The fight between doctors and insurance companies over 'downcoding'
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Re: The fight between doctors and insurance companies over 'downcoding'
#2Good startup idea would be to work with medical practices to use AI to automate the disputing of the "downcoding" by insurers.
Re: The fight between doctors and insurance companies over 'downcoding'
#3If someone invoices me, and I don’t pay the full amount in a timely manner, what do you think will happen? Late fees, reports to credit bureaus, collections agencies hounding me, maybe even lawsuits?
If insurance companies underpay, doctors should treat that no differently. Don’t appeal through the insurance company itself. Imagine I go to a store and pay less than the full amount at the register, and then the grocery store appeals to ME to decide whether I actually should have paid the correct amount. It’s absurd.
Doctors should treat the insurance companies like anyone else who owes them money and isn’t paying in full on time.
Re: The fight between doctors and insurance companies over 'downcoding'
#4Good startup idea would be to work with medical practices to use AI to automate the disputing of the "downcoding" by insurers.
The business will be very quickly bought up to kill the product.
Re: The fight between doctors and insurance companies over 'downcoding'
#5Good startup idea would be to work with medical practices to use AI to automate the disputing of the "downcoding" by insurers.
The business will be very quickly bought up to kill the product.
If they can afford it. What's Mark Cuban been up to lately?
Edit: in case the reference isn't clear -- https://en.wikipedia.org/wiki/Cost_Plus_Drugs
And I think it is a sad state of affairs when the government has been so villified that we have to depend on billionaires for basic public good works.
Re: The fight between doctors and insurance companies over 'downcoding'
#6If someone invoices me, and I don’t pay the full amount in a timely manner, what do you think will happen? Late fees, reports to credit bureaus, collections agencies hounding me, maybe even lawsuits? If insurance companies underpay, doctors should treat that no differently. Don’t appeal through the insurance company itself. Imagine I go to a store and pay less than the full amount at the register, and then the grocer…
I was thinking the same thing. Would it be permissible to bring each underpayment to small claims court as a separate case? If enough doctors did this, it would very quickly be a legal DDoS attack, like we've seen happen with mandatory arbitration.
Re: The fight between doctors and insurance companies over 'downcoding'
#7Good startup idea would be to work with medical practices to use AI to automate the disputing of the "downcoding" by insurers.
Man this is a hellscape.
I can quickly see something like this turning in an AI arms race between insurance and the provider with each auto-approving/denying/disputing the other. All the while locking out smaller players because they can't afford the 3rd party disputotron.
Re: The fight between doctors and insurance companies over 'downcoding'
#8Ah yes, this is a fight between the practices (sometimes not the doctors!) upcoding their visits and the insurance companies wanting to push back and downcode the visits to what they actually entailed.
Healthcare practices want to maximize revenue and push up the “level” of a doctors visit and they can do it with just adding one or two extra little questionnaires or an extra test or two that you might not pay attention to so they can get an extra several hundred dollars a day for billing higher level cases daily.
Re: The fight between doctors and insurance companies over 'downcoding'
#9If someone invoices me, and I don’t pay the full amount in a timely manner, what do you think will happen? Late fees, reports to credit bureaus, collections agencies hounding me, maybe even lawsuits? If insurance companies underpay, doctors should treat that no differently. Don’t appeal through the insurance company itself. Imagine I go to a store and pay less than the full amount at the register, and then the grocer…
good luck suing when lawyers cost the doctor 2k/hour and the insurance companies have armies of in house counsel.
Re: The fight between doctors and insurance companies over 'downcoding'
#10Earlier quoted context omitted.
The business will be very quickly bought up to kill the product.
If they can afford it. What's Mark Cuban been up to lately? Edit: in case the reference isn't clear -- https://en.wikipedia.org/wiki/Cost_Plus_Drugs And I think it is a sad state of affairs when the government has been so villified that we have to depend on billionaires for basic public good works.
> the government has been so villified that we have to depend on billionaires
https://knowyourmeme.com/memes/were-all-trying-to-find-the-g...