Respectfully submitted by Lawrence E. Rafferty(rafflaw)-Guest Blogger
If you have had any medical procedures lately, you may already be aware of the enormous prices being charged by hospitals. What you may not be aware of is just how expensive this medical treatment is and how relying on private health care may just be reducing our lifespans. I apologize in advance on the length of the following examples, but they are necessary to understand the enormity of the issue.
“Brill’s article begins with the story of a 42-year-old Ohio man named Sean Recchi, who traveled to MD Anderson Cancer Center in Houston for treatment of non-Hodgkin’s lymphoma. He and his wife Stephanie had paid $469 a month, or about 20% of their income, for insurance that covered $2,000 per day of hospital costs. His financial troubles started when MD Anderson told him, “We don’t take that kind of discount insurance.” But he had to go to the hospital. His wife recalled that he was “sweating and shaking with chills and pains. He had a large mass in his chest that was..growing. He was panicked.”
Stephanie asked her mother to write a check for $48,900. Sean waited for 90 minutes while the hospital confirmed that the check had cleared. He was also required to advance MD Anderson $7,500 from his credit card. The total cost for the initial treatment and chemotherapy was $83,900, including a $15,000 charge for lab tests for which a Medicare patient would have paid a few hundred dollars, $283 for an x-ray that Medicare categorizes as a $20 charge, and $1.50 for a generic version of a Tylenol pill.” CommonDreams
Those charges were just the start of the enormous costs that Mr. and Mrs. Recchi would be subjected to while dealing with his illness. His total bill for the beginning of his treatment for cancer was $83,900! If Mr. Recchi had been treated under Medicare for the same procedures and blood tests his cost would have been much less. “Had Recchi been old enough for Medicare, MD Anderson would have been paid a few hundred dollars for all those tests. By law, Medicare’s payments approximate a hospital’s cost of providing a service, including overhead, equipment and salaries.” Time
The hospital in this example is a non-profit division of the University of Texas, but its profits are enormous. ‘ “The hospital’s hard-nosed approach pays off. Although it is officially a nonprofit unit of the University of Texas, MD Anderson has revenue that exceeds the cost of the world-class care it provides by so much that its operating profit for the fiscal year 2010, the most recent annual report it filed with the U.S. Department of Health and Human Services, was $531 million. That’s a profit margin of 26% on revenue of $2.05 billion, an astounding result for such a service-intensive enterprise.1
The president of MD Anderson is paid like someone running a prosperous business. Ronald DePinho’s total compensation last year was $1,845,000. That does not count outside earnings derived from a much publicized waiver he received from the university that, according to the Houston Chronicle, allows him to maintain unspecified “financial ties with his three principal pharmaceutical companies.” ‘ Time
Not only is this hospital reaping huge financial windfalls on the backs of its patients and their insurance companies, the compensation of the hospital’s CEO, as noted above, is astronomical. And that compensation does not even include the “unspecified financial ties” with pharmaceutical companies. Does that mean that the CEO is allowed to receive kickbacks from some of the companies that his hospital may be using for their medications?
This is just one example, but the Time magazine article linked above delves into other examples of this type of outrageous medical costs charged to patients. If the patients noted in the examples were able to take advantage of a Medicare for all plan, the costs would be a small fraction of what Mr. Recchi was subjected to. It is interesting to note that the Administrator of Medicare for the entire country made a small fraction of what this one hospital CEO took home. “The Medicare administrator made a base salary of approximately $170,000 in 2010.” TheNation
Just what do we get in terms of service and results for these extraordinary charges? “Our private health care system has indeed failed us. We have by far the most expensive system in the developed world. The cost of common surgeries is anywhere from three to ten times higher in the U.S. than in Great Britain, Canada, France, or Germany.” Common Dreams Our expensive private health care system does not even produce better medical results than the results achieved under Medicare.
“We now have a shorter life expectancy than almost all other developed countries. A National Research Council study placed the United States LAST among 17 high-income countries.
It wasn’t always this way. Since 1960 there has been a close parallel between worsening life expectancy and increased health care costs as a percentage of GDP. Most disturbing is our growing infant mortality rate relative to other countries. A UNICEF study places the U.S. 22nd out of 24 OECD countries in “children’s health and well-being.” In startling contrast, Americans covered by Medicare INCREASED their life expectancy by 3.5 years from the 1960s to the turn of the century.” Common Dreams
That last factoid on life expectancy is amazing. We are paying far more than any other country in the world for our private health care system, but we are not getting the world-class results for those high prices. Why do we as a nation continue to allow the medical industry to charge these exorbitant rates? The answer is the lobbying money spent on our politicians in Washington and in state capitals all over this country. We have to take over the for profit health care system and replace it with a Medicare for all type system or we will continue to overpay for less. Will Obamacare help this situation? It may, but we won’t know for a few more years if costs are controlled and results are improved.
Will Obamacare start us down the road to a single payer system? One can hope, but I am not holding my breath. Does it make sense to cut Medicare services and push back the eligibility age in light of the huge national costs incurred in the private health care system? What do you think?
I am pi$$ed off. These god dam health companies, they are the problem with health care, billing insurance companies way above cost, above decency.
This company, Americas Home Health, wants almost $10,000 for something I can buy on line for $3,500.00 [from a company who is also making a profit] and what is worse, the insurance company goes along with it.
You want to know why we have Obama Care? Greedy, venal companies like America’s Home Health.
These machines probably cost around $2,000 to $2,500 to buy wholesale, so America’s Home Health is making almost $8,000.00 to do paper work and deliver the machine to my house and make a couple of minor changes to the settings I can do myself. And people wonder why medical care is so expensive? We are all getting the shaft because of people like this. This is why we have Obama Care, because someone thinks it is OK to charge the insurance company 4 times what it is worth. This is why patients ought to be in charge of the money and not insurance companies and not government. If I can buy on-line I will save $650 of my hard earned money; I have a 10% copay on equipment.
I think Ben Carson is on the right track with health savings accounts, put the patient in charge of the money. When you can save $650 with a couple of phone calls and an hour or 2 of your time, thats a good deal.
I am all for profit and lots of it but offer something of value for that profit; it is someone’s hard earned money.
This piece of garbage Obama passed was nothing but a backdoor lining the pockets of Insurance Companies and Big Pharma. Obama is a fraud. A Liar. He should be impeached.
Please do not call that lying piece of garbage a Liberal. He is a lying Corporate Fascist. Worst President ever in US History. Hard to believe the 2 worst Presidents ever by far, came back to back, 2 terms each. This country cannot handle 16 years of Neo-Facist Presidents.
Elaine M.
Thanks for the link. I do wonder who will decide what is medically necessary and whether, like Medicaid now, there will be a cost-effectiveness component and a restriction on payment for experimental services. Because I see the government denying people services now, I am skeptical that it would be different under the single payer. (Although as I wrote before, I think s/p would be to my benefit.)
Insurance wants to deny payment on basis of discharge diagnosis. What a novel idea and surprise. They should be basing it on the presenting complaint, not the discharge diagnosis. Any doctor will look at the symptoms presented and do tests accordingly as they proceed through the diagnostic “rule out” algorithm.
So a guy comes in with all the symptoms of stroke, but turns out to be hyperglycemia. Private insurance refuses coverage for the brain scans, emergency blood thinners and possibly one day in ICU. Insurance companies have two ways of treating this matter. First, they deny and the patient is stuck paying for the visit.
Alternately, they deny payment, but the health service provider is sent a confidential letter with the EOB (explanation of benefits), The letter will say, in effect, “Upon review, the services you provided are deemed not necessary based on the discharge diagnosis. Under the terms of your contract with us, you may not bill the patient and may not disclose to the patient we are denying payment.”
Did I mention that I absolutely despise the profit-driven corporate insurance industry?
ED Discharge Dx Not Best Basis to Deny Payment
By Nancy Walsh, Staff Writer, MedPage Today
Published: March 19, 2013
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Action Points
A potential source for cost savings in healthcare is to reduce overutilization in the emergency department. One consideration for doing this has been to deny payment if the patient’s diagnosis upon discharge appears to reflect a “non-emergency” condition.
This study found that among emergency department visits with the same complaint as those ultimately given a primary care treatable diagnosis based upon discharge diagnosis, a significant proportion required immediate emergency care or hospital admission.
Limiting or denying reimbursement for emergency department (ED) visits based on patients’ discharge diagnosis is not a reliable — or justifiable — strategy for cost saving, researchers found.
In a national sample of 35,000 ED visits, 6.3% (95% CI 5.8 to 6.7) of patients were discharged with a diagnosis that, in theory, could have been treated in a primary care office, according to Maria Raven, MD, of the University of California San Francisco, and colleagues.
But these patients’ presenting complaints were shared by 88.7% (95% CI 88.1 to 89.4) of all ED visits, including those of patients with serious conditions, the researchers reported in the March 20 issue of Journal of the American Medical Association.
“Because the presenting complaints of patients who are ultimately recognized to have non-urgent conditions overlap so extensively with the presenting complaints of those with more severe conditions, it is not possible to justify denial of payment based on final diagnosis,” James Adams, MD, of Northwestern University in Chicago, wrote in an accompanying editorial.
Several states have begun limiting payments in this fashion in an effort to hold down costs, but the trend has been criticized as being oversimplified and unfair.
An example offered by Raven and colleagues was the elderly diabetic whose presenting complaint was chest pain. The patient was ultimately was discharged with the diagnosis of gastroesophageal reflux, but had been correctly worked up for acute coronary syndrome.
To examine the correlations between presenting symptoms and discharge diagnoses, the research team undertook a secondary analysis of data from a national survey conducted by CDC’s National Center for Health Statistics.
They classified ED visits according to an adaptation of an algorithm originally developed at New York University as being emergent or non-emergent, and further divided emergent visits as “emergency,” “primary care-treatable,” or “emergency-ED needed,” based on assumptions of what resources would be needed for evaluation and treatment.
The emergency-ED needed category was further subdivided as preventable/avoidable if routine outpatient primary care would have sufficed.
The overall lack of correlation between presenting complaint and discharge diagnosis was observed across age groups.
For children, 5.5% (95% CI 4.7 to 6.3) were discharged with diagnoses suitable for primary care treatment, but their main presenting symptom was the same as 90% (95% CI 88.6 to 91.1) of all children.
Among adults 65 and older, 3.2% (95% CI 2.8 to 3.8) had non-emergency discharge diagnoses, but shared their presenting complaints with 86.9% (95% CI 85.8 to 88.1) of all ED visits by older individuals.
For the ED visits with discharge diagnoses considered appropriate for treatment in primary care, 11.1% (95% CI 9.3 to 13) were determined at triage to require immediate care.
In addition, 12.5% (95% CI 11.8 to 14.3) required hospital admission and 3.4% (95% CI 2.5 to 4.3) were sent straight to the operating room.
Among those who were admitted, 11.2% required admission to a critical care unit, the researchers noted.
The most common discharge diagnoses where the presenting complaint was considered non-emergency were:
Abdominal pain: weighted proportion 3.60 (95% CI 3.23 to 3.97)
Upper respiratory tract infection; weighted proportion 2.87 (95% CI 2.51 to 3.23)
Chest pain: weighted proportion 2.75 (95% CI 2.41 to 3.09)
“These results highlight the flaws of a conceptual framework that fails to distinguish between information available at arrival in the ED and information available at discharge from the ED,” Raven and colleagues explained.
Simply trying to cut down on ED use isn’t likely to be beneficial to the health of the overall population or to provide significant cost reductions, they pointed out.
“Instead, a more innovative and sustainable path forward is through policies that allow for the creation of integrated systems of health and community care through which risk is shared and resources are allocated rationally,” they stated.
In his editorial, Adams highlighted the importance of access to care for all.
“Patients’ access to primary care physicians and specialists, to a reliable supply of medicines, to clear and consistent information, and sometimes to effective supports to keep them well are all required to optimize the use of healthcare services and achieve high-quality outcomes,” he wrote.
Limitations of the study included its reliance on the ED algorithm and a lack of information about patient concerns and comorbidities other than the chief complaint.
The study was supported by the Emergency Medicine Foundation, the NIH, and the Robert Wood Johnson Foundation.
The lead author has consulted for the United Hospital Fund and a co-author has been a consultant for the American College of Emergency Medicine.
Primary source: Journal of the American Medical Association
Source reference:
Raven M, et al “Comparison of presenting complaint vs discharge diagnosis for identifying ‘nonemergency’ emergency department visits” JAMA 2013; 309: 1145-1153.
Additional source: Journal of the American Medical Association
Source reference:
Adams J “Emergency department overuse: perceptions and solutions” JAMA 2013; 309: 1173-1174.
http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/37950?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&xid=NL_DHE_2013-03-20&eun=g554649d0r&userid=554649&email=leejcaroll@aol.com&mu_id=5681871
I think that makes sense not to go to the ER first if there is an option. My assumption was what OS said, that ins companies do not do the kind of double checking audits that m/m does.
I see no winning or losing here, only conversation. (:
mahtso & leejcarrol,
I suppose what I wrote was confusing and unclear. Apologies for that. Let me try again.
I did not mean that tests would not have been run if the patient was on Medicaid/Medicare. When somebody comes into an emergency department with a complaint of chest pain, there is a set protocol to follow. A series of tests are run that comports with the presenting complaint, just as they were when I suspected I might have a DVT. Emergency rooms who do not follow the protocol are inviting a malpractice lawsuit if they don’t run the required tests to rule out all the possibilities, and end up overlooking something serious. Emergency departments, especially Level I Trauma Centers such as the one my grandson went to, are held (legally) to a higher standard of care than your family doctor or average walk-in clinic. That higher standard of care is expensive.
I am saying that had he not followed the mistaken advice and gone to the walk-in clinic or family doctor, they would have used a different assessment and treatment protocol that is not as expensive. For one thing, family doctors typically do not have CT and MRI machines, so that expense is eliminated from the git-go. After the initial assessment, if the family doctor determines the problem is too serious to treat in their clinic, the patient is sent on to the emergency room for a more thorough assessment and intensive treatment.
I think where my message got mixed was that I was objecting to him going to the ER in the first place. Contrary to advice to the public from professional politicians, ER medicine is extremely expensive. Why run up a bill into four figures when it is not necessary? He could have stopped by any of the walk-in clinics and gotten seen for a hundred dollars or so. If he was assessed as having a serious problem, he would have been transported to the ER. In cases like that, insurance usually does pay, even if out of network, because the family practitioner has declared what is called a “medical emergency.”
As far as audits, insurance companies do some audits, but over the years, I have not seen nearly as many from private insurance companies as from the Medicare/Medicaid Commission. When private insurance does an audit, it is usually a single patient file, not several thousand charts. Furthermore, private insurance companies are not able to call in the FBI or other Federal law enforcement in cases of fraud or overbilling. Private insurance companies can sue, but they cannot impose huge fines and send offenders to prison.
As for single payer, I am in favor of something like Medicare for everyone and continue Medicaid for the very poor and disabled. You have to pay premiums for Medicare and there is a deductible. Medicaid does not require payment of a monthly premium, and there is no deductible. The reason for that is due to the fact this is insurance for the poor and disabled who have no funds to pay either premiums or deductibles. We need to wrest control of health care from the corporate insurance industry.
mahtso,
Here’s one explanation of single payer from Physicians for a National Health Program
http://www.pnhp.org/facts/what-is-single-payer
Excerpt:
What is Single Payer?
Single-payer is a term used to describe a type of financing system. It refers to one entity acting as administrator, or “payer.” In the case of health care, a single-payer system would be setup such that one entity—a government run organization—would collect all health care fees, and pay out all health care costs. In the current US system, there are literally tens of thousands of different health care organizations—HMOs, billing agencies, etc. By having so many different payers of health care fees, there is an enormous amount of administrative waste generated in the system. (Just imagine how complex billing must be in a doctor’s office, when each insurance company requires a different form to be completed, has a different billing system, different billing contacts and phone numbers—it’s very confusing.) In a single-payer system, all hospitals, doctors, and other health care providers would bill one entity for their services. This alone reduces administrative waste greatly, and saves money, which can be used to provide care and insurance to those who currently don’t have it.
Access and Benefits
All Americans would receive comprehensive medical benefits under single payer. Coverage would include all medically necessary services, including rehabilitative, long-term, and home care; mental health care, prescription drugs, and medical supplies; and preventive and public health measures.
Care would be based on need, not on ability to pay.
Payment
Hospital billing would be virtually eliminated. Instead, hospitals would receive an annual lump-sum payment from the government to cover operating expenses—a “global budget.” A separate budget would cover such expenses as hospital expansion, the purchase of technology, marketing, etc.
Doctors would have three options for payment: fee-for-service, salaried positions in hospitals, and salaried positions within group practices or HMOs. Fees would be negotiated between a representative of the fee-for-service practitioners (such as the state medical society) and a state payment board. In most cases, government would serve as administrator, not employer.
Oterray Scribe
Again you are mistaken, because I am not trying to “win” anything here. I am trying to understand how the proposed single payer would work.
leejcarrol
I don’t read OS’s comments the way you do. Quite the contrary he has written that the tests would not have been ordered if the patient was on Medicare or Medicaid. Maybe if he had been willing to answer my questions, he could have clarified his intention, but instead, apparently, he wants to “win” something.
How do the Medicaid audits differ from private insurance companies scrutinizing bills?
Mahtso you have made our point, tests were ordered that is required evidently by medicare, etc and it is audited. as opposed to having private ins coverage that would have allowed for many more tests then ‘required’..but for which cost could be billed..
More and more irrelevant in a dead thread. Give it up sport, you ain’t winning.
leejacarrol
Here is the entire comment (w/o embeded video)
“mahtso,
To continue the point to both you and Bron. What a lot of people do not know is that doctors are audited frequently by both Medicare and Medicaid. Big insurance companies do not do that. Hospitals are also audited. Penalties are severe for abuse of the system, overbilling, and tests given that do not mesh with the presenting complaint and final diagnosis.
When a Medicare/Medicaid patient comes in, there are strict rules that have to be followed. Additionally, all payments to providers are heavily discounted, far more than regular insurance. If my grandson had whipped out a Medicare or Medicaid card, the attending physician or Nurse Practitioner would have been a bit more judicious. He would have gotten an X-ray and some blood enzyme tests. When those came back negative, he would have been sent home with some Flexaril and told to take ibuprofen. There would have been a bill for several hundred dollars, because it costs a lot more to run an emergency department in a medical center than a walk-in clinic.
The reason he went to the ER in the first place was because his other grandmother believed the advice given by Mitt Romney: “…just go to the emergency room.””
I pay 104 per month for my medicare, I pay 254 for my BC/BS. Many years ago (I do not know if would be the same now) I was in the hospital for a month, in ICU for a couple of days, had 2 major surgeries and got a bill for $138,000. I was amazed to see that Medicare had picked up all but 800$ that was billed to my BC/BS. My BC premiums really hurt me but I am too afraid to let it go for the one time medicare doesn’t step up to the plate. (and even my docs often accept my medicare and do not bill me for the co pay left over, a real kindness on their part)
leejcaroll,
If I understand it, the complaint was that taxpayers pay for single payer services instead of sending that same money to the corporate insurance industry. Also grumbling about doctors being paid a lot. Facts are troublesome things. They get in the way of ideology.
All Medicare recipients pay for coverage, but the premiums are a heck of a lot less than for private insurance. The teabaggers and Randians cannot seem to understand that when taxpayers pay into single payer coverage, they do not need to pay several hundred dollars a month to the corporate insurance industry. Said private insurance carrier has a vested financial interest in keeping payouts to providers at a minimum while they pay themselves out of the funds they save by denying coverage. Single payer does not have that problem.
But, what can we expect from folks who buy into an economic model created by a sociopath for the benefit of sociopaths who run it.
I cannot find again the original posting. I recall him writing about “out of network” I do not about more tests etc because not on Medicaid, medicare but given your comments one wonders if the opposite would not be the case: not that they did not do tests because it was not Medicaid, medicare, but they did not do unnecessary tests because it was not paid for by m/m
leejacarroll
Maybe you have the same problems with reading that I do, but when I initially asked OS whether the e/r visit was medically necessary, one of the things that I was uncertain of was whether the poor judgment he said his grandson showed was based on hindsight.
Also, OS wrote that e/r staff did work that it would not have done if the grandson was on Medicaid or Medicare. From his comments, a reasonable inference is that these services were not medically necessary. But assuming I am wrong and they were m/n, then we have a situation where those using Medicare or Medicaid are getting lesser service than anyone else (in this case meaning not getting all the m/n services). But yet, Medicare is held out as an example of government run healthcare being better.
Otteray Scribe
Maybe I cannot write either because I don’t recall writing that medical school would be easy. If it would be too hard for you, so be it, but all your negativity will not change my positive outlook. (One of the things that people embarking on a can-do, positive attitude in life need to be ready for is the naysayers because there will always be people saying you can’t do it, it’s too hard, etc. Perhaps Mr. Spock put it best when he said: Historically it has always been easier to tear things down, than to build them up.)
If you will explain why my prior explanation of Ms. Hemingway-Hall makes what she does was not reasoned or which part of it you did not understand, maybe I’ll take another crack at it.
I was going to write that I was a bit surprised that Mr. Bush’s name is being brought up in a discussion about medical school, but on reflection it fits well with the tenor of your arguments.
Guys, here is how it works when you go to the ER with a complaint.
A few days after taking a trip Alaska and back, I started having pain in the calf of my leg. It did not feel like anything I ever experienced before. That was not long after NBC news reporter David Bloom died of complications from a DVT he acquired from sitting in a cramped Army M88 Tank Recovery Vehicle for hours at a time.
The triage nurse asked me why I was there. I told her I had a pain in my leg and was worried it could be a DVT, because I just spent a total of 24 hours in cramped airline seating. Twelve hours each way to Alaska. She rushed me to an exam room, and within two minutes a doctor and couple of nurses were in there. The doctor asked me what about the pain made me think it was a DVT. I told him I had never had a DVT, so I had nothing to compare it with, but I thought it felt like what a DVT ought to feel like. They ran a number of tests including scans and ultrasound on my leg.
After a while, the doctor came in and said I had a strained muscle deep in the calf of my leg, and it was not a DVT. I apologized. He replied, “No. You did exactly the right thing. It could easily have been a DVT. With stuff like that don’t take any chances. And if you ever even suspect you have a DVT, do not hesitate to come back.”
Medicare paid the bill. It was a strained muscle, probably from sitting in that cramped airline seat. If I had commercial private insurance, they too would have most likely paid unless I had run up against coverage limits or a rider limiting coverage for those services.
In doing medical assessment, it is a process of ruling out things. A diagnosis is not made until all the possible options are explored. Insurance will not pay if the tests run are inconsistent withe the presenting complaint. If someone comes in with abdominal pain, running a CT scan of the brain is not appropriate. If they come in with a suspected concussion, then a brain scan is appropriate. As with any rule of thumb, there are exceptions. If the patient presents with abdominal pain, but the doctor notices signs of stroke or brain tumor, doing a CT of the head is good practice.
Bottom Line: I went to the ER with a strained muscle in my leg. They ran lots of tests, determined it was not a life-threatening DVT, and sent me home with a prescription for some Flexaril. It was covered by Medicare.
Mahtso,
After a running battle my DiL got the insurance company to pay the out of network provider just as they would have paid as if they had been in-network. They did pay all but the 20% deductible. I think I mentioned that previously, but am not going wade through the comments upstream to find it.
She is an experienced nurse who has worked in a large medical clinic in the past, and knows how the insurance industry works. She got hold of the right supervisor and told them what their own rules were. Suppose she were not experienced in dealing with third party payers, and was just another average person? Think a person like that knows which buttons to push? Not likely, and insurance companies count on that.
Single payer would eliminate that problem, and do it cheaper than private pay insurance. For one thing, Medicare/Medicaid managers don’t get salaries that exceed what a physician makes in two or three lifetimes of service.
As for ER protocol, when anyone of any age comes into any ER in this country (and most foreign countries) complaining of chest pain, that patient will have their undivided attention.
As for “most of us could do it” (become physicians). That’s true, provided you get through pre-med with top grades, make a high score on the MCAT, get accepted, then four years of medical school while maintaining at least a 3.0 GPA.
By your standards, it’s really easy for “most of us” to get through the most academically demanding, science & math heavy, undergraduate program in the university, all the while keeping a GPA 3.5 or higher. Medical school admission offices will not consider applicants who have average grades. Unlike people like George W. Bush, legacies, political connections and wealth earn no brownie points at all with med school admission officers.
Most physicians do not even start their working career until they are in their 30s, and if they spent time in the military, their working career may not begin until they are in their 40s. The oldest new graduate physician I ever met personally was 56 years old. Yep, anybody could do that.
I am still waiting for some reasoned explanation as to why somebody with only a Master’s degree is worth about $13 million dollars a year while the average physician makes 1/65th that amount. According to her online biography:
leejcaroll,
you are correct that preventive measures can save everyone a lot of money in the long term.
It was after the fact they knew it was not necessary, He had chest pain, without more history it was appropriate to see someone, He probably should have gone to the 24 hour place he passed, I grant you that, absent other symptoms, but silent heart attacks do happen, absence of SOB, etc does not mean absence of heart issues.
Yes insurance should pay for that. Better he ignore it and then cost more in terms of long hospital stay, tests, etc because it was not merely a pulled muscle? It apparently hurt enough that he felt he needed to get some assistance or diagnosis.