Discussion in 'Clean Debate Zone' started by beagle9, Jul 8, 2017.
. Good stuff.
I call it creative billing. In many cases service providers have to come up with additional billing in order to service Medicare patients. Recently, one of my Medicare explanation of benefits listed the Medicare approved amount for a chest Xray as $6. It cost more than that for just technician's labor. So they may it up in the cost of the radiologist reading the Xray. My family doctor is paid some ridiculous low rate by Medicare for an office visit so every office visit is an intermediate billing code or first time patient rate.
There you go. You now know more about REAL Pharma pricing than most of Congress. A lot of the conversation about Med inflation is phony, because the MARKET pricing is phony.
Same goes for other med services. The extravagantly high prices people hear have NOTHING to do with the actual COST of the drug or service..
I'm a realist here. DOCTORS and hospitals are hurting from this pricing game as well. Because they are getting BRUTALLY squeezed. Especially by Medicare and MediCaid reimbursements that must be made up by AGAIN -- inflating prices OVER the amounts they actually cost to the consumer.
Exactly. And those unpaid costs for the $6 X-ray are just shifted to their RACK rate. And redistributed to all the OTHER insurance contracts that have more available to pay for services.
So as MediCare progressively squeezes that X-ray cost down --- by for example not allowing for rising labor costs and neglect -- The hospital just keeps on RAISING the BILLED costs to every other insurance negotiation..
That rack rate is like a suggested retail price of clothing. Practically no one pays that today.
For example, my wife has a yearly outpatient treatment for osteoporosis which takes about 1 hour. The hospital billing is $6200 which is way overpriced. The Medicare covered amount is $1850 of which Medicare pays $1480. The patient's responsibility is $370, 20%. The hospital writes off the remainder because like most Medicare providers they accept the Medicare approved amount as full payment.
Now suppose my wife were covered by group or individual insurance. Provided the services are in network which most are these days, the insurance company will have a contracted rate with the hospital for all services they render to policy holders. The rate the insurance company pays is determined by contract negotiations and those negotiation are strongly influenced by the Medicare rate.
The problem is Medicare rates are a fee for service which does not really take into account whether the service is effective or not. We pay the healthcare provider for trying to help, not fixing the problem.
Too many media and politicians FIXATED on "high costs". When in reality, It's the INSURANCE cost that's become the problem. Because they KNOW -- they are beating the providers into submission and WANT the consumers to see the "Retail Price" to CONVINCE THE CONSUMERS -- that only the insurers can protect them from the devious and greedy medical community.
When in REALITY -- EVERYONE should know what the REAL costs are. The patients, the doctors, the policy wonks and the media. They don't right now. So it's all senseless shouting. Folks with MSAs KNOW the real costs of services and have figured out how to negotiate their OWN discounts. Multiply that by a million "negotiations" per year and pretty soon -- the "high costs of health care" WONT REQUIRE "inflated insurance prices" --- just as "protection money"...
. Would it not be that if the medical industry would charge ethical prices to begin with, then wouldn't the insureres up the amount of coverage to their customers, and give them more options within their coverage ??
Yep, Insurer show how much money their customers are saving by showing them these trumped up costs. For profit hospitals use it to try to justify tax write offs. Nonprofits use it to show benefactors how low their reimbursements are. Sadly, hospitals will try to collect this from their customers that don't have insurance.
Insurers are well are aware of these Trumped up cost. Most insurance, individual or group pays based on negotiated rates with their healthcare providers. The Medicare rates which are set based on actual costs are usually a starting point in negotiations.
. Ok, but does this not cause the healthcare provider (out of fear), that the negotiation may go to the extreme on behalf of the insurance company, (who may be playing super hard ball against them in the negotiations), to then cause the patient to suffer the fall out in the ways of poor quality care given now by the provider because it feels it won't get the amount it was asking for ?? And doesn't the patient also suffer the situation of the provider rolling the cost (in which the insurance company refuses to pay), over on to them in which the patients do not have the resources to protect themselves against a provider trying to gouge either the insurer or them as the insured ??
Separate names with a comma.