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What Happens When Doctors Only Take Cash (2017)

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Re: What Happens When Doctors Only Take Cash (2017)

#141

Post by tasty_freeze »

topspin wrote: post #68
harrisreynolds wrote: post #46

I've been wondering for a while now why health insurance companies exist at all. They introduce a massive bureaucracy and massive costs and provide very little value. They evolved from a reasonable idea into a monster that just drains our system and do not provide enough value to justify their existence in my opinion.

I've studied this a little. There are many stories depending on what you choose to believe. I believe the current state of affairs is a consequence of tax policy; health insurance benefits are untaxed income, a tax policy often attributed to powerful labor unions in the early 20th century. ACA attempted to tax "Cadillac" plans but the sunrise on that was kicked years down the road and when it was about to take effect…

These problems far predate the ACA.

I come from a large family (8 kids). When by mom was still alive, I asked her if making medical claims was a pain. Nope, she said: tell your information to the doctor, and sometimes she'd have to pay part of it.

Now, even with "gold plated insurance", many of my families doctors don't handle insurance; we pay them directly, and we have to deal with the insurance companies ourselves. My wife spends countless hours dealing with what I assume is willful incompetence. For example, filing four identical (other than date) forms for a series of physical therapy sessions, and having the insurance company approve two and reject two because the codes were wrong. Or the it was unreadable. Followup calls get a different person every time, and when they review it they say: oh, I don't know why it was rejected, that is fine. I'll personally make sure it gets fixed. And then it doesn't get fixed. Having to call five for six times for one bill is common.

Re: What Happens When Doctors Only Take Cash (2017)

#142

Post by jjeaff »

digi_owl wrote: post #105
rocketpastsix wrote: post #104

Earlier quoted context omitted.

Most likely, they just adjusted the price down to what the Patients Bill of Rights said, and ate the cost. Or pushed it onto tax payers somehow.

I recall encountering the claim that hospitals will mark up the initial bill because they are used to dealing with insurance companies, and said companies will turn over very stone possible to drive the price down. Thus the markup is done to ensure the hospital get their expenses covered after the insurance companies are done with them.

The insurance companies don't do anything that isn't automated and easy. Everything billed is coded and the insurance company already has a set price for that code. If the medical providers don't agree, they can either try to appeal and get an exception or most likely adjust the billing codes until something more reasonable goes through, or they can refuse to accept that insurance plan in their office.

Re: What Happens When Doctors Only Take Cash (2017)

#143

Post by bawana »

conanbatt wrote: post #62
harrisreynolds wrote: post #46

I've been wondering for a while now why health insurance companies exist at all. They introduce a massive bureaucracy and massive costs and provide very little value. They evolved from a reasonable idea into a monster that just drains our system and do not provide enough value to justify their existence in my opinion.

And yet, health insurance companies have very low profit margins, the lowest amongst the insurance companies. So who is getting all the money?

bertolini walked away with 500 million when cvs bought aetna. those were health care dollars paid by working people as premiums

Re: What Happens When Doctors Only Take Cash (2017)

#144

Post by jjeaff »

derekp7 wrote: post #137
conanbatt wrote: post #60

Earlier quoted context omitted.

Because the cost is unknown until treatment is over. Also, funny comparison, try to make it with software engineering.

Car mechanics have "book hours" for each task. It may take them less time, or more, but they charge what is in the book. For example, changing a headlight is 1/4 hour, at $120.00 an hour, so they charge $30.00 plus parts. What I'd like to see for medical services, is something like an apendepticamy takes 1 hour to perform, plus 4 hours of prep, and 2 hours follow up spread over several weeks. The procedure uses one p…

Have you never looked at an itemized medical bill? This is exactly how all medical practitioners in the US that accept insurance do things.

Every procedure, every Tylenol, every operating kit has a code and a price and that is all itemized and billed.

Try calling up your mechanic and asking for a quote. Tell them your car is not working right and you don't know what's wrong, but you want a quote before bringing the car in.

Now, if you call a medical practitioners and tell them exactly what tests or procedures you want, they can probably look that up for you.

Re: What Happens When Doctors Only Take Cash (2017)

#146

Post by javadocmd »

chrisbennet wrote: post #136
javadocmd wrote: post #101

Earlier quoted context omitted.

> When I didn't have medical insurance, doctors charged me twice what they charged the insurance companies. You've identified the symptom but misattributed the cause. You ran afoul of the charge master system of billing, which is a byproduct of our insurance-based healthcare system and the laws which uphold it. In short, providers are "forced" to set their base rates high in the knowledge that insurance companies (th…

”Meanwhile, federal law enforces (under very stiff penalty) that individuals cannot negotiate nor be given a discount from the base rate.” I negotiated a discount for an operation a few years ago. Is this law you’re speaking of relatively new?

Good question. My understanding of this was based on discussions with doctors. I had a bit of trouble finding a citation, so it's possible this isn't as cut and dry as I represented. I did run across this memo from DHHS in 2004 that might shed some light (although I'm not sure this still reflects current law).

https://oig.hhs.gov/fraud/docs/alertsandbulletins/2004/fa021...

It points out a pair of laws -- the Federal Anti-Kickback Statute, and the Social Security Act -- which may have caused some confusion about discounts and waivers. Hospitals, the memo assures, are free to offer discounted services under a specific set of conditions such as methodically established patient financial need, an inability to collect on bills, and given that the waiver does not in any way entice business (i.e., you can't advertise it).

But the implication is that you can't give discounts willy-nilly, as a provider, or risk federal audit.

A separate but related issue is that under-billing may be considered fraud by CMS. A doctor cannot provide a service which they do not bill for, nor bill for a code which is lesser in magnitude than the actual service provided. I can't say if anyone has ever been investigated for under-billing.

In any case it's worth adding that aside from legalities, there are severe ethical ramifications of offering discounts to certain patients and not others unless that decision is made by some impartial measure. You could imagine all kinds of kickbacks, favors, enticement, coercion, biases, and so forth rearing their ugly head if doctors are given the freedom to bill whatever they choose (less or more).

Re: What Happens When Doctors Only Take Cash (2017)

#147

Post by [deleted] »

tasty_freeze wrote: post #141
topspin wrote: post #68

Earlier quoted context omitted.

I've studied this a little. There are many stories depending on what you choose to believe. I believe the current state of affairs is a consequence of tax policy; health insurance benefits are untaxed income, a tax policy often attributed to powerful labor unions in the early 20th century. ACA attempted to tax "Cadillac" plans but the sunrise on that was kicked years down the road and when it was about to take effect…

These problems far predate the ACA. I come from a large family (8 kids). When by mom was still alive, I asked her if making medical claims was a pain. Nope, she said: tell your information to the doctor, and sometimes she'd have to pay part of it. Now, even with "gold plated insurance", many of my families doctors don't handle insurance; we pay them directly, and we have to deal with the insurance companies ourselves…

[deleted]

Re: What Happens When Doctors Only Take Cash (2017)

#148

Post by javadocmd »

wrycoder wrote: post #138
javadocmd wrote: post #101

Earlier quoted context omitted.

> When I didn't have medical insurance, doctors charged me twice what they charged the insurance companies. You've identified the symptom but misattributed the cause. You ran afoul of the charge master system of billing, which is a byproduct of our insurance-based healthcare system and the laws which uphold it. In short, providers are "forced" to set their base rates high in the knowledge that insurance companies (th…

My last visit to the dermatologist was over $1000 for an office visit that involved a skin tag clip with a scissors and two squirts of LN. Medicare negotiated that down 70% to their preapproved rate and paid about $300, of which I paid 20%. Medicare is just another insurance payer, not a health provider. If you are talking about the US, we have several times in the past negotiated our bills down as much as 20%. It do…

> Medicare is just another insurance payer

I should have been more careful with my terminology. I used "insurance" as a shortcut for private, for-profit insurance, excluding government insurers like Medicare.

Re: What Happens When Doctors Only Take Cash (2017)

#149

Post by yorby »

harrisreynolds wrote: post #46

I've been wondering for a while now why health insurance companies exist at all. They introduce a massive bureaucracy and massive costs and provide very little value. They evolved from a reasonable idea into a monster that just drains our system and do not provide enough value to justify their existence in my opinion.

health insurance is so expensive in the USA that it is usually cheaper to not have any... and the service providers usually give discounts for the uninsured... I wish that we still could get catastrophic-only health insurance, but Obama care doesn't allow me to do that anymore...

Re: What Happens When Doctors Only Take Cash (2017)

#150

Post by Pokepokalypse »

jjeaff wrote: post #140
maxxxxx wrote: post #76

Earlier quoted context omitted.

The same happened to me when I had an HSA. Estimated price for a procedure was first $4000, then $2000, then $100. Eventually paid $500. they just seem to make up prices.

I don't think they necessarily make up the prices, but I wonder if there is an accounting reason for the "MSRP" on procedures being so high. I will frequently see things like a $2,000 charge to the insurance company and then it will show that they ended up paying something like $185 for the service and they disallow the rest. Perhaps it is just to make sure they always get the max from the insurance companies. Or may…

I've heard explanations that it has to do with something called "pay master" software, which sets the prices - but they do set a high price as a negotiating point for insurance companies.

Personally, I believe this practice to be outright blatant fraud. There is a complete lack of price-transparency for the end-user, whether there's an insurance company involved or not. And for people who supposedly champion the so-called "Free Market", Congressional Republicans are certainly quiet on this one issue, when they're criticizing the current healthcare system and regulations.

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