5 ms·

Tip of the iceberg. I know a fellow that got a bill a drug testing company didn't mean to send him. He was meant to check for a single restricted medication b

Tip of the iceberg. I know a fellow that got a bill a drug testing company didn't mean to send him. He was meant to check for a single restricted medication because of some treatment regimen he was on. Instead, it checked for pretty much everything and automatically rechecked both positive and negative results. Long story short, a $50 test turned into a $2500 test, invisible to all but the testing company and the insurance company. The testing company told him to ignore the bill and, indeed, he wasn't charged that amount. It piqued his curiosity and offended his sense of fairness and it led him down a disturbing rabbit hole of uncovering some very bad behavior and desperately trying to get folks to do notice what was happening and do something about it. Basically, this company seems to be in the business of bribing doctors through ridiculously priced leases in their medical office that they pay for to house their 'testing advisors'. We're talking on the order of $15K a month for a broom closet. In return, doctors use the testing company's pre-filled documents for requesting testing -- standing orders for the whole suite of tests with re-checks rather than just what is needed. By the time the insurance companies caught on they'd amassed a huge war chest and were more than happy to tie up the courts fighting claims that they're doing something wrong. One reason I support universal healthcare even though, generally, I'm a free-market proponent, is because it would make this kind of fraud a lot easier to spot and the federal government has a lot more tools to bring to bear to stop it.

seibelj 7y ago
I agree that if we are to maintain this opaque system where customers (patients) pay a flat rate for ludicrously overpriced insurance, and then have no insight into prices nor ability to reduce them because they don’t pay for the actual services, then universal healthcare is better. However, universal healthcare is not a panacea as evidenced by many angry patients waiting for procedures in Canada and the UK - although they are leaps and bounds better off than many in the current USA system. An alternative would be to have transparent pricing and open the market much more to for-profit businesses. Notice how vasectomies and laser eye surgery, 2 procedures not typically covered by insurance, have become safer, cheaper, and more effective over the past 20 years as they have been forced to advertise directly to consumers and compete with other vendors. This is the opposite trajectory of almost everything else in the healthcare system. I’m not saying all procedures can become like this - obviously a heart attack is a heart attack - but there are many other specialist procedures that are indeed scheduled in advance that could benefit from a heavy dose of transparency and competition. As another example, I’ve been on the same medication for the past 8 years. I get the same dose, and it’s never changing. Yet my provider makes me visit every 3 months for a refill. They put me in a room and “check up” to make sure the meds are "going well". Often this 30 minute scheduled meeting is less than 5 minutes because my doctor just hits a button on the computer to refill it. Yet insurance pays 4 times a year for this unnecessary visit to a specialist doctor. It doesn't cost me anything (other than deductible) so I'm most annoyed about the time wasting, but I also know that the system is being bilked for thousands of dollars. Multiply that anecdote by a million other situations. I should just be able to buy my meds without being forced to go through a doctor.
- mrep 7y ago
  > As another example, I’ve been on the same medication for the 8 years. I get the same dose, and it’s never changing. Yet my provider makes me visit every 3 months for a refill. Know the feeling, my girlfriend has to get pap smears every 1 or 2 years in order to get birth control and she despises those checkups. Yeah, let's put more barriers to women getting birth control... Fortunately, I only have to deal with yearly eye exams to get contacts which are still super annoying but the pap smears sound awful.
  - pravda 7y ago
    > Fortunately, I only have to deal with yearly eye exams to get contacts Try http://daysoft.com http://daysoft.com
  - elliekelly 7y ago
    It's ridiculous that birth control even requires a prescription in the US but it's not an issue you ever hear debated or discussed. The reason? If it were OTC (and no longer covered by health insurance) it would be prohibitively expensive for many of the young women who need it the most. So instead we end up getting annual pap screening even though it's only necessary every 3-5 years. Quite a corner we've painted ourselves into with this whole health insurance mess.
    - astura 7y ago
      Birth control can safely be prescribed without a pap test. A pap test is merely a screening for cervical cancer. The fact that a medical provider would require a pap for a birth control prescription when that's not medically necessary is a problem. Overscreening for cervical cancer is also a big problem. Once every year is an inappropriate screening interval for most people.[1] In some states pharmacists can prescribe birth control pills after a consult.[1] There's no reason why we can't require insurance to cover birth control pills even if they are OTC. We can still have a pharmacist run it through insurance, you just don't need a doctor's note. [1] https://www.cancer.org/cancer/cervical-cancer/prevention-and-early-detection/cervical-cancer-screening-guidelines.html https://www.cancer.org/cancer/cervical-cancer/prevention-and...
refurb 7y ago
Fraudulent billing is exactly what got uBiome (YC S14) in trouble and the reason the CEO getting the boot.

seibelj 7y ago

I agree that if we are to maintain this opaque system where customers (patients) pay a flat rate for ludicrously overpriced insurance, and then have no insight into prices nor ability to reduce them because they don’t pay for the actual services, then universal healthcare is better. However, universal healthcare is not a panacea as evidenced by many angry patients waiting for procedures in Canada and the UK - although they are leaps and bounds better off than many in the current USA system. An alternative would be to have transparent pricing and open the market much more to for-profit businesses. Notice how vasectomies and laser eye surgery, 2 procedures not typically covered by insurance, have become safer, cheaper, and more effective over the past 20 years as they have been forced to advertise directly to consumers and compete with other vendors. This is the opposite trajectory of almost everything else in the healthcare system. I’m not saying all procedures can become like this - obviously a heart attack is a heart attack - but there are many other specialist procedures that are indeed scheduled in advance that could benefit from a heavy dose of transparency and competition. As another example, I’ve been on the same medication for the past 8 years. I get the same dose, and it’s never changing. Yet my provider makes me visit every 3 months for a refill. They put me in a room and “check up” to make sure the meds are "going well". Often this 30 minute scheduled meeting is less than 5 minutes because my doctor just hits a button on the computer to refill it. Yet insurance pays 4 times a year for this unnecessary visit to a specialist doctor. It doesn't cost me anything (other than deductible) so I'm most annoyed about the time wasting, but I also know that the system is being bilked for thousands of dollars. Multiply that anecdote by a million other situations. I should just be able to buy my meds without being forced to go through a doctor.

mrep 7y ago
> As another example, I’ve been on the same medication for the 8 years. I get the same dose, and it’s never changing. Yet my provider makes me visit every 3 months for a refill. Know the feeling, my girlfriend has to get pap smears every 1 or 2 years in order to get birth control and she despises those checkups. Yeah, let's put more barriers to women getting birth control... Fortunately, I only have to deal with yearly eye exams to get contacts which are still super annoying but the pap smears sound awful.
- pravda 7y ago
  > Fortunately, I only have to deal with yearly eye exams to get contacts Try http://daysoft.com http://daysoft.com
- elliekelly 7y ago
  It's ridiculous that birth control even requires a prescription in the US but it's not an issue you ever hear debated or discussed. The reason? If it were OTC (and no longer covered by health insurance) it would be prohibitively expensive for many of the young women who need it the most. So instead we end up getting annual pap screening even though it's only necessary every 3-5 years. Quite a corner we've painted ourselves into with this whole health insurance mess.
  - astura 7y ago
    Birth control can safely be prescribed without a pap test. A pap test is merely a screening for cervical cancer. The fact that a medical provider would require a pap for a birth control prescription when that's not medically necessary is a problem. Overscreening for cervical cancer is also a big problem. Once every year is an inappropriate screening interval for most people.[1] In some states pharmacists can prescribe birth control pills after a consult.[1] There's no reason why we can't require insurance to cover birth control pills even if they are OTC. We can still have a pharmacist run it through insurance, you just don't need a doctor's note. [1] https://www.cancer.org/cancer/cervical-cancer/prevention-and-early-detection/cervical-cancer-screening-guidelines.html https://www.cancer.org/cancer/cervical-cancer/prevention-and...

refurb 7y ago

Fraudulent billing is exactly what got uBiome (YC S14) in trouble and the reason the CEO getting the boot.