Buddha Bear said:
Gold Tron said:
JXL said:
fadskier said:
I have always said that our health care system is broken (as far as insurance is concerned)...my son went to wound care for four months with a copay of $52.16...it ended Dec 31, 2020. I get a bill for $1,378 for his vistis all the way back to September. I call and ask...billing tells me it is my deductable. I say, I didn't ask that question. I wanted to know why I wasn't billed monthly (no explanation) and why it costs so much...again I get the that's your deductable...again, I say...not my question. What is the cost? They don't know and direct me to another department whrere I have to request itemized bills. I submit request.
I get a packet of pages where every visit to woulnd care is $574 and with visits have an additional $950 added on. I call and ask what these charges are for....no one can answer except say that the amount is not what I owe bu twhet they are billing insurance for. Yes, I know what what was done in wound care that merits $574 and $1,400...no answer,...treansferred to patient care...patient care understand my frustration and will ensure that I get answers...that was a month ago. I got a new bill saying that I am part due.
Maybe it's time for a different way to do this.
Pretty much every developed country in the world does health-care billing better than we do,
Blame Medicare. And people want government totally in charge of medicine...
No. Lack of transparency is a major problem. Insurance and billing are major problems. That is the private sector. The US is the worst at health care billing and pricing. The worst in the entire world. We need to recognize this and demand change. Or it never will.
My biggest fear about moving back to America is having bad insurance coverage or some medical emergency. I've seen how other developed countries run their system. I've experienced it. They have their problems, but none as big as America's healthcare system problems. I prefer another system. The financial risks far outweigh the benefits of our current system.
Correct -- please don't blame Medicare. Doctors, PAs, nurse practitioners are the heroes of the healthcare system. They're not responsible for the way that billing works. Other than their reimbursement rates for procedures under Medicare, they're largely unaware of the crazy quilt that is the larger picture of billing rates and reimbursements in the US system.
I've learned something about it from working with companies in the healthcare revenue cycle management field -- a fancy term that encompasses a lot more than collections but also helping hospitals manage their billing offices. In general, billing offices do a VERY poor job processing third-party claims. They bill the wrong payer or don't manage to bill at all because it's complex and they cherry-pick the easy ones first. As a result, a lot of these claims age out to 90 days and then the hospital simply turns them over to a collection agency for pennies on the dollar -- which means they leave millions on the table needlessly. So they try to make up for it (and for the uncompensated indigent care they are required to provide) by gouging other patients where they can (or trying to gouge insurance companies through up-coding.)
Hospitals also use the slimy practice of outsourcing their ER operations without disclosing this to patients. So you go to your in-network hospital for an ER visit and then get surprised-billed for an outrageous out-of-network charge because you had no idea that the ER doctors at your in-network hospital actually are out-of-network.
And it's aggravating as hell -- I suspect we've all been there -- to get a bill from the hospital/clinic and then a separate bill from the doctors' group, instead of one, consolidated bill.
Almost all of this is as invisible to your doctor as it is to their patients.
My experience has been that, between Medicare and the private insurance companies, Medicare is generally the payer that has its **** together in terms of accurate billing. Their overhead costs also are about half that of the private insurance sector.
And CMS (Center for Medicare and Medicaid Services) has actually been a big driver of cost-saving innovation. For example, under Obama they rolled out bundled payment initiatives for joint surgeries that incentivize the fragmented network of providers in a care "episode" -- physicians, hospitals, rehab centers -- to work collaboratively to save money while maintaining the same high standard of quality. If they bring in the "episode" under a designated cost threshold, they get to share in the savings. That's an alignment of incentives that is absent in most of the rest of the system. Private insurers, who already are making fat profits under the current system, never bothered to push for something like this.
Medicare also was the payer that started docking hospitals if their infection and readmission rates were too high, giving providers a bottom-line incentive to implement better infection-control policies and make doctors wash their damn hands. Private insurers would just pay these additional costs for avoidable readmissions because they knew they could pass them on eventually through premium increases -- no incentive to demand better quality and lower costs.
CMS also has been leading the push to drive a lot of procedures traditionally performed in hospitals to outpatient settings in ambulatory surgery centers, which reduce costs a lot and actually deliver higher quality (measured, for example, by fewer facility-based infections post-surgery and lower readmission rates). Patients also overwhelmingly prefer ASC settings to hospital campuses, so it's a win-win. In the past 2--3 years, Medicare has approved a lot of procedures for reimbursement in the ASC setting, including cardiac procedures and joint surgeries that once never would have been done outside the hospital.
It's just a myth that Medicare isn't pushing innovation in both quality and cost savings.
