Pretty soon you're talking about real money
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The US has a weird system.
The insurers are the customer, patients just a necessary input.
My understanding is that often the physicians and practitioners have no idea what the procedures they do ending up costing. There’s no mechanism in the system to understand the cost / benefit of treatment A vs treatment B.
As in treatment A maybe be 10x more expensive than treatment B, but only slightly more effective in trials. (Or even essentially the same level of effectiveness)
The system is set up that way though. An analogy I heard on an econtalk podcast was that it’s like going to dinner and splitting the bill. You know everyone else might order steak, so you order surf and turf too. Everyone does. We all split the bill and insurance pays. So everyone gets the absolute best that money will buy, at all times.
There’s few market mechanisms in place to keep the cost down. The hospital often doesn’t even know its cost for procedures.
It’s not a market system. It’s a system where we have unlimited private money going in to a system without cost controls.
wrote on 22 Jul 2020, 14:36 last edited by@xenon said in Pretty soon you're talking about real money:
The US has a weird system.
The insurers are the customer, patients just a necessary input.
My understanding is that often the physicians and practitioners have no idea what the procedures they do ending up costing. There’s no mechanism in the system to understand the cost / benefit of treatment A vs treatment B.
As in treatment A maybe be 10x more expensive than treatment B, but only slightly more effective in trials. (Or even essentially the same level of effectiveness)
The system is set up that way though. An analogy I heard on an econtalk podcast was that it’s like going to dinner and splitting the bill. You know everyone else might order steak, so you order surf and turf too. Everyone does. We all split the bill and insurance pays. So everyone gets the absolute best that money will buy, at all times.
There’s few market mechanisms in place to keep the cost down. The hospital often doesn’t even know its cost for procedures.
It’s not a market system. It’s a system where we have unlimited private money going in to a system without cost controls.
Where do you come up with this stuff?
Almost none of what you say is true.
Maybe you have one or two anecdotes.
But of course there are cost controls, and audits and accounting rules.
There is lots of competition in insurance and services and medicine.
Your post is not anywhere near reality.
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wrote on 22 Jul 2020, 14:43 last edited by
@Jolly said in Pretty soon you're talking about real money:
They just need to refile. Errors like this are common.
Yep. I'm dealing with one now for my cataract surgery last fall. Likely coded wrong or incorrectly denied. It helps that I have a background in both healthcare billing and insurance.
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wrote on 22 Jul 2020, 15:58 last edited by Horace
I assume the insurance guy would have been able to tell me that this place was in network and that it was a simple mistake that it was billed as out of network. Also the email I posted above affirms the "out of network" billing. The guy at the insurance company wanted to be included in the conversation when I called the surgery center. He apparently expects this to be a negotiation rather than a simple fix of a clerical error.
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@xenon said in Pretty soon you're talking about real money:
The US has a weird system.
The insurers are the customer, patients just a necessary input.
My understanding is that often the physicians and practitioners have no idea what the procedures they do ending up costing. There’s no mechanism in the system to understand the cost / benefit of treatment A vs treatment B.
As in treatment A maybe be 10x more expensive than treatment B, but only slightly more effective in trials. (Or even essentially the same level of effectiveness)
The system is set up that way though. An analogy I heard on an econtalk podcast was that it’s like going to dinner and splitting the bill. You know everyone else might order steak, so you order surf and turf too. Everyone does. We all split the bill and insurance pays. So everyone gets the absolute best that money will buy, at all times.
There’s few market mechanisms in place to keep the cost down. The hospital often doesn’t even know its cost for procedures.
It’s not a market system. It’s a system where we have unlimited private money going in to a system without cost controls.
Where do you come up with this stuff?
Almost none of what you say is true.
Maybe you have one or two anecdotes.
But of course there are cost controls, and audits and accounting rules.
There is lots of competition in insurance and services and medicine.
Your post is not anywhere near reality.
wrote on 22 Jul 2020, 16:54 last edited by xenon@Copper Is there cost competition on standard of care?
I thought there would be tiered healthcare in the U.S. when I moved here (as in better stuff for people who had more money and better insurance). But if you're insured, everyone seems to get the "gold standard of care". Your insurance just tells you how much out of pocket you're going to pay.
And the U.S. definitely has the best of the best in terms of equipment, drugs and services. (doesn't always equate into best healthcare outcomes though)
A lot of this perspective is from listening to a recent talk by Vivian Lee
The interesting insight for me is that on standard of care - typically physicians aren't looking at cost effectiveness, they're looking at efficacy.
We have physicians here - I'd love to hear from @George-K if he ever thought about treatments and made decisions on the dimension of how much they would cost?
There's competition in the system - but not necessarily in the places that are driving the cost increases.
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wrote on 22 Jul 2020, 16:57 last edited by
I think most of what Xenon said is defensible. At least if you allow for some exaggeration (e.g. there are some cost controls, not none, they're just very weak).
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I think most of what Xenon said is defensible. At least if you allow for some exaggeration (e.g. there are some cost controls, not none, they're just very weak).
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wrote on 22 Jul 2020, 17:12 last edited by
Yes I agree that Xenon makes valid points. I've been commenting on the grotesquery masquerading as a free market in health care for many years here on the TNCRs.
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wrote on 22 Jul 2020, 17:18 last edited by
I just paid the $1400. The place is indeed out of network, while literally all the surgeons they work with are in network. They have a strict 15 day policy from the date they mail the first statement, which I am unaware of ever receiving but which they say they mailed on June 29. They bill the insurance company as out of network. Their business model is apparently to get the tiny fraction that the insurance company pays out of network providers, and a little bit more from the patient. It is unclear to me whether my insurance company would have covered 100% of this had they been in-network - I think they would have, since my deductible is covered. The surgery center gave me a story the morning of the surgery that they would be charging 15k to insurance, who would cover 90% and I was responsible for 10%. That story was completely fabricated as far as I can tell.
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@Copper Is there cost competition on standard of care?
I thought there would be tiered healthcare in the U.S. when I moved here (as in better stuff for people who had more money and better insurance). But if you're insured, everyone seems to get the "gold standard of care". Your insurance just tells you how much out of pocket you're going to pay.
And the U.S. definitely has the best of the best in terms of equipment, drugs and services. (doesn't always equate into best healthcare outcomes though)
A lot of this perspective is from listening to a recent talk by Vivian Lee
The interesting insight for me is that on standard of care - typically physicians aren't looking at cost effectiveness, they're looking at efficacy.
We have physicians here - I'd love to hear from @George-K if he ever thought about treatments and made decisions on the dimension of how much they would cost?
There's competition in the system - but not necessarily in the places that are driving the cost increases.
wrote on 22 Jul 2020, 17:48 last edited by@xenon said in Pretty soon you're talking about real money:
@Copper Is there cost competition on standard of care?
There's competition in the system - but not necessarily in the places that are driving the cost increases.
Of course there is competition.
And of course the better doctors cost more.
Here is a program I used up until last year.
It was not covered by insurance, I paid for it myself so I could have access to the doctor I wanted. Believe me, this was a cost increase.
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@xenon said in Pretty soon you're talking about real money:
@Copper Is there cost competition on standard of care?
There's competition in the system - but not necessarily in the places that are driving the cost increases.
Of course there is competition.
And of course the better doctors cost more.
Here is a program I used up until last year.
It was not covered by insurance, I paid for it myself so I could have access to the doctor I wanted. Believe me, this was a cost increase.
wrote on 22 Jul 2020, 18:15 last edited by@Copper The most expensive thing we've done in the U.S. is have kids.
In SF our OB gyn's resume was ridiculous (Harvard, Standard med school, head of OB at UCSF... lots of other prestigious positions).
In Seattle our OB was fantastic - but a bit more "normal" on the qualifications and earlier in her career (we actually loved her, since she had more time to spend with us).
Don't know what they cost - wasn't any different for us.
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wrote on 22 Jul 2020, 18:49 last edited by
I don't doubt it.
One doctor's story doesn't define the USA healthcare system.
And, by the way, there is no such thing as the USA healthcare system.
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wrote on 22 Jul 2020, 18:59 last edited by
That was just for the surgery center facility. There is another bill for the surgeon, another for the anesthesiologist. Those are all covered directly by my health insurance but there's always a portion I am responsible for, even after the deductible is covered. I figure the whole thumb thing will cost me about 10-15k out of pocket when it's all done.
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wrote on 22 Jul 2020, 22:56 last edited by
Ah I see, kind of like dental insurance on special procedures (like an implant) but way bigger bills.
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That was just for the surgery center facility. There is another bill for the surgeon, another for the anesthesiologist. Those are all covered directly by my health insurance but there's always a portion I am responsible for, even after the deductible is covered. I figure the whole thumb thing will cost me about 10-15k out of pocket when it's all done.
wrote on 23 Jul 2020, 00:34 last edited by@Horace said in Pretty soon you're talking about real money:
That was just for the surgery center facility. There is another bill for the surgeon, another for the anesthesiologist. Those are all covered directly by my health insurance but there's always a portion I am responsible for, even after the deductible is covered. I figure the whole thumb thing will cost me about 10-15k out of pocket when it's all done.
If they are in network, that would seem to be a bit high for your part. Have you received your EOB's on their services?
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wrote on 23 Jul 2020, 00:45 last edited by
I mean across all three surgeries and including all doctor visits, physical therapy, etc.
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wrote on 23 Jul 2020, 00:51 last edited by
@jon-nyc Dont know if you would be willing to share, but what was the gross cost for your medical procedure?
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wrote on 23 Jul 2020, 00:53 last edited by jon-nyc
Around 900k.
But that’s everything, all the visits before and after, special tests (a heart cath can be 10-15k and I’ve had 4 of them), rehab and ‘prehab’, surgery, ICU time, hospital time, etc.
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wrote on 23 Jul 2020, 00:56 last edited by jon-nyc
I don’t know what I spent, it was probably capped at a few grand per year for co-pays.
We even had some reimbursement for relocation, but I was listed long enough that we burned through it. So I probably spent 20-30k of my own money (over, say, 2014-16) if I had to guess.
Most of it didn’t feel like medical bills. Like buying a home oxygen concentrator or paying rent or renting furniture.
