Some doctors are opting out of insuranceand going cash only.
This brings me to a soapbox issue of mine. If all the smart people who want to be rich become doctors then my health care will improve. If they all work for insurance companies all I will get is less medical coverage for more money. So it isn’t in my interest for insurance companies to make any more money than bare survival rates.
Unless my insurance is through my employer. At which point I can bitch to HR about there not being any doctors that take the insurance, but the doesn’t have to care about that (although most likely would).
That’s another big problem: the people buying the insurance aren’t necessarily the ones who will be using the insurance. Most people are at the mercy of their employer, and some employers don’t car much about anything other than the bottom line.
Agreed. The tradition of employer-sponsored healthcare adds a whole 'nother layer of complexity to things.
Some form of transparency might help. There would be sites out there doing all the comaprison for you. Hell, someone would probably create an Angie’s list or Zagat’s for doctors and hospitals.
My buddy uses a billing service that takes 10% off the top. After years of dealing with insurance companies, he thinks its a bargain.
It sounds like you would be in favor of a single payor model as long as single payor doesn’t mean medicare level reimbursements for everyone.
I’d like to hear the hospital’s side of this but this sort of thing seems like fraud.
So you are saying that if medical costs were managable, there would be a much lower demand for insurance. I entirely agree.
But your solution to getting managable medical costs seems to be socialized medicine.
:smack:
Or mattress companies. Mattress companies do everything they can to make it hard to compare apples to apples when you buy a Serta at Macy’s versus a Serta at Mattress Discounters. I recently had a warranty claim on my mattress and they had to replace it and it became very clear that the confusion is intentional.
During the healthc are debate it started to become clear how we could drastically reduce health care costs without sacrificing health care results.
Single payer (or at least a public option) was one important element.
Having medical boards create best practices to prevent unnecessary defensive medicine and shielding doctors from medical liability if best practices were followed.
Controlling end of life health care costs.
We did NONE of these things.
Something like this? It’s a work in progress but when finished should provide very telling information indeed.
What metrics are they going to compare, though? The devil’s in the details. Even contractors can’t always give an accurate estimate for what a job’s going to cost until they get started and see what (if any) hidden problems are there; any such list is more likely to be measuring differences in bedside manner than actual quality of the care given to the patient. (Not that bedside manner isn’t important!)
Pretty much every physician practice uses a specialized billing service these days: billing’s just too complicated to manage without one (which is telling).
I’d put my money on incompetent. In 1996 I busted my leg in a really big way, 2 days before insurance kicked in at my new job. I was quite clear about that fact. And yet the hospital billed an insurance company that hadn’t covered me in years, because it was the last insurance info they had on record. Eventually they had to rebill everything (for surgery & 2 weeks total in the hospital) to the right insurance company (by the time I made it back to my home state, etc. my insurance had kicked in - long story). It was a paperwork nightmare.
I hated that when I had to go to the ER without insurance. Nobody had the slightest clue what anything would cost. All asking got me was a WTF look, and patronizing assurance that I could get everything taken care of later with a social worker.
You can’t balance bill-that’s part of your agreement. In fact, for Medicare it’s fraud. Sure you can refuse to take Medicare. Let me show you how that works with another example.
Let’s make it easy-let’s say the doctor wants to charge $120 for a visit but Medicare allows $100.
-Doctor #1 participates with Medicare. He gets 80% or $80 from Medicare and 20% copay or $20 from the patient for $100 total.
-Doctor #2 is non-participating with Medicare meaning he bills the patients who then collect from Medicare. By law, he can only bill 110% of Medicare so he bills $110. Medicare pays about 65% or roughly $70 and he can bill the patient the remaining $40 for a total of $110.
-Doctor #3 wants to opt out of Medicare entirely. He must sign a 2 year contract that restricts him from taking any Medicare money from any patient for 2 years total. He can bill the patient a full $120 but the patient cannot then collect any money from Medicare and is responsible for the entire bill.
If you practice in a wealthy area where people have money to throw around you can opt out of Medicare but if you have to do any procedures or admit the patient they will be responsible for the full bill which can be thousands of dollars so most will not do it.
So, let’s say Doctor #1 or Doctor #2 wants to bill the patient for the rest of the fee. As noted above, this is Medicare fraud and is charged at triple damages plus $10,000 per incident (not per patient, per incident which means per charge. So, how does the government keep tabs on this? They have hired independent contractors to review billing for fraud and pay them 30% of all money collected. Oh, and don’t forget that underbilling is also Medicare fraud. If you only bill $75 for that visit that Medicare says should cost $100 or if you waive the copay, you can still be charged the $10,000 per incident and remember, these companies are paid at a percentage of what the government collects.
(And yes, I am in favor of single-payor, even at Medicare rates. Even with all of the above I see rampant Medicare fraud, particularly in the DME industry).
Also, remember that there really is no free marketcite. In many states one dominant insurer has most of the market. Also most people cannot afford insurance outside of their work which may offer little to no choice of plans.
One last thing-I can’t remember the term from Economics but medical care is not the kind of good that operates on a strict demand and supply curve. People assume that the mst inexpensive care is the worst care so if two providers charge different amounts, they will often choose the more expensive one since they assume that somebody who charges more must be better. This also encourages providers to jack up fees since it can lead to increased patients.
When you break it down like this, yes its clear indeed that there’s ample room for reform in the industry. That’s why its great this debate is now happening and shifts are being made…in the right direction. It won’t be fixed over night, but we’re inching closer day by day.