Re: Be afraid, be very afraid Health Info

[David Farber <dave () farber net>]

Begin forwarded message:

From: "Ronald J Riley \(RJR Com\)" <rjr () rjriley com>
Date: April 7, 2009 1:20:47 PM EDT
To: <dave () farber net>
Subject: RE: [IP] Re:   Be afraid, be very afraid Health Info

There is also the problem of medical service providers constantly  
sending
inflated bills.  I spent a year going back and forth with one provider  
who
was invoicing me $100 for (insurance paid other items ok) a service  
which
was covered by the insurance policy.  They claimed that the insurance
company rejected the charges, while in fact the service provider had not
properly billed the item.  I eventually got it cleared up, and it  
turned out
that the contract allowed a bit over twenty dollars for the service in
question.

When I pointed out the discrepancy between the allowed amount and the  
billed
amount the service provider rationalized that it was reasonable to  
bill the
$100 even though they knew that I was covered by that policy.

It seems to me that this kind of overbilling is rampant in the current
system.

Ronald J Riley

-----Original Message-----
From: David Farber [mailto:dave () farber net]
Sent: Tuesday, April 07, 2009 10:12 AM
To: ip
Subject: [IP] Re: Be afraid, be very afraid Health Info



Begin forwarded message:

From: Karl Auerbach <karl () cavebear com>
Date: April 7, 2009 9:52:32 AM EDT
To: "David P. Reed" <dpreed () reed com>, dave () farber net
Subject: Re: [IP] Re:    Be afraid, be very afraid Health Info

David P. Reed wrote:
> Karl - the idea you propose is a standard that could be used to
> organize many of the activities being proposed to make health care
> affordable.  Call it "single estimate, single bill" - analogous to
> single payer - and it has a nice "bipartisan" political soundbite to
> it.
> It's far from "shovel ready" though.  To achieve that goal requires
> nothing less than a vast restructuring of the entire health economy
> - all of its institutions.  Perhaps we could have the ribbon cutting
> in one year, and the new structure would be complete in 2025.

Thanks for the additional information about the gordian knot aspect of
the entrenched system.

I do kinda like your phrase "single estimate, single bill".

Unlike medical records unification the job of giving consumers better
estimates and better bills does not need to wait for a national
unification of standards and formats and protocols.  Rather we can
begin with a simple requirement, much like that in the Fair Credit
Reporting Act, that demands that health care providers give reasonably
complete estimates beforehand and bills afterwords, letting the
providers work out the details for their own systems.

Then we can see how well that works and if not we would have more
information and could do focused corrective legislation.

For example if after providers have had a chance to create usable
estimates and bills we find that consumers can't do cross-provider
comparisons, then we can start to deal with that particular issue,
which is one that would require national standards for representing
information.

> That contracting structure has a life of its own.  It cannot be
> destroyed by a tiny uprising of citizens with shovels attacking Dr.
> Frankenstein.

I'm not sure that this uprising would necessarily be tiny.

One thing that is in auto repair estimates that I think we can drop
from medical ones is this: the saving and delivery of removed parts.

                --karl--




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