STYLETHREAD -- LET'S TALK SHOP!

XtinaStyles · Marc Jacobs

Is this insurance fraud?

Elle · Hermes

This is one of the big reasons our healthcare system is in such trouble, and no it's not insurance fraud. Most doctors have a relatively reasonable 'cash price' for direct pay by patients and then an exorbitant 'insurance billing price', because if they don't ask for it they surely won't get it. Even when the insurance company agrees to reimburse them 50% of their exorbitant 'fee', they'd still (in this situation) get $350 and a tax write off for the 'unpaid' portion of their fee. The sheer number of doctors that do this is really really sickening.

We have insurance, but have a out of pocket maximum that has to be met before they cover anything other than yearly checkups and prescriptions. Many times, it's cheaper to negotiate with doctors for services as an individual than to pay the 20% that isn't 'covered'. The way health insurance is set up these days, it's really only good for emergencies - we just end up paying for everything else out of pocket anyway ....

Be glad you didn't have to pay 20% off that doc's bogus $700 fee!

relrel · Marc Jacobs

Yeah, I agree with Elle. It ain't insurance fraud, but it sure as hell does suck.

Here's the deal with the insurance companies and their higher prices--

When you pay cash, you have to pay it right then and their and chances are that if it's super expensive, you won't pay or won't get the treatment. However, the insurance company will sure as shit pay for it (or somebody will...you might find your insurance company knocking on your door for the extra amount).

Plus, chances are that the cash amount doesn't actually the costs of providing the treatment. A doctor will bill an insurance company the cost of the treatment plus a profit plus an amount to cover what the cash people are paying. It's just a way of spreading costs around.

There's different fees for all sorts of different health services. Medicaid and Medicare have different billing amounts versus what the insurance company pays versus what an individual would pay. Plus, each insurance company will pay different amounts based on different contracts. In fact, Medicaid and Medicare both don't pay what the actual services are worth (which is why some doctors don't take these and also why some hospitals have such problems on their Labor and Delivery floors...but I'm getting off topic...). The insurance companies are expected to make up the difference in cost.

The thing about the ring is funny...it really is technically a "foreign body removal". If they were removing a wedding ring that a little kid swallowed (and couldn't pass for some reason), that's how it would get billed. Same service, same billing even if it's actually different services.

Wanna guess who's actually had (multiple) classes on budgeting for medical practices?

Dizzy · Marc Jacobs

"Is this insurance fraud?"

Hee. Try "capitalism."

Suasoria · Chanel

Elle wrote:
The way health insurance is set up these days, it's really only good for emergencies -

Heh. DH cut his finger on the 4th of July and had to go to the ER for ten stitches. We have Aetna, one of the more highly-rated insurance companies in consumer surveys, and they still expect us to pay $1200 of the $7K bill. So even in emergencies, the costs are absolutely insane.

Cortney1982 · Chanel

Suasoria wrote:
Heh. DH cut his finger on the 4th of July and had to go to the ER for ten stitches. We have Aetna, one of the more highly-rated insurance companies in consumer surveys, and they still expect us to pay $1200 of the $7K bill. So even in emergencies, the costs are absolutely insane.

$7,000 for 10 stitches? That's ridiculous. How long did it actually take to put them in? The materials used couldn't even be that expensive.

Elle · Hermes

Suasoria wrote:

Elle wrote:
The way health insurance is set up these days, it's really only good for emergencies -
Heh. DH cut his finger on the 4th of July and had to go to the ER for ten stitches. We have Aetna, one of the more highly-rated insurance companies in consumer surveys, and they still expect us to pay $1200 of the $7K bill. So even in emergencies, the costs are absolutely insane.

No, I mean big hospitalization-type emergencies, where the costs (ours at least) are capped at something like $6k/year out of pocket. My DH cut his face while out of town and went to the ER for a shot of lidocaine and 5 stitches, costing us $350. That kind of shit is seriously enough for me to consider not going to the ER unless I need to be admitted and really might die - a sewing kit is so much cheaper

! Or, superglue!

I know way too many people who have insurance that have gone bankrupt. Isn't that like, the opposite of the point of insurance?

Suasoria · Chanel

I wonder if I still have the itemized bill around here - I must - but it was laughable. He had some sort of painkiller or anesthesia injection that was several hundred dollars. The doctor's time/labor was about half the bill.

AND and and, they wouldn't even give him a prescription for pain pills, as if he'd massively cut himself on purpose to scam them out of drugs or something.

But one of the things we experience here with all medical care is that our costs in L.A. are higher. The insurance company bases their allowed rates on some magic place in the midwest they consider average. If my lab tests cost $300 in L.A., and $120 in Nebraska, they only kick in for $120 (or their share of $120). Anything over that the insurer considers "excessive." Some providers here accept that while others don't, and as far as I can tell, what I eventually have to pay after insurance kicks in is sometimes a total crapshoot.

My FIL had heart surgery that was about $20,000 and he paid $90 out of pocket, but when he had another surgery that was about the same cost, he was responsible for more than half of it. Same insurance, same hospital. The only difference was the second one was considered an emergency so he could not get it preapproved. Also, although the lead surgeon was on his insurance plan, the assistant surgeon working that day was not, so that was a sizable portion of the bill. Unfortunately while he was being admitted to the hospital for an emergency triple bypass, my FIL did not have a chance to interview all the assistant surgeons in the hospital to find out if they accept his insurance.

clothes_horse · Dooney & Bourke

when i was in the hospital having my second child, they charged my insurance $350 per meal! $350 for HOSPTIAL FOOD?!?!? i was supposed to stay for 2 days but i bailed early, figuring that extra day would send us into the poorhouse.

nunzi182 · Kate Spade

I've been noticing this lately too on all my bills. Last month I had to have a D&C due to a miscarriage and they charged $10,200! Not including the aesthesiologist which isn't in my plan but the hospital was. I didn't have a choice as to the anesthesiologist so I don't feel I should have to pay. I was in the hospital for about three hours and the procedure lasted 4 minutes. It's insane. Last year I had my gall bladder removed and it was less than this!