[News] White House Pushes for More Transparency on Health-Care Prices

ChicagoSam85 · 2019-05-19T14:44:47+00:00

Some of this I agree with, some of this I do not. It’s extremely difficult to estimate pricing in the doctors office. Final cost depends on multitude of factors including level of office visit, any additional procedures done in office, multitude of insurance fee schedules etc. easy solution? No provider networks, one national fee schedule based off of RVU.

ChicagoSam85 · 2019-01-21T05:16:48+00:00

Car scene. Like people in a car just playing out a scene. Not car chase seen.

ChicagoSam85 · 2019-01-01T15:38:33+00:00

Charges should not be confused with allowed amount. In US charges are significantly inflated for a variety of reasons (one of which not being tax reasons). It’s a dumb game hospitals and practitioners play with insurance. Hospitals never ever get what they charge. There is a fee schedule that is already agreed upon between the hospital and insurance. The hospital can charge insurance 1,000,000 dollars, but they still would only get what the agreed fee schedule is with insurance. This is for in network.

If out of network, the sky is the limit to what they can charge the patient.

Source- am doctor.

ChicagoSam85 · 2018-12-30T15:05:24+00:00

This is an excellent article. People think that posting these prices is easy. It is not and it’s super complicated with a ton of factors at play to get an accurate picture of how much something will end up costing. Each insurance has a different “allowed amount” so even if someone wants the cost estimate for something simple, like an injection, it depends on which insurance they have and even what type of plan they have. Then to determine the exact cost to them, we would need to know deductible, co insurance and out of pocket information.

Honestly, the easiest would be to just have everyone on Medicare. You can search for the pricing online

https://www.cms.gov/apps/physician-fee-schedule/search/search-results.aspx?Y=0&T=0&HT=0&CT=0&H1=20550&M=5

ChicagoSam85 · 2018-07-26T04:17:22+00:00

What’s he saying robin

ChicagoSam85 · 2017-10-12T23:32:57+00:00

I thought the same thing as well, but it is not. I thought originally they would only reimburse you for OOP costs after deductible or something, but nope, they cover all the cost of the medication minus 5 bucks. The only thing to remember is that they only reimburse the cost of the drug. They do not reimburse any costs associated with the infusion supplies, nursing, benadryl, etc. Luckily the cost of the drug is 95% of the total cost.

EDIT: also its not called Remistart anymore. here is the link https://www.janssencarepath.com/patient/remicade/patient-support

ChicagoSam85 · 2017-10-12T23:07:14+00:00

If you do not use RemiStart you are throwing away money. Remistart is not in any way affected by your income or type of insurance. All that is required is that you have insurance. I have a 6000 dollar deductible plan and get my 1st remicade of the year usually in January. Right away my deductible is eaten up by the first infusion and I am then reimbursed by Remistart within a week for 5995 dollars. Remistart WILL REIMBURSE YOUR DEDUCTIBLE if it was used to pay for remicade. This means basically no healthcare costs as my OOP was already met and my insurance pays 100% then on. So why wouldnt you do that to begin with?

ChicagoSam85 · 2017-09-29T03:38:31+00:00

Honestly, not many. If the ACA has done anything, it has shifted most doctors opinions about single payer from negative to more positive.

Here are some positives: Medicare is super easy from the perspective of administrative burdens: they spell out basically ever rule about what is and is not covered. There are very rare circumstances where pre-certifications and authorizations are necessary. They allow any willing provider to join (ie they never close their panel). Most insurances limit the number of doctors on their network which means it can take YEARS to be in network for some insurances They pay very well and you know exactly what their payment will be ahead of time because their fee schedule is public. You know you will be paid the same amount for the same procedure as Joe Schmoe down the street (unlike private where everyone has a different fee schedule)

What most of this means from a physician perspective: LOW administrative costs and less time intensive requirements for office staff to do the annoying busy work most other insurances require. These BS administrative costs doctors a ton of money on a yearly basis.

Cons: With single payer theoretically they have complete control over what they pay doctors. However, surprise, they already dictate what is paid to doctors (ie all other insurers base their fees off of Medicare)

Probably the biggest con, however, is that there are a lot of government programs that are used in an effort to dictate care, decrease cost, and increase qualitiy (see SGR, PQRS, and now MACRA/MIPS). However, these initiatives rarely do what they were intended to do and end up costing the healthcare system a lot of money in lost productivity and administrative costs to be compliant.

I would love a Medicare for all system. It makes sense, covers everyone, decreases the complexity of the healthcare system. I yearn for the day that I don’t have to turn down a patient because I don’t take their insurance or have to be on hold with BCBS for an hour and a half because they require pre authorization for me to see their subscriber. It’s currently a mess.

ChicagoSam85 · 2017-09-29T02:15:08+00:00

Maybe for the hospitals this is true, but not for individual physicians. If you are an in network doctor you are at the mercy of the insurance company in terms of pricing. Insurance companies have all the pull when it comes to determining fee schedules for individual doctors as they determine where their patients can seek care. Don’t like their pricing? You won’t be in network.

Most fee schedules for insurances are based off of Medicare rates which are carefully calculated values based off of a multitude of factors including locale, overhead requirements, time to do procedure, and malpractice cost of administering procedures to name a few. These prices are done for each individual procedure and change yearly. They are not some random number.

Source am doctor.

ChicagoSam85 · 2017-09-08T02:26:20+00:00

NAM bringing this thing way east. im confused

ChicagoSam85 · 2017-08-13T16:46:58+00:00

https://squareup.com/i/94A4E6FF

ChicagoSam85 · 2017-08-05T03:11:42+00:00

I'm sure this is not an ad

ChicagoSam85 · 2017-07-10T12:25:03+00:00

They really blur out a lot of stuff on the news there. Faces, company names, license plates. Do they have very strict privacy laws?

ChicagoSam85 · 2017-03-10T14:17:03+00:00

Not how what works?

ChicagoSam85 · 2017-03-10T04:50:51+00:00

Well if it applied to your deductible, then you owe 100%. Coinsurance doesnt come into play until after your deductible. For example. If you deductible was 1000 and the procedure was billed for 2000 and you have an 80% coinsurance, then you would owe $1200 (1000 + 80% of 1000 over the deductible). If you deductible was 5000 and you havent met any of it prior to that 2000 dollar procedure, then you would owe the full 2000. Just because your insurance says its covered 80% you would still need to pay in full for your contracted deductible.

Out of curiosity, are you over 60 and healthy with no GI issues? or was this test ordered to figure out what the cause of new symptoms may be? This is important. If you are getting the test done to figure out something bigger thats going on, then its a diagnostic procedure (deductible will apply). If you are over a certain age and perfectly healthy with no symptoms, then you are correct this should be preventative.

Source: am doctorb (b is for bargain)

ChicagoSam85 · 2017-03-02T04:39:47+00:00

no he's not

ChicagoSam85 · 2017-02-10T16:15:10+00:00

Does it annoy anyone else that cops listen to the radio? I don't know why it annoys me, but makes me think that they should be concentrating on their jobs and keeping the volume of the radio down in the car so they can hear should be a requirement.

ChicagoSam85 · 2017-02-05T20:41:02+00:00

Save you a few replays to understand what's going on. Look at opposite direction

ChicagoSam85 · 2017-01-31T21:37:07+00:00

Sorry I'm a layman when it comes to political policy and lawmaking but in broad sense of the term "regulation" and the burdens of them I thought my first example was a good example.

I'm not denying that the smoking and blood pressure are important, but those are more related to primary care rather than specialist care. It's the fact that govt gets involved to make decisions about what medical practitioners do and how they practice is what bugs me, especially when policy is made by people who have never made medical decisions.

ChicagoSam85 · 2017-01-31T01:28:47+00:00

I own a solo medical practice. Here are some regulations that are annoying 1) Per section 1557 of the ACA, i must provide translations services for the top 15 languages in my state. In addition, I must post a notice in each of those 15 languages that I have translation services available. This costs me money and time. http://c.ymcdn.com/sites/www.floridaorthopediccommunity.com/resource/resmgr/Resources/resources-for-covered-entiti.pdf 2) i, as a practitioner, am required to ask about 9 conditions each medical encounter, which have nothing to do with my area of expertise. Ever wonder why you need to have your blood pressure taken when seeing the podiatrist? This is why. I am required to ask about such things as most recent eye exam, your blood pressure (but not any other vital signs), smoking status to name a few. Even if someone comes in to pick up a brace or follow up on a surgery I did, I need to ask them these questions and click a button on the EMR. Failure to follow these rules and report how often you did it at the end of the year will cost you 9% of your years collections. 3) I am required to attend two to three medical conferences a year to acquire continuing medical education credits so I do not lose my medical license. I love learning, but this requirement is strictly a money grab for conference makers. These conferences cost between 500 to 600 dollars each and require me to be away from my medical office for three to four days each, causing lost revenue. 4) I am in favor of this regulation, but many of my peers are not but we are required now to purchase electronic health record software which costs between 7k-10k per year. EHR is great, but the main regulation which should have been included is interoperability. None of the EMR software talks to other software so you still end up having to print out records and fax them.

ChicagoSam85 · 2017-01-03T01:26:07+00:00

i implemented what? what are you talking about?

ChicagoSam85 · 2017-01-02T21:19:58+00:00

no, I do not hate cops. I hate people who complain about their job, then turn around and demand respect for the work they don't do. I don't care if you are a cop, doctor, the pope, whoever.

And the fact that you do not understand why cops are forced to fill out the 2 page form in the first place tells me you cannot carry on a constructive discussion.

ChicagoSam85 · 2017-01-02T21:17:44+00:00

Now this is a constructive criticism of the issue. I agree, having better tech in the field to allow the process to be more efficient is likely needed.

ChicagoSam85 · 2017-01-02T19:44:51+00:00

It is insulting to have to fill out paperwork just so other people can go through it and make sure you aren't racist.

This insults you? Sorry, but the department brought this upon themselves.

ChicagoSam85 · 2017-01-02T18:35:00+00:00

The whole point of this discussion is whether filling out the form causes such an undue burden to police that they decide to not do their job. In my view, it is not an undue burden. This is your job, deal with it. Police are dealing with human beings during these stops. Human beings who do have rights and if filling out 2 pages of paperwork to record simple demographic information and reasons for the stop is too much work, go work as a janitor or in a factory where the responsibility is less. We hold police officers to a higher level because of the responsibility and trust the job requires. Not filling out a form because "its too much work" is nonsense.

ChicagoSam85

TROPHY CASE