Actuarial Outpost
 
Go Back   Actuarial Outpost > Actuarial Discussion Forum > Health - Disability
FlashChat Actuarial Discussion Preliminary Exams CAS/SOA Exams Cyberchat Around the World Suggestions


Reply
 
Thread Tools Search this Thread Display Modes
  #51  
Old 06-20-2018, 11:25 AM
tommie frazier tommie frazier is offline
Member
 
Join Date: Aug 2003
Favorite beer: The kind with 2 e's
Posts: 22,737
Default

the upcoding is all just part of the game. it's a shitty game, but it's the game.

they get squeezed on what they get paid for an office visit, then they figure great, they will bill for some questions that were asked or tiny things they did while looking at you. there are whole seminars and consultancies built around this.

the lack of transparency in pricing is a big problem. I don't want to ask my doc before everything I ask/they ask "will this answer cost me more money?" But maybe I shoud and we all should.
__________________
Removed a dated athletic reference under pressure from a friend. You can still give money to help fund research on neurofibromatosis (nf).

General info at www.ctf.org

Team donation page here.
Reply With Quote
  #52  
Old 06-21-2018, 09:00 PM
dude cool dude cool is offline
Member
 
Join Date: Jun 2003
Posts: 48
Default

Or we could get around all of these ridiculous shenanigans and just pay directly for primary care and other things that are routine and predictable. Primary care is actually very cheap if you cut out all of the extra admin of insurance. It's almost as if insurance used to only cover catastrophic, unlikely, random events for a good reason.
Reply With Quote
  #53  
Old 06-21-2018, 09:30 PM
Childish Gambino's Avatar
Childish Gambino Childish Gambino is online now
Member
SOA
 
Join Date: Jul 2014
Posts: 23,647
Default

Quote:
Originally Posted by dude cool View Post
Or we could get around all of these ridiculous shenanigans and just pay directly for primary care and other things that are routine and predictable. Primary care is actually very cheap if you cut out all of the extra admin of insurance. It's almost as if insurance used to only cover catastrophic, unlikely, random events for a good reason.
Great idea. I'll start implementing it as soon as I get all this toothpaste back in the tube.
__________________
Quote:
Originally Posted by Pseudolus View Post
Trump's biggest weakness is that he utterly lacks the knowledge, experience, interest, attention span, temperament, and common decency to be the marginally effective President of a reasonably-large HOA.
Reply With Quote
  #54  
Old 06-28-2018, 07:05 PM
LICENSED TO ILL's Avatar
LICENSED TO ILL LICENSED TO ILL is offline
Member
 
Join Date: Oct 2005
Posts: 696
Default

Here is a fun upcode that I just witnessed.

The fee schedule for Oxygen states $.50 per unit. Well, the "unit" was supposed to be lbs. The provider figured out if they used PSI they'd be reimbursed more $. Been going on for about 9 months and a total of $320,000 of additional payments from the insurance company. I fixed the fee schedule to apply a different factor.
__________________
Spoiler:
Quote:
Originally Posted by Abelian Grape View Post
Nothing gay about mirin' another bro's gains.
Quote:
Originally Posted by campbell View Post
Want to become aware of my fist?
Quote:
Originally Posted by OddSox View Post
this might be my favorite thread on the AO
Reply With Quote
  #55  
Old 06-28-2018, 07:29 PM
Childish Gambino's Avatar
Childish Gambino Childish Gambino is online now
Member
SOA
 
Join Date: Jul 2014
Posts: 23,647
Default

Quote:
Originally Posted by LICENSED TO ILL View Post
Here is a fun upcode that I just witnessed.

The fee schedule for Oxygen states $.50 per unit. Well, the "unit" was supposed to be lbs. The provider figured out if they used PSI they'd be reimbursed more $. Been going on for about 9 months and a total of $320,000 of additional payments from the insurance company. I fixed the fee schedule to apply a different factor.
Are you going to recoup the fraud? It amazes me he can't be thrown in jail for this.
__________________
Quote:
Originally Posted by Pseudolus View Post
Trump's biggest weakness is that he utterly lacks the knowledge, experience, interest, attention span, temperament, and common decency to be the marginally effective President of a reasonably-large HOA.
Reply With Quote
  #56  
Old 06-28-2018, 08:31 PM
George Frankly's Avatar
George Frankly George Frankly is offline
Member
SOA AAA
 
Join Date: Aug 2011
Location: CO
Favorite beer: Sam Smith Oatmeal
Posts: 9,587
Default

Quote:
Originally Posted by LICENSED TO ILL View Post
Here is a fun upcode that I just witnessed.

The fee schedule for Oxygen states $.50 per unit. Well, the "unit" was supposed to be lbs. The provider figured out if they used PSI they'd be reimbursed more $. Been going on for about 9 months and a total of $320,000 of additional payments from the insurance company. I fixed the fee schedule to apply a different factor.
Did you find this out at work, looking at claims data? I mean, is it possible thereís more than $320k?
Reply With Quote
  #57  
Old 06-28-2018, 10:46 PM
exponentialpi's Avatar
exponentialpi exponentialpi is offline
Member
SOA AAA
 
Join Date: Nov 2008
Location: Po
Studying for ACA
College: Graduate of hard knocks
Favorite beer: Cold Smoke
Posts: 1,402
Default

Quote:
Originally Posted by LICENSED TO ILL View Post
Here is a fun upcode that I just witnessed.

The fee schedule for Oxygen states $.50 per unit. Well, the "unit" was supposed to be lbs. The provider figured out if they used PSI they'd be reimbursed more $. Been going on for about 9 months and a total of $320,000 of additional payments from the insurance company. I fixed the fee schedule to apply a different factor.
But, but, the insurance companies are the evil, greedy ones.
Reply With Quote
  #58  
Old 06-28-2018, 11:37 PM
PeppermintPatty's Avatar
PeppermintPatty PeppermintPatty is offline
Member
CAS
 
Join Date: Sep 2001
Posts: 37,021
Default

Quote:
Originally Posted by mathmajor View Post
Update: I requested the two Dr. appts to be downgraded in severity. The Dr. herself emailed back and refused, offering that I can pay self-pay (for the first claim it's actually less) but questioning their codes will have me dropped as a patient.
Is that legal?
Reply With Quote
  #59  
Old 06-28-2018, 11:39 PM
PeppermintPatty's Avatar
PeppermintPatty PeppermintPatty is offline
Member
CAS
 
Join Date: Sep 2001
Posts: 37,021
Default

Quote:
Originally Posted by George Frankly View Post
Holy hell. I know one provider (oncologist) who typically sees ~40-50 patients per day and I thought that was pretty bonkers.

Also, if you're curious, you can get a peek at which drug and device companies are contributing $$$ to your doc at this link.
I found 18 people with my doctor's name, but not my PCP.
Reply With Quote
  #60  
Old 06-29-2018, 12:15 AM
George Frankly's Avatar
George Frankly George Frankly is offline
Member
SOA AAA
 
Join Date: Aug 2011
Location: CO
Favorite beer: Sam Smith Oatmeal
Posts: 9,587
Default

Quote:
Originally Posted by PeppermintPatty View Post
I found 18 people with my doctor's name, but not my PCP.
Oh. That just means your doc failed their boards and isnít a doc any more.

Seriously, I canít find some of my physicians either. Maybe the database isnít 100%, or maybe that implies your doc didnít receive any money, although I seem to recall I did find some docs with $0 reported.
Reply With Quote
Reply

Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off


All times are GMT -4. The time now is 08:49 PM.


Powered by vBulletin®
Copyright ©2000 - 2018, Jelsoft Enterprises Ltd.
*PLEASE NOTE: Posts are not checked for accuracy, and do not
represent the views of the Actuarial Outpost or its sponsors.
Page generated in 0.19062 seconds with 9 queries