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View Diary: Pressure mounting on call to fight hospital price gouging (164 comments)

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  •  Some proceedures are covered without any deductibl (4+ / 0-)

    Under many insurance policies already in place, and especially under the ACA, there are services that are covered that don't get into toughing the deductible.  People always assume that the high deductibles have to be met first.  Yes, in some cases.  But that isn't true across the board. The details count.  And under the ACA, we are more protected from this than before.

    •  Very, very few procedures. (7+ / 0-)

      "I read New republic and Nation/I've learned to take every view.." P. Ochs

      by JesseCW on Thu Jan 23, 2014 at 11:27:58 PM PST

      [ Parent ]

    •  The "Extortion Generals" of the hospital world (5+ / 0-)
      Recommended by:
      Shockwave, wa ma, misterwade, elwior, mconvente

      are quite adept at finding ways to screw over their patients even when a procedure is "covered."

      One way I have personally experienced is to define what is "covered" so narrowly that the patient is charged for anything that requires the slightest action by the doctor.

      Health insurance through my last employer was junk, but at least it covered (after co-pay) routine visits to my GP & procedures like a routine colonoscopy.

      Or so I thought until rudely disabused of the notion.

      Those routine visits? The "physicians group" (a branch of a famous research hospital) has sent debt collectors after me claiming that for each visit I still owe them out of pocket more than the insurance covered in the first place.

      Why? Because insurer & provider defined "routine visit" as one in which nothing has changed for the patient.

      "How are you doing, Mr Cosmo?" Fine. "Any change in your known problems?" No. "Any new issues?" No. "Do you need refills on your prescriptions?" Yes. "OK, pick them up at the front desk & come back in X months." Elapsed time, 2 minutes, maybe.
      But the minute I mentioned any change in my health, ka-chingg! I would "routinely" get a bill for >$220 for never more than 10 minutes of face time with my GP, of which the "insurer" paid ~$100.

      When I called the provider's billing office they were quite adamant that the level of "service" justified their outrageous charges.

      And that "routine" screening colonoscopy? I had one done, long overdue, just before my COBRA ran out. Covered? Hah. "We found two very small polyps so we took them out & sent them to the lab." The good news is that they were benign. The bad news? ~$700 in lab charges that my "insurer" said I am responsible for.

      In health care, "fee for service" = "license to steal". And they do--over & over & over again. Even the non-profits.

      The greatest trick the GOP ever played was convincing the devil they had a soul to sell.

      by Uncle Cosmo on Fri Jan 24, 2014 at 07:02:47 AM PST

      [ Parent ]

      •  PPACA colon cancer screening-no charge 2U-always (6+ / 0-)
        WAIVER OF APPLICATION OF DEDUCTIBLE FOR PREVENTIVE SERVICES AND COLORECTAL CANCER SCREENING TESTS.—Section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)), as amended by section 4103(c)(4), is amended—
        1167
        HR 3590 EAS/PP
         (1) in paragraph (1), by striking ‘‘items and
         services described in section 1861(s)(10)(A)’’ and in
        serting ‘‘preventive services described in subparagraph
         (A) of section 1861(ddd)(3) that are recommended
         with a grade of A or B by the United States Preventive Services Task Force for any indication or population and are appropriate for the individual.’’; and
         (2) by adding at the end the following new sentence: ‘‘Paragraph (1) of the first sentence of this subsection shall apply with respect to a colorectal cancer screening test regardless of the code that is billed for the establishment of a diagnosis as a result of the test, or for the removal of tissue or other matter or other  procedure that is furnished in connection with, as a result of, and in the same clinical encounter as the screening test.’’.
        If you walk in for a colon cancer screening test under the PPACA, your bill(s) as a patient must be $0 by law.
        •  That's good news but a tad too late for me :( (0+ / 0-)

          Looks like I should've waited on the colonoscopy, damn it all...

          Now how about those "routine" office visits? The physicians' group told me bluntly that they would charge me extra for anything I mentioned that was at variance with my status as of the last visit--& if the insurance wouldn't cover it, they'd be happy to send the debt-collector vultures after me (& have).

          The greatest trick the GOP ever played was convincing the devil they had a soul to sell.

          by Uncle Cosmo on Fri Jan 24, 2014 at 10:29:32 AM PST

          [ Parent ]

          •  Uncle, have you thought about (1+ / 0-)
            Recommended by:
            Uncle Cosmo

            changing doctors?

            They sound like they are more interested in being rich than being doctors.

            If you CHOOSE to stay with them it's on you.

            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 Sat Jan 25, 2014 at 04:43:49 AM PST

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            •  Yes I have, sam, but it ain't that easy (0+ / 0-)

              Ditching a relationship that's been in place for nearly 20 years is tough. Doctor shopping is even tougher...& given the current pandemic level of financial rapacity in health care there is no guarantee it wouldn't be a frying-pan-to-fire move.

              My GP has been pretty good over the years--very open to new ideas & suggestions, very proactive in the one instance when it looked like I might have a life-threatening condition. Only over the last few years, it seems, have the bastards she works for ramped up her patient load & pressured her to concentrate on things they could charge extra for. And unfortunately those employers have their tentacles fastened over Baltimore like Taibbi's infamous vampire squid.

              But I will be a bit more active in looking around for alternatives.

              The greatest trick the GOP ever played was convincing the devil they had a soul to sell.

              by Uncle Cosmo on Sat Jan 25, 2014 at 09:23:39 AM PST

              [ Parent ]

      •  That's all from before the ACA (0+ / 0-)

        So, what is the situation now?

        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 Sat Jan 25, 2014 at 04:41:13 AM PST

        [ Parent ]

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