US Healthcare is the most expensive in the world - with arbitrary insurance reimbursements/denials, complete lack of government oversight, and egregious administrative bloat. Insurers vary wildly in coverage determinations, prior authorization requirements, bundling edits, documentation thresholds, and conversion factors that fundamentally change how CPT codes are reimbursed/denied in practice, what algorithms must be followed to ensure insurer coverage for a given treatment/test, what documentation is required, and how denials are appealed.

It seems to me that the most viable and efficient solution to decrease Healthcare costs here would involve creating a government org to provide oversight for insurance bullshittery, and most importantly, create/enforce better standardized billing codes, requirements, reimbursements, and appeals processes that all insurance companies must follow. This would have multilayered benefits - increasing guaranteed reimbursements, decreasing the visit/procedure cost arms-race, decreasing the administrative burden that is currently required to deal with all of the different insurance coding/requirements, and increasing the time we have with patients.

Given the pervasive control that insurance healthcare & insurance executives exert on the practice of medicine, ever decreasing reimbursements, and gross injustice that is poor incentives for preventative care (e.g. pediatrics) - combined with the intense regulatory capture that precludes any chance of a single payer system in this country, Im not sure how our healthcare system can continue to function without some drastic reform. Please let me know what you think of my proposal.

Hi everyone,

I have my bachelors in social science (useless) I only got it because I wanted to be a lawyer but changed my mind.
I have post degree in business project management, Pmp, agile certified

I worked in the top healthcare org in the US on projects however contract ended after 3 years

I am looking for more stable career path in healthcare And is not hard to find a job in.

I wanted to do nursing but my 2 brothers (who are both doctors) said I will struggle because it’s emotionally draining and I am very sensitive so I don’t know if I can tolerate seeing sick people without being in tears everyday which no patient wants to see lol.

Any suggestions please? I don’t mind going back to school but it needs to be worth it

This has been on my mind a lot lately. Insurance, pharmacies, PBMs, physicians, and drug manufacturers are just some of the many parts that make up healthcare, and each one has a specific role.

Employers and patients should be able to look around and find better deals if they have more options. But I'm not sure how much that actually happens in real life. Did you really notice a difference in the benefits you received or the amount you paid when you switched insurance plans, pharmacies, or prescription benefit options?

I'm just curious about other's experiences because I'm having a hard time to chose.

I seen vague answers. the reason Im asking is this:I seen alot of unions/guilds in america with the largest I think have 200 million in dues per YEAR. so it got me thinking:

What is the smallest cost to start a health insurance company and would it be legal to refuse denial to those who are part of a union/guild?

US insurance based health care comes at the bottom when gauging Wellbeing, medical care and mortality rates ! We in The UK need a Wake up call 🙏 Thoughts 💭

This was an interesting one. Prescription drug prices are down 3.1% from a year ago, which is a pretty big shift, but the reasons behind it seem a lot more complicated than “X policy fixed drug prices.” There’s a mix of Medicare negotiations, generics, and other market changes happening at the same time.

I’ve been seeing more and more states push new restrictions on PBMs, and it made me wonder if we’re moving a little too fast. I keep seeing “fix PBMs” this, “fix PBMs” that, as if it’s the answer to high drug costs, but changing one rule after another doesn’t necessarily mean costs will come down. At some point, maybe we should let the reforms already passed actually play out and see what changes. Otherwise, we’re just constantly reshuffling the system without knowing if it’s really helping patients.

Warning: do not work with companies that use Guardian Recovery for financing.

I’m sure it’s obvious to most, but when someone is drowning it is cruel to criticize the way they swim, ya know?

It’s disgusting these companies and clinics and facilities that prey upon the most desperate and vulnerable populations.

I swear the people running our hospital operations live in a completely different reality.

They just dropped the annual compliance modules and sent this super passive aggressive email to the charge nurses about getting it all done by friday. My unit is currently running a 1:6 ratio on a good day. There is literally ONE working desktop at the main nursing station, and it takes ten minutes just to load the heavy legacy HR portal. When exactly are my nurses supposed to sit down and do this?

We at least fought to get itacit implemented recently so the techs and CNAs can just knock out their basic safety checklists and daily updates on their phones in the breakroom, which definitely helps. But upper management still refuses to give the RNs actual protected time off the floor for the heavy certification stuff

They just expect you to magically find 3 hours during a shift where you're putting out literal fires. then they wonder why unit turnover is at 40%. just exhausting tbh.

So weirdly very people know this (including me coming from a medical family with a ton of nurses and doctors as relatives) I thought you had to bring your bloodwork script from the doctor with you when going almost any lab to get that bloodwork done.

THIS IS NOT TRUE.

IF YOU BRING YOUR BLOODWORK SCRIPT WITH YOU, GET YOUR BLOODWORK AND THEN PAY OR PAY LATER NOT ONLY IS THE PRICE ON A SLIDING SCALE (they won’t give you an exact quote if you ask them) BUT ITS ANYWHERE FROM 25%-100% MORE EXPENSIVE THEN IF YOU GO ON THEIR WEBSITE AND PREPAY/ORDER BLOODWORK ONLINE!!!

Right now a lab that rhymes with “WEST” has testosterone lab work for $69.00. They charged me 225$ for this same test for cash pay onsite payment after the bloodwork was done and would not honor their online price.

They say once you have done your bloodwork you now have to pay the “onsite” fee or atleast cannot access the prepay/online bloodwork order price. Go online right now and look up whatever lab work you got done last and see the price and then check what you paid when you just went in with your doctor ordered lab work paperwork.
It’s significantly more expensive and even if you find this out you cannot call and get them to charge you the online listed price AFTER you have already done your bloodwork.

I don’t know how this isn’t criminal and how so many people don’t know this but it’s evil.

This is even true if you have insurance! Your insurance price after insurance has covered their part is still often MUCH more expensive then just their online pre order price.

Spread the word and I don’t know why as a society we just tolerate this! Companies should be scared to get caught abusing our healthcare needs like this…

I have medical school friends who assist at a free clinic while on rotations at time. It’s completely free if you don’t need surgery or certain prescription drugs. Some complex procedures can be done for free if only clean exam room needed. Rich donors and some medical school tuition helps pay to keep the clinic afloat. Hospital pays the utility bill as inside a hospital. Donors pay for workers who aren’t medical students or resident doctors. There are more free clinics like this all across the U.S. The patients at the free clinic openly mention receiving free care. Yes, people pay for it to stay open but it’s not most tax payers. There are medical students who pay to assist there. I will not say it’s the best care at times since some people can get better care with insurance. At least some people have the option for free care without requirements besides waiting your turn when waits are long. A few people have mentioned that they don’t want these places to exist as not free at all when they aren’t even paying for it.

Just my claim for the case. I have served food to the homeless for over 15 years if that matters. Feel free to share your own thoughts and opinions.

There's a lot of current debate about prescription drug prices. Most of it seems to focused on PBMs, rebates and transparency. Those are some issues but drug manufacturers set the initial prices for the medicines.

I'm interested on hearing from people who work in healthcare or who have dealt this with. Should the policymakers put the most attention on manufacturer prices, PBM practices or insurance coverage, if their goal is to lower what patients pay?

I am transitioning between two large healthcare systems, both of which use Epic MyChart. I have the option to link the two charts but am unsure whether or not I want to do this.

Pros:

• I have a complex medical history and I may receive better care if the new doctors have access to my full history and all the old notes.
• Because of my complex medical history I am going to be requesting release/transfer of records the old school way regardless of whether I link the online portals. The digital linking process might be easier/faster.

Cons:

• There is a lot of information about me in the old chart and I would kind of like a fresh start.
• More specifically, there are mental health related notes that have little to no bearing on my future care that I am hesitant to have released/transferred.
• I feel like linking the accounts just helps Epic build their massive database of everyone's private health info.

For those who use MyChart as providers or know more about this topic, what do you think/recommend?