tag:blogger.com,1999:blog-5883634615775822475.post7050831453948550609..comments2024-03-26T16:46:21.764-04:00Comments on Doctor Grumpy in the House: The BenjaminsGrumpy, M.D.http://www.blogger.com/profile/09858110332436246760noreply@blogger.comBlogger43125tag:blogger.com,1999:blog-5883634615775822475.post-68111555075743073652017-01-31T12:08:36.719-05:002017-01-31T12:08:36.719-05:00Well, this one cuts both ways some times, and the ...Well, this one cuts both ways some times, and the whole system is just broken. Two examples.<br /><br />Recently, my oldest son lacerated his finger with a brand new knife. It was a nasty cut, but one that could have probably just healed on its own. However, he was going camping with friends the next day, and I didn't want him losing his finger to tetanus or wtf because I was too lazy and stingy to take him to urgent care. Except that around here, urgent care closes at like 6:30 PM, so any medium sized boo boo after hours means a trip to the ER. We go there, meet a lot of nice nurses and a great doctor, and get him stitched up. The financial lady comes in to see how we're going to pay, because naturally the ER gets stiffed quite often. I ask what it will be with vs without insurance since sometimes if it's more or less even-steven, it's just not worth running through. In this case, they say it'll be (IIRC) $300 cash, and $250 with insurance. So I run it through insurance. It's covered. I'm happy, the hospital is happy, insurance is happy. However, when I get my benefits statement for the trip to the ER, I notice that the hospital has charged insurance $950. I'm assuming that this was all above board (and honestly, I don't care since I paid my fair share and wasn't being pestered for more) but it sure had a whiff of horseshit lingering around it.<br /><br />I get the same thing with meds that aren't covered by insurance -<br /><br />Pharmacy: "Yup, this here bottle of oil is $145. Insurance doesn't cover it."<br /><br />Me: "Um, you know, I've never paid the same amount for this twice, but usually it's a lot closer to $100."<br /><br />Pharmacy:"Oh. Hmm. Howabout $80?"<br /><br /><br />On another occasion, I was seeing a pain specialist for a consult to get an epidural for sciatica and a few tendonitis injections. I was not there seeking narcotics - not that I wasn't taking them, but my PCP was handling that side of things, and I wasn't doctor shopping or whatever. Regardless, they insisted I take a drug test. I explained that I wasn't looking for a script, and unless they were worried that I was a corticosteroid junkie I really didn't see the point. I was told that it was office policy, and the Dr insisted on testing for all new patients. So, I peed in a cup in a bathroom with no warm water and a lock on the toilet handle, and figured that was that. Nope. A month later, I'm staring at an $850 bill for the testing that "I requested" that was sent to possibly the one single lab not covered by my insanely good insurance (that I now miss very, very much). It took *months* to get that sorted out, but in the end, the lab did bill the doctors office since it was not at all voluntary, and they had not even bothered to look at my insurance to see where to send the test so it was covered.<br /><br />So everyone gets screwed with. Doctors, patients, and even insurance.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-34858180940668305992016-03-07T17:43:32.156-05:002016-03-07T17:43:32.156-05:00I think the problem is more the lack of transparen...I think the problem is more the lack of transparency. In no other industry would I be asked to sign a blank check for an amount which could be anywhere from $0 to many thousands, yet I am asked to do exactly that at every doctors office/blood lab/medical facility I go to. The lab actually requires a credit card and for me to sign a statement that my insurance may or may not cover the tests and that I authorize the lab to go ahead and charge my card whatever amount is billed that ins won't cover. And the lab has no clue how much those tests wIll cost nor are they able to tell me ahead of time what will be covered. And just try prying that information out of Tricare! I would have no problem with paying for stuff if I knew ahead of time how much I would be on the hook for -- then I could do a rational cost/benefit analysis. As it is, I pay hundreds each month (and sometimes thousands) without having any clue what my blank check will be cashed for. And, yes, I have tried to discuss this with the doctors, nurses, admin staff, etc, but they are even more clueless than I, as there are hundreds of insurance plans out there, each with its own arcane little rule system!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-44787711428433405292016-03-05T14:16:03.702-05:002016-03-05T14:16:03.702-05:00Maybe someone (not me) should spend five or ten mi...Maybe someone (not me) should spend five or ten minutes with the patient and explain that the lab tests you want done are going to run 50 gazillion dollars and insurance isn't going to pay for it. But why take any preventative measures when it's so much fun to deal with the apeshit?Chuck Pergielhttps://www.blogger.com/profile/14473338620167201696noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-78125989441652194492016-02-21T11:27:57.418-05:002016-02-21T11:27:57.418-05:00people cannot deal with unexpected expenses and th...people cannot deal with unexpected expenses and the system (even in your narrative) is like rolling dice.<br /><br />years ago, I needed treatment and my dr said, you need x, but your insurance will not cover that unless you have y and z first, so I have to prescribe y and z even though we both know those will not help you. So some algorithm exists that is supposed to be cost saving and it gets applied to every patient whether it is appropriate or not. here is a good Q- when was the last time an ins. co surveyed patients and doctors about their experiences? never because they know what most people would say! <br />Cnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-41495873977357746122016-02-08T16:49:18.615-05:002016-02-08T16:49:18.615-05:00I do consulting for a lab. To run a CBC is less t...I do consulting for a lab. To run a CBC is less than $5, but the infrastructure to do the labs is a lot. Courier services, insurance billing etc. <br /><br />If you want to save money on labs, go to a doc that uses a co-op service. you pay upfront and then bill your insurance yourself. Labs cost around $10 vs going through your insurance company.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-80198903712669952672016-02-08T14:21:04.553-05:002016-02-08T14:21:04.553-05:00My 43 year old husband is on Medicare. He's ha...My 43 year old husband is on Medicare. He's had two cancers in the last 5 years (which rendered him disabled, hence Medicare). Medicare itself pays for jack squat so I also have both a gap plan and a prescription plan for him, which totals another $350 a month on top of the $104 for basic Medicare. Then the cherry is that he is on 50 (yes, FIFTY) meds a month. Some are cheap but most have hefty copays. And he's obviously disabled, since he's on Medicare at the age of 43, so we're living on a very very fixed income. So when you throw in a surprise bill from labs, it's a wrench in the gears. Yes, you are riding that fence between the best care you can carefully choose for your patients and getting expensive tests, but patients, especially those on Medicare, don't always have the extra cash on hand to pay for those tests.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-64810187157374940212016-02-08T09:14:26.717-05:002016-02-08T09:14:26.717-05:00The drink Coke costs maybe a penny to make yet cos...The drink Coke costs maybe a penny to make yet costs a dollar. Both parties are happy with the transaction.<br />Martin Shkreli Raised The Cost Of An HIV Drug By 5000%. The buyers and sympathetic were not happy with the cost.<br /><br />What is the real cost of a lab test? No one suggests a fair price for the licensed lab, labour and materials needed.<br /><br />If a carpenter or plumber does an hour of work everyone acknowledge the cost for the skill they have, the same should be for those that perform the medical analysis.Mark p.s.2https://www.blogger.com/profile/10529811159862096782noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-68995393512093428032016-02-08T08:24:37.272-05:002016-02-08T08:24:37.272-05:00My insurance will not pay for my lab work because ...My insurance will not pay for my lab work because I HAVE a diagnosis. If you get insurance through your job, do the math you are most likely better off to get major medical and cover the "small stuff" out of pocket <br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-26198341253752969672016-02-07T19:18:33.981-05:002016-02-07T19:18:33.981-05:00People will argue 'til they're blue in the...People will argue 'til they're blue in the face that 'healthcare' is NOT a right. ACCESS to decent services IS a civil right for EQUAL PROTECTION under the law. <br /><br />I think some folks don't realize that Medicaid is whatever the State can figure out how to do with the 'money' from federal and state taxes. Medicare is a federal program off the bat. Some citizens live in states where their state government can divy up the funds MORE equally than in other states. Medicare has to answer to the feds.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-20820702982204310882016-02-07T19:13:50.412-05:002016-02-07T19:13:50.412-05:00What is the MOST irritatingly frightening of the w...What is the MOST irritatingly frightening of the whole slough is there is no way to 'get off' to 'get ahead'. <br /><br />It's not simple like the Water Slide, Bumper Cars, or the Teacups or Lazy River or even what you think might be a ride on the merry-go-round. <br /><br />It quickly turns from a Kiddie Coaster to the Coney Island Coaster to The Beast. <br /><br />When you live to tell the tale and try the Mechanical Bull, it might not seem THAT bad and if get through the Tilt-a-Whirl, Troika, Shoot the Chute, Reverse Bungee, or Pirate Ship without spilling anything, and dare attempt the Double-Shot Drop Tower (or what I think of as The Hammer), there's still the Flying Scooters, and the Tragadon and Zipper. <br /><br />If you've still got your cookies, you might just have to have one more go at the Hurricane. Sometimes, it's like a Freakin' Nightmare to go from zero to fifty with just you and the outer epidermis for friction.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-68562052392576932272016-02-07T17:27:55.096-05:002016-02-07T17:27:55.096-05:00To Charles,
Wow, chill out! I speak Portuguese an...To Charles,<br /><br />Wow, chill out! I speak Portuguese and obviously slipped while writing my answer and composing a text in Portuguese at the same time. I am well aware that "Carlos" isn't the same as "Charles". Why you would think that "I felt it was important to change [your] name because [I] didn't agree with [you]" is beyond me. If I wished to insult you I would have done that more directly, I can assure you.Mariananoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-606864957660705942016-02-07T14:40:23.397-05:002016-02-07T14:40:23.397-05:00I hate Medicare. I hate Medicare. I hate Medicare....I hate Medicare. I hate Medicare. I hate Medicare. I hate Medicare.<br /><br />Every time someone tells me how we need a single-payer system "just like Medicare" I tell them just how much Medicare sucks. I hate that you pay monthly for stuff that doesn't cover much. I hate that you then have to get a second insurance (more monthly payments) just for prescriptions. I hate that with those prescription plans, you have to pay out the nose for anything more than the most basic drug coverage, and even then they find ways to bone you. Need insulin to save your life? TOO BAD! Here, pay even more money for you co-pay! And just wait until you hit the [CENSORED] Donut Hole! Then we really screw you!<br /><br />And one thing that really grinds my gears is that in many states, Medicaid covers more than Medicare. I had a nitwit doctor who kept prescribing based on what Medicaid covered (despite my repeatedly saying, "But I have Medi<i>care</i>."). That antibiotic isn't covered and is $200 for a five-day supply? Are you kidding me?!<br /><br />The latest I found out is that in some states, if you have treatment-resistant depression, Medicaid will cover genetic testing to look at what your best options are. Medicare will only cover genetic testing if you're prescribed warfarin.<br /><br />I HATE MEDICARE.<br /><br />Moosehttps://www.blogger.com/profile/10397412122635951126noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-79250478628240385752016-02-07T12:52:10.016-05:002016-02-07T12:52:10.016-05:00@MBee
Yes, patients can line-item veto specific te...@MBee<br />Yes, patients can line-item veto specific tests. I've done it. <br /><br />If you have a piece of paper in hand that you walk from the doctor to the lab, it's easy to see which tests were ordered. Ideally you'd discuss it with the doctor so that the questionable test didn't even show up on the lab slip. It takes a little more work if the doctor is entering orders in the computer and doesn't give you any paperwork. My last trip to the lab had the phlebotomist recruiting help in hunting for a specific tube for a special test. I stopped them and asked what was going on since I knew which tests were supposed to be run and there wasn't anything extra. Turns out that the doctor added another test in the computer (without telling me) because they lost the results from last time that test was done. The lab sent results twice (I have copies of the fax confirmation slip). The doctor still couldn't find the results so I emailed them, but they're not allowed to accept results emailed from patients -- but they are allowed to accept faxes so I then faxed the results myself. I have email from the PA in which we discuss the test results. Yet the doctor still says that they don't have any record that the test was done and wants it repeated. I told the lab that there is no chance that I am paying cash to repeat this expensive test just because the doctor's staff can't get their act together. Next time I'm in for follow-up I will hand the doctor a copy of the lab results so that she can see for herself without any staff preventing delivery of the results. And I know when I go to the lab that I have to ask which tests were ordered so that they don't slip in extras.WarmSockshttps://www.blogger.com/profile/12192702662231361355noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-75455059924826898342016-02-07T10:02:50.869-05:002016-02-07T10:02:50.869-05:00Peter,
Medical costs are deductible only if they ...Peter, <br />Medical costs are deductible only if they exceed 10% of your adjusted gross income. If you pay your insurance premiums with after-tax dollars that amount can be included in deductible medical expenses. If, however, your employer provides insurance and you pay a portion of the premium with pre-tax dollars, the premium amount is not deductible. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-69647005635653529282016-02-07T00:58:35.908-05:002016-02-07T00:58:35.908-05:00Peter;
Yes, in the US medical expenses that excee...Peter;<br /><br />Yes, in the US medical expenses that exceed 7.5 percent (under Obamacare that number is being pushed up to 10 percent sometime soon) of your income can be deducted from US Federal income taxes. (State's income taxes may vary)<br /><br />If your medical expenses all together are less than the 7.5 (or soon to be 10) percent then you cannot deduct them.<br /><br />Also, you have to "itemize" which means list all your deductions by item (e.g., medical expenses, charitable gifts, property taxes, business expenses, etc.) <br /><br />For US federal taxes you have two choices. Itemize or take a standard deduction. The standard deduction is a set amount while the itemized is what your individual deductions are.<br /><br />Many folks want to work it both ways each year to see which will be better for them. In years when you don't have a lot of deductions the standard is better; but, if you have a lot of deductions then it makes sense to itemize. You cannot do both.<br /><br />Nope, you cannot carry the expenses to other years. They are deducted for the year in which the expenses was incurred.<br /><br />Word of warning though; I'm not a tax expert nor a tax advisor; but, I hope this explanation helps.charlesnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-13406682914267266072016-02-07T00:29:46.115-05:002016-02-07T00:29:46.115-05:00Mariana;
No, you look! My name is charles, not &q...Mariana;<br /><br />No, you look! My name is charles, not "Carlos"; But, it seems as if you were responding to me. If so, why did you call me by a different name?<br /><br />Personally, I do not believe in taxing everyone to fund something that the free market does a better job at taking care of than government does.<br /><br />By turning the money raised for medical innovation into a government, instead of free market, enterprise you end up with entrenched parties that are only interested in keeping the funding ongoing, the innovation then becomes secondary. Free markets will tend to drop something if it isn't paying off; thereby saving money instead of throwing it down the rabbit hole.<br /><br />You also run the risk of voters demanding, and politicians giving them, more "free stuff." How's that working out for Greece?<br /><br />As for the US infant mortality rate compared to many European rates; you are comparing apples to oranges.<br /><br />The method for considering what is "infant mortality" is different in the US than in many countries in Europe. If you want to "think about it" perhaps you had best start with the method used to gather the data. As a scientist I thought you would have done so already and would have seen the difference.<br /><br />Nor did I say that the US was the ONLY innovator of medicine; but, it is certainly at or near the top. Just look at the Nobel Prize for medicine. Which country comes out on top in terms of the number of recipients? Cuba? I stand by my statement that if the US goes to government funded healthcare, and no more free market, medical innovation will suffer. If you think that your drugs in Europe are NOT subsidized by the US market you need to do more research.<br /><br />And again, my name is charles. But, I guess you felt it was important to change my name because you didn't agree with me? Well, bless your heart!<br /><br />Please do not disrespect someone by calling them by a different name. And yes, before you decide to do more USA bashing by calling me linguistically ignorant, I am aware that "Carlos" if the Spanish version of the English "Charles"; but, to me they are different names. "Carlos" is not MY name, thank you.charlesnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-61237590188790098172016-02-06T18:15:00.159-05:002016-02-06T18:15:00.159-05:00Sorry, coming from the UK I'm confused by one ...Sorry, coming from the UK I'm confused by one part:<br /><br />"It's a tax deduction if they want to see it that way"<br /><br />Does that mean that in the US medical costs are allowable expenses against personal income tax? Does that apply to everyone and can it be carried forward and backwards against other years?<br /><br />Thanks<br /><br />PeterAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-4156732475943757602016-02-06T16:58:33.043-05:002016-02-06T16:58:33.043-05:00To Carlos:
Look, I, as a physician (and one who ...To Carlos: <br /><br />Look, I, as a physician (and one who deals daily with patients with rare diseases), personally believe healthcare is a right to everyone. I have already understood that you do not agree with me. However, what I would like to stress is that my belief does not mean that I think healthcare is free. It isn't. It costs millions of euros (or dollars, in your case). Pharmaceutical companies will only invest in developing new drugs and laboratories will only invest in new technologies if they receive a finacial benefit. The difference between you and me is that I believe we should all, as a society, contribute to the greater good. That is to say, that money should come from the State through everyone's taxes instead of being paid individually by the citizens through insurance companies (even if it means we will all pay more taxes). <br /><br />Government-funded medicine, where I come from, may have its flaws, but I think the benefits outweigh them. For example, we have one of the lowest infant mortality rates in Europe. On the other hand, USA is the country that spends more on healthcare and does not have the best rates in the world. Gives you something to think about, doesn'it it? (Or maybe no - your call).<br /><br />Btw, scientific innovation is not a bastion of the USA, but that is a whole another post.Mariananoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-51750673695361227332016-02-06T12:06:23.226-05:002016-02-06T12:06:23.226-05:00At least from the pharmacy side, we know if a medi...At least from the pharmacy side, we know if a medication is covered or if it requires a prior authorization. Some people understand the process. Others don't. I usually says because it's expensive and insurance companies make money by not paying claims. Naturally, prior auths are put in place for a reason. If a drug was prescribed that required prior auth, most of the time the insurance company wanted to know if you tried drugs A,B, and C (cheaper alternatives). If you failed them, the prior auth is more likely to be approved. If it was prescribed because sales rep had a nice rack and provided the staff lunch, well, that probably won't be coveredAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-52710498857170556312016-02-06T07:50:16.298-05:002016-02-06T07:50:16.298-05:00Hospitals jack up the "charges" so that ...Hospitals jack up the "charges" so that they can either, put the screws to people without insurance (not so much, they will negotiate with patients) or, and much more important to them, write off the bulk of charges and claim they provided millions of dollars of "uncompensated care" to the community allowing them to remain non-profit, pay the CEO big bucks, and polish their halos in public. It's a huge con. If "charges" equaled what they really get from someone with insurance, the system would be much more transparent and fair.KJLhttps://www.blogger.com/profile/14020813371913296154noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-17937117618056702412016-02-05T23:58:24.648-05:002016-02-05T23:58:24.648-05:00"but healthcare is NOT FREE. Someone is payin..."but healthcare is NOT FREE. Someone is paying for it, even if it's not the patient."<br /><br />That is spot on Grumpy, spot on. <br /><br />It never ceases to amaze me that most folks, in the US anyway, do not know the terms deductible, co-pay, charge vs. allowable, accept assignment, etc.<br /><br />But, their biggest ignorance is that they all seem to think that healthcare is a "right" and that they shouldn't have to pay anything.<br /><br />Further, those who live in countries that have all their healthcare "free" seem to think that they are truly getting it free. If/when the US becomes like that we will see all new innovations, new drugs, etc. disappear from the market. Only government funded medicine will be available - run just like the DMV.<br /><br />And I do not mean just here in the US; it is the "free market" in the US that provides the rest of the world with medical innovations and new drugs. So, those of you outside the US who like to bash good ol' USA, just remember that it is our system that basically provides your "free" system with medical innovations and new drugs.charlesnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-49812255348956729272016-02-05T14:30:59.704-05:002016-02-05T14:30:59.704-05:00@Anonymous. I cannot be sure but I would say that...@Anonymous. I cannot be sure but I would say that most of those bills are worth what is being charged. It is simply the insurance company refusing to pay. My doctors' office had to discontinue giving flu shots because it was costing them to give them so for example, if the vaccine cost $20, the insurance company would only pay $11 and the patient could not be billed for the difference. <br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-77804290448313555642016-02-05T13:23:26.432-05:002016-02-05T13:23:26.432-05:00People Probably go ape shit over the actual price ...People Probably go ape shit over the actual price of labs versus the principal of having to pay for something. For example, I require an occasional CA125 blood test. If my dr forgets to send a note with it, insurance rejects it and I get a $200 bill from the lab. For the record I DO NOT think this is the doctor's fault and I would never treat them as your patients do. I simply call them up and ask the dr to send her note on and she does and then, here is the part that pisses me off. The insurance negotiates the bill down to $17. They pay $14. I pay $3. So happy I only pay $3...but why the hell can the lab charge me $200 and insurance only $17. That means the test is only worth $17. I know this is a total rhetorical point to make but this is the problem with healthcare and i think this might be what more people get mad about. They see a $200 bill when it's only worth $17. Not all patients because obviously some people don't get it and just call you screaming but I think this is the fundamental problem with people upset about paying for their healthcare. Not that they are so entitled they have to pay something but that they have to pay jacked up price. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-32211486756552722372016-02-05T11:00:03.487-05:002016-02-05T11:00:03.487-05:00The difference between the television scenario and...The difference between the television scenario and what happens with medical bills is that nobody will tell me ahead of time what the medical care is supposed to cost. So I get coerced into signing off on diagnostic tests that may or may not result in life saving treatments with no idea whether I'll be charged zero dollars or all my worldly possessions. Then, several weeks or months later, I get a bill that might make sense to me but probably doesn't. Being told that the full bill was actually 5 billion dollars and I'm only being charged my first born son doesn't actually make it sound like a good deal. It makes it sound like a con job. Meanwhile, the fact that the doctors are burning themselves out doing all sorts of things behind the scenes to get the insurance companies to pay up is not obvious to me because it's happening, you know, behind the scenes. All I'm getting is that there are angry people who claim to care about my wellbeing sitting here telling me that I should stop whining and accept the bill because I've got three other kids anyway and we all have to pay our own way in this world.<br /><br />Metaphorically speaking, of course.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-86826308412431864032016-02-05T09:44:31.078-05:002016-02-05T09:44:31.078-05:00Hey Anon ^^^^^ - yes, and I get to pay for the peo...Hey Anon ^^^^^ - yes, and I get to pay for the people who do divert their meds, fake illness/injury, and so on by peeing in that cup.<br /><br />I (mostly) didn't complain about that - that, my dear, is a whole 'nother rant.<br /><br />I complained about the stupidity of a lab test costing $5K. <br /><br />However, because I'm generous I'll let you have the next specimen. Because, gold.Anonymousnoreply@blogger.com