Med insurance question
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Thread: Med insurance question

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    Senior Member NGF Addict! square target2's Avatar
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    Default Med insurance question

    I spent 5 days in the hospital a few months ago with a blood clot in my lung. Afterwards i receive a summary from my insurance company which usually comes a week or two before i get any bills. It showed that there was roughly 24k in bills and none of it was covered so i call the insurance company. They told me i needed pre authorization and i told her it was a life threatening emergency and i almost died so she put me on hold and called the hospital. She came back a few minutes later saying yeah you're right, they just did the billing under the wrong code. She said it would 30-45 days before they redo it and i get any bills which was fine as i was in no hurry to get more medical bills. Yesterday i got the summary in the mail and now it's billed at 48k, the insurance paid just under 4k and i owe nothing. Not complaining that i owe nothing but I'm curious why i was billed 24k and then when the insurance company was billed it was pretty much doubled for the same treatment.
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    Grand Imperial Poobah NGF Addict! Mad Scientist's Avatar
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    It's the "contract" insurance companies have with medical providers. They require the providers to jack up the price for medical procedures, then heavily discount the charges when the insurance company pays. That way the general public feels that they "need" insurance (which they pay for) to offset the sky-high medical charges. It's the biggest con, against the public, that insurance companies play.
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    Government medical 'insurance' (O-Hole care, Meidcare, etc.) has forced medical providers to engage in 'creative billing' to reach their break even point.
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    Wag
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    Quote Originally Posted by Mad Scientist View Post
    It's the "contract" insurance companies have with medical providers. They require the providers to jack up the price for medical procedures, then heavily discount the charges when the insurance company pays. That way the general public feels that they "need" insurance (which they pay for) to offset the sky-high medical charges. It's the biggest con, against the public, that insurance companies play.
    Quote Originally Posted by Popeye View Post
    Government medical 'insurance' (O-Hole care, Meidcare, etc.) has forced medical providers to engage in 'creative billing' to reach their break even point.
    Both correct. The cash billing rate is always lower and you'll pay less. Sometimes, even less than your deductible or out of pocket maximum. If you can get on their sliding scale, you'll pay even less and the providers write off the difference.

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    There are times when I'm glad I have the VA Medical Center access.
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    Medical billing is a nightmare. Contracts, private pay, medicare, medicaid, negotiated fees, discounts and more are all part of the equation. For example, Medicare determines the pricing structure and off of that they pay the allowable.People are often upset when they see a billed amount versus allowable; not understanding Medicare sets the billed amount, rarely the provider. The same holds true for Medicaid and other payers. Let's add to the confusion, it is different for different regions of the country.

    People need to know that it is not always the provider that sets the prices.
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    It is all a BS numbers game. If I am a doctor who needs to get $200/hour to make costs and profits and insurance will only pay a certain percentage of my billing, I inflate the billing to make sure I get my $200/hour. I have a friend who stopped taking any insurance; you pay him cash (you also get a full half hour to hour of his time) and you bill your insurance. Once folks started seeing how little he was getting back, he lost some patients; but he was also able to eliminate 5 staff positions who did nothing but billing and replace them with an extra PA. He says he likes only seeing 8-12 patients per day instead of 80-90 just to make things work. Better health care, better service.
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    I think i read somewhere that Trump is making all the medical providers supply us with the information on the discounts and actual charges the give to the insurance companies.
    It is all a scam and that is why drugs and hospital stays are unreal.

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