Bit late, but I hope the OP didn’t pay the orthopedist’s bill. If the physician didn’t examine your child or do a telehealth consult, there’s no billable activity there.
Of course we paid it.
Billing for non billable activity is of course fraud. But as long as they are billing the patient not Medicare or the insurance company, who has the resources to fight this in court when they ruin your credit.
And insurance companies aren’t always in your corner. Over 30 years ago, I went to the ER after hurting my shoulder on the tennis court. This was before all this in-network, $3000 deductible bullshit “consumerism”, stuff.
The insurance company refused to pay because I “did not cooperate” in their attempt to claim reimbursement from the tennis facility. Which means they were not satisfied with my truthful answer that there was no collision with other players or equipment leading to my injury. I ended up paying off the $300+ five years later when buying a house because that judgement from the hospital was on my credit record. And my battle with the insurance company was still ongoing.
Huh. I fought a hospital once, and eventually the bill went away. I supported my insurance company in not paying a fraudulent claim. And i stopped going to a dentist who billed for stuff he didn’t do. He didn’t understand why i cared, since that was stiff the insurer paid for. But i didn’t like supporting fraud. (And it’s a lot easier to find a new dentist than a new doctor.)
I guess only one of those was a bill to me, but i did win it.
They’re almost never in your corner. But they are always in the business of making money and they have no interest in paying bills for treatment their insureds haven’t actually received.
With high deductibles that are in vogue these days, they aren’t paying, you are. The $50k claim they will fight to the [your?] death over. $500 that you are paying not so much.
Arguably true. But there are also insurance-adjacent people to handle this stuff. If you have an employer health plan, there will be a broker or third-party administrator with an ombudsman-type service to help with billing issues.
In any case, you don’t really need the insurance company to fight a bill for a medical visit you didn’t receive. What would you do if you got a bill from a hotel for a nonexistent stay? This is no different.
I think that depends on how much the person knows about medical billing. I ( or my insurance company) get billed by radiologists I never saw. I get billed by pathologists I never saw. I get billed by labs that I never went to. How am I going to know whether the specialist my PCP consulted with is allowed to bill me even though I didn’t see them?
People understand that that would be straightforward fraud. And your credit card company will probably take your side.
Medical billing is a morass of “colorable” claims that no layperson understands. For example Max_S’s chances of being convicted of something criminal by clicking a box on a webform are close to zero, even if that results in bogus bills. Maybe they get adjusted after many rounds of arguments with the patient, insurer or even regulators, but literally the worst that happens is that you don’t collect on some of your “aggressive” billings.
This made me curious about the situation here in Ontario, where of course we have single-payer health care. Brand-name prescription drugs are usually very much cheaper in Canada than in the US (sometimes like one-tenth the cost) but Paxlovid is only slightly cheaper.
One thing the govenment has done is explicitly authorize pharmacists to dispense Paxlovid on their own authority when certain conditions are met for confirming COVID. That basically means you can walk into a pharmacy for Paxlovid the same way you can for a COVID shot.
Paxlovid is on the Ontario Drug Benefit (ODB) formulary, but one of the shortcomings of our system is that unless you’re in one of the specified groups for ODB coverage, which includes seniors 65 or over, you’d need supplemental insurance for drug coverage, which is usually provided by the employer. But seniors (of which I am one) are likely to be in greater need of Paxlovid than younger folks. If I needed it, it would be free.
You may have to pay for the pharmacist to review your case, but pharmacists can prescribe Paxlovid in the US , too.
You may have to in the US, yes, but the Ontario government bulletin explicitly says there is “no cost” to the patient for the pharmacist prescribing Paxlovid, except for the usual small dispensing fee, which is sometimes waived anyway.
Pharmacists here (and probably in most US states, too) have the authority to prescribe drugs on their own authority, wherein they become “the prescriber of record”. But they’re often reluctant to do this, and when they do, it’s usually for small quantities intended to tide the patient over until they can see a doctor. The directive about Paxlovid puts it in a special category.
That’s pretty much the same here. CVS charges $60 for the consultation, which isn’t an unreasonable fee. The major problem with the program is that the patient needs to provide evidence of bloodwork in the past 12 months that show their kidney and liver function is good enough to take paxlovid, or else the pharmacist needs to talk to the patient’s doctor. (A print out of your blood tests is good enough, or the numbers on your phone app, but only if you had those blood tests in the past year.) Nurse practitioners (like at an urgent care clinic) can also prescribe Paxlovid, and don’t need to see blood tests.
The price of the drug is a major barrier, but getting someone to prescribe it if you have risk factors really isn’t. (Risk factors like being old, or fat, or…)
Years ago I had someone trying frantically to reach me on a weekend concerning something about work. When I eventually accepted the call, they were very pissy. They wanted me to go into work and accept their payment of $180. Seems they bounced a check to me for that amount many years prior and now they were trying to obtain a mortgage and the delinquency was an issue.
I explained to them that the account had been sent to a collection agency. If I accepted the sum from them, I’d then be responsible for determining the amount owed to collections, which after that much time would be the majority of the total.
I refused to participate in their problem in any way. Hell, I wasn’t even certain to whom I had sent the delinquent bill. They argued that I had to help them. Felt good to tell them to fuck off.
“Pay your shit on time you fucking deadbeat.”
I could get behind that.
This is not exactly pitting the US health care system, but it’s related.
Bit of background. I was reading one of those clickbait articles about Canadian Prime Minister Trudeau’s appearance on the Colbert show a few nights ago, and had a look at it despite the fact that it was a link to the UK paper The Daily Mail, more accurately known as the “Daily Fail”, written by and for right-wing morons. I actually saw that episode of Colbert and it was mostly pretty bland, but “The Daily Fail” set me off by representing it as Trudeau being “smug” and “condescending” because, among other things, he promoted the benefits of the Canadian universal health care system.
But what really made me need to vent were some of the comments to the article. Some asshole from Nevada said that he had “a cousin” in Canada who had to wait 18 months to get a cardiac bypass operation, concluding the comment with “you can keep your universal health care”.
This kind of ignorance drives me totally nuts. The one time in my life that I was hospitalized was after a mild heart attack. The medical team looking after me recommended bypass surgery. The waiting time was not “18 months”. It was not “18 weeks”. It wasn’t “18 days”. It was closer to about 18 hours, and it wasn’t even particularly urgent. But I pushed back against it because it’s such major surgery, and asked them to consider stenting instead (PCI, in the medical vernacular). Which they did. The great thing about UHC is that there’s no insurance company to pervert clinical decisions on the basis of cost; decisions are made entirely on the basis of medical judgment and patient preference.
Another comment on that same article about UHC is about how we poor befuddled citizens with “free” health care actually pay through the nose for it in taxes. The moron who bloviated that particular comment has obviously never seen a graph of health care costs in the US compared to every other country in the world that has UHC. The private health insurance system that afflicts the US results in an overall health care system that is by far the most expensively wasteful on the planet.
It drives me nuts to see how incredibly stupid many people are on this subject, and yet they bloviate the most appalling bullshit with supreme confidence. Dunning-Kruger at its finest.
There were dozens more comments but I just couldn’t take it any more. These are the morons who believe that Haitians in Springfield, OH are consuming their neighbours’ dogs and cats for dinner. These are the morons who will undoubtedly be voting for Trump.
Yeah Its pretty typical of American online discussions of Canadian healthcare. Somebody’s cousins’ friend has talked to one of the 1% of Canadian’s that wants American healthcare.
Hey, there is lots to criticize about Canadian healthcare, but only vapid idiots think the solution is American healthcare.
Most of the Canadian side of my family claims to be in favor of American style “free market” health care. But that is because they are horrible racists and have now got to glom on to all the horrors the right wing in the USA promotes because the Alt-Right in the US is their political lodestar.
And of course all the immigrants getting free healthcare in Canada.
All my relatives are immigrants. None was born in Canada.
You might be too generous in calling it “ignorance”. I’m am sure there are plenty of US residents who don’t know the first thing about Canadian healthcare - but I am also sure that there are plenty who will make up a story about Canadian healthcare because they think there’s some underlying truth. I caught my mother doing it with the ACA - she was going on about how one of her granddaughters had to pay a penalty because she couldn’t afford health insurance. She only had one granddaughter who was too old to be on her parents insurance and she made so little that insurance on the exchange would have cost her nothing. But my mother didn’t like something about the ACA (which didn’t affect her one bit) so she made up a story.
We have a fairly strong move towards NHS in this 3rd world country (South Africa)
I get the benefit of free health care anyway, if my income is below a certain amount. I earn more than that, but at government hospitals is still vastly discounted.
I could go to Groote Schuur hospital - my closest, and the site of the world’s first heart transplant, so a fairly top-notch place - for free, completely free of charge care, if I earned nothing.
Or I could use medical aid insurance to go to a slightly fancier place 3km away, and get my medical aid to pay for a small step up in luxury.
I mean, I know this whole thread is about how nuts the US system is, but, guys, if we - a Trump-defined-third-world-shithole - can get health care right, you are doing something badly wrong.
EtA, and off topic: South Africa is a popular destination for surgery students doing internships, because we have amongst the highest rates of stabbing in the world (knives, glass, etc) and thus makes Groote Schuur and Tygerberg (2nd biggest hospital in the Cape) the most popular for overseas interns.
Update on the unfolding Steward situation, for anyone not following the news:
The CEO was subpoenaed to appear before Congress. He tried to get out of it. The committee said nope, too bad, you gotta show up. He didn’t bother to show. The committee held him in contempt.
And now he’s trying to sue them.
Insert “bold move cotton” gif here.