They’ll just flip it back on their customers in a med zone.
Hopefully they have a good delivery coverage plan to cover that.
3 Likes
Right? It’s called taxes, dipshits, look it up.
People are assholes.
Yes. My kid is a curse… /s 
Yeah. The coverage we get is okay, but I’m lucky that everyone in my family is relatively healthy with no pre-existing… I had to have surgery for my nose not long ago, and we thought it might turn into us having to pay $20,000 or so, as the insurance co decided that it wasn’t necessary though my doctor disagreed with their assessment, so they fought it, but that would have sucked.
10 Likes
Yeah, they do that. That’s why I went to Canada for gender confirmation surgery. I had to pay out of pocket, and the favorable exchange rate at the time saved me about $5,000. I don’t even know if my current insurance would have covered that. It might have, but I’m also going to a law school at a Catholic university, so maybe not.
12 Likes
It’s really simple peeps. This is exactly what to expect from a healthcare industry. We do not have a healthcare SERVICE here in the USA, a 3rd world country
6 Likes
I suspect that you don’t need all the staff: my understanding (which has held true in the thankfully-not-all-that-frequent brushes with medical care) is that there is a significant separation of labor between the doctors and nurses and similar on the patient care side and the billing and coding specialists who perform the transmutation of the records of what procedures were performed into the actual bill. In the case of the doctors I’ve dealt with personally, the only one that had a fairly strong sense of exactly how his write-up of the session was going to translate into a bill/request-to-insurer was a psychologist in small private practice who simply didn’t have any back office handling that for him. The others were willing to be candid about what they were coding/let me shoulder-surf as they fought with the EMR software disaster; but openly professed to be unable to tell me what was going to come out of the billing side of the house.
This isn’t to say that the patient care side people are all ethically stainless and it’s just the sinister cabal in the back office; but it is the case that you don’t necessarily need to force them, especially not all of them, a few ethically flexible maximalists probably don’t hurt, into writing cases up in ways they feel are ethically troubling lies in order to produce a bill that they would probably find…tenuously related…to the services they actually performed.
Conveniently, from the perspective of management, medical billing and coding (while a matter of nontrivial subject-area expertise that does have expected training/coursework and certification paths) is a significantly shorter course of study, pays less, is less prestigious; and is otherwise more amenable to pressure than a lot of the jobs on the care side, especially MDs, particularly those with specialist qualifications in some area.
That said, there are also the egregious cases where the doctors aren’t just on board; but are more or less active conspirators: specifically, when an out-of-network doctor embeds himself in an in-network hospital and acts like a normal agent of the hospital until you suddenly get the bill from a 3rd party entity that rendered services in the hospital you thought you were dealing with.
4 Likes
Undeniably true; but also a rather sick side effect of the fact that (de-facto) tying of insurance to employment creates additional perverse incentives: in large outfits (I’m sure it’s a thing industry-wide, but the example that comes to mind involved IBM) HQ knows that the rate they are paying to provide whatever the employee health plan is depends on the demographics of the employees so there’s an incentive to factor that in to any headcount-reduction schemes you may be running since you’ll save money by culling older and sicker people. In small outfits you don’t get as much of the ‘on average’ thinking; but you get the much more direct “If your colleagues know that you have an expensive condition or a kid with cancer or something they also know that you are probably a nontrivial factor in what the health plan costs”.
Some people are just assholes to the core(at least until something happens to them; and they’ve no longer got theirs…); but the smaller the risk pool the bigger and more visible the impact of a specific person and the greater the likelihood of direct resentment of someone who is probably at least an acquaintance.
With a nation-level health scheme people can certainly still grumble about people with lifestyles they consider less physically and morally virtuous than theirs, or high-profile reports of some exotic 7-figure treatment for a rare disease; but it’s a lot harder to get worked up about any specific case when it’s divided across millions of people in a risk pool that also includes plenty of healthy and inexpensive cases.
If the risk pool is under a thousand, though, the idea that a specific person you are aware of is having a measurable impact on you is both more plausible and more emotionally salient. Under 100 even more so.
You’ll always have the types who are all eugenics and sacrifice-the-weak, at least as long as they are young and healthy; but employer healthcare setups are a much, much, worse case in terms of making people who would glaze over and chill out if presented with a big number take things personally instead.
2 Likes
Doesn’t mean they’re not assholes. It’s not an either/or situation. People who are unwilling to abandon our for-profit health care system, for whatever reason, are just assholes. i’m tired of pretending like this is an issue where both sides are just as reasonable. They’re not.
10 Likes
“How are we going to pay for it?”
Scream it from the rooftops:
WE ALREADY DO
Hospitals “up-charge” because they know THEY WILL BE PAID. Maybe not exactly the billed amount, but something.
If you have any health insurance of any sort, some part of what you pay, some tiny fraction of a cent, goes to my healthcare. And my wife’s. And my mother’s. And your mother’s. And the people in your neighborhood.
If you pay taxes to the state or federal government, it’s the same story. Medicare and Medicaid don’t operate in a vacuum.
WE - the citizens of the country and anyone else who gets healthcare here - ALREADY PAY FOR ALL OF IT.
13 Likes
A friend of mine does data analysis for a major hospital, and has done the same for two others. He flatly states that no one has any idea of any correlation between work/services/supplies and what is billed and what ends up being paid. The simply have no clue. The decisions on what to charge are based on arcane connections between what the hospital needs to bring in to cover its costs and what they expect to receive from insurance companies and the government. To ask why it charges x dollars per hour for an anesthesiologist is to be met with blank incomprehension. The so called market forces that drive what medical providers get paid are divorced from patients completely.
13 Likes
By providing them with insurance, pay, and enough steps in the system to provide plausible deniability to themselves. You take a roomful of desperate people and tell them that all births are coded xyz. That goes to a different roomful of people who attach xyz to a dollar amount. That gets sent off to a third person and on down the line. The closer you are to interacting with a patient the less you are allowed to be clear on the cash value and the other way as well. All of my friends involved in medical billing are terrified of losing their insurance.
4 Likes
Yep.
Going in for surgery, great. It’s covered, the surgeon is in-network, good. All the meds necessary are covered, awesome.
Have surgery, recover, go home, 5 weeks later bill comes in the mail. Everythibg is covered except “Anesthe|” cutoff or abbreviated on the bill. Costing like $45,000.
Oh, it turns out the anesthetist who is integral in making this surgery even possible, is not in network and wants to be paid too.
Honestly, in situations like these, I feel either the anesthetist or the hospital should just eat the bill.
It’s impossible to have a market with no prices listed. Anyone who says healthcare is or should be a market is either an utter fool, or psychopathic.
14 Likes
Another case of this:
5 Likes
And then some. Everybody in the chain has to make a profit.
9 Likes
It must be fraud. The hospital is taking money out of the pockets of the shareholders and executives of the insurance companies. /s
That is a stunningly wrong take on the problem.
You’re still thinking in US terms.
In single payer, the company bills the government, and if they overbill the government will deal with it. There is much less chance of that because the hospital doesn’t present a bill for every aspirin and cotton swab.
I as a patient see none of this, and there’s no way I can “play a role in causing the overbill”.
7 Likes
It’s not quite as good here in Canada. The gougers at the hospital charge for parking, which for a typical childbirth can total upwards of $50. And good luck finding a space on the side streets.
4 Likes
I’ve now put the /s in. But isn’t the way it is in the land of the free that the shareholders and ‘job-creators’ are the most important people in consideration of anything. /s
2 Likes
Wait… babies can DRIVE in Canada?
5 Likes
Only with a government-approved car seat. Our freedoms are not absolute.
8 Likes
