Health Insurance Question for fulltime players - Page 4

Jaquen H'gar · #31 07-08-2005, 11:50 PM

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You are correct in what you point out. You are also correct that the government is suppose to get the highest general discount, you are incorrect in saying that they can not offer a greater discount on a deal basis if there is a compelling documentable reason.

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Actually, I did say they could do this but the documentation can be a pain in the ass. If the physician doesn't accept Medicare, the gov't has no say-so. The way most docs get away with charging less is to cut back on the medical documentation. If the physician provides a level 5 service (e.g. $200 charge) but only documents to that of a level 1 (e.g. $40 charge), then per Medicare/insurance regs he can only bill a level 1. Medicare actually instituted these regs hoping to cut down on what they would have to pay so it is ironic.

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I, like yourself also had an incredible hospitilization bill that actually was a fair bit more significant that wht you are saying. I paid most of it out of my pocket, but the one thing that was made very clear to me is that these items are quite negotiable and that there is room to work out items assuming you have time.

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Unfortunately, other than a heart bypass, organ transplant, or spinal surgery, most large hospitalization bills are for emergency conditions precluding negotiation ahead of time, but your point is well taken.

Jaquen H'gar · #32 07-09-2005, 12:08 AM

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Does anyone know how to get the discounted rates that the insurance companies get? For example... they bill you $500... insurance company says we'll only pay $250 or whatever, and get that rate.

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If you don't have insurance, you should ask ahead of time if the physician will accept Blue Cross rates/reimbursement. Most will be glad to. The billing personnel for the physician can tell you what Blue Cross pays for each procedure. You just might have to remind them when you get the big bill!

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I have a really high deductible and the insurance company didn't lower my charges at all, even though i think they would have if they were the ones paying the bill.

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They would lower it even if they weren't paying (i.e. still below your deductible). The charges may not have been lowered because you were billed at exactly or possibly less than what your insurance would pay. If your insurance company agrees to pay $500 for service X, then no adjustment will be made if you are billed $500 or less. Just a thought.

raisethatmofo · #33 07-09-2005, 12:11 AM

I just got health insurance this week. I play poker only for money.

I went here: http://www.anthem.com/jsp/antiphona/home.jsp

I got the $120/month plan. I believe it was $500 deductible PPO. It was the B plan on the left side after you get the list of plans. I got the one that paid for doctor visits etc. The works almost. I think the other plans are kind of rip offs. Good company in my opinion. I got health insurance within 2 weeks of signing up. I'll probably save about $500/year on prescription drugs and office visits alone with almost pays for half the coverage right there. No claim forms, either. Not bad.

Shoe · #34 07-09-2005, 01:05 AM

Thanks for the info. I never actually called the insurance company to see if I got charged their normal rates or not.

I was charged about $330 to see a neurologist for about a half hour (no special tests or machines were used). I understand they are a specialist and will cost more than a regular doctor, but I thought that price was pretty ridicolous. I paid it because I have a 3k deductible and figured there was nothing i could do.

However, i did not go in for additional tests that she recommended because the damn doctor's office couldn't even give me a quote for how much the procedure would cost. They could not even give me an estimate. (I would have gone to the tests, but I was having a problem with my foot that got better on it's own shortly after my visit). How are you supposed to negotiate a price if they won't even quote you a price ahead of time?

I felt like taking this to court and saying they can't charge me for past consideration or something like that (i know that wouldn't work, but they should atleast be able to give me some rates or something). oh well.

StellarWind · #35 07-09-2005, 01:48 AM

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Does anyone here just essentially pay themselves premiums in a designated "health" account? THis would avoid the rake.

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Even a billionaire should probably have health insurance.

Health insurance is not just risk prevention. You are also buying the insurer's volume discounts, prenegotiated rate schedule (you can't negotiate price in an emergency), and vigilance against mistakes and gouging.

It's a national disgrace that those without insurance pay the highest prices, but it's true.

Jaquen H'gar · #36 07-09-2005, 01:56 AM

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I was charged about $330 to see a neurologist for about a half hour (no special tests or machines were used). I understand they are a specialist and will cost more than a regular doctor, but I thought that price was pretty ridicolous.

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Man, that's stout but I don't know what part of the country you're in. In middle America, I would expect a level 5 (highest) initial consultation to be around $200 for a neurologist. And based on your description of your problem, I would have anticipated only a level 4 visit ($150).

Completely off topic, did you know docs are rewarded for being ignorant? It's true. A specialist sees you. If he immediately knows what's wrong with you and diagnoses/treats it, it's likely a level 3-4. If he documents that he has no clue what's wrong with you (through his own lack of competency or because your problem is mystifying), it's a level 5 and worth another $50-75. Based on this system of reimbursement, I don't think Jesus would have made much money healing the blind and the lame [img]/images/graemlins/smile.gif[/img]

StacysMom · #37 07-09-2005, 02:42 AM

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Does anyone here just essentially pay themselves premiums in a designated "health" account? THis would avoid the rake.

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Even a billionaire should probably have health insurance.

Health insurance is not just risk prevention. You are also buying the insurer's volume discounts, prenegotiated rate schedule (you can't negotiate price in an emergency), and vigilance against mistakes and gouging.

It's a national disgrace that those without insurance pay the highest prices, but it's true.

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I never knew this was the case. I now see the light... INSURANCE IS THE GG!