Getting an insurance claims education...not sure I want it (benefits, patient)
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
Just out of curiosity, do you see any dollar limit at all that should be imposed on someone for doing five hours worth of emergency care? Is $50,000 too much? How about $100,000?
This particular client has a job where he earns about $12 an hour or roughly a gross income of $24K per year.
His entire gross income for a year got spent on five hours worth of emergency services. Think something is out-of-whack? The problem should be apparent to even someone who didn't make it through high school. These kind of charges are unsustainable.
Finally, I get worked up about stuff like this because I see this as simply killing this country. We can't afford this system at this rate and something is ultimately going to have to give. Its simply a question of where and what.
The doctors in the ER who order the tests do not get paid anything for them. The hospital charges for the use of the equipment and the radiologist charges to read it. Doctors cannot even refer patients to a radiology facility in which they have a financial interest.
In Mr. Smith's case, how much would it have been worth to him if the CT had discovered something life-threatening? Would he think a year's salary might be a bargain?
How would you suggest pricing emergency services in such a way as to ensure that those services continue to be available?
Keep in mind that insurance companies demand and get large discounts beacuse they choose which hospitals their subscribers may use.
The doctors in the ER who order the tests do not get paid anything for them. The hospital charges for the use of the equipment and the radiologist charges to read it.Doctors cannot even refer patients to a radiology facility in which they have a financial interest.
In Mr. Smith's case, how much would it have been worth to him if the CT had discovered something life-threatening? Would he think a year's salary might be a bargain?
How would you suggest pricing emergency services in such a way as to ensure that those services continue to be available?
Keep in mind that insurance companies demand and get large discounts beacuse they choose which hospitals their subscribers may use.
The whole damn health industry runs far too many tests--many of which are harmful. A single CT scan puts more radiation in the body than tens of thousands of dental x-rays.
Nearly 30,000 Americans get cancer from this one procedure every year!!!
Quote:
CT scans yield higher-resolution images than regular medical X-rays. Unfortunately, they also expose the patient to hundreds and sometimes thousands of times the amount of radiation.
The routine use of CT scans has vastly increased. In 1980, there were roughly 3 million CT scans performed. By 2007, that number had increased to 70 million. CT scans are now being promoted to healthy people -- even whole body CT scans.
According to Life Extension Magazine:
“The problem is that the explosion in unnecessary CT scans has been going on every year. If we carry this back just ten years, this means that 150,000 Americans are facing horrific deaths from CT scan-induced cancers.”
So maybe we should think about FEWER tests in the ER rather than more. Why do you think there is such an increased use of CTs? Better health? How about more money for the hospital and physicians that use them? I think the latter is a far more reasonable answer. In addition, ER physicians are always being pushed to admit as patients those who can pay.
These recent patterns of firings send yet another strong message to every doctor and nurse who has ever considered speaking up about dangerous and fraudulent medical care: Speak up and risk destroying your career.
The culture of health care needs to change. Medical mistakes cause too many needless harm or deaths, yet few people see the problem in this context because we rarely have an open and honest conversation about the quality of health care in America.
Apparently, according to the last sentence of the first paragraph quoted above, it is not a problem for ER doctors to recommend patients be admitted to the hospital they work in, and as often as possible---but I suspect only if they have insurance.
Last edited by Wardendresden; 01-17-2014 at 10:24 PM..
The whole damn health industry runs far too many tests--many of which are harmful. A single CT scan puts more radiation in the body than tens of thousands of dental x-rays.
So maybe we should think about FEWER tests in the ER rather than more. Why do you think there is such an increased use of CTs? Better health? How about more money for the hospital and physicians that use them? I think the latter is a far more reasonable answer. In addition, ER physicians are always being pushed to admit as patients those who can pay.
Apparently, according to the last sentence of the first paragraph quoted above, it is not a problem for ER doctors to recommend patients be admitted to the hospital they work in, and as often as possible---but I suspect only if they have insurance.
That is why there should be an indication for every test and a valid reason for every hospital admission. ER doctors should not be pressured to admit people who do not need to be admitted and their compensation should not be affected by admissions.
Certainly there is reason to limit the number of CT scans. Do them only when necessary. Use only the amount of radiaition needed to get a good image.
But if we are going to talk about the ER, we need to provide some protection for ER doctors from lawsuits if they decide not to do a scan and miss something. Since the ER docs do not generate any income from ordering CT scans, the liability risk is a far greater pressor.
Just out of curiosity, do you see any dollar limit at all that should be imposed on someone for doing five hours worth of emergency care? Is $50,000 too much? How about $100,000?
This particular client has a job where he earns about $12 an hour or roughly a gross income of $24K per year.
His entire gross income for a year got spent on five hours worth of emergency services. Think something is out-of-whack? The problem should be apparent to even someone who didn't make it through high school. These kind of charges are unsustainable.
Finally, I get worked up about stuff like this because I see this as simply killing this country. We can't afford this system at this rate and something is ultimately going to have to give. Its simply a question of where and what.
And how much would he be making if he had a stroke because of an undetected blood clot...
No, there should not be a limit as long as there is a reason for the tests..and in your client's case, there were MANY reasons for the tests he received. Did he have health insurance? That is why you have health insurance, so you don't spend every dime you make paying medical bills . Yes, it sucks that some people can only make $12/hour but guess what, his dr doesn't.
It's not killing our country, far from it. There are a lot worse things killing our country but advanced medical care is not one of them---failure to take proper precautions against catastrophic expenses however, is one think that is crippling our country...
Next time you pick an insurance plan, pick an HMO....and see what limiting dr's ability to dr does for you....
The doctors in the ER who order the tests do not get paid anything for them. The hospital charges for the use of the equipment and the radiologist charges to read it. Doctors cannot even refer patients to a radiology facility in which they have a financial interest.
In Mr. Smith's case, how much would it have been worth to him if the CT had discovered something life-threatening? Would he think a year's salary might be a bargain?
My experience is this is like finding a needle in a haystack. It happens, but its pretty rare. You might see what I write below about this.
How would you suggest pricing emergency services in such a way as to ensure that those services continue to be available?
Keep in mind that insurance companies demand and get large discounts beacuse they choose which hospitals their subscribers may use.
My opinion is different than many. I would accept the fact that competition is a poor model in health care. In many communities there are only one or two hospitals. The potential for competition is limited. I've written other posts in this forum indicating why the free market has done a poor job of reducing or even holding prices to some level for patient care. The short way for me to put it is that consumers lack the market information necessary to make informed choices, the health care market is characterized by a small number of buyers and sellers, licensing and other restrictions limit the supply of health care, and decisions to obtain medical care are often made quickly and in response to a crisis which leaves the consumer little room to bargain or negotiate.
I would regulate health care the same way that utilities are regulated. I'd set prices to cover costs and allow for some reasonable return on the capital invested. Price increases and the installation of expensive new technology would require the equivalent of a rate approval hearing before a commission.
The large insurance companies "getting discounts" is a bone that sticks in the throats of many small business owners across this country. What that means is that the rest of us who aren't lucky enough to have something like Federal Blue Cross Insurance make up the difference for the deal that federal employees, state employees, or employees of large corporations get when we have to pay for medical care. If my wife were not a government employee, getting health insurance through the county, I suspect that even though I make good money, I'd have to have given up running my own law practice years ago. I hope for something better with the ACA.
And how much would he be making if he had a stroke because of an undetected blood clot...
This is anything but scientific. I've observed hundreds of injury claimants over the years who've had CT scans and MRI scans. Nothing like that has ever turned up. I have seen things like ruptured cervical and lumbar discs. However, these were not emergencies. These would have been picked up later when my client had persistent leg tingling or numbness for weeks after an accident.
I'll note this. I am aware of two people who were not given a scan of their brain following some minor head trauma. Both ended up returning some days/weeks later for further evaluation because of headaches and dizziness. The problem was picked up at that point and surgery to remove a hematoma was done. These were two out of hundreds of people I've seen who had a concussion in an accident.
No, there should not be a limit as long as there is a reason for the tests..and in your client's case, there were MANY reasons for the tests he received. Did he have health insurance? That is why you have health insurance, so you don't spend every dime you make paying medical bills . Yes, it sucks that some people can only make $12/hour but guess what, his dr doesn't.
Go back and read my statement about Smith. He didn't have health insurance because he couldn't afford to continue his plan after he was laid off. He signed up for coverage under the ACA, but it hasn't kicked in yet. Yes, people who can't afford health care are always in the wrong in your little world. Low income earners are always to blame for their circumstances.
It's not killing our country, far from it. There are a lot worse things killing our country but advanced medical care is not one of them---failure to take proper precautions against catastrophic expenses however, is one think that is crippling our country...
Its sad what a bubble you live in. Many other hard working people have not been as fortunate as you. I deal with them on a daily/weekly basis. Many committed the unpardonable crime of being unable to land a job with good benefits, despite having college degrees and lots of working experience. We are rapidly constructing a world in America that is great for the top 5% and acceptable for the next 20%. The rest have seen a deterioration in their standard of living for the last 40 years. The health care debacle is one of the most visible manifestations of what I am talking about.
As far as CT scans and MRI scans go, our system has the distinction of giving more than any other country and charging more for them any other country does as well.
That is why there should be an indication for every test and a valid reason for every hospital admission. ER doctors should not be pressured to admit people who do not need to be admitted and their compensation should not be affected by admissions.
Certainly there is reason to limit the number of CT scans. Do them only when necessary. Use only the amount of radiaition needed to get a good image.
But if we are going to talk about the ER, we need to provide some protection for ER doctors from lawsuits if they decide not to do a scan and miss something. Since the ER docs do not generate any income from ordering CT scans, the liability risk is a far greater pressor.
The cost of lawsuits is overblown. Time and again it has been shown that both malpractice insurance AND the awards from malpractice lawsuits are less than two percent of all healthcare costs in the U.S. The overriding portion of costs for health care remains with providers---hospitals and physicians.
Texas capped malpractice awards a number of years ago--there has been no significant change in the health care pricing. Malpractice insurance itself (I was in the insurance business and once underwrote this coverage) is perhaps the most lucrative line of business for carriers, paying out only about 25 cents of every dollar collected from hospitals and physicians. Compare that with auto insurance where the payout is roughly 75-80 cents per dollar collected.
What would reduce the number of scans is a system that was not run by profit, and that would allow physicians to make their best decision based on something other than how much money was going into someone's pocket.
The cost of lawsuits is overblown. Time and again it has been shown that both malpractice insurance AND the awards from malpractice lawsuits are less than two percent of all healthcare costs in the U.S. The overriding portion of costs for health care remains with providers---hospitals and physicians.
Texas capped malpractice awards a number of years ago--there has been no significant change in the health care pricing. Malpractice insurance itself (I was in the insurance business and once underwrote this coverage) is perhaps the most lucrative line of business for carriers, paying out only about 25 cents of every dollar collected from hospitals and physicians. Compare that with auto insurance where the payout is roughly 75-80 cents per dollar collected.
What would reduce the number of scans is a system that was not run by profit, and that would allow physicians to make their best decision based on something other than how much money was going into someone's pocket.
And time and time again it's been pointed out that those facts aren't the point.
It's the effort to avoid the malpractice suit that drives up costs....that of ordering test after test and referring to specialists for so many of the things that your family doctor used to do himself and no longer dares to.
And time and time again it's been pointed out that those facts aren't the point.
It's the effort to avoid the malpractice suit that drives up costs....that of ordering test after test and referring to specialists for so many of the things that your family doctor used to do himself and no longer dares to.
You might want to review this. This was prepared by the Congressional Budget Office. It looked at two issues:
1. The cost of malpractice in terms of insurance premiums and so forth; and
2. The impact of malpractice suits in terms of causing the practice of defensive medicine.
The study concluded that both of these together account for somewhere between 1% and 2% of all the cost of health care in this country.
Most of what is called "defensive medicine" is simply medical providers performing additional tests to make extra money.
Our primary physician does not make one penny more for handing off to a specialist.
Our primary physician does not make one penny more for ordering Xrays or other diagnostic tests .
In those "old days" your family doctor applied casts to simple fractures....some of the times, that was without the benefit of an XRay even........delivered the babies of his own patients...made 'rounds' in the hospital to do the daily for the patients he sent there.......diagnosed things like a broken rib in the office and sent you home with a sling
He, in fact, was the one that OK'd the admission without spending the first few thousands at the ER..........or. conversely, told you that you were just sore and "take an aspirin and call me in the morning"
I doubt very much this type of thing was accounted for in your study and if so, I simply do not believe a 1% or 2% result.
Your last accusation is an broadbrushing, despicable insult to a great many wonderful people in the profession.
Our primary physician does not make one penny more for handing off to a specialist.
Our primary physician does not make one penny more for ordering Xrays or other diagnostic tests .
In those "old days" your family doctor applied casts to simple fractures....some of the times, that was without the benefit of an XRay even........delivered the babies of his own patients...made 'rounds' in the hospital to do the daily for the patients he sent there.......diagnosed things like a broken rib in the office and sent you home with a sling
He, in fact, was the one that OK'd the admission without spending the first few thousands at the ER..........or. conversely, told you that you were just sore and "take an aspirin and call me in the morning"
I doubt very much this type of thing was accounted for in your study and if so, I simply do not believe a 1% or 2% result.
Your last accusation is an broadbrushing, despicable insult to a great many wonderful people in the profession.
That was back when there were more general practioners than specialists. The United States is unique in the developed world by now having 75% specialists to only 25% general practioners. In Canada it is the reverse.
Guess what specialists do? Order tests. The upshot is -- we are treating HEALTHY people more frequently than sick people. Don't believe me? How about a physician who practiced for thirty-four years---
Having recently retired after 34 years in primary care, I couldn’t agree more with Dr. Welch and his commentary about preventive health care. And one of the real tragedies of this changing focus in health care, evaluating the well instead of taking care of the sick, has been for physicians to have full clinic schedules of routine exams while the sick must fight to get into clinics or seek care elsewhere, as in urgent care centers or emergency rooms.
But we know that such care in these facilities is usually more intense than necessary, frequently fragmented by seeing someone who does not know them, and clearly more expensive than traditional outpatient ambulatory care.
Just as unfortunate is the physician, caught up in an onslaught of health care screenings, who is no longer capable of doing what he or she was trained to do: cure the sick and alleviate suffering.
GREGORY L. SHEEHY
Middleton, Wis., Feb. 28, 2012
Another 90 tests and procedures from 17 medical specialty societies have been released as part of the ABIM Foundation’s Choosing Wisely campaign, an effort put together by Consumer Reports and the American Board of Internal Medicine Foundation. Since the campaign was launched last year, more than 130 tests and procedures have been called into question by 25 medical specialty societies with more than 725,000 member doctors.
The new lists include recommendations that advise medical-care providers: · “Don’t use feeding tubes in patients with advanced dementia.” · “Don’t perform routine annual Pap tests in women 30 – 65 years of age.” · “Don’t automatically use CT scans to evaluate children’s minor head injuries.” · “Avoid doing stress tests using echocardiographic images to assess cardiovascular risk in persons who have no symptoms and a low risk of having coronary disease.” · “Don’t routinely treat acid reflux in infants with acid suppression therapy.”
But because so many cared for him, two of the attending residents say, the 32-year-old patient actually got sicker. That's because of the so-called "bystander effect," they say in an article published Thursday in the New England Journal of Medicine.
Authors Dr. Robert R. Stavert and Dr. Jason P. Lott argue that because of changes in health care, more specialists get involved, leading to "decay in coordination of care."
Bottom line is until we do something about changing the percentage of physicians who are specialists--say by paying tuition whole in part for those going into general practice---we are going to get more tests and procedures---that's what specialists do.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
. Yes, it sucks that some people can only make $12/hour but guess what, his dr doesn't. 
