It’s a two way street on this crap. How can a Dr or health care facility charge me $2,000 for a procedure but accept an insurance agreed to pay out of $600.00? That’s and example, but it’s usually 50% or less and my responsibility is 0. If I don’t have insurance I’m stuck with the $2,000.00 bill. Why? I’ve argued and won a few times on dental insurance since I dropped that. I said you accept an insurance payout of “X” so that’s what I’m paying.
Next are the healthcare institutions. I just went through a detailed analysis on some lower back issues. I have free VA healthcare and community care is paid by Optum insurance through the VA. I also have federal BCBS and Medicare since I’m retired. I keep the BCBS for the wife. Medicare is primary.
After checking all the insurances I find the healthcare agency billed and was paid by all three on 6 separate occasions. VA was supposed to be it. So I did a spreadsheet, got all of the EOBs and told them they need to pay back Medicare and BCBS for double billing plus they owe me $211 in charges I paid that the VA paid.
We’re supposed to “discuss” this tomorrow at my next exam. Should be interesting... It won’t be a discussion it’ll be a “this what you’re going to do.”
Insurance is a scam no doubt but part of the cost is the scam the healthcare industry is doing as well.
My God. That has to be wildly illegal... right?? I mean... that's shocking!
Homeowner insurance is another scam that could stand open investigation. And auto insurance is too, esecially since you are gererally forced to have it to be able to operate an auto.
We did the Medicare and BCBS route and BCBS would not reimburse for anything Medicare denied.
We spent far more on BCBS premiums than they ever paid out.
And Medicare SUCKS. I *HATE* it because the coverage is so bad but you have no choice. You
re forced onto it when you turn 65.
Yep, the government is paying 50% of medical bills now at an average reimbursement rate of 15%-20% on the dollar. So if a Dr. or hospital has a procedure that costs them $100., they have to charge $600....a bit inflationary don’t you think? (Yeah, correct...private pay people get stuck with the $600. bill unless you really negotiate hard for govt. or ins. co. rates).
The only real fix is to get government 100% out of providing healthcare coverage and revert to “fee for service”/”cash up front”...then reintroduce true large group health insurance run by actual actuaries....(like the 1950’s/1960’s/1970’s).
The profit margins for hospitals and “big pharma” are a lot lower than some other industries (6.97% for hospitals, 8.9% for reg. pharmaceutical...minus 13% for “Biotech” pharma). Much higher profit for Warren Buffett’s railroads...running at a pretty incredible 23% profit margin.
https://pages.stern.nyu.edu/~adamodar/New_Home_Page/datafile/margin.html
good on you for finding the over payments
now bcbs and medicare will be doing an over payment request.
and will take back the over payed funds