that advice about bp is super bad fyi
nvm misread while not paying attention in a meeting
I cannot imagine ever having to navigate this river of utter shit, let alone on a regular basis. Iām on rage tilt just reading it.
The surgical assistant thing is a well known bullshit move by surgeons.
What is the angle here? I get that itās surprise billing but there must be more to it than that. Have to assume that itās a trap or a freeroll or both but I donāt know if thereās some specific 7-moves-to-checkmate technicality nested in the decision tree of signing / not signing. My gut would be to not sign shit and tell them to suck it from the back.
Iām 100% not signing simply because with coinsurance the dude is on the hook for 10% of any recovery.
Of course even with a balance billing law there is nothing stopping these assholes from eventually turning it over to collections and ruining the dudes credit.
I remember this happened to me when we were having our second kid.
Both were scheduled c-sections and not particularly complicated, but if anything first one was slightly more complex based on what they told us leading up to delivery.
First one, obstetrician does by herself. No problem at all.
A couple of years later, same obstetrician, like 2 minutes before shows up with another doc and is like āThis is Dr. X and she will be assisting me with the procedureā. Seemed pretty bullshit to me, but I wasnāt about to interrogate them and try to call the bluff. I wanted them to be 100% focused on the matter at hand and not distracted in any way. So, I didnāt really say anything.
Everything went fine. There was a large charge for the second doc, but that was also completely covered by my insurance, so that was the end of it for me. Iām still pretty sure the second doc was not exactly necessary, but I guess there is no way Iāll be 100%.
To be honest, if she said, āIāve got this other doc here and Iām just gonna have her stand next to me in case I keel over mid-delivery so that she can take over, but thatās gonna be an extra $1000ā, Iād have told them to take my money.
Itās like if people who actually have money and understand what to do with it struggle this much with understanding this, what change do the rest of us have.
Hereās the thing, assuming good faith, if a surgeon says they need someone else there with them, you fucking want someone else there with them.
System has just been abused, and the outrageous charges are outrageous obviously.
You know what I love doing when Iām in intense pain and am wondering if I should go to the ER? Figuring out if my insurer will deem it a necessary visit or not with 10s or 100s of thousands of dollars on the line if Iām wrong.
This is one of two ways that health care insurance companies are trying to fuck over ER doctors.
Itās pretty interesting from an outsiderās perspective (which thankfully is my perspective in this). Thereās two main battles going on between EM physicians and insurance companies.
- Is above. ER doctors are tasked with ruling out an emergency and liable if they donāt, then donāt get paid if they do rule people out. Thatās utter bullshit.
- Surprise billing laws. This is more of a gray area. Thereās more than a few EM groups that fuck over people by contracting with no insurance companies. This means that even if you go to an āin-networkā hospital, the ER physician isnāt in-network, and will balance bill your ass. The exact particulars of these kind of laws are important though, as if you overdo it, youāre letting the insurer set prices for everything.
Pay is a super touchy issue for ER doctors, who generally have gotten brutally fucked over pay wise since the pandemic started.
And by design. That form is basically a freeroll and probably looks like this to most people:
Maybe one of these is an unmarked self-destruct button. Choose wisely.
What % do we think are signing that form? It has to be a non-trivial number.
Why would hospitals allow billable staff members to be assigned to procedures if they arenāt in the patientās network?
The average ER physician salary according to Google is 250k-350k/year - is that what you mean when you say this? Has their pay been cut during the pandemic or something?
It depends on the exact setup, but most of the time the ER isnāt staffed by hospital employees, and are instead staffed by EM physician groups that are third parties. Thatās why youāll frequently (but not always) receive a bill from a hospital and a physician group when you go to an ER.
The amount of people going to the ER plummeted with the pandemic. This resulted in hours being slashed, which increased supply of labor, which resulted in salaries dropping. Itās been slow to rebound.
Thereās also a midlevel issue (NPs, PAs) that have creeped into more ER jobs.
āpeople love their private insuranceā
Walmartās version of the lifesaving drug is largely identical to insulins sold by the others. Itās a so-called analog insulin, meaning itās the most effective, fastest-acting version, not some older formulation that doesnāt work as well.
Which raises a few questions. Such as, if Walmart can profitably sell insulin at a fraction of current prices, why hasnāt anyone else done so before now?
Alarmingly, some people with diabetes have been forced to ration their insulin doses, placing them at risk of medical complications and even death.
A 2019 study by the Centers for Disease Control and Prevention found that almost 1 in 7 of U.S. adults with diabetes werenāt using insulin as prescribed by their doctors because of the high cost.
But with a handful of companies now cornering the insulin market, he said, āit may take a chiseler like Walmart to break the gentlemanās agreement.ā
FFFFFUUUUU - itās called collusion. The fact that we canāt fix such an egregious and impactful price-fixing scam at the federal level is so disheartening. It has to be complete and total regulatory capture by the drug industry.
Several weeks ago I received a letter from insurance stating that the pharmacy benefits manager for my plan had changed and that I should present the new card beginning mid-July. From there, things have transpired about as I expected: I arrive at pharmacy and get rung up for an exorbitant amount Iām not paying. Tech checks it, says new plan requires brand name (seems odd?), refills it, still denied because new PA required, faxes doctor for PA, office says 3-5 biz ETA which > meds on hand. Itās clear to me at that point (Friday) I should negotiate cash price because PA might be denied, and sure enough I received that denial today. So now itās appeal / letter of medical necessity territory which is more hoop jumping, more friction by design for something Iāve been taking with routine PA renewals for the last 5 years.
Ultimately it shouldnāt be a problem for me even if the appeal is denied. Using Rx coupon sites reduces the cash price to something affordable, but I know that isnāt the case for everyone. Also, the āSurprise! Fuck you!ā factor of finding out only when you make your routine stop at the pharmacy is really enraging. Insurer knows exactly which Rx Iām on and that itās not possible to have enough surplus on hand to wait out an appeal process. By induction, I assumed that this hot tactic must be on the rise which I confirmed within seconds:
https://www.consumerreports.org/prescription-drugs/when-your-insurer-drops-your-prescription-drug/
Every month for several years, April Flowers filled her 14-year-old daughterās prescription for antiseizure medication expecting to pay nothing once she met her deductible. Then just before Christmas in 2019, her Walgreens pharmacist had shocking news: Her out-of-pocket cost had gone upāto $1,700.
The American Medical Association, which represents doctors, has described midyear formulary changes as a bait and switch. Consumers chose their plan ābecause their drugs were going to be covered and affordable,ā the association said as part of a recent campaign critical of PBMsā role in setting prescription drug availability.