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The fight between doctors and insurance companies over 'downcoding'

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Re: The fight between doctors and insurance companies over 'downcoding'

#151

Post by OkayPhysicist »

philipallstar wrote: post #51
jasonlotito wrote: post #44

Earlier quoted context omitted.

> Find some doctors, nurses, researchers, manufacturers etc etc who will work for no money and we can remove money from the problem. Not being for profit doesn't mean you don't pay people. Further, I wonder how the Sixth Amendment works then? So many non-profit people working for... no money? This "work for no money argument" is so incredibly weak, I had to make sure I quoted the argument so the person wouldn't chang…

Eventually everyone works for profit if they get paid. Spending time only is pure profit in money.

Most people do not profit off their labor. 2/3rds of people are living paycheck to paycheck, which means that they are being paid approximately the same amount that their labor costs to produce. That makes their wages an exchange of equal value, and thus not profitable.

Re: The fight between doctors and insurance companies over 'downcoding'

#152

Post by cblum »

i80and wrote: post #70
supportengineer wrote: post #68

Earlier quoted context omitted.

Here are the magic words in US Health Care: "What is the cash price?" It's usually less than you think and often worth avoiding the insurance company hassle. Then you can just get reimbursed with your FSA or HSA anyway.

FSAs are insane, conceptually. "Guess how much money you're spending in a year on healthcare! But beee caaareful: if you guess too high, YOU LOSE IT" I still used mine while I still had access to one, but it was grumpy-making and was usually almost more trouble than it was worth.

> FSAs are insane, conceptually.

Indeed. I don’t understand why they cant just make medical expenses tax-deductible up to a certain amount. The effect would be the same. Why do I need a separate account for it, and why do I have to guess how much I’ll need every year (as you pointed out)?

I guess at least part of the answer is that the companies administering FSAs make money out of this system. Sigh.

Re: The fight between doctors and insurance companies over 'downcoding'

#153

Post by MattGrommes »

stackskipton wrote: post #132
doormatt wrote: post #131

>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.

Yep. Frog, boiling water, etc.

If they get away with it for a few offices and a little money, it just becomes how they do business and grows.

Re: The fight between doctors and insurance companies over 'downcoding'

#154

Post by aspenmayer »

tptacek wrote: post #150
aspenmayer wrote: post #149

Earlier quoted context omitted.

Care providers also likely spend much more time and labor on making that money than the insurance providers spend making their end, though I only have anecdotal evidence of this through my involvement in healthcare providers’ practices as an MSP.

It's $2.5Tn vs $0.3Tn. It's more than 8x more.

That’s one half of the proportion. What is the time/labor spent?

Re: The fight between doctors and insurance companies over 'downcoding'

#155

Post by hylaride »

some_random wrote: post #50
Pet_Ant wrote: post #29

Earlier 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.

Uh, what? Other systems have their problems, but they're varying levels of functional, and the health and life expectancy of the populations in most other developed countries is higher than the US, all the while spending a fraction.

Most other developed countries have a mix of public and private insurance and/or delivery, with the better run systems being better rationalized in dealing with costs and having an actual market where it makes sense to form one (eg you can't practically shop around for ER care, but you can for elective or planable services). The French system is held in high regards in particular (though it isn't really replicatable due to their unique civil service setup).

Re: The fight between doctors and insurance companies over 'downcoding'

#156

Post by mylifeandtimes »

renewiltord wrote: post #55

People get annoyed at insurers who will deny treatment but most of the time you can just pay it yourself. The government has decided that everyone should pay for health insurance but you'll never be denied care if you pay for it yourself. So if you think you do require some care, just ask the medical practice whether they accept self-pay and then you can decide if it's worth paying or not. If you think it's not, it's…

yup. So if you decide you want to have a child, you just get ready to fork out 40-80K for the birth.

Because anyone can afford that, right?

Oh, and by the way, if you are in Texas abortion is illegal. In case you didn't actually __decide__ to get (yourself, your partner) pregnant.

So it's either 40-80K or 40 years. Easy choice.

Re: The fight between doctors and insurance companies over 'downcoding'

#157

Post by cmdli »

costcopizza wrote: post #137

What, 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 efficien…

> I’m surprised there isn’t a Costco like medical group that’s nationwide, has a membership, and works solely to provide care efficiently.

What you are describing is an HMO, which hasn't had that much lower costs historically. Theoretically, you pay once and then they take care of you, but in practice costs haven't been that much lower.

Re: The fight between doctors and insurance companies over 'downcoding'

#158

Post by m101 »

For those looking for a fix to US healthcare I think it's something like this:

- (user incentive to reduce cost) insurance is structured as co-pay of [20+]% on all expenses, no exceptions

- (price transparency) require healthcare providers to quote upfront for care, via API/website/phone/in-person. Price paid by anyone is the same except for expenses related to billing. E.g

https://surgerycenterok.com/

- (create competition) enable creation of small scale clinics, testing facilities, and laboratories

And for God's sake, get the government out of it!!

One (social) system that may work well is the South Korean one: private provision of healthcare services; government run insurance scheme with mandatory payments by those that can afford to pay

https://en.wikipedia.org/wiki/Healthcare_in_South_Korea

I love markets, but health insurance really is a tough one given the govt can't seem to let people make their own mistakes on healthcare, so I think it might make sense to make it govt run.

Edit: the thing to acknowledge here is that it probably won't push the frontier of healthcare as much as the current US system does, but at least it would be high quality and affordable (not people's largest or second largest expense item).

Re: The fight between doctors and insurance companies over 'downcoding'

#159

Post by ChadNauseam »

atomicnumber3 wrote: post #73
renewiltord wrote: post #55

People get annoyed at insurers who will deny treatment but most of the time you can just pay it yourself. The government has decided that everyone should pay for health insurance but you'll never be denied care if you pay for it yourself. So if you think you do require some care, just ask the medical practice whether they accept self-pay and then you can decide if it's worth paying or not. If you think it's not, it's…

>So if you think you do require some care, just ask the medical practice whether they accept self-pay and then you can decide if it's worth paying or not. If you think it's not, it's unlikely someone else will if they have to pay on your behalf. Ok, hear me out for a minute. What if I wanted to pool with several people, so that if any of us had unexpected medical needs, it wouldn't bankrupt any of us. Knowing that mo…

> Sure wish there was a system that just did that, without trying to also generate insane profits off it.

Health insurance companies in the US must pay 80% of premiums to providers. All their overhead (e.g. their accountants and actuaries and so on) comes out of the remaining 20%. What's left is their profit. People have this fantasy that all the money we spend on healthcare is secretly going to greedy insurance companies while doctors struggle to get by. But insurance company profits are a drop in the bucket.

The real villains are the doctors who recommend expensive MRIs and act like it's a complete surprise that the bill they give you is so high. And then go lobby the government to limit their competition. I would love to have a doctor in france look over my radiology and tell me if I have cancer. But that's illegal, I need to hire an American. Coincidentally, the average radiologist in San Francisco makes $660,000/year (about $400/hour).

Re: The fight between doctors and insurance companies over 'downcoding'

#160

Post by iamnothere »

JumpCrisscross wrote: post #104
iamnothere wrote: post #57

Earlier quoted context omitted.

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.

> reasonable wage or salary isn’t usually considered “profit” in a legal sense This is a semantic punt to the word “reasonable.”

The IRS has some guidelines that they use to decide what is “reasonable” but they don’t give out whatever actual formula or process they use to determine this. It’s supposed to be based on industry averages (more or less) but in reality it’s hard to determine what exactly that means. Generally you are “safe” paying in an industry average range, but if outside that range you need legal and accounting support to back up your own assessment.
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