Health care - administrative incompetence

[Ampulla of Vater]

You are assuming that a universal healthcare service would result in lower incomes for physicians. This is by no means a given. You are also overlooking the fact that a government with the will could bring many of these people right onside by writing off their student debts at a stroke.

Much of the debt is owed to private institutions who paid professors and incurred other costs associated with education. The government has no business forcing them to 'write off' what is rightfully owed to them.

Doctors should not be allowed just to put their plate up and see patients. Not in this day and age. The lack of a universal healthcare system seems to have left the USA woefully short in the field of medical audit. Time this got a bit more attention I think.

There are lawyers (hundreds of thousands of them) policing this. God help you if you hang a sign out and are not qualified.

I know this will sound harsh, but the people who would be the real losers would be people like you. People who have evolved to fill the ecological niches carved out in a system where the flow of money is extraordinarily complex. When everybody is entitled to whatever their physician decides they need, within the procedures and drugs authorised by the universal system, an enormous amount of bureaucracy just evaporates. In this context, the amount of money freed up to pay for actual patient care, including to pay doctors, is pretty huge.

Rolfe.

I do understand my future is in question - to a degree anyway. I'd just as soon retire or go do something else anyway. The liklihood of one of 'my' physicians or facilities getting audited looms larger every year. It would render me broke to defend a governmental lawsuit I'd most certainly be dragged into.

The question is, since Medicare is basically socialized medicine for people aged 65 and up, how can you say a totally socialized system would work? Medicare is broke. In 17 years when I turn 65 it will not exist. The U.S. government is incapable of running healthcare - or Medicare would not be in the condition it is in now.

 

[kellyb]

Wait, so you have an entire business dedicated to getting insurance companies to pay what is owed. But the government is broken?

Doctors pay for this service which means that patients pay for this service in the form of more expensive service. Patients also pay in the form of higher premiums because the insurance companies hire people to fight you. The doctors and the insurance companies both get tax breaks for this as it falls under business expense so some of the burden falls on the taxpayers.

Not a bit of that involves caring for a patient's health. It's just another layer of leeches draining the health care budget.

Yep.

 

[Ampulla of Vater]

Wait, so you have an entire business dedicated to getting insurance companies to pay what is owed. But the government is broken?

Doctors pay for this service which means that patients pay for this service in the form of more expensive service. Patients also pay in the form of higher premiums because the insurance companies hire people to fight you. The doctors and the insurance companies both get tax breaks for this as it falls under business expense so some of the burden falls on the taxpayers.

Not a bit of that involves caring for a patient's health. It's just another layer of leeches draining the health care budget.

No. The physicians would have their own billing employees if they did not employ us. The fact is we do it better for far less than what they would pay (or did pay) their own billing department(s).

 

[bookitty]

Much of the debt is owed to private institutions who paid professors and incurred other costs associated with education. The government has no business forcing them to 'write off' what is rightfully owed to them.



There are lawyers (hundreds of thousands of them) policing this. God help you if you hang a sign out and are not qualified.



I do understand my future is in question - to a degree anyway. I'd just as soon retire or go do something else anyway. The liklihood of one of 'my' physicians or facilities getting audited looms larger every year. It would render me broke to defend a governmental lawsuit I'd most certainly be dragged into.

The question is, since Medicare is basically socialized medicine for people aged 65 and up, how can you say a totally socialized system would work? Medicare is broke. In 17 years when I turn 65 it will not exist. The U.S. government is incapable of running healthcare - or Medicare would not be in the condition it is in now.

Medicare was doing OK until it was farmed out to the private sector. The VA, which avoided this trap is doing much better.

 

[bookitty]

No. The physicians would have their own billing employees if they did not employ us. The fact is we do it better for far less than what they would pay (or did pay) their own billing department(s).

It is still a completely unnecessary expense which is born by the patients and does not contribute to quality of care.

 

[Gandalfs Beard]

In the case of adult diapers, Medicare covers something like 96% of adults. Seems to me like they are the biggest target. Can you please try to keep multiple concepts in your head at once? This is very annoying.

So, are you arguing that fraud doesn't exist in the private sector? Have you forgotten that private insurance companies are repeatedly sued by individuals just to get them to pay a claim? Have you forgotten that with just one rescission for a patient like Ducky they can more than cover the $1M fraud in adult diapers? Those rescissions don't make the papers, but diaper fraud does.

<still shaking head>

Apparently xjx388 is arguing precisely that. Otherwise xjx wouldn't continue to ignore posts regarding the huge amounts of Fraud, Abuse, and Waste by Corporations, which they can make up for by keeping their hand in the Public Till.

This is how Weapons Manufacturers and other Military Suppliers and Contractors make their Big Bucks, and keep the US Military budget grossly inflated.

And these frauds and Scandals DO make headlines, even in the US. But they are quickly shuffled off to yesterday's news so that people will conveniently forget about them. Does anyone remember Dick Cheney's Halliburton financial scandals before 9/11 took over the headlines and made him and Bush II heroes? Most people just look at me blankly when I remind them of this.

GB

 

[Ampulla of Vater]

Wait, so you have an entire business dedicated to getting insurance companies to pay what is owed. But the government is broken?

Doctors pay for this service which means that patients pay for this service in the form of more expensive service. Patients also pay in the form of higher premiums because the insurance companies hire people to fight you.

<snip>

Patients do not pay for a more expensive service because the insurance companies set their reimbursement rates. The physicians have no choice in the matter except to not participate with a given insurance company. Like I explained earlier, the physician can charge whatever s/he wants but the insurance company will pay its pre-determined allowed amount.

Insurance companies do not hire people to fight us. We fight their denials, they do not fight us. Not sure what you mean by this.

-P

 

[kellyb]

The question is, since Medicare is basically socialized medicine for people aged 65 and up, how can you say a totally socialized system would work? Medicare is broke. In 17 years when I turn 65 it will not exist. The U.S. government is incapable of running healthcare - or Medicare would not be in the condition it is in now.

Medicare hires insurance companies to "run" it.

The US government doesn't bargain for lower pharmaceutical prices like all the other developed nations.

In a socialized system like the NHS, the NHS runs the labs, instead of there being hundreds of little lab companies each having a millionaire CEO. Same thing with many, many other industries like diagnostic imaging companies, etc.

What is and is not covered is very clear and never disputed so there's no market for companies like yours. (I mean that in the nicest way possible. )

Stuff like that.

 

[Gandalfs Beard]

Medicare was doing OK until it was farmed out to the private sector. The VA, which avoided this trap is doing much better.

Don't forget the Halliburton Walter Reed scandal.

That's what happened when the VA attempted to privatize a segment of their health services for veterans.

GB

 

[Gandalfs Beard]

<snip>

Patients do not pay for a more expensive service because the insurance companies set their reimbursement rates. The physicians have no choice in the matter except to not participate with a given insurance company. Like I explained earlier, the physician can charge whatever s/he wants but the insurance company will pay its pre-determined allowed amount.

Insurance companies do not hire people to fight us. We fight their denials, they do not fight us. Not sure what you mean by this.

-P

But Insurance companies DO hire people to fight patient's claims.

GB

 

[Fiona]

As to the prospects of reducing doctors' pay, let us not forget how the NHS got off the ground: they stuffed the doctors' mouths with gold

 

[kellyb]

Insurance companies do not hire people to fight us. We fight their denials, they do not fight us. Not sure what you mean by this.

-P

The insurance company employees you communicate with are the people she's referring to.

 

[Uncayimmy]

<snip>

Patients do not pay for a more expensive service because the insurance companies set their reimbursement rates. The physicians have no choice in the matter except to not participate with a given insurance company. Like I explained earlier, the physician can charge whatever s/he wants but the insurance company will pay its pre-determined allowed amount.

Insurance companies do not hire people to fight us. We fight their denials, they do not fight us. Not sure what you mean by this.

-P

Wow. You really don't get it. I keep trying to explain this. I'll try again. In the very short term the insurance companies have an incentive to cut costs. In the long term they have an incentive to increase administrative costs on the part of the medical profession so that these costs are passed back to the insurance company which in turns raises its rates. The profit margin remains the same, but the actual profit increases.

I'm not in the insurance field, but in theory a program that randomly rejected claims for no good reason would be a profit center. Some won't be able to dispute it in time. Most will have to pay staff to manage the disputes. Of those, randomly reject 10% and make them go another round. The insurance company ends up paying less than it should. The next year physicians complain about higher overhead, so they negotiate new rates to cover it. The new rates are passed on to employers, the bulk of the clients. It's a paperwork nightmare to switch insurance companies, so unless the increase is really large, you don't lose the client.

 

[Fiona]

Wow. You really don't get it. I keep trying to explain this. I'll try again. In the very short term the insurance companies have an incentive to cut costs. In the long term they have an incentive to increase administrative costs on the part of the medical profession so that these costs are passed back to the insurance company which in turns raises its rates. The profit margin remains the same, but the actual profit increases.

I'm not in the insurance field, but in theory a program that randomly rejected claims for no good reason would be a profit center. Some won't be able to dispute it in time. Most will have to pay staff to manage the disputes. Of those, randomly reject 10% and make them go another round. The insurance company ends up paying less than it should. The next year physicians complain about higher overhead, so they negotiate new rates to cover it. The new rates are passed on to employers, the bulk of the clients. It's a paperwork nightmare to switch insurance companies, so unless the increase is really large, you don't lose the client.

But you are forgetting the free market pixies who sort this all out ...

 

[bookitty]

<snip>

Patients do not pay for a more expensive service because the insurance companies set their reimbursement rates. The physicians have no choice in the matter except to not participate with a given insurance company. Like I explained earlier, the physician can charge whatever s/he wants but the insurance company will pay its pre-determined allowed amount.

Insurance companies do not hire people to fight us. We fight their denials, they do not fight us. Not sure what you mean by this.

-P

You fight their denials in a vacuum? You just say "nope, gotta pay this!" and the insurance companies do so? There's no person on the other end to review the paperwork, ask for a different form, or eventually mail the check?

They also hire people to go over each claim with a fine-tooth comb and find reasons to deny payment, otherwise you wouldn't have a business. You are fighting them.

Keep in mind that doctors can hire specialist to fight the insurance companies. The insurance companies know this. Even with all the additional people going back and forth on who gets paid how much, it is still worth the insurance company's time because it increases profits.

So who wins? How exactly does this benefit the patient? How does this increase quality of care?

 

[Ampulla of Vater]

The insurance company employees you communicate with are the people she's referring to.

If they didn't deny the claim (or lose it) in the first place they wouldn't have to communicate with us at all.

The insurance companies probably spend more money trying not to pay the claim than they would by just paying the stupid thing. They have strict timely filing limitations so if you submit a claim and find out they "just don't have it" but it is 60 days after the service was rendered, you are s.o.l. as you cannot get payment now. And no, you cannot bill the patient either. Think of how much money they are saving with all the physicians who do not have vigilant billing staff and let these time frames lapse.

Much of what we do is also for the patient's benefit - it is easier to get the money from the insurance company than it is to get it from the patient. We are customer service oriented. We want the patients to be happy with us so we spend the majority of our time being the middleman between the patient and their insurance company and leaning on the insurance company to pay.

 

[Garrison0fMars]

A disadvantage of the German model is that it is not universal. Public health insurance in Germany is mandatory for the low and medium incomes; high income people must seek out private insurance (and the public insurers may offer private insurance as well). Holland had the same system as well from 1941 until 2006. There are several problems with such a dual system. Those who'd pay the highest tax burden do not contribute to the public system. People may swap in and out of the public system depending on their income, leading to more bureaucracy.

Yes, they're issues with the Bismarck system (though every system has it's issues), and it's not *technically* universal often, the rich usually have fully private insurance off the regular market, some immigrants are often not covered, etc. France for example technically only has 99% insured rate. There are other problems with Beveridge (Socialised NHS models) and Single Payer insurance models (Canada, Sweden, etc.). Each has their ups and downs. All are pretty much superior to what we currently have in the US though

Provided you first put all the current C*O's of the insurance companies against the wall. A system as you advocate works only, IMHO, if all or most of the insurers are non-profits and also have the mindset of a non-profit. You'd first have to abolish the pervasive mindset of trying to screw your own customers.

Agreed. As I said earlier, I advocate a state by state approach like Canada, keep stabbing their organs piece by piece until they finally die. (The insurance industry, not actual people...)

 

[kellyb]

Much of the debt is owed to private institutions who paid professors and incurred other costs associated with education. The government has no business forcing them to 'write off' what is rightfully owed to them.

No, Rolfe was saying the taxpayers could pay the debt. Maybe it would be a better use of tax money than the fruit lab.

 

[Garrison0fMars]

You don't - the NHS is certainly not the best UHC system out there - I would look at somewhere like France or given the apparent culture of the USA the Australian model.

Agreed. France has a sort of mix between Single payer and Bismarck, which is probably more culturally preferable than government ownership of the medical infrastructure here.

Not really sure how Australia's works, seems similar to Frances though I can't really say.

 

[Ampulla of Vater]

Wow. You really don't get it. I keep trying to explain this. I'll try again. In the very short term the insurance companies have an incentive to cut costs. In the long term they have an incentive to increase administrative costs on the part of the medical profession so that these costs are passed back to the insurance company which in turns raises its rates. The profit margin remains the same, but the actual profit increases.

I'm not in the insurance field, but in theory a program that randomly rejected claims for no good reason would be a profit center. Some won't be able to dispute it in time. Most will have to pay staff to manage the disputes. Of those, randomly reject 10% and make them go another round. The insurance company ends up paying less than it should. The next year physicians complain about higher overhead, so they negotiate new rates to cover it. The new rates are passed on to employers, the bulk of the clients. It's a paperwork nightmare to switch insurance companies, so unless the increase is really large, you don't lose the client.

But the flaw in your theory is the part about negotiating better rates - it is very difficult to get higher rates. It is impossible if you are located near a city. The insurance companies refuse to give you higher rates. They don't care if you participate with them or not because the doctor next door does. You have zero negotiating power.