A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims • Hacker News Board

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#201

Post by tptacek » Mon, Mar 26, 2018, 8:58 PM UTC

currymj wrote: post #200

theluketaylor wrote: post #186

Earlier quoted context omitted.

As a Canadian observer I don't understand why Democrats don't go after the small business angle of single payer much, much harder. Don't get me wrong; the lack of health care for poor and at risk populations in the US is a complete disaster, but that argument hasn't swayed the debate for decades now, so it's time for a new approach. Health care being tied to employment is anti-startup and anti-small business, full st…

Democrats do not all want single payer healthcare. Only the left wing of the party really wants it, although this is slowly changing. Center and center-right Democrats are pretty happy with the ACA as it was intended, although often not as it actually turns out in many states. Unsurprisingly, a lot of them take big contributions from insurers and pharmaceutical companies. I think if single payer becomes widely accept…

Ideologues on both sides have very specific ideas for how health care should be structured, but I think that most people on both sides can agree on basic principles: health insurance (if that's what we have) needs to be guaranteed-issue, premiums have to be reasonable, and pricing needs to be transparent. One thing the ACA got right is the name of the bill.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#202

Post by Spooky23 » Mon, Mar 26, 2018, 11:27 PM UTC

aaavl2821 wrote: post #199

Spooky23 wrote: post #49

Earlier quoted context omitted.

Did you get any sense of how they ran their businesses? My doctor was part of a medium sized practice that was swallowed up by a big regional system. Since that acquisition, they make the .gov that I work for look efficient and streamlined. They literally added 5-6 non-billable staff to an office that was staffed by 2. Per my doctor, that’s typical in most offices!

Most of them focused on two metrics: 1) increasing inpatient admissions (ie volume) and 2) increasing surgical volumes (biggest profit driver in HC services). To increase inpatient volume and surgeries they often buy outpatient clinics so they can control that patient flow. So they often view primary care as a loss leader that is directing patients to the profit center of surgeries. If those nonbillable staff are opt…

It seems like they can direct book specialist referrals, so I guess that’s where the money is.

My doc hates it — they built a good practice and did a lot of innovative stuff. Now it sounds like 10/10 on the awful bureaucracy scale.

The only happy doctor I know is an eye doctor who pays the fine to Medicare instead of putting in an EMR. He keeps the staff minimal and avoids overhead like IT. According to him, all of his colleagues with the big systems are miserable, working 80 hour weeks and probably 50% have alcohol or other substance problems.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#203

Post by bwb » Tue, Mar 27, 2018, 1:52 AM UTC

ethagknight wrote: post #117

tptacek wrote: post #32

Earlier quoted context omitted.

The rate of increase for health insurance prices went down after the ACA was enacted. The motivation for enacting the ACA was, in large part, the untenable increase in insurance prices in the 10 years leading up to it. People have a bad habit of blaming the ACA for insurance prices. The ACA failed at its goal of making individual health insurance affordable, that is true. But it didn't cause that problem, and it did…

Health insurance for my healthy young family of 4 spiraled out of control WITH ACA, so much so that I didn’t purchase proper health insurance in 2017, while also underfunding my income tax in hopes that ACA cannot legally “send me a bill” for 2.5% of my household income. (I mean shit, in a red blooded patriotic American, but that penalty made me absolutely furious) All this while paying cash for prenatal visits for o…

The ACA is not at fault there, that problem was there before.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#204

Post by intended » Tue, Mar 27, 2018, 3:02 AM UTC

whatshisface wrote: post #158

intended wrote: post #153

Earlier quoted context omitted.

How can you knowingly discuss demand elasticity and then apply to healthcare? Healthcare is a non typical market and the cost of a persons health is irrationally high to that person.

Think about this: Everyone on a boat has twenty dollars and absolutely needs an EpiPen to live. You have a supply of EpiPens and want to get as much of their money as possible. There's zero elasticity between 0 and 20 dollars, but you better not charge $21! Now, imagine that there was only one person who needed an EpiPen, but everyone else was willing to pitch in as much as it took to help them out. If the supplier o…

Insurance markets are really really old concepts.

Healthcare is known to be a market which has non standard policy imperatives

The cheapest, simplest and most effective system is single payer with everyone in a single pool.

Every major first world power achieves better outcomes for lower costs than America.

Your theoretical premise would have merit if this was only theoretical, and we had no real world evidence that this was a bad idea.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#205

Post by bbddg » Tue, Mar 27, 2018, 1:23 PM UTC

pg_bot wrote: post #107

bbddg wrote: post #100

Earlier quoted context omitted.

I think there's plenty of room for innovation but we should start from the principal that everyone gets full access to medical treatment regardless of their ability to pay.

We technically have this in the United States (for emergencies). It is illegal for someone to be denied emergency services regardless of ability to pay.[0] No government system guarantees "full access" to medical treatment there is some form of rationing everywhere. https://www.cms.gov/Regulations-and-Guidance/Legislation/EMT...

Okay, maybe I should have said "access to medical treatment shouldn't be decided by ability to pay".

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#206

Post by aaavl2821 » Tue, Mar 27, 2018, 2:56 PM UTC

Spooky23 wrote: post #202

aaavl2821 wrote: post #199

Earlier quoted context omitted.

Most of them focused on two metrics: 1) increasing inpatient admissions (ie volume) and 2) increasing surgical volumes (biggest profit driver in HC services). To increase inpatient volume and surgeries they often buy outpatient clinics so they can control that patient flow. So they often view primary care as a loss leader that is directing patients to the profit center of surgeries. If those nonbillable staff are opt…

It seems like they can direct book specialist referrals, so I guess that’s where the money is. My doc hates it — they built a good practice and did a lot of innovative stuff. Now it sounds like 10/10 on the awful bureaucracy scale. The only happy doctor I know is an eye doctor who pays the fine to Medicare instead of putting in an EMR. He keeps the staff minimal and avoids overhead like IT. According to him, all of h…

Is the doc you're speaking of a primary care doc or specialist? I've been working with some PCPs to try to find new models that allow them to remain independent without sacrificing too much financially. It's a tough needle to thread but I think happier, more independent primary care physicians are a good way to start righting the healthcare ship

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#207

Post by whatshisface » Wed, Mar 28, 2018, 12:48 AM UTC

intended wrote: post #204

whatshisface wrote: post #158

Earlier quoted context omitted.

Think about this: Everyone on a boat has twenty dollars and absolutely needs an EpiPen to live. You have a supply of EpiPens and want to get as much of their money as possible. There's zero elasticity between 0 and 20 dollars, but you better not charge $21! Now, imagine that there was only one person who needed an EpiPen, but everyone else was willing to pitch in as much as it took to help them out. If the supplier o…

Insurance markets are really really old concepts. Healthcare is known to be a market which has non standard policy imperatives The cheapest, simplest and most effective system is single payer with everyone in a single pool. Every major first world power achieves better outcomes for lower costs than America. Your theoretical premise would have merit if this was only theoretical, and we had no real world evidence that…

I'm describing market actors with phrases like "perfectly evil," so I hope my comments aren't coming across as policy proposals. All I was arguing is that uninsured people running out of money was a pressure that used to be restraining the price increases but now isn't.

I really feel like this discussion is suffering from false-dichotomy-itis: I've actually been very careful to avoid saying anything beyond my point, about (say) whether or not single payer is a good idea for the US.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#208

Post by ethagknight » Wed, Mar 28, 2018, 1:19 AM UTC

bwb wrote: post #203

ethagknight wrote: post #117

Earlier quoted context omitted.

Health insurance for my healthy young family of 4 spiraled out of control WITH ACA, so much so that I didn’t purchase proper health insurance in 2017, while also underfunding my income tax in hopes that ACA cannot legally “send me a bill” for 2.5% of my household income. (I mean shit, in a red blooded patriotic American, but that penalty made me absolutely furious) All this while paying cash for prenatal visits for o…

The ACA is not at fault there, that problem was there before.

Absolutely false to say ACA is not at fault. It’s not solely ACA’s fault, but it is complicit. dramatic annual increases occurred every year after ACA. I’m not looking at statistics but my family insurance premiums over time.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#209

Post by ethagknight » Wed, Mar 28, 2018, 1:28 AM UTC

mhdhn wrote: post #160

ethagknight wrote: post #117

Earlier quoted context omitted.

Health insurance for my healthy young family of 4 spiraled out of control WITH ACA, so much so that I didn’t purchase proper health insurance in 2017, while also underfunding my income tax in hopes that ACA cannot legally “send me a bill” for 2.5% of my household income. (I mean shit, in a red blooded patriotic American, but that penalty made me absolutely furious) All this while paying cash for prenatal visits for o…

You are taking a huge, basically unlimited risk with your now healthy family. And note that you will probably save at least as much by the discounts you get through the insurance company's networks as by how much insurance pays vs. patient. Example, had a covered but elective heart procedure. Insurance was billed around $220,000. But they got the hospital and doctors to accept less than $20,000. Yes, I paid some of t…

I do have a catestrophic policy, I wasn’t clear above. Agree it is a risk, but it’s not unlimited. However, The list prices are sham values. Why do you think the doctors would be willing to accept $20k from one payor but not another? Medical billing ultimately becomes a game of persistence, and you can wear down the billing office and reach a settlement that ultimately. Been there, Done that!

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#210

Post by chrisweekly » Wed, Mar 28, 2018, 12:05 PM UTC

tptacek wrote: post #85

chrisweekly wrote: post #82

Earlier quoted context omitted.

Tangent: people tend to fixate on "LLC" as if it were the only reasonable corp structure for small outfits. S-Corp is often a better choice.

It's just the cheapest one to set up. I was assuming that if someone's self-employed and not deducting insurance, they're probably a sole proprietorship, and are probably sensitive to accounting costs.

No, that's one of the wrong assumptions / myths I'm pushing back against: LLC is _not_ necessarily the cheapest to set up. I'm the sole employee of my Massachusetts S-Corp, and it was both less expensive and better tax-advantaged.