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How much of the cost in our health care system is simply related to billing and collecting? Anyone know?

It seems like a significant part of our current system is just figuring out who owes what and trying to collect.


I had an ER trip in July and have still not seen an actual bill. Not sure wtf is going on.
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  • 2 weeks later...

My wife got some blood work done a couple weeks ago and it turns out it wasn’t covered by our shitty insurance so we got a bill for $100. She called the lab to see what the out of pocket cost would have been and it was $15. Great system we got. 

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On 10/18/2023 at 10:59 AM, Texas Jeff said:

How much of the cost in our health care system is simply related to billing and collecting? Anyone know?

It seems like a significant part of our current system is just figuring out who owes what and trying to collect.

I'll give you a hint.  There are two Dallas biilionaires, Ross Perot and Darwin Deason, who became billionaires by selling computers and software to Medicare/CMS and state Medicaid/HHS systems, respectively, for billing (both to patients and from providers).

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On 11/2/2023 at 4:22 PM, tx 3 putt said:

Great idea 

Need to have any all pregnant woman as well.

A judo move to have republicans put their money where their mouth seeing as they’re the party that loves / protects kids & the unborn.

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Sure seems like between profit margins and inefficiency due to lack of uniformity inherent in our current system, a single payer system would be better and more affordable.  It also seems like office visits, prescriptions, and hospital visits are 3 wildly different animals that are getting muddied up but should be treated totally separately (with preventative care a 4th crucial component that really doesn’t even exist in our current system).

Edited by Snake Diggity
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On 10/16/2023 at 11:18 PM, Brisketexan said:

nobody has ever explained to them how the healthcare system and their insurance (believe it or not, many poor folks have a health plan of some sort) works. I’m not sure where we start.

Let’s talk about the ones who are using the ER because they don’t have the ability to pay because they know they ER will see them.

1) If they are uninsured, they are billed at the full list price for services- usually a multiple of the negotiated rate your insurer pays for the same services.

2) The are presented with a bill when they do not pay.

3) This debt is ultimately charged off as a loss and acquired by someone who attempts of collect at pennies on the dollar, and a larger fraction of what insurance would have paid. It also ruins somebody‘s credit, insuring that they stay poor by raising the cost of housing, limiting job opportunities and increasing the price of financial services.

4) The provider takes a tax loss on the unpaid amount of the bill, and builds that loss into the price structure of services to be paid by insured patients, and premiums go up.

in sum:

the ER patient who cannot pay is served according to his need. The insured patient pays to his ability. The hospital, insurers and doctors all profit. 
Marx for us, Friedman for them.
 

Edited by Bozo_Casanova
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13 hours ago, Bozo_Casanova said:

the ER patient who cannot pay is served according to his need. The insured patient pays to his ability. The hospital, insurers and doctors all profit. 
Marx for us, Friedman for them.

And the punchline is that we still do have long waits for appointments and death panels, as all the republicans said we'd get with single payer. Except we're paying a fucking arm and a leg for the privilege of letting some business ghouls dictate what level of care we deserve. 

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5 minutes ago, Captainant said:

And the punchline is that we still do have long waits for appointments and death panels, as all the republicans said we'd get with single payer. Except we're paying a fucking arm and a leg for the privilege of letting some business ghouls dictate what level of care we deserve. 

Yeah, "death panels" are inherent to any system that makes "institutional" (meaning not solely patient-driven) healthcare/treatment decisions.

One thing I have come to appreciate about government bureaucracies that seem ponderous and inefficient:  they do a better job of assessing and accounting for multiple stakeholders in any system than a corporate bureaucracy.  The only stakeholder in a corporate bureaucracy is the profit of the corporation.

Edited by TwiceHorn
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21 hours ago, Bozo_Casanova said:

Let’s talk about the ones who are using the ER because they don’t have the ability to pay because they know they ER will see them

4) The provider takes a tax loss on the unpaid amount of the bill, and builds that loss into the price structure of services to be paid by insured patients, and premiums go up.

in sum:

the ER patient who cannot pay is served according to his need. The insured patient pays to his ability. The hospital, insurers and doctors all profit. 
Marx for us, Friedman for them.
 

Am I misunderstanding this comment? I don't know about hospitals, but individual physicians cannot take a tax loss on an unpaid bill. 

Edited by topochico
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2 hours ago, topochico said:

Am I misunderstanding this comment? I don't know about hospitals, but individual physicians cannot take a tax loss on an unpaid bill. 

I’m not an expert on healthcare accounting, but maybe I don’t understand what your question means. When I say they take a tax loss, what I mean is that they have bad debt they write off along with charity care, and incur costs providing that care which yields negative value. How they account for that loss has some variation from business to business but it’s a loss any way you cut it. So in case of bad debt would that not be bad debt expense?

Are you saying that doctors don’t account for the cost of services rendered? Wouldn’t that be bad debt expense?

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4 minutes ago, tx 3 putt said:


 

good read 

Sweet Tea - not even joking. There are major dietary differences between Texans who live east of the Trinity River, and the biggest one is sugar consumption. Sugar in the tea, sugar in the cornbread and sugar in the grits and everything else. And that dietary pattern is closely linked to the legacy of structural and environmental racism and generational poverty that exists there as well. 

Edited by Bozo_Casanova
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6 minutes ago, fattyflattie said:

Sugar usage? 

Yep.  Look into cheap calories and what "foods" got subsidized/rolled into food aid.

And it's not all racially tied (although a lot is), a shitload of it is economics on its own: diabetes rates are higher among poor black, hispanic, and white demographics.

Long ago, I worked with a hospital in E. Texas.  When I asked the CEO what the #1 thing that could be done to control health care costs in his community might be, he didn't hesitate: "provide gym memberships, free nutritionist visits, and things like that -- every dollar spent, even if underutilized, would save multiple dollars in care."

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2 minutes ago, Brisketexan said:

Yep.  Look into cheap calories and what "foods" got subsidized/rolled into food aid.

And it's not all racially tied (although a lot is), a shitload of it is economics on its own: diabetes rates are higher among poor black, hispanic, and white demographics.

Long ago, I worked with a hospital in E. Texas.  When I asked the CEO what the #1 thing that could be done to control health care costs in his community might be, he didn't hesitate: "provide gym memberships, free nutritionist visits, and things like that -- every dollar spent, even if underutilized, would save multiple dollars in care."

Yeah I get how it’s tied to poor and rural citizens. I was curious about the structural and environmental racism part.  

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24 minutes ago, fattyflattie said:

Yeah I get how it’s tied to poor and rural citizens. I was curious about the structural and environmental racism part.  

In East Texas and the rural south in general you can’t really separate structural and environmental racism from generational poverty or vice versa. That’s not to say that whites are immune to it- quite the opposite. 

Edited by Bozo_Casanova
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An attention grabbing headline, for your medical experts, is this good?

Amazon will offer $99/year One Medical memberships to Prime members. The tech giant acquired One Medical for $3.9B in February as part of its health care push.
 

https://www.wsj.com/tech/amazon-to-offer-lower-cost-primary-care-to-prime-members-in-latest-healthcare-push-59cf618

Edited by BeardIP
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On 11/7/2023 at 3:48 PM, tx 3 putt said:

Not enough insurance execs are getting badly needed lead therapy ….

 

it's literally those execs JOB to ensure that as few people as possible receive care so that their profits can be maximized. If they weren't, they'd be violating their fiduciary duty to their shareholders.

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35 minutes ago, BeardIP said:

An attention grabbing headline, for your medical experts, is this good?

Amazon will offer $99/year One Medical memberships to Prime members. The tech giant acquired One Medical for $3.9B in February as part of its health care push.
 

https://www.wsj.com/tech/amazon-to-offer-lower-cost-primary-care-to-prime-members-in-latest-healthcare-push-59cf618

I am a member of One Medical and I love it. To the extent that this broadens coverage and increases access. I'm very for it. My only concern as a customer is that this could possibly oversubscribe my doctor, but I'll withhold judgement on that one until it becomes an issue. If they can scale without losing quality of delivery, I'll be even happier. 

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53 minutes ago, BeardIP said:

An attention grabbing headline, for your medical experts, is this good?

Amazon will offer $99/year One Medical memberships to Prime members. The tech giant acquired One Medical for $3.9B in February as part of its health care push.
 

https://www.wsj.com/tech/amazon-to-offer-lower-cost-primary-care-to-prime-members-in-latest-healthcare-push-59cf618

On what little I have read, it seems like this product is addressing the real inefficiency of the market: the huge disparity in relative cost of providing care in person, especially in rural areas.  
 

It seems like to me, providing primary care (and even specialty “office visits”) to people in major cities should be pretty cheap, especially if it starts with virtual visits.  The majority of healthcare visits are made up of checkups and routine illnesses and injuries which should be able to be treated without all the infrastructure costs of traditional doctors offices.

Prescriptions seem like they would work the same way; economies of scale should make medicines cheaper in major cities than in rural areas.

It is great to know that if I lose my insurance coverage there’s a product out there that can get me affordable access to a doctor when I need it.  If there was a truly affordable “catastrophic event” health insurance plan out there that covered ER visits, hospital stays, and surgeries, that combined with One Medical and Cuban’s prescription product seem like it’d have all the bases covered to make healthcare reasonably affordable.

Edited by Snake Diggity
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32 minutes ago, Snake Diggity said:

On what little I have read, it seems like this product is addressing the real inefficiency of the market: the huge disparity in relative cost of providing care in person, especially in rural areas.  
 

It seems like to me, providing primary care (and even specialty “office visits”) to people in major cities should be pretty cheap, especially if it starts with virtual visits.  The majority of healthcare visits are made up of checkups and routine illnesses and injuries which should be able to be treated without all the infrastructure costs of traditional doctors offices.

Prescriptions seem like they would work the same way; economies of scale should make medicines cheaper in major cities than in rural areas.

It is great to know that if I lose my insurance coverage there’s a product out there that can get me affordable access to a doctor when I need it.  If there was a truly affordable “catastrophic event” health insurance plan out there that covered ER visits, hospital stays, and surgeries, that combined with One Medical and Cuban’s prescription product seem like it’d have all the bases covered to make healthcare reasonably affordable.

 

If you have a Costco membership, don't sleep on them when it comes to prescriptions. Their regular cost of prescriptions are pretty good. If you're a member, there is an additional discount that usually beats Cuban. I would say that 95% of the time, I don't use my insurance to fill scripts. I get the Costco discounted price and its better (usually 20-50% better)

Their eyeglasses / optometrist services are also a good deal too.

However, I find the following trick to be the best / cheapest way to get glasses and contacts if you have something like VSP or eye insurance through work. Granted, I don't have any major things wrong (like an astigmatism) and am only a little far sighted.

1.) Go to your optometrist but never get glasses or contacts through them

2.) Get glasses through Warby Parker.

- File out of network claim for 'frames'. Usually have a $100 allowance or something. 

-Warby is usually $100-$150 for frames AND lenses and they don't itemize lenses vs frames 

-I just say that the frames are what my allowance is and the lenses are the difference

3.) Buy contacts through Costco

-Fill out the out of network reimbursement form

-Get a years supply to get an additional manufacture discount

Even with a reduced out of network reimbursement, the significantly lower cost of the contacts makes it substantially cheaper.

 

Oh and Also don't sleep on pet meds. Costco has those cheaper too. Or if Costco isn't your thing, at least Chewy.

My dog's heart meds were $140 for 60 pills (Vetmedin)at the Vet. 

It's $83 on Chewy (well only 50 pills to be fair)

and only $73 at Costco for the same 50 pills.

That's a pretty substantial savings.

 

 

That all being said, I hate that I have to fucking do long division every time I need medical treatment / health care. It takes up so much of my time and without years of experience, I would probably be paying at least double what I do on healthcare b/c there is no easy transparency.

I still am constantly being surprised with additional bills for 'testing not covered' or my new favorite thing is that my wife's primary care doctor's office now sells and pushes  supplements that are super pricy.

She likes them and they do a way better job in providing adequate primary care, but it's obvious they're just using pseudo science supplements as a revenue stream b/c they're getting squeezed on the $ they get for providing simple primary care services.

Edited by Dnaguy
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6 hours ago, Bozo_Casanova said:

I am a member of One Medical and I love it. To the extent that this broadens coverage and increases access. I'm very for it. My only concern as a customer is that this could possibly oversubscribe my doctor, but I'll withhold judgement on that one until it becomes an issue. If they can scale without losing quality of delivery, I'll be even happier. 


Does it cover prescriptions too ?

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26 minutes ago, tx 3 putt said:


Does it cover prescriptions too ?

It doesn't - it's just a primary care practice with a really good app, 24/7 availability via zoom, on-site phlebotomy, office staff with living brains, on-time appointments, concierge care coordination of specialists, etc. 

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Does the Amazon $99 cover unlimited in-office visits, or unlimited zoom appointments with a nurse practitioner? If everyone seeing the doctor for 15 minutes only pays $8/month would be a huge loss. That may not cover office rent much less the people involved. If it's zoom nurse practitioner who are working out their house, that's another story.

I would have to think your insurance comes into play when see a primary care doctor, including copays. If not, I'm not ok seeing a doctor who is cool literally making a few dollars for my visit.

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7 hours ago, Captainant said:

it's literally those execs JOB to ensure that as few people as possible receive care so that their profits can be maximized. If they weren't, they'd be violating their fiduciary duty to their shareholders.

Point of order, legally speaking, fiduciary duty does not require the choice to maximize profit.  That's a latter-day spin on it.  The business judgment rule that accompanies fiduciary duty insulates businesses from decisions that consider other factors, like reputation for service, retention of customers, and gasp, even doing the right thing.

The invocation of "fiduciary duty" to justify succumbing to the profit motive is sheer bullshit.

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On 10/16/2023 at 8:02 AM, TwiceHorn said:

Question:

Has anyone ever been sued for medical debt?  Heard of such a thing?  

I know hospitals aggressively collect "liens" in certain situations, as where there is an injury lawsuit or other insurance settlement (from other than a health insurer), but I have never seen nor heard of a hospital suing to collect a debt.

Well, check that, recently I read that the University of Arkansas-Little Rock's hospital sued a bunch of people, including its own employees, but other than that  . . . .

The point being, I tend to assume that most medical debt can kind of be ignored, especially if it doesn't make it onto a credit report.

 

On 10/16/2023 at 8:18 AM, G650 said:

 

Definitely not, I have several employees getting garnishments over medical debt.

 

On 10/16/2023 at 8:18 AM, LCHorn said:

But it does make it onto a credit report.  
 

 

 

Some years ago, we took our daugther to the emergency room when she fell and broke her collar bone. She sat in a room for over two hours until a doctor came into see her, said "Lets get an xray and see what that looks like" and leaves. He's probably in there for less than two minutes. Never even looked at her. An hour later the xray tech comes in takes the xray and says "I'll get this to the doctor and he'll come and talk to to you."

We wait and wait and wait. Hours pass.

Finally, after midnight, we say fuck it and leave. If my daugther is going to lay in bed in pain, it might as well be in her own bed.

Next morning, wife calls daugther's pediatrician, gets an apt for a few hours later. Dr gets the xray from the hospital, says yep simple collar bone fracture, not offset, no separation, gives her a sling and scrip for pain, says come back in two weeks or sooner if it the pain gets worse.

 

Months later we get a bill from the hospital. Mostly or close to 100% covered by my wife's really good insurance. We pay the couple of hundred dollars that are left, sighing in relief. Then a month later we get a bill from the doctor that "saw" her. Thousands of dollars for "examination, diagnosis, consultation." Insurance paid some of it, but we were expected to pay the rest, over 1k.

We sent the doctor or whoever was his billing service a letter that said something like "You were in the room for less than two minutes. You didn't examine her, you didn't diagnose her, you didn't consult with us or her. We feel the payment our insurance has paid you is more than adequate for your services, so we will not be paying you anything else. Also, if this shows up on our credit report, we will sue you."

Never heard from them again. Never showed up on our credit report. Never got sued.

Fuck em.

 

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40 minutes ago, TwiceHorn said:

The invocation of "fiduciary duty" to justify succumbing to the profit motive is sheer bullshit.

Dude have you not been paying attention to the American business climate for the last four decades? That's the go-to justification of every ghoulish greedy action ever taken in the name of profit. "If they didnt do it, they'd get replaced by their board!

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17 minutes ago, Captainant said:

Dude have you not been paying attention to the American business climate for the last four decades? That's the go-to justification of every ghoulish greedy action ever taken in the name of profit. "If they didnt do it, they'd get replaced by their board!

Vigilantly capitalism.

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