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Medical Billing Proposal


By Patrick   Follow   Mon, 9 May 2011, 7:23am PDT   7,587 views   43 comments   Watch (0)   Share   Quote   Permalink   Like   Dislike  

I propose two rules for medical billing in America:

1. Everyone must be charged the same price for the same service from the same provider in each calendar month.

So a hospital would not be able to bill someone with insurance only ten cents for an aspirin, and then turn around and bill someone without insurance $10 for the same aspirin. Price changes would be allowed only on the first of each month, and the new price would again apply equally to everyone using that service from that provider.

2. Everyone must be told the exact cost of everything the doctor or hospital is going to do before it's done, except in life-threatening emergency cases, or where the patient is incapacitated and has no legal representative on hand.

At least then you would know enough to refuse the $10 aspirin, and to walk down the street to a pharmacy for it.

Can we get these two simple and fair proposals made into law?

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Patrick   befriend   ignore   Tue, 10 May 2011, 7:42am PDT   Share   Quote   Like   Dislike     Comment 4

Equal Opportunity In Medical Price Gouging

Sean7593   befriend   ignore   Fri, 13 May 2011, 3:44am PDT   Share   Quote   Like   Dislike (1)     Comment 5

My doctor offers me a significant cash discount (25%). Under your proposal, I would have to pay full price.

Also, I have never had a problem discovering medical costs in advance. I'll sometimes ask my doc the cost for various office visits and procedures. His staff have provided me written estimates each time I have asked. Same for the hospital lab. I have used a different lab on occasion, for some of the more expensive lab tests. And that lab also provided me with the cost for each test.

There are ways to make the healthcare system better. My doc rails against the widespread practice of ordering unnecessary tests and imaging studies. He says a a lot of docs order MRIs that aren't necessary, sometimes due to "cover your ass" and other times due to a deficiency in clinical skills (e.g., elbow hurts, dunno why, order an MRI). Tort reform is opposed by the American Bar Association, or course. And I don't know how you fix retarded docs who lack the clinical skills to make diagnoses without resorting to unnecessary tests.

I suspect that health care costs will continue to increase, and quality healthcare will increasingly be only available to a small, wealthy percentage of our population. Indeed, Medicare is circling the drain, as this article, published today, points out:

http://www.cbsnews.com/stories/2011/05/13/politics/main20062642.shtml

Bleaker outlook for Social Security, Medicare
Government report says bad economy means Medicare, Social Security trust funds will be exhausted sooner than expected

(AP)

The government said Friday that a bad economy has shortened the life of the trust funds that support Social Security and Medicare, the nation's two biggest benefit programs.

The annual checkup said that the Medicare hospital insurance fund will now be exhausted in 2024, five years earlier than last year's estimate. The new report says that the Social Security trust fund will be exhausted in 2036, one year earlier than before.

The trustees for the trust funds said in their annual report that the worsening financial picture emphasized the need for Congress to make changes to avoid disruptive consequences in the future for millions of people who depend on health and pension benefits...

Patrick   befriend   ignore   Fri, 13 May 2011, 4:35am PDT   Share   Quote   Like   Dislike     Comment 6

Sean7593 says

My doctor offers me a significant cash discount (25%). Under your proposal, I would have to pay full price.

No problem, as long as they are required to offer everyone the same discount for cash. So there would still be a published list price that applies to everyone and everyone gets the opportunity to pay cash for the same discount. They could even apply the same late fees to everyone.

The point is to make the same billing terms apply to everyone.

Sean7593 says

His staff have provided me written estimates each time I have asked.

Failed miserably for me. The people treating me just have no clue what it costs.

Sean7593 says

My doc rails against the widespread practice of ordering unnecessary tests and imaging studies.

I agree with your doc, but that's a slightly different issue.

Sean7593   befriend   ignore   Fri, 13 May 2011, 5:28am PDT   Share   Quote   Like   Dislike (1)     Comment 7

Patrick says

Failed miserably for me. The people treating me just have no clue what it costs.

If the provider does not know, ask the biller/billing department. Simple and no new law required.

I vaguely remember hearing somewhere that it's not legal to bill different amounts for the same service. I think the difference you see in cost is in *reimbursement*. So, a hospital bills $10 for an aspirin, but is reimbursed anywhere from $0 to $10, depending upon any contractual agreement between the provider/insurer, etc. The higher paying contracts effectively subsidize the lower (or non) paying insurance (Medicaid, etc.).

My 2 cents, fwiw.

justme   befriend   ignore   Sun, 15 May 2011, 9:27am PDT   Share   Quote   Like   Dislike     Comment 8

Sean7593 says

I vaguely remember hearing somewhere that it’s not legal to bill different amounts for the same service. I think the difference you see in cost is in *reimbursement*. So, a hospital bills $10 for an aspirin, but is reimbursed anywhere from $0 to $10, depending upon any contractual agreement between the provider/insurer, etc.

What a joke. So it is illegal to ASK for different amounts for the same service, but it is NOT illegal to accept different amounts as payment in full, depending on what credentials the customer might have as a member or not of a certain class or group of customers.

Sounds like pure deception and sophistry to me.

TechGromit   befriend   ignore   Sun, 15 May 2011, 10:32am PDT   Share   Quote   Like   Dislike     Comment 9

You have to wonder how it's legal to charge different prices to different people in the first place. If they charged you $10,000 for an operation if your black and $4,000 for the same operation if your white, the civil liberties people be all over that. But some how it's OK to do the exact same thing if you have, do not have or have certain insurance. I believe if someone fought this in court, the hospital would lose hands down.

elliemae   befriend   ignore   Sun, 15 May 2011, 11:55am PDT   Share   Quote   Like (1)   Dislike     Comment 10

Billed charges are normally figured according to what Medicare pays for an ICD-9 code. It's up to the practitioner to figure out what they'll accept. I'm not so sure this would change even with a fair billing act.

Kind of like automotive repair charges - most shops operate according to the manual that estimates the amount of work that it takes to perform a task. I had a motor mount replaced on my old car; I was waiting for a ride and timed the job. From the moment they started until they completed the job was one employee, one hour. They charged me 5.0 hours because according to their billing bible it should have taken longer. I've since found a different shop, they bill what's fair, not what they can gouge you. The first shop is now out of business, btw. I doubt it was because of billing practices.

If they billed for medical costs according to what they actually receive, we would all save money. And they often do order tests that they don't need - but the people who needed the test & didn't get it wouldn't care if the rest of the world gets it or not. complicated issue.

Name for the Act: Fair & Unbiased Compensation Key for Medical Equality...

Anyone?

APOCALYPSEFUCKisShostikovitch   befriend   ignore   Sun, 15 May 2011, 9:37pm PDT   Share   Quote   Like (2)   Dislike     Comment 11

It'll never happen.

You can propose something sensible.

It can go to a Congressional committee.

Then the lobbyists show up in the Congressmen's office with 5 year old boys, bricks of hashish and trunks of cash.

Doctors will be using patients' cold, stiff bodies for ashtrays before any meaningful change will happen to health care in the states.

TechGromit   befriend   ignore   Mon, 16 May 2011, 12:45am PDT   Share   Quote   Like   Dislike     Comment 12

elliemae says

From the moment they started until they completed the job was one employee, one hour. They charged me 5.0 hours because according to their billing bible it should have taken longer.

I can completely understand different Doctors charging different rates for the exact same procedure. A younger, less experienced doctor might give you a break on the price cause they haven't done the procedure too many times and your good practice, then say a top of there field doctor that has loads of experience. My issue is the same doctors charging different people different rates for the same operation. The price may be $6,000 for the young doctor and $15,000 for the experienced doctor. But wait, you don't have insurance, the price jumps to $30,000 and $75,000. And it's not a little adjustment, I might be able to swallow a few thousand dollar difference, but usually it 5 times more the price.

I also understand the whole medicare thing, they government pays doctors/hospitals barely enough to cover there expenses, but they take them anyway cause it helps to keep the lights on. They make there real profits with the people who have medical coverage, but to charge 5 times more for people who do not have medical coverage or medicare, it's just an insult to injury.

FortWayne   befriend   ignore   Mon, 16 May 2011, 2:23am PDT   Share   Quote   Like   Dislike (1)     Comment 13

I don't think (1) would work out well. Because different insurance carriers negotiate different pricing. And ironically it's the provider networks that put pressure to keep these rates hidden.

This makes insurance companies be the front man for all the costs this way. When insurance sends someone a bill for 2000 that individual gets upset at insurance. They don't see the hospital billing $60,000 from insurance on the back end. So if you are paying out of pocket to the hospital you "may sometimes" end up paying a lot less than insurance.

What would be great if all prices were completely transparent to the public so one would know what they are paying for and how much.

leo707   befriend   ignore   Mon, 16 May 2011, 8:24am PDT   Share   Quote   Like   Dislike     Comment 14

Sean7593 says

Patrick says

Failed miserably for me. The people treating me just have no clue what it costs.

If the provider does not know, ask the biller/billing department. Simple and no new law required.

I have been given the run around, by both insurance companies and the hospital when trying to determine the price of a procedure.

The response from both was that the price I would be charged was "confidential".

When that was countered with, "Well... won't I find out your 'confidential' price when I get the bill?"

The response was, "Yes, but we can not give you the price now."

Needless to say I was flabbergasted.

I like both proposals, and think that transparency in pricing would be a huge improvement. The problem remains that you are still stuck with a provider, once locked in with a provider it is not like you can not shop prices around.

leo707   befriend   ignore   Mon, 16 May 2011, 8:33am PDT   Share   Quote   Like   Dislike (1)     Comment 15

Patrick says

At least then you would know enough to refuse the $10 aspirin, and to walk down the street to a pharmacy for it.

Unfortunately, not everyone in the hospital that needs the $10 (I got a bill @$36 per acedomedaphyn) over the counter medication can pull themselves out of bed to go get it themselves.

And, it would not surprise me if hospitals forbid the use of "outside medication".

Patrick   befriend   ignore   Mon, 16 May 2011, 9:01am PDT   Share   Quote   Like   Dislike (1)     Comment 16

An excellent example of how medical care is not a free market.

You are not free to choose when you can't even walk away.

Unlimited private profit at the expense of the sick is just evil and wrong.

APOCALYPSEFUCKisShostikovitch   befriend   ignore   Mon, 16 May 2011, 9:18am PDT   Share   Quote   Like (1)   Dislike     Comment 17

You are free to die. No one is stopping you. America is about freedom. If you don't like it, you hate America. Case closed.

Patrick   befriend   ignore   Mon, 16 May 2011, 10:50am PDT   Share   Quote   Like   Dislike (1)     Comment 18

APOCALYPSEFUCK says

You are free to die. No one is stopping you. America is about freedom. If you don’t like it, you hate America. Case closed.

OMG, the perfect summary of the Republican platform!

elliemae   befriend   ignore   Mon, 16 May 2011, 11:32am PDT   Share   Quote   Like   Dislike (1)     Comment 19

APOCALYPSEFUCK says

You are free to die. No one is stopping you. America is about freedom. If you don’t like it, you hate America. Case closed.

He forgot to add: ...then the terrorists win.

------------------------------
I'm hurt that no one "got" the acronym for "Fair & Unbiased Compensation Key for Medical Equality."

sigh

justme   befriend   ignore   Mon, 16 May 2011, 4:53pm PDT   Share   Quote   Like (1)   Dislike     Comment 20

We got it. There is just that there is so much innuendo on Facebook these days that we have become blase' :).

Sean7593   befriend   ignore   Wed, 18 May 2011, 5:22am PDT   Share   Quote   Like   Dislike (1)     Comment 21

Interesting study that suggests utilization goes down when providers are informed about the costs for lab tests.

It is common practice at hospitals to test patients' blood every day and it is wasting money and time, according to the study's authors from the University of Miami and Brown University.

Study: Routine tests can add up.

The researchers started by monitoring the baseline daily per-patient cost for two common lab tests, complete blood count and total chemistry panel, among surgical patients at Rhode Island Hospital in Providence. Then they started a program of scripted weekly announcements to surgical house staff—the doctors-in-training who order the bulk of the tests—and their attending physicians, about the cost of the tests.

At the beginning of the program, the daily cost per non-intensive care patient was $147.73. Over the 11 weeks of the study, that dipped as low as $108.11, in the eighth week. There were a couple of weeks where the cost of tests went up from the previous week, but those corresponded with a new influx of intern physicians, the authors write.

"There was no telling anyone when, or when not, to order a particular test," says Elizabeth Stuebing, a study co-author and a fellow in trauma and critical care at the University of Miami's Miller School of Medicine. Over 11 weeks, the total saved was $54,967, though that figure, and the per-patient savings are based on the sticker price of the tests, not the amounts paid by Medicare or negotiated with third-party insurers. That means the true savings was lower, Dr. Stuebing says.

But she says it shows what can happen merely by giving physicians information they don't usually have. "We never see the dollar amount of anything," Dr. Stuebing says. "The first week I stood up and said that in the previous week we'd charged $30,000 on routine blood work and I could hear gasps from the audience."

more at link:

http://online.wsj.com/article/SB10001424052748704281504576327463166456754.html?mod=googlenews_wsj

Sean7593   befriend   ignore   Wed, 18 May 2011, 5:58am PDT   Share   Quote   Like   Dislike (1)     Comment 22

justme says

What a joke. So it is illegal to ASK for different amounts for the same service, but it is NOT illegal to accept different amounts as payment in full, depending on what credentials the customer might have as a member or not of a certain class or group of customers.

Sounds like pure deception and sophistry to me.

I wouldn't go that far. It's all negiotiable, AFAIK. Your doc could be a provider with Blue Cross, and therefore have to accept, by contract, a certain reimbursement if you were a BC member. For example, she bills $100 for an annual physical, but would be contractually obligated, as a provider, to accept $75 as a Blue Cross provider.

If you had no insurance, she would still bill the same $100, and you'd be liable for the entire amount.

But she might (as my doc does) offer a discount for uninsured/cash patients. I sign a payment agreement (contract) form to get that discount.

A universal system would certainly simplify things. Right now, good insurance seems to help balance crappy insurance from a doctor's perspective. And cash patients sometimes (if no discount is offered or negotiated) pay a lot more than insurance companies for the same service, when the doc is contracted with the insurance company.

It's not fair, and it's not fair that it's not fair. Being an informed consumer can help, though.

Sean7593   befriend   ignore   Wed, 18 May 2011, 8:34am PDT   Share   Quote   Like   Dislike     Comment 23

Sean7593   befriend   ignore   Wed, 18 May 2011, 8:35am PDT   Share   Quote   Like   Dislike     Comment 24

I'm in Mammoth Lakes, CA, and just saw the above ad in "The Sheet" (local rag):

----------

Colonoscopy at Competitive Prices

Package Prices

*Wellness with out (sic) biopsy = $2750

*Wellness with biopsy = $3750

Our Board-Certified General Surgeon...has over 10 years experience performing laproscopic (sic) surgery and endoscopy and has performed over a thousand colonoscopies to date. Be proactive about your health and schedule your colonoscopy today.

---------

I'm too young to need a colonoscopy, I think, but would not go to a surgeon with an ad that contains spelling and grammatical errors.

At least the prices are listed, which should make some folks happy.

elliemae   befriend   ignore   Wed, 18 May 2011, 2:35pm PDT   Share   Quote   Like (1)   Dislike     Comment 25

I would want my colonoscopy with a side of blopsy, thankyou.

elliemae   befriend   ignore   Wed, 18 May 2011, 2:42pm PDT   Share   Quote   Like (2)   Dislike     Comment 26

So, you go to the hospital with chest pain and they admit you for monitoring. You have asthma and allergies, as well as high blood pressure and a pain in your leg.

You will be assigned a Hospitalist to oversee your care. You will be seen daily by a cardiologist, an internist, an allergist, a pulmonologist, and get at least a consult with an ortho doc. They'll draw daily labs, and you'll surely get a CT, MRI and whatever other test is necessary to diagnose the pain in your leg. You'll also possibly receive IV's and other treatments, requiring additional labs.

That's how it works, folks. You go into the hospital and you'll be treated for pretty much everything if you have insurance... but if you don't you'll be treated and streeted - and turfed to an outside doc for follow up. It's up to you if you can't afford treatment to find a way to pay for it.

Sean7593   befriend   ignore   Wed, 18 May 2011, 5:00pm PDT   Share   Quote   Like   Dislike     Comment 27

elliemae says

That’s how it works, folks. You go into the hospital and you’ll be treated for pretty much everything if you have insurance… but if you don’t you’ll be treated and streeted - and turfed to an outside doc for follow up. It’s up to you if you can’t afford treatment to find a way to pay for it.

The fear of death shames us all.

God bless you, ellimae.

And God bless the United States of America.

elliemae   befriend   ignore   Sun, 22 May 2011, 4:21am PDT   Share   Quote   Like   Dislike     Comment 28

I would postulate that the fear of living with pain & anguish is worse than the fear of death. I've seen a lot of suffering. That sucks.

elliemae   befriend   ignore   Sun, 22 May 2011, 1:57pm PDT   Share   Quote   Like   Dislike     Comment 29

Zlxr says

Human bodies are not identical inside.

No, but it's possible to have more fair pricing. There's always the unpredictable, even with mechanics. It's just that it's a life or death proposition with doctors - even when it's a minor procedure.

elliemae   befriend   ignore   Sun, 22 May 2011, 11:56pm PDT   Share   Quote   Like   Dislike     Comment 30

Zlxr says

I get the idea that they make everything cost more because it generates more income and they are not interested in making people healthier so procedures will cost less.

I believe that physicians and many other providers truly want to cure their patients. They couldn't go to work every day if they didn't. Drug companies - they seem to want to introduce new medications as quickly as possible to generate tons of revenue whether or not the product is safe and effective.

All those little plastic pieces cost tons because of overhead, from the property taxes and building maintenance funding to salaries to electronic costs to paying lobbyists and paying insurance, etc. They also figure in the losses of the non-funded ER patients so that they can make up for that. And they can't use any old plastic pieces, they have to be sterile and are replaced often, some times multiple times a day.

And then they add in the cost of administration, which is always a quagmire of the good ol' boys & girls who hire their friends and respond to the drama generated by family members.

Sean7593   befriend   ignore   Tue, 24 May 2011, 8:15am PDT   Share   Quote   Like   Dislike (1)     Comment 31

elliemae says

I believe that physicians and many other providers truly want to cure their patients. They couldn’t go to work every day if they didn’t. Drug companies - they seem to want to introduce new medications as quickly as possible to generate tons of revenue whether or not the product is safe and effective.

So how do drug reps go to work every day?

elliemae   befriend   ignore   Sat, 28 May 2011, 12:37pm PDT