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insurance co. suck!

Discussion in 'The Lounge' started by nc87k5, Apr 17, 2006.

  1. nc87k5

    nc87k5 3/4 ton status

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    I had a visit with the dr. today about a sinus infection. she checked me out and upon some observations, suggested that I have a sleep apnea (sp?) test done but for me to call my insurance co and see if they will cover it. well, I just got off the phone with them and sure enough, they'll cover the test.........if I'm diagnosed thru the test. :mad: :mad: :mad: wtf?! how will I know if I'm not tested?????? how can they tell you that we'll pay 90% if you do have it but if you don't, then it's my bill to pay, all 100%. these companies are a rip off, I'm glad I don't pay my premium and my employer does, I'd really get ugly with someone if I did.
     
  2. docgab

    docgab 1/2 ton status Premium Member

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    yup, they are crap for the people. Even more fun is being a healthcare provider and dealing with em. *sigh* I'm about to get back to the trading chickens for adjustments!!
     
  3. k2mslskier

    k2mslskier 1/2 ton status

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    A lot of it has to do with the Doctor's offices. Example...a couple of weeks ago we took our daughter to Urgent Care because we figured she had Strept(sp) throat...well she did. Anyway, the insurance that covers the kids has lapsed due to some stupid paper error with the company so we had to pay out of pocket for the visit. The front desk told my wife that since we were paying cash that we would get a discount which ended up being $120. She asked how much they would have charged the ins. company...can you believe this??? Almost $400....for the same treatment. So if you wanna blame anyone blame the Doctors...it's their fault we pay so much for insurance or don't get things covered. They're almost as bad as lawyers....G.D. bloodsuckers. Okay, rant over.:D
     
  4. Skigirl

    Skigirl 1/2 ton status

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    Charges and reimbursements have little to do with each other. A provider (doctor) gets paid according to the fees negotiated in a contract with the insurance carrier. Typically, these reimbursements are based on Medicare's reimbursement schedule and are some percentage of it. So, a doctor's charge of $110 for an office visit may be reimbursed by medicare at about $50. If your insurer was Blue Cross, for example, the doctor might get paid $60 (or 120% of Medicare's allowable fee). In some cases the insurance carrier pays less than Medicare, as is the case with Tricare.

    Doctor's fee schedules have some small effect on determination of reimbursement, but much, much less than it was 20 years ago.

    I do not believe that it is the doctors' fault that whoever pays health coverage pays so much. I believe that the problem has much to do with 1) insurance companies are in the investment business, not the insurance business so keeping as much money in their investments for as long as possible is in their best interest, so sets up an acrimonious rel;ationship with providers, 2) technology to extend quantity and quality of life is expensive, as are drugs 3) people do not do enough to remain healthy. This becomes very expensive, which means that insurance carriers have to increase premiums and lower reimbursement and/or coverage to keep their profit margins.

    For example, 90% of medicare's reimbursement goes to managing the effects of chronic illness (heart disease, diabetes, etc.), most of which could have been mitigated significantly by patients taking more responsibility for their own wellness.

    I would say that most of the problems associated with our failing health care system fall with us (the user).
     
    Last edited: Apr 17, 2006
  5. Corey 78K5

    Corey 78K5 1 ton status

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    You don't have sleep apnea. Your just on CK5 to late at night. Problem solved, Dumbass.
     
  6. nc87k5

    nc87k5 3/4 ton status

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    :haha: :haha: . no sh!t for brains! I work nights so I have to be up all night.
     
  7. Corey 78K5

    Corey 78K5 1 ton status

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    So You work all night and stay on CK5 all night. No wonder You don't get no sleep. Boy are You ever focking stupid:D
     
  8. nc87k5

    nc87k5 3/4 ton status

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    well, stay on ck5 and work at the same time. look who's the dummy. :p:
     
  9. colbystephens

    colbystephens 1 ton status GMOTM Winner

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    my father in law has sleep apnea - he's got this wierd machine he has to wear at nite to make sure he's breathing properly. i feel bad for his wife. dude looks like a robot with it on.
     
  10. diesel4me

    diesel4me 1 ton status Premium Member

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    My sister too...

    My sister has to use one of those machines at night too...they work though,she hardly snores at all now,or has those long intervals between breaths since she's been using it the past few years..It was me who told her I heard her gasping for breath after several minutes of silence,and her loud snoring when she stayed over here a few times,that prompted her to get the "sleep" test,and diagnosed with sleep apnea..her doctor said it was serious,she could have DIED if she had done nothing about it!!..:eek1:
     
  11. docgab

    docgab 1/2 ton status Premium Member

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    Thank you. You said that so much better than I was gonna. lol :D
     
  12. Skigirl

    Skigirl 1/2 ton status

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    You're welcome. I'm surprised chiros get on plans at all. May be a blessing in disguise. Wait until pay for performance hits. You'll be glad most of your patient base is cash pay (if it is). Charges and reimbursements really won't have anything to do with each other then.
     

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