Fridaily

[ellenmillion]

I approved the second digital proofs of the new coloring books today - I got the first round about 10 days ago, and decided it needed one tweak. I should get the physical proofs in a few days, then we can do actual printing, horrah! I am hopeful (but not holding my breath) to have them on hand when I re-open the webpage.

I managed to overcome one of the major coding hurdles I was working on yesterday, and the interlinking is becoming more and more seamless. A few tweaks still to make, and some work on the credits/karma handling, but we're into things I'm *comfortable* with, so it should go quickly from here. I think I've leveled up again this week.

If it is not raining tomorrow, I will be doing a few hours of chalkpainting in the park with Liz and Jennie (and others?)!

Catie is crowdfunding her next novella for moving expenses

On the TV front, I'm almost finished with Buffy, and Jake and I are enjoying the cheese that is Roswell. I adore Netflix streaming. I don't think I will ever watch broadcast TV* again - even just the Stanley Cup (go Hawks!) was enough to make me appalled all over again with commercials.

Dance rehearsal last night was silly and fun, though I wasn't in a particularly silly or fun mood. Still sore, but my endurance is definitely improving.

Reminder! Torn World's Muse Fusion is next Tuesday, and EMG's Sketch Fest is Fri-Sat!

I did a pile of invoicing, bills and miscellanea today, mostly for house and health things. One of the things that came over my desk was a statement from the insurance company which about gave me a heart attack - a bill for a surgery assistant was set at $5100, and the insurance company said they'd only pay about $1400, which sticks me with $3700. As we'd made our deductible (loooong since) and hit our out-of-pocket cap, this was a $3700 surprise that we weren't really prepared to deal with. I called the surgeon and explained the situation, desperately hoping that they'd billed something using the wrong code or something else easily fixable. "Oh," they explained to me, "you don't owe that, don't worry - that's how we bill these things."

See, each insurance company has a different idea of what is reasonable and customary for a surgery assistant. The standard operating (pun not intended) procedure of medical offices is to bill them the full total for a surgeon, accept whatever the insurance company will pay, and the adjust the remaining bill so I only have to pay $50.

Now, $50 is a helluva lot better than $3700, and I was obviously very relieved and hung up the phone feeling mollified.

But on reflection... does that seem BROKEN to you? Rather than setting a standard price for a necessary service, they charge whatever the market (in this case, an insurance company) will pay - then add $50. Now, first of all, I'm paying for insurance to cover exactly this kind of thing. We pay a lot for our insurance and it's very good. Once I've hit my cap, why should I pay ANOTHER $50 - not because that's what it cost, but because they know they can charge that?

And doesn't this feel like a reason that insurance companies are struggling so badly? Because they're being charged the moon for services. So, the burden is on them to figure out what's normal and customary, and basically a patient is just along for the ride. Seriously. The Torn World licensing system feels reasonable compared to this.

I had another rant I was going to rant about - about being afraid - but that will have to wait until another day.


*With the obvious exception of PBS.

Comments

[minor-architect.livejournal.com]

But on reflection... does that seem BROKEN to you?

Oh yeah. I know this dance...where specialists and hospitals charge whatever they want, then negotiate with the insurance companies to see how much they can get away with. When I had my own gallbladder removed, the hospital stay alone was over $15,000. After the dust settled, they billed me for only $1,500.

(And if I'd had NO insurance - what the hell, does the hospital think I have $15,000 just lying around?!)

[ellenmillion.livejournal.com]

Between the bajillion tests, the surgery and the hospital and the anesthesia, I think it's totaled over $20k. We're going to be out about $1500 as well, I think. It just sort of boggles the brain. Someone on my friendslist has a family member going in for this surgery - or trying to. They *don't* have insurance, and the hospital won't do the surgery until they can pre-pay it. That seems just... so wrong. I can't imagine having to save that kind of money to solve a problem that painful.

[gymnopedie.livejournal.com]

just from looking at this sketch.. I would be wary of that top most curved branch. I suggest perhaps moving it up higher so some of it goes off the page? It makes for an odd negativespace/border up there. or something else that can help balance it, since you have left/right sides floating out. Maybe have it curve like that, but at the peak of the top bend, put a few branches shooting off?

[ellenmillion.livejournal.com]

You are brilliant! Thank you, I have adjusted the sketch significantly.

[(Anonymous)]

From what I've been told by people who work in the medical industry, insurance companies oftentimes only pay a small portion of the cost they're billed for. Whether insurance or private, most hospitals only actually get about 28% of what they've billed. This means that medical service providers jack up their prices, because they know they're never going to get the full amount. This also means that many places will offer a "discount" to people without insurance...since they're more likely to actually get paid that way.

Broken? Totally.

[ellenmillion.livejournal.com]

How does a system end up this weird?