I do medical billing for a major hospital and I believe for-profit health care is evil. AMAA

My Medicine cost $147k a year, so Im pretty much fucked no matter what right?

Jesus. I mean, I dont want to say yes to that, but like

I work with someone who never pays her medical bills and hasn’t for years. She claims she has a credit score in the high 700’s and that none of her medical collections show up on her credit reports. Is that possible?

I've never heard of it. I know ours show up in a couple days

Do the providers keep letting her make new appointments?

I would think you would be banned from everything except the ER after much of that.

They sell it off. Doesnt make a difference to them most of the time

This is a fascinating AMA for the rest of the the world outside of the USA. My question is, why does the USA cling so desperately to their healthcare system in defiance of evidence from the rest of the world?

Like many things in the world, because people make a lot of money off things staying the way they are, and said people also have a lot of power to keep things the way they are.

And the winner is...

How long after a visit can I be billed? I got one from over a year ago. Can I contest it?

Your insurance legally has up to 2 years to reprocess your claims before issuing final billing

I recently had bloodwork done to determine if I had signs of potential cancer, after a 25cm ovarian cyst was discovered. I received a letter from my insurance stating that the claim for coverage of those tests was denied, as they considered it "unnecessary for treatment/investigational". I'm pretty sure it's necessary to know if I potentially have cancer, but I digress.

I am in my mid 20s and have never had anything medically wrong with me. No stitches, no broken bones, no hospital visits. I have used insurance purely for routine yearly checks, dentists visits, and eye exams. Therefore, I have no idea what to do about making insurance cover this, as I can't afford the $600 after paying $2,000 for the surgery to remove this cyst. Any advice on appealing the decision and how that process even works?

You might be able to get the clinic that performed the procedure to notify the insurance of medical necessity and provide medical records, but if that already been done you might be out of luck. As far as the appeals process goes, your best option is always to talk regularly with the clinic and keep them informed that you're appealing, trying to stay on top of it, etc.

are bills negotiable?

It depends on the facility. In mine, we're "non-profit" (as if) so we have various discounts and financial assistance. I know of one other facility in my state that actually offers "pay off" discounts for paying in full. Some, the prices are set and that's too bad if you dont like it.

thanks.

No problem. You can also always ask someone at the facility how they do their billing. Usually they'll tell you.

I've been in the hospital a lot. Every time I call after I get a bill and ask how much if I pay in full. They always take 40% if I pay them. Doctors, hospitals, services, everyone.

Not every facility does that, but I'm glad you can afford to do that.

Block out the bar code btw.

What type of nonsense codes should we be looking for in our billing statements that hospitals have added to line their pockets that don't relate to actual care?

How can we counter bills from doctors who "consult" on a case but never actually see the patient but expect a huge fee (many times not covered by insurance)?

If you receive a bill from a doctor for a bullshit exam how can you fight the bill? (Real world example: My sister went into the doctors for a checkup because she has some on going health issues. The doctor walked in and asked her if she'd had a period recently. She said yes, 2 weeks ago. Doctor walked out and sent her a bill for $600 with no explanation and no help with her medical issues.)

The thing about codes is that they're all essential in one way or another. The shittiest ones are those for Medicare and Tricare because their rules change so often and they're both very picky. My employer does facility based billing as opposed to provider based because we're non profit, so all our codes will say 'hospital' or 'outpatient'. The problem there is that some insurances wont pay certain procedures if they're outpatient.

As far as consulting physicians, you can try requesting the ranking physician because that's typically who consults, but it's unlikely you'll get your pick. The best choice there is to avoid large facilities. More docs = more residents = more consults.

On the bullshit charges... exasperated sigh

Doctors have no idea how billing works. They don't know that every single thing they enter becomes a charge, and if a patient has existing conditions, they will almost certainly charge for 'maintenance' of that condition. If you're following up on that specific issue, only schedule a consultation for that, and do NOT let the doctor change the subject. Anything else? Say no. They're required to write down anything discussed, and as a result, coders are required to turn every word in to coding.

Pro tip; talk to your insurance about what's covered and NEVER the doctor. They have no clue, and will 100% tell you its covered to get you to come in.

EDIT FOR CLARIFICATION:

I am NOT saying you shouldn't discuss issues with your doctor. You absolutely should. What I'm trying (and failing) to say here is that your appointment's status is not set in stone until its entered in coding. If you go for a wellness exam but discuss your diabetes/former cancer diagnosis/menstrual cycle, the visit will no longer be considered annual wellness. If you discuss an issue other than the original reason for scheduling, the coding can/will change. Absolutely discuss medical issues with your doctor.

Dude I hate it too. I am in your same kinda boat. Texas, MRI Outpatient facility... we are freestanding but owned by a hospital so it’s all outpatient based. Used to work for an in house MRI place where an MRI would be $350 Physicians rate. But outpatient it’s a $3000 MRI for no reason other than greedy scum.

My favorite thing on that garbage is when I have to explain that the cost is higher 'because we're a level 1 trauma center, and our rates are comparable to other centers for the same care across the country'

My local world-renowned hospital told me they charge more because they're "a teaching hospital". Yet the other hospital system that is also very much a teaching hospital manages to not only charge less, but also create mostly straightforward bills.

Preach.

My dad had both his knees replaced (separate) and each one was outpatient. If they can hack open his leg and replace a major joint, then send him home 4 hrs later, what major life saving things could be out patient with modern medicine?

It's more of an office visit vs outpatient issue. Like freezing a wart off, but then it getting billed as an outpatient procedure.

Wait, you're telling me the corporations profiting from sick and diseased people is not a good thing? Well that sounds too close to socialist propaganda for me to listen to. I'm going to lock myself in a closet and blast Tucker Carlson until I forget about this post.

What other response could I expect from NotTedCruz?

Do you want to keep your anonymity?

FYI. What you've blurred out, isnt nearly enough if you don't want to be identified easily. You might want to edit the ibb image further. I know its kinda late for the 6 hours, but you should consider removing even more. show 0 of photo, and 0 of barcode.

I used to work with a variety of data and I could probably identify you with whats there in probably less than 1 hour and I was a junior engineer when I used to work in that area, and that was almost 5 years ago. I'd imagine its only even easier now.

I am 99% sure what hospital OP is at just based on the lettering and font on the top of the ID card.

He will probably be fired tomorrow morning.

Yeah OP is definitely getting fired.

Thanks for the support guys lol

Thanks for doing this!!! I have a question, because I'm in a bit of a pickle myself. I had a standard surgery go wrong, and now I owe the hospital a whole fuckton. But they did this to me....is there any point in arguing with them? My insurance company already shelled out 5 figures at least...at what point do they cover it because they fucked up?

Malpractice suits and quality of care issues are really the only ways to get it back to them. They'll do everything they can to fight it though. Truly, best of luck.

It sounds like you work at a not for profit and still encounter a bunch of issues. Why do you think for profit is the issue as opposed to the design of the system itself?

The system itself is for profit, which is why it still presents us with so many issues. Getting private insurers to pay is more difficult a lot of times because they come up with fun new ways to deny every time. Medicare's biggest problem, honestly, is how impossible it is to keep costs standardized when the market fluctuates like crazy. They change constantly because they have to keep up with the market.

What does the last a stand for in AMAA?

Anything. But the second one stands for Almost.

What are the profit margins at hospitals actually like?

Absolutely ludicrous

What are, if any, possible ways to fix this disgusting broken system?

BURN IT.

But also, letting doctors do their jobs without pinching every penny and regulating the system in to single payer. That's my suggestion.

How much do you make and should I get a degree in medical coding?

I make $16.50/hour, personally, but our department has two operating systems to keep track of, a shitload of incoming calls, and we're the gobetween for a lot of other departments.

My MIL has a coding degree, and i know a few of the coders at my facility. I can say that they all seem to have a pretty 'medium' opinion of their jobs. The pay is decent, the hours are decent, and they're some of the only people able to work from home, but their work is VERY closely analyzed and nit-picked, so if you're not in to criticism or review, maybe not.

What is the best way then to create a system that offers quality health care to communities where it's not like the VA, in which you wait forever to be seen by a doctor? I think of Canada in which you could theoretically die waiting for a doctor?

You can do the same here, and then they'll bill your family. My suggestion is single payer with no market, but regulation through lack of profit margins. Cut the red tape. It's that barrier that makes it so most people can't get in to a doctor, and can't get one to talk to them for more than 10 minutes.

Why do you think The U.S. cannot simply adopt the healthcare system of other countries who have universal healthcare?

Because of people like Stellarspace1234. They think helping people needs to be about profits instead of just like... about helping people.

How would you do it differently? If you had the power to reform the system, how would you tear it down and rebuild?

Single payer, merits in the form of time off, eliminate the profits factor

I am european so I am not into US system but I am curious.

who do you bill to? the patient or the insurance? if the hospital is no profit does it mean that his that costs are equal to income? which is the highest voice of cost? how much does a physician is paid by the hospital? thanks!

Billing goes to insurance first, then the patient, unless the patient was involved in a third party incident (worker's compensation, car wreck, etc.)

My employer is listed as non-profit, which is supposed to mean we operate with charges at a low profit level to compensate cost of operations and employee pay.

I'm not sure what you mean by voice of cost

Physicians at our facility all make at least 100k/year, and they are also given division bonuses based on their divisions cash collections every quarter.

How do private insurers pay for inpatient hospitalizations if they don't use MS-DRGs (Medicare) codes?

why does Medicare pay less than Private insurance for inpatient hospitalizatoins?

It seems to be a benefit/drawback situation. Part A literally ONLY pays for inpatient, and since they're what's called a guaranteed payer and they're nation wide, they get superb rates. Part B covers most everything else, but their clinic costs usually adjust UP not down, to $103.86 if memory serves.

The supplemental do a lot of the work too, which reduces the top line on medical charges a lot. Privates like United and BCBS have higher deducties, which is how they get away from having worse rates than Medicare gets on procedures.

Is it not evil to force doctors to work minimum wage to reduce health care costs?

I mean... nobody said they should?

I'd be very interested in why you think that?

I swear I just came from the hospital where my mother died and I'm almost certain they made her sicker so they could load up on medical billing. I can't help but feel doctors/hospitals try to make people sick so they can make more money.

But I'd love to see proof.

Money is the name of the whole game. That's all any of us are to these people. I see it at slavery wlquarterly financial meeting.