Hippa

[J.R.]

Than you have the niceities of bundling or unbundling of services. Forget your Surgeon and Assistance, more then likely the Anesthesiologist may very well make more than the surgeon. I had to go to the Oral Surgeon not that long ago, during the initial consultation he gave me a itemize bill of the cost, it was correct except for an additional charge of $50 for unexpected cost. Now I never had a Medical Dr. or Med. Facility do that for me, why?

Valid points. I was talking to my girlfriend who is a RN this evening heads up a Radiology clinic and we were discussing issues that we have seen that need to be corrected pertaining to medical bills. Personally, I do not really care if a doctor, nurse, etc. makes XXXXXXXXXXX amount a year. I care about getting the proper tests and treatment available. You hit it on the head James by talking about an itemized bill. The vet provided one to us and was a couple of hundred off the final bill. Not a bad gig if you ask me. Had it been off a couple of thousand that would be a different issue. What is to stop a hospital or physician's office from doing the same thing???? It doesn't really matter what the hospitals charge because the insurance company is only going to pay what is negotiated and what is stipulated in their contract.

If a doctor says he recommends I take a test and the insurance company says that it is not authorized, fine......but I should be able to know this beforehand and not when I see the medical bill.

It was brought up recently that an individual I know had $1000 plus in charges for some tests that were denied from the lovely HMO. $1000 is not going to put that person in the poor house, but what really pisses me off is that this type of thing happens all the time because people do not speak up. I am starting to see the value in the way that some companies explain their plans or lack therof.

 

[James]

"I had to go to the Oral Surgeon not that long ago, during the initial consultation he gave me a itemize bill of the cost,...

Come to think of it, I had this same experience, an itemized bill from the oral surgeon in advance. I guess that since the surgeon knows there is no such thing as true dental "insurance" that will pay anywhere near the cost, they don't mind, and probably prefer, to have you know in advance how much you're going to have to cough up.

True, but I do have a pretty good dental plan with no limits. Yet though, I don't see why the medical Dr. can not do the same but, I doubt you'll find one.

 

[James]

Valid points. I was talking to my girlfriend who is a RN this evening heads up a Radiology clinic and we were discussing issues that we have seen that need to be corrected pertaining to medical bills. Personally, I do not really care if a doctor, nurse, etc. makes XXXXXXXXXXX amount a year. I care about getting the proper tests and treatment available. You hit it on the head James by talking about an itemized bill.

Goes further than then that, look at Lasik surgeory. Since Insurance for the most part do not cover the procedure it came down in price and now performed quite sucessfully at ever increasing places with convienence in mind to the patient. Now go ask the med. Dr. to treat you in a more convienent manner, place and time. What you think you would be told?

 

[J.R.]

Goes further than then that, look at Lasik surgeory. Since Insurance for the most part do not cover the procedure it came down in price and now performed quite sucessfully at ever increasing places with convienence in mind to the patient. Now go ask the med. Dr. to treat you in a more convienent manner, place and time. What you think you would be told?

Quite true, but that doesn't mean things will not change. 20 years ago it was consider immoral to question anyone with the letters after their name, but times have changed.

 

[somarco]

don't shop at Macy's and have no idea who Gimbel's is

Watch Miracle on 47th Street.

I am not talking about what hospitals pay for their equipment

Neither am I.

I am referring to the prices carriers pay providers as part of a negotiated agreement.

Mr. Smith needs to have surgery and will require a primary surgeon and an assistant surgeon, with a few days of inpatient and outpatient care,

Just any surgeon, or one who specializes in the procedure and has a good track record?

How many days? Two, three, 16?

followed by some treatment at home for a week

What kind of treatment? How often? Daily? Every 2 days? How much time for each treatment?

All of these must be factored in to the equation. How many consumers are informed enough to ask the right questions and form an opinion?

It's bad enough that the bean counters at the MCO's are telling docs how to do their job. Now you are going to have consumers doing likewise?

Gee doc, don't you think 40 stitches will work just as well as 50? Go easy on the gas, I am a guy, I can take it.

Because it would make the consumers more aware of what they are paying and/or the benefits they receive w/out dealing with the BS of greed on either side

When it comes to medical care, consumers really dont care how much it costs.

All they really want to know is their liability before the carrier kicks in. Beyond that they really dont care.

The hospitals of course want to get the person in and out and quickly as possible

Actually, no.

The hospital is charged with filling beds. The more bed that are occupied the greater their revenue.

The carrier, more specifically, the MCO, is the one that is counting the beans & limiting inpatient care.

In the era of managed care, the rules of engagement are different. The carriers and the MCO determine what level of care is needed and how much will be allowed for each procedure. The insureds responsibility is to read their contract (which no one ever does) and understand what they are responsible for and what the carrier will pay.

Since consumers do not conduct due diligence before buying insurance, and fail to read their policy until AFTER they have a claim, what good will it do to provide them with even more information they will choose to ignore?

I tell prospects exactly the questions they need to ask before buying anything. I tell them where to go to find the answers they need to make an intelligent decision. Guess how many of them even bother to read the directions and follow thru?

About 20% bother to read my instructions and fewer than that fail to act.

Consumers are idiots.

 

[somarco]

Most dental procedures that are in xs of $300 - $500 must be pre-approved, including an itemized statement submitted to the carrier for review.

 

[somarco]

Goes further than then that, look at Lasik surgeory. Since Insurance for the most part do not cover the procedure it came down in price

It came down in price because demand increased to the point of allowing the docs performing the procedure to cover their costs over many patients rather than a handful.

When something is new, and unproven, the cost is quite high. Once the procedure caught on, more patients mean more sales volume, which allows other docs to get into the picture and undercut their competition.

This is nothing more than basic economics in a free market society.

 

[J.R.]

Watch Miracle on 47th Street.

Gotcha.

How many consumers are informed enough to ask the right questions and form an opinion?

Minimal I would imagine.

It's bad enough that the bean counters at the MCO's are telling docs how to do their job. Now you are going to have consumers doing likewise?

That is not the arguement I am making. Consumers have a right to question a doctor, nurse about any treatment they receive and the options available. We are talking about looking at things objectively.

All they really want to know is their liability before the carrier kicks in. Beyond that they really dont care.

That was my point that apparently was missed. I should have been clearer. That being the case, how many people, especially on a group plans are aware of their liability "Prior" to receiving treatment?

I tell prospects exactly the questions they need to ask before buying anything. I tell them where to go to find the answers they need to make an intelligent decision. Guess how many of them even bother to read the directions and follow thru?

Would you be kind enough to share that information with the group or send me something?

Thanks...

 

[somarco]

how many people, especially on a group plans are aware of their liability "Prior" to receiving treatment?

Probably less than 2%.

Mostly because they do not read their policy, do not read their EOB, they pay their copay and maybe the deductible and assume everything else is covered.

I field way too many questions from consumers on other forums to believe the behavior is any different. Most of them are complaining about how the carrier ripped them off (if they bothered to read their EOB) or how the carrier failed to pay their claim (which is now in collections) or how something was supposed to be covered but was not (despite the policy language that specified otherwise).

Consumers are lazy and stupid.

Would you be kind enough to share that information with the group or send me something

Exerpts:

Read everything carefully, all the way through, before taking ANY action.

Ask if your agent is licensed in your state. Check with the DOI to confirm.

Ask if the carrier is licensed in your state. Check with the DOI to confirm.

Here is a goody that no one ever does. Ask your doctor if they are in the network.

Ask for a written proposal before buying anything.

Ask about potential underwriting effects on your final rate & terms.

You do not need to give out a credit card number or SS# to anyone until you have read the proposal, asked questions about the coverage, have completed your due diligence and are ready to buy.

OK, now guess how many actually follow thru?

 

[johnrocks]

Come to think of it, when I went to the Oral Surgeon I got an itemized summary of charges before I had my work done and also at the dentist's office. What an original idea!!! Now if only doctors, hospitals and the rest of the med. profession would get off their high horses, we could actually stabalize the system...