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Yeah I dont smoke on account of the really bad wheezing problem. I dont think telling them I smoke is a great idea. I believe i'll get a large add on for cost if I do.
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Sep 12, 2021 02:44
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McNugget Buddy posted:On the other hand, if they already know, free pneumonia vaccine! yea just making that point so nobody who doesn't smoke thinks it's a good idea to go tell a pharmacy that they do smoke to get a vaccine thru their insurance. that is a v bad idea
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Sep 12, 2021 02:46
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Judge Dredd Scott posted:yeah i always assumed if the system didnt fully collapse on itself, a medicaid buy-in option would emerge. would be way better than what we have now The feds are already trying their damndest with the ACA expansion. 29% of all rural Pennsylvanians are on Medicaid right now. There will come a point where Medicaid / DSNP LTSS / Medicare insures everyone except extremely rich people and those people will be covered by commercial programs that basically turn into concierge healthcare. Unfortunately every loving step of that process is being fought by pretty much everyone. fwiw no insurers make money on ACA marketplace insurance. The money is in Medicare / Medicaid incentive-for-performance pay.
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Sep 12, 2021 02:47
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silicone thrills posted:Yeah I dont smoke on account of the really bad wheezing problem. I dont think telling them I smoke is a great idea. I believe i'll get a large add on for cost if I do. I work for an insurance company, lie whenever you can get away with it.
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Sep 12, 2021 02:48
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Judge Dredd Scott posted:yeah i always assumed if the system didnt fully collapse on itself, a medicaid buy-in option would emerge. would be way better than what we have now I think you guys are underestimating the USA's lust for the death of the poor, this country is more than willing to hurt literally everyone from top to bottom including the rich if it means a few more poor people will suffer and die. it's better if they profit from it but the suffering of the poor is an end goal just as much as it is a means to an end in this country Pittsburgh Fentanyl Cloud posted:The feds are already trying their damndest with the ACA expansion. 29% of all rural Pennsylvanians are on Medicaid right now. are DSNP plans usually, like, good? I ask because I'm curious as to whether I should expect calls of frustrated angry dying seniors or people who are mostly getting what they need
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Sep 12, 2021 02:48
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Pittsburgh Fentanyl Cloud posted:I work for an insurance company, lie whenever you can get away with it. Pharmacy audits consist of an insurance company showing up unannounced and saying "let us see 20 random prescriptions so we can check them for errors", and it's usually for the most high cost medications because otherwise they don't care If the insurance company pays the claim while you're standing there waiting for the shot, there's a 99% chance it never gets followed up on - that would require A. An audit to happen for your $100 vaccine B. Them actually checking any attestation you signed saying you were qualified to receive the vaccine (there likely is no signed attestation)
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Sep 12, 2021 02:53
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empty whippet box posted:are DSNP plans usually, like, good? I ask because I'm curious as to whether I should expect calls of frustrated angry dying seniors or people who are mostly getting what they need Serious talk here, DSNP or LTSS (long term services or supports, used synonymously sometimes with DSNP but it isn't) are last resort programs for people who have no other means of support. They're basically compassionate last-resort care. I'm glad we're doing them because it's a sign that our society isn't a total toilet bowl yet. If you're going to be fielding plan related calls it's good odds you'll be dealing with caregivers or proxies more often than those being cared for. It's not an easy job.
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Sep 12, 2021 02:54
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empty whippet box posted:I think you guys are underestimating the USA's lust for the death of the poor, this country is more than willing to hurt literally everyone from top to bottom including the rich if it means a few more poor people will suffer and die. it's better if they profit from it but the suffering of the poor is an end goal just as much as it is a means to an end in this country youre underestimating just how much the us government wants to give free money to private business
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Sep 12, 2021 02:54
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McNugget Buddy posted:Pharmacy audits consist of an insurance company showing up unannounced and saying "let us see 20 random prescriptions so we can check them for errors", and it's usually for the most high cost medications because otherwise they don't care Claim audits are based on automated kickouts and are rare as hell. Human beings don't look at every single claim because how the gently caress could they in 2021.
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Sep 12, 2021 02:56
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Judge Dredd Scott posted:youre underestimating just how much the us government wants to give free money to private business Right now, sadly, this is the #1 path to high quality care for Americans. ie Medicaid.
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Sep 12, 2021 02:56
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Pittsburgh Fentanyl Cloud posted:Serious talk here, DSNP or LTSS (long term services or supports, used synonymously sometimes with DSNP but it isn't) are last resort programs for people who have no other means of support. They're basically compassionate last-resort care. I'm glad we're doing them because it's a sign that our society isn't a total toilet bowl yet. hopefully you mean THEIR jobs aren't easy
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Sep 12, 2021 02:58
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fwiw my entire job is writing software that interprets customer care data for a set of quality-of-care metrics called HEDIS, which the government cares very much about and applies to every aspect of care in America from the insurance company POV. Commercial, marketplace, medicare, medicaid. There is a very serious push towards government-funded healthcare because that is more effective. Entrenched interests mean that it's going to take four times longer than it should and take a bunch of dipshit circuitous routes that shouldn't be necessary in a sane system, but this is where we are. The 1970s HMO explosion was a mistake.
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Sep 12, 2021 02:59
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empty whippet box posted:hopefully you mean THEIR jobs aren't easy There aren't any easy jobs out there.
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Sep 12, 2021 03:00
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Pittsburgh Fentanyl Cloud posted:There aren't any easy jobs out there. sure there are, they're just only for rich people.
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Sep 12, 2021 03:04
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empty whippet box posted:sure there are, they're just only for rich people. Yeah. SNP/LTSS programs are a giant loving burden fwiw, they're taken on by MCOs because the MCO can expect preferential Medicaid contracts if they perform well at SNP/LTSS. That's fine, but it ain't easy. The MCO I work for is taking them on to chip away at a 50+ year incumbent. That incumbent is abandoning Medicare/Medicaid and moving to commercial in other states in response.
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Sep 12, 2021 03:08
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empty whippet box posted:yea just making that point so nobody who doesn't smoke thinks it's a good idea to go tell a pharmacy that they do smoke to get a vaccine thru their insurance. that is a v bad idea it’s one way to end up in a : “you lied eat poo poo assured” situation.
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Sep 12, 2021 03:45
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Nitevision posted:I went to the doctor a couple years ago because I kept feeling lightheaded. I was assigned a resident who wasn't totally sure about his answer to me, so he pulled in the supervising doc for 3 minutes to talk through a couple things and double check. $100 bill that my insurance wouldn't cover because of the second doctor showing up Lol seems kind of weird the first doctor needed to see a doctor in the middle of your session with him to diagnose his stupidity, but it's a loving crime he's literally passing down the costs of his medical problems down to you hang them all
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Sep 12, 2021 04:12
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Private Cumshoe posted:seems kind of weird the first doctor needed to see a doctor in the middle of your session with him to diagnose his stupidity, but it's a loving crime he's literally passing down the costs of his medical problems down to you I'm sure if I got a bullshit charge it would still be an endless legal quagmire that automatically assumes I'm the bad guy and the bill is valid, but it makes me feel better about it. I have successfully disputed bullshit charges, and have not yet paid a bullshit charge, but that form hasn't come up as part of the argument yet. If someone tried to spring that "$100 fee for an extra doctor you didn't ask for who just entered the room and had nothing to do with you" bullshit on me, I would definitely invoice the hospital $250 for my time, plus $100 for my helpfully consulting a second doctor, and let a small claims court decide whether either both bills for something nobody asked for, or neither bill for something nobody asked for, is valid. Apparently the "another doctor enters the room and bills for it" thing is a common and intentional racket (sometimes while you're unconscious!) https://www.cbsnews.com/news/surprise-medical-bills-how-you-can-fight-back/, along with "aha, you asked a question, that's an extra $150 that we won't tell you about until we send the bill". https://www.moneyunder30.com/double-billing-doctors
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Sep 12, 2021 12:39
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roomforthetuna posted:A fun thing I like to do with medical facilities is when they ask me to sign the form that says something along the lines of "I agree to pay anything you decide to bill me for", before I sign it I alter it to say "I agree to pay anything you decide to bill me for provided I have been informed of the charge in advance in writing and signed off on it". I even told them I did this and they still accepted it. lol yeah bad news about that. you can’t alter a contract like that in the states. they will hold you to the original contract language and a court will let them. now that’s different in parts of Europe though.
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Sep 12, 2021 17:42
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Bar Ran Dun posted:lol yeah bad news about that. you can’t alter a contract like that in the states. they will hold you to the original contract language and a court will let them.
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Sep 12, 2021 23:04
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yeah last shot is a European thing unfortunately.
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Sep 12, 2021 23:58
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What a timely thread! In early August, I had to get some emergency surgery. It wasn't urgent enough that I couldn't get a pre-approval, but was urgent enough that I found out I needed it just a few days before I had it (found out July 28, had surgery August 3). I went to a facility that is 100% in-network, with the facility, department, and all personnel covered in-network by my plan. I should be good, right? On August 27, they mailed out a letter asking me whether I had other insurance, or whether I am eligible for Medicare (AKA, "Can we have somebody else pay out on this $95,000 claim?"). It didn't arrive until September 9, at which point, I responded using their web site within five minutes of opening the letter. On September 10, they denied my claim for "not responding to their inquiry". Never mind that I did respond, the mail is unpredictable these days, and they have my phone number to call me directly about important poo poo. So, now, I get to deal with their outsourced customer service bullshit (customer service is literally carved out to a third party, and my actual insurance company refuses to talk to me directly about anything, ever) to get them to process my claim. Oh, and the hours for the outsourced support are only M-F during business hours. And I'm on the west coast. gently caress this lovely system. The whole thing needs to burn. Edit: Looking at the explanation of "benefits", they actually denied the claim on September 8. Before I got their stupid letter. Kreeblah has issued a correction as of 19:43 on Sep 15, 2021 |
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Sep 13, 2021 00:45
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Oh, this is even better. I called the third-party support today, and they couldn't find my claim. I sent them the EOB so that they could take a look at it and try to track it down, and it turns out they hadn't been sent the info yet (apparently that takes like a week after the insurance company processes it). But the person I spoke to pointed out that the date on the EOB indicated that they denied my claim the same day that the post office delivered the letter asking for info (AKA, before I ever received their request).
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Sep 13, 2021 17:41
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so heres an urgent care and a hospital literally next to each other. you'd think they would be in the same network right? wrong, as my dad found out having your primary care be one of them means the other is outside the network and unless you got a referral first you have to pay big thankfully the insurance person was strangely and surprisingly nice and helpful and switched the primary care after the fact and re-ran the claim
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Sep 13, 2021 18:01
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My GF was vomiting, even in the waiting room of this urgent care we went to in Maryland. They made us sit down in a room for an hour while she was still sick, just to come in and be like uhhhh we don't do stomach stuff, you gotta go to the ER across the way. Dr. House over here took an hour to figure out vomiting is a stomach thing and therefore not something they "do". So I had to bring my still sick girlfriend all the way across that parking lot. A saline bag is all she ended up needing and her symptoms got much better once she could hydrate. I've written off Urgent Cares as a place to actually get healthcare. I've literally never had a good experience at one. Probably great places to do some insurance fraud or get a crooked oxycodone scrip though.
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Sep 14, 2021 00:10
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skooma512 posted:My GF was vomiting
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Sep 14, 2021 00:13
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I accidentally sliced open my thumb washing an apparently brittle glass. After they stitched me up they said a surgeon would need to look at it for possible tendon damage. I couldn't really move it. My insurance is Cigna. I asked, "Does the surgeon accept Cigna?" and the ER doc said "He'll work with your insurance provider." I said, "Thanks but I really need to make sure he's in network, I've read about people getting surprise six-figure bills and I can't afford that. If he doesn't accept my insurance I'd really appreciate another surgeon who does." The ER doc paused and then said very carefully "The surgeon will work with your insurance provider." I made the appointment anyway and went home to search for a plastic surgeon through my insurance website. This is the same website where I submitted five "Information out of date" reports while trying to find a PCP because it took an hour of calling disconnected dial tones, not accepting new patients, no longer practicing here, and pediatric only before getting a word of mouth referral from a friend for a community practice and getting an appointment within the week. Anyway, one tendon repair surgery and three months of rehab and living one-handed later, I get a bill from the surgeon for $69,000. Nice. The surgeon was apparently out of network. I called the surgeon's office to laugh at them for thinking I even had $69,000 to give them and enjoy not getting fully paid until 2050 you unfortunate assholes but they referred me to the billing department who said they needed me to resubmit the claim to my insurance company under a different code and then some magic would happen and everything would be fine. I was extremely hesitant to a) follow instructions from the people who sent me a surprise bill for $69,000 in error, maybe, and then told me to fix it b) interact with my insurance company on this matter who doubtless wanted me to use the wrong secret phrase and legally condemn myself to paying the whole bill, so I sat on this for a bit and asked friends and relatives for advice. A few weeks later I got a call from the surgeon's office asking me to sit on a call with the insurance provider while they negotiated the bill. For some reason I no longer needed to resubmit the claim. So I join the conference call and it's your typical Zoom meeting esque at 3pm deal where everyone greets each other, one person says the purpose of the call, a second person says a magic phrase, and the insurance person does a verbal Zelda secret chime and everyone says "Thanks" and hangs up. Two months later I get a letter from my insurance company informing me that they negotiated a discount with my surgeon, so the bill went from $69,000 down to $3,000 and they would cover $2,300 of it, so I was on the hook for $700. But, as my friend who works in nursing informed me, this number was imaginary because I already met my deductible, and at the end of the month insurance cuts checks out to all the doctors for the remaining balance, so I owed nothing, and in fact never received a bill for $700 from anyone. I was surprised that my surgeon was willing to let go of $66,000 like that. I didn't understand why they needed me on that call, or why the didn't need me to resubmit that claim. The surgeon actually did a pretty good job on my thumb, but he didn't restore my distended joint, since their policy is only to restore functional mobility. I'm currently looking for an eye doctor.
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Sep 14, 2021 14:27
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The American healthcare system would unsettle Kafka.
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Sep 14, 2021 14:35
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You pretty much have to be an insurance lawyer to get healthcare in this country if you have anything more than the usual check up and prescriptions, and watch the insurer like a hawk. At least they did a three-way and worked it out without you the end user having to learn ICD-10 codes yourself. This is not always guaranteed. The only thing worse than getting a bill, is not getting a bill. Who knows if it's just sitting around on file waiting to go to collections? I went to the ER after getting injured at work, at the hospital. I was never billed even though they took my info and said I would be. Who knows whether a bill was generated, or if it was paid, and how I could prove either. Lucky for me they went bankrupt and closed. Meanwhile my current work didn't post a bill for over a month, and when they finally did they gave me just 2 weeks to pay it.
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Sep 14, 2021 19:29
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skooma512 posted:My GF was vomiting, even in the waiting room of this urgent care we went to in Maryland. They made us sit down in a room for an hour while she was still sick, just to come in and be like uhhhh we don't do stomach stuff, you gotta go to the ER across the way. they're popping up everywhere around me. good to know its another scam. what will they take care even. RadiRoot has issued a correction as of 22:13 on Sep 14, 2021 |
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Sep 14, 2021 22:10
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Ardennes posted:The American healthcare system would unsettle Kafka. https://twitter.com/MartinKulldorff/status/1437466102078984193 Great Barrington Moderation
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Sep 14, 2021 22:16
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lol my health insurance premium is going to be fourteen times more expensive next year
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Sep 14, 2021 22:17
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it's still really low comparatively, but that's crazy
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Sep 14, 2021 22:17
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skooma512 posted:You pretty much have to be an insurance lawyer to get healthcare in this country if you have anything more than the usual check up and prescriptions, and watch the insurer like a hawk. Medical Billing Advocate services negotiate down bills on your behalf and then charge you a percentage of the savings. I've used this one before and had success - you just upload your bills and agree to pay the balance due as a lump sum when they finish: https://www.copatient.com/
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Sep 14, 2021 22:23
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canadian perspective: i recently got in an accident where i broke some stuff and needed surgery, and all i could think about is how much this would have cost in an american hospital and now i know its much worse than that. whenever i see any critiques drawn up of canadian coverage by americans (warranted or not) i honestly think those people could never even fathom what universal health care could look like
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Sep 15, 2021 05:42
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Radirot posted:they're popping up everywhere around me. good to know its another scam. what will they take care even. urgent care is for when you're uninsured and need antibiotics for an infected cut, or you think you have pneumonia or strep throat or something and it's not getting better on its own.
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Sep 15, 2021 10:14
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McNugget Buddy posted:Medical Billing Advocate services negotiate down bills on your behalf and then charge you a percentage of the savings.
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Sep 15, 2021 12:52
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ok here's a fun exercise. open your search engine of choice and look up "usa average cost covid-19 hospital stay" god bless america. i don't know how you stay sane to be honest.
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Sep 15, 2021 13:15
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Buck Turgidson posted:ok here's a fun exercise. open your search engine of choice and look up "usa average cost covid-19 hospital stay" I've had two surgeries on my knees to clean up my meniscus. Meniscuses? meniscii? Anyway after the first surgery in 2012 my insurance company at the time sent me an explanation of benefits. In at 9 AM, out at 11 AM, total cost to the insurer $42K.
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Sep 15, 2021 13:23
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Anyway I work for an insurer now and we were talking on the quarterly about a recent pregnancy + birth that cost $3m
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Sep 15, 2021 13:24
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