Health Insurance is Not Healthcare

[TX OMFS]

ER just called to arrange out-patient follow-up for a pt. They told me pt is uninsured. Doc says, "Not sure if that is a problem". Umm, no. I don't know a single Dr. that refuses cash or CC. Luckily they called the least expensive surgeon in town.

Health insurance doesn't help much when you have a $5k+ deductible and a $10k+ yearly out of pocket max. Shopping around helps, especially now that some of us post our fees on our websites.

Even better, the guy drove by the tax-payer funded county hospital to a private hospital. Thanks EMTLA. Why do we even pay taxes for the county hospital to exist?

Why is the ER doc only concerned about cost AFTER they order an unnecessary CT scan & attempted surgery themselves? I'm the bad guy b/c I have a reasonable fee but don't work for free. They're the more noble Dr despite a huge bill.

I do work for free quite frequently, BTW. Just not when there is no real emergency.

/rant

 

[vmax]

When you go to a dealership for car service, many of them have a board posted with prices for common services
Why dont doctors and dentists do the same thing?

 

[avvidclif]

When you go to a dealership for car service, many of them have a board posted with prices for common services
Why dont doctors and dentists do the same thing?

Easy, they don't want you shopping around. Besides most of the time you need a Dr you're not in a mood to price shop, yearly physicals and elective surgery exempted.

 

[Mowingmaniac 24/7]

Pt?

EMTLA - Would you please explain what this means. I looked it up, but still need clarification/

Thanks!

 

[dsgrey]

Spouse had an appendix issue a few years back that was discovered in her doctor's office. Funny how they berate you for not coming in sooner when I also have employer insurance with a $5k deductible and $10k out of pocket max. Not everyone has $10k to spend annually on insurance deductibles. Dying in pain last year I went to the ER to find out I had a kidney stone. Just ER visit in the county hospital with negotiated rates cost me my deductible and copay without any procedure being performed. Unfortunately an ER visit conjures up in your mind you'll be paying $10k so one must think it's serious to go.

 

[Mowingmaniac 24/7]

I'm surprised more people don't show up at ER's, claim to be i.d.-less and homeless and get 'free to them' treatment......

 

[TX OMFS]

Pt?

EMTLA - Would you please explain what this means. I looked it up, but still need clarification/

Thanks!

Yes sir. I'll explain later. Honey-do's right now!

 

[TX OMFS]

When you go to a dealership for car service, many of them have a board posted with prices for common services
Why dont doctors and dentists do the same thing?

Because the customers haven't demanded it. Most patients only care if the doctor "accepts their insurance".

But, I post mine. www.rivercityoms.com

So does the Surgery Center of Oklahoma and Texas Free Market Surgery.

https://surgerycenterok.com/

https://texasfreemarketsurgery.com/

Check SCO out on Twitter.

 

[TX OMFS]

Spouse had an appendix issue a few years back that was discovered in her doctor's office. Funny how they berate you for not coming in sooner when I also have employer insurance with a $5k deductible and $10k out of pocket max. Not everyone has $10k to spend annually on insurance deductibles. Dying in pain last year I went to the ER to find out I had a kidney stone. Just ER visit in the county hospital with negotiated rates cost me my deductible and copay without any procedure being performed. Unfortunately an ER visit conjures up in your mind you'll be paying $10k so one must think it's serious to go.

Zactly. You have actual insurance like a home owner's policy or car insurance. Your out of pocket is so high you are forced to be a real consumer looking for a deal.

The serious problem is the premiums don't match up for your catastrophic plan. You are paying for a gold plated Cadillac plan & getting a catastrophic plan.

There are a few of us doctors out there trying to help guys like you.

Health care sharing ministries or HSAs combined w/ a high deductible insurance really are the best way to go in today's market.

Demand a price up front. Shop around.

 

[TX OMFS]

 

[TX OMFS]

 

[TX OMFS]

Pt?

EMTLA - Would you please explain what this means. I looked it up, but still need clarification/

Thanks!

EMTLA was a gift from Reagan like amnesty & the Hughes amendment.

The Emergency Medical Transfer & Labor Act says that anyone who walks into an ER that accepts federal money (Medicare or Medicaid) has to receive an emergency medical screening exam to be sure no emergency exists. If an emergency exists they have to be stabilized and admitted if necessary. If that ER or hospital does not have capacity (appropriate beds available) or capability at that time to treat the patient they may transfer the pt to a hospital or ER that can handle it.

Any other hospital that accepts federal money and has capacity & capability to treat the pt MUST accept that pt on transfer. The sending hospital has no geographic restrictions. The sending hospital can transport a patient past 50 hospitals capable of handling the case if they so choose. If Anchorage calls me & wants to send an oral surgery patient I cannot refuse based on distance.

Also, a woman in labor cannot be turned away.

These laws apply regardless of the patient's ability to pay.

When you walk into an ER they immediately ask for your ID & copay. You cough it up. Many of the people around you say they have no money & no insurance & don't pay. In other words, by EMTLA law American ERs are free care centers that give patients unlimited access to every specialty.

Prior to EMTLA there were charity & religious hospitals & clinics that provided care to the indigent. When Big Brother stepped in that almost went away. EMTLA is the reason indigent patients can bypass the county hospital in favor of the nicest, newest place.

Hospitals can afford to deal w/ the EMTLA costs b/c Medicare increases their reimbursement for Medicare patients in part based on how much free care they give.

When doctors had to start taking care of so many people who never pay their bills the doctors just stopped taking call for the hospital. So hospitals started paying doctors to take call. 30+ years ago doctors took call at the hospital for free. It was part of the job. Now most doctors are paid to take call or there would be no doctors on call.

I collect 8-10% of what I bill to patients seen through the ER. If the hospital didn't pay me I would stop taking call. I like taking care of the really sick people I see in the ER but not at a 90% discount.

 

[TX OMFS]

Because of EMTLA & the fact that most oral surgeons don't take hospital call, I get calls from ERs all over Texas wanting to transfer patients to my hospital.

Tyler called me once. TYLER! To send to San Antonio! Houston calls a few times a year. Conroe called once. Corpus calls a few times a year. Austin calls frequently. The Valley calls pretty often too. Del Rio & Eagle Pass call frequently.

There are two private practice oral surgeons taking hospital call in San Antonio. We are friends and only cover the Methodist hospitals. Only Methodist hospital in San Antonio has ENT. If you go to a Baptist or Christus hospital in San Antonio w/ an emergency & need an oral surgeon or ENT you will be put on an ambulance & sent to Methodist or Methodist Specialty & Transplant Hospital.

That's why I say in one of my YouTube videos that you need to be sure your oral surgeon has hospital privileges & can be reached easily after hours. Otherwise you could receive an ambulance ride for a minor problem.

 

[Brains]

So how do we fix the problem of providers billing "Hail Mary's" to customers like me that feel obligated to pay my debts? With the birth of each of my little ones, two different hospitals charged things to the bill that were not legit. The excuses were worse than the fraud. "Oh those are standard charges" or "it's part of the labor and delivery package" or the simple favorite "clerical error." Charges for items or services not provided/performed. Medications that would never be prescribed to an obstetrics patient. Double billing of some items. Incorrect procedure codes. Bills from a doctor we never saw, and who the hospital could provide no record of care provided. There's more instances, but those really stood out. Certainly has happened more often than simple coincidence.

 

[TX OMFS]

So how do we fix the problem of providers billing "Hail Mary's" to customers like me that feel obligated to pay my debts? With the birth of each of my little ones, two different hospitals charged things to the bill that were not legit. The excuses were worse than the fraud. "Oh those are standard charges" or "it's part of the labor and delivery package" or the simple favorite "clerical error." Charges for items or services not provided/performed. Medications that would never be prescribed to an obstetrics patient. Double billing of some items. Incorrect procedure codes. Bills from a doctor we never saw, and who the hospital could provide no record of care provided. There's more instances, but those really stood out. Certainly has happened more often than simple coincidence.

There are too many contracts & middle men. The place to start is to get back to direct pay. Patients pay the hospital, doctor, provider, etc. Insurance reimburses. Just like homeowners & auto.

We get there by deregulating. You should not be forced to buy any insurance at any level. Open the market & let the market sort it out.

Right now there are too few hospitals that think this way. Doctor owned free market hospitals help but there aren't many of them.

The nickel-and-dime billing needs to stop. Mechanics don't bill for every bit of shop supplies they use as a line item. At most they have a "supply fee". I don't nickel and dime either. I have a flat fee.

Tl;dr It's not easy

 

[Mowingmaniac 24/7]

TX OMFS,

Thank you for taking the time and effort to explain.

I very much appreciate it!

 

[TX OMFS]

I accepted a transfer from the Valley recently. Pt had a doctor lined up to see pt down there. Pt didn't want to see that doctor. ER doctor didn't push it. Pt rode up here in an ambulance for a non-emergent problem. On you dime. Thanks for paying taxes.

 

[Brains]

There are too many contracts & middle men. The place to start is to get back to direct pay. Patients pay the hospital, doctor, provider, etc. Insurance reimburses. Just like homeowners & auto.

We get there by deregulating. You should not be forced to buy any insurance at any level. Open the market & let the market sort it out.

Right now there are too few hospitals that think this way. Doctor owned free market hospitals help but there aren't many of them.

The nickel-and-dime billing needs to stop. Mechanics don't bill for every bit of shop supplies they use as a line item. At most they have a "supply fee". I don't nickel and dime either. I have a flat fee.

Tl;dr It's not easy

Oh Good Lord would I love that, but then again I'm a man of means and the 'other' party feels the only solution is their solution where "someone else" pays the bill. I've worked hard to provide for my family, and make no excuses for it.

FWIW I'm not seeing that doctor owned hospitals aren't really the answer either, North Cypress Medical Center is a prime example.

 

[TX OMFS]

FWIW I'm not seeing that doctor owned hospitals aren't really the answer either, North Cypress Medical Center is a prime example.

Sorry, I didn't follow that. NCMC is owned by HCA. They will never publish their prices.

 

[Brains]

They are now, it was a recent acquisition.