Daniel Almond sure is upset about a lot of things.
Man, I wish we could get some climate control over here. You know rain's forecast for tomorrow, and I was supposed to go on a picnic?
I too am upset about climate control. When climate is outlawed only outlaws will have climate!
People keep posting things about this to FB too, and I just have to ignore them. I got about 30 seconds into a tea party speaker yelling about how he's lived his life as a slave because he has a phone bill (wait, what? from a private phone company... do you... what?) and crying for "fighting in the streets." Then I decided that this is just one of those things that will shorten my life if I think about it any more.
I know this is a terrible thing to say, but I hope somebody gets shot at their dumb-assed dick-measuring party armed stand for liberty. Non-fatally, I should add, though I only sort of mean it.
On Saturday I was going to the White House garden with my girlfriend. They wouldn't let me in with my Leatherman pocket knife, so we turned around and left, which sucked. There was no place I could leave it at the security checkpoint. It was throw the pocketknife in the trash or leave. Sure, it's partly my fault, I should have read the ticket when we left the apartment - or just slipped the thing on T.'s bag, because I've taken that on planes before, though, in my carry-on luggage, with no problems. Also, they let me through the metal detector with my sunglasses case (metal) in my back pocket, which I had honestly forgotten about. Apparently, based on my experience with airport security, a pocket knife is only a security risk if the security guard personally sees you take it out of your pocket and put it on your bag. Other than that, though, meh, no problem, go right through.
Stupid security theather.
In 5, "put it on your bag" should be "put it in your bag", of course.
The guy also says that the Pledge of Allegiance is socialist propaganda. I'm starting to think these people don't even agree with each other about anything. They just really enjoy feeling angry, yelling, and listening to other people yelling.
Wait, the tea-partiers are against the pledge? That's... unexpected.
8: It's not a small pleasure. I used to be involved in ACT-UP, and that was a big part of its appeal -- admittedly, in the service of an actual cause.
I don't think he's kidding. He's making a demonstration on the Virginia side of the river, just a few miles away from the Capitol. While I've got that 1995 feelin', 'armed demonstration' smacks more of 1862.
m, if you know what I mean
9: My gast is similarly flabbered. I thought the only thing the Tea Peoples love more than the pledge of allegiance is their imaginary version of the constitution.
Weren't the Persons of Teabagginess screaming the pledge at Democratic politicians during the whole HCR town hall fiasco?
What the hell is "Ft. Hunt National Park"? I've never heard of it, and it isn't on the NPS list of parks in Virginia.
I was first, but neb's was more derisive, so it's not technical pwnage.
Here's the video. I can't watch more than a little bit of it, but you're welcome to do so. This Dan Gonzales character is confused to a degree that's actually creepy. If you don't like getting a phone bill, and it makes you a "slave," isn't that an argument for nationalizing telephone services? Or... is he arguing that we shouldn't be using phones? Or... I have to go write my dissertation.
Heh. I had just found it and was about to post a follow-up comment.
I mean, I heard the same argument from Slavoj Zizek at a lecture, where he talked about how freedom is reduced when individual citizens spend all their time shopping around for better deals for necessary services when we could be, like, fucking or watching movies or something.
The idea is to maximize individual liberty by screwing like rabbits.
I don't get a cell phone bill! I'm not a slave!
The guy also says that the Pledge of Allegiance is socialist propaganda.
Well, it IS socialist:
The Pledge of Allegiance of the United States is an oath of loyalty to the national flag and the republic of the United States of America, originally composed by Francis Bellamy in 1892. The Pledge has been modified four times since then, with the most recent change adding the words "under God" in 1954.The socialists of the time were concerned that all the different european immigrant groups couldn't communicate and thus would not bond with each other and the United States. Thus, the pledge.
They didn't add under God until the 50's to help ensure the godless communists knew that they would have to pry the socialist pledge from our cold dead fingers.
m, real right-wingers don't pledge allegiance
I would imagine actual slaves might appreciate access to a phone.
Every time I spend hours on the phone with my health "insurance" company, I am bitterly reminded that I could be fucking right now. This isn't true, but it's something to think about while on hold.
22: I know! But why is someone whose main talking point is communist raging against the historical taint of socialism?
24: Urg. Blood rage. I was venting to a doctor friend about a recent dental denial of coverage, There's a reasonable case for it to be covered under my regular health, and the doctor friend said matter-of-factly something like, "Well, just keep working each insurance company until one relents."
Aggggggggggggggggggggggggg!
Pledge of Allegiance is socialist propaganda
Huh, and to think that for all this time, I thought the Pledge was fascist propaganda.
26: I've been trying to get a $1100 bill for a wellness visit and blood stick covered for five months. (a) I had no idea it would cost that much; the doctor's office only told me about the $400 charge for being in their office, not the $700 of lab fees. (b) They never submitted the paperwork to my insurance company, despite repeated pleas to do so. (c) When it went into collections and I insisted they bill my insurance, the insurance company agreed to pay for $60 of the whole thing, despite telling me over the phone they'd cover it.
I hate everything.
27: Haven't you heard? The fascists were Socialists...National Socialists! I mean, it's right there in the name.
26/28: Thank god this whole despicable industry is going away in 2014. I can't wait.
29 wuz me. 28 (the facts related therein, not the post itself) is so annoying that I feel annoyed even from this considerable geographic and personal distance.
$1100 bill for a wellness visit and blood stick
That is insane.
Regarding how nutty the gun nuts are, it's worth noting that according to the article in the original post, there are two gun nuts groups that happen to be meeting somewhere near DC this week (or maybe this very day), and one of them would call the other one nuts. It seems that the group at Ft. Hunt (the gathering explicitly devoted to the new rules, which most people here seem to be talking about) is more schizophrenic (both literally and figuratively). The gathering at the Washington Monument probably has plenty of teabaggers and racist nuts and all that, but more sane people than the other group. FBOFW.
7: heh, whoops. I have the feeling I shouldn't use my girlfriend's real name on blogs in connection with mine (it probably wouldn't matter, but you never know), and I'm too lazy to come up with an epithet or acronym, so I've just been using her first initial.
32: Agreed. Good luck AWB.
28: Ugh. That crap brings back flashbacks of the hospital that kept billing us for shit that was covered by my HMO because the HMO had, in the interim, gone under and thus wasn't paying it. I argued back and forth for weeks and they didn't back off until I found and faxed to them the Illinois statute that prohibited them from billing a patient under those circumstances. No doubt plenty of insureds who didn't sit in a room surrounded by law books all day just paid those bills never knowing that they shouldn't have.
Poke around and see if NY has a department of insurance or such thing on the web -- I think I figured my thing out by starting with links, etc., on the dept. of insurance webpage.
I argued back and forth for weeks and they didn't back off until I found and faxed to them the Illinois statute that prohibited them from billing a patient under those circumstances. No doubt plenty of insureds who didn't sit in a room surrounded by law books all day just paid those bills never knowing that they shouldn't have.
You should've sued their asses off.
My boyfriend reports that he nearly started a fight last week in DC with some Tea Baggers who'd decided to kill time before the big rally by visiting some free, government-funded Smithsonian museums.
35: Probably true. Ironically, I kind of hate lawsuits.
No room at the Supreme Court for issues like that. It doesn't have anything to do with things that God hates, or increasing the rights of corporations versus humans.
28: I can relate. I'm still dealing with bills from last year. I'm starting to suspect that the Doctor's office is simply sending out bills in the hope that I'll just pay without reading too closely.
...and my irritation with the medical profession is compounded by the fact that I'm getting far more responsive, attentive, compassionate, and financially transparent care for my cat (who just had a flare-up of urinary tract problems) than I have ever had from a medical professional in the US.
I'm starting to suspect that the Doctor's office is simply sending out bills in the hope that I'll just pay without reading too closely.
I hope you are not saying that sarcastically. I am reasonably sure that this is a part of the business model for many insurance companies, hospitals and private practices. Policies are deliberately confusing and ambiguous, and they count on a certain number of people not bothering to fight.
The same thing works on arguments between these groups, too, which is why ever doctor's office does what Stanley describes in 26.
41: Sadly, I am not being sarcastic. How the hell am I supposed to trust someone with my life when I can't trust them not to try to steal from me?
Some context on the new guns-in-parks law: It was one of the things the Bush administration tried to push through at the last minute in late 2008. Obama halted it (by executive order, I think) as soon as he got into office, before it was set to take effect. This got congressional Republicans all fixated on it, and Tom Coburn managed to stick it into a bill that was a big administration priority. The congressional Democrats and the administration decided they didn't care enough to fight over it, so they let it through; this was sometime last spring. It took effect in February.
It's a pretty ridiculous rule, and an obvious sop to the gun-rights crowd, which is running out of things to complain about now that the Democrats are no longer pushing for stronger gun-control laws. Guns are still prohibited in federal buildings, including those in national parks, so this new rule only allows them in outdoor portions of the parks. It's very unclear why you would want a gun in a park in the first place. Hunting isn't allowed in national parks, although it is in national preserves, which I believe are unaffected by the rule change (in practice, although they may technically be covered by it). It's extremely unlikely that you would need a gun to defend yourself against violent crime or robbery in a park, since there are (armed) rangers everywhere who are easily able to respond quickly to most situations. The only circumstance I can think of where a gun would be useful for protection would be an encounter with a bear or something in the backcountry, but even then I doubt the gun would help much in most situations.
So the practical impact of this is pretty limited, I think. It's mostly a symbolic thing for people like the tea party folks at Fort Hunt. And it is of course an example of a concession to them by the Obama administration, although they are unlikely to perceive it that way.
I thought 40 was sarcastic; I'm sure 42 is.
It's a pretty ridiculous rule, and an obvious sop to the gun-rights crowd, which is running out of things to complain about now that the Democrats are no longer pushing for stronger gun-control laws./i>
See, these statements are just wrong. They will have things to complain about as long as it is profitable for them to complain about things.
They will have things to complain about as long as it is profitable for them to complain about things.
Sure, but if the Republican Party wants to continue to harness that unrest for its own purposes it has to find things to offer them, which means identifying ways in which their gun rights are being restricted. Which are getting harder to find.
Anyway, regardless of what the NRA actually thinks, this particular rule was a very obvious sop to them by the Bush administration.
29: 27: Haven't you heard? The fascists were Socialists...National Socialists! I mean, it's right there in the name.
Ayup. Nazi's were nationalistic socialists. It just so happened their party was lead by a racists right-wing demagogue, who decided to square the circle of his personal leadership of a leftwing German political party by invading Russia and killing all the Jews. Which I take to imply that he was crazy.
I am an American Universalist Nationalist, which means that I have no enemies to my left that are still alive. (Mensheviks, Bolshies, and V.I. Lenin are all dead.) I am uncomfortably close to neo-conservatives (who are Universalist American Nationalists) but way the hell far away from neo-Confederates who are not Universalist. Or American either, which is why they would not, for example, recite the Pledge of Allegiance.
Liberal Fascists don't exist, which is why having an idiot like Jonah Goldberg making up political terminology is going to cause trouble. Liberals of the left or right are the antithesis of fascist, left-wing or right-wing. But you can be a left-wing fascist like I. Stalin. The main difference twixt me and modern leftish types, is that I am old-fashioned and thus a Universalist nationalist, and I can recite the pledge and like it, and would be happy to have everyone else recite it as well.
See?
m, it isn't that complicated
You know, concealed carry isn't allowed at either my seven-year-old's school or my almost-five-year-old's. How will they learn about gun safety? Will no one think of the children?!
44: Nope, deadly serious. I consider the medical profession in the US to be quite corrupt. It's not a matter of deliberate and mindful defrauding of patients, but rather a set of attitudes and unquestioned assumptions that lead inevitably to corrupt acts.
44 should have referred to 39, not 40--sorry. I agree with 50 (which makes the attitude expressed in 39 and 42 surprising).
Other fun tea party news: Tom Tancredo says that we should send Obama back to Kenya. Another guy asks Lindsay Graham to own up to being gay. (Isn't that something people her have speculated on, too?)
The video for Tancredo's comment has been removed. I hope someone else got it on tape.
It's not a matter of deliberate and mindful defrauding of patients, but rather a set of attitudes and unquestioned assumptions that lead inevitably to corrupt acts.
I'd make a stronger claim than that. A huge number of institutions, big and small, are deliberately pushing gray areas of the law because they know they have better lawyers and more patience than anyone they are ripping off.
And when you move from talking about defrauding patients to defrauding the government, it is clear that there is a shitload of full blown fraud going down.
pushing gray areas of the law
I initially misread "gay" for "gray" there and was quite confused.
I've only skimmed this, but it appears that Texas' economy is doing relatively well ok because of stronger regulation and alternative energy sources. (Yeah, there are other factors, but it's more fun to focus on just those two.)
I'm getting far more responsive, attentive, compassionate, and financially transparent care for my cat (who just had a flare-up of urinary tract problems) than I have ever had from a medical professional in the US.
I would totally get my primary care from my vet if I could. They spend more time with my dog than my GP spends with me on a visit and they do routine lab work right away while you wait. Also tummy rubs and treats.
Veterinary medical care is fully privatized and out-of-pocket. Human medical care could work just as well if we would behave more like corporations and lose our sentimental attachment to being alive vis-a-vis being dead.
The doctor I saw just yelled at me the whole time. I was clearly suffering from debilitating anxiety, and my therapist had told me to go to the doctor to find out if there might be any obvious biological problems. I guess it irritates doctors when crazy people are in their offices, and I apologized for the fact that I was obviously crazy, but damn, she was pissed at me for being crazy, kept sighing dramatically and rolling her eyes. I burst into tears a few times, and she'd groan and threaten to walk out of the room. Fuck, lady, I'm sorry, but you are not making this easier.
Human medical care could work just as well if we would behave more like corporations and lose our sentimental attachment to being alive vis-a-vis being dead.
Question for people who know German: is this "vis-a-vis" like "beziehungsweise"?
I.e., I would have killed for a tummy rub and a treat.
That is fucking ridiculous. I'm so sorry, AWB. I hope things get better for you soon.
58: That sucks, Bear; sorry to hear it. Having recently had the chance to hang out with some recently finished-with-med-school doctors, I had the impression that one popular and successful way to endure the rigors of med school is to be an indefatigable asshat.
58: Good lord. This woman was a doctor?
I always understood beziehungsweise as "respectively."
When I told her my heart pounded and I fainted sometimes, she said, bluntly, that I probably had some kind of heart condition that my insurance wouldn't cover, or it could be a neurological disorder. Oddly, I got the recommendation for this doctor from a friend of mine who said she was the sweetest person in the world. But he's really charming, and I was very very not charming.
Thanks, Di. It's a money problem now, I guess, though I basically never ever want to see a medical professional again in my life.
62: I feel compelled to mention that my doctor is definitely not an asshat. He spoke gently to me about how I was so darned smart for knowing when to come in, and how crappy the industry and society as a whole is with mental health issues, and how this economy is just making everyone fucking miserable because either you have no job or you have an employer who treats you like crap because you have limited mobility in this market.
Another guy asks Lindsay Graham to own up to being gay. (Isn't that something people her have speculated on, too?)
Speculated?
66: Right. Plenty of nice doctors out there, and I didn't mean to imply that it was impossible to emerge from med school untinged by asshattery.
65: I feel like I've already made the "check your thyroid" suggestion. But in case I haven't, my own autoimmune thyroid disease was initially diagnosed in response to palpitations. (I was also having fainting spells at the time, but don't think I ever mentioned it to the doctor.) If that's what it is, it's really easy to fix.
69: That's what I got for my $1100, confirmation that it's not my thyroid, blood sugar, or any of that, just pure crazy.
Also, I'm doing much better than I was then. I don't throw up every time I think about going to work, and I haven't flat-out fainted since October.
she said, bluntly, that I probably had some kind of heart condition that my insurance wouldn't cover, or it could be a neurological disorder.
IANAD, but this is puzzling; why wouldn't your insurance cover a heart condition (is it a preexisting condition, or do you have only catastrophic coverage?)
Agreed with Di that it could be endocrinological -- I think all it takes to produce anxiety-related issues is a hormonal screw-up of some sort, and that includes everything from electrolyte imbalances to thyroid to adrenal glands. Hopefully your blood tests are a complete work-up.
72 answered by 70. No low sodium or potassium or anything like that? (I should have known from the $700 lab work bill that they must have run every test in the book.)
IANAD, but this is puzzling; why wouldn't your insurance cover a heart condition
A broken heart? Or maybe one that feels too much?
73: Naw, my blood's good. Very healthy stuff.
I don't know why she kept saying that my insurance would probably drop me. I think she was griping generally about insurance not paying for stuff, but given the situation, it was pretty uncalled-for.
75: If this is getting too nosy/personal, say so, but do you just have individual health insurance coverage, or is it through school (which is what I'd assumed)? If the latter, I don't think they can drop you.
Naw, my blood's good. Very healthy stuff.
Team Edward, right?
73: No low sodium or potassium or anything like that?
Eat bananas! People will still think you're crazy but they won't bother you about paying for things when you're obviously nuts like a monkey.
m, just tell them the pills did it
75: Uncalled-for, and really fucking damning (I would think) if you do wind up having some heart-condition that she didn't diagnose or even look into. "Yeah, you should see a doctor about that."
76: It's through the state, which goes through three different companies for different things, many of which are not listed on the card, so it's really hard to figure out what to say to doctors. The doctors end up billing and getting rejected claims, so they bill me. I try to get them to send it to the right people, who reject most of the claim for reasons I don't understand. It's not that they've literally dropped me from the rolls, but they won't pay for anything at all, just a measly $60. I am one of the joyful people with health insurance, for the first time in my adult life, and it has made my life considerably worse. I'd far rather go to the free clinic than deal with this shit, or just ignore my body altogether, which is more likely.
It does not help that my anxiety is triggered by situations in which I feel there is some vast and invisible conspiracy to make me feel like I'm doing everything wrong all the time, in ways that I can't correct without pissing someone else off. I'm going to stop thinking about this for the rest of the day.
79: Truly! "I could figure out what's wrong with you, but then your insurance company would drop you, and then I'd have to just let you suffer or die from it because I wouldn't get any money out of it. And by the way, why are you so upset? Are you crazy or something?"
Kinda related: this is appalling and heartbreaking.
75: You could probably afford better health insurance if you'd just regularly sell your very healthy blood to Keith Richards.
I am one of the joyful people with health insurance, for the first time in my adult life, and it has made my life considerably worse.
And over the next four years, tens of millions more people are going to have that exact same experience, or have their wages confiscated as a penalty. Win-win!
Dealing with the financial end of a various serious medical condition of a relative has brought home to me just how weird the current system has gotten. Fortunately the individual has good insurance that has generally held up so far, but it has been amusing/alarming to watch the three-way financial tussle between hospitals, doctors and insurance. The most extreme was when a hospital bill (where all the doctors were subcontractors who billed separately) came in at $634,000--knew it was going to be high, but wow! And then a couple of weeks later the insurance pays off, $93,000 citing existing contracted rates. I've seen ratios that big on Explanation of Benefits forms before, but never really thought about them scaling up (and I'd estimate the true costs at the hospital had to have been around $200K at a minimum.)
I'm going to stop thinking about this for the rest of the day.
I'm sorry -- I understand. For what it's worth, I understand the feeling.
And despite the good insurance, there have been a few gotchas where a doctor is in-network, but the x-rays etc. within the same office are not.
87 is perverse. (As are many of the comments preceding it.) We badly need something roughly equivalent to a strong-toothed CFPA for the health-insurance industry, that could set up some clear guidelines about how all these things should be dealt with, and dramatically simplified from the patient's perspective. (We didn't just create one recently, did we? Honest question.)
or have their wages confiscated as a penalty
? Do you mean as a penalty for declining to purchase health insurance? I thought it had been made clear that this would not be so. This was once of the insurance industry's complaints, in fact: that the mandate was toothless.
I'm unclear what you mean here. Over the next four years? The mandate doesn't go into effect for four years (I believe), so perhaps you're referring to something else?
OT good news: I was just offered an MA class in my field! Same adjunct rate as always of course, so it's exploitative, but yay! Grad students!
That was the fastest delivery on a good wish ever.
I hope I get a big pile of money.
88
(We didn't just create one recently, did we? Honest question.)
I think the left-of-center consensus is that the recent health care reform package was better than the status quo but nowhere near enough. Consensus breaks down over whether you think it makes further steps more likely, less likely, or what, and over exactly how depressing you found the strenuous nature of the legislative process.
Yay 91! And 85 makes me think that your insurer's $60 payment does not leave you with $1040 left to pay. Is there someone you trust who could look over the explanation of benefits, etc., with you? (Not to suggest you aren't smart enough or anything, but I know how that kind of anxiety affects me, and trying to figure that shit out when you are already anxious seems like torture.)
Tom Coburn managed to stick it into a bill that was a big administration priority.
I believe it was the credit card bill.
Nope. Maybe it only works for other people. I hope Parsi gets two big piles of money.
Remember who your friends are, Parsi...
87: To diagnose my younger son's cerebral palsy, he had to get an MRI. Now, Roberta is a Duke University Medical Center employee, carrying the kids on her DUMC health insurance. The MRI was ordered by a DUMC physician to be performed at Duke Hospital. As I'm filling out all the paperwork, they say that they don't have payment authorized from *their own goddamn insurance company* and can't get anybody on the phone to get it, so I'll need to sign a form affirming that, if payment is refused, I will cover the ten to eleven thousand dollar charge for the MRI. But don't worry, they're pretty sure it won't be any problem.
I'm reluctant to sign my name to any such agreement, but finally do rather than having to miss the appointment and reschedule it for two months down the road. I told them, however, that they'd never ever get 10K out of me if "pretty sure" turned out to be "uh, actually".
They did end up covering it, but it was one very unpleasant conversation for both parties because I was awfully damn angry it.
94: No, I'm really actually not smart enough. Who would talk to me about this? I think all of my friends might be dumb in the same way I am, but I could be wrong, and the ones who are not dumb would rather do just about anything else with their time.
Opinionated Academic has some sort of private dental cover, which seems to pay about half the dental bill at vast cost. I strongly suspect that self-insurance* would beat it out.
(*i.e pay the premiums into a tax-efficient savings account)
This just confirms me in my belief that private health insurance is a way for non-drugs people to enjoy the delights of drug addiction.
Meanwhile, did anyone suggest to Mr T. Bagger that he join a fibre coop?
94 is a good point. I get statements from my insurance company all the time of the form:
Your bill: $1450
Payment from Your Insurer: $82
Unpaid Balance: $1368
Amount You Owe: $0
But the last line isn't always obvious or prominent.
94: Oh yeah, from what I have, no more money is owed to the hospital--just used it as an illustration of how crazy it all is.
87: there have been a few gotchas where a doctor is in-network, but the x-rays etc. within the same office are not.
Yeah. I've been plugged into the health care system for long enough now (as a patient with a preexisting condition) that I'm jaded, but yeah, this is standard with some major health insurance plans: my own plan covers lab work done only by one LabCorp, and imaging work done only by [some other company, forget the name]. I may see a doctor in a hospital, but woe betide me if I allow the hospital to run any bloodwork, unless it's an emergency admittance or in-patient situation. It must be farmed out to LabCorp.
Pretty much all doctors I've dealt with know this, though, and don't make that mistake with my bloodwork.
100 is right.
101 is an interloper of some kind!
Come to think of it, I do know someone who works for my insurance company, but in a different division from what I need, and he also hates thinking about these problems and hates his job to the point of throw-up anxiety.
Geez, AWB, that whole experience sounds terrible.
Best wishes for some sort of reasonable resolution.
(on preview, Apo's 97 also sounds terrible)
Speaking of tummy rubs, and how hard it is to get them when you need it most, I had an idea a while back that I would start a business for grumpy people. If you're feeling grumpy, you can pay like $30 for someone to come over, make you some tea while you grump in bed, and read a dumb novel to you for an hour. You don't make conversation or get a handjob or anything--that would cost a lot more. But throughout this whole anxiety business, I would have blown a huge amount of my income on a service like this.
If you're feeling grumpy, you can pay like $30 for someone to come over, make you some tea while you grump in bed, and read a dumb novel to you for an hour.
Isn't that what cats are for?
I mean, not exactly that, obviously, but something roughly therapeutically similar.
Or to make some nice soup for single people who get sick. That's the worst thing about being single -- no one to baby you when you are ill. (Rory's finally getting old enough, thank god.)
(I wouldn't know--I don't like cats. But having some stranger come make me tea and read to me in bed also sounds awful to me, probably just because I'm not a cat person.)
AWB, have you received a bill since your insurance made a payment? When insurance pays or is supposed to pay a contracted rate, you generally are off the hook, or at worst stuck with a copay or a fraction of the original bill as a deductible. This is almost always the case with lab work, especially.
Further to 100's rough analysis of an Explanation of Benefits form: somewhere there will probably be a line like:
Disallowed amount: $1,200
Or whatever. Basically, the health care provider has agreed to the health insurance company's terms for what counts as a reasonable fee for service x.
Say the agreed-upon amount for that service is $150. The provider (doctor, hospital, lab) charges $400. The Explanation of Benefits form will say:
Charge: $400
Disallowed: $250
Paid to provider: $95
Owed by patient: $55
If you already paid a $30 co-pay at the time of the visit, you owe $25. That's what the bill from the provider's office should say: $25.
Yes, what Parsimon said. I'd guess the reason you got sucha big bill the first time was that the doctor's office was operating as if you had no insurance. But you do have insurance, so they now have to reëvaluate what they billed you.
I would like to think about these comments, but my next-door neighbor (she of the 30-second sex) has apparently discovered the existence of The Knife's "Heartbeats" and is playing it over and over at top volume. I'm going to go for a walk.
The Knife's "Heartbeats" and is playing it over and over at top volume.
Annoying for you no doubt, but otherwise a course of action I find it difficult to argue with.
Oh, I went through my own phase with The Knife, but I made myself sick of them a few years ago.
Um, I know this is a vexing topic, but I'll just say that this is one of the positive things about health insurance -- group health insurance, that is. They can negotiate lower rates for services.
In my example in 113, say, I was puzzled for a while about why the hell a provider would continue to charge that $400 for a service when it was going to be disallowed (for those with insurance) every time. But duh: for one thing, if you're a self-pay client, uninsured, you're going to be on the hook for the full $400.
Hm. Well, this is murky territory. It gets into who's subsidizing whom, whether reimbursements to providers are actually fair, whether health insurance companies are driving providers into the poorhouse. Answering those questions requires more macro data than I have access to, certainly. From a patient's point of view, however, even though health insurance claims are often a Pain in the Fucking Butt (it took me over a year to iron out a hospitalization incident a few years ago), the amount you're on the hook for is very likely going to be a lot less than it would otherwise be.
Of course you're paying a premium for that service. And premiums are too high; the industry's explanation for that is that the pool of insured persons is sometimes risky, too small, too old, too unhealthy. We need single payer, nationalized health care, true universal coverage, to expand the coverage pool, spread the risk, and take a lot of the goddamn paperwork out of the equation.
(/passionate tedium)
hey AWB- I sent you a facebook message.
118
Um, I know this is a vexing topic, but I'll just say that this is one of the positive things about health insurance -- group health insurance, that is. They can negotiate lower rates for services.
This also applies to people covered by individual policies.
... And premiums are too high; the industry's explanation for that is that the pool of insured persons is sometimes risky, too small, too old, too unhealthy. ...
The main reasons that premiums are high are that medical providers charge too much and order unnecessary procedures.
120: yes, individual people can renegotiate their healthcare policies as well, in the land where the fairies dance and there's a pot of gold at the end of every rainbow.
Meanwhile, back in consensus reality, you oddly enough have more power as a group of customers than as one single customer to negotiate.
I kinda doubt that doctors "charge too much" or order "unnecessary procedures" -- is an MRI scan unnecessary because it didn't find anything -- but could be persuaded certain kinds of doctors are overpaid.
Reading about all the healthcare insurance problems all y'all have in the US makes em that much more grateful for the Dutch system, still not perfect but workable[1]. My partner has been in and out of hospital since december, when we had a kidney transplant, and the one thing I've haven't had to worry about was how much it all cost -- the only thing we own our insurer is the 165 euro in mandatory own risk.
[1] A two tier system, with the standard healthcare package compulsory and no insurers obliged to accept everybody. This covers a state mandated package of care, most of the big stuff covered with the exception of dental care. Additional insurance can get you the luxeries the basic package doesn't cover, but at least in my case isn't cost effective -- it costs so much more in premiums but still covers barely any dental operations
is an MRI scan unnecessary because it didn't find anything
If you have no reason to think it will find anything, yes.
If you have no reason to think it will find anything, yes.
Are you suggesting that doctors order MRI scans when they have no reason to think they'll find anything?
If they are afraid, usually not for a good reason but because they hear horror stories from their colleagues and their trade association, of being sued for failing to do an MRI after a problem arises than might have been detected by an MRI, then yes.
Funny how doctors' malpractice paranoia and ability to bill an insurance company for running more tests seem to go together.
The other thing all this notional pricing and cross-billing reminds me of is UK rail privatisation. We broke up the national railway into its component parts - one company got to run the infrastructure, other companies got to own the trains, still others leased the trains from them and ran the train services, even further companies bought things like maintenance depots and parts distribution. The idea (such as it was) was that all these systems interfaces would be governed by contracts.
The infrastructure company then proceeded to sack most of the engineers and outsource everything to construction firms with no rail experience, thus adding yet further layers of contracting.
The upshot was gigantic inefficiency, continuous litigation, and eventually, a reasonable pile of corpses and the collapse of the system. And that when, eventually, the infrastructure was re-nationalised, nobody had any idea what it cost to, say, replace a rail until they bit the bullet and tried taking a stretch of track back in house, whereupon the new government agency set up to run it discovered that the construction industry had been flagrantly robbing the railways for years.
re: 126
That sort of kleptocratic practice seems near endemic in almost all public-sector or quasi-public-sector outsourcing in the UK.
Also, having worked in public sector IT development [where the work is done in-house rather than out-sourced], and in private sector IT, the idea that there are efficiency savings to be had because of mystical private sector wooo is good for a laugh.
128 is very true. It should also be apparent to the meanest intelligence. Apart from the tendency for salaries to be slightly higher in the private sector, the best outcome if you outsource a function that is efficiently run in house (and to everybody's surprise, most of them are) is that you i. add a contract management function, which is an overhead, and ii. have to pay the provider enough for them to make a profit rather than break even.
The idea that there would be savings (as opposed to pay-offs for your mates) in doing this was AFAIK based on no research beyond the bright ideas kicked around by a few Tory boys in the pub in 1978.
It should also be apparent to the meanest intelligence.
Most of the people I know who believe otherwise haven't arrived at that position based on intelligence or reasoning. It's the same category of belief as Jesus walked on water and rose from the dead. No amount of evidence can shake their conviction that government is inherently inept/corrupt and industry is inherently efficient/virtuous.
Has this been linked to yet? It's a fun read:
Is there a dumber or lazier person on the planet than Megan McArdle?
121
Meanwhile, back in consensus reality, you oddly enough have more power as a group of customers than as one single customer to negotiate.
When you buy an individual health insurance policy you become part of a pool of customers who have bought individual health insurance policies and the insurance company negotiates rates from health care providers on behalf of all of you.
And the insurance company is inclined to share its savings with you rather than to keep it as pure profit ... why?
128 is very very true, but the best result for pure inefficiency is to have a public sector company outsource its IT development to private sector companies: you get almost a one for one replacement of programmers, testers and such with people whose job it is to keep the contractors on track. All the fun of a state bureaucracy mixed with the work avoiding habits of a profit driven company.
When you buy an individual health insurance policy you become part of a pool of customers who have bought individual health insurance policies and the insurance company negotiates rates from health care providers on behalf of all of you.
No, this is not true. You're a fool.
It's the same category of belief as Jesus walked on water and rose from the dead. No amount of evidence can shake their conviction that government is inherently inept/corrupt and industry is inherently efficient/virtuous.
Precisely. This douchenozzle running for Congress in my district right now apparently sees no contradiction between the views "I was in the Navy! We were sweet and could have bombed some Soviet submarines!" and "The government can't be trusted to do anything ever. At all. Dot Com."
136: Of a piece with "Liberals are weak lazy dissolute idiots who run the world through hyper-efficient secret conspiracies," or "Homosexual acts are intrinsically disgusting and people must be protected from them lest they be seduced by the irresistible draw of hot man-on-man action."
This douchenozzle running for Congress in my district right now apparently sees no contradiction between the views "I was in the Navy! We were sweet and could have bombed some Soviet submarines!" and "The government can't be trusted to do anything ever. At all. Dot Com."
To be fair (I love being fair to douchenozzle's), the standard conservative idea is that governments are good at war and terrible at everything else, so there isn't really a contradiction here. (Unless he was actually applying the second of your two quoted statements to warfare, which I doubt he was.)
re: 138
I think the standard US conservative idea is that the US government is uniquely good at war -- deriving in part from the testicular magnificence of the American conservative male -- and all others are terrible, especially the French.
Likewise, that "immigrants are lazy welfare chiselers who take all the best jobs because they work too hard for low wages"
Such conservative might look up the etymology of snafu and fubar. Only if they want to risk having reality mess up their belief system, of course.
139: I don't think the standard US conservative idea is that the French government is terrible at war, just that the French people are limp-wristed cowards.
I was going to make a joke about Louis LeBeau, but see that the actor was a concentration camp survivor.
134: Love, my friend. American companies love their customers in a way that no European could ever understand. I sometimes bathe in a tub full of Coca-Cola so that I can luxuriate in the feeling.
Such conservative might look up the etymology of snafu and fubar.
But, see, everything would have been fucked up even worse if anyone else were doing it.