domain:nfinf.substack.com
Throwaway05
12hr ago
Oh yeah I see - yes we are in an area where you run into two problems "this should have a billing code and doesn't" (classic example again - insurance fuckery) and as in this case "even if this had a billing code it would be unwise to use."
If you use "low priority - don't need to see patient" billing code on someone and they have an adverse outcome you are going to get eviscerated on the stand "you could have saved her life if you just went to see her!" and going to straight to bankruptcy.
I don't know what the right solution is to this but I am pro-tort reform.
It's true that I under emphasize coinsurance and deductibles in these conversations but the deductible is going to end up used fully if anything significant happens in most insurance plans and should be considered a sunk cost when evaluating plan choices.
Ultimately using hospital pricing information if it was available would be difficult since the hospital prices interact with your insurance in unpredictable way and a lower sticker price could end up being an order of magnitude higher when comparing after insurance costs.
You are right that I need to be more active at remembering that in some of the individual situations though, even if it doesn't impact the more structural issues.
MaiqTheTrue
Renrijra Krin
12hr ago
The difference is that China still believes it’s good and that it is capable and has a right to do things and claim the benefits of having done them. The West probably at least since the 1950s has been browbeaten into being a henpecked househusband hoping that by acting weak it can appease everyone else. Until the West believes in itself like China does, expect no large scale projects.
Plaintiffs are unlikely to succeed on the merits. Connecticut’s restrictions on AR-15s, .300 Blackout-chambered “other” firearms (in Plaintiffs’ intended configuration), and large capacity magazines are one more chapter in the historical tradition of limiting the ability to “keep and carry” dangerous and unusual weapons. The challenged statutes are “relevantly similar,” to historical antecedents that imposed targeted restrictions on unusually dangerous weapons of an offensive character—dirk and Bowie knives, as well as machine guns and submachine guns—after they were used by a single perpetrator to kill multiple people at one time or to inflict terror in communities.
Unanimously, the 2nd Circuit has now redefined "dangerous and unusual" to mean "unusually dangerous". I don't see many ways to resolve this which don't leave the Second Amendment a dead letter, or at best allow a gun in a circumstance. The logic? To repeat myself: (because fuck you, that's why)
Association of N. J. Rifle & Pistol Clubs, Inc. v. Platkin updates
In theory, recent changes to the 3rd Circuit's makeup could result in this case having a pro-gun and perhaps even fast decision. The case had no chance at the appeals level (two judges, Schwartz and Freeman, have already signed onto pretty bad anti-gun rulings), so this could even simplify matters.
In practice, I'm not that optimistic. The whole circuit has only a slight R-D lean, and it has enough squishy Rs on a complex enough topic that it'd be a hard situation to run on, and unlike Range has no easy way to limit to the borders of this case or the limits of the popular.
On the other hand, I guess it could be worse. It could be Koons. Except then there's a question why the en banc Koons, too.
greyenlightenment
investments: META/FBL, TSLA, TQQQ, TECL, MSFT ...
12hr ago
I always assumed that life-saving care must be rendered unconditionally, but that the insurance company can still refuse to cover certain elective procedures, in which the hospital is under no obligation to perform them.
greyenlightenment
investments: META/FBL, TSLA, TQQQ, TECL, MSFT ...
12hr ago
Summary:
There is an extreme amount of intraindividual variability, yet advice tends to be one-size-fits-all. This is especially relevant for fitness and dieting advice.
Advice does not work as well in adversarial situations, in which both parties are applying the same advice.
Too many people applying the same advice dilutes it effectiveness. This is seen in college admissions, where everyone follows the same essay-writing advice.
Survivorship bias may make some advice appear better than it actually is. Those who are successful at applying advice will tell others. The majority, who fail, will just go away.
Other advice is time sensitive or topical, and what worked in the past will not work now or in the future. 'Value investing' worked great for much of the 20th century, but became less effective in the 21st century.
Azeltir
12hr ago
Your comment suggested to me that the provider shouldn't be concerned about what you're calling "patient comfort" here - that "bad feelings happen" and who cares if it's before your surgery. The author of the NYT piece is communicating that the provider SHOULD be (and probably is) concerned about that emotional state, and that having scary financial concerns get dropped on you the day before a surgery is something that ought to be avoided.
And not to get too linguistic-descriptivist, but I'm afraid it's too late to be too prescriptive about the expansion of the meaning of "mental health" for the wider world.
I don't know what your heuristics are. If it's a game you would like at all, there's enough of it that it's easily worth $30. It's the pinnacle of most of the genres it's attached to, a masterpiece in almost the traditional sense (one very competent guy polished it for 8 years, it's a completely realized coherent vision), and very fun.
Probably 15-20 hours to beat the part of the game that most people will stop at (having greatly enjoyed their time with it), and 100+ hours to optionally go beyond that if you still don't want to put it down.
dev
13hr ago
I'm not objecting to base charge for a level 2 emergency room visit ($700) which should have covered the facilities and the nurse time (which was very little). I'm objecting that they upcoded that to a $2400 charge while then itemizing and also charging for the things that supposedly triggered the upcoding (the doctor's time and the ultrasound).
dev
13hr ago
Just looked over my bills. We got itemized $600 for the radiologist, $800 for the emergency room doc. Then on top of that was the $3,300 for the ultrasound itself. Then on top of that was the up-coding of the ER visit from level 2 (which would have been $700) to level 4 which was $2,400. And then there was also another $900 for catheter insertion and $940 for labs. Everything feels over charged ($900 for a two minute catheter insertion..?) but it particularly galls me that they up-coded me from 2 to 4 because of the ultrasound and decision making and then charged us separately for those things.
RoyGBivensAction
Zensunni Scientologist
13hr ago
How many run-ins with HR must a man have
before he recognizes the pattern?
The answer my friend
Is blowing in the wind
Starship isn't really made for the moon either.
The last couple years have had several notable tipped landers (more the norm than the exception, almost). That SpaceX plans on landing something that enormous and tall on the moon directly seems to be asking for trouble. It lacks robust mechanisms for lots of things (the LEM had a separate ascent engine partially because of concerns about the descent engine getting damaged on landing --- and a ladder), and honestly the Starship HLS and Artemis mission plans look like something a kindergarten class drew up: single sourcing not one, but two novel heavy lift launch vehicles (see Akin's Law 39, twice over). Build a permanent space station because you'll need to resupply (Gateway), then dock a single-sourced comically large lander that doesn't really need resupply anyway.
RoyGBivensAction
Zensunni Scientologist
13hr ago
If fart-sniffing prestige magazines did not spend an inordinate amount of time lavishing praise on people who very conspicuously do not need it, how would we know who’s better than we are?
I do greatly enjoy FdB's outrageous seething.
If someone asks me, “Why do you write?” I can reply by pointing out that it is a very dumb question. Nevertheless, there is an answer. I write because I hate. A lot. Hard. And if someone asks me the inevitable next dumb question, “Why do you write the way you do?” I must answer that I wish to make my hatred acceptable because my hatred is much of me, if not the best part.
Oh no! LDS theology has something in common with Hinduism? That's terrible! Anyways.
If your idea of God is one that can change, then it is one that can be acted on.
Acted on by himself, sure. It's a stretch to say someone capable of changing themselves is not self-existent, and has more to do with the rest of the bundle of Christian theology than with the word "self-existence." It's not that such a being is not self-existent, it's that Christian theology holds that a self-existent being is (for other reasons) incapable of change.
Your idea of God doesn't really explain anything about the world and we are still left with the question of why is there something instead of nothing.
It's more that for both of us, our idea of things that are self-existent explains nothing about why there is something (self-existent being(s)) rather than nothing. This question predates self-existent beings in both cases.
The ontological argument attempts to address this, but I and most others find it unsatisfying, to say the least. Basically just word salad. If existence is a necessary quality of the greatest possible being, is it not also a quality of the most evil possible being? Why is existence only a quality of the greatest possible being?
My point is that LDS teaches something like "God is just like us, just more self-actualized and powerful. Theosis is us leveling up according to the nature we already have that is equal to God's."
Classical Christian thought is more like, "We have a different nature from God's, but He promises Theosis anyways through the marriage of Heaven and Earth in the Person of Jesus Christ. Human nature has now been grafted onto a Divine Person and we are able to participate in the internal life of God through conformity to the perfected human nature of Jesus."
The latter is also how I'd describe LDS theology. We put off the natural man, and put on the divine nature. We don't really believe in "natures" in the classical Christian way, but inasmuch as you can use the word nature we certainly don't share God's nature yet.
God is definitely like us, but more self-actualized and powerful. I don't think any LDS person would say that he's "just" more self-actualized and powerful though. There's a fundamental difference of type, it's just not as fundamental as in classical Christian theology.
I have my complaints with classical Christian theology too, and don't particularly care to litigate them right now. I just think it's pretty silly to say that LDS people see God as like a superhero. It's just not true. It's your way of fitting LDS theology into classical Christian theology, retaining just enough of LDS theology to make it look silly. Frameworks can't fit inside each other, though; you need to address them on their own terms rather than saying "within my framework your framework is wrong." Yes obviously it's wrong by definition if the argument assumes your framework to be true. That's not a productive conversation to have.
I didn't see anything the insurance denied. Altogether, our insurance and ourselves paid $8,500 $9k for an ER visit that involved a six hour wait in a crowded waiting room, then a brief consultation with the doctor, a catheter insertion and lab tests, and an ultrasound. The bill seems totally unreasonable to me, there is no way I can get that amount by calculating their costs from first principles. They had to be overcharging me above costs in order to pad their overall revenue.
MotteInTheEye
13hr ago
Nice job getting people to commit to specific predictions. Even though it's super awkward, this is my favorite norm of the rationalist community, because you don't realize how reluctant people are to make specific, testable predictions until working out the terms of the bet forces them to.
It will be interesting to see whether you win all of them or not, and personally I have updated a bit towards your view of Musk and his companies being more grounded than I thought.
I don't know if I'm being clear but my specific and very minor gripe is that ICD has codes for everything under the sun but not a code for a physician phone consult (which would cover the time and hassle?) Or is there one and it wasn't used here?
Edit for clarity: This wasn't Out of Pocket, I had insurance. Not every insurance has a Co Pay system, even when you do have a "Co Pay" on the card you still get billed for more than the co pay later on, I've noticed this on your comments a few times over the years but you seem to have always had really good insurance and don't know what the average experience is like.
ArjinFerman
Tinfoil Gigachad
13hr ago
I don't think this is accurate. Insurance knows how much it costs to insure someone in aggregate and where to set their premiums.
Do you think when you're buying a hot dog at a stand, they're charging you the price of that particular hot dog, or the aggregated price within a particular time-window that the stand owner is operating in?
I'm still hopeful for SpaceX to at least make operations on the moon more feasible, though I'm skeptical of making a real go at Mars colonization, especially as Elon's star has fallen so far recently.
Starship isn't really made for the moon either. Their best bet is high-throughput LEO transport, but I don't think they'll get it to work for that either.
It's a bit off topic, but I doubt there'll be a better place to post it any time soon. I had a bet about Starship going to orbit with two other posters. It was driving me crazy because I couldn't find it for the life of me, and I was starting to think I got pulled into the Berenstien universe, but I finally managed to find the relevant comments, so I thought I'll post them as a reminder, and to make future reference easier:
- It turns out that I just won my bet with @slothlikesamwise.
- I have 1.5 years to go for my bet with @TheDag
- I thought I had one with @self_made_human, but it turns out I just coaxed some predictions out of him. We've breezed through his 50% confidence interval one, just passed his 70% interval, and have one year left to resolve his 90% interval prediction.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
13hr ago
Definitely, but they're less common than is the case for Skyrim. Most Rimworld mods tend to play well together, but I have a taste for massive overhauls.
I don't personally use mod packs, at most, I check compatibility for some of the more comprehensive mods like Combat Extended. However, the best that comes to mind are usually the themed collections made by Mr. Samuel Streamer, he's got dozens of playthroughs up, and each one has a link and setup guide. Do you want Starwars flavored Rimworld? Medieval? Post-apocalyptic? There's a series for you.
You will (and definitely should acquire anyway) the RimPy mod manager. It can import mod lists, handle load orders, note many incompatible mod combinations and will make life a lot easier. The vanilla mod manager, while not useless, is lacking in comparison.
Throwaway05
13hr ago
Modern U.S. healthcare is probably more adversarial than you think because of the role of insurance companies that will try and refuse expensive things.
This doesn't work well for a million reasons (including Pharma basically paying the insurance company to only accept certain med requests). But supposedly we have these systems in place including with Medicare/Medicaid (sort of).
The problem is that nobody agrees what is an appropriate use of these things and in America that's going to be impossible.
Even if you can get agreement on what kinds of things are worth it........every last person is going to disagree when it's their turn to be told no, especially when it's no....you'll die now.
With respect to fraud it does happen but it's rarer than you think, calling out Medicare fraud is actually incredibly profitable for the whistleblower. Which is neat and stops a lot of bad stuff.
The government has also come under fire in the last few years for faking fraud because they had a quota system.
The supposed "RNG problem" is a skill issue tbqh. I found that keeping a list of tasks and theories loosely sorted by likelihood, and playing each run flexibly with "I'll start out aiming for X but will pursue something else if that's where the rolls go", I was never bottlenecked to grinding on a single theory until very late in the game (much later than you would have gotten by your description), and almost every run moved at least something forward.
And by that point
But then again I just loved the basic drafting game and would take any excuse for another run. This would probably still be GOTY for me just for the main gameplay loop without most of the stuff beyond the first credits-roll.
Throwaway05
13hr ago
For context I have Idiopathic Thrombocytopenia and I think my OB wanted to ask how to titrate Prednisone.
Yeah my suspicion is this is one of those weird situations where the OB legitimately needed help and wanted to make sure the hematologist got paid for their expertise. They may even have done you a solid by not making you go to a random doctor's office unnecessarily since this was OP.
What was supposed to happen was that the doctor was supposed to review your chart (probably did), see you (clearly no), and write a note (maybe?).
Not seeing you and saying they did is fraud but it's also okay sometimes. Does the delirious or sedated patient really need to see the psychiatrist to give an agitation rec? No.
Unfortunately physicians do a lot of unreimbursed work (like providing education to colleagues) and attempts to get some credit for this can be sketchy or fraudulent without actually being bad behavior.
Obviously in your case you may have appreciated the chance to ask the doc questions but most people would be excited if offered "hey let me just call this guy instead of scheduling you an extra appointment somewhere else" but it's technically not allowed.
Sometimes what we can vs cant bill for is stupid as hell (for instance: dealing with insurance!).
Since the hematologist would have accepted legal liability they def wanted to make sure they got paid and because most people's bill turn into a 20 dollar copay it doesn't get looked at closely.
Personally I think this is sketchy but fair, for those who think otherwise consider the side effects of formalizing things and reducing flexibility.
VoxelVexillologist
Multidimensional Radical Centrist
14hr ago
Or Desert Bus.
It doesn’t seem obviously retarded to me to have both a per-patient complexity-weighted administrative charge, and also a per procedure/per doctor-hour charge. Invoices for complex professional services are incredibly dense like this in many industries.
More options
Context Copy link