Healthcare Rant

Ooooooooh. I feel your pain!

Staying in the hotel, kid #3 splits his head open on the night table--2 inches wide open across the forehead. 

Quick trip to the ER, < 30 minutes total.  Kid sees a doctor for less than 10 minutes of that time during which the doc superglues his head shut.  No stitches. No meds.  The only thing the doc used was a pair of latex gloves and the glue.

We just got the bill last week, total = $1590. 

Emergency Room $800

Physician $165

Procedure fee $595 (yes, that's right, for superglue)

Administrative $30

I don't know who gets to code for this stuff, but that is insane. 

After insurance our out-of-pocket cost is $585.  This is in addition to the "full-coverage" insurance we already pay for. Broken is right!

I have added superglue to my first aid kit.

100% covered medical services always include an asterisk and fine print now.  Unfortunately, you don't learn about the fine print until the bill arrives a couple months later.

Yup, there's always a cash discount.  Saves them paperwork, A/R time and admin, I guess. Same thing happened to me back when I got sick in 2008 and had a lot of bills to deal with

Pretty F'd up to pay more when insured, huh?

A coworker of mine is from Texas, but lived in Canada for around 10 years. She married a Canadian. All she does it talk about how great healthcare is up there and how she wishes she could go back. 

Obviously when we have in the US is broken for the consumer. 

I figured out the only use for my health insurance is if something catastrophic happens to me (bike wreck, with broken bones, cancer, etc.). And I'm stuck with this plan till the end of the year. 

Healthcare in the US is so messed up. I'm not going to turn it in the political debate, but I hope we can all just agree that it's broken and something needs to be done to help fix it. Seems like on the rich can truly afford healthcare.  

Here's how broken the system is:   People are complaining that insurance is working EXACTLY how insurance is supposed to work. 

Why in the world would anyone want "insurance" for a yearly exam?   WHY?   It's a known event.  You don't buy insurance for known events.  You buy insurance for unexpected events.    You budget and pay for known events. 

Here's how broken the system is:   People are complaining that insurance is working EXACTLY how insurance is supposed to work. 

Why in the world would anyone want "insurance" for a yearly exam?   WHY?   It's a known event.  You don't buy insurance for known events.  You buy insurance for unexpected events.    You budget and pay for known events. 

 Here's how broken the system is:   People are complaining that insurance is working EXACTLY how insurance is supposed to work. 

Why in the world would anyone want "insurance" for a yearly exam?   WHY?   It's a known event.  You don't buy insurance for known events.  You buy insurance for unexpected events.    You budget and pay for known events. 

I was going to post the same thing. This is the exact purpose of insurance: to cover expense associated with a catastrophic event. You wouldn't expect your homeowner's insurance to pay for painting your house or other routine maintenance, would you? Should your car insurance pay for your oil change?

however, the way our insurance is implemented that doesn't work...there should be a difference between preventative healthcare and emergency insurance...but when it all gets rolled into one bundle payment its harder to differentiate ideally, I believe, that everyone should be entitled to a set number of dr's visits per year that encompasses basic health care - yearly examinations, school physicals etc - these visits should be limited in cost because they occur on a regular basis/frequency - easily paid out of pocket then health insurance for no issues

You are correct that "insurance" is working the way it is supposed to work, but the system is still broken. 

What's truly "broken" about the system is the consumers do not get information to make informed decisions.  How much is a visit to the doctor?  List price might be $200 (IF you can even get them to tell you anything).  The "cash price" might be $160.  The "negotiated price" might be anywhere from $85--175 depending on which insurance company you have.  My son had a medical issue and the negotiated price for one of the lab fees was less than 10% of the list price.  Really?  Don't claim it's a $30 procedure if you'll really accept $2.70 for it...

I talked to a cardiologist's office a few years ago after my company doc recommended a follow up.  "How much for a new patient consultation?"  The office couldn't tell me exactly...it could be anywhere from $150 to $450 depending on how it was coded.  So I asked them how to differentiate between the $150 exam and the $350 and $450 exams.  Was it time or additional tests?  Again...they couldn't tell me...

As a recent divorcee I am finding just how good I has while married.  My ex-husband had excellent coverage and now I'm struggling to find a policy I can afford.  Apparently I don't qualify for a medical card and a basic medical policy will run me about $225/month ($3000 deductible) with dental running about $50.  I haven't even looked at vision insurance.  

This is definitely not set up to help the lower income portion of our population.  

Because you can't anymore.  ACA fixed that for you. 

The doctor doesn't know how much ___ will cost.  Medical billing 101 from a doc who has been around the bloc

1-Charges are a fantasy.  Everything is billed as a percentage of what medicare would pay which is percentage that someone has negotiated with your insurer.  It doesn't matter what I charge I will get whatever that percentage is so don't freak out over charges
2-Your provider has no idea how much it costs.  I am on over 200 insurance plans.  Its not my job to know YOUR insurance plan.  My job is to help you get well. 
3-Everything is billed by code.  I write a code on a piece of paper and give it to billing
4-For each insurer there can be 20+ plans......for instance BCBS will have 20+ different plans that pay 20+ different ways
5-Look at your plan and be your own advocate.  Know what your deductible is, how it is applied and what is and is not covered under your plan.  Know which doctors are on your plan.  Is PT covered? Is DME covered?  Call your insurer or look at your booklet they mail you.
6-Most physicians are employed these days. They are just worker bees who have no control over the bill or the negotiated rates with your insurer so typically they can't just not charge you or reduce the bill. It would be like going into walmart and asking the check out person to take an extra 10% off just because. 
7-THIS IS IMPORTANT It is illegal to balance bill.  Say we bill at 200% of medicare.  Your insurance pays 150% of medicare.  Its illegal to bill the pt the balance if the doctor is on your plan. 
8-Doctors/hospitals etc get paid differently based on zip code.  I am worth a lot more in Texas or Wisconsin than I am providing the same services in Florida.  FL is one of the worst paying states in the country but even within a states you get paid more or less for the same services based on your zip code.  Pretty much if you practice any place you might want to live you get paid crappy. Its my personal opinion that if they leveled the playing field it would help a lot of things because my skill set doesn't change based on where I live
9-Its going to get worse before it gets better.  A lot worse.  The system is terribly broken but the insurers have deep pockets and both they and the government have bilions invested in the current system so its not going to get thrown out. 
10-You need to be your own best advocate.  It is not your doctors job to know how much your plan pays and what it pays for.  I treat everyone the same regardless as to what insurance plan they have or if they are workers comp or if they have no insurance at all.  MY goal as your doctor is to treat you with respect and give you the best possible care.  I can fix your broken ankle but I cannot fix your insurance plan. 

Because you can't anymore.  ACA fixed that for you. 

The doctor doesn't know how much ___ will cost.  Medical billing 101 from a doc who has been around the bloc

1-Charges are a fantasy.  Everything is billed as a percentage of what medicare would pay which is percentage that someone has negotiated with your insurer.  It doesn't matter what I charge I will get whatever that percentage is so don't freak out over charges
2-Your provider has no idea how much it costs.  I am on over 200 insurance plans.  Its not my job to know YOUR insurance plan.  My job is to help you get well. 
3-Everything is billed by code.  I write a code on a piece of paper and give it to billing
4-For each insurer there can be 20+ plans......for instance BCBS will have 20+ different plans that pay 20+ different ways
5-Look at your plan and be your own advocate.  Know what your deductible is, how it is applied and what is and is not covered under your plan.  Know which doctors are on your plan.  Is PT covered? Is DME covered?  Call your insurer or look at your booklet they mail you.
6-Most physicians are employed these days. They are just worker bees who have no control over the bill or the negotiated rates with your insurer so typically they can't just not charge you or reduce the bill. It would be like going into walmart and asking the check out person to take an extra 10% off just because. 
7-THIS IS IMPORTANT It is illegal to balance bill.  Say we bill at 200% of medicare.  Your insurance pays 150% of medicare.  Its illegal to bill the pt the balance if the doctor is on your plan. 
8-Doctors/hospitals etc get paid differently based on zip code.  I am worth a lot more in Texas or Wisconsin than I am providing the same services in Florida.  FL is one of the worst paying states in the country but even within a states you get paid more or less for the same services based on your zip code.  Pretty much if you practice any place you might want to live you get paid crappy. Its my personal opinion that if they leveled the playing field it would help a lot of things because my skill set doesn't change based on where I live
9-Its going to get worse before it gets better.  A lot worse.  The system is terribly broken but the insurers have deep pockets and both they and the government have bilions invested in the current system so its not going to get thrown out. 
10-You need to be your own best advocate.  It is not your doctors job to know how much your plan pays and what it pays for.  I treat everyone the same regardless as to what insurance plan they have or if they are workers comp or if they have no insurance at all.  MY goal as your doctor is to treat you with respect and give you the best possible care.  I can fix your broken ankle but I cannot fix your insurance plan. 

So what do you do when someone doesn't do the "preventative care" and ends up in an emergency situation? 

E.g.  high blood pressure, but doesn't go the doctor (no time, even if the exam is free) or pay for maintenance medicine and then has a heart attack? 

Exactly. When I have running injuries, I never go to the Dr. Why? Because I have no clue how much it is going to cost and I fear getting some outrageous bill. My coach will say, "go to the Dr." and I reply with, "I won't go because I am scared of how much it will cost". Now, I know it isn't like high blood pressure, but I seriously ONLY go to the Dr. if I HAVE to go. I wouldn't even go to the gyno once a year (going to cost me!) if I didn't need BC. That was a $120 trip I wasn't budgeting for.