Insurance “adjustments”

[doggieandsam 765]

oh man, don't even get me started on this one! i knew before coming to the US that healthcare was very expensive here, but i also kind of expected a level of service and attention that is more or less proportional to the expense. oh, how wrong i was. our family GP charges $150 per visit - sometimes she spends time with me discussing my issues and then sometimes, she just says hi and is already by the door before i even finishes my first sentence! i went for a routine ultrasound, got charged something like $2000, insurance adjusted 75% and my final out of pocket was $500. why, why do they do this? why don't they just simplify it? the simpler the process, the less people they have to employ, and the faster they get their payment. makes sense to me. my poor husband has tried to explain to me the intricacies (i say, evil greed) of the US healthcare industry many times and i still don't get it.

[-Trinity- 513]

7 hours ago, Bill & Katya said:

You can say the same thing about a dentist office.  Way back when (1970s) our dentist had one receptionist and no assistant.  Now, I go to the dentist, and there are 2-3 assistants, 2-3 hygienists, a receptionist, a billing clerk and a business manager.   

Health care business is a money machine. 

[-Trinity- 513]

32 minutes ago, doggieandsam said:

oh man, don't even get me started on this one! i knew before coming to the US that healthcare was very expensive here, but i also kind of expected a level of service and attention that is more or less proportional to the expense. oh, how wrong i was. our family GP charges $150 per visit - sometimes she spends time with me discussing my issues and then sometimes, she just says hi and is already by the door before i even finishes my first sentence! i went for a routine ultrasound, got charged something like $2000, insurance adjusted 75% and my final out of pocket was $500. why, why do they do this? why don't they just simplify it? the simpler the process, the less people they have to employ, and the faster they get their payment. makes sense to me. my poor husband has tried to explain to me the intricacies (i say, evil greed) of the US healthcare industry many times and i still don't get it.

Me neither, I'm to the point that I don't even go to the doctor cause it's just traumatic, especially after receiving the Bill lol.

 

But you're right, service is horrible. Not everywhere, cause some doctors actually try to work with you. But I don't even have a GP right now cause it's....just horrible. Sigh...

[Voice of Reason 10,298]

26 minutes ago, -Trinity- said:

Health care business is a money machine. 

Troof.  And We the People have to pay, either way.

[TBoneTX 45,962]

There's also something to be said for walking into a pharmacy and getting almost anything one wants.

E.g., it can really help to have a home supply of antibiotics to nuke illnesses before they start, and before one can visit the doc.

[Boiler 45,956]

5 hours ago, TBoneTX said:

There's also something to be said for walking into a pharmacy and getting almost anything one wants.

E.g., it can really help to have a home supply of antibiotics to nuke illnesses before they start, and before one can visit the doc.

I am going to disagree with this but I understand why in the US it is done.

 

Let me see if I can find a recent article.

[Cyberfx1024 7,980]

6 hours ago, TBoneTX said:

There's also something to be said for walking into a pharmacy and getting almost anything one wants.

E.g., it can really help to have a home supply of antibiotics to nuke illnesses before they start, and before one can visit the doc.

You know a lot of Preppers use Fish Antibiotics because it's basically the same thing without a prescription.

 

 

http://www.prepper-resources.com/fish-antibiotics-in-your-medical-stockpile/

[Cyberfx1024 7,980]

17 hours ago, doggieandsam said:

oh man, don't even get me started on this one! i knew before coming to the US that healthcare was very expensive here, but i also kind of expected a level of service and attention that is more or less proportional to the expense. oh, how wrong i was. our family GP charges $150 per visit - sometimes she spends time with me discussing my issues and then sometimes, she just says hi and is already by the door before i even finishes my first sentence! i went for a routine ultrasound, got charged something like $2000, insurance adjusted 75% and my final out of pocket was $500. why, why do they do this? why don't they just simplify it? the simpler the process, the less people they have to employ, and the faster they get their payment. makes sense to me. my poor husband has tried to explain to me the intricacies (i say, evil greed) of the US healthcare industry many times and i still don't get it.

This is why that I am glad I am rated 100% by the VA. They(VA) pay for insurance for my family called ChampVA which in all honesty is not a good primary insurance to have at all, it is more like a last resort if it's your primary. But as a secondary insurance they are really good because they pay for a majority of our out of pocket expenses that my primary insurance gave us to pay the left over amount. So I am happy in that regard. I don't bother them for the simple stuff like small copays but I did use them for my baby's helmet she had to wear. We were billed $4k for the helmet and my primary picked up $2500 of that expense and ChampVA picked up the remaining $1500 out of pocket expense that we would have had to pay.

[yuna628 9,700]

6 hours ago, TBoneTX said:

There's also something to be said for walking into a pharmacy and getting almost anything one wants.

E.g., it can really help to have a home supply of antibiotics to nuke illnesses before they start, and before one can visit the doc.

Antibiotic abuse is a problem that is leading to more serious illnesses. In addition it really should be up to a doctor to determine which antibiotic would work best for an illness. Antibiotics won't do anything for a cold or flu and even if you have bacteria in your system certain antibiotics won't be as effective. Many have conditioned themselves to thinking it's just a simple drug to take with no consequences on the body. But studies show in some cases, it's little better than a placebo. And what about cross reactions? I went to one doctor that decided to try a newer antibiotic on me, it made me so sick and allergic, I now not only can never take that antibiotic again, I cannot take antibiotics that used to give me no harmful effect because it may cause a cross reaction. That has left me with limited antibiotic options for treatment.

[Boiler 45,956]

Global antibiotic overuse is like a ‘slow motion train wreck’

 

Deadly antibiotic resistance is predicted to eclipse the number of people affected by cancer by 2050, and one of the biggest causes is overuse. A new study out Monday found the use of antibiotics worldwide has increased 65 percent in 15 years. Science correspondent Miles O'Brien joins Lisa Desjardins to discuss the latest research into the growing crisis.

 

https://www.pbs.org/newshour/show/global-antibiotic-overuse-is-like-a-slow-motion-train-wreck

[doggieandsam 765]

46 minutes ago, cyberfx1024 said:

This is why that I am glad I am rated 100% by the VA. They(VA) pay for insurance for my family called ChampVA which in all honesty is not a good primary insurance to have at all, it is more like a last resort if it's your primary. But as a secondary insurance they are really good because they pay for a majority of our out of pocket expenses that my primary insurance gave us to pay the left over amount. So I am happy in that regard. I don't bother them for the simple stuff like small copays but I did use them for my baby's helmet she had to wear. We were billed $4k for the helmet and my primary picked up $2500 of that expense and ChampVA picked up the remaining $1500 out of pocket expense that we would have had to pay.

that is a really good set-up. i was used to zero or very little fixed copays (AED 50 / US$ 15 max) for doctor's visits (GP and specialists alike) in Dubai so the co-pays here hurts.

[Voice of Reason 10,298]

2 hours ago, cyberfx1024 said:

This is why that I am glad I am rated 100% by the VA. They(VA) pay for insurance for my family called ChampVA which in all honesty is not a good primary insurance to have at all, it is more like a last resort if it's your primary. But as a secondary insurance they are really good because they pay for a majority of our out of pocket expenses that my primary insurance gave us to pay the left over amount. So I am happy in that regard. I don't bother them for the simple stuff like small copays but I did use them for my baby's helmet she had to wear. We were billed $4k for the helmet and my primary picked up $2500 of that expense and ChampVA picked up the remaining $1500 out of pocket expense that we would have had to pay.

Not trying to get into your business, but why don't you have Tricare instead of CHAMPVA?  Feel free to PM me if you'd rather.

[Cyberfx1024 7,980]

28 minutes ago, IDWAF said:

Not trying to get into your business, but why don't you have Tricare instead of CHAMPVA?  Feel free to PM me if you'd rather.

It's ok, I am not bothered by answering questions like that. You can only receive Tricare if you were either Retired from the military or Medically Retired from the Military. I was not medically retired from the Marines at all and I was only in 8 years so I could not do regular retirement which needs at least 15 years before you can retire.

 

I am looking into since I am now rated 100% by the VA if I can go back and see if they will retroactively medically retire me. I have heard of it happening before but I think I will have to involve a lawyer to help me file for that. That way I could get Tricare, and other benefits that being retired from the military gets you.

[Neonred 3,632]

On 3/29/2018 at 9:47 AM, Bill & Katya said:

You can say the same thing about a dentist office.  Way back when (1970s) our dentist had one receptionist and no assistant.  Now, I go to the dentist, and there are 2-3 assistants, 2-3 hygienists, a receptionist, a billing clerk and a business manager.   

Yes,I see that more and more.  In my office it's me, my wife that is the receptionist/billing clerk/business manager/insurance person, one assistant and one full time and one part time hygienist.  Very similar to the way my father practiced.  Sure, my gross is not nearly as impressive as many other offices.  My overhead is shockingly low.  Bottom line is that what I make in the end is nearly the same, with much less stress.  My daughter is just finishing a pediatric dental residency and it will be interesting to see which way she decides to set up her practice.

 

I am often shocked to learn just how high the overhead is in some practices.  I have a friend in town that is an oral surgeon in a solo practice.  He has 7 or 8 women that work for him.  I just cannot imagine...

 

 

 

 

[TBoneTX 45,962]

6 hours ago, Neonred said:

He has 7 or 8 women that work for him.  I just cannot imagine...

Cute blondes, perhaps?

 

The psychiatrist was interviewing candidates to be his secretary.  He chose one interview question to ask each.

"What is 2 and 2?" he asked.

"Four," said the first girl.

"Twenty-two," said the second.

"It could be 4, or it could be 22," said the third.

So which one did the psychiatrist hire?  The prettiest one, of course!