Posted on 07/02/2011 2:13:22 PM PDT by 2ndDivisionVet
I'm sorry but I am going to have to throw a "BS" flag on this morons statement. Cowards are always wrong and liberal cowards are wrong twice on every day that ends with a "Y"
Tea Party "Rage contorted faces" WTFO? if this SFB had an ounce of G2 he would get sh!tcanned in about half a second but in the "stupid world" he inhabits he will probably get a raise or a cabinet position or at the very least a czarina posting.
I was referring to the photo of the creep who wrote this. His teeth do not look very attractive. It was just a joke.
I’m sorry. I didn’t get that.
He really got my blood pressure up there with that article of drivel.
this post is just to inform, not debate with anybody. I am 63 and self-employed and have only had health insurance the past 40 years (480 months), about 10% of the time or about 40 months. None of that was continuous, just here and there. During one period of having health insurance, I had a heart ablation. Cost: $75,000. Got lucky! Insurance paid all but about $7,500. I negotiated that $7,500 to half and paid them off to clean up credit report issues.
Now, basically, I just can’t get insurance so last week I negotiated an MRI down from $2,000.00 to $495.00. Then, a few days later, I had a spine lumbar disc procedure. Cost to insurance was $750.00. I paid cash for $366.50.
I estimate that in 40 years I have saved at an average of 5k a year in premiums or about $200,000.00.
Now, there are all sorts of conclusions that all sorts of people can draw about the foregoing experiences. But, one is not debatable. When a patient pays CASH..........the price goes down...........but you gotta shop around and you gotta ASK!
Anybody paying the INSURANCE PRICE is just a damn fool.
THIS ALSO PROVES THAT THE ONLY WAY TO BRING HEALTH CARE COSTS DOWN NATIONALLY IS TO BRING THE PATIENT INTO EACH TRANSACTION WHERE HE/SHE HAS SOME SKIN IN THE GAME! SINCE IT WAS MY MONEY, AND NOT SOME INSURANCE COMPANY’S, I CHECKED AROUND AND DID SOME OLE FASHIONED NEGOTIATING!!
Well, these loonies do have a way with the ole blood pressure. Sorry you’re stuck with him!
Randall -- on another thread, you mentioned putting out conservative views where the liberals until now have roamed untrammeled. Rob, you've mentioned it too.
*PING* to both of you.
Read the article, here's the deserter / (citizenship-renouncing?)'s email address:
jacktodd46@ yahoo.com
You hit the nail on the head. Let the patient be involved. But like I said, if the hospital will accept a lessor amount from the insurance company it should accept a lessor amount from the cash paying patient.
It has also been my experience to pay as small a deposit as possible up front. They are more than likely to accept less money after the procedure is finished. One of the reasons is they’re getting paid just as much as the insurance company and getting it a lot faster.
It’s been my experience they’ll take about 40% of the bill as paid in full in a one time cash payment, if you can afford it. Write on the check PAID IN FULL. I discounted a bill about 80% and sent a check with PAID IN FULL on the memo. Two days later I got a call saying they couldn’t accept that amount but they would accept 40% but would need a new check. I told her I’d be there in about an hour with a check and she could give me my old check back.
And that’s another thing that pisses me off. It it’s going to take an insurance company 6 months to pay them 40% they should allow cash patients 6 months to pay 40%.
I wonder where you could get your hands on a pay list of the insurance amounts providers will accept for each procedure.
Well, that's the problem, isn't it?
You appear to have a knowledge of the system that allows you to see the trees but blinds you to the forest.
That Canadian health system did wonders for Natasha Richardson. You should read about her journey from the mountain to the Montreal hospital.
Hey Jack, I guess you missed your mom’s funeral, you traitor.
Well, there was his initial olive branch, when he crossed the aisle to bitch-slap Republicans, tell them "I won", and to quit listening to anything Rush says.
That was pretty cross-the-aisley, wasn't it? Or did the author say, "crossing right"?
Too bad the GOP controlled Congress couldn't do it when Bush was President.
The Usual and Customary or Reasonable (UCR) fee is defined as the charge for health care that is consistent with the average rate or charge for identical or similar services in a certain geographical area. To determine the UCR fee for a specific medical procedure or service in a given geographic area, insurers often analyze statistics from a national study of fees charged by medical providers, such as the data base profile set up by the Health Insurance Association of America (HIAA). Some insurers compile their own data using their own claim information; UCR can therefor vary by carrier. Carriers use these statistics to chart a range of fees for each geographical area in which services are provided. Then, when you submit your claim for a specific treatment or procedure, the insurer pays all or part of the claim, depending on whether the amount of the claim is within the Usual and Customary allowance. The amount that the insurance carrier pays is called the allowed amount, the remainder is the write-off amount.
ALL carriers consider their fee schedules to be "proprietary" (confidential information belonging to the insurer, not shared with the public). If there is time you can request a predetermination of benefits from the insurance company. Most carriers will request a written statement from the doctor with the industry CPT codes for the proposed procedures before providing a predetermination of benefits.
Many carriers utilize medical bill review companies. These entities review procedures by CPT code and evaluate the reasonableness for the procedure in accordance to protocols established for each ICDM-9 diagnosis code. Procedures may be denied as not necessary for any arbitrary ICDM-9 dx. The charge for that CPT code would then be forwarded by the provider to the patient in accordance to established UCR billing. The difference between billed and UCR is writen-off.
Suppose an insurer determines that it will pay UCR fees falling below the 80th percentile of the fee range. If you have a tonsillectomy and your medical provider charges a fee for a tonsillectomy that is higher than what 80% of the providers charge in that region (according to the insurer’s UCR fee schedule), the plan will exclude coverage for the amount over the 80th percentile and that amount will be the patient's responsibility. If your provider charges a fee that is below what 80% of the providers in the region charge for a tonsillectomy (according to the company’s usual and customary fee schedule), your claim will not be reduced. The patient coinsurance amount is calculated after the UCR fee is determined. Therefore, if your policy pays 80% for the tonsillectomy, the benefit paid will be 80% of the UCR fee (which is calculated at the 80th percentile).
If the provider is "non-participating" (doesn't have a contract) with the carrier, they are NOT under any obligation to accept the reasonable and customary payment whatsoever either in part or in full; the patient may be balance billed. If the provider is participating (has a contract) with the carrier, the patient may not be balance billed, except for co-payments and/or co-insurance (if applicable). That constitutes insurance fraud; contact the carrier and ask that it step in. Depending on the circumstances that could result in denial of ALL claims made by that provider. It is really no different than disputes made by a customer against a vendor.
If the patient is covered by a preferred provider option policy (PPO), then they must use participating providers to obtain the best benefit available under the policy. The PPO policy allows the patient flexibility to use non-preferred or non-participating providers (as opposed to Health Maintenance Organizations (HMOs), which explicitely limit the patient to the closed network of providers). However, this flexibility may come at a great out of pocket cost which may not be realized when reviewing benefits. Many PPOs now pay non-participating providers based upon the negotiated rate that would have been paid to a participating provider had one been used one. For example, let’s say that a PPO policy pays 70% for non-participating surgeon charges and a bill for $5,000 is incurred from a non-participating surgeon. Now let’s say that a participating provider would have been paid $2,000 for the same surgery. Using the contracted or negotiated rate as a basis for payment, the carrier will pay 70% of $2,000 for the surgery. The patient's out-of-pocket will be $600.00 for the 30% copayment and another $3,000 for the amount over the negotiated fee. NOTE: the $3,000 does not accrue to the out-of-pocket maximum on the policy.
Another fee methodology being used by some carriers is payment for non-participating provider claims based on a percentage (for example 200%) of the Medicare published rate for the same or similar service. This methodology can result in very low reimbursement of the non-participating provider claim because Medicare rates are relatively low rates established by the federal government for payment of Medicare claims.
Cost accounting for medical providers is one of the most complicated subjects known to man. What has to be kept in mind is that for any provider there are fixed and variable costs. As soon as the patient walks into the door they're paying for the rent, utilities, salaries and maintenance costs. Moreover, there are several schools of thought with regards to equipment. Suppose that a facility acquires a major piece of diagnostic equpment costing $15 million.
According to Generally Accepted Accounting Principles (GAAP), the equpment must be depreciated w/in a set period of time. Typically after 5 years the equipment has residual value that of scrap. So $15 million over 5 years is straight line depreciation of $3 million per year. You either use that equipment on everybody, or you only use it once per year. If you do one test per day, each test would cost $8200. OR you charge $5000 per test, and spread the remaining $1.6 million equitably across ALL other procedures performed. Otherwise each test costs $3 million. Suppose the insurance company pays $5000 per test. That means that $2.995 million would be distributed across ALL other procedures. On the other hand, if the equipment is used on EVERYBODY, although per test costs are much less the equipment wears out faster and significant repair expenses are incurred. Furthermore, the equipmnt may not be available in an emergency.
One of the major costs incurred by medical facilities are that of emergency care and trauma facilities. Now throw in the GAAP allowance for doubtfull accounts and cost accounting for medical facilities can quickly become an intractible mess.
One solution that has been proposed is establishment of fixed pricing. Each and every item has a fixed price and each and every occupation has a specific wage. These things are established by edict.
Are you actually throwing at me what a teenaged pop star “thinks”. Can teenagers think, or do they just parrot what the last person told them? Can pop stars think? Do we hold these pre-adults as paragons of public opinion? Give me a break, I thought this was a semi-serious forum.
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