Insurance/Medical Madness

[The Nature Boy 4,224]

I apologize in advance for the non-GZ post

Not sure to blame the libtards, conservtards, govt or insurance for this one.

This is just bass akwards

I got a bill today for 1800 dollars for my wife's lab works for some procedures she had done. So make the OMG call. They did not have my insurance on file. So now that I have insurance they write it down to around 450.00 dollars of which the insurance pays 90%.

Now in a non bizarre world that was not backwards you would think-- They are paying cash. we will give a discount becuse we don't have to pay the coder, the retro review nurse , the person on the other end will not have to process.. Well you get the picture. A lot of admin work in filing insurance. yet the insurance price is about 25% of the private payer price.

So what the heck folks. Is the world crazy. If I thought Obama care would help this I would be all for it, but it is so complicated they don't know what end is up.

In what backwards universe is credit cheaper than cash ?

[I AM NOT THAT GUY 5,715]

It's Obamacare. It is one of those things that was supposed to save people money but doesn't. I posted an article about it last month. Most insurance companies only pay the contract rate. Anybody that doesn't even have a basic dental policy, is also paying more for dental services. Somebody has to be stuck paying for all the uninsured folks, and it sure isn't the insurance companies.

[belinda63 3,047]

Yep, insurance companies "negotiate" prices. If you don't agree to the reduced rates they will not list you as a preferred provider. Imagine the lack of clients if you weren't listed on Blue Cross, Anthem, or Humana as a preferred provider. This is how it works, the medical provider (doctor, lab, hospital, whatever) charges as much as they think they can get away with and even more. They know if the consumer has insurance the charges will be reduced. If the consumer has medicaid or medicare the prices will be reduced a lot. They make up for the lack of profit by over charging the non-insured.

Look up "usual and customary charge" in regards to Medicare. They poll medical providers in an area and determine what the average rate is for a specific procedure. Then, usually they knock a bit off this. That is how Medicare determines what the provider will be paid. They usually bundle the procedure in what they pay, say a colonoscopy they may pay $200 for the procedure...period...end of it. When us poor private insured suckers, or non-insured as it may be, get the bill we are charged for everything. Oh, the doctor had to bend over to pick up the paper, the doctor had to use a kleenex to sneeze, we had to use betadine to clean the IV insertion point ($5), you get the idea.

Working in a medical office for a short period of time, I was trained to find every ICD-9 code I could that might apply to a patient so we could maximize what we charged.

[The Nature Boy 4,224]

Yep, insurance companies "negotiate" prices. If you don't agree to the reduced rates they will not list you as a preferred provider. Imagine the lack of clients if you weren't listed on Blue Cross, Anthem, or Humana as a preferred provider. This is how it works, the medical provider (doctor, lab, hospital, whatever) charges as much as they think they can get away with and even more. They know if the consumer has insurance the charges will be reduced. If the consumer has medicaid or medicare the prices will be reduced a lot. They make up for the lack of profit by over charging the non-insured.

Look up "usual and customary charge" in regards to Medicare. They poll medical providers in an area and determine what the average rate is for a specific procedure. Then, usually they knock a bit off this. That is how Medicare determines what the provider will be paid. They usually bundle the procedure in what they pay, say a colonoscopy they may pay $200 for the procedure...period...end of it. When us poor private insured suckers, or non-insured as it may be, get the bill we are charged for everything. Oh, the doctor had to bend over to pick up the paper, the doctor had to use a kleenex to sneeze, we had to use betadine to clean the IV insertion point ($5), you get the idea.

Working in a medical office for a short period of time, I was trained to find every ICD-9 code I could that might apply to a patient so we could maximize what we charged.

But the other end of the coin. No way the top notch facility I was in today could afford to do my procedure for 200.00 bucks.

I would be all into a law, that everyone gets the same price period. Prices are published. If your facility charges more than UCR you eat the difference.

Edited July 17, 2013 by The Nature Boy

[DaveE 178]

Agree - I didn't reallize the difference between the bill presented, and the negotiated rates. Being military most of my life I was insulated from the cost factor. Retired military get a hulluva deal. I paid $460 per year for my entire family. Dr visit copay was $12, prescription copay was $3, labwork and tests MRI, CAT scan etc have no copay.

Two years ago I was working in the mountains of New Mexico (White Sands Missile Range), doing some testing for the government. I contracted pneumonia and toughed it out for three weeks and refused to see a doc, ( mission mindset and all that stuff).

After the test I want back to Georgia and just got worse. Finally I went to my Dr, who called me a dumb a$$ and admitted me immediately.

Discovered that I had damaged my heart and it was down to 25% function. Had to spend 10 days in the hospital recovering, and wear a portable defibralator for two months.

Bottom line - hospital bill was over $183,000.00. TRICARE negotiated price was $16,000.00. My portion was $11.00 per day. Under TRICARE it is cheaper to be admitted that see your family Dr. $11 vs $12

Edited July 17, 2013 by DaveE