Insurance company follies:

[hedgehog]

I live in NYS, so I have no-fault insurance which means my car insurance is paying my medical bills resulting from my car accident. There is a deductible, which then goes against my deductible for heath insurance. I expect to be fully healed well before all the bills settle!


I think insurance companies aren't really selling insurance (investing premiums and paying claims from the proceeds) so much as they are selling price negotiation. The auto insurance company refused to pay all of the bill for the ER because the hospital billed more than the agreed price. I read down the list, stuff like $10 billed when the agreed fee is $1.87, $52 for $13. The real shocker was this: the hospital billed $4759 for a code that is contracted as $111!

[Common Sense Party]

1. It's crap like that that makes healthcare so damn unaffordable.

And the ACA doesn't seem to do much to address it.

[DURHAM D]

2. Would you rather insurance companies not have the

allowed charges schedule?

I am confused.

[unblock]

3. the point is, you get the insurance company's pricing power, not actual payout.

of course ultimately you are relying on their deep pockets, but in practice it does often seem that the primary benefit from insurance is being able to pay health care providers the rate the insurance company negotiated rather than the retail price.

[DURHAM D]

4. Yep. Too bad SSA/Medicare/Congress didn't take a lesson from the insurance companies

when they created Part D and negotiate for bulk buying fee schedules for prescriptions.

[unblock]

8. i believe they quite specifically are barred from doing this.

and guess it was big pharma that lobbied for that but i don't imagine the insurance companies objected.

[DURHAM D]

9. Yes. When the ACA was being debated

the White House agreed to retaining this ridiculous ban because big pharma said they would step back and not lobby against the ACA.

[hedgehog]

6. I should have titled the OP Hospital follies -

I swear they throw charges up against the wall to see what sticks!

[denverbill]

5. What's needed is a law banning different pricing for different customers.

If you and I go to the hospital we should be charged exactly the same amount whether we have the best insurance in the world or whether I'm uninsured. Right now the people who can least afford big bills (the uninsured) are the ones who pay the highest prices for care. States and/or the feds should fix that.

[hedgehog]

7. Especially when evidence is emerging that "non-profit" hospitals

are using the excess money collected to build ever larger campuses whether needed or not!