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Message
re: 7 in 10 Louisiana children are on Medicaid
Posted on 10/19/23 at 9:47 am to Scruffy
Posted on 10/19/23 at 9:47 am to Scruffy
quote:
listened to my department head discuss it a few years back and it’s a percentage, not a dollar amount that entities, like Medicaid, will pay.
The hospital increases the cost because Medicaid/Medicare will only pay 20-30% anyway.
It isn’t a defined amount, but instead a percentage of the charge. It may even be less than the 20-30% quoted above, and it is constantly decreasing.
This is correct. Even BCBS negotiates a percentage that they will pay of a quoted cost, I see it on statements/bills.
It's still the same issue. They charge enough to make sure that 20-30% from medicaid/Medicare is still a profit above the actual cost. They're making money from medicare/medicaid, and they're making a fortune from private insurance.
1
Posted on 10/19/23 at 9:58 am to Hopeful Doc
quote:
There are over 10,000 CPT codes, each of which is a distinct billable service which Medicaid, and each other third party payer, have matched to an amount they will pay and each biller has set to a bill. The lower number on either side is what gets paid.
Hospitals often strike deals with the state and federal governments to take x% Medicaid in exchange for funding or for certain amounts of indigent care for some amount of money.
Which is why your fee schedule should be set to bill the highest payable fee for each code that you have contracted with any insurance carrier, so that you aren't missing out on any $$.
Posted on 10/19/23 at 9:58 am to Scruffy
quote:
fix is to essentially remove insurance from general health care and save it for the reason insurance actually exists, critical life altering events.
A lot of people would opt for that, the problem is making the option available to just pay the 90 the doc wanted in the first place available for a cash payment.
Posted on 10/19/23 at 10:05 am to Steadyhands
quote:
This is correct. Even BCBS negotiates a percentage that they will pay of a quoted cost, I see it on statements/bills.
It's still the same issue. They charge enough to make sure that 20-30% from medicaid/Medicare is still a profit above the actual cost.
This isn't exactly how it works. Think about it, if they were just going to pay a percentage of whatever is charged, what is to stop the hospital from just charging a higher amount? There are contracted rates for each charge, but the hospital only has one fee schedule, they aren't going to charge BCBS one amount and Medicare another amount. They are going to charge them both the same, knowing that BCBS's negotiated payment for that charge may be lower than what the charge is, and that Medicare's allowable will also be lower. But, United Healthcare may pay more than the BCBS contracted rate. They are going to charge all of them the same amount, but in order to not miss out on $$, they have to set the charge at the highest negotiated rate they have for any insurance carrier for that charge.
Posted on 10/19/23 at 10:08 am to LSUFanHouston
that's astonishing really. I had no idea . how much does a major medical insurance policy on a kid cost these days? it can't be that huge of an expense can it?
Posted on 10/19/23 at 10:58 am to LSU Tiger Jason
You're an idiot loser who can't think critically. What do you think causes healthcare costs to be so high? It's because the people who do pay for insurance have to cover the cost of the freeloaders.
Get rid of the freeloaders and the cost of health insurance goes down.
Get rid of the freeloaders and the cost of health insurance goes down.
Posted on 10/19/23 at 11:02 am to geauxkoo
quote:
You're an idiot loser who can't think critically. What do you think causes healthcare costs to be so high? It's because the people who do pay for insurance have to cover the cost of the freeloaders.
Get rid of the freeloaders and the cost of health insurance goes down.
You'll never be rid of the freeloaders. There are not enough jobs that provide health insurance for everyone to have it. One way or the other, the haves will pay for the have nots. Emergency rooms, medicaid, Affordable Care Act subsidized insurance policies, national health system, etc. I don't like it, but reality doesn't care what I like.
Posted on 10/19/23 at 11:07 am to GreenRockTiger
quote:
Do you really think an hour with a general practitioner is worth $375?
Plenty of professions bill $300+ for services. I’d argue most of those professionals have less training and overhead than a general practitioner
Posted on 10/19/23 at 11:12 am to GreenRockTiger
quote:
Medicaid will only pay a percentage, therefore hospitals raise prices to increase what that percentage is. but if the hospitals settle for whatever reimbursement- then why can’t that be the price for everyone? Bc hospital ceos want to make a lot of money
If Medicaid will only pay 40% of the procedure, the hospital will charge $100 and make $40. If they make the price $40 for everyone else, Medicaid will pay $16. It’s how percentages work.
Posted on 10/19/23 at 11:14 am to Scruffy
quote:
At the same time, most hospitals are heavily understaffed. It’s the weirdest situation.
Just like colleges, administration has boomed in number.
Posted on 10/19/23 at 11:16 am to lsunurse
quote:
Hospitals across the nation are hurting baaaaaaaddddd financially
Why?
Posted on 10/19/23 at 11:18 am to Damone
quote:
That will never happen. The big “fix” that got rammed through under Obama didn’t help anyone but health insurance companies who were handed a compulsory customer base on a silver platter.
It’s almost like big regulations only benefit big companies
Posted on 10/19/23 at 11:30 am to LSUFanHouston
That us entirely way way too many and a good reason why Louisiana is in the shape it is in.
Posted on 10/19/23 at 11:31 am to Knuckle Checker
quote:
Every country is paying for healthcare. They just pay for it through higher taxes. No one is working for free and supplies aren’t free in these countries with universal healthcare. They pay much higher taxes than we do, and that includes poor people.
Its not true. Most of them pay about 45% of their income in taxes which cover everything from their income taxes, social security, health insurance, etc etc etc. When you add everything we pay in the US it is comparable yet many Americans do not have health insurance and when they are treated by providers, and they are, the paying customer has to foot the bill. But the paying customer is also on the hook for the collections effort...the provider ain't paying for shite out of pocket, it is all paid for out of revenue and if there is any left the provider gets a salary.
How do they do this? They do not pay for their own national defense...not only are the taxpayers of the US paying for those in the states who do not have health insurance we are also facilitating the health insurance costs for people in other nations by alleviating them of the need to pay for their own national defense. Donald Trump, idiot that he is, is the only politician in the history of the world since the end of WW2 to point this out....and I will gurantee you many of his stoutest supporters will balk at the idea that our defense spending allows national health care around the world even though their boy said as much...because it makes them feel better to blame poor people in the US and the idea of those poor people suffering miserably makes their peckers hard and the Vajayjays moist....
Posted on 10/19/23 at 11:32 am to Oilfieldbiology
quote:
If Medicaid will only pay 40% of the procedure, the hospital will charge $100 and make $40. If they make the price $40 for everyone else, Medicaid will pay $16. It’s how percentages work.
If that's how it works, why doesn't he hospital just charge 10k for the procedure so that Medicaid pays 4k?
Posted on 10/19/23 at 11:35 am to LSUFanHouston
That’s a mind-blowing statistic. Meanwhile we suckers are paying hundreds of dollars a week for health insurance that leaves us with high out of pocket expenses.
Posted on 10/19/23 at 11:36 am to Hopeful Doc
quote:
The expectations of the citizens are extremely different. We have a very sedentary society that wants medicine to fix problems better cured by lifestyle changes, and we have a healthcare system that takes into account the patient satisfaction with care (like one that introduced pain as the 5th vital sign, blessed Purdue Pharma for OxyContin being marketed as “nonaddictive” and then basing part of how doctors and hospitals get paid based on how patients rate their own pain, quite literally inducing the opioid epidemic), so there’s a ton of frivolous spending to keep patients happy on things they don’t really need instead of addressing the actual problems that are the root cause of diabetes, obesity, heart disease, etc.
Nations with national healthcare have a vested interest in keeping people healthy. This leads to those nations spending money on things like walking and bike paths, sidewalks even in rural areas (Imagine a rural county in the US building a sidewalk LOL), swimming pools, gyms etc. Those nations pay for all of that by not paying for their own national defense. No one ever says it but Donald Trump did, idiot that he is he got that 100% spot on correct....
Posted on 10/19/23 at 11:37 am to AwgustaDawg
quote:
Nations with national healthcare have a vested interest in keeping people healthy.
Posted on 10/19/23 at 11:39 am to ct4lsu
quote:
This is honor codes legacy
Watch when he beats Cassidy (who voted to convict Trump) and swings a future Senate
This post was edited on 10/19/23 at 11:40 am
Posted on 10/19/23 at 11:41 am to AwgustaDawg
Nations with national healthcare do not have a massive injury lawyer industry and contingency based lawsuits are almost unhear of. Their various other types of insurance is also far more affordable...auto, homeowners, workers comp, general liability, all of them, simply because everyone has health insurance and therefore no matter how they were injured, slip and trip, auto accident, no matter, the medical portion of their injury is covered. The medical portion is what is expensive and what drives the contingency based personal injury litigation industry in the US.
And again they do not foot the fill for their own national defense. You and I do that for them. They don't appreciate it and will call you an idiot for not having national health care. Donald Trump, idiot that he is, pointed this out and no one wanted to hear it.
And again they do not foot the fill for their own national defense. You and I do that for them. They don't appreciate it and will call you an idiot for not having national health care. Donald Trump, idiot that he is, pointed this out and no one wanted to hear it.
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