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Thread: Health Insurance

  1. #241
    Peaceful Oasis TomAz's Avatar
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    Default Re: Health Insurance

    Archie I get what you're saying and you make some valid points. However, reality is a little more complex.

    Medicaid and Medicare payment rates are set by law -- the hospital or physician has no say in the matter. Medicaid payment rates vary by state but even in the highest paying states hospitals don't even cover their costs -- they lose money on every Medicaid patient that comes in the door*. Medicare payment rates are better but they may just barely cover costs, or may just fall short.

    Payments from commercial insurers are where providers make their money. They will negotiate deals with all, or some, of the health plans available in the market. They generally give better deals to the larger plans who represent a bigger portion of their patient base. This makes sense from the point of view of them running their own business, but it has adverse macroeconomic consequences. It gives the largest health plans a built-in competitive advantage over smaller ones: lower payments to hospitals and doctors means lower premium rates.

    As for the uninsured, what you say is technically true but again here the reality is muddier. A few states have laws that require providers to accept Medicaid or Medicare payment rates. In other areas, a hospital system will usually provide some sort of reasonable discount off of billed charges to uninsured patients that is consistent with the discounts they negotiate with mid-level commercial carriers. (Doctors operate a little differently, and for routine office visits will often not provide discounts).

    Hospital billed charges are generally only paid by visiting Saudi sheikhs and the like.


    * - technical caveat on this statement: measuring of hospital and physician "cost" is a gray area with lots of room for judgment. When I say most hospitals lose money on Medicaid, I mean on a fully-allocated fixed cost basis. On a pure marginal cost basis, they are probably at least breaking even.
    Last edited by TomAz; 07-30-2013 at 06:23 AM.
    Quote Originally Posted by efrain44 View Post
    Anyone know who the guy in the Cardinals jersey is? I've seen him in pictures on the board and I thought I saw him this year.

  2. #242
    old school westcoastpirate's Avatar
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    Default Re: Health Insurance

    We are on a CDHP plan and had to take our daughter to the emergency room in late May. After our daughter's emergency room visit we received a bill from the hospital, and another from the ER doctor. Both bills were for the insurance negotiated rate, per the CDHP plan. I have a good friend who works at Blue Cross Blue Shield and when we met up for lunch a couple weeks ago he said all hospital bills are negotiable. Unfortunately I already paid the hospital bill with our HSA before he told me this, but I hadn't paid the ER doctor bill yet. I decided to test out what my buddy said so I called the number on the bill from the ER doctor and asked them what I should do if I don't have the money to pay the full bill. They asked if the charges went towards my deductible, and I said yes, and they then asked me to mail them a copy of the explanation of benefits and they would make the adjustment and send me an updated bill. #1, I'm thinking to myself, well that was pretty easy, and #2, how big of an adjustment can they make?
    Fresh off his "JUICY AUSTRALIA TOUR"

  3. #243
    ankle biter guedita's Avatar
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    Default Re: Health Insurance

    I didn't realize that you could negotiate hospital bills either, until my uninsured ex-boyfriend woke up in a hospital hooked up to an IV after being found alone in a bar bathroom covered in vomit.

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  4. #244
    zeezus amyzzz's Avatar
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    Default Re: Health Insurance

    I'll have to remember that when I get the bill for my ER visit from last Friday.
    Quote Originally Posted by guedita View Post
    Because fucking millenials that's what

  5. #245
    Gummi bear sultan miscorrections's Avatar
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    Default Re: Health Insurance

    Unless the bill is pretty low, people in general should not be paying the whole billed amount. Always call and ask for a reduction and a payment plan.
    Quote Originally Posted by bmack86 View Post
    Has anyone gone on a date with a sandwich recently? What base did you get to? Ham?

  6. #246
    old school westcoastpirate's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by amyzzz View Post
    I'll have to remember that when I get the bill for my ER visit from last Friday.
    My Blue Cross buddy's wife just gave birth to their second child. My buddy said they got the hospital bill and I can't remember the exact amount but I want to say it was $1,500. He called the hospital and said I can give you $1,000 now or I will have to go on a payment plan for the full amount. They took the $1,000 as payment in full.
    Last edited by westcoastpirate; 07-30-2013 at 10:07 AM.
    Fresh off his "JUICY AUSTRALIA TOUR"

  7. #247
    Peaceful Oasis TomAz's Avatar
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    Default Re: Health Insurance

    Hospitals don't lose everything they write off.

    Hospitals have to complete (&have audited) these things called "Medicare Cost Reports" which attempt to measure the costs associated with care provided to Medicare enrollees. Part of those costs are fixed overhead.. stuff like the costs associated with running and maintaining the hospital physical plant, for example. Also included in fixed overhead is bad debt. So the hospital took the $1000 but saved itself collection costs and admin expense associated with a payment plan, and then they got to charge the federal government for their "fair share" of the $500 they wrote off. (This is an oversimplification but you get the idea).
    Quote Originally Posted by efrain44 View Post
    Anyone know who the guy in the Cardinals jersey is? I've seen him in pictures on the board and I thought I saw him this year.

  8. #248
    Member nahuatldream's Avatar
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    Default Re: Health Insurance

    I'm getting my masters in social work at the moment and there's a woman in our cohort who's doing her practicum at an agency, of which one of the primary functions is to assist people with negotiating their medical bills with the hospitals. Prior to that I was also not aware this was possible. She reports being able to get a lot of bills mostly or completely discharged.
    Upcoming: 04/11/14-04/13/14 - Coachella Weekend One; 04/18/14-04/20/14 - Coachella Weekend Two; 08/19/14 - NIN/Soundgarden (Isleta Amphitheater - Albuquerque, NM)

  9. #249
    Coachella Junkie PlayaDelWes's Avatar
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    Default Re: Health Insurance

    Anyone try bartering?
    Quote Originally Posted by dj12inches View Post
    What makes me qualified? I've watched EVERY fucking episode of American Idol, and every single episode of The Voice...Forget that I won departmental music awards when I was in the 8th grade choir.

  10. #250
    AMBIVALENT bobert's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by PlayaDelWes View Post
    Anyone try bartering?
    "If you remove my appendix, I'll throw in a kidney to sweeten the deal. How say you?"

  11. #251
    Peaceful Oasis TomAz's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by efrain44 View Post
    Anyone know who the guy in the Cardinals jersey is? I've seen him in pictures on the board and I thought I saw him this year.

  12. #252
    Gummi bear sultan miscorrections's Avatar
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    Default Re: Health Insurance

    Three necklaces and a case of dried corn for a head MRI.
    Quote Originally Posted by bmack86 View Post
    Has anyone gone on a date with a sandwich recently? What base did you get to? Ham?

  13. #253
    old school Cheddar's Cousin's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by guedita View Post
    I didn't realize that you could negotiate hospital bills either, until my uninsured ex-boyfriend woke up in a hospital hooked up to an IV after being found alone in a bar bathroom covered in vomit.
    Ex? He sounds like a keeper to me...
    Youth, you son of a bitch, where did you go?

    Quote Originally Posted by Emma Ocean View Post
    so I assume you've never been cunt punched at a festival? Well lucky you!

  14. #254
    zeezus amyzzz's Avatar
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    Default Re: Health Insurance

    Wes, you ARE joking, right?
    Quote Originally Posted by guedita View Post
    Because fucking millenials that's what

  15. #255
    ankle biter guedita's Avatar
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    Default Re: Health Insurance

    I've moved on to a bigger and better drunk.

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  16. #256
    Banned thelastgreatman's Avatar
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    Default Re: Health Insurance

    ... aiming for the stars.
    Quote Originally Posted by schoolofruckus View Post
    Look, your parenting is yours and Randy's business alone.
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  17. #257
    Coachella Junkie algunz's Avatar
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    Default Re: Health Insurance

    My doctor, whom I have been seeing since I was 15, asked for $150 a year as sort of a membership to keep their practice open. If I was over 50, they're asking for twice that. I hate the idea of finding another doctor after 25 years, but this just seems wrong.
    Last edited by algunz; 07-30-2013 at 03:12 PM.

  18. #258
    Coachella Junkie PlayaDelWes's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by amyzzz View Post
    Wes, you ARE joking, right?
    Maybe like a bottle of nice wine at Christmas Chanukah or couple positive yelp reviews wouldn't hurt.
    Quote Originally Posted by dj12inches View Post
    What makes me qualified? I've watched EVERY fucking episode of American Idol, and every single episode of The Voice...Forget that I won departmental music awards when I was in the 8th grade choir.

  19. #259
    Bambi menikmati's Avatar
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    Default Re: Health Insurance

    12 years since I last went to a doctor's office for any reason.

  20. #260
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    Default Re: Health Insurance

    ... there's no way in hell there's not a ton of things wrong with you. You look like you just got over the plague.
    Quote Originally Posted by schoolofruckus View Post
    Look, your parenting is yours and Randy's business alone.
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  21. #261
    Member Archie Bunker's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by TomAz View Post
    Archie I get what you're saying and you make some valid points. However, reality is a little more complex.

    Medicaid and Medicare payment rates are set by law -- the hospital or physician has no say in the matter. Medicaid payment rates vary by state but even in the highest paying states hospitals don't even cover their costs -- they lose money on every Medicaid patient that comes in the door*. Medicare payment rates are better but they may just barely cover costs, or may just fall short.

    Payments from commercial insurers are where providers make their money. They will negotiate deals with all, or some, of the health plans available in the market. They generally give better deals to the larger plans who represent a bigger portion of their patient base. This makes sense from the point of view of them running their own business, but it has adverse macroeconomic consequences. It gives the largest health plans a built-in competitive advantage over smaller ones: lower payments to hospitals and doctors means lower premium rates.

    As for the uninsured, what you say is technically true but again here the reality is muddier. A few states have laws that require providers to accept Medicaid or Medicare payment rates. In other areas, a hospital system will usually provide some sort of reasonable discount off of billed charges to uninsured patients that is consistent with the discounts they negotiate with mid-level commercial carriers. (Doctors operate a little differently, and for routine office visits will often not provide discounts).

    Hospital billed charges are generally only paid by visiting Saudi sheikhs and the like.


    * - technical caveat on this statement: measuring of hospital and physician "cost" is a gray area with lots of room for judgment. When I say most hospitals lose money on Medicaid, I mean on a fully-allocated fixed cost basis. On a pure marginal cost basis, they are probably at least breaking even.

    I wouldn't have a problem if Medicare/Medicaid costs were fixed lower than everyone else's costs, if it's truly the case that those prices don't allow the health provider to show a profit.

    However, I still stand behind my assertion that the "negotiated rate" differences are absurd and simply should not be legal.

    Health care is a necessity, not a luxury. While I am NOT a proponent of a socialized system, I also don't feel that people without insurance should be punished with staggeringly higher prices. Whether you can sometimes negotiate those bills down is immaterial. They should not be billed that high in the first place, and I have known of many providers that are quite inflexible with lowering the billed rate -- or at least nowhere near their insurance negotiated rates. Like, sometimes the billed rate is 5x the negotiated rate, and they might knock off 20% if you press hard enough, but you're still paying 4x too much.

    Taking Medicaid out of the equations, insurance companies and health care providers should (and already have) come up with a compensation system that is mostly fair, which allows both the doctor and the provider to profit to both of their satisfaction. An uninsured person should be eligible to pay the exact same rates, except he will not get subsidized by a check from an insurance company. This system is simple, fair, and eliminates the outrageous "billed charges" that are submitted and then reduced for certain parties.

    Sometimes you (and I'm not talking about you personally, Tom) need to step back from the existing bureaucracy, ask yourself, "Does the current system make any sense?", and if not, scrap the entire thing and do it right. This is one of those times.

    A change like this would benefit everyone.

    More people would pay their medical bills (many are intimidated by the giant billed amounts, and simply ignore the bills, figuring them unmanagable), the uninsured would still have a fair shake at getting care (albeit paying more out-of-pocket), and this wouldn't place any additional burden on providers or insurance companies.

    It would not solve everything wrong with our health care system, but it would be a great start, and would fix a big hole that exists right now.
    Everybody Wang Chung tonight.

  22. #262
    Member Archie Bunker's Avatar
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    Default Re: Health Insurance

    I support CDHPs in theory, and I feel they are the right direction for our health care to head.

    For the record, as a self-employed American, I have an individual plan with a high deductible, a few basic benefits (such as $40 office visits & prescription coverage, independent of the deductivble) and a low premium.

    I do feel CDHPs still have plenty of bugs, and the system needs fixing, but it's on the right track.
    Everybody Wang Chung tonight.

  23. #263
    Member Archie Bunker's Avatar
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    Default Re: Health Insurance

    Tom:

    Give me your opinion of this statement:

    "Unless you know you have dental work coming up (that can be delayed until the benefit waiting period is up), dental insurance is a waste of money."
    Everybody Wang Chung tonight.

  24. #264
    Peaceful Oasis TomAz's Avatar
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    Default Re: Health Insurance

    Rarely are these things black and white, Archie. As with medical, many dental plans have negotiated discounts off of billed charges with dentists; depending on your needs, the discounted fees related to routine/preventive care may make the net cost of dental insurance much lower. Especially if you have children who require routine preventive care. Also, if you have an employer who is chipping in some or most of the cost of dental, then no it is not a waste.

    If by 'waste' you mean simply 'you'll pay more in premiums than you get in benefits', then this is true of most insurance.

    But, I think what you're getting at is: Most dental care is something that isn't urgent and can be planned out over a year or two, and as a result is budgetable, and hence really not an insurable event. In addition, even if you do have an unexpected dental emergency with unforeseen expenses, the cost of dental care is nowhere near as expensive as medical care, and thus someone with some savings in the bank can probably safely afford to self-insure.
    Quote Originally Posted by efrain44 View Post
    Anyone know who the guy in the Cardinals jersey is? I've seen him in pictures on the board and I thought I saw him this year.

  25. #265
    old school JorgeC's Avatar
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    Default Re: Health Insurance

    Quote Originally Posted by Archie Bunker View Post
    Taking Medicaid out of the equations, insurance companies and health care providers should (and already have) come up with a compensation system that is mostly fair, which allows both the doctor and the provider to profit to both of their satisfaction.
    I hope that shrinking down this quote doesn't make this out of context, but this particular sentence really stood out to me. The majority of For-Profit companies will NEVER be satisfied with it's current profit margin.
    Quote Originally Posted by guedita View Post
    Which healthcare provider will euthanize you the fastest as a service to society?
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  26. #266
    Peaceful Oasis TomAz's Avatar
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    Default Re: Health Insurance

    This is not the thread to construct your proto-Marxist fantasy arguments, Jorge. But if you think doctors aren't greedy, you've obviously never done business with doctors.
    Quote Originally Posted by efrain44 View Post
    Anyone know who the guy in the Cardinals jersey is? I've seen him in pictures on the board and I thought I saw him this year.

  27. #267
    ankle biter guedita's Avatar
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    Default Re: Health Insurance

    I don't think he's denying that doctors aren't also susceptible to greed, Tom. Doctors & health care companies are both for-profit.

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  28. #268
    Peaceful Oasis TomAz's Avatar
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    Default Re: Health Insurance

    Then I'm not sure what his point was. Two opposing parties, similarly motivated, negotiating a middle ground.. where's the problem?
    Quote Originally Posted by efrain44 View Post
    Anyone know who the guy in the Cardinals jersey is? I've seen him in pictures on the board and I thought I saw him this year.

  29. #269
    ankle biter guedita's Avatar
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    Default Re: Health Insurance

    Jorge was, I think (I'm sure he can chime in) reading Archie's comment as if Archie intended to suggest that eventually, both parties will be "satisfied" with the amount of profit they've negotiated, and will then cease to negotiate for increased profits.

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  30. #270
    zeezus amyzzz's Avatar
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    Default Re: Health Insurance

    ahhh! too many negatives, Cara.
    Quote Originally Posted by guedita View Post
    Because fucking millenials that's what

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