Feeling backed into a corner

EvanB wrote:

Sky_Render wrote: It should be a crime to be a health insurance company. Health insurance executives should be taken out and executed. *Publicly*.

So everyone pays for their medical bills out of pocket without even the option of it being covered by insurance? Sounds like that would really solve the issue you are mad about.

National health care seems to work just fine for every other first-world country.

EvanB wrote: So everyone pays for their medical bills out of pocket without even the option of it being covered by insurance? Sounds like that would really solve the issue you are mad about.

In a round-about way, it might. If the average person was forced to pay out-of-pocket for most procedures, costs would be forced to go down. Yes, there will be instances where costs will exceed what the average family can afford, but that should be where insurance comes in.

HiTempguy wrote: I also find it quite callous to think that everyone doesn't have a right to live, which for all intents and purposes, is what Duke advocates. It's cool that he is fine with human suffering, I'm not.

I think everyone has a right to live. That is not the same thinking that everyone has a right to have life provided for them.

I'm also not cool with human suffering. It sucks. Bad things happen to good people, my immediate family included. That still doesn't mean that people who have had bad things happen to them are entitled to get reparations and support.

I think it's great that people choose to help others and donate time, money, and skill. I have been on the receiving end of generosity and I have offered my own to others. The vast special charity networks and outpourings of support after disasters are evidence of that good part of human nature.

But I also think it's highly counterproductive to indoctrinate entire generations and cultures to think that the government is an omni-present, omni-generous, benign entity that is always there like a giant daddy and mommy to kiss them and make their boo-boos go away.

Sky_Render wrote:

Swank Force One wrote:

Sky_Render wrote:

Datsun1500 wrote: They make the money investing the premiums, not short changing the providers. They take the risk that If I pay them $X that they will make enough off of $X to justify paying $Y on my behalf. I have no issue with that. If I stay healthy, they win. If I need a bunch of stuff, they lose.

No, they make money by paying out as little as possible. Example: My friend does not have good health insurance. Her doctor requested a test that she (the doctor) felt needed to be performed. The doctor sent a written letter to her insurance company to "pre-authorize" said procedure. The insurance company *refused* to pay for the test, saying that my friend would have to suffer certain "confirmed" symptoms three times before this test would be authorized. Those symptoms could be life-threatening. It should be a crime to be a health insurance company. Health insurance executives should be taken out and executed. *Publicly*.

Your friend always has the option of having the services rendered anyways. I'd never suggest letting money get in the way of serious health issues.

Not if the test is too expensive. My point is that health insurance companies basically have the right to say "No, your doctor is incorrect; you *don't* need that procedure/test/whatever." A company, whose best interest is to keep as much money as possible and thus provide you as little service as possible, is making your healthcare decisions for you, *not* your doctor. Execute them.

Still wrong. You're putting money in front of health again.

Health insurance companies do not, i repeat DO NOT, determine whether or not you can have services rendered. They just determine whether or not they will pay for it. Your friend has the option of having the services anyways, skipping out on the bill, and letting everyone else pay for it.

It's how it's always been, and if they're genuinely afraid, they should probably go ahead and do that.

You have a very skewed and rather well... ignorant view on what health insurance companies can and can't do, as well as what they do, and don't do.

I can say with 100% certainty that we're not in the business of denying claims. I can also say with 100% certainty that in terms of profits, health insurance is the LAST place on earth you should be looking at and getting pissed over.

Fun fact: In 99.99% of scenarios (Unless instructed to do otherwise by your employer), private health insurance companies follow Medicare guidelines in terms of what can and can't be paid.

Sooo.... hrm.

Swank Force One wrote:

Zomby Woof wrote: In reply to alfadriver: I said it before, and I'll say it again. As long as the insurance companies are involved, you will always have a second rate healthcare system. If that's what you "free market" guys want, then more power to you. I LOL at you guys sometimes. Just like the copyright discussion. You think there's only one way to do things. Anything else can't possibly work. Have a look around. How's it working out for you?

I'm curious to see how you think that insurance has any impact on Quality of Care.

I didn't say it did.

Swank Force One wrote: Still wrong. You're putting money in front of health again. Health insurance companies do not, i repeat DO NOT, determine whether or not you can have services rendered. They just determine whether or not they will pay for it. Your friend has the option of having the services anyways, skipping out on the bill, and letting everyone else pay for it. It's how it's always been, and if they're genuinely afraid, they should probably go ahead and do that. You have a very skewed and rather well... ignorant view on what health insurance companies can and can't do, as well as what they do, and don't do. I can say with 100% certainty that we're not in the business of denying claims. I can also say with 100% certainty that in terms of profits, health insurance is the LAST place on earth you should be looking at and getting pissed over. Fun fact: In 99.99% of scenarios (Unless instructed to do otherwise by your employer), private health insurance companies follow Medicare guidelines in terms of what can and can't be paid. Sooo.... hrm.

So firstly, you're advocating someone having services performed and not paying for them? How is that ethical? And how would that affect the person who now has a negative score on their credit, especially if they have to do this more than once?

Not in the business of denying claims? Really? How exactly do you make money then? Your entire business model is built on people paying into your system and you paying out less than that. Therefore, more claims paid means less profit.

Zomby Woof wrote:

Swank Force One wrote:

Zomby Woof wrote: In reply to alfadriver: I said it before, and I'll say it again. As long as the insurance companies are involved, you will always have a second rate healthcare system. If that's what you "free market" guys want, then more power to you. I LOL at you guys sometimes. Just like the copyright discussion. You think there's only one way to do things. Anything else can't possibly work. Have a look around. How's it working out for you?

I'm curious to see how you think that insurance has any impact on Quality of Care.

I didn't say it did.

You did, though... you said "Healthcare." How does insurance lower the quality of the care of your health?

Sky_Render wrote:

Swank Force One wrote: Still wrong. You're putting money in front of health again. Health insurance companies do not, i repeat DO NOT, determine whether or not you can have services rendered. They just determine whether or not they will pay for it. Your friend has the option of having the services anyways, skipping out on the bill, and letting everyone else pay for it. It's how it's always been, and if they're genuinely afraid, they should probably go ahead and do that. You have a very skewed and rather well... ignorant view on what health insurance companies can and can't do, as well as what they do, and don't do. I can say with 100% certainty that we're not in the business of denying claims. I can also say with 100% certainty that in terms of profits, health insurance is the LAST place on earth you should be looking at and getting pissed over. Fun fact: In 99.99% of scenarios (Unless instructed to do otherwise by your employer), private health insurance companies follow Medicare guidelines in terms of what can and can't be paid. Sooo.... hrm.

So firstly, you're advocating someone having services performed and not paying for them? How is that ethical? And how would that affect the person who now has a negative score on their credit, especially if they have to do this more than once? Not in the business of denying claims? Really? How exactly do you make money then? Your entire business model is built on people paying into your system and you paying out less than that. Therefore, more claims paid means less profit.

Firstly, i'm not advocating anything. Calm it down.

I'm saying that if it's a life/death situation, berkeley what anyone says, get that E36 M3 done. It's the same in the end. I go to the doctor maybe twice a decade. I'm already paying for someone else to go. It's how it works. If i get in an accident today and have $1 million worth of services rendered, i'm not paying for that E36 M3. Insurance will, or they won't, it doesn't matter.

And really, we're not in the business of denying claims. The entire business model results in a 1-3% profit with current regulations. You're mad about that?

Of course more claims means less profit. This doesn't mean that we arbitrarily choose claims to not pay "because well... screw this person, that's a lot of money, we'd really rather keep it."

But like i said, you don't understand how it works. Cutting out your friend's situation doesn't save insurance companies anything worth talking about. It's obviously not a common situation. Because there are no common situations in which that happens. (Besides denying massage therapist claims when they try to masquerade as physical therapists)

Yes, the idea is to pay out less than we take in. Saying that we get there by denying claims is beyond ludicrous and completely asinine. No, we get there by charging premiums that equal out to more than what the member base requires to be paid out, plus operating costs.

And it's cut close. VERY close.

And again, we follow government guidelines. If you have a problem with what private insurance is doing, you have a problem with Medicare and Medicaid as well. Are you wanting the government to take it over to solve the problems?

Swank Force One wrote: How does insurance lower the quality of the care of your health?

I didn't say that it did.

Zomby Woof wrote:

Swank Force One wrote:

Zomby Woof wrote:

Swank Force One wrote:

Zomby Woof wrote: In reply to alfadriver: I said it before, and I'll say it again. As long as the insurance companies are involved, you will always have a second rate healthcare system. If that's what you "free market" guys want, then more power to you. I LOL at you guys sometimes. Just like the copyright discussion. You think there's only one way to do things. Anything else can't possibly work. Have a look around. How's it working out for you?

I'm curious to see how you think that insurance has any impact on Quality of Care.

I didn't say it did.

You did, though... you said "Healthcare." How does insurance lower the quality of the care of your health?

I didn't say that it did.

Then why does having insurance companies guarantee that we'll always have second rate healthcare?

Sky_Render wrote:

Datsun1500 wrote: They make the money investing the premiums, not short changing the providers. They take the risk that If I pay them $X that they will make enough off of $X to justify paying $Y on my behalf. I have no issue with that. If I stay healthy, they win. If I need a bunch of stuff, they lose.

No, they make money by paying out as little as possible. Example: My friend does not have good health insurance. Her doctor requested a test that she (the doctor) felt needed to be performed. The doctor sent a written letter to her insurance company to "pre-authorize" said procedure. The insurance company *refused* to pay for the test, saying that my friend would have to suffer certain "confirmed" symptoms three times before this test would be authorized. Those symptoms could be life-threatening. It should be a crime to be a health insurance company. Health insurance executives should be taken out and executed. *Publicly*.

My sister had a similar issue while she was in, some of your heads will explode but here goes, Paris. She had to have symptoms for x number of days before she could get treated. She did get treatment immediatly after getting back to the US.

In reply to Swank Force One:

Cost and access.

What you had wasn't working (if you think it was, I won't argue). What you are about to have is worse.

My point was, if you are going to reform the system, or create some sort of national health care plan, as long as the insurance companies are involved, your health care will never be the number one priority. Several layers of profit will always come first. That, IMO, is a second rate health care system.

Zomby Woof wrote: In reply to Swank Force One: Cost and access. What you had wasn't working (if you think it was, I won't argue). What you are about to have is worse. My point was, if you are going to reform the system, or create some sort of national health care plan, as long as the insurance companies are involved, your health care will never be the number one priority. Several layers of profit will always come first. That, IMO, is a second rate health care system.

I agree with this. They need to E36 M3, or get off the pot. Make it universal health care and suffer those issues, or open it up free market.

Sky_Render wrote: National health care seems to work just fine for *every other first-world country.*

Wait?

You want to eradicate a system because its' administrators limit services because of costs but you want to replace it with a system that does the exact same thing?

Swank Force One wrote: And really, we're not in the business of denying claims. The entire business model results in a 1-3% profit with current regulations. You're mad about that?

I would like to point out... couple of years ago friend of mine from germany needed some catscans after an accident. While he did not pay (he was in germany) he did get an invoice for the proceedure. It cost all of about $700

Last year his son needed some cat scans done due to an illness that he should have gotten shots for when a baby (he's 13 now) but because they were in Germany and they were not required, never got.

The price for the same proceedure here in the US? $3500

Somebody is making a profit

mad_machine wrote:

Swank Force One wrote: And really, we're not in the business of denying claims. The entire business model results in a 1-3% profit with current regulations. You're mad about that?

I would like to point out... couple of years ago friend of mine from germany needed some catscans after an accident. While he did not pay (he was in germany) he did get an invoice for the proceedure. It cost all of about $700 Last year his son needed some cat scans done due to an illness that he should have gotten shots for when a baby (he's 13 now) but because they were in Germany and they were not required, never got. The price for the same proceedure here in the US? $3500 Somebody is making a profit

I went to the ER for what ended up being a kidney stone. After being there for 8 hours or so, I went home. I later got the statement from my insurance and the total bill was $8600.

Two months later I am in Germany on vacation. Same pain, now I know what my problem is and go straight to the hospital. I paid $200 euros as a deposit. They did the same thing to me, gave me meds and had me on my way. Three months later ai got a letter from the "Klinikum" asking for my bank account in order to deposit $120 euros that I overpaid.

:)

You can't compare costs.based on the U.S. hospitals billed amount. You have to look at the paid amount by the ins company. You also can't use the billed amount in other countries because the system is govt subsidised.

Datsun1500 wrote: In reply to Sky_Render: How would your friend pay if she didnt have insurance (if there was none) You say there shouldn't be insurance, so how would that have been better? They didn't say she couldn't have the test, they said they were not going to pay for it. Did she have it?

Here is the problem with our system.

She could very well go have the tests done, they come back positive and now her ins co could say 'since you chose to go outside of our guidelines you are now on your own'. Doesn't matter that she has paid her premiums and had a piece of really E36 M3ty luck.

So maybe it costs $250,000. (Just picking a figure.) He choices are: have it done and spend the rest of her life paying this back and living miserably or skipping the whole thing and dying early because of it.

That's a berkeleyed up choice to have to make, particularly when the ins co CEO could very well be sitting on his ass somewhere with people bringing him mai tais or mint juleps or whatever as he watches the stock ticker.

Gotta keep the shareholders happy, don'cha know.

MrJoshua wrote: You can't compare costs.based on the U.S. hospitals billed amount. You have to look at the paid amount by the ins company. You also can't use the billed amount in other countries because the system is govt subsidised.

There's a minor flaw in those statements, or rather, something of a caveat: If you DON'T have insurance and have to pay for things yourself, out of pocket? You WILL be paying the billed amount- and it can be absolutely berking absurd at times. There was an article I read a ways back I wish I could find again where they tried to find out what a number of different hospitals charged for procedures, and what Medicare & insurance companies paid vs. what individuals paying 'ala carte' was SUBSTANTIALLY different- the hospitals nickel and dimed (and by that I mean '$500 & $1000'd) the individuals an unbelievable amount, sometimes charging upwards of $10 for a sterile bandage that the hospital gets in a pack of 100 for $20- and that Ins/Medicare will only pay $.50 for if they pay for it at all since common consumables like that are supposed to be covered under the general daily fee the hospital charges.

Overall though, that's part of the problem- there really ISN'T a good way to compare apples to apples in this situation, even between hospitals here in the US much less between the US and different countries...

Anyone else find it a bit odd that the group that wants everyone to have the choice of life also wants to publicly execute insurance execs?

In reply to Ashyukun:

I think that depends on the hospital and your approach. Where I find that to be a painful truth is when you use your insurance for a procedure that isn't covered. If you run it through ins you pay the billed amount. If you pay out of pocket at the time of service some hospitals discount the bill by 60-70 %.

Bobzilla wrote: Anyone else find it a bit odd that the group that wants everyone to have the choice of life also wants to publicly execute insurance execs?

Yep-save the helpless and kill the more fortunate.

MrJoshua wrote:

Bobzilla wrote: Anyone else find it a bit odd that the group that wants everyone to have the choice of life also wants to publicly execute insurance execs?

Yep-save the helpless and kill the more fortunate.

I vote kill em all

Datsun1500 wrote: One of the reasons the bills are so high is because of the number of people that do not pay. The people that actually do pay, are paying for all that don't, legal or otherwise

Wonder if much of the issue is that for now, they are rating based on that assumption and if/when the law actually catches up with people not paying (meaning non-pays are decreased) it will get better...

In reply to Apexcarver:

Our bankruptcy laws protect people too well. Not that it'd ever change or matter, worthless berkeleys continue being worthless berkeleys.