If this EO happens, this could give insurance companies 100% unilateral control of hospital/surgery center/imaging center/ etc reimbursement rates. We would then essentially have one universal reimbursement rate (it would be the same as Medicare). In a nut shell, this is the backdoor to socialized medicine/universal health care

I'm not sure I buy this. You would have to have insurance. Not really universal. And I dont think you are required to accept insurance or Medicare are you?

Currently, a hospital or other medical facility can completely opt out of Medicare (Forest Park model) and be 10O% out of network.
This EO might change that.

If you remove the option to go out of network, you have no leverage when negotiating with insurance companies
They set the rates universally the same as Medicare.
The last four years we were hoping that health insurance companies would have less control. This gives them all of it.

The hospital and providers that do and have done this brought this on themselves. If they are permitted to practice at a particular hospital they should accept the same plans as that hospital. They have gotten away with this forever and the hospitals are complicit in it. I say there is no defense since no one in the business has moved to disclose this plainly to unsuspecting patients. As for the Forest Park model, they went out of business and many people went to jail. Next up, truth in pricing, give everyone not just insurance companies your charge schedule.

I hear what you are saying and would agree if the medical provider could provide a menu with a price list. McDonalds has one, the Ferrari dealership has one, you build a house you know the cost, you buy shoes they have a price tag, but for some reason the medical business doesnt find this important. For elective surgery they have a price list also. Is there some reason doctors and hospitals dont want to post prices for services?

I’ve been asking this same thing since I became an adult. My son busted his chin and had to get stictches two months ago. My daughter broke her arm a month ago. Both went to ER and I asked what the bill was going to be. No one could tell me just said wait and we’ll mail it to you.

When people rail about socialized medicine, my response is, "We already have it. The insurance companies are the socialists."

It's not a conversation they want to have and I have real questions about why.

One of the biggest problems is it's all 3rd party pay.

I can’t speak for other doctors, but my fee schedule is determined by negotiated in network rates that are provided to the patient

Forest Park went out of business due to Federal violations; there are plenty of other 100% out of network medical facilities and providers. Most psychiatrists, for example, are 100% out of network.

I can hire a contractor to build a restaurant and get a bid schedule turn key for 30 different subs and a hospital cant tell you the cost of getting your tonsils taken out day surgery.

The Health Insurance companies in fine print state that approval for the procedure does not guarantee payment....and if you do get reimbursed 30-60 days later, the amount may not be a reflection of the negotiated price.

Why doesn't pre approval guarantee payment? A few months ago, I spent two weeks jumping through hoops to get pre authorization, only to have them deny the claim anyway. I have a hard time understanding how socialized medicine would be worse.

Under socialism where everything is free, there isn’t anything to be had.

It is telling the blurb was sent out by anesthesiologists as they are the biggest participants in SURPRISE!!! got cha Billings.

The re-imbursement game was changing long before Obamacare.
When medical providers started adjusting the charges to make up for the reduced percentage amount reimbursed , the cost game started to spiral upward.
Insurance companies and their network providers manipulate the contracted rates, Provider gets 70-80% of contracted rate from X and the "consumer patient" pays the 20-30% . As the fee structure increased so did patient responsibility.

The consumer got left out of establishing the fee structure, the "Premium" game went crazy when Insurance companies tried to offset losses.

I would think the laundry list of lab work and tests has to be up there on the list. Every year I have the same conversation when I get physical regarding only the tests that are covered and invariably I get a bill for three or four more test the insurance company deemed unneeded and I end up with a bill from a lab bigger than everything else. This is not by accident. By the way dentists and orthodontist tell you right up front usually. I know exactly what I was spending to the nickle when both my kids got braces.

There are certainly some issues with out of network. The out of network ambulance or helicopter ride to the hospital comes to mind.

Ah yes ...... Negotiated rate...........consumer was not included.


Looks to me the Executive Order is for the scenario of honest folks not being balance billed from an ER doctor who declined to participate but DID agree to work at the hospital ER that is IN-Network because I delayed seeking immediate care to check the BCBS provider list. My focus on my injured child didn't allow me to see the "NOT In-Network" designation on his name tag. The EOB from BCBS was nice enough to put a note that I could contact the TDI about questionable billing charges.

I'd vote for just about anything that would bring transparency to medical costs, you can call that socialist if you'd like. This price gouging has gone on for way too long.

Yep
I am hard core conservative, but I would vote for single payer or government ran if it forced doctors and hospitals into bidding wars. Pharma also needs to be cut off at the knees. 7 11 needs to sell my drugs, prescription free

I will never vote for single payer or government-run healthcare. It’s too expensive, it will lead to higher taxes, it will lead to poorer care and less advancement, and it’s not a function of the government that needs to be added, out of principle.

There are other ways to lower the cost of healthcare. Adding more government to an issue government created is not the answer.

We already have a government run health care system with the VA
It works only if you are healthy requiring preventative care and a yearly check up
Government run anything (except tax collection and military) is slow, monetarily inefficient, bureaucratic, out dated, and low quality.

Do you ever wonder why insurance companies don't negotiate a better deal with hospitals, pharma, medical device companies and docs? If you were restricted to 20% of the pie and wanted more pie what would you do?

That industry was a mess before Obama. I have very little confidence it will do anything except get worse.

My opinion is that people need to have insurance for catastrophic events. Everything else should be out of pocket. That cuts insurance out of a lot of it. It also will force doctors to act like other businesses where they need to quote prices. Too many folks, me included, don’t worry about it because insurance is involved. It’s a terrible system, and has been for a long time. There is a lot of blame to go around.

The guy at WellCare looks a little suspect. Must’ve hit the pub prior to the photo.

I say it would be this...[img]https://texasfishingforum.com/forum...ae5e440_5c17_4342_aa18_350e849dcae8.jpeg[/img

The government is the answer. There is no other way.

Bingo

It’s not hard.... “Your XXXXX is busted. I can do this for $458 or I can fix it for good for $973. Here are the risks and benefits of both or you can choose neither. Pay the lady up front and we will get started or go do the discount place down the road.”

This is the first time in history the dentists have been the example to follow. Yea, us!

P.S. Don’t listen to WAWI.... He hasn’t set foot into a dental office since 1978!

Single payer will just create more corruption in the already screwed up system.

Medicare and insurance companies are partners with the medical fields. They basically serve as the collection agency and in this case unlike most others they are collecting up front. What's screwed up is the pricing is not determined up front or even between the customer and provider. It set by the collection agency and the provider. They have managed to create a large pot of money and the only thing you really see is a push pull between the 2. The customer is not in the conversation. There is a similar situation between other types of insurance and lawyers. Dental and orthodontics show a more realistic number because typically the dental coverage is much lower so the customer has to be in the conversation for any significant services. But I flip burgers so what do I know.

And dont worry Doc. When I need that dental work I'm coming to you. Probably get you a new boat by the time you get done with my mouth lol.

Surprise Billing should be illegal, unless the patient can agree to the charge(s) before treatment. Then it is no longer a surprise. I remember getting bills from ER physicians and anesthesiologists who where out of network. Was never told, just got a bill for hundred's of dollars after insurance had paid.

This is true - dentists are just about the only office you can call and get a straight answer on price.

I'm not sure why other offices struggle with it so much. I think it has much less to do with the doctors or office staff and much more to do with corporate policies that intend to gouge consumers. Government is absolutely not the answer, but there has to be some way to put more transparency into it. It seems to me that the large companies know their time is limited and they'd rather milk the cow for all she's worth for a few more years and then hand it over to the government than try to be fair and push off socialized medicine for another few decades.

Pre-Covid, the medical industry was spending a half a billion dollars a year on lobbying. Far and away the largest lobbying effort in history. This is what we describe as corruption in other countries, but call it legal here in America.

I’m just a pediatric dentist and I performed most of my procedures while patient was under general anesthesia. The patients, depending on their insurance would pay anywhere from $0 to $3500 for the OR room. They would know beforehand what the cost would be. My procedure cost would vary depending on what was found during the procedure but they’d be aware of any changes in the treatment based on the findings. Rarely were we ever surprised

And that's how it should be. In every other transaction you can imagine there is very close to 100 percent transparency yet it the medical field they fight it tooth and nail.

I would also second Dave's opinion on catastrophic policy. I'm under cobra currently and pay 24k a year for a family policy. I will be shopping hard for a 10k deductible where I pay 100 percent upto that point when my cobra runs out. In hindsight I wish I would have done this already.

I

That would be great but this is what I always had. it was 500mth for my family. I paid anything under 7k. Now that is pretty much how all policies work now but the cost is 1200 mth.
The way it works now when you get sick you spend all the wealth your family might have and then you beg for money on the internet. sad
Think about WAWI plan ,24k a year!!? That is outrageous and unsustainable. If you make 50-60k can you pay over 10K for insurance? not unless you live under a bridge.

When you say you are paying 500 a month are you self employed or is your employers paying the rest. Most full coverage plans I have seen with low deductibles cost in the range of what I pay. You have to add the employer portion to get the real cost. I'm self employed so I pay entire amount

Obama was elected largely on the promise of health care reform and made an effort to make it a bipartisan effort, which was a big mistake. As a result, the public option was scuttled which would have kept the insurance companies in line. As a result, insurance companies with well-funded lobbys took it over and slanted it to their benefit. Even though I'm on Medicare with no complaints compared to my pre-Medicare coverage and costs, I do realize the ordeals younger folks especially with families go through to get affordable, effective coverage. One of the reasons I will vote for the candidate who at least hints at pursuing a public option. This one of the most important issues to many citizens in this country. I am ready for action other than trying to ditch the old plan with no evidence, except for empty rhetoric, of a replacement after 4 years.

As a result of the bipartisan effort, the public option was scuttled, yet the plan received zero republican votes?

If that was the fix to all this, why didn't they add it back in since they didn't get any GOP votes anyway?

Answer: democrats don't have a %@##%*&(! clue how to fix anything in this country, including healthcare.

I will agree with you on one thing - Trump promised a replacement plan and came up completely empty. Totally unacceptable if he didn't actually have a plan. But at least he's tried to reign in drug costs, which has helped.

I was employed but this was 2007 and I paid my own insurance.

This^^^

Is Medicare Socialized Medicine???

How are Medicare hospital stay, surgeries, and doctor bills calculated?

I had the same experience, went to an "Approved IN Network ER" with what we thought was a hear attack. Two of the attending doctors were NOT in network at said in network ER and got the surprise bills from them. Found out later that both hospitals in town were in network but the insurance company preferred us to use the other one. When your ticker is messed up the extra few miles to the other hospital is not on your mind. Needless to say, I had the heart cath done at the preferred one later on once they thought they had it figured out.

It is weird how the charges work. My wife is not yet to Medicare and went to a “Doc in the Box” with bronchitis. She did not even see a physician but saw a PA. She had Aetna through TRS as a retired teacher. The office visit with a “PA” was $350! Of course Aetna wasnt gonna pay that so the patient gets hammered. As was mentioned before the medical profession has helped create this. My thought is that if Biden is elected his plan will be as bad or worse to push his left agenda.

And for you young Forum members out there dreaming of retirement- MEDICARE IS NOT FREE! My Part B is $144 a month and Supplement (Medigap) is up to $250. Part D medicine is $25. That being said I have never had a Copay going through doctors visits including testing as well as 2 Surgeries. Just a heads up.

The closest the USA has to Socialized Medicine is VA care. FYI, I have been getting great VA care for many years. Yes there have been problems. Had a bad Doc once. Filed a complaint, as many other patients did, and he no longer worked there. But overall, my health care (even appointment times) have been far better than when I was being seen by civilian Docs before I got into the VA system. I don't have to worry about cost. I have a medical problem, I just make an appointment or go into the urgent care/emergency room.

Theres no single problem or fix. Emit, you may be the exception for great VA care. All we ever hear is how bad it is. Anyway, it's a revolving door for docs and insurance companies. They both get to line each others pockets. The docs may get the short end of that deal but they still get paid. Bottom line is money over morals but that's a whole different topic. My thoughts are no network, no state borders for insurance, just total free market where prices have to be set and shown before the work is done. You have to get the insurance out of the position they are in with the upper hand and let the people get that back. The only way to do that and keep it a free market is with a true free market and competition. That and crack down like a bad @$$ on anybody that works together to fix prices or services

Free market and competition only works for larger cites for an industry like health care.

Proof?
Is this a theory?
Don't you think there are a huge number of doctors and nurses which would love to work in small towns.
Is there suddenly a logistics problem?
Can we not ship medical supplies to small cities.
This is BS

Where is the competition when you only have 1 County hospital and the closest other ones are in Cites 45 minutes or more away? You must not know how Free Market and Competition work. There actually has to be a market big enough to drive competition.

Hmm
Drive 45 miles or pay 10x the costs....
Seems like an easy decision.
Convince will always be a premium, but it doesn't mean monopoly

This EO is a political stunt for the election. It is essentially a rebranding of Obama Care.

Yup, you clearly don't understand living in Rural America nor how Free Market and Competition works. But you are like my dad was. He would drive 30 miles to save 2 cents per gallon for gas. It would cost him more to drive there and back, but he had his principle to live by.

I pay more for gas to use the old country store. I chit chat with the olds who are in there each morning and listen to them talk about how screwed up the left has made our nation. I am nothing like your cheap dad was. I also support the local fishing supply store. If I didn't think all doctors were scum sucking bastages, I might support them too. They have shown their colors. Green and greed.

That is how the free market works. If health care or insurance is important to you, then you’ll find a way. People live in the sticks for many reasons, and choose to do so giving up a lot of things they can get in the big city.

To say have a true market health insurance system wouldn’t work because there are people who live out in the country is, no offense, one of the silliest arguments to not have a true free market system. We have to stop governing this way. Free markets woke, but the government only creates winners and losers with everything it does. Let the free markets work, let people choose, and let individuals determine what’s best for them.

We are so far away from free markets in a lot of industries, but the “people living in the country” argument might be the weakest one I’ve ever seen for arguing against free markets.

Well, if that was the case the prices in stores, cars, etc would be jacked up for small towns. That's not the case though. The prices set by the larger, more competitive markets will drive the overall price just like everything else. Your point also points to the need for plans for catastrophic stuff, plans that we could Taylor specifically for us. Plans that we could pick the things we want to be covered for would be nice. There are ways besides single payer. Single payer is nothing more than a monopoly that will be used to funnel money to other things and pockets of politicians