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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'

#171

Post by hintklb »

potatoicecoffee wrote: post #162
3D30497420 wrote: post #46

This 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…

In Australia I just take my blood test form to any pathology place and they do it for free (for me) and bill the government a set price from the medicare benefits schedule.

Hmm sure, but there must similarly be things that are denied right?

I lived in both systems. In a single payer system, the state essentially decide what is allowed and what is not. And with the state as a single payer, they also go back and forth on price with the hospitals.

It still is a better system overall but there is no places where you can just spend as much as you want on healthcare without some type of centralized supervision.

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

#172

Post by potato3732842 »

nocoiner wrote: post #99
potato3732842 wrote: post #36

Earlier quoted context omitted.

Every party at every point in the system is various shades of complicit in fleecing us. That's the magic of the system. It's all divided up in so many ways and so many of the feedback loops touch through the people getting screwed that it's impossible to build a "these guys might not be wholly responsible, but they're responsible enough things will get better if we push them off a cliff or legislate them into poverty…

You think nurses and couriers are the ones who need to take pay cuts to get healthcare expenses under control??? Lm, and I cannot stress this enough, fao.

The size of the haircut the whole industry needs to take is so large that in all likelihood nobody will be unscathed.

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

#173

Post by renewiltord »

mylifeandtimes wrote: post #156
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.

The ones who can't afford it (System seems fine, though I think I'd prefer if we completely subsidized childbirth and 12 months after for all (because those are people who will keep us solvent in the future).

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

#174

Post by Taikonerd »

throwawayqqq11 wrote: post #79
eigencoder wrote: post #28

My pediatrician always charges us for an office visit + preventative care when we go in for a preventative care visit. It's obviously to get more $$ from insurance. I feel like this goes both ways...

An obligation to pay is always good for the billing side. Think about the sociopathic prices of US pharmaceuticals. Afaik any other country with mandatory health care also puts a ceiling on prices. In germany, there is a price catalog for any service, with only few exceptions, and doctors/hospitals cannot legally charge anything else for these covered services. Now guess what the US does not have, even thought obama…

> In germany, there is a price catalog for any service, with only few exceptions, and doctors/hospitals cannot legally charge anything else for these covered services. Now guess what the US does not have

Well, we sort of do: we have Medicare's reimbursement rates, which are indeed a price catalog for every service... but only if you're covered by Medicare, of course.

I've heard that price negotiations between private payers and providers are often done with reference to the Medicare rate: "I'll pay you 20% over Medicare for this."

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

#175

Post by crazygringo »

There's plenty of upcoding going on with doctors as well though.

I go to a particular doctor and I'll see a bunch of random things on the bill that don't seem to have anything to do with my visit. Like a thousand dollars worth.

But then insurance rejects them, but I still don't have to pay a cent -- the doctor never actually charges me.

It seems quite clear they're just trying to throw things at the wall and see what sticks.

Everything about American healthcare is bad.

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

#176

Post by cameldrv »

I've seen a lot of upcoding on my bills and it really aggravates me. It's fraud and the doctors should be happy that the insurance company is just reducing their payments instead of dropping them or trying to get them prosecuted. When someone loads their grocery bag full of cosmetics and razor blades, they get on the news and YouTube, but when a doctor systematically bills for services he didn't perform to the tune of millions of dollars, almost nothing happens.

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

#177

Post by trentnix »

supportengineer wrote: post #68
3D30497420 wrote: post #46

This 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…

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.

I’ve found, as a fairly recent phenomenon, it’s often higher than the insurance price. The pessimist in me thinks that insurance companies have worked to close that loophole. They need to maintain the illusion of their utility, after all.

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

#178

Post by poncho_romero »

jasonlotito wrote: post #42
antonymoose wrote: post #23

Earlier quoted context omitted.

Pretty sure fraudulent billing practices exist in a variety of nations and industries.

It does. And having lived 10 years in Canada and 10 years in the US and used both their healthcare systems quite a bit, I have seen both sides. Let me just say I moved to the US for healthcare 10 years ago and we do not regret it one bit. The US is easy to point and laugh at, but that just comes from ignorance.

Are you wealthy?

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

#179

Post by dotancohen »

testing22321 wrote: post #167
lotsofpulp wrote: post #63

Earlier quoted context omitted.

Health insurance companies have told me, on the phone, that they will not tell me the codes the doctor needs to charge for preventative visits in order to for my visit to be covered as preventative care (meaning I don’t have to pay anything). However, I could tell the insurance customer service person a code, then they could tell me if it was classified as a covered preventative service. So I, the insurance company’s…

> However, I could tell the insurance customer service person a code, then they could tell me if it was classified as a covered preventative service. Malicious compliance engaged. Start with code “1” and go to “99999999999999999” until they tell you it’s covered.

Or ask your favorite LLM.

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

#180

Post by khuey »

cblum wrote: post #152
i80and wrote: post #70

Earlier quoted context omitted.

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.

> I don’t understand why they cant just make medical expenses tax-deductible

We have that, although the deduction only starts after a certain amount which makes it useless to almost everyone.

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