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i used the work in the substance abuse treatment space, where it's even more impactful. People with addictions go to treatment for 30-45 days, and when they ge

i used the work in the substance abuse treatment space, where it's even more impactful. People with addictions go to treatment for 30-45 days, and when they get home, they have a $30k check to pay for the treatment. Same deal - insurance pays the individual who pays the center. But I could not imagine a worse recipient, in terms of responsibility, than a recently recovered addict.

lotsofpulp 5y ago
Why would a substance abuse treatment provider agree to treat a customer if their insurance company will not pay the provider directly?
- edmundsauto 5y ago
  Because they generally get their money, and because that's kinda how insurance works. It also may not have been obvious which situation would arise when they did the admission. Additionally, many places charge $5-10k directly and then bill insurance to the max they can - even if they can't always collect the check sent to the patient, it's still profitable. (IIRC, cost to admit a patient was $7-11k/month at the facilities we saw.)
  - lotsofpulp 5y ago
    It still does not make any sense to me that a business would continue engaging with another business that is causing them to lose money. If a business is getting ripped off, then they need to ask for cash up front, or have contracts requiring direct payment. But if they are going to continue willingly engaging with a party that jerks them around, I do not see who they have to blame but themselves.
    - edmundsauto 5y ago
      To be clear, I'm not suggesting the facilities are getting ripped off. In reddit terms, Everyone Sucks Here. Facilities use every shady tactic to get people in the door, so nobody should shed a tear for them. My overall answer is that companies that bill insurance live in a complex world. Insurance tries to dodge payouts and will pay the insured; the facilities try to jam billing. Perhaps an anecdote will be representative: I worked for one of the biggest providers, with dozens of facilities. They had a call center whose job it was to get insurance to approve another 3 days of treatment (30 day stay = 10 of these calls). Insurance companies don't staff their end, so the call centers were paying people to wait on the line for several hours, just to get treatment approved. (I ended up building a Twilio integration to queue up without a person on the phone.) This is just a shitty, awful area of medicine and business and insurance.
      - lotsofpulp 5y ago
        That is embarrassing in a developed society.

lotsofpulp 5y ago

Why would a substance abuse treatment provider agree to treat a customer if their insurance company will not pay the provider directly?

edmundsauto 5y ago
Because they generally get their money, and because that's kinda how insurance works. It also may not have been obvious which situation would arise when they did the admission. Additionally, many places charge $5-10k directly and then bill insurance to the max they can - even if they can't always collect the check sent to the patient, it's still profitable. (IIRC, cost to admit a patient was $7-11k/month at the facilities we saw.)
- lotsofpulp 5y ago
  It still does not make any sense to me that a business would continue engaging with another business that is causing them to lose money. If a business is getting ripped off, then they need to ask for cash up front, or have contracts requiring direct payment. But if they are going to continue willingly engaging with a party that jerks them around, I do not see who they have to blame but themselves.
  - edmundsauto 5y ago
    To be clear, I'm not suggesting the facilities are getting ripped off. In reddit terms, Everyone Sucks Here. Facilities use every shady tactic to get people in the door, so nobody should shed a tear for them. My overall answer is that companies that bill insurance live in a complex world. Insurance tries to dodge payouts and will pay the insured; the facilities try to jam billing. Perhaps an anecdote will be representative: I worked for one of the biggest providers, with dozens of facilities. They had a call center whose job it was to get insurance to approve another 3 days of treatment (30 day stay = 10 of these calls). Insurance companies don't staff their end, so the call centers were paying people to wait on the line for several hours, just to get treatment approved. (I ended up building a Twilio integration to queue up without a person on the phone.) This is just a shitty, awful area of medicine and business and insurance.
    - lotsofpulp 5y ago
      That is embarrassing in a developed society.