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KingNastidon has summarized things nicely. One of the big roadblocks to improved care and improved billing is that the insurance company can question the recommended care of your provider, essentially acting as a second opinion that is usually biased because they are identified to cover as little as possible. Prior authorizations are part of this problem. Your misreading the context OP, "prior auth" means your doctor needs to get prior authorization from your insurance to even offer the prescription. "prior" meaning before pen goes to script and "auth" coming from the payer. I don't know if it's fair to fully demonize HCPs for pricing issues like the other poster did. They are complicit and generally run by for profit boards, but the price gouging comes because so many payers are negotiating adjustment contracts. You only ever see the insane numbers if you run out of coverage and have to self-pay, and at that point the hospitals generally don't expect to receive payments and will just write off the remainder as charity or losses. ILL Machina fucked around with this message at 00:24 on Aug 7, 2020 |
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Aug 7, 2020 00:19
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Glory to Italia! 
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Tomberforce posted:Have you ever considered that forcing someone to provide you a service is called slavery so publically funded medical care mesns making doctors into slaves. But this doesn't apply to any other public sector job for reasons. Rand Paul has said this publicly. He's saying if you're off duty or not on call and someone needs help, you would have to respond no matter what or the government could hold you criminally accountable. It is a tech, to be sure, and seems like would only be managed with more regulation protecting schedules, overtime, and on-call respect...which I think his libertarian sensibilities would contest.
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Aug 7, 2020 00:27
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The insurance industry is the problem. I don't see any other way around it. I wouldn't have a job of the system wasn't so hosed and everyone could do accounting without machine learning leaps, but I would prefer it. Obama said in an exit interview that he wanted to be more progressive and fight for something like a single payer system, but the insurance industry is huge and employs many thousands of people. It should happen for our own good, but it will be very disruptive. ILL Machina fucked around with this message at 01:57 on Aug 7, 2020 |
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Aug 7, 2020 00:56
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