what a freaking joke the medical field/insurance can be

[cliaz]

I love the pre-approval process. I think it's great how you get really sick and the first thing you've got to do is call the insurance company to get pre-approved for a hospital visit. That was partly the issue with my daughter and her stay - the insurance company sent a letter (!) after an emergency admission saying that they didn't think it warranted an overnight stay. Who the F are these bureaucrats to decide what is and isn't needed? Not only that, it arrived two days after she was discharged.

 

 

I hate insurance companies. When the twins were born we wanted to put two 10k life ins policies on them. My agent said, no problem but you have to pay full price for 50% of the coverage for the 1st 2 years since they were pre-mes.

 

Crap.

[rocknrobn26]

I love the pre-approval process. I think it's great how you get really sick and the first thing you've got to do is call the insurance company to get pre-approved for a hospital visit. That was partly the issue with my daughter and her stay - the insurance company sent a letter (!) after an emergency admission saying that they didn't think it warranted an overnight stay. Who the F are these bureaucrats to decide what is and isn't needed? Not only that, it arrived two days after she was discharged.

 

Exactly my case also!!!! The Hosp. said we didn't need to call. We did anyway. That's the only thing in my favor. Plus I told the hosp. I wanted to go home after day one, and the Hosp. said NO! I should have gotten that in writing! Regardless how this turns out, I AM LEARNING!!!! If I or the Mrs. ever have to go in again (there's a sure bet), those MF'ers are gonna get writing cramps from what I will demand! Mine is over 5 months now! And when I call (Hosp. & Ins. Co.), the people I speak w/ are a-holes. Arrogant, short, condesending, and just freakin' rude, passing the buck as they go! I have a long fuse, but it's getting short and I want to bust some heads here!

 

How did your's turn out, Ursa? Or is it still pending?

[wildcat2334]

If I had it to hand, I would itemize the lines on a bill for my daughter to spend one night in a Madison hospital. Some of them were flat out insane. Suffice to say it was over $7,000 total - I had to enlist the aid of our excellent benefits admin to avoid the insurance company sticking me with the entire bill.

 

Completely- it is utter nonsense. Last year I ended up in the hospital after being jumped, had a concussion, fractured eye socket- I came out ok though, I think . I have good insurance, but the entire itemized bill came to..........

 

Hospital....... 17k

Dr. charges another 4k

 

Now, I was covered well, but I still had to pay quite a bit out of pocket. Well, I had an MD buddy of mine go over the bill and he found a few very nice lttle discrepancies.

 

They x-rayed my knee twice, my knee wasn't hurt, or even scraped at all.

In addition there were 3-4 other duplicate procedures, X-rays, MRI's that were not needed. What an effing joke. I ended up being able to negotiate my out of pocket cost down quite a bit- but this entire system is a mess. Not sure where to even begin, a combo of un-insured peeps drifing costs up, Insurance beaur, malpractice suits/ins - seriously out of control.

[Yukon Cornelius]

 

 

And you can go bankrupt if you get ill for a long time - in fact, that's a near certainty.

 

yup and till it happens to u or some one u know people still beleive rush and the republitarrdddssssss

[Ursa Majoris]

How did your's turn out, Ursa? Or is it still pending?

 

Like I said earlier, we are really lucky to have a great benefits administrator at my company (she replaced an equally great one). Since we've only just started with this new outfit, they backed down and I was just liable for the $125 emergency room co-pay and the insurance picked up the rest.

 

I told our benefits folks that if the insurance didn't pick it up, I was going to withdraw from insurance altogether and start my own savings account paying in bi-weekly where at least I'd make some interest off it until I needed it. What's the point of insurance if it doesn't pay out for legitimate claims?

 

There's two problems here - the hospitals are charging like defense contractors and the insurance people are trying to stiff us with the bill, or part of it.

[My Name Is Jimmy]

I enjoy committing sins.

[cliaz]

Now here is my question - once my wife returns to work she has amazing medical/dental/eye benefits through the county as a teacher (one of the perks for being a teacher) so I am going to opt out of my ins at verizon (either through quitting there and starting my own busines like i've talked about on here or just refusing their packages at work if I end up staying.) so am I to receive additional money from the company because I am refusing benefits?

 

I'm not talking about the money I pay per month for full family ($310). Verizon pays on average $600 to 800 a month for employee benefits. Should I receive something like $200 additional to my pay? I've heard that receiving that is very common.

 

 

Anyone know?

[Ursa Majoris]

yup and till it happens to u or some one u know people still beleive rush and the republitarrdddssssss

 

A guy at my work had an accident in his truck and broke his back. My company did everything they could for him, holding fundraisers and god knows what, continuing to pay his salary way past the point where they had to, but his bills reached such a level he and his family had to file for bankruptcy because the insurance ran out. Their lawyer advised them that in order to keep their house, they may have to divorce. It didn't come to that because friends and family chipped in $$$ to help.

 

He's back at work for us now, in a wheelchair of course. He's lucky my company is like it is. Can you imagine what it must be like to lose your mobility, be forced into bankruptcy and on top of all that maybe have to divorce because it would be financially better, all because of a no-fault accident?

 

This doesn't happen anywhere else.

[CaP'N GRuNGe]

Don't forget that when you go to the hospital you're also subsidizing those that can't afford to pay for their care but the hospitals are obligated to care for them. I work for a health system, but I'm just a lowly accountant and not a rich doc so please don't throw stones.

[Ursa Majoris]

Now here is my question - once my wife returns to work she has amazing medical/dental/eye benefits through the county as a teacher (one of the perks for being a teacher) so I am going to opt out of my ins at verizon (either through quitting there and starting my own busines like i've talked about on here or just refusing their packages at work if I end up staying.) so am I to receive additional money from the company because I am refusing benefits?

 

I'm not talking about the money I pay per month for full family ($310). Verizon pays on average $600 to 800 a month for employee benefits. Should I receive something like $200 additional to my pay? I've heard that receiving that is very common.

Anyone know?

 

If I wasn't paying insurance, I'd get $50 extra per pay period (2 weeks), plus I wouldn't be forking over my portion of the insurance, of course.

 

And it'd be taxed.

[Ursa Majoris]

Don't forget that when you go to the hospital you're also subsidizing those that can't afford to pay for their care but the hospitals are obligated to care for them. I work for a health system, but I'm just a lowly accountant and not a rich doc so please don't throw stones.

 

Hospitals claim that back off the gubment, surely? And none of that excuses a $75 tray and all the other hogwash that is itemized on the bill.

[cliaz]

A guy at my work had an accident in his truck and broke his back. My company did everything they could for him, holding fundraisers and god knows what, continuing to pay his salary way past the point where they had to, but his bills reached such a level he and his family had to file for bankruptcy because the insurance ran out. Their lawyer advised them that in order to keep their house, they may have to divorce. It didn't come to that because friends and family chipped in $$$ to help.

 

He's back at work for us now, in a wheelchair of course. He's lucky my company is like it is. Can you imagine what it must be like to lose your mobility, be forced into bankruptcy and on top of all that maybe have to divorce because it would be financially better, all because of a no-fault accident?

 

This doesn't happen anywhere else.

 

 

 

that is amazing that your company did that for him. The only reason I am where I am today is because when I started out way back with DIGEX (the first name of my company) I worked logistics and inventory. Because I knew server hardware back and forth I was allowed to help out the techs on building them. One tech Steve dumped his bike at 120 mph and hit a guard rail. He is alive today but cannot work.

 

my company moved me into his position and gave him the cold shoulder when the ins. company refused treatment for him because he had 2 beers that night.

 

He lost his colon, part of his liver (which grows back. yeah go human body!) his spine is fused, lost 80% of his vision, broke both of his legs and one of his arms ( i believe, cant' remember. it's been 7 years.) and had a whole bunch of other injuries. He is lucky to be alive.

 

Our company could have given 2 turds about him. You work for a great company if they did all of that for your friend. You are very luck my friend.

[CaP'N GRuNGe]

Hospitals claim that back off the gubment, surely? And none of that excuses a $75 tray and all the other hogwash that is itemized on the bill.

 

 

Hey, i'm not making excuses. I think the whole system if f'd up too. First off even though I'm in accounting i'm not heavily versed in the billing process. I do know from a general ledger stand point we establish revenue and two types of contra revenue - bad debt and contractuals. Bad debt is accrued for accounts you don't think you will be able to collect on. Contractuals are reductions of income based on certain payer contracts. For example Medicare will only pay X amt of dollars for certain types of procedures or diagnoses (something like that) or we contract with different insurance companies for capitation which basically covers a pool of patients at a flat amount and is adjusted depending on certain circumstances. We're a not for profit so maybe a bit different from the for profits in operation and billing. Not sure though.

[Ursa Majoris]

that is amazing that your company did that for him. The only reason I am where I am today is because when I started out way back with DIGEX (the first name of my company) I worked logistics and inventory. Because I knew server hardware back and forth I was allowed to help out the techs on building them. One tech Steve dumped his bike at 120 mph and hit a guard rail. He is alive today but cannot work.

 

my company moved me into his position and gave him the cold shoulder when the ins. company refused treatment for him because he had 2 beers that night.

 

He lost his colon, part of his liver (which grows back. yeah go human body!) his spine is fused, lost 80% of his vision, broke both of his legs and one of his arms ( i believe, cant' remember. it's been 7 years.) and had a whole bunch of other injuries. He is lucky to be alive.

 

Our company could have given 2 turds about him. You work for a great company if they did all of that for your friend. You are very luck my friend.

 

My company is darn good. I know I rant on about corporations and all, but if they were all run like mine there would be few problems. Sure, our owner is very wealthy, but he donates 5% of our pre-tax profits to charity every year without fail, we are all encouraged to make an allotment from our salary for charity (it's not mandatory, but it is convenient) and the owner does a whole raft of charity stuff beyond that. Not only that, he's worked his nads off to take us well into the $1 billion + range. He's an example of what it ought to mean to be a rich company owner.

 

The guy in the accident actually works for HR now, instead of his previous highly skilled job which he just can't do any more. The post he's in was created for him. Pretty cool place to be - we all work insanely hard, but it's all good.

[Ursa Majoris]

Hey, i'm not making excuses. I think the whole system if f'd up too. First off even though I'm in accounting i'm not heavily versed in the billing process. I do know from a general ledger stand point we establish revenue and two types of contra revenue - bad debt and contractuals. Bad debt is accrued for accounts you don't think you will be able to collect on. Contractuals are reductions of income based on certain payer contracts. For example Medicare will only pay X amt of dollars for certain types of procedures or diagnoses (something like that) or we contract with different insurance companies for capitation which basically covers a pool of patients at a flat amount and is adjusted depending on certain circumstances. We're a not for profit so maybe a bit different from the for profits in operation and billing. Not sure though.

 

Yeah, you frequently see on statements of benefit from the insurance that the original bill has been adjusted down because the insurance will only pay xx for certain procedures. Or I used to see that when we were with our previous insurance company - this new lot just seem to pass it through.

 

I'd like to see a state system that you could opt in to but that's for another thread.

[Gonkis]

Don't go to a hospital. They charge too much. Just suck it up and hope it is a 24 hour bug.

 

 

Wish I could.

 

6 people in the family, 3 are male and 3 are female. The males account for 5% of the medical bill activity, the females, well, get sick more, break bones, have longer recovery times, etc. It's getting better now, though, because the babies are 2 and 4 yo.

 

I've gotten to the point where I almost immediately call the hospital or doctor and tell them, "I just got my portion of your bill and it's for $900. I'll give you $450 for it." A LOT of the time, they take it and run.

 

I itemize my medical deductions for the IRS every year and undoubtedly hit that 7.5% of taxable income number target. Someone in my salary range shouldn't be hitting that for 3 years straight.

[Yukon Cornelius]

more and more people dont have ins... they go tot eh emergancy room to get help and that taxes the hospital and makes prices go up... its only going to get worse.... i have a million doller baby and know the scames and the ways around them with the ins. companies...... hmo... non profit ...my ass

[Czarina]

The free and reduced care pool of money isn't a huge portion over all of the cost for everyone, IMO. When they figure the cost for reduced care, I suspect they figure out a lot closer to the actual cost for things than what they charge the insurance companies.

 

You have to realize too, that most hospitals are FOR PROFIT businesses. Usually only city hospitals and places like the Shriners hospitals are non profits. Of course, non profit doesn't mean that they don't pay their administrators well, btw.

[CaP'N GRuNGe]

The free and reduced care pool of money isn't a huge portion over all of the cost for everyone, IMO. When they figure the cost for reduced care, I suspect they figure out a lot closer to the actual cost for things than what they charge the insurance companies.

 

 

If I'm understanding what your saying, you're guessing that different people are billed different rates. That would be illegal. Everyone is billed the same rate for the same procedure. (Unless you're breaking the law.) Again though because you are free to negotiate with different insurance carriers and because Medicare only allows certain payment structures, what is actually collected can vary from payor type greatly. Medicare is actually one of our best payors I believe. To give you an idea, in 2005 the amount expected to be collected was only like 35% of the total billed - and that doesn't include bad debt.

 

Again - i'm referring only to the company I work for...a non-profit.

Edited June 17, 2006 by CaP'N GRuNGe

[jgcoach]

My mother started her career as a accounts receivable rep. in a hospital and just recently retired as a VP from Kessler Institute. It's a shame but, the insurance companies are mostly to blame for the ridiculous billing in the medical profession. If you get a bill from a doctor or hospital, question it. You'd be surprised the stuff you get billed for but shouldn't. Question it, it gets taken off. Don't question it, you and your insurance pays the price. I'm not saying they intentionally try to rob you but, there are proceedures that have flat rates and bill for some things that are usually used or required. Many times they don't get used or aren't needed but billed for anyway as a flat rate. Ask for an itemized bill and check it out.

[Chargerz]

My mother started her career as a accounts receivable rep. in a hospital and just recently retired as a VP from Kessler Institute. It's a shame but, the insurance companies are mostly to blame for the ridiculous billing in the medical profession. If you get a bill from a doctor or hospital, question it. You'd be surprised the stuff you get billed for but shouldn't. Question it, it gets taken off. Don't question it, you and your insurance pays the price. I'm not saying they intentionally try to rob you but, there are proceedures that have flat rates and bill for some things that are usually used or required. Many times they don't get used or aren't needed but billed for anyway as a flat rate. Ask for an itemized bill and check it out.

 

Good info here!!!!!

[BeeR]

I'm looking over a bill that was sent to me. After going to the ear, nose and throat Dr. I received a bill for the amount that I owe. No biggie, it's only $101 I have to pay out of $680. But one of the charges on there is just plain stupid. It's called Surgical Tray Fee and it costs me/my insurance $75.

 

Chargerz please enlighten me as to why a tray would have a fee of $75? When all he had on it was a flexable strobe and some paper towls.

 

I agree, but this is no more lame/stupid than buying a car and paying a $200 "processing fee" or the 5 gazillion BS "we're going to rip you off and couch it under some goofy name" fees you pay when buying a house. Sounds to me like the med field is just catching on.

[The Holy Roller]

Now here is my question - once my wife returns to work she has amazing medical/dental/eye benefits through the county as a teacher (one of the perks for being a teacher) so I am going to opt out of my ins at verizon (either through quitting there and starting my own busines like i've talked about on here or just refusing their packages at work if I end up staying.) so am I to receive additional money from the company because I am refusing benefits?

 

I'm not talking about the money I pay per month for full family ($310). Verizon pays on average $600 to 800 a month for employee benefits. Should I receive something like $200 additional to my pay? I've heard that receiving that is very common.

Anyone know?

 

 

My school district pays non-participating employees a monthly annuity. I've got over 20K in that annuity as of today. I refuse to participate in the insurance/medical care rip-off. What a f'n ripoff!! Thieves, thieves, and more thieves. They are from Satan.

[CaP'N GRuNGe]

Now here is my question - once my wife returns to work she has amazing medical/dental/eye benefits through the county as a teacher (one of the perks for being a teacher) so I am going to opt out of my ins at verizon (either through quitting there and starting my own busines like i've talked about on here or just refusing their packages at work if I end up staying.) so am I to receive additional money from the company because I am refusing benefits?

 

I'm not talking about the money I pay per month for full family ($310). Verizon pays on average $600 to 800 a month for employee benefits. Should I receive something like $200 additional to my pay? I've heard that receiving that is very common.

Anyone know?

 

 

My wife gets $15 a pay period (2 weeks) for declining insurance. You have to have proof you are covered by another plan in order to receive that. We actually both work for the same company so our family premium is actually reduced by the $30 a month if you look at it that way which is kind of nice. I can't imagine employers pay what you're talking about for not taking their healthcare benefits. That seems like a nice option though if they do!

[Czarina]

You'll typically get only a small fraction of the dollar value of your health insurance back if you decline it. The reasoning for this is--

 

1. Hey, saves the company a ton of bucks

2. Too many people, especially the young and stupid ones, would decline their insurance to put a few extra bucks in their pockets, then not be able to pay for themselves when they actually get sick.