dagblog - Comments for "Hospital Chain Said to Scheme to Inflate Bills"

We've just gone through the

Ramona — Sun, 09 Mar 2014 01:27:35 +0000

We've just gone through the whole Medicare/supplemental changeover because my husband's company has decided to get out of the provider business. Our premiums starting April 1 will be about half what they are today, and that'll include optical, which we didn't have before.

We could have opted for a plan where we would pay out-of-pocket exactly $0 per month but we wanted better coverage with lower deductibles and co-pays so we decided on a plan that will cost us something over and above what the company is going to pay.

It seems too good to be true, so we're not breaking out the apple juice just yet, but there's no doubt that health care is changing and moving toward fairer, more equitable solutions.

It's worth noting, too, that

Peter Schwartz — Sun, 09 Mar 2014 00:32:27 +0000

In reply to The profit motive just does

It's worth noting, too, that virtually everyone is always trying to make more.

The profit motive just does

Peter Schwartz — Sun, 09 Mar 2014 00:31:01 +0000

In reply to The article makes the point

The profit motive just does not jive with the practice of medicine, period.

Yes, it's hard to disagree.

I could pick a nit that charging a high fee isn't the same as profit.

But does it really make sense to have the CEO of a chemical manufacturer making 5 million a year, while a highly skilled professional with years of difficult and expensive training behind him and who saves lives and keeps people from getting sick or sicker shouldn't make as much or more?

At some level, what "we" pay people reflects how much we value them, and I certainly value the doctor over the CEO, all things being equal. Of course, other things enter into what someone gets paid, but keeping their remuneration down while allowing others to make quadzillion seems a bit perverse.

I agree with this guy

Peter Schwartz — Sun, 09 Mar 2014 00:24:37 +0000

In reply to Basically a primer on how

I agree with this guy totally.

However, whenever I read these things, I always think I must be the luckiest guy in the world. This stuff doesn't happen to me. And when I ask how much X costs, they always tell me right then and there.

As far as I can tell from this article, the doc himself isn't paying hardly anything for this--which is significant for the consumer.

Ultimately, insurance companies and providers will duke it out as the government keeps premiums down or at a certain percentage. I just got a full blood work up and a shingles shot and paid a total of $20 for my co-pay. Somewhere in the back of my mind, I thought my copay was $40, so I was surprised to learn it was half that.

That small amount I was paying for my generic drugs a few months back? It's been zeroed out...

Interesting example, cuz I

jollyroger — Sat, 08 Mar 2014 23:39:27 +0000

In reply to Being a relatively savvy

Interesting example, cuz I went for the scare ad and got the shingles vax but I had to self-procure thru Med D at the Pharmacy and walk it in to get shot up, cuz Med. B won't reimburse for it.

That said, I'm glad I got it cuz I did have chicken pox, back in the day...it did seem to me that the ad (one in three gets shingles) referenced a hell of a lot of shingles.

Being a relatively savvy

artappraiser — Sat, 08 Mar 2014 23:27:07 +0000

In reply to When medical office

Being a relatively savvy consumer of medical care since pre-internet days, who also seeks out docs that are simpatico with that, I have been privy to some docs and staff actually splainin' to me how using this code or that code could help me or mine out in our situation, whatever that may have been at the time.

But this is really a brave new world where everyone is starting from scratch. Excellent evidence for that: the biography of the writer of the Healthworks post: Bill Crounse, MD, is Senior Director, Worldwide Health for the Microsoft Corporation.He is responsible for providing worldwide thought leadership, vision, and strategy for Microsoft technologies and solutions in the healthcare provider industry. Even he got fooled until he starting investigating the bills. Shouldn't have fallen for that "now let's talk about how your insomnia problem is going" line...if the doc says "now, let's move on to" or "have you ever thought of getting a...?", suspicion is your friend.

The proper answer to the Shingles vaccine thing in his post, mho: Is it included? No? Well then, doc, since I and my insurance are going to be charged extra for it anyway, I am going to go home and research whether I think it is right for me. Unless it is a trusted doc that you have been going to for many years and knows your body well, doing otherwise is exactly what feeds the part of our medical industrial complex that not only raises costs but causes iatrogenic illness. Mho, you always have to be on guard for iatrogenic illness with a new doc that does not know your history well.

When medical office

jollyroger — Sat, 08 Mar 2014 23:04:04 +0000

In reply to Basically a primer on how

When medical office administrators reference "the art of coding elegantly", they are not talkin' about writing beautiful computer programs (like the rest of us C++ geeks...)

Basically a primer on how

artappraiser — Sat, 08 Mar 2014 23:03:43 +0000

In reply to Hospital Chain Said to Scheme to Inflate Bills

Basically a primer on how some docs have already learned how to inflate income for wellness checkups under ACA. Suffice it to say: don't be surprised if your wellness checkup never ends up being free of charge. Realize that every step of the way, you have to ask the doc: "is this going to be extra?"

Still Missing: Price Transparency in Healthcare
By Bill Crounse, Healthworks Collective, March 6, 2014

A few weeks ago, I saw my primary care provider for a scheduled physical exam or what the health insurance industry now likes to call a “wellness checkup.” If you recall, a major selling point of the Affordable Care Act (Obamacare) is that we are moving from a fee-for-service world to a place where value takes precedence over volume. Physicians will be rewarded for keeping people well. That is why most heath insurance plans, even those with high deductibles, now cover scheduled, annual wellness exams at 100 percent.

So imagine my shock and surprise when I received the explanation of benefits (EOB) summary from my insurance company for my wellness checkup. The first shock was seeing the total amount that had been billed to my insurance plan--more than $880. The second surprise came when I saw what my physician, or more likely his coders, had charged for my visit.

Actually, I had been charged for two visits on the same day. There was one charge for $300. That was for my wellness checkup. There was a second charge of $225 for an office visit. The remainder of the total charges were a vaccine administration fee of $36, and a charge of more than $300 for the shingles vaccine. The good news was that my insurance company would pay for all but $126 of the total charges. None-the-less, I decided to investigate a little to find out why my “wellness checkup” was costing both my insurance plan and me a whole lot more than I would have anticipated [....]

BTW from reading the above kinds of sites lately, I get the impression that the big news in provider world is that the new illness coding system is still being mandated for fall and that the Obama administration does not appear to want to give any mulligans on that, even though they have given many mulligans to ACA rollout and many are begging for delays. I don't know much about it all, but from what I see, it will open a whole new world of manipulation, the old manipulations no longer good, new ones needing to be learned by hard experience and invented. That as George Bush might say, it's hard work trying to figure out how to be paid more for something in medical care these days, people changing all the rules means figuring out new ways to get around them...

Insurers and providers should

Peter Schwartz — Fri, 24 Jan 2014 18:37:37 +0000

In reply to The article makes the point

Insurers and providers should be adversaries, at least somewhat. Ambition or greed checking greed. Especially now that the insurers can't refuse the sick.

Ugh.

Peter Schwartz — Fri, 24 Jan 2014 18:36:00 +0000

In reply to Hospital Chain Said to Scheme to Inflate Bills

Ugh.