That's not entirely accurate



But this is not exactly why because he did say he doesn't "have a problem with a medical professional being paid ...."


The reason why his post sounds like it doesn't make sense is because what he meant to say is something like he "has a problem with mom being directly billed at the point of care". He presumably doesn't have a problem with mom being indirectly billed through a system of progressive taxation.

I'm with hobbes on this one. It's really a matter of circumstances, preference, and cost. If the doc giving you the news is someone who you've had long-standing relationship with, I think him over video is better than some random doing it in person that you barely know. Such a situation is fairly contrived, because I imagine the doc with the long-standing relationship would only really use the video as some sort of last resort.

I also suspect younger folks for whom skyping and facetime is completely natural, it would be less of an issue.

There is the also the cost aspect. If you had to pay out of pocket and your choice was to pay $X for news via video and $3X in person. I doubt many would choose the latter. Sure it's a ****ty choice to have to make, but we're in a world of finite resources.

If we're thinking about the overall health care system, if we've got to save somewhere in order to be able to cover anyone, I think this type of saving measure is unfortunate but necessary.

I think the real **** up here is that they could have at least waited until the whole family was present and set up the video so that the dude could hear it. Better execution would have gone a long way.

So... the facility should pay the professional but shouldn't bill for the service?

What if the professional owns the facility (as is often the case)?

So basically pay the doctors but to the mother it should be free? And someone else government should foot the bill?

I could live with that. It's just a really weird way to say this.

WRT to the bill itself overall:
~1600 OOP seems reasonable for C-section delivery considering how much facility and staff time is involved. Even the 6087.15 insurance pays seems okay. ~7700 for a C-section isn't that bad if you normalize OECD costs by GDP/capita.

The real absurdity is 5566.82 "contractual allowance adjustment." That's basically "I'll screw you over if you didn't have insurance."

This bill isn't anywhere close to the worst I've seen. I've seen bills where the contractual allowance alone is more than half of the sticker price... sometimes like 80%.

Of course not.

I'm saying that the salary for the medical professional should come from tax dollars.

that bill looks cheap to me

Does anyone know anything about getting private PPO insurance in USA#1? I'm trying to get cleared for surgery for a rare disease using a network of experts not covered by whatever HMO/Marketplace/Medicaid options are available here. It's making this difficult because I already know where to go but they are trying to push me to people who've maybe seen like one or two cases.

I think open enrollment into insurance plans has to be done at the end of the year. There is a short window. You can buy outside the window if you have a qualifying event like moving, switching jobs, etc.

Yeah I'm pretty sure you're correct. But to get a PPO plan (there were none available to me on marketplace last time) I'd have to contact some insurance-peddling middleman or something? It all appears to be a "Request a Quote Today!" stuff that looks like straight-up scams.

What you're trying to do (enroll in a plan just for a surgery) is exactly why they have open enrollment periods.

Don't bother with a quote. One of the things underwriters ask is if you anticipate surgery soon.

Move, quit your job, or do something that is a qualifying event.

I am considering moving to get special enrollment. That alone doesn't solve my problem though. I need insurance to cover a doctor that's thousands of miles away and the small network of expert surgeons he refers cases to. How do I get that coverage after I move?

Good luck, Lawnmower Man. I don't have any advice. I'm just enraged that you may have to move or quit your job or whatever to get treated. What a disgrace.

Thanks man. It sucks. One thing I've definitely learned is that when you get into true rare disease territory, there may only be a few people that have seen a lot of cases of it. Chances are they won't be in your HMO network. My local specialist is good but she's seen four cases; my disease expert has diagnosed hundreds of cases, many of those being the most difficult ones. She even said she would have blown me off if not for seeing his notes on it. Now she wants to send me to Mayo Clinic.

LM will get treated. He's just going to get to see someone who's not one of the pre-eminent authorities.

If the case is truly rare and no quality care is only available at Mayo clinic, chances are the insurance company will do something for you. But if the "local specialist" can provide care (having seen only 4 cases doesn't preclude her from providing quality care) then you're stuck.

There are PPO plans available with national networks. You won't get access to Mayo anyway but they tend to be more experienced with negotiating coverage with Mayo or will have other options. The only way to do this is to look them up before you move. You could even just ask Mayo about what insurances their patients had success with.

I am by no means an expert, so don't take this as expert advice or anything, but more just an option to research. I would look into whether I could move into that doctor's state, and get coverage over the marketplace that would allow me to see him (this would probably be a high level plan on the marketplace, though, and could be quite expensive). I would also anticipate a risk of a legal challenge, so I'd look into that first too - is moving for this reason legal, can they deny you coverage, do you have enough evidence of the move, etc?

Sucks that you have to go through this ordeal and I'm really sorry to hear it - I hope it all works out okay.

That would be a pretty extreme move for me. The thing I was trying to leverage is that I could do most of the testing/imaging at home through in-network providers and that he uses some surgeons located near my family (if it comes to that). I actually got through about 75% of the workup before they stopped honoring the orders. We have solid evidence for disease but it doesn't all line up perfectly, so I need more testing before they saw me in half.

And the more general point I'm trying to make here is that it seems like out-of-network coverage options have all but vanished as healthy people tend to opt for the lowest-premium plans. That's fine if you have the flu or a broken leg but maybe not if you have one of the 6,700 disorders on the GARD list. Additionally, the small amount of advocacy I have seen tends to focus on access to drug coverage as opposed to specialized testing or expert physicians.

And the Trump administration now changes course and says the whole law should be struck down.

https://www.cnn.com/2019/03/25/polit...aca/index.html

I can't help but wonder if it would almost be better if this happens at this point... It will make the 2020 election almost entirely about healthcare, which would mean it would be about Medicare for All vs. Nothing at All.

Of course if it did, I'd be uninsured for 2020 and likely 2021, hoping for the best until Medicare for All kicked in, assuming the Dems won.

Like personally, I would never want to risk it... But in terms of what could happen long-term foe the country, I think the administration is making a big mistake - one which the courts will likely save them from.

and all the Repubes who ran on protecting pre-existing conditions in '18 suddenly fell silent

and all the Repubs that decry "legislating from the bench" grew silent

That’s a huge gift to the Dems. 2020 should be 100% a referendum on healthcare.

Republicans will be great at health care with a plan of only healthy people can get it. Costs go down because we won't treat cancer unless you're rich/white anymore. What? Some people aren't gonna like that? well **** em.

With some of the dem plans--seems like a few of the problems would get amplified (many doctors already assume you have nothing when you go there/dgaf, if everyone gets to go for free, that's just gonna get even more ridiculous and obviously there will be waiting times and I would expect as a result you're gonna have a huge doctor shortage that's unaccounted for atm) Here's some drug now go away instead of actually trying to identify or solve the problem pisses me off but I guess that's what society wants.

However, the current system blows and I have no ideas that are catchy slogans so carry on.

Too many fights on all fronts for this is a shame and why it's so hard to get anything done.

lawnmower man

best of luck. You're an extremely bright and funny poster

My Dad is an MD and works for some umbrella organization with a couple hundred medical specialty-group members or something. Never quite certain what he does. But anyway, he was able to refer a member of our extended family to one particular Doc, the very best in his discipline, that he had met during his rounds over the years at various functions.

It was some serious vascular thing, where there was a risk of fatal rupture, and the cluster of veins/arteries that required attention wasn't easily accessible iirc

The patient is fit as a fiddle now, as you will be, and my Dad is the best.

Hot damn. Lol, I thought she might bring up the Nazis attacking Pearl Harbor. Good stuff though.

https://twitter.com/ShaneGoldmacher/...435727872?s=19