Fun with health care billing (RANT)

[Lady's Human]

A conversation with my doc prior to minor surgery:

So, how much is this going to run?

We don't know.

Huh? It's a simple procedure, local, slice, a couple stitches, done.

Well, it all depends on your insurance co, the anesthesiologist who's used, the nurse who's used, we can't tell until it's all done how much it's going to cost.

__________________________________________________ ___________________________

And therein, boys and girls, lies the problem.

A mechanic in NY state has to post their hourly rate prominently in their customer area, and has to tell you up front how many billable hours a repair is going to be.

The health care industry is under no such restrictions, even for simple exams and procedures.

[RICHARD]

A conversation with my doc prior to minor surgery:

So, how much is this going to run?

We don't know.

Huh? It's a simple procedure, local, slice, a couple stitches, done.

Well, it all depends on your insurance co, the anesthesiologist who's used, the nurse who's used, we can't tell until it's all done how much it's going to cost.

__________________________________________________ ___________________________

And therein, boys and girls, lies the problem.

A mechanic in NY state has to post their hourly rate prominently in their customer area, and has to tell you up front how many billable hours a repair is going to be.

The health care industry is under no such restrictions, even for simple exams and procedures.

There is a 'set' price list for healthcare procedures!

This is how it works.

There are two costing 'guides' that are used.

One is called the International Classification of Diseases and the other is called a Diagnosis Related Group.

The ICD is a coding guideline that is used to classify a disease/illness into a numeric format.

The DRG deals with the average cost/stay/care of a hospital stay.

Back in the late 70's an appendectomy/birth of a child was a minumum
3-4 day hospital stay. Now? I have seen appy's discharged after an overnight stay- some new moms have been sent home the same day-hours after delivering a baby.

In an HMO setting, some med centers actively discourage physicians/docs/surgeons from keeping patients past a certain time frame.

A DRG is the averaging of any hospital stay or illness.

The guvmint uses those averages to pay back the centers/facilities for services rendered.

If an appy surgery costs 10k and two days in the hospital and the patient stays in for 5 days because they had an unforseen illness/condition?

The provider has to justify the extra days/care in order to get the money from the guvmint.

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During the years I worked in the industry? I saw many cases where a patient suffered because of cost cutting measures, worries about being paid and the ineptness of staff.

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The next time anyone has a problem with billing, costs, care and other shiat in the HC industry?

Look no farther than the industry itself.

The system is set up to maximize the profits and needs a reform like no one's business. The Health Care Initiative is a joke and the prez of the US should be ashamed of passing that bowel movement and making us believe that it's for the common good.

The system needs to be dismantled, there has to be caps on malpractice insurance and jury awards .

There is a local commercial where a woman tells the story about her husband passing from mesothelioma. Her quote is "the asbestos fell from the sky, like snow..." She goes on to praise the law firm that got her a HUGE settlement.

Lady,
Your husband literally killed himself to give you a house and to feed you while he was alive.

Now you want to make MORE MONEY off his death.

She'll get a nice settlement, the lawyers get paid and the workers get their insurance pulled because the company can't afford to cover the workers.

Brilliant.

[Puckstop31]

A conversation with my doc prior to minor surgery:

So, how much is this going to run?

We don't know.

Huh? It's a simple procedure, local, slice, a couple stitches, done.

Well, it all depends on your insurance co, the anesthesiologist who's used, the nurse who's used, we can't tell until it's all done how much it's going to cost.

I work, everyday, in a business that runs on variable costs.... They can give you an ballpark idea. "My insurance company is X, you tell me who is working the day I am scheduled... Now, tell me how much its going to be. I understand that there area great many variables and im not telling you how to do your job, but what will this cost if everything goes as planned? You don't know? OK, point me to somebody who does." Perhaps I am just one of those pain in the butt customers who does not take no for an answer? I am also fully aware that healthcare is very complex.... Im still not taking their word for it.

The system is not used to the customer caring about such things, so its natural to just BS you. Be polite, but be firm. Maybe im lucky, but my experience has been quite different than yours I suppose.


I guess you are rolling your eyes at me right now. Thats fine. I'm used to it. LOL

Just don't take "I don't know" for an answer, ever. If the person I am working with does not know, somebody does. Find that person. This is a key tenent of my business and it flows over into many other things.

The health care industry is under no such restrictions, even for simple exams and procedures.

Are you saying that you want it to be?

[Lady's Human]

Stores have to put the price on the shelves.

Repair businesses have to put their labor rate in plain view for the consumer to see.

I don't have contractors in to do work without an upfront quote.

I see no reason why healthcare shouldn't have the same rules in place. It would be a great simplification of the current mess relating to billing. Charge whatever you want, but tell me UP FRONT.

[RICHARD]

I don't want to turn this topic into an arguement or fight.

Someone mentioned before that HC has always been a 'the insurance will take care of it" idea.

It's time that the mystery is taken out of insurance/hospital/healthcare costs.

For years we have taken that indusstry for granted and now, more than ever, we need to push back the curtain and really pay attention to the guy pulling the levers and telling us the Great and Powerful Oz is on the up and up.

Medicine isn't an exact science, no matter what the TV says.

As a matter of fact, most of those shows really suck.

I love House.........where else can a drug addicted, crippled doctor buck the system and keep his job?

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Another GIANT change to the HC system is going to happen in 2013.

The ICD codes are going to be revised and the 10th edition will be put into effect and that is going to change the way hospitals collect their money.

The ICD codes are broken into two 'books'. One deals with illnesses and the other deals with operations/procedures.

The procedural revisions are going to be so detailed and in depth, that MCs are going to lose money because the docs are into healing, not keeping books.

An example of this?

A knee surgery? You have to code the 'approach'. Is it an incision or will they use a scope? What kind of surgery? A ligament repair, excision of a meniscus?
is it an exploratory surgery?

Every part of that surgery has a code attached to it and that code equals money - for the costs associated with that procedure.

Plus you have room, anesthesia, personnel, materials and surgeon charges.

It's a complex formula and most of the time, doc doesn't know what the eff he is going to find once they get in.

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The HC system is a frustrating system that for years has been shrouded in mystery and we need to take that out of the equation and make it more 'transparent'. There no real way to cost out a hospital stay.

LH, the idea of a cost guide on the wall of a doc's office is one way of doing business, but I think most of us would not even bother to go thru with a surgery IF WE KNEW THE COSTS.

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One of the saddest stories about HC was one my mom told me about a woman in a pharmacy trying to bargain with the clerk for some prescriptions drugs.

She could not afford the whole bottle, so she tried to buy a few pills until her check (SS, maybe?) came in.

THAT is a story that has bothered me for years.

Imagine that.

A country so powerful and rich, that we have reduced our citizen's to try and barter for their healthcare.

One thing I do advocate is for EVERYONE to pay attention to HC costs and their insurance coverage from now on.

Things are going to get tougher from here on out when it comes to costs and the stupid HCI that out benevolent guvmint has foisted upon us.

Knowledge is power-and that is the only way we will be able to afford HC in the future. We have to know what is going on behind the scenes.

[wombat2u2004]

I love House.........where else can a drug addicted, crippled doctor buck the system and keep his job?

He's a doctor ??? I thought he may have wandered in from the street looking for a handout.