So this sucks but you can avoid this with a simple trick. Call your insurance company first with the CPT codes for what you need done and where you plan to get it done. Your doctors office can give you the codes. They aren’t a trade secret or anything. Get diagnoses codes too if you can. Have the insurance company run the codes for you before you go. This does a couple things:
You verify everyone involved is in network (be wary of anesthesiologists)
You are getting a quote on a recorded line. The end price won’t be exact (especially is if the claim involves a hospital, fuck them, go to smaller providers whenever you can)
if you get sticker shock anyway, you can call the insurance company back on that same recorded line and say the word “misquote”. This triggers an investigation that can strengthen your appeal.
You now have evidence you can file internally with a quality of care/quality of service complaint if the provider did something shady with the billing, or with your state’s department of insurance if your insurance company is being bitchy.
Ideally, we would have single payer insurance, but we instead have a government that pays itself to make private enterprise do its job, then the shareholders in that private enterprise make sure nothing ever gets changed. -sigh-
In the mean time, if you really want to fuck them over, consider switching to health insurance company that does not have shareholders. In many states, they are legally mandated to refund any profit they make over a certain percentage at the end of the year and without shareholders, it’s harder to hide the money, which puts much more pressure on them to spend it on patient care.
United Health Care want you to believe their way is the only way to do this. They are wrong. A shareholder-free insurer still isn’t perfect but the pressures are different without the parasites.
jfk. I had to take someone to the hospital yesterday for an acute problem (which turned out ok). When leaving, after 7 hours at the hospital, I started to reach for my wallet and the lady looked at me and said wtf are you doing put it away. And the two presriptions- free instead of the usual $5 each. I laugh when those repubs call my country a “social hellscape”
Agreed. But the fact is there is a lot of money in paying for medical expenses that keep going higher and not a lot of money going to the pot that pays it out. Single payer would address all of that instantly but the rich would be unhappy so we basically have to pay a survival tax to insurance companies every month.
Any tips on finding an insurance company in your state that doesn’t have shareholders? A big part of the insurance issue is that you have to practically be an industry insider to navigate… Anything in insurance, really.
There are those of us in n this industry that want that changed but we don’t have as much power as the bigger companies do so the best we can do is play by their rules. :(
Single payer moves the bargaining power out of the hands of the service provider party using the government’s power to set prices. It doesn’t give all of the power to the user side, since if the government tries to set a too low price, the providers can just choose to not offer that service, so it is still a negotiation, it’s just no longer based on “how badly do you want to live/get better?”
There must be a limit to the necessary size. Small countries can offer affordable health care. So an insurer of that size should be able to handle the risk as efficiently.
Well in a small country there’s not an incentive to raise prices endlessly for medical care. In America there is. So now you have the providers which always want more (don’t misunderstand this, it’s not always the doctor you are seeing that’s commanding a higher price. In fact, it rarely is. It’s the others down the line that want their cut for his work.) and insurers that need to pay for things but can’t just constantly demand more money themselves.
Enter the business majors.
They have decided the insurance companies just need to play chicken with the providers and deny paying for things they deem unreasonable. It does stop some scams, but it also backfires sometimes. So for things like insulin, we don’t have direct control over the price. So we will say “fuck them, if we start paying for insulin X, everyone’s prices go up, not just yours, and we won’t be able to covers everything. Get something more reasonably priced.” It doesn’t matter that insulin X would be perfect for you. Lots of other people need it too, and if we cover it, that money has to come from somewhere and people are financially strapped as is.
Drug companies don’t want to do us any favors. They price insulin like it’s a new fucking iPhone. Luxury insulin. It’s not a new thing. It’s been around forever. It’s settled. But they have the patent and the money to bribe congress critters to prevent regulating prices so here we are.
In other cases, like HIV medication, those drugs are incredibly expensive because they are ridiculously expensive to develop for. The drug company does have to recoup their costs. However they do offer patient assistance programs for a lot of those drugs where THEY will cover your copays. Plus in many countries they aren’t allowed to sell the drug there unless they agree on a reasonable price. And in India, their government said “fuck you” and just outright copied an HIV drug.
Then we get things like GLP-1 inhibitors. Those can be a blessing for diabetics that need them. But as many people as there are that legitimately need it, there are even more that can be sold to for insecurities in appearance and given it as a way to slim down. So guess who the drug companies market to? Demand surges and the price is high because they intentionally created a scarcity like they are selling the next PlayStation. And many insurance companies won’t cover it anymore. And the reason is surprising. Everybody wants this damn thing until they actually get it. Very few actually want to stay on it. They usually vomit constantly on it and they stop taking it. So that’s all that money getting spent on what’s basically TikTok marketing instead of patient care. And then for those that do stay on it, they have to stay on it forever. The longer they take it, the worse they are when they stop. All the weight lost comes back PLUS more. So they end up worse than they started and we paid for that instead of someone’s MRI.
It’s the scarcity that drives up the prices. More money coming in from single payer systems kills the scarcity, and the prices are forced to come down because they have to compete with eachother. But rich people are just business majors with hoarding issues. They always need more. They will never be happy. And they will make us all suffer over their endless persist to bleed the country dry.
We do what we can. This really is the responsibility of a larger entity with more resources than we have, like a fucking government, but they figured out all they have to do keep resources scare to keep us fighting amongst eachother. Add shareholders and you get cartoon villain evil shit like United Health Care. All the while tax dollars go in and do nothing but blame us for trying to make this losing game work.
Imagine your heath insurance just being part of your taxes. You pay them that way. Now imagine that that health insurance tax is less than a third of what you are paying for health insurance now to get better coverage. Thats the absurdity of it. We have a government that doesn’t want to do its job, so business majors swoop in and screw us all.
It kinda scales. What’s the likelihood of 10 million people at once being sick in a country of 10 million? And what’s the likelihood in a country of 300 million?
The number of sick people also scales.
The likelihood for 100 thousand sick out of 10 million is the same as 3 million sick out of 300 million.
What changes is the variation. If you have 10 people, it’s possible that all are sick at the same time. All being sick is much less likely for 10 million and even less for 300 million.
An insurance company must have a certain size to handle variation but after that point a bigger size is not needed for that but can help with other properties.
So this sucks but you can avoid this with a simple trick. Call your insurance company first with the CPT codes for what you need done and where you plan to get it done. Your doctors office can give you the codes. They aren’t a trade secret or anything. Get diagnoses codes too if you can. Have the insurance company run the codes for you before you go. This does a couple things:
Ideally, we would have single payer insurance, but we instead have a government that pays itself to make private enterprise do its job, then the shareholders in that private enterprise make sure nothing ever gets changed. -sigh-
In the mean time, if you really want to fuck them over, consider switching to health insurance company that does not have shareholders. In many states, they are legally mandated to refund any profit they make over a certain percentage at the end of the year and without shareholders, it’s harder to hide the money, which puts much more pressure on them to spend it on patient care.
United Health Care want you to believe their way is the only way to do this. They are wrong. A shareholder-free insurer still isn’t perfect but the pressures are different without the parasites.
is this seriously what you americans have to do?
Most of us bend over and die.
jfk. I had to take someone to the hospital yesterday for an acute problem (which turned out ok). When leaving, after 7 hours at the hospital, I started to reach for my wallet and the lady looked at me and said wtf are you doing put it away. And the two presriptions- free instead of the usual $5 each. I laugh when those repubs call my country a “social hellscape”
Yes. Everything is a fight against the rich.
Freedom isn’t free
The fact you have to jump through these hoops at all IS FUCKING STUPID AND ISNT HOW IT SHOULD WORK.
Agreed. But the fact is there is a lot of money in paying for medical expenses that keep going higher and not a lot of money going to the pot that pays it out. Single payer would address all of that instantly but the rich would be unhappy so we basically have to pay a survival tax to insurance companies every month.
I hate it here.
Any tips on finding an insurance company in your state that doesn’t have shareholders? A big part of the insurance issue is that you have to practically be an industry insider to navigate… Anything in insurance, really.
It’s like they’ve made the system so convoluted that you have to be an underwriter to receive services.
There are those of us in n this industry that want that changed but we don’t have as much power as the bigger companies do so the best we can do is play by their rules. :(
This is the first time I see this solution mentioned. It doesn’t seem to be known much. Why would a single payer insurance lower costs further?
Single payer moves the bargaining power out of the hands of the service provider party using the government’s power to set prices. It doesn’t give all of the power to the user side, since if the government tries to set a too low price, the providers can just choose to not offer that service, so it is still a negotiation, it’s just no longer based on “how badly do you want to live/get better?”
Single payer means more people are in the group, diluting risk further. There’s no way to compete with that. The costs are impossible to beat.
There must be a limit to the necessary size. Small countries can offer affordable health care. So an insurer of that size should be able to handle the risk as efficiently.
Well in a small country there’s not an incentive to raise prices endlessly for medical care. In America there is. So now you have the providers which always want more (don’t misunderstand this, it’s not always the doctor you are seeing that’s commanding a higher price. In fact, it rarely is. It’s the others down the line that want their cut for his work.) and insurers that need to pay for things but can’t just constantly demand more money themselves.
Enter the business majors.
They have decided the insurance companies just need to play chicken with the providers and deny paying for things they deem unreasonable. It does stop some scams, but it also backfires sometimes. So for things like insulin, we don’t have direct control over the price. So we will say “fuck them, if we start paying for insulin X, everyone’s prices go up, not just yours, and we won’t be able to covers everything. Get something more reasonably priced.” It doesn’t matter that insulin X would be perfect for you. Lots of other people need it too, and if we cover it, that money has to come from somewhere and people are financially strapped as is.
Drug companies don’t want to do us any favors. They price insulin like it’s a new fucking iPhone. Luxury insulin. It’s not a new thing. It’s been around forever. It’s settled. But they have the patent and the money to bribe congress critters to prevent regulating prices so here we are.
In other cases, like HIV medication, those drugs are incredibly expensive because they are ridiculously expensive to develop for. The drug company does have to recoup their costs. However they do offer patient assistance programs for a lot of those drugs where THEY will cover your copays. Plus in many countries they aren’t allowed to sell the drug there unless they agree on a reasonable price. And in India, their government said “fuck you” and just outright copied an HIV drug.
Then we get things like GLP-1 inhibitors. Those can be a blessing for diabetics that need them. But as many people as there are that legitimately need it, there are even more that can be sold to for insecurities in appearance and given it as a way to slim down. So guess who the drug companies market to? Demand surges and the price is high because they intentionally created a scarcity like they are selling the next PlayStation. And many insurance companies won’t cover it anymore. And the reason is surprising. Everybody wants this damn thing until they actually get it. Very few actually want to stay on it. They usually vomit constantly on it and they stop taking it. So that’s all that money getting spent on what’s basically TikTok marketing instead of patient care. And then for those that do stay on it, they have to stay on it forever. The longer they take it, the worse they are when they stop. All the weight lost comes back PLUS more. So they end up worse than they started and we paid for that instead of someone’s MRI.
It’s the scarcity that drives up the prices. More money coming in from single payer systems kills the scarcity, and the prices are forced to come down because they have to compete with eachother. But rich people are just business majors with hoarding issues. They always need more. They will never be happy. And they will make us all suffer over their endless persist to bleed the country dry.
We do what we can. This really is the responsibility of a larger entity with more resources than we have, like a fucking government, but they figured out all they have to do keep resources scare to keep us fighting amongst eachother. Add shareholders and you get cartoon villain evil shit like United Health Care. All the while tax dollars go in and do nothing but blame us for trying to make this losing game work.
Imagine your heath insurance just being part of your taxes. You pay them that way. Now imagine that that health insurance tax is less than a third of what you are paying for health insurance now to get better coverage. Thats the absurdity of it. We have a government that doesn’t want to do its job, so business majors swoop in and screw us all.
I hate it here.
It kinda scales. What’s the likelihood of 10 million people at once being sick in a country of 10 million? And what’s the likelihood in a country of 300 million?
The number of sick people also scales. The likelihood for 100 thousand sick out of 10 million is the same as 3 million sick out of 300 million.
What changes is the variation. If you have 10 people, it’s possible that all are sick at the same time. All being sick is much less likely for 10 million and even less for 300 million.
An insurance company must have a certain size to handle variation but after that point a bigger size is not needed for that but can help with other properties.