Wife said what?!?!

[k0ua]

What I hate is the fact that I have to decide when I retire where my retirement salary goes. I can give it in various combinations to myself, to my wife, or both. And these decisions are based on your best guess about how long you’re going to live. LOL - what is behind door number one?

What I hear was if we knew how long we were going to live and how hour health would be along the way, we wouldn't have any problems making these insurance and LTC decisions. Either that or we invest in a good crystal ball.

 

[Snobdds]

I worked in the billing dept and managed the insurance contracts at a cardiology office years ago. The "list" price is determined this way if Medicare pays X multiple by 3 (some places will go upto 5x). This happens because the insurance will only pay up to the amount the provider asks for so we have to over shoot it (when they should just pay the contract amount).

So for a procedure we charge $500.
Medicare allows payment of $100
Insurance A pays $80
Insurance B pays $200

If we only asked for $100 we would be paid
Medicare allows payment of $100
Insurance A pays $80
Insurance B pays $100


I'm glad I got out of billing.

I'm an actuary for BCBS and do oversee the provider reimbursement methodologies for providers. It's a lot more involved than this, and there is a huge difference in reimbursement methodologies between hospitals (institutional) and doctors offices (professionals).

We work off of charge masters that hospitals and doctors offices send for their pricing. We actually have pricing factors and matrices for each billable diagnosis code. We even have it broken out by area factors. For example, you could see the same doctor for the same procedure in an urban area and a rural areas and the insurance will pay different prices depending on where you are. Doctors and hospitals in large urban areas get reimbursed less than doctors and hospitals in rural areas or less densely populated areas. It's all a numbers game.

 

[MoKelly]

I'm an actuary for BCBS and do oversee the provider reimbursement methodologies for providers. It's a lot more involved than this, and there is a huge difference in reimbursement methodologies between hospitals (institutional) and doctors offices (professionals).

We work off of charge masters that hospitals and doctors offices send for their pricing. We actually have pricing factors and matrices for each billable diagnosis code. We even have it broken out by area factors. For example, you could see the same doctor for the same procedure in an urban area and a rural areas and the insurance will pay different prices depending on where you are. Doctors and hospitals in large urban areas get reimbursed less than doctors and hospitals in rural areas or less densely populated areas. It's all a numbers game.

I cannot tell you how many times I’ve heard hospital executives say they “Lose money” on Medicare patients.

I guess it’s the definition of “Lose money “.

Since I know of no hospital refuting to accept Medicare patients, I find it hard to believe.

MoKelly

 

[Industrial Toys]

Back on TOPIC.

Can anything be worse for a guy, when his Wife suggests they get rid of his pickup in favour of a minivan?

 

[k0ua]

Back on TOPIC.

Can anything be worse for a guy, when his Wife suggests they get rid of his pickup in favour of a minivan?

I have a pickup and a minivan.. problem solved.

 

[airbiscuit]

Here is some good training.

 

[tradosaurus]

 

[Industrial Toys]

Actually, the BEST way is for a guy just to disappear. If you were really wrong, admit it "ONCE" and apologize. That should be the end of it. If not, maybe disappear for good.

ALWAYS let a woman believe that she loves you more than you do her. You will have a much more enjoyable relationship.

 

[fried1765]

Would that be a single axle or tandem axle trailer?

That would depend on the weight to be carried

 

[MoKelly]

ALWAYS let a woman believe that she loves you more than you do her. You will have a much more enjoyable relationship.

Hummmm.

I think, unfortunately, if you get your marital bliss advice from our tractor forum you are —- well, in trouble!

MoKelly