What Are You Thinking About v.CC

[LETSGOBROWNIES]

 

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Your arguements are shallow. Since they can be made with any proce point. Could be 4 million for stiches “hey i didnt show up at your door.” Its one thing to gouge price a product its another to gouge for a life saving treatment.

Or, instead of going to an ER for a dislocated thumb, you go to an urgent care. 

If you have insurance, which was mandatory for years until recently, you either had a copay or deductible for an ER visit.  Many folks, especially young dudes, never take the time to actually read their insurance policy and are then shocked to find out what things cost when they actually happen. The fact that they never saved for healthcare, or never bothered to learn their treatment options, is then a systemic problem.

I’ll leave that there as to keep the discussion about insurance and healthcare, not politics.

[LETSGOBROWNIES]

1 hour ago, jrry32 said:

Healthcare doesn't work like other industries. Consumers can't compare prices.

You can’t compare prices for insurance and compare the policies?  My insurance company has a cost estimator tool that allows you to compare MD’s and facilities in your area on their website, free to use.

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Consumers don't have the knowledge to make intelligent decisions.

I’d argue that’s a choice. You can read your policy, understand what your responsibility would be a financially prepare for that.

The fact that someone decided today is the day to go to an ER for back pain they’ve been dealing with for 6 months, an STD check or a cold (all of which happen REGULARLY)is their bad decision and isn’t my fault, or the hospital’s or the insurer. If I called a 24/7 HVAC worker to my home off hours to change the setting on my thermostat, who’s fault is it when I get the bloated bill? I’m those situations I could have figured it out myself (a cold) or chosen more cost effective options.

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And consumers rarely have legitimate choices. Plus, the barriers to entry are massive. I can't open a hospital in my garage. It's why the industry can get away with such exorbitant and ridiculous pricing. There isn't choice. There is limited ability to truly compete on prices.

Yes and no.  There are tons of treatment options, not everything requires an ER, but that’s a lot of people’s default option. PCP, specialists, urgent care, convenience care clinics (CVS MinuteClinic for example), virtual visits (Teledoc for example) and even free nurselines provided by your insurer to help you decide which is appropriate. Sometimes that is an ER, but that’s a small percentage. 

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In what other industries can you do that? I bet the ones you can name lack legitimate competition. "Oh, you didn't like your sandwich? Well, you showed up at my restaurant. I didn't show up in your kitchen." This is only further proof of all the problems with the healthcare industry.

I’m not saying there aren’t issues, and discussing them is hard without heading into forbidden territory. But my point is simply that in many cases people don’t take the time to educate themselves to their different treatment options (the “competition”) nor do they understand their financial obligations as it relates to their insurance. Every one of us can look at our insurance plan and we’ll know right now what an ER visit will cost, what our responsibilities are, etc.  There shouldn’t be a shock when you see the price, and in most cases (insured) the total cost is irrelevant as that’s not entirely your responsibility. Your deductible and out of pocket cost is the same whether the bill is 10k or 200k

[ramssuperbowl99]

2 hours ago, LETSGOBROWNIES said:

 But my point is simply that in many cases people don’t take the time to educate themselves to their different treatment options (the “competition”) nor do they understand their financial obligations as it relates to their insurance.

This is set up by design, as is the "bill everything you can and put the onus on the customer to repeatedly complain" mindset seen in most large health insurance companies. In each case, the goal is to write off expenses they would be required to pay in a well-functioning system.

2 hours ago, LETSGOBROWNIES said:

 But my point is simply that in many cases people don’t take the time to educate themselves to their different treatment options (the “competition”) nor do they understand their financial obligations as it relates to their insurance. Every one of us can look at our insurance plan and we’ll know right now what an ER visit will cost, what our responsibilities are, etc.  There shouldn’t be a shock when you see the price, and in most cases (insured) the total cost is irrelevant as that’s not entirely your responsibility. Your deductible and out of pocket cost is the same whether the bill is 10k or 200k

Unless you have to have blood work done with samples shipped or are referred anywhere or see a specialist in that same hospital who may be in a different unit with completely different levels of coverage. And, if it's a real emergency, the expectation of our system is that the patient needs to be actively managing and potentially delaying their care to ensure confirmation of in-network status at every single hand off throughout their stay instead of focusing on getting better. That includes secondary or tertiary handoffs where they might not even be directly consulted.

That is insane.

Edited February 19, 2018 by ramssuperbowl99

[LETSGOBROWNIES]

15 minutes ago, ramssuperbowl99 said:

This is set up by design, as is the "bill everything you can and put the onus on the customer to repeatedly complain" mindset seen in most large health insurance companies. In each case, the goal is to write off expenses they would be required to pay in a well-functioning system.

Such as what? Most issues where insurers don’t cover “normal” stuff is due to lazy billing practices by the provider (incorrect diagnostic codes, not allowing enough time for prior auths, not meeting authorization requirements, etc).

15 minutes ago, ramssuperbowl99 said:

Unless you have to have blood work done with samples shipped or are referred anywhere

You can ask where they ship samples to and find an in network lab.  All you have to do is ask and verify.  

15 minutes ago, ramssuperbowl99 said:

or see a specialist in that same hospital who may be in a different unit with completely different levels of coverage.

Typically this only applies to anesthesia and ER MD’s, and yes, it’s awful, I agree.

15 minutes ago, ramssuperbowl99 said:

And, if it's a real emergency, the expectation of our system is that the patient needs to be actively managing and potentially delaying their care to ensure confirmation of in-network status at every single hand off throughout their stay instead of focusing on getting better. That includes secondary or tertiary handoffs where they might not even be directly consulted.

That is insane.

I don’t disagree.  I never said it was perfect, but a lot of the issues people have are avoidable. This isn’t exactly what was being discussed here, but your point is valid nevertheless.

[cddolphin]

2 hours ago, LETSGOBROWNIES said:

You can’t compare prices for insurance and compare the policies?  My insurance company has a cost estimator tool that allows you to compare MD’s and facilities in your area on their website, free to use.

You can't compare prices of services. If you're footing a pre-set portion of the cost, there should be price transparency. There is none.

[LETSGOBROWNIES]

21 minutes ago, cddolphin said:

You can't compare prices of services. If you're footing a pre-set portion of the cost, there should be price transparency. There is none.

If the provider is in network, the cost of the service is already determined. 

Ask for the cpt code and call your insurer and they’ll tell you at any time.

[LETSGOBROWNIES]

28 minutes ago, cddolphin said:

You can't compare prices of services. If you're footing a pre-set portion of the cost, there should be price transparency. There is none.

And I wanted to double check before stating so, but the tool I’m referencing does show cost of services, as well as how much will be covered per my plan. 

[ramssuperbowl99]

2 minutes ago, LETSGOBROWNIES said:

I don’t disagree.  I never said it was perfect, but a lot of the issues people have are avoidable. This isn’t exactly what was being discussed here, but your point is valid nevertheless.

You'll know more about specifics on billing codes and chains of communication than I do, but my understanding is that the (overwhelming?) majority of errors are made in ways that increase the obligation to the patient.

Regarding sample shipments, my understanding is that hospitals aren't nearly as judicious as they should be regarding those releases, which to be fair is difficult given the number of draws a patient might have or different places samples need to go. I am a little more familiar (though, again, probably not as much as you) with sample management and it's a nightmare. Checking every single time is, realistically, a massive burden that is currently placed on patients.

 

To distill this down, you're saying "it's on the patient to know the ins and outs of their policy, and to set their healthcare up in a way that reduces their costs". True. That's the rules of the game we've set up.

But other people are commenting that the game is absolutely ruthless when people don't play it exactly the right way, which is a fair criticism. And jrry has outlined that it's really not in human nature to play this game during high stress, emergency medical situations (which may or may not be emergencies to medical professionals, but are going to influence patient decision making nonetheless). I'd add that even if you do play the health insurance game, and play it right, it adds additional stress which absolutely has a negative impact on outcomes.

The corporate term to describe this would be "room for improvement".

 

[cddolphin]

19 minutes ago, LETSGOBROWNIES said:

Ask for the cpt code and call your insurer and they’ll tell you at any time.

So you're saying it's a simple matter of getting the CPT code from the hospital ahead of requesting the service? Just to be clear.

[eagles101]

And we have found the problem with the health care in america. “Welp i guess its your problem you dont understand the extremely complicated thing that i only understand because i deal with it literally everyday” 

[LETSGOBROWNIES]

7 minutes ago, ramssuperbowl99 said:

You'll know more about specifics on billing codes and chains of communication than I do, but my understanding is that the (overwhelming?) majority of errors are made in ways that increase the obligation to the patient.

To some degree yes, you have to know who is charging what and how they’re billing it ahead of time and if you need prior authorization for coverage.  A PIA, no doubt, but doable for all non emergencies, which how most stuff is done.  

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Regarding sample shipments, my understanding is that hospitals aren't nearly as judicious as they should be regarding those releases, which to be fair is difficult given the number of draws a patient might have or different places samples need to go.

In a hospital setting most samples are run in-house. Outpatient is a different animal.  Outpatient is all preplanned though.

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I am a little more familiar (though, again, probably not as much as you) with sample management and it's a nightmare. Checking every single time is, realistically, a massive burden that is currently placed on patients.

Can’t argue that, huge burden (potentially).

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To distill this down, you're saying "it's on the patient to know the ins and outs of their policy, and to set their healthcare up in a way that reduces their costs". True. That's the rules of the game we've set up.

But other people are commenting that the game is absolutely ruthless when people don't play it exactly the right way, which is a fair criticism.

It’s unforgiving at times, I can’t argue that, but so is life in general.  “I had no idea I couldn’t get a good paying job with my art history degree, now I’m 100k in student loan dept.

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And jrry has outlined that it's really not in human nature to play this game during high stress, emergency medical situations (which may or may not be emergencies to medical professionals, but are going to influence patient decision making nonetheless).

In an actual emergency, you bet.  If you don’t know the difference, learn to ask.  If you have insurance with Anthem, UHC, Humana, etc you have 24/7/365 access to a nurse line free of charge to help with these decisons.  

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I'd add that even if you do play the health insurance game, and play it right, it adds additional stress which absolutely has a negative impact on outcomes.

The corporate term to describe this would be "room for improvement".

 

I completely agree, but it’s pretty hard to make everyone agree to one specific set of contracted rates for services.  

[LETSGOBROWNIES]

3 minutes ago, cddolphin said:

So you're saying it's a simple matter of getting the CPT code from the hospital ahead of requesting the service? Just to be clear.

For non-emergency services, yes.

[LETSGOBROWNIES]

2 minutes ago, eagles101 said:

And we have found the problem with the health care in america. “Welp i guess its your problem you dont understand the extremely complicated thing that i only understand because i deal with it literally everyday” 

The fact that you haven’t bothered to educate yourself on the matter doesn’t then make it someone else’s problem, whether it’s healthcare or anything else.

Ignorance is usually expensive.

Is it complicated? Yes.  Is it ruthless? Yes, at times.  I’m not arguing otherwise.  I’m saying a LOT of the issues most people have with healthcare can be avoided with some research, planning and using resources provided.

[cddolphin]

2 minutes ago, eagles101 said:

And we have found the problem with the health care in america. “Welp i guess its your problem you dont understand the extremely complicated thing that i only understand because i deal with it literally everyday” 

American Medical Association, American Hospital Association, Big Pharma, and Blue Cross combined spend 1.38 billion yearly on lobbyists.

That's $2.58 million per elected congressman.

[ramssuperbowl99]

1 minute ago, LETSGOBROWNIES said:

The fact that you haven’t bothered to educate yourself on the matter doesn’t then make it someone else’s problem, whether it’s healthcare or anything else.

Ignorance is usually expensive.

Is it complicated? Yes.  Is it ruthless? Yes, at times.  I’m not arguing otherwise.  I’m saying a LOT of the issues most people have with healthcare can be avoided with some research, planning and using resources provided.

You're arguing a different point than what you're responding to. You're saying "that's the rules" and people are responding saying "it's silly to set a system up that way". 

It's "what is" versus "what should be".