patrick.net

Here is another that pertains to the inefficiency and waste at insurance companies.

"But the thing that few people talk about, and that no serious policy proposal attempts to fix—the arrangement that accounts for much of the difference between health spending in the U.S. and other places—is the enormous administrative overhead costs that come from lodging health-care reimbursement in the hands of insurance companies that have no incentive to perform their role efficiently as payment intermediaries."

"Because insurers are paid a fixed percentage of the claims they administer, they have no incentive to hold down costs. Worse than that, they have no incentives to do their jobs with even a modicum of competence."

http://www.bloomberg.com/bw/articles/2013-04-10/the-reason-health-care-is-so-expensive-insurance-companies

elliemae says

Unlike you, I don't blame Obama. I do blame greedy hospitals and a system that allows multi-tiered billing.

NOOOOO! Of course not... now why on earth would I suggest such a preposterous notion about something that started out touted as Healthcare reform would create fair "Transparent" and honest medical billing?
Just what kind of Idiot do you think I am anyway?

My Car insurance went up out of the blue yesterday. NO reason I haven't had as much as a traffic ticket since my twenties.
Called them up no reason, they just raised it because, Obamacare makes it look so easy.

I don't blame Obama really, I blame his Sheep for that.

CaptainShuddup says

My Car insurance went up out of the blue yesterday. NO reason I haven't had as much as a traffic ticket since my twenties.

Maybe they read Patnet and believe you to be oozing with a deep-seated anger, expecting you to explode with road rage when you see a commercial for a healthcare provider? It's a distinct possibility.

CaptainShuddup says

Just what kind of Idiot do you think I am anyway?

How much time you got?

First of all, the fact that the bill came to 44K and then the bill was jewed down to 2800, there should be serious investigation into that, as to why the hospitals is playing favorite with insurnace companies.

I agree, why isnt there an investigation into the jewing down of the bill?

errc says

I agree, why isnt there an investigation into the jewing down of the bill?

The tax payers are being screwed over, seeings hows Obamacare is a tax and all.
Gotta save the Company store!

Those billions not being paid, could have been use to create the next million dollar cancer treatment breakthrough.

The simple reality is that healthcare is another example of the tragedy of the commons. AKA fuck the taxpayer in the ass...

Tim Aurora says

Why can't you ever find out the cost of treatment in advance? Then you could shop around and force prices down.

That is one of the biggest scams in the medical industry

I work in the healthcare industry and I agree that the lack of price transparency is a complete scam to keep competition from driving prices down. Everyone blames the insurance companies, but it's not all their fault...the providers have a scam going to overcharge patients ridiculous amounts of money, and the insurance companies benefit because it forces people onto health plans so that the massive discounts can be had.

debyne says

I work in the healthcare industry and I agree that the lack of price transparency is a complete scam to keep competition from driving prices down. Everyone blames the insurance companies, but it's not all their fault...the providers have a scam going to overcharge patients ridiculous amounts of money, and the insurance companies benefit because it forces people onto health plans so that the massive discounts can be had.

AKA the tragedy of the commons

CaptainShuddup says

Secondly seeings hows the REAL BILL you know the one for realzies if Obamacare didn't come along and fuck everything UP

The "real bill" has been inaccessible for decades, long before HillaryEmailCare.

And bills have been bouncing back and forth between the insurance company and the provider for decades. The usual drill is that the bill gets smaller with each bounce.

Where have you been living?

indigenous says

Once again economic illiteracy...

Citation please

sbh says

and the insurance companies benefit because it forces people onto health plans

Plus the higher health costs increase the MLR payout the ins cos can take (limited to 15 - 20%)

Philistine says

Citation please

The definition of inflation:

3 Then, following the common idea of inflation, Mises (1912, , p. 272) tries to develop a more precise definition of inflation: In theoretical investigation there is only one meaning that can rationally be attached to the expression Inflation: an increase in the quantity of money (in the broader sense of the ...

The definition of the tragedy of the commons:

The tragedy of the commons is a dilemma arising from the situation in which multiple individuals, acting independently, and solely and rationally consulting their own self-interest, will lower the yield a shared limited resource, even to the point of ultimately depleting it, even when it is clear that it is not in everyone's short or long term interest for this to happen. This dilemma was first described in an influential article titled "The Tragedy of the Commons," written by Garrett Hardin and first published in the journal Science in 1968.[1]
In 1940, Ludwig von Mises wrote concerning the problem:

If land is not owned by anybody, although legal formalism may call it public property, it is utilized without any regard to the disadvantages resulting. Those who are in a position to appropriate to themselves the returns — lumber and game of the forests, fish of the water areas, and mineral deposits of the subsoil — do not bother about the later effects of their mode of exploitation. For them the erosion of the soil, the depletion of the exhaustible resources and other impairments of the future utilization are external costs not entering into their calculation of input and output. They cut down the trees without any regard for fresh shoots or reforestation. In hunting and fishing they do not shrink from methods preventing the repopulation of the hunting and fishing grounds.[2]

For purposes of this conversation, I'm using this to apply to tax revenue and money printed against the good will of the reserve currency status

The definition of cronyism:

the appointment of friends and associates to positions of authority, without proper regard to their qualifications.

That should give you a rudimentary understanding of why her statement shows economic illiteracy.

We recently decided to go out on our own. So, we left the big medical practice with all its egomania and dysfunction and are opening our doors under our own flag in the next two weeks. Developing our web page, I was trying to figure out the best way to reflect prices. First, we are a mostly cash business (about 70% cash/30% insurance) because what we do isn't typically covered by insurance in the state of CA. So I started to do some research to see how other clinics have handled this. I thought that since we are dealing mostly in cash patients, there would be no confusion when it comes to listing a fee schedule. We wouldn't be dealing with differing amounts from network contract to network contract, for example. In our field of reproductive medicine, I couldn't find a single practice that listed a specific fee schedule. Some might give a range, but that was the most specific they got. The range wasn't even really for a specific treatment... It was more like an average cost for a full treatment. For example, you might find something like "an average cost for IVF will range from $12k - 15k, excluding medications." So even though it seems like they are listing fees... they really aren't. IVF has a lot of moving parts. I couldn't figure out why clinics didn't just list it broken out in its component parts (monitoring, saline sonogram, retrieval, mock transfer, transfer, laboratory, storage, ICSI, assisted hatching, thawing, etc...) First, not everyone needs everything. Some might require more monitoring than others, for example. What's the big secret? However, NO ONE lists prices. And it isn't just California.

My initial reaction is that there must be some reason why no one (maybe a few, but I couldn't find them) does it in this country. Is there a way this could come back to bite you legally, perhaps? When we were in Ireland, they did list out all the fees by each individual treatment. What's different? IVF isn't covered there, either.

For in-network fees, it's not really that hard to figure out what an insurance company might reimburse an in-network doctor. Doctors network contracts are usually between 120% and 200% of the Medicare reimbursement rates. The exact percentage depends on market and specialty. But it will fall within that. As for cash treatments, what's the secret? You'll have to fess up at some point. Okay, I'm rambling...

Getting back to Ellimae's original question... My only thought is that not listing specific numbers has more to do with out-of-network charges. That's where the reimbursement is based on a percentage of charges.... which is why you'll see absurd charges in this particular scenario. Since you cannot have multiple fee schedules (you are only supposed to have one... you can discount it, but you cannot have multiple schedules for in-network, out-of-network, and cash) this is probably what's driving your original $44,000 charge. They have to have one set of fees... The fees make no difference for in-network, as the reimbursement amounts were already agreed to and doctors are barred from balance billing. The fees do make a difference with out-of-network patients, as the reimbursement is a percentage of CHARGES.

turtledove says

IVF....

is a fascinating field with excellent potential, though it can frighten some people. As more women postpone childbirth, demand will likely increase. The potential continues to amaze: freezing eggs (now possible although not yet reliable), artificial wombs (Brave New World, coming within a decade to an IVF clinic near you), IPS cells enabling older couples and same sex couples to have kids who are genetically theirs (stand by for the usual religious chomos to call it evil), etc.

In anything medical, costs may vary depending on intrinsic factors (patient age and condition, etc.). Further, different people have different priorities: overachievers might pay extra for premium service including precise scheduling, while others have more time available and don't mind waiting for appointments. You might want to invite people in for a free consultation, at which you can assess their needs and goals and provide a written estimate.

I think a reason why probably most clinics don't publish prices is because they don't want to scare away potential customers. It's a bit like cellular phones: advertise pictures of the latest gewgaw, say customers can have it for "only" $99 (or even "free"), sign them to 2-year contracts costing $2k, PROFIT while the customers go broke. If one store says up front "our phone will cost you $2k", it might get fewer customers than the store across the street offering the same phone "free". So, I suppose, honesty comes at a price, and most sellers avoid it if they can, and then they end up with the inevitable personality problems and dysfunction that go with basing a business model on deceiving people in the guise of helping them.

Psychologically, it's probably healthier to estimate based on results rather than procedures, although financially it is probably common to lure people in with low estimates and keep raising the total. It may depend on what sort of life you want to have. Now that some companies are offering egg freezing as an employee benefit, you might want to work with employers to quote an IVF package based on results rather than procedures. Doctors at Mayo Clinic (which negotiates prices with insurers based on diagnosis rather than fee for service) tend to report lower incomes but more satisfaction in their work and their lives.

HEY YOU says

elliemae,

Since your here why didn't you get a mental evaluation while in the hospital?

Don't you know that following Patnet will make you looney? Hell,I'm proof.

I'm sure that you meant this to be funny (and it was, a little). But I am part of the vast conspiracy that is able to place patients on a psychiatric hold against their will for up to 72 hours. To qualify for the free stay in a hard bed with shitty-ass food, they need to be a danger to themselves or others. A few years back I worked for a nursing home and the administrator wanted me to send a woman with dementia out to the psych hospital so that they could hold her for three days. After that, she would qualify for Medicare to pay $800 per day for her to receive physical therapy, occupational therapy and speech therapy. It didn't matter that she lacked the cognitive ability to retain anything that she might have learned and that the therapies wouldn't make a bit of difference because they weren't at all necessary... so I refused to sign the forms. She yelled at me, then threatened me with my job. She also threatened to file a report against my professional license. She insisted that the patient might wander out the front door into traffic - which doesn't constitute a "danger to herself or others," (although it did say a lot about a nursing home that admitted a patient who wandered without the ability to monitor her whereabouts). But I digress - her threats didn't work.

For those of you who are movie buffs,,. think of the bank scene from "Leaving Las Vegas." I simply couldn't sign the forms.

She got a nurse to sign the forms, and suspended me a couple of weeks later. She was fired soon after that. But she still works in the industry, ruining people's lives and controlling the elderly by ignoring their rights and treating them subhumanely.

Once Ten Ounce Dumbass fixes our healthcare system with his delightful insights, let's allow him to fix the system that allows a confused elderly woman to be held hostage against her will in order to allow a nursing home to fraudulently bill for services she doesn't need while her family stands by, trusting the word of a deranged woman with a two-year college degree, a license and not an ounce of compassion.

Blurtman says

enormous administrative overhead costs that come from lodging health-care reimbursement in the hands of insurance companies that have no incentive to perform their role efficiently as payment intermediaries.

The base pay of insurance executives, hospital executives and even hospital administrators often far outstrips doctors’ salaries, according to an analysis performed for The New York Times by Compdata Surveys: $584,000 on average for an insurance chief executive officer, $386,000 for a hospital C.E.O. and $237,000 for a hospital administrator, compared with $306,000 for a surgeon and $185,000 for a general doctor.

But all the losers keep harping on salaries of physicians who work a hell of a lot harder to pay for medical school, survive medical school and get through residency.

Mark T. Bertolini, the chief executive of Aetna, earned a salary of about $977,000 in 2012 but a total compensation package of over $36 million, the bulk of it from stocks vested and options he exercised that year. Likewise, Ronald J. Del Mauro, a former president of Barnabas Health, a midsize health system in New Jersey, earned a salary of just $28,000 in 2012, the year he retired, but total compensation of $21.7 million.

And studies suggest that administrative costs make up 20 to 30 percent of the United States health care bill, far higher than in any other country. American insurers, meanwhile, spent $606 per person on administrative costs, more than twice as much as in any other developed country and more than three times as much as many, according to a study by the Commonwealth Fund.

“At large hospitals there are senior V.P.s, V.P.s of this, that and the other,” said Cathy Schoen, senior vice president for policy, research and evaluation at the Commonwealth Fund, a New York-based foundation that focuses on health care. “Each one of them is paid more than before, and more than in any other country.”

She added, “The pay for the top five or 10 executives at insurers is pretty astounding — way more than a highly trained surgeon.”

Again, I know all the willfully ignorant people will just gloss over that fact. The dummies wanted obamacare, without realizing that all they are really doing is enriching the hospitals and insurance execs, while squeezing doctors. Doctors should be willing to take pay cuts if their education is subsidized as it is in all the countries that offer single payer. If this is an incorrect statement, feel free to correct me.

With medical tourism reaching the shores, some people, especially those doing procedures (Orthopedics, Cardiothoracic Surgery) will certainly take a haircut in the next few years.

http://www.nytimes.com/2014/05/18/sunday-review/doctors-salaries-are-not-the-big-cost.html?_r=0

turtledove says

IVF has a lot of moving parts. I couldn't figure out why clinics didn't just list it broken out in its component parts (monitoring, saline sonogram, retrieval, mock transfer, transfer, laboratory, storage, ICSI, assisted hatching, thawing, etc...) First, not everyone needs everything. Some might require more monitoring than others, for example. What's the big secret? However, NO ONE lists prices

Out of the four I went to (small sample size) only one broke it down; but it's not really an a la carte kind of thing. All of those moving parts are things that are required to ensure an optimal outcome.

Why can't you ever find out the cost of treatment in advance? Then you could shop around and force prices down.

Most of the DPC practices do this. Some surgeons (although rarer) do it as well. Like this guy in Las Vegas

http://www.generalsurgerynews.com/ViewArticle.aspx?d=In+the+News&d_id=69&i=November+2011&i_id=783&a_id=19624

elliemae says

The cost of traveling, difficulty finding providers, etc wouldn't have been worth it.

Correct, because you already have good insurance. Maybe your insurance doesn't have a travel benefit. Even then, it isn't the case that you have to book the ticket and find the provider on your own. Assuming your insurance covers it, or doesn't cover it, you would have a case manager who you call and they would coordinate it for you. Hospitals that cater to foreign travelers, have entire departments designed to handle travel plans and reimbursement. One phone call would basically solve that.

Plus, employer-paid surgeries abroad appear to be taking hold: According to a 2014 survey by HR consulting firm Aon Hewitt, although only 5 percent of employers currently cover those surgeries, 25 percent say they may add this in the next three to five years. Ellis' employer, with 2,500 employees, has saved nearly $11 million on health care since the company started its medical-travel program in 2010, according to benefits director Tim Isenhower.

Also, in many cases (maybe not your specific case), insurers and employers, both public and private, are not only picking up the cost for overseas care — some are even throwing in a cash bonus for the employee. It could be a good idea to discuss this possibility to achieve cost savings with HR/ Management.

The providers are almost certainly more skilled than your providers in St George, UT, by virtue of the fact that they do so many more procedures.

How to pick a doctor/facility:

http://www.aarp.org/health/conditions-treatments/info-2014/medical-tourism-surgery-abroad.2.html

http://www.aarp.org/health/conditions-treatments/info-2014/medical-tourism-surgery-abroad.html

http://www.nbcbayarea.com/news/local/Medical-Tourism-The-Future-of-Healthcare-233414371.html

http://www.darkdaily.com/medical-tourism-continues-to-flourish-as-u-s-patients-seek-lower-cost-healthcare-in-overseas-countries-207#axzz3UQnHGI6j

elliemae says

I blame Obama for that. :)

You had insurance before obama and you have insurance after, not sure what or who there is for you to 'blame'

MMR says

Out of the four I went to (small sample size) only one broke it down; but it's not really an a la carte kind of thing. All of those moving parts are things that are required to ensure an optimal outcome.

Would you mind telling me the clinic? I would love to see how they're doing it. Thx!

This is why I'm a believer in non-profit Accountable Care Organizations (i.e., basically HMOs) as the way to go. Because they're integrated and it's based on a regular premium you pay for care, the ACO is motivated to keep costs down and manage care in the most efficient way possible IF THERE IS COMPETITION. This is why I'm opposed to a single-payer system because they're no competition and you'll have kingdom builders not caring about making things as efficient as possible. ACA is making small strides to push things this direction and is already causing significant stirs in healthcare payers and providers to get more streamlined...I know this, because I live it every day in my job.

You're just making a case for why if the Government is going to meddle in Healthcare then it MUST be a self contained tax funded agency, from education to administering healthcare and medicine. Otherwise they should just stay the fuck out of it.

Anycare is better than this!

MMR says

elliemae says

I blame Obama for that. :)

You had insurance before obama and you have insurance after, not sure what or who there is for you to 'blame'

It was more a commentary on TPB's continual blaming of Obama for the rising cost of everything from his auto insurance to weed.

elliemae says

It was more a commentary on TPB's continual blaming of Obama for the rising cost of everything from his auto insurance to weed.

Weed is cheap in illegal states. We get all of the weed that wasn't good enough to be sold in the dispensairies.

Apparentley there's better weed than the cheap stuff we're getting that makes us googeley eyed stupid.