TragicMonkey
Poisoned Waffles
I wonder if Anthem is re-thinking their new policy of not paying for anesthesia during surgery if it exceeds the allowed time. Not the best timing for that to come out.
-
Security incident: ISF was recently accessed by intruders. Please change your password, and change it anywhere else you used it. Read more
Assassination of United Healthcare CEO
- Thread starter crescent
- Start date
shemp
a flimsy character...perfidious and despised
More likely they're spending the savings to boost security for their executives.
Thermal
August Member
It's a weird paradox, though. For anyone denied treatment, you could probably find 1,000 patients that lifesaving treatment was given freely to. And if the insurance company system didn't exist, the patient often wouldn't have any options at all, unless you assume hospitals and doctors and all suddenly got devil-may-care about their own profits and lived on food stamps. And I pretty much doubt that.
Kind of why single payer makes more sense every day. But on another Community thread recently, Euro members were complaining about running around with constant toothaches for months because there are no dentists around.
Thermal
August Member
Yeah, but... is the anesthesiologist going to watch the clock and pack up their gear when the second hand hits the alloted time?
While I'm not familiar with anesthesiology, presumably it's like most things: the bulk cost is in the initial setup and run time. If it goes for five hours instead of four, it doesn't literally cost 25% more; the setup was the lions share. It sounds more like your boss making you work 9 hours instead of your generally agreed 8, which we all kind of do sometimes, especially when you are already well paid (wouldn't apply to a minimum wage worker). And does the anesthesiologist refund time if the surgeon closes up faster? I don't think so. I think they get their flat allotment?
3point14
Pi
- Joined
- Nov 4, 2005
- Messages
- 23,211
According to the BBC:
"Deny, defend, depose': Words on shell casings confirmedpublished at 13:06
13:06Breaking
Earlier, we mentioned that US media said police have found three shell casings with words on them.
Our US partner CBS News has just confirmed with law enforcement officials that the words "deny," "defend," and "depose" were written on the shell casings recovered at the scene of the attack.
Officials say they are examining whether the words point to a motive related to insurance companies' responses to claims.
That the words were written on the shell casings, according to officials, was first reported by ABC News"
The motive remains a mystery...
"Deny, defend, depose': Words on shell casings confirmedpublished at 13:06
13:06Breaking
Earlier, we mentioned that US media said police have found three shell casings with words on them.
Our US partner CBS News has just confirmed with law enforcement officials that the words "deny," "defend," and "depose" were written on the shell casings recovered at the scene of the attack.
Officials say they are examining whether the words point to a motive related to insurance companies' responses to claims.
That the words were written on the shell casings, according to officials, was first reported by ABC News"
The motive remains a mystery...
Thermal
August Member
"Today's episode of Sesame Street was brought to you by the letter D"
Donal
Philosopher
- Joined
- Sep 8, 2006
- Messages
- 9,377
I have family in Ireland who complain about their system, but then they see what we deal with here. Obviously, there is no perfect answer, but there are defintely better answers.
It isn't just that we have a for-profit system. We have a profit-at-all-cost system. It's why rural areas are losing their hospitals.
It isn't just that we have a for-profit system. We have a profit-at-all-cost system. It's why rural areas are losing their hospitals.
Jack by the hedge
Safely Ignored
- Joined
- Oct 14, 2009
- Messages
- 27,865
The problem with dentists here (UK) is that the vast majority are in private practice. The way the NHS system was set up made working for it voluntary and it's less lucrative. They can choose to do work for the NHS but far too few do. So you can pay for dental insurance or pay cash for treatment or patiently try to find an NHS dentist to treat you at no cost.
TragicMonkey
Poisoned Waffles
Anesthesia time is billed in 10 or 15 minute increments. It's very expensive. No, they won't stop giving the anesthesia during a surgery if the time ticks over into another interval that Anthem says it's not going to pay for; they'll give that anesthesia and Anthem will simply not pay it. It'll be either the hospital takes the loss or the patient pays out of pocket. And it's not cheap.
eta: it looks like you're thinking of it as the anesthesiologist's time billed. That's not it, it's not their pay. It's the charge for having anesthesia as a service.
Thermal
August Member
Thanks for that. Probably this isn't the place for it, but:
As I understand it, you guys pay higher taxes that basically amount to paying for health insurance? Over here, my family is covered under my wife's state run health plan (she works in thd school system). We get literally anything, and fast, at world class medical institutions. My wife has most of her care from UPenn. Fast, quality treatment, and a $10 co-pay, and like $3 for most prescriptions. So it seems fine to me.
At local hospitals, uninsured people don't get turned away. They work out pay arrangements later. An uninsured buddy of mine went in the hospital for a while, and came out with some bill that looked like a small nation's GDP. They agreed to take $50 per month as payment, and no claim on his property for the balance when he dies.
So if you don't mind me asking : we hear over here that you pay nearly 40% of your gross income in taxes that fund this. Is that +/- correct? If so, you're paying a lot more for your medical care than we are, although it's certainly a bonus that the poor don't have to jump through hoops.
Thermal
August Member
Not their time billed. I'm thinking of a woman I know who is a radiologist working for a dental place. She told me (years ago) that you don't need annual x-rays. But the dentist occasionally needs x-rays, but there's this big expensive machine to pay for and the tech that is on staff to run it (no matter how many billables she submits). So the cost of actually doing x-rays is not actually that high; the cost of the machine and staff being there, working or not, is being spread out.
Back to the anesthesiologist: the main costs are having the machines on site and a salaried staff technician. Whether treatment goes for two hours or two and a half is not proportionately longer. The dope itself, yes, but staffing and equipment are essentially already covered. Not the case?
TragicMonkey
Poisoned Waffles
You're having a surgery, and being put under. In addition to the other costs, the time you are under anesthesia will be billed. The first 15 minutes $X. The second 15 minutes $X. The surgery only lasts 30 minutes, your bill will include 2 charges for $X. Your insurance, if it's not Anthem, will probably pay for that. If it's Anthem, though, and Anthem decided that your particular surgery should take no more than 15 minutes, it's only going to pay the first 15 minutes, $X. You are on the hook to cough up the second $X, or the hospital eats the loss.
Anesthesiologists are not usually salaried employees of the hospital. They're certainly not "technicians". They're doctors. Expensive doctors. Very, very expensive doctors. Anesthesiology is not a trivial branch of medicine. It's not pain management. It's "keep this person alive but unconscious while other people cut them open". Literal life and death there, even if the surgery and the ailment it's correcting are not life-and-death serious themselves. You can die in surgery from badly done anesthesia. You will definitely die from not having anesthesia for a lot of surgeries -- humans aren't designed to be opened up while awake.
It's probably the last area where cost-cutting should occur, and it certainly shouldn't be the decision of an insurer whether anesthesia past a certain minute is justified or not. The insurer knows this, of course, they know damn well only the surgeons doing the surgery can decide how long to take. Anthem just wants to not pay the expense on something they know they can shove off on the hospitals and patients because the former has an ethical code and the latter's life is at stake. It's prime parasitical behavior, insurors abusing their power in order to screw everyone else more and more egregiously.
ponderingturtle
Orthogonal Vector
- Joined
- Jul 11, 2006
- Messages
- 54,796
I don't know about that, merely using paralytics and having the patient feel the whole thing is an option. I know that happens in surgery anyway that the patient is conscious and feeling everything but paralyzed. Those surgeries seem to go fine from the doctors point of view.
"
According to the largest study of its kind recently published in the journal Anaesthesia – in which researchers surveyed more than 3 million patients who received general anesthesia in the United Kingdom and Ireland – roughly one in 19,600 patients “accidentally” wakes up during surgery.
Previous studies in the United States reported a far higher rate of one in 1,000 surgical patients. However, cases of anesthetic awareness in the new study were reported voluntarily by patients, which could misrepresent the true number. Researchers did find that certain surgeries requiring “lighter” anesthesia, like emergency C-sections, carried a higher risk – a rate of one in 670."
link
ponderingturtle
Orthogonal Vector
- Joined
- Jul 11, 2006
- Messages
- 54,796
But then you have to question the entire purpose of the health insurance industry, that kind of heresy against capitalism will not be tolerated.
TragicMonkey
Poisoned Waffles
Yeah, that was my point. Insurance holds way too much power it shouldn't in medicine, and people are not happy with them. Hence the reaction to this UHC CEO getting murdered. Every day things get worse. More and more money is paid in, less and less to show for it, as those at the top heap up their personal fortunes. Something's gotta give eventually, and the longer it takes the bigger the explosion will be.
A steady, sensible unwinding of the current system, restraining the worst excesses of capitalism, would make things smooth and peaceful. But this, what we got going on now? We're headed for a revolution.
The Great Zaganza
Maledictorian
- Joined
- Aug 14, 2016
- Messages
- 32,979
By definition, an insurance company that regularly makes big profits is overcharging its customers. If there was actual market competition, this would not be possible.
Thermal
August Member
Ok: the *actual* costs (I am positing) for the first 15 minutes at $X are not remotely comparable to the next 15 minutes at the same $X. The initial $X covered the anesthesiologist, assistants, equipment, etc for a half day, which would be their base billing for anything they do. Like, they can't literally charge for 15 minutes of their time when they have to dedicate a half day in order to be available at game time.
So each *additional* 15 minute increment is actually runaway profit territory. Dragging it down to the simplest terms: I'm a building contractor. When I go on some bull ◊◊◊◊ service call, I'm charging the same whether I am on site for 10, 20, or 30 minutes. The expense was getting me and my toys to the site when needed, not the miniscule individual minutes spent there.
That is my layest of layperson's understanding of the insurer's cutting off the payout line. The insurer knows that the total cost of the anesthesia has been covered in the first $X (which is why we see five digit billing for services provided in minutes). After a certain number of the redundant half day charges, the insurance company is saying "look, we are paying for two full days of anesthesiology in a two hour time frame. Enough already".
Again, purely lay understanding. But it is consistent with my experience. Looking over my wife's recent statement for treatments received at a fully covered visit, the insurance was billed for six... count them, six.. separate "consultations" at north of $800 per. Her treatment? She had her blood pressure and stuff taken, then talked with one and only one doctor for just over ten minutes, and he said "I dunno what to tell you, maybe try a specialist". That was it.
TragicMonkey
Poisoned Waffles
No. The anesthesiologist's pay, the assistants, the equipment, the supplies, all the rest are other charges. Anesthesia TIME is a separate charge. You are paying for the time you are under anesthesia, for the process that is being-kept-unconscious-per-second. In increments of 10 or 15 minutes. All the other stuff? That's separate. Anthem wants to blow off responsibility for covering anesthesia time charges if they exceed the length Anthem assumes each particular procedure should take.