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(Politico)   Surprise medical bill fight brewing in Congress   (politico.com) divider line
    More: Murica, Blue Cross and Blue Shield Association, Insurance, Vice President of the United States, Vice president, network rate, health insurers, Biden administration, Biden administration's interim final rule  
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3298 clicks; posted to Politics » on 19 Dec 2021 at 2:38 PM (21 weeks ago)   |   Favorite    |   share:  Share on Twitter share via Email Share on Facebook



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2021-12-19 2:45:41 PM  
I can't believe the Democrats want to take away our right to have surprises!
 
2021-12-19 2:48:01 PM  
If it's just brewing, then how is the fight a surprise?
 
2021-12-19 2:48:28 PM  
aintnothinggoingtohappen.gif
 
2021-12-19 2:50:17 PM  
Does it require 60 votes? If yes, ain't gonna happen.

Does it require 50 votes? If yea, still ain't gonna happen.
 
2021-12-19 2:52:30 PM  

Peki: Does it require 60 votes? If yes, ain't gonna happen.

Does it require 50 votes? If yea, still ain't gonna happen.


From the article it seems it has already been passed. It is a war on how it will be implemented.
Whatever happens insurance companies will make bank and we will be screwed.
 
2021-12-19 2:52:32 PM  
Private practice physician here.  I'm just a grunt, all the insurance and payment decisions are hashed out at the corporate level way above my paygrade.  This is what it looks like to me:

Step 1: cut payment rates to in-network providers = decrease average payment rate

Step 2: cancel contracts with in-network providers = decrease average payment rate

Step 3: remaining out-of-network providers forced into arbitration = paid average payment rate

Rinse and repeat.

Also: "We want world-class healthcare, but we only pay the industry average."

Not so CSB: I got a letter from the patient's insurance company saying, "that surgery is considered experimental and is not covered"  *after* the surgery was performed (I'm not the surgeon).  The surgery had 2 parts, and each part separately is considered standard of care, but apparently performing both at the same time is "experimental," so they paid **nothing.**  Level of difficulty: nationally known and used insurance provider.

In summary: insurance companies are evil.
 
2021-12-19 2:52:47 PM  
when it comes to all types of medical costs be it meds/test/transport/hospital stays/etc just do it the easy way.  Have it code in the law the cost for each.  no more fighting between whatever.  you can charge no more then what the laws lets you.
 
2021-12-19 2:52:55 PM  
Much of the Senate need some surprise colonoscopy.
 
2021-12-19 2:53:43 PM  
Republicans: We should let free markets set these policies.

Democrats: agreed.

I dunno...that's not really much of a fight.
 
2021-12-19 2:55:11 PM  

sinner4ever: Peki: Does it require 60 votes? If yes, ain't gonna happen.

Does it require 50 votes? If yea, still ain't gonna happen.

From the article it seems it has already been passed. It is a war on how it will be implemented.
Whatever happens insurance companies will make bank and we will be screwed.


That's what I get for not RTFA. lol
 
2021-12-19 2:56:14 PM  

Peki: sinner4ever: Peki: Does it require 60 votes? If yes, ain't gonna happen.

Does it require 50 votes? If yea, still ain't gonna happen.

From the article it seems it has already been passed. It is a war on how it will be implemented.
Whatever happens insurance companies will make bank and we will be screwed.

That's what I get for not RTFA. lol


TFA:

Former President Donald Trump signed the measure last year, but the Biden administration wrote the rules governing how it will be implemented.

It seems that nobody is Harry with the rules.
 
2021-12-19 2:56:29 PM  
poppaskwat: ...

In summary: insurance companies are evil.

ih1.redbubble.netView Full Size
 
2021-12-19 2:56:33 PM  

misanthropicsob: Peki: sinner4ever: Peki: Does it require 60 votes? If yes, ain't gonna happen.

Does it require 50 votes? If yea, still ain't gonna happen.

From the article it seems it has already been passed. It is a war on how it will be implemented.
Whatever happens insurance companies will make bank and we will be screwed.

That's what I get for not RTFA. lol

TFA:

Former President Donald Trump signed the measure last year, but the Biden administration wrote the rules governing how it will be implemented.

It seems that nobody is Harry with the rules.


Happy not Harry. Stupid autocorrect.
 
2021-12-19 2:56:40 PM  
This explains a lot about the Republican and Fox News anti-vaxxer suckups. If you're seriously sick because you haven't been vaxxed the insurers and medical providers make a fortune.

In Australia where we have universal health care it's only a couple of total whackjob conservatives who ares spouting this anti-vaxx crap. Follow the money, folks.
 
2021-12-19 2:57:39 PM  

misanthropicsob: misanthropicsob: Peki: sinner4ever: Peki: Does it require 60 votes? If yes, ain't gonna happen.

Does it require 50 votes? If yea, still ain't gonna happen.

From the article it seems it has already been passed. It is a war on how it will be implemented.
Whatever happens insurance companies will make bank and we will be screwed.

That's what I get for not RTFA. lol

TFA:

Former President Donald Trump signed the measure last year, but the Biden administration wrote the rules governing how it will be implemented.

It seems that nobody is Harry with the rules.

Happy not Harry. Stupid autocorrect.


I was about to ask wtf Reid had to do with this...
 
2021-12-19 2:58:50 PM  
Just as long as it doesn't fark with surprize buttsecks.
 
2021-12-19 3:00:51 PM  

poppaskwat: Private practice physician here.  I'm just a grunt, all the insurance and payment decisions are hashed out at the corporate level way above my paygrade.  This is what it looks like to me:

Step 1: cut payment rates to in-network providers = decrease average payment rate

Step 2: cancel contracts with in-network providers = decrease average payment rate

Step 3: remaining out-of-network providers forced into arbitration = paid average payment rate

Rinse and repeat.

Also: "We want world-class healthcare, but we only pay the industry average."

Not so CSB: I got a letter from the patient's insurance company saying, "that surgery is considered experimental and is not covered"  *after* the surgery was performed (I'm not the surgeon).  The surgery had 2 parts, and each part separately is considered standard of care, but apparently performing both at the same time is "experimental," so they paid **nothing.**  Level of difficulty: nationally known and used insurance provider.

In summary: insurance companies are evil.


Insurance companies are evil.

However, it's average cost by locale, not by world. If we have world class health care on average, then the average cost should be for world class health care.

/then again, some of our health care related numbers compared to the rest of the world don't really make us seem world class, so YMMV.
//sidenote - I do thank you for going into health care. As you said, billing is not actually your problem.
///third slashie to support universal health care
 
2021-12-19 3:01:59 PM  

poppaskwat: In summary: insurance companies are evil.


I'll agree that the way we do health insurance now is not optimal. So what is your solution?
 
2021-12-19 3:06:10 PM  

Pincy: poppaskwat: In summary: insurance companies are evil.

I'll agree that the way we do health insurance now is not optimal. So what is your solution?


The same thing every other developed country does...
 
2021-12-19 3:08:08 PM  

Aussie_As: This explains a lot about the Republican and Fox News anti-vaxxer suckups. If you're seriously sick because you haven't been vaxxed the insurers and medical providers make a fortune.

In Australia where we have universal health care it's only a couple of total whackjob conservatives who ares spouting this anti-vaxx crap. Follow the money, folks.


Eh. From what I understand, insurers in America want the pandemic to be done so they can go back to raking in cash from business as usual.

Insurers don't make money off of unvaxxed patients needing tons of life-saving care. Insurers make their money off of routine American healthcare services.
 
2021-12-19 3:08:24 PM  

flamingboard: Pincy: poppaskwat: In summary: insurance companies are evil.

I'll agree that the way we do health insurance now is not optimal. So what is your solution?

The same thing every other developed country does...


I agree with you. But I'm asking the private practice physician here. You'd be surprised how many of them do not agree with you.
 
2021-12-19 3:11:03 PM  

Pincy: poppaskwat: In summary: insurance companies are evil.

I'll agree that the way we do health insurance now is not optimal. So what is your solution?


Universal healthcare / Medicare for all, like every other developed country.
 
2021-12-19 3:16:33 PM  

flamingboard: Pincy: poppaskwat: In summary: insurance companies are evil.

I'll agree that the way we do health insurance now is not optimal. So what is your solution?

The same thing every other developed country does...


There are no two developed countries that do universal healthcare the same way, and many of them require citizens to chip in money.
 
2021-12-19 3:17:52 PM  

Pincy: Just as long as it doesn't fark with surprize buttsecks.


It means they're going in dry.
 
2021-12-19 3:18:55 PM  

pdieten: flamingboard: Pincy: poppaskwat: In summary: insurance companies are evil.

I'll agree that the way we do health insurance now is not optimal. So what is your solution?

The same thing every other developed country does...

There are no two developed countries that do universal healthcare the same way, and many of them require citizens to chip in money.


The study for Medicare for All showed the average American would pay less and receive better care.
 
2021-12-19 3:21:43 PM  

sinner4ever: Peki: Does it require 60 votes? If yes, ain't gonna happen.

Does it require 50 votes? If yea, still ain't gonna happen.

From the article it seems it has already been passed. It is a war on how it will be implemented.
Whatever happens insurance companies will make bank and we will be screwed.


The main war is about arbitration over who gets farked the most from costs outside of the insurance benefits. Like if it ends yup with an adverse determination that's more than $400 of the quoted cost, who eats that cost, the insurance company or the hospital?

The HHS saying doctors are overcharging is over simplifying their charges, as the chargemaster is usually what they use to negotiate with insurances and is much more than the average general costs because the insurances are lowballing on their end to pay less than the average general charges.

If the hospitals eat the costs it will certainly change how our healthcare system works as there will be more restrictions for what's allowed to be done without layers of prior authorization to ensure they don't eat the costs, some of the costs also can't be predicted. Oddly this will likely make there be more administration costs to hospitals which will make things more expensive.

Whole thing is an attempt to do something good but without considering the consequences
 
2021-12-19 3:24:15 PM  

sinner4ever: pdieten: flamingboard: Pincy: poppaskwat: In summary: insurance companies are evil.

I'll agree that the way we do health insurance now is not optimal. So what is your solution?

The same thing every other developed country does...

There are no two developed countries that do universal healthcare the same way, and many of them require citizens to chip in money.

The study for Medicare for All showed the average American would pay less and receive better care.


What's the definition of Medicare in that study?

If it's the same thing that >65s get now, it's full of holes that would cause problems for people who need things like, for example, prenatal care. Not generally a priority for the elderly.

It's full of other holes too even for those over 65. That's why advantage plans are so popular with people who can afford them.
 
2021-12-19 3:25:28 PM  
1. Universal health care (complicated in how we implement it, but get it done).
2. While we work on universal care, a hospital is now a general contractor. I don't pay every single guy fixing my roof. I shouldn't pay every doctor separately. You get one bill per visit, no matter what. That also means that Doctor X who once asked who that patient is in the room doesn't get to bill you and be out of network.
3. If the hospital can't bill you in 30 days, they can't bill you at all.
 
2021-12-19 3:25:39 PM  
Fark user imageView Full Size
 
2021-12-19 3:27:11 PM  

sinner4ever: Peki: Does it require 60 votes? If yes, ain't gonna happen.

Does it require 50 votes? If yea, still ain't gonna happen.

From the article it seems it has already been passed. It is a war on how it will be implemented.
Whatever happens insurance companies will make bank and we will be screwed.


The health finance tech companies and debt collection companies will lose big time.
Insurers will simply continue to charge higher premiums because reasons.
In reality, COVID has already collapsed the rural health care systems in the USA.  It's federal dollars subsidizing them to stave off bankruptcy.  Hospitals across the country even demanded huge pay cuts and longer hours plus hazard from COVID.  It's insane.
But don't call it socialism if it's white people living off welfare.
 
2021-12-19 3:28:39 PM  

pdieten: flamingboard: Pincy: poppaskwat: In summary: insurance companies are evil.

I'll agree that the way we do health insurance now is not optimal. So what is your solution?

The same thing every other developed country does...

There are no two developed countries that do universal healthcare the same way, and many of them require citizens to chip in money.


I guess that means it's unpossible... Oh, well. Back to getting farked for capitalism.
 
2021-12-19 3:32:51 PM  
It's simply the best healthcare system in the world!
 
2021-12-19 3:37:15 PM  

pdieten: sinner4ever: pdieten: flamingboard: Pincy: poppaskwat: In summary: insurance companies are evil.

I'll agree that the way we do health insurance now is not optimal. So what is your solution?

The same thing every other developed country does...

There are no two developed countries that do universal healthcare the same way, and many of them require citizens to chip in money.

The study for Medicare for All showed the average American would pay less and receive better care.

What's the definition of Medicare in that study?

If it's the same thing that >65s get now, it's full of holes that would cause problems for people who need things like, for example, prenatal care. Not generally a priority for the elderly.

It's full of other holes too even for those over 65. That's why advantage plans are so popular with people who can afford them.


It is completely different. Bernie Sanders wrote the Medicare for All bill.

A Democrat opponent actually got caught off guard and admitted Americans would have better insurance.

Medicare for All Opponent Admits It's "Awesome" Insurance
Youtube D5MoS9Ddj7Q
 
2021-12-19 3:50:12 PM  
This still doesn't fix the stupid cost of healthcare in the US. It just makes it less surprising.
 
2021-12-19 3:53:22 PM  

Jumpthruhoops: 1. Universal health care (complicated in how we implement it, but get it done).
2. While we work on universal care, a hospital is now a general contractor. I don't pay every single guy fixing my roof. I shouldn't pay every doctor separately. You get one bill per visit, no matter what. That also means that Doctor X who once asked who that patient is in the room doesn't get to bill you and be out of network.
3. If the hospital can't bill you in 30 days, they can't bill you at all.


The target should be to get no bill per visit.
 
2021-12-19 3:55:19 PM  

Peki: Does it require 60 votes? If yes, ain't gonna happen.

Does it require 50 votes? If yea, still ain't gonna happen.


The bill already passed Congress and Trump signed it last year. It requires HHS to draft the administrative rules.
 
2021-12-19 3:57:53 PM  

AllCatsAreBeautiful: Peki: Does it require 60 votes? If yes, ain't gonna happen.

Does it require 50 votes? If yea, still ain't gonna happen.

The bill already passed Congress and Trump signed it last year. It requires HHS to draft the administrative rules.


Lol thanks. I fell in the DNRTFA trap. 😝
 
2021-12-19 4:04:41 PM  
I don't know how yet, but we're farked again.

/Keeps the blood pressure in check.
 
2021-12-19 4:15:08 PM  

Jumpthruhoops: 1. Universal health care (complicated in how we implement it, but get it done).
2. While we work on universal care, a hospital is now a general contractor. I don't pay every single guy fixing my roof. I shouldn't pay every doctor separately. You get one bill per visit, no matter what. That also means that Doctor X who once asked who that patient is in the room doesn't get to bill you and be out of network.
3. If the hospital can't bill you in 30 days, they can't bill you at all.


I think point 2 is where the disconnect really is. The doctor at the hospital, whether they are an ER doc, an anesthesiologist, or something else, their argument appears to be if they don't agree with the rates from the insurance company their only recourse is to be out of network. My counterpoint is the hospital is in network when I go to the ER or get admitted and I don't get a menu of doctors to pick from to make sure they all are in network too. If you don't like the reimbursement rates go work at a different, out of network, hospital. I'm not going to say reimbursement rates are always "fair" but I will say the difference between the allowed rate and the billed rate makes me suspect the billed rates certainly aren't.
 
2021-12-19 4:16:51 PM  
This is why you pan pharmaceutical companies from advertising
 
2021-12-19 4:18:27 PM  

Lumbar Puncture: sinner4ever: Peki: Does it require 60 votes? If yes, ain't gonna happen.

Does it require 50 votes? If yea, still ain't gonna happen.

From the article it seems it has already been passed. It is a war on how it will be implemented.
Whatever happens insurance companies will make bank and we will be screwed.

The main war is about arbitration over who gets farked the most from costs outside of the insurance benefits. Like if it ends yup with an adverse determination that's more than $400 of the quoted cost, who eats that cost, the insurance company or the hospital?

The HHS saying doctors are overcharging is over simplifying their charges, as the chargemaster is usually what they use to negotiate with insurances and is much more than the average general costs because the insurances are lowballing on their end to pay less than the average general charges.

If the hospitals eat the costs it will certainly change how our healthcare system works as there will be more restrictions for what's allowed to be done without layers of prior authorization to ensure they don't eat the costs, some of the costs also can't be predicted. Oddly this will likely make there be more administration costs to hospitals which will make things more expensive.

Whole thing is an attempt to do something good but without considering the consequences


So we just keep fscking the consumer, who had no role in selecting the out of network entity....got it
 
2021-12-19 4:41:17 PM  

Jumpthruhoops: 1. Universal health care (complicated in how we implement it, but get it done).
2. While we work on universal care, a hospital is now a general contractor. I don't pay every single guy fixing my roof. I shouldn't pay every doctor separately. You get one bill per visit, no matter what. That also means that Doctor X who once asked who that patient is in the room doesn't get to bill you and be out of network.
3. If the hospital can't bill you in 30 days, they can't bill you at all.


How about this.   Basic insurance has no deductible and is comprehensive.  No more than $20 for any service.  No other financial obligations except a small cost for prescriptions.
You can pay for it either by single payer public or subsidized semi-private.
Public would require a tax on individual income, likely converting premiums and consultant costs into a tax for employers.
 
2021-12-19 4:45:52 PM  

sinner4ever: pdieten: There are no two developed countries that do universal healthcare the same way, and many of them require citizens to chip in money.

The study for Medicare for All showed the average American would pay less and receive better care.


"What flavor of cake should we get?"

"Studies say that people like cake."
 
2021-12-19 4:47:34 PM  

sinner4ever: Peki: Does it require 60 votes? If yes, ain't gonna happen.

Does it require 50 votes? If yea, still ain't gonna happen.

From the article it seems it has already been passed. It is a war on how it will be implemented.
Whatever happens insurance companies will make bank and we will be screwed.


Yeah all you can hope for is a rule that only lets them put the tip in.
 
2021-12-19 4:57:17 PM  
A capitalist society preys upon itself until there's nothing left but revolution.
 
2021-12-19 5:03:07 PM  

BMFPitt: sinner4ever: pdieten: There are no two developed countries that do universal healthcare the same way, and many of them require citizens to chip in money.

The study for Medicare for All showed the average American would pay less and receive better care.

"What flavor of cake should we get?"

"Studies say that people like cake."


Okay the answer is literally any of them dingus. Chocolate cake, sponge cake, cheesecake, anything but fermented shiat cake.
 
2021-12-19 5:03:33 PM  
Medicare for All: Last Week Tonight with John Oliver (HBO)
Youtube 7Z2XRg3dy9k


Only in America would we see a two-party system where *both* parties' leaderships aren't able to agree about whether we should all have healthcare, even amid a pandemic where over 800K people have died and millions more have lost their health insurance.
 
2021-12-19 5:04:40 PM  
I don't need to be protected from receiving high medical bills. I'll simply tell whoever sends it, This is why I pay for insurance, if insurance doesn't send you a payment, your beef is with them. I'm not bankrupting myself just for the comfort of YOUR shareholders, beeyatch.
 
2021-12-19 5:10:37 PM  

mathamagical: Okay the answer is literally any of them dingus. Chocolate cake, sponge cake, cheesecake, anything but fermented shiat cake.


That's a stupid answer.  Maybe try putting thought into things.  There are huge differences.
 
2021-12-19 5:13:02 PM  
c.tenor.comView Full Size
 
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