# Another pitting of the US health ”care” system **URL:** \ **Category:** The BBQ Pit\ **Created:** [July 26, 2022, 11:00am UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581 "2022-07-26T11:00:55Z")\ **Posts on this page:** 20\ **Page:** 16
**Author:** ![Atamasama](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/atamasama/32/12961_2.png) [@Atamasama](https://boards.straightdope.com/u/Atamasama)\ **Post date:** [July 19, 2024, 6:54pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/301 "2024-07-19T18:54:49Z")
> [@psychobunny](#): > > W56.21XA-bitten by orca, initial encounter (no explanation why bear bites are by mammal not otherwise specified but orcas are singled out with their own codes) That’s to ensure people get treatment to avoid becoming wereorcas. Werebears and even werewolves are fictional but wereorcas are a growing problem. I think treatment includes ivermectin and a bleach injection but I’m not a doctor so don’t bank on it. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [July 24, 2024, 9:35pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/302 "2024-07-24T21:35:01Z")
> [@psychobunny](#): > > S09.90XA/Y93.T1-injury to head and face caused by injury while riding a roller coaster > > T61.8X2A-toxic effect of other seafood intentional self-harm initial encounter (this is the code for eating improperly prepared fugu) Well, the roller coaster thing could be due to negligence on the part of the amusement operator, so not NECESSARILY a jackass thing. On the seafood self-harm: “Initial encounter”. Is there another code if you do it TWICE??? > [@psychobunny](#): > > Z20.3/W55.81XD- bitten by rabid fox (technically, exposure to rabies caused by the bite of a mammal not otherwise specified, subsequent encounter). Is there a different code for “bitten by a fox that is SUSPECTED to be rabid”? I mean, hopefully if you’re bitten by a wild animal, you get medical care right away, rather than waiting for it to be caught and tested, right? ---
**Author:** ![psychobunny](https://avatars.discourse-cdn.com/v4/letter/p/54ee81/32.png) [@psychobunny](https://boards.straightdope.com/u/psychobunny)\ **Post date:** [July 24, 2024, 9:45pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/303 "2024-07-24T21:45:57Z")
It’s the same code for suspected exposure to rabies. In this case, the fox was killed and a necropsy done immediately and by the time I saw her the diagnosis was definite ( she initially went to the ER). Also, fugu is not always fatal. You can get a small dose of neurotoxin which can cause mild symptoms but not kill you so you definitely could try it twice, but each time it is the initial physician encounter for that episode. ---
**Author:** ![Cervaise](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cervaise/32/16693_2.png) [@Cervaise](https://boards.straightdope.com/u/Cervaise)\ **Post date:** [August 21, 2024, 1:43pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/304 "2024-08-21T13:43:18Z")
Bump with a news item. If you’ve ever been curious about what would happen if the vampire-capitalist techniques that fucked up Red Lobster were applied to a hospital system, wonder no longer. > **[CEO of failing hospital chain got $250M amid patient deaths, layoffs, bankruptcy](https://arstechnica.com/science/2024/08/as-hospitals-failed-and-patients-died-ceo-reportedly-netted-250m/)** > > Steward Health Care System, run by CEO Ralph de la Torre, filed for bankruptcy in May. It’s almost exactly the same Red Lobster playbook, from selling the land under the hospitals and turning them into renters to offloading managerial expenses to consultation firms owned by the executive class. It’s just applied to the medical-care industry instead of a restaurant chain. Warning: Do not click and read unless you have a _very_ high tolerance for boiling blood. ---
**Author:** ![Mighty\_Mouse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mighty_mouse/32/7776_2.png) [@Mighty\_Mouse](https://boards.straightdope.com/u/Mighty_Mouse)\ **Post date:** [August 21, 2024, 4:30pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/305 "2024-08-21T16:30:06Z")
My wife works for a company that provides non-medical services to hospitals. Her employer has refused to send people to Steward owned hospitals for many years. Because they never pay. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [August 21, 2024, 7:52pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/306 "2024-08-21T19:52:30Z")
This may account for some of the poor healthcare outcomes in Louisiana. ---
**Author:** ![excavating\_for\_a\_mind](https://avatars.discourse-cdn.com/v4/letter/e/e8c25b/32.png) [@excavating\_for\_a\_mind](https://boards.straightdope.com/u/excavating_for_a_mind)\ **Post date:** [August 22, 2024, 6:48pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/307 "2024-08-22T18:48:40Z")
A pile-on. Skipping the background, in June I had a blood draw requested by my cardiologist scheduled for Aug 20, at 9AM, in the morning because I have to be fasting for 12 hours. At 8 AM on the 20th, they call me saying they have to re-schedule because the nurse who is to draw my blood is not there. No biggie, they re-schedule for 9AM on the 22 (today). On the 21st (yesterday, the day after they cancelled and re-scheduled), they call me at 2PM (no message, no nothing) and again at 3PM (left a message simply saying to call them). I was busy shopping, driving all over town when they called. When I got the message, I called them back and get stuck in a call-queue, listening to a helpful notice telling me that patients who cancel 3 appointments will be dropped from their patient list and will be charged $100 to re-enroll. After about 5 minutes on hold, I get re-scheduled for 9AM tomorrow, the 22nd. Oh, did I mention that for the two previous appointments, I got numerous texts, e-mails, and urgent messages on their patient portal notifying me that the appointments had been made and then reminding me of my those appointments, wanting me to “check-in”, but none notifying they had been canceled? Guess who is never going to get a confirmed appointment, again? Whew… I feel better, anyway. My gripe is, in what other service industry would this behavior be tolerated? If you had a haircut appointment, for example, and they called you up to say they had to cancel, you might say, OK, let’s re-schedule. If, right before that new appointment, they called again to cancel, I’d be thinking I need a to find someone else to cut my hair. If your insurance agent called you and arranged for an appointment at his office to review your coverage on Tuesday morning, but canceled at the last minute, but re-scheduled for Thursday. You might say, fine. If, on Wednesday afternoon, he called to cancel again, it would be time to find another insurance agent. In both of the above cases, the Libertarians would say, that’s how the Free Market is supposed to work. Services that make things easier for their customers will flourish while those that don’t will fade away. But with medical (and it seems, dental, too) offices, that doesn’t apply. The reason? You aren’t the customer. No, the insurance company is the customer, you are only the product. Product to be processed by the system in order to be able to bill the insurance company. It’s all set-up to be convenient for the insurance company, not the patient. Convenience for the patient? A waste of effort, time, and, of course, money. Want a kick in the head? They just called cancelling tomorrow’s appointment. They want to re-schedule again. In two weeks. I wish I was kidding. I am not. ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [August 22, 2024, 6:51pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/308 "2024-08-22T18:51:16Z")
Why do you need a particular nurse to do a blood draw? Can’t you just go to the clinical lab at the hospital and have an outpatient phlebotomist do it? ---
**Author:** ![excavating\_for\_a\_mind](https://avatars.discourse-cdn.com/v4/letter/e/e8c25b/32.png) [@excavating\_for\_a\_mind](https://boards.straightdope.com/u/excavating_for_a_mind)\ **Post date:** [August 22, 2024, 7:10pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/309 "2024-08-22T19:10:06Z")
Good question. If I was a customer, they might answer it. As it is, it is like a head of lettuce trying to ask the grocer if they have to be put on the top of the pile. Honestly, my guess is that if it is done at the hospital, the hospital would get the money from the insurance, not the clinic. They have to do it at the clinic because, you know, maximize profits! I dealt with a similar issue with my wife. She is seeing a specialist whose office is about an hour and a half away. She only has to see him once a year, or so. At first, however, she would go to an appointment, have her blood drawn, then wait to have the Dr. tell her to come back next week so he can review the results with her. Of course, we’re talking about three hours worth of traveling, plus the time in the office, so at least a half-day off work, then another one in a week. So, I ask her to see if the Dr. will let a local clinic draw the blood, so that he will have the results for the appointment. Per my wife, he hems and haws and finally says, OK. It’s all about the money. It has nothing to do with health care or concern about another individual. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [August 22, 2024, 7:14pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/310 "2024-08-22T19:14:27Z")
> [@excavating\_for\_a\_mind](#): > > Good question. If I was a customer, they might answer it. As it is, it is like a head of lettuce trying to ask the grocer if they have to be put on the top of the pile. Ask your doctor. Your doctor only cares a little about the billing, and will probably both answer you and write the paperwork for you to get the blood drawn elsewhere. (And if your doctor cares more about the revenue from one blood test than about your health, try to find a new doctor.) ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [August 22, 2024, 7:17pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/311 "2024-08-22T19:17:21Z")
Even better than going to the outpatient clinical lab at the hospital, you should certainly be able to go to a Quest or Labcorp clinic, both of which are located all over the place. Not sure who’s paying but I think the actual cost for a blood draw is cheaper at those places rather than the clinic or hospital. ---
**Author:** ![Mighty\_Mouse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mighty_mouse/32/7776_2.png) [@Mighty\_Mouse](https://boards.straightdope.com/u/Mighty_Mouse)\ **Post date:** [August 22, 2024, 8:05pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/312 "2024-08-22T20:05:30Z")
> [@puzzlegal](#): > > Ask your doctor. My doctor will say he cannot do anything about the administrative and billing processes. And before anyone says change doctors, my daughter is transitioning from pediatrics to adult primary care. She has made dozens of calls and filled out untold number of online forms. The calls result in “we have no doctors taking on new patients” and the web forms seem to go nowhere. All you get is an acknowledgment that you submitted a form. Five months later she has not been able to find a PCP within 15 miles in one of the most densely populated parts of the country. ---
**Author:** ![Max\_S](https://avatars.discourse-cdn.com/v4/letter/m/46a35a/32.png) [@Max\_S](https://boards.straightdope.com/u/Max_S)\ **Post date:** [August 22, 2024, 8:55pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/313 "2024-08-22T20:55:15Z")
> [@excavating\_for\_a\_mind](#): > > But with medical (and it seems, dental, too) offices, that doesn’t apply. The reason? You aren’t the customer. No, the insurance company is the customer, you are only the product. Wrong. The reason is because the number of cardiologist outfits is vastly smaller than the number of hairdressers or insurance agents, so you, the customer, are less inclined to go to the trouble of switching. You are more attached to the one you have because there may be only one or fewer competitors you can reasonably switch to. ~Max ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [August 22, 2024, 9:00pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/314 "2024-08-22T21:00:47Z")
> [@Dewey\_Finn](#): > > I remember reading a study from, I think, the Harvard School of Public Health that hospitals and clinic spend twenty percent of their budget on billing and working with the various insurance companies. Meanwhile the insurance companies are searching for ways to deny coverage. Some of that overhead would be reduced (though perhaps not eliminated) in a single-payer system. Sorry for the delayed response to this old post, but I haven’t visited this thread in quite some time. I nevertheless feel a need to plug single-payer health care again in response. The US has the highest per-capita health care costs of any industrialized country in the world, and by a wide margin. Some of that is due to the inability to control provider costs, some to insurance industry profiteering, and some to inordinately high administrative costs. In terms of administrative costs, which includes billing and other non-clinical costs, the figures I’ve seen put them between 15% to 30% of the patient billing. I’m surprised it’s not even higher – doctors’ offices maintain clerical staff solely to deal with insurance companies and their paperwork, something that is non-existent in single-payer systems. In Canada, under single-payer, the paperwork I deal with as a patient when seeing a doctor or visiting a clinic or admitted to a hospital is precisely zero, unless you count them scanning my health card, which takes literally one second and is where the entirety of my financial interests in medical procedures begin and end. Since there is no co-pay or deductible and there is no “insurance company approval” required, the patient faces no bureaucracy and when the visit is done or when they’re discharged from hospital, they say “thanks” and leave. There is no possibility of a claims denial since (at least from a patient standpoint) there is no “claim”, just a fundamental principle of full universal coverage. Under private insurance, the patient in effect is paying for the “privilege” of allowing an insurance bureaucrat to review their claim and potentially reduce the payment or deny it altogether. That bullshit is where a lot of the 15-30% overhead comes from, and it’s completely counterproductive to doctor and patient alike, benefiting only the health insurer. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [August 22, 2024, 9:16pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/315 "2024-08-22T21:16:30Z")
> [@Dewey\_Finn](#): > > Why do you need a particular nurse to do a blood draw? Can’t you just go to the clinical lab at the hospital and have an outpatient phlebotomist do it? Forget that - why does the cardiologist apparently only have one staff person who can draw blood? My cardiologist practices alone, and has at least three people who can draw blood. Maybe I might have certain tests rescheduled because someone is out sick, but not a blood draw. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [August 22, 2024, 10:39pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/316 "2024-08-22T22:39:01Z")
My sister-in-law recently got a job in the receptionist bank at a large group practice near her home. It sounded like a work atmosphere that was beyond toxic (among other things, they wanted them to come in on Saturday on their own time, and that was the only time they wanted calls returned!) and there was a woman doctor who was really abusive to the whole staff. After working there a few weeks, she left for lunch and didn’t come back. ---
**Author:** ![excavating\_for\_a\_mind](https://avatars.discourse-cdn.com/v4/letter/e/e8c25b/32.png) [@excavating\_for\_a\_mind](https://boards.straightdope.com/u/excavating_for_a_mind)\ **Post date:** [August 22, 2024, 10:49pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/317 "2024-08-22T22:49:44Z")
No, you’re the one who is mistaken. Yes, the number of cardiologists in this area is less than the number of hairdressers. But, that isn’t the issue. The issue is the hairdresser (or insurance agent, or grocery store) are paid by the person being served. For anything medical (or dental), it’s the insurance company that pays the bill. Sure, you may pay a co-pay, depending on the policy, but it’s the **insurance company that supplies the cash that keeps the business afloat**. That’s why Drs offices suck at customer relations so bad. If they were that bad dealing with insurance companies, they’d go out of business. Look at the OP. A $20 brace on Amazon costs $75 at the supply store or $170 from the Dr. You know why? The med-supply store and/or Dr bills the insurance. If your insurance doesn’t cover the cost, and you complain to the med-supply store, they will drop the cost to maybe $40. They can’t match Amazon, since they have a higher overhead but are probably using the same supplier as Amazon. The Dr has to charge the $170 because he is getting it from the med-supply store. ---
**Author:** ![Max\_S](https://avatars.discourse-cdn.com/v4/letter/m/46a35a/32.png) [@Max\_S](https://boards.straightdope.com/u/Max_S)\ **Post date:** [August 22, 2024, 10:56pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/318 "2024-08-22T22:56:02Z")
> [@excavating\_for\_a\_mind](#): > > Sure, you may pay a co-pay, depending on the policy, but it’s the **insurance company that supplies the cash that keeps the business afloat**. You _almost_ have a point. So close! I think you’re leaving something out. If you go to a different cardiologist, the insurance company stops paying the former office. So, I say, you are still the customer. ~Max ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [August 22, 2024, 10:56pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/319 "2024-08-22T22:56:39Z")
> [@Mighty\_Mouse](#): > > > [@puzzlegal](#): > > > > Ask your doctor. > > My doctor will say he cannot do anything about the administrative and billing processes. So will mine. But if i can’t get my blood drawn at the first place he sends me, he’ll fill out the paperwork for me to get my blood drawn elsewhere. That precise situation has never come up, because my doctor practices at a hospital that has a phlebotomy department, and there are usually 3 people there drawing blood all day. But i have had trouble getting prescriptions filled, and he (or his nurse practitioner) just writes a new script for another place. That’s happened a few times. (I one asked him how much a flu shot would cost, and he replied he had no idea, and he practiced as an employee of a hospital so he didn’t have to know or care. He’s not into helping with billing. But he does help me actually get the care and tests i need.) ---
**Author:** ![Dr.Drake](https://avatars.discourse-cdn.com/v4/letter/d/ad7895/32.png) [@Dr.Drake](https://boards.straightdope.com/u/Dr.Drake)\ **Post date:** [August 22, 2024, 11:01pm UTC](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581/320 "2024-08-22T23:01:49Z")
That presumes the patient can easily go to a different cardiologist without having to pay the whole thing out of pocket, which none but the wealthiest could manage to do. This means: 1. You can’t change cardiologists without the prior approval of the insurance company and 2. You probably can’t anyway without disrupting the continuity of care, which (depending on your condition) could actually be fatal. I don’t think either of those things is a trivial point. [Previous page](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581.md?page=15) [Next page](https://boards.straightdope.com/t/another-pitting-of-the-us-health-care-system/968581.md?page=17)