GlockTalk.com
Home Forums Classifieds Blogs Today's Posts Search Social Groups



  
SIGN-UP
Notices

Glock Talk
Welcome To The Glock Talk Forums.
Reply
 
Thread Tools Display Modes
Old 10-14-2013, 17:58   #176
Z71bill
Senior Member
 
Z71bill's Avatar
 
Join Date: Feb 2007
Location: Texas
Posts: 10,846
My wife had to go to the emergency room August 8, 2013 -

BTW - she is fine now.

I just paid the bills - BCBS of Texas in my insurance provider -

The hospital portion of the bill has 7 separate items -

First charge - Emergency room service $1,320 - BCBS amount allowed $20 ---- they reduced this fee by $1,300.
More than a 98% reduction.

Try and explain this - you can't - no reasonable person could possible think this is just free market forces at work.

She also had an injection - they billed $171.77 BCBS said pay $32.68 they reduced it by $139.09

A few items BCBS agreed to pay the whole amount -

Total hospital $2,073.96 I paid $486.64


The doctor billed separately $1,254 but BCBS cut it exactly in half - I paid $627.

Even though the situation was not life threatening it was bad enough that we went to the emergency room on a Sunday - and I sure as heck did not want to have a freaking negotiation with them about how much it was going to cost to treat my wife.

Last edited by Z71bill; 10-14-2013 at 18:01..
Z71bill is online now   Reply With Quote
Old 10-14-2013, 18:26   #177
Cavalry Doc
Silver Membership
MAJ (USA Ret.)
 
Cavalry Doc's Avatar
 
Join Date: Feb 2005
Location: Republic of Texas
Posts: 41,153


Quote:
Originally Posted by Z71bill View Post
My wife had to go to the emergency room August 8, 2013 -

BTW - she is fine now.

I just paid the bills - BCBS of Texas in my insurance provider -

The hospital portion of the bill has 7 separate items -

First charge - Emergency room service $1,320 - BCBS amount allowed $20 ---- they reduced this fee by $1,300.
More than a 98% reduction.

Try and explain this - you can't - no reasonable person could possible think this is just free market forces at work.

She also had an injection - they billed $171.77 BCBS said pay $32.68 they reduced it by $139.09

A few items BCBS agreed to pay the whole amount -

Total hospital $2,073.96 I paid $486.64


The doctor billed separately $1,254 but BCBS cut it exactly in half - I paid $627.

Even though the situation was not life threatening it was bad enough that we went to the emergency room on a Sunday - and I sure as heck did not want to have a freaking negotiation with them about how much it was going to cost to treat my wife.
What you are seeing is the constant back and forth between the players. You have the customer, your wife in this situation. The provider, the health care facility. And the payer, your insurance company.

The fourth player, that is not documented, is the guy or gal, or illegal alien the ER is legally mandated to provide care for, but will never be compensated for. They play an integral part of this dance.


The fifth player is the guy wanting to get the money all the other players can skim off the top. Barry fixed that, and is now a player.
Middlemen and non-payers drive up costs for those that can pay.

Last edited by Cavalry Doc; 10-14-2013 at 19:10..
Cavalry Doc is online now   Reply With Quote
Old 10-14-2013, 18:39   #178
MtBaldy
Obie Wan, RIP
 
MtBaldy's Avatar
 
Join Date: Jul 2005
Location: At the beach
Posts: 15,946


Quote:
Originally Posted by M2 Carbine View Post
My doctor of many years (and others around here) have said they will take early retirement before they will practice under obamacare.
.
Same here. She said when Obamacare was first proposed she would not work for the government. She's only about 50 but she's made some very good investments. She's in the process of closing down her practice now. I think she was waiting to see if there was any chance Obamacare could be stopped but it's looking pretty grim right now.
__________________
A democracy cannot exist as a permanent form of government. It can only exist until the majority discovers it can vote itself largess out of the public treasury."
― Elmer T Peterson
MtBaldy is offline   Reply With Quote
Old 10-15-2013, 04:10   #179
jim goose
"The Goose"
 
jim goose's Avatar
 
Join Date: Mar 2011
Location: STL, MO.
Posts: 681
I sell health insurance for a living, so moving towards a single payer system, or caping admin dollars at 20% is NOT in my interest.

Having said all that, I don'e see how a change was not coming one way or another. Too many people, in too many states did not have access to health insurance. And if they did, the high risk pool, or low income burden was shifted directly on the tax payers. Im not ashamed to say most of those people work as hard as anyone in this country, and deserve healthacre too, even if it means I have to find a new career one day.

I'm just getting started with Obamacare, it pays pretty poorly relative to the other stuff I sell, but from what I've seen so far in Mo. the prices are no worse that buying it individually before Oct 1st.

I think reform could have come in much better ways, but this is what we got. As a self employed person with a pre existing condition (type 2), I was always denied coverage. Even though I remain perfectly healthy through a proper diet and exercise and need no medication. What sense does that make?

Try paying 650 dollars in cash for a simple blood test once a quarter and you will relaize the problem. In fact, try finding a specialist who will accept cash, or who does not have a 3 month wait to be seen, that is private healthcare? No, I would argue an insurance based system is perfectly socialist. Those of you in group plans are paying to support everyone at your company who is grossly overweight and unhealthy. And anyone of you who ended up on Cobra knows what it was really costing.

If there is a better plan, then lets hear it.
jim goose is offline   Reply With Quote
Old 10-15-2013, 07:09   #180
Roger1079
Senior Member
 
Join Date: Mar 2008
Location: South FL
Posts: 1,735
Quote:
Originally Posted by jim goose View Post
I sell health insurance for a living, so moving towards a single payer system, or caping admin dollars at 20% is NOT in my interest.

Having said all that, I don'e see how a change was not coming one way or another. Too many people, in too many states did not have access to health insurance. And if they did, the high risk pool, or low income burden was shifted directly on the tax payers. Im not ashamed to say most of those people work as hard as anyone in this country, and deserve healthacre too, even if it means I have to find a new career one day.

I'm just getting started with Obamacare, it pays pretty poorly relative to the other stuff I sell, but from what I've seen so far in Mo. the prices are no worse that buying it individually before Oct 1st.

I think reform could have come in much better ways, but this is what we got. As a self employed person with a pre existing condition (type 2), I was always denied coverage. Even though I remain perfectly healthy through a proper diet and exercise and need no medication. What sense does that make?

Try paying 650 dollars in cash for a simple blood test once a quarter and you will relaize the problem. In fact, try finding a specialist who will accept cash, or who does not have a 3 month wait to be seen, that is private healthcare? No, I would argue an insurance based system is perfectly socialist. Those of you in group plans are paying to support everyone at your company who is grossly overweight and unhealthy. And anyone of you who ended up on Cobra knows what it was really costing.

If there is a better plan, then lets hear it.
The better plan is to leave it alone. There is already "free" healthcare for people with no insurance. Just look at the ER in just about any hospital on just about any day. The irony of all this is that some people will argue that the ER is a reactive approach to healthcare rather than proactive causing more hospital visits and higher prices. I wonder how many of the uninsured would actually go to the doctor for their routine annual checkups? My guess is very few. Obamacare does nothing but hurt businesses that actually provide benefits to their employees. If you don't like our healthcare system in it's pre-Obamacare form, feel free to relocate to Canada or Europe.
Roger1079 is offline   Reply With Quote
Old 10-15-2013, 08:02   #181
SC Tiger
Shaved Ape
 
SC Tiger's Avatar
 
Join Date: Aug 2011
Location: South Carolina
Posts: 6,997
Quote:
Originally Posted by devildog2067 View Post
Reimbursement rates are widely benchmarked to Medicare. I thought this was fairly well known.
I think I knew that.

How does Medicare calculate it? Is it a simple case of "this is how much we will pay" or is there more to it?

I think that is probably where the BS in the system gets exposed.
__________________
Hug your barking irons as the Devil hugs a witch

Quote:
Originally Posted by Keoking View Post
If you're gonna be stupid, don't pull up short. Saddle up and ride it all the way in.
SC Tiger is online now   Reply With Quote
Old 10-15-2013, 08:23   #182
Hej Hej
Senior Member
 
Join Date: Dec 2012
Location: Chesterfield, MO.
Posts: 545
Quote:
Originally Posted by Mr981 View Post
An Obamacare horror story--to which I'll add another:

My wife's best friend is a tech at a vet clinic;she does'nt get paid
a lot and had her hours cut due to obama car and her minmal
Health care cover provided by her vet has been cancelled.

Now she finds out the gov.plan for her will cost $300/month or
or pay s fine that will be $600/year in 2015.

So, she's lost her coverage, part of her wages and will end
uppaying a fine because she csn't afford obamacare.
BTW--she voted for him.
Sometimes we get what we ask for.........
__________________
I do not love the bright sword for its sharpness, nor the arrow for its swiftness, nor the warrior for his glory. I love only that which they defend.
J.R.R. Tolkien, The Two Towers

G19 Gen4; Llama .22LR; Astra .380 ACP
Hej Hej is offline   Reply With Quote
Old 10-15-2013, 08:26   #183
Z71bill
Senior Member
 
Z71bill's Avatar
 
Join Date: Feb 2007
Location: Texas
Posts: 10,846
Quote:
Originally Posted by SC Tiger View Post
I think I knew that.

How does Medicare calculate it? Is it a simple case of "this is how much we will pay" or is there more to it?

I think that is probably where the BS in the system gets exposed.
It is what I was trying to explain in a prior post -

It is subtle - a system that was developed over decades where the government wants to get a lower price so they are always trying to MANDATE a discount - and private health care providers trying to set a rate that allows them to treat Medicare patients - accept the lower (government gets their discount) government payment yet still cover the cost.

Do a search on the "doc fix"

http://www.washingtonpost.com/blogs/...6wkN_blog.html

When you take market forces of price discovery OUT and add in GOVERNMENT negotiated prices you end up with $1,500 hammers and $4,000 toilet seats -

It does not matter if it is rocket systems - military aircraft - toilet seats - heart bypass - education - road construction - the result will always with out exception be higher total costs.

Government is never spending their own money so are not capable of making good decisions.

So the solution to all of this mess - created in large part by government meddling and force - is to give the government more money and more control.

At this point everyone knows we have a screwed up system -

The solution will always be the exact same - just about every government solution to every problem they have ever tried to solve uses the exact same play book.

Give us (the government) more money - and more control - increase regulation - trust us we got this figured out.

When that fails the solution is again always the same -

We studied the problem and determined that the real cause is we (government) don't have enough resources (money) and we need more control - increase regulation. So give us more money and more control and we will solve the problem.

When that fails - see above - because the solution never changes.




Last edited by Z71bill; 10-15-2013 at 08:28..
Z71bill is online now   Reply With Quote
Old 10-15-2013, 08:42   #184
JFrame
Senior Member
 
JFrame's Avatar
 
Join Date: May 2001
Location: Mid-Atlantic, US of A
Posts: 31,574
Quote:
Originally Posted by Z71bill View Post
It is what I was trying to explain in a prior post -

It is subtle - a system that was developed over decades where the government wants to get a lower price so they are always trying to MANDATE a discount - and private health care providers trying to set a rate that allows them to treat Medicare patients - accept the lower (government gets their discount) government payment yet still cover the cost.

Do a search on the "doc fix"

http://www.washingtonpost.com/blogs/...6wkN_blog.html

When you take market forces of price discovery OUT and add in GOVERNMENT negotiated prices you end up with $1,500 hammers and $4,000 toilet seats -

It does not matter if it is rocket systems - military aircraft - toilet seats - heart bypass - education - road construction - the result will always with out exception be higher total costs.

Government is never spending their own money so are not capable of making good decisions.

So the solution to all of this mess - created in large part by government meddling and force - is to give the government more money and more control.

At this point everyone knows we have a screwed up system -

The solution will always be the exact same - just about every government solution to every problem they have ever tried to solve uses the exact same play book.

Give us (the government) more money - and more control - increase regulation - trust us we got this figured out.

When that fails the solution is again always the same -

We studied the problem and determined that the real cause is we (government) don't have enough resources (money) and we need more control - increase regulation. So give us more money and more control and we will solve the problem.

When that fails - see above - because the solution never changes.




You absolutely nailed it, Bill. The Okie Corral


.
__________________
"When newspapers are controlled, it's amazing how ignorant and immune from pressure the government can be." -- Amartya Sen

--
JFrame is offline   Reply With Quote
Old 10-15-2013, 09:06   #185
Z71bill
Senior Member
 
Z71bill's Avatar
 
Join Date: Feb 2007
Location: Texas
Posts: 10,846
This is real -- call the 800 number if you don't believe me.

Take the Obama care hot line phone number

(800) 318-2596 use the letter keypad - you know like they do with - 800 flowers


1 (800) my options are in caps.

3 your options (deF)

1 (no letters use blank)

8 (tUv)

2 (abC)

5 (jKl)

9 (wxYz)

6 (mnO)

Is this just the Obama administration telling you what they really think?


Last edited by Z71bill; 10-15-2013 at 09:23..
Z71bill is online now   Reply With Quote
Old 10-15-2013, 09:26   #186
ChuteTheMall
What Difference
 
ChuteTheMall's Avatar
 
Join Date: Aug 2000
Location: Sinkholeville
Posts: 57,352


Quote:
Originally Posted by WarCry View Post

What's amazing to me is that, with all your company is doing to their employees, you're still looking to stand up for them and blame someone else.
What's amazing to the rest of us is that you are still loyal to Obama.

__________________
"One morning I shot an elephant in my pajamas. How he got in my pajamas, I don't know."
ChuteTheMall is offline   Reply With Quote
Old 10-15-2013, 09:28   #187
ChuteTheMall
What Difference
 
ChuteTheMall's Avatar
 
Join Date: Aug 2000
Location: Sinkholeville
Posts: 57,352


Quote:
Originally Posted by Z71bill View Post
Is this just the Obama administration telling you what they really think?

Thanks for reminding me, I cracked up yesterday when I heard this on the radio!
ChuteTheMall is offline   Reply With Quote
Old 10-15-2013, 10:28   #188
Rabbi
Lifetime Membership
The Bombdiggity
 
Rabbi's Avatar
 
Join Date: Dec 2004
Location: San AntonioTexas
Posts: 29,872


Quote:
Originally Posted by jim goose View Post
Im not ashamed to say most of those people work as hard as anyone in this country, and deserve healthacre too, even if it means I have to find a new career one day.
No one deserves anything.

Lets be real honest. For everything you think one person "deserves" you have to perform an injustice on someone else.

In our country that mean you want a third party to , by force, take it from someone else...unless you yourself are rich, then they take it from you.

For every bleeding heart "its not fair" people like you advocate for, all you are really doing is saying "I want this, so I will have someone else go steal it for me."

There is nothing noble about what you think. You are a thief who avoids feeling you are one because you cant see past your own causes.
__________________
In the world to come, each of us will be called to account for all the good things G-d put on earth which we refused to enjoy. ~ The Babylonian Talmud

Whenever you get mad as hell about it all, grab your rifle and head outside. If you are the only one there...it's not time yet

I cross my heart and hope not to die. Swallow evil, ride the sky. Lose myself in a crowded room. You fool, you fool, it will be here soon
Rabbi is offline   Reply With Quote
Old 10-15-2013, 10:51   #189
OMEGA5
Senior Member
 
OMEGA5's Avatar
 
Join Date: Jun 2001
Location: Tennessee
Posts: 1,716
Got our bad news today. The Health plan we've had for
20+ years does NOT meet ACA standards so we'll be
paying for every lowlife that's never worked a day in their
life's health care so we can have sub-standard care ourselves.
From what I can find out, our cost will at least double and
our deductibles and out of pocket expense will be close to
triple what it is now.
What happened to keeping the plan we have? Just like every
word that comes out of his mouth, that was a lie too. I really
hope all those fools that put that socialist in office are
getting royally screwed by this too!!
Dano
__________________
VietNam Vet 68-69.
Retired LEO After 41 years
NRA Endowment Life Member
OMEGA5 is offline   Reply With Quote
Old 10-15-2013, 11:58   #190
Z71bill
Senior Member
 
Z71bill's Avatar
 
Join Date: Feb 2007
Location: Texas
Posts: 10,846
If you think health insurance costs a lot now - just wait until you see how much it costs after the government makes it free.
Z71bill is online now   Reply With Quote
Old 10-15-2013, 12:29   #191
ArtificialGrape
CLM Number 265
Charter Lifetime Member
 
ArtificialGrape's Avatar
 
Join Date: May 2007
Location: Colorado Springs
Posts: 5,542
Blog Entries: 1
Quote:
Originally Posted by Z71bill View Post
If you think health insurance costs a lot now - just wait until you see how much it costs after the government makes it free.
"If you think health care is expensive now, wait until you see what it costs when it's free." -- P.J. O'Rourke, The Liberty Manifesto (1993)
ArtificialGrape is offline   Reply With Quote
Old 10-15-2013, 15:40   #192
s&wfan
Senior Member
 
Join Date: Dec 2011
Posts: 624
It's all by design and it was the plan for years and years now. Businesses want to end health care benefits, the way they had planned to do this was to socialize medicine.
s&wfan is offline   Reply With Quote
Old 10-15-2013, 15:43   #193
happyguy
Na Ben Don Chat
 
happyguy's Avatar
 
Join Date: Jun 2003
Location: Indiana
Posts: 14,226
Quote:
Originally Posted by Rabbi View Post
No one deserves anything.

Lets be real honest. For everything you think one person "deserves" you have to perform an injustice on someone else.

In our country that mean you want a third party to , by force, take it from someone else...unless you yourself are rich, then they take it from you.

For every bleeding heart "its not fair" people like you advocate for, all you are really doing is saying "I want this, so I will have someone else go steal it for me."

There is nothing noble about what you think. You are a thief who avoids feeling you are one because you cant see past your own causes.
Well said.

Regards,
Happyguy
__________________
"Success isn't a result of spontaneous combustion. You have to set yourself on fire." - Arnold H. Glasgow
happyguy is offline   Reply With Quote
Old 10-15-2013, 15:53   #194
nursetim
Senior Member
 
nursetim's Avatar
 
Join Date: Mar 2006
Location: liberalville N. M.
Posts: 6,613
I just talked with our benefits people at my new job. We are ok for a year, but after that, who knows. This is my line in the sand, I will not sign up. I'll John Gault first.
__________________
Malo periculosam libertatem quam quietum servitium. - I prefer liberty with danger to peace with slavery.
nursetim is offline   Reply With Quote
Old 10-16-2013, 00:01   #195
sdsnet
CLM Number 43
NRA Member
 
sdsnet's Avatar
 
Join Date: Feb 2007
Location: Texas
Posts: 4,738


Quote:
Originally Posted by M2 Carbine View Post
Hey you obama voters, how's this "Hope and Change" working out for you, you ******* idiots.



My doctor of many years (and others around here) have said they will take early retirement before they will practice under obamacare.


The least we should do is force obama and the rest of those stinking politicians to have to use obamacare to.
I'm tired of those rat ******** passing laws and exempting themselves from it.

.
This. We need a law that states that lawmakers can never exempt themselves from any law citizens are subject to.
__________________
NRA Member
Black Rifle Club # 1995
Kalashnikov Klub # 1995
Ham Shack Club # 1995
Walther Club # 1995

-My username has nothing to do with Students for Democratic Society-

Last edited by sdsnet; 10-16-2013 at 00:02..
sdsnet is offline   Reply With Quote
Old 10-16-2013, 04:59   #196
Diesel McBadass
Tactically Epic
 
Diesel McBadass's Avatar
 
Join Date: Apr 2011
Location: Maine
Posts: 4,850
Tricare is mow raising rates


Sent from my SCH-R830 using Ohub Campfire mobile app
__________________
Rest In Peace Silent_Runner.
Diesel McBadass is online now   Reply With Quote
Old 10-16-2013, 05:51   #197
frank4570
Feral human
 
frank4570's Avatar
 
Join Date: Jun 2004
Location: Cul Va
Posts: 16,679
Blog Entries: 1
Quote:
Originally Posted by jim goose View Post
Too many people, in too many states did not have access to health insurance. And if they did, the high risk pool, or low income burden was shifted directly on the tax payers. Im not ashamed to say most of those people work as hard as anyone in this country, and deserve healthacre too, even if it means I have to find a new career one day.
In addition to paying for insurance, I am also paying $10,000.00 per year to get good medical treatment. I'm going to the doctor today and my insurance company won't pay for it.
Obama care is going to charge me more for insurance I don't use, and drive good doctors out of the field. More people will pay more money for healthcare that is much worse than it is now. It's what you call "fair".
__________________
Fear your government.
"Rats aren't creepy, experimenting on them IS." Emilie Autumn.

For too long people have said "screw NY, IL, etc" or "that'll never happen here." Yes, it will eventually. If we dont start standing up together now, it will never stop.-ilgunguygt
frank4570 is offline   Reply With Quote
Old 10-16-2013, 06:05   #198
TX OMFS
Right wing nut
 
TX OMFS's Avatar
 
Join Date: Mar 2004
Location: Texas
Posts: 1,784
Quote:
Originally Posted by SC Tiger View Post
How does Medicare calculate it? Is it a simple case of "this is how much we will pay" or is there more to it?
Short answer: yes, it's arbitrary and pulled out of the air.

Long answer: they take every billable code in the book and assign a Relative Value Unit (RVU) to it. Then, they set a dollar amount for one RVU, search around their agency to find someone that can do simple math, and determine prices. If you look in the book a procedure will be worth 2.17 RVU or an exam worth 1.03 RVU, etc.

Of course, everything can be adjusted with a modifier code.

Oh, and don't forget if you do 3 procedures only the first one you listed will be paid at full price. The others will be discounted up to 75%. Can you image if I did that to my mechanic?
__________________
Bad decisions make good stories.
TX OMFS is offline   Reply With Quote
Old 10-16-2013, 06:14   #199
TX OMFS
Right wing nut
 
TX OMFS's Avatar
 
Join Date: Mar 2004
Location: Texas
Posts: 1,784
Quote:
Originally Posted by WarCry View Post
I honestly don't know, and I'm not going to pretend I do. I had people ask me that a LOT in the job ("How do you guys set the rate?") as well as asking to about the doctors' acceptance ("Why would any doctor sign a contract for that?"). My answers, respectively, were that I wasn't an actuarial and so had no honest idea how those amounts were determined, and to perhaps ask the doctors why they would accept those rates.
Docs sign those contracts because of market competition and people's expectation they shouldn't pay for healthcare out of pocket.

Unless you're the only doc in a small town you have competition. A competitor will sign up for a plan if you don't. Most patients will switch doctors to avoid paying an extra $20.

The dream that some doctors achieve is to be so well known and in demand that patients will come in, insurance be damned. That is rare.

Ask yourself if you would pay $100 for an exam if a in-network doc will do it for $15.
__________________
Bad decisions make good stories.
TX OMFS is offline   Reply With Quote
Old 10-16-2013, 07:16   #200
JFrame
Senior Member
 
JFrame's Avatar
 
Join Date: May 2001
Location: Mid-Atlantic, US of A
Posts: 31,574
Quote:
Originally Posted by Rabbi View Post
No one deserves anything.

Lets be real honest. For everything you think one person "deserves" you have to perform an injustice on someone else.

In our country that mean you want a third party to , by force, take it from someone else...unless you yourself are rich, then they take it from you.

For every bleeding heart "its not fair" people like you advocate for, all you are really doing is saying "I want this, so I will have someone else go steal it for me."

There is nothing noble about what you think. You are a thief who avoids feeling you are one because you cant see past your own causes.

Excellent post.


.
__________________
"When newspapers are controlled, it's amazing how ignorant and immune from pressure the government can be." -- Amartya Sen

--
JFrame is offline   Reply With Quote
Reply

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off

Forum Jump




All times are GMT -6. The time now is 20:07.



Homepage
FAQ
Forums
Calendar
Advertise
Gallery
GT Wiki
GT Blogs
Social Groups
Classifieds


Users Currently Online: 1,451
446 Members
1,005 Guests

Most users ever online: 2,244
Nov 11, 2013 at 11:42