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Posted on 12/5/24 at 7:57 am to coolpapaboze
(no message)
This post was edited on 5/11/26 at 9:05 pm
Posted on 12/5/24 at 7:59 am to Big4SALTbro
(no message)
This post was edited on 5/11/26 at 9:05 pm
Posted on 12/5/24 at 8:23 am to Penrod
quote:This is off topic, but I love business discussion with business owners. It is empowering to learn from people who are risk takers. If you want to move this discussion to the money forum, let me know, but what kind of businesses and how was the overall partner experience and how did you engage these partners (angel investors?) to investigate and ultimately invest in your ideas? Were any or all successful?
I’ve had about eight or ten companies, and every partner I’ve had
This post was edited on 12/5/24 at 8:24 am
Posted on 12/5/24 at 8:28 am to Penrod
I didn’t say they don’t charge by procedure, in fact I knew surgeons do because I have family in the medical field. Perhaps you should learn some reading comp my man.
I said how many are dragging arse vs how many spin people out.
I said how many are dragging arse vs how many spin people out.
Posted on 12/5/24 at 8:28 am to Asleepinthecove
quote:
Anesthesia is at the mercy of the surgeon.
And that's who the policy is aimed at (well, technically the anesthesiologist).
Guaranteed what was happening is that anesthesiologists were overbilling and this policy is to stop the overbilling.
The codes involved are likely timed codes and they were almost certainly billing for too many units.
I would be shocked if this resulted in any patients getting a bill. This is BC/BS telling the doctors that they will no longer get away with padding the bill by claiming so many timed units under anesthesia.
Posted on 12/5/24 at 8:31 am to OMLandshark
She might and I agree her tweet in their own words is clearly a dog whistle. I just pointed out anyone with a functioning brain can find the ceo of blue cross name and pic
Posted on 12/5/24 at 8:32 am to OMLandshark
Kim Keck looks like a younger clone of Dafna Yoran
Posted on 12/5/24 at 8:35 am to Penrod
quote:
What if anesthesiologists are intentionally milking the system by unnecessarily prolonging their engagement?
They likely aren't even prolonging the encounter, they likely are just billing for too many units of the code. (Yes, lying).
That's actually very likely how BC/BS can justify the decision, because they probably collected data over time and compared how many units of the anesthesia were billed for a certain procedure and then they compared that to how many of those procedures were done and the numbers didn't match.
As in, the billings for the anesthesia for this procedure averaged 1.5 hours but the billings for the actual procedure indicate an average of performing 12.5 a day. So the average provider was working 18 and 3/4 hour days?
quote:
What we have here is a wonkish issue that almost none of us knows shite about.
I happen to know something about this wonkish issue. This firmly intersects with the business I just sold back in March.
This post was edited on 12/5/24 at 8:42 am
Posted on 12/5/24 at 8:35 am to wackatimesthree
quote:
Guaranteed what was happening is that anesthesiologists were overbilling and this policy is to stop the overbilling.
I was thinking this might be the case. Makes more sense than the idea of only paying for a 30min of a 45min surgery.
I'm sure the Anesthesiologists lobbyists will say its the damn insurance companies being greedy though.
Posted on 12/5/24 at 8:40 am to Turnblad85
quote:
I'm sure the Anesthesiologists lobbyists will say its the damn insurance companies being greedy though.
It's honestly both of them.
3rd party pay is of the devil.
When one party receives a service, one separate party pays for the service, and a third separate party provides the service, this is what you get.
It becomes a game of Spy vs. Spy.
The insurance companies unfairly deny some billings that should be legitimate so the providers look for ways to make it up by billing for things they shouldn't (and feel justified in doing so b/c the insurance company started it).
It's very much like the IRS and taxes.
Posted on 12/5/24 at 4:48 pm to wackatimesthree
quote:
And that's who the policy is aimed at (well, technically the anesthesiologist). Guaranteed what was happening is that anesthesiologists were overbilling and this policy is to stop the overbilling. The codes involved are likely timed codes and they were almost certainly billing for too many units. I would be shocked if this resulted in any patients getting a bill. This is BC/BS telling the doctors that they will no longer get away with padding the bill by claiming so many timed units under anesthesia.
Anesthesia is billed as base units plus time. Let’s say you’re having your gallbladder out. That’s 7 base units. Insurance payment per base unit varies based on the insurance and the contracted rate. Medicaid pays roughly 13-14 dollars per base until and Medicare is around 18-20 dollars. Commercial insurance can be anywhere from 25-50 on average. That means that to put a patient to sleep for a gallbladder case would pay base unit rate x 7. Each 15 minutes thereafter is an extra base unit. If the case takes an hour, that’s 11 units of reimbursement. If it’s 50 dollars per unit, anesthesia gets paid 550 dollars for that case.
This post was edited on 12/5/24 at 4:51 pm
Posted on 12/13/24 at 4:46 pm to Penrod
Sorry, but this is my industry.
Tonsillectomy & addenoidectomy (T&A)… one of the most common pediatric surgeries.
Tonsillectomy & addenoidectomy (T&A)… one of the most common pediatric surgeries.
Posted on 12/13/24 at 4:48 pm to OMLandshark
This CEO should be proud of her company's stance, I don't see a problem here at all unless she thinks doing this is wrong and doesn't want to be associated with it
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