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Medical Costs Bankrupt Patients; It's the Computer's Fault
nbauman writes "Don't get cancer until 2015. The Obama health reform is supposed to limit out-of-pocket costs to $12,700. But the Obama Administration has delayed its implementation until 2015. The insurance companies told them that their computers weren't able to add up all their customers' out-of-pocket costs to see whether they had reached the limit. For some common diseases, such as cancer or heart failure, treatment can cost over $100,000, and patients will be responsible for the balance. Tell me, Slashdot, how difficult would it be to rewrite an insurance billing system to aggregate a policyholder's out-of-pocket costs? 'A senior administration official, speaking on condition of anonymity to discuss internal deliberations, said: "We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which told us that their computer systems were not set up to aggregate all of a person's out-of-pocket costs. They asked for more time to comply."'"
The rollout is being delayed until after the 2014 congressional elections. The problem is political, not technical.
quiquid id est, timeo puellas et oscula dantes.
We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which told us that their computer systems were not set up to aggregate all of a person's out-of-pocket costs.
So what's on the other side of this "balanced" solution?
As long as the payers for service and consumers of it are different entities, this sort of nonsense will keep happening.
In Soviet Washington the swamp drains you.
please let me know. I'll be happy to volunteer
- I've got bad karma because I won't parrot everyone else's opinion
My current plan already does this and I'm certain it's a basic tenet of all medical insurance plans. After all, most people choose a plan by balancing the up front premium costs with the out of pocket costs on the backend. Der, someone is fibbing. X-/
Well damn, better go tell Microsoft to stop making Excel... *facedesk*
How the heck does this happen?
Who said you had to use a computer?
Place nail here >+
It's the age old problem of disparate computer systems and subsequent integration problem.
And I'm surprised that no one knows about MML - which is surprising since the insurance companies pretty much wrote the ACA.
So instead of just doing the paperwork on paper(or excel) theyre going to let the patients die if they cant cough up the cash, because the insurance company doesnt want(or cant) do 6th grade math.
Today your government is brought to you by PepsiCo and Corrections Corporations of America, Low on regulation and high on regulatory capture.
It's just another example of bought and paid for politicians sucking the dick of corporations. The famous words "of the people, by the people, for the people" are such a sick joke if you look at the USA government. Coming from a country that covers 100% of such common procedures, I just can't imagine how people can live like that. And Americans still think they have the most superior country in the world. America! Fuck Yeah! Please stop spreading your ideas of freedom to the world and try spreading those ideas at home instead.
Get ye head out of your ass and implement universal health care already.
Tell me, Slashdot, how difficult would it be to rewrite an insurance billing system to aggregate a policyholder's out-of-pocket costs?
That depends entirely on whether the insurance company wants to remain in business or not. Next question.
#fuckbeta #iamslashdot #dicemustdie
Huh, they sure seem to be able to add up stuff to tell me I haven't reached my deductible yet...
Oh ... nevermind.
Which is what Obama has wanted since day one.
1) Pass a bunch of rules with an unreasonable compliance schedule that no insurance company on Earth could hope to meet
2) Blame insurance companies when the new "free healthcare for all" law fails miserably
3) Use it as an excuse to ram single-payer down everyones' throats
4) Government now has the power to decide who lives and dies, based on political ideology, which is what leftist despots like Obama want.
When insurance companies don't want to cover you anymore they have all the history they need to get rid of you. When they want to help you, its going to take time. I do not know many billing systems that can't tie an account's billable together.
Hospitals know how much they charge people, so lets just work around insurance companies and use the real end cost from hospitals. insurance companies won't be able to work around with accounting tricks and loop holes.
The best part about that will be the forcing of a central patiant records because all hospitals will have to be compliant.
-(sorry don't have a login) Pete
How much did Obama sell *that* decision for?
By what legal authority did Obama delay this implementation?
Do you have ESP?
So what is the opposition party alternative? Repeal.
That will limit the out of pocket costs when? Never.
Plus it will eliminate the various positive effects that the ACA is already having.
Basically the people that are screwing up here are the beneficiaries of the higher out of pocket costs, our Medical Insurance Overlords.
I'd make one very simple addition to all insurance building systems:
while(true) {
DontBeBastards();
RememberYoureDealingWithHumanBeings();
}
These costs that they are denying, they haven't even bothered to calculate them, they don't even have the means to determine what the costs are, and yet they are still denied
How is it that they are allowed to call their product "insurance" when they freely admit that they don't even know the costs that they are "insuring" against
Easy answer on this one from someone who has worked in the insurance industry for a few years... the systems suck.
I am not defining 'suck' from the standpoint of performing because they do what they need to... however they become so bloated with complexities that even minor changes seem daunting. No person or team in my organization knows how the systems work from end-to-end and even the vendors need to use reverse engineering to resolve issues because of the complexities.
Not unusual for an insurance company to build a new system to support new plans because integration of the benefit rules into an existing system is not worth the pain. In the end the company ends up with several systems and IT silos built up around them.
The system at my current work will not be able to handle tracking co-payments over any period of time. The jobs that run overnight to price claims and track this sort of thing are already running at capacity.
On top of all this the executive management in this industry tend to be incredibly conservative and avoid risks like the plague.
As if these soul-sucking, perverse leeches on humanity (that health and sickness should be a source of capitalist profit is 100% my definition of perversity) don't have the ability to track every. single. penny. that passes through their disgusting hands. Another lovely chapter in the american long-con.
Businesses exist to maximise profits, all profits, even those derived from delaying compliance activities. It becomes a simple cost benefit case. Is it cheaper to pay some politician's wage and go moan about how hard it is for your one programmer to re-write the software within a timeframe, or is it cheaper to simply hire the right number of people to do the job properly and quickly.
The answer is nearly universally the former. Major companies (not just healthcare) will rather moan about how hard done they are by the government than actually step up to comply with the new regulations. If a large fine is linked with non-compliance they'd have the software modified by the end of the month.
I've seen similar cases in industry too. Companies will replace truly horrendous parts of their plant like-for-like because installing what they want is tied with meeting the new standards of the day rather than the easier standards of when the equipment was originally designed, and thus we have a plant basically half replaced as new with no gear that meets any modern emission standards.
There's simply no motivation to go down the more expensive route.
An old programmer once told me that insurance companies run on OpenEdge (aka Progress), and old versions at that.
Gigabytes of proprietary spaghetti code <<shudder>>
I'm not putting my hand up to fix that.
Step 2 is an immediate response, step 4 is handled in batch processing nightly. So far so good. Except that the Affordable Care Act makes it *illegal* to make a patient pay more than the annual limit. The authorizer and/or the pharmacy can be charged for forcing the patient to pay above the annual limit. This means that the authorizer must be aware of limit of each patient and be able to respond in real-time so that neither they nor the pharmacy will be sued. The insurance company doesn't have that information available real-time, nor do they make it available to the authorizer.
It is a computer issue, but as simple as everyone thinks. Putting individual insurance files on-line so that the out of pocket expenses can be tracked real-time isn't trivial. Now, maybe the Insurance companies were hoping the law wouldn't be implemented so they didn't do the hard work necessary to get set up, or maybe the rules were only written as to how to handle the annual limit must be handled.
Just remember, the last time companies put together a real-time on-line credit/debit system, the government decided that they charged too much to support the infrastructure, and started regulating it. That was the Durbin amendment to Dodd-Frank, which put a fixed limit on per swipe fees - regardless of what the infrastructure and support costs actually are.
jerry
"Software is the difference between hardware and reality"
Tell me, Slashdot, how difficult would it be to rewrite an insurance billing system to aggregate a policyholder's out-of-pocket costs?
It's somewhat more difficult when you waste three years assuming the Republicans are going to win big in 2012 and repeal the whole ACA. You gamble, you lose.
Snark aside, the real answer seems to be in the article:
The health law, signed more than three years ago by Mr. Obama, clearly established a single overall limit on out-of-pocket costs for each individual or family. But federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs. In many cases, the companies have separate computer systems that cannot communicate with one another.
So insurance companies outsourced different parts of their work to different companies that don't talk to each other. It's not "the computer's fault", it's an administrative problem within the insurance company itself. That text was right above the paragraph quoted in the summary, but curiously the submitter felt the need to ask a rhetorical question instead of including the most important piece of explanation in the entire article.
(Also, have you ever heard a story about a giant years-old financial/billing system that was clean, well-implemented, and easy to maintain and modify? I sure haven't. Not sure why we'd expect anything to be a trivial change in one of those...)
Visit the
The implementation has been illegally delayed. If you find yourself owing more than 12,700$ in one year for one incident, and the insurer claims you owe more, sue. The law states you do not. It doesn't matter what the administration says. They don't have the actual authority to delay this law, which states implementation dates.
If they really want health care to be more affordable they need to do one two things:
1) Force providers to charge consistent rates (i.e. no negotiating with insurance companies)
2) Force providers to provide cost information to the public so people can compare.
This can of course be started at the state level, because fuck congress.
The solution is simple. Make them responsible for all of those costs until their software can handle it. Watch how fast that update happens.
Business creates opportunity and government creates oppression, not the other way around. Check your premises.
I want to delete my account but Slashdot doesn't allow it.
Doesn't it disgust you when those charged with upholding the law decide to selectively enforce it?
My insurance company (Aetna) already has an out-of-pocket limit on my policy. They're able to track what I've paid (at least as far as costs that're coverable under the insurance go) and determine when I've hit that limit. Every other insurance plan from every other company offered at every employer I've worked for has had the same sort of limit. The only ones that don't are the fake "insurance" policies you see offered on the low end that (if you read the fine print) aren't actually insurance, they're just a discount plan (and they don't actually pay the doctors, they pay you and you're 100% responsible for paying the bill). So if the insurance companies can keep track of out-of-pocket already, I fail to see why they'd have any difficulty doing so in the future.
"Tell me, Slashdot, how difficult would it be to rewrite an insurance billing system to aggregate a policyholder's out-of-pocket costs?"
you forget the part about needing to run on a PDP-11 and interface with an existing billing system written in the early 1970s
"They asked for more time to comply."
And this is why we should have gone to a Single Payer Health System a long time ago.
--
BMO
If your software are able to handle the law just do it manually.
(Those of you here who are too young to know about "Mister Rogers Neighborhood" need to move along.)
I can imagine Mister Rogers saying in response to the claim of the insurance companies. "This is bullshit. This is what it looks like. Can you say 'bullshit', children? Good. I knew you could."
It's really quite a simple choice: Life, Death, or Los Angeles.
Comment removed based on user account deletion
My wife had cancer in 2007. No one at Kaiser told us when our plan reached the maximum out of pocket costs. When I called because we were close I was told I had to send them an accounting for verification. I sent them a printout of a spreadsheet and they verified my records and confirmed my calculations. I was later mailed a hand written card stating we were not responsible for insurance co-payments for the rest of the year. The card was accepted for future hospital, lab and surgical appointments.
Why couldn't they use those other kind of computers?
You know, the ones they use to compute their profits..??
What? Too simple for you? I guaran-fucking-tee you that if you put this mechanism in place, the insurance companies would suddenly discover that they can, in fact, figure out how much you've been billed over the time period in question. "Oooh! THAT billing info! We just need to look in this computer for THAT!"
I'm trying to teach myself to set people on fire with my mind... Is it hot in here?
Obama wants to delay the effect of his healthcare bill until after the election so that voters don't get angry and punish the democrats for it.
That is all it is... nothing more or less.
I've decided to stop wasting my time responding to AC trolls/sockpuppets... so if you want a response from me... login.
Give me two days and I can write one in Python.
-AC
HR 676, Medicare for All would be simpler and cheaper.
I used to work for a company that wrote applications that process medical billing. If someone figures out who it was, I don't have anything against them, but this is just how the industry is. I lost more brain cells than I can count (have since grown them back) trying to understand the medical billing process, and EDI made me want to kill babies. Trying to understand medical billing itself, along with all the conditions? Hell no. Having read some of the comments here, the situation is even more egregious than I thought possible.
Every other first-world nation has a single payer system. Why doesn't the US?
(It seems you can do that with a lot of things. "Every other first-world nation has X. Why doesn't the US?")
Why would this be a technical problem when my current medical plan has a maximum out of pocket limit?
In database design, it's a best practice for a schema to support zero, one, or unlimited amount of something. Perhaps the schema is architected to support only one limit, that of your current medical plan, not a second limit, that of the Affordable Care Act.
spends more per capita on health at $4437 compared to $2919 for the UK government.
This is, perhaps, the price that you pay for having one of the least efficient health systems in the world. You do however spend even more on military spending.
Bullshit. The US spent ~$600 to $700 billion on the military in 2012. The US has over 300 million people. That would be over $1.3 trillion for Health care.
My computer isn't set up to pay the bills. It isn't set up to pay the penalties for not paying the bills either. I was too busy programming an interface to my asset protection plan. It's beautiful. You should see it. Rounded corners and everything, and the interest on my overseas accounts is lined up in formatted columns and everything. It doesn't do medical billing outlays though. So sorry. I'm sure you'll understand.
For all intensive purposes, "whom" is no longer a word. That begs the question, "who cares"?
If you fixed the health care system and cut 50% each of the defense and intelligence budgets, our GDP would not longer be #1 in the world. We might be #2 or maybe even #3.
Ok, maybe the insurance companies that need to catch up, should get "dumb insurance company" protection.. so they can cover the cost of upgrades to their systems.. they clearly need an upgrade. Does that insuirance exist? I mean they almost carry every other plan out there.
Seriously. The human body needs maintenance, and we have the technology to give it that maintenance. Why do we need a middle man? When There's something we all need to live why wouldn't we just pool our resources. We do it for water and electricity and it works great. Hell, the few times we've 'privatized' basic utilities all we've accomplished is socializing the loses and privatizing the profits.
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Wouldn't that be a different plan?
For one thing, for existing insureds with an out-of-pocket limit higher than permissible under the Affordable Care Act, the insurance company would have to cancel the remainder of the old policy and enroll the insured in a new policy with the lower limit as of the effective date of the Affordable Care Act. Recording this cancellation and enrollment would take some coding. For another, what a policy defines as an out-of-pocket cost and what the Affordable Care Act defines as an out-of-pocket cost may differ. An insurer may have to count costs that are deemed out-of-pocket under the Affordable Care Act separately from costs that are deemed out-of-pocket under the current policy, and it may be complaining that it lacks infrastructure to separately count these costs.
Here is an example of how your healthcare benefits are actually administered. Lets say you have Medical, Dental and Vision coverage from your employer. In this case there are typically at least 4 different companies actively involved in administering your benefits.
So if we use a typical BCBS company as an example your pure healthcare benefits are managed by BCBS which is a subsidiary of a much large company Health Care Corporation that provides the infrastructure to support administration and claims payment.
There is no real time reporting system for health care providers to use. If you are a new patient your doctor's office will actually call a customer service rep and they will lookup information in their system which is just a skin on top of a massive mainframe system.
If you go to the pharmacy there is a completely different company involved in administration, a Pharmacy Benefits Management company, again in the case of a specific BCBS company that PBM is Prime Therapeutics (there are others Medco, CVS/CareMark, etc..). Now Prime doesn't have a real-time link to BCBSIL so they will send massive EDI files back and forth over night. So at best your info is at least 1 day behind at Prime. Then if we add in Dental which is sometime sold as part of Health which is actually administered (again in the case of BCBSXX) by another subsidiary of the same large healthcare company that owns the BCBS comapny and again the data is not real time but nightly batched. And it is the same process for Vision, Life and Disability Insurance if they are sold as a package from your health insurer.
If everything is working downstream data is only one day out of date, more likely it is 2 days behind if you have spend thru multiple channels. Which commonly happens when going to the doctor and getting a lab test and a prescription on the same day. In that case you are likely to have 3 separate bills thru 2 different administration entities (BCBS & Prime).
The day I decided to leave insurance was after sitting thru a project wrap up meeting and having management joke about how quickly we got the project done. The project had started 16 years earlier and had been stopped and started 6 different times due to project mismanagement, terrible development practices, and general incompetence. This was a relatively simple project to get a nightly feed from another of our subsidiary partners and load it into our system without having a user manually process the data.
Nove of this is a valid excuse for the insurance companies sitting on their hands for the last 3 years, but it does illustrate the complexity of the problem and the horrible development practices that have gone on in this industry for too long.
I wish the administration would focus on the cost breakdown of medical procedures. I have read articles that basically seem to show hospital costs are pulled out of thin air and that the costs have no basis in care provided, or in any kind of reality. I mean $400 for an aspirin type stuff. Why does 1 night in a hospital cost $10,000? Hospitals are supposed to be non-profit after all. Why is a short ambulance ride $1000? It seems completely nonsensical to me. Until this is well understood, there is no hope. I basically assume the reason for these costs are either 1) They make up for people getting treated for free or 2) fraud. If the case is 1), I want to see this makeup cost as an explicit line item. It is also odd that surgeons get a small part of the total bill, and that hospitals are broke. Where does the money really go?
just do away with insurance companies and switch to single payer. We all need health care to live and stuff. What we don't need is a middle man that adds no value between us and our doctors.
Face it, health 'insurance' made since when the only thing a doctor could do was a) amputate and b) give out aspirin. It didn't matter that they only did a few big things that were mostly comfort before you died. Now we want to _use_ insurance. Insurance can't be profitable if we're all going to use it. The entire _point_ of insurance is that most of us aren't going to use it.
It's like hurricane insurance in Florida. Good luck buying it.
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would not be in the pocket of big money, the story would go in that manner:
What? Not ready by 01/01/2014 - it's going to cost you a million a day per case penalty and all the systems would be able to add up the numbers at deadline just fine.
This is laughable
An yes, the whole Obamascare show is political: http://www.dailykos.com/story/2013/08/11/1230529/-The-real-reason-for-the-GOP-s-all-out-war-on-Obamacare?detail=email
So it can't be that difficult (it's one of the Blue Cross Blue Shield companies).
They even have the statements automatically totaling my out of pocket history since I started my current job, (even though I've switched plans within the job) and my OOP from the job I had that I had a completely different plan with them like 10 years ago that I can access online. They're big on online.
I don't have any of them but there are some 'lifetime out of pocket' riders available, mostly dealing with Big Chronic things like MS and Cancer. You can even request the rider after diagnosis, and while they won't let you have it immediately, if you are under treatment for some period (2 years? 5 years? I don't know) the rider then takes effect and also counts the backdated OOP from when you applied.
I sure can't wait for the next George Bush administration to decided what medical procedures I'm allowed to get.
Paying taxes to buy civilization is like paying a hooker to buy love.
I wish they would give a detailed explanation of what they want to do; the reward for any person or group that actually does it; and the condition that their code is opensource.
Over and over you hear of these medical computer systems going into the billions (yes billions) and still not really working. Some parts of the system do involve some long drudge work such as entering the zillion codes for every ailment (mud in your eye) but I can't see the bulk of it being that terribly hard. As an open source project I could see groups of people just joining in for some altruistic fun.
But alas the large computer consultancies seem to have this locked up. They somehow convince the various governments to build systems that are so complicated that the documentation alone would fill tractor-trailers.
A great example of this would be the Canadian gun registry. It ran to around 2 billion dollars, never registered that many guns, and was an all around failure. My friends and I did some math and found that you could literally do the entire system in blocks of stone cheaper. That is you could carve all the records into blocks of stone and store them for access by people who would walk up and down the aisles with cell phones when someone called in a data request; and do this all much cheaper than 2 billion dollars.
But back to the opensource crowd sourced project. Why not give it a try? Worst case scenario it is a failure plus that failure wouldn't cost an arm and leg.
This is another example of how private health care doesn't work! Coming from Canada and having a few rare / serious medical conditions I just can't understand how anyone can support private healthcare.
What do you mean switch? We already have Medicare/Medicaid, and 1/3 of the uninsured go into those programs under Obamacare.
W..w..W - Willy Waterloo washes Warren Wiggins who is washing Waldo Woo.
Healthcare billing is seriously F####d
For example, we had the bureaucrats put in place the NPI or National Provider Identification number. Great. Now for every tax id number I have, I will have one provider number instead of 40, 50, 500, etc.
Except, the bureaucrats don't know that the Medicare/Medicaid/etc systems are still run with 50 year old COBOL code and they can't do that.
So, we are forced to "sub-part". Now for every legacy provider number we had, we now have a brand new NPI number.
The healthcare software billing systems in GOVT are seriously fubar'd.
NC has new medicaid system that "I S##T you knot" is written partially in cobol.
CSC NCTRACKS if you want to google.
Seriously - it may be a software problem that enables them to fix (temporarily) a political problem.
"... to fleece everyone before you partially close the gravy taps!"
Don't just stand there, get that other dog!
The insurance companies do this already and already have out of pocket maximum calculated each year for many policies. It's clearly an empty excuse. They've known the law was coming for years. Obama knows this too. He just rolled over and did their bidding.
they don't get to decide. Doctors do. It's single PAYER, not single INSURER. It doesn't work the way you're thinking in Europe, Canada, Germany or any of the other single payer systems where people are entitled (whoops used a bad word) to health care. The only purpose of the gov't is to pay doctors. And they can be well paid and still provide great service.
:).
But far be it from me to let a little thing like facts and the failures of the US healthcare system get in thy way of irrational fear mongering perpetuated by a multi-billion dollar insurance industry. Viva la death panels (well, the private ones anyway)
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The insurance industry agrees with you.
It was the government that forced them to include coverage for all sorts of everyday procedures.
One way to reduce the cost of Cancer may be to support
alternatives to "Cut, Burn & Poison" = another docu-
mentary, eg:
1. Burzynski's Antineoplaston treatments, which seem
to be capable of resolving brain cancer in children, etc.
Documentary: "Burzynski - Cancer is Serious Business"
reports some successful cases, showing before & after
-scans- for tumors / tumor growth / resolution, from
well-known, large medical centers & traditional cancer
treatment facilities. (Patents for his antineoplastons are
cited with patent numbers.)
An adviser to Pres Obama is cited as one who has
said that a reason Burzynski's treatments aren't
recognized or getting any public funding is: They
could cause collapse of -exsiting- Cancer research &
treatment enterprises, including pharmaceutical co's.
(Parts 1 & 2 are out, with Part 3 on the way.
See: www.BurzynskiMovie.com for details.)
[Movie may also be found & viewed on YouTube.com]
Controversy: FDA has repeatedly investigated the
inventor / doctor (Burzynski) with at least four (4)
Grand Juries -declining- to find reason for charge.
(US FDA appears to be "the bad guy" in this story.)
Burzynski might do well to consider CrowdSourcing
the $$$'s needed to complete remaining clinical trials
of his treatments - past & future.
2. TED.com as at least one short talk on using Electric
Fields to stop cancer tumor growth.
Add your fav alternative cancer treatment in replies
- IFF the source(s) you cite -include- scans showing
before & after scans, etc.
Obamacare is really an attempt to create the sort of socialism that Americans can stomach. I got a good buddy with some serious health problems who relies on gov't health care (got several actually, because if you have a health problem it isn't long until you die or need help from the gov't unless you're an Heir/heiress).
Anyway, I started asking him what he was gonna do. How would he use private insurance. Wouldn't they insurer just keep raising his rates. He said that would be wrong, and so somebody should do something 'bout that. I asked who, and how and he said there should be a law that the insurance companies could only charge so much.
Basically he, like most Americans, deep down want single payer health care. But we're been taught from cradle to grave that socialism is bad. We're indoctrinated. It's called cognitive dissonance. He knows he needs socialism to live. He knows he needs help, and he knows it's his right (as a human) to live. Not just to have some blind dumb chance at good luck, but to actually have a life. But he's been taught, over and over, lied to and lied to. So he breaks down.
Obama recognized that there's lots of people like that. So he's giving them what they need (socialized health care) but doing it in the only way he can. He's letting the devil have it's due, and he's going to give billions and billions to parasitic insurance companies who's only purpose is to make us feel better about getting something that's a basic human right.
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lots of states will not opt those people in. Lots more will use lies and subterfuge to keep people off the roles. Arizona does everything it can to disqualify people. I've got friends with kids on the local medicaid program that have to report birthday money from granddad as 'income'...
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It is just Medicare, but it would cover everyone. HR 676 would save taxpayers $350 billion a year.
Tell me, Slashdot, how difficult would it be to rewrite an insurance billing system to aggregate a policyholder's out-of-pocket costs?
Well I know that in a case where it is very very much in the interest of the insurance company to provide an accounting of payments made for certain medical conditions, they are unable to do so, despite their financial interest. (Accounting for costs that are subrogated in an automobile accident.)
The insurance companies are criminals. They are taking money under false pretenses. They never intend to ever pay anyone out for anything. Preexisting conditions clauses nullify every claim. Private medical insurance should never have been allowed. It should be a federal program, with everyone paying in on a monthly basis, and everyone claiming with all collections and payments made by the state. Its a zero sum game. With private insurance, profits to private individuals/corporations removes money from the system, meaning people get less than what they pay for, and greed by these groups prevents people from getting health care. I should have never been allowed. Its a sucky system. My desperate hope is that the ultra-right all die of very expensive diseases and maladies, and they all go very broke paying far too much for far too little care. There are so many other countries with great national care programs, yet the US insists on suffering because they are too stupid to know better, and the political right is making a killing running insurance companies that charge money for nothing, while at the same time declaring that national medical care is too expensive and wrong. If Americans had half as good a national medical plan as any other country in the world (with a national plan), the republicans would never get another vote (let alone another seat) in public office, ever again.
out_of_pocket = client.payments.current_year.inject(0){|sum, payment| sum += payment}
They pay less where there is any kind of error so it will hurt them to fix it fast.
I don't even need to see a business card to tell you who this is and what they're doing. It's not even an insurance company. It's a borderline investment company. They group people into groups, usually 50, and if someone has a significant claim that exceeds the premiums of the entire group added together, every single claim from anyone else in it is automatically denied regardless of ANY circumstances. Then you have to threaten to sue and get a 3rd party auditor up their ass to get them to cover it. The same thing happened to me. They were on the hook for $8 after my copay from a one time injury and they claimed it was a per-existing condition. Yes, loading out a band at a concert on stage crew and hurting my back was a per-existing condition. Mmhmm. This is why everyone should stick to larger, more reputable companies. I'm dropping those assholes at the end of this month.
As a Canadian I have yet to see the very interference of the government into my health. I have never had any government official stop me getting an x-ray, stomp on my doctor when he ordered an ECG, or any of the other numerous tests and prescriptions he has ordered for me.
It's true that there are flaws, but when my wife was diagnoses with a life threatening cancer, no time wastes in diagnostics and in the two surgeries that followed. Better still, I was unemployed by the second surgery and we didn't have to bankrupt ourselves to save her life.
The world's burning. Moped Jesus spotted on I50. Details at 11.
Single payer would be you paying your own bills on your own. Government payer forces millions of people to contribute to your care against their will. Having said that, I'm in favor of your version of "single payer" if it also entitles me to free car seats for my children.
Because I know the insurance industry upgraded systems every few years. So as a result they're constantly making changes to software.
Brings to mind a prosecution against a doctor I was involved with a decade ago. The Billing company TRIED to assert that they didn't keep more than three months of data online. But we got the data we wanted. Years later their I.T. guy who came with them to the meeting, he and I are working in the same I.T. unit. He said I was right - they had YEARS of data online. They just didn't want to seem complicit in knowing the doctor was upcoding his medicare patient visits. Oops.
I work in healthcare IT. I can understand just about everything that goes on in the hospital, from medical/clinical stuff to the physics behind imaging to legal requirements. I can't wrap my brain around the billing. There are thousands of pages of rules for Medicare/Medicaid, there are dozens to hundreds of pages per private insurer *plan*, with many (dozens?) of plans per insurance company per state. The state laws add additional complexity.
What treatments count as "elective" versus "medically necessary," what counts towards a deductible and/or out-of-pocket maximum, what counts as part of the write-off, what can and can't be billed for is a nuanced and complicated thing that has to account state law, federal law, regulatory rules interpreting and explaining the laws, individual plan details, specific hospital carve-outs, and negotiated contract differences.
In general, IT systems can't be adapted until the final rules come out (which for many aspects of the health care law they are not out yet), and once those rules are out getting every system, and all players, to adapt generally takes 12-36 months. Oh, and many of these systems were home-grown POS in back-wards languages (we still have vendors selling us VB-6 products), so "just fixing them" isn't always very fast.
There's a lot of politics here, but I was surprised anybody thought it would be possible to implement on time.
Tell me, Slashdot, how difficult would it be to rewrite an insurance billing system to aggregate a policyholder's out-of-pocket costs?
Tell me, Slashdot, how much would insurance companies have to charge all their even remotely healthy people to cover the hundreds of thousands of dollars thrown away in a futile attempt to save every life using every possible means regardless of cost?
Do you really want to know why the delay was put in place? Basic mathematics. The insurance companies have actuarial tables which tell them down to 1-3% mark just how much it'll cost them to cover all their millions of customers. The new legislation skewed the numbers by forcing insurance companies to add tons and tons of very sick people who'll never pay into the pool what the pool will pay out on their behalf. As such, they have to adjust their rates to match, but that big a change wasn't politically feasible; the backlash would have sunk the politicians and the insurance companies. So the extra time was built in to ensure a feasible boiling frog effect.
Boil, froggy. Boil and believe the lie that at least we've all got our own pot of water now.
-- "Government is the great fiction through which everybody endeavors to live at the expense of everybody else."
Yeah, ever so much better to let a vastly overpaid CEO make that decision.
Comment removed based on user account deletion
On the contrary, health insurance only "made sense" because during World War 2 businesses were prohibited from increasing wages to attract workers (because it would increase costs of material for the war effort), so they started offering employer-sponsored health insurance instead. Once the war ended, the idea stopped making sense again (but stuck around anyway).
"[Regarding the 'cloud,'] ownership was what made America different than Russia." -- Woz
When there is only one payer, they control absolutely what things they will choose to pay for.
The doctor has no choice in what they offer you in a single payer system; that is pure illusion. They give you whatever the sole source of income agrees to - and NOTHING else no matter how small or helpful.
"There is more worth loving than we have strength to love." - Brian Jay Stanley
If I screw up, such as being late with a payment, I get charged a fee. The insurance executives had almost four years to solve the problem, but have no incentive to fix it. They get more money with the status quo. Meanwhile, people go without medical care or go bankrupt from medical costs. It is time to penalize the executives, so limit their pay to a maximum of $400,000 until they solve the problem. Also, for any family that has to pay more than $12,700, each company involved should pay $500 fee for each incident, and three times the amount over $12,700. I bet they solve the problem really fast.
Actually, we (the United States) should just get rid of the insurance companies and implement a single-payer system. Everybody would be covered. Nobody would die for lack of health care. Patients would have more freedom and could choose any doctor they want. Copayments and deductibles could be eliminated, and there would be no medical bankruptcies. The country would save $592 billion in 2014 if we went to a single-payer system.
Come on, let's be real. Out of pocket maximums have been a part of insurance policies for decades and often change from year to year. This is not a difficult problem, merely an excuse. More likely, is the financial problem of covering pre-existing conditions with a low out of pocket maximum. My bet is that they are delaying and hoping healthy people will signup instead of paying fines.
Insurance can be quite profitable even if the ensured want to use it. But the problem isn't that people want to use it - it's that everyone wants it to endlessly pay out dollars while paying in only pennies. And that's the insidious part of Obamacare... the notion that dollars can be printed from pennies is now enshrined in law. (Without actually fixing any of the real problems in our healthcare system.)
Within a decade of Obamacare taking full effect, you're going to see a wave of bankruptcies ripple through the insurance industry. The knock-on effects will make 2008 look like a child's tea party.
Could someone define "out of pocket expenses" for non-US readers. For me out of pocket expenses is buying a coffee in the Costa at the hospital reception, plus the pay and display parking ticket for the hospital car park. From the article it makes it sound like "out of pocket expenses" is the full treatment cost!
Obamacare is a compromise forced by unions and large corporations that want to maintain their tax deductible "cushy" medical plans whilst the rest of the populous get forced into a command-economy style health care industry.
If Obamacare was actually single payer, or socialist, the cushy medical plans couldn't really exist (because the infrastructure that would have supported them meaning the insurance companies and the pay-for-service medical providers would have evaporated) and there would have been no support for it. Regardless if the that is what Obama wanted, his support base wanted to be able to keep their plans, so this is what came out of the backroom deal.
If you want some evidence of this, I suggest you start with the sad fact that congress needed to hastily pass a law to allow their staffers to get a federal subsidy to help pay for getting their insurance through Obamacare since they feared "brain-drain" of people fleeing public service to get better health coverage from the private sector. No, the people in charge of Obamacare don't want the same coverage for everyone, they just want to change the way healthcare is funded for the masses, not the elite.
Tiered coverage often doesn't work with single payer very well, because of economies of scale limit the availability of competition for supplemental insurance resulting in a very have and have-not price points. As an example of this, you can start by looking into the fact that in the US medicare supplemental insurance needs to be subsidized by the government to keep providers in the market. If that seems like an inherently unfair use of government resources to give health benefits to some people over other people, well, you are probably looking at a preview of Obamacare in a few years if they want to keep private insurers in the market as costs rise, but premiums are capped due to political pressure.
On the other hand, if you are a cynic, you probably think that this design was an intentional long-term policy to drive out all insurers so that the system has to convert to single payer. If you want to see some evidence of this, look at what Obamacare is doing to Medicare Advantage programs (alternate Medicare-like insurance provided by private insurers).
With the current US heath care system you can't. Bankrupting the patients is an essential part of the business plan. You need to switch to a single payer health care system like every other civilized country in the world.
As a Canadian living in the US, I HAVE seen the interference of health insurance companies into my family's health. My wife has a chronic migraine issue and insurance refused to allow an EKG prescribed by a neurologist to help in a proper diagnosis.
They also regularly either restrict the quantities or refuse to allow certain expensive prescription drugs to relieve the symptoms.
Computer says 'No'.
- Mad, ingenous - they've both left you puzzled -
Well, depends on how good your COBOL skills are.
There is just no reality in these laws. Picture a person suddenly fighting cancer. Chances are they can not work. Their on hand money will vanish in an instant. So they need to pay $12,700 in co-pays. And how do they house themselves, feed themselves, and get back and fourth to the doctor?
The notion of co-pays enables that two pocket problem. Toss in insurance companies and now the medical industry can feast on three pockets. The only thing that has a chance is to have the government take over medical care stem to stern and disallow co-pays or insurance companies and immediately take care of people who suddenly are in a life and death battle. Even if the poor victim survives will he or she be left sitting on a curb, impoverished and unable to work? And how about their children?
My wife was in a very serious motorcycle accident on June 14th of this year. It took 30 min for ambulance to get to her to transport her to a local hospital where she never even left the parking lot but was loaded onto a helicopter and flown to a level 1 trauma center. I've avoided the avalanche of bills that have come in until she as finally home this past weekend, but out of all of them the bill for the helicopter ride was the most outrageous. The MINIMUM fee for life flight to take off from the pad is TEN THOUSAND DOLLARS. I sat in my wifes' hospital room for almost 3 weeks overlooking the helipad and it was as busy as a municipal airport. The cost per mile was 75 dollars btw. Our bill was $13,000. As grateful as I was for it's existence in no way is it possible that the cost to keep this service running 10,000/flight, especially not when there had to be a dozen flights a day on average. I am aware that the flight crew are specialists, not only pilots but nurses, but even if they were flying the surgeons to the accident it couldn't possibly cost this much. I am thinking very seriously about pressing the issue in some way to try and limit this egregious and larcenous practice. I read recently where some municipalities were going to try and force all ambulance rides to be my helicopter. I can't imagine why....
If I sound stupid, it's not me talking....
Given the number of significant digits on medical bills, it looks like its time for 128 bit OSs.
The computer says No.
As a developer in the health care industry (pharmacy point of sale), I can tell you that it is fraught with many non-technical issues. When do you make these changes? With health care being a political football, you don't want to get started early because Uncle Sam may change his mind. How do you deal with privacy? In this case every payer would need access to a patients total related out of pocket expenditures. In today's world everybody is scared to death assuming more responsibility for personal health information than is absolutely necessary and sharing what you have gathered with everybody else who needs it is scary too. HIPPA HiTech and security certifications potentially with independent audits are expensive and time consuming. What exactly are the changes that need to be implemented? As a developer, do you really want your requirements document to be the total text of the Affordable Health Care Act? These systems are large, complex, and in many cases old. You cannot just edit a few lines of code and slam it into production. Changeing anything at all is a big deal. Unfortunately its a shitty situation and the problems are deceptively hard to solve. Tweaking this existing monstrosity of a system is a bitch. From a technical perspective, starting from scratch would make more sense.
Greed is the root of all evil.
Sick people don't make health insurance companies money. Healthy people do.
If information wants to be free, why does my internet connection cost so much?
"out of pocket" is calculated BY the insurance company however they want based on any point in time they chose. If they decide that a CATscan should cost $1000 based on the tables they use from 1987 then that's what the 'out of pocket' is calculated as. $12,700 is based on what THEY feel the costs SHOULD be not what they are. So if your CATscan costs $5700 and they reimburse 80% that out of what's left, a $1000 goes towards your out of pocket.
Somebody would have to type a SELECT.. WHERE line, you can't expect that.
back in 1995 I was working for a larGe TElco when my director called me into her office and instructed me to go down to Hartsfield (ATL airport) & pay the walk-up fare to get on the next flight to Raleigh b/c they couldn't process commissions & the SE sales reps were revolting ("you ain't kiddin' - they stink on ice" - sorry, couldn't resist). I immediately knew what problem was (well, 99+%) but felt conflicted so called (then) girlfriend (now wife) and said: "${DIRECTOR} just told me to get on next flight to Raleigh to fix commission processing but I'm 90% sure someone just didn't check ASCII->EBCIDIC when they uploaded the file" (which was prepared in 1-2-3) "I could probably walk them through it over phone in 5 min but it's effectively a free vacation day & I can probably get upgraded" (since I was medallion at time). she told me I should do the right thing & unfortunately I was born with the ethics gene (I probably be worth a lot more w/o it) & just called the desktop support guy in Raleigh who confirmed/fixed in 30 sec.
I just always thought that was funny - they were dead seriously telling me to pay probably $1K & waste a whole day to check an "x" in a dialog (& sadly I was too honest to take them up on it).
"Obamacare" contains a provision capping the profit margin of health insurance companies. ... in the long term, hiding your profits this way is a PITA and prevents the CEO's visions of empire from taking root.
The practical result in the near-term is that they simply engage in Hollywood style accounting (who knew you that copier in the corner cost $100k/month to operate!??). But
Ok, so ... now imagine the absolute fucking goldmine that Obamacare is *without* the provisions the insurance companies find bothersome (the profit cap, the out of pocket expense cap, the pre-existing condition ban, etc).
Now look at how fucking persistently the Republican party has attempted to "repeal Obamacare" ... even though they knew that they had zero chance of succeeding. Take a look at who's interests the Republican party *really* represents. That shit was for show. They're simply setting the stage for a "reasonable repeal of only some parts of Obamacare", and they're stalling for time until they've won enough elections to make it happen.
Hell ... all you have to do is have a memory that stretches to the incredible depth of *10 months ago* and if you recall correctly this was the *EXACT STRATEGY* touted by the Republican candidate for president "repeal only some parts of Obamacare".
So ... being as this shit is fucking inevitable, I s'pose the smart thing to do is to go buy up as much stock in Health Insurance companies as I can afford. Give it 5 years and you'll be rolling in dough. Just don't hold onto it too long, 'cause the 'boomer population boom is a bubble ...
In Libertarian Amerika, you have only the rights you can afford.
In Libertarian Amerika, we don't let people die, they let themselves die because they can't pay the bills.
In Libertarian Amerika, medical providers can charge whatever they want to and the market will take care of itself; without government regulations.
In Libertarian Amerika, its your own fault for not being able to afford your healthcare, because you should be better at shopping around for your own healthcare, never mind that doctors, pharmacies, and hospitals don't publish a price list and you don't even know what exactly you will need before going to the doctor; you should know exactly what you're going to need because you need to be a responsible customer.
Hey, quit injecting your facts and experience into their wild speculation.
Yet another reason to get rid of obamacare & democrats!!! obama don't care!!! democrats lie, cheat & steal!!!
I don't care how antiquated insurance providers' systems are. With the amount of profit they make and the fact health insurance pretty much guarantees a continuous revenue stream (and the Affordable Health Care Act that's causing this very discussion pretty much locks that revenue stream down stream down). There should be absolutely NO problem investing in system overhauls or redesign, in fact, it should have already been on going. I have absolutely no pity for insurance providers here.
As a Canadian I have yet to see the very interference of the government into my health. I have never had any government official stop me getting an x-ray, stomp on my doctor when he ordered an ECG, or any of the other numerous tests and prescriptions he has ordered for me.
It's true that there are flaws, but when my wife was diagnoses with a life threatening cancer, no time wastes in diagnostics and in the two surgeries that followed. Better still, I was unemployed by the second surgery and we didn't have to bankrupt ourselves to save her life.
The Canadian system provided substantially slower and lower quality care to my Canadian grandmother than she would have received in the US. She lost an eye due to a viral infection that was never treated with any antiviral medicine. Eventually the surgery to remove the eye was scheduled with a long (close to a year) delay, requiring a daily nurse home visit in the mean time. While I understand that health care is not limitless and that treating a middle-aged person with cancer should be a higher priority than a 75-year-old with a severe eye infection, Canadians should not deceive themselves into thinking that their care is as good as someone with a good insurance plan in the US.
I have relatives in England and Ireland and all of them carry supplemental private insurance. Routine checkups, etc, are fine, but for specialized testing and treatments, they have faced long waits and poor experiences across the board. One cousin of mine (in his 60s) was told he had to wait 3 months to have a hernia treated, when he could barely move around the house from the pain. I've heard many similar experiences.
Quite frankly, I'd always been quite idealistic and in favor of socialized medical care, but the care I've seen administered under such a system has been awful. We pay out the nose for it over here in America, but the quality is generally top-notch. What we need to do is burn the insurance companies to the ground and start over.
Any halfway intelligent person can solve this problem in any number of ways, but we have powerful people that have a vested interest in the current system. These people, making a killing off the current US healthcare system, either are denying that the US healthcare system will collapse or they are frantically trying to make a much "big money" they can before the collapse.
Solutions exist but they are useless without the will to implement one of them.
My insurance has a max out-of-pocket and they do keep track of it. I see it on stuff they mail and I see it when I log in to their awful site. I don't get it.
simple, fast homepage with your links: http://www.ngumbi.com/
While in Jakarta, I took my daughter to the 24-hour emergency room after she had injured her arm and was unable to move it on her own. Two hours later, I was relieved to find out it was only a pulled muscle.
Next came the bill.. and I could hardly contain my laughter as I looked it over:
Proris (painkiller) - 5,706 IDR
Outpatient Doctor Consultation - 150,000 IDR
Radiology Services (7 x-rays) - 220,000 IDR
Total cost: $36.48 USD!
How's about until they upgrade their computer system, they just stop charging for out-of-pocket expenses altogether. Problem solved - entirely compliant.
More seriously, they could have (1) enforced the out-of-pocket limit per policy (so no policy individually charges more than the limit), and (2) let anyone whose totals are over the limit apply for a refund by submitting the bills from any other policies manually.
So instead, apparently while the limit for major medical expenses will be in place, there's (1) no limits on out-of-pocket expenses for prescription drug plans, and (2) no mechanism for refunding costs over the limits. ;-(
Am I the only one worried by the fact that there are going to be so many out of pocket costs that the software can't handle it? Am I gonna have to pay $400 for an asprin?
Yes, I'm sure. But you have to have a good insurance plan.
I'm sorry, health care ain't perfect up here, but when I see what saw of my acquaintances south of the border have to put up with, I wouldn't wish the US "system" on my worst enemy.
The world's burning. Moped Jesus spotted on I50. Details at 11.
Writing the computer code is relatively simple. The hard part is getting all the graft and kickbakcs sorted out. Getting all those back room negotiations sorted out takes time. When all that is done, the public will be screwed properly.
The problem with the phrase "of the people, by the people, for the people" is that at least the way SCOTUS sees it corporations are persons. The actual people of the US (The liittle folk NOT corporatios) will have to kick those politions that believe this crap out of office! When that happens, maybe such crap will not happen.
(Don't hold your breath.)
Here in reality, we don't have teams of coders sitting around doing nothing, waiting for the government to spring regulatory requirements on the industry so they can swing into action and hammer out a compliant system in days.
Here in reality, these things cost a fuck-ton of money because billing systems are some of the most arcane, convoluted, and incredibly complex software systems on the planet, especially when it comes to insurance plans.
Here in reality, these things must be thoroughly tested through hundreds of thousands of scenarios, which also adds months to your schedule.
Here in reality, redesigning a billing system requires months of careful design, planning, and coding work.
Here in reality, "ready in 18 months" is an absolutely reasonable and fairly typical "enterprise" schedule.
Sorry not everybody works in a 3-server shop, champ. The insurance companies have millions of customers each that they must get billing right for. Failure to do so will cost them support expenses, possible lawsuits, and regulatory fines as well.
This isn't "change the color of the facebook logo by tomorrow night." This is "overhaul the guts of your billing system to comply with the new regulations, and get it right the first time, or be fined out of existence." Anybody who thinks it can be done quickly and cheaply is a moron.
It's also delayed so the insurance companies can phase in the required premium increases. Because if the costs are capped, they aren't going to pay the rest out of their own pocket. I am guessing the premium increase is substantial so they want to phase it in over a few years so it's more palatable to the public.
We need single payer. End of story.
Aetna/Blue Cross is already tracking this on my statements. HSA has been around for a while...
RIGHT NOW, every medical insurance company knows if you've gone over your out-of-pocket limit. Proof: for those of you with a) medical coverage and b) any deductable at all.
There is zero excuse for this, other than their political power used to keep profits up.
mark
My wife is Canadian and believes strongly in both government intervention and government/single payer/universal health care.
But the more she is exposed to American politics and American politicians, the more she is willing to agree that it might not be a good idea to let them be the ones in charge of an American single payer system.
If I felt I could trust my national government in any way shape or form to pursue my best interests, I might feel differently. Right now I believe it probable that, should the US deploy a national health system, lobbyists in DC will have more say in my healthcare than my doctor or my family.
I work for an EMR that has a billing side to the company. We are considering a re-write of our practice management system since it is a web-based app that was written 15 years ago. Anyway, that means all of our billing functionality is included in that re-write. The problem isn't writing the code. The problem is all the rules and regulations in the medical billing industry. Sort of like the tax code, it's just too complex. Some of that complexity has to be there because humans are complex. Some of it is just stupid. The other problem is dealing with 15 years of legacy code that kept having one more thing added as rules and regulations change. Now, I admit that is really our fault for not maintaining the system better but from what I've seen many other's are in a similar boat. Some hospitals are still running system that were built 15 or 20 years ago. From a technical life-cycle perspective, that's several generations ago. Of course, most of those system can be upgraded, though probably at great cost to the hospital. Anyway, a big part of it is all the medical compliance and billing regulations. Not that there shouldn't be any, it absolutely needs to be there. I'm just saying it needs to be re-factored.
I sure can't wait for the next George Bush administration to decided what medical procedures I'm allowed to get.
Why do people always say this? Is it any better that some for-profit corporation decides what medical procedures you're "allowed to get"?
That's how it is now, and nobody likes it!
At least if the government is making the decisions, you know who to blame and have a right to at least some tiny chance of doing something about it. Like maybe electing a Congressman who isn't a complete idiot. When it's Big Private Insurer calling the shots, you're completely SOL.
(one other thing, it's never "what medical procedures I'm allowed to get"... that's FUD. It's what medical procedures will get paid for by someone other than you.)
Take it easy, Charlie, I've got an Angle...
They can't get their computers to aggregate the out of cost expenses? What a load of crap! I am fortunate enough to have health insurance and as someone with a chronic illness, reach my out of pocket every year. The insurer already does accumulate how much I've spent so far and it's even more complicated with things like co-insurance paying certain percentages based on billing code. They just want another year to rape the consumers. Having lobbyists pays dividends yet again!
it should be done by now. Slashdotters have probably posted it somewhere. Can't scroll through the comments to find it tho. (Too lazy!)
Sadly, a Libertarian cannot force his views on another, and freedom cannot spread as does the cancer known as religion.
It doesn't matter to me, I've already decided that if my insurance rates go up at all, I'm going to cancel my healthcare insurance (laws be damned), and set the money asside. odds are, I will still save more money, and at the higher rates, even if I do have a major operation, I should be able to save up the money for it first. And if my rates don't go up, then I still won't aknowledge actually having any insurance. Not on any form, not on tax returns, not verbal, etc. Any forms that have a check box, will be left blank.
Fines won't be paid, any forced fine such as accounts or taxes, or garnishment will result in other inventive ways of taking the money back.
Obamacare is illegal, unconstitutional, and we have drawn our line.
The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family.
It makes no sense to set the same limit for everyone. To Bill Gates, $12,700 is nothing, and to others, it's completely unaffordable. Also, not everyone has the same tolerance for risk.
When it comes to other types of insurance, we are still free to choose how large our deductible is. How long until that freedom is also taken away from us?
That that is is that that that that is not is not.
Look, computers are great as entertainment devices, and with some contortions they can even perform some light mathematical calculations. But they were never designed to add up numbers in the HUNDREDS OF THOUSANDS. It's unreasonable to expect to solve a task of this complexity using computers. The only hope seems to be some unknown future technology, and that's unlikely to happen be 2014.
If someone claims an out-of-pocket expense, you have to evaluate that it's not fradulent, while respecting al lthe privacy laws, and regulations, and working across dozens of systems which is actually pretty hard. If you could take people's word for it and just reimburse for whatever they claimed then it's pretty easy, but I'm pretty sure nobody could stay in business doing that.
I haven't been able to find this mentioned here, but these systems are already in place. There are insurance companies that offer high deductible plans, often linked with HSA accounts. These plans are supposed to be cheaper because you kick in more of the cost of health care and its supposed to make you "price shop" for services. These plans send monthly statements that not only list how much you have spent out of pocket to date, but itemize that list. So you can see what was spent, where and when how much of a "discount" you got from the MSRP. This whole "Our computers can't handle this type of detail" baloney is just because they want to delay spending the money to upgrade their systems, the software and tech are already available. Everyone would do well if they kept in mind that there are only two types of statements that come out of insurance companies: Lies and Damn Lies.
you don't have to chip in _anything_. The insurance companies profits would pay for your healthcare. You buy wholesale if you can, right? Then why do you have an insurance company between you and life saving medicine?
Hi! I make Firefox Plug-ins. Check 'em out @ https://addons.mozilla.org/en-US/firefox/addon/youtube-mp3-podcaster/
COBOL? MUMPS? CADOL?
I used to be
The problem is there is not standard price for medical services. If you go to Germany, the prices of procedures are laid out like you were selecting food from Mc Donalds. In the USA, neither the receptionist, nor the doctors, nor hospital know the price of a procedure before they run it through their 'magical system'.
Republicans often say Obama care is socialized medicine. However a true conservative would realize the system we have now is socialized. The best solution to the worlds problems is a market economy; where the individuals pay for the services they receive. This ensures that adam smith's invisible hand allows for the most people receive the greatest benifit from the servies they receive. However, under the health care insurance system. Individuals pay the insurance company (who are tyring to make a profit) with the mistaken idea that they will pay the doctors for the services they recieve. The docotors are constrained by the legal system, and the AMA. There is nothing in this system that is market driven. It is a mistake to believe that big business wants competition. They want monopoly and control. Why are you handing you health care to the big coooporations that do not care about you.
Seriously the only solution to the health care catastrophe is to abolish, the AMA, the lawyers, and most importantly the insurance companies. This means the patients would be paying the doctors directly. If the doctors were charging too much they would go out of business. This neccesarily would mean that rich people would get better health care than poor people. So bee it. This has always been the case and always will. The conservative wants to elevate all members of society to an unheard level of wealth. The Republican / Democrats wants to ensure their special interest (insurance companies/ goverernment contractors) are taken care of so they can live large while their subjects scramble for the hand outs they give them.
Obama care was a nice idea. but unfortunately due to a poor implementation will only allow for a greater degree of wealth to be accumulated by the government contractors / insurance companies. As it is the greatest cost of health care is due to overhead. This system will only increase the problem. Why is it the USA spends the most on health care, and our system sucks dick. It would be better to really go to a totally government controlled system than this cooporate / governent controlled health care fuck fest. However the BESTEST solution would be to go to a market driven system where people not insurace companies pay the bill. Sure The rich would have better health care. So what. There ain't no such thing as a free lunch. I would rather be treated by a doctor who had a 2.0 average that I could afford than to not be treated by the best of the best doctor with a 4.4 gpa who I could not afford.
Everything I just said used to be common sense, but is no longer so.
It's unproven treatments that don't get covered. There are lots of Cancer treatments like that. It might extend your life, it might not (and have bad side effects).
/. :).
The super rich will still get the best of the best. You're not going to change that. What single payer does is make sure you get good basic care and usually a bit more.
If you think you'll do better on you're own you're being silly. If you were one of the super rich you'd have better things to do than post on
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Hmm, somebody with a proven track record or someone that is just good at convincing others to vote for him...
Paying taxes to buy civilization is like paying a hooker to buy love.
Someone who can be gone in under 4 years or someone you have no influence over at all and could be there for ife.
They've had four years to get ready for this. As for integrating different systems, bitch please. Massive enterprises constantly make use of middleman software to pass requests from Database A to Database C and back again, every second of every day.
This is about profit, not capability.
Usually you see this excuse with lawsuits, or raising the minimum wage, but it's all the same crap.
All companies maximize revenue all the time.
If company can make more money by raising prices or firing workers, they'll go right ahead and do so.
As a Canadian I have yet to see the very interference of the government into my health.
Ok, so you don't see the interference. I'm not sure why that is relevant.
I have never had any government official stop me getting an x-ray, stomp on my doctor when he ordered an ECG, or any of the other numerous tests and prescriptions he has ordered for me.
And what of the stuff that your doctor might have ordered for you, but didn't? Opportunity cost is invisible.
I heard an interview with an insurance company employee who explained that the problem was a lack of real time communication with the pharmacies. Pharmacies hire outside companies to handle benefit info, and those companies only talk to the insurance company once a day.
So. You an get out of the hospital and go to the pharmacy, where you may be overcharged because the insurance company hasn't been able to tell the pharmacy that you are over your deductible. So, you get overcharged and the insurance company gets hit with a penalty for it, even though it's not their fault the pharmacy only wants to talk to them once a day.
And what of the stuff that your doctor might have ordered for you, but didn't? Opportunity cost is invisible.
What about that stuff? If they're invisible, they cannot be used to help us make decisions. It's one thing to recognize we don't know everything about anything, but when it comes to making decisions, people can only do with what they've got.
In fact, one of the problems with the US and other countries today is that people are letting all these invisible things affect their decisions. Invisible costs, invisible risks, invisible boogeymen, etc.
It's how they (special interest groups, lobbyists, con men) get you. They will tell you how their opponent's pet project is a waste, that it comes at the opportunity cost of something better. But if you *don't* give your money to their pet project, there would be this HUGE opportunity cost down the line! They might be right, or they could be lying, but how would anybody know? Nobody can verify, since the costs are invisible.
The result is that decisions are made not based on reason and facts, but on emotions and fear.
Then that's a problem I have with my doctor. I have yet to see any test he ordered be turned down. This is a bizarre bit of logic you're applying here.
The world's burning. Moped Jesus spotted on I50. Details at 11.
The insurance world needs to wake-up. They do not have the power to keep passing on the increase cost to the public paying CEO.CFO, and stock holder out of line increases. American health insurance company and the medical establishment are profit corrupt. Profit at all cost, the public is not smart enough to see who is at fault!!
someone you individually have no choice but to accept or someone whom you can take your business elsewhere.
Paying taxes to buy civilization is like paying a hooker to buy love.
Yes, you can go to one of his golf buddies instead, but it's the same deal there plus, your fatal condition will then be 'pre-existing'. That and recission had to be outlawed at the federal level to make them go away after decades of a 'free market' failed..
Huh?
Paying taxes to buy civilization is like paying a hooker to buy love.