Bunny Trails

[Judas Maccabeus]

I think some people are far too close to this situation to fairly evaluate medical system which has just critiques of it.

Covid death being linked to money on the other hand... I have no opinion different then JM due to lack of knowledge.

Oh, there are plenty of just criticism. I know I guy who got excluded from medicare for waste and abuse. He was putting in stents when there really was no indication. They don't need the standard they need in a criminal trial for this, just preponderance of evidence. Last time I heard from him, he was in Japan. The risks of putting in codes that don't apply is just too great. And if you are hourly, absolutely no incentive. Most of us do not get paid be the charges we put in, but by the hour.

Frankly, having worked in a social medicine context in the past, I can see the advantages of that system. FAR less administrative overhead, and in a non fee for service context, less incentive to do unnecessary service.

J.M.

[Josh]

I have little pity for the heathcare industry that makes massive amounts of money and often overpays their staff while building and renovating millions of dollars of facilities just to convince the rich to go there. There is still a massive amount of deaths each year from healthcare mistakes. Doctors and self important nurses are not God. I will not worship them, but challenge them. I have found many lacking.

Yes, this is all because of capitalism, but the other side is they have to accept the fall when it happens. One can not gain the benefits of the good times and just ignore the struggles of the bad times. Only banks get to do that now.

I suppose you seek out hospitals with old and obsolete facilities and that that underpay their staff?

If you want to follow the money, look no further than the insurance industry. Last time I looked, they just moved money around, and took a rather hefty cut to do it.

J.M.

Stop repeating this slander. Since the ACA became the law of the land, insurers are required to pay out at least 80% of their premiums in claims. Insurers are the only people doing anything to control costs. Providers just bill crazy high amounts, and then claim their charge master is some very special trade secret (despite California requiring charge masters to be public info, and it not hurting hospital bottom lines at all there).

Some insurers in other fields such as auto do such a good job with investments they actually pay more out in claims than they collect in premiums.

[Josh]

Off topic, so I will carry this no further, but this is why I am not so blinded by medical personnel.

https://mymedicalscore.com/medical-error-statistics/

Medical billing errors cost Americans $210,000,000,000 annually.
Roughly 12,000,000 Americans are misdiagnosed each year.
Medical errors cause an estimated 250,000 deaths in the United States annually.
As many as 80 percent of medical bills contain at least one error.
A little more than 4,000 surgical errors occur each year.
It’s estimated that 7,000 to 9,000 patients die every year from medication errors.

Some studies indicate that death from medical errors could be even higher due to the way medical errors are reported on death certificates—with as many as 440,000 people dying every year from medical errors. The number of deaths caused by medical errors is far too high.

Those aren't "medical billing errors" That is just outright fraud. It it was just random "error then the over-charges would be balanced out by under-charges and the net cost to Americans would be $0 and not $210 billion. That is systematic and fraudulent overcharging. There is no "error" involved at all.

Back when I worked with this kind of thing, Ohio’s Medicaid system was estimated to be around 15% fraud - and apparently that was better than the average for other states.

Unemployment fraud has been a huge deal in 2020. WA state lost $600 million; California lost billions. Most the money disappeared to Eastern Europe, Russia, Nigeria, and other places where you can be sure that money won’t be being returned to its rightful owners.

[Josh]

There is no incentive to modify a cause of death, so unless you have something better than "i heard this from some doctor" please stop repeating this, as you are accusing people who are trying to take care of you of dishonesty. This should not happen, so unless you have some kind of real evidence, other than rumor, please stop.

If someone does have evidence (not hearsay) of a falsified cause of death, please contact jahertz. He has been looking for documentation, or someone he can discuss this with firsthand, for six months or so. Last I heard, he has not yet been able to track down a single verified source.

Nobody who values keeping their job is going to discuss intentional “billing errors” with some third party they don’t know.

[Ken]

Off topic, so I will carry this no further, but this is why I am not so blinded by medical personnel.

https://mymedicalscore.com/medical-error-statistics/

Those aren't "medical billing errors" That is just outright fraud. It it was just random "error then the over-charges would be balanced out by under-charges and the net cost to Americans would be $0 and not $210 billion. That is systematic and fraudulent overcharging. There is no "error" involved at all.

Back when I worked with this kind of thing, Ohio’s Medicaid system was estimated to be around 15% fraud - and apparently that was better than the average for other states.

Unemployment fraud has been a huge deal in 2020. WA state lost $600 million; California lost billions. Most the money disappeared to Eastern Europe, Russia, Nigeria, and other places where you can be sure that money won’t be being returned to its rightful owners.

Robert was talking about hospitals defrauding patients by deliberate over-billing.

You are talking about doctors and other providers defrauding Medicaid and other insurance programs through fraudulent billing.

As for stuff like unemployment fraud. That is partly due to the fact that states have let their computer systems atrophy over they years and have ridiculously archaic systems. But also due to the fact that we have no secure form of national IDs or secure methods to verify ID online. So ID theft is rampant and it complicates everything from government services, taxes, voting, and everything you do online.

[Robert]

Robert was talking about hospitals defrauding patients by deliberate over-billing.

I was not focusing on overbilling or fraud, but deaths PER YEAR from medical mistakes. Billing is bad, but deaths are real bad.

[ohio jones]

There is no incentive to modify a cause of death, so unless you have something better than "i heard this from some doctor" please stop repeating this, as you are accusing people who are trying to take care of you of dishonesty. This should not happen, so unless you have some kind of real evidence, other than rumor, please stop.

If someone does have evidence (not hearsay) of a falsified cause of death, please contact jahertz. He has been looking for documentation, or someone he can discuss this with firsthand, for six months or so. Last I heard, he has not yet been able to track down a single verified source.

Nobody who values keeping their job is going to discuss intentional “billing errors” with some third party they don’t know.

How did the subject change from a misrepresented cause of death to billing errors? He's looking for family members of the deceased, not necessarily medical personnel, in an attempt to establish that there are actual cases, not merely urban legends.

[Judas Maccabeus]

I suppose you seek out hospitals with old and obsolete facilities and that that underpay their staff?

If you want to follow the money, look no further than the insurance industry. Last time I looked, they just moved money around, and took a rather hefty cut to do it.

J.M.

Stop repeating this slander. Since the ACA became the law of the land, insurers are required to pay out at least 80% of their premiums in claims. Insurers are the only people doing anything to control costs. Providers just bill crazy high amounts, and then claim their charge master is some very special trade secret (despite California requiring charge masters to be public info, and it not hurting hospital bottom lines at all there).

Some insurers in other fields such as auto do such a good job with investments they actually pay more out in claims than they collect in premiums.

You actually prove my point here. That 20% they take IS part of the problem. No other industrialized society would put up with this. Common estimates for Medicare range between 3% (From it's advocates) to 5.5% from it's detractors, still it is better than 20%. Remember, that 20% (or 15% percent, I will gladly concede) does not go to treating a single patient, paying a single bedside nurse, or buying needed medication. It goes to maintaining an administrative machine that frequently PREVENTS good care. Care denied drops to the bottom line.

I am sure you know what a "Pre-auth" is, for others it is the insurance company deciding what treatment you can have, regardless of what your doctor thinks. Denials, and hence denial of good care are far too frequent. I will not give you examples from my professional life, but I will give you one from my personal life instead.

One of my friends from the mission field had symptoms of trigeminal neuralgia. Tests confirmed this, his neurologist wanted to refer him for surgery. Preach was declined, and the insurance mandated treatment with medication and PT instead. Neurologist tried again, after this had failed for 3 months, then again at 6. Denied. Fortunately, his wife was Austrian, and had residency in Austria. Got on a plane, got an appointment at the teaching hospital. Diagnosis, trigeminal neuralgia, he said he told them about the treatment he had in the states. Answer-"That will never work, you need surgery." Was booked in 3 weeks, and the surgery relieved his symptoms.

So if you think our system is wonderful, and that the insurance company will cover what you need, think again. Care denied drops to the bottom line, in other words becomes profit.

I could say more about "charge masters" but I don't want to confuse the issue.

J.M.

[Outsider]

I don't really want to get into it here, but as medical costs (and let's add educational too) are a nation-wide discussion, I'd like to point out that the AMA had a great deal to do with the creation of the "insurance model" of medical payment- to the point of threatening the medical licenses of doctors who opted for doctor-side co-opts (where doctors made a set wage, then split the corporate dividends at the end of the year, and patients paid a monthly fee to access all the services they needed). Doctors made more from the "insurance model". Education costs also went through the roof with federal student loans coming onto the scene- along with the propagandistic trope that "everyone needs a college education". Professors can make several hundreds of thousands of dollars a year nowadays.

Just thoughts.

[Josh]

You actually prove my point here. That 20% they take IS part of the problem. No other industrialized society would put up with this. Common estimates for Medicare range between 3% (From it's advocates) to 5.5% from it's detractors, still it is better than 20%. Remember, that 20% (or 15% percent, I will gladly concede) does not go to treating a single patient, paying a single bedside nurse, or buying needed medication. It goes to maintaining an administrative machine that frequently PREVENTS good care. Care denied drops to the bottom line.

+/- 20% does not make a big impact in care. It's 20%.

I am sure you know what a "Pre-auth" is, for others it is the insurance company deciding what treatment you can have, regardless of what your doctor thinks. Denials, and hence denial of good care are far too frequent. I will not give you examples from my professional life, but I will give you one from my personal life instead.

Myself and one of my close friends have a couple pre-auths out on us. Doctor's office requested it, it got approved within a day or two, prescription filled.

Same story for a neurological MRI. Insurance preauth was the easy part. Hard part was finding a provider who could take an appointment. Ended up waiting 4 months to get an appointment (an earlier one got cancelled because the whole office was closed due to COVID.)

One of my friends from the mission field had symptoms of trigeminal neuralgia. Tests confirmed this, his neurologist wanted to refer him for surgery. Preach was declined, and the insurance mandated treatment with medication and PT instead. Neurologist tried again, after this had failed for 3 months, then again at 6. Denied. Fortunately, his wife was Austrian, and had residency in Austria. Got on a plane, got an appointment at the teaching hospital. Diagnosis, trigeminal neuralgia, he said he told them about the treatment he had in the states. Answer-"That will never work, you need surgery." Was booked in 3 weeks, and the surgery relieved his symptoms.

So if you think our system is wonderful, and that the insurance company will cover what you need, think again. Care denied drops to the bottom line, in other words becomes profit.

This is the exact opposite of how insurance works, with care management being a large focus in insurers to try to control costs to avoid very expensive hospitalisations. Of course, since your background is providers, I can see that you can see insurers as a fountain of evil and providers as pure and righteous, but this is a vast oversimplification of the situation. My work with care management revolved around making sure people who were diabetic, etc. got regular visits from an (insurance company employee) nurse for follow up care to avoid hospitalisations or death - both of which are very expensive for insurers.

I could say more about "charge masters" but I don't want to confuse the issue.

J.M.

Why do hospitals and other providers keep them a secret? California forced them to be public record, and it seems to be working fine there. From my point of view, hospitals want to charge outrageous prices and then collude with large insurance companies on pricing, and rip off everybody else. Neither providers nor insurers are innocent in this.

They should post exactly the prices they charge for various services, patients should know what they are expected to pay, and it would be clear and transparent what insurance pays or would not pay. Medicare and Medicaid patients would continue to not have to pay anything if they are covered. This is how insurance works with things like auto body shops. I don't see why medicine is so different.