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Heathcare insurers have websites that mislead the public. For instance, when a claim is supposed to be 100% covered, is it? What are common ways your healthcare insurer gets out of paying your claim?
Heathcare insurers have websites that mislead the public. For instance, when a claim is supposed to be 100% covered, is it? What are common ways your healthcare insurer gets out of paying your claim?
You call the doctor's office and ask the receptionist whether that doctor will accept your "X" healthcare insurance. She says," Yes, we accept all insurances."
Are you covered? No. Only if that doctor has entered into a contract with your "X" healthcare insurer. Otherwise (no contract) the doctor takes what "X" healthcare insurance will pay for that visit, procedure, etc. and the doctor will bill you the difference.
My wonderful Obamacare policy had our children's doctor's office call us up to tell us about the "free" physical the plan had. Took in DD, they cheerfully said Oh there is no co-pay, it's Free!
About a month later, the bills for the free physical started coming in. Apparently, free doesn't actually mean free. You won't be billed for the office visit, but every lab test, vaccination, ect is billed.
So we got the ball rolling - private health insurance
Quote:
Originally Posted by Mistermobile
You call the doctor's office and ask the receptionist whether that doctor will accept your "X" healthcare insurance. She says," Yes, we accept all insurances."
Are you covered? No. Only if that doctor has entered into a contract with your "X" healthcare insurer. Otherwise (no contract) the doctor takes what "X" healthcare insurance will pay for that visit, procedure, etc. and the doctor will bill you the difference.
Let's say you called and asked if the physician contracted with "X" healthcare insurer to accept without coming after you the cost of the doctor's visit, procedure, test, etc. The doctor says yes.
Will "X" healthcare insurer pay your doctors' bills?
Probably not. Why? The "X" healthcare insurer's deductible. Until all your healthcare costs for that year equal your deductible which could be huge, you are still on the hook. For most of us that aren't seriously ill, the deductible is why some healthcare policies are bogus. Who is going to run up $10,000 doctors' bills in a year?
Remember, Obamacare is not Medicare. Its private insurance.
If people didn't expect that their lives should be free of charge (with the exception of the service they provide, of course), there would be no caterwauling. They would simply find a doctor that charged what they thought was acceptable. Those doctors charging what the majority of the populace thought to be unacceptable would go out of business.
So the doctor-patient market will be self regulating
Quote:
Originally Posted by ChrisC
If people didn't expect that their lives should be free of charge (with the exception of the service they provide, of course), there would be no caterwauling. They would simply find a doctor that charged what they thought was acceptable. Those doctors charging what the majority of the populace thought to be unacceptable would go out of business.
So you say the doctor-patient market will be self regulating. But it isn't. Doctors are expensive. Period. Good luck finding one "that charged what they thought was acceptable." I don't know of one doctor that went out of business for lack of patients.
I do agree that there are millions of people who either don't pay for their medical treatment (illegal immigrants) or rely on the American taxpayer to fund their free or subsidized healthcare.
Another and sometimes the most expensive waste of your money is using the healthcare insurer's drug plan (formulary). Again the "X" healthcare insurer's website will tell you that because you are a member you are eligible to receive a "deal" on commonly prescribed drugs usually your maintenance drugs that you take all the time. Not true.
A story taken from fact follows:
A member of the "X" healthcare insurer's plan required a commonly prescribed glaucoma drug. So common in fact it is given to dogs at $10 @ vial for the same condition. However through the "healthcare insurer's drug plan, the member's copay was $22 @ vial. The member then went to Rite Aid and was told that drug sold for $80 @ vial and the co-pay was $22. The member then went to COSTCO and was told that the drug sold for $26 but again the member's co-pay was $22.
So despite the different prices for the same drug, using the formulary pricing the "X" healthcare insurer still required its member to pay a co-pay of $22. Once the member gave the pharmacy the "X' healthcare insurer's ID card, the co-pay was always $22 no matter the price of the drug or where it was purchased.
A way out of this
Write your congressman. Let me know how that comes out.
Join another drug plan and dump your "X" healthcare insurer's drug plan. Don't show your pharmacist your "X" healthcare insurer's ID card and never order drugs through I unless they are a best buy. Watch out. Your doctor just might send a drug prescription script to the "X" healthcare insurer without asking you. Much better for you just to take it from him and walk it to your own pharmacist.
Join another drug plan and dump your "X" healthcare insurer's drug plan. Don't show your pharmacist your "X" healthcare insurer's ID card and never order drugs through I unless they are a best buy. Watch out. Your doctor just might send a drug prescription script to the "X" healthcare insurer without asking you. Much better for you just to take it from him and walk it to your own pharmacist.
Good luck with that plan. In some states that isn't even possible to get a paper copy and walk out the door. They call them all in to prevent prescription fraud abuse.
My wonderful Obamacare policy had our children's doctor's office call us up to tell us about the "free" physical the plan had. Took in DD, they cheerfully said Oh there is no co-pay, it's Free!
About a month later, the bills for the free physical started coming in. Apparently, free doesn't actually mean free. You won't be billed for the office visit, but every lab test, vaccination, ect is billed.
I don't understand this. I've had yearly free checkups with labs, never a charge, since 2011. One year I added in a VAP test (after calling my insurer to make sure it was covered in the ACA yearly preventative maintenance).
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Partial Answer
