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View Diary: Health Care Reform Doesn't End with Insurance Companies (4 comments)

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  •  All new medical billing of natural persons (2+ / 0-)
    Recommended by:
    jfdunphy, FloridaSNMOM

    should be based on clearly posted Medicare amount multiples.

    In emergency and ER care appropriate cases, the person should only be charged the Medicare amount, even if the provider doesn't take Medicare.

    In other cases [where shopping is practical], providers should have to bill not exceeding a provider selected and posted DRG multiple of the Medicare DRG amount not exceeding two and other services and products provided based on a provider selected and posted non-DRG multiple not exceeding three of the Medicare non-DRG amount.

    Independent providers working in the facilities of hospitals should be capped at a multiple of two unless they individually and directly contract with the patient separately at least twenty-four hours in advance of the patient's arrival at the hospital and the contract clearly lists the applicable multiple.

    Each provider should have to post the two multiples on each outside door of their business premises and provide them on telephone request if they have a business phone line and on their website, if any.

    The multiples should only be changed on IRS estimated tax due dates and by no more than ten percent a quarter.

    Unpaid bills after 30 days would be subject to interest at the IRS rate[or less if contracted for or limited by state law].

    If a hospital would get $12,000 from Medicare [exclusive of the disproportionate share amount used to pay for the indigent] for an operation, then if the hospital posts a DRG multiple of 1.5, the maximum allowed charge to a person like me would be $18,000.

    If the anesthesiologist posts a multiple of 2 and Medicare would pay her $325, then she could bill me $650.

    If the surgeon posts a multiple of 1.7 and Medicare would pay him $800, then he could charge me $1,360.

    France is implementing a standard tariff scheme in all services. Medical practitioners are categorized as either conventioné or non-conventioné. Conventioné practitioners adhere to the standard tariff rate while the non-conventioné can charge the rate they like. However, almost all health practitioners (97%) are conventioné, even the private ones for competitive reasons.

    The usual rates for professional consulting are€21 for a médicin traitant, €24 for children aged two-six years old, and €25 for children under 2 years old. An additional euro is charged but that cannot be reimbursed by the patient.

    Services and prescribed medicines are not fully reimbursed. Oftentimes, this based on the income level of the individual or a family. Typical reimbursement rate is 95% for a major surgery, 80% for a minor surgery, 95% to 100% for pregnancy and childbirth, 65% for prescribed medicine with blue labels and 35% for white labels, 70% for x-ray, and 75 to 80%% for GP/specialist consultations and treatment.  Thus around 80% of the French population still avails of supplemental health insurance to cover the difference in actual cost and reimbursed amount. This again costs employees with about 2.5% of their salaries. Most supplemental health insurance is provided by employers as part of their employment benefits to their employees.

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