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Less expensive than tijuana!!!
The Dismantling of ObamaCare - Ongoing Updates.
- Thread starter AllenChicago
- Start date
Can't help, Jen.
BX is more messed up than any of the other carriers.
36 different carriers in the country. Countless networks and plans. I haven't placed anything with them in years, but not too long ago a small group proposal had something like 80 different plans. They had dozens of networks, tailored to the product (IFP, small group, large group, MA). Add in the national PPO and I doubt if you can get a correct answer from Blue direct.
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For those who are not aware of the medical billing process, the links below might be of interest.
The process of medical billing
For those who want visuals and screenshots
The Medical Billing Process - Step By Step
And then there are videos
The Medical Billing Process
I find most of the complaints about health insurance and health care come from folks (including agents) who don't really know all that goes into health care, billing, claims processing, insurance underwriting and pricing, etc.
It is easy to criticize something that is not understood but don't expect to get away with it forever.
You don't have to like the system, but it is what it is. Obamacare made it even more complicated.
And no, single payer is not the answer, nor is it feasible.
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Kenny, thanks for the link and reminder. I blogged on this 5 years ago. Search links.
There are a lot of things a private practice can do when they do not receive federal funding (which includes payments by Medicare & Medicaid). They deal in cash only. Bills must be paid at time of service. Truly a streamlined process.
BX is more messed up than any of the other carriers.
36 different carriers in the country. Countless networks and plans. I haven't placed anything with them in years, but not too long ago a small group proposal had something like 80 different plans. They had dozens of networks, tailored to the product (IFP, small group, large group, MA). Add in the national PPO and I doubt if you can get a correct answer from Blue direct.
----------
For those who are not aware of the medical billing process, the links below might be of interest.
The process of medical billing
For those who want visuals and screenshots
The Medical Billing Process - Step By Step
And then there are videos
The Medical Billing Process
I find most of the complaints about health insurance and health care come from folks (including agents) who don't really know all that goes into health care, billing, claims processing, insurance underwriting and pricing, etc.
It is easy to criticize something that is not understood but don't expect to get away with it forever.
You don't have to like the system, but it is what it is. Obamacare made it even more complicated.
And no, single payer is not the answer, nor is it feasible.
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Kenny, thanks for the link and reminder. I blogged on this 5 years ago. Search links.
There are a lot of things a private practice can do when they do not receive federal funding (which includes payments by Medicare & Medicaid). They deal in cash only. Bills must be paid at time of service. Truly a streamlined process.
workerscomp1
Expert
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PREDICTION!!!" THE PROCESS OF MEDICAL BILLING" in all it's glory (visuals, screenshots and videos) will sweep the nation!!!!!! No gathering big or small, Liberal or Conservative, young or old will not be complete without it!!!! WOW!!Finally something we can all rally around!!
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"It is what it is", is not working anymore. Major fundamental changes are needed within the healthcare and health insurance system.
That does not necessarily mean single-payor. But the overhead, the rx, the special interests, the gaps in care, the gaps in cost, the lack of any transparency before hand, the difficulty of navigating a complex system, etc. etc. etc. The list goes on and on. And there is nothing meaningful being done about it. Just paying for it out of a different pocket and calling those payments different names.
Everyone is looking out for themselves but there is nobody looking out for the American people.
The ever-increasing complexity of medical billing is a huge factor in the steep rise in the cost of care. Doctors offices have more staff working in claims/billing than they do on the patients.
The patient should not have to deal with that level of complexity. Admin staff at the provider, sure.
But a sick patient should not have to spend hours reading about how to deal with their doctor/pharmacy/hospital/etc..
We already have a single-payor system. The day we turn people away at the ER, is the day we stop having a Single-Payor system.
I like how the local hospital automatically offers a 20% discount off patient's part of the claim when paid up front. It was hilarious explaining how I would be taking the $$ out of an HSA and didn't want to pay them the entire OOP when there were other claims that could be paid first and would reduce the amount I owed them. I was willing to pre-pay them if they'd guarantee me a flat $1,000 off the final amount owed and put it in writing. I didn't want to pay them then have to put over-payment back into the HSA and make sure that the bank did the paperwork correctly when reporting to the IRS.
I went to the other providers except my Doc and asked for the same 20% that the hosp offered. All reluctantly agreed and I ended up with slightly more than a $3,500 expense for a $5,000 OOP. The process was a pita but $1,500 is $1,500. None were focused on total charges or even knew what they were. All concentrated on getting known cash now.
It is aggravating that finding the allowed charge is so difficult. The clerks at carriers only have access to a particular member claim and don't have the interface with the database to look up by code. I have been able to send a large claim through the group rep when quoting on a decent sized case where we were competing against another carrier's network.
We left 1 dentist in a market many good dentists available because he insists on getting paid up front AND doesn't file claims. I don't mind paying him but am not set up to file claims expecially when I don't have to.
Re: single payer, I don't know that it matters who the administrator is AND we have a lot of duplicated infrastructure. It's pretty much a big complicated, convoluted mess.
My son is selling car parts and there is no standardized parts-identifying system that works well. There are many overlapping, competing systems none of which are complete. It is also difficult to have a new part number which is the equivalent of a new procedure code added.
I went to the other providers except my Doc and asked for the same 20% that the hosp offered. All reluctantly agreed and I ended up with slightly more than a $3,500 expense for a $5,000 OOP. The process was a pita but $1,500 is $1,500. None were focused on total charges or even knew what they were. All concentrated on getting known cash now.
It is aggravating that finding the allowed charge is so difficult. The clerks at carriers only have access to a particular member claim and don't have the interface with the database to look up by code. I have been able to send a large claim through the group rep when quoting on a decent sized case where we were competing against another carrier's network.
We left 1 dentist in a market many good dentists available because he insists on getting paid up front AND doesn't file claims. I don't mind paying him but am not set up to file claims expecially when I don't have to.
Re: single payer, I don't know that it matters who the administrator is AND we have a lot of duplicated infrastructure. It's pretty much a big complicated, convoluted mess.
My son is selling car parts and there is no standardized parts-identifying system that works well. There are many overlapping, competing systems none of which are complete. It is also difficult to have a new part number which is the equivalent of a new procedure code added.
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I don't know why this pricing inquiry worked, but a couple years ago in Virginia one of my PPO BCBS insureds on a small group ($2,000 deductible/$3,500 MOOP) came to me with a dilemma. The MRI needed was an issue due to the facility requiring an upfront payment of the full price, about $1,200. We were able to get other facilities to do a quote, including the network price. All about the same. Step 2, contact facility billing, negotiate a payment plan. They agreed to 1/4 up front, the rest over 3 months. It seems they were able to plug into the system, directly to BCBS and get network pricing for the MRI. That's a pretty narrow code, I guess, compared to what can happen in other situations, like an office visit or a complex surgery. This particular BCBS is also now contacting folks before these procedures, with offers of other network providers with lower costs for MRI's and CT's.
There are also supposed to be shopping tools now on lots of carrier's client portal access.
I wonder if the area BCBS group sales team could help. They are selling all the new bells and whistles of client empowerment.
1. Make networks illegal, as price fixing
2. Make providers publish their fees, as a dollar amount and as a percent of Medicare allowable, for every service code that their office uses.
3. Make doctors tell patients exactly what service codes are being provided.
4. Let patients decide on cost, quality, and necessity, based on input from their doctors and other trusted advisers.
Problem solved.
I love "reference based pricing" like self-funded groups are doing. Set a maximum (like 130% of Medicare allowable, for instance). This eliminates networks. If the patient gets balance billed, the insurance company goes after them for charging more than is reasonable, rather than making the client bare the cost.
Let's get back to cash prices, like a regular economy.
Yes, this eliminates cost shifting, and will alarm hospitals for unreimbursed care at the ER, but it would be less expensive to indemnify hospitals than the crazy dance we are doing now.
2. Make providers publish their fees, as a dollar amount and as a percent of Medicare allowable, for every service code that their office uses.
3. Make doctors tell patients exactly what service codes are being provided.
4. Let patients decide on cost, quality, and necessity, based on input from their doctors and other trusted advisers.
Problem solved.
I love "reference based pricing" like self-funded groups are doing. Set a maximum (like 130% of Medicare allowable, for instance). This eliminates networks. If the patient gets balance billed, the insurance company goes after them for charging more than is reasonable, rather than making the client bare the cost.
Let's get back to cash prices, like a regular economy.
Yes, this eliminates cost shifting, and will alarm hospitals for unreimbursed care at the ER, but it would be less expensive to indemnify hospitals than the crazy dance we are doing now.
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The Republicans own the White House and both houses of Congress. But the above is not likely to happen because the Republicans are owned by the large insurance carriers and big pharma.
I heard a song on the radio today that was done way before my time... but some of you might remember this snippet from Won't Be Fooled Again:
Meet the new boss
Same as the old boss
Same as the old boss
What a lost opportunity TrumpCare is turning out to be.
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NYLife11023: why we need to get campaign finance reform. Elected officials spend a huge amount of their time just fundraising and favor seeking to get re-elected. The pretense of government separated from commerce is pretty much being discarded now.
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Cash prices, like it. Web based transparency would help, too. True web car sales, no haggle types send traditional dealers scrambling, with their "I have to run it by my manager" tactics. I bought my car from the no bs no haggle online buying option from a dealer 3 hours away. I know, cars aren't health, but if the competition doesn't make it shameful to ask up front about the cost, the ones who can't tell you cost up front will have to change.
Back to healthcare: When I was born, in my rural area, cash was the main option. I looked it up--the cost for my birth, hospital and doc in today's money, is about $767. The actual cost was $75. Hospital stay, the usual then, was 7 days, too.
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Cash prices, like it. Web based transparency would help, too. True web car sales, no haggle types send traditional dealers scrambling, with their "I have to run it by my manager" tactics. I bought my car from the no bs no haggle online buying option from a dealer 3 hours away. I know, cars aren't health, but if the competition doesn't make it shameful to ask up front about the cost, the ones who can't tell you cost up front will have to change.
Back to healthcare: When I was born, in my rural area, cash was the main option. I looked it up--the cost for my birth, hospital and doc in today's money, is about $767. The actual cost was $75. Hospital stay, the usual then, was 7 days, too.
Best quote for today is from CNBC:
CBO report on Trumpcare confirms it. You can't fix stupid--Commentary
The rest of the editorial is really good too,
This screaming headline "24 million Americans will lose their health coverage" is topping almost every story on the Republican Obamacare replacement plan now that it's been studied by the Congressional Budget Office. But I have a better headline: "Government can't fix stupid."
That's the real takeaway because as it turns out, most of those 24 million people projected to "lose" coverage will be doing so of their own free will. Here are the CBO's own words:
Most of that increase, (in uncovered Americans), would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.
In other words, now that the government can't make them do it, a lot of people who can afford to buy health insurance simply won't do it anymore. And therein lies the problem. The role of government is to operate under the consent of the governed, not to act as the nanny state.
That's the real takeaway because as it turns out, most of those 24 million people projected to "lose" coverage will be doing so of their own free will. Here are the CBO's own words:
Most of that increase, (in uncovered Americans), would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.
In other words, now that the government can't make them do it, a lot of people who can afford to buy health insurance simply won't do it anymore. And therein lies the problem. The role of government is to operate under the consent of the governed, not to act as the nanny state.
CBO report on Trumpcare confirms it. You can't fix stupid--Commentary
The rest of the editorial is really good too,
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