Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

The fight between doctors and insurance companies over 'downcoding'

nbcnews.com

Post reply on HN
Print view View original

261–270 of 354 posts

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

#261

Post by doctorpangloss »

oakmad wrote: post #243

I’ve lived under several different healthcare systems around the world as an adult. Coming from my time America, nothing felt more like freedom to me than walking out of a hospital in London, with a new child, and having had no interaction with a billing desk.

On the other hand, aren’t comments like yours about the aesthetic experience of billing exactly the problem? It’s not like you didn’t pay for healthcare in Europe, you just had good vibes about the particular way that you paid. Employer sponsored health insurance plans are popular and also give good vibes.

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

#262

Post by wisty »

int_19h wrote: post #247
wisty wrote: post #138

Earlier quoted context omitted.

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…

I'm sorry, but this is bullshit. The American system is nothing like the Soviet one. I've seen both first hand. Both are kinda crappy but in very different ways. If I had to choose one though it'd be Soviet for sure because it's still guaranteed healthcare no matter what your financial situation is.

So you deny that both the US healthcare system and USSR economy are / were bogged down in red tape and regulation, which is clearly my main point? Or you're just mad that I'm using Communism as a punchline when criticising neoliberalism?

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

#263

Post by philipallstar »

iamnothere wrote: post #57
philipallstar wrote: post #51

Earlier 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.

I'm not saying profit in that sense. I'm just saying that it's monetary profit all the way down when it comes to paid work. People work for profit. People invest for profit. People bet for profit.

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

#264

Post by polski-g »

Ancalagon wrote: post #78
polski-g wrote: post #14

Earlier quoted context omitted.

There is immense pressure on insurance companies to lower costs, as they get blamed for the "American health care system". The only one on the side of the payer is the insurance company, they're the only one who wants to keep costs down for the consumer. Given the massive amounts of fraud in government health insurance (medicare) it would of course be prevalent in the private insurance market. https://www.azcentral.c…

why dont other countries have similar amounts of healthcare fraud in their single-payer systems?

They do. Billions are lost in Germany every year due to fraud.

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

#265

Post by lotsofpulp »

deathanatos wrote: post #226
lotsofpulp wrote: post #76

Earlier quoted context omitted.

I don’t understand why any decision maker in any business in the USA chooses to offer their employees (and hence themselves) health FSAs at all, especially when the much superior in every way Fidelity HSA is available.

I've never seen the point of HSAs, either. The only benefit is the tax difference. There are (usually unknown, unstated upfront) plan fees that eat into that, and coupled with the higher deductibles and worse plan coverage, you're going to pay more out of pocket. It's never been clear to me if (higher OOP + plan fees) And it's a time suck.

An employer sponsored HSA is the single most tax advantaged account in the US, and Fidelity HSA have no fees. No FICA tax, no income tax going in, on investment returns, and coming out. Worth tens of thousands of dollars over 20, 30, 40+ years.

If your employer is shitty and doesn’t offer Fidelity HSA, you can also easily rollover the HSA funds to Fidelity every year to avoid the fees.

The coverage for HDHP plans is the same, since it’s the same insurer. The only change is deductible/copay/oop max, which is offset by lower premiums and higher cash flow for younger/healthier/higher earners shouldn’t matter.

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

#266

Post by 3D30497420 »

jimbokun wrote: post #128
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.

"What is the cash price?" magically puts you back in the land of Classical Capitalism, where the service provider wants to keep you as a customer and knows their internal costs and you as a consumer of the service can evaluate their reputation for quality and cost vs other providers. It's adding 3rd parties like "insurance" (which only works as insurance in very limited catastrophic circumstances) and government plan…

I'm not sure how much I want healthcare accessibility determined by "Classical Capitalism". The vast majority of things I buy are fundamentally optional, so the supply/demand can be negotiated. Some reasonable part of healthcare is largely non-optional.

I suppose you could make an argument that my sky-high demand should encourage new market entrants thereby balancing the supply to the market demands. However, in many healthcare cases, there are too many impediments for that to be realistic (patent exclusivity, manufacturing complexity, etc.).

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

#267

Post by philipallstar »

ratelimitsteve wrote: post #91

the health insurance industry needs to be razed to the ground and rebuilt from scratch. there's no saving something that is ostensibly designed to help people get healthcare but realistically denies them what they're entitled to for years (in some cases, they just try to keep the ball in the air until the patient dies, then there's no one to appeal) and then once the care is approved steals from the service provider…

If you keep the same regulatory environment then the same industry will arise.

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

#268

Post by philipallstar »

silexia wrote: post #24

I went to the dentist a couple of weeks ago and had the shortest dental visit I've had. They did the X-rays, then the dental assistant spent five minutes cleaning my teeth and pronounced them good. The dentist came in and looked for about one minute and said they were fine. I was sent on my way. They billed my insurance for over a thousand dollars.

Indeed. Part of the problem is news vendors will only tell one side of the story. If that dentist only billed, say, $150 ($40 per x-ray including time, wear, consumables), $20 for teeth cleaning time, $50 for rent, property rates, taxes, profit) then you'd pay far less in insurance. They all bill more because they can.

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

#269

Post by naijaboiler »

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.

not magic words. sometimes cash price is non-insurance price and is 3x the insurance price. since insurance and providers have a negotiated rates. so paying cash means paying 3-5x

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

#270

Post by balderdash »

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.

lol totally agree. At my first job I had one, and totally misjudged. I ended up with an extra thousand dollars left and then had to read the fine print on what to spend it on - ended up buying a 10 pack of acupuncture sessions that I didn’t need but were very relaxing
Post reply on HN