Author Topic: Health Insurance, you THINK you have it...  (Read 3768 times)

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Offline peteruk

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Health Insurance, you THINK you have it...
« on: December 02, 2009, 12:29:00 PM »
...but in reality, you probably don't.

I'm with Blue Cross, most of my Providers are at UCI for ongoing treatment, they called me on December 1st to inform me they are now out of the BC network   :'(

Here's something from the OC Register...

http://healthyliving.freedomblogging.com/2009/12/01/uci-drops-blue-shield-in-payment-dispute/13705/

Offline tmare

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Health Insurance, you THINK you have it...
« Reply #1 on: December 02, 2009, 12:36:00 PM »
So apparently they already dropped Blue Cross a while ago and now they are also dropping Blue Shield? My employer switched to Blue Shield from Blue Cross this year. They are both equally awful. They refuse to pay so the hospitals and doctors continually send the insured bills which they do not owe, hoping that eventually someone will pay. No wonder providers are refusing to take this "insurance". One particular hospital bill from my family showed that Blue Cross paid 2% of the billed amount.  The hospital is still sending me bills even though my family has 100% hospital coverage.

Offline peteruk

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Health Insurance, you THINK you have it...
« Reply #2 on: December 02, 2009, 01:19:00 PM »
I'm with Blue Cross and up until Dec 1st they were accepting it at UCI.....they dropped BC a while back and took them back after a few months...now they dropped them again..the article sites Blue Shield but it's Blue cross as well....

Offline centralcoast

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Health Insurance, you THINK you have it...
« Reply #3 on: December 02, 2009, 01:27:00 PM »
The whole health insurance/hospital system is all smoke and mirrors as far as I am concerned. Hospitals have such bogus billing systems that it's impossible to know what their financial situation really is, and insurance companies just keep figuring that premiums, and investments of premiums, will be larger than expenses.

As an example of the bogus billing systems.... I fractured my shoulder a year or so ago. The initial X-ray to confirm the fracture was billed at $675. A follow up X-ray, same view, was billed at $175. The reason? My first was via the Emergency Room, so it was billed differently than the second one, which was billed as "outpatient."  It was the exact same procedure, done in normal business hours, neither procedure required calling in staff or waking up a radiologist to read the image.  I was separately billed for the ER visit, so the higher radiology cost wasn't an attempt to recoup those expenses.  The only difference was which door I used when I walked into radiology. My insurance paid 80% of each bill, and since I work at the hospital, the hospital discharged the remainder.

Offline peteruk

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Health Insurance, you THINK you have it...
« Reply #4 on: December 02, 2009, 02:05:00 PM »
CC, I know exactly what you mean, I could write a Book...the sad part is, People are under more than enough stress when they're sick or injured, the prospect of going Bankrupt as well just adds to the misery...especially when they THINK they're covered, which is my whole point...

Offline mojo

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« Reply #5 on: December 03, 2009, 03:56:00 PM »
You should see some of the back end payments that I see too.

Most times, the providers and insurance companies have agreements for SIGNIFICANTLY lowered amounts, which are not given to you if you dont have insurance.

For example.  If you need a particular treatment, you get billed $2450.00.  If you have, say, Aetna, they may come in and pay $590, which satisfies the entire bill.  Now, if you are the same person needing the same treatment, but are not paying through insurance, that original $2450.00 figure is what you are billed and told to pay, as you dont have a preexisting agreement with the provider.

This is also the reason why hospitals will negotiate bills down if you become a pain in the ass - because they routinely accept a fraction of the bill anyway.
« Last Edit: December 03, 2009, 03:57:00 PM by Anonymous »

Offline peteruk

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Health Insurance, you THINK you have it...
« Reply #6 on: December 03, 2009, 11:03:00 PM »
Thanks Mojo....

Offline novaseline

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Health Insurance, you THINK you have it...
« Reply #7 on: December 04, 2009, 11:34:00 PM »
Quote from: "Mojo"
You should see some of the back end payments that I see too.

Most times, the providers and insurance companies have agreements for SIGNIFICANTLY lowered amounts, which are not given to you if you dont have insurance.

For example.  If you need a particular treatment, you get billed $2450.00.  If you have, say, Aetna, they may come in and pay $590, which satisfies the entire bill.  Now, if you are the same person needing the same treatment, but are not paying through insurance, that original $2450.00 figure is what you are billed and told to pay, as you dont have a preexisting agreement with the provider.

This is also the reason why hospitals will negotiate bills down if you become a pain in the ass - because they routinely accept a fraction of the bill anyway.


I can't explain why, but they can't offer you the discounted price up front because it would constitute Medicare fraud if they did.

Offline centralcoast

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Health Insurance, you THINK you have it...
« Reply #8 on: December 05, 2009, 07:01:00 PM »
That's true, no-vas, and I'll see if I can explain it. First, I think Mojo was talking about commercial insurance. Aetna, Blue Cross, those guys all negotiate flat rate payments based on procedures. So the hospital bills $10,000 for a overnight stay and hysterectomy, but the insurers pay whatever the contracted rate is, generally at least 40% less.  If an uninsured migrant worker comes in, has a hysterectomy, and stays the night, they get billed the $10,000 rate. There were a bunch of lawsuits a couple of years ago against the larger hospital corporations, claiming discrimination against poor people because they couldn't get the better rates, and most hospitals will now accept lower payments, but you have fight for it.

Now, for Medicare, there's a federal regulation that makes it fraud to allow someone with Medicare to privately pay for care that would otherwise be covered by Medicare.  I think the intent, if there was one, was to keep hospitals or physicians for telling Medicare patients... "well, you really need your gall bladder taken out, but Medicare doesn't pay me enough to break even on the procedure, so unless you want to give me an extra $500, you'll have to find someone else to take it out."

If a provider gets caught taking private payments from Medicare recipients, they are banned from participating in the program again. So, some MD's will simply opt out of the Medicare program, and only take private pay patients. Last I heard, here on the Central Coast, there are no psychiatrists that participate in the Medicare program. If you have Medicare, and need psychiatric care, you have to go to Santa Barbara, or Salinas.

 

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