- My Forums
- Tiger Rant
- LSU Recruiting
- SEC Rant
- Saints Talk
- Pelicans Talk
- More Sports Board
- Fantasy Sports
- Golf Board
- Soccer Board
- O-T Lounge
- Tech Board
- Home/Garden Board
- Outdoor Board
- Health/Fitness Board
- Movie/TV Board
- Book Board
- Music Board
- Political Talk
- Money Talk
- Fark Board
- Gaming Board
- Travel Board
- Food/Drink Board
- Ticket Exchange
- TD Help Board
Customize My Forums- View All Forums
- Show Left Links
- Topic Sort Options
- Trending Topics
- Recent Topics
- Active Topics
Started By
Message
re: Why is medicine the only retail service that can't figure out billing?
Posted on 9/3/15 at 4:32 pm to GeauxTigers777
Posted on 9/3/15 at 4:32 pm to GeauxTigers777
quote:
But you are looking at Healthcare as a service. I am looking at it as a business. What would entice the hospital to want to act as the general contractor?
I appreciate your honesty.
The billing practices are absurd, but they are a symptom, not a cause. The cause is the out of control insurance model we have.
A system does fix some of the symptoms of the billing practices... but you would again need some pretty large scale changes in the medical field.
I'm still fighting over a bill from 9 months ago because between myself, the provider (a hospital) and the insurance company, no one can figure out what exactly provision of my insurance contract applies. The insurance company has changed their mind 5 times over whether a) covered at all and b) it's a preventative (ins pays 100 percent) or an office visit (I pay a co-pay, ins co pays balance) or a hospital visit (applies to my deductible).
Meanwhile, the hospital just wants to get paid.
2
Posted on 9/3/15 at 4:57 pm to LSUFanHouston
In all of my arguments, i 100% agree there needs to be a strong revision. The billing practices are absurd, and it baffles me that costs are still not published data prior to procedures. A practice in Oklahoma has offered this service for flat fee operations. It is intriguing to me, but I could see it having a lot of qualifiers.
For instance, I would be reluctant to offer an obese and diabetic patient a flat fee, global coverage operation. The risk of adverse effects is just too high. What happens to these patients' Healthcare? Do they have to go to lesser physicians? Do physicians offer what will be discounted services? Do you add qualifiers to cover these expenses i.e. Not flat fee?
What about emergent conditions where prognosis/procedure is unknown? Where does the fee come into that? Just part of the reason this is such a hard fix. It is the most complicated system in the world because we want to make it both a philanthropic cause to preserve human life and make a healthy living.
I am torn daily, and the billing/services has zero direct correlation to me.
For instance, I would be reluctant to offer an obese and diabetic patient a flat fee, global coverage operation. The risk of adverse effects is just too high. What happens to these patients' Healthcare? Do they have to go to lesser physicians? Do physicians offer what will be discounted services? Do you add qualifiers to cover these expenses i.e. Not flat fee?
What about emergent conditions where prognosis/procedure is unknown? Where does the fee come into that? Just part of the reason this is such a hard fix. It is the most complicated system in the world because we want to make it both a philanthropic cause to preserve human life and make a healthy living.
I am torn daily, and the billing/services has zero direct correlation to me.
This post was edited on 9/3/15 at 4:58 pm
Posted on 9/3/15 at 5:00 pm to LSUFanHouston
Insurance is the cause for all of the issues in determining net out of pocket.
What I would be a small victory is knowing what the maximum amount I can expect to pay assuming insurance covers nothing. This could be complex for some types of surgeries, but for most routine work this should be pretty straightforward.
I want to have a general idea of whether X procedure might cost me $2,000 or $10,000 if all goes according to standard procedure and tests/results.
The lack of consumer-centricity is truly due to a completely fractured market that results in incomplete information for the consumer. As more health professionals can say, "X procedure will cost you Y amount", the rest of the market will have to adjust practices and fall in line. Otherwise, their "business" will fall off as consumers choose the transparent option.
What I would be a small victory is knowing what the maximum amount I can expect to pay assuming insurance covers nothing. This could be complex for some types of surgeries, but for most routine work this should be pretty straightforward.
I want to have a general idea of whether X procedure might cost me $2,000 or $10,000 if all goes according to standard procedure and tests/results.
The lack of consumer-centricity is truly due to a completely fractured market that results in incomplete information for the consumer. As more health professionals can say, "X procedure will cost you Y amount", the rest of the market will have to adjust practices and fall in line. Otherwise, their "business" will fall off as consumers choose the transparent option.
Posted on 9/3/15 at 5:29 pm to Golfer
If medicine was in a free market you would get a far better customer experience. However, medicine is heavily regulated and socialized. It is basically government. You shouldn't expect a different result than say visiting a DMV.
Posted on 9/3/15 at 5:37 pm to lsu13lsu
quote:This ain't the Poli Board. Regulation is not the cause of every problem. The problems with the health care "market" are inherent due to its nature.
If medicine was in a free market you would get a far better customer experience. However, medicine is heavily regulated and socialized. It is basically government. You shouldn't expect a different result than say visiting a DMV.
Posted on 9/4/15 at 6:45 am to Golfer
quote:
If a third party payor was involved with your burger purchase, it would be a mess as well. The insurance decides how much you get paid for a service, not you.
Non-sense. The ability to streamline the billing process is still available absent of any changes in insurance.
Every medical professional in here seems to simply deflect and blame on someone else. Here's an idea...figure it out yourself.
________________________________
I did. I have been a cash pay up front physician for 7 years. Have not billed an insurance company and will never do it again.
If a third party payor was involved with your burger purchase, it would be a mess as well. The insurance decides how much you get paid for a service, not you.
Non-sense. The ability to streamline the billing process is still available absent of any changes in insurance.
Every medical professional in here seems to simply deflect and blame on someone else. Here's an idea...figure it out yourself.
________________________________
I did. I have been a cash pay up front physician for 7 years. Have not billed an insurance company and will never do it again.
Posted on 9/4/15 at 7:13 am to SECdragonmaster
That will change when the government requires you to accept all insurance.
Posted on 9/4/15 at 8:48 am to LSUSUPERSTAR
quote:
That will change when the government requires you to accept all insurance.
If they could do that, they would have done it with Medicaid already.
Surprisingly, the only payer ever to blackmail me, was BCBS.
They said if we didn't sign a contract with their exchange product, that they would be "reevaluating" our participation in other BCBS plans.
It was so brazen, and direct, all I could do was
and sign.Posted on 9/4/15 at 2:13 pm to MSMHater
Bahahahahahaha now they want $25 for them to give her a copy of her own MRI...on a CD.
I told her to get a pack of 100 from Wal-Mart for $4.99 and sell the remaining 99 to them for $700.
Or here's an idea...share the file electronically?
Baton Rouge Radiology is on the publicly shamed list.
I told her to get a pack of 100 from Wal-Mart for $4.99 and sell the remaining 99 to them for $700.
Or here's an idea...share the file electronically?
Baton Rouge Radiology is on the publicly shamed list.
Posted on 9/4/15 at 3:10 pm to Golfer
Is this the same fiasco that prompted you to refinance your student loan?
Posted on 9/4/15 at 3:17 pm to Golfer
quote:
Bahahahahahaha now they want $25 for them to give her a copy of her own MRI...on a CD.
I told her to get a pack of 100 from Wal-Mart for $4.99 and sell the remaining 99 to them for $700.
Or here's an idea...share the file electronically?
Baton Rouge Radiology is on the publicly shamed list.
I agree. That's absurd. It takes almost zero time and cost to burn a CD. I would let your physician that referred you know about that.
Trust me, physicians and healthcare providers understand your frustration. Do you think we enjoy having to hire umpteen more employees just to make sure we get paid for what we do? Insurance companies are not at all friendly to physicians or other providers.
I would love to be a cash-only practice, and divorce myself from insurance. But until the patients (consumers) give up that attachment, I'm not putting myself or my family's financial security at risk.
Your "solution", though, does nothing more than give even MORE power to the hospitals. And I can assure you, no one cares less about patient care than the giant hospital systems and their administrators (as long as 'satisfaction scores' and other bullshite look good of course).
Posted on 9/4/15 at 3:37 pm to NOMT
Solid post.
Posted on 9/4/15 at 5:06 pm to NOMT
quote:
Your "solution", though, does nothing more than give even MORE power to the hospitals.
Well BR radiology group isn't a hospital
Posted on 9/6/15 at 3:04 pm to Golfer
Interesting takes here.
The financial aspect of US medicine certainly has its warts. Sort of a weird premise that "figuring out billing" would relate to independent bills for independent services though. Sounds like you'd prefer to pay a premium in order to receive one bill. May be an "opportunity" on its way with bundled payments.
From an insider perspective, the question in bundled payment is obviously who controls the money. The ACA is moving things in that direction with a push for bundled payments issued to hospitals, then distributed by the hospital to providers. Though it is an internal issue now, as it affects the system, it will eventually be a concern for patients as well.
With control of money will follow control of care. That control will fall further away from your doctor, and toward the hospital. Translates to less personal tailoring of care, and much more money-based decision making.
But you will have your single bill.
The financial aspect of US medicine certainly has its warts. Sort of a weird premise that "figuring out billing" would relate to independent bills for independent services though. Sounds like you'd prefer to pay a premium in order to receive one bill. May be an "opportunity" on its way with bundled payments.
From an insider perspective, the question in bundled payment is obviously who controls the money. The ACA is moving things in that direction with a push for bundled payments issued to hospitals, then distributed by the hospital to providers. Though it is an internal issue now, as it affects the system, it will eventually be a concern for patients as well.
With control of money will follow control of care. That control will fall further away from your doctor, and toward the hospital. Translates to less personal tailoring of care, and much more money-based decision making.
But you will have your single bill.
Posted on 9/7/15 at 1:14 pm to Golfer
quote:Then the doctor would become the collection agency for all the other providers. AND, it's illegal for the doctor to profit from most things he/she orders. Got a problem? Talk to your insurer. It's done on purpose to create confusion about billing and payments. We are given deadlines to file claims or refile denied claims. If we don't, it's written off. Insurers count on this. It's a clusterfrick.
Process everything, route it back to the office, then send me one bill. Where I then pay one bill for the one service and that office will pay the doctor, etc.
Why can't we give a price? We don't know it. It's different for every insurance. Hell, I don't know what most of my charges are past routine visits. If someone is paying cash, I can give them a lump sum price. Otherwise, who the frick knows? And we don't set the prices. The insurers do. Think bill is too big? That's the price your insurer set. Pay cash. File your own damn insurance and deal with them yourself. The only prices I control are cash prices. Those are even inflated due to insurance. I have to pay all my billing staff whether you pay cash or not. And since 95% of my pt's are insured, I can't cut overhead to what my true cash prices would be if I weren't burdened by all the expense and pain in the arse to deal with insurers. Just a rough guess is that I could reduce my charges 50% across the board if insurance was not involved at all.
This post was edited on 9/7/15 at 1:23 pm
Posted on 9/7/15 at 1:28 pm to yellowfin
quote:
Is there a website or something for locating these? as far as I know there isn't one in my city
Just out of curiosity, how much would you be willing to pay for the services? Monthly fee? Visits? What would you expect in return? I've contemplated a move into this in a few years or adding it to current services if I could find a couple of competent partners. I've seen a wide variety of billing arrangements. I would want a monthly fee for each member and a flat fee for visits with time based increases. Additional services could be negotiated.
Posted on 9/7/15 at 7:31 pm to LSUSUPERSTAR
quote:
That will change when the government requires you to accept all insurance
Now you have demonstrated how little you know about the industry. This is still a free country and the government can't force me to do anything as a medical provider.
They can't force an electronic medical record (still use paper) and certainly can't force me to take insurance (never will).
The only control the government has is to not pay me when I bill them. As long as patients understand my care is worth cash up front, it will never change.
If I had to bill an insurance company, I would retire.
Posted on 9/7/15 at 8:01 pm to NC_Tigah
quote:
The financial aspect of US medicine certainly has its warts. Sort of a weird premise that "figuring out billing" would relate to independent bills for independent services though. Sounds like you'd prefer to pay a premium in order to receive one bill. May be an "opportunity" on its way with bundled payments.
From an insider perspective, the question in bundled payment is obviously who controls the money. The ACA is moving things in that direction with a push for bundled payments issued to hospitals, then distributed by the hospital to providers. Though it is an internal issue now, as it affects the system, it will eventually be a concern for patients as well.
With control of money will follow control of care. That control will fall further away from your doctor, and toward the hospital. Translates to less personal tailoring of care, and much more money-based decision making.
But you will have your single bill.
Excellent post, as usual. Exactly correct.
Posted on 9/7/15 at 8:59 pm to Golfer
quote:
Bahahahahahaha now they want $25 for them to give her a copy of her own MRI...on a CD.
Considering that my father was charged $25 for an aspirin, administered two days after his death (according to hospital billing records), I think you're getting one hell of a deal on that CD. I'd jump on that with both feet, before they up the price, if I were you.
Page 5 of 5
Popular
Back to top
Follow TigerDroppings for LSU Football News