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I suspect that we will find out that insurance isn’t paying much at all for most health care procedures, and the bulk of the cost is payed by the patient.
by rblatz 6y ago
I suspect that we will find out that insurance isn’t paying much at all for most health care procedures, and the bulk of the cost is payed by the patient.
- paledot 6y agoThis is true. My wife paid out of pocket for a procedure that should have been covered, and when she finally made it through the labyrinthine process to seek reimbursement, they only wanted to reimburse her for half of the cost, because that's the negotiated price the provider would have paid the hospital. In case you were still a bit unsure if the entire American health care system is irreparably broken or not.
- maxerickson 6y agoMy billing statements always include the insurance portion and the patient portion. Could be a Michigan law. The bills also include the billed price and the covered price (so the portion that they 'negotiate' is also on there). It would be big news if the amounts they said they paid weren't actual payments.
- jtbayly 6y agoThat’s after the fact, though. You don’t get to see any of those numbers until it’s too late to matter.
- maxerickson 6y agoIt matters in the sense that the payments made by the insurance company are already transparent; the other poster is speculating that it will be revealed that the patient portion is larger than the insurance portion, which people in (at least) Michigan already know isn't the case.
- jtbayly 6y agoI didn’t read the grandparent the same way, but that makes sense. Still, I don’t think it’s accurate to say that the prices are transparent when you can’t find them out without first signing away an unknown amount of your own money.
- maxerickson 6y agoSure, it's not price transparency, it's payment transparency (which I don't think is a redefinition of anything I've said above).
- nerdponx 6y agoThis I believe is standard practice at major insurers. It's called an "explanation of benefits" (EOB), and I have always been able to see them easily on my insurer's website.
- wasdfff 6y agoFew people incur north of their 10k deductible in medical fees a year, but nearly everyone pays for something every year out of pocket.
- coredog64 6y agoAs someone else has already pointed out, ACA imposes an 80% medical loss ratio on insurers. That means 80% of premiums have to go towards medical expenses. Insurance is a financial product, and there will be winners and losers. I pay my auto insurance bill on time and without a complaint even though I haven’t had an accident in 20+ years.