*rant* insurance companies and the US healthcare industry can kiss it

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Captante

Lifer
Oct 20, 2003
30,316
10,814
136
My last boss had his entire mouth done with implants and $50k was substantially more (like nearly double!) then he paid for the whole dang thing ... and he's a wealthy man by "Darien CT" standards so he's "really" loaded and paid cash.

I'm beginning to suspect certain folks around here are actually full of baloney.

Ever notice how people who brag a lot tend to be liars?

;)
 
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nakedfrog

No Lifer
Apr 3, 2001
59,239
13,840
136
As the saying goes, teeth are luxury bones.

And y'all are reminding me I need to apply for VA healthcare, so maybe by the time I'm retired I'll be approved for it...
 

Meghan54

Lifer
Oct 18, 2009
11,684
5,222
136
I'm just glad I'll be eligible for Medicare in roughly 6 more years.... hopefully I'll survive until then!

:oops:

AND the travesty is that unless you buy expensive "gap" insurance Medicare doesn't fully cover a whole lot of stuff, however usually it's the care-PROVIDER (Doc and/or hospital) that gets screwed by this after the fact.


Plan G in GA is $95/mo 67 yo female; $121/mo for 68 yo male.

I rationalize the cost by telling myself I’m just pre-paying the in-hosp deductible by monthly payments. Who cares if I haven’t been hospitalized in decades….

It also pays fully for MD office visits w/ no co-pay, all labs, radiology, etc

But you’re correct…a fuckin travesty that I have to pay over $250/mo for health ins at my age. But the coverage is decent.
 
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ponyo

Lifer
Feb 14, 2002
19,688
2,810
126
My last boss had his entire mouth done with implants and $50k was substantially more (like nearly double!) then he paid for the whole dang thing ... and he's a wealthy man by "Darien CT" standards so he's "really" loaded and paid cash.

I'm beginning to suspect certain folks around here are actually full of baloney.

Ever notice how people who brag a lot tend to be liars?

;)
Unless you have absolute proof, don't go around calling people liars. So your old boss had some dental work done long time ago. So that makes you expert on dental costs and treatment? Something can't be true because it seems impossible to comprehend in your tiny little world? You and I live in completely different world and lives. You have no idea how little or much money I have. You might have thought your old boss was rich and maybe he was. But how do you know if he was richer or poorer than me? What do you know financially about me?

This is treatment my mom received. Total treatment was $50,357 which I paid.
 
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Captante

Lifer
Oct 20, 2003
30,316
10,814
136
xgzfz.jpg


(also TL: DR) ;)
 

nakedfrog

No Lifer
Apr 3, 2001
59,239
13,840
136
And dental insurance would have covered maybe $1500 of that in a single year :confused_old:
It might have gotten some discounts though, the crown I got last year was billed at $1227, discounted to $990, the "plan eligibility" amount was $869, and insurance paid $355 of it, leaving me with $636.
 

otho11

Member
Feb 16, 2011
117
22
81
Check out the stock performance for United Healthcare, Anthem etc. They've more than doubled up the total market in the last 5 years. It's gross. CVS owns Aetna and Caremark, so it sells insurance, sells drugs and negotiates prices with itself.

Universal healthcare should absolutely happen ASAP. The insurance companies supposedly employ near 1 million people so it's going to be disruptive.

It's almost inconceivable that either current political party will pass true universal healthcare without some catastrophic set of events. There's just too much money being made and too many voters affected.
 
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ponyo

Lifer
Feb 14, 2002
19,688
2,810
126
In order to apologize I would need to be sorry. ;)

EDIT: Actually okay... I'm sorry you have such thin skin how's that?
Too proud to apologize but not too proud to be on government cheese. It figures. When I was young, calling someone a liar to their face without proof got you punched in the face. But then again, when I was young, people generally had too much pride to leech and live off government too. But some people have no shame.
 

Captante

Lifer
Oct 20, 2003
30,316
10,814
136
Too proud to apologize but not too proud to be on government cheese. It figures. When I was young, calling someone a liar to their face without proof got you punched in the face. But then again, when I was young, people generally had too much pride to leech and live off government too.


Show me where I called you a liar, genius? :p And when was the last time YOU punched ANYONE? (lol) Cut the "tough-guy" nonsense it's embarrassing.

I simply made statements directed at nobody and you reacted defensively.

Sorta telling actually. ;)
 
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MtnMan

Diamond Member
Jul 27, 2004
8,960
8,191
136
As the saying goes, teeth are luxury bones.

And y'all are reminding me I need to apply for VA healthcare, so maybe by the time I'm retired I'll be approved for it...
I recently applied for VA healthcare, not that difficult. Did it online, and they needed more info, so I mailed a copy of my DD-214 to an address they provided. About a week later got a phone call saying I had been approved for VA care. The guy I talked to said I could make appointments, or just put it in reserve for when I did need it, but I'm now in the system.

My decision to do it now based on the fact the VA system is getting better, combined with the fact our local hospital system that was excellent was purchased for a "for profit" system, and they are cutting cost and staff at every opportunity. Too many horror stories of just crappy care. It motivated the nurses to vote to unionize, and it won by a huge percentage, a rarity in the south. Now they are testifying at FTC hearings on the crap that has gone on since the takeover by HCA.
 
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Meghan54

Lifer
Oct 18, 2009
11,684
5,222
136
I recently applied for VA healthcare, not that difficult. Did it online, and they needed more info, so I mailed a copy of my DD-214 to an address they provided. About a week later got a phone call saying I had been approved for VA care. The guy I talked to said I could make appointments, or just put it in reserve for when I did need it, but I'm now in the system.

My decision to do it now based on the fact the VA system is getting better, combined with the fact our local hospital system that was excellent was purchased for a "for profit" system, and they are cutting cost and staff at every opportunity. Too many horror stories of just crappy care. It motivated the nurses to vote to unionize, and it won by a huge percentage, a rarity in the south. Now they are testifying at FTC hearings on the crap that has gone on since the takeover by HCA.


I remember you speaking about this....and I've read a little.

I worked for an HCA hosp. in the mid-1980's as a contract RN, ICU. Did 6 weeks in one near St. Petersburg. Dreadful experience. It was so bad that I refused to renew there and took a contract at Tampa Gen. Hosp., which was not a short drive from my apt in Largo. But the difference was night-and-day, despite my working in a "private ins only" area of the hospital.
 

nakedfrog

No Lifer
Apr 3, 2001
59,239
13,840
136
I recently applied for VA healthcare, not that difficult. Did it online, and they needed more info, so I mailed a copy of my DD-214 to an address they provided. About a week later got a phone call saying I had been approved for VA care. The guy I talked to said I could make appointments, or just put it in reserve for when I did need it, but I'm now in the system.

My decision to do it now based on the fact the VA system is getting better, combined with the fact our local hospital system that was excellent was purchased for a "for profit" system, and they are cutting cost and staff at every opportunity. Too many horror stories of just crappy care. It motivated the nurses to vote to unionize, and it won by a huge percentage, a rarity in the south. Now they are testifying at FTC hearings on the crap that has gone on since the takeover by HCA.
I'm in the absolute lowest tier, since I'm 0% disabled and still under 50 and don't meet any of the other criteria that move you up the ladder. But it's good to hear that it wasn't a big deal.
 

MtnMan

Diamond Member
Jul 27, 2004
8,960
8,191
136
I'm in the absolute lowest tier, since I'm 0% disabled and still under 50 and don't meet any of the other criteria that move you up the ladder. But it's good to hear that it wasn't a big deal.
I'm also in the lowest tier, nothing service related... etc. Not sure how age factors in to the tier ranking.

A friend who is actually who motivated me to apply in addition to the local hosp turning into a shitshow. Historically felt like the VA was a last resort for healthcare, but enrolled about a year ago. He is pretty high on them now, even though he is under the care of a cardiologist outside the VA, but still teaches spin classes (he's in his mid 70s). He has received hearing aids, and glasses, plus a bunch of routine labs and scans at the VA.

I'm also fortunate as the VA here is ranked pretty high in the VA system.
 

nakedfrog

No Lifer
Apr 3, 2001
59,239
13,840
136
I'm also in the lowest tier, nothing service related... etc. Not sure how age factors in to the tier ranking.

A friend who is actually who motivated me to apply in addition to the local hosp turning into a shitshow. Historically felt like the VA was a last resort for healthcare, but enrolled about a year ago. He is pretty high on them now, even though he is under the care of a cardiologist outside the VA, but still teaches spin classes (he's in his mid 70s). He has received hearing aids, and glasses, plus a bunch of routine labs and scans at the VA.

I'm also fortunate as the VA here is ranked pretty high in the VA system.
It has been on my mind since they're occasionally emailing me to tell me that it's easy to sign up, guess I ought to quit putting it off! I admit part of my delay has been dealing with changing my name with various entities, and the VA is one of the ones I haven't done yet.
 

Grey_Beard

Golden Member
Sep 23, 2014
1,825
2,007
136
I work in health care. I will try to brief, but I need to outline and unpack some things so, please understand. I have worked for 95% of my career running health care providers, going on 35 years. I have worked in senior/executive management and understand all too well everything being said here. I have mainly worked in post-Acute care (those service after a Hopsital stay or services): psych, chemical dependency, home health, hospice, home infusion, durable medical equipment, etc. I have worked within systems and have run independent organizations. Most of my work is in non-profit, that is not to say they do not make profits, as they do. Health systems are ruthless. I could do on and on, but just want to express that many that work in the field feel it’s broken too.

I was proud that the organizations I ran did many things within the community. Through philanthropy, we built hospice residences to house indigent hospice patients, we built low income senior housing, we purchased an office building and property in an economically depressed area of the city to facilitate revitalization. I say this only to lend perspective that organizations can do many things. We treated people in our area for 125 years and still going strong. We were the original health system, as home medical care was all there was in 1890. It was mainly helping with child birth and maternal care, along with an increase in activity around the 1918 flu and our work to immunize every one. We were a Community Chest (yes that was not just Monopoly, it really existed) organization that was the fabric of our community. I am very proud of the work we did and continue to do. I no longer run that organization, but now do consulting in health care.

Insurance gets a bad rap because they work at it. They are paid to take money from one and give it another. Really add no value. They make money by denial of claims and for delayed payment of claims. Like a blank, it is amazing how much money you can make by simply holding money in interest barring accounts for 15 days longer than you should. The reimbursement, especially with Medicare, is not done to promote health, but treatment. More treatments more dollars. Not really how this should work. Population health is all the buzz, but if a health system does things to keep people healthy, they will stay out of their system, they lower their revenue. Not how it should be. Our root causes of our health problems go all the way to the food system and mass production of food that is cheap to make, addicts us to the wrong things like, salt, sugar and fat. I will not derail this here, just making a point.

I also want to point out that even though Medicare is better than most, there is a concerted effort from CMS to move everything to Medicare Advantage (MA) which is managed care for Medicare beneficiaries. My point is the insurance companies will be a major part of Medicare as we move forward. Today 46% of all beneficiaries are in an MA plan. The goal is by 2040 for 70% of all payment to be through an MA plan, this will mean about 85% of all beneficiaries. Remember that the 15% not in MA are the high cost patients and would make up most of that 30%, as actually probable 5% of beneficiaries would be that much of the spend.

I have given you much to digest. I have inside knowledge to the system. If anyone of you need any help with understanding how the system works and what programs can be accessed, please reach out, as I helped many over the years.

OP, I understand what you are going through. The first thing that happened in the 80’s was the removal of all psychiatric benefits to reduce costs for the employers. Until then, it was standard to have substantial mental health benefits along with the ability to get addiction treatment in your employee benefits. This is when I worked in these areas. We have left mental health to the states and they have failed miserably. We seem to care more about an extra $5 in our paycheck than in helping or paying for people that need this care. This is also directly related to the political situation we have today, as we have a nation that pays attention to only price and ignores any other attribute like quality or local economics. We have suffered for that.

My rant is over, but please let me know if you have specific questions and I will do my best to help you and answer the question. I have extensive knowledge of the payer and provider markets in health care. I will confess much of what has been said is really on point. As an example, I have paid for health insurance my entire working life. I have had two surgeries which have cost multiple $100,000 in paid fees. This is much more than I have ever put into the system over those 35 years, which is another reason why this is such a difficult subject.
 

dainthomas

Lifer
Dec 7, 2004
14,635
3,509
136
As the saying goes, teeth are luxury bones.

And y'all are reminding me I need to apply for VA healthcare, so maybe by the time I'm retired I'll be approved for it...

If you have a service connected disability of > 40% (I think) you can get care for everything there. I haven't paid for health coverage for years.
 

FelixDeCat

Lifer
Aug 4, 2000
29,613
2,262
126
I told you guys I got stuck with a $4,000 medical bill this year, didnt I? Insurance companies are now brazenly denying to pay for care.

And the best part?! IT DOES NOT COUNT AGAINST MY $3,000 DEDUCTIBLE !1ONE!!1CAPS!


I dont think socializing medicine is the answer but we need to figure something out.
 

IronWing

No Lifer
Jul 20, 2001
70,210
28,913
136
I told you guys I got stuck with a $4,000 medical bill this year, didnt I? Insurance companies are now brazenly denying to pay for care.

And the best part?! IT DOES NOT COUNT AGAINST MY $3,000 DEDUCTIBLE !1ONE!!1CAPS!


I dont think socializing medicine is the answer but we need to figure something out.
^ Rejects the solution that works, demands a solution.
 

SteveGrabowski

Diamond Member
Oct 20, 2014
7,428
6,157
136
You can imagine my shock when I moved here from NZ back in 2004. $500 ER bills WITH good insurance....wtf. Oh, and let's not forget those surprise bills a year after your visit because someone somewhere decided in a random fashion something was undercharged.

No one seems interested in changing anything though. People seem to think it's normal to be billed $800 to have a freckle on your second nutsack looked at.

God why would you ever leave New Zealand for this shithole country?
 

SteveGrabowski

Diamond Member
Oct 20, 2014
7,428
6,157
136
Check out the stock performance for United Healthcare, Anthem etc. They've more than doubled up the total market in the last 5 years. It's gross. CVS owns Aetna and Caremark, so it sells insurance, sells drugs and negotiates prices with itself.

Universal healthcare should absolutely happen ASAP. The insurance companies supposedly employ near 1 million people so it's going to be disruptive.

It's almost inconceivable that either current political party will pass true universal healthcare without some catastrophic set of events. There's just too much money being made and too many voters affected.

Meh 1.5 million or so Americans dying from COVID is far from catastrophic when it's not the oligarchy dying off.
 
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