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Thread: Ill tell you why people want natl health care...

  1. #81
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    I know that, but thats part of the problem in my opinion. When you take away free market controls the consumer has as they do in any other business, and then allow hospitals to charge whatever they want its no surprise people don't pay the bills.

    My $140 month Time Warner Cable bill as itemization down to the last cent. You'd think a $7300 bill would be able to do that, and that people would be able to know what they are getting into not weeks later. Its important to me to know what Im paying because not only have I heard from several people the bills are often wrong but we have a family friend who works at a local hospital, and has told us in the past to always check the bill. That many times they will charge for services and doctors visits that never happened, ect.

    Im not disparaging doctors and nurses. My wife is in home health nursing field, and is working and going to school right now. Its all the laws, administrators, politicians, companies, and others that have got us to this point.

    I have an appointment on Wednesday with a GI doc, and he does HALF price visits for cash patients.....

  2. #82
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    Quote Originally Posted by lanesmith View Post
    The federal EMTALA (Emergency Medical Treatment and Active Labor Act) prevents us from offering a price list to most patients presenting to the emergency department. That is to say, we are required to provide a medical screening exam (which may include physical examination, lab tests, and any necessary imaging tests) to identify an emergency medical condition (any illness that risks life/limb or organ function) to any person requesting care. Allowing state malpractice laws to regulate the quality of the exam, EMTALA is vague about what that exam includes for a particular complaint, and only says that the exam must be fairly consistent with common practice for similar situations (i.e. I can't order a bunch of tests for the insured but only a few tests for the uninsured).

    We must then stabilize any found emergency condition which may include admission to the hospital or transfer to an appropriate higher level of care. Although EMTALA allows us to collect billing information while the evaluation and stabilization is taking place, we cannot require payment or use previously unpaid bills as an excuse delay or stop the evaluation. This point is very important - we cannot delay the exam to collect billing information without being in violation. EMTALA has gone so far as to say that any hospital behavior that might discourage an uninsured person from seeking care such as publishing high costs or even encouraging excessive wait times (i.e. closing beds when staffing is available so that uninsured elope without care) is a violation. There have been instances of hospitals being in violation for publishing inaccurately long wait times (i.e. we can't seen you for 4 hours when the wait is actually 1 hour).

    Therefore, we would be committing a violation to present you with a cost menu and withholding the exam while you decide what tests you want. That single violation is at least $50K and may threaten the providers ability to participate in Medicare/Medicaid - essentially ending their career in medicine. EMTALA violations come out of the doctors pocket and are not covered by malpractice insurance.

    In your case, you presented with severe abdominal pain which opens the door to any number of emergency conditions such as appendicitis, abdominal aortic aneurysm, hollow viscous perforation, acute cholecystitis, etc. The hospital staff is then required to perform a medical evaluation that at most institutions will require labs, likely some imaging, and medications. Had the hospital presented you with a cost list and then waited for you to decide, they would be guilty of an EMTALA violation for delaying your medical screening exam. While the waiver that you describe may afford some state malpractice coverage, it offers no federal EMTALA protection for the providers.

    If people with libertarian beliefs don't like this law and want to be consistent with their beliefs, then stop going to emergency departments for problems that have been brewing for weeks. Instead, save your money and go get the tests you need through a clinic that can offer a price list because they are not subjected to EMTALA. If you can't afford one of these clinics, then you should have made some better choices with your life and I'll see you on the other side. People who use the ED for their convenience are supporting an unconstitutional law and contributing to the rising costs of healthcare.
    Excellent explanation for those who don't know what EMTALA means. I would only add that after our ED docs diagnose and provide initial stabilization, those of us who deal with emergent conditions are not in position to provide a price list with projected survival rates depending of extent of medical care chosen by a patient. We're legally obligated to provide an accepted standard of care irrespective of ability to pay; in my case, under the pressure of ticking clock. I've been doing what I do for a few years now and I am yet to see a patient who asked to see a menu for a heart attack treatment.

  3. #83
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    Write them a certified letter with a copy of their statement telling them you reject this and don't owe them anything. Tell them that if they have itemized proof of the debt you'd be willing to pay them. But that until they send you an itemized bill you don't owe them a thing. A statement is not a bill. It is merely a statement of account.

    (I'd also try and tell them that you will pay them at whatever discount they offer to the insurance companies)


    Quote Originally Posted by Belmont31R View Post
    So I got my bill today. $7300, and due date is on the 26th of this month. Statement date is the 16th. No itemization of costs at all.





    Just called the hospital, got transferred to billing, and all that number does is go to a pre recorded message saying you can pay it online.
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  4. #84
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    Quote Originally Posted by Redmanfms View Post
    That isn't entirely true, because most people never see the actual rate the insurance company is paying.
    Sure they do (after the fact). You should get an EOB (Explanation of Benefits) for every insurance claim that is submitted by the doctor/hospital/caregiver. On that EOB it will show the original billed amount and the accepted amount that they actually paid according to their agreed upon fee schedules.

    For example: say you get billed $100 for an exam of some sort by the physician. You get a bill from the physician with this amount, but the physician submitted it to the insurance company. The insurance company looks up the codes the doctor used to describe the exam, finds out that their fee scheduled they have agreed with the physician says that code is worth $60. So they send $60 to the physician, or send back the claim to the physician to say that is only worth $60 but you have not reached your deductible yet, so to send the bill to you for $60 (not $100), or they might send $48 and tell the physician to bill you $12 as you are on a 20%/80% plan. The EOB will say how much the insurance says can be charged for that service according to agreements, and how much of that amount is the patients responsibility.

    After a while, you will get an updated bill from the physician showing the total bill was really $60 and a $40 "medical writeoff" or some other term to show what they wrote off due to insurance contracts. It will also show what they received from the insurance company and what you have left to pay.

    Also, most insurance doesn't let you simply walk in to any healthcare provider and seek treatment, they have lists of plan providers with whom the company has negotiated a "group rate" of sorts. Buying in bulk counts in the medical world too. Doctors are usually more willing to work out lower rates that are still profitable for them since they are so used to uninsured folks stiffing them and being massively underpaid by Medicare/aid.



    It sucks that government manipulation has brought us to this, but that is simply the way it is.

    BTW, no offense, but even as a young relatively healthy man, you're being stupid not having insurance. Had I not had insurance a couple years ago when I had a serious bout of kidney stones my bill for the surgery to remove a 9.2mm stone that was blocking my ureter would have been nearly $30,000 (and that's what the insurance company was billed, might have been even more if I was uninsured).

    Given this experience and that bill, you might consider investing in some insurance and chalk it up as a "teachable moment."
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  5. #85
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    Quote Originally Posted by BrianS View Post
    Best way to do it is to get catastrophic insurance so you get the negotiated prices for services and drugs with a really high deductible through your insurance and then put the savings between the cost of that and regular insurance into a health care savings account. I ended up saving several thousand dollars a year going to catastrophic only.
    +100000

    We have this sort of insurance (actually a pretty good version of it that pays for some preventative things up front) provided by my wife's job. They actually pay 100% of the premiums for us for this high deductible type plan. We could pay extra if we wanted the standard "maintenance plan" low deductible / copay type insurance but that would be several hundred dollars a month that we would have to pay. Instead, we take that money and put it into an HSA that we keep and administer. When we have a medical expense we pay for it out of the HSA. Only twice have we reached the deductible: once with a new baby and then last year where we had both an expensive ambulance ride and ER trip for my daughter, for what turned out to be a one-time febrile seizure related to a high fever she had (no neurological cause), and I broke my ankle and had an ER trip plus surgery -- all this in the same year, plus a couple hundred $ for the wife to check up on some things.

    So, since we usually don't meet the deductible, we usually end up paying 100% of most things (some preventative checkups are included as are most vaccinations so they pay up front for a few small things), but we get the negotiated low insurance rates and we save hundreds of dollars a month on insurance costs that go into our HSA instead which is our money. And since most years we don't have that much medical anyway, we would end up paying out of pocket for most of it anyway since even the low deductible plans have a deductible of like $500/person or $1000 or $1500 a family anyway (numbers from memory and could be off by hundreds of $) and so we with a normal "maintenance plan" type health plan, we would be paying hundreds of dollars in premiums each month and end up paying most of our medical anyway due to deductible, even when low compared to our catastrophic plan.

    So yes, for most people, the catastrophic type high deductible plan with payments into an HSA make way more sense than the normal copay/low deductible/high premium plans you normally see and people are used to. Even those times we hit the deductible or otherwise had very large medical expenses compared to normal, I figured out we broke even more or less once I subtracted out the savings we have monthly on premiums and then compared what was left with the high priced / low deductible plans deductible anyway.

    I am convinced that the healthcare costs in the country would go drastically down if most people adopted a high deductible plan and HSA instead of the low deductible high premium plan they have now. Especially if things could be streamlined where they could avoid having to submit the claims to the insurance company first and just bill you the insurance rate up front and you pay it from the HSA and get a receipt, that you can use later if you need to by getting up to the deductible.
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  6. #86
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    Quote Originally Posted by Belmont31R View Post
    My wife has two kinds of insurance and my kids have insurance. Just not me.
    You are more than paying for a high deductible catastrophic plan for yourself with this one incident.

    Take this as a lesson and go find yourself a high deductible, catastrophic plan and pair it with an HSA. (Better yet, see if you can get something for the whole family that you can roll your other wife and kid plans into)

    Next time this happens, your bill will probably be 1/2 or less (my whole broken ankle with ER visit, drugs, CT scan, many Xrays, physician bills from ER visit, doctors office followups, plus same-day surgery at the hospital, so more physician, anesthesiologist, drug, xray tech, and hospital OR fees, plus medical appliances (crutches, big boot thing) etc. cost me about $2850 or so, not including PT rehab, and the insurance company ended up paying a couple thousand I think, since we hit the deductible AND The max out of pocket because of some other issues in the same year. All $2850 came out of our HSA which had money in it that we saved instead of paying for high priced low deductible insurance)

    (The PT rehab was a good deal as well. I had 22 visits at $20 a visit without insurance involvement because this office was not signed up with this insurance company, though their main office was, so they agreed to see me for just what a normal co-pay would have been -- they offered to see me for just the co-pay and I explained I did not have a co-pay on my insurance [it is strict 20%/80% after deductible until you hit max out of pocket] so we agreed to the $20 average co-pay)

    What my pontification comes down to: go get yourself on a catastrophic type plan and you will probably end up saving money in the long run since you get the lowered insurance negotiated rates and if you have a real catastrophe, you get coverage once it gets ridiculously priced. This one bill of yours would probably have been enough less to pay for such a plan, ie, it probably would have paid for itself on this one trip.
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  7. #87
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    Quote Originally Posted by YVK View Post
    Excellent explanation for those who don't know what EMTALA means. I would only add that after our ED docs diagnose and provide initial stabilization, those of us who deal with emergent conditions are not in position to provide a price list with projected survival rates depending of extent of medical care chosen by a patient. We're legally obligated to provide an accepted standard of care irrespective of ability to pay; in my case, under the pressure of ticking clock. I've been doing what I do for a few years now and I am yet to see a patient who asked to see a menu for a heart attack treatment.
    Good point. I get a few patients asking me how much something will cost. This often happens when people with potentially serious symptoms (i.e. chest pain) and need a significant number of tests or observation admission. Only the hospital financial aid counselor (who works bankers hours) has access to this information on the spot.

    On a related note, there is a growing trend where emergency departments provide a medical screening exam, and require a co-pay or flat fee if the problem does not meet the emergent criteria. This has taken hold in some busy ERs where a physician is placed in triage or at the entrance podium to see everyone as they enter to better identify subtle presentations of serious illness and reduce the number of people who elope from the waiting room without being seen. If the patient has trivial symptoms (such as dental pain, uncomplicated back pain, common cold, or ankle sprain), the physician can perform a quick screening exam to rule out serious conditions and then require payment for any further treatment since a reasonable exam failed to find a serious illness. Usually, the fee is about $250.

    This can be an effective tool to redirect non-emergent patients to less expensive venues for their care. Not surprisingly, this strategy is most effective for the Medicaid patients who represent the largest growth in ER volumes. These Medicaid patients have no co-pay and get no bill for their ER services. They have every incentive to use the ER which will generally see them quickly rather that wait a week for a primary care appointment. Unfortunately, very few places are doing this due to a variety of liability and public relations concerns.

  8. #88
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    imo, the bigger picture & bottom line is it's about control & ingress to RFID chipping that they want to do for control/tracking/monitoring. That is the end game make no mistake regarding the intention or direction under the guise & curtain of your welfare etc. The rest is all Political Prestidigitaion & drama all purposely done at a high rate of speed currently.

    Make no mistake, the Wolf is at the door.

  9. #89
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    Quote Originally Posted by HOPLOETHOS View Post
    imo, the bigger picture & bottom line is it's about control & ingress to RFID chipping that they want to do for control/tracking/monitoring. That is the end game make no mistake regarding the intention or direction under the guise & curtain of your welfare etc. The rest is all Political Prestidigitaion & drama all purposely done at a high rate of speed currently.

    Make no mistake, the Wolf is at the door.
    Huh? Who wants to do RFID chipping?

  10. #90
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    Hmac writes: Huh? Who wants to do RFID chipping?



    It's all there hidden in the contents of bill etc. It's purposely obtuse & vague. Of course most people today are Zombies and not paying attention. The dumbing down of our society. People would rather watch Ray Jay, Basketball Wives, Housewives of Whatever shithole etc.

    If you actually take some time to watch people going about their lives most have no clue. Sad in reality. Interesting times ahead count on it.

    H.R. 3200 section 2521, Pg. 1001, paragraph 1.
    The Secretary shall establish a national medical device registry (in this subsection referred to as the ‘registry’) to facilitate analysis of postmarket safety and outcomes data on each device that— ‘‘is or has been used in or on a patient; ‘‘and is— ‘‘a class III device; or ‘‘a class II device that is implantable, life-supporting, or life-sustaining.”

    What exactly is a class II device that is implantable? As you saw earlier, it is the device approved by the FDA in 2004.

    Federal Food, Drug, and Cosmetic Act:
    http://www.fda.gov/downloads/Medical...andGuid…


    Medical devices incorporating RFID
    In 2004, the FDA authorized marketing of two different types of medical devices that incorporate radio-frequency identification, or RFID. The first type is the SurgiChip tag, an external surgical marker that is intended to minimize the likelihood of wrong-site, wrong-procedure and wrong-patient surgeries. The tag consists of a label with passive transponder, along with a printer, an encoder and a RFID reader. The tag is labeled and encoded with the patient's name and the details of the planned surgery, and then placed in the patient's chart. On the day of surgery, the adhesive-backed tag is placed on the patient's body near the surgical site. In the operating room the tag is scanned and the information is verified with the patient's chart. Just before surgery, the tag is removed and placed back in the chart.


    The second type of RFID medical device is the implantable radiofrequency transponder system for patient identification and health information. One example of this type of medical device is the VeriChip, which includes a passive implanted transponder, inserter and scanner. The chip stores a unique electronic identification code that can be used to access patient identification and corresponding health information in a database. The chip itself does not store health information or a patient's name.

    http://www.knowthelies.com/?q=node/4880

    Surely you can't be that naive to think that that will not be modified/ratified by an Executive Order or Super Congress ?

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