The Medical Scam

[greybeard]

Ok, Son of Butch and TT, now I'm really confused. Is it really true that you can now, regardless of income/assets, just not get insurance (under the ACA); private-pay for any minor expenses during the year (and pay the penalty for not having insurance); then just jump right in on an ACA plan if you, say, need bypass surgery; or are in a car wreck with massive injuries; or get diagnosed with cancer? Assuming you have assets, aren't the premiums pretty high then?
Seems like a pretty big loophole (or, depending on how you view it, great way to game the system???). What am I missing????

If I understand it correctly, it depends if the catastrophe happens during the ACA enrollment period or not. One of the terms of ACA is that pre-existing medical problems are no longer a basis for being turned down by any insurer that participates in ACA. ACA plans go by whatever rules medicare sets up but I don't think you can retroactively sign up for Obamacare and have the insurer pay for procedures that have already taken place before you applied.

 

[Son of Butch]

ACA plans go by whatever rules medicare sets up but I don't think you can retroactively sign up for Obamacare and have the insurer pay for procedures that have already taken place before you applied.

Correct.
But that does not stop you from enrolling to mitigate Future expenses from a pre-existing catastrophic condition.
There are always some additional risks in not having insurance, the key is keeping the risks to a manageable level.

 

[Caustic Burno]

I don't know with my luck I get screwed somehow my last medical
procedure the bill was 120k.

 

[Workinonit Farm]

I don't know with my luck I get screwed somehow my last medical
procedure the bill was 120k.

:shock: :shock: :shock:

Wow!

 

[Son of Butch]

I don't know with my luck I get screwed somehow my last medical
procedure the bill was 120k.

Billed to you?
or
Billed to insurance?

My Mom's bill was $74,000 it was billed to insurance and insurance paid the hospital $18,000 as payment in full.

 

[Caustic Burno]

That is what was paid to the hospital and Dr by insurance the statement
claimed I saved 26k.

 

[TCRanch]

We have some friends, fully insured, that racked up a $10K hospital bill. They went to the billing department to arrange a payment schedule & the hospital negotiated the bill down to $5K if they could pay in full. Done deal. Clearly there is a lot of "wiggle room" but I suspect, at least for this hospital, it's because so many people never pay their bill or not in full.

As far as paying the penalty, you may very well come out ahead, dollar-wise. BUT as a Rancher (or Farmer, small business owner, etc) I personally avoid anything that would draw attention to my finances.

No it's because lots of small town or regional hospitals like lots of business are poorly managed and somebody there wanted to make payroll that week. 5k pays a few hospital workers this week.

No.
It's because the average retail price or medical bill is 3-6 times more than the actual price negotiated in advance and received from insurance companies. It's darn near impossible for a consumer to get a shop rate from any hospital to comparison shop anything. Dealing with American medical system is worse than dealing with used car salesmen.
The vast majority of all medical insurance fraud is perpetrated by doctors and hospital billing departments.

So the reason my husband's heart-cath was delayed twice (because insurance had not yet approved it) is because the insurance company was still negotiating $$$$$ with the hospital? Regardless of the fact his cardiologist decided he needed this potential life-saving procedure ASAP? At what point did our health care diminish into nothing other than a business transaction? (that's actually a rhetorical question but my point is still valid)

 

[slick4591]

So the reason my husband's heart-cath was delayed twice (because insurance had not yet approved it) is because the insurance company was still negotiating $$$$$ with the hospital? Regardless of the fact his cardiologist decided he needed this potential life-saving procedure ASAP? At what point did our health care diminish into nothing other than a business transaction? (that's actually a rhetorical question but my point is still valid)

The moment you check in to the hospital. These days you are made to feel like a grocery item as you have your own UPC and it gets scanned before anything is done.

 

[JMJ Farms]

It's because the average retail price or medical bill is 3-6 times more than the actual price negotiated in advance and received from insurance companies. It's darn near impossible for a consumer to get a shop rate from any hospital to comparison shop anything. .

This is it exactly. Rates are artificially inflated to account for insurance negotiations.

Exactly right Butch. My dad was a hospital CFO for many years. He told me 20 years ago that Medicaid and Medicare had started "telling" the hospital how much they were gonna pay. He said it's only a matter of time before these other insurance companies say "if Medicaid and Medicare can do it, so can we". And he was right.

Doesn't make it right, but the hospitals have to jack up the prices in order to try and compensate for these "negotiations" bc running a hospital is still a business. If they can't at least break even then they've got to close. If they are privately owned, then they've pretty much got to turn a profit, or be closed. Sad. But it is what it is.

 

[boondocks]

Read an interesting article today. One of the things Uncle Sam is trying to do is to measure patient satisfaction with their health care; reimbursements are now being tied in part to the surveys that Medicare and Medicaid patients fills out as to how happy they are with their drs/hospitals. As part of the survey, one of the major questions they are being asked is whether their pain was adequately controlled.
Now, in many areas of the country (including mine), we have a scourge of opioid addiction. The "pillheads" now know that drs and hospitals are getting in trouble and getting their reimbursements cut if they don't roll over and "give them their pills." So, they are demanding that the drs roll over and give them the meds. So, doctors are trying mightily to stem the over-prescribing of painkillers as they are being pressured to cut down on, but at the same time getting complaints filed by patients for not keeping them doped up and happy.
My son is thinking about taking the MCATs in a couple months and I increasingly wonder if it's worth it...seems like (as with teachers), we are expecting a few poor souls to cure all of society's ills...OR ELSE!

 

[JMJ Farms]

Dang slick. That's the first I've heard of that. Par for the course though ain't it?

Dammed if you do dammed if you don't.