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.
Everyone agrees that our healthcare system has been broken for some time. Obama apparently thinks the grand solution is to get everyone covered under health insurance.
But the question I've asked for a long time is what good is insurance when the industry is slated charges prices which have no bearing in reality?
I will share my recent healthcare experience. My story is no different than what millions of other people experience. It started last summer when I developed chronic headaches. I was having a headache every day, and went to see my family doc. He thought it was a sinus infection and gave me some anti-biotics.
The headaches continued. I decided to bypass my doc and go see a specialist. I went to an ENT doctor hoping to get some answers and believing that it was a sinus issue. My copay for seeing a specialist is $35. I paid the $35 up front and waited an hour to see the doctor. Finally he came in, and immediately asked if a cat scan had been performed. He looked a bit in my nose and gave me another anti-biotic to try. See him again in 6 weeks if I still have headaches. Total time of visit was about 5 minutes.
After 6 weeks, I went back for a followup. I was surprised that I wasn't asked for the copay. I waited another hour, and the doc basically said I would need a cat scan. He said if I could come back the next day, he would be able to discuss the results of my scan right after the test. I returned the next day, and got the cat scan. I waited an agonizing 90 minutes before the doc finally came in. He told me that the scan looked clear and he was going to send me to a neurologist. I left feeling relieved, but also feeling back at square one with not even an educated guess as to what was causing my headaches. I went to the neurologist, and my heart sank when I found out that this doc had not even ordered a full ct head scan. He only looked at my sinuses. So I could not even rule out a brain tumor at this point.
Then the bills started rolling in. $70 bucks in copays. I was ticked off because I took time off work, waited an hour and was charged $35 bucks just for this doctor to say come back for a test. They could have accomplished the same thing with a simple phone call. Then I got the bill for the cat scan. $700 dollars. Thankfully, my insurance covered it. Yesterday, I get a 3rd bill for $300 bucks. I owed $15 after insurance paid. It was a consult fee.
So why am I complaining when my insurance picked up most of the tab? Because the charges are unfair in the first place. I was charged a doctor's visit fee just for a 5 minute visit where this doc only says come back for a test. Then another fee just for the doctor to pass me off to someone else. And he didn't even read the scan? I have to pay more because someone else read it? If I didn't have insurance, I would be looking at a $1200 bill with no diagnosis or treatment. Now I'm out about $200. That's still a lot of money to me, and my story would be magnified 1000% if I had to go in the hospital and get all kinds of labs and tests done. The focus has gone away from true patient care to maximizing profits.
Obamacare should have focused attention on the healthcare cost spectrum, not completely on the savings side of things. The only question now facing many Americans is which will bankrupt you first, Obamacare or the healthcare industry?
"Everyone agrees that our healthcare system has been broken for some time." Pure opinion on your part.
"what good is insurance when the industry is slated charges prices what good is insurance when the industry is slated charges prices which have no bearing in reality?"
"which have no bearing in reality?" Really? Prove it. Prices of just about everything has gone up for decades.
With the major advancement in medical care of course it is going to go up.
Do you have any idea what the net profit of insurance companies is? I doubt it.
So it is the fault of medicine that Tx went to several doctors, received a couple of prescriptions and came away with the most reasonable and highly probable diagnosis - one that his PCP could have given him in the first place - benign, idiopathic headaches. That probably would not have satisfied him, though. So, it never stops with the PCP anymore - there has to be the complete workup. There are several things are work here including patients demanding tests and a "real explanation" and doctors practicing defensive medicine to name two.
The way to stop this is rationing - not referring patients to specialist and for testing that has a very low probable yield. Yes, a few more will die due to undiagnosed life threatening conditions, but the costs overall will be contained. Pick your poison.
It's not TXDave's fault. So yes, it is the fault of the health system that we designed in the United States. Once again, a diagnosis of idiopathic isn't a diagnosis, it's a "we don't know". Idiopathic means "we don't know". It doesn't stop with the PCP anymore, because that's how we designed the system. Insurance, lawsuits, profits, are all part of the design. They were choices that we as a society made about healthcare. Every choice is made because we think the benefits outweigh the drawbacks. But over time, the benefits change and the drawbacks change, and we have to re-think our choices. TXDave's OP wasn't an argument for rationing healthcare, it was an example of benefits no longer outweighing the drawbacks. It was an argument for thoughtfully evaluating our healthcare system, of the benefits and the drawbacks, and rationally approaching the problem as a problem that has solutions. You see the solution as rationing of healthcare, which is certainly a valid solution, but it's not the only solution. Insurance is actually a tool that is used to ration healthcare right now, today. So it's in the toolbox. But there are a host of other tools we have to think about using and how to use in fixing the healthcare system.
Right now, too many people don't understand what's really at stake here. A lot of people think our healthcare system isn't broken. A lot of people don't understand what the real problems are. TXDave is 100% right that costs are the problem. Healthcare costs are the problem. And with the baby boomers poised to exacerbate that problem, we have to approach the problem from every angle, with every tool available. And we have to do it aggressively, because time is a factor.
My son just recently broke his hand.
Got an X-ray and they sent him for a cat scan as well.
Then they wanted to see him weekly for the 6 weeks the cast was on.
Should have said no to the cat scan because it turns out the X-ray didn't show any abnormality in the break.
But I did say no to the weekly visits for the next 6 weeks and we made the appt to get the cast removed.
Cast got removed and they recommended another X-ray.
Said no to that as well.
Recommended therapy and said no to that as well.
Now I broke my foot oh..about 20 years ago.
Got an X-ray, a cast and told to come back in 6 weeks to get it off.
Once off I was told to take a walk every night.
Why all the visits now ? Why all the X-rays and cat scans now ?
Cost are going up but they are doing a lot more now than they used to.
Doctors will tag you as 'uncooperative' in the Obamacare database and refuse to see you.
"Everyone agrees that our healthcare system has been broken for some time." Pure opinion on your part.
Well I guess the two parties have been at loggerheads and the ACA just dropped out of thin air then as we all know governments risk re-election on changing things folks are already really, really happy with.
"what good is insurance when the industry is slated charges prices what good is insurance when the industry is slated charges prices which have no bearing in reality?"
[/b]"which have no bearing in reality?" Really? Prove it. Prices of just about everything has gone up for decades.
[b]Those pesky prices for those unnecessary things just keep going up and up because you've got Insurance companies passing the costs on to YOU through higher copays and base premiums NOT because the technicians and procedures have changed or gotten more expensive.
It's not like we're talking triple digit inflation in every OTHER field of endeavour are we?
With the major advancement in medical care of course it is going to go up.
Nonsense; some procedures and tests should actually become cheaper. Cat scan technology is not new or considered a major advancement in normal bone break analysis. It should only be ordered if the physician believes through the use of an Xray and his normal diagnostic procedure there is a specific need to verify something untowards via a cat scan; otherwise it's superfluous and unnecessarily being called for to simply pad the bill to the insurance company.
Do you have any idea what the net profit of insurance companies is? I doubt it.
You probably don't either as that's the very last thing they would want you to know. Here's a simple test though; just access the CEO's salary posted and google the policy of raising their salary coincidental with the denials to policy holders and you might get a good idea.
"Everyone agrees that our healthcare system has been broken for some time." Pure opinion on your part.
I can't imagine anyone who truly believes our healthcare system works great and is cost efficient for everyone.
Quote:
Originally Posted by Quick Enough
"what good is insurance when the industry is slated charges prices what good is insurance when the industry is slated charges prices which have no bearing in reality?"
"which have no bearing in reality?" Really? Prove it. Prices of just about everything has gone up for decades.
How many other service providers make $700 bucks for 5 minutes of their time? Let's take my experience and translate it into something like taking my car in to get fixed.
1. I'm charged $35 for initial consult and mechanic puts on a part that might fix the problem.
2. Problem not fixed, I return for another $35 consult fee. The only thing that happens in this consult is the mechanic says I must come back again so he can run a diagnostic test on my car.
3. I come back again and charged a 3rd consult fee just for the mechanic to tell me what the guy who ran the test told him. The mechanic says he is referring me to another more specialized body shop. Then I'm charged a 4th consult fee from the guy who actually ran the test on my car.
Do you see how ridiculous the system is now?
Quote:
Originally Posted by Quick Enough
Do you have any idea what the net profit of insurance companies is? I doubt it.
Why are hospital administrators of non-profit hospitals making multi-million dollar salaries? It sounds like the healthcare providers are making a ton of $$ along with the drug manufacturers.
Good illustration of the problem. One of the ways the ACA went about trying to fix this is via those high deductible policies that so many complain about. Of course people can choose lower deductibles and apparently they are from early returns, but the idea is that if patients have skin in the game then, like you, they will refuse certain services. How many though are going to go against what the doctor says. At some point the docs have to come out and tell people "see you in six weeks" instead of "see you next week". Will the patients accept this? Maybe if it saves them significant money.
I dug up the Aetna statements (as of today I still have not received any bills).
We went to Scott and White for the broken hand which is in-network for me.
The cat scan was originally billed for $1159
Insurance didn't accept that (footnotes to statement about what provider will accept)
Then the cat scan came back again billed for $213
Insurance accepted that.
I have no clue what went on between them as my statement doesn't say why that cost got reduced.
Now you tell me what the heck went on with that one ?
We're victims of a huge ponzi scheme between health providers and health insurance.
How much can they bill and get away with seems to be the mantra.
And we're stuck with the difference when they finally settle on some "number".
I don't think he's proposing rationing of care at all. I think he's proposing rationalization of care. A doctor's time is valuable. But so is my time. If a doctor is going to charge $70.00 for a five-minute, "come back tomorrow" "consultation", then he's wasting his time AND mine, the only difference is evidently he's making $840 an hour, so he can afford to waste that 5 minutes. Whereas that 5 minutes translates in time I'm taking off from work, the cost and time of going to his office, the time spent in the waiting room. It costs me a lot more than $70.00, even with insurance picking up part of the tab. Doctors have an incentive to cram as many patients into their schedules as possible. But that's probably not good medicine. If the system were changed so that quality mattered as much as quantity, TXDave probably wouldn't have a diagnosis of "idiopathic" which translates into "we don't know". He might have a real explanation of why he's experiencing these headaches, and a treatment plan.
The doctor's time, that you don't see, is spent reviewing your medical records (history) before he comes to examine you, his examination, and his time documenting his findings in your medical records.
Then, I assume, you checked in with a receptionist and a nurse saw you to the exam room. These people are paid out of the fee you are charged. It is not as if the doctor pocketed your "$70 for five minutes."
The doctor's time, that you don't see, is spent reviewing your medical records (history) before he comes to examine you, his examination, and his time documenting his findings in your medical records.
Then, I assume, you checked in with a receptionist and a nurse saw you to the exam room. These people are paid out the fee you are charged. It is not as if the doctor pocketed your "$70 for five minutes."
That is so BS it isn't funny.
They "review" your records when they come into the room to see you.
And with these group practices you don't even see the same doctor each time.
I dug up the Aetna statements (as of today I still have not received any bills).
We went to Scott and White for the broken hand which is in-network for me.
The cat scan was originally billed for $1159
Insurance didn't accept that (footnotes to statement about what provider will accept)
Then the cat scan came back again billed for $213
Insurance accepted that.
I have no clue what went on between them as my statement doesn't say why that cost got reduced.
Now you tell me what the heck went on with that one ?
We're victims of a huge ponzi scheme between health providers and health insurance.
How much can they bill and get away with seems to be the mantra.
And we're stuck with the difference when they finally settle on some "number".
A couple years back I had to spend a night in the hospital. The bills came to something like 40K, but the insured bill was less than 10K and my coinsurance was figured from that. These are the prices that the insurer has negotiated with provider networks. Why they bother to tell you the full billed amount is beyond me. Maybe to make you think what a fine job they are doing on your behalf. I guess if you do not have some insurance coverage or go out network, though, that higher amount is what they are going to try to collect from you.
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.
