Patrick Haig

@lennysan Product Designer, Remote, jobs.gem.com/goodbill/am9ic…

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@dvasishtha Request the UB04 from MGB and start with what they submitted to BCBS. It’s your right.

Just got an EOB from BCBS MA saying that I owe Mass General Brigham $6k for my daughters NICU stay. Now I need to spend next week figuring out who fucked up billing the claim as routine and preventative: BCBS MA making an error in processing the claim or MGB in submitting it.

@iseff No, not at all wrong.

lololol, not wrong. @prhaig

@Schmidt95819 @dp_oneill @_Imagine360 Honestly think this is a response to providers dominating in IDR for NSA eligible claims. Providers are disproportionately successful in IDR, and mostly going with provider QPAs, so payers will put pressure where they can to cut NSA eligible claim volume that might hit IDR.

@dp_oneill @_Imagine360 However there not really a “in network” it’s OON, so perhaps now that I’m thinking of it irrelevant to the Anthem panel, but the idea is open network which Anthem is narrowing.

@WallStreetApes You can demand the provider not share your info with your insurer, but you have to “pay in full” (whatever that means). Takes the know-how, and is thus terrible, but works. Also need to catch it at the right time (before they send the claim). ecfr.gov/current/title-…

This man’s daughter was in an ambulance. After receiving a bill, they were resent a more expensive bill He’s calling to find out why. “The first bill we got without the insurance was $600. And then the second bill was almost $1,300” Their response, “You're not eligible for the discount since you are insured” The billing department says, “The bill was $2,342.14. We billed your insurance. Your insurance only paid $1,078.85 Can I go back to the discount without the insurance? No, so you're insured, so you're not eligible for the discount.” So because he has insurance he has to pay almost $700 more, for a total of $1.300… Make it make sense Healthcare in America needs SERIOUS REFORM

@EverettLebherz @joefigs2 @JAMAHealthForum @DavidBlumenthal @HarvardHPM @harvardmed @Health4Texas @shaochee_sim Agree with the sentiment, but I think hospitals book charity care write-offs at cost — not at billed charges / chargemaster rates. #en_US_2024_publink51526bd0e294" target="_blank" rel="nofollow noopener">irs.gov/instructions/i…

This is exactly why the Hospital Charge is 10s of thousands, when the insurance negotiated rate is sub $10,000 and the insured responsibility is sub $5,000. The Hospital Charge is SO high because when an uninsured shows up and doesn't pay, they can apply this to charity care even though it's multiples higher than what they negotiated from insurance companies.

Non-profit hospitals receive tax exemptions (up to ~$37.4 billion/yr) to provide “community benefits” In new @JAMAHealthForum study, we find that the non-profit tax system is *structurally discriminatory* Socially vulnerable communities benefit less… jamanetwork.com/journals/jama-…

@AlexSalkever @goodbill That’s such a sad truth of the industry. Many negotiated rates are terrible. Happy to help and let me know if you have any feedback / questions.

@AlexSalkever @goodbill We serve both!

@chrissyfarr I’d guess a 99282 at high rates, with all hitting deductible, so you’re out the full amount. And almost all of that being facility billing. I’d argue the leveling, use ACEP E/M facility billing guidelines to get to 99281. If it’s already a 99281, then argue the rate. $3K is high.

My husband went to the ER, sat there for two hours without getting seen, then an intern triaged him, and still he didn’t get seen. He felt better in that time so he ended up leaving. A $3,000 bill arrived. Apparently it’s $3,000 for the privilege of being in the waiting room now. I’ve asked for an itemized bill. At this point I’m curious about how you even code for that? “Waiting charge?”

@LeonDerczynski Seattle awaits your many flags.

Denmark criminalises my hobby tomorrow, namely vexillology / flying flags. Though we and others who pass through our neighbourhood enjoyed all our many, many flags in the past, it's all over now - only local flags. No longer will we be able to: * Celebrate my American son by flying the stars and stripes on the 4th July (or his birthday) * Remember my grandma, who escaped the axis powers three times, by flying the anti-Lukashenko pagonya Belarusian protest flag * Get nostalgic about past travel and brighten a cloudy day (there are many) by flying a Tibet flag * Proudly fly a San Diego flag on the day the city named after the charity I volunteered over there for all the work we did I collected and flew almost 100 flags here, and it was a great bit of fun and something passers by and neighbours constantly stopped by to say that they enjoyed. But the government has decided the Danish flag is threatened, and must be protected, and so nationalism settles into law again. No moral or call to action here. Just mourning a lost freedom.

@tjparker @alexlmiller @RobertMSterling @goodbill Thanks for the mention @tjparker. Happy to chat @alexlmiller — feel free to DM me.

@alexlmiller @RobertMSterling @goodbill @prhaig

Trillion dollar idea: AI app that reads your health insurance plan, scans all your medical bills, and tells you how badly screwed you’re getting on what you’re getting billed for, what insurance is covering, and what you’re paying out of pocket. Bonus points if it includes an AI agent that emails your doctor and your insurance company and resolves the ensuing disputes on your behalf. You could easily charge a 30% rake on savings realized. If anyone is actually building this, please let me invest. Serious offer. I’ve got degrees in math and finance, and I literally worked as an actuary, yet I still can’t interpret any of this stuff for the life of me. People desperately need help with this.

@elliotcohen @MegaGenius @Austen Whenever AEOBs land, that’s effectively what it is and for INN and OON care, too. Provider sends GFE (plans to use the FHIR Claim resource in fact) to payer, payer generates AEOB, sends AEOB to provider and to patient. hl7.org/fhir/us/davinc…

The no surprises act is mostly about non-insurance use cases (so it doesn't help with the majority of this), estimation doesn't really improve this either because of the regulatory complexity if you are wrong. Unless you have real time claims that get run before the visit, then I do not believe many providers will flip to this.

So… if medical debt isn’t included in credit score, is there any incentive whatsoever to pay it off? And if that’s true, won’t default rates skyrocket? And if default rates skyrocket, won’t most providers simply stop serving people who can’t pay upfront?

@dp_oneill Potentially because hospitals solve problems with headcount, not technology. It’s a mindset that may be shifting, but is very entrenched. Was on with a dir of RCM who complained of increased admin burden and was resigned to more FTEs. No whisper of tech.

It’s fine to write stories about how hospitals are (supposedly) struggling financially, but then you need a theory for why they are also adding 15 - 20K staff to payrolls every month. A hiring binge isn’t what you usually see from organizations struggling with tight budgets.

@bling0 Yes and huge problem. Some states (TX and TN) recently passed laws forcing payers to give some members credit towards deductibles even if they pay the lower cash rate and go outside the provider <> carrier contract. forbes.com/sites/theapoth…

Today I got an MRI done. Coincidentally I asked what the out of pocket cost of the same MRI would be without insurance. Out of pocket cost (co-pay w/ insurance): $733 Out of pocket cost (no insurance): $350 So a patient pays 2x out of pocket w insurance! Is this normal?

@nicksoman @Decent

Cigna sent me four emails insisting we shouldn't expect a refund. After I pushed them to show their work, they found an "error in their calculations" and told me to expect $11,364.04. Ladies and gentlemen, this is US healthcare. Can't wait to get on a @Decent plan next year.

@dteten 👋 thanks for sharing. Working hard to keep money in people's pockets and improve their position in our otherwise pretty patient-hostile billing system.

Interesting: We negotiate hospital bills for you | Goodbill goodbill.com #hospital, bills, health, insurance

How much will an ER visit for a urinary tract infection cost you? Roughly $2K, but some hospitals may charge you 10-20 times more, according to Goodbill's price analysis. How much does your hospital charge? goodbill.com/er-visit-cost-…

@dp_oneill Overall lack of enforcement on hospitals sucks. Mult. system execs say regs that COULD lead to change have no teeth. E.g., patient access requests for data. It’s a risk analysis of exposing data that makes them look bad + gives patients info, sapping potential consumer pressure.

*listens* ...yep, yep that's exactly what we're doing. Hospitals act like what we're doing for patients is a bad thing. Kicking or screaming, welcome to a more transparent world.

@chrissyfarr That last one is us @goodbill. 👋

What are the most obvious ideas in health care that haven't been started yet b/c of structural issues? I'll shoot: -- A ubiquitous platform to check prices -- A provider quality scorecard -- A system to double check medical recs -- A platform to dispute medical bills