CMS/govt decided that there should be different reimbursements for hospitals

Nov 1, 2024
8:36:01am

cougfanz All-American

for the same services that can be provided in an outpatient setting.

This was one of the main driving forces that destroyed private practice, allowing hospitals to buy out such practices to consolidate all services under their umbrella.

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cougfanz

Previous username: ndfan
Bio page: cougfanz
Joined: May 15, 2011
Last login: Nov 1, 2024
Total posts: 18,783 (1 FO)

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Messages

Author

Time

Got two bills for the SAME medical service (routine x-ray), one is 10x the other

Bobber Contributor

7:03am

And where I live the hospital is functionally a monopoly. We could drive

AggieWeekendCougar

7:12am

There's no free market if consumers don't know prices upfront. We need laws--providers claim "we can't tell you because

Sunflower

7:13am

And, they could at least tell you the maximum they would possibly try to bill you (before insurance adjustments).

Sunflower

7:16am

No they wouldn’t, because they don’t own the facility/hospital, don’t own the

cougfanz

7:19am

Two simple things would help immensely:

Schultz is back

7:32am

All I know is that there’s not going to be one piece of legislation that

cougfanz

7:38am

The hierarchy in medicine:CMS>Insurance>hospital admin>>>>>>doctors>patients

Powerbait DPM

7:44am

The back and forth between insurance and medical providers is crazy at times

NYC and Japan

9:13am

Why are car repairs not nearly so insane on this point?

Mitty

9:57am

Not nearly the regulations as medical

NYC and Japan

10:05am

And get rid of the in-network out-of-network monopoly crap, allow people to shop

Mitty

9:56am

You mean in-cartel, out-of-cartel, right? 😃

Bobber

10:00am

If none of their "employees," as you call them, can charge for any service unless the price is upfront, I'm sure they

Sunflower

8:23am

Why not require insurance companies to publish their rates since they set the

Powerbait DPM

8:36am

I own my own practice. I’ll tell you how it works.

Powerbait DPM

7:32am

Are you saying the specialist who referred me to the hospital got a 10% kickback for the referral?

Bobber

7:56am

cougfanz

7:57am

No, that’s highly illegal. That specialist likely had no idea how much it would

Powerbait DPM

7:59am

So certain medical systems out there have optimized billing rules that they

tamasiaina

7:34am

With imaging there are 2 components that are bulked: the technical fee that pays for the acquisition of

Littlerich

7:38am

It's the same CPT code in both cases

Bobber

7:52am

It’s “place of service” that changes it. It costs more because its at the

Powerbait DPM

8:19am

What exactly are they billing? Not just the cpt code?

Littlerich

8:33am

CMS/govt decided that there should be different reimbursements for hospitals

cougfanz

8:36am

So hospitals make more $$$ from the same insurance for the same service?

Bobber

9:09am

Yes. And the trend in medicine has been for hospitals to buy up free-standing

EQD2

9:14am

If that isn't govt putting their "thumb on the scale" I don't know what is

Bobber

10:04am

Hospital lobby...

cougfanz

11:16am

Just did walk in service for a broken bone at a large network clinic.

DirtyWater

7:42am

People don't understand how hospital based medicine is one of the

EQD2

7:44am

This is the problem with PRE-PAID healthcare under the guise of insurance. If it

Benfica1

9:14am

Isn't this basically the goal of high deductible plans?

NYC and Japan

9:23am

Yes. Unfortunately, all plans combine to skew the costs of healthcare.

Benfica1

10:49am

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