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Started By
Message
re: USA will have Socialized Medicine in 20 Years - It's Inevitable
Posted on 7/14/22 at 10:47 am to Bronc
Posted on 7/14/22 at 10:47 am to Bronc
quote:
Not to mention one of the dynamics once thought true, that larger health insurers benefit from better negotiated reimbursement rates is often not true, and for inexplicable reasons. The entire pricing dynamics in health care are incredibly broken and warped. Anyone that tries to apply normal economic assumptions to this space is showing their ignorance to how much of the market fits the economic definition or a market failure.
To further illustrate your point, my experience recently with having an EGD (upper endoscopy):
I have Humana commercial insurance. I had to have a scope done to verify whether I was having bile reflux (potential complication from last year's gallbladder removal). Really simple, common, procedure. Outpatient takes less than 15 minutes for the scope itself.
Night before the hospital calls me to tell me that the insurance company had still not verified my procedure that was occurring the next morning (and had been scheduled almost two weeks before). I had already paid the $1,800 they estimated would be my up front (due to having not met the deductible).
They proceed to tell me that if my insurance doesn't cover the procedure it's ok, as the hospital would consider it covered by my $1800 pre-pay as a negotiated deal.
The insurance did cover it, the total bill was over $10k and I'm now being billed an additional $600 by the hospital because the insurance does not want to cover the small biopsy they did of my stomach lining (I've had a history of gastritis, so it was a valid biopsy).
The same exact procedure was performed on my cousin, who has Medicaid, and she paid nothing.
Make it make sense, y'all. I'm having a hard time seeing where the government could do much fricking worse.
2
Posted on 7/14/22 at 11:23 am to BluegrassBelle
quote:
Humana commercial insurance
I see that you're obviously not one of them, but for all the people who love their "private" insurance delivered by a publicly traded company: is their priority your health or shareholder value?
I think the answer to this problem is an extremely complicated one, but the first step in my opinion would be to not allow your health to be balanced against shareholders' desire for profits.
In your case, the biopsy is reasonable, but in its desire to make money, Humana declines to reimburse your biopsy. They then give everybody involved a bunch of hoops to jump through hoping you'll find it not worth your time and just pay it out of pocket. Shareholders rejoice.
Posted on 7/15/22 at 10:24 am to BluegrassBelle
quote:
The insurance did cover it, the total bill was over $10k and I'm now being billed an additional $600 by the hospital because the insurance does not want to cover the small biopsy they did of my stomach lining (I've had a history of gastritis, so it was a valid biopsy).
The same exact procedure was performed on my cousin, who has Medicaid, and she paid nothing.
Make it make sense, y'all. I'm having a hard time seeing where the government could do much fricking worse.
You are correct. The government probably wouldn't do worse. It doesn't make sense, but basically Medicaid never pays anything...they aren't supposed to have money. Your insurance company has a contract with the hospital and also with you. Their contract with you is based on whatever you signed up with your employer. However, the huge problem is the insurance company gatekeepers. Insurers make it hard for physicians and hospitals to get things approved. That is the insurance company's job. They want to pay less. They try to pay less. The hospital is trying to get everything they can approved and so it the doctor's office.
In so many ways, our system is so unfair. It's all based on which insurance company your employer decides they can afford because some are definitely better payers than others. Some give everyone a hard time and we know we will have a hard time collecting from them.
The 2 biggest problems with a single payor system in the US are:
1. All those Senators and Reps that will want a plan set up a certain way to take care of this person and that company, etc. It's the reason that Obamacare is ridiculous...the fact that government decided that certain plans were "substandard" because they didn't offer certain types of care that people didn't want to spend extra money to buy. If it were just left to experts/industry/physicians/etc to design a plan and base rates on costs +, that could be done fairly easily! The info is readily available.
2. If people have coverage, they'd go to the doctor before a condition was emergent and not end up in the ER...the most expensive level of care. But, we do not have enough primary care docs to see those additional patients.
And for any of it to work and be affordable...we need people to take better care of themselves. Move, eat right, be a compliant patient.
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