quelle surprise

I'm sure I've written this up before but it works like this:

1) The provider contracts with insurance. They send the provider a giant book of rates. The provider agrees to them or doesn't. They are not allowed to discuss their rates with anyone else -that's "price fixing" and is a felony. Meanwhile if they show the provider one contract to look over and another contract to sign with 'whoopsie!' different prices in it that's just an honest mistake don't be so paranoid (true story).

2) The patient goes to the place that supposedly is covered by his insurance and gets a simple procedure. However, that simple procedure becomes a contested game of bingo as the provider attempts to Twister their way to as many ICD10 codes as possible while the insurer denies denies denies denies denies. Everything the insurer denies gets passed on to the patient so now the patient is mad at the provider for charging them $9 for aspirin without knowing that the insurer pays $9 for baby aspirin but not brand name aspirin and a nurse fucked up.

3) The insurer hires the stupidest, most laggard, least intuitive people they can find to run their billing. They have a 40 hour night course in something that sucks because they were promised an exciting rewarding career in the medical field but six weeks into it they realize that they're being kept in the dark about everything except what magic codes get money and what magic codes don't because their exciting medical career is literally making sure that patients don't get to use their insurance to pay for healthcare.

Medicaid fixes this. Prices are published, insurers take those prices or leave them. We are contracted with no less than seven insurers, all at the same prices. Not all of those prices are great - but that's between me and my representatives, not some back-room deal with United Healthcare.

An example? We get paid like $650 for an IUD insertion no matter how we bill it. The IUDs we're allowed to insert cost like $675 through our medical supplier - now you know why they're an "unpopular" form of birth control. Except LOL you can get 'em for $75ea off eBay because they come gray market from Cyprus. So fuckin'A we be some IUD-insertin' docs up in this bitch. At least, until customs seizes your IUD, or your bank stops payment on a credit card transaction with Cyprus. So now we're putting in Israeli market IUDs for $75 ea.

The healthcare system in the USA IS this dumb.