Misplaced Hatred

AQUANOVA · #1 09-02-2011, 06:52 PM

I just found out that I've had misplaced hatred for Health Insurance companies for years.

To all you Health Insurance companies, I apologize.

I had to get an MRI scan of my liver and had to pay out of pocket because I didn't have coverage.

I called to find out how much it would cost and was told $1900.

I asked if it they would negotiate a lower price for me like they did with insurance companies and was told,
"we're already giving you a discount because you're paying out of pocket. We would bill insurance more than $6000 for the same test".

Oh?

I guess I'll direct my hatred towards medical billing now.

My liver is fine btw.

jonathan_matos5 · #2 09-02-2011, 06:55 PM

its all numbers. i seriously doubt that much money is dealt to either party.

sandmangeck · #3 09-02-2011, 07:02 PM

Do you know how much those machines cost? The doc to read it? The tech to run it? The rent? lights, utilities, insurance? 1900 isn't bad for an MRI.

iamlowsound · #4 09-02-2011, 07:02 PM

And the US wonders why their health care system is crappy.

lowsound

i_got_a_mohawk · #5 09-02-2011, 07:17 PM

Quote:

Originally Posted by sandmangeck

Do you know how much those machines cost? The doc to read it? The tech to run it? The rent? lights, utilities, insurance? 1900 isn't bad for an MRI.

Not to mention the liquid helium to keep them cooled!

Granted, I think you can get a lot now that use LN2 cooling, which is significantly cheaper, but helium costs a mint!

waleross · #6 09-02-2011, 07:35 PM

Hang in there, I didn't have Health Ins. for over 5 years and while my doctors did discount some of my fees, blood tests and other tests weren't covered. I had treatment for my liver and at the time I had Cobra Ins. before it ran out. Now I do have basic coverage (GoBlue) and with a pre-existing condition its better than nothing. This doesn't cover hospitals , which is more money. I made deals in the past with the collections dept. after I received the bill. It seems that now major ins. companies are taking on people that were previously uninsured. Maybe Obama-Care is trickling down ....who knows ....Take care........

**Staccato** · #7 09-02-2011, 07:37 PM

That's a common attitude about 'those cos. Kind of a love/hate relationship for their subscribers. Love it when they pay those bills, and hate the way they seem (or do) operate.

AfroCubanFunkMa · #8 09-02-2011, 07:56 PM

As Chris Rock said.. What if nothing happens this year, can I get my money back..?

Luckily there's been more of those years than not... Knock on wood!!!

**colcifer** · #9 09-02-2011, 08:52 PM

Quote:

Originally Posted by iamlowsound

And the US wonders why their health care system is crappy.

lowsound

No, we know exactly what's wrong with it.

BurningSkies · #10 09-02-2011, 08:58 PM

The big secret us that they may charge 6k, but the insurance company responds with "we'll give you 1.5k for that"...and they do.

sandmangeck · #11 09-03-2011, 12:09 AM

Quote:

Originally Posted by iamlowsound

And the US wonders why their health care system is crappy.

lowsound

Is that why a decent amount of canadians hop boarders to get procedures done, that would take months if not years at home?

Every Canadian patient I've encountered has complimented us on how much more efficient our system is over theirs.

Munjibunga · #12 09-03-2011, 12:14 AM

I can guarantee you that health insurance companies have not made a dime off me. I can say I've never complained about any of the treatment I've gotten under my insurance. Well, except once, but they fixed it, more or less. Car insurance and home insurance? That's a completely different story.

PazzoBasso · #13 09-03-2011, 12:23 AM

Quote:

Originally Posted by sandmangeck

Is that why a decent amount of canadians hop boarders to get procedures done, that would take months if not years at home?

Every Canadian patient I've encountered has complimented us on how much more efficient our system is over theirs.

Yup, Canucks get the choice of free medical @ home or pay-per-visit abroad. Pretty awesome I'd say...

AQUANOVA · #14 09-03-2011, 12:14 PM

Quote:

Originally Posted by BurningSkies

The big secret us that they may charge 6k, but the insurance company responds with "we'll give you 1.5k for that"...and they do.

I'm sure that's how it works.
But why is there this shell game on pricing?
There should be one flat fee to cover their costs and pay their people.

joshmat · #15 09-03-2011, 01:01 PM

jonathan hit it on the head, it's a numbers game.

If it's a group health plan, the docs and the insurers in the group somewhat decide on the pricing for that group and for a particular area or zip code. Health care/benefits administration is a very tricky business in the US and the insurance companies are taking on a liability but we all know that they profit.

Think about all the money residing in a coffer so-to-speak and then being invested by pro's and being used to pay actual claims. The insurance companies wouldn't make any money if they couldn't cover the claims and they work hard to ensure they don't lose money.

Some companies fund their own plans as well and take that liability on themselves, but decisions like that are typically based on the company's claim "experience" and the company's demographics as there are various liabilities associated with different demographic groups. That "experience" also drives the price of insurance for a company.

I personally like the concept of an individual participating in a Health Savings type of plan from an individual's first day of employment and letting that balance add up over the years, as you switch jobs or whatever. Hopefully, taking the liability away from the insurance company and driving down some of the cost. There will always be instances where you can't afford the claim, but similarly instances where you haven't personally made a claim for an entire plan year.

The story of employee benefits is that the company sponsoring a plan/program receives wonderful tax breaks for offering and maintaining that plan. The employee receives a tax break for the monies they put towards it (IRC, section 125c). Typical employer and employee splits on the premium cost from the health insurance company are around 80/20. However, the folks that do the design and valuations and such on the plans are highly intelligent and very well compensated (actuaries) and the administration of the plan is very low profit (plan administration). Which if you work for a big organization in the US is most likely being done halfway here and halfway over seas with the aid of some customized software with one of the large HR outsourcing firms. These types also have huge budgets for errors and omissions (read administration mistakes).

It get's even more shocking when you see how this works for retirement plans (401k's and traditional pension plans). The basic premise for pensions initially was tax deferment for owners as they would save more by spending money to provide an annuity to what they refer to as the "rank and file" workers than they would paying the taxes on high compensation year after year. Companies collectively began offering various plans (health and retirement) to employees to stay competitive for talent back when people used to work for companies from high school through retirement. Things have changed dramatically amongst the work force (job hopping, etc) since then and benefits design tries to keep up with that by offering immediate vesting in contributory plans (401k, 403b) and cash balance designed defined benefit pension plans.

None of this discounts that an MRI is an expensive procedure on account of the equipment, etc. Just trying to shed some light on the back workings of employee benefits plans and how that plays into what an individual pays for care.

hdracer · #16 09-03-2011, 01:10 PM

Quote:

Originally Posted by sandmangeck

Is that why a decent amount of canadians hop boarders to get procedures done, that would take months if not years at home?

Every Canadian patient I've encountered has complimented us on how much more efficient our system is over theirs.

+1 Just drive through any hospital or clinic parking lot in a border city (I have seen it myself in Duluth) and Canadian license plates out number US ones 10 to 1

::::BASSIST:::: · #17 09-03-2011, 01:22 PM

Quote:

Originally Posted by i_got_a_mohawk

Not to mention the liquid helium to keep them cooled!

Granted, I think you can get a lot now that use LN2 cooling, which is significantly cheaper, but helium costs a mint!

Helium eh? Guess I better stock up on the birthday party ballons.

i_got_a_mohawk · #18 09-03-2011, 03:26 PM

In liquid form

Very cold, Helium boils at not a lot over absolute zero! (4.2K/-269C/-452F)

Hard to keep things that cold too, so a lot of it boils off, even during transport!

knumbskull · #19 09-03-2011, 05:29 PM

must. not. get involved. rage rising....

best of luck, OP

runmikeyrun · #20 09-03-2011, 05:54 PM

I had to quit my job because two of my medications, which are not available in generic, were not covered by my prescription plan. I had to pay the full amount for them, $1700/month for the two. I wrote and appealed for coverage, they denied me. I quit my job and now qualify for free medications through the drug manufacturers. There are more reasons why I quit my job other than that just that i needed medication, but it was a major deciding factor in my decision. I have been a medic for 16 years and worked in the ER and on a squad. Things are just getting worse and worse. Something needs to give. The system is so broken that almost anything else would be better than what we have now. The last two employers I have worked for said that the way insurance costs are going they won't be able to afford to insure us at all in less than 5 years. Obamacare might not be the best solution, but it's a start. For one, I will finally be able to get private coverage that I currently cannot buy, due to a "pre-existing" condition.