Insurance Insanity (Non-Aviation)

[kyleb]

I tweaked a knee a few months ago. It has improved, but not to 100%. So my GP gave me a "prescription" for physical therapy and (after a bunch of phone calls) I got the PT scheduled for today. But wait! Insurance was involved.

Last Friday, the PT clinic called to give me a heads up that the PT was going to be very expensive because (as it turns out), I'm out of network. How expensive, I inquired?

$500/session. Whaa? Yep, $500/session. A session is 30-45 minutes of me doing exercises under the supervision of a PT tech who ain't making more than about $30/hr.

OK, how about I self pay, what's that price? Oh, we can't give you that price since you have insurance and are out of network. So, you'd rather lose my business totally than have me pay cash for each session? Well, that's the policy, I know it doesn't make a lot of sense. Sorry.

It was a polite conversation because I knew the person on the phone had nothing to do with creating the situation.

I cancelled the PT session. Later they called back and said: Again, a PT session is $500, but we can offer you a free 30 minute consultation. "With a therapist?"... No, with a doctor.

So a PT session is $500 but 30 minutes with a doctor is free? Yep.

The visit with the doctor was very nice. She gave me a half dozen exercises to do at home.

And I remain puzzled that a consultation with a doctor is free but a visit with a PT tech is $500...

Go figure.

 

[Let'sgoflying!]

My experience with one PT place is that 90% of the time, the "therapist" is 20' away jawing with a coworker or on their phone. Barely noticing if you are ripping out important tendons or not.

Except for Erin. Erin was...lovely.

 

[idahoflier]

Makes no sense to me!

 

[StraightnLevel]

Medical insurance procedures and rules are designed to appease people who find FAA regulation to be too common-sense and customer focused for their tastes.

 

[robin ardoin]

Medical insurance procedures and rules are designed to appease people who find FAA regulation to be too common-sense and customer focused for their tastes.

Sad, but true. Example- A particular facial skeletal procedure is preauthorized by my patient’s insurance company. I have an operating room in my center for such reconstructive and cosmetic procedures that are not covered under insurance to improve the affordability to patients. I propose to perform this particular case in my center and charge a facility fee less than 1/10th of the hospital fees for the OR/supplies/implantable hardware/anesthesiologist/recovery. The insurance would not cover my facility fee; it has to be done in an in network facility. I the perform the surgery, which cost BC/BS tens of thousands of dollars more than if they would have covered my facility fee which was not much over my actual overhead. I called one of the VP’s at La BC/BS discussing the lunacy of it and all he wanted to do was convince me to become an in network provider. I said NFW if that is the logic used to run their company. That was over 20 years ago. I’m still not in network with any insurance companies.

 

[455 Bravo Uniform]

It’s too big of a perceptual motion machine to try to get off. It’s fkn corrupt. So wrong.

 

[Tarheelpilot]

Sad, but true. Example- A particular facial skeletal procedure is preauthorized by my patient’s insurance company. I have an operating room in my center for such reconstructive and cosmetic procedures that are not covered under insurance to improve the affordability to patients. I propose to perform this particular case in my center and charge a facility fee less than 1/10th of the hospital fees for the OR/supplies/implantable hardware/anesthesiologist/recovery. The insurance would not cover my facility fee; it has to be done in an in network facility. I the perform the surgery, which cost BC/BS tens of thousands of dollars more than if they would have covered my facility fee which was not much over my actual overhead. I called one of the VP’s at La BC/BS discussing the lunacy of it and all he wanted to do was convince me to become an in network provider. I said NFW if that is the logic used to run their company. That was over 20 years ago. I’m still not in network with any insurance companies.

I need to find a doc like you to be my GP.

 

[FORANE]

If you like your doctor, you can keep your doctor.

 

[GeorgeC]

I bet you're one of those deadbeats who pays the credit card balance in full every month.

Did we tell you the name of the game, boy?

 

[SkyChaser]

Health insurance has turned into (maybe always was?) such a scam. Supposedly, you get insurance to cover medical bills that would be too expensive without it, but then everything medical goes up by a cost factor of what seems like five or twenty because insurance.

 

[StraightnLevel]

Health insurance has turned into (maybe always was?) such a scam. Supposedly, you get insurance to cover medical bills that would be too expensive without it, but then everything medical goes up by a cost factor of what seems like five or twenty because insurance.

Yes, we are over-insured. What we have today is analagous to buying auto insurance that would cover oil changes, tire rotation, paying to have gas pumped, and pay for someone to come out to your house with a compressor to put air in your tires.

 

[Randomskylane]

Property insurance on tiny retail space doubled this year

Homeowners up 33%

Auto up 25%

No claims

 

[Clip4]

Yes, we are over-insured. What we have today is analagous to buying auto insurance that would cover oil changes, tire rotation, paying to have gas pumped, and pay for someone to come out to your house with a compressor to put air in your tires.

I encourage you to become educated about health insurance in the US because you are one of the 90% who are clueless about it what it.

 

[Katamarino]

The American health system is designed to keep people alive just long enough to drain their wallet. The motive is profit, not well-being.

 

[StraightnLevel]

I encourage you to become educated about health insurance in the US because you are one of the 90% who are clueless about it what it.

I'm sorry, but I must strongly disagree.

There is a tremendous amount of time and bureaucratic cost that has been added to each and every basic office visit, and most of it provides absolutely no value.

What value is created by going back and forth a half-dozen times with EOBs and FSA paperwork for a basic physical? This should be simple - schedule it, show up, get the physical, pay the doctor. Instead, we pay a half-dozen or more people to get in the middle, adding cost and wasted effort.

Insurance is necessary for catastrophic care. It is wasteful for basic preventive medicine, however, and the red-tape monster we have created in both private and government funding models is purely indefensible from a standpoint of cost and efficiency.

 

[DJTorrente]

Sad, but true. ...

I called one of the VP’s at La BC/BS discussing the lunacy of it and all he wanted to do was convince me to become an in network provider. I said NFW if that is the logic used to run their company. That was over 20 years ago. I’m still not in network with any insurance companies.

I had an issue with my spouse needing an emergency dental extraction a few years ago. Due to an HR F*** up, my insurance (and I was not the only person to suffer this) was dropped at open enrollment. I wasn't notified of this fact until I tried to get an oral surgeon appointment on an emergency basis.

The practice was In Network with my insurer. All I asked was "I will pay you cash, in full, whatever you would have gotten from the insurer, and I will hunt down the insurance problem after the fact to reimburse myself." Nope! Cash rates are $****. So I paid, and did straighten out the human refuse occupying the HR department. In the final analysis, after the claim was processed the practice was paid about 1/3 less than the cash price. Mind you, the cash price would not have required the salaries of a gaggle of back office hens to process claims with the insurer.

What I come back to is the wisdom of a friend who navigated the medical insurance labyrinth when his father suffered a TBI -- Medical insurance exists because medical providers want it to. They created it, and it enables ordinary people to pay more for their services than they would have the capacity to pay in its absence.

ETA: And this specific practice advertised itself as "The Official Oral Surgeons of the NJ Devils". So if you want a mouth that looks like an NHL locker room, these are your guys!

 

[jbarrass]

Our system is a wasteful mess for sure. More like pre-paid medical coverage than insurance. But having lived a significant portion of my life overseas in countries "with great government insurance", nope, ours is the best by a long shot.

 

[DJTorrente]

Yes, we are over-insured. What we have today is analagous to buying auto insurance that would cover oil changes, tire rotation, paying to have gas pumped, and pay for someone to come out to your house with a compressor to put air in your tires.

Insurance is supposed to be a sharing of risk. You cannot profitably insure against what is inevitable for everyone -- like needing routine medical care.

 

[robin ardoin]

The American health system is designed to keep people alive just long enough to drain their wallet. The motive is profit, not well-being.

Interesting viewpoint. Being a member of that system, I excuse your ignorance.

 

[Clip4]

I'm sorry, but I must strongly disagree.

There is a tremendous amount of time and bureaucratic cost that has been added to each and every basic office visit, and most of it provides absolutely no value.

What value is created by going back and forth a half-dozen times woth EOBs and FSA paperwork for a basic physical? This should be simple - schedule it, show up, get the physical, pay the doctor. Instead, we pay a half-dozen or more people to get in the middle, adding cost and wasted effort.

Insurance is necessary for catastrophic care. It is wasteful for basic preventive medicine, however, and the red-tape monster we have created in both private and government funding models is purely indefensible from a standpoint of cost and efficiency.

Disagree if you like. You are still clueless. You equated tire changes? What health insurance do you have that buys your shoes?

You think preventative medicine is a waste. Let one women employee in a small business pass on a mammograms and later have stage 4 breast cancer. The premium at the company sky rockets and changing insurance companies doesn’t help you even after her death because the company is rated for claims and cancer care is very expensive with 90% of all health care dollars are spent in last year of life.

Medical costs remain a main driver of bankruptcy in the US and you think people are getting air in their tires.

 

[Katamarino]

Interesting viewpoint. Being a member of that system, I excuse your ignorance.

"Ignorance" is an amusing claim.

Perhaps if medical professionals had more say than insurance staff I'd believe you.

Look how well it's working:

 

[Clip4]

"Ignorance" is an amusing claim.

Perhaps if medical professionals had more say than insurance staff I'd believe you.

Look how well it's working:

So you are supporting the govt health care systems of most the countries in your chart which cover everyone?

 

[DJTorrente]

Look how well it's working:

I can't help but wonder how much of that cost differential reflects drug price caps that foreign governments impose; and manufacturers accept because the US economy is truly subsidizing drug development worldwide.

Perhaps if medical professionals had more say than insurance staff I'd believe you.

From my POV -- taking into account my experience above of being rather severely overcharged as a cash customer -- the insurers are most valuable as price negotiators. Compare the "submitted" cost to the "allowed" cost on your next Explanation of Benefits mailing. It's like having AAA for roadside assistance negotiated in advance instead of haggling with the tow driver while your car is steaming out on the side of the road.

 

[Katamarino]

So you are supporting the govt health care systems of most the countries in your chart which cover everyone?

100% yes. I have lived in five of the countries on the chart, and the US system is so inferior overall that it's sad.

Note that most Americans are ignorant of the fact that private insurance is available, and affordable, in pretty much all of the countries mentioned.

 

[robin ardoin]

"Ignorance" is an amusing claim.

Perhaps if medical professionals had more say than insurance staff I'd believe you.

Look how well it's working:

That one graph has more to say about the general health and lifestyles of the population and has zero relation to purported sole profit motive of healthcare in the US. Try again, please.

 

[robin ardoin]

100% yes. I have lived in five of the countries on the chart, and the US system is so inferior overall that it's sad.

Note that most Americans are ignorant of the fact that private insurance is available, and affordable, in pretty much all of the countries mentioned.

Well then, I defer to your expertise. Carry on, worldly traveler.

 

[Katamarino]

That one graph has more to say about the general health and lifestyles of the population and has zero relation to purported sole profit motive of healthcare in the US. Try again, please.

Why would I need to try again?

You literally posted your own example of a non-sensical decision where funneling money to a particular "favoured" provider took priority over using the money efficiently to help patients, despite your best efforts as the actual professional.

 

[Katamarino]

I can't help but wonder how much of that cost differential reflects drug price caps that foreign governments impose; and manufacturers accept because the US economy is truly subsidizing drug development worldwide.

I think the biggest chunk of the difference would come from the fact that while all the other countries are paying for actual healthcare, the US is paying for both their healthcare and also millions of useless insurance middle-men who are nothing but leaches on the system, and actively get in the way of people receiving treatment.

 

[DJTorrente]

I think the biggest chunk of the difference would come from the fact that while all the other countries are paying for actual healthcare, the US is paying for both their healthcare and also millions of useless insurance middle-men who are nothing but leaches on the system, and actively get in the way of people receiving treatment.

Well, those leeches, as you put it, ended up saving me considerable coin, even after accounting for the costs they imposed on the provider (see, "back-office hens") and something for their trouble. YMMV.

 

[Katamarino]

Well, those leeches, as you put it, ended up saving me considerable coin, even after accounting for the costs they imposed on the provider (see, "back-office hens") and something for their trouble. YMMV.

This is Stockholm syndrome.

The only reason that the absurdly high prices are quoted up front is due to the way the insurance companies work. If they weren't involved then the up front price would have been sensible to start with. Try pricing say a hip replacement as a cash customer in the US vs Spain.

The actual medical professionals in all these countries including the US are great. The unique factor that wrecks the US is the giant sponge that is the insurance industry.

 

[DJTorrente]

This is Stockholm syndrome.

The only reason that the absurdly high prices are quoted up front is due to the way the insurance companies work. If they weren't involved then the up front price would have been sensible to start with. Try pricing say a hip replacement as a cash customer in the US vs Spain.

The actual medical professionals in all these countries including the US are great. The unique factor that wrecks the US is the giant sponge that is the insurance industry.

If you say so. Good luck with NHS.

 

[Baked Potato]

Well, those leeches, as you put it, ended up saving me considerable coin, even after accounting for the costs they imposed on the provider (see, "back-office hens") and something for their trouble. YMMV.

I'm not sure that a system where one must pay a considerable monthly fee to a third party in order to receive a lower price than someone who directly pays the provider of a service is a great endorsement of said system.

 

[StraightnLevel]

You think preventative medicine is a waste.

I did not say that. I said that INSURING for preventative medicine is wasteful.

If you know that over the course of a year you will see a doctor twice for regular check-ups and normal tests, and the doctor will receive $2K (totally fictitious number) for those services, then we should be going to the doctor and paying him/her $2K. Instead, we pay $1,800 in copays and insurance premiums deducted from our paycheck and placed into HSA/FSA accounts, our employer pays $2,500, and a whole lot of people in between create paperwork and filings that don't improve the quality of care nor change the outcome one little bit.

Nothing makes my blood boil faster than hearing a politician state that "people need health coverage". NO! People need health CARE, not health "coverage."

IMO (admittedly not especially well-versed in medical technology), our doctors are as good or better than anywhere else in the world. I just see far too many other leaks in the financial system surrounding medical care in the US, and that is part of the reason our total expenditures are so darned high without showing a commensurate benefit in improved outcomes.

 

[DJTorrente]

I'm not sure that a system where one must pay a considerable monthly fee to a third party in order to receive a lower price than someone who directly pays the provider of a service is a great endorsement of said system.

Do you have AAA roadside coverage? An equivalent through your auto insurer? How about 128 million households who pay $60/yr for membership to Costco? Its a very workable business model.

 

[Baked Potato]

Do you have AAA roadside coverage? An equivalent through your auto insurer? How about 128 million households who pay $60/yr for membership to Costco? Its a very workable business model.

Well, no, I don't have AAA or Costco membership.

I don't see that it would be a challenge for me to obtain towing services, paper towels, or a flat screen TV without those, with freedom of selection and price comparable to people who do have those subscriptions.

 

[DJTorrente]

Well, no, I don't have AAA or Costco membership.

I don't see that it would be a challenge for me to obtain towing services, paper towels, or a flat screen TV without those, with freedom of selection and price comparable to people who do have those subscriptions.

Hey, I was against Obamacare. As far as I'm concerned, you don't "HAVE" to buy health coverage either. But I digress...

As a cash customer, my experience is that it was and is a challenge to pay a reasonable market rate for medical services in the US. YMMV. Hell, I once couldn't even get any of several practices' billing managers to quote me a simple price. If they don't know, who would? That problem was solved when I presented as an in-network insured.

 

[Katamarino]

If you say so. Good luck with NHS.

Thanks. Good luck paying more and dying younger.

 

[robin ardoin]

Thanks. Good luck paying more and dying younger.

But we die with nicer teeth!

 

[DaleB]

Do you have AAA roadside coverage? An equivalent through your auto insurer?

Those are profitable because the vast majority of roadside assistance customers will never need roadside assistance; those customers fund the ones who do need a tire changed or a jump start or a tow. You can assume that pretty much everyone will need to see their doctor.

How about 128 million households who pay $60/yr for membership to Costco? Its a very workable business model.

Not understanding the parallel with Costco here... my Costco membership in and of itself gets me nothing other than through the door of a Costco store.

 

[Clip4]

I did not say that. I said that INSURING for preventative medicine is wasteful.

If you know that over the course of a year you will see a doctor twice for regular check-ups and normal tests, and the doctor will receive $2K (totally fictitious number) for those services, then we should be going to the doctor and paying him/her $2K. Instead, we pay $1,800 in copays and insurance premiums deducted from our paycheck and placed into HSA/FSA accounts, our employer pays $2,500, and a whole lot of people in between create paperwork and filings that don't improve the quality of care nor change the outcome one little bit.

Nothing makes my blood boil faster than hearing a politician state that "people need health coverage". NO! People need health CARE, not health "coverage."

IMO (admittedly not especially well-versed in medical technology), our doctors are as good or better than anywhere else in the world. I just see far too many other leaks in the financial system surrounding medical care in the US, and that is part of the reason our total expenditures are so darned high without showing a commensurate benefit in improved outcomes.

You are arguing efficiency. Paying for chemo to extend the life of a cancer patient 6 months isn’t efficient and that care at the end of life costs 90% of resources.

Medicare doesn’t pay for many preventative care services because people are old. Preventive care is for the young and middle age folks. You say insurance pays for the equivalent of oil changes. Medicare pays only 3 pints of blood over your life. After that, You pay.