Coming February 6, 2024 . . .
MURDER, POLITICS, AND THE END OF THE JAZZ AGE
by Michael Wolraich
Pre-order at Barnes & Noble / Amazon / Books-A-Million / Bookshop
Coming February 6, 2024 . . . MURDER, POLITICS, AND THE END OF THE JAZZ AGE by Michael Wolraich Pre-order at Barnes & Noble / Amazon / Books-A-Million / Bookshop |
Zuckerberg San Fransisco General hospital, renamed after the billionaire Facebook founder donated $75 million, does not accept any private insurance carriers—which can leave unwitting patients with tens of thousands of dollars in medical bills, Vox reported Monday report. Because of the hospital’s unusual policy, all private insurers are considered “out of network,” meaning that in some cases, they only cover a small fraction of medical costs. One woman, who suffered a broken arm, was given a $24,000 bill, and her insurance only paid about $3,800; another woman is still fighting the $31,000 she’s been asked to pay to treat a broken ankle. This system, patients say, is especially unfair to those who are transported in emergency situations via ambulance, because they have no say over where they are taken.
Comments
Though not with hospitals yet, the "we don't take any insurance" thing is definitely a trend I've noted among the highest rated medical providers in the tri-state NYC area. And it's not because they only want to serve rich people, it's more like they have decided they want quality of life, too, and being good at what they do, feel they have the luxury of opting out of a system that had become a nightmare for them.
by artappraiser on Mon, 01/07/2019 - 2:27pm
Explain that to the people with insurance who are going to still be bankrupted.
by rmrd0000 on Mon, 01/07/2019 - 2:34pm
I didn't say I liked the trend, I just noted it, that it is one unexpected result of "Obamacare."
Edit to add to be clear: providers must negotiate contracts with a multitude of constantly changing insurance companies to be "in plan". In the tri-state area, if you need a specialist in a certain something, you can never be sure from websites or literature, including insurer websites, whether a provider is "in plan" or out. The situation changes so often, they cannot keep published data correctly updated. You must call the provider to be sure that they still are in contract with your insurer, it is constantly changing, constantly. Because the insurers squeeze the providers all in different ways, and the contracts are continually ending and they decide to no longer be together or re-negotiate. It is a ton of work for providers who accept many insurances. This is also why many doctors decide to give it up to work for salary for big conglomerates who will do that work for them.
Likewise with prescriptions. Insurers, drug companies and pharmacies are constantly making deals and then negotiating and changing them. So one day you could be covered for a certain drug, and the next day not.
by artappraiser on Mon, 01/07/2019 - 2:53pm
p.s. When you are an advocate for a loved one in a hospital with special needs, you learn not to believe that "there is no product like that" or "there is no service like that" from hospital staff. What they are really saying is that "we don't have a contract with a company that offers that." A hospital that offers everything out there that is possible is not a hospital that is on a budget induced by insurance companies. (I.E. not everyone with aphasia from stroke gets to have a Stephen Hawking type synthesizer to express their thoughts, not every obese patient with incontinence gets to have diapers that fit them, not every amputee gets state-of-the art prostheses, Insurance companies make sure of this.) To be clear: I don't know what kind of care Zuckerberg's hospital offers or doesn't offer, what is clear is that they have decided not to negotiate with insurers at all.
by artappraiser on Mon, 01/07/2019 - 3:10pm
From the article, it is uncommon for an ambulance to take you to a major hospital ER that is not in network
by rmrd0000 on Mon, 01/07/2019 - 3:05pm
Not here. I am dealing with that personally over 5 years now. The ambulance cos. here don't care. They don't even bother to find out who the insurer is for their own fee, they just bill the client or his/her estate and expect the client to be the responsible one and file a claim with their insurer. They will ask the client if he or she is verbal where they want to go, that's all. The client is in the end responsible to go to a provider that is covered. Most plans will cover out-of-plan emergency rooms in case of a true emergency, but you have to read the fine print in the plan. They may also argue with you later about whether it was a true emergency as well.
About a decade ago I had a loved one on Medicare with supplemental retiree insurance that superceded Medicare rules. Which is sort of the situation everyone has now under Obamacare. She was in the ICU too long and had to be moved to an LTAC (long term acute care hospital.) She was still basically in life/death situation. The hospital transferred her to the one that was in the same complex. The insurance company called and said they don't cover that one and my family will have to pay if she stays there. They wanted to move her via ambulance to the other LTAC hospital in town who they had a contract with (and which was also known to have lousier care). Which would probably kill her. They didn't care, they didn't want to pay a full rate that they hadn't negotiated. We challenged and they backed down. But doctors had to help argue that moving her would kill her. Doctors don't like having to argue with insurance companies all the time, that's not what they went to med school to do.
by artappraiser on Mon, 01/07/2019 - 3:24pm
Sorry about you situation.
Here, the hassle is figuring out your copay. It is easier if your care is through one of the university affiliated hospitals, so all your bills come from one source despite multiple physicians.
by rmrd0000 on Mon, 01/07/2019 - 3:37pm
Problems with insurance cimpanies didn't start with Obamacare. "About a decade ago" there was no Obamacare.
LTAC is not what the vast majority of emergency or hospital care involves, as with the 24 year old bike rider with the $24,000 bill in SF.
BTW a lot of doctors who accept insurance are very good at what they do, and have a quality of life that is centered on curing the ill, while they also deal with insurance stonewalling.
NYC Health + Hospitals/Kings County (Brooklyn, N.Y.) is among the ten busiest emergency rooms in the nation:
Our mission is to provide health care to all New Yorkers without exception. We accept most insurance plans and offer discounted fees if you do not have insurance or your insurance does not cover what you need. We also offer discounts on prescription medications.
Your care team can also help coordinate your care across various specialties. Some of the specialties and services available include:
Cardiology
Endocrine
Podiatry
Neurology
Asthma
Behavioral Health
Pulmonary (Chest)
Ophthalmology
Gastroenterology
Renal
Dermatology
Surgery
Patient/Family Education
Health & Self‐management support
Pediatrics
by NCD on Mon, 01/07/2019 - 4:16pm
Thread here explaining sounds like standard nightmare to me in the NYC tri-state area
including the part about them still using fax. They make docs use fax to challenge denials. One doc told me he had to send a 20-page fax to get me some eyedrops that were denied. Another doc just lost a fight trying to get me another medication, that dragged on for a a month. And I couldn't easily communicate with him about what I knew would be the best argument to challenge, as he's protected by a huge wall called Advantage Care Physicians. The only person I can talk to is a call center, and leave him messages to call back, then a nurse calls me back and she doesn't really get what I am talking about. Or I can leave messages on the website, which no one answers.
It's complicated, but basically it comes down to this: Insurance cos. just won't cover anything they don't have a contract for.
by artappraiser on Fri, 01/11/2019 - 11:48am
Such costly hospitals are as painful as the diseases people visit hospitals. We at our medical facility, Manhattan Medical AArdvarks make sure our patients feel highly satisfied with both treatment and cost when they leave our office.
[yes, twas edited by me, PP]
by asd (not verified) on Mon, 03/04/2019 - 12:27pm
Very nice p.r., I love the patient satisfaction approach myself, remember it fondly, and it seems to have disappeared. But it looks like you don't take insurance, and there aren't any wealthy Manhattanites here
by artappraiser on Mon, 03/04/2019 - 12:51pm