Aces High Bulletin Board
General Forums => The O' Club => Topic started by: rogwar on May 21, 2010, 02:25:19 PM
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I generally always see this sort of thing in the "explanation of benefits" statement but not to this extent. Luckily I've got great employer provided insurance through a major, nationwide company.
This is mad. It was for the blood tests and such done during a recent annual physical.
Amount billed: $321
What my plan paid: $33
Discount: $287.36
What I owe: $0
What the hell kind of weird business model is this anyway?
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The lab (and Doctor, etc. ) are under contract with your insurance carrier. The contract requires them to accept payment for various services based on a rate schedule, and cannot bill the patient for the balance. If the doctor or whoever, is outside the network, then you probably will see a balance bill as they are not being held to that contract.
The doctor writes the difference off on his taxes as a loss, so is able to accept these terms without losing his shirt, as they generally grossly overcharge with this in mind anyway.
The problem is if someone doesn't have insurance, they get hit with the huge charges that were originally intended for milking this system. This is how medical insurance has turned our old system into a money machine and made the cost of medical care go sky high.
Of course when people complain about the cost of medicine in the U.S. they get a a cock and bull story about covering the cost of research, expensive equipment, etc. but this is what is really going on.
A similar system raises the cost of medicine as well, with the pharmaceutical companies lowering costs for many foreign companies, or their government subsidizing it; as the insurance scheme doesn't exist there.
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Rogwar, I feel your pain brother. I've had two different COBRA providers and have had a TON of
medical expenses over the past year. I've had 7 outpatient surgeries and 2 inpatient ones. The strange
part is that the outpatient ones are for my dialysis access in my arms and the inpatient ones were for
hip surgery and a left foot amputation, but the costs are similar for both kinds :rolleyes:
I wouldn't mind the bills so much if the nurses and doctors were being paid better, but it all seems to
go to "providers". :huh
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See Rule #14
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I generally always see this sort of thing in the "explanation of benefits" statement but not to this extent. Luckily I've got great employer provided insurance through a major, nationwide company.
This is mad. It was for the blood tests and such done during a recent annual physical.
Amount billed: $321
What my plan paid: $33
Discount: $287.36
What I owe: $0
What the hell kind of weird business model is this anyway?
Almost all insurances cover your annual check ups (they called 'prevantative' stuff) fully. Blood work included.
However, if you get more bloodwork done, you will have to pay for it.
I had 5 blood tests done a couple years ago. insurance covered the first one.. the other 4 I got nailed for. Despite the fact they were done by the doctor because the first 4 couldn't find what was wrong..the fifth one did. Go figure.
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See Rule #14
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umm ... mean uk wage £30k, Tax & NI £615pcm, NHS is 18% of public spending, so NHS costs £110/month for someone with average wage.
you're seriously telling me the most expensive insurance policy in the US costs less than $160 a month? :huh
Heck, I'm paying alot more than that for COBRA benefits even after the government helps me out.
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the real figure is actually alot less than that because of the way Tax & NI scales are structured and the way funds are allocated, I just did a basic calc. for a £30k salary figure on closer to $110 per month for the NHS.
I ran some numbers when the healthcare thing started just out of interest and found that I could take out BUPA insurance (the most comprehensive plan without the homeopathic nonsense), plus pay my contribution for the NHS through tax (at a higher rate than above) and it would still be alot cheaper than private healchcare would be in the US for me ...
I'll leave you to figure out why (the invoice in the OP is a hint). Put it this way, I know a few doctors and a surgeon and none of em have a ferrari parked in their drive ...
edit: I also know a Smithkline Beecham exec (big pharma!), he drives an aston. so some things are the same both sides of the pond ...
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I was really trying to point out the craziness of the business model and pricing structure...the vast difference between the medical service provider's "list" price and negotiated/contracted rate. Only paid $15 for the complete physical including lab work.
It's similar to when I went for a sleep study the other day. The list price was like $1,200. Insurance paid a contracted rate of $550 and me $15.
Talk about a weird pricing structure!
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I'm not sure why my last post was deleted. I didnt post anything about race, religion, or politics. :headscratch:
Health care costs boil down to this: we either pay from our own pockets to private health insurers, or we pay out the wahzoo AND our our own pockets via taxes to pay for a government run health care system. The costs are big time more expensive when the gubmint takes control.
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yeah ditto :headscratch:
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i
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I'm not sure why my last post was deleted. I didnt post anything about race, religion, or politics. :headscratch:
Health care costs boil down to this: we either pay from our own pockets to private health insurers, or we pay out the wahzoo AND our our own pockets via taxes to pay for a government run health care system. The costs are big time more expensive when the gubmint takes control.
Allllrighty then.
Clue rakes, asle 5.
Didn't you blame everything in your OP on a certain individual? Some sort of public figure?
wrongway
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Insurance companies rule the world. :devil They possess more cash, assets and land than any other
group on earth, they also have a lobbyist base the population of most small countries. You will do what
they want, when they want, how they want ! :cheers:
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Allllrighty then.
Clue rakes, asle 5.
Didn't you blame everything in your OP on a certain individual? Some sort of public figure?
wrongway
Nope. Citing that Obama wanted to have socialized medicine is not placing blame. That is fact. His admin just tried to do it. I didnt throw a position of negative reinforcement either way. If I would have come out and called him a red headed communist with dream of making the US a socialist country... sure thing. But I didnt.
Back on point: Do we want to pay $500 to a pvt company for health care or $700 in taxes to the gubmint for health care? Ask anyone who has had to deal with workers comp, the VA, medicaid, or medicaid and let me know what the majority of them say. ;)
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sorry smokinloon you just did it again. making political comments is not allowed by the rules. your first paragraph is that, a political commentary. which has nothing to do with the posting about how crazy health insurance billing is.
I once went to a local doctor due to a pulled muscle on my back. young lady at the front told me that it would be about 50 for the consultation. I had no insurance so i was going to pay cash, no way i was gonna go to the er and wait for 5 hrs to 2 days the standard wait in los angeles. (I actually once waited for 36 hrs to see a doctor at an er, after 9/11 had no insurance was unemployed, no money but that's another story). anyway when the doctor came to examine me he asked me how I hurt my back, I mentioned to him that i was moving some boxes for my boss. at that point he stopped the examination and said that the price was actually $350 for worker's comp cases. I told him I was not filing a worker's comp case that I was only helping my boss at his house. he refused to examine me unless i paid the full $350 up front, which i could not afford. I ended up leaving went next door to another doctor who asked me again how i hurt myself and this time i told him i was moving some boxes at my house, paid about $60 got a cold pack some otc painkillers and left.
I now have insurance and get pain medications for my back, (had an accident last year), I have no copayments, i am lucky enought to have dual coverage now, but I see that my insurance company sells those medications for $650 for a 3 month supply to the public. my co-worker has different insurance and his sells it for 1/2 that to the public. go figure. it is just crazy how some of it gets priced.
semp
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I'll leave you to figure out why (the invoice in the OP is a hint). Put it this way, I know a few doctors and a surgeon and none of em have a ferrari parked in their drive ...
edit: I also know a Smithkline Beecham exec (big pharma!), he drives an aston. so some things are the same both sides of the pond ...
Might also have something to do with the doctors/surgeons being small business entrepeneours vs. multi-billion dollar international company exec's..
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Rogwar, I feel your pain brother. I've had two different COBRA providers and have had a TON of
medical expenses over the past year. I've had 7 outpatient surgeries and 2 inpatient ones. The strange
part is that the outpatient ones are for my dialysis access in my arms and the inpatient ones were for
hip surgery and a left foot amputation, but the costs are similar for both kinds :rolleyes:
I wouldn't mind the bills so much if the nurses and doctors were being paid better, but it all seems to
go to "providers". :huh
and it's gonna get worse.
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Ior we pay out the wahzoo AND our our own pockets via taxes to pay for a government run health care system. The costs are big time more expensive when the gubmint takes control.
Sorry, but taxes where I live (NZ) are some of the lowest in the world, significantly lower than the USA for example. Plus we have an excellent public healthcare system, so good that despite having a work paid for healthcare plan I've always used the public services. I also have a family which includes 2 kids, and my elderly mother in law. So I get a good looksie at the 'big picture' of the service. Sure the public service has it's crappy moments, but it also has some really shining ones too ;)
So I play less tax than you, plus get free superior overall healthcare for my entire family.
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See Rule #14
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There was a UN survey recently that took stuff like that into account, we still came out far better. I have no idea if the changes in the US healthcare will work, but I just want to open the eyes of the public healthcare naysayers to show them that it works for other countries.
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See Rule #14
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Sorry, but taxes where I live (NZ) are some of the lowest in the world, significantly lower than the USA for example. Plus we have an excellent public healthcare system, so good that despite having a work paid for healthcare plan I've always used the public services. I also have a family which includes 2 kids, and my elderly mother in law. So I get a good looksie at the 'big picture' of the service. Sure the public service has it's crappy moments, but it also has some really shining ones too ;)
So I play less tax than you, plus get free superior overall healthcare for my entire family.
In Australia we have a hybrid system of public and private. But most private hospitals generally don't have ER's so you almost always end up in a public hospital at first. When my wife was pregnant with our twins, we were told that if she went early she would be automatically taken to a public hospital with a specialist ward even if we wanted to use a private hospital for the delivery.
We've had to take our boys twice in 4 years to a public hospital emergency ward. The first time we took one of my sons when he was 3 because he had a very high fever, and we thought he may have had a fit. It was late sunday night and my wife took him in the front door while I quickly parked the car, and in the few minutes that took she was taken through to the pediatric ward and was being assessed by a specialist nurse and doctor. As it was we were there for about 6 hours while they brought his temp down and wheeled in a TV and DVD player and a selection of kids movies to keep him occupied while they monitored him. The nursing staff and docs were awesome. The second time was because of a serious infection and we only waited for 20 mins after the inital assessment and had the same great level of care. Our local GP that we always take the boys is bulk billed via our medicare card so is also free.
In Aus we're taxed up the wazhoo, and our system has its flaws but no state or federal govt would dare take it away.
Tronsky
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I just want to open the eyes of the public healthcare naysayers to show them that it works for other countries.
yup, that was my point, its possible to provide decent universal healthcare which is cheaper than a private system, if you can do it right.
this will be tricky in the US though because of the cost side of the equation. even if you remove the effects of the insurance companies operating an oligopoly, doctors in the US have to charge alot because its cost them alot to qualify. in the UK university fees are subsidised and capped at ~£3,200/yr so 5yrs in medical school costs the doctor about £16,000 total. I understand in the US this costs in the region of $250,000.
@ trigger: you're basing your opinions on numbers you've just guessed (eg. IRS costs $1 trillion per year to run :huh) all these figures are in the public record, how about spending 5mins on google and using the real numbers?
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***edit***
Never mind - sailing too close to rule 14