@Tonythetiger Us smokers tried to warn everyone...welcome to the party, pal!

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Fast forward a few weeks. The hospital and providers are still going back and forth with the insurance. My brother calls one and they blame the other and vice versa.

I handle, at a rather high level, medical & dental claims, benefits and eligibility issues. For both commercial and medicare lines of one of the largest medical insurance orgs in the US. The *VAST MAJORITY* of the time in any case like this, one or the other (or both) have made some sort of mistake, almost certainly due to the complexity of the interlocking systems, rules and regulations. It's... insane. And honestly, the only advice I can give you is to be patient. Eventually the problem will work it's way up to the person who can point at something and say "here's the problem, here's how to fix it."

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NOT ONE DOC OFFICE COULD TELL ME HOW MUCH A TREATMENT WAS WITHOUT FILLING FOR THE INSURANCE FIRST

In my experience, they lied. You need their npi number (public info.) You also need to have the cpt codes they will bill and sometimes the diagnosis codes too.) Call the insurance company and ask what they allow that provider to bill for those codes. If they are in network with the insurance, they will risk their contract for trying to collect any more than that from you.

Good luck to you and anybody else dealing with this nightmare. Remember, they are limited by law to 10% profit. How do you make more money for your shareholders? Yea. Be glad you can't see it from the inside.

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It's justifiably immoral to deal morally with an immoral entity.

Festina lente.

My daughter had a bad experience with Obamacare.

She developed severe pain & drove to a nearby clinic. They refused to see her because they didn't take her insurance. Sent her to a nearby hospital. She was admitted. After 18 hours of not finding anything from several blood draws they were about to discharge her when they realized she was bleeding to death internally and rushed her to the ER.

Because this was an out of plan hospital she spent hours & months dealing with this. She was able to get some of the charges reduced when she successfully argued that it was an emergency and she had no choice but to go to the closest hospital.

The next year she had to get Obamacare again. She noted the 3 hospitals in her plan were all 45 to 60 minutes from her. She lives in a major metropolitan area where there are 3 closer hospitals (within 10-15 min). I told her they were trying to discourage her from going to the hospital because of distance!

The 3rd year she solved her problem by getting married to a man with a good insurance plan.

Last year my husband is completing the paperwork for his company plan when he says we can get a discount if you say you'll do these 5 things. It was stuff like go to the dentist, exercise, etc. I said sure say I'll do it. Lol. It was stupid.

I used to go to a doctor who refused to take any insurance. You paid him directly. If you wanted to file a claim later to your insurance his office would help you write the correct info on the form. I actually signed a contract with him for prenatal care for a specified amount.

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It is difficult to get a man to understand something when his desires depend upon his not understanding it.
~Upton Sinclair slightly paraphrased

The vaccine portion of the article covers what has been violated and needs to be repaired - the Hippocratic Oath and medical privacy. An excellent starting point.

The trick is recovering that pre-covid standard. In every western country the trend continues to be towards further violations.

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NOT ONE DOC OFFICE COULD TELL ME HOW MUCH A TREATMENT WAS WITHOUT FILLING FOR THE INSURANCE FIRST



In my experience, they lied. You need their npi number (public info.) You also need to have the cpt codes they will bill and sometimes the diagnosis codes too.) Call the insurance company and ask what they allow that provider to bill for those codes. If they are in network with the insurance, they will risk their contract for trying to collect any more than that from you.

I'll say they lied because I wrote medical billing software and have seen and used many competing packages. ALL of them include a "fee schedule" feature that tracks exactly what that office will be paid for a given diagnosis code or procedure, and they all have "what if" features because some people need to juggle secondary coverages and the like.

And all fee schedules have a cash-only option.

No need to contact insurers at all.

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Welcome to TF: The "T" stands for "Thoughtcrime"

Of course they lied.

Until people start being forced to pay for that sort of lie ON THE SPOT, since we already know nobody will prosecute, it won't stop.

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@Asimov said:

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the only advice I can give you is to be patient

Yep --- my brother is old school in that he just wants it to go away and will do stupid things to make it go away. I did tell him to be patient and wait for the 2 groups to get their crap right. He didn't want to get hounded by the collections departments of the hospital and providers. That's when I told him to tell them to not call back until each side has filed and finished the insurance claims. That actually worked. He did have to pull up on his phone the insurance statement where is gave the date the provider received their check. The provider was trying to pull one over on him.

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In my experience, they lied...You also need to have the cpt codes they will bill and sometimes the diagnosis codes too.) Call the insurance company and ask what they allow that provider to bill for those codes.

Oh, I did. Since I wrote billing interfaces at the time I and had access to the rules they used, I could figure out a few things. Remember this was 2005,2006,2007 and pre Obamacare. I just wanted to know what particular offices would charge for non-insurance arbitrary prices. The price set by the government is really stupid. But that's another debate. And you mention the 10% cap on profit. That's stupid too. It's almost a single payer system without it being a single payer system.

And on the the ...

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they lied

... part, you're correct. I know they knew. I was trying to see what provider I could use in my area. My previous doc had just retired so I was searching for a new one at the time.

For people with high deductible health insurance, you can open a Health Saving Account (HSA) and save federal (and in most cases state) taxes, on qualified medical expenses. Qualified medical expenses for an HSA are any that occur after the account is opened. You do not need to have the money in the account when the expense occurs. You can open the account (with the minimal required funding) and add money and reimburse expenses as they occur, up to the contribution limit each year. If you have expenses over the yearly limit, the next year you can add funds and reimburse them. Also, they changed qualified medical expenses to include over the counter drugs, bandages, and menstrual products.

You cannot reform a system that is run and staffed by stupid people who have lost the capacity for critical thinking, that are cowards without a moral compass and whose incentives are geared towards profit over the people they took an oath to serve.

Medicine is no different than any other institution in our formerly great country in that regard. The vast amounts of $$$$ involved have completely distorted decision making. Remove the $$$ and the system collapses. So you have to keep printing and spending. It is a Red Queen strategy - running ever faster but staying in place and exhausting yourself in the process.

Our medical system is right now held afloat by the $$$$$ flowing out of DC. There is no way any individual state could match that money. You only get more money if you spend to the limit of your current budget or volume.. It is a warp-speed race to the bottom to attract the paying patients.

There is not 1 single "quality" or "cost reducing" program to come out of CMS that has created "quality" or saved a dime. The Oncology Care Model was designed to reward physicians with $$ for reporting certain quality measures as well as for using less expensive drugs. It cost $787,000,000 and cancer care costs in aggregate increased 15%.

Now that the CARES act increased the hospital reimbursements 20% for all things covid and remdesivir was billions of Medicare spending in $$$ in 2021-2022, the race to the bottom financially is at Warp 10.

Meanwhile, I am having freaking IV fluids denied on my cancer patients to try to keep them out of the hospital or a trip to the ER. A bag of normal saline is about $1.00 cost. FFS.

I LOVE my HSA.

Guess what I can buy with it?

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'Keep pushing fuckers, you'll find the trip wire eventually'
~ Quik49

'This is the part where you find out who you are'

They frequently run 10 or 20% off sales @Workerbee...

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Good!
Thanks!

In my 'buy later' cart.

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'Keep pushing fuckers, you'll find the trip wire eventually'
~ Quik49

'This is the part where you find out who you are'

How is that eligible for FSA HSA?

It's a "health-related" item. Home blood pressure cuffs (automated), EKG devices, BAC (might help you stop drinking), etc. Anything reasonably health-related is generally HSA qualified.

I've had one for a LONG time. They eventually puke (the sensor dries out; its an electrolytic cell) and should be sent in annually for calibration (about $20.) When it fails calibration they'll email you and usually offer you a decent discount off another one.

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Imagine how expensive it would be to get an oil change if your car insurance policy was modeled after medical insurance. You would stop into the nearest Jiffy Lube and find 2 technicians working in the bay with 40 people in the back office processing the paperwork. You would still end up with a 20 to 30 dollar co-pay which doesn't seem too bad (assuming your insurance paperwork went through,otherwise it would be a $500 oil change). And heaven forbid if you have a leak somewhere because they would have to find the billing code for that and charge it against your insurance to the tune of another hundred bucks or so. So let's say you survived with no major issues....You might think you got away cheap, but your insurance premium for your car has now increased from $1k to $5k/yr. Sound familiar?

A lot of the cost issue would go away if medical insurance was only available for serious and/or catastrophic issues (just like car insurance). Then free market forces would keep the routine and preventative care a lot more cost effective.

@Workerbee: are you taking a page out of my book?

@Rollformer hells yeah
I know a good idea when I hear it

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'Keep pushing fuckers, you'll find the trip wire eventually'
~ Quik49

'This is the part where you find out who you are'

Tickerguy wrote..

Naw, you let 'em flee. The optics on that get them hunted down and slaughtered by the residents if they do it; there's no way to spin "soak the private party dude with no insurance who incidentally is probably poor too" that doesn't end up with stretched necks.

Never mind that when the cost of medical care collapses in your state the instant rush in from every business in the nation will be beyond your wildest dreams.

@Tickerguy -- Exactly this.

You could add in a multiplicative effect by passing a law (1) repealing all laws requiring insurance and (2) allowing insurance-customers demanding a full jury trial for judging whether or not a policy is to pay out: this would force insurance companies into a more equitable and honest relationship -- after all, how often do insurance companies try to worm out of paying out*, even when clearly within the policy? (Remember that the insurance companies refused to pay out for business-insurance that had explicit clauses for coronaviruses.)

Luis calls out the obvious injustice of letting one be judge in his own controversy in this video:





* Funnily enough, it's not considered "insurance fraud" when the insurance company commits fraud for/by refusing to honor its policy.