Health Care Costs

[matt819]

I spent some time earlier this week clearing some overdue medical bills, mainly to keep track of some new bills expected in the next group of invoices.

Here's one observation. We get most of our health care from one major health care system. And within that system we mostly use two facilities. And yet. . .

I receive bills from nine - count 'em, nine - separate entities.

First of all, that one major health care system doesn't treat patients as if they are in one major system. So goint to multiple facilities results in multiple bills.

Next, I receive bills from the hospital, from the clinic connected to the hospital (for doctor visits), and from individual practices, including orthopedics and radiology.

And then, for no apparent reason, I receive bills from the same entity under different account numbers.

Now, add in my spouse, and we're looking at more than 15 separate accounts for two people.

Is this fucked up, or what?

[elleng]

1. We don't have a health care 'system,'

as your experience clearly demonstrates, but health care chaos.

ACA is as complex as it is for the reason your experience shows, among others. Took a long time to come up with ACA, and will take longer, and be more painful, if repugs really try to replace.

What makes sense? 'Single payer,' that is, medicare for all. As a participant, I can say they appear to handle the complexity well.

[Hoyt]

3. Medicare is definitely a better system, but all those entities are still billing Medicare.

As the patient/beneficiary, you will either get a bill from those entities if you owe a portion (usually coinsurance) or a notice from the insurance company handling Medicare administration in your area of the bills/claims Medicare has paid on your behalf.

The only time I ever found these aspects handled efficiently was when I had Kaiser's Medicare Advantage plan for a short time before I went back to work full-time. If I went to my primary care doc and he told me I needed a colonoscopy, I went where they told me and didn't receive any bills from anyone. Now that I have insurance through my employer again, every entity and provider bills separately. Don't know if that will change anytime soon.

Medicare has tried to develop systems where hospitals, doctors, etc., share one payment, but the providers just start fighting over their share. And, Trumpster's nominee for Health and Human Services is against such payment bundling and attempts to improve the system.

[elleng]

5. Yes, and medicare is handling it, at the moment.

I have a co-insurance, retired/federal, so they pay the little that medicare doesn't pay.

My point was/is that we have no 'system,' and some of us are fortunate that our 'plans' work things out more smoothly than others.

[alarimer]

2. We would save so much money as a nation by switching to single-payer.

There would be no need for armies of coders and billers at doctors' offices. Of course, I guess that would mean these people would need to find another job, but imagine how much time would be saved by doctors and nurses not having to do massive amounts of paperwork.

There would also be no need for in-network or out-of-network plans. I had gall bladder surgery last year and I know some of the providers were out of network but I was in no position to check on that, if I could even do anything about it at all. The way it is right now, not all doctors, nurses anesthesiologists, etc. work for the hospital you may use. They are contractors I suppose. I also received incorrect bills, bills of identical amounts (which seemed suspiciously like double-billing, but I have no idea if it was).

The current system is needlessly complex and complicated.

[Hoyt]

4. How do you figure that? Coders are needed to bill Medicare and Medicaid, and over 30% of Medicare

beneficiaries belong in Medicare Advantage systems with networks. Unless you put providers on government payroll, coders are going to be necessary.

The system is complex because everyone involved is greedy.

[politicat]

6. Yes. I've got one on my desk right now for $0.00

My grandmother was in a rehab for a stroke a year ago. Medicare and her supplemental policy covered it, no problem. (I was/am responsible for her; she died two weeks ago.) I have issues with some of Medicare's decisions and providers interact with the system, but not with patient care or coverage. It's a beautiful single payer system, and if more people under age 50 had to interact with it on a regular basis, I bet we'd have more single payer support.

I've been getting these $0.00 statements for months. I call the billing company, we have a conversation, they assure me I need do nothing... and two months later, I get another one, call the company, have a conversation...

That's one provider.

But here's the thing - medical billing services are considered good jobs, aspirational for someone in retail or food service. When we start talking about single payer, people (at least subconsciously) realize that there will be a lot fewer of those indoor, safe, clean, stable jobs. That's a part of the discussion that we don't take into account when we talk about single payer. And we have to talk about it, because it's a significant part of the economy.