Trumpcare?

[disneysteve]

I vote that the thread be closed.

As long as people can keep the personal comments out of it, I think it's actually an interesting conversation. For sure, there is a lot of misinformation out there, evidenced by numerous posts in this thread, so it's good to have a place to clear them up and explain how things actually work.

With that in mind, earlier you said something that I haven't had a chance to respond to.

Most providers are incentivized to bill more/see more/do more. Even primary care. My wife went to an internal medicinr practice to consult about her elevated liver enzymes. Four weeks later we get a bill for over $800. Multiple lab tests performed at their lab, many of which the necessity was highly questionable, a $200 charge for a sonogram that "might" be necessary in the future, etc.

This just isn't true, or at least not as a blanket generalization.

When I send a patient for blood work, I make nothing on that. The lab bills the patient's insurance company and/or the patient directly. If we draw the blood in our office, we do get a small drawing fee (a few dollars) but it's certainly no incentive to do unnecessary blood work. If I send a patient for an ultrasound, I make nothing on that. The radiology site bills the patient's insurance company and/or the patient directly. In fact, it technically costs us money because we have to pay staff to get the authorization for the test and issue the referral. It's not like the old days where I could just write a prescription and send you on your way.

[PeggyHefferon]

Yeah, I read the entire exchange. While I can agree that assisted suicide should be a legally available option, I think you might be grossly overestimating how many people with expensive medical conditions would be interested in taking that route. And when someone who has firsthand experience with a 250k to 1 mil annual cost of care tells you that what you said was pretty offensive, you should maybe listen to them.

Your opinion is based on your personal experience as is mine. I don't need to throw out dollar figures of what I have seen firsthand in order to justify my opinion.

I am happy for you that the medical care of your loved ones has allowed them to live a happy & pain free life. There are many illnesses that don't have that same result.

I wish no ill will toward anyone suffering from severe illness. I simply just believe that they should have the option to have a medical professional end their life if that is what they choose. Also, it shouldn't be come down to choosing pain & suffering in order to leave a life insurance payout.

[TexasHusker]

As long as people can keep the personal comments out of it, I think it's actually an interesting conversation. For sure, there is a lot of misinformation out there, evidenced by numerous posts in this thread, so it's good to have a place to clear them up and explain how things actually work.

With that in mind, earlier you said something that I haven't had a chance to respond to.



This just isn't true, or at least not as a blanket generalization.

When I send a patient for blood work, I make nothing on that. The lab bills the patient's insurance company and/or the patient directly. If we draw the blood in our office, we do get a small drawing fee (a few dollars) but it's certainly no incentive to do unnecessary blood work. If I send a patient for an ultrasound, I make nothing on that. The radiology site bills the patient's insurance company and/or the patient directly. In fact, it technically costs us money because we have to pay staff to get the authorization for the test and issue the referral. It's not like the old days where I could just write a prescription and send you on your way.

If my wife's internist - who is a partner in the practice, isn't making a boat load off of labs and an ultrasound, why would they be billing me for such, unbundling CPT codes, billing me for an ultrasound they didn't perform, and all of this at 332% to over 600% of Medicare? Oh and billing for 60 minute visit when she was with the doctor no more than 15?

You're living in fantasy land.

[disneysteve]

If my wife's internist - who is a partner in the practice, isn't making a boat load off of labs and an ultrasound, why would they be billing me for such

You're living in fantasy land.

I'm not sure what you aren't understanding.

In my practice, we don't perform blood tests. Therefore, we can't bill for blood tests. If your wife's doctor does, then he can.
We don't perform ultrasounds, so we can't bill for them. If your wife's doctor does, then he can.
We can only charge for things we do. We can't charge for things we don't do.

If, however, he charged her for a test that wasn't actually performed, that is an error and should be corrected.

[TexasHusker]

I'm not sure what you aren't understanding.

In my practice, we don't perform blood tests. Therefore, we can't bill for blood tests. If your wife's doctor does, then he can.
We don't perform ultrasounds, so we can't bill for them. If your wife's doctor does, then he can.
We can only charge for things we do. We can't charge for things we don't do.

If, however, he charged her for a test that wasn't actually performed, that is an error and should be corrected.

Your practice may be different, but few-for-service medicine by its very nature incentivizes physicians to do more. My wife's doctor unbundled the labs for more $$$, upcoded the E&M code for more $$$, charged for services not performed for more $$$, and charged for tests not needed for $$$.

It was just dumb luck we saw the bill - the insurance company would have never known.

I called the office manager and told her we would be filing complaints with the TX medical board and Dept of Insurance if they didn't get everything corrected. Fraud is willful intent to mislead, and if this wasn't fraud I'm not sure what would be.

[disneysteve]

fee-for-service medicine by its very nature incentivizes physicians to do more.

Absolutely. No argument on that point at all. When doctors earn more for doing more, there is a clear incentive to do more.

My wife's doctor unbundled the labs for more $$$, upcoded the E&M code for more $$$, charged for services not performed for more $$$, and charged for tests not needed for $$$.

This, however, is an entirely different issue. If they are intentionally upcoding, overcharging for labs, and billing for services not performed, that's fraud. That has nothing to do with an incentive created by a fee-for-service payment arrangement.

You just implied earlier that every doctor makes a ton of money for ordering more tests, and that simply isn't true.

[hamchan]

I'm actually living it now with my dad.

Do you feel his life isn't worth the expense? Does he feel that way? Do you think you'd feel any different if it were your spouse or your child?

[TexasHusker]

Do you feel his life isn't worth the expense? Does he feel that way? Do you think you'd feel any different if it were your spouse or your child?

Of course he's worth it. Every penny plus billions more. I have no complaints.

[Like2Plan]

"I don't know what else to say other than Obamacare is the law of the land. It'll remain law of the land until it's replaced," he said. "We're going to be living with Obamacare for the foreseeable future." Speaker Paul Ryan

I was worried about the upcoming changes to the law, but I can honestly say I am a little surprised at this turn of events.

[txex86]

Just wait until the 2018 premiums/deductibles are released for Obamacare in October, along with which exchanges will have insurers leaving. This isn't done, IMO. Obamacare will implode under the weight of spiraling costs.

[Thrif-t]

Dang it! This is a little selfish of me but DH has one of the cadillac health plans at work. I was so hoping this would get repealed so we would get to keep our great benefits

[disneysteve]

Dang it! This is a little selfish of me but DH has one of the cadillac health plans at work. I was so hoping this would get repealed so we would get to keep our great benefits

Why would he lose the plan he has now?

[Like2Plan]

The Patient Protection and Affordable Care Act (PPACA, as amended by the Health Care and Education Reconciliation Act of 2010), imposes an annual 40% excise tax on plans with annual premiums exceeding $10,800 for individuals or $29,500 for a family starting in 2020, to be paid by insurers.[4][7] The tax is not imposed on the total cost of the plan, but on the costs exceeding the aforementioned values, which, after 2020, will adjust to inflation annually. These costs include any part of a person's income allocated to flexible spending accounts, health reimbursement accounts, and health savings accounts, but not expenditures for stand-alone dental, vision, accident, disability, or long-term care insurance coverage.[7][8] The tax is not a deductible business expense and so plan administrators pay income tax on the excise tax, significantly increasing the effect of the 40% tax.[8] The tax is intended to do three things: help finance the PPACA; reduce overall health care costs; and address the unequal tax benefit of excluding employer-based health insurance coverage from taxes

source wikipedia: https://en.wikipedia.org/wiki/Cadillac_insurance_plan

Another link: http://www.healthaffairs.org/healthp...hp?brief_id=99

[Thrif-t]

^ Oh 2020 I thought it was 2018!! DH needs to get knee replacements and I can't get him to get this done. He's 53 and thinks he's too young. I want him to start the process now while his insurance is good. But no, he'll wait until the above kicks in and his job changes his insurance and it'll be more expensive. He always costs me more money.

[PeggyHefferon]

^ Oh 2020 I thought it was 2018!! DH needs to get knee replacements and I can't get him to get this done. He's 53 and thinks he's too young. I want him to start the process now while his insurance is good. But no, he'll wait until the above kicks in and his job changes his insurance and it'll be more expensive. He always costs me more money.

Kick him and his rickety old knees to the curb