4 ms·
> could the patient have covered the last session at the price insurance companies pay? No, cash payers pay less, not more.[1] But even "less" is financially d
by allenz 11y ago
> could the patient have covered the last session at the price insurance companies pay?
No, cash payers pay less, not more.[1] But even "less" is financially devastating for most people in the context of chemotherapy.
> does the insurance company run down that upper limit
based on the amount they're billed, or the amount they pay?
The amount they pay; the former would be fraud.
> given that they have a pool of money, do you allocate that toward the least sick people?
> you don't have perfectly clear obligations
> the insurance company gets to decide the worthiness of paying out
Insurance companies do not operate for charity; if they have extra money, it goes to shareholders. Outside of a few publicity stunts, companies have clear obligations as specified by copay, deductible, maximum limits, and covered providers/procedures, and people who pay more for better coverage get better coverage (so poor people have a bad time). But insurance generally doesn't have robust margins--many earn their profits purely on float.[2]
You are of course right that questions of allocation always involves questions of values. But these questions are decided by the political process, in battles over healthcare regulation in areas such as minimum coverage requirements, excessive rates, and preexisting conditions.
[1] http://www.wsj.com/articles/how-to-cut-your-health-care-bill-pay-cash-1455592277 http://www.wsj.com/articles/how-to-cut-your-health-care-bill...
[2] http://www.wikinvest.com/wiki/Float http://www.wikinvest.com/wiki/Float
- jfoutz 11y ago> No, cash payers pay less, not more.[1] Cash payers may pay less, if they have the opportunity and sense to negotiate the prompt-pay discount. I was a freelancer before ACA and paid more than i should have out of pocket, because i was dumb. But yes, if you're savvy, you have a chance. Getting medical care out of insurance's prying eyes may have some weird consequences, payer-provider agreements might prohibit direct interaction [1]. Seems unlikely they'd drop you, but weird things might happen if it turns out you get a CT scan from X that doesn't know you have insurance from Y, and X has another agreement not to take cash payments from Y's customers. I'm not saying you're wrong, i'm saying just like everything else in health care it's really fucking complicated. > The amount they pay; the former would be fraud. The ACA specifically calls out 'dollar value'. AFAICT, it varies from state to state. If you hit me with your car, and the court decides you have to pay my medical bills, North Carolina limits it to just the actual amount paid. Wisconsin says it's up to the court to decide what 'dollar value' means, and they can take into account billed and paid (and anything else they want). That's all personal injury stuff though, there might be special definitions for ACA. > Insurance companies do not operate for charity; Yeah. I'm not claiming they should. I'm not a fan of the system, but it's the system we have. As with all things, the way I think it should work, and the way it actually works are very different things. Mostly, i was trying to call out how ridiculously complicated it is. The OP's assertion: > Insurance is a math problem and it has a precise answer. may be true. But that math problem is way beyond the 3 body problem. I don't think we can really find a precise answer for any real world case. [1] http://clearhealthcosts.com/blog/2014/09/saving-money-paying-cash-even-youre-insured-draft/ http://clearhealthcosts.com/blog/2014/09/saving-money-paying...