill so let's give DrSmart 2 mill for using a CD24 code"

That is how insurance works though. I was of course exaggerating when I gave a timeline of today vs tomorrow, but my example is accurate just with smaller (not by much) numbers.

 

[DrNotaDr]

That's not at all how this works.

It is though. Is this familiar? “Ding email from coders: make sure you call it acute hypoxia respiratory failure instead of shortness of breath” ... “make sure you call it nstemi instead of tropinin leak” and on and on and on.

The rich people don’t care. The Medicaid patients don’t pay a dime and have no reason not to go to the ED. It’s the middle class with private insurance like me that gets screwed, as this study points out.

How have healthcare prices grown in the U.S. over time? - Peterson-KFF Health System Tracker

In this analysis, we explore trends in prices for health services over time in the U.S. (A related chart collection shows trends in prices and utilization in the U.S. and comparable countries). We find that prices have increased for a variety of health services more rapidly than general economic...

www.healthsystemtracker.org

 

[VA Hopeful Dr]

It is though. Is this familiar? “Ding email from coders: make sure you call it acute hypoxia respiratory failure instead of shortness of breath” ... “make sure you call it nstemi instead of tropinin leak” and on and on and on.

The rich people don’t care. The Medicaid patients don’t pay a dime and have no reason not to go to the ED. It’s the middle class with private insurance like me that gets screwed, as this study points out.

How have healthcare prices grown in the U.S. over time? - Peterson-KFF Health System Tracker

In this analysis, we explore trends in prices for health services over time in the U.S. (A related chart collection shows trends in prices and utilization in the U.S. and comparable countries). We find that prices have increased for a variety of health services more rapidly than general economic...

www.healthsystemtracker.org

So you're making 2 different points.

One is completely wrong. Insurance decides what to pay regardless of what rates we charge. Those rates are negotiated (sometimes) between insurance and large hospital systems and not negotiated between smaller groups and insurance companies. The billing doesn't matter. I can promise you that BC/BS, Cigna, Aetna don't care about what we charge. The real reason hospitals charge so much is to make sure the amount they charge is higher than every possible insurance plan. If I bill $100 for an office visit and Cigna's allowable charge is $120, they're paying me $100. I missed out on $20 for the same procedure. So hospitals (and everyone really) charges super high rates to make sure that never happens. They know that no one pays the charged rates (its why self-pay patients in most places get 60+% discounts from the charged amount.

Two is correct but not why you think. Office visits are billing for higher complexity because a) we're actually billing for what we do (historically we've been undercoding) and b) because with EMR its easier to hit what you need to get those higher levels. I have passed every audit 100% in the 8 years I've been in practice and my codes are significantly higher complexity than most of my peers.

As for the geographic differences (and basic increases in price), that's a result of basic monopolies. If your large metro area has one health system the dominates the market they can negotiate for better prices. Same thing can happen if its a very major player (Mayo in Minnesota being the prime example).

 

[DrNotaDr]

So you're making 2 different points.

One is completely wrong. Insurance decides what to pay regardless of what rates we charge. Those rates are negotiated (sometimes) between insurance and large hospital systems and not negotiated between smaller groups and insurance companies. The billing doesn't matter. I can promise you that BC/BS, Cigna, Aetna don't care about what we charge. The real reason hospitals charge so much is to make sure the amount they charge is higher than every possible insurance plan. If I bill $100 for an office visit and Cigna's allowable charge is $120, they're paying me $100. I missed out on $20 for the same procedure. So hospitals (and everyone really) charges super high rates to make sure that never happens. They know that no one pays the charged rates (its why self-pay patients in most places get 60+% discounts from the charged amount.

Two is correct but not why you think. Office visits are billing for higher complexity because a) we're actually billing for what we do (historically we've been undercoding) and b) because with EMR its easier to hit what you need to get those higher levels. I have passed every audit 100% in the 8 years I've been in practice and my codes are significantly higher complexity than most of my peers.

As for the geographic differences (and basic increases in price), that's a result of basic monopolies. If your large metro area has one health system the dominates the market they can negotiate for better prices. Same thing can happen if its a very major player (Mayo in Minnesota being the prime example).

PCP’s like yourself should be the highest paid physicians outside of surgeons; an ounce of prevention will save a pound of treatment. These ridiculous costs are generally not from primary care.

Let’s do a deeper dive here; why is it legal for an insurance company, who has a obligation to provide a service for which it is paid, to pay less than what the cost of the healthcare really was?

 

[dpmd]

PCP’s like yourself should be the highest paid physicians outside of surgeons; an ounce of prevention will save a pound of treatment. These ridiculous costs are generally not from primary care.

Let’s do a deeper dive here; why is it legal for an insurance company, who has a obligation to provide a service for which it is paid, to pay less than what the cost of the healthcare really was?

Their only obligation is to pay what they agree to pay. If doctors don't like it they can opt out and not be in network (which has consequences and which is why most will agree to the network rates as long as they don't lose too much money with the deal).

 

[VA Hopeful Dr]

PCP’s like yourself should be the highest paid physicians outside of surgeons; an ounce of prevention will save a pound of treatment. These ridiculous costs are generally not from primary care.

Let’s do a deeper dive here; why is it legal for an insurance company, who has a obligation to provide a service for which it is paid, to pay less than what the cost of the healthcare really was?

Read the actual insurance policy, it tells you exactly what it covers and with whom you can get said services and have them covered.

 

[DrNotaDr]

Their only obligation is to pay what they agree to pay. If doctors don't like it they can opt out and not be in network (which has consequences and which is why most will agree to the network rates as long as they don't lose too much money with the deal).

Why should that be legal?

 

[Captain_Falcon]

Why should that be legal?

Why should it be legal that a company only pays an agreed amount on a contract with another company? Seriously?

 

[DrNotaDr]

Why should it be legal that a company only pays an agreed amount on a contract with another company? Seriously?

If there’s a contract with a agreed upon amount why would a hospital bill for 4 times that amount??

 

[Captain_Falcon]

If there’s a contract with a agreed upon amount why would a hospital bill for 4 times that amount??

Likely because of reasons laid out in VA Hopeful Dr's post about Cigna missing out on $20

"If I bill $100 for an office visit and Cigna's allowable charge is $120, they're paying me $100. I missed out on $20 for the same procedure"

 

[DrNotaDr]

Likely because of reasons laid out in VA Hopeful Dr's post about Cigna missing out on $20

"If I bill $100 for an office visit and Cigna's allowable charge is $120, they're paying me $100. I missed out on $20 for the same procedure"

When was the last time a insurance company agreed to pay more for inpatient care than it was billed? 1957?

 

[Captain_Falcon]

When was the last time a insurance company agreed to pay more for inpatient care than it was billed? 1957?

You missed the point

 

[dpmd]

Why should that be legal?

Because the alternative is the government setting prices and I have no interest in moving to a fully government run economy. I take straight medicaid patients because I choose to be generous to the less fortunate. If it were my only reimbursement option then my life would look very different than it does and I don't see a reason I should do that so you can avoid your 5k out of pocket max.

 

[VA Hopeful Dr]

When was the last time a insurance company agreed to pay more for inpatient care than it was billed? 1957?

I feel like you're not understanding this.

Let's say I bill insurance for a routine office visit. Here are what the current insurance company allowable charges are:

Cigna: 75
Aetna: 95
BC/BS: 125
United Healthcare: 110
Medicare: 102

If I charge 100 then BC/BS, United, and Medicare will pay me 100 despite having an allowed rate higher than that. To prevent that, most places will take the Medicare rate (which is standard and publicly available) and multiple by 4-6. That way you never miss out on the potential charges. Its much easier to do that than keep a list of every iteration of insurance and charge exactly what they allow.

That is 100% the reason charges are so high.

 

[DrNotaDr]

You missed the point

No, I think you have no answer for me. If two private entities have a contract for an agreed upon amount, as you stated verbatim, why should one reimburse only 25% of that amount?

 

[dpmd]

If there’s a contract with a agreed upon amount why would a hospital bill for 4 times that amount??

Because occasionally you get a patient who comes for emergency care out of network and their insurance pays the whole amount. Or you get a rich person who pays cash up front for the whole amount. Those times you make a tidy profit that offsets some of the times you lose money.

 

[DrNotaDr]

I feel like you're not understanding this.

Let's say I bill insurance for a routine office visit. Here are what the current insurance company allowable charges are:

Cigna: 75
Aetna: 95
BC/BS: 125
United Healthcare: 110
Medicare: 102

If I charge 100 then BC/BS, United, and Medicare will pay me 100 despite having an allowed rate higher than that. To prevent that, most places will take the Medicare rate (which is standard and publicly available) and multiple by 4-6. That way you never miss out on the potential charges. Its much easier to do that than keep a list of every iteration of insurance and charge exactly what they allow.

That is 100% the reason charges are so high.

I completely understand how this works, it also insidiously drives up healhcare costs. I do appreciate your thorough explanation though.

 

[DrNotaDr]

Because occasionally you get a patient who comes for emergency care out of network and their insurance pays the whole amount. Or you get a rich person who pays cash up front for the whole amount. Those times you make a tidy profit that offsets some of the times you lose money.

I don’t think the healthcare systems are losing enough money to justify for billing policies.

 

[Captain_Falcon]

No, I think you have no answer for me. If two private entities have a contract for an agreed upon amount, as you stated verbatim, why should one reimburse only 25% of that amount?

VA Doc explained it again for you in this post

I feel like you're not understanding this.

Let's say I bill insurance for a routine office visit. Here are what the current insurance company allowable charges are:

Cigna: 75
Aetna: 95
BC/BS: 125
United Healthcare: 110
Medicare: 102

If I charge 100 then BC/BS, United, and Medicare will pay me 100 despite having an allowed rate higher than that. To prevent that, most places will take the Medicare rate (which is standard and publicly available) and multiple by 4-6. That way you never miss out on the potential charges. Its much easier to do that than keep a list of every iteration of insurance and charge exactly what they allow.

That is 100% the reason charges are so high.

 

[VA Hopeful Dr]

No, I think you have no answer for me. If two private entities have a contract for an agreed upon amount, as you stated verbatim, why should one reimburse only 25% of that amount?

Because they don't?

 

[DrNotaDr]

VA Doc explained it again for you in this post

Again, physicians are not the problem here and don’t represent the largest healthcare costs, but why is a clinic charging for more than what they provided? You guys are all defending the illogical, and the more you discuss healthcare costs, the more illogical it all is revealed to be.

So it’s obviously not a “contract” in the traditional sense then, yes?

 

[DrNotaDr]

Because they don't?

I’m quoting @Captain_Falcon from a previous post.

 

[DrNotaDr]

Why should it be legal that a company only pays an agreed amount on a contract with another company? Seriously?

This quote, here.

 

[VA Hopeful Dr]

This quote, here.

Looks like sarcasm to me

 

[Captain_Falcon]

Again, physicians are not the problem here and don’t represent the largest healthcare costs, but why is a clinic charging for more than what they provided? You guys are all defending the illogical, and the more you discuss healthcare costs, the more illogical it all is revealed to be.

So it’s obviously not a “contract” in the traditional sense then, yes?

The clinic is not charging for more than what they provided. They are charging a total amount that ensures they are paid the maximum payment from what the variety of insurances say they're time is worth.

BCBC says an exam is worth 120.
Cigna says it is worth 90.

If the physician "bills" for 130 for every insurance to get the Max without missing out on income, it's not like the absolute difference (for instance in this example of 10 dollars for a pt with BCBS or 40 dollars for Cigna) that was "billed" versus paid is forced upon the patient themselves to pay.

That is separate from premiums and deductibles and copays

 

[VA Hopeful Dr]

Again, physicians are not the problem here and don’t represent the largest healthcare costs, but why is a clinic charging for more than what they provided? You guys are all defending the illogical, and the more you discuss healthcare costs, the more illogical it all is revealed to be.

So it’s obviously not a “contract” in the traditional sense then, yes?

I'm using clinic because that's what I'm familiar with, but the same principle applies to everything in medicine. You Bill for what you do, hard stop. if you do anything other than that, you're guilty of fraud and the penalties are severe.

 

[DrNotaDr]

The clinic is not charging for more than what they provided. They are charging a total amount that ensures they are paid the maximum payment from what the variety of insurances say they're time is worth.

BCBC says an exam is worth 120.
Cigna says it is worth 90.

If the physician "bills" for 130 for every insurance to get the Max without missing out on income, it's not like the absolute difference (for instance in this example of 10 dollars for a pt with BCBS or 40 dollars for Cigna) that was "billed" versus paid is forced upon the patient themselves to pay.

That is separate from premiums and deductibles and copays

I know how the system works, my question to you is why does BCBC or signa have the authority to decide what a physicians time is worth? Insurance companies do not provide healthcare, and do not receive healthcare as the patient. This should be between the physician and the patient, ideally with a single payer ideally the government (who are accountable to the people they represent) cutting the overhead and the profiteering that helps out insurance company CEO’s while hurting both physicians and patients.

 

[VA Hopeful Dr]

I know how the system works, my question to you is why does BCBC or signa have the authority to decide what a physicians time is worth? Insurance companies do not provide healthcare, and do not receive healthcare as the patient. This should be between the physician and the patient, ideally with a single payer ideally the government (who are accountable to the people they represent) cutting the overhead and the profiteering that helps out insurance company CEO’s while hurting both physicians and patients.

if you think we don't have enough power to control billing now, why on Earth do you think that would be better under single-payer?

 

[DrNotaDr]

if you think we don't have enough power to control billing now, why on Earth do you think that would be better under single-payer?

You would be able to vote out politicians who don’t push the reforms you want. There’s at least the possibility of accountability that doesn’t exist now.

 

[VA Hopeful Dr]

You would be able to vote out politicians who don’t push the reforms you want. There’s at least the possibility of accountability that doesn’t exist now.

Not even close.

You can change to a different insurance company if you don't like the one you have.

 

[DrNotaDr]

Not even close.

You can change to a different insurance company if you don't like the one you have.

Not even close, not with what middle class Americans make.

 

[VA Hopeful Dr]

Not even close, not with what middle class Americans make.

That doesn't make any sense