Do we dare discuss the Supreme Court decision re: Healthcare

[Cataholic]

I don't know if this is directly related to the ongoing debate, but one big problem with medical care is: try getting a quote for something you want done. Say, a knee replacement. GOOD LUCK! Every other product or service I can think of has the prices transparent. I reckon if people knew what they were paying, they could decide if they are getting what they pay for. If someone wants to buy a Kia and sees a Cadillac price, they know right away something's not OK. No such "common lore" exists, AFAIK, in health care prices.

I went to the doctor last week. As I was leaving, I asked for a bill (I have a big deductible, I know I have to pay for the visit). Again, I heard, "we don't know what the charge will be...it depends on your insurance". LOL. It shouldn't! The charge should be what the charge should be. A doctor's ten minutes in the exam room with the patient.

[Randi]

I went to the doctor last week. As I was leaving, I asked for a bill (I have a big deductible, I know I have to pay for the visit). Again, I heard, "we don't know what the charge will be...it depends on your insurance". LOL. It shouldn't! The charge should be what the charge should be. A doctor's ten minutes in the exam room with the patient.

Of course the charge should be what the charge will be, not what they can "get out of it"! Anything else sounds like a banana republic.

[RICHARD]

Ind. woman accused of embezzling $300K from pet insurance firm
THE ASSOCIATED PRESS
First Posted: July 04, 2012 - 4:01 am
Last Updated: July 04, 2012



JEFFERSONVILLE, Ind. — A southern Indiana woman faces dozens of forgery and theft charges alleging that she embezzled more than $300,000 from a pet insurance company.

Christina Heaven of Jeffersonville has been charged with 59 forgery and theft counts accusing her of embezzlement from PetFirst Healthcare. Her trial is scheduled for November.

The Courier-Journal of Louisville, Ky., reports (http://cjky.it/O25Yra ) the 35-year-old Heaven was an administrative worker at the Jeffersonville company. She's accused of using her boss's social security number to open a secret checking account in the PetFirst name with a credit card account in 2010.

Heaven allegedly deposited checks from PetFirst customers totaling $314,723 into that checking account and then withdrew $293,703.


Brandon Smith, one of Heaven's attorneys, urged the public "not to rush to judgment before the evidence is available."


___

This would NEVER happen to a human insurance company.....

[Karen]

I went to the doctor last week. As I was leaving, I asked for a bill (I have a big deductible, I know I have to pay for the visit). Again, I heard, "we don't know what the charge will be...it depends on your insurance". LOL. It shouldn't! The charge should be what the charge should be. A doctor's ten minutes in the exam room with the patient.

Unless you have some really obscure plan, the person who handles the billing ought to be able to tell you that right away, or with a quick search on his or her computer! Sheesh!

Just today, I was on the phone with an insurance company. In May, as you know, I ended up having my gall bladder removed. Good riddance. But part of that was, my primary care's office suggested I go to a nearby Urgent Care place, as they didn't have anyone who could see me that afternoon. So I dutifully looked up where it was, went there, and briefly saw a doctor, who told me they didn't have any ultrasound available there, so it was most likely my gall bladder, but I would go to the Emergency Room at the hospital. They had taken all my information, and said they'd call, and let them know to expect me. Before I left, I said, "Now, before I leave, don't I owe you a co-pay?" I was in pain, yes, but still had the presence of mind to inquire. "Na," I was told, as we couldn't really do anything for you, so go on ahead, you don't owe anything." I asked if they were sure, they said yes, and onward I went.

This week, more than a month later, I got a bill for $15. That's my copay, I KNOW that amount. I had no problem paying it, just would have preferred to get it over with while I was there the first time! Instead, they had to wait, generate paperwork, bill my insurance company for the whole amount, figure out there was $15 the insurance didn't pay, and send me a bill for that. And have someone available to answer the phone when I called to ask, "What the heck?" Talk about a waste of everyone's time and money!

[Edwina's Secretary]

Unless you have some really obscure plan, the person who handles the billing ought to be able to tell you that right away, or with a quick search on his or her computer! Sheesh!

Not really Karen. Many insurance plans have doctor co-pays that are dependent on many factors. If you have met your deductible - and you could have a variety of doctors billing toward that deductible can make a difference in what you owe. Sadly, it is not at all unusual for a doctor's office to not be able to tell what the patient's co-pay is until they have processed the claim to the carrier and learned what the carrier is going to pay. Many plans vary what the co-pay will be based on the purpose of the visit as well.

Plans that have the same doctor co-pay regardless tend to be HMO type products.

Plans with variable co-pays are probably the most common these days as the insurance companies continue to look for ways to control costs and increase profits.

Don't blame the doctor's staff! It is just often not as easy as a quick computer search. I was in Kaiser HMO for a year and knew exactly what a doctor visit would cost. Now that I am back in a PPO (high deductible) I don't have a clue until the doctor files the claim and bills me.

(And if you wonder why I went back - I am tied to what the employer offers!)

[Lady's Human]

Not really Karen. Many insurance plans have doctor co-pays that are dependent on many factors. If you have met your deductible - and you could have a variety of doctors billing toward that deductible can make a difference in what you owe. Sadly, it is not at all unusual for a doctor's office to not be able to tell what the patient's co-pay is until they have processed the claim to the carrier and learned what the carrier is going to pay. Many plans vary what the co-pay will be based on the purpose of the visit as well.

Plans that have the same doctor co-pay regardless tend to be HMO type products.

Plans with variable co-pays are probably the most common these days as the insurance companies continue to look for ways to control costs and increase profits.

Don't blame the doctor's staff! It is just often not as easy as a quick computer search. I was in Kaiser HMO for a year and knew exactly what a doctor visit would cost. Now that I am back in a PPO (high deductible) I don't have a clue until the doctor files the claim and bills me.

(And if you wonder why I went back - I am tied to what the employer offers!)

This in a nutshell, is a huge fault with the current system.

It's why people wind up in bankruptcy for medical bills, hard to plan when you have no earthly idea what your expenses are going to be beyond some very, very vague guidelines, further exacerbated by the contractor shell game. (Well, yes, all our staff are PPO for your insurance, however, Dr XYZ isn't part of our staff, he/she contracts with us through Dewy, Screwem and Howe, and therefore aren't part of our PPO group. hat do you mean you didn't realize what you were agreeing to while you were in excruciating pain? We have your signature, it's valid.)

[Edwina's Secretary]

This in a nutshell, is a huge fault with the current system.

It's why people wind up in bankruptcy for medical bills, hard to plan when you have no earthly idea what your expenses are going to be beyond some very, very vague guidelines, further exacerbated by the contractor shell game. (Well, yes, all our staff are PPO for your insurance, however, Dr XYZ isn't part of our staff, he/she contracts with us through Dewy, Screwem and Howe, and therefore aren't part of our PPO group. hat do you mean you didn't realize what you were agreeing to while you were in excruciating pain? We have your signature, it's valid.)

A perfect description of a very, very imperfect situation! With our policy the deductible (as with most policy) is a family deductible so I would need to keep track of what the insurance has paid for my husband, what has not been paid, what will not be paid, how much I have spent so far this year, divided by two taken to the fifth power and the square root of 3.

I sympathize with the doctors as well. How can they predict their revenue? How do they know if they are being paid correctly?

I cannot imagine how the system could get much more screwed up!

[RICHARD]

http://shine.yahoo.com/parenting/par...183800609.html


Healthcare!

[pomtzu]

http://shine.yahoo.com/parenting/par...183800609.html


Healthcare!

Pretty damn scary. I wonder if the parents had insurance, and if they didn't, that it made a difference in the "care" the boy received.

[cassiesmom]

Not really Karen. Many insurance plans have doctor co-pays that are dependent on many factors. If you have met your deductible - and you could have a variety of doctors billing toward that deductible can make a difference in what you owe. Sadly, it is not at all unusual for a doctor's office to not be able to tell what the patient's co-pay is until they have processed the claim to the carrier and learned what the carrier is going to pay. Many plans vary what the co-pay will be based on the purpose of the visit as well.

Plans that have the same doctor co-pay regardless tend to be HMO type products.

Plans with variable co-pays are probably the most common these days as the insurance companies continue to look for ways to control costs and increase profits.

Don't blame the doctor's staff! It is just often not as easy as a quick computer search. I was in Kaiser HMO for a year and knew exactly what a doctor visit would cost. Now that I am back in a PPO (high deductible) I don't have a clue until the doctor files the claim and bills me.

(And if you wonder why I went back - I am tied to what the employer offers!)

I learned something very interesting when I worked for a company that paid its own claims. The claims are generally paid in the order they arrive. So if a big bill gets to the carrier and you haven't met your deductible, they will apply it toward your deductible. Then the next one that comes in might be paid because you met the deductible with the previous huge one. It was a bugger for people who were reaching their policy maximum because the providers who got their claims in first got paid, and the ones who dragged their feet got denied because the member had met their policy maximum. I've also worked for two Fortune 500 health plans and I can say with certainty that it's a huge help if you are familiar with your plan - deductible, co-pay, out of pocket and all that stuff. Someone from the physician's office can call the 800 number but they frequently have to plow through a lengthy menu of phone prompts to get the information they need.

I had a high-deductible health plan for a little while. It was expensive but relatively easy to manage- I paid for everything and submitted claim forms. I think the Affordable Care Act is going to have more people confused and uncertain about their coverage and benefits for awhile until the payors and providers figure out what the laws require, and it all gets sorted out.

This in a nutshell, is a huge fault with the current system.

It's why people wind up in bankruptcy for medical bills, hard to plan when you have no earthly idea what your expenses are going to be beyond some very, very vague guidelines, further exacerbated by the contractor shell game. (Well, yes, all our staff are PPO for your insurance, however, Dr XYZ isn't part of our staff, he/she contracts with us through Dewy, Screwem and Howe, and therefore aren't part of our PPO group. hat do you mean you didn't realize what you were agreeing to while you were in excruciating pain? We have your signature, it's valid.)

This is how we used to coach patients to respond to the contractor shell game. Say to the provider: No no no no. That was emergency department care. Payable at in-network level under prudent layperson rule. I want Dr. XYZ's care to continue to be paid at the in-network level for continuity of care purposes. What do I have to do to make sure that's done? What else can you do to help me get that done?
Then call your insurance. If you contact the payor yourself they might send the claims back for reprocessing at the higher level. The squeaky wheel gets the oil, so squeak!.

[Jessika]

On the subject of medical costs, a friend went to the ER with excruciating pain one night (involuntary moaning/screaming in pain type of pain). Their triage was so bad they made her sit in the waiting room while people with cuts, etc, go in before her. She ended up passing a kidney stone while sitting in the waiting room. They finally call her in (after all that was over), took some vitals, palpated her abdomen, and said "well looks like you've already passed it, if you experience it again come back, otherwise here's a prescription for some pain meds".

She got the bill a week or so later -- over $1000. OVER A THOUSAND DOLLARS to have her vitals taken and abdomen palpated after she passed the kidney stone IN THE WAITING ROOM.

THIS is wrong.

[Catty1]

Jessika, that is abominable! I don't know who she would write to - but notifying the media is a good start!

[Lady's Human]

This is how we used to coach patients to respond to the contractor shell game. Say to the provider: No no no no. That was emergency department care. Payable at in-network level under prudent layperson rule. I want Dr. XYZ's care to continue to be paid at the in-network level for continuity of care purposes. What do I have to do to make sure that's done? What else can you do to help me get that done?
Then call your insurance. If you contact the payor yourself they might send the claims back for reprocessing at the higher level. The squeaky wheel gets the oil, so squeak!.

I was shunted to a lawyer, and the bill sits. It's not enough for them to go to court to recover. Both the Ins. Co and the hospital have stonewalled. I refuse to pay, I actually invited them to take me to court to collect, and they have refused.

The contractor shell game is completely supported by state and federal law, so the consumer is screwed.