Understanding medical bills and charges

[MJ]

I think having a basic standard of coverage spread over everybody is important. We were all born. Just like we all went to school even though not all of us had children, yet we pay property taxes that support education for everyone’s children. Costs are spread across everyone as a way of lowering the costs for each individual.

Sure, people want to only pay for insuring the things they think they might need, for a lot of folks that means not carrying any insurance at all because they don’t need it right away and they prefer not to buy it until after something bad happens. That is not how insurance works and shouldn’t be allowed.

Offering services across state lines - very complicated as providers are local. I’m not sure health care services can scale that way at all even though it sounds good as a sound bite. Couple that with insurance being regulated per state.

I wholeheartedly agree. As a society, you can't just pick or choose which tax you want to pay just because you don't need specific social services UNLESS you want to leave our society and live along side Ernest T Bass (The Andy Griffith Show)

 

[travelover]

..........In my state there is only one insurance provider in the private marketplace. Blue Cross essentially tells the state regulators how much it will increase prices each year and threatens to pull out of the state if it doesn't get the increase it wants...........

It is somewhat of a chicken and egg situation. Per the ACA, an insurance company has to pay out 80% of premiums, with 20% for overhead and profit. If medical costs do not rise, the insurance company can't raise rates. That said, since they get to raise rates and keep 20% if costs go up, their incentive to hold down rates is mitigated.

 

[Gotadimple]

+1

Look at what HealthSherpa.com did in the early days when the ACA website was struggling. We need a national health care consumer-sponsored website that has the ease of use of HealthSherpa.com with the reach of GasBuddy.com. Shoot I'd even be willing to pay a subscription fee to such a service.

You are describing one of HealthSherpa's competitors: ehealthinsurance.com.

Both are not consumer-sponsored, they are licensed agents. They have licenses in all 50 states and agency contracts with all the health insurance carriers. Any licensed agent can sell an ACA policy, the get paid a commission by the carrier for making the sale.

 

[Just_Steve]

And good luck keeping up with when a doctor (service provider) is "in-network" with lower negotiated rates or "out of network" with full cost.

True story.

We went to a doctor who was listed as "in-network" on our insurance companies web site. When the bill was received at the insurance company, they paid the negotiated rates as a "in-network" provider. The doctor received the payment but said "no", they had dropped out of that insurance providers network a few months earlier. So the insurance company recalculated the payment as "out of network" and paid the higher rates. Of course then the doctor charges us a higher rate too for our co pay. We are disputing the higher rates and particularly the misleading (wrong) information on the insurance companies web site. (Which has now been changed to show that doctor as "out of network")

So if a insurance company says a doctor is in-network (according to their web site) and processes the bill as in-network, but later changes their opinion, who is responsible for the mistake? (hint, it isn't the insurance company or the doctor ). Anyway, we are protesting the billing difference with our insurance company and if that fails, I plan to take this to the state insurance board as an unfair business practice.

Merry Christmas.

Couldn't this whole situation have been avoided by simply asking if they accept your insurance when making the appointment?
I know on my insurance company provider lookup site there is a disclaimer stating that you should confirm participation with provider. I assume just so situations like you have can be avoided.

 

[sengsational]

I think they indicated they took the insurance, then, in a customer hostile move, decided later that they didn't take the insurance. That's the kind of treatment customers get when they are dealing in a market where they are prevented from shopping.

 

[Car-Guy]

Couldn't this whole situation have been avoided by simply asking if they accept your insurance when making the appointment?
I know on my insurance company provider lookup site there is a disclaimer stating that you should confirm participation with provider. I assume just so situations like you have can be avoided.

We had been going to this doctor for a couple of years without a problem and this was just another routine visit. (And yes, I check the insurance web site periodically to be sure our doctors are still in-network) In the past, we have been notified by the insurance company when a service provider we have been using drops out of their network. As I said originally, good luck keeping up.

 

[Just_Steve]

We had been going to this doctor for a couple of years without a problem and this was just another routine visit. (And yes, I check the insurance web site periodically to be sure our doctors are still in-network) In the past, we have been notified by the insurance company when a service provider we have been using drops out of their network. As I said originally, good luck keeping up.

Pretty underhanded by the Dr's office to not tell a long time patient that they don't accept what has alway been accepted after the fact.