Regarding medical insurance...

[driver8]

For the past year or so, I have been dealing with a melanoma on the retina of my eye. I have seen numerous doctors, had surgery, and radiation. I am lucky in that I have excellent health insurance.

So I am filing away some statements from the insurance company and I can't help but notice the difference between what a doctor bills for a procedure and what the insurance company pays.

For example, the total cost of one of my procedures was approximately $7,000.00. The insurance company paid $1,500.00. I think my part of the bill came to $23.00 or something like that. I mentioned to my wife that this didn't seem right. If a doctor is willing to accept $1,500.00 for this procedure, why isn't that is what is billed in the first place? Also, those people without insurance are charged $7,000.00 for the same procedure and are expected to pay this out of pocket?! The people who cannot afford or do not have insurance are charged the full price?

WTF? How can anyone not see that something is definitely wrong here?

[JHB]

1. Because if he billed for $1500, the company would only pay $321

Yes, this sort of billing-kabuki-theatre is a problem, one of many that are a byproduct of the system we have now.

[KT2000]

2. You nailed it!

They now have a cookbook that some non-doctors put together for the insurance companies - cost for each procedure.
Insurance is where the group negotiates a lower price for services.
Those without insurane are not part of a group - therefore they have to pay full fare.
Doctors who participate in this scam are as bad a s the insurance companies if you ask me.

Pretty idiotic, huh? I think it is called "thinning out the herd."

[Warpy]

3. They charge the uninsured the full rate

and then, when pressed, will often cut it down to half so the uninsured patient feels like s/he is getting a great deal when s/he is still paying 200%-300% more for the same proceudure than the insurance company does.

This is nuts.

Insured patients used to subsidize the medically indigent. Now the people with the least ability to pay are subsidizing the breaks the insurance industry gets.

This is also nuts.

Hospitals and docs will get paid. They will garnish wages and put liens on property. They have even been known to jail people who miss a payment. If the patient is completely without means and lacks the ability to work, they will get the patient on Medicaid. The bottom line is that they will get paid.

Expand Medicare NOW. Anything else is cruel, futile, and immoral.

[fed-up]

4. that's why Arnold wants to keep insurance companies in the loop- nt

[scorpiogirl]

5. It's all such bullshit!

I am super pissed at insurance companies and medical groups right now because of a situation with my husband. Where's the freaking care? I have a friend who suggested that socialized healthcare wouldn't be better and then we'd have to pay more taxes. If I knew that every man, woman and child living in the U.S. would get care, I'd gladly pay more taxes. She wouldn't, but I guess that's why she's a republican.

On edit: The way they have it set-up, the individual has zero negotiating power against insurance companies. Yet, when you have an HMO, for instance, they charge you up the ass for monthly premiums and then give you extremely limited services.