No. of Recommendations: 18
... Medical Financial Rape.

Millions of Americans Could Face Surprise Emergency Room Bills in January
https://www.bloomberg.com/news/articles/2018-12-07/millions-...

A flood of surprise hospital bills could start arriving in U.S. mailboxes as early as January unless two giant for-profit health care companies resolve a dispute over whether thousands of doctors remain in patients’ insurance networks.

America’s biggest health insurer, UnitedHealthcare, is pitted against one of the country’s largest employers of doctors, Envision Healthcare, in a massive contract fight over prices that Envision’s 25,000 emergency doctors, anesthesiologists and other hospital-based clinicians charge.

</snip>


Health care profiteers like Envision typically bill an out-of-network patient 4 or 5 times the Medicare reimbursement for a procedure while in-network rates average Medicare + 30%.

Here in WA State where we have a Democratically-elected Insurance Commissioner that answers to the voters every 4 years, legislation to curb this practice has been proposed and the insurance commissioner has invited Medical Financial Rape victims to share their stories of being violated in the care of an ethically-challenged doctor or hospital administrator. (See link:)

https://www.insurance.wa.gov/surprise-medical-billing

</snip>


intercst
Print the post Back To Top
No. of Recommendations: 17
The problem of out-of-network providers embedded in in-network hospitals isn't confined to ER docs.

Some anesthesiologists are out-of-network. I asked about this before my last surgery and was assured that the anesthesiologist was in-network.

But the pathology lab was out-of-network. I was hit with a bill for over $3,000 because the &^%$ path lab was negotiating with my health insurance company and not in-network.

Wendy
Print the post Back To Top
No. of Recommendations: 6
WendyBG writes,


But the pathology lab was out-of-network. I was hit with a bill for over $3,000 because the &^%$ path lab was negotiating with my health insurance company and not in-network.

</snip>


You should file your story with the WA State Insurance Commissioner. The more people the politicians hear screaming, the more likely they are to fix it.

In Vancouver all our TV stations are on the Portland side of the Columbia River, so I saw a lot of ads from the Oregon Governor's race. One candidate was an orthopedic surgeon and healthcare profiteer who owned some 15 doctors' practices scattered around Oregon and the adjoining States. I saw lots of ads calling him out for billing out-of-network patients at 4x the Medicare rate -- which would be tens of thousands of dollars extra on any kind of orthopedic surgery.

He lost by 6 points to an unpopular incumbent -- I guess more people are starting to do the arithmetic on this.

intercst
Print the post Back To Top
No. of Recommendations: 30
Some anesthesiologists are out-of-network. I asked about this before my last surgery and was assured that the anesthesiologist was in-network.

But the pathology lab was out-of-network. I was hit with a bill for over $3,000 because the &^%$ path lab was negotiating with my health insurance company and not in-network.


I'm with intercst on this. You should scream bloody blue murder to the insurance commissioner, the local paper, and whoever else.

If you have cancer you should be able to focus on your treatment and not have to spend your precious, limited energy drilling down on basic contract details of each of your providers. It costs your pathologist the exact same amount regardless if you are in or out of network.

Screwing over people who are trying to focus on survival just seems so needlessly pointless and cruel.
Print the post Back To Top
No. of Recommendations: 15
He lost by 6 points to an unpopular incumbent -- I guess more people are starting to do the arithmetic on this.

intercst


I'm always amazed that these sorts of things continue in a democratic country? Healthcare is not optional, everyone will need it like roads, water, electricity, education, police and firefighters. It is totally within the public interest to have a healthy population that is not bankrupted by the process.

Anymouse
Print the post Back To Top
No. of Recommendations: 4
If you really wanna get mad at the healthcare industry and want to give the doctors a break, an interesting read ... much of it on how the drug industry cranks up profits by manipulating drug availability and prices. Too much to snip it all but a few of the more egregious examples. It does not just affect Canada, just so happens the story is written here.

Tim

http://www.canadadrugshortage.com/causes/

Canadian Drug Shortage

Causes
Possible Causes of the Drug Shortage
The causes are unknown to most people –patients, pharmacists, and physicians–who are dealing with this problem.

Those who do know the causes are reluctant to publicize them.

The following is a list of 14 robust possibilities that we have gleaned from the literature on the problem:

1. Big pharmaceutical companies discontinuing or actively combatting generics in order to enhance sales of newer, more expensive, brand-name drugs. Sometimes companies discourage sales of their own cheaper brands or arrange “deals” in marketing. ...

...

3. Pharmacists choosing not to stock cheaper drugs because profit margin is too narrow. Canadian pharmacists reject this hypothesis, since they make their money from dispensing fees — not from the prices of drugs, ...

...

4. Shortage of substrate (raw materials to make drugs). This cause is frequently invoked by pharmaceutical companies, but it is insufficient on its own. The same materials are used in making expensive brand name drugs, which are not in short supply.

...

...

6. Manufacturing or quality control breakdowns within production lines owing to lack of investment to improve or maintain standards. Closing two of four plants for base ingredients over pollution concerns is said to be the cause of the early 2017 shortage of penicillin G. ...

7. Blaming government: manufacturing slowdowns or lack of competition owing to policies or to greater vigilance by FDA or Health Canada .

...
Print the post Back To Top
No. of Recommendations: 14
Sadly, with incentives the way they are, patients' wellbeing is a rather secondary objective. Goldman has figured it out:


Goldman Sachs asks in biotech research report: 'Is curing patients a sustainable business model?'

... Richter cited Gilead Sciences' treatments for hepatitis C, which achieved cure rates of more than 90 percent. The company's U.S. sales for these hepatitis C treatments peaked at $12.5 billion in 2015, but have been falling ever since. Goldman estimates the U.S. sales for these treatments will be less than $4 billion this year, according to a table in the report.

"GILD is a case in point, where the success of its hepatitis C franchise has gradually exhausted the available pool of treatable patients," the analyst wrote. "In the case of infectious diseases such as hepatitis C, curing existing patients also decreases the number of carriers able to transmit the virus to new patients, thus the incident pool also declines …

https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patie...


... What do these examples teach us? We have not reached the limits of scientific innovation. But we have reached the limits of common sense and common decency. When the most important investment banking enterprise in the world wonders whether it is a good idea to support companies that want to develop cures, we truly have reached rock bottom.

What is next for health care? We always knew that prolonging life was expensive. Now it seems that curing people isn't profitable enough. Want to make money? Develop drugs that cure nothing, but yet promote long-term use and dependency, and shorten life. Bankers and payers will love it.

Oops! I forgot. We have those drugs already. They're called opiates.

https://www.medpagetoday.com/blogs/revolutionandrevelation/7...
Print the post Back To Top
No. of Recommendations: 3
'Is curing patients a sustainable business model?'

Don't invest in cures, invest in palliatives for "non-curable" diseases, a sustainable business model. BTW, lots of "non-curable" diseases are curable. I can vouch for ulcerative colitis, type 2 diabetes, heart disease, high cholesterol, and a few more. All it took was losing 50 pounds of nasty fat by eating right. It's not healthcare that is expensive, obesity is the bank beaker!

The Captain
Print the post Back To Top
No. of Recommendations: 8
It's not healthcare that is expensive, obesity is the bank beaker!

Since 1990, obesity rates in the shiny city on a hill have more than doubled.

https://stateofobesity.org/adult-obesity/

Steve
Print the post Back To Top
No. of Recommendations: 0
Since 1990, obesity rates in the shiny city on a hill have more than doubled.

Brings whole new meaning to 'America First'! I thought Mexico was #1 a few years back?

The 2017 Obesity Update by the OECD placed Canada among its most overweight countries, with 25.8 per cent of the population aged 15 and over considered obese. Only South Africa, the U.K., Australia, Hungary, New Zealand, Mexico and the U.S. had higher rates.Jul 13, 2017

Anymouse <once again we beat the Aussies, that is the only important standard for us>

https://www.google.ca/imgres?imgurl=https://shawglobalnews.f...
Print the post Back To Top
No. of Recommendations: 5
I'm always amazed that these sorts of things continue in a democratic country? Healthcare is not optional, everyone will need it like roads, water, electricity, education, police and firefighters. It is totally within the public interest to have a healthy population that is not bankrupted by the process.

Anymouse


This guy gets it. Beautifully said, my man.
Print the post Back To Top
No. of Recommendations: 25
<Screwing over people who are trying to focus on survival just seems so needlessly pointless and cruel. >

I agree with you 100%. Unfortunately, that is the model of health care in the U.S.

I am fortunate that I can afford health insurance and the copays. Many working people can't afford either.

Read this link and weep.

https://www.nytimes.com/2018/10/17/upshot/health-insurance-s...

I un-joined the Memorial Sloan-Kettering breast cancer online support group after reading a heartbreaking note from a woman who lost her home and her insurance due to breast cancer costs and was living in her car. Doctors wouldn't look at her without insurance. I just couldn't stand to read anymore. I joined MyBCTeam.com whose members focus on medical and emotional but not financial hardships.

Syke6, when your breasts have been cut off, you are in intense pain despite drugs, your surgical wounds are hideous and your drains are filling with blood and have to be tended every couple of hours, the last thing you want to do is argue with an insurance company.

Wendy
Print the post Back To Top
No. of Recommendations: 12
WendyBG posts,

Read this link and weep.

https://www.nytimes.com/2018/10/17/upshot/health-insurance-s...

Mr. Berger had a steady income and good benefits when he worked as the housekeeping director for a retirement community. But once he became too ill to keep working, his income fell. Fifty-three percent of people in the survey said their work had been interrupted by illness, causing financial difficulties and compounding the burden of medical bills.

Research suggests that such work interruptions can have long-term consequences for people who become ill or are injured. A recent paper in the American Economic Review found that, for middle-aged Americans, going to the hospital could mean an average income reduction of 20 percent that persists for six years or more.

</snip>


With American for-profit health care, we've gotten to the point where you'd be doing your family a favor if you just refused ambulance transport and died by the side of the road.

intercst
Print the post Back To Top
No. of Recommendations: 3
<<Mr. Berger had a steady income and good benefits when he worked as the housekeeping director for a retirement community. But once he became too ill to keep working, his income fell. Fifty-three percent of people in the survey said their work had been interrupted by illness, causing financial difficulties and compounding the burden of medical bills.>>



News flash: people get ill!


Are prudent people helpless when that happens? No, because they buy insurance and accumulate savings to protect themselves from the slings and arrows of outrageous fortune.




Seattle Pioneer
Print the post Back To Top
No. of Recommendations: 6
Seattle Pioneer analyzes,

Are prudent people helpless when that happens? No, because they buy insurance and accumulate savings to protect themselves from the slings and arrows of outrageous fortune.

</snip>


The people who are getting these thousand (and tens of thousands dollar) "out-of-network" bills have insurance, but they've stumbled into the care of an ethically-challenged doctor or hospital administrator and gotten financially screwed as a result.

Medicare and Medicaid have regulations prohibiting this abuse. For-profit healthcare and private insurance does not.

intercst
Print the post Back To Top
No. of Recommendations: 2
With American for-profit health care, we've gotten to the point where you'd be doing your family a favor if you just refused ambulance transport and died by the side of the road.

intercst link: More than two-thirds of people in the survey said their doctors had never discussed the cost of their care. Medical providers generally don’t, particularly when dealing with the most acutely ill.

How odd, ours don't either? }};-$

Yet the healthcare providers always get paid. Most expensive part of wife's BC treatment (for us) was the parking at the downtown hospital and once things settled down to regular radiation treatments they gave us a half price chit, I didn't even ask for it.

Anymouse

http://www.iwk.nshealth.ca/your-visit/parking-iwk

For anyone curious, this thread from Women's Health Issues Board mostly covers it.

https://boards.fool.com/we-report-in-at-0715-tomorrow-mornin...
Print the post Back To Top
No. of Recommendations: 4
Agree Anymouse gets it and want to add that any libertarian who isn't so blinded by ideology as to be able to see beyond their own nose should see as well that universal healthcare is plainly in one's (enlightened) self-interest. Sigh.
Print the post Back To Top
No. of Recommendations: 4
Agree Anymouse gets it and want to add that any libertarian who isn't so blinded by ideology as to be able to see beyond their own nose should see as well that universal healthcare is plainly in one's (enlightened) self-interest. Sigh.

Oddly while I'm Canadian I was somewhat late in discovering how much I appreciate the advantages. I almost grew up in the military and their medical system (joined at barely 17) and retired after 27 years in Germany where I worked for the next 10 years. It was only after I retired again and moved back to Canada that I was handed my first personal Provincial Healthcare Card.

After listening to the experts (US wingnuts on the Fool boards) telling me all about the death panels and long wait times lying on the floor in the hallways with jars of leeches on shelves I had my first real experience (beyond my wonderful family doc).

A gangrenous gall bladder forced me to head for ER. The immediate care I received was professional and caring, I tried to show the paramedic my card but he wasn't interested. Discovered that care comes first and paperwork if necessary later by law and the offending smelly object was removed late that night in General surgery. They apologized that the private room I was entitled to from my supplemental insurance was not available (all being used for MRSE cases) but insisted on setting up the TV and phone for me for the short time I was there in a semi private. I never did see the bill, couldn't even get it if I asked I'm told.

My supplemental insurance (covers both wife and I) costs C$72.13 a month and pays for 80% of my pharma costs, a pair of glasses every second year and travel insurance for $500,000 plus some other stuff I never bother to read up on. My basic healthcare requires only that I get a new card in the mail every five years and keep them updated on my address and phone number.

Anymouse <seems like a pretty good deal to me and far less administration and bill collecting makes it cheaper?>
Print the post Back To Top
No. of Recommendations: 1
With American for-profit health care, we've gotten to the point where you'd be doing your family a favor if you just refused ambulance transport and died by the side of the road.

If you did that, the life insurance company would call it suicide and refuse to pay, so your family would be stuck with all the bills you ran up before you died, plus the thousands the funeral home wants.

Steve
Print the post Back To Top
No. of Recommendations: 2
Agree Anymouse gets it and want to add that any libertarian who isn't so blinded by ideology as to be able to see beyond their own nose should see as well that universal healthcare is plainly in one's (enlightened) self-interest. Sigh.

Yes, the kind of system that has NEVER worked well, and has FREQUENTLY failed dramatically, is obviously the best possible choice.

(Granted, it would be hard to accidentally come up with a system worse than what the US currently has - but free markets work pretty consistently, so maybe we should try that approach for a change.)
Print the post Back To Top
No. of Recommendations: 0
If you did that, the life insurance company would call it suicide and refuse to pay.

In most states, the insurer can only do that during the first year the life insurance policy is in force.

intercst
Print the post Back To Top
No. of Recommendations: 5
<You should file your story with the WA State Insurance Commissioner. The more people the politicians hear screaming, the more likely they are to fix it.>

Yes, the WA State Insurance Commissioner is really great. Apparently some people did scream. I just received a check to reimburse me for that charge which I paid in 2015.

Wendy
Print the post Back To Top
No. of Recommendations: 9
but free markets work pretty consistently, so maybe we should try that approach for a change

Many aspects of health care can not be a free market. No-one who is having a heart-attack can shop and choose the health care transport and providers who will care for them in the immediate aftermath of the attack. Just as one for-instance.
Print the post Back To Top
No. of Recommendations: 2
but free markets work pretty consistently, so maybe we should try that approach for a change

Many aspects of health care can not be a free market. No-one who is having a heart-attack can shop and choose the health care transport and providers who will care for them in the immediate aftermath of the attack. Just as one for-instance.


Which, even if completely true in all such cases (it isn't), is not an argument for eliminating the free market in ordinary circumstances.

Free markets are the best known way to determine who is most suitable to provide service in those exceptional circumstances.
Print the post Back To Top
No. of Recommendations: 2
No-one who is having a heart-attack can shop and choose the health care transport and providers who will care for them in the immediate aftermath of the attack. Just as one for-instance.


Ben, you are very far from the first person to mention that to him, some sort of blockage methinks?

Anymouse
Print the post Back To Top
No. of Recommendations: 3
Free market ideologues cannot be reached by appeals to facts.
Print the post Back To Top
No. of Recommendations: 3
Free market ideologues cannot be reached by appeals to facts.

Avoiding the subject and attacking the messenger don't seem to be the best ways to carry on a conversation, the purpose of discussion boards such as this one. What were you trying to accomplish?

The Captain
Print the post Back To Top
No. of Recommendations: 30
"Agree Anymouse gets it and want to add that any libertarian who isn't so blinded by ideology as to be able to see beyond their own nose should see as well that universal healthcare is plainly in one's (enlightened) self-interest. Sigh."

"Yes, the kind of system that has NEVER worked well, and has FREQUENTLY failed dramatically, is obviously the best possible choice."

The only way a person could arrive at the conclusion that universal healthcare doesn't work and has frequently failed dramatically would be if that person literally ignored all of the counter-evidence of what is happening in the rest of the world. Every other first world country has some form of universal healthcare for all of it's citizens. Only in America is getting lung cancer a prescription for going bankrupt and losing everything.

"but free markets work pretty consistently, so maybe we should try that approach for a change."

It is clear that anyone who advocates free market approaches for healthcare doesn't really understand what free markets are.
Print the post Back To Top
No. of Recommendations: 44
<free markets work pretty consistently, so maybe we should try that approach for a change.>

Warrl, I have a lot of respect for you, but you are young and you have obviously never needed serious health care.

It is impossible, let me repeat impossible , to have a free market without price discovery and comparison.

It is IMPOSSIBLE, let me repeat, IMPOSSIBLE, to discover the cost of any procedure from a hospital, even for elective procedures. Even for simple elective procedures, let alone complex procedures such as surgery with a hospital stay and diagnostic tests. Try phoning the billing department and you will get ZERO information. Only a gobbldeygook of "we don't know what billing codes will be used...we don't know how your insurance company will reimburse..." even if you are calling a participating provider.

What about if you had an emergency? Someone else has already pointed out the absurdity of price shopping when you are dying.

I wish you the very best of continued good health. But please do not suggest that a free market works for health care when you have never tackled our #$%*ed up system.

Wendy
Print the post Back To Top
No. of Recommendations: 3
Warrl, I have a lot of respect for you, but you are young and you have obviously never needed serious health care.

Wrong twice so far.

It is impossible, let me repeat impossible , to have a free market without price discovery and comparison.

Well, you got that one right. Tell me how government regulations have improved price discovery. Tell me how tax incentives for expansive paid-by-someone-else insurance has improved price discovery.

The fact that government interference has made a mess of our health-care system is not a good argument in favor of more government interference.

It is IMPOSSIBLE, let me repeat,But please do not suggest that a free market works for health care when you have never tackled our #$%*ed up system.
IMPOSSIBLE, to discover the cost of any procedure from a hospital, even for elective procedures.


That's right. You can thank the government, in part (but not exclusively) through the aforementioned insurance incentives. There's no reason that a hospital couldn't put real fixed prices for routine procedures online, with adjustments for after-hours and weekends and emergency versus scheduled, and charge everyone based on that list - with prices set so that the hospital covers its costs and makes a reasonable profit on average. This patient has more complications and costs more? Well, that's where the "on average" comes in - the hospital will lose money on this patient. Or maybe the hospital buys insurance against such cases, and includes the cost of the insurance when calculating its prices.

Except... with the insurance system we have, there's no incentive to do that and in fact the published prices would be meaningless for most patients. And for that matter, it would actually be illegal in some states.

But please do not suggest that a free market works for health care when you have never tackled our #$%*ed up system.

Okay, I'll wait. Is it 1995 yet? Waiting's over. The system we have sucks, primarily because of government, and more government will make it suck more.

Oh wait.. it's well past 1995... and there's more government involvement, and the system sucks more.
Print the post Back To Top
No. of Recommendations: 3
It is impossible, let me repeat impossible, to have a free market without price discovery and comparison.

Absolutely! Free means competitive, where buyers can do competitive shopping [impossible under single payer].

It also means that the insurance market has to be free and competitive [no cartels, no collusion].

I still think that the best health insurance is what we used to call major medical that covers just about anything -- world wide -- between a steep deductibe and a limit. You can add regular health insurance to cover the steep major medical deductibe, depending on your financial condition.

The Captain
Print the post Back To Top
No. of Recommendations: 20
All free market approaches to healthcare have one thing in common:
To achieve cost control, they rely on the patient:

1. To act against the advice of their doctor and forego treatment or diagnostics measures

2. To decide not to go to the doctor in the first place


It is not obvious to me that this is an efficient approach.
Print the post Back To Top
No. of Recommendations: 4
It is not obvious to me that this is an efficient approach.

It isn't except economically but the alternative is a superior institution taking control of our lives. It's been tried before, all the isms do it.

Speaking only on a personal basis, my very fine cardiologist didn't cure me in over 25 years of treatment. I cured myself in about five by losing weight, 50 pounds of fat! My stepfather didn't take care of himself and by the time he saw a doctor it was too late. He didn't regret it! He placed his bets and took his chances. I believe that individual choice, freedom, liberty, trumps efficiency.

The Captain
Print the post Back To Top
No. of Recommendations: 2
captainccs writes,

Speaking only on a personal basis, my very fine cardiologist didn't cure me in over 25 years of treatment. I cured myself in about five by losing weight, 50 pounds of fat! My stepfather didn't take care of himself and by the time he saw a doctor it was too late. He didn't regret it! He placed his bets and took his chances. I believe that individual choice, freedom, liberty, trumps efficiency.

</snip>


I'm glad you're "cured". But most people don't improve their health by ignoring their doctor's advice, or refusing to see one if they're ill.

This is kind of like the Powerball winner who is now trying to sell lottery tickets as a retirement plan.

intercst
Print the post Back To Top
No. of Recommendations: 3
But most people don't improve their health by ignoring their doctor's advice...

That was AD's point to which I was responding. Did you miss it? Did you miss my intro: "Speaking only on a personal basis" and that I gave two examples with contrary outcomes?

By the time I took my health into my own hands I had researched the subject quite extensively and I did consult several cardiologists because I looked for a second and a third opinion. In the end I settled on the fourth opinion, mine. ;)

But my point is, do we want to give away our right to self determination? There is a wonderful play and movie Whose Life is it Anyway? that deals with this difficult subject. Patients and medical professionals often have very different agendas and very different frames of reference. I firmly believe that my life is for me to live as I wish. You place your bets and you takes your chances.

There are many real life examples where the official guidelines prove to be harmful because their objective is to protect the bureaucrats, mostly just CYA. One such is the story behind The Eden Alternative, a retirement community dedicated to "A Life Worth Living" and the fight Dr. William Thomas, its founder, had to put up against the New York State geriatric autorities and regulations.

The Atheist, Anarchist Capitain


The Eden Alternative
http://www.edenalt.org
Print the post Back To Top
No. of Recommendations: 6
It costs your pathologist the exact same amount regardless if you are in or out of network.

Ok, so this part of the thread is directly in my wheelhouse since I'm an anesthesiologist and DW is a now retired pathologist. There have been times where both of us have been out of network with various insurance companies because of failed/broken down negotiations. They always want to pay us less, never more.

So, it can cost the pathologist more depending on your insurance. Why? According to DW, some insurances won't pay for certain tests. However, according to pathology guidelines, you start down a certain trail trying to make a diagnosis, there are predetermined tests to run. For example, say breast cancer, look at a slide, yep cancer. But what receptors? And with all the new immuno-therapies out there, there is a test to see if they could/would respond. Does everyone pay for that? Nope. But you're obligated to do it anyway. And its not cheap.

For me personally, I've told my billing agent, if it was an emergency, take what their insurance would normally pay. If it was totally elective, send the appropriate bill.

JLC
Print the post Back To Top
No. of Recommendations: 3
It is impossible, let me repeat impossible , to have a free market without price discovery and comparison.

I've always wondered why more places like this hasn't popped up?


https://surgerycenterok.com/

JLC
Print the post Back To Top
No. of Recommendations: 0
I've always wondered why more places like this hasn't popped up?


https://surgerycenterok.com/


Insurance companies, governments, and some medical practices put considerable effort into making it illegal, if not impossible, to enable price discovery.

As this surgery center shows, they aren't always successful.

The notion that price discovery is impossible has some severe and obvious holes (along with less obvious ones). There are certain drugs that are fairly commonly described in just a few standard doses. There is no reason pharmacies couldn't publish their prices for standard quantities of most drugs.

And even if you don't happen to need any of the listed drugs at the moment, if the price lists WERE published you could at least compare lists between pharmacies and get an idea which ones have generally-lower prices.

But, thanks largely to the government's tax policies encouraging absurdly-comprehensive medical-care insurance, such publication would be meaningless to most of their customers. (On top of which it would annoy the insurers, because there are actually a fair number of medications where you'll pay more if you have your insurer cover them than if you go to a different pharmacy, claim to be uninsured, and pay out of pocket.)
Print the post Back To Top
No. of Recommendations: 32
So, it can cost the pathologist more depending on your insurance. Why? According to DW, some insurances won't pay for certain tests. However, according to pathology guidelines, you start down a certain trail trying to make a diagnosis, there are predetermined tests to run. For example, say breast cancer, look at a slide, yep cancer. But what receptors? And with all the new immuno-therapies out there, there is a test to see if they could/would respond. Does everyone pay for that? Nope. But you're obligated to do it anyway. And its not cheap.

Again, this seems to be an issue for the insurance commissioner. It should be illegal to hold patients responsible for failed negotiations between insurance companies and medical practitioners. Every insurance commission makes judgments about what procedures are covered or not. If a certain procedure is obligated by best practice, then it should be covered by law. Making sure necessary procedures are covered is what insurance commissions do. That's why they exist.

This is yet another example of the complete failure of our medical system. A for-profit insurance company is able to over-ride the pathologists best judgement over what tests are required.

It blows my mind that even a single person in this country thinks this is an acceptable situation.
Print the post Back To Top
No. of Recommendations: 14
I remember how it worked where I was. We had pamphlets and there was a comparison chart. The comparison chart was where you started, read the asterisks, symbols, etc., talked over coverage with your mates, narrowed choices. It was easy.

25 years later - no meaningful chart. Calls to insurance companies about medicine coverage met with uniform non-availability of information. Discussions on savings plans. Listening to tales of medical coverage problems destroying people's carefully built savings because of gotchas. I watched one person at work whither, become am invalid, retire and die within a short period of time due partly to not taking care of himself, but partly because he couldn't afford expensive meds. Figuring out my coverage became a nightmare with charts I made myself and ultimately making choices between plans I didn't like with gaps of knowledge not available. It is the insurance companies gaming the system.
Print the post Back To Top
No. of Recommendations: 2
It is the insurance companies gaming the system.

Like a street thug "your money or your life"

Steve
Print the post Back To Top
No. of Recommendations: 1
It should be illegal to hold patients responsible for failed negotiations between insurance companies and medical practitioners.

So what do you do when its a single payer system and the government is the judge, jury, and prosecutor?

Just dealing with Medicare/Medicaid is a gigantic headache. Paperwork trying to justify my care is mind boggling. In my career I've had plenty of charges denied simply because they were deemed "unnecessary" by some pencil pushing geek that is clueless about patient care and the situation of that particular case. If you don't fall within a cookbook formula, it gets denied. The biggest areas involved post-op pain control and invasive monitoring.

Being the sap that I am, I just did what was right by the patient and let the uncollectibles fall where they may.

JLC
Print the post Back To Top