There must be a pony in here somewhere.

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dbcooper
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Re: There must be a pony in here somewhere.

Post by dbcooper » 24 Jul 2017, 23:51

JasonL wrote:
24 Jul 2017, 23:46
I'm so tired of docs hiding behind everyone when the thing is they are the ones being overpaid. Emcare is doing it because docs want them to do it. Those docs don't just so happen not to have agreements with insurance companies, they want the bargaining power and don't do those deals so they get paid more.
+1
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Re: There must be a pony in here somewhere.

Post by Aresen » 25 Jul 2017, 00:07

JasonL wrote:
24 Jul 2017, 23:46
I'm so tired of docs hiding behind everyone when the thing is they are the ones being overpaid. Emcare is doing it because docs want them to do it. Those docs don't just so happen not to have agreements with insurance companies, they want the bargaining power and don't do those deals so they get paid more.
Oh, you mean that our highly-esteemed caregivers can be rent-seekers like any other special interest? :shock:
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Re: There must be a pony in here somewhere.

Post by Sandy » 25 Jul 2017, 00:07

Mo wrote:
24 Jul 2017, 21:22
This is why we're going to get single payer and why we'll deserve it.
Will single payer really fix that, though? I'd think in a price-controlled system there'd be even more incentive for private providers to pad their billing.
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Re: There must be a pony in here somewhere.

Post by Aresen » 25 Jul 2017, 00:11

Sandy wrote:
25 Jul 2017, 00:07
Mo wrote:
24 Jul 2017, 21:22
This is why we're going to get single payer and why we'll deserve it.
Will single payer really fix that, though? I'd think in a price-controlled system there'd be even more incentive for private providers to pad their billing.
In Canada, the de jure monopsony tells the doctors what they are going to be paid.
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Re: There must be a pony in here somewhere.

Post by Sandy » 25 Jul 2017, 00:15

Aresen wrote:
25 Jul 2017, 00:11
Sandy wrote:
25 Jul 2017, 00:07
Mo wrote:
24 Jul 2017, 21:22
This is why we're going to get single payer and why we'll deserve it.
Will single payer really fix that, though? I'd think in a price-controlled system there'd be even more incentive for private providers to pad their billing.
In Canada, the de jure monopsony tells the doctors what they are going to be paid.
Except we have single-payer in Medicare and Medicaid and we get just that kind of overbilling all the time--either fraudulently billing a higher tier of service than performed or simply padding out the procedures to maximize return. Sounds exactly like what the company was doing in this case.
Hindu is the cricket of religions. You can observe it for years, you can have enthusiasts try to explain it to you, and it's still baffling. - Warren

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Re: There must be a pony in here somewhere.

Post by Mo » 25 Jul 2017, 07:14

Sandy wrote:
Aresen wrote:
25 Jul 2017, 00:11
Sandy wrote:
25 Jul 2017, 00:07
Mo wrote:
24 Jul 2017, 21:22
This is why we're going to get single payer and why we'll deserve it.
Will single payer really fix that, though? I'd think in a price-controlled system there'd be even more incentive for private providers to pad their billing.
In Canada, the de jure monopsony tells the doctors what they are going to be paid.
Except we have single-payer in Medicare and Medicaid and we get just that kind of overbilling all the time--either fraudulently billing a higher tier of service than performed or simply padding out the procedures to maximize return. Sounds exactly like what the company was doing in this case.
That assumes the market stays the same with one dominant single payer provider. It's a lot easier to squeeze what there are few, if any alternatives. Also, Medicare isn't directly single payer as a lot of folks get Medicare from third party insurance that gets paid by Medicare.
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There must be a pony in here somewhere.

Post by Mo » 25 Jul 2017, 07:26

Also, the shadiest bit is turning a bunch of in-network hospital visits into out-of-network visits. I am surprised no one has tried to take these hospitals to court over false advertising.
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Re: There must be a pony in here somewhere.

Post by nicole » 25 Jul 2017, 08:57

I like people who didn't get brain cancer.

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Re: There must be a pony in here somewhere.

Post by Pham Nuwen » 25 Jul 2017, 14:21

Mo wrote:
25 Jul 2017, 07:14
a lot of folks get Medicare from third party insurance that gets paid by Medicare.
And they don't know that they don't have actual insurance. It's some kind of stigma to them. They get really agitated if you don't say the correct words to them.
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Re: There must be a pony in here somewhere.

Post by Sandy » 25 Jul 2017, 14:58

OK, I still haven't heard how single payer will fix billing the top-tier services when not warranted.
Hindu is the cricket of religions. You can observe it for years, you can have enthusiasts try to explain it to you, and it's still baffling. - Warren

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Re: There must be a pony in here somewhere.

Post by Aresen » 25 Jul 2017, 16:08

Sandy wrote:
25 Jul 2017, 14:58
OK, I still haven't heard how single payer will fix billing the top-tier services when not warranted.
I cannot speak for how it would work in the USA, but here in Canada:
1) Many services can only be provided by hospitals, which are almost all provincial government owned.*
2) The government also decides how many physicians may bill the medicare system in any given area. Further, it dictates how many patient visits a physician will be compensated for.
3) The government also decides which services/procedures it will pay for. It also dictates what it will pay for a given service. It will not pay for any service deemed 'experimental' or 'not proven.'
4) You can get private insurance for 'premium' care - mostly this means things like private hospital rooms. But what they can supply is limited.
5) The government also dictates the price of many drugs, though patients and (private) insurers must pay for the drugs themselves. (There is pharmacare for poor people.)

*I waited 18 months for hernia surgery. It would have been longer if my surgeon hadn't had a newly licensed surgeon join his practice who had OR time available. (The original surgeon offered to do the procedure in his office on a Saturday for $1000 cash. I didn't have $1000 at the time. This practice has since been outlawed.)
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nicole
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Re: There must be a pony in here somewhere.

Post by nicole » 25 Jul 2017, 16:17

Aresen wrote:
25 Jul 2017, 16:08
*I waited 18 months for hernia surgery. It would have been longer if my surgeon hadn't had a newly licensed surgeon join his practice who had OR time available. (The original surgeon offered to do the procedure in his office on a Saturday for $1000 cash. I didn't have $1000 at the time. This practice has since been outlawed.)
Really, I didn't know things were going in that direction (in BC). I was living in Quebec when the courts overturned the ban on private insurance.
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Re: There must be a pony in here somewhere.

Post by Mo » 25 Jul 2017, 16:28

Isn't a lot of it solved by changing from fee-for-service reimbursement to value-based bundled payment? So if someone has condition X, you get paid $Y for treating with payment contingent on positive outcomes.
his voice is so soothing, but why do conspiracy nuts always sound like Batman and Robin solving one of Riddler's puzzles out loud? - fod

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Re: There must be a pony in here somewhere.

Post by Jennifer » 25 Jul 2017, 20:15

Mo wrote:
25 Jul 2017, 07:26
Also, the shadiest bit is turning a bunch of in-network hospital visits into out-of-network visits. I am surprised no one has tried to take these hospitals to court over false advertising.
I had a similar thought -- someone does all the "financially responsible" things, makes sure she had good insurance, goes only to hospitals in the insurance network .. and still gets dinged by massive bills insurance won't necessarily cover, because "This ER is in the insurance network" is NOT synonymous with "this ER's actual on-staff doctors aren't in the insurance network."

I remember when "Pharma Bro" Martin Shkreli bought the patent for some important life-saving drug and raised its price by many thousands of a percent -- something like "it went from under $20 per dose, to nearly a thousand bucks" -- I thought "It's like he's going out of his way to live up to every stereotype of 'evil heartless capitalist ensuring that only the rich can afford medical care'." And this sleazy company is doing the same thing -- like, what, is Emcare run by single-payer secret-agents whose mission is to do all they can to make for-profit medical care look downright evil?
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Re: There must be a pony in here somewhere.

Post by Mo » 25 Jul 2017, 20:43

I don't blame Emcare. I blame the hospitals. They sure as fuck know who Emcare has as in network insurance. The hospitals want to be advertised as in network, but get the financial benefits of out of network (I would be shocked if Emcare doesn't throw back some sugar). When Mrs. Mo went through this exact same issue 7 years ago (went to an in network ER, got out of network doctor, told later that every single doctor is out of network), it was a royal pain in the ass. If that were to happen to us again today, rather than bitch and moan and then hand over the money, like I did 7 years ago, I will take them to the cleaners*. I struggle to think of how, "We have an in network ER, but not a single doctor on staff is in network," can pass the muster of legitimate advertising. Plus, now I have the resources to burn on spite and my lawyer friends are experienced enough to win in court.

* Yes, this is decoder ring hand in, but if the hospital can use the power of the state to make me pay an unfairly issued bill, I will use the power of the state to enforce norms
his voice is so soothing, but why do conspiracy nuts always sound like Batman and Robin solving one of Riddler's puzzles out loud? - fod

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Re: There must be a pony in here somewhere.

Post by Jennifer » 25 Jul 2017, 20:51

Mo wrote:
25 Jul 2017, 20:43
I don't blame Emcare. I blame the hospitals.
I'll split the difference and blame both. Here's a quote from the story you linked:
In addition to its work in emergency rooms, EmCare has been buying up groups of anesthesiologists and radiologists. In these hospital specialties, it is hard for patients to shop, and out-of-network billing is common.
Uh-huh. So EmCare just happens to buy up ER doctors and specialists in those areas where a patient in need of care is NOT in a position to comparison-shop to ensure those doctors are indeed covered by their insurance networks?

For that matter, I can't find any indication of which insurance companies EmCare does actually agree to be covered by.

The AMA deserves a lot of blame for the fact that there is a shortage of doctors in the country -- but EmCare deserves blame for doing all it can to take advantage of this, on the backs of patients who need care.

EDIT: Fixed typos
Last edited by Jennifer on 25 Jul 2017, 21:50, edited 1 time in total.
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Re: There must be a pony in here somewhere.

Post by Painboy » 25 Jul 2017, 21:42

While I certainly don't like dealing with hospitals or insurance company bullshit the ire I have for them is pretty tepid. They both are just playing by the fucked up rules passed by the government. Any companies that may have tried being "nice" likely got pushed out of business long ago.

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Re: There must be a pony in here somewhere.

Post by Mo » 25 Jul 2017, 21:45

Painboy wrote:While I certainly don't like dealing with hospitals or insurance company bullshit the ire I have for them is pretty tepid. They both are just playing by the fucked up rules passed by the government. Any companies that may have tried being "nice" likely got pushed out of business long ago.
How so, the in-network out-of-network bullshit is part of the "free market" portion of health care. There are distortions to that market due to tax benefits and the like, but that shit is on them.
his voice is so soothing, but why do conspiracy nuts always sound like Batman and Robin solving one of Riddler's puzzles out loud? - fod

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Re: There must be a pony in here somewhere.

Post by Painboy » 25 Jul 2017, 21:53

Mo wrote:
25 Jul 2017, 21:45
Painboy wrote:While I certainly don't like dealing with hospitals or insurance company bullshit the ire I have for them is pretty tepid. They both are just playing by the fucked up rules passed by the government. Any companies that may have tried being "nice" likely got pushed out of business long ago.
How so, the in-network out-of-network bullshit is part of the "free market" portion of health care. There are distortions to that market due to tax benefits and the like, but that shit is on them.
They wouldn't have to play these games if these institutions could make money straight up instead of constantly having to bury their prices to see a profit.

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Re: There must be a pony in here somewhere.

Post by Mo » 25 Jul 2017, 22:12

Painboy wrote:
25 Jul 2017, 21:53
Mo wrote:
25 Jul 2017, 21:45
Painboy wrote:While I certainly don't like dealing with hospitals or insurance company bullshit the ire I have for them is pretty tepid. They both are just playing by the fucked up rules passed by the government. Any companies that may have tried being "nice" likely got pushed out of business long ago.
How so, the in-network out-of-network bullshit is part of the "free market" portion of health care. There are distortions to that market due to tax benefits and the like, but that shit is on them.
They wouldn't have to play these games if these institutions could make money straight up instead of constantly having to bury their prices to see a profit.
The nature/cost of health care means that direct payer models wouldn't exist for all but basic and preventative care for the bulk of the market.
his voice is so soothing, but why do conspiracy nuts always sound like Batman and Robin solving one of Riddler's puzzles out loud? - fod

no one ever yells worldstar when a pet gets fucked up - dhex

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Painboy
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Re: There must be a pony in here somewhere.

Post by Painboy » 25 Jul 2017, 22:28

Mo wrote:
25 Jul 2017, 22:12
Painboy wrote:
25 Jul 2017, 21:53
Mo wrote:
25 Jul 2017, 21:45
Painboy wrote:While I certainly don't like dealing with hospitals or insurance company bullshit the ire I have for them is pretty tepid. They both are just playing by the fucked up rules passed by the government. Any companies that may have tried being "nice" likely got pushed out of business long ago.
How so, the in-network out-of-network bullshit is part of the "free market" portion of health care. There are distortions to that market due to tax benefits and the like, but that shit is on them.
They wouldn't have to play these games if these institutions could make money straight up instead of constantly having to bury their prices to see a profit.
The nature/cost of health care means that direct payer models wouldn't exist for all but basic and preventative care for the bulk of the market.
Health care isn't some magic pixie land that is immune to market forces. It's only different from other industries due to the ridiculous amount of regulation and market busting rules that has been draped over it in one form or another over the past 100 years.

To sum up, don't hate the player, hate the game.

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Re: There must be a pony in here somewhere.

Post by Jennifer » 25 Jul 2017, 22:29

Mo wrote:
25 Jul 2017, 22:12
Painboy wrote:
25 Jul 2017, 21:53
Mo wrote:
25 Jul 2017, 21:45
Painboy wrote:While I certainly don't like dealing with hospitals or insurance company bullshit the ire I have for them is pretty tepid. They both are just playing by the fucked up rules passed by the government. Any companies that may have tried being "nice" likely got pushed out of business long ago.
How so, the in-network out-of-network bullshit is part of the "free market" portion of health care. There are distortions to that market due to tax benefits and the like, but that shit is on them.
They wouldn't have to play these games if these institutions could make money straight up instead of constantly having to bury their prices to see a profit.
The nature/cost of health care means that direct payer models wouldn't exist for all but basic and preventative care for the bulk of the market.
And even in cases where it is possible to know in advance exactly how much a given procedure costs, too many hospitals nonetheless kept things opaque for the patients, and/or hid behind insurance company "What you pay depends on which policy you have" crap. Remember that infamous blood-cholesterol test whose cost to the patient ranged anywhere from $10 to $10,000? After spending years pulling stunts like that, hospitals will have no right to complain when and if single-payer slashes their profit margins, not when their profligate greed led to so many Americans to demand that government step in and Do Something about out-of-control medical costs.
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Re: There must be a pony in here somewhere.

Post by thoreau » 25 Jul 2017, 22:53

Painboy wrote:
25 Jul 2017, 22:28
Mo wrote:
25 Jul 2017, 22:12
The nature/cost of health care means that direct payer models wouldn't exist for all but basic and preventative care for the bulk of the market.
Health care isn't some magic pixie land that is immune to market forces. It's only different from other industries due to the ridiculous amount of regulation and market busting rules that has been draped over it in one form or another over the past 100 years.
Certainly less regulation could bring down prices, but even if you slashed all prices by 75% a lot of services would still be steep enough that the smart move would be to insure rather than pay out of pocket.

And this stuff would still involve expensive equipment and highly trained personnel. Yeah, yeah, less serious stuff would be done by PAs and nurse practicioners, but the person doing your colonoscopy will still be (at a minimum) somebody with 4+ years of formal education and a few more years of supervised practice before they can do it correctly. Producing people like that is not cheap; teaching hospitals will continue to be expensive. And when they get out into private practice they will still need expensive equipment, a team of support staff*, and lots of liability insurance against either missing a tumor, causing complications during the procedure, or making a mistake when you have unexpected problems with the sedation.

The person figuring out if your chest pains are heart disease or not will still have a lot of formal training, an extensive apprenticeship, a whole bunch of equipment for which they need to cover both the purchase price and the maintenance costs, and liability insurance up the wazoo.

And PAs and NPs already do a lot. I've been to the ER for stitches, and it was done by an NP. I've seen a PA in urgent care.

In the end, if you want high-end services then you're talking about very sophisticated equipment, and very specialized personnel. That isn't cheap. Especially if you want everything up to date.

*I took a day off work to take my wife to her colonoscopy and take care of her at home as she recovered from the sedation. There's one team that got her ready in one part of the building, and another team that monitored her as she woke up from sedation in another part of the building. It was run like a factory, with the doctor doing one colonoscopy after another all day. But his productivity was enabled by a large team, a large office suite, and the right equipment.
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Mo
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Re: There must be a pony in here somewhere.

Post by Mo » 25 Jul 2017, 23:04

Painboy wrote:
25 Jul 2017, 22:28
Mo wrote:
25 Jul 2017, 22:12
Painboy wrote:
25 Jul 2017, 21:53
Mo wrote:
25 Jul 2017, 21:45
Painboy wrote:While I certainly don't like dealing with hospitals or insurance company bullshit the ire I have for them is pretty tepid. They both are just playing by the fucked up rules passed by the government. Any companies that may have tried being "nice" likely got pushed out of business long ago.
How so, the in-network out-of-network bullshit is part of the "free market" portion of health care. There are distortions to that market due to tax benefits and the like, but that shit is on them.
They wouldn't have to play these games if these institutions could make money straight up instead of constantly having to bury their prices to see a profit.
The nature/cost of health care means that direct payer models wouldn't exist for all but basic and preventative care for the bulk of the market.
Health care isn't some magic pixie land that is immune to market forces. It's only different from other industries due to the ridiculous amount of regulation and market busting rules that has been draped over it in one form or another over the past 100 years.

To sum up, don't hate the player, hate the game.
Indirect payer markets are frequently going to be jacked up. And you'll tend to see indirect payer markets in industries where the costs are very high*. Health care tends to have an urgency that's less relevant in other markets, which increases search costs by consumers. If I don't like the price offered by my local barber, spending a few days or even weeks looking for a more reasonably priced option isn't a big deal. Not so much if I need a stent.

There are also plenty of very free market industries with very screwed up economics from a market efficiency POV. Like the real estate broker commission has remained 6% for my entire life, despite greater efficiencies in the market, lower search costs, low barriers to entry** and relatively little regulation in the market. Or if we go down to the lower end of the market, how is the glasses industry still super screwed up by Luxottica and why did we need the internet to give us a Wrby Parker level disruption? Same goes for the mattress industry. A lot of that is based purely on the specific weirdness of the market dynamics related to the products.

* Lasik is a popular example for free market health care, but even back in the day when it was expensive, it was $8K. That's less than a complication free birth and 100% voluntary
** When I lived in CA, there was a joke that a person wrote a check at the supermarket and the clerk said, "Can I see your real estate license? The shopper said, "Don't you mean my driver's license?" and the clerk responded, "No, not everyone has a driver's license"
his voice is so soothing, but why do conspiracy nuts always sound like Batman and Robin solving one of Riddler's puzzles out loud? - fod

no one ever yells worldstar when a pet gets fucked up - dhex

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