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U.S. health care's widespread overbilling problem

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Re: U.S. health care's widespread overbilling problem

#51
At the risk of spiking my blood pressure I will write a few words on this topic. I will start by saying this:

The whole system is fucked.

I am referring to the system that facilitates American residents getting healthy and staying that way.

What is the basis of my claims? I admit that I am a healthy 33 year old white male and I probably have only seen that tip of the iceberg. I am also a father of 3. My oldest daughter was born with a chronic health problem, diagnosed at 19 weeks gestation.

Since her birth, a little over 7 years ago, we have received a bill from the hospital that provided her care at least once per week. This continues today, despite not having had any services provided in almost a year.

If I paid all of these bills, bankruptcy would be my only recourse. I try to communicate with my insurance provider (employer provided), to determine what's legitimate, and what should be covered. In the end, I'm mostly left to my own devices to pay for the services that I think I received. Every year we pay the deductible, and every year we get billed for significantly more.

As another example, not along ago, my third daughter was born. Due to the complications of my wife's first pregnancy we received care from two different OBGYN facilities, one local to us, and one at the delivering hospital.

Though the local facility was only responsible for less than 10 checkups, they claimed that we still owed our entire deductible to them, prior to delivery. We paid half.

A week prior (this much is hilarious in itself) to delivery by a doctor from the other facility, we received a bill for the full deductible amount, due to them also.

When the delivery actually happened, it took less than 2 hours, and we stayed one night. We also had 3 checkups at this other facility. Our bill of course is the same as everybody else's, regardless of whether they had a C-Section and stayed for 5 nights, or had 30 hours of labor. I could actually be OK with this (I'm onboard for socialized healthcare), if they could get the billing part right.

Again:

* I am constantly billed directly by healthcare providers over and above what my insurance policy says I should pay.

* I pay almost 25% of my yearly earnings in insurance premiums.

* I end up deciding what I will pay and what I will not pay. I admit that this is probably not the best situation for anyone.

The whole system is fucked.

Re: U.S. health care's widespread overbilling problem

#52

I would like to ditch insurance and find a doctor who would allow me to pay a monthly subscription fee, much like a gym membership, for preventative care. Isn't the primary purpose of insurance for exceptional and accidental situations? If that's true, then why am I using it for predictable monthly expenses?

This is available for rich folks. This is "boutique medicine". Possibly the way of the future - to coexist with social medicine, of course.

Re: U.S. health care's widespread overbilling problem

#53
They don't even mention the harm caused by fraud that involves inventing conditions and treatments out of thin air. Those doctor's notes follow you around forever when you go to do things like purchase disability insurance or seek treatment.

Suddenly you are no longer a healthy individual you are an individual with a history of condition X and Y which you have never even heard of. And because a doctor wrote it down it's now a reality and the patient is a liar!

Re: U.S. health care's widespread overbilling problem

#54
There are so many variables that affect healthcare cost here in the US. Looking from outside, things are different than looking from inside. There is something really wrong with current US healthcare system, and it's really difficult to put a blame on one or two things.

Side note, I work IT in healthcare, so I sometimes view "interesting" things to say the least. A while back I stumbled upon a document that was accidentally shared. It showed accounts receivable in collections agencies for one hospital in our system. Between 2009 and 2012, there was $154m dollars in collection agencies from delinquent accounts. Remember, this is just one hospital that is actually in a more upscale location. We have some hospitals who are always in red due to their locations.

Then you deal with inflated prices for services and drugs. I really don't even know if they can ever fix this part.

Re: U.S. health care's widespread overbilling problem

#55

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

This strikes me as absolutely absurd. Here, as an example, dentistry is highly regulated and prices are listed in a book. If you want procedure X done it will cost $Y no matter which dentist you visit. This means it's easier to budget for such things, you never have to price shop, and the insurance companies can also easily predict what the costs will be given statistical trends.

This idea of medical procedures having random prices is the sort of thing you have to deal with at veterinarians where a simple procedure can cost anywhere from $75 to $500 depending on the place you're going to.

Re: U.S. health care's widespread overbilling problem

#56
post #6

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

Totally agree. If people in the US want to have markets for health care there should be price transparency. When I had a high deductible plan I always tried to compare prices but you almost never get a straight answer. If the Republicans want to reform health care that's where they should be starting.

[deleted]

Re: U.S. health care's widespread overbilling problem

#57
post #23

Healthcare will always be overpriced so long as we allow this guild system to limit the supply of doctors for its own member's profit. Everything else is window dressing.

Coming from a country where the number of MDs per capita is 100x that of the US, I am sorry to tell you that this would not have the impact you think it would have. As of now, no first world country seems to have found a real solution to healthcare prices. My personal opinion is that doctor salaries have a minor impact on prices. Healthcare system structure and culture (as in how much do insurance companies control,…

According to the WHO the country with the most MD's per capita is Cuba with 7.5 per 1000, while the US has 2.5 per 1000. So at best you come from a country with 3x that of the US, not 100x.

Edit: http://gamapserver.who.int/gho/interactive_charts/health_wor...

Re: U.S. health care's widespread overbilling problem

#58

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

Transparency would certainly help but it cant solve everything. But medical care isn't regular and predicable, so at best you can get better transparency about the routine costs.

My car was recently hit in the parking lot. The body shop said, here's the cost of the repair of the items we can see, but with the warning that it could go higher if we open things up, and find additional damage. Same with people.

The other thing is the you know with a car exactly what you will end up with in the end. And with simpler medical procedures that is true, but as they get more complex - the more you are navigating a mess of interlocking procedures, probabilities, and outcomes.

Re: U.S. health care's widespread overbilling problem

#59

Earlier quoted context omitted.

This "shadow" socialized system fills me with anger simply because we can't seem to deal with it in a mature and constructive way. As long as Americans can't stomach the idea of turning away people who cannot pay for emergency care to die we have socialized medicine. I don't understand why we can't, as a society, have a "grown up" conversation about this fact.

>As long as Americans can't stomach the idea of turning away people who cannot pay for emergency care to die we have socialized medicine. Seems a tad callous even by my standards as a staunch classical liberal; may be all other medical services but not emergency services.

I'm not stating an opinion about this fact, I'm simply stating it. (Personally, I think Americans ought to have socialized medicine.)

The "conservatives" who bellyached that the ACA created "socialized medicine" willfully ignored (or were ignorant of) the fact that the mandate to treat emergency patients regardless of ability to pay "socialized" medicine when it was passed (by "conservative" stalwart Ronald Regan) in the EMTALA[1] in 1986.

[1] https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an...

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