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Everyone blames the insurance company. But my pharmacy billed insurance 272 for a generic on the $4 Walmart list and it got paid in full. My doctor’s PA bille

Everyone blames the insurance company. But my pharmacy billed insurance 272 for a generic on the $4 Walmart list and it got paid in full. My doctor’s PA billed $440 for a 20 minute telemedicine call and it got paid in full. My insurance has never denied a medication or procedure ordered by my doctor. I think it’s not simply insurance companies that are the issue. For some reason people just feel more comfortable blaming them than admitting the doctors and other staff are massively overbilling. Maybe we should try to fix that. They must be trying to hide other costs in those ridiculous bills to be. That’s not fair to me.

wetpaws 2y ago
[dead]
Insanity 2y ago
True, the issue is pretty much the entire US healthcare “system”. But insurance companies do play a not insignificant role in that.
timschmidt 2y ago
The Affordable Care Act requires that "Insurers must spend at least 80–85% of premium dollars on health costs; rebates must be issued if this is violated." So insurers bought hospital networks, inflated the bills, and took their profit from the other side of the equation. Before you forgive your insurance company and blame your pharmacy and doctor, check first that they aren't owned by the same corporation.
- bpodgursky 2y ago
  Do you have any examples? I am quite confident I have never been in this situation, I have never heard of anyone except Kaiser patients (who are FWIW very happy with their service) getting this.
  - tmpz22 2y ago
    My extended family has been Kaiser for decades and it has plenty of faults (Bay Area region). I’ve personally had multiple severe misdiagnosis by tired over worked doctors. I’ve had massive ER bills with trivial operations. I’ve gotten damagingly inaccurate mental health care, and at times long delays to see various specialists. The partnership of Kaiser and Reagan are largely responsible for the healthcare system America has today. Do not give them a pass.
  - timschmidt 2y ago
    United Health Group is covered in "What Happens When Your Insurer Is Also Your Doctor and Your Pharmacist" - https://www.wsj.com/health/healthcare/what-happens-when-your-insurer-is-also-your-doctor-and-your-pharmacist-8df727af https://www.wsj.com/health/healthcare/what-happens-when-your... There's also https://en.wikipedia.org/wiki/Centene_Corporation https://en.wikipedia.org/wiki/Centene_Corporation You mentioned Kaiser Permanente who acquired Geisinger Health System's network of hospitals: https://en.wikipedia.org/wiki/Kaiser_Permanente https://en.wikipedia.org/wiki/Kaiser_Permanente See also: https://pahealthaccess.org/promises-made-promises-broken-what-really-happens-when-local-hospitals-are-acquired/ https://pahealthaccess.org/promises-made-promises-broken-wha... https://www.kff.org/health-costs/issue-brief/ten-things-to-know-about-consolidation-in-health-care-provider-markets/ https://www.kff.org/health-costs/issue-brief/ten-things-to-k...
  - solarpunk 2y ago
    I think the term used to describe the imposed cost regulation is 'Medical Loss Ratio (MLR)', and the providers that own both ends of the claims transactions can use inflated costs to artificially manipulate their MLR.
  - dumbmrblah 2y ago
    Kaiser is great, until you get sick. Then it’s a nightmare, especially if you have anything complex going on. I’m a physician that works at an ultra specialized hospital.
    - Brian_K_White 2y ago
- TheNewsIsHere 2y ago
  I would also add that those of us on HM are probably more likely to have good insurance versus what most Americans have access to. Insurance carriers like low risk and thrive on people not fighting adverse decisions either because of a lack of time and resources or knowledge. The variables matter. My insurance carrier has also never denied a claim, but I’m in more or less good health for my age, have an HSA (at a bank owned by the insurance company) with a significant annual contribution from the issuing employer, and I don’t have anything going on (at the time I write this) that would end up in medical review. And if I did have to deal with that, theres financial cushion available to me to rely on while I fight it out with insurance.
ninetyninenine 2y ago
Shouldn’t competition eliminate over billing? It doesn’t because there isn’t much competition due to lack of supply of doctors. Why is there a lack of supply of doctors? Because the ama deliberately lobbied congress to decrease available residency.
- timschmidt 2y ago
  We also don't honor medical degrees obtained from non-US institutions. I know several folks who were doctors in India or elsewhere, who have blue collar jobs in the US because their schooling is not recognized here.
  - throwaway48476 2y ago
    Not every med school graduate matches for a residency in the US.
    - timschmidt 2y ago
      If your point is that artificially limiting supply of trained medical personnel leads to reduced access, inflated prices, and worse outcomes overall, then I'd agree.
      - throwaway48476 2y ago
        It's a factor. I just think it would be easier to make sure there are residencies for US graduates whose training is more aligned with US Healthcare than to import foreign doctors who also require training for transition.
        timschmidt 2y ago
        I'm not sure which would be easier, or if that's even a useful measure. Both seem like points of leverage to [in/de]crease supply. I think we should do everything we can do educate, enable, and employ citizens to the highest degree of which they are capable or desire. I feel similarly about putting the talent of new immigrants to work as well, and I don't see inherent conflict there. Growing the pie can mean larger shares for all.
cyberax 2y ago
> Maybe we should try to fix that. They must be trying to hide other costs in those ridiculous bills to be. That’s not fair to me. The thing is, your doctor is likely not making that much in the end. Because he needs to keep a staff of "offensive coders" who make sure that the insurance company actually pays for the correct procedures, and a couple of helpers to deal with all the paperwork. Then they also need to deal with patients with poor insurance who can't pay. Trying to get payments from these patients is soul-crushing, and doctors typically just don't bother. $440 for a quick call is also unusual.
- 8note 2y ago
  > The thing is, your doctor is likely not making that much in the end. what defines "that much" a hundred bucks? a thousand? a million? a hundred million? a hundred bilion?
  - cyberax 2y ago
    That's an interesting question. Here are some answers: > Medicare physician payment has decreased by 26% since 2001. Additionally, a recent Harvey L. Neiman Health Policy Institute study found that physician reimbursement per Medicare patient decreased 2.3% between 2005 and 2021 when accounting for inflation. And this was despite a 45.5% increase in physician services to each patient. Again, less pay and more work. https://www.medpagetoday.com/popmedicine/popmedicine/110901 https://www.medpagetoday.com/popmedicine/popmedicine/110901
    - renewiltord 2y ago
      Medicare patients are not the majority for practically every doctor.
      - cyberax 2y ago
        It's even worse in the non-Medicare world. There's a reason hospitals are getting rapidly bought out by the private equity. And to give some context, UnitedHealthcare has a payday service. For doctors. To help them borrow against future claim reimbursements. At the 35% rate. Nice, ain't it?
solardev 2y ago
The insurance industry is the reason the drugs and all the other healthcare costs so much to begin with. They lobby and bribe hard to keep the US the only developed nation without nationalized healthcare and give you the illusion of free market choice while providing substandard care at inflated prices. It's regulatory capture at its worst. Their greed directly kills people every year. That's why nobody shed a tear for that guy. His company was among the worst.
ratg13 2y ago
The primary discussion being had is about a single company using AI to make life or death decisions, and getting it wrong repeatedly without consequences. I assume you work for a pr cleanup team and are attempting to railroad the discussion.
- rootusrootus 2y ago
  > I assume you work for a pr cleanup team I encourage you to seek therapy. Life can be happier.
8note 2y ago
if the insurance company was good, wouldnt they negotiate the rest down to keep their own rates down?
raffraffraff 2y ago
Exactly this. Me and the wife were talking about this a few moments ago and concluded that the entire health system in the US is fucked. I've seen people post itemized bills from their outpatient procedure or brief hospital stay and, to a European, it's mind boggling. People in the US are getting gouged on everything healthcare related. Wife's position is that the free market works fine for non essentials but when it comes to essentials that you don't have a choice but to pay (water, medicine, housing, food) the market can be dangerous. Telling someone that their life saving cancer treatment comes to 500k isn't far from putting a gun to their head and saying "gimme 500k or you're dead". It's why I support ideas like the British NHS (it's not perfect but it's free), zero water charges for homes (paid through income tax, with surcharges for heavy usage like swimming pools).
- kortilla 2y ago
  > housing, food) the market can be dangerous Housing and food are free market because they are easy to get substitutes for in most of the western world (move to a different neighborhood, buy different food). Those two categories don’t really belong with water and healthcare. The barrier to entry to provide tap water or provide healthcare is very high.
  - raffraffraff 2y ago
    Housing in Ireland isn't a free market. We have had a chronic shortage of housing for decades, but the influx of asylum seekers has put more pressure on it. Renters stand in lines half a mile long to view a grotty shoe-box that costs more than a mortgage. But yeah, maybe in other places it's different. Yes, food is a free market right now, and in addition, it's subsidised (well, production is). Wait 20 years though, if climate change driven storms and floods destroy whole crops, that could change things dramatically.
  - jjav 2y ago
    > food are free market because they are easy to get substitutes for in most of the western world (move to a different neighborhood, buy different food) In the US, a very small number of corporations own nearly all the supermarkets. You can move all you want, it is the same stores (possibly under different brand name, but same ownership).
masklinn 2y ago
Insurance companies are a major of not the primary cause of those prices: - they require deep discounts to put you in network, so providers increase their prices such that they end up whole after the mandatory discounts, that is why you can very often get your bills slashed to a fraction of the original if you pay crash - obtrusive insurances means offices waste hours working on insurance instead of medical duties and many need to hire dedicated clerks
throwaway48476 2y ago
Health care billing works like a black Friday 'sale' where the price is jacked up and the 'sale' price is the same as the normal price. Usually health insurance 'negotiates' the price down to what it should cost and then you pay the full 'true' cost. When I had my wisdom teeth out my insurer negotiated the price down from $4k to $700, of which I paid 100%.
Brian_K_White 2y ago
You could say that insurance creates that environment, and profits from it. Insurance actually makes more money on the big bill, since they just charge whatever premiums are required to pay it plus their percentage. The bigger the better. And insurance creates the disconnect that allows a price to have no feedback control. They are happy to collect their income and benefit from the system they create, so they should not be granted any excuses for it's failures. The poor insurance companies are not the abused parties here.

wetpaws 2y ago

[dead]

Insanity 2y ago

True, the issue is pretty much the entire US healthcare “system”. But insurance companies do play a not insignificant role in that.

timschmidt 2y ago

The Affordable Care Act requires that "Insurers must spend at least 80–85% of premium dollars on health costs; rebates must be issued if this is violated." So insurers bought hospital networks, inflated the bills, and took their profit from the other side of the equation. Before you forgive your insurance company and blame your pharmacy and doctor, check first that they aren't owned by the same corporation.

bpodgursky 2y ago
Do you have any examples? I am quite confident I have never been in this situation, I have never heard of anyone except Kaiser patients (who are FWIW very happy with their service) getting this.
- tmpz22 2y ago
  My extended family has been Kaiser for decades and it has plenty of faults (Bay Area region). I’ve personally had multiple severe misdiagnosis by tired over worked doctors. I’ve had massive ER bills with trivial operations. I’ve gotten damagingly inaccurate mental health care, and at times long delays to see various specialists. The partnership of Kaiser and Reagan are largely responsible for the healthcare system America has today. Do not give them a pass.
- timschmidt 2y ago
  United Health Group is covered in "What Happens When Your Insurer Is Also Your Doctor and Your Pharmacist" - https://www.wsj.com/health/healthcare/what-happens-when-your-insurer-is-also-your-doctor-and-your-pharmacist-8df727af https://www.wsj.com/health/healthcare/what-happens-when-your... There's also https://en.wikipedia.org/wiki/Centene_Corporation https://en.wikipedia.org/wiki/Centene_Corporation You mentioned Kaiser Permanente who acquired Geisinger Health System's network of hospitals: https://en.wikipedia.org/wiki/Kaiser_Permanente https://en.wikipedia.org/wiki/Kaiser_Permanente See also: https://pahealthaccess.org/promises-made-promises-broken-what-really-happens-when-local-hospitals-are-acquired/ https://pahealthaccess.org/promises-made-promises-broken-wha... https://www.kff.org/health-costs/issue-brief/ten-things-to-know-about-consolidation-in-health-care-provider-markets/ https://www.kff.org/health-costs/issue-brief/ten-things-to-k...
- solarpunk 2y ago
  I think the term used to describe the imposed cost regulation is 'Medical Loss Ratio (MLR)', and the providers that own both ends of the claims transactions can use inflated costs to artificially manipulate their MLR.
- dumbmrblah 2y ago
  Kaiser is great, until you get sick. Then it’s a nightmare, especially if you have anything complex going on. I’m a physician that works at an ultra specialized hospital.
  - Brian_K_White 2y ago
TheNewsIsHere 2y ago
I would also add that those of us on HM are probably more likely to have good insurance versus what most Americans have access to. Insurance carriers like low risk and thrive on people not fighting adverse decisions either because of a lack of time and resources or knowledge. The variables matter. My insurance carrier has also never denied a claim, but I’m in more or less good health for my age, have an HSA (at a bank owned by the insurance company) with a significant annual contribution from the issuing employer, and I don’t have anything going on (at the time I write this) that would end up in medical review. And if I did have to deal with that, theres financial cushion available to me to rely on while I fight it out with insurance.

ninetyninenine 2y ago

Shouldn’t competition eliminate over billing? It doesn’t because there isn’t much competition due to lack of supply of doctors. Why is there a lack of supply of doctors? Because the ama deliberately lobbied congress to decrease available residency.

timschmidt 2y ago
We also don't honor medical degrees obtained from non-US institutions. I know several folks who were doctors in India or elsewhere, who have blue collar jobs in the US because their schooling is not recognized here.
- throwaway48476 2y ago
  Not every med school graduate matches for a residency in the US.
  - timschmidt 2y ago
    If your point is that artificially limiting supply of trained medical personnel leads to reduced access, inflated prices, and worse outcomes overall, then I'd agree.
    - throwaway48476 2y ago
      It's a factor. I just think it would be easier to make sure there are residencies for US graduates whose training is more aligned with US Healthcare than to import foreign doctors who also require training for transition.
      - timschmidt 2y ago
        I'm not sure which would be easier, or if that's even a useful measure. Both seem like points of leverage to [in/de]crease supply. I think we should do everything we can do educate, enable, and employ citizens to the highest degree of which they are capable or desire. I feel similarly about putting the talent of new immigrants to work as well, and I don't see inherent conflict there. Growing the pie can mean larger shares for all.

cyberax 2y ago

> Maybe we should try to fix that. They must be trying to hide other costs in those ridiculous bills to be. That’s not fair to me. The thing is, your doctor is likely not making that much in the end. Because he needs to keep a staff of "offensive coders" who make sure that the insurance company actually pays for the correct procedures, and a couple of helpers to deal with all the paperwork. Then they also need to deal with patients with poor insurance who can't pay. Trying to get payments from these patients is soul-crushing, and doctors typically just don't bother. $440 for a quick call is also unusual.

8note 2y ago
> The thing is, your doctor is likely not making that much in the end. what defines "that much" a hundred bucks? a thousand? a million? a hundred million? a hundred bilion?
- cyberax 2y ago
  That's an interesting question. Here are some answers: > Medicare physician payment has decreased by 26% since 2001. Additionally, a recent Harvey L. Neiman Health Policy Institute study found that physician reimbursement per Medicare patient decreased 2.3% between 2005 and 2021 when accounting for inflation. And this was despite a 45.5% increase in physician services to each patient. Again, less pay and more work. https://www.medpagetoday.com/popmedicine/popmedicine/110901 https://www.medpagetoday.com/popmedicine/popmedicine/110901
  - renewiltord 2y ago
    Medicare patients are not the majority for practically every doctor.
    - cyberax 2y ago
      It's even worse in the non-Medicare world. There's a reason hospitals are getting rapidly bought out by the private equity. And to give some context, UnitedHealthcare has a payday service. For doctors. To help them borrow against future claim reimbursements. At the 35% rate. Nice, ain't it?

solardev 2y ago

The insurance industry is the reason the drugs and all the other healthcare costs so much to begin with. They lobby and bribe hard to keep the US the only developed nation without nationalized healthcare and give you the illusion of free market choice while providing substandard care at inflated prices. It's regulatory capture at its worst. Their greed directly kills people every year. That's why nobody shed a tear for that guy. His company was among the worst.

ratg13 2y ago

The primary discussion being had is about a single company using AI to make life or death decisions, and getting it wrong repeatedly without consequences. I assume you work for a pr cleanup team and are attempting to railroad the discussion.

rootusrootus 2y ago
> I assume you work for a pr cleanup team I encourage you to seek therapy. Life can be happier.

8note 2y ago

if the insurance company was good, wouldnt they negotiate the rest down to keep their own rates down?

raffraffraff 2y ago

Exactly this. Me and the wife were talking about this a few moments ago and concluded that the entire health system in the US is fucked. I've seen people post itemized bills from their outpatient procedure or brief hospital stay and, to a European, it's mind boggling. People in the US are getting gouged on everything healthcare related. Wife's position is that the free market works fine for non essentials but when it comes to essentials that you don't have a choice but to pay (water, medicine, housing, food) the market can be dangerous. Telling someone that their life saving cancer treatment comes to 500k isn't far from putting a gun to their head and saying "gimme 500k or you're dead". It's why I support ideas like the British NHS (it's not perfect but it's free), zero water charges for homes (paid through income tax, with surcharges for heavy usage like swimming pools).

kortilla 2y ago
> housing, food) the market can be dangerous Housing and food are free market because they are easy to get substitutes for in most of the western world (move to a different neighborhood, buy different food). Those two categories don’t really belong with water and healthcare. The barrier to entry to provide tap water or provide healthcare is very high.
- raffraffraff 2y ago
  Housing in Ireland isn't a free market. We have had a chronic shortage of housing for decades, but the influx of asylum seekers has put more pressure on it. Renters stand in lines half a mile long to view a grotty shoe-box that costs more than a mortgage. But yeah, maybe in other places it's different. Yes, food is a free market right now, and in addition, it's subsidised (well, production is). Wait 20 years though, if climate change driven storms and floods destroy whole crops, that could change things dramatically.
- jjav 2y ago
  > food are free market because they are easy to get substitutes for in most of the western world (move to a different neighborhood, buy different food) In the US, a very small number of corporations own nearly all the supermarkets. You can move all you want, it is the same stores (possibly under different brand name, but same ownership).

masklinn 2y ago

Insurance companies are a major of not the primary cause of those prices: - they require deep discounts to put you in network, so providers increase their prices such that they end up whole after the mandatory discounts, that is why you can very often get your bills slashed to a fraction of the original if you pay crash - obtrusive insurances means offices waste hours working on insurance instead of medical duties and many need to hire dedicated clerks

throwaway48476 2y ago

Health care billing works like a black Friday 'sale' where the price is jacked up and the 'sale' price is the same as the normal price. Usually health insurance 'negotiates' the price down to what it should cost and then you pay the full 'true' cost. When I had my wisdom teeth out my insurer negotiated the price down from $4k to $700, of which I paid 100%.

Brian_K_White 2y ago

You could say that insurance creates that environment, and profits from it. Insurance actually makes more money on the big bill, since they just charge whatever premiums are required to pay it plus their percentage. The bigger the better. And insurance creates the disconnect that allows a price to have no feedback control. They are happy to collect their income and benefit from the system they create, so they should not be granted any excuses for it's failures. The poor insurance companies are not the abused parties here.