Health Care Scams

[dirkterrell]

We've had some lively discussions here in the past about the rising cost of health care. Here is a good explanation of why:

http://www.market-ticker.org/akcs-www?post=183165

That's what you get when you don't have fair and open competition.

Dirk

[Ricky]

Bill for my ankle surgery came in at $24,999 (damn car salesmen), and UHC paid something like $1800 at the "contracted rate" for the procedure.

[Snowman]

How much had you paid in premiums up to the point of your accident?

What do you expect from a for profit health care system?

[Ricky]

4.5 years at about $200/mo for just me. So, about $11,000 paid in. I've been to the Dr a few times, but nothing else aside form that injury. I also paid $2000 out of pocket for that injury. Medical bills at the end were about $38,000.

[asp_125]

The ride last month in the amberlamps from the gondola to the Vail Valley Med Center was invoiced at $1K. WTF for a two mile trip? UHC paid 80%

My ankle bill was approx $31K, plus out of pocket about $3500 FWIW

[Snowman]

Bill for my ankle surgery came in at $24,999 (damn car salesmen), and UHC paid something like $1800 at the "contracted rate" for the procedure.

4.5 years at about $200/mo for just me. So, about $11,000 paid in. I've been to the Dr a few times, but nothing else aside form that injury. I also paid $2000 out of pocket for that injury. Medical bills at the end were about $38,000.

You have a fixed leg and out $13,000.
The hospital was paid $3,800 to cover the cost of the procedure.
Your insurance company made $9,200 profit.

So who has the better bean counters?

[Sean]

http://www.market-ticker.org/akcs-www?post=183165

Sorry, but this is just one sided propaganda. It's not a "scam." Scam, would imply that there are exceptions to these examples, I doubt there are. It's impossible to grasp how fucked up our healthcare system is. You can't point the finger in only one area. It's a combination of health insurance companies, hospitals, pharmaceutical companies and the decreasing health of Americans.

The "fair and open competition" commercial health insurance companies are some of the most souless, money-hungry vultures, screwing people over at any chance.

I'm not going to get into this. I post on CSC to get away from work.

[Ricky]

They make serious money off me.

I disagree that competition wouldn't help fix a bit of it. Excellent example is the competition between auto insurance companies. But profit is the main issue here. People die when other people profit.

[Snowman]

How can you compare costs vs services when you're bleeding out on the floor of an emergency room?

Last time I was put into an ambulance I wasn't asked which hospital I wished to go to, which Doctor I wanted to treat me or supplied a price sheet of their services.

[bulldog]

United Healthcare (UHC) is going to ruin the US healthcare and has already started. They have bought out almost every competing insurance (minus BCBS) and will soon regulate how all claims are paid because they will have no competition!

[Sean]

United Healthcare (UHC) is going to ruin the US healthcare and has already started. They have bought out almost every competing insurance (minus BCBS) and will soon regulate how all claims are paid because they will have no competition!

Yeah, they scare me. Don't they now own Pacificare, Secure, Evercare and tons of little (crappy) insurance companies? That only really leaves Cigna and BCBS, as major players.

[bulldog]

Yeah, they scare me. Don't they now own Pacificare, Secure, Evercare and tons of little (crappy) insurance companies? That only really leaves Cigna and BCBS, as major players.

Yup, and they just bought out Healthnet. Cigna bought Great West, so only them and BCBS are left of the major players.

My company has already lost two major contracts because UHC comes in and buys these insurance companies and voids all the contracts they had in place. They are horrible business men and it all comes down to profit to them! Very scary!!!

[Ricky]

Don't forget Kaiser... although they are in a league of their own.

Know what is great about UHC? From a patient perspective, they are awesome. They were a delight to deal with through my ordeal.

[bulldog]

Don't forget Kaiser... although they are in a league of their own.

Know what is great about UHC? From a patient perspective, they are awesome. They were a delight to deal with through my ordeal.

Kaiser may seem big, but they are really only big here in CO and CA and are only offered in a few other states.

Oh yeah, UHC knows what they are doing, which is becoming a monopoly in healthcare. Of course they are going to keep people happy and also offer the best rates to employers. Then when they have nearly the entire market they will be able to charge whatever they want and pay out doctors whatever because they won't be able to turn away all their business if everyone has UHC of a company owned by it. Plus don't forget their presence in Medicare and all their Medicare Advantage Plans they offer that is pulling in even greater numbers with all the seniors nowadays!

[Sean]

Don't forget Kaiser... although they are in a league of their own.

Not a bad ins, but way to self contained. Better than Tricare, but similar.

Know what is great about UHC? From a patient perspective, they are awesome. They were a delight to deal with through my ordeal.

1. You got pretty lucky that it was that simple. UHC (and its subsidiaries) generally deny any claims over $1000-2000. Making it a long, terrible battle for the patients and provider.

2. Dove-tailing on my last comment, they are much worse behind the curtains. It's amazing what patients never see or know about.

[dirkterrell]

Sorry, but this is just one sided propaganda. It's not a "scam." Scam, would imply that there are exceptions to these examples, I doubt there are.

Not following your logic. He's pointing out that these sorts of things are ingrained in the industry. i.e that this sort of thing is the rule rather than the exception.

It's impossible to grasp how fucked up our healthcare system is. You can't point the finger in only one area. It's a combination of health insurance companies, hospitals, pharmaceutical companies and the decreasing health of Americans.

I don't recall saying that this was the only thing but it sure is a big one. I think the basic problem is that the consumer has no real voice in the current system. We ultimately pay the costs but there is a lot of obfuscation in between, obfuscation that is designed to reduce competitive pressure towards lower costs.

Most people are tied to insurance through their employer. I have never understood why my employer should be the slightest bit involved in my health insurance. It was the first slide towards an anti-competitive system. Allowing health care providers to charge wildly different prices for the same treatment, depending on who's paying, was the second. Karl explains that once nicely here.

Dirk

[bulldog]

1. You got pretty lucky that it was that simple. UHC (and its subsidiaries) generally deny any claims over $1000-2000. Making it a long, terrible battle for the patients and provider.

I agree!!!!! Seems like it is almost common practice to deny and let you go through the difficult appeal process. So many people just pay the bill the are sent because they do not know any better.

Ugghh...don't even get started on the pharmacy companies. Medco Health (also with UHC) has now made it mandatory to use their mail order pharmacy for ALL routine drugs (meaning you refill them every month) unless you want to pay a higher cost by going to Walgreens, King Soopers, etc. So basically they can regulate which drugs/manufacturer you can use unless you want to pay their higher "tier" drugs which are not your standard $10 copay (more like five times that amount if not more). Your drug gets on UHC prefered list and BOOM, the manufacterer is in the money and another one to back their monopoly.

[Sean]

Not following your logic. He's pointing out that these sorts of things are ingrained in the industry. i.e that this sort of thing is the rule rather than the exception.

After reading the link, I felt he was going after healthcare providers fairly strongly. Not to say that providers to deserve some blame, but not the bulk of it.

I don't recall saying that this was the only thing but it sure is a big one. I think the basic problem is that the consumer has no real voice in the current system.

I wasn't responding to anything you said, more so, what was in the link. I agree that consumers have no real say in any of it. I'm not sure how we can at this point in time.

Most people are tied to insurance through their employer. I have never understood why my employer should be the slightest bit involved in my health insurance.

But you don't have to be tied through your employer, I know many that aren't. There are a lot of individual healthcare options for people out there. The option is yours.

It was the first slide towards an anti-competitive system.

I see larger companies taking over smaller ones, but that's really the only lack of competition that I'm aware of. Can you give me an example?

Allowing health care providers to charge wildly different prices for the same treatment, depending on who's paying, was the second.

There's alot that goes into this. Insurance companies generally pay a percentage of what ever the pre-agreed amount is. If you charge less, the ins company won't care and they'll pay you less for your services. If you charge more, they'll deny your claims because they are not the agreed $$ amount.

ex:
Dirk goes to hospital, whatever happens, Pacificare (Dirks insurance) is going to pay 25% of what is charged (then Pacificare encourages it's customers to go to that provider). So for a $10,000 clm, the hospital knows it's only getting $2500. If the hospital charged more (to justify dr's, facilities, medical insurance, drugs), Pacificare would not pay the claim. If the hospital charged less, they would probably get less. It's bullshit, I know that, but that's how it currently works.

As for cash discounts, the reason they give a big discount up front, is because that is probably the only way that the hospital will ever see any money. Out of 40 self-pay/non-insurance customers, a hospital will probably only get fully paid from 12-15 of them. It's the hospital's way of trying to make people have insurance, so they'll get some money from providing the services. Hospitals lose a lot of money on people without insurance. Especially through programs like WeCare and CICP.

I'm not justifying any of this, just stating how one hospital works.

[dirkterrell]

But you don't have to be tied through your employer, I know many that aren't. There are a lot of individual healthcare options for people out there. The option is yours.

You don't have to be but the premiums will be significantly higher on the individual plan, factors of several in many cases. It might even be financially impossible. Why should the cost of insuring me be determined by deals struck with my employer? That situation leads to people's losing coverage when they change jobs. I don't have to worry about my car insurance if I change jobs. Why should I have to worry about losing health insurance?

I see larger companies taking over smaller ones, but that's really the only lack of competition that I'm aware of. Can you give me an example?

That's the heart of it. Because insurance companies work deals with employers rather than employees, through financial pressures they can more easily corner the market. If I had a dozen companies to choose from, you can bet overall costs would be lower because they would have to answer to the real threat that I would take my business somewhere else. Competition among health care providers would also force downward pressure on costs. If my doctor said "I'm going to bill you $60,000 for a $74 ultrasound." I'd say "No thanks. I'll shop around."

Dirk goes to hospital, whatever happens, Pacificare (Dirks insurance) is going to pay 25% of what is charged (then Pacificare encourages it's customers to go to that provider). So for a $10,000 clm, the hospital knows it's only getting $2500. If the hospital charged more (to justify dr's, facilities, medical insurance, drugs), Pacificare would not pay the claim. If the hospital charged less, they would probably get less. It's bullshit, I know that, but that's how it currently works.

Yes, and it's what needs to change. Currently they can shift those costs on to someone else via a specific legal exemption from what in every other field is against antitrust laws.

As for cash discounts, the reason they give a big discount up front, is because that is probably the only way that the hospital will ever see any money. Out of 40 self-pay/non-insurance customers, a hospital will probably only get fully paid from 12-15 of them. It's the hospital's way of trying to make people have insurance, so they'll get some money from providing the services. Hospitals lose a lot of money on people without insurance. Especially through programs like WeCare and CICP.

And other sorts of social engineering experiments that have led to the mess we are in. When there is no penalty for not being responsible for your own well-being, a large fraction of people will mooch off the rest of society. Healthcare is just one example. The outrageous deficit spending by the federal government driven by the fact that Social Security, Medicare, Medicaid, Unemployment and Welfare consume every single penny of federal tax revenues, is going to drive us right into the wall. The chickens are finally coming home to roost.

[rforsythe]

The ride last month in the amberlamps from the gondola to the Vail Valley Med Center was invoiced at $1K. WTF for a two mile trip? UHC paid 80%

Sounds about right. It costs a lot of money to operate an ambulance even when everyone pays, which a lot of people don't. This leaves the insured subsidizing the freeloaders and "treat and release" calls. Mountain/rural EMS also costs more to operate in general for a number of reasons, so that trip charge is going to be higher than if you called from the middle of the city.

[modette99]

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[Sean]

You don't have to be but the premiums will be significantly higher on the individual plan, factors of several in many cases. It might even be financially impossible. Why should the cost of insuring me be determined by deals struck with my employer? That situation leads to people's losing coverage when they change jobs. I don't have to worry about my car insurance if I change jobs. Why should I have to worry about losing health insurance?

It does kind of make sense. If employers are going to contribute and/or pay for health ins, they should get a say in what plan you get. And it's completely possible to get your own insurance. It's not cheap, but completely possible. Kaiser and BCBS have some individual plans for people who are self-employed or don't want there companies health plan. But sure, the employer is always going to get better rates because like anything else, there's strenght in numbers.

That's the heart of it. Because insurance companies work deals with employers rather than employees, through financial pressures they can more easily corner the market. If I had a dozen companies to choose from, you can bet overall costs would be lower because they would have to answer to the real threat that I would take my business somewhere else. Competition among health care providers would also force downward pressure on costs.

It just doesn't work that way with health insurance companies. I bet I could get you close to a dozen different individual plans today, and there are multiple places where you can be provided health service, unfortunately it doesn't drive the cost down. Wher you are currectly located, there are options for different insurance and healthcare providers.

When there is no penalty for not being responsible for your own well-being, a large fraction of people will mooch off the rest of society. Healthcare is just one example.

Hospitals try to go after the money. My hospital works with many collection agencies and tries hard to hold people responsible, but it just doesn't pan out most of the time.

The outrageous deficit spending by the federal government driven by the fact that Social Security, Medicare, Medicaid, Unemployment and Welfare consume every single penny of federal tax revenues, is going to drive us right into the wall.

Have you ever seen the pay scale for Medicare/Medicaid? They sure as shit aren't paying there cash to hospitals/doctors! It may go somewhere else, I have no idea, but not to facilities. Medicare usually pays about 10% of whatever is charged. The rest is a write-off to the provider. Most hospitals lose money everytime they care for medicare/medicaid patients. I'm not saying that they aren't dirty bastards, but I don't know where all of the funding goes.

[modette99]

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[dirkterrell]

It does kind of make sense. If employers are going to contribute and/or pay for health ins, they should get a say in what plan you get.

But my basic point is "Why should they be involved in the first place?" In the short term, say back in the 1950s, in made sense to offer such things to employees. But longer term, it became a nightmare. Look at GM. They manufacture vehicles. That is the business they are in. But what they became was essentially a huge health insurance and pension provider, and without robbing taxpayers to bail them out, they would have gone under, largely because of those liabilities. Companies need to focus on what they do. Let employees focus on taking care of themselves, vis a vis health insurance and retirement.

It just doesn't work that way with health insurance companies. I bet I could get you close to a dozen different individual plans today, and there are multiple places where you can be provided health service, unfortunately it doesn't drive the cost down.

Of course it wouldn't because the system is dominated by the cost-shifting that is allowed.

Hospitals try to go after the money. My hospital works with many collection agencies and tries hard to hold people responsible, but it just doesn't pan out most of the time.

That's because the federal government, in its typical "put the load on someone else" approach has mandated that care be provided no matter what. If hospitals could say "No insurance. No treatment." a lot of this would disappear. Now, before the predictable crowd screams about the morality of that, let me say that the response is the formation and funding of private hospitals by those who wish to enforce that morality. I would (and do) support hospitals like that and I would be able to vote with the only thing of real power, my money, in response to the way I see the operation run. With taxation, I have essentially no say and people are free to game the system as much as they like.

Have you ever seen the pay scale for Medicare/Medicaid? They sure as shit aren't paying there cash to hospitals/doctors! It may go somewhere else, I have no idea, but not to facilities. Medicare usually pays about 10% of whatever is charged. The rest is a write-off to the provider. Most hospitals lose money everytime they care for medicare/medicaid patients. I'm not saying that they aren't dirty bastards, but I don't know where all of the funding goes.

And that's PRECISELY why I am against government intervention in something that citizens themselves ought to run. If I saw massive waste and fraud in a private hospital I donated to, I could stop supporting it. But with taxes, I have no such choice and without that pressure, fraud and waste will naturally grow. Politicians are supposed to do that, but corporate interests and the politicians have destroyed that check. The politicians get us, the citizens, arguing about whether to vote for someone based on whether they believe in the right version of god rather than the things like this that really matter, so we keep voting the same lying jackasses back in. It's on track to do us in, and that's a real shame because we have so much potential as a nation.