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re: The story about anesthesia insurance coverage is a lot more complicated than it looks
Posted on 12/5/24 at 9:12 pm to pussywillows
Posted on 12/5/24 at 9:12 pm to pussywillows
quote:
so you'd prefer to pay premiums that create billions of dollars of profits to an insurance company than to pay an actual medical care provider what the market deems is an appropriate salary?
Thank you.
The doctor making their market value isn’t the issue. The doctor had to go to undergrad, medical school, take out hundreds of thousands in student loans, work up to 80 hours (legally) a week for a minimum of 3 years in residency (4 for anesthesia and up to 7-8 for subspecialists) just to be credentialed in their respective fields. Then they have to worry about constant fear of lawsuits in our litigious society when anything goes wrong. $400k is on the low end tbh. You’ll create an even bigger scarcity of providers if you start taking part of the incentive in becoming one away.
1
Posted on 12/5/24 at 9:16 pm to Jizzy08
quote:
The doctor making their market value isn’t the issue.
exactly...if this was the driving factor, insurance companies would not be making billions in profits every year...this board has a serious problem with medical providers making more money than they do...
Posted on 12/5/24 at 9:18 pm to deeprig9
Physician reimbursement is 9% of dollars spent on healthcare in the United States. So try again.
Posted on 12/5/24 at 9:18 pm to deeprig9
quote:
Yes, they do. Insurance #1 expense is paying the medical providers. #1 expense.
No it’s not.
30% of cost is administrative
quote:
More than half of excess U.S. health spending was associated with factors likely reflected in higher prices, including more spending on: administrative costs of insurance (~15% of the excess), administrative costs borne by providers (~15%), prescription drugs (~10%), wages for physicians (~10%) and registered nurses (~5%), and medical machinery and equipment (less than 5%). Reductions in administrative burdens and drug costs could substantially reduce the difference between U.S. and peer nation health spending.
Posted on 12/5/24 at 9:18 pm to HailHailtoMichigan!
Doctors aren't going to let patients wake up, administrators are going to find another way to bill more, they always do.
Oh, and the two ears, two charges is pretty much universal across healthcare, it is two procedures, sometimes you will have dozens of procedures in one session but the patient only thinks of it as 1. There are multipliers built into the software where you just change the number and it automatically bills X1, X2, or highest I have seen is a lil over 150.
Oh, and the two ears, two charges is pretty much universal across healthcare, it is two procedures, sometimes you will have dozens of procedures in one session but the patient only thinks of it as 1. There are multipliers built into the software where you just change the number and it automatically bills X1, X2, or highest I have seen is a lil over 150.
Posted on 12/5/24 at 9:20 pm to HailHailtoMichigan!
quote:
Populists misunderstood the regulation, stirred up rage, and killed the reform
That's the thing about populism. You can't control it and you can't predict where it will go. It's working for conservatives right now but that shite can turn on a dime and make them long for the GOPe.
Posted on 12/5/24 at 9:23 pm to RicFlairWhoooooo
quote:
Physician reimbursement is 9% of dollars spent on healthcare in the United States. So try again.
That's a wild number that needs some context.
Posted on 12/5/24 at 9:27 pm to deeprig9
I know that when I was involved in billing 10 years ago, some insurance companies would indirectly make in network anesthesia groups bill 5-10x what they actually collected. So even though you were billed $1500 the insurance company paid $300. Made you think you were grateful for insurance when they really paid a negotiated rate which was a fraction of the billing.
tldr: what you are billed is not always what is collected
tldr: what you are billed is not always what is collected
This post was edited on 12/6/24 at 8:46 am
Posted on 12/5/24 at 9:28 pm to HailHailtoMichigan!
You say that like that's a lot of money.
Posted on 12/5/24 at 9:45 pm to HailHailtoMichigan!
As a behavioral health provider that works directly w BCBS, there is nothing you can do that will convince me that company acts in the best interest of the patient.
Posted on 12/5/24 at 9:55 pm to HailHailtoMichigan!
quote:
I know when I was involved in billing 10 years ago, some insurance companies would indirectly make in network anesthesia groups bill 5-10x what they actually collected. So even though you were billed $1500 the insurance company paid $300. Made you think you were grateful for insurance when they really paid a negotiated rate which was a fraction of the billing.
tldr: what you are billed is not always what is collected
Just curbing the shell game that is medical billing would go a long way to fixing the provider/insurer issue.
This post was edited on 12/5/24 at 9:57 pm
Posted on 12/5/24 at 10:07 pm to deeprig9
quote:
Yes, they do. Insurance #1 expense is paying the medical providers. #1 expense.
Kinda ironic, then, that medical providers, especially anesthesiologists, pay some of the highest insurance premiums for malpractice coverage.
Posted on 12/5/24 at 10:25 pm to deeprig9
quote:
The provider salaries/costs are what drives the insurance costs. It's not a one-way street.
Maybe 15% of healthcare dollars pay provider salaries.
Posted on 12/5/24 at 10:34 pm to HailHailtoMichigan!
quote:
Advocates against surprise-billing had been targeting bcbs to adopt Medicare rules for anesthesia: aka cap the amount that can be billed. Medicare, Medicaid, and many other insurance firms restrict the amount of time that anesthesiologists can bill to insurance, as studies have found that they are the number 1 culprit behind surprise billing.
I didn't link it to surprise billing so I got that part wrong, but I told y'all from the get that this was about anesthesiologists overbilling.
Posted on 12/5/24 at 10:36 pm to Pintail
quote:
No it’s not.
30% of cost is administrative
I have no idea what the actual healthcare cost breakdown looks like, but that’s not what your link/quote says. It doesn’t say 30% of US healthcare cost is administrative; it says 30% of the excess healthcare cost relative to “peer nations” is administrative.
Posted on 12/5/24 at 10:36 pm to scott8811
quote:
As a behavioral health provider that works directly w BCBS, there is nothing you can do that will convince me that company acts in the best interest of the patient.
That's not their job.
The doctor is supposed to act in the best interest of the patient.
If a doctor is overbilling and causing a patient to get a "surprise bill" b/c they exceeded reasonable and customary charges or overbilled, that's the doctor failing to look out for the patient, not the insurance company.
Posted on 12/5/24 at 11:17 pm to wackatimesthree
quote:
That's not their job.
Then tell me why as a behavioral health practitioner working with children and teens on the autism spectrum I have insurance reps dictating MY treatment plan. Just to name a few I've had insurance tell me:
-teaching a teenage boy to shower independently instead of his mom doing it wasn't socially valid
-a 16 year old boy who seriously hurt and scared his parents didn't have a medical need for therapy anymore
-that I didn't need as much 97155 (protocol modification by licensed professional) because I shouldn't be using it to...get this....modify protocols (don't worry I won that appeal)
-a client needed a drastic reduction in therapy because they were working mainly on communication and hadn't learned enough words (violation of health parity laws but ok)
-a client that reduced from self-injuring from 150-200 times a session down to 50 should discontinue because we hadn't been able to eliminate it..
I could go on...but these are some of the things that PAYORS have donated to ME the practitioner.
You're job as a payor is to pay, not dictate whay treatment entails.
This post was edited on 12/6/24 at 8:37 am
Posted on 12/5/24 at 11:25 pm to Pintail
Soooo… single payer?
Posted on 12/5/24 at 11:30 pm to scott8811
quote:
I could go on...but these are some of the things that PAYORS have donated to ME the practitioner. You're job as a payor is to pay, not dictate whay treatment entails.
Payors don’t dictate treatment? Where does such a healthcare system exist?
Posted on 12/5/24 at 11:35 pm to deeprig9
quote:
ETA- it was $750 per ear. Just for the anesthesiologist. To administer laughing gas.
The dr. was laughing all the way to the bank.
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