Interesting angle on the pressure between the insurance companies, pricing, and large health care institutions that causes small practices to merge. If there is intent, is that called collusion??
I hear Medicare actually does a much better job negotiating rates.
Dan, yes, 1) healthcare cost is on the rise like any other items; 2) Health Insurance and Medicare Shopping are confusing with many choices 3) hospital price transparency legislation is going to become effective on 01/01/2022 w resistance from AHA
FAQ
1) Do we have the rights to shop around? Yes
2) Can we choose providers? Yes
3) Do we have the rights to ask for a pre-estimate before agreeing to the procedure? Yes
Plus there are brokers who are diligently helping consumers with non-bias professional advice based on his or her healthcare need as your guide.
I had a stress fracture in my hip from training for a marathon. The doctor told me I needed to keep complete weight off of it and I could get crutches billed through the insurance but it was going to cost several hundred dollars. We instead went to Walgreens, got a $50 pair of adjustable crutches and I took them to the physical therapist I was seeing so he adjusted them correctly and showed me how to use them. Oh and we had a high deductible plan and an HSA which I could charge the 50 dollar crutches to. Another instance was with stitches. My daughter had to have stitches right around her eye. She was only 7 at the time. We had to go to the ER because nothing else was open given it was evening. Because of the size of stitches and the place of them the doctor recommended us going back to the ER to get them removed. We did and were told we’d have to pay a second ER visit for the removal of the stitches. We walked out without doing it and ended up going to the pediatricians office where we still ended up being charged but at least it was cheaper than two ER visits
Someone (AARP, AMAC, elected official or special interest group) should try to get hospitals to provide details on this type of equip ... mfg (can be various), all specs, and THEN give you in writing so you go and get it for less,. Agree. Should be 'the norm' for patients.
Medequip billed Humana for a sling I got following shoulder surgery. The bill was for $1,050.00. For a sling.
No way was Humana gonna be hosed like that- paying over $1k for a sling? No way. They would only pay the “negotiated rate” of $670. For a sling that could be purchased at retail for $160. Good negotiators there at Humana.
And since I have a 20% co- insurance for DMG, I got billed from Medequip for app $142.
Just discovered your excellent newsletter on a google search for "why do health insurance companies suck" -- this Substack article was ranked #1. I'm learning just how @#$&*! up our healthcare system is, post-Obamacare as I try to sign-up for a new plan thanks to a "qualifying event." I used to have a catastrophic plan for $200 a month before the ACA, and now I'm being quoted $1,200 for a plan with a $10k deductible! Thanks Government, for screwing up yet another part of our lives.
Late to the party here, but the worst insurance is on the marketplace exchange. (Obamacare) A friend of mine who is self-employed needed a hip replacement, and she contacted one of the best ortho surgeons in Chicago because he did non-invasive replacement and claimed to have patients sent home the same day--rather than stay in a hospital. She had BCBS insurance via the exchange (the "gold" option). She checked the ortho's website (he's part of Rush hospital) and they accepted BCBS.
Until they didn't.
The receptionist informed my friend that she would have to pay the full ($22,000) outpatient surgery doctor's fee because the doc "only accepted corproate-based (insurance through an employer) BCBS policies." My friend was mystified, and said that she had the EXACT SAME BCBS policy (PPO Preferred) that would be offered by an employer. The receptionist responded that, although that was true, the corpoorate-based policies agreed to the doctor's rate for the surgery--whereas the exchange policies would not reimburse the doc at his desired fee. They also will NOT take any other employer-based health insurance (Aetna, United Health) because those insurance companies also will not reimburse the doc at the level he wants.
I didn't believe it, so I called myself to ask about hip replacement. They asked for my insurance info, and asked right away, "Is this an exchange policy or a policy through an employer?" When I asked why that should matter, the response was that exchange policies don't reimburse at a high-enough level.
Interesting angle on the pressure between the insurance companies, pricing, and large health care institutions that causes small practices to merge. If there is intent, is that called collusion??
I hear Medicare actually does a much better job negotiating rates.
Dan, yes, 1) healthcare cost is on the rise like any other items; 2) Health Insurance and Medicare Shopping are confusing with many choices 3) hospital price transparency legislation is going to become effective on 01/01/2022 w resistance from AHA
FAQ
1) Do we have the rights to shop around? Yes
2) Can we choose providers? Yes
3) Do we have the rights to ask for a pre-estimate before agreeing to the procedure? Yes
Plus there are brokers who are diligently helping consumers with non-bias professional advice based on his or her healthcare need as your guide.
Yes - help is available and on its way!
I had a stress fracture in my hip from training for a marathon. The doctor told me I needed to keep complete weight off of it and I could get crutches billed through the insurance but it was going to cost several hundred dollars. We instead went to Walgreens, got a $50 pair of adjustable crutches and I took them to the physical therapist I was seeing so he adjusted them correctly and showed me how to use them. Oh and we had a high deductible plan and an HSA which I could charge the 50 dollar crutches to. Another instance was with stitches. My daughter had to have stitches right around her eye. She was only 7 at the time. We had to go to the ER because nothing else was open given it was evening. Because of the size of stitches and the place of them the doctor recommended us going back to the ER to get them removed. We did and were told we’d have to pay a second ER visit for the removal of the stitches. We walked out without doing it and ended up going to the pediatricians office where we still ended up being charged but at least it was cheaper than two ER visits
Someone (AARP, AMAC, elected official or special interest group) should try to get hospitals to provide details on this type of equip ... mfg (can be various), all specs, and THEN give you in writing so you go and get it for less,. Agree. Should be 'the norm' for patients.
Medequip billed Humana for a sling I got following shoulder surgery. The bill was for $1,050.00. For a sling.
No way was Humana gonna be hosed like that- paying over $1k for a sling? No way. They would only pay the “negotiated rate” of $670. For a sling that could be purchased at retail for $160. Good negotiators there at Humana.
And since I have a 20% co- insurance for DMG, I got billed from Medequip for app $142.
Just discovered your excellent newsletter on a google search for "why do health insurance companies suck" -- this Substack article was ranked #1. I'm learning just how @#$&*! up our healthcare system is, post-Obamacare as I try to sign-up for a new plan thanks to a "qualifying event." I used to have a catastrophic plan for $200 a month before the ACA, and now I'm being quoted $1,200 for a plan with a $10k deductible! Thanks Government, for screwing up yet another part of our lives.
Late to the party here, but the worst insurance is on the marketplace exchange. (Obamacare) A friend of mine who is self-employed needed a hip replacement, and she contacted one of the best ortho surgeons in Chicago because he did non-invasive replacement and claimed to have patients sent home the same day--rather than stay in a hospital. She had BCBS insurance via the exchange (the "gold" option). She checked the ortho's website (he's part of Rush hospital) and they accepted BCBS.
Until they didn't.
The receptionist informed my friend that she would have to pay the full ($22,000) outpatient surgery doctor's fee because the doc "only accepted corproate-based (insurance through an employer) BCBS policies." My friend was mystified, and said that she had the EXACT SAME BCBS policy (PPO Preferred) that would be offered by an employer. The receptionist responded that, although that was true, the corpoorate-based policies agreed to the doctor's rate for the surgery--whereas the exchange policies would not reimburse the doc at his desired fee. They also will NOT take any other employer-based health insurance (Aetna, United Health) because those insurance companies also will not reimburse the doc at the level he wants.
I didn't believe it, so I called myself to ask about hip replacement. They asked for my insurance info, and asked right away, "Is this an exchange policy or a policy through an employer?" When I asked why that should matter, the response was that exchange policies don't reimburse at a high-enough level.
Un. Be. LIEVE. Able.