Medical billing - seriously?

[Craig T]

Originally Posted by motion

I won't play into the system. I'm self-insured and will grind them down any time I need them and have to pay cash. I will also seek out medical help out of the country when I need it.

If something major happens to me, I will grind them down to 10% of the billing.

My 0.02

There's actually a lot to this^^^ To prevent cost-shifting to Medicare, Medicaid, and Medi-Medi (gov payors), there are "Lowest Charge" provisions that prohibit some healthcare services from charging anybody, or any private payor, less than the government plans. To avoid violating Lowest Charge, many healthcare providers bill everybody at the rate of the highest payor's reimbursement schedule, then they just "accept assignment" if a insurance or institutional payor pays less. e.g Diagnostic, dermatology, and pathology labs often have a 75% "contractual allowance" (bad debt) allocation on the P&L. The person this practice hurts most is cash paying or high deductible patients. If nobody complains, medical providers are happy to take all the money, but almost all will agree to negotiate WAY down if you pay in cash (or CC).

I negotiated my sinus surgery down from $15K to $5K by offering cash. If you say you're not going to pay it and go ahead and turn you over to collection, they'll almost always accept a discounted offer. Collection agencies take 50%, so a 40% discount is a no-brainer.

[MBAtarga]

Originally Posted by legion

Absolutely. So is the cost of malpractice insurance. So is the cost of unnecessary tests to ward off lawsuits. So is the cost of unnecessary tests mandated by various laws. So is the cost of maintaining a staff to collect from insurance. So is the cost of maintaining a staff to meet government reporting requirements. So is the cost of jumping through various government-mandated hoops to justify pursuing certain courses of treatment.

Chris,
The only thing I see you left off was the car payment for the Tesla that my dermatologist drives.
Mark

[Tobra]

Originally Posted by greglepore

What is rampant is the culture of "bill anything" because we need to consume care. Its not like we'll won't get treated. The other thing that I believe is criminal is the non-transparancy of billing-procedures are routinely billed to the uninisured at rates hundreds of times greater than the insurers. I do get that the collection rate is low on these, hence the great discount, but this is why we need a single payer system.

not so much

Insurance companies negotiate for a discounted rate, pretty simple.

[fastfredracing]

Almost a year ago to the day. I went and had some tests. I have good insurance from my wifes company, and I still had my own super high deductible crappy insurance .
$4500 total bill. They billed to the wrong insurance company. No big deal right? Wrong. I bet I have 25 phone calls over the course of the year wrapped up in this . I have had 3 different collection companies chasing me for the dough.
The lady at the collections said I should just pay the money, then when it gets straightened out, I will get a refund. Uh, yeah, right.
Finally got a letter last week , my final tally is $145.00 I sent the check

[legion]

Originally Posted by motion

I know of someone that has generated 10's of thousands of dollars in fake billings. Its easy and this person feels some kind of immunity from prosecution. I'm pretty sure this practice is rampant among the medical community.

In certain corners of the medical community, fraud is rampant. I've put thousands of doctors, lawyers, and other medical professionals in prison. Chiropractors, physical therapists, and massage therapists commit the bulk of medical billing fraud. It seems like every medical professional in Miami-Dade county is involved in fraud. There are many doctors that make a living by ripping off medicare and medicaid.

[greglepore]

Legion- I agree about the dark corners. The PI/med community in philly was notorious when I practiced there, ins companies developed algorithms showing that facilitates were billing multiples of what they could physically treat. Lots of these guys went to jail.

Tobra- I agree the insurers negotiate the rates, but on what rationale? Either thats the true value of the service or the rate billed to the cash buyer is accounting for something else - what?


Sent from my iPhone using Tapatalk

[Tobra]

Insurance companies negotiate with the providers to get a discount for access to the patients insured by that company. You agree to take less, with the idea that you have access to a larger patient population. For the most part, the rates are based on what Medicare would pay, which is set by the government.

[flatbutt]

Originally Posted by Gogar

.

Total so far = $453.92.

.

That's what my catheters cost every month...with medicare AND medigap.

[GWN7]

To open a file on you seems a bit high seeing that you are unlikely to see him again but the Pathologist's report is about right. I paid $200 to find out my furry friend of 16 years has cancer.

[ejfbmw]

Yes, our insurance companies negotiate payment on our behalf, that is what we pay them to do for us. But what is the actual price charged by the provider for medical goods and services based on? What is driving the prices charged by the providers, and this included the pharmacals, for goods and services? We now, by law have to buy medical insurance, and the insurance companies, by law, have to pay our medical bills. Then the insurance companies increase the price of medical insurance to cover payments for medical goods and services. But the real issue is the outrageous prices charged by medical providers for goods and services in the first place. Why is this not discussed? Why are the wages, benefits and perks enjoyed by the health care industry employees untouchable? Why are the prices charged by heath care industry contractors untouchable? Recently an allergy nasal spray cost $112 and six months later $234. Why? This spray is the most popular one out there right now. Is there a shortage? Probably not. A lawyer once told me it was an insurance companies job to only pay out what they, the insurance company, could be legally required to pay. OK, I get that, that makes sense. But what doesn’t make sense is why the high prices charged by the medical industry providers of goods and services in the first place are not part of the health care reform conversation?
It is reasonable to pay taxes and buy insurance. It is not reasonable that the health care industry unjustly benefits from the natural circumstances of life.

[dewolf]

Originally Posted by Gogar

Ok so I admittedly am very new to this.

I went to the dermatologist to get a mole removed from just above my ear, in my hairline.

It wasn't a mole, it was a "something or other, no big deal. Very common." 15 minute visit.

They ran my high deductible UHC card and admitted it would probably not cover much.

No problem. I have a HSA with plenty of dough ready to go.


So far here is what has trickled in.

$165.92 - New Patient Visit.
$90 - Cauterize and remove the thingy.
$178 - Pathologist examine the thingy.

Total so far = $453.92.

Is this in the zone? Thanks. I just can't believe it but again I don't have much experience at the doctor.

Wow, I just had a similar thing done but on my back. Had four stitches with a path report. AU$66.00

[cashflyer]

Sounds like something that could have been handled in the shop with grain alcohol, diagonal cutters, and a soldering iron. All of these are things I keep on hand in my shop, and my shop rate is only $90/hr.

[Shaun @ Tru6]

^^^

Either that or some rope, a ball gag, cigarette and a camcorder (for posterity) would do the trick.

[Noah930]

^^^^ You taking off a mole? Or making some kinky porn there?

[Shaun @ Tru6]

Originally Posted by Noah930

^^^^ You taking off a mole? Or making some kinky porn there?

Think about it, he could be MAKING money off of the procedure.

[Les Paul]

It's easy to make jokes but the reality is one of those biopsys saved my ass. I retired in 09 with a Cadillac insurance plan. I think it was 10 deductible 90% on anything. I was the poster boy for skin trouble to say the least. Lifeguard, ran without a shirt for 35 years, went to the beach, etc. It all started that year when I went in for some places on my back. Standard slice, dice, cut, burn, freeze and no more sun. Standard 6 month appointments sailing along. Then I had a small mole on the back of my neck that started actually hurting 24/7. I went in and told my doc this one hurts. She said looks like a bla, bla, bla. We'll biopsy anyway. Ten days later I get the call. Are you sitting down? Yep. You have melanoma. Not one of those things you want to hear. Did the surgery along with removing several lymph nodes in my neck. They then tell me stage 4. I had no idea what that meant but the oncologist told me to get my life business in order you have an 80% chance of getting one of the major cancers. Brain, liver, bone, lung. WTF? Long story short I got 356 ready for some road trips. Went to Rennsport IV in California a 5,000 trip. All the while this dark cloud hangs over everything. The way it works is 80% chance of one of those cancers the first year and like a bell curve the longer you make it the better the odds. And here I am knocking on wood every day. Hell I get nervous about mosquitoes bites now�� My point don't ignore those spots.

[john70t]

Originally Posted by dewolf

Wow, I just had a similar thing done but on my back. Had four stitches with a path report. AU$66.00

Be safe out there.

https://en.wikipedia.org/wiki/Skin_cancer_in_Australia
"Skin cancer in Australia kills over 2,000 each year, with more than 750,000 diagnosed and treated
Australia spends more than $2 billion annually treating cancer,"

https://www.quora.com/Why-is-there-a-hole-in-the-ozone-layer-over-Australia
"Currently (February 2017), there is no ozone hole over the Antarctic either. It closed in December of 2016, and usually closes at the same time every year.
...
An ozone hole, of some size and depth, forms in late winter thru early spring over EACH pole and has for 500 million years."

Ozone hole over Antarctica expands to near-record levels, now four times size of Australia - ABC News (Australian Broadcasting Corporation)
"Scientists from the UN said the increase was due to colder-than-usual temperatures, rather than any extra damage being done to the Earth's protective layer.
...
The hole in the ozone layer above Antarctica has been carefully monitored for over 30 years."

[bpu699]

Originally Posted by ejfbmw

Yes, our insurance companies negotiate payment on our behalf, that is what we pay them to do for us. But what is the actual price charged by the provider for medical goods and services based on? What is driving the prices charged by the providers, and this included the pharmacals, for goods and services? We now, by law have to buy medical insurance, and the insurance companies, by law, have to pay our medical bills. Then the insurance companies increase the price of medical insurance to cover payments for medical goods and services. But the real issue is the outrageous prices charged by medical providers for goods and services in the first place. Why is this not discussed? Why are the wages, benefits and perks enjoyed by the health care industry employees untouchable? Why are the prices charged by heath care industry contractors untouchable? Recently an allergy nasal spray cost $112 and six months later $234. Why? This spray is the most popular one out there right now. Is there a shortage? Probably not. A lawyer once told me it was an insurance companies job to only pay out what they, the insurance company, could be legally required to pay. OK, I get that, that makes sense. But what doesn’t make sense is why the high prices charged by the medical industry providers of goods and services in the first place are not part of the health care reform conversation?
It is reasonable to pay taxes and buy insurance. It is not reasonable that the health care industry unjustly benefits from the natural circumstances of life.

Costs are out of control... true...

Yet, most hospitals are barely staying afloat, margins of 2-3 % are considered pretty good. In any other business, that pretty lousy...

Most hospitals are cutting staff, hours, etc.

I work in healthcare... There are huge shortages of doctors looming. Anyone checked the wait to get services lately?

The issue isn't in the minutia. Its in the big details. Providing cutting edge care, to everyone, is unsustainable. Everyone gets pretty much the same unlimited healthcare, regardless of ability to pay. Many, never pay a dime.

For the system to survive, those that can pay, carry the cost for those that can't. Not fair, but that's the set up...

No solution, I am afraid...

Used to be optimistic, but now 90% sure we will have socialized healthcare soon.

[Tobra]

Originally Posted by ejfbmw

Yes, our insurance companies negotiate payment on our behalf, that is what we pay them to do for us.

That is among the things they are paid to do, but it benefits them at least as much, and probably more, to get a good price.

Originally Posted by ejfbmw

But what is the actual price charged by the provider for medical goods and services based on? What is driving the prices charged by the providers, and this included the pharmacals, for goods and services?

RBRVS is the basis for determining prices, for the most part

Originally Posted by ejfbmw

We now, by law have to buy medical insurance, and the insurance companies, by law, have to pay our medical bills. Then the insurance companies increase the price of medical insurance to cover payments for medical goods and services. But the real issue is the outrageous prices charged by medical providers for goods and services in the first place. Why is this not discussed? Why are the wages, benefits and perks enjoyed by the health care industry employees untouchable? Why are the prices charged by heath care industry contractors untouchable?

What is charged is not what is paid. It is not discussed by anyone in the know because it does not have much to do with costs.

Originally Posted by ejfbmw

Recently an allergy nasal spray cost $112 and six months later $234. Why? This spray is the most popular one out there right now. Is there a shortage? Probably not. A lawyer once told me it was an insurance companies job to only pay out what they, the insurance company, could be legally required to pay. OK, I get that, that makes sense. But what doesn’t make sense is why the high prices charged by the medical industry providers of goods and services in the first place are not part of the health care reform conversation?

You don't have a very good understanding of this subject

Originally Posted by ejfbmw

It is reasonable to pay taxes and buy insurance. It is not reasonable that the health care industry unjustly benefits from the natural circumstances of life.

Life is hard, especially if you are angry and don't understand why.

Will you be happier when we go to the single payer system that Obamacare was designed to give us after it fails? If you pay more and have to wait longer for care, will you be more satisfied with the knowledge that it is impacting most people, so the suffering is spread out more?