Started By
Message
re: OT- Medical Billing in Georgia
Posted on 6/7/23 at 10:47 am to deeprig9
Posted on 6/7/23 at 10:47 am to deeprig9
quote:
It shows an insurance payment of something like $83.92 random number, but somehow the balance owed to the provider is exactly $25.00.
I think it's a fricking shakedown.
Chill
83.92 is probably the full billed cost
25.00 is probably your co pay
Insurance has paid their part, allowing you to now be billed, and you owe 25
0
Posted on 6/7/23 at 11:39 am to meansonny
quote:
You don't think the government is a for profit scam?
What I know is that every other first world government has either a legitimate public option or a full blown government paid for healthcare system. Meanwhile we trip over ourselves to defend a system that has failed us again and again because somehow we believe corporations are somehow more virtuous than the government.
This post was edited on 6/7/23 at 11:39 am
Posted on 6/7/23 at 12:03 pm to dawgfan24348
quote:
Meanwhile we trip over ourselves to defend a system that has failed
We have the worst system.
It isn't private free commerce.
It is a Mish mash of government regulations stripping peoples rights away and forcing a 1 policy fits all approach to health insurance.
It is fascism.
Posted on 6/7/23 at 12:15 pm to meansonny
quote:
It is fascism.
Pretty sure it’s not even close to fascism
quote:
forcing a 1 policy fits all approach to health insurance.
What we have now is a government that serves the insurance companies thanks to lobbyist money. These companies take in a shite ton of money while people go into massive debt and often have to decide if they should even seek treatment because of fear of not being able to pay. shite like this only exists in the US because the US has become a pseudo oligarch
Posted on 6/7/23 at 12:27 pm to dawgfan24348
quote:
quote:
It is fascism.
Pretty sure it’s not even close to fascism
State sponsored corporatism?
I'm not a fascist expert.
You will have to educate me by poking holes in what we have now.
quote:
quote:
forcing a 1 policy fits all approach to health insurance.
What we have now is a government that serves the insurance companies thanks to lobbyist money.
Lol. No.
We have a government who feels it's sole purpose is to "fix things".
The fixes are because people are stupid (democrats) and don't realize that the government is incapable of fixing anything.
The insurance companies happily go along with it because what the government mandates by law is so ridiculously expensive that the insurance companies are happy to target that 3% margin on a gigantically larger cost.
quote:
These companies take in a shite ton of money while people go into massive debt and often have to decide if they should even seek treatment because of fear of not being able to pay.
I want you to be very clear.
People pay a lot of money "because of the insurance companies"?
Think before you answer.
I will go ahead and argue that they pay more because of the government mandates and regulations. The insurance companies are trying (they do lose money on occasion) to slice 3% off the gross. No different than your local county tax assessor slicing off 2% for being a middle man when people are forced to pay by way of lien.
quote:
shite like this only exists in the US
Because of the US government.
This isn't free market competition.
You think that you get to choose the type of coverages that you pay for (and by contrast, "do not pay for")?
You think insurance companies are pricing you out based on actuarial science?
Posted on 6/7/23 at 1:25 pm to meansonny
quote:
that the government is incapable of fixing anything.
Expect the government is entirely capable of fixing things. Thinking hey just leaving it to the free market will solve things isn’t the way at least not with something like healthcare
quote:
insurance companies happily go along with it because what the government mandates by law is so ridiculously expensive that the insurance companies are happy to target that 3% margin on a gigantically larger cost.
You can try and blame the government all you want but corporations will always look to make sure their bottom line remains in tact. Regulations are needed to make sure corporations don’t frick over employees and customers although the medical field is a mess
quote:
will go ahead and argue that they pay more because of the government mandates and regulations. T
You think the government is the reason for high prices? What do you think will happen if the government completely removes all regulations? There won’t be a true free market because the few insurance companies that exist will price out any potential competitor then you have an extremely small market where these companies have free rein to do what ever. This belief that libertarian style of government will somehow work is pure fantasy. We’ve seen what works in other nations but instead we continue to defend our corporate system because entire generations were brainwashed into believing that Reganomics actually worked and didn’t frick over the middle and lower class and didn’t put us into an amount of wealth disparity not seen since the French Revolution
Posted on 6/7/23 at 1:37 pm to dawgfan24348
quote:
Expect the government is entirely capable of fixing things. Thinking hey just leaving it to the free market will solve things isn’t the way at least not with something like healthcare
There are basic fundamentals about healthcare. And the government can't fix them. They can only exacerbate problems.
1) cheap
2) comprehensive
3) readily available
You can only have 2. No government in the world has 3. And the ones who try usually screw up 2 in the process (hello obamacare).
quote:
You can try and blame the government all you want but corporations will always look to make sure their bottom line remains in tact
Which corporations are you referencing? You are already losing your argument here.
quote:
Regulations are needed to make sure corporations don’t frick over employees and customers although the medical field is a mess
Regulations have made healthcare super expensive and slow in this country.
That isn't the result of health insurance. That isn't the result of healthcare providers.
The only thing regulations have accomplished is a broad open coverage which encourages poor people to not buy crappy health insurance until they already have an ailment and need it.
quote:
You think the government is the reason for high prices? What do you think will happen if the government completely removes all regulations?
I can buy a policy with the specific coverages that I care about.
I can remove abortion coverage.
I can remove maternity coverage.
I can literally pick and choose the coverages which I need.
Then, health insurance companies can actually rate healthy people with healthy rates. And healthy smokers with healthy smoker rates. And unhealthy people with unhealthy rates. And unhealthy smokers with unhealthy smoker rates.
People are actually held accountable for their health (do you see a lot of that?).
Then... insurance companies can decline coverage for people with preexisting conditions.
This makes " not having" health insurance too scary to avoid paying the premiums.
More people pay into the system.
More idiots who tried to gamble the system get left out without coverage.
Then you and I will actually see a system where premiums are low and care is readily available.
Coverage will only be comprehensive if you choose to pay extra for comprehensive care.
You have 2 strong legs to healthcare and 1 opportunity for people to pay extra if they "need" comprehensive care.
3% margins shrink when the total costs shrink. And your big bad evil insurance companies make less money.
This is basic economics.
This is basic capitalism.
But democratic dogooders cry because people without insurance may become uninsurable. And if they can be insured, they become cost prohibitive because they are actually being rated as a high risk (this is a tough concept for you. That is how insurance works).
This post was edited on 6/7/23 at 1:41 pm
Posted on 6/7/23 at 3:05 pm to dawgfan24348
quote:
Expect the government is entirely capable of fixing things
when has the govt fixed anything?
Posted on 6/7/23 at 4:01 pm to deeprig9
I love getting that extra bullshite bill for 200-300$ for some lab fee or some other bullshite just as soon as you thought it was all taken care of.
Last time I busted my head open I paid for the whole ER visit at the hospital and they told me that was it I wouldn’t get another bill. Then a few months later boom. $250 for the company that “manages the ER”. So I call them and they’re like yeah that’s not right we will check into it. Next thing I know I’m getting threatened with collections. Still didn’t pay it and nothing went to collections. It has been two years.
Last time I busted my head open I paid for the whole ER visit at the hospital and they told me that was it I wouldn’t get another bill. Then a few months later boom. $250 for the company that “manages the ER”. So I call them and they’re like yeah that’s not right we will check into it. Next thing I know I’m getting threatened with collections. Still didn’t pay it and nothing went to collections. It has been two years.
Posted on 6/7/23 at 9:15 pm to Griffindawg
quote:
I love getting that extra bullshite bill for 200-300$ for some lab fee or some other bullshite just as soon as you thought it was all taken care of.
Last time I busted my head open I paid for the whole ER visit at the hospital and they told me that was it I wouldn’t get another bill. Then a few months later boom. $250 for the company that “manages the ER”. So I call them and they’re like yeah that’s not right we will check into it. Next thing I know I’m getting threatened with collections. Still didn’t pay it and nothing went to collections. It has been two years.
That's what I'm talking about. It's a fricking shakedown. I'm not paying the $25. Put it on my credit report, I don't give a frick.
Posted on 6/7/23 at 9:26 pm to deeprig9
Imagine going to Chick Fil A and getting a sandwich, and you pay for it on the spot, which is customary, and 9 months later they send you a bill for 35 cents for the pickles.
Posted on 6/7/23 at 9:31 pm to deeprig9
Imagine if your dog went to the vet for a regular checkup, and you paid your $85 to the counter girl, and then 9 months later they send you an envelope with a bill for another $25 "just because".
Shakedown Street
Tell me this town ain't got no heart...
Shakedown Street
Tell me this town ain't got no heart...
Posted on 6/7/23 at 9:59 pm to deeprig9
Medical facilities need a McDonalds menu board with listed prices for each service.
Unfortunately, their practice is typically to charge the maximum allotment for every insurance provider.
Why should one insurance provider pay a different amount than another?
Why can I not call a hospital and get a statement of fees before I go in for a procedure?
But the system is fricked up because of the health insurance companies?
It is fricked up 7 ways to sunday. And it starts with the government regulations
Unfortunately, their practice is typically to charge the maximum allotment for every insurance provider.
Why should one insurance provider pay a different amount than another?
Why can I not call a hospital and get a statement of fees before I go in for a procedure?
But the system is fricked up because of the health insurance companies?
It is fricked up 7 ways to sunday. And it starts with the government regulations
Posted on 6/7/23 at 10:15 pm to meansonny
quote:
Why should one insurance provider pay a different amount than another?
Because providers negotiate reimbursement rates with insurance companies, same as lots of other businesses.
quote:
Why can I not call a hospital and get a statement of fees before I go in for a procedure?
You can call and get your cpt code listing from the provider and then call your insurance company and they should be able to tell you. Except sometimes things like anesthesia are outsourced so then you'd have to call the anesthesia company. It's stupid.
quote:
But the system is fricked up because of the health insurance companies?
I mean yeah, they should at least get some of the blame.
quote:
It is fricked up 7 ways to sunday. And it starts with the government regulations
Which ones though because I kind of like the ones that regulate quality of care
Posted on 6/7/23 at 10:22 pm to FinleyStreet
quote:
quote:
Why should one insurance provider pay a different amount than another?
Because providers negotiate reimbursement rates with insurance companies, same as lots of other businesses.
So the cost of service shouldn't have anything to do with the client?
And that isn't fricky to you?
quote:
quote:
Why can I not call a hospital and get a statement of fees before I go in for a procedure?
You can call and get your cpt code listing from the provider and then call your insurance company and they should be able to tell you.
Again... the service provider can't provide the consumer an honest answer and that is normal to you.
The fact that a service provider is physically unable to charge less than the maximum price allowed per the insurance company should be a red flag.
In other industries (non health) that is called insurance fraud. Indemnification is funny that way.
quote:
quote:
But the system is fricked up because of the health insurance companies?
I mean yeah, they should at least get some of the blame.
They love the system.
As I said... 3% of the biggest number imaginable is best for their bottom line. Oil companies lay people off when the price of oil drops. Margins are funny that way.
quote:
And it starts with the government regulations
Which ones though because I kind of like the ones that regulate quality of care
I'm unfamiliar with government laws regulating health insurance regarding quality of care.
Quality of care comes from the service provider. And from where I sit, is judged by the consumer (not service provider. Not insurance provider. Not bureaucrat).
Posted on 6/7/23 at 10:28 pm to FinleyStreet
As I said, it is basically a fascist system.
There is no market for a consumer to shop prices.
According to Finley, it isn't even the hospital using market forces (supply/demand) to set prices.
If a consumer can't shop and a retailer can't react to the consumer, then it is clear as day not capitalism.
And that is why we are in a bloody mess.
Thank you uncle Sam.
My town has a cash provider (general practitioner).
And ironically, he is considered the best in the entire county.
So much less expensive than the insurance market. And much quicker for service too.
Edit to add: and that is a perfect example of how the federal government continues to frick our lives up.
Does anyone want to share their premiums, deductibles, and out of pocket maximums before obama's "affordable care act"?
There is no market for a consumer to shop prices.
According to Finley, it isn't even the hospital using market forces (supply/demand) to set prices.
If a consumer can't shop and a retailer can't react to the consumer, then it is clear as day not capitalism.
And that is why we are in a bloody mess.
Thank you uncle Sam.
My town has a cash provider (general practitioner).
And ironically, he is considered the best in the entire county.
So much less expensive than the insurance market. And much quicker for service too.
Edit to add: and that is a perfect example of how the federal government continues to frick our lives up.
Does anyone want to share their premiums, deductibles, and out of pocket maximums before obama's "affordable care act"?
This post was edited on 6/7/23 at 11:03 pm
Posted on 6/8/23 at 6:55 am to meansonny
quote:
So the cost of service shouldn't have anything to do with the client?
Hospitals are trying to make money. They do that by negotiating the best possible rates with insurance companies.
quote:
The fact that a service provider is physically unable to charge less than the maximum price allowed per the insurance company should be a red flag.
Technically a provider could bill for less, but they're not going to since they're trying to make money.
quote:
I'm unfamiliar with government laws regulating health insurance regarding quality of care.
My bad, you said "government regulations" I thought you meant any regulation around healthcare.
For the record I don't think any of it is good or normal. Just trying to provide some clarity around how it works. It's obviously a very broken system.
Posted on 6/8/23 at 7:43 am to FinleyStreet
I get it.
I want the hospitals and doctors to make money.
Insurance companies too.
I also understand that the health insurance companies allegedly are using their size to negotiate prices on behalf of the customers.
But there really isn't any free market capitalism going on here.
It is like arguing that State Farm is negotiating their rates on behalf (for the betterment) of their mutual policyholders.
Free market is at the consumer and producer level. Like you said... we have a broken system.
Quick question.
Are health insurance approved healthcare costs zip code specific?
Or just state specific?
You may see where I'm going with "maximum fees allowed". In my mind, this is one of the greater sins of the industry.
I want the hospitals and doctors to make money.
Insurance companies too.
I also understand that the health insurance companies allegedly are using their size to negotiate prices on behalf of the customers.
But there really isn't any free market capitalism going on here.
It is like arguing that State Farm is negotiating their rates on behalf (for the betterment) of their mutual policyholders.
Free market is at the consumer and producer level. Like you said... we have a broken system.
Quick question.
Are health insurance approved healthcare costs zip code specific?
Or just state specific?
You may see where I'm going with "maximum fees allowed". In my mind, this is one of the greater sins of the industry.
Posted on 6/8/23 at 7:45 am to FinleyStreet
Follow up...
Are negotiated fees at the facility level?
The fees paid to BCBS from Emory may be different for the same service as the fees paid from Northside?
Are negotiated fees at the facility level?
The fees paid to BCBS from Emory may be different for the same service as the fees paid from Northside?
Posted on 6/8/23 at 10:38 am to deeprig9
quote:
I know you think Trump is a nazi
Folks are missing the correct historical figure as a Trump comparison.
Lucius Domitius Ahenobarbus aka Nero
Nero was popular with the members of his Praetorian Guard and lower-class commoners in Rome and its provinces. Most contemporary sources describe him as tyrannical, self-indulgent, and debauched. Declared a public enemy by the Roman Senate.
Most Roman sources offer overwhelmingly negative assessments of his personality and reign. The historian Tacitus claims the Roman people thought him compulsive and corrupt. Suetonius tells that many Romans believed that the Great Fire of Rome was instigated by Nero to clear land for his planned "Golden House". Tacitus claims that Nero seized Christians as scapegoats for the fire and had them burned alive, seemingly motivated not by public justice but by personal cruelty.
I would bet my last dollar both Nero and Trump had NPD
Page 2 of 3
Latest Georgia News
Popular
Back to top
Follow SECRant for SEC Football News