re: What in the hell is wrong with medical billing?

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Want to see single payer in US, look at the VA.

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I agree that our government does fk up most everything it touches. But with the percentage of people we have who depend 100% on it for their healthcare (I didn’t even include the VA and tricare in my above post, only medicare/medicaid/uninsured), i don’t see taking the government out of the equation as a viable solution. I hate to think that we as a country just suck and this is why we can’t have nice things.

Son went to urgent care. They ordered a stool sample and sent orders to Christus. We swung by. Stool sample done. Negative

Get bill for 5200 dollars. Ins paid 470 write off most, told us we owed 1000.

Said it was so high because he was an inpatient. I explained he was not, fell on deaf ears. I will end up paying a grand for this. But I will never shadow the doors of that hell hole again.

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Son went to urgent care. They ordered a stool sample and sent orders to Christus. We swung by. Stool sample done. Negative

Get bill for 5200 dollars. Ins paid 470 write off most, told us we owed 1000.

Said it was so high because he was an inpatient. I explained he was not, fell on deaf ears. I will end up paying a grand for this. But I will never shadow the doors of that hell hole again.

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Don't pay it. I'd rather pay a fricking low life lawyer than pay a crooked medical practice.

Ok, now i see where you are going with this. Yes, i think it would lower prices in the long term. Would it ever be allowed, though? With EMTALA, i don’t see hospitals being allowed to do this. Also, would they allow this for Medicare and Medicaid patients? What happens when the patients don’t pay? Will you be allowed to refuse to see them again until they do?

I’ve been fighting with Oshner for 5 months over a $300 pediatrician bill. I have no issue paying it but nobody in their billing department can tell me what it’s actually for so I’ve just refused. The doctors office is no help, they just tell me to call oshner

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Ok, now i see where you are going with this. Yes, i think it would lower prices in the long term. Would it ever be allowed, though? With EMTALA, i don’t see hospitals being allowed to do this. Also, would they allow this for Medicare and Medicaid patients? What happens when the patients don’t pay? Will you be allowed to refuse to see them again until they do?

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The Dutch system requires payment (or a payment plan or IOU set up) before an outpatient visit or test is performed. No pay, no service. For inpatient and ER visits they require a down payment (it was the equivalent to $100 when I lived there) before they will even give you the paperwork to sign in. If the costs of your visit was more that the downpayment the downpayment was applied to the amount that you owed. Obviously most people cannot afford a ER visit or multiday hospital stay so require patients to sign an IOU which is to be paid within 30 days of the patient's insurance company issues its reimbursement. People whose income falls below have to prove it to the insurance companies (which is basically the same as proving you qualify for medicaid in the USA) a certain threshold are issued a second card with their insurance card and this card allows hospital fees and the cost for the doctor's visit and medications to be sent directly to the insurance companies. Granted insurance companies in the Netherlands are all public-private partnerships so technically it meets the definition of single payer. However, a similar system could easily be implemented without the government involvement.

ETA: A lot of US laws would need to be changed and no I do not think anything like my proposed system would ever come to pass. The government and corporations have the power under the current system and they like it that way.

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Insurance has no control over how a medical facility bills

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Well yeah. But they certainly do control decisions of payment based on what they consider medically necessary per their medical guidelines. In some cases the insurance company may be in the right, in other cases they may not be. Even if a service is pre authorized, they may decide not to pay.

Obviously these situations leave patients in a bind when hospitals and providers attempt to collect on services rendered but denied by the patients insurance.

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Everyone gets charged the same rate regardless of your insurance plan. Each insurance plan reimburses according to the contract that the physician and/or hospital signed. If you're in network, then the physician cannot collect the difference in the charged amount and the reimbursed amount.

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I see the difference, though it amounts to the same thing in terms of what the provider gets paid for each service being different for each patient. This being the case, if a doctor had a posted “price list”, this would not be the cost to you but the maximum possible cost to you as a patient.

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If you are out of network, then you may owe the difference(this is called balance billing).

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Here is where the confusion lies. A patient goes to a doctor that is in network, expecting everything that is done via that doctor to be in network. What they don’t realize is that the lab, the radiology, and any other services ordered by that same doctor might be out of network. I’m sure this has been covered already in this thread.

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Some types of practices do now operate on a cash based system.

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Decreasing the overhead on the practice should in theory decrease costs. But the fact that they are all out of network would then raise costs and there is the added uncertainty of being reimbursed at all. Are most of these practices things like cosmetic or anti-aging treatment type places?

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Decreasing the overhead on the practice should in theory decrease costs. But the fact that they are all out of network would then raise costs and there is the added uncertainty of being reimbursed at all. Are most of these practices things like cosmetic or anti-aging treatment type places?

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Maybe. If the price is posted/transparent, and the patient and physician are agreeable to the price, isn't that what we want?

It doesn't necessarily raise the total price, but it may change the amount the patient co shares in the price. I.e. the insurance may only reimburse 60% of the cost instead of 80% etc. And the rest is on the patient. But at least the patient would know upfront about this.

Yes, the possibility of not getting reimbursed from insurance has always been there. It just shifts from the hospital/physician to the patient. But at least the patient would know ahead of time what their cost would be if the insurance denies.

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Are most of these practices things like cosmetic or anti-aging treatment type places?

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No. There are several primary care practices who do this. There are a few ENT practices that follow a similar model. However this can't be applied to every practice type or speciality. Most people getting cardiac surgery can't really price shop for a fixed cost.

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However folks would benefit from learning more about their plans or receiving education about it.

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Go to doctor for sniffles, dr looks at you, gives shot/prescribes medicine, I slip the receptionist $30 on the way out. That’s how it was for yrs and in the case of my ENT, that’s how it’s still done. Take kids to the pediatrician and it’s like they spin a wheel on the final amount, even wellness checkups.

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I can tell people aren’t in healthcare

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Not to be rude, but no shite Sherlock. I’m not a petroleum engineer either, but generally know why I’m being charged what I’m being charged when I fill my tank up.