New MEDICAL BILLING concept:  PAY the Patient for processing time ! - Page 1
Forum section: electronics / general

author: RJSV
author_rank: Super Contributor
timestamp: November 04, 2024, 06:18:17 am
content: Time to rethink the whole aspect of a passive patient, often navigating endlessly (stupid) systems.After all, the HMO and Medicare crowd has 'thought up' scheme after scheme, many making cash money, hand over fist.They PAY a patient, now, to 'Be Well', ...even calling that a 'wellness' transaction.I realized the advantage, for the patient already spending hours and hours, (if they have the competence to do the proper paperwork). BUT, ironically, THAT word; 'Advantage' is taken, as trademark for...well, a 'wellness advantage.Now, my current situation is only given for example, (not asking for medical sympathy.)Quit the current medical 'insurance' and replaced that with another...that was 5 months ago, June 1, but nobody seems to have taken notice. Between the 3 or 4 various case 'managers' I'm never sure who needs to approve things, who gets my monthly due, etc.I suppose there are NINE offices that would, technically, 'need to know' (that they've been dropped, or switched to the other insurance).I guess, technically, it's myself that has to, trudge over to each separate office, and copy them my NEW CARD.But especially vexing, is the ones I DID tell...they are just as clueless.How could this be ? I'm thinking, in such a serious field, having such chaotic management. I've started hitting down the hours, two hours easy, but that was just with one letter / bill ($10).THAT one went straight to collections, lol.So I'm thinking, in corruption so thick you could slice it with your plastic, medical plan card, why not PAY a patient for managing their own, confusing pile of bills and notices.Because, you see, I'm also a'attempting' to recover a couple of bills, retroactively, paid before the notice came.Good luck there, I'm thinking, as I will need to get the old guys, to reverse their billing, and bill by way of the the 'new guys',...a completely separate private, for profit org."No problem, our office handles everything". The office worker had said...(I think that was July).- - - Rick B.

author: tom66
author_rank: Super Contributor
timestamp: November 04, 2024, 08:24:17 am
content: Or -- this sounds a bit crazy so hold on...We have some kind of national health system. Or service. All taxpayers contribute, and if you get ill, the doctors, nurses and other professionals that are paid by that system will look after you.That means if someone falls on hard times, loses their job because of their illness, they'll still be looked after the best we can.Probably won't ever happen so we'll have to deal with the corporate hell of healthcare insurance, I guess.

author: krish2487
author_rank: Frequent Contributor
timestamp: November 04, 2024, 09:05:04 am
content: Quote from: tom66 on November 04, 2024, 08:24:17 amBut... but... why should my taxes and insurance pay for someone elses medical care/sarcasm in case it wasnt obvious...

author: Analog Kid
author_rank: Super Contributor
timestamp: November 04, 2024, 09:33:31 am
content: Well, you Yurpeens can joke all you want. Just be glad you don't live in the "land of the free and home of the brave", where we have to put up with the goddamndest stupidest Frankensteinian excuse of a "health care system" where you're free to starve to death and live out on the street if you have the misfortune of running up sky-high hospital bills not covered by insurance ...Cuba would literally be a better place in that regard.

author: wraper
author_rank: Unknown
timestamp: November 04, 2024, 10:01:47 am
content: ^The fun part is that US government still spends money on this "free market" healthcare system. Actually more money per capita than (wealthy) EU countries with free healthcare.

author: Analog Kid
author_rank: Super Contributor
timestamp: November 04, 2024, 10:17:03 am
content: ^Yep. "Obamacare" was custom-designed by the insurance and pharmaceutical industries.U-S-A!

author: SiliconWizard
author_rank: Super Contributor
timestamp: November 04, 2024, 08:46:31 pm
content: Apparently, some people have jumped on a few keywords, but I for one am not sure I got Rick's point. It's confusing.

author: jpanhalt
author_rank: Super Contributor
timestamp: November 04, 2024, 09:37:38 pm
content: Does Rick have a point? Is this just trolling?Medical reimbursement/insurance/billing in the US is a mess that began with LBJ's approval of Medicare on June 30, 1965. I dealt with it first hand until 2006. It was supposed to make medical care "more affordable." What it really did was the opposite. It turned America's first class medical care into a commodity.Anyone who wants to self-pay ends up paying 3 to 4 times what is reasonable. Your copays are a significant portion of what the caregivers actually get. Insurance companies became rich. Government bureaucrats extended the "insurance" to individuals who paid almost nothing in to buy votes. Office expenses for billing exploded. Now, a small physician group of 2 or 3 needs three people just to handle billing that used to be done by a part-time person.Most important to me, diagnostic innovations are inhibited because reimbursements for new methods are de minimis. Big diagnostics companies are in control. Our regulations favor older and antiquated methods by controlling reimbursements based on method used rather than utility of results.I don't see the point of this non-technical thread. It's not unlike the currently popular thread on a humanoid robot. Yes, I reported it, but seeing no action, I decide to respond.

author: Stray Electron
author_rank: Super Contributor
timestamp: November 04, 2024, 09:59:30 pm
content: Quote from: Analog Kid on November 04, 2024, 09:33:31 amFeel free to move to Cuba.

author: Analog Kid
author_rank: Super Contributor
timestamp: November 04, 2024, 10:04:28 pm
content: Quote from: Stray Electron on November 04, 2024, 09:59:30 pmTheir medical system is actually superior to the US's in significant ways.Even better when you factor in their extreme disadvantages due to continuing absurd sanctions.Watch Michael Moore'sSickofor more details.

author: EEVblog
author_rank: Unknown
timestamp: November 04, 2024, 10:20:21 pm
content: Quote from: tom66 on November 04, 2024, 08:24:17 amThat system sounds rather familiar to non-US people...

author: Stray Electron
author_rank: Super Contributor
timestamp: November 05, 2024, 01:04:18 am
content: Quote from: Analog Kid on November 04, 2024, 10:04:28 pmYou must be a complete idiot to believe anything that Michael Moore is pedaling!If the medical system is your only concern then you should be very happy in Cuba, but I've lived in four different countries including one with socialized medicine and I'll be staying the U.S. even with the absurd medical costs.Bon voyage and let us know when your banana boat to the People's Paradise is due to set sail.

author: Analog Kid
author_rank: Super Contributor
timestamp: November 05, 2024, 01:28:17 am
content: Quote from: Stray Electron on November 05, 2024, 01:04:18 amWhat? I thought he was too fat to ride a bicycle.

author: SiliconWizard
author_rank: Super Contributor
timestamp: November 05, 2024, 02:33:05 am
content: I think to objectively judge a health system, one should use objective figures, like the global health of people in a given country, life expectancy, and so on. Not necessarily an easy task, because we can be tempted to compare oranges and apples.But it's very often judged based on purely subjective points, or by taking a few examples here and there and making them a generalization. We tend to think of the US system as pretty bad, but I haven't seen blatant evidence that the global heath of americans was much worse than in other countries that are thought much "better" in this area (and I'm not talking about health issues due to bad eating habits, which is a real problem, not just in the US, but in particular there, and that has little to do with its health system per se). It's often thought that if you're poor in the US, you must have horrific health because it's just too expensive - but probably people should look at other countries where it's thought to be better and see if poor people there are better off. It's not completely obvious, objectively. It's just different approaches, that don't necessarily lead to a hugely different result. What's true though, as wraper mentioned, is that the US actually spends a lot more money for health than almost any country in the world, for a questionable benefit. That doesn't make it hugely worse than others though. Things are getting pretty bad progressively in Europe as well, so soon enough, I'm not sure we'll be able to give lessons to the US in that area.As to Rick's musings, I still don't know for sure. I sense that he's kind of annoyed with the bureaucracy of it all, mostly, but again, still confused.

author: wraper
author_rank: Unknown
timestamp: November 05, 2024, 02:42:36 am
content: ^For example, US is the worst in people rationing insulin by a huge margin (which is very dangerous, some die doing so)https://pmc.ncbi.nlm.nih.gov/articles/PMC11070566/#:~:text=Insulin%20rationing%20was%20reported%20by,and%20Canada%20(Figure%203B).Also I don't know any other country where people are afraid of calling ER or go broke after doing so.Quote

author: Halcyon
author_rank: Unknown
timestamp: November 05, 2024, 08:12:00 am
content: Quote from: jpanhalt on November 04, 2024, 09:37:38 pmI did see your report. I'm in two minds about locking/removing it.I think robust discussion is important, even if it is off-topic. The thread might also arguably comply with the "occasional off-topic allowed" rule. Not sure what the other mods think?

author: Zero999
author_rank: Super Contributor
timestamp: November 05, 2024, 08:51:23 am
content: Whilst I generally think pubically funded healthcare is a good idea, our failing NHS isn't much good either. The main excuse provided by the mainstream media is lack of funding, but its budget keeps increasing. I doubt the amount of money wasted on pointless training courses, health tourism, providing interpreters for those who don't speak English, unproven treatments, corruption etc. is accurately reported.

author: tom66
author_rank: Super Contributor
timestamp: November 05, 2024, 09:34:49 am
content: Quote from: Zero999 on November 05, 2024, 08:51:23 amThe problem with the NHS is the same problem every healthcare system will face. As the population grows older and more complex diseases occur, and complex treatments for these become available, it costs a lot more to manage those. Alzheimers for instance usually causes repeated hospitalisations because of falls and seizures. 30 years ago, someone in that condition would live a shorter life for many reasons and so the impact they could have on the health system was minimal. We also have the impact of obesity which has peaked somewhere around 2022 (lots of hope that GLP-1 antagonists may reduce this, but early days.) Obesity causes a lot of problems like arthritis and heart disease before it kills someone.All of this talk about DEI managers and health tourism and all that is missing the point that the medical staff budget of the NHS has increased ahead of inflation as the population is getting sicker faster than the economy grows. There's definitely mismanagement but it's a small part of the problem compared to the population.

author: themadhippy
author_rank: Super Contributor
timestamp: November 05, 2024, 10:25:49 am
content: The biggest waste of money in the nhs is the multiple layers of management. 4 electricians don't need 6 charghands and managers

author: jpanhalt
author_rank: Super Contributor
timestamp: November 05, 2024, 10:33:28 am
content: Quote from: wraper on November 05, 2024, 02:42:36 amThat report equates paying for something (out of pocket expenses) with rationing. That means gasoline, food, and everything else a consumer buys is "rationed." Personal responsibility doesn't quite have the same zing as "rationing."How about looking at how long it take to get cataract surgery? Spain is 6.2 months (ca. 188 days )(https://pmc.ncbi.nlm.nih.gov/articles/PMC1857690/). The US is about 14.4 weeks (101 days). NB: The effects of COVID were different depending on country In England, some areas reported waits of 18 months; in the US, waits may actually have decreased in some areas. Those numbers given above presumably were not affected by COVID.

author: Zero999
author_rank: Super Contributor
timestamp: November 05, 2024, 10:47:27 am
content: Quote from: tom66 on November 05, 2024, 09:34:49 amLifespan also hasn't increased that much since the industrial revolution, once reduced infant mortality has been taken into account. The main reason for our ageing population is a reduction in birth rate. I don't buy into the ageing population argument. Japan's health system is far superior and they have a much older population.You have a point regarding obesity, but are way off the mark about pharmaceutical products being the solution. We didn't have that problem 50 years ago. It's a lifestyle problem.DEI and health tourism are only part of the problem. Massive amounts has been wasted on unproven treatments and corruption (our regulatory bodies are very much in bed with big pharma) but we'll never know how much.

author: wraper
author_rank: Unknown
timestamp: November 05, 2024, 10:53:00 am
content: Quote from: jpanhalt on November 05, 2024, 10:33:28 amIf you're willing to pay out of pocket, you can get it in a week, most likely for less than a co-pay of US health insurance.QuoteDunno how you came up with it, quote please. Did you just read nothing more than the title and figure out so? Literally in the first sentence:Quote

author: jpanhalt
author_rank: Super Contributor
timestamp: November 05, 2024, 11:06:06 am
content: My father was a generalist physician. He was drafted at the beginning of WWII and spent the duration. After his discharge in 1945, he started his practice from scratch. It was part of our family, so I can't avoid comparing 1950's medicine to the current situation in the US.Here's what Google AI said:QuoteWhat changed? As mentioned previously, in 1965 America embarked on nationalization of medicine. Today, individual self-pay is non-existent, and one must navigate a web of bureaucracy and regulations even with private insurance. Reimbursement is set de facto by the government and is unrelated to actual charges. The cost of bureaucracy is heavy and is not unique to America's broken system. Even "single-payer" systems like the NHS have burdensome bureaucracy.Worst of all, access to care has diminished. How many physicians still make house calls? My dad did almost every night, including weekends. Wait times were minimal. Today, one's more likely to see physicians work in shifts and pass patients off to others when "their shift is over." There is supposed to be communication when that happens, but that step is often broken. Of course, we can't go back to the good old times, but I simply can't blame the dedicate providers for the mess. Creating more bureaucracy is not a solution.

author: asmi
author_rank: Super Contributor
timestamp: November 07, 2024, 12:29:01 am
content: Quote from: SiliconWizard on November 05, 2024, 02:33:05 amActually it kind of does - when government gets to pick up the tab, it has a vested interest in making sure the population is healthy, and so it's much more willing to invest money into various programs to improve it - from propaganda of healthy lifestyle to ensuring there is required infrastructure in place for maintaining that lifestyle (parks, gyms, emission controls, etc.), and limiting or even outright banning the most dangerous GMO garbage that for some reason is called "food" in US and is sold as such, when the most natural part of it is the paper it's wrapped in as opposed to whatever is inside.

author: Analog Kid
author_rank: Super Contributor
timestamp: November 07, 2024, 12:33:21 am
content: Quote from: tom66 on November 05, 2024, 09:34:49 amYes. Blame the inverted population pyramid (a global problem, BTW).

author: vad
author_rank: Frequent Contributor
timestamp: November 07, 2024, 04:22:05 am
content: Quote from: jpanhalt on November 05, 2024, 11:06:06 amWhile 11.6% might sound like a lot, how does this compare to premiums paid for mandatory government health insurances (such as Krankenversicherung), higher income tax rates, and higher consumption taxes like VAT in socialist countries, such as Germany?

author: vad
author_rank: Frequent Contributor
timestamp: November 07, 2024, 04:38:01 am
content: Quote from: asmi on November 07, 2024, 12:29:01 amGovernments are extremely inefficient in spending public money, much worse than private companies.

author: SiliconWizard
author_rank: Super Contributor
timestamp: November 07, 2024, 04:39:05 am
content: Yeah speaking of VAT. We pay around 20% (or more depending on the country) on all sales in Europe, isn't the average sales tax more like around 8-10% in the US (let me know if I'm not up to date with that)? That's a gigantic amount of money that everyone pays, even the poor. If we gave people with low income half of the VAT they pay on everything back, they could definitely afford private health insurance with good coverage. Again, different approach, but analyzing real expenses is always interesting.

author: HackedFridgeMagnet
author_rank: Super Contributor
timestamp: November 07, 2024, 04:57:54 am
content: I've heard the US is getting one of the Kennedys as their new health minister, maybe he can sort it out?

author: krish2487
author_rank: Frequent Contributor
timestamp: November 07, 2024, 05:04:17 am
content: Quote from: HackedFridgeMagnet on November 07, 2024, 04:57:54 amNaah... American healthcare is so expensive, he had to become a minister just to get the worm removed from his head!

author: wraper
author_rank: Unknown
timestamp: November 07, 2024, 09:32:04 am
content: Quote from: vad on November 07, 2024, 04:22:05 amI already mentioned it, but do you realize that US government spends more tax money on healthcare per capita than Denmark?

author: tom66
author_rank: Super Contributor
timestamp: November 07, 2024, 09:53:04 am
content: The way to look at this is healthcare budget, for the UK that's £181.7 billion, or for every adult in the country (about 50 million) that's about £3,600 (~US$4,700) per adult.Which is less than most US healthcare premiums, and there's little to no additional contribution required. (The NHS requires you to buy your own prescriptions, but these are capped to around £120 annually, and dental care isn't free, just subsidised to around 1/10th of its actual cost.)A quick search suggests that average adult US healthcare premiums cost between $6,000 ~ $10,000 per year, with copays/excesses of up to $5,000 per year on top of that.So I think it would be fair to say that the NHS is between 1/2 and 1/3rd the cost of American healthcare. It's an even better deal if you have a young family since kids aren't taxpayers, well, not until they're over 16 at least.

author: vad
author_rank: Frequent Contributor
timestamp: November 07, 2024, 08:12:15 pm
content: Quote from: tom66 on November 07, 2024, 09:53:04 amThis aligns well with average healthcare costs in the US: between $3,000 per person annually (an elderly on Medicare) and approximate average of $5,750 per person on private health insurance (average premiums of $23K annually for plan for a typical family of four).Do you know the VAT rate in the UK? Here in Massachusetts, the sales tax is 6.25%, with groceries exempt. In nearby New Hampshire, a 20-minute drive from my home (the same distance it took me to reach the local Bunnings when I lived in Melbourne), there’s no sales tax.

author: wraper
author_rank: Unknown
timestamp: November 07, 2024, 08:48:27 pm
content: Quote from: vad on November 07, 2024, 08:12:15 pmAs if other taxes do not exist. Such comparison makes sense only if total tax revenue is what's compared. Taxation structure is different, you cannot compare apples and oranges directly. For example main tax in New York is property taxhttps://www.rosenbergestis.com/blog/2024/07/nyc-budget-2024-2025-and-property-tax-updatesQuote

author: tom66
author_rank: Super Contributor
timestamp: November 07, 2024, 09:14:12 pm
content: Quote from: vad on November 07, 2024, 08:12:15 pmNo that's not even close to normal. A family of four in the UK would pay the equivalent taxes of two working adults - the kids wouldn't pay. So somewhere around half of that, if you can even consider taxes to be directly comparable to insurance premiums. If we go on the healthcare budget of the country as being divided by the full population, the cost is around £2,600 peradultperson.You also have ignored the cost of any copayment to the insurance company. Many insurers charge thousands of dollars before they will cover $1 of healthcare costs. You also have prescription costs and doctor's office visits. I can get my prescription nasal spray (for rhinitis) for £9.90 per month. It's subsidised, of course. I had a root canal and a filling done recently, at a cost of £74. I don't pay at all to see a doctor of any kind and if it is medically necessary, the NHS will pay for it. (Of course, what NICE, our healthcare 'accountancy', and what -you- deem medically necessary may differ; but these sorts of decisions are also applied by insurance companies.)Nothing stops an ordinary Brit from buying private healthcare, and in fact many employers offer it as a perk. This lets you skip the line on some things and gets you a nicer room if you have an operation. The NHS still exclusively provides emergency care, no private firm in the UK does that. But if you get cancer or something you would be covered by the healthcare insurance. Because all of the really major care is handled by the NHS, premiums are quite a bit lower, around £100-200 per month for an a middle age adult with few comorbidities, usually with no excess payable.The NHS isn't perfect but I'll defend it until the end, the American healthcare system is anutter nightmarein comparison.Edit: 'adult' should have been 'person'.

author: themadhippy
author_rank: Super Contributor
timestamp: November 07, 2024, 09:28:36 pm
content: Quoteeven if only one parent is working or the 15 year old son has a side hustle bringing in a couple of grand a month?

author: langwadt
author_rank: Super Contributor
timestamp: November 07, 2024, 09:44:51 pm
content: Quote from: vad on November 07, 2024, 08:12:15 pmso unlike a tax paid system, the lower your income the higher percentage of your income has to go to a healthcare plan

author: vad
author_rank: Frequent Contributor
timestamp: November 08, 2024, 12:53:39 am
content: Quote from: wraper on November 07, 2024, 08:48:27 pmFair enough. But then all other taxes should also be considered - such as personal income tax, which is higher in the UK, payroll taxes that employers pay instead of offering more competitive wages, tariffs.Looking at disposable per capita income in PPP, the one that also accounts for social transfers in kind, such as healthcare or education provided for free or at reduced prices by governments, would probably be a fairer comparison:https://en.m.wikipedia.org/wiki/Disposable_household_and_per_capita_incomeUK - 40.8K PPP dollars per capita, US - 62.3K.

author: Zero999
author_rank: Super Contributor
timestamp: November 08, 2024, 07:41:13 am
content: Quote from: vad on November 08, 2024, 12:53:39 amYou're right, Britain is a rip-off, but even though our health system is inefficient, it's down to many other factors, too numerous to mention here, rather than state provided healthcare. Plenty other countries provide universal healthcare, in a much more efficient manner, than the UK.

author: tom66
author_rank: Super Contributor
timestamp: November 08, 2024, 09:28:26 am
content: The US is a richer country full stop, so of course their disposable income is higher. Why the US is richer is more complex but for sure their love of pure unabaited capitalism is a factor, and the UK could learn some lessons there (as long as healthcare isn't one of the things we change). US healthcare is more expensive because of the lawsuit culture around it (doctors need to be certain they aren't missing anything) and there is no incentive to control costs. Arguably the NHS is too in favour of controlling costs, as successive governments have struggled with the ever expanding budget that a large older population requires, but of the two options I'm definitely picking the NHS.According to a statistic here, the US healthcare industry'sprofitsalone were around $583 billion in 2022. Enough to pay for half an NHS on a per-capita basis ($1,740 USD).https://www.mckinsey.com/industries/healthcare/our-insights/what-to-expect-in-us-healthcare-in-2024-and-beyondPure for-profit healthcare is a failure which is why most countries have abandoned it and the US is alone in having this system. There's no problem with running individual services via competitive tender (provided that the competition is well managed), but when you're bleeding out in the back of an ambulance, you're not comparing who is offering the best healthcare per $. And when your insurance company is deciding whether to approve your care or not, they're just looking at future risk, not your wellbeing. If you die sooner, that's actually a perk for a customer with large future liabilities like complex cancers. The incentives are all wrong.

author: krish2487
author_rank: Frequent Contributor
timestamp: November 08, 2024, 09:41:13 am
content: Quote from: tom66 on November 08, 2024, 09:28:26 amThe incentives are right... for their capitalistic system... for exactly the reasons you mentioned.In a for-profit model, the service provider's goal is to minimize the money they spend..Apart from the pure medical / health care aspect of it, middle managers and above are monetarily incentivized to minimize spending. They literally have a vested interest to not pay for your healthcare, or make it ridiculously expensive for you..Especially in the insurance industry.

author: asmi
author_rank: Super Contributor
timestamp: November 08, 2024, 11:29:25 pm
content: Quote from: vad on November 07, 2024, 04:38:01 amExcept that private companies have no interest whatsoever to care about people's health, while the government which pays for their treatment does.

author: vad
author_rank: Frequent Contributor
timestamp: November 09, 2024, 05:16:41 am
content: Quote from: asmi on November 08, 2024, 11:29:25 pmNot in my experience. Take preventative care, for example. In the US, many private health insurance plans cover weight loss medications like Wegovy. My friend is paying only a $15 deductible per month. In Australia Wegovy isn’t covered by PBS, leaving patients to pay the full A$460 monthly cost.

author: tom66
author_rank: Super Contributor
timestamp: November 09, 2024, 11:02:32 am
content: Quote from: vad on November 09, 2024, 05:16:41 amThe NHS covers GLP-1 type drugs in the UK, though currently only for severely obese patients (BMI>=35). The criteria are being relaxed as supply increases, as currently there isn't enough supply for everyone over BMI of 27 or so, the priority is those with type 2 diabetes and those likely to develop diabetes. That's a big pharma problem more than the NHS. (https://www.sps.nhs.uk/articles/prescribing-available-glp-1-receptor-agonists/)Preventative care is one of the best things public health care can provide, since a healthy individual likely contributes to society and pays taxes, so the equation works both ways (lower future health costs, and more tax revenue).And it doesn't cost you thousands of dollars if you get ill!

author: Zero999
author_rank: Super Contributor
timestamp: November 09, 2024, 01:26:20 pm
content: Quote from: tom66 on November 09, 2024, 11:02:32 amThe problem with these medications is they've not been proven to work in the long term. Even if they do help to maintain weight loss and reduce the risk of certain weight associated health problems such as type 2 diabetes, it doesn't mean the reduce mortality, disability, or improve the quality of life, in the long run. Unfortunately, it seems unlikely anyone will bother to conduct randomised long-term trials.

author: vad
author_rank: Frequent Contributor
timestamp: November 09, 2024, 01:37:08 pm
content: Quote from: tom66 on November 09, 2024, 11:02:32 amIt doesn’t cost thousands of dollars here either, as long as you have insurance. The issue lies with uninsured and underinsured people, who lack health coverage either due to cost or by choice.I have experience with healthcare systems in several countries, both as a patient and as the spouse of industry professional. There are many areas where the US outperforms Australia, such as ER wait times, waiting times for scheduled surgeries such as for cancer, access to advanced imaging, and coverage of new medications and diagnostics. Yet, I agree that the Australian healthcare system is better overall, and that the absence of a safety net, like universal health coverage, is a significant drawback in the US.

author: vad
author_rank: Frequent Contributor
timestamp: November 09, 2024, 01:53:58 pm
content: Quote from: Zero999 on November 09, 2024, 01:26:20 pmLongitudinal studies are inherently time-consuming and are rarely randomized or blinded due to ethical and practical constraints. Such studies for this class of drugs may be in progress, but we will need to wait a decade or two for their results.

author: RJSV
author_rank: Super Contributor
timestamp: November 09, 2024, 03:44:25 pm
content: Actually a very relevant and very technical and science topic / subject. Partially presented in a loose and incoherent (seemingly), but I'd say the motivation for writing about it has been the whole COVID after-effects.But I do still appreciate the feedback. The problem I see is one of excess attention placed on spending (big government) to a certain threshold, and that being a similar term, of'Big Private'...a new term descriptive of a giant health care corporation as mentioned by some replies.One person here has mentioned, how the doctors are also part of the changes, needing a large staff to do billing. Many specialists here, with city areas, have several offices scattered around.The proliferation of 'web sites' to join, with attendant sign-in and passwords gets to be a pain to manage. (And an easy target for those who dismiss that particular peeve, as trivial.)My point ? That would be that the systems are not delivering at acceptable levels, in terms of wasted time and misdiagnosis, as doctors and patients get inundated by the management confusion.Examples:I'm thinking, make appointment with colon doctor, he should be in office Tuesdays and Thursdays...then, wait,...that's the cardiac guy, the other office is open. Getting into the weeds, needing LAB work first; another schedule, another transit VAN ride to schedule.Regardless of my own experience, point is that the system is seemingly choked with functions that feel more like management, rather than medical or science related.Choking on office work, to accommodate the changes to systems, now, and so perhaps asking for 'pay' as THAT gets their attention!

author: Zero999
author_rank: Super Contributor
timestamp: November 09, 2024, 03:53:43 pm
content: Quote from: vad on November 09, 2024, 01:53:58 pmSuch studies are very difficult to perform. For example statins aren't definitively proven to reduce mortality or severe disease in the long run. It's true, they "improve" blood test results, but that doesn't mean they do anything else. Confounding factors, such as socio-economics (Do people taking statins, see their doctor more often?, Are they richer?, Do they eat more healthily? etc.) mean it's virtually impossible to disentangle the effect of the medication from everything else. The same can be said for many other treatments and public health interventions (blood pressure medications, seasonal influenza vaccinations etc.). Now of course I'm not calling for scraping seasonal influenza vaccinations, statins or for anyone to stop taking them (always talk to your doctor), but for more robust evidence.

author: vad
author_rank: Frequent Contributor
timestamp: November 09, 2024, 05:37:53 pm
content: Quote from: RJSV on November 09, 2024, 03:44:25 pmWhile billing overhead is noticeably higher in the US, where most hospitals are private, for-profit corporations that account for costs, doctors’ productivity has improved significantly in recent years due to the support they now receive from PAs and NPs. This support allows doctors to focus on what they love and do best: performing surgeries and taking extended family vacations.

author: RJSV
author_rank: Super Contributor
timestamp: November 11, 2024, 05:30:59 pm
content: So, we'd like to keep the 'advantageous' aspects, of a system with lots of good specialists, but toss the administrative burden. There,...solved that ! No, of course that's joking, but really would like to keep the network, of specialists (like liver, etc.).Just the organizations and their cards, is SIX,...or at least was. Now, I've got another two in the works, plus I did place an additional card representing my 'advisor'.Blue cards, at top of that pile, shown, is the current insurance...

author: ZenHombre
author_rank: Newbie
timestamp: November 11, 2024, 05:35:17 pm
content: @RJSV,your posts are a fever dream.

author: RJSV
author_rank: Super Contributor
timestamp: November 11, 2024, 05:39:01 pm
content: So that was the insurance and HMO provider mess, that can have bewildering aspects, to the point where I've often had to ask; "which one ?". Meaning which card does this office need.It's a confused overlap of functions, there.For the specialists, you could add in another 7 or 8 offices,...but that's on the appointment and xo-pay aspects.In total, that 'map' becomes clogged with maybe 14 or more items...really gets to be a chore, confronted on my desk, there...

author: wraper
author_rank: Unknown
timestamp: November 11, 2024, 07:01:43 pm
content: The major difference with US system came to my mind. You can get health insurance here as well, however the big difference (beside an order of magnitude lower cost of paid services) is that price for insurance companies is exactly the same as for individuals. Pre-approval is not needed as well, it's either covered by insurance policy or not. If insurer/healthcare provider have a contract, they just keep you out of payment process. If not, you pay the bill by yourself and bring receipt to insurer for reimbursement. Insurer has no way to force you to use particular healthcare provider. While in US, insurance and healthcare providers secretly negotiate their prices, not transparent at all. Often in a way that you will get billed 10x the price if pay for the same service by yourself.

author: vad
author_rank: Frequent Contributor
timestamp: November 11, 2024, 10:56:59 pm
content: Quote from: wraper on November 11, 2024, 07:01:43 pmHealth insurance rules vary by state, so policies work differently depending on where you live, but in Massachusetts, if you have a PPO plan, you’re free to see any provider, but you’ll save on coinsurance if they’re in-network. Major insurers usually have large networks, so it’s tough to find a provider who is NOT in one - most doctors join several networks as it is an easy way to attract patients.Insurance companies want you to stick with in-network providers because they have negotiated discounts with them FOR YOU. Go out-of-network, and you’ll be on your own for negotiating costs. This is a free market economy, and providers are free to set their own prices, and the rates can vary wildly. But if you’re uninsured, remember you can ask for a a discount similar the provider gives to patients who go through insurance. You may not have the bargaining power of an insurance company, but clinic staff are often willing to work with you on price.You can also negotiate prices at pharmacies. Discount services like GoodRx offer huge discounts, sometimes cheaper than insurance. A friend of mine often skips his insurance for GoodRx because his deductible would be higher than the price after GoodRx discount.Another example: I know young, healthy friends who choose to go without insurance. They got a hefty ER bill (around $10K) few years ago, and managed to negotiate it down to about $1.5K just by talking to the billing department.

author: wraper
author_rank: Unknown
timestamp: November 11, 2024, 11:35:30 pm
content: Quote from: vad on November 11, 2024, 10:56:59 pmDo you really believe that? Or maybe they negotiated that your co-pay actually pays half of the actual service done, so they can spend premiums on ads to make 30% of all ads about insurance (no other country has so much insurance and drug ads)?https://www.emarketer.com/content/data-drop-5-charts-on-us-insurance-digital-ad-spendingYou barely see any insurance, drug ads here. And AFAIK prescription drug advertising is banned.QuoteAnd that's why your system is shit. Publicly available non-negotiable price list for everyone (on discretion of healthcare provider) would bring the price down and largely fix the system. As individual, you have zero leverage in this corporate buddy system. Nor you have a reasonable way to compare the pricing between healthcare providers.

author: Halcyon
author_rank: Unknown
timestamp: November 12, 2024, 07:45:39 am
content: Quote from: vad on November 11, 2024, 10:56:59 pmI'm sorry, I agree with wraper. Since when are insurers concerned about you? I have first hand experience with these clowns (not with health insurance but a major vehicle insurer). They don't give a shit as long as their profits increase.No different to energy retailers, real estate agents, or vehicle manufacturers.It's their way of locking you in to their product.I live in a country where I've never had health insurance and I don't see myself having the need to in the foreseeable future. At best, it might be a minor tax benefit for me. Yet the cost of healthcare at anytime in the past or in the future as I approach my 40's has ever been a concern.

author: krish2487
author_rank: Frequent Contributor
timestamp: November 12, 2024, 08:04:34 am
content: Quote from: vad on November 11, 2024, 10:56:59 pmAgain... If I m suffering from a heartattack... why should I worry about where to go for healthcare?? Why should any of these factors come into play for my health.. period?? I m paying hefty taxes to alleviate this decision fatigue. What concern is it of mine to evaluate if a doctor is "in network" or not?? or to google for the nearest specialist "in network" in order to get the negotiated discounts ? why should my healthcare depend on the bargaining ability of a for profit company?? I m certain they will not pass on any discount they can negotiate... if anything both the insurance company and the hospital have an incentive to charge me more..In what world does it make sense that it is acceptable to spend hundreds of thousands of dollars on medical procedures in order to have hundreds of thousands of dollars of medical debt kill you??Hyperbole sure.. but its the truth.. you are looking at the bill covered by your insurance . ... It is the marked down from several thousands / hundreds of thousands to several hundreds / thousands.. why have this in the first place?? Its like your black friday pricing of health??Artificially inflate the prices.. then mark it down after a "bargain" to make your customers feel that they got a good price..ridiculous..

author: RJSV
author_rank: Super Contributor
timestamp: November 14, 2024, 07:51:38 pm
content: Krish, you are hitting some of my points, here.My 'plan' landscape has the doctor's group as the people that approve each of the various specialists appointments, (and drugs).A big portion of this topic is just the pure confused state, of having multiple agencies. Now in that sense, it was ironic when someone told me 'No, you can't ask that group about your cost or portion'. That portion or co-pay always seems to cipher down to an exact, $ ten dollars.Out of a couple of those organizations with issued cards, I don't even have any communications !

author: RJSV
author_rank: Super Contributor
timestamp: November 22, 2024, 02:40:13 pm
content: So I've been tracking the performance aspects, where one entity or another has been informed of a switch (away) to some other separate HMO, Doctor's Group, etc.The legal aid person recently related that "They needed to inform their people, of the cancelation, but they often don't do it".Great. Then what do I do, staring at my notebook, journal entries ?You've got an (ineffective) patient, with some memory deficiencies, (and chronic fatique'), and so now I'm thinking, how about that PAY thing...maybe I could try just sending an itemized bill...for my time spent doing Doctor level work. (And I don't maintain any malpractice insurance).Heck, I might even be breaking the law, practicing as a doctor! Literally, not just a knee jerk humourous thought!That's it...(I'm gonna have to call R.F.K.)Logging my time,- - Rick B.

author: RJSV
author_rank: Super Contributor
timestamp: November 22, 2024, 02:46:24 pm
content: (maybe could send the bill directly toRFK JR.)

author: RJSV
author_rank: Super Contributor
timestamp: December 17, 2024, 05:54:13 pm
content: (I know about current news, with Health Care organizations getting trashed, or worse;That 'news', on HMO CEO is pretty gross, but I'm hoping readers can put the recent news aside, for a second.)I've been on this track for at least 6 months so I hope that helps pre-date this stuff, (before it got weird). Subject topic is a bit off, from direct electronics theory, but I'm interested in the enterprise management aspects, so that should relate (to electronics manufacturers and management / marketing.)Part of my fascination, here, is the methods and wording used, in promotions of various Health Care commercial products and services.Other older coverage of this kind of thing had mentioned that an ORGANIZATION will often create duplicate entities.That's a well known factor, where there is appearance of 'bloat' or useless excess structure (and job titles). Thus, we see things like:Dept. of Divisional Creation,And,Dept. of Making Divisions.That's maybe my own lame example.Dept. of Duplicate Words Dept.At any rate, I've been working and speculating about presenting these thoughts, of seemingly serious but silly sounding names and titles, but that really, really, actually only say one thing.'Health Care.'. Of course.'Comprehensive Health Maintainence'(Ditto).I even considered some customized titles and groups, designed to appeal to certain cultural niches:'Wellness Crew', as a street smart sounding (African American). My fictional example of course, but this is the kind of silly madness we see, in the giant health care initiatives and targeted advertising.'Physician's Group'...What do they do, (you ask); Well, they don't pay anything (at least visibly), their purpose is to 'approve' some procedure, and amount approved to pay out.Hard to decode all the seemingly duplicative functions, each with their own, similar sounding terms. It gets tough, though, when a person actually needs to comprehend the complex organization before them.

author: Analog Kid
author_rank: Super Contributor
timestamp: December 17, 2024, 09:27:06 pm
content: Quote from: RJSV on December 17, 2024, 05:54:13 pmI think you may be getting at what the Firesign Theater brilliantly called "The Department of Redundancy Department".(In the 1970s!)

author: RJSV
author_rank: Super Contributor
timestamp: December 17, 2024, 11:47:04 pm
content: Yes, that's part of the sarcasm, to take some things straight out of Monty Python,...I think maybe because the writers have cleverly captured some essences. Thanks, Analog Kid.I'm a big fan, of clever frauds, as they reveal things, tactics and preparation, that, ironically, help myself in managing / responding to human problems and relationships nearby.Landlord, girlfriend, and others sometimes place new stresses, and knowing about the waste and frauds (here in this thread) provides a sort of self defensive set of tools, if needed.Although, lol; my landlord will never offer 'zero' rent, no matter how clever I negotiate.Most people looking into 'Health Care' systems maybe are seeking more conventional oversights, like checking excessive profits if warranted (getting political on that, though).Another aspect that's currently bugging me, a problem of indefinite cost estimates, (or cost to patient in shared paying).One place / doctor has new co-pay amount that is $225 in low end, but could be as much as $5@0, for the one day (to be scheduled).

author: RJSV
author_rank: Super Contributor
timestamp: December 18, 2024, 01:19:06 am
content: Sooo, I'm operating as a kind of 'Unauthorized Think-tank, confiscating the language quirks being used, often as cover for 'malfeasance'...along with other measures.The whole Fireside Theater style criticism has focus on strangely modified words; a good example being the California use of'MEDI-CAL'That mis-appropriated term has a different pronunciation: I'm'medical' has pronounced 'cal' as in 'cull'.'MEDI-CAL' changes the pronounced syllable as in 'calcium'. Seemed clever I guess, but it's ultimately a stumbling block, and a verbal mess of a term,...not even necessary.P(Medi-Cal is a California version, of one of the many 'flavors' of government health programs.)I could imagine a whole Monty Python piece just in that dual-use mangled word.

author: Analog Kid
author_rank: Super Contributor
timestamp: December 18, 2024, 01:28:02 am
content: Quote from: RJSV on December 18, 2024, 01:19:06 amFiresignTheater, not Fireside.Very common error.

author: RJSV
author_rank: Super Contributor
timestamp: December 18, 2024, 01:35:13 am
content: A lot of that dialog, above, can be fun, and silly, but on the serious side, I'm seeking to have a set of 'handles' useful when inquiring to the various web of multiple billing departments.I actually don't expect spectacular results in that, the whole mess just 'don't smell right', as someone residing in somewhereike TENNESSEE.Here is an example:You take your 'member ID number',Put that on your payment check, to the 'insurer'. Go to the 'Doctor's Group for your authorization.Your specialist might recommend some other 'specialist', in another group;'Doctors Group of Pennsylvania'sSee what I mean, about needing proper entity 'handles' used while in conversation (with office workers). So I can communicate more effectively in the giant mess of....

author: Analog Kid
author_rank: Super Contributor
timestamp: December 18, 2024, 01:39:45 am
content: You lost me there, pal. Devolving into word salad.

author: RJSV
author_rank: Super Contributor
timestamp: December 18, 2024, 01:42:57 am
content: The wisecrack about folks from Tennessee was meant to say that someone from that region wouldn't tolerate this BS for any amount of time, and would note that the whole Health Care Management mess 'Don't smell right.',...a statement involving personal intuition.

author: RJSV
author_rank: Super Contributor
timestamp: December 18, 2024, 01:49:23 am
content: Yes, yes, that.It's meant to reflect the word salad that is seen by anyone in serious interactions with the various entities.If you are noticing word salad, then I've properly constructed this deliberate essay piece.Just still need to 'monitize' my efforts, here.(I've been informally keeping track of HOURS consumed.Just don't know (yet), what entity to BILL , while meanwhile keeping things legal here.

author: RJSV
author_rank: Super Contributor
timestamp: December 21, 2024, 04:35:05 pm
content: Fiasco yesterday is a perfect example:Spent 1 1/2 hours just trying to convince my medical group that THEY were, indeed, the ones that issue (and replace) THEIR OWN plastic cards, for doctor services.Crimony Alagators ! Their own friggin CARD."You have to go to the HMO to order your replacement for a lost card, sir".That sounded reasonable but the HMO customer service person then said:"You must go to your Medical Group, to request any card replacement, sir."OK, now we are in 'Territory Ridiculous', though ultimately a Tempest in a Teapot, in terms of urgency. Still, that took 90 minutes of my time, and I've gotten tired of tolerating such low level hang-ups.That's the same motivation that I expressed originally, for this thread. Why not issue a BILL, for services rendered...a snarky method, and unconventional method, for getting their attention, in a civil manner.But wait, Bills that come due, (and lawsuits, lol), DO get someone's attention, when they start having to pay others that desire compensation. I never signed up, to be a medical office coordinator...and a task that yeilded no viable control, over the administration of six or seven different and duplicative entities.The group issues the 'insurance card', but they don't PAY the Doctor's bill....THAT function is performed by the 'Insurance company'.But, the doctor's office asks for your 'Insurance Card' at any actual appointment, when, technically, that's a Medical Group card.I can let a lot of small problems like this go, but still I need my friggin card replaced !So round and round we went, eventually I suggested a conference call; Supervisor from one and calling the, uh, 'Insurance place'.Voila,....after 1 1/2 hours, they understood the request, for replacement card. The 'Medical Group' will do that, as always has been that way.A no-brainer took 90 minutes, and I'm looking to dash off a peaceful, civil request:PAY THE MAN, HIS FRIGGEN BILL !This, though is also simply interesting, and quite boring, at the same time. A study of waste and duplication. Now, in current events, I've noticed a great expanded interest, in solving the BLOAT and barely functional management.Anybody know how much I should, reasonably CHARGE, for the services rendered?

author: RJSV
author_rank: Super Contributor
timestamp: December 21, 2024, 04:58:30 pm
content: To keep my original points in reinforcement, I actually face a dilemma:Which organization gets that BILL, assuming I stay brave & bold enough to pull this off ?Who, out of 'approximately' 3 or 4 players, is literally responsible ?1.). The Doctor's office ? No, although it would be nice if they knew about associated things like, my HMO is canceling (United Health Care) although that's just one of the 'Plans' they offer, through Medicare AARP.I'm actually laying out a bit of detail, in hopes, (snicker snicker), hopes that dear Readers will get confused, trying to follow all this nonsense ?Lately, I've been deluged with flyers and mail advertisements, for help in this kind of mess, (I naively thought...lol). Nope;Those AD flyers are solely for available help in signing up for yet more new features and 'Plans (tm)." If you need help, with our insurance, call your doctor...(we offer CARE, on how to sign you up.)Round and round, (and round).Good thing no really crucial things going on, medically speaking, the doctors are generally quite good, but the system management, is like a D- grade, in their competence.Anybody know, how much I should reasonably charge, for my time over the last six months ?And who to send that BILL to ?Thanks, Rick B.(The struggling Inventor)

author: jpanhalt
author_rank: Super Contributor
timestamp: December 21, 2024, 08:41:09 pm
content: I wrote a relatively long (for me) and specific response, but decided not to post. Are you serious? Did you read and understand the papers you signed to get access? Are you covered by private insurance or Medicare/Medicaid/Medicare C(Advantage)? What do you expect to accomplish besides a rant here?

author: RJSV
author_rank: Super Contributor
timestamp: December 21, 2024, 11:01:50 pm
content: Thanks, if you'd rather send PM, that might be less sensational or drama. Words don't hurt so much, if it's something I should change, convincingly. Thanks.I was clearly stating what I want, first just a simple wallet card replaced.I'd love to not be the person teaching medical office 'news' to an office staff.Getting paid is a distant third. THAT would be a shame, and a disgrace. Or, wait; I should say "...shame and disgrace, still."I'm expecting more...or some confidence that the various multiple players can function.Consider some ER visit (knocking on wood, because), where the ER Doctors access my electronic files, to start. Start right there, as those files are a mess, listing a mix of old dental medications, along with discontinued medications, and weirdly spelled 'allergies'.Nice to have a sense of humor, here, as, in the ER couple years ago, the doctor had come to me, to ask things, due to the records being so screwed up. So, right there I was in a Doctor's re, discussing and re-interpreting the notes, for the Doctor.I'm not a doctor, although I can recite things other Doctors have said.It's largely highly inappropriate but also a personal safety defect.Charging for my time, in itself, isn't inappropriate but I'm not certain about legal aspects, (like for example, my 'clients' haven't consented to a time and materials contract.Or, even gave implied consent.)Time I've spent, on blogging this is way less, than time spent on Medical system bloat.Expecting, I'm going to start sounding like the current trend, for investigating bloat and waste, but I've gotten a 6 month lead, on those other folks (RFK JR).Or, the investigator's are going to start talking like me....

author: soldar
author_rank: Super Contributor
timestamp: December 22, 2024, 11:05:09 am
content: Quote from: asmi on November 08, 2024, 11:29:25 pmI would disagree with that. A private company is interested in paying out less so it is in their interest that their patients/insured are healthy while governments do not care about costs at all because if they spend more they just raise taxes... which are not optional.I find the notion that "if we remove the profit margin from the equation we will have the same result but cheaper" utterly mistaken because it is the profit that gives the service provider the interest in providing the service. To me it is like saying "we have found that the motor in a car is what is using so much fuel so we thought that taking the motor out will mean a lot of fuel will be saved". Yeah, right.I am not taking any position on the topic of health care because I believe it is complicated and cannot really be discussed in a meaningful way in a forum. But in general if the private enterprise can do it then they can do it better and cheaper than the state.

author: Analog Kid
author_rank: Super Contributor
timestamp: December 22, 2024, 08:48:15 pm
content: Wellll, you're probably correct that this is a topic that's not really susceptible to being discussed very rationally in a forum like this.However, we do like to air our opinions. And mine is this:At least here in the United States of Amnesia. the for-profit health-care system is pretty much totally slanted towards thems who can make money off it, so I think that, overall, the sweeping generalization that the system doesn't really give a shit about the health outcomes of the people who receive care under that system is largely correct. Let's say to a first approximation.It depends on at what scale and at what point in the chain of healthcare delivery you look:The last employer I worked for, the owner of a mid-sized hardware store, was a very conservative guy, actually a Trumper. Pretty much diametrically opposed to my own political beliefs. But I can honestly say that he was probably the best employer I ever worked for in many ways.One of those ways was his provision of health-care insurance to his employees, which was done, of course, with many complaints (valid complaints at that) about the system, and yet he provided more than he was required to do. So at least in his case the profit motive was subservient to other considerations, like the health of those who worked for him (what a concept!).And yet at the top we see, as recently revealed by the gunning down of that United Health Care CEO, the utterly depraved and despicable behavior of the system at the top, where it really is concerned with profituber alles. Add that to a system that is basically a Frankensteinian monster cobbled together by the bad guys--the insurance companies, Big Pharma, and Wall Street in general--and you have a system designed to succeed (for the bad guys and their investors) and to fail, utterly, for patients.It's really so bad that if I had my druthers as to where I'd live based solely on the health-care outcome, you know where I'd go?Cuba.I'm not joking, trolling or otherwise exaggerating to make a point: I'm dead serious. Because Cuba, despite all their poverty and the ill effects of an authoritarian system, have a health-care system that is not only all out of proportion in terms of quality relative to their size and economic standing, but that is really designed to deliver quality health careto the patientand not exorbitant profit$ to the providers.Obama was just the latest in the line of probably well-intentioned reformers who basically gave away the game to the bad guys I mentioned above.

author: RJSV
author_rank: Super Contributor
timestamp: December 22, 2024, 09:16:04 pm
content: It takes focus, and sharp memory to reply in a lot of bulky explanations, but thanks, here is just a tiny jewel of a comment, for now:My 'plan provider' has these people specializing in patient 'CASE Management' and that sure sounds helpful.But, reality turns out different, as those Case management people are there only to usher folks into some new marketed 'plan', often in a open enrollment time period.Time and time again I've gotten blocked, when asking that 'Case Worker' some case and plan question(s). Naive on my part to continue that expectation.My place DOES have a Care Management Nurse,...a credentialed person.She recited that 'Some diagnosis made her STALE, and irrelevant, after a time.'Thing I haven't seen, is supposedly SKY-HIGH drug prices. Mostly free now, on AARP Medicare Advantage United Health Care Hills Physicians group.Yes, that's the conglomerate of entities and they also have my monthly premium at'$ 0' dollars. (zero due).Part of that is from excessive COVID relief money.Oh, and I left one organization out of that long list...that is that Medicare also is needing me to sign up on a 'plan' that I select.I thought I WAS signed up...Three meetings, with Health Advocacy counseling, so far. I'm close, to getting everything in ship-shape, so it's not discouraging to any extreme.

author: RJSV
author_rank: Super Contributor
timestamp: January 19, 2025, 07:27:23 pm
content: A few more notes, and some results, after some six months evaluating a typical or higher volume uses, of doctors, specialists, etc. including many actual Billing dept. experts.Not the most popular thread (boring shit).But it's in the context of organized entities, and some of the more ridiculous and wasteful shit. Likely, the second worst topic, in EEVBLOG history...lol.First, some conclusions, from my 'study' as an unpaid analyst.I don't so much see the popular trend stuff, where supposedly an insured patient gets often denied reimbursement, or authorization. Not that it isn't happening, but I don't perceive the denial thing as significant.Ditto for drug prices, at least those prices the consumer pays...(just the opposite).The drug prices are heavily, heavily substidized by the COVID related funds (in the U.S.). That means a patient copay of zero, lately. Problem is, the REAL drug prices are substidized in a manner that isn't sustainable, financially.Flu shot costs, for example, are $12 but the doctor's office 'adds' in a $ 375 charge, just for the needlework and other misc. like gloves (disposable, $25 charge.)So there is that aspect, of a billing waste and excess, putting a strain on government sponsorship.But the real problematic waste is in the lazy or non-existent level of competence in the record keeping accuracy and customer service.Customer service, usually by phone, has been the terrible aspect, of the whole Private-Government HMO deal. Plagued by operator language problems, and general access of the service person, to any really significant and accurate billing.

author: RJSV
author_rank: Super Contributor
timestamp: January 19, 2025, 09:09:09 pm
content: "What do you care ?", said one of the doctors,"...You aren't PAYING for it.".That quote right there provides a fitting context, in this discussion, on medical billing situation, in U.S. Direct from one player.What an attitude, (and snarky too !). That's a pretty substantial expression of contempt, that some lay-person is getting into their business.Almost like they were saying to 'mind my own business' and don't examine things, financial, that are going on constantly, in the billing and accounting aspects, of doing business as a doctor's office (a corporation, often).But for the really bad, in all this, is the so-called 'Annual Wellness Checkup'.I believe that each doctor's office gets forced into doing the barely useful 'test' as a simple means of generating easy profits.I don't think any medical office gets into troubles, when they toss out government issued ca$h money. Indeed, that waste spending is encouraged.In case readers have not encountered this, the Wellness Checkup includes a blood pressure reading, and asking a set of standard pain screening questions.In my case, I've recently had several occasions where this so-called 'Wellness check' actually was placed into my scheduled stuff, totally derailing the needed business (major spine stenosis).So, I suppose, this could be viewed as messing with a patient's good outcome, medically, in reference to the financial advantage, of a doctor's appointment that has high charges for the dubious 'service' of only asking simple questions.Next, I was planning on viewing the bill, as that will have itemized services, by my doctor's office. I have heard that the newer medical offices are virtually forced to do these seemingly nonsense simple 'screening', by way of a short, short series of a set of questions.I still have not gotten over that they (office workers) literally changed my appointment purpose, without any notice !Billing a reasonable cost, is not so bad, (as long as they are consistent, and know what proper charges are. They don't.My health care HMO (yes, it's United), did CANCEL their insurance coverage plan, moving out of California markets. No notice, as the billing office has no clue that had happened.At least, lol, I had been able to help them out, here in the local doctor's office.(A hero!)Thanks for reading...I know it can be boring!

author: jpanhalt
author_rank: Super Contributor
timestamp: January 19, 2025, 09:39:08 pm
content: Quote from: RJSV on January 19, 2025, 09:09:09 pm1) Get another doctor, if it really was a doctor.2) United Healthcare was absolutely the worst of the insurance companies we had to work with -- even worse than Medicare. It's CEO at the time was paid many times more than the murdered CEO's $10 million/year (as published). I don't know what his total compensation was.3) For anything that is non-urgent or emergency (i.e., elective), think about getting "pre-approval." That will establish cost and give you an argument against unexpected add ons.

author: RJSV
author_rank: Super Contributor
timestamp: January 19, 2025, 10:48:49 pm
content: Yeah, thanks for backing up my view, (And for recognizing the point about doctor snarky comments).I would take your advice, however, the various entities I typically put in a phone call. Goes to voice mail, getting virtually no call-back, or...some person sounding like English isn't their language. (One didn't comprehend what an independent contractor does).Essentially to use phones is a collosal cluster of f- ups.Sorry to contradict your practical advice, (to get pre-authorized), but even when in touch the service person (and a supervisor as well), they couldn't comprehend, and, like I said, didn't even realize, in their terminal screens, that the healthcare had 'adjusted' (cancelled) the Medicare Advantage plan, as leaving California.Ah, but they DO provide 'case managed' help...but only help in completing your enrollment.Argh. It's voluntary, doing this study. But passed seven months now ! Up to some 28 entities, now, although mostly I use Medicare card, at office visits.The multi-specialist thing might not be simplified, easily, but this plus multiple blood testing lab work, really gets to be a drag, on regular life business, daily.

author: tom66
author_rank: Super Contributor
timestamp: January 19, 2025, 11:08:28 pm
content: A friend recently had some experience with private healthcare in the UK for a diagnosis (I won't reveal what but it required reasonably specialist people.) His private healthcare was provided through his employer.So, he phoned the insurance company up, and they agreed to pay for the diagnosis. He saw a consultant within two weeks, received treatment a few weeks after that, and continues to receive private prescriptions to manage the condition.The total outlay was around £125, which was his co-payment. The process was hassle free and he was satisfied. At no point did he have to jump around between consultants to get the best price, or find out in advance how much the cost would be, or chase for bills to be paid or settled. It was all just handled. He pays tax for his healthcare as it is an employment benefit, but it's only about £400 a year in tax (the healthcare policy is ~£1,200 a year.) The cost to the insurance company was likely on the order of several thousand pounds based on clinic hours and published prices.Perhaps private healthcare does really well in countries with public healthcare because you have to offer better service to compete. And why having a good public option is essential to keep the private system in check.

author: jpanhalt
author_rank: Super Contributor
timestamp: January 19, 2025, 11:09:50 pm
content: All of that is BS.1) In the US, every patient has the right to demand another doctor, if conscious. A physician who treats without consent can be charged with assault. Of course, consent can be implied, but that doesn't negate that you can demand another physician.2) Presumably, you made your choice of insurance, Do better next time. If on Medicare, there are situations when you can change outside of open enrollment.

author: RJSV
author_rank: Super Contributor
timestamp: January 20, 2025, 05:45:00 am
content: Actually, (if your comment was directed to myself) I DID change primary doctor. It was amazing amount of hassle, as system doesn't seem ready to react to such a switch. It took some 4 months, if I recall.Today, perhaps 30 % of my various providers and specialists are even remotely aware, that I've switched, not that I haven't tried.Heck, like I stated recently here, many still have me on the cancelled 'plan' with United, who has left the state marketplace.

author: jpanhalt
author_rank: Super Contributor
timestamp: January 20, 2025, 10:44:56 am
content: My experience in changing plans and PCP's is entirely different. I have had 4 different plans in the past 15 years. When I have changed plans, it was just a matter of showing each provider or group admissions person my new card. It was scanned and everything switched over. That's not a whole lot different than updating plan information each year. Same story at Walmart pharmacy.I have not changed PCP recently, but it is just a simple matter to tell your insurance the new name and address (providers may have more than one office, and whether they are in network may differ by address). My current carrier has an online form for doing that. I don't believe that is even mandatory for Medicare, at least not for my current carrier. It does recommend doing so, as it makes office visits simpler. A first visit to a new PCP or even specialist will probably take longer as each will need to review your history.I have been on Medicare of 15 years. Rules for private insurers, employer-provided insurance, and VA may be different.