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Raptorpat

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PCP assigned by health insurance: in network

Affiliated lab next door: not in network

 

Interfacing with an unintelligible, unnecessary bureaucracy overlayed on top of interfacing with the bureaucracy of the actual healthcare providers themselves is the #1 reason expanding access to health insurance coverage won't actually expand the use of healthcare providers for people not already in the routine of going to doctors etc.

/rant

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I'm able to get free health coverage from my work place, that said though if I had a spouse or kids I'd have to pay for those.

I've been told that our coverage is pretty good but I still avoid using it just cause I don't want to pay the deductibles. There's a few things I would like to see a doctor about but I don't want to spend the money yet.

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55 minutes ago, resurrected said:

I've never heard of free health care being provided by an employer. Unless it's an ICHRA, where they reimburse you. Which is shit.

Might as well pay the deductible and use it. But I'd wait until the New Year, since deductibles have to be met every year. 

My healthcare is United healthcare. I'm technically considered employed by my city, us being part of a union. Healthcare is provided for us as an individual for free, but if I had people added to it like a spouse or kids I'd have to pay for them.

The issues I want to see them aren't anything serious, mostly cosmetic. Something that doesn't require me to see someone about, especially not during this pandemic.

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7 hours ago, Ginguy said:

Thank aside, healthcare is so damn expensive precisely because of the involvement of insurance companies.

Wow.

You're the biggest fucking snake.

 You know it's private insurers that make the cost so high and still rally against Medicars for All?

You're a deeply vile person.

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11 hours ago, scoobdog said:

Healthcare is expensive because no controls exist to cap costs for suppliers and tributary services.

Pretty much this. My sis has a full time job at the hospital in our town (not a doctor or a nurse) and she doesn't even make $14 an hour, and yet just for her, my brother in law, and nephew she's paying at least $200-250 a month.

My step-dad with his work is paying around the same price for him my mom and their kid. That's just for a family of three, who knows how much families of 4 or 5, or even more have to pay for health coverage.

My healthcare is good from what I've been told, but they stopped giving the workers in our union dental coverage over a decade ago. I got lucky back in January cause a wisdom tooth of mine came in at an angle where it isn't impacting anything and I don't need it removed, if I had to get wisdom teeth removed I'd be paying a grand at minimum.

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19 hours ago, Raptorpat said:

I agree, let's get rid of private insurance companies.

A single-payer system, combined with tuition reforms at medical schools, will go a long way towards controlling the costs of healthcare while also eliminating unnecessary insurance bureaucracy, without placing the burden of paying (disincentive) on the patient.

Yeah, no. I said get rid of insurance companies. No single payer, it is too expensive, it only drives up the costs and destroys quality of care. I do agree with tuition reform, but it shouldn't be limited to med school. People shouldn't have to go into 40k of debt for a degree in Gender Studies that will get them a 20k/yr job grinding beans at a Starbucks if they are lucky.

 

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21 hours ago, Raptorpat said:

I agree, let's get rid of private insurance companies.

A single-payer system, combined with tuition reforms at medical schools, will go a long way towards controlling the costs of healthcare while also eliminating unnecessary insurance bureaucracy, without placing the burden of paying (disincentive) on the patient.

and here i thought your op was against single payer lol. 

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9 hours ago, Ginguy said:

Yeah, no. I said get rid of insurance companies. No single payer, it is too expensive, it only drives up the costs and destroys quality of care. I do agree with tuition reform, but it shouldn't be limited to med school. People shouldn't have to go into 40k of debt for a degree in Gender Studies that will get them a 20k/yr job grinding beans at a Starbucks if they are lucky.

 

Because after removing healthcare companies, the medical institutions definitely won't continue to gouge prices.

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11 hours ago, Ginguy said:

Yeah, no. I said get rid of insurance companies. No single payer, it is too expensive, it only drives up the costs and destroys quality of care. I do agree with tuition reform, but it shouldn't be limited to med school. People shouldn't have to go into 40k of debt for a degree in Gender Studies that will get them a 20k/yr job grinding beans at a Starbucks if they are lucky.

 

The US pays more than twice per capita for healthcare than the vast majority of western countries yet ranks somewhere in the high-teens to mid-20s in most tangible metrics of healthcare outcomes.  Try again Jingo.

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On 9/10/2020 at 1:17 PM, Ginguy said:

Yeah, no. I said get rid of insurance companies. No single payer, it is too expensive, it only drives up the costs and destroys quality of care. I do agree with tuition reform, but it shouldn't be limited to med school. People shouldn't have to go into 40k of debt for a degree in Gender Studies that will get them a 20k/yr job grinding beans at a Starbucks if they are lucky.

 

I would argue that a single payer system with a statutory and fiduciary obligation to negotiate fair costs on behalf of the taxpayers that rely on the service would, in contrast, lower the cost of medical care in comparison to the present system wherein insurance companies and other segments of the health care industry play off both providers and patients. In contrast with eliminating insurance entirely, a single payer system allows for the pooled leverage of buying power to ensure that products and services are not only affordable, but that access to services isn't limited by individuals' direct ability to pay. The quality of care would not be negatively impacted to the extent that the profit motive of health care providers would not be negatively altered (as opposed to the profit motive of the insurance), and it would improve the quality of service and care to the extent that patients are freer to shop around from provider to provider due to the elimination of insurance networks.

Tuition reform is necessary across the board, but that process also desperately requires a national discussion on what the intent of post-secondary education actually is, how or when the value of a degree should or shouldn't be tied to career tracks, and why a post secondary education is now viewed as nearly mandatory by society despite the escalating costs. 

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On 9/14/2020 at 11:12 PM, Raptorpat said:

I would argue that a single payer system with a statutory and fiduciary obligation to negotiate fair costs on behalf of the taxpayers that rely on the service would, in contrast, lower the cost of medical care in comparison to the present system wherein insurance companies and other segments of the health care industry play off both providers and patients. In contrast with eliminating insurance entirely, a single payer system allows for the pooled leverage of buying power to ensure that products and services are not only affordable, but that access to services isn't limited by individuals' direct ability to pay. The quality of care would not be negatively impacted to the extent that the profit motive of health care providers would not be negatively altered (as opposed to the profit motive of the insurance), and it would improve the quality of service and care to the extent that patients are freer to shop around from provider to provider due to the elimination of insurance networks.

Tuition reform is necessary across the board, but that process also desperately requires a national discussion on what the intent of post-secondary education actually is, how or when the value of a degree should or shouldn't be tied to career tracks, and why a post secondary education is now viewed as nearly mandatory by society despite the escalating costs. 

I worry when it is he government that is ultimately in charge of picking winners and losers, particularly when it comes to life and death/healthcare. I would argue that instead we have a system with multiple choices to allow individuals to have maximum freedom of choice to meet their needs. You can do a couple of things to drive costs down; make the Health Care sector tax exempt, allow pharmaceuticals to bring their medications to market in a quicker manner while not compromising safety, organize providers into networks (with fiduciary requirements) that patients can buy a membership in, allowing employers to offer 1:1 matching HSA (tax exempt for employer and employee up to 25k/yr). All of those measures taken together will lower costs considerably while giving the individual patient the flexibility to find the provider they are most comfortable with, as opposed to being assigned one.

Tuition reform is needed because colleges get fed at the Fed piggy trough. Here is your worthless degree for 40k/yr in loans that you will never be able to pay back but hey, it's the Feds doling it out so the screwl doesn't care, they already got paid it is just the poor student who gets stuck with the bill they can't escape (no bankruptcy). I mean, if I can go to Google's "lern2c0de" for six months and get a job making 60k/yr why do I need to go take 40 hours of gender studies and weather and climate? The schools currently offer some degrees which are viable, and others which aren't. Maybe schools should have to guarantee the economic viability of their degree programs, if a graduate can't get a job in their field of study within a year the school has to assume the loan debt. I wonder how fast that would change things. Come to think of it, I'm going to be going to a picnic this weekend with my Congressman's field staff, maybe I'll mention that. Seems like a good idea to me, save taxpayers some cash.

 

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14 minutes ago, Ginguy said:

I worry when it is he government that is ultimately in charge of picking winners and losers, particularly when it comes to life and death/healthcare. I would argue that instead we have a system with multiple choices to allow individuals to have maximum freedom of choice to meet their needs. You can do a couple of things to drive costs down; make the Health Care sector tax exempt, allow pharmaceuticals to bring their medications to market in a quicker manner while not compromising safety, organize providers into networks (with fiduciary requirements) that patients can buy a membership in, allowing employers to offer 1:1 matching HSA (tax exempt for employer and employee up to 25k/yr). All of those measures taken together will lower costs considerably while giving the individual patient the flexibility to find the provider they are most comfortable with, as opposed to being assigned one.

Tuition reform is needed because colleges get fed at the Fed piggy trough. Here is your worthless degree for 40k/yr in loans that you will never be able to pay back but hey, it's the Feds doling it out so the screwl doesn't care, they already got paid it is just the poor student who gets stuck with the bill they can't escape (no bankruptcy). I mean, if I can go to Google's "lern2c0de" for six months and get a job making 60k/yr why do I need to go take 40 hours of gender studies and weather and climate? The schools currently offer some degrees which are viable, and others which aren't. Maybe schools should have to guarantee the economic viability of their degree programs, if a graduate can't get a job in their field of study within a year the school has to assume the loan debt. I wonder how fast that would change things. Come to think of it, I'm going to be going to a picnic this weekend with my Congressman's field staff, maybe I'll mention that. Seems like a good idea to me, save taxpayers some cash.

 

Those measure would sure make healthcare providers (not health workers) richer, but how would they actually also cause prices to go down?

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On 9/16/2020 at 5:15 PM, Ginguy said:

I worry when it is he government that is ultimately in charge of picking winners and losers, particularly when it comes to life and death/healthcare. I would argue that instead we have a system with multiple choices to allow individuals to have maximum freedom of choice to meet their needs. You can do a couple of things to drive costs down; make the Health Care sector tax exempt, allow pharmaceuticals to bring their medications to market in a quicker manner while not compromising safety, organize providers into networks (with fiduciary requirements) that patients can buy a membership in, allowing employers to offer 1:1 matching HSA (tax exempt for employer and employee up to 25k/yr). All of those measures taken together will lower costs considerably while giving the individual patient the flexibility to find the provider they are most comfortable with, as opposed to being assigned one.

Tuition reform is needed because colleges get fed at the Fed piggy trough. Here is your worthless degree for 40k/yr in loans that you will never be able to pay back but hey, it's the Feds doling it out so the screwl doesn't care, they already got paid it is just the poor student who gets stuck with the bill they can't escape (no bankruptcy). I mean, if I can go to Google's "lern2c0de" for six months and get a job making 60k/yr why do I need to go take 40 hours of gender studies and weather and climate? The schools currently offer some degrees which are viable, and others which aren't. Maybe schools should have to guarantee the economic viability of their degree programs, if a graduate can't get a job in their field of study within a year the school has to assume the loan debt. I wonder how fast that would change things. Come to think of it, I'm going to be going to a picnic this weekend with my Congressman's field staff, maybe I'll mention that. Seems like a good idea to me, save taxpayers some cash.

 

The existence of private insurance is the greatest obstacle toward maximizing freedom of choice.

Freedom of choice, within health care at least, comes from fewer servicers. If you have 200 networks, hospitals/doctors won't deal with all of them.

A single payer system has just one network. All doctors accept it.

As it stands, employers choose what insurance you get. What insurance you get determines what doctor you can see. In other words, your doctor is more or less picked by the employer. You like my doctor, you lose the job that insurance is tied to, you lose the doctor you liked.

That's not choice. It's coercion to force you to stay in a job no matter how good or bad it is since if you get sick you'll be s.o.l. without that [likely dramatically worse than Medicare] insurance.

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On 9/16/2020 at 8:15 PM, Ginguy said:

I worry when it is he government that is ultimately in charge of picking winners and losers, particularly when it comes to life and death/healthcare. I would argue that instead we have a system with multiple choices to allow individuals to have maximum freedom of choice to meet their needs. You can do a couple of things to drive costs down; make the Health Care sector tax exempt, allow pharmaceuticals to bring their medications to market in a quicker manner while not compromising safety, organize providers into networks (with fiduciary requirements) that patients can buy a membership in, allowing employers to offer 1:1 matching HSA (tax exempt for employer and employee up to 25k/yr). All of those measures taken together will lower costs considerably while giving the individual patient the flexibility to find the provider they are most comfortable with, as opposed to being assigned one.

You keep inferring that a single payer system would reduce choice when the reality is that the opposite is true. Instead of a private insurer assigning you providers based on who is in their network, every provider would be in network. In the vast majority of scenarios, the patient is two degrees separated from true freedom of choice, as options are limited by insurer networks and insurers are limited by the patient's employer. If you are concerned about a government monopoly, I would suggest that private insurers be able to compete with a single payer system in the same way that private schools compete with public schools. Removing the insurer's financial incentive and imposing a statutory obligation to cover care means that the theoretical single payer system is not picking losers in the way that a private insurer currently is.

On 9/16/2020 at 8:15 PM, Ginguy said:

Tuition reform is needed because colleges get fed at the Fed piggy trough. Here is your worthless degree for 40k/yr in loans that you will never be able to pay back but hey, it's the Feds doling it out so the screwl doesn't care, they already got paid it is just the poor student who gets stuck with the bill they can't escape (no bankruptcy). I mean, if I can go to Google's "lern2c0de" for six months and get a job making 60k/yr why do I need to go take 40 hours of gender studies and weather and climate? The schools currently offer some degrees which are viable, and others which aren't. Maybe schools should have to guarantee the economic viability of their degree programs, if a graduate can't get a job in their field of study within a year the school has to assume the loan debt. I wonder how fast that would change things. Come to think of it, I'm going to be going to a picnic this weekend with my Congressman's field staff, maybe I'll mention that. Seems like a good idea to me, save taxpayers some cash.

On 9/14/2020 at 11:12 PM, Raptorpat said:

Tuition reform is necessary across the board, but that process also desperately requires a national discussion on what the intent of post-secondary education actually is, how or when the value of a degree should or shouldn't be tied to career tracks, and why a post secondary education is now viewed as nearly mandatory by society despite the escalating costs. 

 

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  • 2 years later...

Annual physical in December is rescheduled.

"The doctor will be unavailable, but you can meet with the nurse practitioner if that's fine."

Me: "sure why not"

Nurse orders some tests, telehealth call in January to go over results.

Insurance Notice: YOUR CLAIM HAS BEEN DENIED AS THE PROVIDER IS OUT OF NETWORK, YOU OWE $600.

Me: hey I got this notice that says that the nurse I saw who works for my in-network primary care physician is out-of-network, this seems wrong.

Insurance call center girl: are you sure you went to the same office? (Uh... Yeah.) I don't see her showing up when I look them up. (Well she was definitely there.) Oh wait I see her on the doctor's website, I will submit an appeal and send this link that shows she works there.

TWO WEEKS LATER

Insurance Notice: WE HAVE PARTIALLY ACCEPTED YOUR APPEAL. YOU VISITED AN OUT-OF-NETWORK PROVIDER BUT WE'LL SPOT YOU $200

Provider Billing: I can't help you, you have to call the office itself.

Provider Office: I can't help you, you have to call billing. (I did and they said they can't help and to call you.) I will put in a note but you may not hear back for a couple weeks.

new Insurance Call Center girl: Ah yes, your claim was denied and you owe the remainder. Would you like me to send you a list of in-network providers in your area?

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40 minutes ago, Raptorpat said:

Annual physical in December is rescheduled.

"The doctor will be unavailable, but you can meet with the nurse practitioner if that's fine."

Me: "sure why not"

Nurse orders some tests, telehealth call in January to go over results.

Insurance Notice: YOUR CLAIM HAS BEEN DENIED AS THE PROVIDER IS OUT OF NETWORK, YOU OWE $600.

Me: hey I got this notice that says that the nurse I saw who works for my in-network primary care physician is out-of-network, this seems wrong.

Insurance call center girl: are you sure you went to the same office? (Uh... Yeah.) I don't see her showing up when I look them up. (Well she was definitely there.) Oh wait I see her on the doctor's website, I will submit an appeal and send this link that shows she works there.

TWO WEEKS LATER

Insurance Notice: WE HAVE PARTIALLY ACCEPTED YOUR APPEAL. YOU VISITED AN OUT-OF-NETWORK PROVIDER BUT WE'LL SPOT YOU $200

Provider Billing: I can't help you, you have to call the office itself.

Provider Office: I can't help you, you have to call billing. (I did and they said they can't help and to call you.) I will put in a note but you may not hear back for a couple weeks.

new Insurance Call Center girl: Ah yes, your claim was denied and you owe the remainder. Would you like me to send you a list of in-network providers in your area?

I'm speechless.

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Just now, Doom Metal Alchemist said:

I'm speechless.

They said "the doctor is unavailable but you can still meet the nurse practitioner."

They didn't say "the doctor is unavailable but you can meet the nurse practitioner but it's a mystery whether it will be covered so check into it first because we surely aren't."

In the grand scheme of things, it's not worth $1000 out of pocket just to find out I have a Vitamin D deficiency and slightly elevated cholesterol. WHEN I'M ALREADY PAYING FOR INSURANCE TO PAY FOR ME.

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Just now, Raptorpat said:

They said "the doctor is unavailable but you can still meet the nurse practitioner."

They didn't say "the doctor is unavailable but you can meet the nurse practitioner but it's a mystery whether it will be covered so check into it first because we surely aren't."

In the grand scheme of things, it's not worth $1000 out of pocket just to find out I have a Vitamin D deficiency and slightly elevated cholesterol. WHEN I'M ALREADY PAYING FOR INSURANCE TO PAY FOR ME.

Who's your provider? I need to know so I never sign up with them.

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32 minutes ago, Doom Metal Alchemist said:

I mean your insurance provider.

This is similar to the same shit that had me fighting my insurance company last year.....it was BCBS....

OU health and BCBS were fighting and I was in the middle

After about 8 months of pulling teeth.....I still have BCBS...

Sadly, none of my specialists are in many networks.

Which is the huge difference in pat's thing...no clue how they justified their dick move, especially since it was just his regular primary Dr office, but it's an insurance company...no matter how the ball was dropped, you'll probably be stuck holding the bag.

 

Edited by André Toulon
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1 hour ago, André Toulon said:

no clue how they justified their dick move

No one has to justify it if they're absolved from responsibility.

Insurance line was a poor women from another country just trying to follow a script. Provider billing line lady said they can't challenge an insurance determination and didn't know/care about the network status of the nurse because that's an issue for the providers office. And the lady on the provider's office line said it was an issue for the billing office that already rebuffed me.

If no one takes the blame, surely no one was at fault.

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That definitely seems the case. 

I actually got them to go back and cover one procedure and I had another 12 days later that they say it was the job of the provider to apprise me of changes and the provider is like nuh uh....

But instead of reliving the cyclical nature of these conversations, seems I'm just gonna pay out of pocket and now I'm collecting all new providers...which kind of is a blessing in disguise, but ugh...

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  • 2 weeks later...
  • 5 months later...
On 4/6/2023 at 3:02 PM, André Toulon said:

Which is the huge difference in pat's thing...no clue how they justified their dick move, especially since it was just his regular primary Dr office, but it's an insurance company...no matter how the ball was dropped, you'll probably be stuck holding the bag.

I got the bill put on hold over the summer while it was supposed to be resubmitted properly (billing under the physician instead of the nurse), because I was still getting late bill notices despite it being their job to redo it. So I wasn't supposed to get any further notices until it was resolved.

Then a week or two ago I got another notice that my full bill was overdue and needed to be paid by the end of the month.

So I finally call back over, the first woman checks the history and says that their internal review (to just change the name on the bill from the nurse to the doctor and resend it to insurance) was never completed and didn't know why the bill was resubmitted. Transferred me to another office.

Second woman has to put me on hold to review the extensive notes from months and months of back-and-forths and she tells me that the bill was actually re-denied by the insurance company on the grounds that they took too long to get their shit together and bill them properly. She said that by law if the insurance company isn't obligated to pay because the provider's billing department fucked up, then neither is the patient and the provider is supposed to just eat the cost. So she said I was never supposed to get that last bill and the ultimate resolution is supposed to be my bill being readjusted to $0. 

So theoretically I'm off the hook, but I still need to wait for it to come out of that central billing purgatory to see that in writing. She said she put another (real this time) hold on the bill, but who is keeping track at this point. Could have been a fuck up, or could have been a last ditch (illegal) attempt to get paid, idk.

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At least you got some kind of confirmation. I'm just assuming someone got their shit together since I no longer get texts or emails about the situation and it doesn't appear to be in collections.

Ironically.....or really, coincidentally (ironically just rolls off the tongue) getting all new providers somehow led me right back to OU Health, which I have a procedure October 9 in their offices. 

When they called to schedule, I told them I still have BCBS and if they weren't going to cover it I didn't want to schedule anything until I hear costs and payment options. She assured me that they were no longer slap boxing and I should be ok. 

I really feel like I'm I falling for the same shit but I'm not a good enough adult to know how to fight or defend against curve balls. 

Honestly whatever happens, happens.....I've used this phrase quite a bit lately but my ignorance is just gonna be my bliss....until it isn't.  I hear my mother always talking about a donut hole....I have no fucking clue what that even is and I just hope it never applies to me.

Edited by André Toulon
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  • 4 months later...

Guess whose billing got fucked up and denied again, after telling everyone who would listen not to let the billing people mess up again? This time they put down the name of a provider I've never even met before and probably isn't even be a person in that office.

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On 2/3/2024 at 3:21 PM, Raptorpat said:

Guess whose billing got fucked up and denied again, after telling everyone who would listen not to let the billing people mess up again? This time they put down the name of a provider I've never even met before and probably isn't even be a person in that office.

Be honest Pat

 

Who did you anger at your insurance company?

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