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Medical Costs Bankrupt Patients; It's the Computer's Fault

Soulskill posted about a year ago | from the i-blame-the-schools dept.

Medicine 637

nbauman writes "Don't get cancer until 2015. The Obama health reform is supposed to limit out-of-pocket costs to $12,700. But the Obama Administration has delayed its implementation until 2015. The insurance companies told them that their computers weren't able to add up all their customers' out-of-pocket costs to see whether they had reached the limit. For some common diseases, such as cancer or heart failure, treatment can cost over $100,000, and patients will be responsible for the balance. Tell me, Slashdot, how difficult would it be to rewrite an insurance billing system to aggregate a policyholder's out-of-pocket costs? 'A senior administration official, speaking on condition of anonymity to discuss internal deliberations, said: "We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which told us that their computer systems were not set up to aggregate all of a person's out-of-pocket costs. They asked for more time to comply."'"

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A cynic's view (5, Insightful)

mariox19 (632969) | about a year ago | (#44559723)

The rollout is being delayed until after the 2014 congressional elections. The problem is political, not technical.

Re:A cynic's view (5, Insightful)

Anonymous Coward | about a year ago | (#44559841)

A cynic would also know that billing system software is some of the most byzantine crapware on the face of the planet. It's hacking on this kind of software--plus payroll, HR, accounting, etc--that sustains both Oracle and IBM, plus thousands of smaller consulting firms.

So, the administration's excuse is both plausible and fortuitous. In other words, I doubt the insurance companies had to twist the administration's arm to postpone the mandate and cap.

Re:A cynic's view (5, Interesting)

gander666 (723553) | about a year ago | (#44559891)

This.

The mess is deep and wide, and likely still has some duct tape applied to cover up the Y2K transition. Many/most of these systems are ancient, and creaking under their own mass.

Re:A cynic's view (5, Interesting)

cusco (717999) | about a year ago | (#44560105)

The last time I had to deal with the insurance programs they were nothing more than a web GUI hiding a dumb terminal interface. Most are still on mainframes.

Re:A cynic's view (2)

Gr8Apes (679165) | about a year ago | (#44560375)

Creaking? They're cemented together with blood, sweat, and duct tape that has solidified into a solid mass over the years. It's probably more stable than Roman mortar, given all the attempts to replace them. Have the original travel systems ever been replaced that travel agents used to look things up on?

Re:A cynic's view (4, Insightful)

KernelMuncher (989766) | about a year ago | (#44560051)

Even with these complexities if the insurance companies really wanted to cooperate, the could add up the out of pocket costs and when it was >12,700, just stop and exempt the person. But obviously that would cost them money so they throw up the "technical difficulties" flag and say it's impossible.

What they are really saying is "We want to delay this for as long as possible so we can keep maximizing our profits".

Re:A cynic's view (3, Insightful)

ganjadude (952775) | about a year ago | (#44560061)

why is no one talking about the fact that obama does not have the power to delay the law from being implemented? i mean i am not a fan of the law (its longer than the IRS code) but still, he has no authority to be delaying this from being implemented. But not having authority has never stopped him before. Our congress needs to grow some balls and call him on his shit.

Re:A cynic's view (0)

Anonymous Coward | about a year ago | (#44560225)

Don't talk shit. The system works right now, the companies concerned have multiple prices per line item and adding another supplier is a few minutes work. You have no idea how complex the medical system is, and how it can cope with a plethora of systems and payment types already.

Save your GOP trolling for elsewhere.

Re:A cynic's view (0)

Anonymous Coward | about a year ago | (#44560307)

Maybe Obama could redirect some of the employees handling the large-scale illegal surveillance on American citizens and the storage of resulting information into helping these companies with their little bookkeeping problems.

Re:A cynic's view (4, Funny)

msobkow (48369) | about a year ago | (#44559913)

Oh, come on.

Do you really think insurance executives know how to add?!?!?!?

Re:A cynic's view (1)

budgenator (254554) | about a year ago | (#44560281)

Do you really think insurance executives know how to add?!?!?!?

Well since you mention it, i don't think that there is any guarantee that they do. Anyone who has dealt with third-party health benefits providers will not think this is snarky.

Re:A cynic's view (4, Insightful)

mc6809e (214243) | about a year ago | (#44559915)

A cap on out of pocket expenses means the insurance company has to pay more.

Where will they get that money? They'll get it from higher premiums.

Forcing people to pay higher premiums just before the election would look bad, hence the delay.

Re:A cynic's view (0, Troll)

Anonymous Coward | about a year ago | (#44559977)

Forcing people to pay higher premiums just before the election would look bad, hence the delay.

All you really need to know about Obamacare's costs are that, just before going on vacation, Obama granted Congress a waiver so that they no longer have to participate in the system.

It's too costly for our elected officials to pay for, so his Obamaness has decided that they don't have to.

Re:A cynic's view (3, Informative)

Anonymous Coward | about a year ago | (#44560349)

All you need to know is that's not true [politifact.com] .

Re:A cynic's view (0)

Anonymous Coward | about a year ago | (#44560357)

Fact 1: Have you heard about the 80/20 rule? Because healthcare is more like 90/10. Insurance companies likely already have enough from everyone for the 10% who will actually go over the limit.

Fact 2: Despite fact 1, the insurance companies most likely will still increase premiums. Would you give up the insane profits they are already experiencing, just because the law now says you have to pay more? Of course not, you'd find a way to comply with the law and continue making those insane profits (or at the very least, do something shady that, if caught, the fine is low enough that it is still worthwhile).

Re:A cynic's view (3)

MrBigInThePants (624986) | about a year ago | (#44559945)

Annnnd the fact that every time this sort of article gets posted there is this fundamental and extremely naive assumption that you are still in control of your government, it is still supposed to work for the people and that the politicians (and their masters) are not fully aware of what they are doing.

Remove that and this faux surprise and outrage goes away and the real work can begin...fixing the ACTUAL problem...

Re:A cynic's view (4, Interesting)

dkleinsc (563838) | about a year ago | (#44559965)

For who's benefit, though?

As far as I can tell, Republican partisans believe that everyone will hate Obamacare once it actually exists, which would mean that the Democrats are trying to avoid having it exist. The Democrats could have cut a deal with the insurance companies to prevent things from rolling out on schedule so they wouldn't have to deal with the negative campaign ads about their support of it.

On the other hand, Democratic partisans believe that everyone will love Obamacare once it actually exists, which would mean that the Republicans are trying to avoid having it exist. The Republicans could have cut a deal with the insurance companies to prevent things from rolling out on schedule so they wouldn't have to deal with the negative campaign ads about their opposition to it.

Or, alternately, gerrymandering has made it almost guaranteed that the House will be controlled by the GOP, and Obama is not up for reelection, so no matter what happens in November of next year nothing will get done. And don't think waiting 2016 will help, because the staunch Republican voters are slowly dying off making the president likely to be a Democrat, but still have a majority in enough congressional districts to keep the House Republican. So there's a good chance that absolutely nothing useful will come out of Washington D.C. for at least another decade.

Re:A cynic's view (1)

ganjadude (952775) | about a year ago | (#44560095)

believe it or not there are more and more younger people (under 30) who are starting to see beyond the bullshit of both the democrats and the republicans. There is a large number of younger people are are unsatisfied with obama and will either vote 3rd party or not vote, some might even vote for the republican.

Balance :) (3, Interesting)

Mitreya (579078) | about a year ago | (#44559729)

We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which told us that their computer systems were not set up to aggregate all of a person's out-of-pocket costs.

So what's on the other side of this "balanced" solution?

Competition, not regulation (0, Troll)

mi (197448) | about a year ago | (#44559731)

As long as the payers for service and consumers of it are different entities, this sort of nonsense will keep happening.

Re:Competition, not regulation (2)

fuzzyfuzzyfungus (1223518) | about a year ago | (#44559811)

As long as the payers for service and consumers of it are different entities, this sort of nonsense will keep happening.

Does your scheme include room for the risk-pooling functions that people tend to like in situations with low-probability very-high-cost possibilities?

I'm not sure that there is a worse implementation of insurance than our present one; but a medical payment system without some provision for risk-pooling is DOA.

Re:Competition, not regulation (-1)

Anonymous Coward | about a year ago | (#44559893)

What scheme?

You appear to have replied entirely on auto-pilot. Grandparent poster proposed no scheme.

I'm not sure that there is a worse implementation of insurance than our present one

Most people would recognize this as a symptom of not knowing what they're talking about. Of course there are worse implementations. Try getting sick in China, where a quarter of Earth lives.

a medical payment system without some provision for risk-pooling

You appear to be just stringing words together which sound medical. Risk pooling is about handling people whose insurance costs exceed their standard bracket rates.

This is about doing the basic accounting balance to see where they stand.

You might as well argue that you can't balance your own checkbook without accounting for the bank's other customers' risk of defaulting on their mortgages.

Utter tripe.

Re:Competition, not regulation (4, Insightful)

mcrbids (148650) | about a year ago | (#44560227)

The USA health care system has some of the worst possible perverse economic disincentives. At literally no point is there a clear economic incentive for you to be healthy and taken care of.

1) Consumers have no interest in keeping costs down. They pay the same deductible no matter what happens. Unfortunately, this is only up to a point (see #4 below) but that's not going to enter casual consideration.

2) Hospitals have no interest in keeping costs down. They blatantly inflate their costs knowing that the insurance companies will only pay a fraction anyway. They also have no incentive to keep supplies costs down since they are paid "cost +" by insurance companies. They'll tend to buy whatever sponge or soap dispenser is in "the catalog".

3) Providers of supplies to hospitals have no interest in keeping their costs down. Hospitals get paid on a "cost +" basis by the insurance companies so charging $35 for that "medical grade" sponge that cost them $0.35 wholesale has 99% profit margins as its incentive.

4) Insurance companies have some incentive to keep costs down, which they generally do by axing their most expensive customers with any of the myriad of technicalities written into their eye-gouging 10 page contracts full of inverted double negatives and exceptions. A good example is somebody with a job who gets cancer. Sure, he/she may have excellent health insurance, but what about when he/she loses his/her job because they didn't show for four months while undergoing chemo therapy? Even so, the myriad of regulations in place (and a legal department that ensures that one plan can't be compared to another) provides an opaque enough service offering that customers are unable to distinguish which plan is actually "cheaper".

5) Doctors had to just about kill their mother to get through medical school, and are saddled with enough debt to make anybody contract stress-related symptoms. Since they get paid for the work they actually perform, they have every incentive to declare a medical emergency and take you under the knife, regardless of whether or not it's necessary or even beneficial. I'm not saying every doctor will give you heart surgery when you come in with a rash, but I'm not alleging something that doesn't happen [nytimes.com] . Citation 2 [usatoday.com] .

The majority of bankruptcies in the United States are for medical reasons [cnbc.com] , and the majority of *those* are by people who had health insurance at the time they got sick. Anybody who says this ridiculous would-be-laughable-if-it-wasn't-true system is lying or misinformed.

Re:Competition, not regulation (2)

msmonroe (2511262) | about a year ago | (#44560373)

Competition not regulation? Let's do away with the middle men, the only way true competition could work if the consumer deal directly with the provider. No insurance company! The insurance company acts as an arbiter that artificially raises the prices to the consumer, their negotiated prices are usually much, much lower than what we as the consumer can get the services.

if anyone is starting an open source project (1)

jsprenkle (2009592) | about a year ago | (#44559733)

please let me know. I'll be happy to volunteer

That's funny (2)

Y2K is bogus (7647) | about a year ago | (#44559737)

My current plan already does this and I'm certain it's a basic tenet of all medical insurance plans. After all, most people choose a plan by balancing the up front premium costs with the out of pocket costs on the backend. Der, someone is fibbing. X-/

Re:That's funny (5, Informative)

Sarten-X (1102295) | about a year ago | (#44559941)

Having worked firsthand in the medical data field, I'm actually more inclined to believe them. It's pretty easy for a billing system to say "You haven't met your deductible" or "You've paid about enough"... but as I understand it, the legislation requires that each patientis cost be tracked on a per-patient basis - not per-policy or even per-insurer. That means the records have to be combined from every participating hospital, correlated with information from every other insurance provider, and deduplicated accurately, before they can be added.

There are many people with multiple health insurance policies, who go to several healthcare systems, or have incorrect identification data in their records. What's being asked is not simply adding a few numbers in a bill, but rather merging trillions of records with few errors, across hundreds of formats from thousands of providers.

I wish them luck, and I'm glad I'm not in that field any more.

Re:That's funny (0)

Anonymous Coward | about a year ago | (#44560121)

i dunno, sounds like a goldmine to me

Re:That's funny (2)

SQLGuru (980662) | about a year ago | (#44560133)

My policy has an out of pocket maximum for individuals and for family. If an individual reaches the max, they don't pay for the rest of the year. If the family combines to reach the family max, no one pays for the rest of the year. How is that any different than the 12.7K max per person?

Re:That's funny (0)

Anonymous Coward | about a year ago | (#44560283)

Here is a hint, once you reach that maximum there are STILL out of pocket costs. I did it two years ago and if you read the fine print its in there. The max out of pocket does not include co-pays which can be $500+ for some CAT/PET scans. I think I went $2k over the out of pocket max that year, but if you look at the total cost paid by the insurance company its really hard for me to complain.

Just letting you know, the max out of pocket is for deductables, but you still have copays after that and some of those can get pricey. Overall I would still rather keep my private insurance, that fully covered me, than the nebuluous always changing Obamacare. I'm just glad I had my issues before all this crap is hitting the fan and I hope it gets sorted out before I have another issue.

Re:That's funny (0)

Anonymous Coward | about a year ago | (#44560381)

Because the per policy doesn't differentiate between different person's covered under a policy, so if you have a family policy, 4 people on it, 2 adults, 2 children, you have a total max of 50.8K, but if one individual reaches 12.7 K, then only further claims on that individual would not be hit with an out of pocket charge. .

It's not just the calculations, which can be tricky, but aren't super complicated, its integrating that within all the systems and making sure that the changes don't impact other parts of the program. To complicate matters even more, some insurance companies have multiple systems because they don't migrate to a single system when mergers/buyouts happen.

Yes, it''s ugly, and if this was the only system change that they needed to make, it would probably be doable, but when combined with all the other changes that the PPACA requires, it becomes a huge task that is very easy to say that the insurance industry cannot comply with ACROSS the entire industry. It's not enough to say that 50% of the providers can comply, they all have to.

Re:That's funny (0)

Anonymous Coward | about a year ago | (#44560261)

It's already been done by a number of providers, blue cross being one of the more prominent. I know, I've hit the cap two years running due to a nasty case of Hodgkin's Lymphoma.

What you're seeing is insurance providers that dragged their feet on implementing the law in the hope that it'd get nuked by the SCOTUS, and they didn't want to get too deep into the massive software upgrades w/o assurance that it was going to really be law.

It makes sense when you consider that huge software projects like that run on the order of ~$25,000,000.

Re:That's funny (1)

budgenator (254554) | about a year ago | (#44560355)

It's pretty easy for a billing system to say "You haven't met your deductible" or "You've paid about enough"... but as I understand it, the legislation requires that each patientis cost be tracked on a per-patient basis - not per-policy or even per-insurer.

That's understandable, what I don't get is why the the limit has been waived for a year instead of instating it as a minimum of per-insurer basis; if a patient is over for an insurer, than they are that as a minimum.

Re:That's funny (0)

Anonymous Coward | about a year ago | (#44560149)

Most plans have deductibles and limits. You pay up to the deductible. The insurer pays up to some limit, which can be yearly, for-life, or both. Then you start having to fork out, either 100% or some substantial fraction.

If you don't know this, then you don't know squat about insurance. You've almost certainly never had to buy it on the open market, as opposed to selecting from a handful of plans picked for you, and subsidized, by your employer. And unless that employer was a large corporation there were almost certainly such limits in all of those plans, because insurers rarely offer uncapped plans to small and medium sized businesses.

This is why the majority of Americans who declare bankruptcy do so because of health care bills, despite over 85% of Americans being insured, with the bulk of the uninsured being young people not getting sick and not going bankrupt.

Bankruptcy is another form of "insurance" (I put it in quotes because health insurance isn't like regular insurance either), in that your creditors are stuck absorbing the costs. But bankruptcy is a terribly inefficient mechanism to use so routinely like this.

Computers can't add? (1)

Mistakill (965922) | about a year ago | (#44559745)

Well damn, better go tell Microsoft to stop making Excel... *facedesk*

How the heck does this happen?

Re:Computers can't add? (2, Insightful)

Anonymous Coward | about a year ago | (#44559809)

How the heck does this happen?

Technical people don't understand politics.

Re:Computers can't add? (4, Interesting)

ShanghaiBill (739463) | about a year ago | (#44560013)

Well damn, better go tell Microsoft to stop making Excel... *facedesk*

Go ahead and try to put health data into Excel without violating HIPPAA and going to jail. The same medical procedure can be billed at hundreds of different rates, depending on numerous criteria, many of which are covered by privacy laws, or are calculated by third party labs or testing facilities. If you really think this is easy, then you don't have a clue. There is a reason that we spend 2 trillion a year on health care, and if you compare America's longevity, infant mortality, etc. to other countries, it is pretty obvious that all that money isn't being spent on actual effective medicine. My family doctor's office has one doctor, two nurses, and four people in the billing department.

Re:Computers can't add? (1)

ganjadude (952775) | about a year ago | (#44560113)

The same medical procedure can be billed at hundreds of different rates, depending on numerous criteria,

and this right here is the biggest problem. There is no reason going to see a doctor with the flu should cost hundreds of dollars for some people and nothing for others* i mean why cant simple general practice doctor's simply be paid by the hour (even if its at 200 an hour, going to see him for the flue is 15 minutes - 50 bucks) but no insurance makes sure it costs 1000 bucks , of which you pay 20 bucks (or nothing) so you dont know the real costs.

Computer? (1)

MasterOfGoingFaster (922862) | about a year ago | (#44559769)

Who said you had to use a computer?

This is what was said in TFA (1)

Anonymous Coward | about a year ago | (#44559771)

But federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs.

In many cases, the companies have separate computer systems that cannot communicate with one another.

It's the age old problem of disparate computer systems and subsequent integration problem.

And I'm surprised that no one knows about MML - which is surprising since the insurance companies pretty much wrote the ACA.

Yeah.. (2)

NettiWelho (1147351) | about a year ago | (#44559783)

So instead of just doing the paperwork on paper(or excel) theyre going to let the patients die if they cant cough up the cash, because the insurance company doesnt want(or cant) do 6th grade math.

Today your government is brought to you by PepsiCo and Corrections Corporations of America [wikipedia.org] , Low on regulation and high on regulatory capture.

Re:Yeah.. (0)

Anonymous Coward | about a year ago | (#44560043)

you forgot carl's jr.

Re:Yeah.. (0)

Anonymous Coward | about a year ago | (#44560069)

So instead of just doing the paperwork on paper(or excel) theyre going to let the patients die if they cant cough up the cash

Well, that's one way to look at it.

Another way to look at it: when you buy insurance, you decide how much coverage you want to have, vs. how much you want to pay in premiums. Some plans have higher lifetime limits and higher premiums; some have lower lifetime limits and lower premiums.

Now, this choice will no longer be ours to make. The Federal government has decided for us: all of our premiums need to go up, all together, probably a lot. (The Federal government didn't just set a new target, like 2 million dollars, for the cap; they erased the cap, and the potential expenses are HUGE as a result. Insurance premiums will inevitably go up, unless you believe it is possible to get something for nothing.)

This is fine for me, by the way, as I make pretty good money. It would have purely sucked back when I was first starting out and didn't make much money.

The Affordable Care Act is a stealth transfer of wealth from the young and healthy to the older and less healthy, and to the Federal government.

P.S. The stated aims of the ACA could have mostly been handled by expanding the reach of Medicare. This wasn't done, IMHO, because the actual aims of the ACA are not the same as the stated ones. You may not believe this, but in a few years we will see how this plays out. (The earliest promises are already exploded: premiums are going up, not down; plans are vanishing, so you can't keep your plan if you like it; and it definitely isn't lowering the debt.)

Re:Yeah.. (1)

NettiWelho (1147351) | about a year ago | (#44560197)

The Federal government didn't just set a new target, like 2 million dollars, for the cap; they erased the cap, and the potential expenses are HUGE as a result. Insurance premiums will inevitably go up, unless you believe it is possible to get something for nothing.)

Uhhhh, what? Then how come every other western country can provide better average healthcare for lower pricing than US? Just because the potential expense is big doesnt mean that this scenario will play out for half, 1/3, 1/20 or even 1/1000 of the cas

Are you saying american society is less capable than all others?

(The earliest promises are already exploded: premiums are going up, not down; plans are vanishing, so you can't keep your plan if you like it; and it definitely isn't lowering the debt.)

Jesus fucking christ what are you people doing over there?! Your healthcare is already the most expensive while only being mediocore effectiveness with 3rd world country infant mortality rate.(unless you can afford to dip in the really wealthy side of the pool by fortune of having born with a silver spoon up your ass).

Re:Yeah.. (1)

pubwvj (1045960) | about a year ago | (#44560273)

So instead of just doing the paperwork on paper(or excel) theyre going to let the patients die if they cant cough up the cash

No, what they do is put you in debt instead of letting you die. If you get sick now you can lose everything you have, all your assets, to pay your bills. By putting this off the government saves a whoppering bucket of money which goes to the insurance companies. This is really about politics and lobbying, not about health or caring for people.

What a sick system (5, Insightful)

Anonymous Coward | about a year ago | (#44559787)

It's just another example of bought and paid for politicians sucking the dick of corporations. The famous words "of the people, by the people, for the people" are such a sick joke if you look at the USA government. Coming from a country that covers 100% of such common procedures, I just can't imagine how people can live like that. And Americans still think they have the most superior country in the world. America! Fuck Yeah! Please stop spreading your ideas of freedom to the world and try spreading those ideas at home instead.

Re:What a sick system (1)

Anonymous Coward | about a year ago | (#44559877)

> Coming from a country that covers 100% of such common procedures, I just can't imagine how people can live like that.

Try having Aspergers + ADHD & getting 37 bills from a single visit to the hospital, then trying to keep them straight and make sure the insurance company pays its share properly. Even if cash isn't a problem, it's *overwhelming*. I avoid going to the hospital just because the avalanche of post-hospital billing paperwork is almost worse than being sick.

Re:What a sick system (0, Insightful)

Anonymous Coward | about a year ago | (#44559935)

I know what you mean. The system in the USA preys on its weakest members instead of helping them. Honestly I can't see how thinking Americans can sing their own national anthem without wanting to puke.

Dear merica, (1)

Anonymous Coward | about a year ago | (#44559789)

Get ye head out of your ass and implement universal health care already.

Re:Dear merica, (1)

TechNit (448230) | about a year ago | (#44559859)

My thoughts exactly... Excuses? Pure political bullshit!!

Re:Dear merica, (0)

Anonymous Coward | about a year ago | (#44560071)

I've already seen enough abuse of public welfare. I will not pay a cent more for fucktards to rip me off of the fruits of my labors while they sit around watching TV and playing video games.
 
By how the numbers have went over the past 20 years the fucks in Washington have no intent on reigning in this form of extortion.

Re:Dear merica, (2, Insightful)

Anonymous Coward | about a year ago | (#44560363)

Typical 'merican outrage over a perceived yet fictional generalization. Face it middle America, you will never be rich so stop blindly supporting policies you think will some day benefit you. You are only hurting yourself. The lazy American sucking off the tit of society that you are so scared of is either you today or you in the near future. You are unsophisticated, undereducated, and unprepared for the future and that is just the way they want you and imaging, chances are, you live your life through part of the 60's. You had the great privileged to experience some of America's fat years, as long as you were white and somewhat educated. Those days are not coming back and your children will have an ever increasingly hard time.

Re:Dear merica, (1)

pwizard2 (920421) | about a year ago | (#44560259)

My sentiments exactly. The only reason why we have this dysfunctional for-profit healthcare system is because of Richard Nixon and the deal he cut with Kaiser. People should be lined up for miles to piss on his grave for that--he deserves it!

Q&A (4, Funny)

girlintraining (1395911) | about a year ago | (#44559795)

Tell me, Slashdot, how difficult would it be to rewrite an insurance billing system to aggregate a policyholder's out-of-pocket costs?

That depends entirely on whether the insurance company wants to remain in business or not. Next question.

Re:Q&A (0)

Anonymous Coward | about a year ago | (#44560065)

Explain this: if health insurance is really "insurance", why doesn't the policy you had in effect at the time some chronic, life-long illness strikes pay the bills related to that specific illness for the rest of your life? If your house gets destroyed by a hurricane on August 17th, you can rebuild it five years later and still collect your full benefits, even if your insurance policy was cancelled the next day.

Health insurance companies currently get to have it both ways... they're allowed to exclude pre-existing conditions, but they aren't required to cover your expenses arising from a covered chronic illness for the rest of your life if it first manifests itself during your policy.

If health insurance worked like homeowners insurance, you got cancer, and insurance companies weren't allowed to exclude pre-existing conditions from coverage unless they could prove some other company already had financial responsibility for covering it, your future premiums would probably go DOWN, because they'd know that the single most expensive thing you're likely to die from someday is already somebody else's financial problem. Add cardiac problems to the equation and attach them to company #2, and company 3 is left with little more to worry about than kidney stones and accidental injuries.

Re:Q&A (1)

Anonymous Coward | about a year ago | (#44560329)

If your house burns down, you buy a new house and go on your merry way, you'd probably pay higher premiums if it happened again, and if it kept happening, people would stop insuring you.

The way health insurance works now is like car insurance. You total your car? Well, according to our book it was worth about $38.26 so here's a check, have a nice day. What's that? You wanted a new car out of the deal? LOLno. If you total your body (either your own fault, or your own "fault" for the just-world-protestant-didnt-read-the-book-of-job-ethic losers out there who think anyone who gets sick was asking for it) they can't scrap you, so you're just fucked, usually permanently. That's why nobody wants to deal with you anymore. Kindly go die in a ditch, kthxbye.

Of course the really funny thing about all this? Everyone is comparing to the wrong thing. Think life insurance. Consider that before obamacare, health insurance had a lifetime cap of $1M or $3M or so dollars (some fancy plans went all the way to $5 million dollars!!1!!1). Compare the cost of $1M of term life insurance to the shittiest, least expensive plan you could find 3 years ago (remember: this plan would dump you on medicare if you lived to 65 and no, you don't get to withdraw whatever's left, just like term life), and you'd realize YOU'RE STILL BEING RIPPED OFF. It's not for nothing United Healthcare was able to give its CEO a B illion dollar bonus.

The really, really funny thing about all this is that if the government was going to come in and stomp around, it should have made life insurance (specifically term life if we kept Medicare around) the model for it all: buy into an $X million plan when you're young and healthy and keep it for the rest of your life (or until you hit Medicare). The life insurer would find it in their best interest to spend up to ($X million - profit margin) to keep you alive.

And just like term life, some (possibly large) percentage of people will never cash out the whole $X million. No idea why it doesn't work this way without the government forcing it, I bet there's some law somewhere that says life insurance policies can't pay to keep people alive, only pay when they die.

Horse-pockey (1)

bearinboots (743355) | about a year ago | (#44559813)

Huh, they sure seem to be able to add up stuff to tell me I haven't reached my deductible yet...

Re:Horse-pockey (0)

Anonymous Coward | about a year ago | (#44559865)

Amen brother.

This is a joke, right? (0)

Anonymous Coward | about a year ago | (#44559847)

Oh ... nevermind.

Alternatives... (1)

Luthair (847766) | about a year ago | (#44559871)

  • Export to Excel
  • A Calculator
  • Pen & Paper

Paver Stones on the Road to Single-Payer (3, Insightful)

Anonymous Coward | about a year ago | (#44559883)

Which is what Obama has wanted since day one.

1) Pass a bunch of rules with an unreasonable compliance schedule that no insurance company on Earth could hope to meet

2) Blame insurance companies when the new "free healthcare for all" law fails miserably

3) Use it as an excuse to ram single-payer down everyones' throats

4) Government now has the power to decide who lives and dies, based on political ideology, which is what leftist despots like Obama want.

Re:Paver Stones on the Road to Single-Payer (5, Insightful)

Gavrielkay (1819320) | about a year ago | (#44560007)

5) This is an improvement over the decisions about life or death being about share prices and executive bonuses. I don't want it to even remotely cross the mind of anyone with a say in my health care that they might possibly make more money if they leave me sick.

6) Having someone in the family get a very nasty, expensive disease no longer ends in bankruptcy. Which means the rest of us continue to pay for it, but the afflicted family isn't ruined. As we live longer and eat more crap, this begins to affect almost everyone.

7) We quit talking about health care as though it should be less important than police or roads or a standing army - things we already care enough about to devote tax dollars to.

Re:Paver Stones on the Road to Single-Payer (2)

ebno-10db (1459097) | about a year ago | (#44560017)

Paver Stones on the Road to Single-Payer ... Which is what Obama has wanted since day one.

How I wish that were true.

They have history when they want(Preexisting Cond) (0)

Anonymous Coward | about a year ago | (#44559885)

When insurance companies don't want to cover you anymore they have all the history they need to get rid of you. When they want to help you, its going to take time. I do not know many billing systems that can't tie an account's billable together.

Hospitals know how much they charge people, so lets just work around insurance companies and use the real end cost from hospitals. insurance companies won't be able to work around with accounting tricks and loop holes.

The best part about that will be the forcing of a central patiant records because all hospitals will have to be compliant.
-(sorry don't have a login) Pete

Hopenchange! (0)

Anonymous Coward | about a year ago | (#44559921)

How much did Obama sell *that* decision for?

Just curious (5, Interesting)

Trailer Trash (60756) | about a year ago | (#44559943)

By what legal authority did Obama delay this implementation?

Re:Just curious (1, Insightful)

Amigan (25469) | about a year ago | (#44560137)

By what legal authority did Obama delay this implementation?

None.

But then again, what legal authority did he (or HHS Secretary) have for:

  1. waivers
  2. delaying employer mandate
  3. giving Congress (and their staff) 75% price support

None are legal because the law itself doesn't give anyone the power to change it willy-nilly, as each changes the law without the necessary legislation to modify the existing law.

jerry

Re:Just curious (1)

budgenator (254554) | about a year ago | (#44560173)

Obama doesn't need legal authority, he uses executive orders now.

Re:Just curious (1)

cartel1982 (2955737) | about a year ago | (#44560211)

You know that executive orders are a normal part of the President's job that go back to George Washington, right? Directing federal bureaucracies like HHS is Obama's job, much more so than participating in Congressional debates is.

Re:Just curious (1)

Qzukk (229616) | about a year ago | (#44560343)

Same authority that has been used for centuries to put off doing what the government doesn't want to do:

Come make me.

Not as fast as one would hope. (4, Informative)

the eric conspiracy (20178) | about a year ago | (#44559989)

So what is the opposition party alternative? Repeal.

That will limit the out of pocket costs when? Never.

Plus it will eliminate the various positive effects that the ACA is already having.

Basically the people that are screwing up here are the beneficiaries of the higher out of pocket costs, our Medical Insurance Overlords.

How would I? (1)

klingers48 (968406) | about a year ago | (#44559991)

I'd make one very simple addition to all insurance building systems:

while(true) {
DontBeBastards();
RememberYoureDealingWithHumanBeings();
}

Re:How would I? (1)

meta-monkey (321000) | about a year ago | (#44560083)

refactored:

while(true) {
DontBeADick();
BeExcellentToEachOther();
}

Re:How would I? (1)

ebno-10db (1459097) | about a year ago | (#44560287)

It's simpler than that:

banishForProfitMedicalInsurance();

Incredible (0)

Anonymous Coward | about a year ago | (#44559997)

These costs that they are denying, they haven't even bothered to calculate them, they don't even have the means to determine what the costs are, and yet they are still denied

How is it that they are allowed to call their product "insurance" when they freely admit that they don't even know the costs that they are "insuring" against

Insurance Systems Suck (3, Informative)

Anonymous Coward | about a year ago | (#44560003)

Easy answer on this one from someone who has worked in the insurance industry for a few years... the systems suck.

I am not defining 'suck' from the standpoint of performing because they do what they need to... however they become so bloated with complexities that even minor changes seem daunting. No person or team in my organization knows how the systems work from end-to-end and even the vendors need to use reverse engineering to resolve issues because of the complexities.

Not unusual for an insurance company to build a new system to support new plans because integration of the benefit rules into an existing system is not worth the pain. In the end the company ends up with several systems and IT silos built up around them.

The system at my current work will not be able to handle tracking co-payments over any period of time. The jobs that run overnight to price claims and track this sort of thing are already running at capacity.

On top of all this the executive management in this industry tend to be incredibly conservative and avoid risks like the plague.

They really do think we're idiots... (1)

Jahoda (2715225) | about a year ago | (#44560037)

As if these soul-sucking, perverse leeches on humanity (that health and sickness should be a source of capitalist profit is 100% my definition of perversity) don't have the ability to track every. single. penny. that passes through their disgusting hands. Another lovely chapter in the american long-con.

Compliance time linked to the punishment (4, Insightful)

thegarbz (1787294) | about a year ago | (#44560055)

Businesses exist to maximise profits, all profits, even those derived from delaying compliance activities. It becomes a simple cost benefit case. Is it cheaper to pay some politician's wage and go moan about how hard it is for your one programmer to re-write the software within a timeframe, or is it cheaper to simply hire the right number of people to do the job properly and quickly.

The answer is nearly universally the former. Major companies (not just healthcare) will rather moan about how hard done they are by the government than actually step up to comply with the new regulations. If a large fine is linked with non-compliance they'd have the software modified by the end of the month.

I've seen similar cases in industry too. Companies will replace truly horrendous parts of their plant like-for-like because installing what they want is tied with meeting the new standards of the day rather than the easier standards of when the equipment was originally designed, and thus we have a plant basically half replaced as new with no gear that meets any modern emission standards.

There's simply no motivation to go down the more expensive route.

An old programmer... (2)

madmarcel (610409) | about a year ago | (#44560075)

An old programmer once told me that insurance companies run on OpenEdge (aka Progress), and old versions at that.

Gigabytes of proprietary spaghetti code <<shudder>>

I'm not putting my hand up to fix that.

Re:An old programmer... (0)

Anonymous Coward | about a year ago | (#44560163)

lol - Progress was a helluva lot better than SQL *shudders uncontrollably* was and is today.

used to run progress 4gl over the top of the other databases all the time, write once, run on multiple platforms, worked great.

I despise GU interfaces as they make it burdensome to get the job done, there are times for GUI and the rest of the time CHUI rules.

  Finally, the whole issue could be resolved by just charging people without insurance the same prices as the biggest insurance companies can broker..

ie 1 price for a service across the board - no *discounts* for volume....

one of my medications - 30 days supply, no insurance 6700.00 USD. With insurance, $43.00 - wow - really - what does the insurance company actually pay? about 373.00 of the 6700.00...

small outpatient procedure - without insurance 1700.00. Insurance pays 470 - 1330 difference.

People wouldn't be bankrupted if health care providers weren't trying to make up for insurance company underpayment... they also wouldn't get the huge black-eye they get when patients find out how little insurance companies pay for the same procedures.

Re:An old programmer... (1)

Yaur (1069446) | about a year ago | (#44560359)

You pay more when you are self pay because there is a much higher risk that you won't pay at all... i know every time I've walked in to a doctor's office with cash or a debit card I've gotten prices at or below what insurance companies are paying.

Real-time processing required (4, Informative)

Amigan (25469) | about a year ago | (#44560081)

From what I heard today, the problem is as follows:
  1. 1) patient goes to pharmacy to get prescription filled
  2. 2) pharmacy contacts authorizer to find out what the cost of the prescription is under patient's plan
  3. 3) patient buys drugs for price returned by authorizer
  4. 4) authorizer sends bill on to insurance company

Step 2 is an immediate response, step 4 is handled in batch processing nightly. So far so good. Except that the Affordable Care Act makes it *illegal* to make a patient pay more than the annual limit. The authorizer and/or the pharmacy can be charged for forcing the patient to pay above the annual limit. This means that the authorizer must be aware of limit of each patient and be able to respond in real-time so that neither they nor the pharmacy will be sued. The insurance company doesn't have that information available real-time, nor do they make it available to the authorizer.

It is a computer issue, but as simple as everyone thinks. Putting individual insurance files on-line so that the out of pocket expenses can be tracked real-time isn't trivial. Now, maybe the Insurance companies were hoping the law wouldn't be implemented so they didn't do the hard work necessary to get set up, or maybe the rules were only written as to how to handle the annual limit must be handled.

Just remember, the last time companies put together a real-time on-line credit/debit system, the government decided that they charged too much to support the infrastructure, and started regulating it. That was the Durbin amendment to Dodd-Frank, which put a fixed limit on per swipe fees - regardless of what the infrastructure and support costs actually are.

jerry

Re:Real-time processing required (1)

Amigan (25469) | about a year ago | (#44560235)

Note that the authority says that the Insurance companies can handle this, it's the fact that there is no real-time connectivity from pharmacy to insurance company that is the major problem.

Insurance Expert explains the problem [rushlimbaugh.com]

Re:Real-time processing required (1)

ebno-10db (1459097) | about a year ago | (#44560255)

It is a computer issue ...

And if not implementing it would cost them money, wanna bet they'd have it ready on time? Funny how that works.

Re:Real-time processing required (1)

cartel1982 (2955737) | about a year ago | (#44560327)

Yeah, the more I look into the ACA, the more my opinion becomes "well, it's better than nothing at all, but not much"

It seems to me the way to handle it would be to set a minimum standard of coverage and a maximum payout and then issue a mandate (preferably funded, but even if not..) that each state had to insure that level of coverage for its citizens.

Vermont and Minnesota would have come up with Single-Payer plans, Georgia and Alabama would have had monstrous corporate handouts and everyone else would have fallen somewhere in between on the spectrum. Eventually it becomes an issue in governor and state senate races and the "laboratories of democracy" would have mostly come up with better solutions than the ACA.

There was a time in America when a big federal health plan could have worked, but this isn't the 1940s, and Obama ain't FDR.

Re:Real-time processing required (1)

Amigan (25469) | about a year ago | (#44560377)

The federal government does not have the constitutional power to order the states to do anything. At best, they can coerce them by withholding federal aid, but that part of the ACA was deemed optional by the SCOTUS - hence the 30 states that have refused to create state wide heath exchanges. That forces the federal government to create the federal exchange, but the law says that there will be no subsidies to those in the federal exchanges.

Re:Real-time processing required (1)

Todd Knarr (15451) | about a year ago | (#44560353)

I guess my question would be "Why the middle-man?". The insurance company's the one who decides whether the item is authorized or not. Why is the pharmacy calling someone who isn't the insurance company to find out whether it's authorized or not? Just change step 2 to "Pharmacy contacts patient's insurance company to find out what the cost of the prescription is under the patient's plan." and now the insurance company has it's records right there and can see how much is left until the limit's hit. As an added bonus we remove the extra costs introduced by that third party from the system.

No, I'm not guessing at what's involved. I wrote large chunks of a system just like that, so I know what's involved. Except that our system had an absolute hard 5-second limit on responses, enforced by the CEO showing up at your desk to find out what's going on when things glitched for more than a few minutes at a time. We tried really hard to avoid meeting him like that.

Bad summary (2)

AdamHaun (43173) | about a year ago | (#44560089)

Tell me, Slashdot, how difficult would it be to rewrite an insurance billing system to aggregate a policyholder's out-of-pocket costs?

It's somewhat more difficult when you waste three years assuming the Republicans are going to win big in 2012 and repeal the whole ACA. You gamble, you lose.

Snark aside, the real answer seems to be in the article:

The health law, signed more than three years ago by Mr. Obama, clearly established a single overall limit on out-of-pocket costs for each individual or family. But federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs. In many cases, the companies have separate computer systems that cannot communicate with one another.

So insurance companies outsourced different parts of their work to different companies that don't talk to each other. It's not "the computer's fault", it's an administrative problem within the insurance company itself. That text was right above the paragraph quoted in the summary, but curiously the submitter felt the need to ask a rhetorical question instead of including the most important piece of explanation in the entire article.

(Also, have you ever heard a story about a giant years-old financial/billing system that was clean, well-implemented, and easy to maintain and modify? I sure haven't. Not sure why we'd expect anything to be a trivial change in one of those...)

Illegal, so sue (1)

Anonymous Coward | about a year ago | (#44560101)

The implementation has been illegally delayed. If you find yourself owing more than 12,700$ in one year for one incident, and the insurer claims you owe more, sue. The law states you do not. It doesn't matter what the administration says. They don't have the actual authority to delay this law, which states implementation dates.

Bullshit (1)

gr8_phk (621180) | about a year ago | (#44560145)

We had to balance the interests of consumers with the concerns of health plan sponsors and carriers

If they really want health care to be more affordable they need to do one two things:
1) Force providers to charge consistent rates (i.e. no negotiating with insurance companies)
2) Force providers to provide cost information to the public so people can compare.

This can of course be started at the state level, because fuck congress.

The solution is simple (1)

Zaphod-AVA (471116) | about a year ago | (#44560147)

The solution is simple. Make them responsible for all of those costs until their software can handle it. Watch how fast that update happens.

It's the government's fault (0)

Gothmolly (148874) | about a year ago | (#44560193)

Business creates opportunity and government creates oppression, not the other way around. Check your premises.

Re:It's the government's fault (1)

ebno-10db (1459097) | about a year ago | (#44560239)

Taxes are theft!
Collected by men with guns!
Which are then used to pay for two wolves and a sheep deciding what to have for dinner!

And Justice for All.. (0)

Anonymous Coward | about a year ago | (#44560209)

Doesn't it disgust you when those charged with upholding the law decide to selectively enforce it?

My insurance already does total it up (1)

Todd Knarr (15451) | about a year ago | (#44560247)

My insurance company (Aetna) already has an out-of-pocket limit on my policy. They're able to track what I've paid (at least as far as costs that're coverable under the insurance go) and determine when I've hit that limit. Every other insurance plan from every other company offered at every employer I've worked for has had the same sort of limit. The only ones that don't are the fake "insurance" policies you see offered on the low end that (if you read the fine print) aren't actually insurance, they're just a discount plan (and they don't actually pay the doctors, they pay you and you're 100% responsible for paying the bill). So if the insurance companies can keep track of out-of-pocket already, I fail to see why they'd have any difficulty doing so in the future.

Easier said then done. (1)

sir-gold (949031) | about a year ago | (#44560269)

"Tell me, Slashdot, how difficult would it be to rewrite an insurance billing system to aggregate a policyholder's out-of-pocket costs?"

you forget the part about needing to run on a PDP-11 and interface with an existing billing system written in the early 1970s

Foot dragging. (1)

bmo (77928) | about a year ago | (#44560275)

"They asked for more time to comply."

And this is why we should have gone to a Single Payer Health System a long time ago.

--
BMO

do it manually (1)

Denis Bergeron (2884689) | about a year ago | (#44560311)

If your software are able to handle the law just do it manually.

A Mister Rogers moment here (1)

mendax (114116) | about a year ago | (#44560319)

(Those of you here who are too young to know about "Mister Rogers Neighborhood" need to move along.)

I can imagine Mister Rogers saying in response to the claim of the insurance companies. "This is bullshit. This is what it looks like. Can you say 'bullshit', children? Good. I knew you could."

Socialisation of health care (1)

Tim99 (984437) | about a year ago | (#44560323)

In view of what passes for debate on private and public insurance and health care, you might be surprised to find that the US government spends more per capita on health [theguardian.com] at $4437 compared to $2919 for the UK government. The USA in total spends 17.9% of GDP compared to 9.6% for the UK.

This is, perhaps, the price that you pay for having one of the least efficient health systems in the world. You do however spend even more on military spending.
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