Health Insurance

The reason healthcare cost's are so high IS a result of all those things you mention AND it has to cover the treatment of patients who cannot/wont pay. I dont see how "party" has much to do with it. Its the private sector in control of it all.

 

OK poor choice of words on my part..by "party" I refer to person, group, or provider..not a political party.

For instance..doctors will bill $100 or more for a 5 minute visit. Could they be cheaper? Sure. Should they be? I dunno..that's a long time in school and the knowledge of a very important subject.

Another driver is people who go to the ER when they are not feeling well. Hospital visits even for something simple are well over $1000 easy.

I'll agree that part of it does help pay for care for those unable to..no doubt.

 

OK, here's my question about the insurance and billing practices in the US and I haven't gotten a logical answer for it yet.

It's like the medical providers want you to have and reward you for having insurance. For example recently a family member had surgery and and hospital stay. We got the paperwork from Blue Cross and the total charges submitted by the hospital was $20K some odd. And because they are a Blue Cross preferred provider they knowingly and gladly accepted around $7K as total payment. We only owed our $100 copayment.

But if we did not have insurance, I assume the hospital would have expected the full $20K+ from us? I know the doc wants the full $125 from cash customers instead of the 50 he would get from insurance customers.

So which end of the scale represents the true costs of medical care? And how can providers legally expect and pursue collection based on the (I assume) inflated figures while they are gladly profitting on lesser amounts with insurance customers?

 

thats strange, My doctor charges less for cash patients than ones on insurance plans. I don't know what to tell you here. mt guess is you have a bill, the insurance company negotiates a lesser amount and it gets paid. If you don't have insurance, I am not totally sure you would have to pay the full twenty thousand. Do you know it to to true?

 

I'm pretty sure that's the case here in GA. Maybe there is some sort of negotiation process for an individual, but they sure don't publicize it if so. I think you can declare a monthly amount you are able to pay and they can't legally go after you as long as you keep paying that, but not sure.

We got hit one time paying 60% of a hospital bill due to the insurance having lower coverage on the specific condition. GA laws have changed sinced then and that wouldn't happen now.

 

This might get a little confusing, so bear with me.

When a medical provider agrees to contract with an insurer, part of their contract is that they will agree to accept payment of an allowed charge (what we consider fair) as full payment of their charged amount (your $20k figure)..you pay the copayment and they write off the balance.

You're correct that the provider can charge the full 20K (or frankly whatever they wish) if you walk in without insurance.

Which end is the truth? Tough to give a stock answer I'm afraid. To the insured, it's the 7k. To the uninsured, the 20k.

The other thing is, assume you have no insurance. Sure they'll bill you the 20k probably but jeez how can you get blood from a turnip? Someone with that large of a bill will barely be able to pay that a little at a time, I'd imagine if someone had 20K kicking around they'd have bought insurance.

 

You're correct on the 2nd sentence of that. Some doctors will charge less for a cash patient but they don't have to. Perhaps they are figuring they'd get a lower amount from insurance anyway..or perhaps just giving a little back to those who really can't afford insurance.

Could the hospital bill the 20K? Of course. Will they get it? Probably not. I'd have to figure that one could attempt to get free care through the state..or perhaps some help from the hospital as well.

 

I have decline health insurance for the past two years. But since I'm moving to Colorado in 5 weeks, and I KNOW I'll be breaking a couple of bones either skiing or rock climbing/bouldering, I'll have no choice but start getting it thru my employer. It was really neat not to have it though, as I really don't believe in modern medicine.

 

Just remember Walgreens doesn't give a shit about you.. it's a shame. The W can suck it!

 

Try being in MA..if you don't have health insurance, you get penalized on your income tax returns.

 

Yes, I understand the provider-insurance contract agreements.

I figure some of it just a price tag shell game played by both parties to encourage you to have and keep your insurance. It is probably advantageous for both the providers and the insurance co.'s to have everyone paying for some type of umbrella plan. I know the local doctors here wouldn't stay in business very long, if they didn't accept Blue Cross, issued by the largest employers in the area.

 

I suppose it could be seen as that..but it's a way that the insurer can keep costs down as well. Like you said, no large facility in their right minds won't contract with a big insurer.

For doctors, it depends on the specialty. I find of those who don't contract a good chunk of them will be mental health providers..most every internal medicine doctor will though