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If private insurance is going to work, then every healthcare provider has to accept payment from every insurance. This clusterfuck we have where you have in-net
by imgabe 8y ago
If private insurance is going to work, then every healthcare provider has to accept payment from every insurance. This clusterfuck we have where you have in-network providers with one price and out-of-network providers with a different price just has to stop.
Oh you went to an in-network hospital, but this one doctor walked into the room for five minutes and she was out-of-network, so now your bill is 10x higher than it otherwise would be, etc. etc. It's ridiculous.
- paulddraper 8y agoThe reason this doesn't work is because not all doctors are equal. Insurance companies want to contract with the healthcare providers with the highest quality outcomes that don't have overprescription, relapses, and readmissions. Search terms: "narrow networks"
- conanbatt 8y ago1) Pass law providers require to support all insurances 2) Make insurance company that reimburses 1$ per visit 3) Profit
- u801e 8y agoI've always wanted to add a clause to those consent forms stating that my consent is conditional to the provider being in-network for the insurance information I provided the hospital. It is their responsibility to make that determination before they start treatment. If they provide treatment and find that they're not in network, then they forgo the right to bill for that service.
- ThrustVectoring 8y agoA great alternative strategy is to structure your finances so that it's impossible for creditors to seize your assets - that way, your practical liability is limited to the up-front costs. Which, by being up-front, you can actually reason about and make informed decisions on. This is less difficult than it sounds. Move to Texas, and keep all your assets in retirement accounts, home equity in your primary residence, and possibly annuities if you've made too much money for that all to hold everything. Note that this should be done before possibly incurring debts.
- henrikschroder 8y ago> A great alternative strategy is to structure your finances so that it's impossible for creditors to seize your assets It is absolute insanity that this is even a thing to consider. The funniest thing about it is that if you do this, you are effectively socializing your personal losses and letting everyone else insured through your provider bear the cost for your healthcare. If that's not an argument for actually socializing healthcare costs for everyone, I don't know what is.
- ThrustVectoring 8y agoIf I could cap my downside risk from medical events through insurance, I would do that instead. And this is not a replacement for insurance, since many medical providers will refuse to provide non-emergency care if they didn't expect that they could bill my insurance for services rendered. But, unfortunately, it's currently impossible to set a maximum price you could wind up owing due to receiving medical care. Any provider you go to could end up incurring out-of-network charges and wind up balance billing you. The only fix is to cap the actual damage of creditor judgements in general.
- henrikschroder 8y ago> But, unfortunately, it's currently impossible to set a maximum price you could wind up owing due to receiving medical care. Of course, because demand for healthcare is infinite, so you could wind up costing the insurance company an infinite amount of money. And if their expenses are uncapped, they're not going to cap how much you can pay them. And if they cap their expenses on your behalf, it's not really insurance, it's just a shitty payment plan.
- ThrustVectoring 8y agoI misspoke a little: it's impossible to set a maximum price that the 95th percentile household can afford. A single medical event can bankrupt households but not the state of California.
- 8y ago
- conanbatt 8y agoOnly that insurance takes 3 weeks to process the claim. Delaying care 3 weeks for that guarantee would have caustic medical implications.
- rtkwe 8y agoimgabe just said in network not that the claim gets accepted. There's been a couple cases where not everyone administering as part of the procedure was in network so there's a surprise bill for one part [0]. You can do all the right homework to make sure the principal people involved are in network and still get screwed! [0] https://www.cbsnews.com/news/out-of-network-anesthesiologist-leaves-family-with-3700-bill-after-birth-of-their-son-2019-04-17/ https://www.cbsnews.com/news/out-of-network-anesthesiologist...
- conanbatt 8y agoIf the procedure is not covered it doesn't matter if its in-network. You will face the same issue: the provider doesn't know if he will get paid from insurance until at least 3 weeks later.
- edmundhuber 8y agoThey won't let you have the procedure if you attempt to alter the agreement. I've tried!
- smacktoward 8y agoWhen you go to the hospital, you just need to wear a Darth Vader mask and rasp "pray I don't alter it any further."
- fzeroracer 8y agoI agree, however this is the unfortunate reality of the private healthcare system maximizing for profit. Consumers rarely have proper choice in shopping around or choosing doctors and insurance providers take advantage of this by inventing as many different systems as they can to avoid paying out. That's why I think full free market healthcare simply won't work. It's far too much at odds with people that need medical care, made worse if you need timely medical care.
- conanbatt 8y ago> unfortunate reality of the private healthcare system maximizing for profit > Consumers rarely have proper choice in shopping around If you have a M4A, you have less choices not more. > That's why I think full free market healthcare simply won't work The last thing I would call healthcare in the us is free market.