re: Medical billing.. is there a cure to this chaos?

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When they mailed us a $300-500 bill, we would ask the insurance company, and found out these were called "Walk-By Doctors." The Insurance co. would call them, tell them to frick off, and we wouldn't hear from them anymore

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Another example of greedy doctors. This should be a criminal charge for insurance fraud.

I literally have to call the insurance company on every bill. It’s been a rough few months for my kids from broken arms to RSV and the last bill I got they charged the whole thing to my deductible and I had already met my deductible prior to this hospital visit.

My now 10 month old had a tongue tie procedure done earlier this year and I paid the the anesthesiologist originally and a few months later I get another bill from them for $1000 where my insurance took unauthorized discounts. It’s been a nightmare trying to resolve. Can’t wait to see what this latest hospitalization for my 10 month old due to RSV holds.

Are you billing or getting billed ? If you are billing, I suggest hiring a company to do it.

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Sounds like Tulane Med where each doctor sends their own bills instead of just one damn bill from the hospital.


That's all hospitals. The doctors, radiologists, anethesiologist, all contractors. They all send their own bills.

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Not necessarily. Tulane med center is an HCA hospital, so they probably have a lot of contractors. If you go to a state hospital like UAB then the physicians will likely be employed by UAB (therefore the state). It depends on the hospital structure. To make it more confusing, places like Ocshner main campus are mostly (if not all) employeed doctors, but other Oschner hospitals have contractors staffing them.

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Democrats and Republicans are both equally responsible for the limbo our healthcare system is in.

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Couldn't agree more. The core issue is the incredible cost of healthcare in this country. We have the most expensive healthcare in the world. Healthcare is almost 20% of the nation's GDP. People that is a big number. The government has continuously failed to control these spiraling costs. As many know, you get sent to a doctor, they order a procedure, test, lab, hospital visit and then you're handed a bill. No one consults you about the costs, whether it will be covered by your insurance or anything else. You do what your told. You don't question because it's your doctor. Then they hand you the bill and move on. I was recently sent to the hospital, run through a battery of tests and a simple biopsy. Received a letter from Blue Cross. The biopsy was $117,000 of which $0 may be covered. How is it possible to order procedures, not talk to the client and then simply hand them a bill of that size? In what other industry can you just do work for a client and then just hand them a bill?

There is a lot of work needed in the US Healthcare system.

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He said it as if it was a matter of standard practice.

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Because it is. Each health system negotiates their own rates. You can get a procedure at one hospital in town and the exact same procedure is a different price if you go to a hospital down the street. And each insurance company can pay different rates for the exact same procedure at the same hospital.

So for example at a home health care company I used to work at, medicare advantage patients did not make us any money. In fact we lost money on them. A patient receiving the exact same care under Medicare or another provider would generate a profit.

We used to bargain with the health systems and say "OK if you send us 4 Medicare patients to every 1 Medicare Advantage patients we will do business with you."

I've been apart of conversations that discussed discharging patients on Medicare Advantage solely because we lost our arse on them. It's not the patients' fault their insurer pays shite rates, obviously. But these aren't uncommon conversations in the healthcare space at all.

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Of course there is: Medicare-For-All.

Mainstream politicians have advocated this for years

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They're the biggest clusterfrick of all!!!
You obviously don't know shite about the medical coding/billing business. It is shitty, complicated and unworkable by design.

Please go to medicare for all. Will give me an excuse to finally go all cash and not be the bad guy. Those able to pay will have access to the better doctors and facilities. Those that can't will get the gov't doctors/"providers".

The single best solution now would be for everyone to be swapped to healthcare savings plans that are adequately funded. With large deductibles, but adequate money put in yearly it would give incentive for patients to take better care of themselves, not abuse visits, demand needless test and imaging and be able to negotiate prices. That's what many people don't understand. YOUR INSURANCE SETS THE PRICE!!!! We contract to serve their customers at that price. We can't charge more or less if we wanted to. Your insurance company wants healthcare to be more expensive. So long as premiums outpace payouts, the more expensive healthcare is, the more they make. Not only that, but the less you can afford to be without it no matter how shitty and expensive it is.

The health insurance industry and gov't regulations are the biggest drivers of healthcare costs and inefficiency. Check out the profits of major insurers since Obamacare went into effect. Now look and see how pay to providers has been frozen or cut. Look at the number of medical administrators now in comparison to physicians now v. 15 years ago.

Our clinic had two people to handle all insurance related issues 18 years ago and we saw more total pt's with 2 providers than we currently do with 5 and have 6 people that are essentially dedicated to coding, filing, reconciling and refiling of denied claims. Then you get the referrals, pre-certs for imaging/procedures etc. PA's for meds and formulary exemptions, etc.