Join Early Retirement Today
Reply
 
Thread Tools Display Modes
Old 11-05-2018, 09:16 AM   #61
Moderator
sengsational's Avatar
 
Join Date: Oct 2010
Posts: 10,656
Quote:
Originally Posted by MichaelB View Post

One of the issues we (collectively) are dealing with now is many health care providers apply billing codes that generate the most revenue for the visit, not necessarily the actual service that was provided. The billing code system is so complex it is not realistic to expect patients to navigate and challenge.
Billing for something that wasn't performed is fraud, and should be reported to your state's attorney general. Of course they'd say it was just a mistake, but if enough people report them, they'd have a hard time claiming so many mistakes that went in their favor.
sengsational is offline   Reply With Quote
Join the #1 Early Retirement and Financial Independence Forum Today - It's Totally Free!

Are you planning to be financially independent as early as possible so you can live life on your own terms? Discuss successful investing strategies, asset allocation models, tax strategies and other related topics in our online forum community. Our members range from young folks just starting their journey to financial independence, military retirees and even multimillionaires. No matter where you fit in you'll find that Early-Retirement.org is a great community to join. Best of all it's totally FREE!

You are currently viewing our boards as a guest so you have limited access to our community. Please take the time to register and you will gain a lot of great new features including; the ability to participate in discussions, network with our members, see fewer ads, upload photographs, create a retirement blog, send private messages and so much, much more!

Old 11-05-2018, 09:28 AM   #62
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
SecondCor521's Avatar
 
Join Date: Jun 2006
Location: Boise
Posts: 7,865
Quote:
Originally Posted by MichaelB View Post
One of the issues we (collectively) are dealing with now is many health care providers apply billing codes that generate the most revenue for the visit, not necessarily the actual service that was provided. The billing code system is so complex it is not realistic to expect patients to navigate and challenge.
MichaelB, can you point me to the data that demonstrates your first statement?

I agree that the billing code system is very complex. I don't think it was made complex in order to facilitate billing fraud; I am not sure if you are implying that or not. Personally I think it was made complex because medicine and the human body is complex and because the health care and health insurance industry want to collect more data in order to provide care more cost effectively.
__________________
"At times the world can seem an unfriendly and sinister place, but believe us when we say there is much more good in it than bad. All you have to do is look hard enough, and what might seem to be a series of unfortunate events, may in fact be the first steps of a journey." Violet Baudelaire.
SecondCor521 is offline   Reply With Quote
Old 11-05-2018, 09:59 AM   #63
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
ivinsfan's Avatar
 
Join Date: Feb 2007
Posts: 9,953
I'm not MichaelB but I took his statement to mean there are so many codes to describe basically the same service that the default is to look for and select the most expensive one that might apply rather then the least expensive one that might apply.

For example my DH was on blood thinners for awhile and used the INR clinic, which is staffed with RN's but the bill always got through as a short office visit with a doctor he's never seen in his life..we got a Medicare questionnaire asking us to rate the doctor...LOL
ivinsfan is online now   Reply With Quote
Old 11-05-2018, 10:07 AM   #64
Administrator
MichaelB's Avatar
 
Join Date: Jan 2008
Location: Chicagoland
Posts: 40,586
Quote:
Originally Posted by SecondCor521 View Post
MichaelB, can you point me to the data that demonstrates your first statement?

I agree that the billing code system is very complex. I don't think it was made complex in order to facilitate billing fraud; I am not sure if you are implying that or not. Personally I think it was made complex because medicine and the human body is complex and because the health care and health insurance industry want to collect more data in order to provide care more cost effectively.
I didn’t say the billing system was made complex to enable fraud. As you point it, it is complex by nature. Still, there is little doubt that some providers exploit the billing complexity to further increase their revenues by up-billing, which is very difficult to prove in any specific case but easier to identify by group behavior. ProPublica has published a lot about this, here is one example.
https://www.propublica.org/article/s...-office-visits
Quote:
As it stands now, doctors and their staffs decide how to bill for a patient visit based on a host of factors, including how thoroughly they review a patient’s medical history, the intensity of the physical exam and how complicated the medical decision-making was. The coding system developed by the American Medical Association gives doctors five options.
In addition, hospital are now engaging in wildly abusive and mostly uncontrolled overbilling. By overbilling, I mean charging more than the reasonable and customary price. That is the thread topic, and there cannot be any doubt.

Sarah Kliff has been working on a fascinating project to document actual hospital bills and analyze the results. This is quite difficult because of privacy laws. Here’s a write-up. https://www.cjr.org/q_and_a/sarah-kliff-vox.php
Quote:
IT STARTED WITH A BAND-AID. A $629 Band-Aid.
MichaelB is online now   Reply With Quote
Old 11-05-2018, 10:55 AM   #65
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
SecondCor521's Avatar
 
Join Date: Jun 2006
Location: Boise
Posts: 7,865
Quote:
Originally Posted by MichaelB View Post
I didn’t say the billing system was made complex to enable fraud. As you point it, it is complex by nature. Still, there is little doubt that some providers exploit the billing complexity to further increase their revenues by up-billing, which is very difficult to prove in any specific case but easier to identify by group behavior. ProPublica has published a lot about this, here is one example.
https://www.propublica.org/article/s...-office-visits


In addition, hospital are now engaging in wildly abusive and mostly uncontrolled overbilling. By overbilling, I mean charging more than the reasonable and customary price. That is the thread topic, and there cannot be any doubt.

Sarah Kliff has been working on a fascinating project to document actual hospital bills and analyze the results. This is quite difficult because of privacy laws. Here’s a write-up. https://www.cjr.org/q_and_a/sarah-kliff-vox.php
MichaelB, thanks for the reply.

The first article you linked showed a total of 1,825 health care professionals who statistically appear to be engaged in fraud and probably are.

The first Google result I found for "How many health care professionals are in the United States" gave a link to the CDC and the number of 18 million: https://www.cdc.gov/niosh/topics/hea...e/default.html

1,825 / 18 million = 0.0001014 or 0.01014 percent.

Health care professionals obviously includes nurses and others who may not be responsible for coding and billing.

I agree that there is fraud in medicine, just like any other field. Your previous post could have been read to mean that the problem was widespread or systemic. I'm not sure if that's what you meant, but I don't think I would agree.

I'll look at the hospital article as well.
__________________
"At times the world can seem an unfriendly and sinister place, but believe us when we say there is much more good in it than bad. All you have to do is look hard enough, and what might seem to be a series of unfortunate events, may in fact be the first steps of a journey." Violet Baudelaire.
SecondCor521 is offline   Reply With Quote
Old 11-05-2018, 11:30 AM   #66
Administrator
MichaelB's Avatar
 
Join Date: Jan 2008
Location: Chicagoland
Posts: 40,586
SecondCor521, it was never my intent in either post to suggest fraud is rampant or the primary cause of high medical billing. It is also not trivial, despite your math. Medical coding is a black hole, and the evidence of abusive hospital bills is too overwhelming to give the benefit of the doubt to the service providers. The links in my previous post were not intended to quantify the entire scope, just give examples.

The thread is about outrageous prices. Among the reasons we don’t have more examples are privacy laws and secrecy pact and practices. There is still enough documentation to see this as a highly complex pervasive issue that is, if anything, growing in scope.
MichaelB is online now   Reply With Quote
Old 11-06-2018, 04:51 PM   #67
Full time employment: Posting here.
 
Join Date: Aug 2017
Location: claremont
Posts: 586
I try to get a quote in advance and shop the business around for elective stuff.
indiajust is offline   Reply With Quote
Old 11-06-2018, 07:19 PM   #68
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
JoeWras's Avatar
 
Join Date: Sep 2012
Posts: 11,701
Quote:
Originally Posted by MichaelB View Post
S Medical coding is a black hole, and the evidence of abusive hospital bills is too overwhelming to give the benefit of the doubt to the service providers. The links in my previous post were not intended to quantify the entire scope, just give examples.
Some of these codes now have modifiers. This is one place where confusion and possible mischief is occurring. Or, the person doing the coding simply always gives the "level 4" modifier because that's what they've always done, not knowing why.

This article gives a good example: https://www.vox.com/policy-and-polit...emergency-room


Quote:
What jumped out at Peterson was that her emergency room would charge different prices for her follow-up visits. To her, the visits all seemed the same: a quick stop by the emergency room to receive a shot of the rabies vaccine.
But sometimes her visits were billed with a “level 1” facility fee, the cheapest fee for the simplest visits. But another visit was coded as “level 2,” which came with a higher price. And still another was “level 4,” typically reserved for some of the most complex visits.
“Every time, the fee was different,” Peterson says.
JoeWras is offline   Reply With Quote
Old 11-07-2018, 02:26 PM   #69
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
MRG's Avatar
 
Join Date: Apr 2013
Posts: 11,078
Just had a small example of the insanity. A couple weeks ago I was given a holter monitor to wear for a week by my in network cardiologist.

When I packed it up to return it, I noticed a pamphlet about billing issues and the network they're in. Well go figure, they have cardiologists and they're in some networks not others.

Today my health insurance denied their claims. Wow, $5,500 that is all out of network! The pamphlet said, call us about billing issues. The gal told my they'd would make an appeal. I asked about appealing out of network, as I certainly wasn't paying that price. "Oh don't worry sir, the maximum we charge you is $255." WTx?
MRG is offline   Reply With Quote
Old 11-07-2018, 02:45 PM   #70
Recycles dryer sheets
 
Join Date: May 2014
Posts: 412
Quote:
Originally Posted by MichaelB View Post
In addition, hospital are now engaging in wildly abusive and mostly uncontrolled overbilling. By overbilling, I mean charging more than the reasonable and customary price. That is the thread topic, and there cannot be any doubt.

Sarah Kliff has been working on a fascinating project to document actual hospital bills and analyze the results. This is quite difficult because of privacy laws. Here’s a write-up. https://www.cjr.org/q_and_a/sarah-kliff-vox.php
The article above starts with a "$629 bandaid" as an example of abuse. But really, who goes to the ER for a cut finger? Perhaps the treatment was a bandaid, but the patient went in there thinking it was an emergency, and this is what one should expect to pay for service that specializes in emergencies of any stripe - from gory accidents to heart attacks. It was not the bandaid that cost so much, it was the setting the patient chose to go to. If you don't want to pay $629 then go to an urgent care clinic. Our medical care has lots of problems with costs, but this one is on the patient.
TwoByFour is offline   Reply With Quote
Old 11-07-2018, 02:59 PM   #71
Administrator
MichaelB's Avatar
 
Join Date: Jan 2008
Location: Chicagoland
Posts: 40,586
Quote:
Originally Posted by TwoByFour View Post
The article above starts with a "$629 bandaid" as an example of abuse. But really, who goes to the ER for a cut finger? Perhaps the treatment was a bandaid, but the patient went in there thinking it was an emergency, and this is what one should expect to pay for service that specializes in emergencies of any stripe - from gory accidents to heart attacks. It was not the bandaid that cost so much, it was the setting the patient chose to go to. If you don't want to pay $629 then go to an urgent care clinic. Our medical care has lots of problems with costs, but this one is on the patient.
From the article
Quote:
This whole project actually started with a bill that a reader sent to me. This guy in Connecticut had taken his daughter to the emergency room. It was a 1-year-old girl and he’d been clipping her fingernails and had cut her finger, and it was gushing blood. He was really worried, and it was a weekend, so the urgent care was closed. So he took her to the emergency room. And they said it was nothing to worry about, they put a Band-Aid on her finger and sent them home. And then he received a bill for $629.
Read the entire article, it's very interesting. Emergency rooms see lots of people that would be better treated elsewhere.
MichaelB is online now   Reply With Quote
Old 11-07-2018, 03:03 PM   #72
Moderator
Walt34's Avatar
 
Join Date: Dec 2007
Location: Eastern WV Panhandle
Posts: 25,300
Quote:
Originally Posted by TwoByFour View Post
The article above starts with a "$629 bandaid" as an example of abuse. But really, who goes to the ER for a cut finger?
Apparently a lot of people do. Last night I waited three hours to be seen in the ER because of all the people who use the ER as primary care. Those are the ones without insurance, on Medicaid, some on Medicare. The whole hospital didn't have a single bed available and ambulances were being told to divert because of this nonsense.

The staff was telling me that people go to the ER for sore throats, earaches, headaches, nosebleeds, minor stuff that most people deal with themselves, go to their primary care physicians, or perhaps an urgent care place.

But these people go to the ER because they'll never pay the bill.
__________________
When I was a kid I wanted to be older. This is not what I expected.
Walt34 is offline   Reply With Quote
Old 11-07-2018, 03:04 PM   #73
Moderator
sengsational's Avatar
 
Join Date: Oct 2010
Posts: 10,656
This site "https://erbills.vox.com/" is kind of like what I was talking about when I started this thread/poll:


http://www.early-retirement.org/foru...res-79499.html


My idea was to automate the process of pulling information off of EOB's that are sent to individuals so that a database of negotiated prices could see the light of day.


I don't think anybody here would object to more light shed on prices that people actually paid, along with the CPT codes and facility. The idea lost steam with me when my insurance company started publishing EOB's without CPT codes. It didn't last long, but there was a few months where the codes were missing. I wonder if the attorney general got them back on track (I did report them). A supplier tried that crap with me and I called them and said unless you give me the codes, I'm not paying. The relented and sent me a bill with the codes. I can't believe the business practices they try to get away with; about as close to criminal as they can get.
sengsational is offline   Reply With Quote
Old 11-07-2018, 03:15 PM   #74
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
audreyh1's Avatar
 
Join Date: Jan 2006
Location: Rio Grande Valley
Posts: 38,007
Quote:
Originally Posted by MRG View Post
Just had a small example of the insanity. A couple weeks ago I was given a holter monitor to wear for a week by my in network cardiologist.

When I packed it up to return it, I noticed a pamphlet about billing issues and the network they're in. Well go figure, they have cardiologists and they're in some networks not others.

Today my health insurance denied their claims. Wow, $5,500 that is all out of network! The pamphlet said, call us about billing issues. The gal told my they'd would make an appeal. I asked about appealing out of network, as I certainly wasn't paying that price. "Oh don't worry sir, the maximum we charge you is $255." WTx?
Wow!

But you know I had a very similar thing happen last year. A special test that I knew was far more reliable than the standard very unreliable one. I paid some amount up front, and submitted my insurance information.

Then a few weeks later I see a claim for a far higher amount is denied by my insurance and treated as out of network. OK was expecting that. So I get this much larger bill - about 6x what I originally paid, and no mention of my prepayment. This amount is quite a bit higher than I would have paid up front as self-pay/no insurance.

So I decide to call and ask for more details especially why wasn’t I credited for this prepayment on my bill or an explanation of how that factored in. Talking to billing, they look it up, and announce that my account has zero balance. I’m don’t owe anything. OK good for me, but Huh? They weren’t going to send me another statement. Do they just hope someone pays these bogus bills?

BTW - some of these games here are writeoffs the providers take.
__________________
Retired since summer 1999.
audreyh1 is offline   Reply With Quote
Old 11-07-2018, 03:26 PM   #75
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
JoeWras's Avatar
 
Join Date: Sep 2012
Posts: 11,701
Quote:
Originally Posted by MichaelB View Post
From the article
Read the entire article, it's very interesting. Emergency rooms see lots of people that would be better treated elsewhere.
For sure. When I was a kid, a trip to the doc office for most stuff like bad cuts and broken bones was routine. He was our emergency room. That of course assumes working hours. We kids usually got in trouble during the day in the summer. We planned well.

I read the article and saw the linked article about rabies shots. THAT was interesting. Apparently, if you think you were bit or scratched by a rabid animal, usually a bat, going to your doctor won't help. They only stock the required medicines in emergency rooms since this is an aggregated site that handles the medicines with occasional usage.

What was eye opening was the patient in the article was perplexed that the subsequent visits to the ER for the shots got graded randomly from level 1 to 4. There was no choice but to go to the ER, and they didn't know what kind of grade they would get, even if it was for a simple shot. One would think a follow up shot would be level 1. Not the case, it varied even though all the visits were short, sweet and scheduled.
JoeWras is offline   Reply With Quote
Old 11-07-2018, 03:45 PM   #76
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
audreyh1's Avatar
 
Join Date: Jan 2006
Location: Rio Grande Valley
Posts: 38,007
Quote:
Originally Posted by MichaelB View Post
From the article
Read the entire article, it's very interesting. Emergency rooms see lots of people that would be better treated elsewhere.
If in the case of a badly bleeding wound, and the urgent care clinic is closed, and assuming the doctors office also, where is someone supposed to go?
__________________
Retired since summer 1999.
audreyh1 is offline   Reply With Quote
Old 11-07-2018, 03:56 PM   #77
Administrator
MichaelB's Avatar
 
Join Date: Jan 2008
Location: Chicagoland
Posts: 40,586
Quote:
Originally Posted by audreyh1 View Post
If in the case of a badly bleeding wound, and the urgent care clinic is closed, and assuming the doctors office also, where is someone supposed to go?
I wasn't suggesting they go elsewhere, just acknowledging the basis for the article and the project Sarah Kliff is carrying out.
MichaelB is online now   Reply With Quote
Old 11-07-2018, 04:36 PM   #78
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
travelover's Avatar
 
Join Date: Mar 2007
Posts: 14,328
Quote:
Originally Posted by MichaelB View Post
........ Emergency rooms see lots of people that would be better treated elsewhere.
I don't understand why emergency rooms don't have two sections, real emergencies and everyone else. The second half, an urgent care center could be staffed with nurses, PAs and other appropriate staff. Since the hospital is paying for the indigent anyway, it would seem to be in their interest to lower their real costs.
travelover is offline   Reply With Quote
Old 11-07-2018, 05:52 PM   #79
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
JoeWras's Avatar
 
Join Date: Sep 2012
Posts: 11,701
Quote:
Originally Posted by travelover View Post
I don't understand why emergency rooms don't have two sections, real emergencies and everyone else. The second half, an urgent care center could be staffed with nurses, PAs and other appropriate staff. Since the hospital is paying for the indigent anyway, it would seem to be in their interest to lower their real costs.
Some do. They don't make it obvious, but they have two wings that they triage the patients to.
JoeWras is offline   Reply With Quote
Old 11-07-2018, 06:20 PM   #80
Recycles dryer sheets
 
Join Date: May 2014
Posts: 412
Quote:
Originally Posted by audreyh1 View Post
If in the case of a badly bleeding wound, and the urgent care clinic is closed, and assuming the doctors office also, where is someone supposed to go?
If it can be treated with a bandaid, probably don't need to go anywhere except maybe the pharmacy to get some antiseptic ointment. If it requires stitches to get it to stop bleeding, and the urgent care place is closed, ER is the only choice. The article was about the former, not the latter and used it as evidence of excess costs. But I put a lot of the blame on a public that uses the ER for non-emergencies, and a public that is too prone to run to the doctor for a lot of things they can manage themselves.
TwoByFour is offline   Reply With Quote
Reply


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
Motley Fool article on health care billing kevink Health and Early Retirement 3 05-20-2013 04:17 PM
TWC - Billing Nonsense and total RUBBISH JustMeUC Other topics 10 02-19-2013 10:42 PM
More Celebrity nonsense... Westernskies Other topics 5 03-09-2010 08:06 PM
Sigh, More Terror Nonsense brewer12345 Other topics 4 10-07-2005 06:19 PM

» Quick Links

 
All times are GMT -6. The time now is 03:58 PM.
 
Powered by vBulletin® Version 3.8.8 Beta 1
Copyright ©2000 - 2024, vBulletin Solutions, Inc.