Insurance companies wrongfully charged customers billions of dollars

Bravo for Sen. Rockefeller! But ... (4.00 / 1)

This is not news - this is self-evident truth that millions of Americans already knew. Perhaps if members of Congress actually were responsible for paying out-of-pocket for much (most?) of their health insurance, the way the rest of us are, they would have already known about this.

Oh. That's right. That's one of the perks of being elected. And you can be sure the bastards in the health insurance industry have great big flags they plant all over congressional members' (and their immediate families) records to make sure they get royal treatment.

I wonder if any enterprising reporter would survey all of Congress to find out if they've EVER been turned down for reimbursement or treatment ...

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by: blonde moment @ Wed Jun 24, 2009 at 14:18:09 PM CDT

Ignorance about how healthcare works. (0.00 / 0)

If you actually read the article fully, you see that they are talking about Out of network providers, and how the insurance industry doesn't pay them as much.  This article twists what happens.  They say that the industry arbitrarily makes up low ball price points.  the problem is, they don't mention that these low ball amounts are what they pay their In Network Providers.  Let's educate some people on what this means and how this will work, and if it's changed, how people will have to pay MORE for healthcare.  First, if you go to an in network provider, your provider has agreed to accept whatever payment the insurance has decided to pay for this procedure.  They may charge a normal person $3000, but the insurance says they will only pay $1000.  Well, if the provider is in network, and the patient has benefits, then the insurance will only pay that amount.  What happens to the $2000? It's written off by the doctor.  No one has to pay it.  Now, if that patient decides they are too good to get the same doctor everyone else does and wants to go out of network?  Well, let's say that doc charges $5000.  What will the insurance pay?  $1000.  Why? Because that's what it customerally pays it's In Network providers.  That means that the person is liable for the $4000 difference because that provider didn't want to be in network, becasue he wanted to charge and get more money.

Well, then the insurance should pay more since a provider expects more out of network?  Well, what if you or I have a co-insurance, meaning the insurance will pay a certain percentage of its' allowed amount, and I pay the rest.  Well, if it's an 80%/20% splite, in the first case I would be liable for $200.  If we increas the paid amount because people who want to go out of network don't want to pay as much, so the insurance pays teh $3000 charge that is't In-network providers would like to charge, i'm sudenly paying $400 MORE, because my neighbor wants to pay LESS for not following the guidelines that are there to keep them from having to pay more money.

Why is the insurance company evil for wanting to keep costs low by having a network of low cost providers?  Why is it bad that they want to keep these providers from charging the difference to their patients?  The problem is, most people don't understand and follow the rules.  They make them laboriously complicated? No, people don't read anymore.  They don't take the time to understand what their benefits are.  The steps needed for most people are just find someone in the network and go to them.  You pay slightly more for that kind of insurance, but then it's more convient and easy.

HMO's take a lot of flack for being complex.  But the complexity is in the fact you just have to go to your primary care physcian before you go to a specialist.  It's not up to the insurance, it's up to your provider.  If he doesn't think you need it, then it won't get paid.  The upside is the plans are cheaper for you and your company.

Which leads to the real culprit in this.  The ones who decide what does and does not get covered by an insurance company, for the most part, is the business that is paying for the contract.  Except in extreme cases where the procedure is experimental (ie no scientific evidence that it actually works), insurance companie cover everything.  then they go to a business and that business decides how much they want to pay, and will pay less if they don't want to cover a particular procedure.  So when you are told your benefits don't cover the 4 day nursery care for your newborn because you had complications related to the birth, it's not the insurance company that is saying know. It's the insurance company enforcing the contract with your employeer who decided they didn't want to pay extra to cover that.

I'm not saying all insurance companies are happy and sweet and will bend over to do whatever you want them to do, but their primary concern is keeping their customers happy.  And you are not their customer.  Your company is their customer.  Keep that in mind when you read in the news about how the insurance companies don't want to cover Aunt Emma's surgery because her insurance will only pay $1,000,000 in benefits for total lifetime.  It's because her boss wanted to pay lower premiums, not because the insurance company didn't want to part with the money.

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by: seraphmonkey @ Wed Jun 24, 2009 at 18:02:42 PM CDT

Uh-huh. (4.00 / 1)

Except in extreme cases where the procedure is experimental (ie no scientific evidence that it actually works), insurance companie [sic] cover everything.

Can you say "rescission?"

http://www.latimes.com/busines...

Yeah, that's the employers' fault ...

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by: blonde moment @ Wed Jun 24, 2009 at 18:54:33 PM CDT

[ Parent ]

Insurance execs refused to end the practice (0.00 / 0)

Even when challenged by Congressional reps on both sides of the aisle to end such practices, they refused.


When a man embarks upon a crime, he is morally guilty of any other crime which may spring from it. Sherlock Holmes.

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by: Carnacki @ Wed Jun 24, 2009 at 21:26:22 PM CDT

[ Parent ]

insurance is a financial instrument (4.00 / 1)

it is a method of payment, not health care delivery. My boss picks our menu of plans and a committee here narrow it down and we go with only one. My boss is not deciding coverage, the death by spreadsheet actuarial are after we have signed the contract. Any concept of what we have can be changed at anytime by the way it is administered. And with a second round of paperwork you can change their decision. This supports the "deny first" meme that is out there.

Now I find out two years after being treated for having legs like Richard Nixon that my primary care physician has decided the reimbursement rate from my current plan is not sufficient for their group and suggested I buy other insurance. Since I benefit from the pooling in the state in which I am employed, I am sure this would be an expensive proposition to revert to an individual plan from the state in which I live which did not pool. But this is what I am faced with to keep the physician of my choice. Or has your numbers state, paying the difference btw the BC/BS price and the Add to this equation buying as an individual with a pre-exiting condition. Impossible without trading my commitment to my children's education.

Family practitioners are the bottom of the totem pole. They can do everything except maybe major surgery. They are the foundation of wellness and prevention. Specialist are paid 3x more. Don't come back with post-doc, FP do it extra too because they can to OB/GYN and minor surgery and peds, etc

I'm not saying all insurance companies are happy and sweet and will bend over to do whatever you want them to do, but their primary concern is keeping their customers happy.  And you are not their customer.  Your company is their customer.  

When BC/BS was non-profit I could buy this line of reasoning. Insurance companies and hospitals are now for profit business, a big change from the past. Hospitals are aggressive in collections against the poorest to discourage them from returning. Insurance is responsible to their stockholders, not my boss or me. I am part of their loss ratio. Wall Street, that is who drives this. And as the era of fake profits exploded, and returns of investment dwindled, pressure on income from premiums increased.

$100 visit and I paid $20 when she was "in network" or under the BC/BS contract what ever you want to call it. She would then get another $55 to come up to $75 total, or 75% of her published rate.

Now I will have to pay $100 up front, so the doctor is up $25. I file insurance and get 80% of the $75 allowed or $60. So I have paid $40 for each visit now, so I am down $20. My premiums are the exactly the same. I changed nothing. My boss changed nothing. The group the doctor is in made their business decision.

SANDERS S.703

But not me personally were those cheers for (1-6-7-5-2-8-3-4)--Sarah Palin

You know, you have such a stunningly superficial knowledge of what went on that it's almost embarrassing to listen to you--Zbigniew Brzezinski

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by: CA Berkeley WV @ Thu Jun 25, 2009 at 01:47:55 AM CDT

[ Parent ]