Obamacare

Doctors Get Stuck with Bills for Deadbeat Obamacare Patients

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Empty wallet
NoHoDamonFoterCCBY-NC-ND

Last year I wrote that Obamacare could leave doctors holding the bag for claims for patients who don't pay their insurance premiums. That's because the law includes a three-month grace period during which health insurers must continue to cover patients who sign up, but don't pay the price of their insurance. If the patients eventually make good, there's no problem. But if patients don't pay the owed premiums, the insurance company has to cover the cost of claims filed during the first month. Providers are stuck with the tab for any claims filed during months two and three.

The piece I wrote last July was theoretical. The notification letter I'm holding in my hand, addressed to my wife's pediatric practice, is reality. And reality costs, in this case, over $600. That's the outstanding balance owed the practice by a patient insured by BlueCross BlueShield of Arizona. It's a balance that my wife might have to eat, or else try to collect herself.

Here's the letter, from which my wife redacted all identifying information before showing it to me.

Dear Practitioner:

Under the Patient Protection and Affordable Care Act (PPACA), if an individual purchases health insurance through the Individual Marketplace and receives a subsidy to assist with premiums, there is a three month grace period in which the individual can make premium payments. During this period, insurance companies may not disenroll members, issuers must notify providers as soon as practicable when an enrollee enters the grace period and, during the second and third months of the grace period, they are required to notify providers that claims incurred in the second and third months may deny if the premium is not paid.

The member referenced above purchased health insurance through the Marketplace and currently receives a subsidy to assist with premiums. This letter is a courtesy notification to make you aware that this member and any covered dependents are currently in the 3rd month of their grace period.

What this means to you

  • This claim was incurred during the second or third month of the member's grace period and was pended. All individual claims under this contract are also in the second or third month of their grace period.
  • Any additional claims incurred during the second and third month of the grace period may be pended until the full premium due is paid by the member.
  • If the premium is paid in full by the end of the grace period, and pended claims will be processed in accordance with the terms of the contract.
  • If premium is not paid in full by the end of the grace period, any claims incurred in the second and third months may be denied. If claims incurred in the second and third month are denied due to non-payment of premium, you may seek reimbursement directly from the member.

The American Medical Association (AMA) has more information about the grace period here, though the letter above covers the high points. Given the potentially high costs providers can face when the insurance coverage they process for patient care turns out to be more of a conditional suggestion than a firm guarantee, the AMA also offers physicians guidance, and urges them to enter into financial agreements with patients who receive subsidized care. The idea is to get them to promise to pay their own bills if they stiff the insurance company.

Of course, those patients promised to pay their insurance companies, too.

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  1. The incompetence of Pelosi, Reid, Bacchus and Obama is the gift that keeps shitting giving!!!!!

    1. But, people have a RIGHT to health care!

      1. No, they have a right to health care *INSURANCE*.

        This is almost as good. Maybe they can’t get in to actually see a health care professional, but, if they could, they would be covered.

        1. No, they have a right to negotiate with providers over health care insurance.

          1. No, they have a right to negotiate with politicians to force health care providers to negotiate with health care insurance.

  2. There was no “incompetence”. The plan was to pass a health care bill that sounded good to the typical idiot voter, got the insurance companies onboard, and fucked over the “wealthy”, including doctors. They’re three for three.

    1. Unfortunately your are correct. The true believers were open about how it was doomed to fail, and once the insurance companies were bleeding red ink, the people would cry out for the Great White Father in Washington DC to save them with DMV-style ‘single payer’ health care.

  3. “DOJ Investigates ‘Deadbeat Patient’ Deaths”

    1. They won’t investigate. It’ll be like the VA. “DOJ concludes there’s nothing to see here, folks.”

  4. Who is with me to form a new Med bill collection agency – Lightworker Debt Collections, LLC. We can use SugarFree to write the collection letters and if that doesn’t terrify them into paying, we can have Warty and STEVE SMITH as “persuasion” to keep payments current…

    1. Dear Mr. Johnson,

      It has come to our attention that you owe a rather large sum of money to our client. We would like you to pay this money back. If you do not, we will open several large orifices on your face and neck and a shaved sasquatch will rape you in them. Repeatedly. And with gusto. These orifices will never heal, as sasquatch semen is highly corrosive.

      Please do not force us to send the sasquatch. It’s been almost a week since his last assignment and we can assure you that he is absolute chock-full of fizzing spunk.

      Sincerely,
      The Guys With The Rapesquatch

      1. What, no knee capping dead beats?

        *Sighs and puts baseball bat back into closet*

        1. Knee caps are involved, when STEVE SMITH has a hankerin’.

          1. STEVE SMITH PREFER BACK OF KNEE JOINT.

            WARM AND SQUISHY. UNTIL LEG COME APART.

        2. Those deadbeats will need their kneecaps to continue making money to pay off their debts. This isn’t the government, where nonpayment of fines or court costs means spending working hours in jail.

    2. We could also run a pay-porn site that allows people to stream videos of us levying non-monetary payments from debtors to settle the debts!

      eg five minutes with Warty = $100 debt relief.

      i’m in!

      1. I like the cut of your corporate jib.

      2. A less violent method would be a Physician Revenge Porn site. If you don’t pay your bill, HIPAA is suspended and your exams can be posted online. With Video.

        It’s no less constitutional than the rest of Obamacare.

    3. I can threaten to show up at their front door butt naked every morning until they pay up. That should scare them into turning over the rent money!

  5. They won’t be stuck holding the bag. They will just pass the costs on to the rest of us. This whole thing is a horrific yet fascinating case study of what happens when people who refuse to accept the laws of supply and demand make policy. They honestly thought the way to cut overall healthcare spending was to give more people more access to health care. It is literally the same thing as designing a system to reduce the cost of cars in America by mandating everyone purchase one.

    1. “The first lesson of economics is scarcity: There is never enough of anything to satisfy all those who want it. The first lesson of politics is to disregard the first lesson of economics.”

      ? Thomas Sowell

      1. I wish Thomas Sowell was mot dad!

      2. While we’re talking about Thomas Sowell:

        If we cannot afford to pay for doctors, hospitals and pharmaceutical drugs now, how can we afford to pay for doctors, hospitals and pharmaceutical drugs, in addition to a new federal bureaucracy to administer a government-run medical system?

        1. I think that is the part that amazes me the most, that adding a huge bureaucracy somehow lowers costs. It’s not even the wilfull blindness to the extra paperwork and that every business has to hire its own bureaucrats to cope with the extra paperwork — it’s the refusal to recognize that all those bureaucrats cost money.

          It’s literally thinking that any product can be cheaper if the government raises taxes to hire people to interfere in the process, and I just cannot fathom the wilfull ignorance necessary to go along with that idea.

          1. Then you haven’t met Tony or Alice.

            1. Met them in these comments, and it proves my point. I still argue with them at times, knowing it’s a wasted effort, but it always seems like something ought to get through their thick skulls, in spite of past experiences.

          2. Lowering costs was not the goal. Making sure the high costs were paid somehow was the goal.

      3. “The first lesson of economics is scarcity: There is never enough of anything to satisfy all those who want it. The first lesson of my cock is to disregard the first lesson of economics.”

        ? Sexy Thomas Sowell

    2. Unfortunately for the docs, with the way insurance payments currently work, it will be extremely hard for them to pass on the increased expense. Capitated payments rule the insurance world in hospitals and it is moving to offices next. Basically this just discourages anyone with any brains from becoming a doctor.

      1. Good point. But they will pass on some of it. We will all pay for this somehow, even if it ends up being in the form of there being fewer doctors.

        1. That’s an interesting point. Fewer docs seeing more patients, but offering substandard care. I can definitely see that developing.

          1. That is exactly how it will work. Simple people like me think that if the problem is that health care is too expensive, maybe the government should do something to increase the supply of health care. You know, build more medical schools, pay off doctors’ student loans so they can accept lower paying positions and give VISAs to more foreign doctors and get rid of a lot of the credentialing so PAs and nurses and pharmacists can do some of the work doctors are doing now freeing doctors up to provide more care in other areas. Increasing the supply of health care so the price of it goes down and it is more available is just so crazy it might work.

            But, who listens to a simpleton like me. Better to let a bunch of top men with political science degrees whose solution to the cost of health care is to make steps to increase the demand for the existing health care.

            1. I gave a talk on the supply side of the issue. Government doesn’t even need to subsidize supply, but rather stop actively cutting back on supply. See the Flexner report, the partnership between states and the AMA, the ridiculous licensing regime, the crony corporate hospitals partnering with the states to regulate imaging distribution e.t.c.

              I am currently applying to medical school. My standardized test scores are in the top 13% and they’re below average for acceptance rates.

              Now I know it’s important that doctors be intelligent, dedicated, and serious about their jobs, but I mean even if we accepted the top 30-40% of qualified applicants we’d have a ton more physicians. Over 50% of applicants don’t get in on a given year. The average age of your entering class keeps getting older.

              And don’t even get me started on nursing/pharmacist/PT restrictions that increase cost. Although this is moving in the right direction with pharmacists now being able to give shots…

              1. Also, I should be a top man. I have your political science degree AND a biochem degree. Pick me instead!

              2. The fact is that you don’t have to be a genius to be a good work a day doctor. This is especially true in the information age where the best research and clinical information is at your fingertips.

                Yes, we want geniuses going into medicine. But we mostly want those people doing research. We could get by just fine letting more people into med school.

                1. My dad’s on medicaid and ended up at a community clinic for his GP (a PA, natch) where a good 1/4 to 1/3 of the PAs (overseen by a couple of MDs) were graduates of SMU in the Cayman islands. Trust me, it makes a difference.

                2. Yes, and if the NSA is reading my posts, please pass along this recommendation to your bosses. Thanks.

          2. Fewer docs seeing more patients, but offering substandard care.

            So…the NHS?

        2. If I were a doctor, I’d cut out the middleman/insurance company and work for cash only.

          1. My father sort of does this. I’ve never really asked him so maybe I’m wrong but he once told me he gives care to patients with government insurance for free because to try to get reimbursement would actually be more expensive. Not worth his while to bother.

          2. These are known as “concierge” practices, roughly.

            Some take insurance, so its not a perfect fit.

          3. The Surgery Center of Oklahoma does exactly that.

            http://www.surgerycenterok.com/

            1. Reason did a nice feature on that center a while back.

      2. They can refuse to accept insurance purchased through the exchange, unless the insurance company agrees to cover claims during the grace period.

      3. Nah, it just means doctors should just take cash up front, and let patients work it out with their insurance. Though I doubt we would be so lucky, it could be an opportunity to kill third-party-payer-outside-of-catastrophic-care dead.

        1. Eliminating insurance is the key. Cut out the middleman.

          1. In and of itself, insurance is fine. It’s the combination of employer provided coverage being a pre-tax benefit and it being perceived as a must pay almost everything that is the problem.

            Insurance is risk management, not regular or common expense management.

      4. “Basically this just discourages anyone with any brains from becoming a doctor”

        or accepting insurance. private pay or maybe some Medicaid patients as glorfied charity.

      5. My grandparents and my uncle were/are doctors. None of my 4 siblings continued the tradition (Engineer, lawyer, CPA, pilot, artist). I was interested in being a doctor when I was a kid, but saw the writing on the wall when I grew up.

        It was nice having my granny write prescriptions without having to go in for a doctor’s visit before she passed away though. (I think we should get rid of the prescription system.)

        1. My wife’s family is similar, first generation – all doctors, 2nd generation – one doctor, and all of them are telling the third generation to do something else.

        2. (I think we should get rid of the prescription system.)

          Consider the fact that most Americans can’t point out the Nation’s Capitol on a map. Do you really think it’s a good idea to let them walk into a pharmacy and purchase whatever drugs they want?

          “I’ve got a cold. I’d like 100 – 500mg ciprofloxacin tablets and some Dilaudid please”

          Unless you’re willing to let nature take its course with stupid people, we really do need some regulations.

          Cueue the “Slaver!” comments in 3…2…1…

          1. You honestly think people too stupid to find DC on a map would know to ask for 100-500 mg of ciprofloxacin tablets and some hydromorphone at a pharmacy? No. The modern drug classification and prescription system is not the reason why the vast majority of people consult with a doctor about the treatment of their illnesses.

            You’re also presuming an awful lot in thinking that a pharmacy would hand over those drugs to anybody who walked in and asked. Pharmacies in libertopia would be perfectly free to refuse service to anyone, and the majority would undoubtedly participate in a voluntary program with medical insurance providers that would restrict access to certain drugs without physician approval, if for no other reason than to limit their risk exposure. Remember, libertopia is a very litigious place since in the absence of a massive regulatory state with statutory rules, most disputes are handled in civil court. If you don’t think the market can provide safe medications to people without the intervention of the state, then maybe the slaver thing isn’t all that misplaced.

    3. Hey, eliminating Certificate of Need laws would cut costs and give more people more access as would eliminating the requirement that doctors be licensed to practice.

      What they really thought was that giving more people access to more health care products and services that they don’t have to pay for themselves would somehow magically lower costs

      1. The infamous must provide service law in 1986 effectively made every hospital in America a charity hospital. And they are shocked this caused prices to rise. Shocked I tell you.

    4. Reducing costs was never the plan.

      The point of ObamaCare was to provide sick people with free healthcare.

      If healthcare is a right, then cost doesn’t matter. It’s a right. The left is totally incapable of allocating scarce resources, or in this case, even recognizing scarcity at all.
      Recognizing scarcity would get in the way of their delusional idea that everyone has a right to the same scarce resource.

      Anyway, economics is just evil propaganda invented by corporate capitalists to brainwash you all into false consciousness!

      1. Yes Hazel, that is what they thought. But they also honestly thought costs would go down if you gave people free healthcare. They really did. It is called the “preventative care unicorn”.

        And the irony of the whole thing is that the poor, thanks to the must provide laws were already getting their care, or as much as they wanted, for free. All this does is make them buy crappy insurance they never wanted or needed.

        I keep telling people, there is no free shit brigade to save this thing. It manages to be a welfare program that doesn’t pay anyone.

        1. Oh it’ll be paying people – the bureaucrats that administer it will get rich.

        2. Well, that part is just rationalization.

          1. Their entire ideology is one big rationalization. Haven’t you figured that out Hazel? Reality has nothing to do with it. Everything these people do is about their own particular sets of neurosis and need for fulfillment.

  6. What a great way to encourage the best and the brightest to go into the medical profession!

  7. So Obamacare works just fine if I wait until I need medical care to sign up for “insurance” that I need never pay the first penny on and somebody else will pay for my medical care? Why would anybody sign up for medical insurance before the minute they’re actually being admitted to the hospital?

    1. To avoid the penaltax. Also, it is not quite that simple. If I am in a car accident today, I am stuck with the costs it takes to save me even if I do buy insurance once I get out of surgery. So even with requiring coverage of pre existing conditions, I am still risking medical costs by not having insurance.

      Further, depending on my condition, it still may not make sense to buy the insurance. Suppose I have a bad leg and need a knee replacement. Okay, just buy the insurance and get the replacement. Right? Well maybe. Do that if I can afford the deductable and the premiums.

      1. You probably have medical coverage through your car insurance for accidents.

        If the accident isn’t your fault, the other driver’s insurance will cover it.

        1. IF the guy has insurance and if it is not my fault. And even if he does have insurance, most states only require $250K or so policy. If I am seriously hurt, I will run through that real quick. And don’t forget, my attorney will take a third of it for collecting it for me. And, it is going to take months or years to get the insurance company to pay. Insurance companies are total assholes who make a living waiting out desperate plaintiffs to accept less than they deserve.

          It sounds nice to say “oh the other guy’s insurance will pay for it if it is his fault”. In reality, that is a pretty shitty answer.

      2. Theres that and even though the insurance companies must take us pre-exisiting conditioned types the cost per month is now “how much do you make?”

    2. Not quite that bad, you can apparently only “sign up” during the open enrollment period unless you had a qualifying life event or qualify for Medicaid.

      1. One of the qualifying “life events” is moving to a new state. I think it would be pretty easy to use the address of an out-of-state friend or family member to game the system.

  8. Gamers are awesome. Oh. Not those kind of gamers. I thought you had to have a gaming license, anyway.
    (Who would have EVER guessed that someone could take advantage of PPACA, one of the most well thought out legislative actions EVER!)

  9. In addition, health care providers are going to get screwed even if the patient has insurance. Because when all someone can afford is an Obamacare policy with an eight thousand dollar deductible, it’s very doubtful that they have any money to pay it. The deductible that is.

    1. And remember, one reason for Obamacare was to get rid of those “junk policies” that had… high deductibles.

      In some ways, this is all working as planned: redistributing wealth to poor sick people from rich doctors.

      1. In some ways, this is all working as planned: redistributing wealth to poor sick people from rich doctors.

        Otherwise known as buying votes with other people’s money.

    2. I work in the medical equipment industry, and we check everyone’s insurance before we dispense the product. If they have a large deductible, they have to pay for it up front, and we bill their insurance for it. We have had many people say they can’t afford it and walk out.
      It amazes me how many adults have no idea what their deductibles or copays are.

  10. What this means to you

    This claim was incurred during the second or third month of the member’s grace period and was pended. All individual claims under this contract are also in the second or third month of their grace period.
    Any additional claims incurred during the second and third month of the grace period may be pended until the full premium due is paid by the member.
    If the premium is paid in full by the end of the grace period, and pended claims will be processed in accordance with the terms of the contract.
    If premium is not paid in full by the end of the grace period, any claims incurred in the second and third months may be denied. If claims incurred in the second and third month are denied due to non-payment of premium, you may seek reimbursement directly from the member.

    Translates as “Its on you, sucka”

    1. If the premium is paid in full by the end of the grace period, and pended claims will be processed in accordance with the terms of the contract.

      Some hospitals I know of will pay this premium on behalf of the patient. The insurers hate this, and are arguing (behind closed doors) that it is a violation of fraud and abuse laws.

  11. “Dear patient: We do not currently treat patients that are under the grace period. If you would like a referral to another doctor, please don’t hesitate to ask.
    FYTY,
    Your Doctor”

    1. Exactly what I was thinking.

      “I’m sorry, we don’t take medicare patients [because the compensation is shit]”

    2. Hey, the third world has lots of doctors who’d rather be here than in their respective hell holes, open the borders and let ’em in.

      Also, licensing by the state is a bad thing, so let the newcomers set up practices without bureaucratic interference.

      Provider supply problem solved, anyway.

      1. Without state licensing you’d end up with the exact equivalent anyway, only privately administered. Insurance companies would insist on it. That would be a better way to do it, of course, but I’m not sure on the whole how much difference it would make on a practical level. Not every expansion of liberty is a utilitarian gold mine. Some things you do on principle.

        1. Not every expansion of liberty is a utilitarian gold mine.

          Those of us who dont give a damn about utilitarianism already realize this.

          Some things you do on principle.

          Some?

          1. My point being that most expansions of liberty do have a practical benefit as well, so they hold up to utilitarian scrutiny. Other expansions of liberty may not have an immediate, or even any actual utilitarian benefit, but they should still be done anyway just because it’s the right thing to do. I’m pretty confident that many state licensing schemes currently in existence would be replicated by the market to limit liability in the absence of the state. Doesn’t mean it shouldn’t be done. Just means some of the practical benefits of doing away with licensing entirely (like vastly expanding the supply of doctors, for example) may not fully materialize.

            1. I really want to scrutinize the principles and think through the implications of their full acceptance before agreeing.

    3. Dr. Doctor — if you would like to keep your license, you will treat all comers regardless of ability to pay.

      Smooches,
      State licensing agency.

      1. I quit.

        Fuck you,

        Every doctor

        1. True enough, there will be a point that we won’t get many new American-trained doctors because the the high cost of training won’t be adequately compensated.

          Foreign doctors, with cheaper or likely subsidized educations, will be happy with this outcome. Some day will be offering them incentives to come here. They will be doing jobs Americans can’t afford to do.

          It would be nice if we could make it easier to turn more of our competent people into medical providers. I don’t believe, for example, that straight As in physical chemistry are necessary to demonstrate competence for a general practitioner.

      2. Shit like this is why I suggest only half-jokingly that we need single-payer legal care, with all the same restrictions people want ot put on doctors being put on lawyers.

  12. the AMA also offers physicians guidance, and urges them to enter into financial agreements with patients who receive subsidized care.

    “Nice [body part] you got there ….”

  13. Of course, if you have actual assets as a productive person, you cant game the system because the doctor will come after you.

    So this gaming is perfect for people who are living on the government in other ways.

    1. You watch, the solution to this will be to go after deadbeats who are not paying their fair share. They will make bankruptcy for medical bills harder to do. They will loosen the rules for debt collecting. That of course will not affect the bums, since they don’t have anything to lose anyway. It will, however, totally fuck a bunch of honest people who had the misfortune of getting sick.

      Every single thing they do is designed to screw any honest hard working person and benefit any bum. It is just not fair that people who work for a living have it better than bums I guess.

      1. This.

        What they will do is establish a “bad debt pool” that will be run by the state. Providers will sell their uncollectable debt into this pool.

        Once the state realizes that they can’t collect the debt either, they will do what they do with literally every other sovereign debt – they will make it undischargeable, and they will seize and garnish EVERYTHING to get that money back. Because the alternative is some politician somewhere having to cast a vote to pay for their programs with actual tax money, and they will tear the flesh from debtors’ bones before they admit that progressivism costs money.

        1. Exactly. It is like student loans. There are a million truely heartbreaking stories about student loans out there. I am not talking about some dumb ass who got a puppetry degree for $200K. I am talking people who went to school, got their degrees but then got sick or were unemployed for a while or had some other bad break and the interest compounded so quickly that they will no never pay them back. But that can’t discharge them in bankruptcy. No. That would require the government admitting college costs money or the worse the academic class living within its means.

          At the same time, I could go out tomorrow and run up a half million dollars in credit card debt feeding my gambling and hooker addiction, and walk away from every dime of it.

      2. Oh, I don’t know. I could see a system arising that is modeled on the current child support payment one.

        1. I would not be surprised at all if we ended up there.

  14. Labs, radiologists, etc… They are holding the bag too.

  15. So I was recently at my doctor’s office. There were some dudes loading various pieces of diagnostic equipment into a large truck.

    Me: You’re not closing up shop, are you doc?
    Doc: Nope. I’m getting rid of all this equipment because it’s costing me money.
    Me: How so?
    Doc: Medicare and Medicaid only pay X amount of dollars per use, and it costs me more than I make on them just for maintenance and calibration.
    Me: So where do people who need these diagnostics go to get them?
    Doc: Nowhere. Everybody is getting rid of them. They’re like a hole in the floor that you just keep throwing money into.

    Oh well, at least the emergency rooms and ICU’s will be busy.

    1. We are screwed.

    2. Doctor services and lab menus are being trimmed down to just the cheaper test for the state-run programs. CA in particular.

    3. Will this make it more worthwhile to open entrepreneurial diagnostic centers where such machinery can have a higher load factor and hence pay off?

      Assuming, of course, that the regulators don’t squelch the idea.

      1. MedPAC (which advises Congress on Medicare) is trying to stamp out independent labs.

        1. What? There is a robust lab industry in the U.S. (Outside the U.S. it is very weak due to socialized medicine)

          Any non-hospital lab in the country will gladly perform tests for cash. Here is an example.
          http://firstchoicelabsusa.com/

        2. This has more to do with Medicare payments. Labs are a target for cost savings.

      2. I think that these already exist. I assume that’s what the AnyLabTest chain that you see in strip malls does.

    4. I hope he didn’t get rid of the machine that goes bing.

      1. We need more apparatus!

    5. Me: So where do people who need these diagnostics go to get them?

      Sudan or other developing country – as soon as the equipment is offloaded and donated to the local school/hospital.

    6. They’re like a hole in the floor that you just keep throwing money into.

      Sounds like a boat. Though, I do get to choose to own the boat and the government has not yet made it prohibitively expensive to operate.

  16. Unfunded mandates–is there nothing they can’t do?

  17. $600.

    Three Tylenol?.

  18. OT: Finally some millenial information that is useful.

    Best Cities For Millennials

  19. the AMA also offers physicians guidance, and urges them to enter into financial agreements with patients who receive subsidized care. The idea is to get them to promise to pay their own bills if they stiff the insurance company.

    Yes, because signing yet another form that says they promise to pay is really going to hold them to their word.

    Realistically, the only thing doctors can do is:
    a) not accept patients with ACA exchange purchased insurance, or
    b) only accept those plans that promise to cover the losses themselves

    Ultimately, I think the market will work things out so that only (b) type plans exist, which means that premiums will go up to cover all the people stiffing the insurers.

  20. By the way:

    Why does Mrs. Tuccille put up with this “no really baby I’m a writer” nonsense from JD, when she has a REAL job?

    KEPT MAN ALERT

    1. Shh! Don’t ruin a good thing.

    2. No shit. It is the 21st Century I guess.

      1. She must really like that libertarian smell.

        1. She must. I bet her parents were horrified. “We sent you to med school to marry a doctor, not some bohemian nerd.”

          1. That’s not very nice. Maybe her parents are happy that their grandchildren have a stay at home dad.

            1. There is that.

            2. Right.

              I bet they said, “Aw, it’s so nice that JD has a way to keep busy and has interests outside of his housework. We had encouraged him to volunteer at the animal shelter – but his blogging is nice, too.”

  21. It’s a balance that my wife might have to eat, or else try to collect herself.

    $600.00 is a lot of money. Imagine if your wife had to deal with several of those cases at once. Your wife would have to either abandon her practice, become a concierge doctor or work for cash from the back of a 1967 Econoline van.

    1. So highly paid professionals have an obligation to get stiffed now and then because they can afford it? Or were you being sincere and my sarc detector needs calibration?

      1. it’s okay. the docs had to get rid of the detector because they were losing money on it.

  22. Sounds like they’ve hit upon another ingenious way of bending the health care cost curve downward; just don’t pay the doctors. It ranks right up there with letting veterans die! Can’t wait to see what other brilliant ideas we can come up with.

    1. Logan’s Run had a good (and final) solution.

  23. “….and, if you DON’T like your doctor, you can stiff your doctor”
    The part he left out.

  24. OT: It’s from the Kossacks so put on your derp gloves

    http://www.dailykos.com/story/…..=facebook#

    This is just tragic, but it falls in line with the batshit craziness that has been going on with law enforcement as of late. An Independence MO cop used a taser and critically injured a 17-year-old child (Bryce Masters) during a traffic stop…

    But the plot thickens?

    The kid’s dad is a cop with the Kansas City Police Department and the Masters’ family has asked The Justice Department to step in and lead an investigation of the Independence MO Police Department.

    1. Just saw that on the Daily Mail. Too bad it will be treated as a bad apple instead of a result of police culture.

      1. Well, thats SOB at this point, but I’m sure the twist that it was a cop’s kid will make the story interesting.

        1. Yeah. Dad is in a real bind here. He knows that investigations are rigged, and wants to preserve that in case he kills someone for pissing him off. At the same time, this is his son. So he’s got to choose between his brothers or his son.

    2. First, a 17 year old is not a fucking child. Second, just because the cop used the tazer, doesn’t mean the little bastard didn’t leave the cop no other choice.

      I am certainly willing to admit the cop may have been wrong here. But it will take more than the mere fact that he tazered the guy and that resulted in serious injury.

      1. Looks like you didn’t read the story. I’ll summarize.

        Hero tells kid to put down the window. Kid tries to explain that the window doesn’t work. Hero sees this as a threat to his safety and deploys his tazer. He throws the kid to the ground for his safety, cuffs him for his safety, and then drags his cuffed and convulsing body around as blood pours out of the kids mouth. For his safety. When the convulsing gets bad he put his foot on the kids back for his safety. All the while taunting and threatening him. For his safety. Finally the kid dies. Five minutes later medics revive him. Our hero goes home to his family.
        Witness accounts and video contradict the hero’s report.

        1. How did he tazer him if the window was up?

          1. Apparently he got it down a crack. I dunno. Read the story. It’s pretty disturbing how the cop shows depraved indifference as the kid is convulsing on the ground after being smashed face first onto the pavement. Of course, depraved indifference is just part of being a cop.

          2. It’s all very confusing. They say the window was cracked open; the cop demanded he open it wider, and the kid said the motor was broken and he couldn’t.

    3. “Roll down your window”

      “Fuck you man, my dad’s a cop and I don’t have to listen to you”.

      Bzzzzzzzzzzzzzzzzzzzzzt.

      Pick your battles wisely.

  25. Around our office, we don’t have any non-paying clients. When we bill you and you don’t pay, you are no longer a client. AKA no tickee no washee.

    I wonder if doctors can get away with that.

    1. One solution is to remove the Doc-Insurance payment exchange.

      You pay Doc, You collect form insurance.

      Just like, with, oh, every other insurance system.

      When my roof was damaged, the insurance company wrote me a check. Not the repairman.

  26. There’s black markets in everything. How far will O-care push medical professionals into the cash only/grey market/black market?

    I lived in an heavily immigrant neighborhood ten years ago. My neighbors kept advising me to stop giving my money to those expensive, licensed, dentists and go to a friend of theirs. The friend had a little practice in her garage and had, so she claimed, been a DDS in El Salvador. Had a nice set up with chair and drills and stuff.

    She cleaned my teeth and gave me a check up for $40 – about a quarter what those fancy licensed dentists charge. Probably not worth the risk of getting a cavity filled. But you never know.

    Now would I go to an off the books proctologist? hmmmm

    1. Depends on what he or she looked like and if you were into that kind of thing. NTTAWWT

    2. Now would I go to an off the books proctologist? hmmmm

      Just come to southern NV. You can pay the licensed physician rate and still roll the dice on hep c.

    3. Now would I go to an off the books proctologist? hmmmm

      I lost track here, are you still trying to get a cavity filled?

    4. Cash only isn’t black or even grey. There have always been practices working that way, just few and far between. They’re getting a lot more common now. That and concierge practices which, as I understand them, you are basically insuring yourself directly for access to the practice, not via an outside third party company.

  27. Here’s another good one: I spend most of my time traveling, so it’s really hard to make and keep a doctor’s appointment. I can’t not fly to Tampa or Virginia Beach or DC or wherever for the week, just because I have a 30 minute doctor’s appointment on a Wednesday. I was just informed that due to new regulations, one of my prescriptions cannot automatically be refilled. I must make an appointment and see the doctor every month if I want a refill. I’ve been given a choice by our rulers: Miss work or miss meds. Thanks Uncle Sugar. I really needed you to insert yourself between me, my doctor, and my health care decisions.

    Now instead of paying for two doctor visits a year, my insurance company and I get to pay for 12 visits a year.

    1. My insurance won’t pay for medication that has been prescribed more than three times unless I mail order it through them and get a ninety day supply.

      Maybe you can get three months worth instead of one. Then you only need to visit four times a year.

      1. Nope. One month supply, doctor’s visit for refill. No other options.

        1. That sucks. What about a strip mall clinic? Seriously. They charge like seventy five bucks a visit or something. Less than a traditional practice. And they’re usually more flexible with the scheduling.

        2. Let me guess, it is a controlled substance, Adderall maybe?

      2. I’m guessing he’s probably on a recently-rescheduled opioid pain medication, in which case his doctor wouldn’t write a 90 day refill even if he/she was allowed to for liability reasons. Unless you’ve got a real good rapport with your local DEA agent, you don’t want to be dispensing 1 pill more than the national average.

        1. Bingo, only until recently my doc would prescribe them for months at a time. I find that if you sit down with a doctor and have an intelligent conversation regarding the symptoms, treatment, potential side effects, and outcome of a disease, you can pretty much treat yourself. If you walk in breathing through your mouth utterly clueless, you’re getting the idiot treatment. If you walk in and explain that prior medications were ineffective, you understand and acknowledge the risks and side effects, and that you have a on-off schedule to guard against possible addiction, most doctors are quite reasonable. It helps if your hands look like they got caught in a tank track.

    2. Oh, I’ve got this one too.

      I am so screwed by health insurance that it’s laughable. I have a high deductible and ridiculously high medical expenses, but since they’re transition related, every last bit of it is excluded. I do okay with negotiating cash payments, but I can’t even use an FSA or HSA for it. I don’t even have the option of dropping insurance to save up for it. Remember back when a useful HSA and cheap catastrophic insurance was an option? Yeah, that would be nice.

      I’m in the humiliating position of hoping that we trans babies can whine loudly enough that Mommy will take pity on us and force everyone else to pay for our care, since I very much doubt that at any point in my lifetime I will be allowed the option to pay reasonable prices for my care.

      1. That’s whats known as a Faustian bargain.

        1. Hey, I’m on board with true healthcare reform, Libertopia, or violent anarchic revolution whenever you guys feel up to it.

          1. Is there someone in command of this “violent anarchic revolution”…a leader…, rules of engagement…, or are you just going to run around in uncoordinated chaos shooting each other?

            Irony: It’s what’s for dinner.

  28. my neighbor’s aunt makes $61 hourly on the laptop . She has been fired for 9 months but last month her income was $14380 just working on the laptop for a few hours. you could look here….

    ???????? http://www.netjob70.com

  29. I think we all need to quit debating the illusory justifying reasons thrown out for the ACA. We all say “it was never about lowering costs”, etc. but then go right on with laying out reasons why it won’t atually lower costs. It doesn’t matter.

    The goal was insurance industry and healthcare industry cronyism and payouts, and setting them up for easy money. Period. Lobbyists. Let’s quit dignifiying the “affordable care” sham with responses. It simply provides validity to the lie. Go for the throat, and call them on the real evil and (like here) the negative consequences.

    The anecdote about the doctor ripping out his diagnostic machines is pretty impactful.

    1. It was always a coalition of intentions with no real interest in outcomes.

  30. It sounds like it may be in the physician’s best interest to consider paying the 2 months of premiums for the delinquent patient. The monthly payments for a heavily subsidized patient might be quite low. Maybe making a $200 payment could clear the way for you to receive the $600 you are owed…
    Just a thought.

    1. That’s probably not even entirely legal under the current rules, plus you could likely get a better rate from a AR financing company, in which case there’s no practical benefit aside from a sense of altruism, I guess. Depending on the doctor, the practice, and the patient, 2 months of the subsidized rate is more often than not probably going to be a break-even proposition at best anyway.

      1. AR financing company?

        Automatic Rifle?

        1. Accounts Receivable.

          1. (AR financing companies basically buy your accounts at a discounted rate, then they handle collection and take over the risk of non-payment)

      2. I imagine you’re right but…If your patient had an expensive procedure costing thousands…It could work out..Unless it’s illegal :-/

        1. Right, it could theoretically work if you do it only for patients who ALREADY had an expensive procedure.

          HMMMMMM. Or those who could potentially have expensive procedures done in the near future. Ones you could recommend to them.

    2. ARBITRAGE!!!!!

    3. The problem is, as soon as your patients find out you are doing this, they are all going to stop paying their premiums.

  31. And reality costs

    Only if you’re a racist, teabagging, rethuglican.

  32. America, land of the ‘free to be a deadbeat.’

  33. Something tells me it’s going to become very difficult to find a doctor who will accept Obamacare.

  34. Puts a little different perspective on it, doesn’t it? What I would give for a politician that would say: “medical people are human beings who need to get paid for the work they do” or “yes a pre-existing condition is a terrible situation but a person who has a million dollars of medical bills coming up and has been paying for no health insurance is not a simple problem to solve.” But “rights” (there are no economic rights which require one person to pay for something for another) to health care just role off the tongue easier, don’t they?

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