Let's talk about health care

[Surgicalcric]

Originally posted by Roguish Lawyer
OK, me. A little at a time.

What does a doctor or other health care provider do when an insurance company pays only part of an invoice?

The answer would depend on if the health care provider was private practice or 3rd party govt funded (County Hospitals, County EMS).

In either case the patient is generally billed for the remaining balance of the procedure after insurance has paid their predetermined portion.

In the private sector if the bill is not satisfied by the patient after several billing cycles they are generally turned over to collections.

Anyone owing money to either the county hospital system or EMS after several billing cycles here in SC will find their tax refunds, if there is one, garnished for the due amount(s) by the state revenue service.

[Surgicalcric]

Originally posted by Doc T
from what i understand they will still be deemed "temporary workers".... do employers have to offer insurance under those conditions...i didn't think so...

I believe it would fall under the same FWLL's as contract labor?

If so the employer also does not have to pay for worker's comp insurance.

[Sacamuelas]

Originally posted by Surgicalcric

In the private sector if the bill is not satisfied by the patient after several billing cycles they are generally turned over to collections.

Anyone owing money to either the county hospital system or EMS after several billing cycles here in SC will find their tax refunds, if there is one, garnished for the due amount(s) by the state revenue service.

James-
I am sure you are aware of this. Not trying to start an argument but I want to make sure people who have not dealt with this situation are aware.


In the first case, I assure you that providers don't get paid the full amount or anything close to it. That also means that the people owed the money have to pay to get their money collected.

In the second situation, obviously, that leaves out a substantial portion of the "free" healthcare abusers in the system. All of NDD's immigrant friends (errr...legal worker bees or whatever) will be exempt as they mostly fall in the lower wage contracted labor catagory. Lower income contractees usually don't have state and federal taxes withheld out of their checks during the year therefore avoiding this well intentioned law. Obviously, very low income and unemployed citizens are exempt too. That still leaves my favorite group of beggars/cheaters... the scumbags that put down a very large number of exemptions to avoid having taxes withheld from their checks- usually to avoid having delinquent child support taken out of it by the gov.

Met someone in a prison(that's for another thread! ) that bragged about that last scam to me... he was "proud" of himself for getting out of his responsibility for his child and beating the system.

Overall, that law is a good idea. It is just a start though.

[Roguish Lawyer]

Originally posted by Surgicalcric
The answer would depend on if the health care provider was private practice or 3rd party govt funded (County Hospitals, County EMS).

In either case the patient is generally billed for the remaining balance of the procedure after insurance has paid their predetermined portion.

In the private sector if the bill is not satisfied by the patient after several billing cycles they are generally turned over to collections.

Anyone owing money to either the county hospital system or EMS after several billing cycles here in SC will find their tax refunds, if there is one, garnished for the due amount(s) by the state revenue service.

I mean next time you bill the insurance company.

[Roguish Lawyer]

Originally posted by Sacamuelas
RL... got any smiles for Doc T's response too?

Yes. I agree with what she said.

[Surgicalcric]

Originally posted by Roguish Lawyer
I mean next time you bill the insurance company.

Next time I bill as a paramedic or filing a claim for myself?

[NousDefionsDoc]

Stop sending aid to Vietnam and use the money to build hospitals on their side of the border. Take Castro out of play and get that great Cuban doctor machine to staff them.

And they're not immigrants, they found the land and killed the Indians fair and square for it, then Mr. Chuck came along and took it away. Or do you think Arizona, Texas, California and New Mexico are the names of gardens in England?

[Surgicalcric]

Originally posted by Sacamuelas
James-
I am sure you are aware of this. Not trying to start an argument but I want to make sure people who have not dealt with this situation are aware.

Why would I presume you were starting an argument by overstating the obvious?

Overall, that law is a good idea. It is just a start though.

Gotta start somewhere.

[Sacamuelas]

Originally posted by Surgicalcric
Why would I presume you were starting an argument by overstating the obvious?

Well, you know how it is James. Due to the ADA requirements, I was making sure my message could be understood by our "special" members too. LOL

[Surgicalcric]

OUCH!

Had to pull out the ADA card didnt ya... There is another discussion in itself.

[Roguish Lawyer]

Originally posted by Surgicalcric
Next time I bill as a paramedic or filing a claim for myself?

If the insurance company always cuts 20% off your bills, you're going to increase your bills by 20% to compensate. It is a vicious cycle.

[Roguish Lawyer]

Originally posted by Sacamuelas
RL... Let's hear your ideas since you must be the expert with all your experience in the field.

. . .

From your little quote to me, maybe you think the problems are mostly provider and treatment derived. Please elaborate.

I think some of the problems are the following:

1. Economics. Treatment is given without informing the patient of the price of treatment. I think this generally is wrong. While there obviously are exceptions like emergency treatment, patients should know how much a treatment costs and be permitted to decide whether they want the treatment or not. If they can't afford it, they'll decline it. Even if they can afford it, they'll ask their provider what benefits they'll get for the price (see Doc T's 2 years or 2 days example above). In order to address this problem, I propose that third-party payments (i.e. direct billing to insurance companies) be BANNED. Also BAN group coverage. Allow insurers to sell single coverage only. Make patients pay themselves and seek reimbursement from their insurers. When the insurer won't pay, the insurer will lose business. Today, this does not happen, or at least not very quickly, because the patients don't even choose their coverage -- their employers do.

2. Tort reform. I agree with the comments above. One issue that has been missed is the wasteful "defensive medicine" caused by malpractice lawsuits. Look at the number of C-sections that get done today -- the increase was caused by doctors and hospitals not being willing to take the risk of not doing a C-section. That's just one example.

3. Health care is a commodity, not a right. I absolutely dispute that anyone is entitled to health care, just like I dispute that they're entitled to food or a job or anything else. If you can't afford it, you shouldn't get it unless someone decides to be charitable. Unless we decide as a society that we want to subsidize health care for the poor -- I might do that under some circumstances, but generally it is a bad idea. I refer back to my filet mignon and '61 Lafite example -- not everyone should get that level of health care.

Out of time. I'll add more later. May edit the above too -- first draft but kids are out of the bathtub.

[Sacamuelas]

Originally posted by Roguish Lawyer
Unless we decide as a society that we want to subsidize health care for the poor -- I might do that under some circumstances, but generally it is a bad idea. I refer back to my filet mignon and '61 Lafite example -- not everyone should get that level of health care. .

RL-

Are you saying that this is how you think our system works today?



With your economics part, you may have just made NDD's "people's list" ! LOL

[NousDefionsDoc]

GH - advocating bourgeoisie exploitation of the proletariat
CRad - crimes against Martha
RL - OMG!

[pulque]

your "economics" sounds like tort reform for the insurance industry. how do you get all those insurers to change the way they make their money? back to vocational school for them.

what do civil lawyers do when they get the tort reform bug?