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View Diary: The Eighth Factor Driving Up Health Care Costs (18 comments)

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  •  One cost I've never seen mentioned is (2+ / 0-)
    Recommended by:
    Agathena, ban nock

    the cost resulting from insurance companies who deny as many claims as possible for picayune reasons, forcing doctors, hospitals and other providers to either hire lawyers so they can collect, or just give up on collecting and raise their rates to cover the losses.

    When my daughter had ACL surgery, pre-certification was not required if the hospital stay was to be less than 24 hours, which was normally the case.  However, when they removed the catheter after the surgery they wouldn't discharge her until she had urinated.  Unfortunately, it was several miserable hours until she was able to do that, taking her over the 24 hour limit.  Because of that, United Health Care (our insurance co. at the time) denied ALL the coverage - surgeon, anesthesiologist, hospital, etc.  They ended up suing UHC through the Maryland Insurance Commission, but it was at least a year before they finally were paid.  Apparently these insurance companies really nit-pick every little thing to avoid paying.  That's one reason medical costs are so high - all those doctors, the hospital, etc. had to pay lawyers to get UHC to pay up, and UHC had to pay lawyers also.  UHC also denied coverage the prior year for a procedure my husband had done to his knee and the doctor never was paid.

    Just this week, one of our employees learned that our insurance is denying coverage of a cat scan and overnight hospital stay from when he was diagnosed with lymphoma two weeks ago.  He's having a tough enough time dealing with the lymphoma and now he's upset that he's got insurance that won't cover the costs.

    I wouldn't be surprised if the cost of this regular denial of coverage actually exceeds the costs from malpractice suits, if only because it's so much more common.

    Medicare for all, I say!

    •  Did he NEED a cat scan and an (1+ / 0-)
      Recommended by:
      Lujane

      overnight stay? if it wasn't medically necessary they have reason. Over treatment is what drives up the costs.

      You should always pre clear hospitalizations especially if there is anesthesia involved.

      Course if she was on Medicare the deductible for one night or more (to 60 days) hospitalization is about $1100.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Mon Oct 29, 2012 at 04:27:15 AM PDT

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      •  I don't know the details; (0+ / 0-)

        he had a lump on his neck that ballooned from nothing to the size of two tennis balls over the course of about a week and was extremely painful.  Apparently they did some kind of surgery (perhaps a biopsy?) while he was at the hospital and wanted to observe him.

        We're in the bicycle business and know nothing about these matters so we just have to trust the doctors and hope they're doing everything right.

    •  Usually the doctors would just make you pay (1+ / 0-)
      Recommended by:
      Lujane

      instead of suing the insurer. Where is this coverage where if the insurer doesn't pay it comes from the doctors or hospitals pocket?

      How big is your personal carbon footprint?

      by ban nock on Mon Oct 29, 2012 at 05:01:12 AM PDT

      [ Parent ]

      •  If the doctor/hospital is a "participating (1+ / 0-)
        Recommended by:
        ban nock

        provider" they're expected to know all the rules and follow them exactly.  If they don't, they aren't paid and can't charge the patient, at least in our situations.

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