Healthcare: Opaque System, Limited Visibility
Healthcare professionals and outside observers alike struggle with a lack of transparency and understanding of how the system operates. Data is incomplete, decisions are driven by external forces (like insurance companies), and those within the system lack a full view of the factors influencing patient care. This creates frustration and a desire for greater clarity.
SOURCES (60)
“I refused statins because of the monitoring requirement. I was working in remote areas with limited facilities for months at a time (merchant Mariner). My numbers are good now.”
Ok thank you! Do you know if its the same for PACS hospitals
“I have a super unique situation that I'm dealing with. My father had a medical emergency in October 2023 which led to cognitive impairment, disability, and life in a nursing home. For that reason, I was scrambling to take care of his taxes. I know I missed tons of deductions that could have reduced his tax liability (because he was a real-estate investor and I know nothing about that world, all I could do was go by the receipts I could locate. Plus, he was having cognition problems before th”
“My grandmother went into a very high end place, like $20k/month. She did that until she was tapped out and then she is allowed to stay until she passes. She's 101 next month so the math is working against the place. The most fatfire way I have seen it done around here is an apartment building in the downtown of our suburban town. They had some issues with the HOA suing the developer for water leaks so values were depressed though it was generally a nice building in a great location. A couple”
“AI prescribing medication? So who takes the fall in the inevitable lawsuit?”
“https://www.reddit.com/r/leanfire/comments/1tufzqr/it_appears_expansion_medicaid_will_remain_a/ After reading that wonderful update by u/Zphr , I'm contemplating the best option for me in 2027. Option 1: Expanded Medicaid - $580/month up to 138% of the federal poverty level Option 2: "Silver 94" ACA - 138% to 150% of the FPL I make an annual Roth conversion, so both are viable options. Does anyone have experience with both to compare and contrast? Are there any considerations I may”
“Same could be said for HSA, esp. if they're not going to fix a damn thing re: our insurance scam”
“EDIT: Why the downvotes? Did I do something wrong? I feel incredibly dumb but I only JUST found out that you could see all the meds a patient has had filled, who prescribed it, and when (it will even grey out the ones that are already in your med list) in RCopia. Are there any other tips/tricks/shortcuts/etc any of you use with it? Our EHR uses it as a backend prescribing system so you don't actually get into Rcopia unless you specifically click into the patient's med profile but now tha”
“Can you get fired for giving your number to a patient? What about if the patient gives you their number in an outpatient setting? submitted by /u/Loose-Cycle-7848 [link] [comments]”
“I would call our healthcare system broken but I don’t think it is. It’s working exactly how a few entitled people want it to work.”
“Layperson here. The recent thread on physicians guarding themselves from the noise of bad reviews made me curious about the other side: genuine misconduct. My PCP ended up referring me to a PE-backed gastro practice whose behavior was bad enough that they openly stopped referring. Online reviews seemed to repeatedly mention the same informed consent issues, which I saw in my own encounter. My question: how does honest signal ever reach a physician like this? Is it naive to think someone could be”
“I recently came across a case that made me think about how we all approach these situations. A patient reviewed their lab results, called the office, and requested that a statin be prescribed immediately. The physician preferred to wait until the scheduled follow up so they could review the patient's cardiovascular risk, discuss benefits and potential adverse effects, and decide together whether starting a statin was appropriate. The patient was unhappy and management became involved. I'”
“Hello everyone! I won't trauma dump the entire story out of respect for everyone's spoons, but I had a really bad experience at the doctor. I did have a witness but my dumbass forgot to record it. Anyway. I have reported to ombudsman and the state medical board in the past (different doctors, no I did not go back)... and nothing comes of it. But I need to do something productive with this or it's going to eat me alive. I need some chance that how this provider showed up will create p”
“Just got laid off in June and my husband's clinic closed. So, of course, he didn't ask the right questions and we're on his insurance. He thought that the healthcare was continuing through July. Turns it, it was canceled at the end of June when the clinic closed. So now he started a new job last week and apparently we aren't eligible for his insurance until... wait for it... OCTOBER 1. I know... I know. I'm furious. I've asked him multiple times for clarity. He had 2 offe”
“Our mom & pop family medicine practice just received our first ever SIU Review letter from one of our payers for 99214 & G2211. We've always billed what is appropriate, and we only recently started using G2211 this year after learning when it should be billed for longitudinal primary care. Has anyone else gone through this? What was the process like? Any advice is appreciated. Thanks! submitted by /u/Flacko305 [link] [comments]”
“How many times do you hear this statement in a day? submitted by /u/peachycpht [link] [comments]”
“Advent health. I can’t find my upcoming appointments. I cannot find where to upload my insurance card. Nothing about it. Seems intuitive at all.”
“Our hospital announced that providers, not MAs have to get consent for the AI scribe due to liability. At this rate, I may as well room the patient and get paid for it submitted by /u/yetstillhere [link] [comments]”
“Hey everyone- I have been out of residency 8 years. I love EM. In my career I am watching things get worse and worse from the financial and logistical side of medicine. We are constantly squeezed. Whether it be private equity, large hospital systems, or the insurance cartel it seems everyone is tryin to profit from our labor and know how. Currently, insurance companies are hiding behind the no surprises act and are straight up not reimbursing us. We see and treat their patients, send the, the bi”
“Everyone already explained to you what an HSA is, but they all kind of missed on why HSAs exist which I think you're asking more about. The easiest way to understand HSAs is by understanding HDHPs (High Deductible Health Plans). HDHPs are health insurance plans with lower premiums in exchange for higher deductibles compared to ordinary health insurance plans. You're essentially betting on your health: If you're healthy as an ox and don't have to "see the doctor" that of”
“I asked AI to translate what these new CMS proposed rules mean and it essentially said payment models would prioritize ACO’s over fee for service, in other words value based care over RVU models. Doesn’t this go against what most people have been told, ie pick the job that pays highest wrvu rate so that if you see more patients then you get higher pay. I don’t have much experience with this, just curious how a value based model works. Sounds like you wouldn’t get your bonuses until maybe 1-2 yea”
“Report is a waste of time. 99% of the time they can’t tell you anything you won’t find in the chart.”
“My hospital is switching from Cerner to Epic and I have no idea what to expect as I've only used Cerner and Meditech. Ive heard some pretty great things about it but I've also heard some not so great things. I personally don't have a problem with cerner right now but I can see why others do. What are the cons I should be aware of? submitted by /u/aIoneinvegas [link] [comments]”
“Hi everyone. I was wondering if anyone uses some template, app or other to help optimize selecting visits. I accept home care cases for mostly CPSE and sometimes Medicare part A. After accepting I try to perform the juggling to make all the visits work and I am in over my head with cases. Just curious as to what others are doing to accept/decline cases based on distance, traffic or time of day. Thanks submitted by /u/Immediate-Cookie-861 [link] [comments]”
no you're actually proving it's the medical system that is the racket.
“I'm thinking more specifically with HIPAA and GDPR compliance issues since that's what I'm working with. If our application leaks patient data we basically die both from fines and loss of trust from clients because obviously no one wants to work with a company whose application leaks patient data.”
“Do you guys still see patients on hospice in office? Our local hospice seems to punt everything back to PCP. Previously they didn’t see us any longer and hospice managed all problems. I have a patient on my schedule as a work in tomorrow, hospice nurse called, “weak, fatigue, decreased appetite.” I’m so confused what I’m supposed to be doing and also what Medicare will cover for this patient submitted by /u/bellieliz [link] [comments]”
“Was it a provider? A lot of ours use dictation software that will make mistakes like that, plus gender swapping patients every other sentence, because it doesn't pick up on some of the letters being pronounced (especially if the provider has an accent. Our Indian docs get hit the worst on the gender swaps.)”
“Just a vent and maybe a way to feel like I’m not the only one. American. SAHM. Second baby on the way. Planned pregnancy. No insurance through work. Chose the absolute best gold level insurance we could get with the lowest out of pocket max available. Out of pocket max is 8k. I’ll be having a c section so we know that’s what we will end up paying since surgery is wayyy more than that. My first kid was born in Europe and it was completely free. Ugh. So crazy that we knowingly and willingly did th”
“Please please advise. I was toying with the idea of getting the genetic carrier screening for my pregnancy, but my insurance wouldn’t cover it and I’ve been paying so much for multiple other things such as NIPT so me and my husband decided that we weren’t going to get the carrier screening. However, before I decided against it, I had called my doctor and asked what they think if I should do it or not and she said it sounds like you want to so I can order it to the lab and then you can go in and”
“I think this post is lowkey prepping for their official Health official release. I have been looking into this and i definitely see the value on AI to use it for triage and for minor questions, stuff you can read into and verify. But closed-source, closed-weights AI? Hard no. You do not want to get into health advice from chatbot that has been RLHF’d to prioritize corporate liability and extracting your health data over your actual welfare. ‘Safety guardrails’ only protect companies from liabili”
“This is my concern. I recently had a surgery that’s considered particularly brutal and I have a lot of health anxiety. My mother died of a methadone overdose after getting hooked on opiates, so I was looking up a lot of information about opiates, interactions with my meds, how long it took to grow dependent. What were some alternatives? I was able to get off the opiates in ten days and onto alternatives that have been doing a great job for the last two and a half weeks. But the history of lookin”
“She’s telling you what kinds of patients and situations she deals with, and you’re sitting there accusing her of making shit up? Do you even hear yourself?”
“For older people I think it's fear of losing independence. Sitting in the hospital now with my FIL for the 15th consecutive day. Didn't mention his problem until he couldn't stand. As long as he could use his walker he was fine.”
“We had a free dental clinic recently. Opened at 6am first come/first serve. They opened the parking lot at midnight. It was full long before the clinic opened.”
“Lack of insurance or high deductible insurance. They simply cannot afford it. Source: Volunteer free clinic work. A man looked me in the eyes and told me the ER doc was highly suspicious of cancer. He has no coverage and cannot get a scan because they won’t schedule a scan without pre-payment or insurance. Can’t get a surgeon to see him without the scan. Can’t get a biopsy without a surgeon. He now has all the symptoms of advanced cancer and still cannot get anything done because he makes too mu”
“I'm increasingly seeing this occurring. A psychiatrist prescribing Ozempic, I suppose because it has been found to help in addictions and other behaviors. It is obviously something new to them because the electronic Rx has missing or inappropriate or inadequate directions. And, then, a regular pediatrician and a regular internist are prescribing ADHD meds. From what I understand this is not out-of-scope. Out-of-scope would be an Optometrist prescribing Sumatriptan, no? submitted by ”
“How do you guys handle the constant requests for GLPs for non Medicare patients? This has been a nightmare I can’t seem to find any way out if in primary care. They call their insurance agent, insurance agent says “yEp Ur c0veR3d “ but fail to mention the approval rate is like less than 17%. I’ve tried explaining the mountains of paperwork for just one prescription makes it highly unlikely it’ll be covered, then they go back to the pharmacy and I get blamed for being a lazy primary…. Tf ??? What”
“I've been an MA for 20+ years. For most of that time referral tracking at every clinic I worked in was either a sticky note system, a shared Excel nobody maintained, or just nothing. Patients would fall through. You'd find out weeks later a referral never got followed up on. I came up with a way that actually works for how I operate- tracks status, follow-up dates, insurance, all of it in one place. Zero visibility so far, which honestly might just be me not knowing what I'm doing he”
“It’s unlikely their provider is going to be able to do anything in the next three days - whether it’s talk to the patient, order equipment, deal with insurance, etc. You either muscle through the next 3 days or you quit now. That’s really your only options.”
“ok, so not currently in a health care system, but have access to Epic to multiple systems. When I last worked in one of these systems, the essence was ROIs are nice but under continuity of care, we can coordinate care and that was part of the intention of HIPAA. Certain records have extra protections. I have generally not had an issue coordinating with providers via in basket over the last few years and then in the last two months, I have had two providers state they needed an ROI despite being”
“Hello, I have a contract to work as a nurse in a hospital with a 40% medical/medicaid payer mix. How do you find the payer mix of a hospital? submitted by /u/Aggravating-Ad-1875 [link] [comments]”
“Does anyone know what standard practice is for residents and fellows regarding malpractice/liability coverage? I just found out that my hospital lists residents and fellows as “self insured”, with a fake “liability certificate” which was issued to me as “proof of insurance”. When the insurance broker was called to verify insurance they stated there was no policy under the policy number, and no policy they had held by the hospital through them as well as no policy just under my name. Looking at t”
“How can an insurance company do this without any legal repercussions? Where is the pushback from the AAFP or the AMA? Where’s the outrage from hospital admin? Doesn’t this also hurt their bottom dollar? Why is it that I have to justify being paid for the work that I do? It’s already so hard to become a physician, to practice, to put up with patient’s unrealistic expectations, and the bullshit admin throws. And now we have to fight to be paid what we’re due? It’s bullshit and I’m sick of it. Pati”
“They announced this policy and it's now gone in effect. We're seeing it. All 99214 billing codes are being automatically downcoded to 99213 and paid as such. It doesn't matter what diagnostic codes you attach, how long you saw the patient, etc. It's happening automatically. They're saying that you can appeal, but it's a long, unclear, arduous process. BCBS IL is the largest private insurance in IL. This is massive. It's around a $40 loss on every patient encounter tha”