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Now let’s look at what all this means. When a business sends a bill, to you or to another business, you pretty much expect the bill to show the value of what they provided, and therefore what they expect to be paid. But an insurance company pays the hospital based on pre negotiated rates, no matter what the bill asks for. The hospital can turn away all patients with that insurance, of course but, for each insurance company, that would mean turning away a lot of patients—the insurance companies are now very big.
So because the hospitals know that they’ll only ever get less than what they bill, the process of hospital billing has stopped being a normal business transaction, and turned into something more like a kid daydreaming about his Christmas list. But it works, (well, not really), as long as it’s just a game between the hospital and the insurance company.
Here is where it goes Totally Wrong.
Hospitals see no problem in sending bills to insurance companies for five to ten times the amount that they actually expect, because they are simply playing the game that the insurance companies fashioned. But remember, they only produce one kind of bill, and it’s designed to send to someone who holds all the cards (an insurance company), and so can just refuse to pay anything they didn’t already agree to pay. That’s their game.
But what happens when you have to play the game with the hospital alone (if you don’t have insurance, or if your insurance doesn’t cover that stay for some reason). Then you’re on the hook for the entire amount. Most hospitals have a policy that allows people to negotiate for a lower amount, but most people don’t know this. And don’t expect the hospital to tell you about it, let alone help out. So even if you can remember to negotiate while you’re convalescing from a long hospital stay, good luck trying to get the deal the insurance company gets.
originally posted by: rickymouse
Ok, now on topic. Insurance companies now are allowed to charge based on how much they pay out and they are allowed to get a percentage for overhead and profit based on what they pay out. The more they pay out now, the more profit they can make. There are usually and customary charges, but because all companies are in on this, the medical and pharma companies are raising costs and doctors look the other way because they also get more income and bennies.
It is just business, we really need to switch over to socialized medicine to stop the madness, and there needs to be a restructuring of costs, New hospitals are going up all over, the more they spend on upgrading, the more they can charge.
originally posted by: hopenotfeariswhatweneed
a reply to: Edumakated
Seems like you guys are getting screwed, u suspect the reason Americans get ripped off on healthcare is because the insurance is a giant cash cow, so large in fact it's lobbying power is immense .
Playing on people's fear is key here, these insurance companies have free reign as nobody with the resources to pay will choose not to because health is so important.
This is partly why those of us that enjoy socialised medical have a hard time grasping why you guys are so against a medical system that for the most part works quite well.
originally posted by: JAGStorm
a reply to: Edumakated
Anyone with vision insurance really needs to weigh out the costs.
Many times buying glasses or contacts are cheaper without insurance.