Oh, and here’s an odd situation: my mother was in the hospital last year for about 2 weeks. She checked out (the bad way, unfortunately) on February 5, 2008. In the 14 months since then we have received not one single piece of correspondence regarding her hospital stay. Not from the hospital, nor the doctors, nor the radiologists or other specialists. Nothing - NOTHING - from the insurance company. Totally bizarre.
If they ever manage to crank out a bill, it’s going to be one big hot mess.
That’s fine. But they should know that the people that they hire to take care of business really screw the pooch. Not sometimes. Most of the time.
My Wife recently went through similar surgery (same employer, same hospital, pretty much the same thing[it was her thumb, mine was a shoulder]) She is giving me a wink and a nod. Saying that the worst is yet to come (she gave me a phone number of the only person that she trusts at the insurance ‘company’). She wrote the name and number on her insurance card with a super fine sharpie. 'cause she needed to talk to her so many times.
And this is all out patient stuff.
It’s silly.
Nice way to unironically complain about inefficient bureaucracy and advocate socialized medecine. Yeeeesh.
Nothing is free. Time to grow up.
I’ve read stories about general practice physicians who have decided they’re not going to take any insurance at all any more, but they continue their private practice. Patients have to pay, but the rates are similar to many folks’ co-pays due to the massive cost-reduction in not needing to hire lots of full-time staff to handle paperwork. I wonder how common this is. I also wonder what range of procedures they offer compared to before they dropped insurance.
Of course nothing is free. The point is that some costs are worth it and some aren’t and some costs can be distributed in a way that benefits society as a whole. The costs of private health care have long ago begun to outweigh the costs of universal health care.
This assumes that a society’s goal is to benefit society as a whole. A society can also decide to allow individuals to reap unequal benefits.
Sure, it costs me 5.5% of my salary each and every month of my working life in health taxes. Plus the damn parking fees…
Oh–I think I misunderstood your post. You were trying to make a joke by saying that you were stressing about “the bill” and then it turns out you are talking about the parking bill because you have socialized medecine. Well alrighty then.
All the paperwork seems pretty time-consuming and confused. I see a great business opportunity to set up a middle-man between the health providers, insurers and patients, with the exclusive role of managing billing for each health-care customer. Sure, it would drive up prices a little, but nothing is free.
I’ve yet to run into a private practice anesthesiologist. Anything requiring serious OR time is probably going to be through a hospital. In which case, the docs are employees of the hospital just the same as the billing people.
Sure they can, but with health care doing that is incredibly stupid. One of the stupidest most short sighted things you can do. It undermines that society’s ability to compete with smarter UHC societies since over all America’s healthcare costs are between twice, and three times as high as most first world UHC countries.
As the moronic mess that inspired this thread shows; UHC is simply much more efficient, and only an ideological fool, or an asshole who cares nothing for their country would be against it.
If an American product has twice the healthcare costs associated with it’s production verse a Canadian. Which product do you think is more competitive? Which country gets more manufacturing?
That’s just ridiculous and flat out impossible without psychic powers.
I can have no idea in advance whether the planned procedures will be covered because even if I call the insurance company before hand, tell them my name, my plan number, my employer, my plan type, my blood type, which doctor I want to see, where, and what I want to have done, they will flat out refuse to say whether that’s covered under the plan they wrote. The best I’ll get is “well, we can’t really say for sure.” All I can do is hope they figure it out in my favor when the bill arrives.
For doctors I choose, I can sometimes use the insurance company’s “Doctor search function” (which has warnings that says it hasn’t been updated since 2004, so don’t use that as the actual guide - and again, customer service again “can’t really say for sure”) to tell whether they’re in plan or out of plan. More often than not, the doctors themselves don’t know whether or not they’re in plan or out of plan. For doctors who show up after things have started rolling, it’s often too late to stop everything while we figure out whether they’re covering by my insurance company, seeing it’s the 3rd Tuesday of an even numbered month.
I had a lot of medical appointments and bills earlier this year - the typical statements would come back with lines saying:
Code: W32841X34
Cost: $480.00
Allowed cost: $320.00
Insurance paid: $293.34
Your responsibility: 26.66
There’s no possible way for me to know what code W32841X34 is, much less whether or not it might be covered by insurance. The doctors are certainly not about to tell me. I can make some reasonable guesses based on which company is billing me, but who knows for sure.
There may be a formula for “allowed cost,” but so far as I can tell, it’s rather like the stairs formula for grading final exams. It’s usually less than or equal to the original cost.
But you’re telling me that it’s my responsibility to know how much I’m really going to owe a certain doctor? How? How can I possibly do that?
It’s no easier for the doctors, believe me. I work in a radiology clinic, and Medicare refuses to guarantee that they’ll pay for an X-ray until we tell them the diagnosis. Um, hello? An X-ray is a diagnostic procedure, we won’t know the diagnosis until we’ve DONE THE DAMN EXAMINATION.
Speaking as somebody who works in medical billing and who tries to get everything within my power to go smoothly, the problem is this: none of the people in the industry seem to take any time to consider what the patient wants.
The patient wants simple, definite answers; the patient wants reassurance that he is paying premiums and is getting a service for that money he paid; the patient wants not to have to think about things. The way it was in the 1950s, I presume. Unfortunately, at the moment, the insurance companies and the medical providers are not geared to give the patient the kind of experience he wants.
Insurance companies do not want to say, “Sure, have anything you like, we’ll pay it.” Instead, they say: “Oh, that sounds expensive. You’d better request authorization in triplicate and have our monkeys in the claims department look at it. Then we’ll issue an authorization which is good only at one doctor’s office within 120 miles, good between 2 pm Tuesday and 4 pm Wednesday.”
Doctors are not going to say, “We absolutely guarantee your insurance will pay this, and your balance will be $X.XX.” Instead, they say: “Well, we can provide a written quote for the services indicated on the referral, but you can never be 100% certain with a medical exam that something unknown won’t come up. Plus, you might have a co-pay, a cost-share, surgical co-pay, a deductible, personal injury protection, or a coordination of benefits. And if you’ve had similar services in the past year at another facility, all bets are off, because your insurance might only grant you one such exam per 12-month period.”
Patients are not going to say, “I want my doctor to have full access to my insurance information, including which items will be fully covered and which will not, and let him use his best discretion.” Instead, they say: “I’m not telling my doctor anything about my insurance. I don’t want him ordering unnecessary tests just because he knows he’ll get paid for them.”
Patients complain when our office doesn’t send them a statement (because we’ve billed insurance). They complain when our office does send them a statement (even though we’ve billed their insurance). They complain when they get a bill for under $5.00 because they think we should write off all small balances. They complain when we send them a bill for more than $25.00 because “people who are sick should get special discounts.”
The doctor’s office can’t get the insurance company to give a straight answer. In fact, insurance companies do not allow us to request an authorization. The authorization request must come from the patient. Why? Who the fuck knows? All I know is that I can’t — as in, am not permitted by the insurance bureaucracy — help the patient obtain authorization for our services.
The industry is built on the premise of Cover Your Ass. It has ceased to be built upon Treat Patients and Get Paid a Fair Price.
:shrug: Don’t know what difference it would make, but my anesthesia bill is from ‘ANATHESIA CONSULTANTS, P.C.’ Not the hospital.
And my Doc/surgeon is not an employee of the hospital. I got a separate bill from him for the surgery. My doc is part of a specialized sports medicine clinic.
I got a separate bill for use of the surgery center.
And the hospital up here is different I guess. My wife’s surgery was actually in the hospital. My surgery was done in the Peak One Surgery Center. Same Doctor/surgeon. They are in the same building, but I don’t know how they are affiliated.
In my experience, anaesthesiologists are always private practice. They’re called in by the surgeon as needed, but they’re not employees of the hospital.
Just so you know, validate is a nice way of saying pay for your parking. With doctor’s fees being cut all over the place, malpractice insurance through the roof, overhead rising and staff expecting raises even though the doctors make less each year, why should they pay for your parking?
If your mother had Medicare and a good supplement policy, it is very possible that there IS no bills. I also advise my clients to accept ‘insurance only’ on deceased patients as a courtesy so that may have also contributed to the no bill situation
Okay, let me try this again.
You have two options in the US regarding paying for healthcare. You can pay the costs in full out of your own pocket or you can pay for an insurance company to cover some of those costs for you.
If you choose option B, your insurance company works for YOU, not the physician. You want them to cover the bill so you get the service you pay for. Your issue is with them. If they won’t tell you what you need to know, find another insurance company that has better customer service.
You are entitled to know what your treatment will cost from the provider. Get the fee, the codes they intend to bill and call your insurance company. Is it annoying? Sure but if you don’t care to do that, there is always option A. Pay your health care costs out of your pocket.
Most private offices don’t have full time babysitters to walk patients through their individual coverage.
Sorry but that is the reality of the system we have.
Although it may be regional, I have never seen a group that isn’t private either.
Yes, they are business people. My husband is a physical therapist (not a doctor) and we have several friends who are orthopedic surgeons. They are definitely aware of how much each treatment bills with insurance vs. Medicare vs. workman’s comp. My husband is aware of the patients who have larger co-pays and tries to work with them to limit their office visits. The therapists at his company (and at every company he has ever worked for) are evaluated on how many patients they can see per hour. The doctors we know are all either partial owners of their practice or they have profit-sharing contracts. Trust me, they are highly motivated to decrease visit times, increase billable treatments, and increase the ratio of patients whose insurance pays more as opposed to the Medicare/worker’s comp people. All of them are ethical people whose first priority is the patient’s well-being, but they are absolutely cognizant of the bottom line.