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Re: 67% Worry About Unexpected Medical Bills

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Message 1 of 13

When I signed up for Social Security, I went directly to the local Social Security office, waited on a long line, and was finally told that I didn't have an appointment. They recommended I should sign up online.


It took several attempts, but I was finally able to sign up online. At times, it was a fustrating experience.


When I told co-workers that they could sign up online, all of them decided not to. They preferred to let the Social Security office do the work for them.


When I reached Medicae age, I spent many hours online researching different Medigap plans (and Drug Plans), along with talking to family and friends who were already on Medicare. When I finally made my decision, I did it all online.


Once again, I told my co-workers that they could signup for Medicare online. I tried to share my experience, and what I had learned about the pros and cons about Medicare Advantage versus Original Medicare.


So how did they sign up for Medicare?


A telemarketer would call, or they would receive an advertisement in the mail. The Medicare Advantage sales person would come to their door, and sign them up.


Many people I know are very trusting. They walk around for years with their insurance cards feeling very confident that they are covered. They go the doctor for a cold or flu - and the insurance card works. Then, one day they need surgery, or a special treatment, or have an emergency, and discover they are not covered as well as they thought.

 

People I know are working longer than they expected to pay off those "unexpected bills".

Some retire, then go back to work to pay off those medical debts. They're learning the hard way.

 

 

medicare finished choosing.jpg

 

 

 

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Re: 67% Worry About Unexpected Medical Bills

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Message 2 of 13

@GailL1 wrote:

@mickstuder

 

Section 2718(e) of the Affordable Health Act already gave the consumers the right to ask for this pricing transparency.

 

ACA Section 2718(e) - see page 11 of 91 of this pdf

 

Under Section 2718(e), “each hospital operating within the United States shall for each year establish (and update) and make public…a list of the hospital’s standard charges for items and services provided by the hospital.” CMS has previously interpreted Section 2718(e) to require hospitals to either make public a list of standard charges or implement policies for allowing the public to view a list of the standard charges by individual request. It was originally believed by CMS that patients could use such information to compare charges for similar services across hospitals, just as someone “shops around” for the best price in plumbing services. However, CMS contends that Section 2718(e), as is currently written, is insufficient to establish the necessary hospital price transparency.

 

How many people actually used it or even knew it was there?

The current Administration is just enforcing this ACA clause a little stricter - but most people will still find it difficult to use without help (WOW - what a great idea for a service business - interpreting hospital chargemaster online price list for procedures.)

 

In order to do this, the consumer will have to know which Hospitals or outpatient facilities are in -network.  Then what happens if the doctor they choose to perform the whatever procedure only has provider rights at one of those hospitals?  Are they gonna change doctor or hospitals?

 

As government often does, whether this Administration or the previous one, they use the ole CTA (Cover Their A**) method, giving the average consumer little good info.

 

 Now wouldn't it be better for the consumers insurers to give out this info??  And at the same time, verify that the provider is in network and their procedure is covered as medically necessary.  After all, it is the insurers price which the consumer will pay a part of - 

 

Want price transparency - get it directly from the insurer, in writing.

 

 


I Believe I Already Covered a Majority of this is my first post on the Subject

 

Maybe you missed it

 

Hospitals already have to make prices for procedures available on request, but a new rule requiring them to post the information online goes into effect on Jan. 1, 2019.

 

Most of us Already Know - Many Americans would rather be Programed than lift a finger to Request Any New Knowledge - but most will at least read some of it - if it's already put in front of them on Internet Websites & Social Media

 

After all look how well Trump has Mastered this Medium

 

Again, any opportuntity to make people aware of and enabled to participate in their own Commerce - Healthcare especially is Progress -

 

Anything that provides the Public even glimpses of Transparency is Progress and after Decades of gaining this Knowledge some of them might actually pass it on to their Children & advise them to contact their Legislators and ask How Come our Healthcare Costs So Much Compared to ever other Industrialized Nation -

 

Could it be because it costs Healthcare to Purchase You Every Year My Legislator?

 

My Goal is not begging Insurance Companies or Health Insurance Conglomerates if they would be so kind as to inform me of the charges of Procedures & Drugs in advance

 

My Goal is to force them to reduce their Exorbitant Profits - Gaining even a bit more insight into the Facts is in my estimation another Data Point on my Quest & it should be Everyones

 

 

( " If I do not believe as you believe, it proves that you do not believe as I believe, and this is all that it proves. Sam Adams )

" )
" - Anonymous

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Re: 67% Worry About Unexpected Medical Bills

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Message 3 of 13

@GailL1 wrote:

@mickstuder

 

Section 2718(e) of the Affordable Health Act already gave the consumers the right to ask for this pricing transparency.

 

ACA Section 2718(e) - see page 11 of 91 of this pdf

 

Under Section 2718(e), “each hospital operating within the United States shall for each year establish (and update) and make public…a list of the hospital’s standard charges for items and services provided by the hospital.” CMS has previously interpreted Section 2718(e) to require hospitals to either make public a list of standard charges or implement policies for allowing the public to view a list of the standard charges by individual request. It was originally believed by CMS that patients could use such information to compare charges for similar services across hospitals, just as someone “shops around” for the best price in plumbing services. However, CMS contends that Section 2718(e), as is currently written, is insufficient to establish the necessary hospital price transparency.

 

How many people actually used it or even knew it was there?

The current Administration is just enforcing this ACA clause a little stricter - but most people will still find it difficult to use without help (WOW - what a great idea for a service business - interpreting hospital chargemaster online price list for procedures.)

 

In order to do this, the consumer will have to know which Hospitals or outpatient facilities are in -network.  Then what happens if the doctor they choose to perform the whatever procedure only has provider rights at one of those hospitals?  Are they gonna change doctor or hospitals?

 

As government often does, whether this Administration or the previous one, they use the ole CTA (Cover Their A**) method, giving the average consumer little good info.

 

 Now wouldn't it be better for the consumers insurers to give out this info??  And at the same time, verify that the provider is in network and their procedure is covered as medically necessary.  After all, it is the insurers price which the consumer will pay a part of - 

 

Want price transparency - get it directly from the insurer, in writing.

 

 


And look how well that is all working out for us. 

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Re: 67% Worry About Unexpected Medical Bills

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Message 4 of 13

@GailL1 wrote:

@mickstuder

 

Section 2718(e) of the Affordable Health Act already gave the consumers the right to ask for this pricing transparency.

 

ACA Section 2718(e) - see page 11 of 91 of this pdf

 

Under Section 2718(e), “each hospital operating within the United States shall for each year establish (and update) and make public…a list of the hospital’s standard charges for items and services provided by the hospital.” CMS has previously interpreted Section 2718(e) to require hospitals to either make public a list of standard charges or implement policies for allowing the public to view a list of the standard charges by individual request. It was originally believed by CMS that patients could use such information to compare charges for similar services across hospitals, just as someone “shops around” for the best price in plumbing services. However, CMS contends that Section 2718(e), as is currently written, is insufficient to establish the necessary hospital price transparency.

 

How many people actually used it or even knew it was there?

The current Administration is just enforcing this ACA clause a little stricter - but most people will still find it difficult to use without help (WOW - what a great idea for a service business - interpreting hospital chargemaster online price list for procedures.)

 

In order to do this, the consumer will have to know which Hospitals or outpatient facilities are in -network.  Then what happens if the doctor they choose to perform the whatever procedure only has provider rights at one of those hospitals?  Are they gonna change doctor or hospitals?

 

As government often does, whether this Administration or the previous one, they use the ole CTA (Cover Their A**) method, giving the average consumer little good info.

 

 Now wouldn't it be better for the consumers insurers to give out this info??  And at the same time, verify that the provider is in network and their procedure is covered as medically necessary.  After all, it is the insurers price which the consumer will pay a part of - 

 

Want price transparency - get it directly from the insurer, in writing.

 

 


The problems you point out are correct, but prices given out by Hospitals are fictions that only the uninsured ever use. We had a court case and the hospital was told to justify its listed prices to the person and they could not. What they came up with was about 5% of what they tried to charge the person. Medicare prices are the gold standard now, and all Insurance Cos. try and get as close as possible to that when they work out prices with a Hospital. In many areas there is only one hospital. Under the present system the Insurance Carriers handle pricing at hospitals and that will not change until we get everyone covered under a Medical program like Insurance, or a govt. program like Medcare, or medicaid. Some areas reimb. a hospital for treating uninsured who do not pay. In my state it is by County and the taxpayers foot that bill. We are seeing Insurance Cos. in large city areas name one hospital to be used for treatment of a certain type for all Insureds. We have also seen Insurance Cos. send people out of country for treatment. They pay for travel and recovery in the area in full plus treatment. The cost is less than in the US. We need a new system where everyone is covered by a program, and that is what the ACA was a step to.

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Re: 67% Worry About Unexpected Medical Bills

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Message 5 of 13

@mickstuder

 

Section 2718(e) of the Affordable Health Act already gave the consumers the right to ask for this pricing transparency.

 

ACA Section 2718(e) - see page 11 of 91 of this pdf

 

Under Section 2718(e), “each hospital operating within the United States shall for each year establish (and update) and make public…a list of the hospital’s standard charges for items and services provided by the hospital.” CMS has previously interpreted Section 2718(e) to require hospitals to either make public a list of standard charges or implement policies for allowing the public to view a list of the standard charges by individual request. It was originally believed by CMS that patients could use such information to compare charges for similar services across hospitals, just as someone “shops around” for the best price in plumbing services. However, CMS contends that Section 2718(e), as is currently written, is insufficient to establish the necessary hospital price transparency.

 

How many people actually used it or even knew it was there?

The current Administration is just enforcing this ACA clause a little stricter - but most people will still find it difficult to use without help (WOW - what a great idea for a service business - interpreting hospital chargemaster online price list for procedures.)

 

In order to do this, the consumer will have to know which Hospitals or outpatient facilities are in -network.  Then what happens if the doctor they choose to perform the whatever procedure only has provider rights at one of those hospitals?  Are they gonna change doctor or hospitals?

 

As government often does, whether this Administration or the previous one, they use the ole CTA (Cover Their A**) method, giving the average consumer little good info.

 

 Now wouldn't it be better for the consumers insurers to give out this info??  And at the same time, verify that the provider is in network and their procedure is covered as medically necessary.  After all, it is the insurers price which the consumer will pay a part of - 

 

Want price transparency - get it directly from the insurer, in writing.

 

 

* * * * * * * * *
MY SIGNATURE: "It’s Always something" - Roseanne Rosannadanna
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Re: 67% Worry About Unexpected Medical Bills

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Message 6 of 13

@GailL1 wrote:

@mickstuder

 

Not sure how much those online charges are gonna help the average person since most cost are listed under the treatment name and many times there maybe more than one.  The prices reflected are also the chargemaster cost - the cost basis from which negotiation begin with commercial insurers and government plans.  

 

When one speaks about "Unexpected Medical Bills", the more immediate problem, at least those with some type of insurance coverage, are those charges which might not be covered only somewhat or not at all.

 

Some examples:

Services provided by a P.A.R.E. Provider which is not covered by the network of the subject insurance plan.  A  P.A.R.E. Provider is a Pathologist, Anesthesiologist, Radiologist or ER Doctor.  Many of these professional work under contract basis with a hospital and thus have different insurance participation or none at all.

 

If a person has picked an insurance plan without any out-of-network coverage and they have use the services of my me of these professional, it may result in a large bill which they weren't expecting.  Then it might be time to negotiate with them, if they negotiate.

 

Another large expenses which could come into play is needing a lift flight.  Some plans cover some of this charge but many do not and it is expensive since the provider has to maintain both staff and vehicles (helicopters) to provide this service.

 

Another is going out of network or in the case of Medicare going to a provider that does not take assignment.

 

Another is perhaps going to ER services with something that could have been handled outside of the ER - this comes into play most often if the person isn't admitted or treated for something that isn't life threatening and it should have been known by the person or their charge that this was the case.  

 

Another thing that adds into this scenario is if the person or their charge take no actions other than going to the ER - like they didn't see or call their in-network personal care physician, a 24-hour insurance provided nurse call center or going to an urgent care facility before ending up in the ER.  Not that the claim is always denied but it will be scrutinized and could be denied.

 

You would be surprised by what some people think their insurance covers - and who.  Some folks never read or learn about their policy - the same is true of Medicare too - traditional or Medicare Advantage.  But most time, the provider knows the Medicare plan and can help the patient make decisions or they offer one of those Medicare ABN forms to clue the beneficiary into charges that might not be covered or they don't and the beneficiary ends up with all or a bigger part of the bill than what they were expecting because the provider balance bills.

 

 

 

 

 

 

 


Geez - I try to give the Trump Administration Credit for at least attempting to try to do something about the High Cost of Healthcare & even that is not good enough

 

But I will struggle on through the Jungle

 

Simply allowing a opportunity for Americans to see Hospital Charges - have the opportunity to compare prices online- is a conduit for previously SECRET - CLOSELY GUARDED - Proprietary Information to become Mainstream

 

Anything that allows a Consumer especially a Healthcare Consumer to participate in a informed meaningful way especially in a reasonably easy way in their own Healthcare Commerce is a Monumental Paradigm Shift

 

Knowledge is Power - Participation is Power

 

Crawling & Baby Steps sometimes produce Olympic Gold Medals

 

 

( " If I do not believe as you believe, it proves that you do not believe as I believe, and this is all that it proves. Sam Adams )

" )
" - Anonymous

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Re: 67% Worry About Unexpected Medical Bills

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Message 7 of 13

@Richva wrote:

Kinder care, elder care, shared retirement plans, universal health coverage, mandatory sick leave, mandatory vacation time, union representation on boards of directors, tuition free education.  Pretty much soulds like America in the late 50's doesn't it? Let's make America great again. 


America in the late 50's ????   Really ????

Guess somebody should have told my parents.

Most people in the 50's used medical care VERY sparingly.

Providers had few treatment to treat extreme illnesses.  Their diagnostic tools were few.  Medicines were few.

 

Medicare / Medicaid wasn't even invented yet.

 

To MAGA - we need a massive amount of educating of the people in how to just manage their own lives - that would be the beginning.

 

 

* * * * * * * * *
MY SIGNATURE: "It’s Always something" - Roseanne Rosannadanna
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Re: 67% Worry About Unexpected Medical Bills

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Message 8 of 13

@Olderscout66 wrote:

. . . . it will cause the very rich to pay more so the very poor can have the right to health care - 


Most of the poor and children are already covered - Medicaid / CHIP.

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Re: 67% Worry About Unexpected Medical Bills

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Message 9 of 13

@mickstuder

 

Not sure how much those online charges are gonna help the average person since most cost are listed under the treatment name and many times there maybe more than one.  The prices reflected are also the chargemaster cost - the cost basis from which negotiation begin with commercial insurers and government plans.  

 

When one speaks about "Unexpected Medical Bills", the more immediate problem, at least those with some type of insurance coverage, are those charges which might not be covered only somewhat or not at all.

 

Some examples:

Services provided by a P.A.R.E. Provider which is not covered by the network of the subject insurance plan.  A  P.A.R.E. Provider is a Pathologist, Anesthesiologist, Radiologist or ER Doctor.  Many of these professional work under contract basis with a hospital and thus have different insurance participation or none at all.

 

If a person has picked an insurance plan without any out-of-network coverage and they have use the services of my me of these professional, it may result in a large bill which they weren't expecting.  Then it might be time to negotiate with them, if they negotiate.

 

Another large expenses which could come into play is needing a lift flight.  Some plans cover some of this charge but many do not and it is expensive since the provider has to maintain both staff and vehicles (helicopters) to provide this service.

 

Another is going out of network or in the case of Medicare going to a provider that does not take assignment.

 

Another is perhaps going to ER services with something that could have been handled outside of the ER - this comes into play most often if the person isn't admitted or treated for something that isn't life threatening and it should have been known by the person or their charge that this was the case.  

 

Another thing that adds into this scenario is if the person or their charge take no actions other than going to the ER - like they didn't see or call their in-network personal care physician, a 24-hour insurance provided nurse call center or going to an urgent care facility before ending up in the ER.  Not that the claim is always denied but it will be scrutinized and could be denied.

 

You would be surprised by what some people think their insurance covers - and who.  Some folks never read or learn about their policy - the same is true of Medicare too - traditional or Medicare Advantage.  But most time, the provider knows the Medicare plan and can help the patient make decisions or they offer one of those Medicare ABN forms to clue the beneficiary into charges that might not be covered or they don't and the beneficiary ends up with all or a bigger part of the bill than what they were expecting because the provider balance bills.

 

 

 

 

 

 

 

* * * * * * * * *
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Message 10 of 13

@Olderscout66 wrote:

The concern over unexpected medical bills is totally reasonable - about 640,000 Americans go bankrupt from medical bills EVERY YEAR - and we're the ONLY citizens of a developed country that can go bust if a kid gets sick.

 

Republicans tell you that is FREEDOM, and having Universal Coverage/Single payer is DEPENDENCY. It's not, but if they tell you the REAL reason they oppose what every other country enjoys- namely it will cause the very rich to pay more so the very poor can have the right to health care - you might think they're rapacious elitists, which they are, but they don't want everyone to know.


Your source is a 2013 thing from "nerdwallet" according to Fact Check.

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