re: What’s a real conservative solution to fix healthcare?

quote:

---

That's only part of the truth. My wife needed an MRI on her knee this year. Insurance said you have to try 6 weeks of physical therapy before we pay for MRI. Called imaging center, asked what if I pay out of pocket, no insurance? They say $450. When can I get in? Tomorrow. Done.

---

I wouldn't say it's only part of the truth given that I stipulated "under our current system." It's true, and what you just gave an anecdote for is an exception that will not be relevant to the vast majority of people, who will not operate outside the current system.

quote:

---

Then why would any company get in the health insurance business?

---

They wouldn't. That dude...

This is a general comment, not necessarily aimed at you, but those of you who think you're going to make much change by selling insurance across state lines or separating insurance form employment...well, you're not.

As long as there are 3 entities and one of them is providing a service, one of them is receiving it, and a third is paying for it, you're going to have some version of what we have now. The market forces that control prices simply don't work under those conditions.

You might reduce insurance premiums somewhat or rearrange who has insurance, but that's about it. It won't solve the cost of the actual care.

As I have posted before, premiums are only one issue. Deductibles have become as much or more of an issue.

Price Transparency is difficult because no 2 people are alike. A young pneumonia patient vs a 70 year old pneumonia patient is an example but you can also have 2 young people who are vastly different. Hospitals can generally give you cash price for things like a simple delivery or a colonoscopy, but any type of complication changes things.

quote:

---

I wouldn't say it's only part of the truth. It's true, and what you just gave an anecdote for is an exception that will not be relevant to the vast majority of people.

---

No. If you call and ask "out of pocket, no insurance" they'll have a price within about 30 seconds. This is for practitioners, not hospitals, which are another animal as described well in this thread already.

Make other companies pay the same as the US for drugs.

Open up insurance to be sold across state lines

quote:

---

No. If you call and ask "out of pocket, no insurance" they'll have a price within about 30 seconds. This is for practitioners, not hospitals, which are another animal as described well in this thread already.

---

I edited my post that you responded to to better reflect my point.

Yes, I am well aware of how it works, as I used to own a medical clinic.

In my state, however, practitioners are required to charge the same fee for service as would be charged to an insurance company. To do otherwise (charge one fee to a person's insurance company and another to a person paying cash) is to operate what they call a "dual fee system," which is illegal in every state I know of except Colorado. There are some minor exceptions that are allowed, but if you discount more than about 15% for cash, you're breaking the law.

And practitioners typically set fees at three times the highest allowed amount that any policy in their area allows, and the reason for that is that sometimes you get an insurance company with whom you are out of network and can negotiate a significantly higher reimbursement. But you can only do it if you first charge a significantly higher fee.

Which is exactly why you got the message you got from your insurance company about them charging $3,000 and accepting $1,000.

So how did the imaging center charge a separate cash price? I don't know that specialty, but likely it has to do with using a slightly different code that they only "bill" to cash paying patients but that allows them to basically do the same procedure. That's how that loophole is usually exploited.

And, sometimes places simply break the law and hope the state Insurance Commissioner never comes knocking. I've seen that a bunch, too. Way more than I ever thought I would before getting into health care.

But trust me. What you're talking about isn't always applicable or possible. At least not legally.

quote:

---

I reached my out of pocket max in October and I’ve been seeing so many doctors since. It feels good to make UHC pay after they have wasted so much of my time fighting claim denials in the past. Might even take an ambulance tomorrow. YOLO.

---

This is not a knock on you, it's just human nature, but this is exactly why having one entity provide a service, one get a service, and a third pay for it will always 'eff up the machine. As long as we use that model, we will always have some version of what we have right now.

quote:

---

Hell, if you've reached your out of pocket max for the year... get any and everything that might need doing done and checked before the end of the year. As you said, YOLO

---

I think I’ve seen 1-2 doctors a week for the last 8 weeks. Going to the dermatologist Monday.

I’m doing this for all of us, guys.

quote:

---

Of course, that'll just lead to even higher premiums in the future.

---

They’re going to increase anyway. Might as well be part of the problem.

quote:

---

But trust me. What you're talking about isn't always applicable or possible. At least not legally.

---

BOOM.

That's the problem.