limeynus

This is the one thing that chaps my hide! You can never get a straight answer as far as pricing goes. And as someone said earlier - who orders a service without an idea of what they are gonna be on the hook for?

limeynus

I'm sure you are right. But I have had a PPO in the past and always found it to be worse on those plans than the HMOs I've had over the last few years.

I do wonder if there'll be a day when the right hand knows what the left hand is doing as far as medical insurance goes - I suspect not!

Pulaski

I agree entirely, I was thinking more about the administration of the process, for example, and not least, how all the participants in a procedure get to bill separately. If I hire a general contractor to build an extension to my house, I get one estimate and one bill,.... I am not going to get a bill from the foundation digger, the framer, the plumber, electrician, painter, etc. so why do medical professionals all bill individually? It's not even like I was given any choice about which anesthetist I wanted when I had an operation.

Pulaski

You know the answer there, .... we all do!

Giantaxe

A rather misleading explanation of the situation:

http://www.washingtonpost.com/politi...y.html?hpid=z7

Duncan Roberts

Just wait for ICD-10. Billing will be interesting.

Poppy girl

Well after nearly 6 pages I am even more lost then I was on the 1st post

scrubbedexpat099

That refers to something else, here you go:

http://www.politico.com/story/2013/0...des-90610.html

Sally Redux

Should we just tell new enquirers that it's a fun lottery for US residents?

Giantaxe

No, it refers to the same thing.

Poppy girl

Melly

CPT (Current Procedural Terminology)codes Vs ICD coding are what determines how much will be paid for a medical service. This is the code you should be watching for, if you want to know how much you/the insurance company will be paying. CPT determines services rendered Vs diagnosis named on the claim. You can google CPT codes after you get your bill, (you will probably have to request a break down of the services) and if you feel something was billed that wasn't delivered, dispute it. I avoided a huge ER bill by closely watching what services were delivered to my son, when I thought he had appendicitis. I knew 10 mins into the exam that I had over-reacted. The Doc wanted to run IVs, do a scan, but I said "No" thank you! I do have some medical training, so felt confident in my decision. When the bill came I asked for the break down of the CPT codes ( I was cynical & thought they probably billed me for the IV, at least) but they didn't. Anyhoo, it pays to have some knowledge, and question things if you have any doubts. I use CPT codes everyday in my work, so I know some codes are reimbursed higher than others. As for the predicated 40% hike in premiums, I just don't see how the economy can sustain that. Ins will be out of reach......period!!!! People will be staking out hospital ERs. Anyone seen "John Q" ?

scrubbedexpat099

My Link

Congressional leaders in both parties are engaged in high-level, confidential talks about exempting lawmakers and Capitol Hill aides from the insurance exchanges they are mandated to join as part of President Barack Obama’s health care overhaul, sources in both parties said.

The talks — which involve Senate Majority Leader Harry Reid (D-Nev.), House Speaker John Boehner (R-Ohio), the Obama administration and other top lawmakers — are extraordinarily sensitive, with both sides acutely aware of the potential for political fallout from giving carve-outs from the hugely controversial law to 535 lawmakers and thousands of their aides. Discussions have stretched out for months, sources said.

Duncan Roberts

You really need to look at both since a CPT code is only valid for certain ICD-9 codes or the ICD-9 code will dictate the rate a CPT code is paid at. There are also other factors such as age and sex and modifiers that are placed on the codes and each insurance company applies them differently. The most common issue I've found is a doctors office not using the correct preventive care CPT/ICD-9 combination so it gets processed as a standard office visit rather than a preventive care visit. That means I get a bill rather than it be covered 100% by insurance and is really annoying to sort out.

Mrs Danvers

I don't think you're meant to understand how royally gipped you get by these people?

More often than not if you question a bill they'll give you a smaller one. This tells me the billers have no clue what they're doing either.