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Guess what my wife's AZ Obamacare policy paid for her 1/1/17 out of state auto accident injuries?
The charges for the month of Jan. were over $1M.
They paid $168K. Vastly underpaid IMO, but there you go.
If she didn't have insurance, they'd charge her over $1 million. Then you'd try to negotiate it down. But still, you'd have a massive bill that many people wouldn't be able to pay. If you didn't pay it all, depending on the state, the hospital could put a lien on your house to get their money. They'd get any equity you have in your house when you sell.
This happened to my aunt when she had a pre-ACA policy. The insurance carrier cancelled her policy retroactively after she got big claims and they refused to pay the claims. The hospital put a lien on her house to get their money even though she had active insurance while in the hospital and the insurance carrier approved the procedures. If same policy was ACA they would never be allowed to do that.
I hope your wife is recovering well. She must have been in a major wreck.
Except that insurance never pays what the hospital charges.
Hospitals pull their charges straight out of their rear ends. Insurance companies know what an aspirin really costs, and have the industry weight to pay what is closer to the real cost than an individual has.
While my mother was in a coma, I received a constant flood of "not-a-bills" from BC/BS (her primary insurer) and Medicare (her secondary insurer). Even between the two of them, they rarely paid the entire bill. There was always a "You may be charged" amount...which I never was.
So if medical providers never get what they charge and yet stay in business at all, that indicates to me they are always overcharging. Substantially.
Of course they are -- but with these Super High deductibles, it's the patient that is picking up the tab on the Inflated prices. It's all a racket.
Of course they are -- but with these Super High deductibles, it's the patient that is picking up the tab on the Inflated prices. It's all a racket.
Aren't almost all ACA plans PPO's or HMO's? With either of those rates are negotiated, providers can bill for whatever they want but the insurer will only pay the negotiated rate and you are not responsible for any excess charges.
It cuts out much of the more generally younger and healthy people and families from Obamacare, where those with pre-existing and chronically ill will remain. So their premiums will rise.
IMO this pushes us closer to a public option, which I continue to support.
We have the generally younger, healthier working people and families, who can do well with a cheaper, less inclusive private sector policy. Freer markets can do well here.
And then we have the poor, elderly and high risk people and families who could do well enough with a public option. Where free markets don't do well. A Medicare or Medicaid type option.
There will still be subsidies for the Pre-Existing and chronically ill ..... I don't think there is any way around that, and it's the right thing to do. I would rather see Federal Taxpayer Subsidies for this 5% than the exorbitant deductibles and premium prices for the majority of the middle class.
Medicare and Medicaid are here to stay - and they are ripe for Fraud as we just saw with the DOJ arrests. Clearly we are not a "one size fits all nation" (i.e. younger/healthier, elderly/poor/disabled, chronically ill) - and it's penalizing the vast majority to cater to the 5%.
I would much rather see the inflated prices come down, reduce the workforce that doctors are forced to employ, reduce the Lawsuits and do the same type of Drug Negotiation that other Nations do ..... instead of the constant demand for "one size fits all" policy and FREE Abortions (like that's the most important Medical issue in the World).
At the very least -- I want to see the Lazy, Risk Avoidance CongressCritters quit hiding under their desks or in the Congressional Lounges and get to work. Real People are going to suffer if they can't get their act together soon. It's about the American People and NOT about the CongressCritter's next Election.
That sounds like a problem with the insurers. After all, they are the ones charging the skyrocketing costs..right?
Yeah, because they need to make a profit. The reasoning behind the individual mandate is that is will lower the costs for those who need it mosts because the profits can come in from other means.
Essentially, because there is an industry that profits off of people dying (which is evil... reframe it all you want, private health insurance should be illegal), certain deregulations will cause increases in premiums for certain groups becasue health insurers aren't actually concerned with health.
Do people really go to the Doctor for a "simple cough, no blood-high fever-shortness of breath- chest pain or other concomitant disease or predisposing factors"? They really do that?
Not unusual after about 4-7 days of persistence IME.
There will still be subsidies for the Pre-Existing and chronically ill
There are no subsidies for pre-existing or chronically ill if the person makes a decent wage (aka isn't poor). Middle class people that work and earn an average wage won't get any subsidies even if they have pre-existing conditions and/or are chronically ill. Instead, they get a massive premium increase and they'll have to pay 100% of the premium with their own funds OR they'll have to cancel their policy and go without insurance.
The new senate bill is drastically increasing monthly premiums for those with pre-existing conditions. Massive. Regular everyday working people that buy their own policies and pay with their own money are going to get huge premium increases. A lot of them want to keep their health insurance but the price increase will be so high that they'll be forced to cancel their policy - or maybe take out a 2nd mortgage to afford the insurance premium. No subsidies for these folks.
Of course they are -- but with these Super High deductibles, it's the patient that is picking up the tab on the Inflated prices. It's all a racket.
This is incorrect. A patient would submit their card to the doctor and then the doctor adjusts the bill to the 'pre-negotiated rate' which is typically 80% discount from sticker price. The patient only owes the pre-negotiated rate. This results in a massive discount for the patient, even when they haven't met their deductible, as long as they use the in-network providers that agree to the pre-negotiated rate. You don't pick a doctor that's not on the insurance plan, else you can't get the prenegotiated rate.
Hospitals can price anything they want. But they rarely get paid that price. Insurance typically does not pay that price, but at a pre-negotiated lower one. What special AMA coding do you refer to?
I know they have a "negotiated" lower price for insurance - can't "negotiate the price" down if it's not HIGH to begin with. . Of course the High Deductible saps don't have the "pre-negotiated" price.
The AMA Codes are like the Medicare/Medicaid Codes you LINKED to -- but they are for the Doctor's Office visits. The AMA has a complete Monopoly on these required Codes. The word the same way the Medicare/Medicaid Codes do - the only think Insurance companies will accept. Good racket for the AMA.
Of course they are -- but with these Super High deductibles, it's the patient that is picking up the tab on the Inflated prices. It's all a racket.
Yes, good point.
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. Of course the High Deductible saps don't have the "pre-negotiated" price.
