Cost-Conscious, Self-Managed Care

[harley]

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.

 

[travelover]

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.

 

[MRG]

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?

 

[Dreaming of Freedom]

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.

 

[travelover]

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.

 

[ziggy29]

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.

True. Of course, the flip side is that the policies they *can* buy are increasingly HMOs with increasingly narrow networks. You can't purchase *any* policy on the Marketplace (i.e. eligible for cost sharing and premium assistance) in much of Texas that will include M.D. Anderson, for example. If you had a preexisting condition with cancer or a family history of it, and you'd normally like to have Anderson as an option, well, too bad.

 

[MichaelB]

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).

It might be that many of us have dealt with this issue and just not posted about it. Or, we managed to deal with it, but only after endless hours on the phone and lots of conflict. Wild overcharging by health service providers is so common it's now (may be) the norm, as is the constant effort to find new things to bill (such as facility fees) and insurance companies effort to avoid paying is very well documented.

 

[travelover]

...........You can't purchase *any* policy on the Marketplace (i.e. eligible for cost sharing and premium assistance) in much of Texas that will include M.D. Anderson, for example........

Amazing, considering how hard Texas worked to make sure the ACA was a success.

 

[redduck]

It might be that many of us have dealt with this issue and just not posted about it. Or, we managed to deal with it, but only after endless hours on the phone and lots of conflict. Wild overcharging by health service providers is so common it's now (may be) the norm..

I've never had to deal with wild over-charging because it always takes care of itself. And, yeah, I receive the big bills, too. For me, the problem often has been that the doc's office neglects to bill the secondary insurance.

There are some docs (and maybe people who work in medical billing) on the forum and perhaps they could explain why the original charges are so wildly exorbitant.