New MEDICAL BILLING concept: PAY the Patient for processing time !

[RJSV]

   So,  we'd like to keep the 'advantageous' aspects, of a system with lots of good specialists,  but toss the administrative burden.  There,...solved that !   No,  of course that's joking,  but really would like to keep the network, of specialists (like liver, etc.).

   Just the organizations and their cards,  is SIX,...or at least was.   Now,  I've got another two in the works,  plus I did place an additional card representing my 'advisor'.

   Blue cards,  at top of that pile, shown,  is the current insurance...

[ZenHombre]

@RJSV,

your posts are a fever dream. 

[RJSV]

   So that was the insurance and HMO provider mess,  that can have bewildering aspects,  to the point where I've often had to ask;  "which one ?". Meaning which card does this office need.

   It's a confused overlap of functions,  there.
For the specialists,  you could add in another 7 or 8 offices,...but that's on the appointment and xo-pay aspects.

In total,  that 'map' becomes clogged with maybe 14 or more items...really gets to be a chore,  confronted on my desk,  there...

[wraper]

The major difference with US system came to my mind. You can get health insurance here as well, however the big difference (beside an order of magnitude lower cost of paid services) is that price for insurance companies is exactly the same as for individuals. Pre-approval is not needed as well, it's either covered by insurance policy or not. If insurer/healthcare provider have a contract, they just keep you out of payment process. If not, you pay the bill by yourself and bring receipt to insurer for reimbursement. Insurer has no way to force you to use particular healthcare provider. While in US, insurance and healthcare providers secretly negotiate their prices, not transparent at all. Often in a way that you will get billed 10x the price if pay for the same service by yourself.

[vad]

The major difference with US system came to my mind. You can get health insurance here as well, however the big difference (beside an order of magnitude lower cost of paid services) is that price for insurance companies is exactly the same as for individuals. Pre-approval is not needed as well, it's either covered by insurance policy or not. If insurer/healthcare provider have a contract, they just keep you out of payment process. If not, you pay the bill by yourself and bring receipt to insurer for reimbursement. Insurer has no way to force you to use particular healthcare provider. While in US, insurance and healthcare providers secretly negotiate their prices, not transparent at all. Often in a way that you will get billed 10x the price if pay for the same service by yourself.

Health insurance rules vary by state, so policies work differently depending on where you live, but in Massachusetts, if you have a PPO plan, you’re free to see any provider, but you’ll save on coinsurance if they’re in-network. Major insurers usually have large networks, so it’s tough to find a provider who is NOT in one - most doctors join several networks as it is an easy way to attract patients.

Insurance companies want you to stick with in-network providers because they have negotiated discounts with them FOR YOU. Go out-of-network, and you’ll be on your own for negotiating costs. This is a free market economy, and providers are free to set their own prices, and the rates can vary wildly. But if you’re uninsured, remember you can ask for a a discount similar the provider gives to patients who go through insurance. You may not have the bargaining power of an insurance company, but clinic staff are often willing to work with you on price.

You can also negotiate prices at pharmacies. Discount services like GoodRx offer huge discounts, sometimes cheaper than insurance. A friend of mine often skips his insurance for GoodRx because his deductible would be higher than the price after GoodRx discount.

Another example: I know young, healthy friends who choose to go without insurance. They got a hefty ER bill (around $10K) few years ago, and managed to negotiate it down to about $1.5K just by talking to the billing department.

[wraper]

Insurance companies want you to stick with in-network providers because they have negotiated discounts with them FOR YOU. Go out-of-network, and you’ll be on your own for negotiating costs. This is a free market economy, and providers are free to set their own prices, and the rates can vary wildly. But if you’re uninsured, remember you can ask for a a discount similar the provider gives to patients who go through insurance. You may not have the bargaining power of an insurance company, but clinic staff are often willing to work with you on price.

Do you really believe that? Or maybe they negotiated that your co-pay actually pays half of the actual service done, so they can spend premiums on ads to make 30% of all ads about insurance (no other country has so much insurance and drug ads)? https://www.emarketer.com/content/data-drop-5-charts-on-us-insurance-digital-ad-spending You barely see any insurance, drug ads here. And AFAIK prescription drug advertising is banned.

Go out-of-network, and you’ll be on your own for negotiating costs.

And that's why your system is shit. Publicly available non-negotiable price list for everyone  (on discretion of healthcare provider) would bring the price down and largely fix the system. As individual, you have zero leverage in this corporate buddy system. Nor you have a reasonable way to compare the pricing between healthcare providers.

[Halcyon]

Insurance companies want you to stick with in-network providers because they have negotiated discounts with them FOR YOU.

I'm sorry, I agree with wraper. Since when are insurers concerned about you? I have first hand experience with these clowns (not with health insurance but a major vehicle insurer). They don't give a shit as long as their profits increase.

No different to energy retailers, real estate agents, or vehicle manufacturers.

It's their way of locking you in to their product.

I live in a country where I've never had health insurance and I don't see myself having the need to in the foreseeable future. At best, it might be a minor tax benefit for me. Yet the cost of healthcare at anytime in the past or in the future as I approach my 40's has ever been a concern.

[krish2487]

The major difference with US system came to my mind. You can get health insurance here as well, however the big difference (beside an order of magnitude lower cost of paid services) is that price for insurance companies is exactly the same as for individuals. Pre-approval is not needed as well, it's either covered by insurance policy or not. If insurer/healthcare provider have a contract, they just keep you out of payment process. If not, you pay the bill by yourself and bring receipt to insurer for reimbursement. Insurer has no way to force you to use particular healthcare provider. While in US, insurance and healthcare providers secretly negotiate their prices, not transparent at all. Often in a way that you will get billed 10x the price if pay for the same service by yourself.

Health insurance rules vary by state, so policies work differently depending on where you live, but in Massachusetts, if you have a PPO plan, you’re free to see any provider, but you’ll save on coinsurance if they’re in-network. Major insurers usually have large networks, so it’s tough to find a provider who is NOT in one - most doctors join several networks as it is an easy way to attract patients.

Insurance companies want you to stick with in-network providers because they have negotiated discounts with them FOR YOU. Go out-of-network, and you’ll be on your own for negotiating costs. This is a free market economy, and providers are free to set their own prices, and the rates can vary wildly. But if you’re uninsured, remember you can ask for a a discount similar the provider gives to patients who go through insurance. You may not have the bargaining power of an insurance company, but clinic staff are often willing to work with you on price.

You can also negotiate prices at pharmacies. Discount services like GoodRx offer huge discounts, sometimes cheaper than insurance. A friend of mine often skips his insurance for GoodRx because his deductible would be higher than the price after GoodRx discount.

Another example: I know young, healthy friends who choose to go without insurance. They got a hefty ER bill (around $10K) few years ago, and managed to negotiate it down to about $1.5K just by talking to the billing department.

Again... If I m suffering from a heartattack... why should I worry about where to go for healthcare?? Why should any of these factors come into play for my health.. period?? I m paying hefty taxes to alleviate this decision fatigue. What concern is it of mine to evaluate if a doctor is "in network" or not?? or to google for the nearest specialist "in network" in order to get the negotiated discounts ? why should my healthcare depend on the bargaining ability of a for profit company?? I m certain they will not pass on any discount they can negotiate... if anything both the insurance company and the hospital have an incentive to charge me more..

In what world does it make sense that it is acceptable to spend hundreds of thousands of dollars on medical procedures in order to have hundreds of thousands of dollars of medical debt kill you??
Hyperbole sure.. but its the truth.. you are looking at the bill covered by your insurance . ... It is the marked down from several thousands / hundreds of thousands to several hundreds / thousands.. why have this in the first place?? Its like your black friday pricing of health??
Artificially inflate the prices.. then mark it down after a "bargain" to make your customers feel that they got a good price..
ridiculous.. 

[RJSV]

Krish,  you are hitting some of my points,  here.
   My 'plan' landscape has the doctor's group as the people that approve each of the various specialists appointments,  (and drugs).

   A big portion of this topic is just the pure confused state, of having multiple agencies.  Now in that sense,  it was ironic when someone told me 'No, you can't ask that group about your cost or portion'.   That portion or co-pay always seems to cipher down to an exact, $ ten dollars.

Out of a couple of those organizations with issued cards, I don't even have any communications !

[RJSV]

   So I've been tracking the performance aspects,  where one entity or another has been informed of a switch (away) to some other separate HMO, Doctor's Group, etc.

   The legal aid person recently related that "They needed to inform their people, of the cancelation,  but they often don't do it".

Great.  Then what do I do,  staring at my notebook, journal entries ?
You've got an (ineffective) patient,  with some memory deficiencies,  (and chronic fatique'), and so now I'm thinking,  how about that PAY thing...maybe I could try just sending an itemized bill...for my time spent doing Doctor level work.  (And I don't maintain any malpractice insurance).
   Heck,  I might even be breaking the law, practicing as a doctor!   Literally,  not just a knee jerk humourous thought!
That's it...(I'm gonna have to call R.F.K.)

Logging my time,
  - - Rick B.

[RJSV]

(maybe could send the bill directly to
RFK JR.)

[RJSV]

   (I know about current news, with Health Care organizations getting trashed, or worse;
That 'news', on HMO CEO is pretty gross, but I'm hoping readers can put the recent news aside, for a second.)

   I've been on this track for at least 6 months so I hope that helps pre-date this stuff, (before it got weird).   Subject topic is a bit off, from direct electronics theory, but I'm interested in the enterprise management aspects, so that should relate (to electronics manufacturers and management / marketing.)

   Part of my fascination, here, is the methods and wording used, in promotions of various Health Care commercial products and services.
Other older coverage of this kind of thing had mentioned that an ORGANIZATION will often create duplicate entities.

   That's a well known factor, where there is appearance of 'bloat' or useless excess structure (and job titles).  Thus, we see things like:
   Dept. of Divisional Creation,
           And,
    Dept. of Making Divisions.

That's maybe my own lame example.
   Dept. of Duplicate Words Dept.

   At any rate, I've been working and speculating about presenting these thoughts, of seemingly serious but silly sounding names and titles, but that really, really, actually only say one thing.

   'Health Care.'.  Of course.
   'Comprehensive Health Maintainence'
(Ditto).

   I even considered some customized titles and groups, designed to appeal to certain cultural niches:
   'Wellness Crew',  as a street smart sounding (African American).  My fictional example of course, but this is the kind of silly madness we see, in the giant health care initiatives and targeted advertising.

   'Physician's Group'...What do they do, (you ask);  Well, they don't pay anything (at least visibly), their purpose is to 'approve' some procedure, and amount approved to pay out.

   Hard to decode all the seemingly duplicative functions, each with their own, similar sounding terms.  It gets tough, though, when a person actually needs to comprehend the complex organization before them.

[Analog Kid]

That's maybe my own lame example.
   Dept. of Duplicate Words Dept.

I think you may be getting at what the Firesign Theater brilliantly called "The Department of Redundancy Department".

(In the 1970s!)

[RJSV]

   Yes, that's part of the sarcasm, to take some things straight out of Monty Python,...I think maybe because the writers have cleverly captured some essences.  Thanks, Analog Kid.

   I'm a big fan, of clever frauds, as they reveal things, tactics and preparation, that, ironically, help myself in managing / responding to human problems and relationships nearby.
Landlord, girlfriend, and others sometimes place new stresses, and knowing about the waste and frauds (here in this thread) provides a sort of self defensive set of tools, if needed.

Although, lol;  my landlord will never offer 'zero' rent, no matter how clever I negotiate.

   Most people looking into 'Health Care' systems maybe are seeking more conventional oversights, like checking excessive profits if warranted (getting political on that, though).

Another aspect that's currently bugging me, a problem of indefinite cost estimates, (or cost to patient in shared paying).
One place / doctor has new co-pay amount that is $225 in low end, but could be as much as $5@0, for the one day (to be scheduled).

[RJSV]

   Sooo,  I'm operating as a kind of 'Unauthorized Think-tank,  confiscating the language quirks being used, often as cover for 'malfeasance'...along with other measures.

   The whole Fireside Theater style criticism has focus on strangely modified words;  a good example being the California use of
   'MEDI-CAL'

   That mis-appropriated term has a different pronunciation: I'm
   'medical' has pronounced 'cal' as in 'cull'.

   'MEDI-CAL' changes the pronounced syllable as in 'calcium'.  Seemed clever I guess,  but it's ultimately a stumbling block, and a verbal mess of a term,...not even necessary.
P
(Medi-Cal is a California version, of one of the many 'flavors' of government health programs.)
   I could imagine a whole Monty Python piece just in that dual-use mangled word.

[Analog Kid]

The whole Fireside Theater style criticism has focus on strangely modified words;

Firesign Theater, not Fireside.
Very common error.

[RJSV]

   A lot of that dialog, above, can be fun, and silly, but on the serious side, I'm seeking to have a set of 'handles' useful when inquiring to the various web of multiple billing departments.

   I actually don't expect spectacular results in that, the whole mess just 'don't smell right', as someone residing in somewhereike TENNESSEE.

   Here is an example:
   You take your 'member ID number',
    Put that on your payment check, to the 'insurer'.   Go to the 'Doctor's Group for your authorization.

   Your specialist might recommend some other 'specialist', in another group;
   'Doctors Group of Pennsylvania's

   See what I mean, about needing proper entity 'handles' used while in conversation (with office workers).  So I can communicate more effectively in the giant mess of....

[Analog Kid]

You lost me there, pal. Devolving into word salad.

[RJSV]

   The wisecrack about folks from Tennessee was meant to say that someone from that region wouldn't tolerate this BS for any amount of time,  and would note that the whole Health Care Management mess 'Don't smell right.',...a statement involving personal intuition.

[RJSV]

  Yes, yes,  that.
   It's meant to reflect the word salad that is seen by anyone in serious interactions with the various entities.
If you are noticing word salad, then I've properly constructed this deliberate essay piece.
   Just still need to 'monitize' my efforts, here.
(I've been informally keeping track of HOURS consumed.
Just don't know (yet),  what entity to BILL , while meanwhile keeping things legal here.

[RJSV]

   Fiasco yesterday is a perfect example:
   Spent 1 1/2 hours just trying to convince my medical group that THEY were, indeed, the ones that issue (and replace) THEIR OWN plastic cards, for doctor services.
   Crimony Alagators !  Their own friggin CARD.

   "You have to go to the HMO to order your replacement for a lost card, sir".
That sounded reasonable but the HMO customer service person then said:

   "You must go to your Medical Group, to request any card replacement, sir."

   OK, now we are in 'Territory Ridiculous',  though ultimately a Tempest in a Teapot, in terms of urgency.  Still, that took 90 minutes of my time,  and I've gotten tired of tolerating such low level  hang-ups.
   That's the same motivation that I expressed originally, for this thread.   Why not issue a BILL, for services rendered...a snarky method, and unconventional method, for getting their attention, in a civil manner.
   But wait,  Bills that come due, (and lawsuits, lol),  DO get someone's attention, when they start having to pay others that desire compensation.   I never signed up, to be a medical office coordinator...and a task that yeilded no viable control, over the administration of six or seven different and duplicative entities.

   The group issues the 'insurance card', but they don't PAY the Doctor's bill....THAT function is performed by the 'Insurance company'.
   But,  the doctor's office asks for your 'Insurance Card' at any actual appointment,  when, technically, that's a Medical Group card.

   I can let a lot of small problems like this go,  but still I need my friggin card replaced !
   So round and round we went, eventually I suggested a conference call;  Supervisor from one and calling the, uh, 'Insurance place'.
Voila,....after 1 1/2 hours, they understood the request, for replacement card.  The 'Medical Group' will do that, as always has been that way.
   A no-brainer took 90 minutes, and I'm looking to dash off a peaceful, civil request:
   PAY THE MAN, HIS FRIGGEN BILL !

   This, though is also simply interesting, and quite boring, at the same time.  A study of waste and duplication.   Now, in current events, I've noticed a great expanded interest, in solving the BLOAT and  barely functional management.

   Anybody know how much I should, reasonably CHARGE, for the services rendered?

[RJSV]

   To keep my original points in reinforcement,  I actually face a dilemma:
   Which organization gets that BILL, assuming I stay brave & bold enough to pull this off ?
   Who, out of 'approximately' 3 or 4 players, is literally responsible ?

   1.). The Doctor's office ?  No,  although it would be nice if they knew about associated things like,  my HMO is canceling (United Health Care) although that's just one of the 'Plans' they offer, through Medicare AARP.
I'm actually laying out a bit of detail, in hopes, (snicker snicker), hopes that dear Readers will get confused, trying to follow all this nonsense ?

   Lately, I've been deluged with flyers and mail advertisements, for help in this kind of mess, (I naively thought...lol).  Nope;
Those AD flyers are solely for available help in signing up for yet more new features and 'Plans (tm).
   " If you need help, with our insurance, call your doctor...(we offer CARE, on how to sign you up.)

Round and round, (and round).
Good thing no really crucial things going on, medically speaking, the doctors are generally quite good,  but the system management, is like a D- grade, in their competence.

   Anybody know, how much I should reasonably charge, for my time over the last six months ?
   And who to send that BILL to ?

Thanks, Rick B.
   (The struggling Inventor)

[jpanhalt]

I wrote a relatively long (for me) and specific response, but decided not to post.  Are you serious?  Did you read and understand the papers you signed to get access?  Are you covered by private insurance or Medicare/Medicaid/Medicare C(Advantage)?  What do you expect to accomplish besides a rant here?

[RJSV]

Thanks,  if you'd rather send PM,  that might be less sensational or drama.  Words don't hurt so much, if it's something I should change, convincingly.  Thanks.

   I was clearly stating what I want,  first just a simple wallet card replaced.
   I'd love to not be the person teaching medical office 'news' to an office staff.

   Getting paid is a distant third.  THAT would be a shame,  and a disgrace.   Or, wait;  I should say  "...shame and disgrace, still."
I'm expecting more...or some confidence that the various multiple players can function.

   Consider some ER visit (knocking on wood, because),  where the ER Doctors access my electronic files, to start.  Start right there, as those files are a mess,  listing a mix of old dental medications, along with discontinued medications, and weirdly spelled 'allergies'.

   Nice to have a sense of humor, here, as,  in the ER couple years ago,  the doctor had come to me, to ask things, due to the records being so screwed up.  So, right there I was in a Doctor's re, discussing and re-interpreting the notes, for the Doctor.
   I'm not a doctor, although I can recite things other Doctors have said.
It's largely highly inappropriate but also a personal safety defect.

   Charging for my time, in itself, isn't inappropriate but I'm not certain about legal aspects, (like for example, my 'clients' haven't consented to a time and materials contract.
Or, even gave implied consent.)

   Time I've spent, on blogging this is way less, than time spent on Medical system bloat.

   Expecting,  I'm going to start sounding like the current trend, for investigating bloat and waste, but I've gotten a 6 month lead, on those other folks (RFK JR).
Or,  the investigator's are going to start talking like me....

[soldar]

Governments are extremely inefficient in spending public money, much worse than private companies.

Except that private companies have no interest whatsoever to care about people's health, while the government which pays for their treatment does.

I would disagree with that. A private company is interested in paying out less so it is in their interest that their patients/insured are healthy while governments do not care about costs at all because if they spend more they just raise taxes... which are not optional.

I find the notion that "if we remove the profit margin from the equation we will have the same result but cheaper" utterly mistaken because it is the profit that gives the service provider the interest in providing the service. To me it is like saying "we have found that the motor in a car is what is using so much fuel so we thought that taking the motor out will mean a lot of fuel will be saved".  Yeah, right.

I am not taking any position on the topic of health care because I believe it is complicated and cannot really be discussed in a meaningful way in a forum.  But in general if the private enterprise can do it then they can do it better and cheaper than the state.