With surgeries, even at the same hospital, you would end up with different prices with different surgeons. Each surgeon does things different, uses different supplies, and amount of supplies, and even different vendors for any implants you might get. All that stuff gets passed on to the patient. Sometimes a bunch of shit is opened, charged to the patient, and then wasted because it wasn't needed. Just depends on which surgeon you get through the luck of the draw.
So how do you explain British private hospitals managing to quote a typical price, huh?
Because in Britain, doctors are (for the most part) employees of the hospital. In the US, doctors are usually not employed by the hospital directly, instead being contractors. Thus is why a simple thing like having a baby can result in having multiple bills from all entities involved.
I had a colonoscopy I wound up getting bills from the hospital it was done, Two different doctors involved, The anesthesiologist, an oncologist looking at a biopsy and somebody else I don't recall off the top of my head. There was no place I could go to find out what I actually owed I would just get mystery bills from people I have never heard of and had no previous contact with. These bills kept randomly coming for like 6 months until I called the insurance company to ask what outstanding stuff was still there for this test and they could not answer me.
The way billing is done is maddening the "customer" can't even know WHO they owe let alone what they owe.
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L Ron HowardThe duckMinnesotaRegistered Userregular
How much would it cost to get 3 hours of airtime on a network where you just have real people telling their insurance horror stories?
Every time I read what some of you folks have to deal with I get angry and heartbroken.
the networks people who need to hear this watch are all owned by clear channel now so
If his insurance doesn’t want to cover it the meds are likely a new non generic medication. They’re unlikely to give out discounts on those
Not always, UHC refused to cover my wife's Nexium which is like 16 dollars a bottle. It may be that the medicine is nongeneric and costs 300 dollars, or it may be that it costs 20 dollars but there is a 10 dollar alternative.
Pharmaceuticals are the next healthcare thing that needs reform once there's a working majority. Along with the various improvements the ACA needs. Hell, the NIH should just get a division that manufactures generics at cost for things like insulin. When something is approaching 100 years old, it shouldn't cost 100x manufacture.
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ChanusHarbinger of the Spicy Rooster ApocalypseThe Flames of a Thousand Collapsed StarsRegistered Userregular
If his insurance doesn’t want to cover it the meds are likely a new non generic medication. They’re unlikely to give out discounts on those
Not always, UHC refused to cover my wife's Nexium which is like 16 dollars a bottle. It may be that the medicine is nongeneric and costs 300 dollars, or it may be that it costs 20 dollars but there is a 10 dollar alternative.
what's frustrating about this is that, yeah, sometimes the generic works differently from the name brand, and it is the only thing that will work for a specific patient
but sometimes that's not the case at all, so why should an insurance company pay $300 for a medication when a $20 is equally effective?
the problem of course being the insurance company only cares about the latter and there's no incentive to consider the former
If his insurance doesn’t want to cover it the meds are likely a new non generic medication. They’re unlikely to give out discounts on those
Not always, UHC refused to cover my wife's Nexium which is like 16 dollars a bottle. It may be that the medicine is nongeneric and costs 300 dollars, or it may be that it costs 20 dollars but there is a 10 dollar alternative.
what's frustrating about this is that, yeah, sometimes the generic works differently from the name brand, and it is the only thing that will work for a specific patient
but sometimes that's not the case at all, so why should an insurance company pay $300 for a medication when a $20 is equally effective?
the problem of course being the insurance company only cares about the latter and there's no incentive to consider the former
So I'm real split on this. Some of what we throw rocks at insurance companies for lies with docs. A lot of docs don't think/like/whatever the whole procedure of running down that list of five other drugs. Not even that they don't run through it, that they improperly document and argue that when it comes to seeking approval for the expensive six drug on the list. A lot of them don't think that's their job. In an ideal world, I'd agree with them. That's not the world we live in. My absolute best doc is the one who knows the various insurers requirements for the expensive drugs that he proscribes and beats them senseless with their own rules. He employs a person to do all the insurance interface stuff themselves but he very clearly has a checklist and knows what they look for to approve their use.
Docs probably shouldn't be required to minor in bureaucracy but with our current insurance set up it's silly to pretend that it isn't a huge portion of the job.
If his insurance doesn’t want to cover it the meds are likely a new non generic medication. They’re unlikely to give out discounts on those
Not always, UHC refused to cover my wife's Nexium which is like 16 dollars a bottle. It may be that the medicine is nongeneric and costs 300 dollars, or it may be that it costs 20 dollars but there is a 10 dollar alternative.
what's frustrating about this is that, yeah, sometimes the generic works differently from the name brand, and it is the only thing that will work for a specific patient
but sometimes that's not the case at all, so why should an insurance company pay $300 for a medication when a $20 is equally effective?
the problem of course being the insurance company only cares about the latter and there's no incentive to consider the former
Yeah, a lot is the pharmaceutical company though because a lot of time that 300 dollar medicine isn’t significanly more expensive to manufacture than the $20 one.
Going to ADHD drugs, vyvanse is like 300 dollars a month while adderall is 20 to 30, but vyvanse is just amphetamine(adderall) with an amino acid attached, not exactly a huge difference in material cost or production cost. So why does it cost 10x as much?
If his insurance doesn’t want to cover it the meds are likely a new non generic medication. They’re unlikely to give out discounts on those
Not always, UHC refused to cover my wife's Nexium which is like 16 dollars a bottle. It may be that the medicine is nongeneric and costs 300 dollars, or it may be that it costs 20 dollars but there is a 10 dollar alternative.
what's frustrating about this is that, yeah, sometimes the generic works differently from the name brand, and it is the only thing that will work for a specific patient
but sometimes that's not the case at all, so why should an insurance company pay $300 for a medication when a $20 is equally effective?
the problem of course being the insurance company only cares about the latter and there's no incentive to consider the former
Yeah, a lot is the pharmaceutical company though because a lot of time that 300 dollar medicine isn’t significanly more expensive to manufacture than the $20 one.
Going to ADHD drugs, vyvanse is like 300 dollars a month while adderall is 20 to 30, but vyvanse is just amphetamine with an amono acid attached, not exactly a huge difference in cost or production cost. So why does it cost 10x as much?
To cross subsidize research, development, and yacht mooring fees.
If his insurance doesn’t want to cover it the meds are likely a new non generic medication. They’re unlikely to give out discounts on those
Not always, UHC refused to cover my wife's Nexium which is like 16 dollars a bottle. It may be that the medicine is nongeneric and costs 300 dollars, or it may be that it costs 20 dollars but there is a 10 dollar alternative.
what's frustrating about this is that, yeah, sometimes the generic works differently from the name brand, and it is the only thing that will work for a specific patient
but sometimes that's not the case at all, so why should an insurance company pay $300 for a medication when a $20 is equally effective?
the problem of course being the insurance company only cares about the latter and there's no incentive to consider the former
Yeah, a lot is the pharmaceutical company though because a lot of time that 300 dollar medicine isn’t significanly more expensive to manufacture than the $20 one.
Going to ADHD drugs, vyvanse is like 300 dollars a month while adderall is 20 to 30, but vyvanse is just amphetamine with an amono acid attached, not exactly a huge difference in cost or production cost. So why does it cost 10x as much?
To cross subsidize research, development, and yacht mooring fees.
The research and development argument works if its something truly novel but falls down a bit though when its a matter of “ooh, lets take this existing drug, toss a methyl group on it, do clinical trials, and if it performs equivalent to the existing drug we get a whole new patent, and we can market it as the new thing that doctors will prescribe as a first line drug even though it costs 10x the price because they saw it in a trade magazine and they don’t give a shit about cost anyway”
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Kane Red RobeMaster of MagicArcanusRegistered Userregular
The maintenance drug for my ulcerative colitis is about $350 a month with my insurance or $780 without. It's fortunate that I didn't develop symptoms until I had a decent paying job or I would be more or less permanently disabled and longing for death.
Or taking the older cheaper drug with fun side effects like 20% chance of kidney failure and impotence.
The maintenance drug for my ulcerative colitis is about $350 a month with my insurance or $780 without. It's fortunate that I didn't develop symptoms until I had a decent paying job or I would be more or less permanently disabled and longing for death.
Or taking the older cheaper drug with fun side effects like 20% chance of kidney failure and impotence.
Burn it all down imo.
I had to roll the kidney failure dice. I was on the good stuff but then insurance stopped covering it. I can handle 10 dollars a month that may destroy my kidney. I could not afford nearly 1k a month for the stuff I had been using.
Especially with medication it's important to remember that the entire market is just a fight between insurance companies and pharmaceutical companies. Both the doctors and the patients and the hospitals and all that are literally just game pieces to be moved and manipulated by either party in order to force the other to give them more money or accept less money.
Pharma raises prices to make more money, so Insurance introduces co-pays to push it's clients onto cheaper options, so Pharma advertises directly to patients and sends minions to influence doctors, so Insurance cuts them out completely, and on and on and on.
None of it is about what a doctor should do for their patient or about what a patient might actually need.
If his insurance doesn’t want to cover it the meds are likely a new non generic medication. They’re unlikely to give out discounts on those
Not always, UHC refused to cover my wife's Nexium which is like 16 dollars a bottle. It may be that the medicine is nongeneric and costs 300 dollars, or it may be that it costs 20 dollars but there is a 10 dollar alternative.
what's frustrating about this is that, yeah, sometimes the generic works differently from the name brand, and it is the only thing that will work for a specific patient
but sometimes that's not the case at all, so why should an insurance company pay $300 for a medication when a $20 is equally effective?
the problem of course being the insurance company only cares about the latter and there's no incentive to consider the former
Yeah, a lot is the pharmaceutical company though because a lot of time that 300 dollar medicine isn’t significanly more expensive to manufacture than the $20 one.
Going to ADHD drugs, vyvanse is like 300 dollars a month while adderall is 20 to 30, but vyvanse is just amphetamine with an amono acid attached, not exactly a huge difference in cost or production cost. So why does it cost 10x as much?
To cross subsidize research, development, and yacht mooring fees.
The research and development argument works if its something truly novel but falls down a bit though when its a matter of “ooh, lets take this existing drug, toss a methyl group on it, do clinical trials, and if it performs equivalent to the existing drug we get a whole new patent, and we can market it as the new thing that doctors will prescribe as a first line drug even though it costs 10x the price because they saw it in a trade magazine and they don’t give a shit about cost anyway”
The maintenance drug for my ulcerative colitis is about $350 a month with my insurance or $780 without. It's fortunate that I didn't develop symptoms until I had a decent paying job or I would be more or less permanently disabled and longing for death.
Or taking the older cheaper drug with fun side effects like 20% chance of kidney failure and impotence.
Burn it all down imo.
The costs are such bullshit too. Remicade pretty much just about any patient that gets it administered on a rebate plan, so that they only pay something like 40ish dollars per treatment because without the rebate program, it would be 2K per treatment. A cost that most people cannot afford to incur, I think my gross pay per year is barely more than what my total remicade treatments add up to over the year. It's such bullshit. Like even the pharma companies know that people can't afford their shit at the prices they charge.
The maintenance drug for my ulcerative colitis is about $350 a month with my insurance or $780 without. It's fortunate that I didn't develop symptoms until I had a decent paying job or I would be more or less permanently disabled and longing for death.
Or taking the older cheaper drug with fun side effects like 20% chance of kidney failure and impotence.
Burn it all down imo.
The costs are such bullshit too. Remicade pretty much just about any patient that gets it administered on a rebate plan, so that they only pay something like 40ish dollars per treatment because without the rebate program, it would be 2K per treatment. A cost that most people cannot afford to incur, I think my gross pay per year is barely more than what my total remicade treatments add up to over the year. It's such bullshit. Like even the pharma companies know that people can't afford their shit at the prices they charge.
On Remicade you should be paying $5 a treatment via Remistart. I guess there are some facility fees but my insurance usually makes those a random number between 3 and 8 dollars. It weirdly varies based on how the insurer classifies it. For me it's an office visit but the iv needle is somehow a different line item or something.
But yeah, Janssen is happy to toss in $55 dollars a treatment to sell thousands of dollars worth of product. Hell, they're happy to toss in a couple thousand dollars to pay my deductible since it means I'll be generating twenty times that in sales to my insurer over the year.
How much would it cost to get 3 hours of airtime on a network where you just have real people telling their insurance horror stories?
Every time I read what some of you folks have to deal with I get angry and heartbroken.
The horrors of insurance in our health care system are already pretty well known. I don't know that increasing awareness any more, especially if it's just anecdotes, would help.
How much would it cost to get 3 hours of airtime on a network where you just have real people telling their insurance horror stories?
Every time I read what some of you folks have to deal with I get angry and heartbroken.
The horrors of insurance in our health care system are already pretty well known. I don't know that increasing awareness any more, especially if it's just anecdotes, would help.
There have been town hall meetings where it's just a stream of people with horror stories confronting their state assembly, congressional representatives and even presidential candidates.
Tuning out atrocities seems to be baked in to the system as long as healthcare is run as a capitalist enterprise.
Well you also have a ton of propaganda that makes the people, who vote for the politicians that enable this atrocity system, believe that people with health issues just aren't be responsible, when it's not a loved one or them. When it's a love one or them, then it becomes "the system sucks because of all the undeserving leaches sucking out money that should go to treat myself and my own."
Trying not to be nihilist, but there is a ton of bullshit flying around that pretty much ensures hours and hours of airtime devoting telling the horror stories of our healthcare system doesn't easily sink with a ton of people. That said, we should tell those stories because it doesn't always fall on deaf earts. just that we should make use of all our options to address the mess, rather than hope that horror story after horror story will finally convince enough people that our system is truly shit, that it's only american exceptional because it's absolute shit compared to most other developed countries.
MayabirdPecking at the keyboardRegistered Userregular
Let me tell a little story about medical pricing.
So I've been working at an urgent care clinic, the type of place set up to keep people with minor issues out of ERs and their enormous costs. There's still a lot of documentation and recording we have to do for different procedures, like stitches. One of the doctors had been wondering why exactly he had to state the precise number of stitches he put in when closing a laceration or cut.
When he found out it was so the billing department could charge per stitch, it was one of only two times he has been heard to swear at someone. The other time was when a literal blizzard had started but the clinic manager refused to close down the location despite the danger because we might get another patient or two in the next couple hours despite the conditions and they could get more revenue from that. How dare we consider turning away more potential revenue?
If his insurance doesn’t want to cover it the meds are likely a new non generic medication. They’re unlikely to give out discounts on those
Not always, UHC refused to cover my wife's Nexium which is like 16 dollars a bottle. It may be that the medicine is nongeneric and costs 300 dollars, or it may be that it costs 20 dollars but there is a 10 dollar alternative.
A lot of insurance plans don't cover drugs that are available OTC. The pharmacy bills them a ton of money for the "behind the counter" version of the same drug.
Also (in this specific case) you can take a double-dose of generic omeprazole and get the exact same effects as Nexium for (maybe) less money.
a5ehren on
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ChanusHarbinger of the Spicy Rooster ApocalypseThe Flames of a Thousand Collapsed StarsRegistered Userregular
my insurance doesn't cover dimysta, which is just azelastine with flonase mixed in and marked up 400%
How much would it cost to get 3 hours of airtime on a network where you just have real people telling their insurance horror stories?
Every time I read what some of you folks have to deal with I get angry and heartbroken.
The horrors of insurance in our health care system are already pretty well known. I don't know that increasing awareness any more, especially if it's just anecdotes, would help.
There have been town hall meetings where it's just a stream of people with horror stories confronting their state assembly, congressional representatives and even presidential candidates.
Tuning out atrocities seems to be baked in to the system as long as healthcare is run as a capitalist enterprise.
That sort of horror story isn't even healthcare in general. It is specifically letting health insurance be primarily a capitalist enterprise where any new regulations are hated by a party likely to get a majority of the seats in a chamber of congress, the presidency, or a majority of SCOTUS justices.
Like even just having the government throw its weight around would do a lot to stop things like a company cornering the market on an old and cheaply made drug without readily available equivalents.
So I've been working at an urgent care clinic, the type of place set up to keep people with minor issues out of ERs and their enormous costs. There's still a lot of documentation and recording we have to do for different procedures, like stitches. One of the doctors had been wondering why exactly he had to state the precise number of stitches he put in when closing a laceration or cut.
When he found out it was so the billing department could charge per stitch, it was one of only two times he has been heard to swear at someone. The other time was when a literal blizzard had started but the clinic manager refused to close down the location despite the danger because we might get another patient or two in the next couple hours despite the conditions and they could get more revenue from that. How dare we consider turning away more potential revenue?
BTW we ostensibly work at a non-profit.
I sure hope when they say they are charging per stitch they are just talking about the actual stitch supply cost and not the procedure. Laceration and cuts are coded by the length of the wound (e.g. 3.5cm) not by the actual number of stitches. If they are coding and billing by stitches they are way out of AMA and Medicare compliance.
I'm a medical coder so I deal with this sort of stuff all day long.
If his insurance doesn’t want to cover it the meds are likely a new non generic medication. They’re unlikely to give out discounts on those
Not always, UHC refused to cover my wife's Nexium which is like 16 dollars a bottle. It may be that the medicine is nongeneric and costs 300 dollars, or it may be that it costs 20 dollars but there is a 10 dollar alternative.
A lot of insurance plans don't cover drugs that are available OTC. The pharmacy bills them a ton of money for the "behind the counter" version of the same drug.
Also (in this specific case) you can take a double-dose of generic omeprazole and get the exact same effects as Nexium for (maybe) less money.
I did not realize this, which is interesting, as even though generic esomeprazole is only $20 or so, omeprazole is like $3.
Kind of sneaky of them to call it esomeprazole rather than the conventional S-omeprazole or levomeprazole too.
Guess I should have known better than to trust a medicine with the same name as a celebrity sex cult.
So I've been working at an urgent care clinic, the type of place set up to keep people with minor issues out of ERs and their enormous costs. There's still a lot of documentation and recording we have to do for different procedures, like stitches. One of the doctors had been wondering why exactly he had to state the precise number of stitches he put in when closing a laceration or cut.
When he found out it was so the billing department could charge per stitch, it was one of only two times he has been heard to swear at someone. The other time was when a literal blizzard had started but the clinic manager refused to close down the location despite the danger because we might get another patient or two in the next couple hours despite the conditions and they could get more revenue from that. How dare we consider turning away more potential revenue?
BTW we ostensibly work at a non-profit.
I sure hope when they say they are charging per stitch they are just talking about the actual stitch supply cost and not the procedure. Laceration and cuts are coded by the length of the wound (e.g. 3.5cm) not by the actual number of stitches. If they are coding and billing by stitches they are way out of AMA and Medicare compliance.
I'm a medical coder so I deal with this sort of stuff all day long.
Follow up: If they are charging per-stitch, they're not actually reusing the leftover lengths of thread... right?
So I've been working at an urgent care clinic, the type of place set up to keep people with minor issues out of ERs and their enormous costs. There's still a lot of documentation and recording we have to do for different procedures, like stitches. One of the doctors had been wondering why exactly he had to state the precise number of stitches he put in when closing a laceration or cut.
When he found out it was so the billing department could charge per stitch, it was one of only two times he has been heard to swear at someone. The other time was when a literal blizzard had started but the clinic manager refused to close down the location despite the danger because we might get another patient or two in the next couple hours despite the conditions and they could get more revenue from that. How dare we consider turning away more potential revenue?
BTW we ostensibly work at a non-profit.
I sure hope when they say they are charging per stitch they are just talking about the actual stitch supply cost and not the procedure. Laceration and cuts are coded by the length of the wound (e.g. 3.5cm) not by the actual number of stitches. If they are coding and billing by stitches they are way out of AMA and Medicare compliance.
I'm a medical coder so I deal with this sort of stuff all day long.
Follow up: If they are charging per-stitch, they're not actually reusing the leftover lengths of thread... right?
So according to CPT guidelines for laceration repair the supplies are considered included as part of the procedure code. So you should ONLY be billing a separate charge for the supplies when due to medical necessity you use over and above the usual amount.
My specialty is mental health, but I walked over to our surgery team to confirm this.
I'm going to hazard a guess that if their pricing is based on counting individual stitches, they are probably not doing that because they want to make sure they only charge the patient just enough to cover costs.
The more detailed the book-keeping, the more miserly the company.
So I've been working at an urgent care clinic, the type of place set up to keep people with minor issues out of ERs and their enormous costs. There's still a lot of documentation and recording we have to do for different procedures, like stitches. One of the doctors had been wondering why exactly he had to state the precise number of stitches he put in when closing a laceration or cut.
When he found out it was so the billing department could charge per stitch, it was one of only two times he has been heard to swear at someone. The other time was when a literal blizzard had started but the clinic manager refused to close down the location despite the danger because we might get another patient or two in the next couple hours despite the conditions and they could get more revenue from that. How dare we consider turning away more potential revenue?
BTW we ostensibly work at a non-profit.
I sure hope when they say they are charging per stitch they are just talking about the actual stitch supply cost and not the procedure. Laceration and cuts are coded by the length of the wound (e.g. 3.5cm) not by the actual number of stitches. If they are coding and billing by stitches they are way out of AMA and Medicare compliance.
I'm a medical coder so I deal with this sort of stuff all day long.
Follow up: If they are charging per-stitch, they're not actually reusing the leftover lengths of thread... right?
So according to CPT guidelines for laceration repair the supplies are considered included as part of the procedure code. So you should ONLY be billing a separate charge for the supplies when due to medical necessity you use over and above the usual amount.
My specialty is mental health, but I walked over to our surgery team to confirm this.
On top of that... sutures can't be that expensive anyways, can they? In terms of producing them, it's just some type of thread in sterile packaging isn't it?
There's no Republican plan. Period. They want to scrap the ACA and put us back where we were so that insurance companies and employers get to dictate who gets treated and everyone else can die in a ditch, either from not seeking medical attention or after being bankrupted by ludicrous medical bills.
Human health should not be a business commodity. Private interests routinely come at odds with providing adequate healthcare and those interests should be removed.
And they'll keep hemming and hawing over 'lack of choice' and 'rationing healthcare', but that shit is already happening. You can't price shop for medical procedures and you don't have a choice of which hospital to go to when you're unconscious in an ambulance. Insurance companies already 'ration' healthcare by denying doctor recommended treatments so they can save money. I've posted enough about it on here before, so I won't pain myself to go into detail again, but my late brother was regularly fucked over by his insurance during his leukemia treatment.
And if that's what Republicans want for the country? Then fuck them forever. No one should be letting Trump or any Republican keep on lying about their 'terrific' healthcare plan. Anytime they say 'repeal and replace', the only question should be 'replace with what?' And do not let them move on without answering it.
The "choice" myth occurs way earlier than the ambulance. I've been a professional with health benefits through my employer for 14 years. My insurance provider and plan has changed probably 10 times and I've never had a say in any of it. Our most recent change was to a high-deductible plan with a shitty HSA that if I had a choice I NEVER would have gone with. The closest thing to choice in my provider I'll see in my entire adult life will be when I likely choose to jump on my wife-to-be's plan after we get hitched.
I froth at the mouth when even Paul Krugman writes about the "loss of choice" that Medicare for All would lead to implying I am losing something I have never fucking had to begin with.
So I've been working at an urgent care clinic, the type of place set up to keep people with minor issues out of ERs and their enormous costs. There's still a lot of documentation and recording we have to do for different procedures, like stitches. One of the doctors had been wondering why exactly he had to state the precise number of stitches he put in when closing a laceration or cut.
When he found out it was so the billing department could charge per stitch, it was one of only two times he has been heard to swear at someone. The other time was when a literal blizzard had started but the clinic manager refused to close down the location despite the danger because we might get another patient or two in the next couple hours despite the conditions and they could get more revenue from that. How dare we consider turning away more potential revenue?
BTW we ostensibly work at a non-profit.
I sure hope when they say they are charging per stitch they are just talking about the actual stitch supply cost and not the procedure. Laceration and cuts are coded by the length of the wound (e.g. 3.5cm) not by the actual number of stitches. If they are coding and billing by stitches they are way out of AMA and Medicare compliance.
I'm a medical coder so I deal with this sort of stuff all day long.
Follow up: If they are charging per-stitch, they're not actually reusing the leftover lengths of thread... right?
So according to CPT guidelines for laceration repair the supplies are considered included as part of the procedure code. So you should ONLY be billing a separate charge for the supplies when due to medical necessity you use over and above the usual amount.
My specialty is mental health, but I walked over to our surgery team to confirm this.
On top of that... sutures can't be that expensive anyways, can they? In terms of producing them, it's just some type of thread in sterile packaging isn't it?
A fixed length of thread, the remainder of which you throw out anyway.
That's what I was getting at: the number of stitches doesn't matter from a cost standpoint. The numbers of packs might.
(Even though they're like $1.50 for 75cm on Amazon)
So I've been working at an urgent care clinic, the type of place set up to keep people with minor issues out of ERs and their enormous costs. There's still a lot of documentation and recording we have to do for different procedures, like stitches. One of the doctors had been wondering why exactly he had to state the precise number of stitches he put in when closing a laceration or cut.
When he found out it was so the billing department could charge per stitch, it was one of only two times he has been heard to swear at someone. The other time was when a literal blizzard had started but the clinic manager refused to close down the location despite the danger because we might get another patient or two in the next couple hours despite the conditions and they could get more revenue from that. How dare we consider turning away more potential revenue?
BTW we ostensibly work at a non-profit.
I sure hope when they say they are charging per stitch they are just talking about the actual stitch supply cost and not the procedure. Laceration and cuts are coded by the length of the wound (e.g. 3.5cm) not by the actual number of stitches. If they are coding and billing by stitches they are way out of AMA and Medicare compliance.
I'm a medical coder so I deal with this sort of stuff all day long.
Follow up: If they are charging per-stitch, they're not actually reusing the leftover lengths of thread... right?
So according to CPT guidelines for laceration repair the supplies are considered included as part of the procedure code. So you should ONLY be billing a separate charge for the supplies when due to medical necessity you use over and above the usual amount.
My specialty is mental health, but I walked over to our surgery team to confirm this.
On top of that... sutures can't be that expensive anyways, can they? In terms of producing them, it's just some type of thread in sterile packaging isn't it?
A fixed length of thread, the remainder of which you throw out anyway.
That's what I was getting at: the number of stitches doesn't matter from a cost standpoint. The numbers of packs might.
(Even though they're like $1.50 for 75cm on Amazon)
I figured. You're charging how much base for the procedure? You can eat the cost of supplies regardless of how much you use at that price.
There's no Republican plan. Period. They want to scrap the ACA and put us back where we were so that insurance companies and employers get to dictate who gets treated and everyone else can die in a ditch, either from not seeking medical attention or after being bankrupted by ludicrous medical bills.
Human health should not be a business commodity. Private interests routinely come at odds with providing adequate healthcare and those interests should be removed.
And they'll keep hemming and hawing over 'lack of choice' and 'rationing healthcare', but that shit is already happening. You can't price shop for medical procedures and you don't have a choice of which hospital to go to when you're unconscious in an ambulance. Insurance companies already 'ration' healthcare by denying doctor recommended treatments so they can save money. I've posted enough about it on here before, so I won't pain myself to go into detail again, but my late brother was regularly fucked over by his insurance during his leukemia treatment.
And if that's what Republicans want for the country? Then fuck them forever. No one should be letting Trump or any Republican keep on lying about their 'terrific' healthcare plan. Anytime they say 'repeal and replace', the only question should be 'replace with what?' And do not let them move on without answering it.
The "choice" myth occurs way earlier than the ambulance. I've been a professional with health benefits through my employer for 14 years. My insurance provider and plan has changed probably 10 times and I've never had a say in any of it. Our most recent change was to a high-deductible plan with a shitty HSA that if I had a choice I NEVER would have gone with. The closest thing to choice in my provider I'll see in my entire adult life will be when I likely choose to jump on my wife-to-be's plan after we get hitched.
I froth at the mouth when even Paul Krugman writes about the "loss of choice" that Medicare for All would lead to implying I am losing something I have never fucking had to begin with.
My choices for health insurance in the US was between two slightly different plans offered by the same company, and while this was some pretty damn good health care it still had co-pays/co-insurance and provider networks that got worse every year. My choice for health care in the Czech Republic is 'this is your insurance, enjoy', but it covers everything, co-pays are trivial, and there's none of this in-network/out-of-network garbage.
Choice is nice, but the quality of what you're choosing between is far more important.
Shut up, Mr. Burton! You were not brought upon this world to get it!
So I've been working at an urgent care clinic, the type of place set up to keep people with minor issues out of ERs and their enormous costs. There's still a lot of documentation and recording we have to do for different procedures, like stitches. One of the doctors had been wondering why exactly he had to state the precise number of stitches he put in when closing a laceration or cut.
When he found out it was so the billing department could charge per stitch, it was one of only two times he has been heard to swear at someone. The other time was when a literal blizzard had started but the clinic manager refused to close down the location despite the danger because we might get another patient or two in the next couple hours despite the conditions and they could get more revenue from that. How dare we consider turning away more potential revenue?
BTW we ostensibly work at a non-profit.
I sure hope when they say they are charging per stitch they are just talking about the actual stitch supply cost and not the procedure. Laceration and cuts are coded by the length of the wound (e.g. 3.5cm) not by the actual number of stitches. If they are coding and billing by stitches they are way out of AMA and Medicare compliance.
I'm a medical coder so I deal with this sort of stuff all day long.
Follow up: If they are charging per-stitch, they're not actually reusing the leftover lengths of thread... right?
So according to CPT guidelines for laceration repair the supplies are considered included as part of the procedure code. So you should ONLY be billing a separate charge for the supplies when due to medical necessity you use over and above the usual amount.
My specialty is mental health, but I walked over to our surgery team to confirm this.
On top of that... sutures can't be that expensive anyways, can they? In terms of producing them, it's just some type of thread in sterile packaging isn't it?
A fixed length of thread, the remainder of which you throw out anyway.
That's what I was getting at: the number of stitches doesn't matter from a cost standpoint. The numbers of packs might.
(Even though they're like $1.50 for 75cm on Amazon)
I figured. You're charging how much base for the procedure? You can eat the cost of supplies regardless of how much you use at that price.
That's what my company does. We don't ever charge for suture supplies even if we exceed typically use. It raises the risk for a denial and its not worth our time to appeal it. Cost wise the procedure for a typical laceration is about 45 dollars more then a typical office visit.
There's no Republican plan. Period. They want to scrap the ACA and put us back where we were so that insurance companies and employers get to dictate who gets treated and everyone else can die in a ditch, either from not seeking medical attention or after being bankrupted by ludicrous medical bills.
Human health should not be a business commodity. Private interests routinely come at odds with providing adequate healthcare and those interests should be removed.
And they'll keep hemming and hawing over 'lack of choice' and 'rationing healthcare', but that shit is already happening. You can't price shop for medical procedures and you don't have a choice of which hospital to go to when you're unconscious in an ambulance. Insurance companies already 'ration' healthcare by denying doctor recommended treatments so they can save money. I've posted enough about it on here before, so I won't pain myself to go into detail again, but my late brother was regularly fucked over by his insurance during his leukemia treatment.
And if that's what Republicans want for the country? Then fuck them forever. No one should be letting Trump or any Republican keep on lying about their 'terrific' healthcare plan. Anytime they say 'repeal and replace', the only question should be 'replace with what?' And do not let them move on without answering it.
The "choice" myth occurs way earlier than the ambulance. I've been a professional with health benefits through my employer for 14 years. My insurance provider and plan has changed probably 10 times and I've never had a say in any of it. Our most recent change was to a high-deductible plan with a shitty HSA that if I had a choice I NEVER would have gone with. The closest thing to choice in my provider I'll see in my entire adult life will be when I likely choose to jump on my wife-to-be's plan after we get hitched.
I froth at the mouth when even Paul Krugman writes about the "loss of choice" that Medicare for All would lead to implying I am losing something I have never fucking had to begin with.
There is loss of choice. It's just not your choice that's being lost.
There's no Republican plan. Period. They want to scrap the ACA and put us back where we were so that insurance companies and employers get to dictate who gets treated and everyone else can die in a ditch, either from not seeking medical attention or after being bankrupted by ludicrous medical bills.
Human health should not be a business commodity. Private interests routinely come at odds with providing adequate healthcare and those interests should be removed.
And they'll keep hemming and hawing over 'lack of choice' and 'rationing healthcare', but that shit is already happening. You can't price shop for medical procedures and you don't have a choice of which hospital to go to when you're unconscious in an ambulance. Insurance companies already 'ration' healthcare by denying doctor recommended treatments so they can save money. I've posted enough about it on here before, so I won't pain myself to go into detail again, but my late brother was regularly fucked over by his insurance during his leukemia treatment.
And if that's what Republicans want for the country? Then fuck them forever. No one should be letting Trump or any Republican keep on lying about their 'terrific' healthcare plan. Anytime they say 'repeal and replace', the only question should be 'replace with what?' And do not let them move on without answering it.
The "choice" myth occurs way earlier than the ambulance. I've been a professional with health benefits through my employer for 14 years. My insurance provider and plan has changed probably 10 times and I've never had a say in any of it. Our most recent change was to a high-deductible plan with a shitty HSA that if I had a choice I NEVER would have gone with. The closest thing to choice in my provider I'll see in my entire adult life will be when I likely choose to jump on my wife-to-be's plan after we get hitched.
I froth at the mouth when even Paul Krugman writes about the "loss of choice" that Medicare for All would lead to implying I am losing something I have never fucking had to begin with.
There is loss of choice. It's just not your choice that's being lost.
I had far more choice in medical providers in Australia, because I could go to literally any doctor who had room for me as a patient, and because I had guaranteed public coverage and nothing medical is tied to my employment, I was completely free to shop around for extra private insurance if desired.
The UK was a bit more constrained in the public system, because I was supposed to enrol with a 'local' service under the NHS, but again, getting additional private insurance would enable me to see damn near anybody in private practise. Hell, I paid out of pocket for a private dentist. Regular checkups over several years, a wisdom tooth removal, and a crown, still didn't cost me more than a few hundred quid all up.
My insurance in the US is excellent, but that's entirely due to my employer. If I change jobs I could easily end up in a scenario where it's cheaper and easier for me to fly back to Australia to get health care than try and negotiate this system.
There's no Republican plan. Period. They want to scrap the ACA and put us back where we were so that insurance companies and employers get to dictate who gets treated and everyone else can die in a ditch, either from not seeking medical attention or after being bankrupted by ludicrous medical bills.
Human health should not be a business commodity. Private interests routinely come at odds with providing adequate healthcare and those interests should be removed.
And they'll keep hemming and hawing over 'lack of choice' and 'rationing healthcare', but that shit is already happening. You can't price shop for medical procedures and you don't have a choice of which hospital to go to when you're unconscious in an ambulance. Insurance companies already 'ration' healthcare by denying doctor recommended treatments so they can save money. I've posted enough about it on here before, so I won't pain myself to go into detail again, but my late brother was regularly fucked over by his insurance during his leukemia treatment.
And if that's what Republicans want for the country? Then fuck them forever. No one should be letting Trump or any Republican keep on lying about their 'terrific' healthcare plan. Anytime they say 'repeal and replace', the only question should be 'replace with what?' And do not let them move on without answering it.
The "choice" myth occurs way earlier than the ambulance. I've been a professional with health benefits through my employer for 14 years. My insurance provider and plan has changed probably 10 times and I've never had a say in any of it. Our most recent change was to a high-deductible plan with a shitty HSA that if I had a choice I NEVER would have gone with. The closest thing to choice in my provider I'll see in my entire adult life will be when I likely choose to jump on my wife-to-be's plan after we get hitched.
I froth at the mouth when even Paul Krugman writes about the "loss of choice" that Medicare for All would lead to implying I am losing something I have never fucking had to begin with.
Absolutely. My employer changes something in our plan practically every year. Sometimes we don't know what changed, yeah they give us a booklet with the plan information but we're not lawyers so it's all mumbo jumbo. Other times, like the change last year, my co-pay almost doubled, from $25 to $45.
It fucking sucks, but at the moment it's the only insurance I can afford. Yay for "choice"
The idea of having options is a joke to anybody who lives in more rural areas of the country. Even just going to a specialist for my HRT as a trans person requires me to drive 70 miles one way. My mother has to drive over three hours every few months to get to a doctor she sees for one medical issue.
The idea of having options is a joke to anybody who lives in more rural areas of the country. Even just going to a specialist for my HRT as a trans person requires me to drive 70 miles one way. My mother has to drive over three hours every few months to get to a doctor she sees for one medical issue.
It's starting to get that way in cities as well, thanks to insurance companies. What I've seen is that there are fewer and fewer generalists as there isn't enough money in it, thanks to insurance companies cutting down on the size of those payments. It's pushing doctors into specialties where they can pay their bills. This has had the knock-on effect of pushing having fewer specialists as they spread themselves out to avoid poaching each other's patents. So while your city may have some of the best cardiac care in the state, it's the same three doctors rotating between them. You only find this out when you try to get appointments and discover that their office is based at a different hospital you saw them at.
All opinions are my own and in no way reflect that of my employer.
Posts
I had a colonoscopy I wound up getting bills from the hospital it was done, Two different doctors involved, The anesthesiologist, an oncologist looking at a biopsy and somebody else I don't recall off the top of my head. There was no place I could go to find out what I actually owed I would just get mystery bills from people I have never heard of and had no previous contact with. These bills kept randomly coming for like 6 months until I called the insurance company to ask what outstanding stuff was still there for this test and they could not answer me.
The way billing is done is maddening the "customer" can't even know WHO they owe let alone what they owe.
Or Sinclair.
Not always, UHC refused to cover my wife's Nexium which is like 16 dollars a bottle. It may be that the medicine is nongeneric and costs 300 dollars, or it may be that it costs 20 dollars but there is a 10 dollar alternative.
what's frustrating about this is that, yeah, sometimes the generic works differently from the name brand, and it is the only thing that will work for a specific patient
but sometimes that's not the case at all, so why should an insurance company pay $300 for a medication when a $20 is equally effective?
the problem of course being the insurance company only cares about the latter and there's no incentive to consider the former
So I'm real split on this. Some of what we throw rocks at insurance companies for lies with docs. A lot of docs don't think/like/whatever the whole procedure of running down that list of five other drugs. Not even that they don't run through it, that they improperly document and argue that when it comes to seeking approval for the expensive six drug on the list. A lot of them don't think that's their job. In an ideal world, I'd agree with them. That's not the world we live in. My absolute best doc is the one who knows the various insurers requirements for the expensive drugs that he proscribes and beats them senseless with their own rules. He employs a person to do all the insurance interface stuff themselves but he very clearly has a checklist and knows what they look for to approve their use.
Docs probably shouldn't be required to minor in bureaucracy but with our current insurance set up it's silly to pretend that it isn't a huge portion of the job.
Yeah, a lot is the pharmaceutical company though because a lot of time that 300 dollar medicine isn’t significanly more expensive to manufacture than the $20 one.
Going to ADHD drugs, vyvanse is like 300 dollars a month while adderall is 20 to 30, but vyvanse is just amphetamine(adderall) with an amino acid attached, not exactly a huge difference in material cost or production cost. So why does it cost 10x as much?
To cross subsidize research, development, and yacht mooring fees.
The research and development argument works if its something truly novel but falls down a bit though when its a matter of “ooh, lets take this existing drug, toss a methyl group on it, do clinical trials, and if it performs equivalent to the existing drug we get a whole new patent, and we can market it as the new thing that doctors will prescribe as a first line drug even though it costs 10x the price because they saw it in a trade magazine and they don’t give a shit about cost anyway”
Or taking the older cheaper drug with fun side effects like 20% chance of kidney failure and impotence.
Burn it all down imo.
I had to roll the kidney failure dice. I was on the good stuff but then insurance stopped covering it. I can handle 10 dollars a month that may destroy my kidney. I could not afford nearly 1k a month for the stuff I had been using.
Pharma raises prices to make more money, so Insurance introduces co-pays to push it's clients onto cheaper options, so Pharma advertises directly to patients and sends minions to influence doctors, so Insurance cuts them out completely, and on and on and on.
None of it is about what a doctor should do for their patient or about what a patient might actually need.
Yeah, those are for the yacht mooring fees.
The costs are such bullshit too. Remicade pretty much just about any patient that gets it administered on a rebate plan, so that they only pay something like 40ish dollars per treatment because without the rebate program, it would be 2K per treatment. A cost that most people cannot afford to incur, I think my gross pay per year is barely more than what my total remicade treatments add up to over the year. It's such bullshit. Like even the pharma companies know that people can't afford their shit at the prices they charge.
battletag: Millin#1360
Nice chart to figure out how honest a news source is.
On Remicade you should be paying $5 a treatment via Remistart. I guess there are some facility fees but my insurance usually makes those a random number between 3 and 8 dollars. It weirdly varies based on how the insurer classifies it. For me it's an office visit but the iv needle is somehow a different line item or something.
But yeah, Janssen is happy to toss in $55 dollars a treatment to sell thousands of dollars worth of product. Hell, they're happy to toss in a couple thousand dollars to pay my deductible since it means I'll be generating twenty times that in sales to my insurer over the year.
The horrors of insurance in our health care system are already pretty well known. I don't know that increasing awareness any more, especially if it's just anecdotes, would help.
There have been town hall meetings where it's just a stream of people with horror stories confronting their state assembly, congressional representatives and even presidential candidates.
Tuning out atrocities seems to be baked in to the system as long as healthcare is run as a capitalist enterprise.
Trying not to be nihilist, but there is a ton of bullshit flying around that pretty much ensures hours and hours of airtime devoting telling the horror stories of our healthcare system doesn't easily sink with a ton of people. That said, we should tell those stories because it doesn't always fall on deaf earts. just that we should make use of all our options to address the mess, rather than hope that horror story after horror story will finally convince enough people that our system is truly shit, that it's only american exceptional because it's absolute shit compared to most other developed countries.
battletag: Millin#1360
Nice chart to figure out how honest a news source is.
So I've been working at an urgent care clinic, the type of place set up to keep people with minor issues out of ERs and their enormous costs. There's still a lot of documentation and recording we have to do for different procedures, like stitches. One of the doctors had been wondering why exactly he had to state the precise number of stitches he put in when closing a laceration or cut.
When he found out it was so the billing department could charge per stitch, it was one of only two times he has been heard to swear at someone. The other time was when a literal blizzard had started but the clinic manager refused to close down the location despite the danger because we might get another patient or two in the next couple hours despite the conditions and they could get more revenue from that. How dare we consider turning away more potential revenue?
BTW we ostensibly work at a non-profit.
A lot of insurance plans don't cover drugs that are available OTC. The pharmacy bills them a ton of money for the "behind the counter" version of the same drug.
Also (in this specific case) you can take a double-dose of generic omeprazole and get the exact same effects as Nexium for (maybe) less money.
which i'm honestly fine with
That sort of horror story isn't even healthcare in general. It is specifically letting health insurance be primarily a capitalist enterprise where any new regulations are hated by a party likely to get a majority of the seats in a chamber of congress, the presidency, or a majority of SCOTUS justices.
Like even just having the government throw its weight around would do a lot to stop things like a company cornering the market on an old and cheaply made drug without readily available equivalents.
I sure hope when they say they are charging per stitch they are just talking about the actual stitch supply cost and not the procedure. Laceration and cuts are coded by the length of the wound (e.g. 3.5cm) not by the actual number of stitches. If they are coding and billing by stitches they are way out of AMA and Medicare compliance.
I'm a medical coder so I deal with this sort of stuff all day long.
I did not realize this, which is interesting, as even though generic esomeprazole is only $20 or so, omeprazole is like $3.
Kind of sneaky of them to call it esomeprazole rather than the conventional S-omeprazole or levomeprazole too.
Guess I should have known better than to trust a medicine with the same name as a celebrity sex cult.
Follow up: If they are charging per-stitch, they're not actually reusing the leftover lengths of thread... right?
So according to CPT guidelines for laceration repair the supplies are considered included as part of the procedure code. So you should ONLY be billing a separate charge for the supplies when due to medical necessity you use over and above the usual amount.
My specialty is mental health, but I walked over to our surgery team to confirm this.
The more detailed the book-keeping, the more miserly the company.
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On top of that... sutures can't be that expensive anyways, can they? In terms of producing them, it's just some type of thread in sterile packaging isn't it?
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PSN: AbEntropy
The "choice" myth occurs way earlier than the ambulance. I've been a professional with health benefits through my employer for 14 years. My insurance provider and plan has changed probably 10 times and I've never had a say in any of it. Our most recent change was to a high-deductible plan with a shitty HSA that if I had a choice I NEVER would have gone with. The closest thing to choice in my provider I'll see in my entire adult life will be when I likely choose to jump on my wife-to-be's plan after we get hitched.
I froth at the mouth when even Paul Krugman writes about the "loss of choice" that Medicare for All would lead to implying I am losing something I have never fucking had to begin with.
A fixed length of thread, the remainder of which you throw out anyway.
That's what I was getting at: the number of stitches doesn't matter from a cost standpoint. The numbers of packs might.
(Even though they're like $1.50 for 75cm on Amazon)
I figured. You're charging how much base for the procedure? You can eat the cost of supplies regardless of how much you use at that price.
3DS: 0473-8507-2652
Switch: SW-5185-4991-5118
PSN: AbEntropy
My choices for health insurance in the US was between two slightly different plans offered by the same company, and while this was some pretty damn good health care it still had co-pays/co-insurance and provider networks that got worse every year. My choice for health care in the Czech Republic is 'this is your insurance, enjoy', but it covers everything, co-pays are trivial, and there's none of this in-network/out-of-network garbage.
Choice is nice, but the quality of what you're choosing between is far more important.
That's what my company does. We don't ever charge for suture supplies even if we exceed typically use. It raises the risk for a denial and its not worth our time to appeal it. Cost wise the procedure for a typical laceration is about 45 dollars more then a typical office visit.
There is loss of choice. It's just not your choice that's being lost.
"If you're not the customer, you're the product."
The UK was a bit more constrained in the public system, because I was supposed to enrol with a 'local' service under the NHS, but again, getting additional private insurance would enable me to see damn near anybody in private practise. Hell, I paid out of pocket for a private dentist. Regular checkups over several years, a wisdom tooth removal, and a crown, still didn't cost me more than a few hundred quid all up.
My insurance in the US is excellent, but that's entirely due to my employer. If I change jobs I could easily end up in a scenario where it's cheaper and easier for me to fly back to Australia to get health care than try and negotiate this system.
Absolutely. My employer changes something in our plan practically every year. Sometimes we don't know what changed, yeah they give us a booklet with the plan information but we're not lawyers so it's all mumbo jumbo. Other times, like the change last year, my co-pay almost doubled, from $25 to $45.
It fucking sucks, but at the moment it's the only insurance I can afford. Yay for "choice"
It's starting to get that way in cities as well, thanks to insurance companies. What I've seen is that there are fewer and fewer generalists as there isn't enough money in it, thanks to insurance companies cutting down on the size of those payments. It's pushing doctors into specialties where they can pay their bills. This has had the knock-on effect of pushing having fewer specialists as they spread themselves out to avoid poaching each other's patents. So while your city may have some of the best cardiac care in the state, it's the same three doctors rotating between them. You only find this out when you try to get appointments and discover that their office is based at a different hospital you saw them at.