How to Avoid Getting Screwed -Healthcare Costs, Mole Removal

[priapism]

Thank you Joe Lieberman

That said the past 2 years I had over $1M of medical costs (inflated insurance rate) covered by insurance simply paying my <$4k OOP max for 2, now 3 years. After the first year my employer switched insurance providers, so thank you fellow policyholders of BCBS and UHC.

I firmly believe the inflated costs of the medical system is what allows the US to have the best new treatments for rare diseases, which cost the country an assload. Kind of gross to grant treatments to the few when many have nothing, but it's between morals and health economics. Definitely I'm conflicted as the beneficiary of a broken system.


e: vv could be an issue of bed/PICU availability vv

[fomofo]

Just out of curiosity, given there were two ground ambulances (one at each end) involved in addition to the air ambulance, why was the air ambulance required? Time? Really any quicker than just driving up door to door? At midnight?



And I can imagine a need to transfer from a rural medical center to a better equipped urban facility, but there was really no option in San Jose or Palo Alto? (Even closer ground ambulance rides.) If someone drove up with such a sick child to an ER in one of those Silicon Valley medical centers they would be redirected to San Francisco?

[SuperChief]

Scalpel??? my derm sliced one off my back with something similar to a cigar cutter… it left a nasty scar and was benign.

[skaredshtles]

<snip>
The nordic countries mentioned here collect on average, 42.6% of GDP in taxes vs the US which collects 26.6%.

Citation?

A large portion of that goes to universal healthcare. A different system comes with a different economic reality.

No doubt. A *better* economic reality for most of their (Norway's) citizens.

[basinbeater]

I did some quick checking on the figures he provided. He is correct, tax burden as % of Gdp for Norway is 42%, Sweden, 50+%. USA according to same source OECD is about 32%. If we compare to Norway at 42%, UK, 38%, and then we add in the %of Gdp spent on healthcare in the US, estimated at 17% of Gdp, that puts US spending up at 49% of Gdp. I think some of that medical spending is public though, so that needs to come out of that number (already accounted for as part of tax burden number) so...found this...
Let's estimate gov spending on healthcare at 40% of total HC spending, so, let's take that %of Gdp that is not public and set it at about 9.5%. add that to the tax burden of Gdp 32 + 9.5 = 42.5% burden. Now remember that we run huge deficits, and it becomes clear, we pay MUCH more per capita for worse outcomes.

[basinbeater]

Meant to bring this into the previous post...

[skaredshtles]

I did some quick checking on the figures he provided. He is correct, tax burden as % of Gdp for Norway is 42%, Sweden, 50+%. USA according to same source OECD is about 32%.

Yeah - I was curious if this was federal tax burden or total tax burden (Fed/State/Local)? Sounds like it might be an estimate of total tax burden?

[basinbeater]

That is what I think it was.

[basinbeater]

If you think about it, of course we pay too much. We even pay so much that the for profit companies are rolling in $. But they aren't just rolling in $, they have so much profit that they are able to pay an army of people to try to fuck everyone over. We pay so much we literally pay an army of people who are trying to to fuck us into paying even more. So fucked up.

Fuck the insurance companies! Universal health care please.

[skaredshtles]

If you think about it, of course we pay too much. We even pay so much that the for profit companies are rolling in $. But they aren't just rolling in $, they have so much profit that they are able to pay an army of people to try to fuck everyone over. We pay so much we literally pay an army of people who are trying to to fuck us into paying even more. So fucked up.

Fuck the insurance companies! Universal health care please.

I did the math - with a 42% tax burden there would be ~$10.5 trillion dollars of tax revenue per year, given the current (2022) GDP estimate of $25.4 trillion.

Seems like we oughta be able to figure out universal health care with that kind of money... just need to increase taxes.

[wkd-rdr]

I did the math - with a 42% tax burden there would be ~$10.5 trillion dollars of tax revenue per year, given the current (2022) GDP estimate of $25.4 trillion.

Seems like we oughta be able to figure out universal health care with that kind of money... just need to increase taxes.

You mean we still can't negotiate the price of cane?

[XXX-er]

10 seconds of Google indicates that the adult obesity rate in the US is ~40% vs ~30% in Canuckistan, so yes.

Back in the day Lucy the telemarktips gal did make the comment " y'all are so fit up here "

[old goat]

To play devil's advocate, I spent a long time in the aeromed industry, our profit margins were slim/non-existent. It costs a lot of $$ to pay nurses, pilots, mechanics to be on call 24hrs a day and keep aircraft flying. Also really fucking rare to go by air "due to blizzard". Almost always the other way around, especially if it was a rotor transport. Helicopters like to fly into the side of mountains in blizzards.

And something stinks, you can not, per EMTALA, transfer a patient to another facility based on insurance reimbursement. It has to be higher level of care requirement or some other patient care concern, but not a financial decision.

Curious to know the details of this. Was this prior to 1985 (EMTALA)?

If air ambulance service is going bust it's because of what the insurers are paying, not what they're charging private paying patients (as if they actually collect that). My guess is the kids insurance could have offered to pay their negotiated rate at a fraction of what the patient was build and the air ambulance service would have been happy to take it.

EMTALA prevents hospitals from transferring people needing emergency care without first examing and stabilizing them. It doesn't prevent elective transfers, like mine. And it's common for people who are going to be in the hospital a long time to be transferred closer to home. My case was Feb 2019.

In my case (broken back after tumbling down ice in Chute 75) I was taken from Olympic Valley to Reno by ground because the helicopter couldn't fly due to storm. About a week later Kaiser had me transferred to Sacramento (which I also wanted). Heli wasn't an option, still storming (did I mention I missed half of an epic season), and driving me on I80 over Donner Summit in a blizzard likewise. We could have gotten stuck for days. Fixed wing was no problem. The weather wasn't too bad in Reno or Sacramento.

As far as whether the kid could have been taken to a closer hospital--3 month old who'd had heart surgery, you're talking UCSF and Stanford, and UCSF was the one that had a bed and was willing to accept the kid Would a ground ambulance have been just as quick? I don't know but we are talking Bay Area and at least in my experience of one an air ambulance is better staffed--I had an RN and a paramedic. I would guess that the docs in the ER had enough experience transferring patients to UCSF to know the fastest safest option. My trip from Reno to Sac involved ambulances at each end and took less time than driving on wide open clear freeway. (We landed at a general aviation airport pretty close to the hospital. I would guess the kid landed at SFO.) Helicopters are nice because they can go hospital to hospital but civilian life flight helicopters aren't good for providing care en route.

[Skistack]

This week’s episodes of Behind the Bastards was health insurance fraud, it’s worth a listen.

They quoted a ProPublica investigation that estimated 10% of all private health insurance premiums go to paying fraudulent claims.

The two takeaways are 1) it’s really easy for doctors and “doctors” to file fraudulent claims, 2) private insurers don’t devote resources to investigating fraud since they can just raise premiums.

The two


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[Trackhead]

This week’s episodes of Behind the Bastards was health insurance fraud, it’s worth a listen.

They quoted a ProPublica investigation that estimated 10% of all private health insurance premiums go to paying fraudulent claims.

The two takeaways are 1) it’s really easy for doctors and “doctors” to file fraudulent claims, 2) private insurers don’t devote resources to investigating fraud since they can just raise premiums.

The two


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Billing and coding in any hospital organization is by the book. We get feedback fairly frequently from coders, and I can assure you hospitals are not submitting fraudulent claims with any frequency. You’ll get your ass in hot water real quick with that many eyes on fraudulent submissions. Private practice? Maybe? But we’re all here essentially talking about hospital based care.

And yes, insurance companies pay attention. We get called out all the time over admissions, having to do “peer to peer” phone conversations with insurance company physicians arguing why we are admitting their patients and them refusing to pay or whatever else. Then there are prior authorizations for imaging studies, etc. Insurance companies aren’t dumb. They run the fucking show.

That “fraud” citation is from scammers not false claims submitted by hospitals per the article your podcast cited.
https://www.propublica.org/article/h...s-who-pays-you

old goat: makes sense…I was looking at your story from an ER perspective, sorry

[bodywhomper]

In my neck of the woods, most accidents requiring ambulances utilize air ambulances.

Twice in the 16 years that I’ve lived in my current area the local regional hospital has become out-of-network to my current insurer, once (2010) when it was part of Catholic Hospital West and this year when it was part of Dignity. The recent change to out-of-network was with Cigna.

I notice some posts in this thread only describe their deductible and max out of pocket costs, but don’t mention their annual premium. For this year, the insurance coverage cost options thru my work remained the same, but the premiums rocketed a lot, especially for those with Kaiser or the equivalent in NE. Premiums increased between 6 to 8x between last year to this year.

[fomofo]

As far as whether the kid could have been taken to a closer hospital--3 month old who'd had heart surgery, you're talking UCSF and Stanford, and UCSF was the one that had a bed and was willing to accept the kid Would a ground ambulance have been just as quick? I don't know but we are talking Bay Area and at least in my experience of one an air ambulance is better staffed--I had an RN and a paramedic. I would guess that the docs in the ER had enough experience transferring patients to UCSF to know the fastest safest option. My trip from Reno to Sac involved ambulances at each end and took less time than driving on wide open clear freeway. (We landed at a general aviation airport pretty close to the hospital. I would guess the kid landed at SFO.) Helicopters are nice because they can go hospital to hospital but civilian life flight helicopters aren't good for providing care en route.

Thx for sharing your take on that.

I notice some posts in this thread only describe their deductible and max out of pocket costs, but don’t mention their annual premium. For this year, the insurance coverage cost options thru my work remained the same, but the premiums rocketed a lot, especially for those with Kaiser or the equivalent in NE. Premiums increased between 6 to 8x between last year to this year.

Wow, that's quite a multiplier, especially over just one year! Just out of curiosity, what was a typical monthly premium in the previous year compared to the current year? Did it shoot from something like $50 to $300, or $200 to, gulp, $1200?

With private healthcare coverage you really are at the mercy of the insurance companies, kinda like what's going on with homeowner coverage in California now.

[XXX-er]

Ski bro told me there are codes for every procedure the MD wants to bill for,

they submit using their physician # and they get paid

no arguing

[MagnificentUnicorn]

Ski bro told me there are codes for every procedure the MD wants to bill for,

they submit using their physician # and they get paid

no arguing

Is this a response to a post? Is this in Canada?
Do they have billing fraud laws in Canada?


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[XXX-er]

this post bounces around but how long you been reading TGR and you don't know I'm in Canada ? I'm sure some body does billing fraud in Canada but its not a problem getting paid in this universal system

[bennymac]

there already is a peak smugness thread

[MagnificentUnicorn]

It just seemed like a really random post. So they never reject service claims in the health system up there? The providers get paid no question asked?


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[bennymac]

just google “fraudulent billing physician Canada”

Plenty of examples

But there are no pre approvals needed in Canada for vast vast majority of medical investigations or surgeries. An investigation or surgery is done if the doctor deems it necessary. “Insurance” plays no role in it.

Doctor says you need a CT scan? They order a CT scan. It gets done. Patient pays no money at any point.

[Trackhead]

Doctor says you need a CT scan? They order a CT scan. It gets done. Patient pays no money at any point.

How long do patients wait for CT, ultrasound, MRI after it’s ordered? Who determines urgency and wait times?

This report paints a wait time Americans would not accept. I end up doing prior authorizations on I’d say less than 10% of the CTs I order in the outpatient setting. Two reports show Canadians waiting weeks for imaging studies.

https://canjhealthtechnol.ca/index.p...ew/HC0052/1170

https://radiologybusiness.com/topics...t-times-canada

Curious on your real world explanation.

[bennymac]

There are always going to be exceptions to everything we are talking about - US or Canada systems. So we’re all speaking in generalities here. And we know that someone needing a scan of their head for a stroke and a patient needing an xray to look for arthritis are going to have different wait times - and it clouds the picture if you lump every imaging and surgery need together.

If a patient needs a CT scan or MRI in Canada that same day then it is done that day. This is determined by the treating physician. The radiologist may be involved in triaging access (if someone tried to order a same day MRI for chronic knee pain it wouldn’t happen because the radiologist would rightfully say no) - but if an ER doctor sees a patient and says they need a scan of their belly or their head etc it just happens - no radiologist is screening those.

There are no admin or insurance people involved in the discussion at any level at any time for any acuity. Not before. Not after.

In a system like Canada’s the urgent patients get the same care as they would in the US. The completely non urgent patients get the same care.

Where you see the glaring differences are the middle of the spectrum - which is why hip and knee replacements get so much press due to the abnormal wait times - these people aren’t dying of their illness - but they are losing significant quality of life waiting for treatment.

But again - in a system like Canada’s - no one whether super urgent, middle of the road, or benign - pays for their investigations or procedures. And no one without medical training makes medical decisions approving or denying investigations or procedures.

Edit: to answer your first question a bit better - if a doctor orders a MRI that isn’t to be done that same day they would indicate on the form the urgency (their clinical opinion of the urgency) - and the radiologist would take that and the clinical picture into account when scheduling the investigation. Same situation with a surgery - patient would be referred to surgeon and they would decide how urgent the need is.