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Healthcare providers tend to overcharge in proportion to how unnegotiable the service is. For example, ambulance charges are a great way to make money, because

by brilee 5y ago

Healthcare providers tend to overcharge in proportion to how unnegotiable the service is. For example, ambulance charges are a great way to make money, because the person on the hook for the ambulance typically isn't in a position to decline ambulance service. I agree with the implementation because it puts the burden in the right place. The error here is not that the insurer is denying payment, but that the hospital is then passing the bills onto the patient. Somehow, we have to reduce unnecessary use of emergency services. The doctors correctly point out that patients can't make that decision. Since the doctors _can_ make that decision, they should be involved in helping reduce ER misusage. The insurance company is setting up the correct incentives for the hospital to do exactly that; however, the hospital is dodging the incentives by passing costs to the patient. So the hospital is in the wrong here.

ceejayoz 5y ago
The insurance company is dumping a giant turd in the patient's lap and forcing them to either eat it or go fight an immensely well funded and resourced organization over the bill. It's a bit baffling to absolve them of responsibility in that action.
Broken_Hippo 5y ago
Well, honestly, doctors can only do so much too. Serious abdomen pain can be gas or something serious. You can cough hard enough to fracture a rib. Chest pains can be acid reflux or a heart attack: I had gastritis when this happened to me. And this is a good deal of the issue: You don't know how serious it is until you go to the doctor. Now, this doesn't cause all of ER misuse, but we aren't doing anything to make that better. A doctor won't see you if you can't pay upfront. This is the same problem with urgent care: Either pay upfront or don't get helped. The ER, though, will bill you. Which does mean that if you are poor - especially just over the income level to get help with a lot of expenses - you either go to the ER when you need a doctor or you don't get seen and have to wait until it IS serious enough for the ER. We can solve this by making sure everyone can very easily afford health car (I no longer live in the US: My out of pocket is $300 per year, and this includes necessary prescriptions, doctors, physical therapy, some dental stuff, and so on). The rest is paid in taxes, which are less than federal + state + health insurance was in the states: Nevermind having to pay a deductible before the out of pocket. (I know my GP will bill me, by the way). But another way to handle this is to have something akin to urgent care on hospital grounds - a place that folks can see a doctor/nurse practitioner for non-emergency things and get billed later.
pkaye 5y ago
> Healthcare providers tend to overcharge in proportion to how unnegotiable the service is. For example, ambulance charges are a great way to make money, because the person on the hook for the ambulance typically isn't in a position to decline ambulance service. That is because ambulance are charged on use basis in the US. The ambulance company has to provide the service even in the patient cannot pay for it. So they charge high rates with the hopes that they can recover from someone with good insurance. There are many rural ambulance systems that are failing due to insufficient insured patients. The real solution is cities/counties fund the service through taxes just like police/fire.

by brilee 5y ago

ceejayoz 5y ago

The insurance company is dumping a giant turd in the patient's lap and forcing them to either eat it or go fight an immensely well funded and resourced organization over the bill. It's a bit baffling to absolve them of responsibility in that action.

Broken_Hippo 5y ago

Well, honestly, doctors can only do so much too. Serious abdomen pain can be gas or something serious. You can cough hard enough to fracture a rib. Chest pains can be acid reflux or a heart attack: I had gastritis when this happened to me. And this is a good deal of the issue: You don't know how serious it is until you go to the doctor. Now, this doesn't cause all of ER misuse, but we aren't doing anything to make that better. A doctor won't see you if you can't pay upfront. This is the same problem with urgent care: Either pay upfront or don't get helped. The ER, though, will bill you. Which does mean that if you are poor - especially just over the income level to get help with a lot of expenses - you either go to the ER when you need a doctor or you don't get seen and have to wait until it IS serious enough for the ER. We can solve this by making sure everyone can very easily afford health car (I no longer live in the US: My out of pocket is $300 per year, and this includes necessary prescriptions, doctors, physical therapy, some dental stuff, and so on). The rest is paid in taxes, which are less than federal + state + health insurance was in the states: Nevermind having to pay a deductible before the out of pocket. (I know my GP will bill me, by the way). But another way to handle this is to have something akin to urgent care on hospital grounds - a place that folks can see a doctor/nurse practitioner for non-emergency things and get billed later.

pkaye 5y ago

> Healthcare providers tend to overcharge in proportion to how unnegotiable the service is. For example, ambulance charges are a great way to make money, because the person on the hook for the ambulance typically isn't in a position to decline ambulance service. That is because ambulance are charged on use basis in the US. The ambulance company has to provide the service even in the patient cannot pay for it. So they charge high rates with the hopes that they can recover from someone with good insurance. There are many rural ambulance systems that are failing due to insufficient insured patients. The real solution is cities/counties fund the service through taxes just like police/fire.