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Post by waltc on Mar 24, 2011 15:49:18 GMT -6
Denninger has a interesting opine on medical costs. I don't necessarily agree with him, but it's interesting none the less. Link: market-ticker.org/akcs-www?post=182896In it he blames the doctors for over charging. There is some truth to that. I've been hospitalized and some doctor pokes his head in for 30 seconds and I get a $3000 medical bill a month later. Another case I went to see a gastroenterologist(sp) and just a 1 minute consult with him was $270 and he tried to sign me up for one of those endoscopy procedures(both ends). All because I get terrible diarrhea from rice milk. Then again this guy ran a endoscopy factory, he was doing maybe a dozen procedures a day. In my brother's instance(he's a dialysis patient) when the nephrologist makes his rounds he charges medi-care $800 for a 30 second talk with a patient. It was even worse prior to dialysis, he was sent to one money grubbing nephrologist after another. Most were foreign born and wouldn't even talk to the patient. One even had a sign in the patient rooms that said "don't speak unless the doctor asks you a question" Oddly enough it's worst with a lot of foreign born doctors who look at Americans as cash cows to be fleeced. The worst billing practices though, come from hospitals. My brother went in for out patient surgery(replace a permacatheter). The hospital charged medicare $20,000 for a 30 minute procedure and about 2 hours in the recovery room. This didn't include the fees for the surgeon and anatheseologist(sp). My mother went to the local ER because of dehydration some time back. All they did was to replenish her fluids. Even with medi-care and HMO coverage she still got a $1000 bill.
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Post by unlawflcombatnt on Mar 24, 2011 16:12:10 GMT -6
Just make sure when you're reviewing doctor's bills, you look at what they're actually reimbursed, not what they bill.
Most doctors bill for several times what they're actually paid. There is actually some kind of Medicare formula for how much doctors should bill, related to what they actually will be reimbursed.
Also remember that how much a doctor "bills for" has nothing to do with what he'll be reimbursed. That's determined exclusively by the insurance company or Medicare. Doctors are paid a pre-determined amount for a service or procedure, regardless of how much they bill for.
For example, If I bill Medicare $80 for a $45 office visit (and Medicare agrees to pay), I'll get paid 80% of $45 dollars.
If I bill $200 for a $45 office visit (and Medicare agrees to pay), I'll still get paid only 80% of $45.
The same thing holds true for private insurance.
It's not how much the doctor bills for that counts. It's how much the insurer has pre-determined that they'll pay for a given service or procedure.
The notion that doctors are running up the cost of health care is so preposterous it's hardly worth addressing.
As I have calculated in another post, of the $2,500 billion paid out in medical costs each year, less than $100 billion goes to paying doctors. That's only 4%. If you completely eliminated what doctors are paid from entire health care system, it would reduce costs less than 4%.
In addition, aggregate reimbursements for physicians are NOT increasing, and haven't increased any over the last 10 years.
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Post by unlawflcombatnt on Mar 24, 2011 16:37:52 GMT -6
Denninger has really done a disservice to the whole debate by posting an isolated, atypical case like this. This is not just the exception to the rule. It is an extremely rare exception to the rule.
In fact, 99% of doctors are paid a pre-set, contracted rate for a given service. Doctors cannot and do not contest this rate. The negotiate it in advance and then they're stuck with it. If they don't accept it, the insurer drops them from the plan and they don't get paid at all.
The big insurers in California reimburse less for most out-of-network services.
Again, the case cited by Denninger is an extremely rare exception. Cracking down on these rare exceptions will make no measurable difference on the cost of health care, because they're as rare as hen's teeth.
Even in this case, the solution is simple. Aetna should simply contract with physicians that perform this service. It is Aetna that has the real pricing power, not the physician.
Here's one key quote from the article that sheds additional light on the subject: "Some of (Doctor) Hannallah’s patients or their employers paid higher insurance premiums for the right to use out-of-network doctors, Conroy said...."
If Aetna is going to charge higher premiums for allowing members to see out-of-network doctors, then they're going to have to pay the price.
Oh, and one more little tidbit from the article:
"Aetna’s net income rose 38% in 2010, to $1.77 billion.".
That means they either collected more in premiums, paid out less in claims, or both.
Aetna has got nothing to complain about.
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Post by jeffolie on Mar 24, 2011 17:23:38 GMT -6
Denninger has really done a disservice to the whole debate by posting an isolated, atypical case like this. This is not just the exception to the rule. It is an extremely rare exception to the rule. In fact, 99% of doctors are paid a pre-set, contracted rate for a given service. Doctors cannot and do not contest this rate. The negotiate it in advance and then they're stuck with it. If they don't accept it, the insurer drops them from the plan and they don't get paid at all. The big insurers in California reimburse less for most out-of-network services. Again, the case cited by Denninger is an extremely rare exception. Cracking down on these rare exceptions will make no measurable difference on the cost of health care, because they're as rare as hen's teeth. Even in this case, the solution is simple. Aetna should simply contract with physicians that perform this service. It is Aetna that has the real pricing power, not the physician. Here's one key quote from the article that sheds additional light on the subject: " Some of (Doctor) Hannallah’s patients or their employers paid higher insurance premiums for the right to use out-of-network doctors, Conroy said...." If Aetna is going to charge higher premiums for allowing members to see out-of-network doctors, then they're going to have to pay the price. Oh, and one more little tidbit from the article: " Aetna’s net income rose 38% in 2010, to $1.77 billion.". That means they either collected more in premiums, paid out less in claims, or both. Aetna has got nothing to complain about. I agree. My brother now has closed his medical offices and retired. He could not charge whatever he wanted and did not. Insurers rule the market according to him. Just getting hospital access for his meant lots of competition with others in his speciality resulting in insurers knocking out high charging practitioners. Denninger was wrong to villianize the doctors with atypical charges. Most of the time that I look at Denninger's rants nowadays, I merely ignore him. Sometimes his rants are great but now, not so much. For many years, I have observed his annual predictions but often find them not very useful nor more likely than a 50% chance of being correct even by his own review of his annual predictions. His swallow the kool aide defense of Japan's nuclear industry is disturbing even allowing for possible improvements in future nuclear energy designs. Hell, the residents of Tokyo just stripped the shelves bare of essentials such as rice, milk, water, toilet paper today in fear of radiaction.
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Post by waltc on Mar 24, 2011 19:32:30 GMT -6
I said I don't agree with Denninger but I've seen the bills my brother and myself have gotten and they're high as hell. It does make one question what is going on and the games unethical doctors and hospitals play in billing.
To a lot of us it's a issue. Remember 75% of bankruptcies are from medical costs. This isn't imaginary.
Jeffolie,
Denninger did a much better job covering and talking the role of nuclear power than any of the hypocritical green pukes/vultures out there that were chortling with joy over the core meltdowns.
Worse, those f**kers were out on blogs like ZeroHedge spreading lies and panic mongering like a rabid dog. They still are.
The greens were gloating over the disaster, they ignored the fact that 30,000 people died, not from radiation but from a tidal wave. Or the fact that the reactor held together with against 9.1 and was only taken out by a tidal wave that hadn't been seen in a thousand years. Not too shabby for a system that was designed in 1970.
BTW you don't see the greens bitching about the Chinese and their pollution(radiation and mercury) from coal or their sucking up Canadian tar sands which is a massive environmental disaster in itself. Screw the greens. Bunch of phonies with a hidden agenda.
Bottom line I've haven't seen squat from the green blowhards in terms of alternative energy sources as to how they'll replace the 20% of nuclear power that can provide that same amount 24hours a day. You know baseline, something solar and wind can't do.
And guess what Jeffolie, cut 20% of electrical power from the U.S. and we'll find ourselves in a 3rd world situation real fast. Rolling blackouts during the evening and peak hours 7 days a week and worse in summer months.
And how about Japan, how are they gonna get power if they don't have nuclear? Once again the Green pukes are silent.
Overall Denninger is lot more honest than the greenies who can't even debate him honestly and cut and run. Just like that phony Stoneleigh from Automatic Earth.
Engineering, ethics and basic math isn't strong point with these clowns. So all they can do is run away from guys like Denninger who ask hard questions.
In terms of predictions. I leave that to astologers and bone rollers. All humans can do is make inferences.
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Post by graybeard on Mar 24, 2011 20:53:46 GMT -6
The disconnect is billed vs. insurance/medi-scare allowed. If you don't have ins, you are stuck with the full retail bill. I understand providers' contracts with insurance mafia won't allow them to discount to the uninsured.
GB
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Post by unlawflcombatnt on Mar 25, 2011 1:58:42 GMT -6
The disconnect is billed vs. insurance/medi-scare allowed. If you don't have ins, you are stuck with the full retail bill. I understand providers' contracts with insurance mafia won't allow them to discount to the uninsured. GB Exactly right. Insurance companies have made it illegal for doctors to offer services for less to those without insurance.
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Post by unlawflcombatnt on Mar 25, 2011 2:29:56 GMT -6
I said I don't agree with Denninger but I've seen the bills my brother and myself have gotten and they're high as hell. It does make one question what is going on and the games unethical doctors and hospitals play in billing. In California, there are no games that doctors can play. They're paid a fixed amount for a service determined entirely by the insurance company. It has nothing whatsoever to do with what the doctor bills--at least in the majority of cases. If a doctor agrees to "participate" with either Medicare or a health insurance company, he agrees to accept a fixed amount for each service. And they are forbidden from balance-billing for any amount over what the insurance company determines is the right charge. For example, if a doctor bills $8K for a colonoscopy, and the insurance company only allows $800, that's the maximum amount the doctor can bill for. If the insurance company has a 20% co-pay, and thus pays only $640 for the procedure, the maximum amount the doctor can balance bill for is $160. It is a contract violation if he tries to collect more. And even more interesting is the fact that the doctor MUST bill for that $160. That's right. It is illegal for him not to bill for that additional amount. The insurance companies have incorporated this into California state law. (The insurance companies don't want patients getting medical care and not have to pay anything for it.) If, in contrast, a doctor does not "participate" in a health plan or Medicare, he can balance bill for the entire amount. But his reimbursement from the insurance company will be less--on the order of only 50-70% of the insurance-company-allowable charge. Thus the non-participating doctor gives away a much more certain 80% of the insurance company's allowable reimbursement--but can at least bill the patient for a larger amount. Doctors almost never take this latter option. Doctors rarely have the financial resources to even to try to collect enough on balance billing to offset the lower amount paid by the insurance company. What's happened in California is that many insurance companies have ratcheted down reimbursements so much that many specialists won't even see their patients. Blue Cross has successfully driven an excellent Orthopedic Surgeon--who's operated on my shoulders--out of their network by either not paying at all, or reducing contracted reimbursement. The bills you pay to your doctor are to cover not only his own income, but that of his staff--including the billers who are fighting an increasingly uphill battle to get paid for services rendered. I agree. It's not imaginary. But it's you insurance company that is causing the problem, not you doctor. Again, if you don't have insurance, the doctor is required by law to bill you for the same amount that he bills his insured patients. Which means if he's billing $400 to get paid $40 by the insurance company and $10 by the patient, he MUST bill cash patients the same $400. It's insurance companies that are creating this problem, not doctors.
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Post by jeffolie on Mar 25, 2011 13:40:54 GMT -6
My just retired doctor brother said much the same as "...It's insurance companies that are creating this problem, not doctors...." His wife continues to run an office of 4 doctors in a different field and the story is the same "...It's insurance companies that are creating this problem, not doctors....".
Yes, medical bills are the horrendously largest cause of bankruptcies, but that does not mean the doctors are unfairly causing the bankruptcies. Cutting edge medicine cost the most but you can goe live in Cuba to avoid these costs ..Cuba has a very different system where Cubans life expectancies approach Americans but their health care system spends a lot lesss. The kicker is that if you need cutting edge medical in Cuba, you most likely will not get the cutting edge medical care in Cuba. Their approach emphasizes avoiding household hazards, slips and falls, plus preventative innoculations.
In America a lot of the expensive systems costs bundle in premature babies and end of life elder intensive care type of costs. Hence, the attention to 'Death Panels' in America and other countries.
Yes, obesity caused diabetisis and/or heart and/or cancers are somewhat avoidable if we all had 'normal' body mass index weights. Obesity related medical expenses are now more common across the world including in China and India. Zealots of weight loss to reduce system wide medical expenses are numerous across the world. Each person eats and lives with the consequences pretty much and can get what they select in America as freedom to eat has not yet become a government program not matter what Michelle Obama spins with her efforts.
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Regarding Denninger...he has a retort today
Denninger's position on nuke energy in Japan does not match the reality of Japan's radioactivity. As far as Japan's immediate energy needs, most likely LNG will be used to make up the lost electricity production. The fear in Tokyo has resulted in hoarding, empty grocery shelves and a shamed government that lied and now will most likely be run out of office. America has not yet coped with the existing spent and very radioactive fuel rods already dangerously stored in pools at existing nuke energy plants that no state will allow into a new centralized storage facility. The existing spent rods issue will not disappear as their halve lifes will outlast all of us posting here.
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Post by jeffolie on Mar 26, 2011 10:02:52 GMT -6
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