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Health system in USA

Health system in USA

Old Apr 18th 2018, 7:14 pm
  #16  
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Default Re: Health system in USA

The expression "GP" is British and is not used in America. Better start learning the lingo.
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Old Apr 18th 2018, 7:38 pm
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Default Re: Health system in USA

Originally Posted by durham_lad
In 2015 I went for a routine colonoscopy to a doctor and facility that was in network. Unfortunately they found a polyp, and the lab that it was sent to for histology was not in network and I was charged $750 for that. It took over a year of appeals before they finally reduced the cost to $50.
I recently got charged a four figure sum for the anesthesiology part of a screening colonoscopy. A quick check of the HHS website told me that this was a covered free service along with the colonoscopy. Charge reversed on appeal, but you can bet anything that some don't appeal against this kind of gouging.
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Old Apr 18th 2018, 8:02 pm
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Default Re: Health system in USA

I wonder whether I spend more time dealing with medical billing than being in an actual doctor's office or hospital. Seems roundly $1000 per person per year is spent simply on billing and insurance paperwork from a quick search, though that would assume everybody was insured which they're not so it's probably more.
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Old Apr 18th 2018, 8:15 pm
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Default Re: Health system in USA

Originally Posted by Giantaxe
I recently got charged a four figure sum for the anesthesiology part of a screening colonoscopy. A quick check of the HHS website told me that this was a covered free service along with the colonoscopy. Charge reversed on appeal, but you can bet anything that some don't appeal against this kind of gouging.
That's a very common scam. Most anesthesiologists are 'out of network' and bill at out of network rates. We got stung a couple of times in Alabama.

Florida have a new law which prevents them doing this. Basically, if the facility/surgeon are in-network all associated services are also in-network.

New York have a similar law and (I thought) CA did as well.

We now get letters from the out-of-network providers asking us to contact the insurance for them to pay the extra. Sure I will...
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Old Apr 18th 2018, 8:35 pm
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Default Re: Health system in USA

Originally Posted by chawkins99
That's a very common scam. Most anesthesiologists are 'out of network' and bill at out of network rates. We got stung a couple of times in Alabama.

Florida have a new law which prevents them doing this. Basically, if the facility/surgeon are in-network all associated services are also in-network.

New York have a similar law and (I thought) CA did as well.

We now get letters from the out-of-network providers asking us to contact the insurance for them to pay the extra. Sure I will...
Don't know about a scam, but I. too, received a bill from the anesthetist when I had a knee op. The surgeon and facility were in network, but, what the heck, the anesthetist was not? Who chooses their own anesthetist?

Bill was reversed when challenged...... Got to watch these medical bills !!
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Old Apr 18th 2018, 8:49 pm
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Default Re: Health system in USA

Originally Posted by scot47
The expression "GP" is British and is not used in America. Better start learning the lingo.
Idle curiosity, what does "GP" mean in the UK? I know that in US parlance, it means General Practitioner. (Although, there is now a recognized specialty of Family Practice. Most US general practitioners had been trained in internal medicine)
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Old Apr 18th 2018, 8:51 pm
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Default Re: Health system in USA

Same in UK
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Old Apr 18th 2018, 8:52 pm
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Default Re: Health system in USA

Also look into HMO's (Health Maintenance Organizations.) Kaiser in California is the largest.
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Old Apr 18th 2018, 8:52 pm
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Default Re: Health system in USA

Originally Posted by SanDiegogirl
Don't know about a scam, but I. too, received a bill from the anesthetist when I had a knee op. The surgeon and facility were in network, but, what the heck, the anesthetist was not? Who chooses their own anesthetist?

Bill was reversed when challenged...... Got to watch these medical bills !!
That reminded me to check a bill for my wife this morning. She had three identical nerve blocking ops which were so quick that I literally didn't have time to finish typing an email from the time she was wheeled away awake to coming back asleep. The bill? $1200 the first time; $1200 the second time; $1050 the third time (multibuy discount?! Or the random bill generator?). Contracted anesthetists but covered the vast majority thankfully.

I've battled and won nearly all of about $3000 worth of bills in 6 years for the family. The others were probably genuine but I question everything I don't understand. Monetarily it's not a huge amount but in terms of time taken it was significant.

I wonder if it's related to needing BP meds now...?

[Edit] Add another $600 for respite sibling care when the sibling was supervised by the parent and thus the respite carer was not looking after the sibling. Sigh.

Last edited by GeoffM; Apr 18th 2018 at 10:19 pm.
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Old Apr 18th 2018, 10:26 pm
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Default Re: Health system in USA

Originally Posted by S Folinsky
Idle curiosity, what does "GP" mean in the UK? I know that in US parlance, it means General Practitioner. (Although, there is now a recognized specialty of Family Practice. Most US general practitioners had been trained in internal medicine)
Yes, it means General Practitioner.....
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Old Apr 18th 2018, 10:29 pm
  #26  
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Default Re: Health system in USA

Originally Posted by MidAtlantic
We may have personal stories about good or bad health experiences but overall the USA spends far more on health care and has the worst outcomes.

Spending, Use of Services, Prices, and Health in 13 Countries - The Commonwealth Fund
Does it really mean anything to this thread of the cost of healthcare in the UK vs. the US? No, it doesn't. The OP is asking about how healthcare in the US works, not how much cost or waste there is in the system.

Originally Posted by scot47
The expression "GP" is British and is not used in America. Better start learning the lingo.
It was always a part of healthcare terminology in the US so I don't know where you have been. Oh, that's right. You're new to the US ;-)

I grew up with a general practitioner as our family doctor. Then doctors in the US started specializing and are called, i.e. surgeons, internists, etc. My GP as an adult had a specialty in gastronology <sp>, but still performed the same function as a GP.
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Old Apr 18th 2018, 10:40 pm
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Default Re: Health system in USA

Originally Posted by Rete
I grew up with a general practitioner as our family doctor. Then doctors in the US started specializing and are called, i.e. surgeons, internists, etc. My GP as an adult had a specialty in gastronology <sp>, but still performed the same function as a GP.
"Primary care physician" seems to be the favored term, at least in my experience.
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Old Apr 18th 2018, 10:47 pm
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Originally Posted by Giantaxe
"Primary care physician" seems to be the favored term, at least in my experience.
I am familiar with that term. If you don't have a PPO but rather a PCP, then you are required to have a primary care physician who oversees your health needs and is the one who will give permission for you to see a specialist. I've had a PPO policy for the last 25 years and have not needed a primary care physician, per se.
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Old Apr 19th 2018, 12:09 am
  #29  
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Default Re: Health system in USA

Originally Posted by GeoffM

I've battled and won nearly all of about $3000 worth of bills in 6 years for the family. The others were probably genuine but I question everything I don't understand. Monetarily it's not a huge amount but in terms of time taken it was significant.

I wonder if it's related to needing BP meds now...?
You could probably find an attorney to argue that case...


I got clobbered a couple of weeks ago when I had to make an emergency visit to an eye specialist, I'm expecting our insurers to send me a bill for two co-pay visits to a specialist for sixty bucks a time, what I wasn't expecting was getting well and truly shafted for the meds.
Specialist insisted on an eye drop called Pred Forte, no generics acceptable - Iritis is a particularly 'fun' little complaint (google at your own risk!) that my UK eye docs have only ever prescribed Pred Forte to treat, so I agree with the specialist's insistence, and needs that treatment to start ASAP to ward off the slight inconvenience of going blind in the affected eye. My pharmacy couldn't get it until the next day, neither could another in-house pharmacy and I could only find one place in a fifty mile radius that had it in stock. One 10ml bottle set me back $292, I was tempted to ask if it's not common practice to use KY jelly before announcing the price but not sure they'd have understood...

(The eye is better, but I'll be on the drops for a week or two more, getting over the shafting might take a while longer...)
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Old Apr 19th 2018, 12:14 am
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Default Re: Health system in USA

Originally Posted by zzrmark
You could probably find an attorney to argue that case...


I got clobbered a couple of weeks ago when I had to make an emergency visit to an eye specialist, I'm expecting our insurers to send me a bill for two co-pay visits to a specialist for sixty bucks a time, what I wasn't expecting was getting well and truly shafted for the meds.
Specialist insisted on an eye drop called Pred Forte, no generics acceptable - Iritis is a particularly 'fun' little complaint (google at your own risk!) that my UK eye docs have only ever prescribed Pred Forte to treat, so I agree with the specialist's insistence, and needs that treatment to start ASAP to ward off the slight inconvenience of going blind in the affected eye. My pharmacy couldn't get it until the next day, neither could another in-house pharmacy and I could only find one place in a fifty mile radius that had it in stock. One 10ml bottle set me back $292, I was tempted to ask if it's not common practice to use KY jelly before announcing the price but not sure they'd have understood...

(The eye is better, but I'll be on the drops for a week or two more, getting over the shafting might take a while longer...)
Good luck with the eye. I've had 3 ops on my eyes in my lifetime (in the UK). Not fun, though thankfully I had a general anesthetic each time. Often during a checkup my doctor will call in a junior doctor to see mine as it's pretty unusual (Coloboma) - but after JerseyGirl's comment about the "Hello, nice to meet you - and by the way here's my bill," I'm a bit more wary.
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