That may well be the case, but if the doctor and his staff can’t tell me my cost for a procedure/test I am not going to schedule it. Given that ultimatum I haven’t been let down yet.
There wouldn’t be in the situation where I go to the doctor and get sent to the hospital. That might be an issue if I was traveling , but not at home.
Agree. And if there is still friction regarding future procedures, you can ask the office to get the procedure prior-authorized by your insurance - that will be in written form and will tell everyone how much each party is expected to pay (insurance, co-insurance, you). Unfortunately, you will never see how much the procedure costs, just how much everyone has to pay for you to have that service.
When I was leaving the hospital the day after stent placement, a nurse brought my daily medications. I told her I had my antihypertensive meds at home and would be picking up my new statin on the way there.
She initially told me I should take them, it would be easier. I demanded to know if they were covered by my insurance and if not what I’d be charged. I saved $70 by asking and refusing.
I"m sorry, but the entire US healthcare system sounds like one giant fucking scam.
“here, take this pill or you’ll die!”
“Oh my god, OK”
("ha ha! We just billed him $4000 for a $3 pill! Sucker!)
Sounds about right.
This is called surprise billing and it’s worst with anesthesiologists.
~Max
PT’s daughter is studying human movement and acrobatics.
Failed to stick a handspring landing on a trampoline last week.
Severe dislocation of elbow inc rupture of tendons which required surgery to correct and three days in hospital.
Haven’t seen a bill. Any gap will be covered by my private medical cover.
Medication in rebab will be supported by the PBS.
Which makes the full house of significant sporting injuries amongst the kids.
Older boy had jaw broken, younger boy had knee reconstruction.
This happened to a coworker of mine who had an emergency c-section. I’m pretty sure they fought it and won.
There’s new legislation (The No Surprises Act) that’s still being fiddled with but requires up-front billing estimates.
What’s PBS, in this context?
Here in the States, an injury like that should (theoretically, anyway) be covered by the facility’s liability insurance.
p.s. Several years ago, my mother, who is on Medicare, tripped and fell at a Panera Bread and broke her wrist. Their insurance paid 100%.
At least 10% of Medicare’s budget is spent on fraudulent claims, some of it quite blatant.
That’s more than $50 billion a year, which would cover a huge percentage of the bills for un(der)insured people, who are often otherwise healthy.
Sorry, Pharmaceutical Benefits Scheme
The PBS is a program of the Australian Government that subsidises prescription medications for Australian citizens and permanent residents, as well as international visitors covered by a reciprocal health care agreement.
The PBS in effect prices medications from the global pharmaceutical manufacturers on the basis of efficacy vs cost. ie a branded medication with a direct equivalent generic have equivalent cost.
Anytime there is talk about US-AUS free trade agreements, the PBS is the first on the list of things the US wants scrapped. Which is why we don’t have a comprehensive free trade agreement.
Lucky for them! My wife was in a terrible accident and had to be flown to a large regional hospital. We were on the hook for about $30,000 of that bill. That’s how we learned medical insurance doesn’t cover a lot of those very expensive bills (well, they did pay about $15,000 of it). And that $30,000 was after I negotiated it “down” directly with the air ambulance company. When we get older, we will probably get that special “life flight” insurance.
I see claims like this, but I’d really like to see breakdowns of what that really means. Is it fraud committed by doctors, who are taking money for procedures never performed, or is it fraud by patients, receiving treatment that they are not eligible for?
For the former, tighten things up and prosecute offenders. For the latter, it means that the system ideally should be covering them anyway.
I wouldn’t be surprised if more money is spent on administrative overhead designed to prevent fraud than would have been lost to fraud if the fraud prevention system didn’t exist.
As I understand it the 10% figure is Medicare’s improper payment rate, that is, any payment that should not have been issued, not necessarily fraud.
~Max
It’s mostly fraud by doctors (submitting claims for procedures/visits that either never happened at all or charging for a “long” visit when it was really a “short visit” ) or by doctors and patients both ( my grandfather used to complain that he had to pay for some sort of injection because Medicare wouldn’t cover it since it wasn’t effective - if the doctor had done what Gramps wanted and submitted a claim for a covered service that wasn’t provided , they both would have been involved in fraud) . Fraud by patients alone, which would basically be a form of identity theft is most likely the least common type as it’s the most difficult to get away with - most healthcare providers ask for photo ID from new patients , so if I’m not eligible for Medicare, I’m unlikely to be able to use my friend’s card to get treatment covered without the provider’s cooperation.
Yeah, there’s a sweet spot somewhere - you have to spend money on fraud prevention, and announce loudly that you have caught and punished folks to keep the “why not give it try folks” from giving it a try. But driving it to zero is impossible, so how much are you willing to spend?
It’s like welfare fraud - I’m willing to allow some small percentage of fraud (1%?5%Haven’t actually thought about a number) in order to ensure that most of the people who need it, get it.
I know first hand about what a ripoff medical clinics can be. I suffered a bad sprain to my right thumb. My insurance covered everything except the brace. A “tech” came in and put it on and had me sign a piece of paper. 2 weeks later I get a bill for $250 for the brace. I find the exact same brace on Amazon for $20. I fought this but the medical supply company refused to budge. Found out the “tech” was an employee of the medical supply company, not the clinic. The clinic flagged what they called my false review. I proved my review was factual. About 6 months later the clinic cancelled the medical supply company contract due to price gouging.