Phoenix Rising asked a good question in my last health insurance post:
If you can explain a bit about in-network vs. out-of-network co-pays & deductibles, that might be really helpful for those who don’t already have an oncologist.
Every insurance product in this country has a network. Federally administered Medicare has a network, and the smallest boutique insurance company has a network. A single insurance company that sells multiple types of insurance (HMO, PPO, CHIP, Medicare Advantage, Exchange etc) will have multiple networks. So let’s understand why insurance companies have networks first, and then we’ll talk about in and out of network pricing.
At the most basic level, a network is a list of providers who have agreed to take a certain payment matrix for services rendered to people who have bought a particular insurance product. Insurance companies will reach these agreements in order to control costs.
Right now, there are three basic fee baselines in this country. The lowest price per service is the Medicaid baseline. Medicaid pays roughly the marginal cost of a service so it is the lowest level of payment. Most providers will take Medicaid payments for some of their patients becuase Medicaid traditionally has been a fast payer, so it helps with cash flow management. Furthermore, Medicaid makes it easy for new med-school graduates to qualify for payment so what often happens is a young doc at a small practice will see a higher percentage of their revenue and patients come from MA than they’ll see in fifteen years when they can afford to move to the burbs. The big issue with the Medicaid fee schedule is that it is very low so some providers won’t take it or more often they’ll take it for exisiting patients but not new patients. PPACA/Obamacare has raised the fee schedule to Medicare levels for PCP services to increase the number of PCPs who take Medicaid patients.
Medicare roughly pays out at average cost of procedure (with some serious back-end adjustments). Medicare’s fee schedule was the basis of the public option pricing scheme in 2009/2010 as the proposal was Medicare plus 5%. Obamacare has significant changes to the structure of the Medicare fee schedule that has begun to tie quality metrics, most notably hospital re-admission rates, to bonuses and clawbacks. But right now, Medicare is still fairly conventional fee for service at a fairly low price.
The third pricing baseline is chargemaster. Chargemaster is also known as usual and customary pricing and it is effectively the provider asking for the moon. Time Magazine had a great article on chargemaster last spring:
For example, the first line in the more than 163,072 lines of data in the CMS file released May 8 covers the treatment of “extra cranial procedures” (“without complications”) at the Southeast Alabama Medical Center in Dothan, Ala. When Medicare reviewed the list prices on bills it received for 91 patients getting that treatment at the Dothan hospital in 2011, the average chargemaster bill claimed by the hospital was $32,963. Medicare paid only an average of $5,777.
The second reason the compilation and release of this data is a big deal is that it demonstrates the point I tried to make in spotlighting the seven sample medical bills in Time’s “Bitter Pill” report: most hospitals’ chargemaster prices are wildly inconsistent and seem to have no rationale. Thus the release of this fire hose of data—which prints out at 17,511 pages—should become a tip sheet for reporters in every American city and town, who can now ask hospitals to explain their pricing.
Someone without insurance will be billed at the chargemaster rates and then negoatiated down to only 50% of the list price while still being massively ripped off.
Insurance companies negoatiate their rate structure agreements with providers based as either Medicare plus some more or as some percentage of Chargemaster. The reason for an agreement is that an insurance company can tell a provider that it can deliver 5,000 potential patients if they reach an agreement, or send those 5,000 patients elsewhere. When an insurance company has the preponderance of leverage, the rate is Medicare plus a kicker. When the providers have leverage, the rate is Chargemaster minus something.
The insurance company will build a network of docs and facilities that are willing to work for a given fee matrix. Providers out of network will submit chargemaster rates for their services to the insurance company. Depending on how a policy is written, the insurance company will pay between nothing and some percentage of the charged amount with the remainder being the responsibility of the individual policy holder. There are exceptions, most notably for emergency care and very specialized services that none of the network providers can provide, then the insurance company will take responsibility for the full charge. Even with the individual getting balanced billed for the rest of the out of network charge, the insurance company is on the hook for a signifcant sum.
The in-network matrix is far cheaper for the insurance company. The goal is to drive as many of their members to use as many services as possible from providers within this cheaper network. That is why the in-network deductible, co-payment and co-insurance are much lower for in-network services than out of network services. The idea, from the insurance company point of view, is to get the lowest possible price per service by having the patient stay in network if at all possible. Making a co-pay for a visit to an in-network doc $20 versus $100 for an out of network doc is one way to steer patients to network providers.
Gratefulcub
As a hospital executive with experience in revenue cycle, I can answer the question of why our chargemaster looks the way it does.
The ‘charges’ are about the most irrelevant portion of the bill. Everything we do is based on the contracts we have with payers. We expect to collect about 20% of our charges as actual revenue (this varies widely by region).
Rate increases, as in increases to the prices on the chargemaster, happen 1 or 2 times a year. Any competent CFO will target these increases towards the charges on the volume we get from a few payers.
– out of network payers that pay a % of charges
– payers that have low volume in our facility that have agreed to a % of charges contract
– payers that pay % of charges on OP services (OP fees are hard to calculate compared to IP, so some payers will agree to % of charges with hospitals they do little business)
That’s where the inflated chargemaster prices come from. We target those areas, like imaging procedures, that will be charged to OP’s, while not increasing charges on Room and Bed charges that hit IP bills.
It sounds dirty from the outside, but it’s how any competent CFO manages the chargemaster.
And we will almost always agree to the Medicaid or Medicare rate for any uninsured patient if they are willing to pay. We expect to get about 3% of charges from those patients, and we write off the rest to Bad Debt.
Everyone in the industry is complaining about Obamacare now, because it has had an impact on IP volume already. But, reducing the uninsured population will be a huge deal in the coming years.
greenergood
Thanks for these posts and more coming. I’ve lived in the UK for a long time, and my mom is in NY and I never can get my head round US health insurance stuff, which is very frustrating because I’d like to able to help her with her copious medical paperwork when I visit her. This may just help me out!
Crashman06
This is a really interesting series of posts. Thanks for the two so far; looking forward to future ones.
Keith P.
I’ve got an insurance gripe – I’ve been on dialysis for a little over 2 years now. Had private insurance for 15 years, all group-based via my employer. I just found out a couple of months ago from a fellow patient that after 33 months, I have to move over to Medicare. Seems kind of messed up in today’s political environment, where someone on Medicare can be branded a freeloader.
Couple of questions, though – does the 33 month clock restart if I change insurance providers, and after I have a transplant, can I move back to private insurance, or is it Medicare for the rest of my life?
richard mayhew
@Keith P.: Honestly, I have no idea
geg6
Don’t know how familiar you might be with the dispute currently happening here in Western PA in regard to Highmark and UPMC, but this whole idea of “networks” is getting a lot of scrutiny now. UPMC, IMHO, screwed up by exposing what a rotten concept it is, made to increase profits for the insurers and the health care providers and no thought for the interest of the consumer/patients. It’s all about creating a monopoly and killing any sort of competition. We all watched how UPMC tried to corner the market on providing health care by trying to kill off the West Penn/Allegheny Health System and now they are trying to do the same to Highmark. People are getting a real education on the profit motives inherent in our medical care and they aren’t pleased in the least with what they are seeing. We are having a situation here where not only will people no longer be able to use any doctors, labs, clinics or hospitals in the UPMC system if they are insured under Highmark, but even drug store chains are now announcing that they will no longer be in the network with Highmark’s customers. Highmark is the largest insurer here and this is nothing but UPMC trying to kill Highmark.
And I’d just like to say that it disgusts me that UPMC is making me stick up for Highmark. In any other situation, I’d find them both to be evil in the extreme. But what I see UPMC doing is its own level of disgusting.
ETA: And to make it clear, I understand that people will still be able to use whomever they wish for care or services as long as they are willing to pay the out-of-network costs. But that’s exactly the problem: the vast difference between in- and out-of-network costs. Which effectively bars most people from going out-of-network.
John
@Keith P.: Have you seen this Medicare booklet: Medicare Coverage of
Kidney Dialysis & Kidney Transplant Services
Also, I’ve found the the customer service via phone for Medicare is pretty good.
John
Anne
Keith P: It’s Medicare the rest of your life! In my case (and I think it’s the case for everyone?) I HAD to enroll in Medicare or lose my insurance through my NJ pension plan, which is Blue Cross.
The good news: My original insurance picks up what Medicare doesn’t cover, so nothing has really changed for me. I have a $10 co-pay whether I have a $45 chiropractor visit or a $350 ophthalmologist exam. And I am not restricted in terms of provider – I live in VT and sometimes go to a medical center in NH. It’s just that everything has to go through Medicare first before other insurance kicks in.
I know I’m lucky. Hopefully this will work out the same way for you.
pillsy
This is mostly stuff I know or half-know, but I appreciate the way it’s all being laid out so clearly. Great posts.
Anne
p.s. Basically, no private insurance company wants to pick up all medical bills for someone over 65 when they know Medicare will pay most of them, so the requirement is that people go through Medicare first, leaving the private insurance company only what Medicare won’t cover.
kindness
I work in Healthcare. From the point of view of my company, an in-network provider has a contracted rate which is much better, price wise, than an out of network provider which is more expensive. Sometimes much more expensive. So co-pays are adjusted to both cover that difference and to prompt people to use the in-house supplier.
Here’s an example: A typical MRI is billed at anywhere from $1200 to $1500. If you get one from a contracted provider the actual cost to the insurance plan is closer to $400. If you go with someone outside that plan the cost could be cheaper if the person is Medicare/Medicaid (MediCal here in CA) because in those cases it doesn’t matter if the provider is contracted or not, Medicare rates are the rates paid. Otherwise if you are a typical subscriber your insurance carrier will pay more. Much more.
It’s both carrot and stick to subscribers as well as adjudication for the insurance provider so their books work out better.
Don’t blame me, I wanted single payer even though that would have put me out of a job.
J R in WV
@Gratefulcub:
Please define “OP” and “IP” on at least the first use – I’m pretty well read and still only have a guess.
Thanks for the informative and factual reporting!
JR
Ohio Mom
Like Phoniex Rising, I also have an oncologist and I have to say, what a timely post. My husband and I just finished going through the paperwork a few minutes ago to try to get our insurance company to pay for my lymphedema sleeve and glove set, and my breast prothesis and mastectomy bras.
Our plan has two different sets of deductibles we must meet, one is for in-network and one is for out-of-network providers BUT there are NO lymphedema garment providers in the network — how convenient for the insurance company! I wonder if the genius who thought that one up got a bonus for it.
I met the limits on out-of-pocket expenses months ago, and yes, everything I did was in-network. But now I have to meet the $1,500 out-of-network deductible. Which I probably will never do. Some smart actuary made sure of that.
I’ll add that lymphedema garments must be fitted by a certified fitter, the cost of a sleeve/glove set is about $200, and they need to be replaced every six months. That’s $400 dollars a year the insurance company is “saving” on this prescription.
There’s no way to spin this, it has zero to do with encouraging one kind or another behavior/choice on my part. Lymphedema is a life-long condition, so if I’m lucky (and live a long life), the insurance company will save that $400 over and over and over again.
Then there’s the fact that there are some, but not many, prothesis/bra providers in-network. The one here that is has nothing on the proverbial used-car salesman.
They tried to sell me a breast form they had lying around that was too big, too heavy and colored in a different racial group’s skin tone — they gave me a run-around because they didn’t want to spend the money to get several different ones from different manufacturers so we could see what actually worked best for me (the saleswoman actually told me she wouldn’t make enough money if she did that). Imagine going into a school store and there’s only one pair of shoes you’re shown and it pinches your toes.
Nordstroms, which made sure I got what I needed, isn’t in-network. A breast form is over $300, should be replaced every two years, and the special bras are about $60 each. Again, these are prescription items.
You can give every explanation of the economic sense behind deductibles, co-pays, in-network and out, etc., but it all comes down to the same thing: the insurance company is after every penny they can get. That, after all, is the reason for their existence, to squeeze out as much profit as possible. As far as I can figure, in the last few months they “saved” over $600 by having ME pay for medically necessary supplies.
Oh well. At least I have some insurance.
Gratefulcub
@JR: Inpatient Outpatient
kindness
@Keith P.: Within my company if you still had your job you would end up being double covered. You’d have a Commercial account but your Medicare eligibility would be activated. That means the Insurance carrier will be paying the lesser of either the contracted commercial rate or the Medicare rate. So to you it will be transparent. You won’t see anything. Now if you get a kidney transplant that changes. Medicare will only pay for follow up for a limited period of time. usually 2 or 3 years. After that you need to find insurance to cover the cost of the anti-rejection drugs you will need to take for the rest of your life. And those drugs are pricey. A bunch of transplant people are very surprised when they are told they need to find a job to cover their health care (if they are under 62 years old).
@Ohio Mom: Contracts are usually made according to need. There has to be a set number of usages of a contract to make it worth making. If not enough people will use a particular service, they won’t cut a contract for it. It’s cheaper in their mind to just pay the higher rate. Now that leaves you screwed as you still have to pay the higher co-pay. Sucks. Sorry ’bout that.
richard mayhew
@Ohio Mom: Appeal the lymphedema garment Out of Network designations. If they are medically neccessary, and there are no in-network providers, you’ll probably (eventually) get an authorization for out of network services with in-network deductible/co-pay.
You’ll most likely get denied the first time but appeal the denial and talk to your state regulator.
Keith P.
Thanks to everyone for the information! Seriously, all this info about double coverage etc is VERY useful info. The social worker at my clinic when I originally started (she got fired last year) was absolutely terrible in terms of being helpful, not telling me juicy bits of info like the Medicare requirement and that dialysis means you don’t have to pay most of your property taxes (she cost me thousands of dollars as a result)…when she showed up to work, all she did was walk around and asked people how they’re doing. At least the new one is more proactive with informing patients; too many folks in the medical field assume that patients know everything from acronyms to procedural minutiae.
Lawrence
Good post. I worked in healthcare for ten years, six of those as a business analyst for the professional services group in a pediatric teaching hospital. Remember that “Not For Profit”, when you are talking about hospitals, means very narrowly that the organization does not pay dividends to investors. They are not and often do not behave like charitable organizations. If you are uninsured do not expect to be offered a reduced rate unless you negotiate. Where I worked they were loath to use charity or bad debt adjustments, preferring to hire multiple collections agencies to squeeze every nickel out, and never resolving the AR for any given month down to zero.
Dead Ernest
Only have a moment but want to say, I too am very happy to see Mr. Mayhew and this series here on BJ. It is certainly timely, informative, and very well done.
Great thanks to John Cole and to Richard Mayhew!
D.E. (physician)
Villago Delenda Est
Richard, thanks for these great posts chock filled with information about the byzantine nature of the health care system.
rb
If you are uninsured do not expect to be offered a reduced rate unless you negotiate.
Agree, indeed the way you say it reads like understatement.
If you are uninsured, expect to receive bills that appear absolutely astronomical and unreasonable in relation to the services provided to you. And good luck in negotiations with the leviathan.
Many / most plans can really suck if you have a serious or very expensive illness. Being uninsured, however, is far, far worse.
Ohio Mom
@richard mayhew: That is somewhat like what we were gearing up to do this morning.
Our plan is to file, not be surprised if we get denied, and then, appeal to someone higher up in my husband’s company to see what strings can be pulled up there. I hope we don’t have to go as far as the state regulator but I am ornery enough to do so if need be.
I’m not hundred percent sure but I believe breast forms are also considered “medically necessary” — I need to do a little more googling on that. What I am sure about is, breast reconstruction surgery IS, under federal law, covered. What does that say about our culture that Congress decided women who have had mastectomies should be able to have free plastic surgery but that lymphedema patients aren’t automatically covered for anything (so far, the efforts on behalf of lymphedema patients haven’t gone any where).
Anyway, I could have had that surgery, which is a pretty involved process (and a lot more expensive than what I got at Nordstrom’s), and the insurance wouldn’t have been able to blink.
What these posts on health insurance haven’t covered so far are “self-insured” companies. Big corporations, like where my husband works, insure themselves but have health insurance companies do the administration. In this system, sometimes what gets covered is what an executive says should be covered.
A small example: About dozen years ago, when we lived in a different city (and my husband worked for a different company), we were surprised to see one of my husband’s co-workers and his wife enter the autism/Asperger’s support group we had long been members of — we hadn’t know their kid was also on the spectrum. His co-worker in turn, was surprised to hear at this meeting that the insurance company was paying for our kid’s speech and OT. Their’s wasn’t being covered, as per the policy manual.
We can’t prove this but we are pretty sure the personnel director, who liked my husband, gave our claims a green light. After she left, we had to join that other family in paying for speech and OT on our own.
PhoenixRising
Can’t say that too many times. I have a cancer that can’t be treated in-network. Partly because it’s rare (330 US cases a year) and partly because I live in a state that has 3 HMOs which have driven down their reimbursement to the point where no one with another option for using their medical license will stay here.
I had to get my brother in law the NY lawyer to write a nastygram and then attend the appeal hearing with me, but eventually we got to the only reasonable outcome, which is that my treatments out of network count toward my in-network deductible. Because otherwise, per the state insurance commish, what we’re doing is incentivizing health plans to under-compensate all specialists and tell members to suck up the actual costs of their own medically necessary care.
? Martin
It’s important to note that health insurance is almost unique among insurance products that consumers buy in that it’s not necessarily a net-loss in aggregate to the consumer. Other forms of insurance generally only serve to distribute risk over time or over population – but the customer base will never be paid out more than they would be if they had pooled their money and self-insured. We don’t do that because it’s, well, impossible to do efficiently, so we pay a small premium to the insurer to do it.
But health insurance, because of the networks and negotiated prices, can be a net savings to the customer base over what they would pay without the insurance. That is, in it’s current form, it is unquestionably cheaper than simply going to the free market and paying out of pocket. There are some edge case exceptions there – but nobody is getting a discount hospital stay without some collective bargaining unit like an insurer or the VA or Medicare.
So even when we try and draw comparisons between health insurance and other kinds of insurance, the comparisons often fall flat for this reason. Health insurers are a form of non-governmental regulation which simply doesn’t have many parallels in the insurance area.
Ohio Mom
@PhoenixRising: Just want to take a moment here to say what Phoenix Rising only hints at: think about all the extra stress heaped on RP, as he/she jumps through hoop after hoop to get the insurance coverage he/she needs and is entitled to, never knowing if he/she is going to clear the hoop and how in the world he/she is going to manage if she/he doesn’t (sorry RP, if there was clue to your gender, I didn’t catch it).
It’s not enough to have cancer, you also have to mount a protracted legal battle. How does that help anyone who is trying to stay as well as possible? Stress is not good for healing!
All this nice talk about co-pays, deductibles, etc., sounds so sensible at first. Until you look a little deeper. One of our system’s huge externalities is that the patient has to do an awful lot of the clerical work. That is another of the “savings” of the insurance industry.
Manyakitty
@Keith P.: Can you get a refund on your property tax overpayment? Seems like it’s worth investigating, right?
Mnemosyne
@Keith P.:
It’s federal law that people on long-term dialysis are put into the Medicare system — before that, people were being dropped by their insurance companies (of course) and could not afford treatment, so the feds agreed to add them to Medicare. It’s called the End Stage Renal Disease Program and has been in place since the mid-1970s.
I hope you’re able to get your transplant — my dad was on dialysis for about 5 years before he passed away (mainly of COPD) in January but, unfortunately, his history of cancer meant that he was not able to be put on the transplant list.
Anna in PDX
PCP = primary care provider? Apologies if I missed where you wrote this out. I am skimming this article because I am at work.
Stella B.
@Ohio Mom: does your PCP or oncologist know that you are having trouble? I’m in California where insurance companies are held on a pretty tight leash and I’ve never had any trouble getting lymphedema garments, mastectomy bras (2 per year), breast prostheses or reconstruction surgery approved. Those have always been automaticly approved. I even got a breast reconstruction approved with no trouble for a young woman with a congenital syndrome that caused her to be missing some ribs and a breast on one side. Sometimes a doctor-to-insurance-company phone call with a few high and mighty threats can do the trick.
I was at the optometrist this morning listening in on a phone call from an uninsured person with “an abcess”. I just want to point out that if you don’t have “vision coverage” that means that glasses and contacts aren’t covered. Annual eye health exams, eye and lid health problems are still covered under your medical insurance. Do not go walking around with a torn retina just because your employer doesn’t offer VSP or something! (Honestly, I’ve seen that happen — happy ending, though, thanks to Obamacare!). If you have medical insurance, then glaucoma, injuries, diabetes, infections etc. are covered, covered, covered.
cckids
@richard mayhew:
Talking to your state regulator (or threatening to, and meaning it) can get you heard much quicker at insurance companies, or even with Medicaid. My oldest son is on Medicaid because he has multiple disabling conditions & we’ve had some luck with fighting the things they don’t want to pay for. Especially if you can get your doctor to sign off that the items are medically necessary.
Medicaid here in Nevada wanted us to keep re-using the inner canulas for his tracheostomy; they are individually sealed, meant for one-day use & specifically state “DO NOT ATTEMPT TO STERILIZE AND DO NOT RE-USE). So, he needs 30-31 per month. Medicaid would pay for 2. Retail for us to buy them was $7.00 each. We fought it for 6 months, and what won for us is that we got the state regulator involved, and kept asking their experts: “Would you be willing to state on the record that the procedure you want us to use follows acceptable medical practice?”. And, of course, they wouldn’t, because it isn’t. They were asking us to follow a procedure that all but guaranteed infections.
Its never easy, and it is exhausting & sometimes demeaning. Good luck to you!!.
cckids
@Ohio Mom: My comment @ 30 was aimed to you, my mistake! Good luck, and hang tough.
Ecks
Thanks for these really well-explained posts. It’s hard to make complex stuff comprehensible, and you’re doing yoeman’s work here.
johnny aquitard
So the fact that these agreements also provide a selling point to the insurance company and can cock-block other companies from the same never figure into it, eh?
I think there’s a lot of marketing, market segmentation and positioning strategy behind these agreements as well. They allow an insurance company to differentiate their product from other companies’ similar products or to strategically prevent another company from doing so. “We’ve got all the xyz-med school docs on board” Or “we’ve got Drs. A, B, and C, the ones with the best rep in the community for specialty X”. Or “We have midwives”.
The reason we can’t get the docs we want in one network isn’t just due to costs.
texasdem
You can be caught unaware by out-of-network charges even if you work in the medical field. When you have an out-patient surgery, you usually don’t meet the anesthesiologist beforehand. I didn’t realize that the one assigned to my case was not on my insurance–even though it’s the largest medical insurer in Texas. He was paid the in-network rate, but then kept billing me for the remainder. I protested to the hospital, since I hadn’t required general anesthesia, just a local administered by the orthopedist (which I had requested before the surgery). Only then did the bills stop coming.
Schlemizel
Thanks for all the good info – Richard in particular but also all the others who have added knowledge to the thread. Its a good read
Ohio Mom
Thanks everyone for your concern and suggestions. I’m pretty confident we’ll eventually get at least partially reimbursed. Being parents of a special needs kids has given us a lot of experience in wrangling the various parts of the health care industry, including the insurance companies. And as I said, I can be very obstinate.
I mainly told my Catch-22 story as an example of how unfair aspects of our system can be. I was out for most of the afternoon and evening and I thought about this post a lot in the meantime. It’s a terrifically helpful post because we all need to know as much as possible about how health insurance companies operate. Forwarned is forearmed, as they say.
I’m glad Phoenix Rising found a way to get covered his/her cancer treatments covered; I’m glad people on dialysis get the wonderful financial assistance they do; I’m glad cckids got the canulas paid for; it goes without saying I’m glad my kid got a year or so of free speech and OT back in the day.
But it seems to me all these stories with happy endings obscure what is missing from the post, and that is the larger picture, the forest to all the trees of details about networks, co-payments and the like. In the end, I believe the “forest” is that the health insurance system is just plain old corrupt.
Some of us manage to get what amounts to special favors, but that’s a reflection of the system’s corruption. On every level, from the individual to the hospital/insurance/corporation level, it’s one special favor and one special deal after another.
There’s an argument I think that the system was born in corruption: employers started to provide health insurance coverage as a dodge around the WWII era-federally imposed wage controls. From the beginning, there was rule-bending.
So yes, let’s arm ourselves with the knowledge of how the system works but let’s not ever find ourselves explaining the system in a way that makes it sound like we think it’s rational and reasonable. Let’s not make it sound like we are condoning it.
Ohio Mom
Sorry for the typos in that last comment, especially in describing my offspring — it should be “kid” not “kids.”
Ruckus
Richard, I think one thing that stands out for me is your use of the idea that insurance companies negotiate with providers to cut costs. They do that to cut the costs to them to drive up profits. It is never about cutting costs to lower the cost of insurance.
Someone up thread pointed out that insurance cos make the consumer do a lot of leg/paper work, and generally at a time when they are least capable of doing so. They also create a lot of paperwork for the doctors. My last private Dr had more people working in the office to handle insurance paperwork than they did Drs and nurses. And each network had different codes, different payment levels for each code and different codes which they would not cover. All of this adds hugely to the overhead costs of providing care. And at this practice each patient was on computer(5-6 yrs ago) so that the office workers didn’t have to shuffle paper and crappy handwriting to do their job. They still had to fill out paper for the insurance company for each patient. Now many of these things I understand that ACA will fix or at least attempt to fix, which will reduce costs.
Ruckus
@Ohio Mom:
This
This
This
It is a totally broken system. The ACA will help in many ways, but the system is broken far worse than this law can fix by itself. We don’t seem to have a lot of what I call twenty dollar corruption any more in this country, like passing a folded twenty behind your drivers license to the cop but we do have corruption of systems. Like the health care industry, like you point out. You get very little for all the money we pay unless you are able to yell too loud to be ignored. And this is far too important for all of us to be corrupt.
Seth Owen
Fantastic and informative thread. Thanks to all. If there’s anything that I think is clear, it’s that the Republicans have made a mistake in their opposition to ACA by not having an alternative to offer. The current system is unsustainable. If not Obamacare, then what?