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

Nov 1, 2024
7:34:22am

tamasiaina Contributor

submit to insurance companies. Meaning that they order the services, procedures, etc. in a certain way to maximize the bill and the reimbursements that they submit to the insurance companies depending on the contracted rates.

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tamasiaina

Bio page: tamasiaina
Joined: Sep 17, 2011
Last login: Nov 1, 2024
Total posts: 464 (0 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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