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Old 05-21-2010, 11:58 AM   #41
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I don't know the answer. But I do know that when I went to the dentist a couple of weeks ago, the entire time I was sitting in the reception area, the lady at the desk was on the phone, calling clients to tell them that their insurance claim didn't work because their insurance company didn't recognize their number, etc, etc. It was ALL about insurance. So there is at least one full-time job at a very small practice, spending 90% of her time dealing with insurance screwups.
And for awhile there between quitting my job and getting health insurance through retirement, I was unable to get private health insurance due to being middle aged and doing a bad job picking my ancestors, despite applying to everyone (oh yeah, once company would take me if they excluded all preexisting conditions and "any tumor"). And I'm HEALTHY (knock on wood).
About medicare - For years now, you couldn't get a private GP doc to take you in this town if you're on Medicare, but the clinics would and still will take you. Something about clinics being paid more per patient than individual doctors. I haven't found the information online - anybody know how that works?
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Old 05-21-2010, 01:44 PM   #42
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I don't know the answer. But I do know that when I went to the dentist a couple of weeks ago, the entire time I was sitting in the reception area, the lady at the desk was on the phone, calling clients to tell them that their insurance claim didn't work because their insurance company didn't recognize their number, etc, etc. It was ALL about insurance. So there is at least one full-time job at a very small practice, spending 90% of her time dealing with insurance screwups.
Yup. We recently dropped the individual dental insurance option from our individual/family coverage, because while the checks cleared every month, the insurer denied that we were covered when the dental office called. Oh, the 'customer service' person would say we were covered when WE called, and would offer to do things like 'push the database' to make sure the claims side knew we were covered, but somehow, that just never seemed to work. I even sat there with the insurance person at the dental office as she tried to put a claim through, and talked to the claims person. No luck.

It's a sweet business model, though. Collect premiums, and 'mitigate losses' by denying coverage.

I worked with the dentist's office, and discovered that what they would actually pay out would never come near covering the costs, and of course would never come close to the premium amount. We worked a deal to get the insurer's 'negotiated rate' discount for cash at time of service, which was a deal that worked out better than Delta Dental's 'cash for nothing' plan.
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Old 05-21-2010, 10:00 PM   #43
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I think both government and insurance companies are playing a game of chicken here. ... as a result of the new law, all they'll do is get people to demand the public option.

Then again, maybe that's what the legislators were hoping would happen...
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Old 05-22-2010, 08:59 PM   #44
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Ok
1) DW is a well known MD in her field and is a salaried federal government physician
2) I've been a Visiting Prof. in Medical or Public health Schools in the USA, Germany and the UK
3) The waste in the US health care system is staggering. Most is in insurance administrative costs. Some is in keeping open hospitals or medical departments that are inefficiently small. Some is huge over payments to a small number of physicians. Physicians are paid much more than is justified by their out of pocket educational costs.
4) Most of the cost of medical malpractice is in providing the future care to those injured by the health care system. That cost will not go away no matter what you do to the plaintiffs or their lawyers. It is a product of very poor quality control in medicine.
5) Physicians in fee for service environments have enormous conflicts of interest, routinely leading to over "treatment" and inflated billing.

I don't have easy solutions but the lobbyists and vested intersts are certainly in control
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Old 05-22-2010, 09:11 PM   #45
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Physicians are paid much more than is justified by their out of pocket educational costs.
The market determines what people earn in the US. The cost of a person's education has only the loosest of associations with what people earn--ask anyone with a PhD in Literature or Women's Studies.

It's all about supply and demand. The supply of physicians in the US is kept artificially low.
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Old 05-22-2010, 09:19 PM   #46
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Whether the demand curve for labor in a specific field is generated by what is loosely called a market varies widely from field to field. Unions, trade associations , professional licenses, patents, foreign competition, monopolies and regulatory statutes are all formal barriers to "markets". Information failure is a less formal barrier.
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Old 05-24-2010, 12:43 PM   #47
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[QUOTE=Emeritus;939336]4) Most of the cost of medical malpractice is in providing the future care to those injured by the health care system. That cost will not go away no matter what you do to the plaintiffs or their lawyers. It is a product of very poor quality control in medicine.
[/QUOTE

Sounds like tort reform is needed..........
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Old 05-24-2010, 01:45 PM   #48
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my personal opinion is americans have shifted the use of insurance from supplementing the costs of major unforeseen events to not having to pay any money for the smallest little incident. In the medical world, this means a physical which costs $75-$100 if paid in cash and upfront, ends up costing significantly more. That's more than I pay a month for both me and DW. Then the doctors have to hire people to do the billing, hound the insurance companies and not get paid for 2 months. Opposed to getting cash, upfront. It's interesting to ask how much services cost at a doctors office. It's typically significantly cheaper if you tell them you will pay upfront in cash opposed to what the insurance companies are billed. Or...they never give you cost. the doctor is the only place where people go get services not knowing how much it will cost and they do not ask any questions.

shifting insurance from "making one whole" to supplementing major incidents would be a huge step. and tort reform.
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Old 05-24-2010, 02:08 PM   #49
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my personal opinion is americans have shifted the use of insurance from supplementing the costs of major unforeseen events to not having to pay any money for the smallest little incident. In the medical world, this means a physical which costs $75-$100 if paid in cash and upfront, ends up costing significantly more. That's more than I pay a month for both me and DW. Then the doctors have to hire people to do the billing, hound the insurance companies and not get paid for 2 months. Opposed to getting cash, upfront. It's interesting to ask how much services cost at a doctors office. It's typically significantly cheaper if you tell them you will pay upfront in cash opposed to what the insurance companies are billed. Or...they never give you cost. the doctor is the only place where people go get services not knowing how much it will cost and they do not ask any questions.

shifting insurance from "making one whole" to supplementing major incidents would be a huge step. and tort reform.

I think I have posted in another thread (maybe this one, but I doubt it)... I have TRIED to find out how much something costs.. no luck...

Next time you go to the office... ASK... see if you get an answer.. I bet not.

I remember one gal said 'what the insurance company pays'... she just codes the stuff and the doctor's office gets money... this is a small podiatrist's office... so you would think that someone there might know...

They tried to make me pay an additional $25 for something... that the insurance company did not pay... I have not... if they could not tell me the cost upfront.. well...
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Old 05-24-2010, 02:22 PM   #50
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It's interesting to ask how much services cost at a doctors office. It's typically significantly cheaper if you tell them you will pay upfront in cash opposed to what the insurance companies are billed.
I'm surprised you've found a medical provider who will do this. My impression was that Medicare and some private insurers specifically prohibit providers from providing any services for a fee lower than that charged to Medicare or the private insurers. So, the only docs who will perform services at a lower cost for cash are those who don't take Medicare or private insurers (at least ones who have this stipulation). If Congress is going to insert themselves into the free market, I'd rather see them prohibit these kinds of clauses than go on a campaign to force credit card companies to cut exchange fees.

I've heard stories about docs having a small "cash and carry" medical practice, and they love it--it's simple, it's cheap, and they get to do medicine and don't need a big staff.

I've heard dentists will often cut a deal for a cash customer.

It's also interesting to note that costs for medical care that is generally not covered by insurance (e.g. LASIK, cosmetic surgery, etc) are not going up nearly as fast as for care covered by insurance. When people pay their own money there is price competition. Who would have guessed that?
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