Ask Lemmy

For those in the US: no medical office dealing with insurance has a clue what they're doing. Why can't you ever "shop around" and get a price for your procedure? Because nobody really knows the price until they submit the claim. It's basically impossible for a human to keep track of the policies that change daily across dozens of insurance providers along with the hugely complicated calculations needed to get a price. And that's before they have software try to rearrange your claim to get the most money possible from insurance companies. And good luck figuring any of this out yourself; even if you manage to track down the policy data, it's written completely in medical insurance jargon and might even leave some room for interpretation.

Basically, even with the insane amount of work medical coders (people who process and interpret medical claims and policies) do to try and stay on top of it all, at the end of the day, you have to just submit the claim to a black hole and hope that it gets accepted. The patient's cost is whatever it spits out.

Also, dozens of doctors across the US get fired, banned from practice in their state, or have their licenses revoked every month. Some of them are unfortunate, like doctors being forced into retirement due to old age or physical inability to do their job, but many others get in trouble for practicing without a license, sexual harassment/assault, and, of course, prescription drug abuse. This data is all publicly accessible, but being on atrociously designed and maintained government websites, it's nearly impossible to keep track of who's in trouble without paying for third party software to do it for you. If you don't happen to catch it, it's pretty easy for a medical provider to move a few states over and set up shop like nothing happened.

Edit: Oh yeah, our company was very serious about HIPAA training and treated patient data with extreme caution. Some offices... really didn't. It got to the point where we'd straight up have to reject ticket requests for having identifying information. Our ticketing system was secure on our end, no telling what was going on outside of it.

As a side note, for the trans people out there, don't accept that you have to be misgendered on your medical records without a bit of a fuss. There's special modifiers that specifically override restrictions on sex-based medical procedures when your reported gender doesn't match their requirements. Unfortunately, whether your provider knows about or uses them is a bit of a toss-up.

On a brighter note, as stupid as it is that every single diagnosis has to be codified specifically for the insurance industry, there are some funny codes in there.

Some favorites:

• Bitten by a dolphin (specifically the first time. There's different codes for a second bite and any more after)
• The weirdly specific set of codes for various injuries on different watercraft
• Of course, something stuck up your ass

Now there's a new standard coming into effect, ICD11. The biggest complaint with ICD10 was the overly specific codes they had to keep track of. They did change things so that you didn't have a completely different code for every single type of, say, dolphin injury, but they did add many more animals.