I recently had a procedure denied (after the fact) because the price charged was apparently "excessively above the average" price for that procedure, leaving me on the hook for the full amount. It felt like the opposite of being insured.
I also couldn't wrap my head around why they didn't just pay whatever they thought it was worth and let me cover the rest.
> I also couldn't wrap my head around why they didn't just pay whatever they thought it was worth and let me cover the rest.
Because nothing is forcing them to do so. If you don’t like it, what are you going to do about it? Shoot their CEO or something? They have all the leverage.
I resent that the Pentagon decides who the bad guys are and that the population large accepts what it’s told.
Was this a non sequitor? Not entirely sure how it’s related to my comment
Not OP, but I think the logic thread goes something like: Through taxes, we pay the government to exercise various protective functions, such as equipping the law enforcement and the military to identify and respond to existential threats. However, they completely miss or ignore bad behavior on the part of some domestic actors, such as healthcare profiteers.
Sorry. I was commenting from my phone and didn’t check to see if my post appeared properly. Overall correct on the logic.
Insurance is a terrible name for what we have, its not insurance, its blackmail.
You dying and zero being paid out by the insurance company is the best profit margin they can ask for, that's the entire goal of an insurance company at this point.
If there are no payouts, then they have to return all premiums. They only get paid a percentage of covered care.
This presents it's own set of tradeoffs, namely between decreasing premiums to attract subscribers, and what is covered, to keep subscribers happy.
Not American but it seems so crazy to me that you can't even realistically choose your provider, since it's combined with your job. Seems insane.
Usually you can choose your provider. Employers typically offer health plans from only one or two payers, but each payer's health plans have many network providers. Of course some of those providers may be inconveniently located or not accepting new patients so depending on where you live the actual choices may be very limited. The other option is to go to an out-of-network provider but that typically means higher out-of-pocket charges for the patient.
Many employer offer some choices. Mine offers two providers and two plans for each. One is for profit (UHC) and the other is non-profit (Kaiser). The consensus is that Kaiser rations healthcare and makes referrals difficult, but procedures are always covered. UHC let's people direct their own care, but reimbursement is less certain.
of course you can but it ain’t cheap. $20k for a family of 3 is what I pay
That is a lot. Does your job pay you the amount they would have paid for you?
unfortunately - no (as you may have guessed it)
I hadn't guessed. Good for your employers I guess. Or are you somehow double-covered?
no, I pay for my own insurance
Nope. It might even be illegal to offer a cash alternative. There are lots of complex laws around what companies can do, must do, and can't do with respect to healthcare.
you can negotiate your way to anything you want. while companies technically might have laws to comply, it is on the employee to negotiate their way into whatever it is that they desire.
for instance, I may be negotiating my salary and get to mutually-agreeable amount X. I can then say I do not want to be covered by your health insurance but in lieu of that I need my salary to be X+$30,000 to cover the cost of the health insurance I will purchase myself for my family. the company of course can say yay or nay on that but this is the avenue one can explore to get around this company-provided-HI nonsense.
They don’t return anything, what are you talking about?
Subscribers are never happy, it’s very expensive and fails to cover many things. But what choice is there? Don’t get coverage and hope you don’t get sick? Often times you don’t even get a choice… the company decides what plan and such you can get. So no, there’s no incentive to do the right thing other than the potential loss of corporate customers (which don’t have the same incentive as individuals) or potential lawsuits.
Im talking about that ACA 85/15% rule. Health insurers must spend 85% of premiums on payouts or return funds to the insured.
> I also couldn't wrap my head around why they didn't just pay whatever they thought it was worth and let me cover the rest.
Because insurance would then just lowball the cost of everything.
Insurance needs to either do what they say they do, cover x% of procedure cost with a maximum yearly deductible or we need to be talking about why we have insurance in the first place.
We need new regulations around health and insurance. Ideally, public insurance.
> Because insurance would then just lowball the cost of everything.
They do. Many, many billable items are priced to the limit that insurance will pay. Insurance and providers have agreements on the prices they can charge for certain procedures or supplies.
It used to be the norm that insurance would pay their maximum and leave the rest to you. Sometimes the provider would waive the difference, sometimes it was billed to you.
The cost of healthcare is 100% an artefact of insurance price fixing and absolutely nothing else.
Was the provider in or out of your health plan's network? If the procedure was performed by a network provider then it's likely they made a billing error and submitted a claim in excess of the negotiated rate. But it does suck that patients are caught in the middle.
In network! I considered challenging it, but the amount was small enough to not be worth my time.
- [deleted]
Doing that would make sense, and we can't have that now, can we?
Related:
Feds help health insurers hide their dirty secret: denials on the rise
Related:
Doctors Say Dealing with Health Insurers Is Only Getting Worse
Calling IncreasePosts to determine whether or not this is just an Internet bubble.
It's no surprise that the Washington Post is capitalizing on domestic terrorism for issues that it approves of.
The single reason that it is able to do this is that these outlets were not held to legal account for doing the same thing surrounding George Floyd.
At least they aren't allowing their January 6th rhetoric to cloud their journalistic vision.
There is no "anger at US Health insurers" that is new. Or is otherwise beyond the anger at the way the system is forced to balance itself in any other arena in which fees, costs, and profit are always in relative flux and people can't get it all.
The only novelty in this anger is that someone was murdered and now the Washington Post has declared the murderers issue to be sanctified. Which is exactly what you aren't supposed to do, or at least when you aren't supposed to do it, when you don't want to be seen to be supporting domestic terrorism.
The insurance industry sucks, but it sucks by its nature. Its not "broken" nor widely exploited except in the notion that its existence is a corrupt economic act.
But its current detractors wouldn't dare be rid of it. Oh no, it isn't that bad. And yet, we are in another period of being harangued with direct and indirect sympathies for murder.