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Old 04-01-2016, 01:53 PM   #161
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I changed to Blue Cross/ Blue Shield this year and they told me that I should be able to get that information from them. I'll see.
Only once did I have an issue with BCBS billing incorrectly and that was straightened out with one phone call. Perhaps that is the rarity and not normality. Clearly, others have had less-than-positive experiences. That said I am given to understand that BCBS is not one entity, but a series of different insurance companies operating in somewhat loose formation. This could account for the wide disparity of outcomes for different people and areas.
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Old 04-01-2016, 02:50 PM   #162
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Only once did I have an issue with BCBS billing incorrectly and that was straightened out with one phone call. Perhaps that is the rarity and not normality. Clearly, others have had less-than-positive experiences. That said I am given to understand that BCBS is not one entity, but a series of different insurance companies operating in somewhat loose formation. This could account for the wide disparity of outcomes for different people and areas.
I think you're right about the variation among BCBS. Here in CA the BCBS company is Anthem.... I've heard very mixed reviews...
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Old 04-01-2016, 03:04 PM   #163
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Only once did I have an issue with BCBS billing incorrectly and that was straightened out with one phone call. Perhaps that is the rarity and not normality. Clearly, others have had less-than-positive experiences. That said I am given to understand that BCBS is not one entity, but a series of different insurance companies operating in somewhat loose formation. This could account for the wide disparity of outcomes for different people and areas.
That describes them as I know them. When I w*rked Megacorp sold software in that space. I'd met with several of the blue's technology folks to discuss system requirements, naturally a discussion of their technology stack and integration followed. As I recall most had different stacks with different 3rd party systems to supply functionality that (individual) blue bought rather than build.

It was funny to watch the true salesman. They wanted to believe as soon as they sold the first blue the rest would just follow along. Wasn't how it seemed to work.
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Old 04-01-2016, 09:07 PM   #164
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It seems as if only a very few people posting in this thread actually got shafted by their doctors, labs and hospitals regarding ridiculously high fees. Lawman (the OP) never returned to the thread, so we don't have enough info. Trawler (post 35) got jerked around for sure and I think there has to be more to Flyboy 5's story (post29). But, mostly the outrageous charges turned out to be just interesting anecdotes (as long as you had insurance).
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Old 04-02-2016, 07:58 AM   #165
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It seems as if only a very few people posting in this thread actually got shafted by their doctors, labs and hospitals regarding ridiculously high fees. Lawman (the OP) never returned to the thread, so we don't have enough info. Trawler (post 35) got jerked around for sure and I think there has to be more to Flyboy 5's story (post29). But, mostly the outrageous charges turned out to be just interesting anecdotes (as long as you had insurance).
For me, it is stressful having to worry about this possibility every time I have any medical care. Granted the outrageous stories are rare enough that people are not in the streets, but it is a very real, but unnecessary problem.
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Old 04-02-2016, 08:11 AM   #166
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For me, it is stressful having to worry about this possibility every time I have any medical care. Granted the outrageous stories are rare enough that people are not in the streets, but it is a very real, but unnecessary problem.
I agree. I am SO thankful that my health issues are mostly dealing with the occasional preventative things. No other professional services that I know of are so mysterious about costs. We've had some expensive work done to our house since we bought it last year. In no case did we ever just agree in advance to pay whatever they billed us. Nor did I have to estimate the cost of our new porch enclosure by calling the factory to get the cost of the panels, getting an estimate from the architect, calling the guys who installed it to ask what they'd charge, etc. We even got competitive bids when replacing our furnace and A/C. Radical, huh?

And, while I'm in a position where blowing through my deductible would hurt (heck, DH and I could fly to Europe in Business Class with that money), there are more people out there who'd be destroyed financially if they had to fork over the whole deductible amount. So yes, it IS stressful.
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Old 04-02-2016, 06:39 PM   #167
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The single best way of engaging in cost-conscious, self-managed care is to minimize your probability of needing it as much as possible. This comes down to diet and exercise management:

The World May Have Too Much Food - Bloomberg

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The past 40 years have seen an unprecedented increase in the number of obese adults worldwide, climbing to about 640 million from 105 million in 1975. If the current trend continues, about one-fifth of adults will be obese by 2025.
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A person who has a body-mass index higher than 30, or weighs at least 203 pounds and is 5-foot-9-inches tall, is considered obese. The world population’s average weight has increased by about 3.3 pounds (1.5 kilograms) per decade since 1975, the researchers estimate. Excess weight raises the risk of diabetes, heart disease, and other chronic conditions.

Governments need to prepare for the jump in medical costs that accompany unhealthy weight and focus on prevention now to avoid higher costs in the future, said Bill Dietz, director of the Sumner M. Redstone Global Center for Prevention and Wellness at George Washington University. “They should be as nervous as a cat on a hot tin roof about the tsunami of diabetes that’s coming their way,” Dietz said. “The cost of this rise in the prevalence of obesity is going to be staggering.”
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Old 04-02-2016, 06:44 PM   #168
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The single best way of engaging in cost-conscious, self-managed care is to minimize your probability of needing it as much as possible. This comes down to diet and exercise management

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I love that it says someone who is 5'9" and 203 is obese. We should all be obese as former NFL running back LaDainian Tomlinson, who was 5'10" and 216 officially, and unofficially over 220.
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Old 04-02-2016, 06:48 PM   #169
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Consumers Union is actively working to stop these surprise out of network bills. Article here includes some steps to take if you have been hit with an out of network charge.

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What to do if you get a surprise out-of-network bill

There's no guarantee that any of these steps will work, but you won't know unless you try. In order, you should:
  • Call the out-of-network doctor and ask for the bill to be lowered.
  • Contact your insurance company, tell it about the problem, and ask if it will use its influence with the doctor.
  • Contact your state insurance department and tell it your problem. Some states have consumer ombudsmen specifically assigned to help. "Even if they can't provide an immediate solution, every insurance department needs to be aware consumers are facing this issue," Hutson said.
  • Share your story with us. It may help to vent, and we use these stories to demonstrate to lawmakers and regulators how the problem is affecting real people.
One can also sign a petition sponsored by CU here.
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Old 04-02-2016, 06:52 PM   #170
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I love that it says someone who is 5'9" and 203 is obese. We should all be obese as former NFL running back LaDainian Tomlinson, who was 5'10" and 216 officially, and unofficially over 220.
I don't think they were referring to NFL running backs.

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The main takeaway? Excess weight has become a far bigger global health problem than weighing too little. While low body weight is still a substantial health risk for parts of Africa and South Asia, being too heavy is a much more common hazard around the globe.
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Old 04-02-2016, 07:07 PM   #171
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I don't think they were referring to NFL running backs.
True. But when someone only uses a height/weight chart to define obesity or someone's BMI, they should know the limitations of it.
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Cost-Conscious, Self-Managed Care
Old 04-02-2016, 07:40 PM   #172
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Cost-Conscious, Self-Managed Care

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The single best way of engaging in cost-conscious, self-managed care is to minimize your probability of needing it as much as possible. This comes down to diet and exercise management.

Boy, did I tick off a friend on FB awhile ago when she posted a stupid meme saying that the reason health insurance cost so much was the exorbitant salaries of insurance company CEOs. I responded that the costs of obesity are far higher-one Harvard study estimated $1.5 billion per year and that was 2009. She got really defensive.

Last night she posted from an ice cream place where she and her BF had gone for dessert after having pizza somewhere else.

I had to sit on my hands to keep from typing a reply.

It doesn't solve the cost transparency issue, though. Those of us who, through luck and discipline, are healthy, still have to deal with preventative testing and the occasional accident or disease that can strike anyone.
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Old 04-02-2016, 08:23 PM   #173
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I love that it says someone who is 5'9" and 203 is obese. We should all be obese as former NFL running back LaDainian Tomlinson, who was 5'10" and 216 officially, and unofficially over 220.

If the hypothetical 5'9" 203 lb person conducts the same physical training as Tomlinson they likely are quite healthy. If, on the other hand, they conduct the same physical training as the typical 5'9" 203 lb person (lift and press that remote, feel the burn...) yeah, they're obese.

Weight/height estimation of health are a first order screening tool. More accurate measurement of body composition can be paid for by any person the initial screen calls overweight or obese, of course. But the typical 5'9" 203 lb person likely knows that would be a waste of money in their own case.


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Old 04-04-2016, 06:22 PM   #174
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Dream with me here for a minute, people.


In my early years in the actuarial field (late 1970s), we were constantly being frustrated because we KNEW what data went into the computer, but the Keepers of the Data insisted that there was no way to get it back out again except in their canned reports. This frustration led to actuaries being generally the first to get a "minicomputer" in their department and get some of the first laptops. We finally just sucked all the data in and took charge of it. (Or, as one colleague used to say, "Just gimme the da*n data".)


Nearly every doc has a computer at his/her fingertips during an office visit. They have to, with the new laws requiring automation of healthcare data. Imagine the doc typing on the computer and saying, "well, I can prescribe Isoveltrex and your copayment would be $50 a month with your insurance, or I could prescribe Oomphimexx and you can get it for $3 at Wal-Mart for 30 days, but I've found people tend to get more stomach upset. What are your thoughts?" Or, I'd like to do a test to rule out arthritis and it will cost $500 with your insurance."


The data exists. It's just in multiple computers and multiple systems. We'd have to get many people, including competitors, playing nice together.


But wouldn't it be worth it?
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Old 04-04-2016, 06:43 PM   #175
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Dream with me here for a minute, people.


In my early years in the actuarial field (late 1970s), we were constantly being frustrated because we KNEW what data went into the computer, but the Keepers of the Data insisted that there was no way to get it back out again except in their canned reports. This frustration led to actuaries being generally the first to get a "minicomputer" in their department and get some of the first laptops. We finally just sucked all the data in and took charge of it. (Or, as one colleague used to say, "Just gimme the da*n data".)


Nearly every doc has a computer at his/her fingertips during an office visit. They have to, with the new laws requiring automation of healthcare data. Imagine the doc typing on the computer and saying, "well, I can prescribe Isoveltrex and your copayment would be $50 a month with your insurance, or I could prescribe Oomphimexx and you can get it for $3 at Wal-Mart for 30 days, but I've found people tend to get more stomach upset. What are your thoughts?" Or, I'd like to do a test to rule out arthritis and it will cost $500 with your insurance."


The data exists. It's just in multiple computers and multiple systems. We'd have to get many people, including competitors, playing nice together.


But wouldn't it be worth it?
for at least prescriptions it could also be checked on someones smart phone, as most pharmacy benefit managers tend to have that online, in particular they like to show you how much you would save by getting your drugs thru their mail order outfit.
Actually if the info was consolidated anyone with a smart phone could login to their insurance companies site, and given the procedure code and the provider be told what the cost would be with no complications.
No need for the physician to do the checking.
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Old 04-04-2016, 06:46 PM   #176
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Maybe. But I've found that with gov't, gridlock is the best people can hope for. Not being able to get things done results in less harm than actually getting things done, due to unintended or unforeseen consequences. In the scenario you describe, I can see all that data being used not to increase our personal choices, but rather to limit them. "Well, I can give you Oomphimex cheaper, but we see here that you like to have a couple of drinks at night and we don't approve, so I'm going to prescribe Isoveltrex because even though it's more expensive, it has side effects that might make imbibing alcohol uncomfortable and we can use that to drive you to behaviors that we find more acceptable." So maybe keeping the data compartmentalized is best for now.

And no, I'm not paranoid. Just experienced.
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Old 04-04-2016, 07:16 PM   #177
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Dream with me here for a minute, people.
..........
I'm with you on this. The opaqueness of the whole medical system has got to be a major driver of the high costs. Everyone from the docs to the techs to the pharmacists to the patients need to know how much things cost. And with technology as it now stands, there is no reason for it now to be readily available.
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Old 04-04-2016, 09:18 PM   #178
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Dream with me here for a minute, people.


In my early years in the actuarial field (late 1970s), we were constantly being frustrated because we KNEW what data went into the computer, but the Keepers of the Data insisted that there was no way to get it back out again except in their canned reports. This frustration led to actuaries being generally the first to get a "minicomputer" in their department and get some of the first laptops. We finally just sucked all the data in and took charge of it. (Or, as one colleague used to say, "Just gimme the da*n data".)


Nearly every doc has a computer at his/her fingertips during an office visit. They have to, with the new laws requiring automation of healthcare data. Imagine the doc typing on the computer and saying, "well, I can prescribe Isoveltrex and your copayment would be $50 a month with your insurance, or I could prescribe Oomphimexx and you can get it for $3 at Wal-Mart for 30 days, but I've found people tend to get more stomach upset. What are your thoughts?" Or, I'd like to do a test to rule out arthritis and it will cost $500 with your insurance."


The data exists. It's just in multiple computers and multiple systems. We'd have to get many people, including competitors, playing nice together.


But wouldn't it be worth it?
You're correct the data exists. You stated the issue as well the data exists in multiple different systems owned by different entities. Actually I've seen some work together too.

Brings back memories er, nightmares! I recall w*rking with about 10 different large insurance companies on a reporting solution they all wanted. They all used a system I worked on for a time. The existing method was to develop each a unique solution, they wanted our guys to develop a common solution for all. Seems simple right! After months of twice weekly calls I still couldn't get each insurance company to agree to what it was they all said they wanted! They really had 10 different ways of using similar terms to describe problems; they really had 10 different problems that sounded similar and needed 10 unique solutions.


It would be nice to use technology to make things better for consumers. In my experience insurance companies only spend money to make them be able to keep more money. What's in it for them?
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Old 04-04-2016, 11:16 PM   #179
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This post is depressing and makes me think I will never be able to retire because I will never be able to purchase a decent health insurance plan on my own. Then again, maybe my employer's health insurance plan isn't all that great, and I just don't realize it because I have not had cancer yet. BTW, I have had to deal with suprise out of network lab bills before, and also in network labs double billing. Although neither case was a catastrophe, they both were time consuming and a pain in the butt to deal with.
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Old 04-05-2016, 08:17 AM   #180
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This post is depressing and makes me think I will never be able to retire because I will never be able to purchase a decent health insurance plan on my own. .........
Look on the bright side. Not too long ago, if you had a pre-existing condition, you might not have been able to buy health insurance at all.
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