Medical Cost

[not2old]

People wonder why insurance is so costly...it's because the procedures are so costly.

Obamacare addressed access to healthcare, without addressing the cost of healthcare. Costs have gone parabolic since 2010.

I only have experience with medical insurance in Canada. Blue cross will only pay for my c-pap supplies if bought from an approved supplier at inflated prices. I don't remember the details but something cost around $200.. and that same brand was available on Amazon for about $30.00

 

[BigGG]

They will not eat it...they will come for the balance after the Medicare reimbursement.

Or demand payment up front before treatment in some cases.

 

[ultrarunner]

The billed amount and amount accepted as payment can vary greatly… so much so that I know docs that no longer participate…

No shortage of creative billing and it will always be discovered if it’s a pattern.

Audits and clawbacks are very real in the world of Medicare.

 

[BigGG]

My wife had a cardiac ablation several months ago. It’s a procedure to prevent atrial fibrillation.

The Medicare statement just came. Total amount billed was over $200,000! Medicare paid $27,000 and Tricare picked up the 20%, so no cost to us.

What does some average person do if they don’t have insurance? It’s bankruptcy and ongoing future problems. One of the main affects is blood clots and likelihood of a stroke.

Dammed if you do, dammed of you don’t.

If I read your post correctly, the provider was compensated about 1/3 of the 'billing'. Sounds about right, a few months ago I had a chemical stress test. The billing was $7,000. Medicare plus supplement paid about $2,300. A few lesser charges were disallowed. Quite a 'discount'.

 

[ultrarunner]

Or demand payment up front before treatment in some cases.

Out patient procedures are this way and why the model is more cost effective.

Reimbursements can be lower when you know you are being paid.

Many hospitals have left or become county in areas where uninsured or under insured are the bulk of the patient population…

 

[ultrarunner]

Every facility has a cash pay fee for service schedule and if you want to zero in on cost it’s a good place to compare providers.

 

[LouNY]

Plenty of mine fields also…

We had a foreign born nurse with 23 years experience ask a patient through family what language does the patient speak and how long the patient has been in the United States and learned 17 years… the nurse said 17 years is a long time to not learn any English… family filed a formal regulatory complaint.

Another investigated complaint when a nurse asked a non binary person male or female to determine if pregnancy test needed prior to surgery… another complaint that was followed up at the highest level…

And that is a reason to restore some sensibility to these damned idiot regulations by bureaucratic DEI idiots.

 

[NorTracNY]

Anyone ever consider MDVIP? Most of their doctors are full and have a waiting list, but it's intriguing. The doctors are more independent and more traditional. You pay a yearly fee for them, but they limit the number of patients so you can actually get in to see them when needed. I've found my primary care doctor to be useless. She just does physicals and referrals.

 

[Dftodd]

The irony is there are still hospitals shuttering all the time… can’t pay the bills to stay open.

A second is many Docs no longer encourage their kids to go into medicine.

In 35 years I have seen both nurses and doctors increasingly foreign born…

We did not have a single foreign born nurse 35 years ago and half today are from the Philippines… very good nurses I might add.

The days of the sole practitioner are all but gone… it’s not possible to be compliant and run a practice today… it’s a full time job coding and billing, another is compliance, etc…

Plenty of mine fields also…

We had a foreign born nurse with 23 years experience ask a patient through family what language does the patient speak and how long the patient has been in the United States and learned 17 years… the nurse said 17 years is a long time to not learn any English… family filed a formal regulatory complaint.

Another investigated complaint when a nurse asked a non binary person male or female to determine if pregnancy test needed prior to surgery… another complaint that was followed up at the highest level…

My sister in laws daughter in law is non binary. Met her once. She's a whackadoodle for sure. I'm waiting for her to get brought up on neglect charges since she handles all the diagnosing of the 4 kids illnesses and refuses to take them to the doctor.

I worry about what would happen if one of the 4 kids was really sick. Hopefully my nephew will kick her in the who-ha and smarten her up if the kids need medical treatment.

 

[Torvy]

The billed amount and amount accepted as payment can vary greatly… so much so that I know docs that no longer participate…

No shortage of creative billing and it will always be discovered if it’s a pattern.

Audits and clawbacks are very real in the world of Medicare.

Good points. The competence of the billing staff also matters greatly. If they code things correctly. They get paid. When they don't, we get on the hamster wheel of finger-pointing.

Note: correctly doesn't always mean right. Wife's doctor knows how to work the system. She needed some test, but doctor had to give her another test first so the needed test would be covered.

We all pay in $ and in frustration because of fraud and tort.