Mylife, I worked for nearly a year in the utilization review department of a very large hospital. Many times, the insurance companies are already on the phone before the patient has been admitted, demanding justification for all procedures, length of stay, etcetera. If they don't get their reviews (from the R.N. case managers) in time, they start threatening to not pay and so forth. It's a brutal, fast-paced department. But these are the people looking out for the patient and the facility at the same time.
My job was to phone the insurance company to confirm the patient's coverage, and then to obtain authorization for services to be performed. Even PPOs require auths for many services, procedures, medical equipment, etc.
So, it's basically patient and provider versus insurance. Now, as the President said tonight, the patient and doctor together are the best ones to make health care decisions, thereby indicating the nuisance that insurance can be.
Although, many are quite happy with the HMO of their choice and benefit greatly financially once they learn how to use the plan's services. I'm working for a large HMO now.
The way my plan works, and it isnt perfect, is that you have an HSA and you use it as you see fit.
If you dont use all the HSA dollars they roll over to the next year and are combined with next years HSA dollars.
If you expend all your HSA account you revert to a 20/80 HMO
Till the next year when the HSA is replenished