I am going to lose my mind with health insurance...

[Slew Foot]

Welcome to the American health insurance industry. Where no one knows anything and everything is designed to be one giant clusterfuck so that you get pissed off and pay the bill yourself.

 

[squarecut1]

How you describe your experience above is all too painfully familiar to me. It is a deliberate racket... these insurance companies.

I really do feel your pain and frustration and wish there was something I could do

 

[shadow9d9]

Insurance has been and always will be absolute bullshit when it comes to health. They are a scammy middleman that sucks money away from the system. Dealing with them is an absolute nightmare. For too long, employers have shielded the reality of health insurance from people. It has nothing to do with the ACA regulations. The regulations still make you deal with the same scumbag companies, because no public option is available.

It is a good thing that people have to deal more hands on with insurance companies now. They will see what nonsense the whole scam is.

 

[Strk]

1. There are approximately 397,000 primary care physicians in the US. There are 314M people in this country. That means physicians on average see less than 800 patients. So, what's your point?
2. Does this include janitors, food workers, receptionists, back office employees? Or are you just pissed and jealous that executives make more money than you?
3. Corporations are groups of folks, many times like-minded, some times not. Either case, a Corporation does not exist without people. If a collective wants to push an agenda, should they not have that right? Unions, Non-profits, advocacy groups, etc. all do the same lobbying and many of them are not Corporations.

The part that makes me laugh is the two expensinses that we're way above other countries are administrative and ambulatory care. We're only a bit ahead on the others. The amount we spend on hospital care isn't much more than other countries.

The ambulatory care expense doesn't make sense to me. EMTs are paid very little. The paramedics, who actually can actually administer heroic measures and a few narcotics (5, I think) aren't paid all that much either. I don't think they even go above $40k without a bunch of OT.

 

[Pulsar]

It sounds to me like the office manager doing the coding and insurance claims are to blame in most of that.

My wife and I have private insurance (double covered) and they screw stuff up all the time. We got a huge bill, but it was obvious they didn't run the second card yet....we called to complain and 2 weeks later, they sent another bill with a different amount. Finally, they sent a "FINAL NOTICE" and threatened to send the bill to collections....and it had a different amount owed on it. All of these bills came from the doc office and it was because they filed it incorrectly.

We've had problems as well even with top notch coverage. While I hate the way the ACA was implemented, I'm laying the blame at the providers doorsteps. This is one of the reasons why health care is so expensive. Can you imagine if they were FORCED to place the costs for different procedures on a menu so that we could all see what we would pay in advance?

My wife recently went into the ER. She tried to pay right then, because there was a 30% discount if you paid immediately. We have a $100 co pay. She had cash on her, but get this - the ER wouldn't take cash. So they billed her and told her she could pay the 70% when we got the bill.

Got the bill, and it was for $115. She called and told them she'd pay the agreed $70 over the phone. She has a photocopied SIGNED receipt from the ER cashier stating she owed $70.

They argued. We pointed out our co-pay for ER is $100. They told us they were charging 'co-insurance'. I told them to fuck off, and that my co-pay was $100. They threatened. We yelled. We took a picture of the signed receipt saying we owed $70 and emailed it to the billing agent on the phone, and she hung up on us.

My wife finally got it sorted by showing up at the ER, with a lawyer friend of ours. This is what happens when a staple of your life like health care gets run through the free market system. You've got no choice, because it's literally life and death, and they hold all the cards.

 

[DrPizza]

This is the fourth time I've contacted my insurance company in order to fix the many errors in my claims. The CS reps obviously can't tell me much other than it'll take 30 days... or 45-60 days... or they've expedited the claims and it'll take 35 days. I can't really get angry with them as they probably just tell me what they're told to say... so I've now asked three times for a supervisor, been put on hold for at least 10-15 minutes all three times and told every time that the current supervisor is on the phone with someone else. I've also been told several times that I would be called back to no avail. I have been told the supervisors have no direct lines. I have been told that extra supervisors come in after 5pm. I have been told supervisors leave at 4pm. I have the name of three supervisors, all of whom are unrecognizable to CS reps I call to follow up on. Are these supervisors ghosts???

Either I'm blatantly being lied to or there are some very serious issues going on with the company. In the meantime, my ability to either budget or pay medical bills as they come in is a complete crapshoot. Somebody has to know SOMETHING and if I have to call 5 times a day, EVERY day, I will get an answer to my questions.

"Hello, I am recording this call for quality control purposes." People don't try to pass the buck when they know there's a physical record of how they conduct their job.

 

[Attic]

We've had problems as well even with top notch coverage. While I hate the way the ACA was implemented, I'm laying the blame at the providers doorsteps. This is one of the reasons why health care is so expensive. Can you imagine if they were FORCED to place the costs for different procedures on a menu so that we could all see what we would pay in advance?

My wife recently went into the ER. She tried to pay right then, because there was a 30% discount if you paid immediately. We have a $100 co pay. She had cash on her, but get this - the ER wouldn't take cash. So they billed her and told her she could pay the 70% when we got the bill.

Got the bill, and it was for $115. She called and told them she'd pay the agreed $70 over the phone. She has a photocopied SIGNED receipt from the ER cashier stating she owed $70.

They argued. We pointed out our co-pay for ER is $100. They told us they were charging 'co-insurance'. I told them to fuck off, and that my co-pay was $100. They threatened. We yelled. We took a picture of the signed receipt saying we owed $70 and emailed it to the billing agent on the phone, and she hung up on us.

My wife finally got it sorted by showing up at the ER, with a lawyer friend of ours. This is what happens when a staple of your life like health care gets run through the free market system. You've got no choice, because it's literally life and death, and they hold all the cards.

Yep, still wow at not just paying the $115.


I'm getting steamrolled by the ACA as well. Frustrating part is being aware of just how many lies were used to get this pile of garbage through.

Why not just be honest and get something better through? If honest about the mess before passage it gets fixed before passage. I don't get why their was such a need to hide the clusterfuck from us before we get owned by it. I get that it was a massive money grab and handout to big insurance, but damn if we didn't get sold out by the congressmen pushing this crap.

 

[bwanaaa]

1. There are approximately 397,000 primary care physicians in the US. There are 314M people in this country. That means physicians on average see less than 800 patients. So, what's your point?
2. Does this include janitors, food workers, receptionists, back office employees? Or are you just pissed and jealous that executives make more money than you?
3. Corporations are groups of folks, many times like-minded, some times not. Either case, a Corporation does not exist without people. If a collective wants to push an agenda, should they not have that right? Unions, Non-profits, advocacy groups, etc. all do the same lobbying and many of them are not Corporations.

1) your data of 397000 is from the first citation of a google search for "how many physicians in the US". from Kaiser Foundation. Reviewing the remaining citations reveals varying Estimates. The AMA said there are 208000 practicing primary care MDs.
http://www.ahrq.gov/research/findings/factsheets/primary/pcwork1/index.html
The definition of active practicing physicians are those that work 20 hours a week. So in terms of full time physicians, their panel would have to be adjusted upwards proportionally to compare against full time physicians when it comes to answering the question "how many physician hours are available for sick people"
Only physicians prepping for retirement carry 1000 patients or less. You cannot afford your overhead otherwise.Typical panels are 2000-4000.

2) 35% of the premium dollar is spent on activity that is not directly related to patient care but lumped under administrative overhead. And this goes to a segment of the healthcare system that adds little value to what the patient receives. Making more rules and hiring more people to make sure the rules get followed is inefficient. It is an attempt to centralize a transaction that should remain much more localized. As a janitor, you do honest work. You make the hospital cleaner and cut down infection rates. But when the hospitals reduce janitorial staff they should also reduce management compensation. After all, there are fewer employees to manage. But their compensation packages never go down.

3) Though corporations are people, they unfairly influence legislation.And yes, advocacy groups have become complex and invisible (the Koch brothers for example) And that tendency has been gaining momentum with the development of PACS and SuperPACs. Their ability to raise capital through various financial tools not available to individuals gives them an unfair advantage. What is abrasive is the concept that financial incentives influence decisions that are swayed to benefit smaller but wealthier groups as compared to larger groups of people who are agnostic to financial leverage.

 

[shadow9d9]

Yep, still wow at not just paying the $115.


I'm getting steamrolled by the ACA as well. Frustrating part is being aware of just how many lies were used to get this pile of garbage through.

Why not just be honest and get something better through? If honest about the mess before passage it gets fixed before passage. I don't get why their was such a need to hide the clusterfuck from us before we get owned by it. I get that it was a massive money grab and handout to big insurance, but damn if we didn't get sold out by the congressmen pushing this crap.

You are getting steamrolled by corrupt and greedy insurance companies, not regulations trying to get them to behave.