DogCo84 said:

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I'd like for some accountant to tell me about something. Given the sometimes HUGE difference between the price billed to insurance, and the actual amount paid by insurance for any given "procedure" or action, are medical companies able to deduct the difference between billed and received--as a "loss" for tax purposes?

---

They will only include in net income the amount they eventually get. A moot point for those that are nonprofit.

Cost of medical care is set by the government and insurance providers based on govt rates. Providers contract with these groups for those rates to get reimbursed using certain codes. There are thousands and thousands of codes that are used. If you participate in Medicare, the lowest cash price you can charge is the Medicare rate. It's so complicated that most people can't understand their insurance plan and what benefits is provides or doesn't. You can even get "pre authorization" from an insurance company for care that it does not cover.

It's all so terrible, it makes single payer almost desirable if you thought they could do it right...but they will not come close. Too many pigs feeding at the trough. If it was just you and your doctor, they would be making more and you would be paying less, both elevating the quality of care.

I had a situation where I was sort of out of it one evening after hours at my office. My son and I were on the phone and (later) he said I wasn't making sense. He called my wife and I drove home (don't remember it) and they took me to the ER. They ran all sorts of scans and stuff. I just wasn't writing to my hard drive for 5 hours or so.

Could not remember what the doctor looked like, or any of the nurses. All I remember is the doc asking me to draw a clock showing the time was 3:50. I started to draw a rectangle, write 3:50 on it, and say I have a digital clock. But I didn't. I drew a circle, put the hour hand on the 3 and the minute hand on the 10, then thought about it, and drew a line through the hour hand and redrew it being almost to the 4, which is where it would be on a real clock. Then I wrote TIMEX on the clock. My wife said the doc said it was the best clock he had ever seen, lol.

I cannot remember all that they did that night, I had all sorts of those electrode things stuck to various parts of me, but I was surprised the charges were as low as they were. My insurance company (Medicare Advantage Plan) sent me a letter telling me that no matter what the invoice showed, I was not to pay but $65. Then the invoice came and it was for like $800 and something and showed my share was $65. Figured it would be way more, but I have only had doctor bills 3 times so did not have much of a reference point to go from.

The Collective said:

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The whole insurance thing sucks.

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This isn't about insurance my wild guess is the hospitals charge people who won't pay ( the uninsured ) astronomical prices write off the non payments against patients/insurance that do pay making the hospital show a loss because the guy with no insurance doesn't pay a $15,000 wipes out 7 patients that do pay their bill through the greatly discounted insurance price.

Of course there might be another explanation but that is the only way I can explain the bizarro price structure where the bill is starts at 5x and because you have insurance there is a huge markdown to x

Doctor probably got $100 of that.

Highway6 said:

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Thanks Obama

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When did Obama bc the czar of private insurance in this country? He didn't do this to the industry. The industry has done this to us.

Couple of years ago I was in a head on car crash in Dever due to a dumbass teenager that hit me. They took me to the main hospital in downtown Denver. It was largely precautionary but my neck and back were pretty sore. I was there for maybe 4 hours total and they didn't do any type of procedure, just a cat scan and other analysis. Not even MRI. The total bill to my insurance? $42k. Insanity. Thanks to the way to Colorado law is though, I made out like a bandit because in Colorado the car insurance company has to go off what the hospital bills, not what health insurance pays.

The problem is the third party payor paradigm.

All economic transactions, including medical service, rely on a service provider seeking to provide value because the service purchaser is seeking value. When you insert an 3rd party between the two, the purchaser no longer has any incentive to seek value and the provider has none to provide value.

And don't cry "life or death" only a small percentage of medical services demand "do it now, damn the cost" decisions.

Go back to paying your own bills and negotiating your own prices. If you have insurance they can pay you directly.

All of this started due to wage/price controls in WWII. Employers had to compete on perks, and medical insurance became one. LBJ's Great Society and MediCaid/Care only exacerbated the problem.

None of the stuff Watermelon has been posting is accurate.
Just one example:

Quote:

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Hospitals were non-profits, as were clinics

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Untrue. Many were for profit and those that weren't were (are) not for profit (not non-profit).

Another example: w/out the profit motive the Spinraza drug that has altered my wife's life/existence would never have been developed.

Who do you think pays that $42K?

Give you a hint, it's not an "insurance company"....

Muy said:

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Highway6 said:

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Thanks Obama

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But everyone is healthier, saving money, and can keep their doctor, right?!!!

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14M people have a basic health insurance policy made you less healthy?

redseven94 said:

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Muy said:

---

Highway6 said:

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Thanks Obama

---

But everyone is healthier, saving money, and can keep their doctor, right?!!!

---

14M people have a basic health insurance policy made you less healthy?

---

Yet we have liberal politicians who voted for Obamacare screaming we have a health crisis again…. 15 years after Obamacare passed.

cecil77 said:

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Quote:

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1) Doctors and hospitals can charge whatever they want because they know insurance will pay for it.

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This, as stated, is absolutely untrue. It's actually the insurance companies (and other 3rd party payors) that can pretty much "pay whatever they want". The billing code and associated contractual rate is all they look at. They don't really care what number the provider charges.

---

Incorrect. You notice how in the old days, they used to have wards with 10 (non-contagious) patients each? For example, in the early 80s, my mom had surgery and had roommates with curtains in her recovery room. A few months ago, my daughter had a kid, and she was given a room all to herself with wood trim, a nice TV, and amenities like she was in a hotel.

THAT is what it looks like when hospital charges whatever they want because they know insurance will pay.

Muy said:

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redseven94 said:

---

Muy said:

---

Highway6 said:

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Thanks Obama

---

But everyone is healthier, saving money, and can keep their doctor, right?!!!

---

14M people have a basic health insurance policy made you less healthy?

---

Yet we have liberal politicians who voted for Obamacare screaming we have a health crisis again…. 15 years after Obamacare passed.

---

$2K month isn't a crisis. Why do you not want people to have healthcare?

redseven94 said:

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Muy said:

---

redseven94 said:

---

Muy said:

---

Highway6 said:

---

Thanks Obama

---

But everyone is healthier, saving money, and can keep their doctor, right?!!!

---

14M people have a basic health insurance policy made you less healthy?

---

Yet we have liberal politicians who voted for Obamacare screaming we have a health crisis again…. 15 years after Obamacare passed.

---

$2K month isn't a crisis. Why do you not want people to have healthcare?

---

lol, okay. Health Insurance =/= Healthcare

hth

aTmAg said:

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cecil77 said:

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Quote:

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1) Doctors and hospitals can charge whatever they want because they know insurance will pay for it.

---

This, as stated, is absolutely untrue. It's actually the insurance companies (and other 3rd party payors) that can pretty much "pay whatever they want". The billing code and associated contractual rate is all they look at. They don't really care what number the provider charges.

---

Incorrect. You notice how in the old days, they used to have wards with 10 (non-contagious) patients each? For example, in the early 80s, my mom had surgery and had roommates with curtains in her recovery room. A few months ago, my daughter had a kid, and she was given a room all to herself with wood trim, a nice TV, and amenities like she was in a hotel.

THAT is what it looks like when hospital charges whatever they want because they know insurance will pay.

---

Medical providers have contractuals with 3rd party payors that state what codes will pay. (period) The insurance company doesn't care what the "rack rate" of the hospital is.

Birthing is different now, e.g. dad's being allowed in. But that's not a function of hospitals "deciding to charge more". They can "charge" whatever they want, but they're not getting paid based upon that.

Muy said:

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redseven94 said:

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Muy said:

---

redseven94 said:

---

Muy said:

---

Highway6 said:

---

Thanks Obama

---

But everyone is healthier, saving money, and can keep their doctor, right?!!!

---

14M people have a basic health insurance policy made you less healthy?

---

Yet we have liberal politicians who voted for Obamacare screaming we have a health crisis again…. 15 years after Obamacare passed.

---

$2K month isn't a crisis. Why do you not want people to have healthcare?

---

lol, okay. Health Insurance =/= Healthcare

hth

---

Do you think people should go bankrupt for needing/utilizing healthcare. LOL.

Burdizzo said:

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I am helping a family member deal with a long term medical issue right now. Medical billing is beyond frustrating. So far the "cost" of the care received is about $47k, but about $34k has just evaporated because of whatever is negotiated between insurance and the providers. Out of pocket costs have been about $2200. I am tracking all this based on the EOBs received. It thought some of this legislation was supposed to make all this more understandable, but I guess not.

One particularly aggravating issue is getting a bill after 30 days because one provider provided service. The we get a second bill 60 days later for the same visit, but it has a different provider listed. When I called billing to get an understanding of this they said, "it is because they use a team approach and bill separately". I have taken the strategy that if they can wait 60 days to bill, they can wait another 60 days for me to process payment. At that, they may only get paid $10 so that they can't say I didn't make an effort to pay something. They will eventually get paid in full.

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That is some bad Mojo!

Mom had multiple ICU to surgery hospital stays. $500k and up. POS sisters never helped.

Kitchen table and island covered in EOBs with matching bills. I typically paid 90 to 120 days after everything came in. I made up my own system, but to everyone's point it's ridiculous and it's fraud / theft against the American people.

cecil77 said:

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aTmAg said:

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cecil77 said:

---

Quote:

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1) Doctors and hospitals can charge whatever they want because they know insurance will pay for it.

---

This, as stated, is absolutely untrue. It's actually the insurance companies (and other 3rd party payors) that can pretty much "pay whatever they want". The billing code and associated contractual rate is all they look at. They don't really care what number the provider charges.

---

Incorrect. You notice how in the old days, they used to have wards with 10 (non-contagious) patients each? For example, in the early 80s, my mom had surgery and had roommates with curtains in her recovery room. A few months ago, my daughter had a kid, and she was given a room all to herself with wood trim, a nice TV, and amenities like she was in a hotel.

THAT is what it looks like when hospital charges whatever they want because they know insurance will pay.

---

Medical providers have contractuals with 3rd party payors that state what codes will pay. (period) The insurance company doesn't care what the "rack rate" of the hospital is.

Birthing is different now, e.g. dad's being allowed in. But that's not a function of hospitals "deciding to charge more". They can "charge" whatever they want, but they're not getting paid based upon that.

---

Same company, same PPO out of pocket costs.

Prenatal care thru childbirth:
1996 - $100
1998 - $300
2000 - $1100

That's all in from "Hey, I'm pregnant to driving home with a baby." I shudder to think what it is now.

one safe place said:

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DogCo84 said:

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I'd like for some accountant to tell me about something. Given the sometimes HUGE difference between the price billed to insurance, and the actual amount paid by insurance for any given "procedure" or action, are medical companies able to deduct the difference between billed and received--as a "loss" for tax purposes?

---

They will only include in net income the amount they eventually get. A moot point for those that are nonprofit.

---

This isn't my understanding. I looked into this a couple years ago, so the law could have changed. Based on the experts I read, the "adjustment" is counted as an expense. The original bill is the "revenue". I think it's a trick to decrease profit margins and make themselves appear less profitable on a percentage basis.

Again, o could be misunderstanding but after looking into it for awhile, this was my understanding. I'm in vet med so I have an idea what the actual costs of different physical inputs (like meds, equipment) are and can compare to what is charged.

What also doesn't make a lick of sense is the difference between cash price and insurance price. Had an incident a few years ago where I need bloodwork. Was told my Copay for the bloodwork would be $110. I asked the cash price just because I was curious, it was $100. Somehow the Copay was lower than the cash pay. The whole system is a rip off and there is a ton of fraud especially within medical coding.

Wow, so much ignorance on this thread that I will regret jumping in.

#1 - Your 15K bill is just an imaginary number. The Hospital ER, free standing ER, or any other ER will get a fraction of this. All insurance payments vary but most places would be lucky to get even $1500 for the visit
#2 - There are insurance rules and billing is pegged to the medicare rates. ERs, clinics, doctor's offices, or whatever follows codes and can not just arbitrarily make up charges
#3 - Hospital based ERs overall charges more than stand alone Ers. I do billing reviews so I know. I have seen many hospital based ER bills charge 50K+ for labs/CT scan.
#4 - ERs are opened 24 hrs/dy and required to see everyone including uninsured. Medicare/medicaid are loss leaders
#5 - Comparing/pricing medicine to picking out a steak is plain ignorant. You walk into Flemings and they give you 10 choices for steak and 20 add ons. You make 100% of the choice so they can price for profit. You go to the ER with chest pain and how the heck should they know what kind of evaluation is required? It could be a simple muscle pull go home or it could be an aortic dissection. This restaurant analogy to medicine would only be true if you walked in, pick what you want done, and the doctor have zero say in your choice. I doubt you can walk into a restaurant, tell them you are hungry and they will give you a price. A child hungry could be a fries and coke. An adult hungry could be 3 cocktails, seafood tower, Tomahawk Ribeye, Salad, and desert. Tell me how you will price if someone tells you they are hungry?
#6 - 50-75% of traditional ERs visits are loss leaders. Uninsured, medicare, medicaid all are net negative to the bottom line. If insured are not profit leaders, there would be no ERs.

There seem to be lots of lawyers here. What if the law stated that
1. your law office had to be opened 24 hrs a day fully staffed
2. that you had to see everyone that walks in before payment
3. that you are required to be versed in all forms of law from O&G to trial to estate planning to immigration to everything else
4. that you are required to work their case and if a bad outcome happened you will be sued
5. that 40% will not pay you anything, that 35% will pay you $10-$25/hr
6. that you will be paid in about 6-12 months or maybe not at all even if they have law insurance requiring hours of work including sending in countless forms


How would you price payment if they happened to have law insurance? Are you charging them the customary $300/hr? Of course not unless you would be happy getting paid about $75/hr blended. Yes that $75/hr goes to paying all of your bills.

Look up how much ER docs make. Yeah they do well but they no better than 50% tile in the house of medicine. If ERs were making so much off your 15K, why do you think most ERs are not profitable?

Muy said:

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Highway6 said:

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Thanks Obama

---

But everyone is healthier, saving money, and can keep their doctor, right?!!!

---

Well that would be: no, no, and no. But other than that, it worked great. In the words of Nancy Pelosi; "We have to pass the bill to see what's in it." Every Congress person that voted for that bill should go to prison

redseven94 said:

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Muy said:

---

redseven94 said:

---

Muy said:

---

redseven94 said:

---

Muy said:

---

Highway6 said:

---

Thanks Obama

---

But everyone is healthier, saving money, and can keep their doctor, right?!!!

---

14M people have a basic health insurance policy made you less healthy?

---

Yet we have liberal politicians who voted for Obamacare screaming we have a health crisis again…. 15 years after Obamacare passed.

---

$2K month isn't a crisis. Why do you not want people to have healthcare?

---

lol, okay. Health Insurance =/= Healthcare

hth

---

Do you think people should go bankrupt for needing/utilizing healthcare. LOL.

---

Go suck on that government teet, buddy.

B-1 83 said:

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Old Army Ghost said:

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B-1 83 said:

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I GUARANTEE they didn't send back the insurance payment.

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you call your insurance company to report the theft or nah?

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This was a "spurter" to the bone. No glue would have done it, trust me.

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Gorilla glue and Flex Tape.

My daughter broke her arm, had X-rays, CT scan, was give morphine for the pain, they attempted an MRI (she couldn't hold the necessary position for the 30 minutes required due to pain), was admitted overnight, and had surgery the next day.

This was at the SECOND visit to the ER. The first ER visit resulted in a misdiagnosis… "sprain".

I'm worried.

B-1 83 said:

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I $h@& you not. I had an "incident" with a knife right before Thanksgiving that resulted in a visit to a local ER specialty facility. Between the doctor, facility, and the removal of stitches it was $15k.

My part ended up being $475. That's reduced from the original where they charged for removing them. I was told that was free, called their billing office, and they waived my part. Here's the odd part- the removing Dr charged more than the actual surgeon and I GUARANTEE they didn't send back the insurance payment.

Politics because this is pretty wild with medical insurance and rising premiums

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Just think how many illegals going to the ER with a cold that your insurance company just paid for!

Muy said:

---

redseven94 said:

---

Muy said:

---

Highway6 said:

---

Thanks Obama

---

But everyone is healthier, saving money, and can keep their doctor, right?!!!

---

14M people have a basic health insurance policy made you less healthy?

---

Yet we have liberal politicians who voted for Obamacare screaming we have a health crisis again…. 15 years after Obamacare passed.

---

They're liberals, and thus, not smart and pretty racist at their ideological core.

DebacleCare was one of the worst things government has ever done to us. Medicare, Medicaid, Social Security, Patriot Act, etc all bad. DebacleCare is the worst.

First time on Texags

Haven't read the thread, as nearly all socialized types of insurance will, by the very nature of the word, increase now, and continue to increase. I'll bet my life on it.

Due to what socialized medicine does, it spreads the risk from old to young, and everything in between.

One thing I haven't heard from anyone on this board or elsewhere is how Obamacare is probably 40% to 50% responsible for young people not being able to afford houses like Americans have been able to prior to 2014. All of that money being spent on healthcare by young people used to be saved for down payments for homes.

Secondly, if anyone has a genuine concern for reducing our $40 trillion deficit, healthcare will HAVE to be reformed. Medicare/medicaid/VA, and Obamacare were $2.4 trillion in our 2025 budget.

Just a thought for those who consider these things.

BigRobSA said:

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B-1 83 said:

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Old Army Ghost said:

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B-1 83 said:

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I GUARANTEE they didn't send back the insurance payment.

---

you call your insurance company to report the theft or nah?

---

This was a "spurter" to the bone. No glue would have done it, trust me.

---

Gorilla glue and Flex Tape.

---

No lie, when I worked at the airport, I sliced my hand open unloading cargo. United airplane mechanic saw it happen, come over with super glue, towel and speed tape. Saved me from going to the hospital or having to take a drug test.

Seamaster said:

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Medical care is the only financial transaction that we consent to without having any inking of what it's going to cost.

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I just noticed a timeshare staring at the floor hoping you didn't see it.

B-1 83 said:

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I $h@& you not. I had an "incident" with a knife right before Thanksgiving that resulted in a visit to a local ER specialty facility. Between the doctor, facility, and the removal of stitches it was $15k.

My part ended up being $475. That's reduced from the original where they charged for removing them. I was told that was free, called their billing office, and they waived my part. Here's the odd part- the removing Dr charged more than the actual surgeon and I GUARANTEE they didn't send back the insurance payment.

Politics because this is pretty wild with medical insurance and rising premiums

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I would have done it in my office for a Hundred bucks.

Muy said:

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redseven94 said:

---

Muy said:

---

redseven94 said:

---

Muy said:

---

redseven94 said:

---

Muy said:

---

Highway6 said:

---

Thanks Obama

---

But everyone is healthier, saving money, and can keep their doctor, right?!!!

---

14M people have a basic health insurance policy made you less healthy?

---

Yet we have liberal politicians who voted for Obamacare screaming we have a health crisis again…. 15 years after Obamacare passed.

---

$2K month isn't a crisis. Why do you not want people to have healthcare?

---

lol, okay. Health Insurance =/= Healthcare

hth

---

Do you think people should go bankrupt for needing/utilizing healthcare. LOL.

---

Go suck on that government teet, buddy.

---

People having military defense isn't sucking on the governments teet to protect them and their families but healthcare is. Please explain?

BusterAg said:

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ABATTBQ11 said:

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Seamaster said:

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Medical care is the only financial transaction that we consent to without having any inking of what it's going to cost.

I can't believe we put up with it.

Imagine going to a restaurant or buying an appliance and not knowing the cost until they bill you. Sounds nuts? But that's what we do with healthcare.

The whole system is beyond broken.

---

"Hey, Mr. Builder, I want a house. How much will it cost?"

"I don't know. How big do you want it? What do you want it made of?"

"I can't tell you. Just give me a price and let's sign a contract."

*Dial Tone*


It's not broken. Doctors, ER's, and hospitals simply can't give you a price for something they know nothing about when you walk in the door the same way a builder can't give you a price for a home he knows nothing about. My son went to the pediatrician last year because he was sick and having trouble breathing. His oxygen was low and didn't come up enough with different steroid treatments, so he ended up in the hospital and staying overnight. Could they have quoted me a price for seeing him at the pediatrician's front desk? What are they supposed to do, eat everything after the $120 for the pediatrician visit or charge everyone $5k for every visit just in case they end up admitted? Medicine is simply filled with unknowns and often very short and hard timelines. There are certainly games played with billing and insurance, but the cash price afterwards can't be given to you upfront for something like an ER visit, and it's going to be way more than an urgent care or GP purely because you're paying for the existence and availability of the facility to treat almost anything.

If you go get an elective procedure, most of the time they're going to work with your insurance beforehand and give you a ballpark or exact price.

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This is crap.

When you go to a restaurant, you don't ask for a price for dinner upfront before you order. You order, and then you pay for what you get, and the prices are provided prior to your order.

There are zero reasons why medicine can't be the same way. Sure, you don't know how much your stay is going to cost you when you go to the ER, but you will know how much you are going to get charged for every service you consume.

---

This is crap.

When you go to a restaurant, you don't ask for a price up front before you order because they're on the menu and you pick what you want. If you go the ER, you're not picking from a menu. If your wife is giving birth and so of a sudden needs a c-section, it's not like you get to say, "No, no. Put her labor on hold, were going down the street because their c-sections are cheaper, unless you guys want to price match."

Medaggie said:

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You go to the ER with chest pain and how the heck should they know what kind of evaluation is required? It could be a simple muscle pull go home or it could be an aortic dissection.

---

Somehow emergency vets are able to propose a fee prior to treatment.

Of course, I've never seen a malpractice attorney circling a vets office.

redseven94 said:

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Muy said:

---

redseven94 said:

---

Muy said:

---

redseven94 said:

---

Muy said:

---

redseven94 said:

---

Muy said:

---

Highway6 said:

---

Thanks Obama

---

But everyone is healthier, saving money, and can keep their doctor, right?!!!

---

14M people have a basic health insurance policy made you less healthy?

---

Yet we have liberal politicians who voted for Obamacare screaming we have a health crisis again…. 15 years after Obamacare passed.

---

$2K month isn't a crisis. Why do you not want people to have healthcare?

---

lol, okay. Health Insurance =/= Healthcare

hth

---

Do you think people should go bankrupt for needing/utilizing healthcare. LOL.

---

Go suck on that government teet, buddy.

---

People having military defense isn't sucking on the governments teet to protect them and their families but healthcare is. Please explain?

---

One is in the Constitution, as a power of the FedGov and healthcare is not. You don't have a right to someone else's work.