There’s a New Squid in Town: the view from the belly of the beast part II

In the first installment of my three-part series on healthcare, I covered the insanity of trying to get things covered by the private insurers.  Today I’m going to examine the second half of the problem: getting things paid.   If you are a healthcare consumer, you are likely at least a little familiar with the former, but not so much the latter. I know I’m spending a lot of time describing the problems with the system. But the thing is, we cannot adequately discuss solutions, or what proposed solutions will and will not work, and WHY, without having a very thorough understanding of just what the problems are from both the patient and the provider end.

I’ll first have to give a quick, VERY simplified primer on how medical services are billed.  Providers do not send a bill to an insurance company saying “20-minute office visit for diabetes and jock itch, $74.”  They use a system called CPT, or Current Procedural Terminology, that assigns a specific numerical code to everything a doctor does, from office visits to counseling to procedures. Office visits are rated from 1-5, depending on how complex the presentation, and how many medical problems were dealt with that visit. There’s a lot of these codes – the current CPT book is a good 4 inches thick. The codes are then fed into a computer, and the insurance pays accordingly, by a contracted fee schedule.   Diagnoses are entered via a separate set of codes, ICD, that must match up with and “justify” the CPT codes used. Got it?

I mentioned in part one the “perpetual adversarial chess game”, and it comes into play here.  The providers are always trying to figure out how to “correctly code” what they did, and the insurance companies are always trying to figure out ways to have the computer reject any given code combination.  Please keep in mind that because there are  so many similar codes,  the “game” gets interesting.  There may be 5 different diagnosis codes for a single illness, and THIS insurance company decides that they require you to use the second one, while THAT one kicks it out unless you use the 3rd one in conjunction with certain CPT codes.  Oh, and they change what will “kick out” all the time, so the code that resulted in your getting paid last month will not necessarily go through this month. Confused yet?

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This was the plan all along

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Glenn Greenwald finally gets it:

That’s obviously true. In fact, it’s so obviously true that no matter how dumb one might think Democrats are, they’re certainly not so dumb that they failed to realize that the GOP was highly unlikely to help Obama pass health care reform no matter what the bill contained. From the start, it’s been obvious to everyone — the Obama White House and Senate Democrats included — that the GOP would not help Obama pass health care reform. Why would the GOP want to help Obama achieve one of his most important and politically profitable goals? Of course they were going to try to sabotage the entire project and would oppose health care reform no matter what form it took. Everyone knew that from the start for exactly the reason that it was so obvious to Benen.

The attempt to attract GOP support was the pretext which Democrats used to compromise continuously and water down the bill. But — given the impossibility of achieving that goal — isn’t it fairly obvious that a desire for GOP support wasn’t really the reason the Democrats were constantly watering down their own bill? Given the White House’s central role in negotiating a secret deal with the pharmaceutical industry, its betrayal of Obama’s clear promise to conduct negotiations out in the open (on C-SPAN no less), Rahm’s protection of Blue Dogs and accompanying attacks on progressives, and the complete lack of any pressure exerted on allegedly obstructionists “centrists,” it seems rather clear that the bill has been watered down, and the “public option” jettisoned, because that’s the bill they want — this was the plan all along. (emphasis added)

Well no shit, Sherlock! That’s why I keep saying – “Failure is a feature, not a bug.” I’m glad to see that people smarter than me are starting to figure it out too.

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One more time:

“Because that’s the bill they want — this was the plan all along”

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Unsocialized Government (a play in 1/2 an act)

(I totally stole this from Violet Socks)

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{{ring}}

Dispatcher:  Midvale Fire Department, how may I help you?

Homeowner:  My house is on fire!

Dispatcher:  May I have your policy number?

Homeowner:  My what?

Dispatcher:  Your homeowners insurance policy number.

Homeowner: What do you need that for?  MY HOUSE IS ON FIRE!

Dispatcher:  I have to verify coverage, sir.

Homeowner:  What the f u . . .?  Just a second, let me find the card in my wallet.

Dispatcher:  I’ll hold, sir.

Homeowner:  Here it is, it’s X123456789

Dispatcher:  Thank you, sir.  Okay, I see you are covered for basic fire.  Is anyone trapped in the house?

Homeowner:  No, everyone got out.

Dispatcher:  That’s good, because you’re not covered for rescues from burning buildings.

Homeowner:  No, everyone’s out.  But the house is burning, can you please hurry?

Dispatcher:  Just a few more questions, sir.  There is a $10,000 co-pay due at the time of service, will you be paying with cash or major credit card?

Homeowner:  I don’t have that kind of cash and my cards are maxed out.  Will you take a check?

Dispatcher:  I’m afraid not sir, would you like to fill out a credit application?

Homeowner:  Yes, yes, whatever.  Just send the damn fire trucks!

Dispatcher:  There is no need for profanity sir.  Do you know how the fire started?

Homeowner:  I think my son was playing with matches.

Dispatcher:  Oh, I’m sorry sir, your policy carries an exclusion for arson.  Have a nice day.

{{click}}

Homeowner:  Hello?  Hello?

THE END

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Total spending on health care, per person, 2007:

United States: $7290
France: $3601
United Kingdom: $2992
Italy: $2686

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Happy Birthday Big Dawg!

Dear President Clinton,

I must admit, I am unabashedly your greatest fan.  I voted for you in 1992 not really knowing much about you, but I did sense something special whenever you spoke.  There was a great heart, soul, and mind within you that emanated from your being.  I felt that you were the real deal.  Sure, I heard all the rumors about your personal failings; but who am I to judge?  I wanted a compassionate human being in the White House and you seemed to fit that bill.  I was looking for a president that would make life better for those of us struggling to make ends meet, to care for our children, and to honor and care for our aging parents as they deserved; one that would breathe new life into the elusive American Dream.  It was beginning to look like the ability to send your kids to college, own a home, go on family vacations, and not worry about medical bills was being buried by those who valued the individual over the collective.  But then you came along.  As I watched your inauguration and listened to you speak of the promised “forced spring,” I sensed that a different world was in the offing.

As your first term progressed, I watched the shenanigans of those who sought to destroy you and Hillary.  A landslide victory giving you a second term did nothing to stem their viciousness.  They were obstructing your ability to serve the American people without debilitating distractions.  I watched them waste millions of our tax dollars chasing rumors and innuendos with nothing to show for it except a stained blue dress.  I also watched as you continued to work for the American people during this time, never wavering, never forgetting US.  As I watched your impeachment I cried.  You were working for ME and they were trying to stop you.  But still you persisted, and continued to do so until the day you left the White House on January 20, 2001.  That was a terribly depressing day for me.

Listening to his closing speech at the meeting of the Clinton Global Initiative in 2006 tells me all I need to know about this wonderful, intelligent, compassionate man.

For those that can handle the heartbreaking reality, Bill Clinton reviews the 8 greatest years of peace and prosperity of our generation, in his farewell speech:

You exceeded all of my expectations Mr. President.  The eight years of your presidency were the best years of my family’s life.  We felt economically secure, we had hope for the future, we felt safe; and you and your wife made us feel like you really cared about us. 

You are the greatest president of our generation.

Thank you for everything Mr. President.  I will never forget.

*****************************************

ADD YOUR BIRTHDAY WISHES FOR THE BIG DAWG!  We all know he reads TC!

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Wednesday “Hump Day” Morning News

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Democrats Seem Set to Go It Alone on a Health Bill
Given hardening Republican opposition to Congressional health care proposals, Democrats now say they see little chance of the minority’s cooperation in approving any overhaul, and are increasingly focused on drawing support for a final plan from within their own ranks. (yeah, right)

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Can you say “Conflict of interest?”

Two firms that received $343.3 million to handle advertising for Barack Obama’s White House run last year have profited from his top priority as president by taking on his push for health-care overhaul.

One is AKPD Message and Media, the Chicago-based firm headed by David Axelrod until he left last Dec. 31 to serve as a senior adviser to the president. Axelrod was Obama’s top campaign strategist and is now helping sell the health-care plan. The other firm is Washington-based GMMB Campaign Group, where partner Jim Margolis was also an Obama strategist.

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American Man Jailed in Burma Heads Home
An American man imprisoned in Burma for sneaking into the opposition leader’s compound but released with the help of a visiting U.S. senator headed home on a flight Tuesday after two days of health checks in Thailand.

John Yettaw, 53, of Falcon, Missouri, was detained in Burma for three months after he swam across a lake and made an unauthorized visit to the home of detained democracy icon Aung San Suu Kyi.

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Obama aims to fix intraparty fissure

Public option wasn’t intended to become a big focus of health overhaul (neither was single payer)

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Marijuana growers sought in Calif. wildfire
30,000 plants found near blaze; Mexican drug cartel suspected

Investigators said Tuesday they believe marijuana growers with possible ties to Mexican drug cartels caused an 88,650-acre wildfire in northern Santa Barbara County, and there are many more pot farms hidden in remote areas around the nation.

“No pun intended, it’s a growing problem,” U.S. Forest Service Special Agent Russ Arthur said.

(L-E-G-A-L-I-Z-E)

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Lawyer: FBI Trained Hal Turner As An “Agent Provocateur”
Internet blogger Harold “Hal” Turner’s attorney said today that Turner’s background as an FBI informant will be a key part of his defense to charges that he incited violence against two state legislators and a state ethics official.
(h/t CANNONFIRE)

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Senate bid dogged by Fiorina’s failure to vote

Republican Carly Fiorina, the former Hewlett-Packard CEO, took her first formal step Tuesday to challenge incumbent Democratic U.S. Sen. Barbara Boxer – but does she pass the Citizenship 1o1 test?
Critics suggest maybe not, considering that Fiorina, 54, who has a spotty voting California voting record, never cast a ballot in two other states where she lived previously, according to public records.

(California has lots of bad politicians, but Barbara Boxer isn’t one of them.)

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Telescopes to show universe soon after Big Bang
It may not be possible to travel back in time, but seeing stars and galaxies as they looked millions or even billions of years ago is no problem thanks to telescopes, the closest thing we have to time machines.

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Report: Much went wrong before BART shooting
BART police bungled the New Year’s disturbance that ended in an officer shooting an unarmed patron to death, says a scathing report now in the hands of BART brass.

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Best Buy Fires Two Employees Who Tackle Thief
(And we want for-profit private companies running health care insurance?)

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Did PETA Just Call Fat Women ‘Whales’?
The animal rights group known for its controversial ways of attracting attention has put up a “Save the Whales” billboard in Jacksonville, but instead of the marine mammals, it shows an image of an overweight woman.

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Whose birthday is it today?

Hurricane Bill churned in the Atlantic Ocean toward the west-northwest as a major Category 3 hurricane Tuesday evening.

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NFL investigating Cable-Hanson altercation
The National Football League is investigating a training-camp incident that landed Raiders assistant coach Randy Hanson in a hospital with a jaw injury, a league spokesman said Tuesday.
Hanson told Napa police he was assaulted by a member of the Raiders’ staff Aug. 5 but declined to name his attacker. When the story leaked Monday, multiple team and league sources identified Raiders head coach Tom Cable as the person involved in the altercation with Hanson.

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