tag:blogger.com,1999:blog-582368152716771238.post122791038081099908..comments2024-03-28T11:14:02.660-05:00Comments on The Grumpy Economist: The $20,000 bruiseJohn H. Cochranehttp://www.blogger.com/profile/04842601651429471525noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-582368152716771238.post-12830587311205725782014-09-30T13:34:18.676-05:002014-09-30T13:34:18.676-05:00I'm one of the co-founders of CoPatient, so th...I'm one of the co-founders of CoPatient, so thanks for the mention! One of the earlier commenters mentioned self-insured employers, and one of the by-products of the increasing trend of employers self-insuring their health plan is that health plans have decreasing incentives to combat these billing problems on behalf of patients. Additionally, continuing consolidation of hospitals has created a very challenging contracting environment for the health plans, so they are often loathe to take up the fight on the consumer's behalf against a dominant health system. As long as these trends continue, we'll continue to have a steady flow of consumers that need our service. We save people an average of 40% of their original bill so it can be done successfully with the right expertise and technology at your side. Rebecca Palmhttp://www.copatient.comnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-35406299790770377442014-09-06T09:12:23.932-05:002014-09-06T09:12:23.932-05:00We need more services like Mr. Leonard's. I ha...We need more services like Mr. Leonard's. I have to educate my patients about how to fight their bills on a regular basis. There are tons of traps in the health care system. For example, your surgeon schedules you for a procedure at XYZ Hospital. You check with your insurer and XYZ is in-network.<br /><br />You have your surgery. The surgeon gets $500. The hospital gets $900. The anesthesiologist gets $1500. Your co-pay on that is $500.<br /><br />What happened?<br /><br />The hospital is in-network but the anesthesiologist is not. I tell my patients to call both the anesthesia group and the hospital and raise a fuss. This usually works but it's a PITA.<br /><br />ER visits are in a world of their own. Pre-authorization, in-network status, etc are often thrown out the window. Have you noticed how many urgent care centers have sprung up? Why do you think that's happening?It's the Wild West. <br /><br />You absolutely must get a detailed bill so you can contest the $10 Band-Aid and the $150 for skin glue, but how many people can decipher these charges? I think ProClaim is a fantastic idea but can you scale it for the little guy or is he out of luck because the yield is too low? In my own experience fighting with insurers on a daily basis, it's a Pyrrhic victory to have a $20/hr employee fight a $15 underpayment if they have to spend 20 minutes on hold and 30 minutes arguing.<br />JB McMunnhttps://www.blogger.com/profile/15468282698533043544noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-47551468983432672112014-09-06T00:30:05.289-05:002014-09-06T00:30:05.289-05:00There are companies that will scrutinize legal bil...There are companies that will scrutinize legal bills....Benjamin Colehttps://www.blogger.com/profile/14001038338873263877noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-3622367098454298822014-09-05T13:09:33.459-05:002014-09-05T13:09:33.459-05:00John,
Thank you for bringing this article to my a...John,<br /><br />Thank you for bringing this article to my attention. It'll make a good marketing piece for my firm, ProClaim Medical Recovey. <br /><br />We work for employers that self-insure their group health plans. Our job: audit medical claim payments to identify and recover overpayments. <br />Kevin Leonardhttp://www.proclaimrecovery.comnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-65577638616988977452014-09-05T12:22:25.721-05:002014-09-05T12:22:25.721-05:00I'm reminded of the AER's recent paper: ht...I'm reminded of the AER's recent paper: https://www.aeaweb.org/articles.php?doi=10.1257/aer.104.9.2900<br /><br />It's about insurance in general, but can be easily be extended to a three-party health insurance setting. Applying their argument to healthcare, when auditing bills is costly, it is not profitable enough to engage in the socially optimal amount of billing error deterrence. <br /><br />The optimal billing error (ie fraud) deterrence strategy depends on the information sets. When both fraud and audit decisions are public information, then obviously we can achieve the first-best of total fraud deterrence . When fraud is private information but audit strategies are publicly known, then it is optimal for insurers to pay a reward for audited bills that contain no errors, and it is possible to achieve total fraud deterrence. In the third-best, audit strategies and fraud are private information, which yields the result that it is optimal for insurers to "nitpick," meaning that they will reduce payments for any audited bill regardless of whether there is a billing error or not (that is, they will offload a portion of the auditing costs onto either the hospital or the patient). However, in the third-best total fraud suppression is not generally possible.Matthew Martinhttps://www.blogger.com/profile/03395599411699593043noreply@blogger.com