As I mentioned in an earlier post, during the admissions process for one of Mrs. Dan’s cancer surgeries, there was a little stand up placard/sign on the person’s desk that stated something to the effect of:
“If you do not have health insurance and will be 100% responsible for charges, we offer a 50% discount when your balance in paid within 30 days of the date of service. If you pay your balance in 15 days or less, the discount is 60%.” Translation (for me): Everything is negotiable. -D > On Aug 12, 2022, at 6:54 PM, Karl Wittnebel via Mercedes > <mercedes@okiebenz.com> wrote: > > I would agree that when it comes to being in the hospital, the patient with > the squeaky wheel family gets better care. As providers, just knowing we > are being observed helps us to remain vigilant and sharp. This applies to > all members of the care team - RNs etc. > > I forgot to mention that if you are uninsured and go to the hospital, then > receive an astronomical bill, you can almost always negotiate a 75% > discount on that for cash. This is because insurance companies typically > get about 80% off the full rate, so hospitals are just giving you the same > deal if you ask for it. But you have to ask. All this is a holdover from > days of yore when insurers paid the full asking price; believe it or not > there are still a few who do and hospitals do not want to miss out on that > income, so they still send out a bill for the full amount because they have > to charge the same rate for everyone. > > Regards, > > On Fri, Aug 12, 2022, 11:08 AM dan penoff.com via Mercedes < > mercedes@okiebenz.com> wrote: > >> Excellent commentary, Karl, Thank you so much for taking the time to put >> this together. >> >> To reflect on a couple of things: >> >> Insurers rejecting claims to “run down” the claimant - I had this happen >> with orthodontic work I had done as a part of an oral surgery that was >> medically necessary. Cigna kept constantly rejecting (legitimate) claims by >> my orthodontic provider for no reason. Mrs. Dan has worked in the medical >> prescription processing (IT) field for some time, so we’re well acquainted >> with claim processing and things like “HICPIC” codes. Not our first rodeo. >> I filed a complaint and requested arbitration, and what do you know? Two >> days after I filed for arbitration the claim got paid. I refuse to believe >> that was a coincidence. >> >> I can’t stress enough how important it is to advocate for yourself when it >> involves medical treatment. That, and make sure your significant other or >> family can do the same in case you’re not able to. I’ve seen too many times >> when people just willingly accept what they’re told, rather than ask the >> hard questions to get the full picture of potential treatments and >> outcomes. That’s not to say all caregivers don’t provide this, but >> oftentimes they don’t or only present what they think is best. Especially >> when it comes to major illnesses or surgeries, it’s incumbent on the >> patient to have as much information as possible to be able to make the best >> informed decision as to their treatment. >> >> When Mrs. Dan was hospitalized for being overmedicated as I mentioned >> before, had I let things go as the caregivers wanted to, the outcome might >> not have been ideal. Instead, I challenged their direction and was able to >> get some of their peers involved who helped us to come to a more >> appropriate approach with a good outcome. Understand that I didn’t >> challenge their knowledge or suggestions, I just probed for more >> information and other potential treatment approaches. Had there been none I >> would have been fine with moving forward as they originally suggested. >> >> You gotta be on the field with the team, not the sidelines. >> >> Again, thanks a bunch, Karl. >> >> Dan >> >>> On Aug 12, 2022, at 1:22 PM, Karl Wittnebel via Mercedes < >> mercedes@okiebenz.com> wrote: >>> >>> I have some thoughts. >>> >>> 19% of the US GDP is spent on health care. It is staggeringly higher >> than >>> the next highest country. So a logical question is: where does the money >> go? >>> >>> >> https://www.statista.com/statistics/268826/health-expenditure-as-gdp-percentage-in-oecd-countries/#:~:text=Among%20OECD%20member%20countries%2C%20the,U.S.%20with%20distinctly%20smaller%20percentages >>> . >>> >>> The medicare observation was correct. Doctors fought it tooth and nail, >> but >>> it ended up making a bunch of MDs very wealthy in the 1970s and 80s >> because >>> they paid well and the private insurers paid asking cost to docs and >>> hospitals. >>> >>> When it became clear that this was unfair and unsustainable, we started >> to >>> see medicare and insurers start ratcheting payments down. This has put >>> pressure on independent providers in lower paying specialties like >> primary >>> care. Consolidation among payors means the small docs are at their mercy >>> for getting paid. Literally insurers wl just reject 10% of claims >> outright >>> and hope that a docs office cannot pay someone to sit on the phone for >> two >>> hours to sort it out. This and other administrative inefficiencies >> account >>> for perhaps 15% of every healthcare dollar spent. >>> >>> Rates for doc payment are actually set largely by the AMA. The whole >> system >>> rewards procedures of various types. This leads to wide disparities in >> the >>> cost of care; unscrupulous for-profit health systems and docs can bilk >> the >>> insurance/medicare system by upcoding visits systematically: >>> >> https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum/amp&ved=2ahUKEwjKsreD5MH5AhWsKkQIHcnxASQQFnoECBAQAQ&usg=AOvVaw2B-tTctc6j_7JCvqiSMUNG >>> >>> But it also drives a lot of the best docs into high paying specialties >>> that do lots of procedures. This is why finding a good primary care doc >>> just gets harder and harder. The US imports foreign medical grads to fill >>> primary care training slots every year, because US grads know their life >> is >>> going to suck if they practice internal medicine. Your example of the >>> cardiologist married to your internist is a great example; the internist >>> can work part time because the cardiologist makes more than double the >>> salary. Otherwise the internist could not live on that income. >>> >>> Because they cant get paid by insurance companies, literally, unless they >>> are part of a larger network of docs, most internists go into practices >>> that they do not own or manage. This is true in the hospital and for >>> outpatient jobs. So most internists are working for the man. If they >> built >>> up a big practice, they will get bought by a hospital network who can >>> negotiate better rates with insurers. Hospital owned practices can also >>> charge a lot more for the same services through a payment adjustment >>> designed to compensate hospitals for the cost of caring for uninsured >> etc. >>> So pracitces are all consolidating due to our frankly corrupt, self >> serving >>> insurance system taking 20% off the top while denying doctors payment for >>> care provided and denying patients access to needed care at the same >> time. >>> >>> The concierge model is great if you get a good doc. There are a lot of >>> quacks out there who are financially motivated and practicing sketchy >>> medicine but are accessible to their patients, who dont always know the >> doc >>> is a quack. There are good concierge docs also. LA is full of them. >>> >>> In any event, the system needs to pay docs to do the right thing. If >>> primary care paid more, more of the smartest people in medicine would do >>> it. GPs in rural Scotland can and do make a killing, for instance, >> because >>> the system values what they do. Our system tends to reward docs for >>> operating on people and doing coloniscopies and putting in heart valves >> and >>> stents, so you get smart, materialistic people doing those things and no >>> coherent primary care provider. Until AMA changes the RVUs assigned to >>> primary care, and Medicare pays more for those visits, this will not >>> change. Same with the opioid epidemic; if pain management providers were >>> paid as much for an opioid weaning appointment as they are for an >> epidural >>> or facet block or radiofrequency ablation, then no one would be strung >> out >>> on prescription narcotics. You get the idea. >>> >>> Of course hospitals get paid more for procedures also, which is part of >> the >>> problem. >>> >>> As previously mentioned, insurance companies are a total scam, skimming >> 20% >>> off every healthcare dollar. They should be limited to 3-5% as they are >> in >>> Germany. Poof your healthcare just got a lot cheaper.. >>> >>> Medicare should be allowed to negotiate drug prices with drug >> manufacturers >>> in the same way other countries and our own VA hospitals do. No reason >> for >>> us to subsidize drug development for the whole world only for drug >>> companies to sell the same drug to Canadians for 1/3 what it costs >>> Americans. Complete graft and unpatriotic. Pigs at the healthcare trough. >>> But we allow it, because Pharma has your congressperson in their pocket. >>> Think about it. >>> >>> We already have socialized medicine. It is called EMTALA and it was >> brought >>> to you by Ronald Regan: >>> >> https://www.google.com/url?sa=t&source=web&rct=j&url=https://en.m.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act&ved=2ahUKEwjLtoGZ38H5AhW4JEQIHZYsBxoQFnoECAkQAQ&usg=AOvVaw1i-EfrMVFLdFFYNq0o9AHB >>> >>> Basically a pregnant lady was refused evaluation at an ED in texas >> because >>> she did not have insurance, and either she or the baby died or both. We >>> collectively decided we are not the type of 3rd world country that lets >>> people die on the curb outside the ED with treatable conditions just >>> because they dont have enough cash in their pocket to pay for care they >>> need. I think we can all get behind that. But it costs money. Hospital is >>> required to evaluate all comers. Then either treat acute conditions or >>> transfer to another facility who willl treat, which there arent any >> because >>> drumroll.... patient has no insurance! Once you have this law, your >>> medicine is pretty socialized. But as you all apparently realize, even >>> though access to healthcare is equal at the ER, ability to choose a >> primary >>> (or specialist) doc who is smart and answers the phone and takes good >> care >>> of you is not at all equal and some types of insurance give you that and >>> some do not. We are all equal, but some of us are just a lot more equal >>> than others, as I think Orwell said. >>> >>> Anyway these are just some thoughts. The fact that american healthcare >>> insurance is frequently tied to people's jobs and employment is another >>> unique and not altogether great feature of our healthcare system. It is >>> basically a big tax subsidy to a part of the population that is already >>> better off than most. And it leaves a huge number of people in lower >> paying >>> jobs completely in the lurch. >>> >>> Basically we don't have a more rational healthcare system because our >> labor >>> movement does not have a political party. All the countries with more >> equal >>> healthcare access have strong labor movements with political >> representation >>> in government. Germany, UK, Australia etc. For more on why we have what >> we >>> have, read The Social Transformation of American Medicine by Paul Starr: >>> >> https://www.thriftbooks.com/w/the-social-transformation-of-american-medicine_paul-starr/246472/item/4795668/#idiq=4795668&edition=2402074 >>> >>> Anyway there is no free lunch. Disincentivizing docs performing >> unnecessary >>> but very expensive and lucrative procedures with a system that rewards >>> health outcomes rather than piecework is a good start, but the healthcare >>> 19% GDP bathtub has many leaks and a lot of that money finds its way back >>> to washington DC to keep things exactly as they are. If you want change, >>> get organized and agitate for it, or donate to candidates who support >> your >>> agenda. This is America. Money talks. Everybody else can f*&$ right off >>> apparently. >>> >>> >> https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly >>> >>> Basically illness and death are part of the human condition. The rain >> falls >>> on the just and the unjust alike; nobody asks to get Type 1 diabetes, PEs >>> or a heart attack or cancer. The country will be a better place when we >>> recognize that fact and invest in programs to promote health for >> everyone. >>> We can pay for it with money we currently waste on overpriced insurance, >>> overpriced drugs and unnecessary or cost-ineffective care. The wealthy >> will >>> always be able to pay for more access to more expensive levels of care, >> the >>> same way they do now. >>> >>> >> https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly >>> >>> My 0.02 >>> Karl >>> >>> On Wed, Aug 10, 2022, 1:50 PM dan penoff.com via Mercedes < >>> mercedes@okiebenz.com> wrote: >>> >>>> Some good points, Greg, thanks for the insight. >>>> >>>> One of my concerns when it comes to socialized medicine is more a matter >>>> of the ability for everyone to have access to free or inexpensive >> medical >>>> care. It may not be timely, which seems to be a common thread in these >>>> systems both in Canada and the UK from my experience, but at least it’s >>>> available to every person at little to no cost. >>>> >>>> I see the person serving up my burger or even my oldest son, who still >>>> doesn’t have medical coverage through his employer, and think about how >>>> they’re just one emergency away from bankruptcy. I took my oldest son >> to a >>>> local walk-in clinic on Monday to be treated for COVID and get Paxlovid, >>>> and the charge for the office visit alone was $135. Had he gone to my >>>> internist’s medical practice it would have been more like $275. >>>> Fortunately, the Paxlovid was free, but still, for someone working for >> $15 >>>> or even $20 an hour $135 is a HUGE amount of money. Lucky for him he >> does a >>>> good job saving and budgeting, so he had it, but how many people don’t? >> And >>>> I’m not talking about people who are indigent, I’m talking about a large >>>> swath of our society. >>>> >>>> There is a large contingent of Canadians that “invade” Florida on a >>>> seasonal basis, and they hit the health care system heavily when they’re >>>> here. My mother in law complains about how tough it is to get a doctor’s >>>> appointment between October and April because of the influx of >> Canadians in >>>> her area. >>>> >>>> -D >>>> >>>>> On Aug 10, 2022, at 4:26 PM, greg via Mercedes <mercedes@okiebenz.com> >>>> wrote: >>>>> >>>>> I think if that were my dr. I would fire him. >>>>> >>>>> My further thoughts: it's a localized supply/demand issue. I have a >>>> really >>>>> good internist and a super cardiologist. I am sure either one could >> earn >>>>> much more in NY or BOS. The internist's wife is also an MD and they >> each >>>>> work 3 days. The cardio is a triathlete and I'm guessing enjoys the >>>>> outdoor opportunities in the PNW. I never have trouble getting my >>>>> appointments or meds. My D-I-L on the coast has all sorts of trouble. >>>>> She's told her scrips are ready then they don't have any when she >>>> arrives. >>>>> >>>>> WRT socialized medicine: I lived in BC for 5 years and paid for >> (heavily >>>>> subsidized) BC Med. It was fine because I retained my US health >> insurance >>>>> and could easily use US services if needed. BC med actually pays for >>>>> flights into the US for some emergency services not available there, >> and >>>>> many Canadians pay in the US so they don't have to wait many months for >>>>> some procedures. I doubt that anyone who lived under socialized >> medicine >>>>> would want it in the US. >>>>> >>>>> Greg >>>>> >>>>>> What do you think about doctors these days? Are they all idiots? The >>>>>> spouse has been sick for a week, to the point she went to the ER >> Sunday. >>>>>> Has a virus and very dehydrated. ER basically did nothing. Could not >> get >>>>>> an IV and just gave up. Today she had a â?owellnessâ? visit with our >>>>>> primary care doctor. She started to discuss the test results etc from >>>> the >>>>>> visit and the huge dehydration problem but he cut her off and said >> this >>>>>> visit was only to review certain things. Basically just going over the >>>>>> most basic items. So you are in a doctors office and they ignore a >>>> glaring >>>>>> illness and say you would need to make a sick visit rather than this >>>>>> wellness visit? It would seem to this recent issue should be addressed >>>> on >>>>>> any visit including a wellness visit. I use the same doctor and >> anytime >>>> I >>>>>> want to ask about my neck problems, or anything related to my blood >>>>>> thinners he doesnâ?Tt want to discuss it, only what is on his >> simpleton >>>>>> agenda for the day. >>>>>> >>>>>> Sent from my iPhone >>>>>> >>>>>> _______________________________________ >>>>>> http://www.okiebenz.com >>>>>> >>>>>> To search list archives http://www.okiebenz.com/archive/ >>>>>> >>>>>> To Unsubscribe or change delivery options go to: >>>>>> http://mail.okiebenz.com/mailman/listinfo/mercedes_okiebenz.com >>>>>> >>>>>> >>>>> >>>>> >>>>> >>>>> _______________________________________ >>>>> http://www.okiebenz.com >>>>> >>>>> To search list archives http://www.okiebenz.com/archive/ >>>>> >>>>> To Unsubscribe or change delivery options go to: >>>>> http://mail.okiebenz.com/mailman/listinfo/mercedes_okiebenz.com >>>>> >>>> >>>> _______________________________________ >>>> http://www.okiebenz.com >>>> >>>> To search list archives http://www.okiebenz.com/archive/ >>>> >>>> To Unsubscribe or change delivery options go to: >>>> http://mail.okiebenz.com/mailman/listinfo/mercedes_okiebenz.com >>>> >>>> >>> _______________________________________ >>> http://www.okiebenz.com >>> >>> To search list archives http://www.okiebenz.com/archive/ >>> >>> To Unsubscribe or change delivery options go to: >>> http://mail.okiebenz.com/mailman/listinfo/mercedes_okiebenz.com >>> >> >> _______________________________________ >> http://www.okiebenz.com >> >> To search list archives http://www.okiebenz.com/archive/ >> >> To Unsubscribe or change delivery options go to: >> http://mail.okiebenz.com/mailman/listinfo/mercedes_okiebenz.com >> >> > _______________________________________ > http://www.okiebenz.com > > To search list archives http://www.okiebenz.com/archive/ > > To Unsubscribe or change delivery options go to: > http://mail.okiebenz.com/mailman/listinfo/mercedes_okiebenz.com > _______________________________________ http://www.okiebenz.com To search list archives http://www.okiebenz.com/archive/ To Unsubscribe or change delivery options go to: http://mail.okiebenz.com/mailman/listinfo/mercedes_okiebenz.com
