Healthcare

[TheVictors]

This past week was a good firsthand experience for me and since my Dad's battle with Leukemia I haven't been as directly involved, but how things have changed ....and no, it's not Obamacare.

The cost of the procedure as well as the ER visit deductible we're far more expensive than had this happened in December (or in 2013 at all), but that is the way it is and the people have spoken. Given my experience as a well-to-do white guy at a fine Hospital, it makes me shudder when thinking about how some might be treated at rural/urban hospitals and without some of the same resources ...because I would rate my experience as a "B" at best.

The docs and nurses were great, almost to a person. The Billing people on the other hand, I'd like a few minutes with in a locked room after I am back to full strength.

I got two Robo-calls from billing last week before ever hearing from a Doc or nurse about the surgery. Billing took my credit card and processed payment before the surgery as is "policy" I was told. After all that, I arrived at the surgical center to be told I hadn't yet paid and would have to pay then, before they would admit me.

"I'm pretty sure I already paid last week."
"Well I'm not showing that and if you did, we will just refund one of the charges ...oh, and this doesn't cover the anesthesiologist or the post-op, just today."

"Oh good, and I wrote my CC # on my ass in sharpie marker in case you need to charge me while I'm under or in case you wanted to order lunch in for the office."

Humorless robot kept on about sign this/that

No wonder people are cynical about healthcare - it's clear the patient comes after the money and the people staffing these medical billing roles are right out of central casting.

Just got a survey to complete about my "experience" too ....just like Marriott does after a hotel stay.

 

[Michchamp]

yeah... medical billing sucks.

we were at Northwestern hospital in Chicago for a few months of Champ Jr.'s term. while we eventually switched because the doctors were TERRIBLE... almost equally annoying at the time was that they had sent us to a collection agency because we didn't pay their first bill for service within 30 days, which seemed insane to me. normally I pay part of it, and wait to pay the rest, since insurance adjustments affect what you owe, and in my experience it takes a while before both of these parties sort their end out and then tell you what you owe.

in some cases the actual medical professionals may be competent, but the non-medical staff are retarded. still... it's fair to blame the professionals because they're the ones who hired them and don't seem to give a shit that their employees sent you someone else's medical records, scheduled you for the wrong date, screwed up your billing, etc.

you make a good point though; we were lucky in that we just switched to a better hospital. If we were in a rural area, or without health insurance, etc. we'd be screwed.

 

[TheVictors]

While laid up yesterday I was watching a "COPS-like" show called Vegas Strip. The cops stopped some 19yr old hooker and were trying to talk her out of her lifestyle. They asked what she wanted to do and she said 'do something in medical.'

Bingo.

I think it is an erosion of quality at the lower levels and increase in red tape for the Docs combining into crap. Quality Docs gets chased off or become staff for the Kaisers of the world just to pay off med school bills. The billing is just downright intentionally confusing. You get crap from the Ins company in the mail - "this is not a bill" and then get something from the docs office that states the bill but isnt a bill .....then you somehow missed a bill.

 

[tinselwolverine]

in some cases the actual medical professionals may be competent, but the non-medical staff are retarded. still... it's fair to blame the professionals because they're the ones who hired them and don't seem to give a shit that their employees sent you someone else's medical records, scheduled you for the wrong date, screwed up your billing, etc.

If by "professionals" you mean the medical professionals hiring the non-medical staff, this probably isn't the case.

There's a whole profession of hospital administration (or it's call healthcare management) that has nothing to do with practicing medicine; but rather running a healthcare facility. Typically this person, or in conjunction with the HR department, is going to hire both the medical professionals AND staff; and naturally as it is in any business, their purpose is to maximize the profitability of the facility.

Obviously, keeping costs down is part of maximizing profits, and part of keeping costs down is keeping remunerations down.

The administrator is a person that a patient is very unlikely to ever talk to or have any direct dealing with.


Many hospital staffers don't get paid a lot of money; including staffers in the billing department.

The head of the department likely has a degree in accounting, but a patient is generally never gonna talk to that person either.

The person you talk to doesn't know much about what they're doing and they don't really have to; billing is done through a computer program and whomever you talk to is just going to tell you what the computer came up with.

And that's just the way shit goes.

I go to UCLA North in Westlake Village. I started going there when my doctor of many years in the Valley ended up there.

I would never, ever go anywhere where I had to part with a dime or had to give anyone my credit number during the visit unless it were a nominal co-pay that I was aware of before going in.

 

[Sbee]

I had this discussion with a friend recently, they talked about how much of a train wreck the federal government was and how he didn't want them messing with healthcare, to which I respond

Are you ever confused by your explanation of benefits? you may owe this? your provider may bill you X?

How about your deductible? in network vs out of network? what % do you owe before and after your deductible has been met?

baby Sbee spent two weeks at Mott with a major kidney problem, underwent a 6 hour surgery at 6 months old. The bills kept coming, some small, some a few hundred dollars, some for a few thousand. I called billing for explanations and it didn't make much sense but I just paid, assumed they were doing it right.

Government may be a train wreck but medical billing now is awful.

 

[tinselwolverine]

Government may be a train wreck but medical billing now is awful.

Medical billing isn't going to get any better under The Affordable Care Act.

Except for the expanding role of Medicaid, it's still private insurance with the same players and the same healthcare facilities.

 

[Michchamp]

If by "professionals" you mean the medical professionals hiring the non-medical staff, this probably isn't the case.

There's a whole profession of hospital administration (or it's call healthcare management) that has nothing to do with practicing medicine; but rather running a healthcare facility. ...

good point. though I still would kinda fault a doctor for working in a bad hospital. and of course, in private practice, they hire those staffs directly, but generally, doctor's offices don't screw up as bad as hospitals do.

...

baby Sbee spent two weeks at Mott with a major kidney problem, underwent a 6 hour surgery at 6 months old. The bills kept coming, some small, some a few hundred dollars, some for a few thousand. I called billing for explanations and it didn't make much sense but I just paid, assumed they were doing it right.

...

as much as it pains me to say it, I've heard Mott is pretty terrible. one of my good friends is a child psychiatrist; he went to Mott for a fellowship, and hated it. he said it was terribly managed, and he couldn't believe some of poor treatment he saw them provide patients. basic stuff like reading a patient's chart was often neglected. Mott seems to be leeching off the UM brand

we felt the same way at Northwestern in Chicago... the doctors would be looking at their watches, doing the bare minimum to bill insurance. they told my wife once to "google it" when she asked some questions... and a couple times she had to remind doctors of things that were in her chart. they hadn't freaking read it beforehand. when we switched to a hospital in the burbs, it was a night-and-day difference. we would get thorough explanations of medical opinion, along with reasoning of why they thought the way they did. We were fully informed of all the choices we had for delivery. was great.

 

[tinselwolverine]

good point. though I still would kinda fault a doctor for working in a bad hospital...

Hospital billing departments suck. It doesn't matter if it's Johns Hopkins or The Mayo Clinic, or if it's Detroit St. Johns or Chicago John H. Stronger Jr.

I just got a bill from UCLA that was a whole bunch more than it was supposed to be; it was just my annual physical that's supposed to be covered under our Wellness Plan (I didn't go to UCLA hospital for my physical, but most likely the billing is all done at UCLA in Westwood) but it was processed incorrectly.

No biggie, it's going to be adjusted and resubmitted and I'm in no hurry to pay anyway.

 

[TheVictors]

Insurance bills are intentionally confusing to the point it isn't always clear which oage follows which and oftentimes, different sections begin on one page and conclude on another and never seem to simply summarize charges. The elderly in particular are probably the most easily confused butits hard to keep straight no matter.

And baby Victors had a seizure at 1-2yrs and went to the ER in an ambulance. We got bill after bill after bill for that and cant say whether we were double or triple charged - there was no "bill" after Ins deductible, just a litany of mailings (which in and of themselves drive up costs).

So far I am out of pocket

$200 for ER deductible
$200 for crutches
$182 for my boot/cast
$782 for the surgery

After the other bills trickle in, I'm guessing $2000-$2500 out of pocket..?

 

[biggunsbob]

Medical billing....

Fuck them all....

Jab my eye with a ice pick....I hate them all and it is the reason I support insurance or everyone under some sort of national health care platform..Which is the same for everyone and it is non profit.... Some day probably 50-500 years from now we will be a nation that cares for one and other instead of just billing it out to the next stiff.

 

[Michchamp]

Insurance bills are intentionally confusing to the point it isn't always clear which oage follows which and oftentimes, different sections begin on one page and conclude on another and never seem to simply summarize charges. The elderly in particular are probably the most easily confused butits hard to keep straight no matter.

And baby Victors had a seizure at 1-2yrs and went to the ER in an ambulance. We got bill after bill after bill for that and cant say whether we were double or triple charged - there was no "bill" after Ins deductible, just a litany of mailings (which in and of themselves drive up costs).

So far I am out of pocket

$200 for ER deductible
$200 for crutches
$182 for my boot/cast
$782 for the surgery

After the other bills trickle in, I'm guessing $2000-$2500 out of pocket..?

what was shocking to me was the difference between what they billed the insurer initially and what the insurance eventually paid. my doctor friend explained that the first bill is usually just what the doctor/hospital thinks they might get away with, then the insurers negotiate them down. then you pay whatever portion you're required too.

 

[tinselwolverine]

what was shocking to me was the difference between what they billed the insurer initially and what the insurance eventually paid. my doctor friend explained that the first bill is usually just what the doctor/hospital thinks they might get away with, then the insurers negotiate them down.

Yes. This is the way it works.

It is standard and customary business practice.

 

[biggunsbob]

Again why does a middle man get a cut in healthcare?
When did this practice start?

 

[tinselwolverine]

Again why does a middle man get a cut in healthcare?
When did this practice start?

What middle man are you talking about?

 

[Gulo Blue]

What middle man are you talking about?

Obama.

 

[TheVictors]

There are many middle men ....

 

[tinselwolverine]

Obama.

Oh.

Well in that case, to answer Bob's question, this practice started this past January 1st.

 

[Sbee]

good point. though I still would kinda fault a doctor for working in a bad hospital. and of course, in private practice, they hire those staffs directly, but generally, doctor's offices don't screw up as bad as hospitals do.



as much as it pains me to say it, I've heard Mott is pretty terrible. one of my good friends is a child psychiatrist; he went to Mott for a fellowship, and hated it. he said it was terribly managed, and he couldn't believe some of poor treatment he saw them provide patients. basic stuff like reading a patient's chart was often neglected. Mott seems to be leeching off the UM brand

we felt the same way at Northwestern in Chicago... the doctors would be looking at their watches, doing the bare minimum to bill insurance. they told my wife once to "google it" when she asked some questions... and a couple times she had to remind doctors of things that were in her chart. they hadn't freaking read it beforehand. when we switched to a hospital in the burbs, it was a night-and-day difference. we would get thorough explanations of medical opinion, along with reasoning of why they thought the way they did. We were fully informed of all the choices we had for delivery. was great.

we had a great experience at Mott, i thought the docs and staff were great, the only bad thing is that our room faced the big house. all joking aside it was an emotional experience, one night i was staying with my son and they invited all parents for pizza in a conference room. you saw parents there with their kids that were going through chemo, burn victims, etc, really bad stuff. it makes you realize how lucky you are, we were there for a bad infection and corrective surgery but after a few days we knew he'd be ok afterward.

as far as what your buddy says, cant say i agree but he's obviously more in the know, i'm just the father of a patient and I thought the experience was great. My wife and I support Mott with monthly donations and attend fundraisers (including the infamous Dhani Jones incident). My son has a toy in his room with a big block M on it from Mott.

 

[Sbee]

what was shocking to me was the difference between what they billed the insurer initially and what the insurance eventually paid. my doctor friend explained that the first bill is usually just what the doctor/hospital thinks they might get away with, then the insurers negotiate them down. then you pay whatever portion you're required too.

I think it's pre-negotiated yearly, they show you the MSRP of the procedure basically but nobody pays that (unless you pay out of pocket).

 

[TheVictors]

However it is negotiated, a line item bill shows the truth -- a 600mg dose of Ibuprofen administered in an Ambulance costs $58 or something ridiculous. A lot of charges, IMO, are cloaked in CYA diagnosing ...just to be sure let's go ahead and run the labs and take another xray, just to be thorough (and add a but more to the bill)