Insurance companies are strange.

[Maxmosbey]

I have had to make claims on my auto insurance twice in as many months. I'm sure that I'm going to be punished for it, but I made the claims anyway. The first was my wife got a huge chip in the windshield of her Solstice. We took it in to the dealership to get an oil change, and I asked the people in the service department if they would look at it and tell me what they could do. They said that they would have someone from the body shop look at it. So they called back a half hour laater and said that they could not repair it, so they needed to replace it. I asked them how much, and they told me $240. Now to set the stage, the car was at G...W.. Chevrolet getting all of this done. So I called up my insurance company, which is Allied Insurance and told them the story. The lady says, "you need to take it to one of our certified glass repair centers to get an estimate." I asked where a certified glass repair center was, and she said that there were several in Ames. So I asked if she might let me know the names of the places. She read off a llist. The third one was G...W...Collision Center. I say, "it is sitting at G....W.... right now. They are the ones that say that it has to be replaced." The lady became confused. She says that she thought that I had it somewhere getting the oil changed. I told her yes, I'm having the oil changed at the dealership. She says again that I have to take it to a certified glass repair centers. I said that G...W.. Collision Center is part of G...W...Chevrolet. She thinks about that for a little while, and then asks me if I want them to do the work. I tell her I do. She says that she will have to call G...W... Collision Center and see if they will replace it for what Allied will pay, or something like that. She calls back in ten minutes and says that they will replace the windshield, but warns me I will be responsible for $50. She doesn't tell me, she warns me. I say that is fine. So I pick up the car later in the day, and the bill says that I owe $50, and it shows that they charged the insurance company $301. What the heck, why can I get a better deal than the insurnce company? Does the insurance company not know that I could get them a better deal? Do they know that the collision center quoted me a lower price? The only think I can think of is that perhaps they are charging more because they have to do a bunch of paperwork for the insurance company, that they wouldn't have to do for me. I don't know though. That is just why my dentist told me he charges the insurance companies so much more than he does otherwise.

The second was last week. I backed into my housekeeper's car. I didn't hit it that hard, but somehow I broke a line to an oil cooler, and had to have it towed. I called the insurance company so they said that I would have to have it towed to an authorized collision center. I asked where there was an authorized collision center and she rattled of a bunch of body shops in Ames here. So my housekeeper picked one. I'll just call it XYZ body shop. I have done business with them before, and they are a good place, but they are a body shop. For a broken oil line I would think that they would send it to a garage, and I even suggested a particular garage, but what the heck. So I asked if I needed to call XYZ and have them come and get the car. The insurance lady said that they contracted with certain tow services, and that she would have one of their "authorized" tow centers send a tow truck to have the car hauled to XYZ. I said,"XYZ has a tow truck, why don't we just have XYZ come and get it", Nope, they would send someone. So an hour and a half later, a wrecker from the garage that I had recommended in the first place shows up to haul the car to XYZ. That whole thing just seems way more complicated than it needs to be. I have to think that they could save a lot of money if they wanted to. What the heck is going on with them?

 

[N801BH]

Sounds to me like you made 61 dollars on the windshield replacement. Surely the cashier at GW can 'adjust' the bill to reflect that.

The second collision is about par for the course.. The insurance people know more then us dumb folks so just sit back and laugh at their chaos.

On your next premuim renewal you better fasten your seatbelts and have the airbags enabeled as that is gonna be a sticker shock. Better yet start shopping for another insurance carrier now.

 

[steingar]

For the first time I have had two insurance claims to different companies. I truly can't complain about either (Progressive and State Farm), at least not yet. I rear-ended a soccer mom in a land yacht on the Goldwing and Progressive took care of it almost effortlessly. The house is getting a new roof, and despite having tried to eat a roofing estimator, I've already been issued a cheque. I've heard so many horror stories about insurance companies, but I have no cause for complaint.

 

[Maxmosbey]

Sounds to me like you made 61 dollars on the windshield replacement. Surely the cashier at GW can 'adjust' the bill to reflect that.

The second collision is about par for the course.. The insurance people know more then us dumb folks so just sit back and laugh at their chaos.

On your next premuim renewal you better fasten your seatbelts and have the airbags enabeled as that is gonna be a sticker shock. Better yet start shopping for another insurance carrier now.

I didn't make anything on the windshield replacement. I paid my glass breakage deductible of $50, and the dealership charged the insurance company $301 for the replacement. I just walked out of there with a $50 windshield.

I'm wondering about when I renew again. I've been with them for 35 years. Do you think they will throw me under the train? Stupid question, sure they will.

 

[Ghery]

I'm amazed that State Farm lets me keep my 0 deductible comprehensive coverage. My Jeep Wrangler is a rock magnet and they've paid for a number of windshields in the past 11 years. That premium isn't insurance, it's an investment that pays off.

 

[vontresc]

Actually I bet your Dealership billed them $301, and after the insurance applies some sort of discount formula they get paid $240. I know it seems dumb but that's the reality. It's even worse in health insurance, but I don't want this to go to the spin zone.

 

[imQ]

My customers and I fight this battle all the time. I work with the body shop to get a good price on an OEM part, both of us making a little money, and the ins co will insist on a reconditioned or used part 100 miles away in an attempt to "save" money. After freight, (sometime)repairs, and lost time, I was cheaper with the new part. And a bunch of the time, the recon part is junk, and I get to sell the new part anyway. Go figure.

 

[COFlyBoy]

Strange things happen in medical insurance too. Have you ever looked at what a doctor or a hospital charges the insurance company vs what the insurance company pays? The bills I've looked at (I've looked at 3 or so) the insurance company paid approximately half of what was billed.

OTOH, if you have no health insurance you pay the billed rate.

 

[weilke]

Strange things happen in medical insurance too. Have you ever looked at what a doctor or a hospital charges the insurance company vs what the insurance company pays? The bills I've looked at (I've looked at 3 or so) the insurance company paid approximately half of what was billed.

This billing practice is the result of federal goverment mandates.

OTOH, if you have no health insurance you pay the billed rate.

If you call up the business office and offer 1/2 of the bill as final settlement today, they will gladly take it. Again, the feds require that you receive the phantasy bill first.

 

[gprellwitz]

This billing practice is the result of federal goverment mandates.



If you call up the business office and offer 1/2 of the bill as final settlement today, they will gladly take it. Again, the feds require that you receive the phantasy bill first.

Could you provide a cite for that please? In the words of Ray Magliozzi, that sounds Bo-o-o-gus!

 

[Tom Veatch]

Could you provide a cite for that please? In the words of Ray Magliozzi, that sounds Bo-o-o-gus!

Wait until you get on Medicare and you'll see it first hand.

 

[Trapper John]

I'm wondering about when I renew again. I've been with them for 35 years. Do you think they will throw me under the train? Stupid question, sure they will.

The comp claim for the windshield shouldn't affect your premium at all. The minor collision will cause a temporary bump, maybe 10% for 3 years as long as you don't have another claim in the meantime.

 

[Dr. O]

All insurers require that you call them FIRST... They will designate the shop(s) and how the vehicle gets there, not you...
I recently had a broken windshield when a loaded dump truck went past me and chucked a 5 pound boulder off its load at that instant (jeeps are not the only rock magnets) onto my spanking new Silverado and I had to drive with my head hanging out the window to see... I called the insurance agency on my cell phone, the lady said take it to xyz auto glass shop about 3 miles away (she offered a tow truck but I said that I had seen Ace Ventura and knew how to do this)... She called ahead, they had the door up when I got there and 90 minutes later I drove out with a new windshield... All it cost me was a fraction of a cent of ink off my ball point pen...
It is amazing how easy it is when you follow the policy...
BTW, the bill I signed was $244 and a couple of cents, and the owner said that was the amount they would pay him per his contract... I wish Medicare would pay its bills to me that way - ya gotta bill a zillion dollars to get $34 for an office call...

denny-o

 

[weilke]

Could you provide a cite for that please? In the words of Ray Magliozzi, that sounds Bo-o-o-gus!

As a medicare provider (which 90+ of practice are), you have to give the feds 80% of 'your best price'.
If a CMS recovery contractor comes around to audit your billing practices and finds that you have been giving other customers a price lower than what you charge to medicare, all your medicare reimbursements for the last 5 years are scaled down to 80% of that 'best price' and you owe the goverment the difference between that and what you actuallly received*.

As a result, every medical bill has a 'funny money' number that is billed out to the insurance company or patient. The insurance companies, similar to medicare, have 'allowed charges' that they reimburse, the overage is autmatically written off.

*exception are approved sliding scale fee scales for low income patients, but that is something mostly for community health centers etc.

 

[Gerhardt]

I had a similar occurrence with my insurer a few years ago. Broken back glass on the SUV. The first estimate was $3,100, so I called a few more shops. Each would ask if I already had estimates, and what the prices were, and they beat the lowest price by a few hundred. After several calls I get the best price at $750. Then I called my insurer to report the claim and give them the price.

A few days later I'm at work and looking at the claim payment (I work for my insurance co.) and see that they paid around $2K. I called the adjuster and asked why they paid $2K when I told the claim rep. on the phone that I had an quote of $750. The adjuster explains that they have a deal w/ the glass shop for a standard % discount off retail and that's the amount they pay. Insurance companies are indeed strange.

I'll be damned if I can figure out how they can afford to pay me for surfing the net all day either.

 

[Maxmosbey]

Now granted, my wife and I take good care of our teeth, but we have not had dental insurance for five or six years. So far, we have been able to beat the premiums. We go in three times a year, for cleaning. So far so good.

 

[RMCN172RG]

Could you provide a cite for that please? In the words of Ray Magliozzi, that sounds Bo-o-o-gus!

Without the gory details Medicare will only n% of the billed price for procedures. let say 50%.

So if you go for a procedure that the hospital needs $100 in revenue to cover the costs they have to charge a minimum of $200 to receive the $100 from medicare patients.

This is compounded by insurance negotiated discounts which the Feds caught on to so if the insurance company is looking for a 30% discount the non insured patient is billed a minimum $260.

That way the government and the insurance company are both saving us money

 

[gprellwitz]

Wait until you get on Medicare and you'll see it first hand.

As a medicare provider (which 90+ of practice are), you have to give the feds 80% of 'your best price'.
If a CMS recovery contractor comes around to audit your billing practices and finds that you have been giving other customers a price lower than what you charge to medicare, all your medicare reimbursements for the last 5 years are scaled down to 80% of that 'best price' and you owe the goverment the difference between that and what you actuallly received*.

As a result, every medical bill has a 'funny money' number that is billed out to the insurance company or patient. The insurance companies, similar to medicare, have 'allowed charges' that they reimburse, the overage is autmatically written off.

*exception are approved sliding scale fee scales for low income patients, but that is something mostly for community health centers etc.

Without the gory details Medicare will only n% of the billed price for procedures. let say 50%.

So if you go for a procedure that the hospital needs $100 in revenue to cover the costs they have to charge a minimum of $200 to receive the $100 from medicare patients.

This is compounded by insurance negotiated discounts which the Feds caught on to so if the insurance company is looking for a 30% discount the non insured patient is billed a minimum $260.

That way the government and the insurance company are both saving us money

I wouldn't characterize the insurance billing practices as being the result of federal mandates as much as being the medical industry's attempt to maximize their revenue given Medicare's attempts to minimize their expense. Yes, Medicare is the 1000# gorilla, but I don't think that there is a law requiring a doctor or hospital to accept Medicare patients. If it is more financially attractive to not accept them than to work the system like this, then that is what they can do.

That said, I suppose one could characterize it as a result in the same sense that it is an unintended consequence.

 

[RJM62]

After 30 years of claim-free driving, I had two claims within one week last year.

The first was a tail-ender (my fault). The fellow in front of me was making a right turn, and I was trying to get around him on his left. I looked left while moving to check for pedestrians, and he stopped when a pedestrian stepped in front of him. I hit his left rear with my right front at low speed. It caused apparently minor damage to both our cars. Yeah, right. Came out to more than five grand when all was said and done.

No biggie, though. Geico set me up with a collision shop and a free rental car while the work was being done. It was all very painless, I might add.

Then I was on the freeway in the rental car when a truck in front of me shed a tread, and there was really no way for me to avoid hitting it. I tried to veer right (there were cars on my left), but it still wacked the front bumber of the rental car. Another five hundred in damages.

I thought sure Geico was going to raise my rates, but amazingly, they didn't. In fact, my next policy renewal came with a reduction. I never called them to ask why, obviously...

-Rich

 

[weilke]

Yes, Medicare is the 1000# gorilla, but I don't think that there is a law requiring a doctor or hospital to accept Medicare patients.

A hospital with a emergency room has to accept/admit ANY patient that presents for treatment.

Medicare considers any provider to be a medicare provider by default. Only if you actively opt out for a prolonged period of time you are not subject to medicare price controls. Through the mechanism mentioned, those controls affect patients who are not medicare beneficiaries.

Their influence on the market is more than their market share would suggest. Rather than a gorrilla, they are more of a mafia Don.

 

[lprellwitz]

As noted, the EMTALA laws on emergency treatment are more far-reaching than just Medicare patients.

With Medicare and other insurance companies, my understanding of the basic premise is the same - you sign a contract, agreeing to accept the reimbursement they wish to pay you for treating patients. Other than having your charge being consistent across all patients, there's no guarantee that you get paid what you charge - most times (unless you're in an area that typically isn't covered by insurance, such as pure cosmetic surgery), providers - docs, hospitals, anyone - don't get paid this amount; and your reimbursement typically doesn't cover the actual cost of care either. One of the few industries where this is actually accepted practice, still can't quite understand that - either that, or let me 'write my own payment' next time I go to fill up the gas tank .

Medicare does have a large influence, I'd say because they're one of the few payers that operates on a national scale; if I'm an insurance company, and I see that Medicare has negotiated a set payment rate for a given type of illness and/or procedure in my market, why should I have to pay the same provider more for my beneficiaries? Multiply that thinking by the U.S. overall, and the rationale behind the negotiation methods become clearer, even if we're not happy with the results.

For those who don't have insurance, we're sort of back in the EMTALA world, where hospitals are under obligation to treat patients regardless of the ability to pay. There are some programs that will work to see if patients quality for an insurance or grant program while they're in the hospital - sometimes even the patients aren't aware of what's out there. The result will likely not pay all the bills, but some reimbursement is better than none, I suppose.

If there's no program available, sometimes providers will work out a payment plan or reduce the fees themselves for those who don't have funds. Can't say it always happens (I'm sure there are many tales where it doesn't), but after a while, it's going to start costing the provider more to try to get paid than it is to simply write off the balance.

An odd world, to be sure; I just wish our medical providers and hospitals got paid more in line with their value. Seen too many places have to cut back on service, or close altogether, because they can't afford to maintain their practice, either through low payments or because of the cost of the staff they need to hire to navigate through the myriad of regulations and paperwork.

Wonder if the barter system would still work - I get the medicine I need, I give part ownership in a cow or something as payment. Just got to make sure we don't end up replacing one fee schedule for another

 

[Doggtyred]

Could you provide a cite for that please? In the words of Ray Magliozzi, that sounds Bo-o-o-gus!

Its true..

Insurance companies negotiate prices on volume. A solitary self pay consumer doesn't have that ability.

Medicare pays 80% of a maximum price that MEDICARE stipulates. Many insurance companies also set maximums that tend to mirror the CMS (medicare/medicaid) ceilings. In effect, its legalized price fixing.

A self pay/uninsured person gets the full non-discounted rate. But you walk in with CASH chances are you will end up paying less than full. Pay it off in installments and you likely will be paying the rest of your life.

 

[Doggtyred]

A hospital with a emergency room has to accept/admit ANY patient that presents for treatment.

Not exactly.

Actually that rule is only binding on providers that participate in medicare/medicaid. Thats how the rule is attached, via the purse strings. That rule also says that it is obligated to treat, or stabilize EMERGENCIES.. as defined by the facility.. as examined by a screening provider (usually a physician).

EMTALA, COBRA, HIPAA... all are contingent on participation in the medicare/medicaid system. So if you opened "Bobs ER" and did not have a CMS number or accept medicare/medicaid as a form of payment, you actually dont have to comply.

And if it IS a CMS participating facility under EMTALA.. if you show up with a stubbed toe from last week and no insurance, you very likely WILL be declared a non-emergency and asked to pay up front before treatment.

The reality: CMS is a major source of funding for practically every healthcare provider and facility in the nation, so the CMS rulemaking process affects 99% of the folks out there.

An example of someone who doesn't (or didn't in the past, if its changed) have to follow CMS guidelines: Shriners Hospitals for Crippled Children. They dont bill (or didn't last time I checked).. and are completely charity supported.

 

[weilke]

An example of someone who doesn't (or didn't in the past, if its changed) have to follow CMS guidelines: Shriners Hospitals for Crippled Children. They dont bill (or didn't last time I checked).. and are completely charity supported.

You have found the only example of publicly accessible hospitals in the US that would not be subject to EMTALA (if they had ERs, they are largely rehab and advanced care facilities, even emergency burn admissions are transfers from other facilities).

Most private hospitals that don't want to be subject to EMTALA simply don't maintain an ER accessible to the public and rather operate an 'acute care receiving center' (or something with a similar tortured name) that requires referral by a provider priviledged at the facility.

And if it IS a CMS participating facility under EMTALA.. if you show up with a stubbed toe from last week and no insurance, you very likely WILL be declared a non-emergency and asked to pay up front before treatment.

In reality, the hospital will fix the toe, send a bill, write it off after 90 days and wrap the expenses into the general overhead (paid for by the insured patients) rather than risking lengthy litigation revolving around emergency definitions.
Unscrupulous legal practicioners have pretty much warped the EMTALA emergency definition into 'It is an emergency if the patient thinks it is one'. The hospitals position to refuse treatment after a initial screening examination is very very weak.

 

[Doggtyred]

In reality, the hospital will fix the toe, send a bill, write it off after 90 days and wrap the expenses into the general overhead (paid for by the insured patients) rather than risking lengthy litigation revolving around emergency definitions.
Unscrupulous legal practicioners have pretty much warped the EMTALA emergency definition into 'It is an emergency if the patient thinks it is one'. The hospitals position to refuse treatment after a initial screening examination is very very weak.

In reality you are incorrect.

Please try not to convince me that hospitals aren't doing what I described, when I am part of the process that makes it happen.

And.. to put it in perspective, refusing treatment is one thing. Asking for payment up front for a clear non emergency is another.. and perfectly reasonable.

 

[Henning]

I didn't make anything on the windshield replacement. I paid my glass breakage deductible of $50, and the dealership charged the insurance company $301 for the replacement. I just walked out of there with a $50 windshield.

I'm wondering about when I renew again. I've been with them for 35 years. Do you think they will throw me under the train? Stupid question, sure they will.

Not necessarily. Insurance is a competitive business. If you have a good history with them over the last 7 years, say no more than a $3000 claim every 2 years, you fall well within their actuary table for a "safe driver" rate so you probably won't see anything from a major carrier, I'm not familiar with Allied though, I've only done auto for Allstate and State Farm. Several carriers even advertise "Accident Forgiveness". The name of the game is retaining customers who fit the actuarial model. Windshields are even more widely forgiven as just "matter of course" and many states have written in free no hassle windshield replacement in the policy because small claims courts were getting too active with "He kicked up or dropped a rock and it broke my windshield." cases. Many states insurance companies are not allowed to hold windshields against you.

As for your experience with the cost of the windshield, there is often a difference in price between "cash price" and "insurance price". There are 2 main factors involved, you have an extra hour and a half's worth of paperwork documenting and submitting, and it takes longer to get your money. The probably only bill the insurance company $180 for the glass and install, 10% + 10% profit and overhead and the rest was what they are allowed under their contract for a claims handling allowance in lieu of having to send an adjuster. They probably don't have in house adjusters which is why you have to go to a designated shop which has a claims handling contract with the insurance company. If they need an adjuster to get involved, they'll have to call an independent and that will cost them more than the rest of the claim.