You now have a chance to DIRECTLY help someone, a real person, not organization. Andrii and I together attended Kiev Polytechnic Institute, together worked on lab assignments, played volleyball and Preferans. Andrii’s son Ivan needs your help. You can conveniently donate via PayPal at http://www.mysql.com/about/help-ivan.html – any size donation matters!

“My family got bad news – doctors said allogenic bone marrow transplantation is the only chance for my son Ivan.

“8 months of heavy and expensive immune suppression brought some positive results so we hoped that recovering is just question of time.

“Ivan is very brave boy – not every human meets so much suffering during whole life, like Ivan already met in his 2,5 years. But long road is still in front of us to get full recover – we are ready to come it through.

“Ukrainian clinics have no technical possibility to do such complex operation, so we need 150-250K EUR for Israel or European or US clinic. The final decision will be made considering amount we able to find. Perhaps my family is able to get ~60% of that by selling the flat where parents leave and some other goods, but we still require external help.”

– Andrii Nikitin, MySQL Engineer

Please join us in raising money for Ivan – donate today.

This is from Google Analytics for one of my sites. (Hint: Where is Lake Michigan?)

John Doe has a PPO plan. He goes to a doctor and pays $20 co-pay. The doctor performs whatever was necessary to diagnose the problem, does some treatment, etc. John is healed, goes back home and a month from the day of the visit gets a letter in mail. In it, his insurance company indicates that the doctor billed a total of $1,000 for 5 different things (charges are itemized and described in “medical” speak). The letter goes on to say that from that $1,000 it applied a “PPO discount” of $850, it paid $130 and $20 is John’s responsibility (co-pay). Everybody is happy, all charges are settled.

Now, here is what strikes me about this situation:

1. While John is at the doctor’s office in the examination room, there is no way for him to find out how much each procedure is going to cost. Even doctor doesn’t know this information – he may know how much he bills (most probably don’t), but he never knows how much John will have to pay for it.
2. What’s the incentive for doctor not to order unnecessary treatment intentionally?
3. What’s the point of describing procedures performed in “medical” speak? If you ask me how to configure firewall to allow incoming web traffic and I answer “iptables -I INPUT 1 -p tcp –destination-ports 80 -j ACCEPT”, will this help you? Only if you are familiar with Linux command line tools (in which case you very likely won’t be asking this question in the first place). In other words, my answer in this case was not meant to help you – it was meant to answer your question (note the difference).
4. How the heck did PPO come up with $850 discount and not say $950?
5. Why a doctor who billed $1,000 agrees to take a payment of $150?
6. Will a person without insurance have to pay $1,000?
7. So is it insurance or a “discount” or “rewards” plan?

IMHO, helthcare costs problem has a lot to do with this simple description of fubared medical billing case. Make it simple (or at least simpler) – and many things will get easier.

I find this disturbing. And not only because I personally will be inconvenienced. It looks to me like both organizations relied on ordinary people to start making phone calls and writing letters to the other party to convince them to give up and sign a new contract. The same ordinary people who often have no choice but to accept insurance offered by their employers. OK, they might have a choice after all, but it’s not economically viable – if my employer offers me insurance, I would have to decline and go buy myself another policy (this would most definitely involve lots of paperwork, fine print and probably pre-certifcation medical exams for all members of our family). It’s very unlikey that many people would choose this option.
Questions that we should be asking:

1. If Condell thinks its reimbursement does not cover its costs, are its costs above its peers? If yes, why?

2. Does BCBS truly provide the same reimbursement to Condell as it provides to its peers? If no, why?

The bottom line – won’t it be nice to have some sort of independent moderator or arbitrator or anybody with some sort of official status to obtain answers to these questions and make them available to the public so that we all could make an informed decision? Maybe it can be a civil lawsuit whose sole purpose would be to get both companies to answer above questions under oath? Instead, they force us to rely on PR departments of both organizations who keep accusing each other.