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Snake-bite victim socked with $55K bill

maryland two fang marks emergency medical tech anti-venom treatment insurance

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#31 ILikeTobacco

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Posted 13 August 2013 - 18:42

Approved expenses being something the insurance company is aware of, has set a cost to, and has qualified in your plan. I think you'd have to have a pretty lousy health insurance plan to not have as much antivenom as prescribed by a  doctor covered.

 

I also don't see how $40,000 is expensive, given what it takes to make and store anti-venom. There are conventional made bio-pharmaceuticals which can cost more than that per dose.

Just because your doctor prescribes something doesn't mean your insurance will cover it. The national standard was lower to Medicare and that's what most insurance companies are lowering their coverage too to save money. They are pretty much required to do anything they can to lower costs so the can offer cheaper insurance. Not covering as much is the easiest way to do that. Test strips for diabetics are approved for up to 3 times a day and no more. If your doctor prescribes more than that, you can get it, but you have to pay 100% of the cost under any plan that is already conforming to federal law. As you said, what is qualified in your plan. If you only 3 test strips a day are qualified, the rest is out of pocket. I was prescribed 9, my health insurance covers 80% of 3, and I can only afford to pay 100% of 3 more, so I only get 6. When you live paycheck to paycheck, what your doctor prescribes doesn't matter. What your insurance allows does.

 

Also, agree with you on the $40,000. If it cost $40,000 to make and you don't have insurance, $40,000 should be your bill. Question is, how much of that price is the real price and how much is just markup for profits.




#32 -Razorfold

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Posted 13 August 2013 - 18:44

I've worked in data mining insurance claims for years now, and one thing I've always found is hospitals overcharge for ER visits like nuts when it gets sent to insurance... heck they will change your carrier $1,000 for an ER visit, that an uninsured person can get for $50... we've had doctor offices charge $250 to insurance for a patient to "fill our paperwork".... some of their claims are just ridiculous... including $500 for a box of gloves when you know they used a couple pair at most! Then they probably charged the next 100 people for that same box of gloves that costs $20 to buy at medical wholesale

It's because the hospital wants the insurance company to pay as much as possible, the insurance company wants to pay as little as possible. In some cases the hospital and insurance have pre-negotiated rates, in other cases they argue.

Its always good fun to read the statements your insurance company sends you every month. For example, my wife had to take 5 physical therapy sessions and I was looking over the bill the other day.

Every session was exactly 1 hour long, did the same thing, no additional things, and here's what the place charged her insurance:

1. $390
2. $222
3. $405
4. $275
5. $350

It's seriously like they just dumped their hand into a bag and pulled out a number and were like "Aha! This is a good amount to charge"

#33 adrynalyne

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Posted 13 August 2013 - 18:47

Just because your doctor prescribes something doesn't mean your insurance will cover it. The national standard was lower to Medicare and that's what most insurance companies are lowering their coverage too to save money. They are pretty much required to do anything they can to lower costs so the can offer cheaper insurance. Not covering as much is the easiest way to do that. Test strips for diabetics are approved for up to 3 times a day and no more. If your doctor prescribes more than that, you can get it, but you have to pay 100% of the cost under any plan that is already conforming to federal law. As you said, what is qualified in your plan. If you only 3 test strips a day are qualified, the rest is out of pocket. I was prescribed 9, my health insurance covers 80% of 3, and I can only afford to pay 100% of 3 more, so I only get 6. When you live paycheck to paycheck, what your doctor prescribes doesn't matter. What your insurance allows does.

 

Also, agree with you on the $40,000. If it cost $40,000 to make and you don't have insurance, $40,000 should be your bill. Question is, how much of that price is the real price and how much is just markup for profits.

My grandmother is approved by Medicare for 6 test strips a day...because the doctor prescribed it that way.



#34 ILikeTobacco

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Posted 13 August 2013 - 18:47

It's because the hospital wants the insurance company to pay as much as possible, the insurance company wants to pay as little as possible. In some cases the hospital and insurance have pre-negotiated rates, in other cases they argue.

Its always good fun to read the statements your insurance company sends you every month. For example, my wife had to take 5 physical therapy sessions and I was looking over the bill the other day.

Every session was exactly 1 hour long, did the same thing, no additional things, and here's what the place charged her insurance:

1. $390
2. $222
3. $405
4. $275
5. $350

It's seriously like they just dumped their hand into a bag and pulled out a number and were like "Aha! This is a good amount to charge"

Its like going to buy a car. They ask for a price they know they wouldn't get but gives them room to negotiate.



#35 ILikeTobacco

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Posted 13 August 2013 - 18:49

My grandmother is approved by Medicare for 6 test strips a day...because the doctor prescribed it that way.

And I was denied, because I am too young and don't qualify. Younger people are suppose to have better control supposedly since they can check themselves unlike some of the older patients. It's like the mouth guard example from earlier. You have to meet very very specific requirements or you get nothing. Same reason I got denied for pills to give me more stable blood sugar levels. Not old enough.



#36 adrynalyne

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Posted 13 August 2013 - 18:51

And I was denied, because I am too young and don't qualify. Younger people are suppose to have better control supposedly since they can check themselves unlike some of the older patients. It's like the mouth guard example from earlier. You have to meet very very specific requirements or you get nothing. Same reason I got denied for pills to give me more stable blood sugar levels. Not old enough.

I see.  I didn't know it changed by age.



#37 -Razorfold

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Posted 13 August 2013 - 18:51

Its like going to buy a car. They ask for a price they know they wouldn't get but gives them room to negotiate.

Yup. and best of all, they like to claim their doctors are really well paid. Couple of years ago wife had a colonoscopy and the bill to the insurance company was:

Procedure + Equipment: $1000
Doctor rates: $1900 an hour

Yeah I'm really sure you're paying your doctors $1900 an hour...The insurance ended up paying a total of $600.

The problem is that its often quite hard for you to find out how much you will be paying with / without insurance, so you can't really shop around. You just have to pick one and stick with it.

#38 +LogicalApex

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Posted 13 August 2013 - 18:51

Just because your doctor prescribes something doesn't mean your insurance will cover it. The national standard was lower to Medicare and that's what most insurance companies are lowering their coverage too to save money. They are pretty much required to do anything they can to lower costs so the can offer cheaper insurance. Not covering as much is the easiest way to do that. Test strips for diabetics are approved for up to 3 times a day and no more. If your doctor prescribes more than that, you can get it, but you have to pay 100% of the cost under any plan that is already conforming to federal law. As you said, what is qualified in your plan. If you only 3 test strips a day are qualified, the rest is out of pocket. I was prescribed 9, my health insurance covers 80% of 3, and I can only afford to pay 100% of 3 more, so I only get 6. When you live paycheck to paycheck, what your doctor prescribes doesn't matter. What your insurance allows does.

 

Also, agree with you on the $40,000. If it cost $40,000 to make and you don't have insurance, $40,000 should be your bill. Question is, how much of that price is the real price and how much is just markup for profits.

You're going all over the map which is why this discussion is going the way it is. The article is talking about a hospital visit that lasted a few days (in patient care) and not prescriptions or dental coverage.

 

Yes, prescription coverage varies wildly and can be good or bad. At my previous job you paid 100% of your prescription costs until you had spent like $3K or something before they would pay anything (it was 100% after that). What that meant was for a fairly healthy person was pretty straight forward, you basically don't have prescription coverage because the few times a year you might need it they won't be paying anything. My new job is a lot better, but again my prescription coverage and my medical coverage aren't the same. Your insurance company will hire a prescription insurance company, like Express Scripts, to handle this since this isn't part of their business.



#39 ILikeTobacco

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Posted 13 August 2013 - 18:54

You're going all over the map which is why this discussion is going the way it is. The article is talking about a hospital visit that lasted a few days (in patient care) and not prescriptions or dental coverage.

 

Yes, prescription coverage varies wildly and can be good or bad. At my previous job you paid 100% of your prescription costs until you had spent like $3K or something before they would pay anything (it was 100% after that). What that meant was for a fairly healthy person was pretty straight forward, you basically don't have prescription coverage because the few times a year you might need it they won't be paying anything. My new job is a lot better, but again my prescription coverage and my medical coverage aren't the same. Your insurance company will hire a prescription insurance company, like Express Scripts, to handle this since this isn't part of their business.

My company just changed to a "cheaper" insurance company just before Obamacare. Everything was fine until that happened. They lowered everything to the medicare standard. Big slap on the face. Paying $100 a month and getting the same coverage others get for free. At the same time, paying $150 a month into Medicare/Medicaid.



#40 +LogicalApex

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Posted 13 August 2013 - 18:58

My company just changed to a "cheaper" insurance company just before Obamacare. Everything was fine until that happened. They lowered everything to the medicare standard. Big slap on the face. Paying $100 a month and getting the same coverage others get for free. At the same time, paying $150 a month into Medicare/Medicaid.

This is why I hate the US system. I would prefer to just have the money paid to me and I can pick my own insurance company and plan. I don't allow work to pick my cell phone plan or what restaurants I can go out to eat at. Why should they have the deciding factor as to what healthcare plan makes the most sense for me?

 

The best thing that could have ever happened was to force break the chain between employment and medical care. If the employers want to still pay it they can reimburse you up the dollar amount they want to pay.



#41 -Razorfold

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Posted 13 August 2013 - 18:58

At the same time, paying $150 a month into Medicare/Medicaid.

I always found the forced payments into social security stupid.

1. I'm not a US citizen, and I may never become one (or live here forever). But I still have to keep paying into it, even though I may not be eligible to receive benefits in the future (if you aren't a US citizen and you move abroad for more than 6 months then you're no longer eligible for benefits).

2. Considering the poor state of social security these days who knows how long it'll be around for in the future.
 

This is why I hate the US system. I would prefer to just have the money paid to me and I can pick my own insurance company and plan. I don't allow work to pick my cell phone plan or what restaurants I can go out to eat at. Why should they have the deciding factor as to what healthcare plan makes the most sense for me?

Because the premiums are usually shared between the employer and the employee and it's cheaper to sign everyone up for one plan.

I get a $250 deductible / $750 out of pocket through my employer which costs me $100 a month (free if I work here for more than 5 years). I'm sure its costing my employer a lot more than that to offer it to me.

#42 HSoft

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Posted 13 August 2013 - 19:00

....claiming the NHS had gone bankrupt....

 

...I do remember you saying the NHS was going bankrupt with hospitals closing all over though. 

 

Two completely different things. Nice to see you change your own argument tho :rofl:



#43 ILikeTobacco

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Posted 13 August 2013 - 19:01

I always found the forced payments into social security stupid.
 

It is a ponzi scheme. Wouldn't work if people weren't forced into it.



#44 tmorris1

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Posted 13 August 2013 - 19:07

I think the government needs to do more to hold the feet of hospitals to the fire. Fortunately, here in Philadelphia charity care is very common and good. My wife had to go to the ER for an issue a couple of years ago and due to some messes with the health insurance company she didn't have coverage. The hospital waived almost all the charges and allowed us to pay a flat $99 for the ER visit. People shouldn't be murdered financially over medical issues, but it is a hard chestnut to crack.

And who do you think will pay for this?  Not the hospital.  They will push those costs onto the people with insurance.



#45 FlintyV

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Posted 13 August 2013 - 19:27

Two completely different things. Nice to see you change your own argument tho :rofl:

 

Not really. Still a ridiculous statement either way. 

 

Nice to see you continuing to ignore the main point of my post  :D