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I analyzed hospital price lists so you didn't have to

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Re: I analyzed hospital price lists so you didn't have to

#391

Post by dheera »

onphonenow wrote: post #143
dheera wrote: post #119

Earlier quoted context omitted.

I really want to expose Stanford's ridiculous billing and shame them to no end, but I don't have enough Twitter followers. I know healthcare billing in the US is f-ed up but Stanford is particularly bad.

Not really that bad. San Francisco used to have crazy bills. Trauma response fees go up to 50k even if nothing is wrong. I can get the price of my fast food burger to the penny - but good luck getting a quote on something that will cost 50,000. I did medical billing for a bit and in my space 70% of the issue was stupid politics

San Francisco as in UCSF?

I'm due for an ICD battery replacement later this year or early next year and trying to figure out where to get it done.

Re: I analyzed hospital price lists so you didn't have to

#392

Post by dheera »

danachow wrote: post #158
dheera wrote: post #112

Earlier quoted context omitted.

I just got billed $5000 for a routine echocardiogram at Stanford, and in the process of fighting it. My insurance is supposed to cover preventative care 100% (not even a copay). They billed $18000 total (yes, for a 1-hour ultrasound) and insurance is leaving me to pay $5000. This is about the 6th time this has happened. It's always 15+ e-mails back and forth, then threatening lawyers, then they back off. I'm wonderin…

> I am insured and it is preventative care How or why do you think an echo is preventative care? While insurance plans are free to define any additional menu of services as preventative - an echo is not included in the minimum set required by the federal government - which are procedures based off of US preventative services task force guidelines - there are no published guidelines that include an echo. I wish you lu…

It's fully preventative in my case. I have heart issues (I'm a cardiac arrest survivor) and an echo is recommended every 2 years to spot any possible future issues early.

Re: I analyzed hospital price lists so you didn't have to

#393

Post by dheera »

danachow wrote: post #324
namdnay wrote: post #230

Earlier quoted context omitted.

There are two categories of healthcare right? Palliative and preventative. Which one would an echo be in this case? If he had violent symptoms it would clearly be palliative, but in this case it can only be preventative

> There are two categories of healthcare right? Palliative and preventative. The simple answer to this is that “preventative” in the case of billed medical services has a specific and clearly defined meaning - it does not even mean all services that ever would be considered preventative. This definition will be found in your insurance paperwork and corresponds at least to the site I posted - so a further philosophica…

> Can you actually think of a disease that an echo would be used to prevent?

Yes, checking the extent of mitral valve prolapse (which I have, doesn't warrant valve surgery yet but it's expected I may need valve repair in 10-30 years if it gets worse), ejection fraction, early detection of dilated cardiomyopathy (which I'm known to be genetically predisposed to), etc.

Re: I analyzed hospital price lists so you didn't have to

#394

Post by danachow »

dheera wrote: post #392
danachow wrote: post #158

Earlier quoted context omitted.

> I am insured and it is preventative care How or why do you think an echo is preventative care? While insurance plans are free to define any additional menu of services as preventative - an echo is not included in the minimum set required by the federal government - which are procedures based off of US preventative services task force guidelines - there are no published guidelines that include an echo. I wish you lu…

It's fully preventative in my case. I have heart issues (I'm a cardiac arrest survivor) and an echo is recommended every 2 years to spot any possible future issues early.

As to the original question, unfortunately I don't know where you got the idea that all possible preventative healthcare interventions are covered under the "free" rule - ie no out of pocket - but in the US that just isn't a thing - the free coverage applies to the list I posted prior (ie ACA Preventive Care) - its a bunch of consensus primary and secondary preventative primarily screenings and medications that are thought to have the greatest impact on public health.

> It's fully preventative in my case.

Fully preventative is not a term of art either for delivery or billing - but there is a difference in categorization between screening tests given to the entire population (ie colon, mammo) and screening given to those with personal risk factors or family history (LD chest CT, echo for congenital HD), and then further on surveillance for personal history of a pre-disposing condition (ie surveillance echo for prior potential fatal arrhythmia).

This is where it starts to get complicated - but the need for an echo every 2 years is not normal. I can't really divine your specific history from the information given - and it isn't necessary - but a history of cardiac arrest alone is not an indication for serial echocardiography. There are numerous specific circumstances where it is recommended, and then there are the cases where it is not consensus recommended but there is controversy. I assume because your insurance company is willing to touch it at all it falls in the former - but we are way off the ranch here in terms of the scope of routine preventative care/health maintenance.

As to whether it should be this way, probably not. If a surveillance echo is clearly indicated to prevent costly sequelae (unfortunately answering this question isn't nearly cut and dry as most think), then it makes sense that an insurance or public health agency would want to do this. Curious if you know if your indication for serial echocardiography falls under the European guidelines? Maybe move there /s. Is Stanford your only reasonable place to obtain an echo?

Re: I analyzed hospital price lists so you didn't have to

#395

Post by danachow »

dheera wrote: post #393
danachow wrote: post #324

Earlier quoted context omitted.

> There are two categories of healthcare right? Palliative and preventative. The simple answer to this is that “preventative” in the case of billed medical services has a specific and clearly defined meaning - it does not even mean all services that ever would be considered preventative. This definition will be found in your insurance paperwork and corresponds at least to the site I posted - so a further philosophica…

> Can you actually think of a disease that an echo would be used to prevent? Yes, checking the extent of mitral valve prolapse (which I have, doesn't warrant valve surgery yet but it's expected I may need valve repair in 10-30 years if it gets worse), ejection fraction, early detection of dilated cardiomyopathy (which I'm known to be genetically predisposed to), etc.

Checking the extent of MVP is not really preventing or treating MVP, is it? The echo isn't preventing the mitral valve prolapse, it is also not an intervention - it is a diagnostic tool to guide further intervention. Yes, this could be considered a type of tertiary prevention - but hopefully it should also be clear how this is more usefully classified as diagnostic. Pretty much all medical care is to some extent preventive, even reducing the broken arm - so it becomes a meaningless word if it is loosely defined as any intervention that can potentially prevent sequelae. That means it’s ultimately going to be defined with some restrictive set of criteria. Is the US ACA definition very restrictive, yes, but that’s how it is.

Ejection fraction is not a disease, but let's call it heart failure. An echo evaluating for heart failure is a good example where we can use it as a diagnostic tool to prevent further progression - but again through other interventions - and if we're evaluating for abnormal ejection fraction we haven't prevented it.

Another example might be evaluating for a shunt to prevent stroke. However we don't routinely screen everyone for this.

Echo for inherited cardiomyopathies is a good example of primary or secondary prevention.

There are definitions within medicine that matter for defining appropriate use criteria, but all this preventive vs palliative is arguing loose semantics - the people you’re up against have already put in place the policy to avoid most of that.

Re: I analyzed hospital price lists so you didn't have to

#396

Post by IG_Semmelweiss »

theossuary wrote: post #340
IG_Semmelweiss wrote: post #322

Earlier quoted context omitted.

While what you are saying is all true, in general terms, but the key story seems missing: The "top of the funnel" system is very much fighting to preserve itself. - Insurance companies are in bed with hospitals to collaborate swindling money from the govt: read about kickbacks sent by the US Govt to hospitals as Disproportionate Share Hospital payments. - Hospitals have a PR arm moving profits to defend their monopol…

Why are DSH payments bad?

Becuase they act as an incentive to raise prices with no incremental value in healthcare delivered.

DSH rules are gamed to extract more from the program

Re: I analyzed hospital price lists so you didn't have to

#397

Post by IG_Semmelweiss »

robertlagrant wrote: post #380
IG_Semmelweiss wrote: post #335

Earlier quoted context omitted.

Medical billing is by a product of government mandates on insurance to cover everything + medicare and medicaid. Make those programs go away, and CPT codes would eventually die. It is not going to go away so unfortunately we need to learn to live life with it, and instead make it irrelevant, or niche, just like a ferrari is niche. The best way to cope is to have an alternative to CPT coding, which means, alternative…

> Hospitals create monopolies, independent doctors break monopolies with competition. The question might be: can we create an Uber-like business that has gives doctors the tech infrastructure to consult with patients without it feeling like a mom and pop shop?

Investors are betting that its possible.

Not in the strict uber model. Mind you. Providers will need to keep more of a share for it to work.

Re: I analyzed hospital price lists so you didn't have to

#398

Post by pocketero-dan »

IG_Semmelweiss wrote: post #335
tunap wrote: post #331

Earlier quoted context omitted.

All valid, but you forgot another big story, for another day: "medical billing". This, in my minimally-informed opinion, is the syndicate keeping the fence running. I've had dealings with 4 owners of separate small-to-moderately sized billers and their top-brass all owned > 1 multi-million dollar homes around the world. Also, their toy boxes contained millions in cars, boats & flying machines. It must be nice, but in…

Medical billing is by a product of government mandates on insurance to cover everything + medicare and medicaid. Make those programs go away, and CPT codes would eventually die. It is not going to go away so unfortunately we need to learn to live life with it, and instead make it irrelevant, or niche, just like a ferrari is niche. The best way to cope is to have an alternative to CPT coding, which means, alternative…

Yes, I think that is correct - ending government intervention in health insurance would wither the medical billing industry. To be fair, the medical billing industry is not parasitic - it adds value by navigating health insurance billing, which is notoriously complex and time-consuming. But health insurance billing is only so prevalent because of massive government intervention. For example:

- The federal government is by far the largest health insurer - through Medicare and Medicaid it pays for 38% of healthcare in the US [1]. - The federal government directly subsidizes private health insurance through ACA [2]. - The federal tax exemption for employer-paid health insurance is by far the largest by dollars exempted [3].

All these government interventions increase reliance on health insurance, which increases the complexity of billing, which grows the medical billing industry.

[1] https://www.statista.com/statistics/237043/us-health-care-sp... [2] https://www.healthcare.gov/glossary/subsidized-coverage/ [3] https://www.npr.org/sections/health-shots/2012/12/04/1664342...

Re: I analyzed hospital price lists so you didn't have to

#399

Post by mrexroad »

hanklazard wrote: post #121
mrexroad wrote: post #117

Earlier quoted context omitted.

My son had strep throat. Stanford billed us just shy of $50K, but not before sending us a letter letting us know they had stopped accepting our insurance (BCBS) a few weeks prior. Obviously, more done than just a throat swab for the 50K, but whole thing was insane.

That is nuts. Was he admitted to the hospital or something?

Yeah, they kept him for a night. Kid complained about sore throat so my wife took him to doctor (regular pediatrician was busy, so another doctor). Kid kinda mentioned a stiff neck, and doctor told my wife to get him to the ER immediately, b/c meningitis. Wife took him to Stanford ER, they were all omg we’re kinda sure it’s meningitis, but we need to do a spinal tap first. While prepping for that they put him on an IV and after ~20min he perked up a bit. A nurse noticed that and said it wasn’t normal if really meningitis, and put spinal tap on hold. Then doctor said there was a chance of an abscess in his throat/neck and wanted to rule it out; ordered a CT scan. Once that returned negative, they were like, oh yeah, it’s just strep… but, let’s prescribe an uncommon liquid antibiotic that tastes like trash reheated. Kid refused to swallow it, despite efforts of 3 nurses trying to waterboard him with the liquid. So the only way to deliver the antibiotic as prescribed was intravenously. Learned several lessons about advocating during that ER trip.

Re: I analyzed hospital price lists so you didn't have to

#400

Post by jboogie77 »

danachow wrote: post #394
dheera wrote: post #392

Earlier quoted context omitted.

It's fully preventative in my case. I have heart issues (I'm a cardiac arrest survivor) and an echo is recommended every 2 years to spot any possible future issues early.

As to the original question, unfortunately I don't know where you got the idea that all possible preventative healthcare interventions are covered under the "free" rule - ie no out of pocket - but in the US that just isn't a thing - the free coverage applies to the list I posted prior (ie ACA Preventive Care) - its a bunch of consensus primary and secondary preventative primarily screenings and medications that are t…

Lol you mad bro? He just wants an echo to make sure his heart is beating normally
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