Worker's Comp Insurance

[Adamski]

Paul,

That story about your Aunt is enough to make me sick.

[jh]

Paul,

There is a big gap between what the doctors/hospitals claim and what Medicare pays out. Typically 40% of the claimed amount as I have been told. This usually happens in every case. Sometimes the doctor/hospital doesn't get a penny if there's any mistake or inconsistency in the documents.

[MrMachine]

Originally Posted by jh

Paul,

There is a big gap between what the doctors/hospitals claim and what Medicare pays out. Typically 40% of the claimed amount as I have been told. This usually happens in every case. Sometimes the doctor/hospital doesn't get a penny if there's any mistake or inconsistency in the documents.

Yeah John, that's right. I've heard that too. It's a little game they all play.
In fact, I have an old friend who works at a hospital and her ONLY job is to max out income from Medicare. She's an RN who doesn't practice anymore. Instead, she's at a computer all day reviewing cases.

It's all about gaming the system. If Medicare gets ripped off like this, just wait until they get their slimy little hands on ObamaCare.

Hmmmm....so let's see....40% of $80,000.00....

[DaveLevenson]

When I had a heart attack, back in 2007, I spent a week in each of two hospitals. At the first, I was given emergency angioplasty, and kept in the ICU for a few days. A week later, after an incident of cardiac arrest, I went to the second for more angioplasty and then a pacemaker/defibrillator implant and a few days of monitoring. The billing from both hospitals and numerous specialists came to about $600,000. The implanted hardware was another $40,000 or so. (Had I not had insurance, I'd have had to sell my house and my laundromat to pay for it.) Horizon Blue paid about $200,000 and I paid another $6,000 out of pocket (deductibles and non-covered procedures). I think the hospitals have to inflate their billing because they expect the insurance industry (and the government, in the case of Medicare patients) to force them to take less.

The real losers are the folks who are not insured and pay the entire bill out of pocket. Perhaps the real winners are the folks who receive treatment and don't pay anything because they're not insured and have no assets. They are subsidized by the huge bills paid by those who can afford it.

As I understand ObamaCare, everybody is supposed to have insurance. Those who can't afford to buy insurance will get government assistance and pay nothing for it. They are subsidized by those who can afford to buy insurance or pay a new tax. Perhaps I'm missing something, but isn't this exactly what's already happening, without the government playing the middleman part?

[Howard]

Mathematically what you are saying is true Dave. The problem is they are demanding more things be covered, and be "FREE". Last I checked nothing is free, what one person gets for free another person has to pay for. Free is very inefficient as it promotes over consumption, like with free dry.

Further anytime you put government in the middle of something it adds costs, creates waste fraud and abuse and is sub-optimal. This entire law is just another attempt at income redistribution.

[MrMachine]

Originally Posted by Howard

Mathematically what you are saying is true Dave. The problem is they are demanding more things be covered, and be "FREE". Last I checked nothing is free, what one person gets for free another person has to pay for. Free is very inefficient as it promotes over consumption, like with free dry.

Further anytime you put government in the middle of something it adds costs, creates waste fraud and abuse and is sub-optimal. This entire law is just another attempt at income redistribution.

EXCELLENT analogy Howard!!

[MrMachine]

Originally Posted by DaveLevenson

I think the hospitals have to inflate their billing because they expect the insurance industry (and the government, in the case of Medicare patients) to force them to take less.

The real losers are the folks who are not insured and pay the entire bill out of pocket. Perhaps the real winners are the folks who receive treatment and don't pay anything because they're not insured and have no assets. They are subsidized by the huge bills paid by those who can afford it.

I would just like to add that I had a plan for about 2 years that didn't pay office visits.
I would go to the doctor's office and as usual, the first thing they ask is where is your insurance.
I told them my plan doesn't pay for office visits. I would then get anywhere from 25 to 50% off depending on the doctor.
Some of the discount is due to the fact that I wasn't covered, but the secretaries also told me that it's much cheaper and easier for them to be paid cash then and there.....no chasing or fighting over bills.

That made me wonder that if doctors and hospitals could be paid on the spot, similar to when you bring your car in to be repaired, we would eliminate a huge amount of red tape.
So medical savings accounts do have some merit, don't you think?

[nycwash]

The number one problem with the system is that people getting the service (patients) are not the ones paying the bills (insurance, medicare). Therefore 99% of people dont care what is being done and how much it costs. If patients had to pay 5-10% of the bill things would have been much different.

[rbh]

Dead on. Its amazing that the same people who will cut coupons to save 50 cents don't give a damn what anything costs for health care.....once you make the connection to their wallet, people will perhaps treat their bodies at least as good as they treat their cars for the same reason....to save money!