I'm starting this thread as a place for people to offer real experiences / insights into the healthcare system in the United States. Additionally, ideas that we might have to fix them. Some things I think are agreed upon:
As for a first hand experience that can kick off the issues I have been seeing. A specialist is seen annually for a condition that exists. In one year, the specialist bills a fixed amount for the visit, the insurance company reimburses the specialist based on an "agreed" charge, this is less than what was billed by the specialist. Because the patient has said insurance, the patient is only responsible for the agreed copayment (a modest fixed amount). The specialist adjusts revenue accordingly (they will never receive the difference between the "billed" amount and the "allowed" amount).
The next year - same visit, same procedures. This time, the specialist bills separately for five different things done for the appointment. The "visit" (representing only one of the five charges) is much less expensive, but the copay is double due to changes in coverage. Since the "copay" is only applicable to the "visit", the patient is now separately responsible to pay for the four other things done to prep (review two tests two different ways, essentially). So this year, the specialists total bill increased 20% and the "allowed" amount increased 20%. However, the patients share increased over 800% and the amount insurance had to pay decreased over 70%.
Meanwhile, premiums all went up.
The amount of cash we're are shelling out is increasing dramatically, while officially the healthcare "costs" only increased 20%. And, of course, from a gov't perspective, we are "insured" - so YAY!! We comply with the requirements of Obamacare (but isn't the word "Affordable" in the title of the actual act?)
Everything discussed above may be legal - but it certainly doesn't appear ethical. The overall direction is frightening. But what can be done when a person has congenital health issues that require the services of a specialist on an ongoing basis?
- Access to quality healthcare is an important issue for quality of life. Disagreement exists with respect to the level needed and whether this is a "right".
- The rising cost of healthcare is outpacing inflation in the US.
- "Something" should be done about it.
As for a first hand experience that can kick off the issues I have been seeing. A specialist is seen annually for a condition that exists. In one year, the specialist bills a fixed amount for the visit, the insurance company reimburses the specialist based on an "agreed" charge, this is less than what was billed by the specialist. Because the patient has said insurance, the patient is only responsible for the agreed copayment (a modest fixed amount). The specialist adjusts revenue accordingly (they will never receive the difference between the "billed" amount and the "allowed" amount).
The next year - same visit, same procedures. This time, the specialist bills separately for five different things done for the appointment. The "visit" (representing only one of the five charges) is much less expensive, but the copay is double due to changes in coverage. Since the "copay" is only applicable to the "visit", the patient is now separately responsible to pay for the four other things done to prep (review two tests two different ways, essentially). So this year, the specialists total bill increased 20% and the "allowed" amount increased 20%. However, the patients share increased over 800% and the amount insurance had to pay decreased over 70%.
Meanwhile, premiums all went up.
The amount of cash we're are shelling out is increasing dramatically, while officially the healthcare "costs" only increased 20%. And, of course, from a gov't perspective, we are "insured" - so YAY!! We comply with the requirements of Obamacare (but isn't the word "Affordable" in the title of the actual act?)
Everything discussed above may be legal - but it certainly doesn't appear ethical. The overall direction is frightening. But what can be done when a person has congenital health issues that require the services of a specialist on an ongoing basis?
via International Skeptics Forum http://ift.tt/1LgYX4e
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