Random Thought Thread

It also doesn’t help that malpractice insurance runs as high as a couple hundred thousand dollars per year per provider depending on specialty.

Stupid restraints by policies such as not being able to see a patient for more than 2 problems per visit (most elderly or chronic disease patients have multiple issues), and having them make another appt to address other issues. And yet PAP smears are performed, charged, and covered for patients with no cervix to actually perform a PAP smear on! Totally crazy and I refused to do them. A GYN exam and swab for STI’s sure, but not falsely performing a procedure.

Other extreme is a healthy guy has a mountain biking accident and has an obvious torn rotator cuff injury diagnosis confirmed by ortho. Insurance will not authorize MRI unless they have had 6 weeks of PT. Nutty.

Medication prior authorizations can be more than infuriating.

Rant over.
 
beeinak said:
Most people who get the raw deal are not necessarily at the lower end, because they likely have Medicaid. The biggest financial burden is for those who either have no insurance, or those who do but not enough coverage. Many people think that insurance coverages are similar, but co-pays and things not covered can vary drastically. Some of my patients were excited about the Affordable Care Act, only to find that they had outrageous deductibles and many medications they had been on were no longer covered. Same with Medicare- plans differ drastically.
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My current employer offers coverage through Blue Cross Blue Shield - a company that's generally well thought of for being accepted by most medical services and providing great coverage. They offered me a policy that coLord, over $3,300 per month in premiums and a $36,000 deductible for a family of 3. I elected a different plan through a different carrier via the exchange with much better rates all around but slightly less than universal coverage. But, after speaking with several of our primary care doctors (none of which are in-network for BCBS), I learned that BCBS is being dumped by most of the major medical providers in my area because they are difficult to deal with and doctors/facilities are tired of wrangling with them for months only to get paid pennies on the dollar. What's the point in paying high dollar for "good coverage" that doesn't cover any doctor you want or need to see?

I'm not entirely convinced that single payer, universal coverage is the best solution. But good lord, Franz Kafka would start to tango in his grave if heard an explanation of whatever sort of system the US tries to get away with.
 
fnordmorph said:
One lesson learned from being on both sides of this... if you are ever hospitalized, ask for an itemized bill. It's amazing the $41x they try to charge you for, in terms of goods and services you did not receive.
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Like someone complaining, “If I knew you were gonna charge $2 PER PILL for the ibuprofen, I would’ve just had my wife bring me a 200 count bottle from Walmart”.
 
The best advice I’ve ever received regarding health care was from my GP, who said to take matters into my own hands and change my life, eat right, exercise, reduce stress, get enough sleep, and avoid getting sick.

Although I still have insurance coverage, I also understand that the onus is on me to do my best to not have to use it, because we don’t have health care in this country, we have sick care.

There’s absolutely no guarantee that I won’t develop something that requires real medical help, but I want to do my best to be ready for it, should it arise.

Americans have demonstrated that they will go to the absolute greatest of lengths to not make the right decisions, even when it’s their own welfare that’s at stake. The shit I see people eating and drinking, while shoveling down medications intended to curb the effects of this poison, amazes me. No country in the world has managed to normalize bad behavior the way that we have…
 
beeinak said:
It also doesn’t help that malpractice insurance runs as high as a couple hundred thousand dollars per year per provider depending on specialty.

Stupid restraints by policies such as not being able to see a patient for more than 2 problems per visit (most elderly or chronic disease patients have multiple issues), and having them make another appt to address other issues. And yet PAP smears are performed, charged, and covered for patients with no cervix to actually perform a PAP smear on! Totally crazy and I refused to do them. A GYN exam and swab for STI’s sure, but not falsely performing a procedure.

Other extreme is a healthy guy has a mountain biking accident and has an obvious torn rotator cuff injury diagnosis confirmed by ortho. Insurance will not authorize MRI unless they have had 6 weeks of PT. Nutty.

Medication prior authorizations can be more than infuriating.

Rant over.
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The most maddening thing about that, to me, is the actual cost of that MRI is probably $400 and the mountain biker would be happy to pay it out of pocket, but because of the way everything is marked up it's just not an option.

For as much as it costs, our health care in this country is a joke.
 
oldmanwilly said:
My current employer offers coverage through Blue Cross Blue Shield - a company that's generally well thought of for being accepted by most medical services and providing great coverage. They offered me a policy that coLord, over $3,300 per month in premiums and a $36,000 deductible for a family of 3. I elected a different plan through a different carrier via the exchange with much better rates all around but slightly less than universal coverage. But, after speaking with several of our primary care doctors (none of which are in-network for BCBS), I learned that BCBS is being dumped by most of the major medical providers in my area because they are difficult to deal with and doctors/facilities are tired of wrangling with them for months only to get paid pennies on the dollar. What's the point in paying high dollar for "good coverage" that doesn't cover any doctor you want or need to see?

I'm not entirely convinced that single payer, universal coverage is the best solution. But good lord, Franz Kafka would start to tango in his grave if heard an explanation of whatever sort of system the US tries to get away with.
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My wife and I have had BCBS for many years through employer. The hospital has now dumped BCBS. It was great insurance, but I also know some providers took advantage of the coverage such as performing costly procedures as frequently as they were covered.
 
Nathan the Machinist said:
The most maddening thing about that, to me, is the actual cost of that MRI is probably $400 and the mountain biker would be happy to pay it out of pocket, but because of the way everything is marked up it's just not an option.

For as much as it costs, our health care in this country is a joke.
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Some radiology centers do have cash prices that are much less. One independent radiology center up here charges about 1/3 the price for some imaging if for example you let them know you don’t have coverage and will be paying cash.
 
beeinak said:
Some radiology centers do have cash prices that are much less. One independent radiology center up here charges about 1/3 the price for some imaging if for example you let them know you don’t have coverage and will be paying cash.
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I tried that once here and the cost for the person without coverage was actually more than the cost to the person with coverage.

How maddening is that.

This $400 procedure costs $1,400

Oh wait, you don't have coverage? Yeah, it's $2,400 now.

I didn't think to bring up cash though.
 
My brother-in-law got a CAT scan at a hospital where his wife was a nurse and they hit them with a $10,000 bill for it. She was like, that's ridiculous screw you I'm not paying that.

I don't know whatever became of it, I'll have to ask.
 
I'm self employed. We (wife and I) haven't had health insurance since the mandate got struck down, because we're relatively healthy and the cost of insurance is insane (and all too often it doesn't pay for what you actually need -- BCBS (when I had it years ago) paid zilch for my wife's hip resurfacing. For most of time since the mortal wounding of Obamacare we've had a health share plan. We 'negotiate' a best price for whatever service (although now they're starting to have pre-negotiated prices with some providers), usually we pay up front, and we get reimbursed after covering an 'unshared amount' (basically a deductible). Average discounts from 'sticker price' are in the neighborhood of 50% for 'self pay' and paying at the time of service. I had a knee MRI a couple years ago that I think I paid around a grand for. I got reimbursed most of that. Cost of the health share plan is on the order of 1/4 to 1/3 what insurance would have cost. Last I looked, there was only one insurance company selling policies on the exchange here.

On the other hand, if you come in to my ER, you will be seen as soon as I can get to you. You might have to wait 10 minutes or 2 hours. You will be treated to the extent that the tiny hospitals I work at are able, and you will get admitted or transferred if you need it (and you don't refuse). You won't get a wallet biopsy while you're in the ER. You won't get discharged due to a perceived lack of ability to pay. Hospitals do write off a lot of the care they provide as uncollectable. On the other hand, if what you have does not require immediate treatment, you will get referred to someone as an outpatient and unless I have actually talked to that doctor (probably at 3am) and they have agreed to see you in followup, they may not see you unless you have insurance or you pay up front.

Part of what I like about the ER is that I don't have to get approval from anyone to do whatever tests I think are necessary in the emergency setting. That rarely includes MRI, or things like nuclear medicine studies, but if I want a CT, I order it, and it gets done promptly.

The system is stupid. Billing is byzantine and opaque, driven by how the hospital can best take advantage of the tangled mess of how insurance companies use information that was originally intended to fulfill weird medicare requirements. Half the time the hospital's billing department has no idea why they are billing a thing, and if you ask for an itemized bill and proceed to dispute individual charges they look at you like you have 3 heads. The care that the US health system is *capable* of providing is outstanding. Actually delivering that care while trying to feed the 14 levels of middle management required by the current system of paying for that care is a nightmare.
 
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This explains everything:

Pournelle's Iron Law of Bureaucracy states that in any bureaucratic organization there will be two kinds of people":

First, there will be those who are devoted to the goals of the organization. Examples are dedicated classroom teachers in an educational bureaucracy, many of the engineers and launch technicians and scientists at NASA, even some agricultural scientists and advisors in the former Soviet Union collective farming administration.

Secondly, there will be those dedicated to the organization itself. Examples are many of the administrators in the education system, many professors of education, many teachers union officials, much of the NASA headquarters staff, etc.
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The Iron Law states that in every case the second group will gain and keep control of the organization. It will write the rules, and control promotions within the organization.
 
GEVZCCbWUAAtTeP.jpg


"Guess I picked the wrong week to bring up reviewing federal health care options!"


I'd never have guessed that my comment about reviewing policies for the coming year would lead to all this. Maybe I can seek an appointment as Surgeon General or Medical Insurance Czar with the upcoming administration. (Can I work from home while still moderating BF? If not, I withdraw my candidacy.)
 
fnordmorph said:
I'm self employed. We (wife and I) haven't had health insurance since the mandate got struck down, because we're relatively healthy and the cost of insurance is insane (and all too often it doesn't pay for what you actually need -- BCBS (when I had it years ago) paid zilch for my wife's hip resurfacing. For most of time since the mortal wounding of Obamacare we've had a health share plan. We 'negotiate' a best price for whatever service (although now they're starting to have pre-negotiated prices with some providers), usually we pay up front, and we get reimbursed after covering an 'unshared amount' (basically a deductible). Average discounts from 'sticker price' are in the neighborhood of 50% for 'self pay' and paying at the time of service. I had a knee MRI a couple years ago that I think I paid around a grand for. I got reimbursed most of that. Cost of the health share plan is on the order of 1/4 to 1/3 what insurance would have cost. Last I looked, there was only one insurance company selling policies on the exchange here.

On the other hand, if you come in to my ER, you will be seen as soon as I can get to you. You might have to wait 10 minutes or 2 hours. You will be treated to the extent that the tiny hospitals I work at are able, and you will get admitted or transferred if you need it (and you don't refuse). You won't get a wallet biopsy while you're in the ER. You won't get discharged due to a perceived lack of ability to pay. Hospitals do write off a lot of the care they provide as uncollectable. On the other hand, if what you have does not require immediate treatment, you will get referred to someone as an outpatient and unless I have actually talked to that doctor (probably at 3am) and they have agreed to see you in followup, they may not see you unless you have insurance or you pay up front.

Part of what I like about the ER is that I don't have to get approval from anyone to do whatever tests I think are necessary in the emergency setting. That rarely includes MRI, or things like nuclear medicine studies, but if I want a CT, I order it, and it gets done promptly.

The system is stupid. Billing is byzantine and opaque, driven by how the hospital can best take advantage of the tangled mess of how insurance companies use information that was originally intended to fulfill weird medicare requirements. Half the time the hospital's billing department has no idea why they are billing a thing, and if you ask for an itemized bill and proceed to dispute individual charges they look at you like you have 3 heads. The care that the US health system is *capable* of providing is outstanding. Actually delivering that care while trying to feed the 14 levels of middle management required by the current system of paying for that care is a nightmare.
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My last interaction with an ER was a few years ago when Abby had a cut.

Jo even called the insurance company ahead of time to make sure we were covered. They said we were.

They changed their mind I guess

I had a bill for around $3,500. I tried to talk to them, like, can we negotiate this or anything? "Fuck you, pay me." So I paid it.

My buddy Shane had a gardening related injury, lol. He got an Ace bandage and a bill for four grand.

I would only go to the emergency room if I was literally dying. And even then, I would drive myself because what they charge for a ride in the ambulance.

We use super glue for cuts around here. Some have been pretty serious too. Both Jo and I have had injuries that hit bone. It's not ideal. It's actually ridiculous when you think about it. But it's the only way because our health care system is working exactly the way it is intended to.
 
How do you get the glue to set when you're bleeding like a stuck pig? That's the reason I went to the ER for stitches last go round.

(Plus the wound was on two fingers of one hand, I'd not have been able to apply it myself, and I doubt the missus would be inclined to do it for me.)

I like the concept though. Just haven't tried it.
 
Nathan the Machinist said:
My last interaction with an ER was a few years ago when Abby had a cut.

Jo even called the insurance company ahead of time to make sure we were covered. They said we were.

They changed their mind I guess

I had a bill for around $3,500. I tried to talk to them, like, can we negotiate this or anything? "Fuck you, pay me." So I paid it.

My buddy Shane had a gardening related injury, lol. He got an Ace bandage and a bill for four grand.

I would only go to the emergency room if I was literally dying. And even then, I would drive myself because what they charge for a ride in the ambulance.

We use super glue for cuts around here. Some have been pretty serious too. Both Jo and I have had injuries that hit bone. It's not ideal. It's actually ridiculous when you think about it. But it's the only way because our health care system is working exactly the way it is intended to.
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On the other hand, if one has the medicaid gold card, they will go to the ER for mild colds, bug bites, hiccups and paper cuts.

I don't go to (or take family to) the ER unless there is a problem threatening life or function -- but I have more expertise in making that determination than most do.

Hospitals are required to have anyone presenting to the ER evaluated by 'qualified medical personnel' -- typically a doc, a nurse practitioner, or a physician assistant. Most hospitals accomplish this by having everyone who comes in seen by a provider and charging them for an emergency visit (and the billing is designed to charge as much as possible). Some big hospitals with crazy ER wait times have tried having a doc in the triage area, who would tell anyone who had a non-emergent problem to go see a primary doc as an outpatient. Angered a lot of people with medicaid, reassured people with no or imperfect non-.gov health insurance. ER bills are crazy, there is no way to tell what it is going to cost going in and there usually isn't much opportunity to shop for the best price. I don't know the right answer, but I have seen a lot of wrong answers.
 
Blues said:
How do you get the glue to set when you're bleeding like a stuck pig? That's the reason I went to the ER for stitches last go round.

(Plus the wound was on two fingers of one hand, I'd not have been able to apply it myself, and I doubt the missus would be inclined to do it for me.)

I like the concept though. Just haven't tried it.
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I can tell you how *I* get the bleeding to stop... direct pressure. If that doesn't work, direct pressure over a lidocaine/epinephrine compress. If that doesn't work I usually just give up and sew it. I have used a lot of cyanoacrylate on wounds over the years.
 
Nathan the Machinist said:
My last interaction with an ER was a few years ago when Abby had a cut.

Jo even called the insurance company ahead of time to make sure we were covered. They said we were.

They changed their mind I guess

I had a bill for around $3,500. I tried to talk to them, like, can we negotiate this or anything? "Fuck you, pay me." So I paid it.

My buddy Shane had a gardening related injury, lol. He got an Ace bandage and a bill for four grand.

I would only go to the emergency room if I was literally dying. And even then, I would drive myself because what they charge for a ride in the ambulance.

We use super glue for cuts around here. Some have been pretty serious too. Both Jo and I have had injuries that hit bone. It's not ideal. It's actually ridiculous when you think about it. But it's the only way because our health care system is working exactly the way it is intended to.
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If you sever a tendon on the inside of your hand, you better go to the hospital and get a hand surgeon on it ASAP. Those tendons will retract all the to your elbow and then it is a nightmare to repair. I got a tiny cut on my little finger from by Basic 5, maybe 2mm, but deep enough to sever the tendon. That required surgery to repair and a two inch scar as a reminder. Several rehab visits as well to restore function. The hand surgeon said the tendons on the outside of the hand are much less time critical and easier to repair.
 
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