Failed ObamaCare co-ops have not repaid $1.2B in federal loans...

[doctorjj]

If half of the co-op's are that far off in debt, how are the other half of them doing? I doubt they are doing great.

I'd bet big money the failed ones with big loans that they will never pay are owned by connected people. Anyone want to take that bet??? LMAO!

 

[Dave70968]

I would be very interested to know if the providers can take the "discounts" as losses for tax purposes.

 

[Shootin 4 Fun]

Providers are essentially forced to play this stupid game. If they just said, okay, we charge $10,000 but you only pay $1,000, so how about let's just charge $1,000, then the insurance companies would say great, so since you charge only $1,000 we are gonna pay you $100. It's a ridiculous game. Believe me, I would much rather charge way less and just deal with cash or payment up front. I pay one girl, full time, to essential jack around with insurance companies. Trying to get approvals.

I honestly believe that you are being forced to play a stupid game, but most insurance companies have agreements with larger providers that they insurance will pay 5%-10% above what Medicare pays. Seems like such a waste of time and burden on everyone involved.

 

[rapidsequence]

I honestly believe that you are being forced to play a stupid game, but most insurance companies have agreements with larger providers that they insurance will pay 5%-10% above what Medicare pays. Seems like such a waste of time and burden on everyone involved.

insurance companies have contracts (your word: agreements) with providers period. large or small. for example, BCBS contracts w providers who wish to see BCBS patients that the provider will accept what they pay, which is typically a little more than MC. different specialties are reimbursed at a different rates, but doctorjj is correct...the charges and actual costs are vastly different, but the discrepancy is almost necessary for survival of the practice. and yes, it is a burden and a huge waste of time.

www.turntablehealth.com is finding a way to deliver needed care and get the crap out of the way.

 

[dennishoddy]

insurance companies have contracts (your word: agreements) with providers period. large or small. for example, BCBS contracts w providers who wish to see BCBS patients that the provider will accept what they pay, which is typically a little more than MC. different specialties are reimbursed at a different rates, but doctorjj is correct...the charges and actual costs are vastly different, but the discrepancy is almost necessary for survival of the practice. and yes, it is a burden and a huge waste of time.

www.turntablehealth.com is finding a way to deliver needed care and get the crap out of the way.

Isn't there a place in OKC that has a similar program, where there is a set price for procedures, no insurance accepted? I looked at them one time, and thought that might be the answer to the ever increasing health care costs.

 

[tRidiot]

I would be very interested to know if the providers can take the "discounts" as losses for tax purposes.

No, they can't. The only losses they can claim are for donated or indigent services provided.

I honestly believe that you are being forced to play a stupid game, but most insurance companies have agreements with larger providers that they insurance will pay 5%-10% above what Medicare pays. Seems like such a waste of time and burden on everyone involved.

Indeed. It's ridiculous and I GUARANTEE you that providers do not want charges to be that much.

Here's why "private pay" costs are so high...

Providers negotiate with insurance companies for payment, Medicare determines on their own what they will pay. No matter WHAT is billed, ok? Ok. Bill $10,000 for an aspirin, it doesn't matter, they're only going to pay $0.10 for it. Ok. Same with insurance providers.

Now... for private payers...

It is ILLEGAL for someone to bill less for a private individual who is paying out of pocket than they bill Medicare. As in, lose everything to fines and penalties, possibly go to jail. So... if Medicare has agreed to pay $2,000 for a specific surgery or procedure, you cannot bill the private-paying patient less than $2,000. Sounds simple enough, right? Ok... but... what you have to think about is that in all honesty, a very large portion of those patients are not going to end up paying that bill. So, what do you do when you have to provide a service to everyone, but only a few people actually pay their bill? Well, you have to pass the cost on to the people who are actually paying. You can't spread that cost out over Medicare and insured people, because Medicare doesn't give a schitt and will only pay what they determine, and you have negotiated contracts with insurers as to what they are going to pay... and they sure aren't going to negotiate higher payouts in good faith to pay for those who have no insurance and in addition are not going to pay their own bills. So who gets that "spread out" cost? Well, the population who is uninsured and paying out of pocket and actually paying their bills.

Now.... we can raise the cost to those patients who are actually paying out of pocket to offset unpaid costs and bills... BUT... remember, you can't bill them more than you bill Medicare or insurance. So how can you do this? Well, you bill Medicare and insurance more on paper, knowing full well that you aren't going to get it. Doesn't matter. Bill it however you want, but you have to be consistent in your billing.


So... now EVERYONE'S bill has gone up, but you're getting your approved reimbursement from Medicare and your contract rates from insurers, deadbeats aren't paying their part, so nothing's changed there, but the responsible patients who are uninsured but trying to pay their own way are stuck out in the cold with the high bill. So, if you are a private payer, you go in to the provider and you negotiate a cash discount for paying in full, up front. NOT a lower bill, a CASH DISCOUNT. That is allowed, but you are NOT allowed to bill less. It's the law.

So, private payers still end up paying more than Medicare, usually, but not the whole bill, if they can afford to pay it up front. Of course, they will sometimes put you on a payment plan, but just like payday loan companies and pay-by-the-week car lots, they know there are going to be a lot of dropouts and collections that will get sold for pennies on the dollar, etc. Collection costs, extra billing and accounting staff and costs, etc. It all adds to the final total that eventually gets written off.

It's the unfortunate way they've been forced to distribute the costs. It doesn't explain EVERYTHING, but it does explain the mentality of how this started and then think about how things spiral out of control. Then, add in the entitlement mentality of all the people who abuse the system and think they deserve everything for free and it's dictated that you provide it for them... you can see what happens.

Yes, it's a broken, messed-up, ******** system. And if you think your providers are happy about it, you're wrong. Very few are. Personally, I'd rather drop it all and start a fecking botox/dermabrasion clinic and get paid cash up front from every patient and never deal with Medicare, insurance, hospitals or anything else. NOT because I'm in it strictly for the money OR because that's the kind of medicine I want to practice - it's not! But because of all the BS, the field has become a misery, in general. As it is, I'm just looking for a way to pay my debt off and flip the whole industry the bird on the way out. Once nobody can find a doctor anymore, they might decide something needs to be done to reform the system. I'm all for it.

 

[Shootin 4 Fun]

insurance companies have contracts (your word: agreements) with providers period. large or small. for example, BCBS contracts w providers who wish to see BCBS patients that the provider will accept what they pay, which is typically a little more than MC. different specialties are reimbursed at a different rates, but doctorjj is correct...the charges and actual costs are vastly different, but the discrepancy is almost necessary for survival of the practice. and yes, it is a burden and a huge waste of time.

www.turntablehealth.com is finding a way to deliver needed care and get the crap out of the way.

My wife's employer contracts with a clinic by the name of CareATC in Tulsa that all employees and insured family can visit with no out of pocket expense to the insured, and they offer many common medications at no cost to the insured. According to my wife, the clinic program has had a dramatic impact on the company's insurance expense and the employees love the benefits. She's telling me as I type that additional benefits include no cost to insured blood work, xrays and she thinks a MRI machine.

 

[Shootin 4 Fun]

No, they can't. The only losses they can claim are for donated or indigent services provided.



Indeed. It's ridiculous and I GUARANTEE you that providers do not want charges to be that much.

Here's why "private pay" costs are so high...

Providers negotiate with insurance companies for payment, Medicare determines on their own what they will pay. No matter WHAT is billed, ok? Ok. Bill $10,000 for an aspirin, it doesn't matter, they're only going to pay $0.10 for it. Ok. Same with insurance providers.

Now... for private payers...

It is ILLEGAL for someone to bill less for a private individual who is paying out of pocket than they bill Medicare. As in, lose everything to fines and penalties, possibly go to jail. So... if Medicare has agreed to pay $2,000 for a specific surgery or procedure, you cannot bill the private-paying patient less than $2,000. Sounds simple enough, right? Ok... but... what you have to think about is that in all honesty, a very large portion of those patients are not going to end up paying that bill. So, what do you do when you have to provide a service to everyone, but only a few people actually pay their bill? Well, you have to pass the cost on to the people who are actually paying. You can't spread that cost out over Medicare and insured people, because Medicare doesn't give a schitt and will only pay what they determine, and you have negotiated contracts with insurers as to what they are going to pay... and they sure aren't going to negotiate higher payouts in good faith to pay for those who have no insurance and in addition are not going to pay their own bills. So who gets that "spread out" cost? Well, the population who is uninsured and paying out of pocket and actually paying their bills.

Now.... we can raise the cost to those patients who are actually paying out of pocket to offset unpaid costs and bills... BUT... remember, you can't bill them more than you bill Medicare or insurance. So how can you do this? Well, you bill Medicare and insurance more on paper, knowing full well that you aren't going to get it. Doesn't matter. Bill it however you want, but you have to be consistent in your billing.


So... now EVERYONE'S bill has gone up, but you're getting your approved reimbursement from Medicare and your contract rates from insurers, deadbeats aren't paying their part, so nothing's changed there, but the responsible patients who are uninsured but trying to pay their own way are stuck out in the cold with the high bill. So, if you are a private payer, you go in to the provider and you negotiate a cash discount for paying in full, up front. NOT a lower bill, a CASH DISCOUNT. That is allowed, but you are NOT allowed to bill less. It's the law.

So, private payers still end up paying more than Medicare, usually, but not the whole bill, if they can afford to pay it up front. Of course, they will sometimes put you on a payment plan, but just like payday loan companies and pay-by-the-week car lots, they know there are going to be a lot of dropouts and collections that will get sold for pennies on the dollar, etc. Collection costs, extra billing and accounting staff and costs, etc. It all adds to the final total that eventually gets written off.

It's the unfortunate way they've been forced to distribute the costs. It doesn't explain EVERYTHING, but it does explain the mentality of how this started and then think about how things spiral out of control. Then, add in the entitlement mentality of all the people who abuse the system and think they deserve everything for free and it's dictated that you provide it for them... you can see what happens.

Yes, it's a broken, messed-up, ******** system. And if you think your providers are happy about it, you're wrong. Very few are. Personally, I'd rather drop it all and start a fecking botox/dermabrasion clinic and get paid cash up front from every patient and never deal with Medicare, insurance, hospitals or anything else. NOT because I'm in it strictly for the money OR because that's the kind of medicine I want to practice - it's not! But because of all the BS, the field has become a misery, in general. As it is, I'm just looking for a way to pay my debt off and flip the whole industry the bird on the way out. Once nobody can find a doctor anymore, they might decide something needs to be done to reform the system. I'm all for it.

What a fawking mess.....

 

[dennishoddy]

No, they can't. The only losses they can claim are for donated or indigent services provided.



Indeed. It's ridiculous and I GUARANTEE you that providers do not want charges to be that much.

Here's why "private pay" costs are so high...

Providers negotiate with insurance companies for payment, Medicare determines on their own what they will pay. No matter WHAT is billed, ok? Ok. Bill $10,000 for an aspirin, it doesn't matter, they're only going to pay $0.10 for it. Ok. Same with insurance providers.

Now... for private payers...

It is ILLEGAL for someone to bill less for a private individual who is paying out of pocket than they bill Medicare. As in, lose everything to fines and penalties, possibly go to jail. So... if Medicare has agreed to pay $2,000 for a specific surgery or procedure, you cannot bill the private-paying patient less than $2,000. Sounds simple enough, right? Ok... but... what you have to think about is that in all honesty, a very large portion of those patients are not going to end up paying that bill. So, what do you do when you have to provide a service to everyone, but only a few people actually pay their bill? Well, you have to pass the cost on to the people who are actually paying. You can't spread that cost out over Medicare and insured people, because Medicare doesn't give a schitt and will only pay what they determine, and you have negotiated contracts with insurers as to what they are going to pay... and they sure aren't going to negotiate higher payouts in good faith to pay for those who have no insurance and in addition are not going to pay their own bills. So who gets that "spread out" cost? Well, the population who is uninsured and paying out of pocket and actually paying their bills.

Now.... we can raise the cost to those patients who are actually paying out of pocket to offset unpaid costs and bills... BUT... remember, you can't bill them more than you bill Medicare or insurance. So how can you do this? Well, you bill Medicare and insurance more on paper, knowing full well that you aren't going to get it. Doesn't matter. Bill it however you want, but you have to be consistent in your billing.


So... now EVERYONE'S bill has gone up, but you're getting your approved reimbursement from Medicare and your contract rates from insurers, deadbeats aren't paying their part, so nothing's changed there, but the responsible patients who are uninsured but trying to pay their own way are stuck out in the cold with the high bill. So, if you are a private payer, you go in to the provider and you negotiate a cash discount for paying in full, up front. NOT a lower bill, a CASH DISCOUNT. That is allowed, but you are NOT allowed to bill less. It's the law.

So, private payers still end up paying more than Medicare, usually, but not the whole bill, if they can afford to pay it up front. Of course, they will sometimes put you on a payment plan, but just like payday loan companies and pay-by-the-week car lots, they know there are going to be a lot of dropouts and collections that will get sold for pennies on the dollar, etc. Collection costs, extra billing and accounting staff and costs, etc. It all adds to the final total that eventually gets written off.

It's the unfortunate way they've been forced to distribute the costs. It doesn't explain EVERYTHING, but it does explain the mentality of how this started and then think about how things spiral out of control. Then, add in the entitlement mentality of all the people who abuse the system and think they deserve everything for free and it's dictated that you provide it for them... you can see what happens.

Yes, it's a broken, messed-up, ******** system. And if you think your providers are happy about it, you're wrong. Very few are. Personally, I'd rather drop it all and start a fecking botox/dermabrasion clinic and get paid cash up front from every patient and never deal with Medicare, insurance, hospitals or anything else. NOT because I'm in it strictly for the money OR because that's the kind of medicine I want to practice - it's not! But because of all the BS, the field has become a misery, in general. As it is, I'm just looking for a way to pay my debt off and flip the whole industry the bird on the way out. Once nobody can find a doctor anymore, they might decide something needs to be done to reform the system. I'm all for it.

Great Write up. Explains a lot. Thanks for putting in the time to do that.

 

[Biggsly]

Which is why people familiar with the industry wanted real reform. Instead we were all forced to buy into the broken system.

This.