>Wagner's office estimates he lost over $3,000 to downcoding in the first half of the year, but other doctors across the country have fared far worse.
That's...not a lot of money.
The fight between doctors and insurance companies over 'downcoding'
131–140 of 354 posts
Re: The fight between doctors and insurance companies over 'downcoding'
#132>Wagner's office estimates he lost over $3,000 to downcoding in the first half of the year, but other doctors across the country have fared far worse. That's...not a lot of money.
Doctors are probably raising alarms over growing practice. It’s 3000 this year, but becomes 10000 next year and 50000 the year after.
Re: The fight between doctors and insurance companies over 'downcoding'
#133Earlier quoted context omitted.
Medicine not in formulary. Their clinical department decided it was not worth covering for $reasons. The Pharmacy, likely to be considered a preferred pharmacy, signed a contract to be bound by that company's clinical formulary for policyholders. $45 was probably cash price, the they can let it go for if they do their ordering through a pharmacy supply group. $12 may be a price with a discount program like GoodRx app…
Turns out there are rational commercial players in these markets if you just go all-cash. The price is abandoning the incantations and local pharmacies, hospitals, ignoring your insurance. Harder to do that with services, but it’s coming as well.
It’s deeply frustrating that the $12 doesn’t go towards the deductible. I just saved the insurer a bunch of money!
Re: The fight between doctors and insurance companies over 'downcoding'
#134Earlier quoted context omitted.
All the FSA money in your account is available immediately at the beginning of the year. Ironically that would make it a better choice for anyone with a lot of medical expenses on an HDHP if it wasn’t for the fact that FSAs are capped by law. As someone who does deal with enough medical stuff to clear the deductible (and sometimes the OOP max) on their normal health plan annually, it’s still much more convenient, aga…
My HSA money is also available in the first pay period of the calendar year. It’s up to the employer to decide when they want to contribute it.
That assumes your employer does any contributions to your HSA. And if your employer is sticking you with an HDHP, that’s not always a given. Your own payroll deductions are pay-as-you-go
Re: The fight between doctors and insurance companies over 'downcoding'
#135Earlier quoted context omitted.
HSAs are only available alongside high deductible plans (HDHP), which aren't necessarily ideal in all situations. FSAs are the only option like that if you don't have an HDHP.
What is the point of having a low deductible when you could put the premium difference in a HSA and use it on either the deductible or something uncovered?
The math on whether you are ahead with the HSA or not is non trivial, especially if you are married and neither employer offers any subsidy when you put your spouse in your plan. HSAs are often better, but it's a very unfortunate math problem, where you carry quite a bit of risk. The HSA contributions from your employer are often nowhere near enough to make it win all the time. If your employer's does, consider yourself lucky. On any given open enrollment, my household has at least 30 combinations of healthcare plans to consider, and that's ignoring dentals, visions and the like
Re: The fight between doctors and insurance companies over 'downcoding'
#136Earlier quoted context omitted.
Man, it's almost like healthcare and human lives shouldn't be for profit...
You're welcome to come up with an alternative system of aligning interests, so far all of the other ones have failed horrifically.
> so far all of the other ones have failed horrifically.
Have they?
i live in neither country but i know i'd rather have cancer in the UK than the US.
That Breaking Bad meme about Walter getting lung cancer in the UK comes to mind.
Re: The fight between doctors and insurance companies over 'downcoding'
#137What, if any, alternative framework other than single payer could be put into place instead of our current hellscape?
Have health sharing plans been successful? Those require a religious affiliation IIRC.
I exclude single payer solely because it’s impossible with our current leadership.
I’m surprised there isn’t a Costco like medical group that’s nationwide, has a membership, and works solely to provide care efficiently.
Re: The fight between doctors and insurance companies over 'downcoding'
#138This sort of thing gets to two critical problems of the American system: 1. It is largely designed to make money, not actually help patients. So every step in the healthcare chain that can extract a bit of value will do so, largely to boost profits. 2. Insane complexity with limited transparency. How much will something cost? Hard to tell. Will it be covered? Who knows? On the opacity, I have one informative anecdote…
I disagree with the language you use.
It was not designed to make money. It was designed to cost less, in the same way the USSR was designed to make workers rich - it simply failed spectacularly.
Neoliberals dislike both regulation and public ownership, but made a Faustian bargain where they replaced public ownership with more regulation, thinking that regulation was the lessor of the two evils. In reality, it's not - like in the USSR where they had corporatised but heavily regulated "companies". A heavily regulated company doesn't make money by offering better value to customers, it makes money by finding loopholes in regulations, and regulators will always lose the cat and mouse game of closing these loopholes.
Neoliberals end up creating a system that's actually a lot like the USSR (if the famous "Well intentioned Commissaire" essay is representative of the USSR) - heavy regulations, with corporate entities outsmarting the regulators to enrich their owners (or managers) while minimising the value they create. Neoliberals deny the need for pubic management, but are forced to badly reinvent it (via heavy regulation). Communists deny the need for incentives, and are forced to badly reinvent it (once again via regulation), ending up not a million miles away from where neoliberals end up - with endless regulation and lost efficiency.
It's worth noting that the US spends far more tax dollars (per capita) than Australia on health (Australia has a hybrid public / private model). Medicare, Medicaid and the VA costs about as much as Canada's expensive public system (per capita) since the US is so insanely inefficient.
(edit: The essay I mentioned - https://highered.blogspot.com/2009/01/well-intentioned-commi...)
Re: The fight between doctors and insurance companies over 'downcoding'
#139Earlier quoted context omitted.
You're welcome to come up with an alternative system of aligning interests, so far all of the other ones have failed horrifically.
I live in NL. I pay 130 euros a month for my health insurance, and a max of 375 yearly on deductibles should I accrue some costs. The only reason I pay 130 is because I earn above a certain number, otherwise it's discounted and even free at a certain level (and I opted into the more expensive tier to also have dental coverage). In my case, my employer even pays for my insurance so in reality I don't even pay anything…
"Healthcare that isn't for profit" doesn't mean just a national health insurance. Just that as a random citizen you are shielded from seeing all the same issues underneath. The pharma companies, test providers, equipment makers and personnel are all making profits. I bet the total amount paid is higher that 130 euros a month. There's profit all through the system, so claims that healthcare should not be for profit are silly.
Now, what happens is that the profits have to be kept in check, either via price controls or sufficient competition. It's not hard to argue that the choices made in the US are quite suboptimal, but it's far more of a regulatory problem than purely a matter of people making money. If nobody makes money, there's no healthcare.
Re: The fight between doctors and insurance companies over 'downcoding'
#140Earlier quoted context omitted.
Eventually everyone works for profit if they get paid. Spending time only is pure profit in money.
A reasonable wage or salary isn’t usually considered “profit” in a legal sense. This is why nonprofits can still pay employees. Any money that is left over after costs (including wages/salaries) needs to be reinvested, spent on the organizational mission, or held for future use, not distributed through dividends or other distributions as in a for-profit enterprise.
Have you spent much time looking inside non profits? A lot of hospitals in the US are non profits. Some are part of non profit universities too. This in no way leads to superior cost controls, or those universities being cheap. What it does mean is that they get some significant tax advantages (for instance, no property taxes), and that there's fewer optimization incentives. When you limit yourself to the US definition of a non profit company, it doesn't make care better or cheaper.