5 ms·

>> Any charges denied by the insurance were just dropped by the provider, not pushed to me. That's a provider choice, and not guaranteed.

nonameiguess 4y ago
Sure, but it's not uncommon, either. If you ever find yourself in a fight with a chronic or long-term condition, check the statement of benefits your insurer sends you every month. They're denying massive amounts of things that you never get a bill for. I even asked my main surgeon's office manager about this once, and he explained to me that insurance companies don't have any sort of upfront published caps on what they're willing to pay and for what, so both sides are kind of winging it. The providers simply bill some very large number that they know is so ridiculous that it has to be larger than the max that will get reimbursed, figuring that by doing so they'll at least guarantee they get that max and not inadvertently sell themselves short. So when you see things like a $14,000 charge for someone consulting over video for 10 minutes of work, or $800 for a bandaid, and you wonder how the hell a charge can possibly be that high, the answer is often that it isn't. That's just an artifact of this blind bidding thing going on between providers and insurers where providers send the largest conceivable bill they can to insurers knowing damn well they won't actually get that much. This also feeds back into why insurance companies have such a horrible incentive to default deny everything. They know the providers are overcharging and charging for bullshit. Both sides are forced into taking equally extreme baseline negotiating positions by the total lack of pricing transparency. It points at a very specific dysfunction of our system that goes well beyond the question of whether the government or private insurance purchasers should bear the bulk of the cost. This is a totally separate and orthogonal problem that both buyer and seller, no matter who they are, treat all transactions, no matter how mundane, like it's a blind silent auction for a rare Vermeer that hasn't seen a public market in 300 years.
- lostcolony 4y ago
  Oh, I know the incentives. I strongly suspect there's even an additional one you don't list - tax writeoffs. And you're going onto a tangent that I am very much in agreement with (that the whole system is massively broken and suffers all sorts of perverse incentives), but -my- point, if you'll recall, is that not everything gets written off. People still get unexpected medical bills -all the time-, for things their insurance didn't fully cover; this despite their deductible and/or max out of pocket. Or, as I commented before, and which you're...agreeing to, in a whole lot of words, it's a provider choice, and not guaranteed. I.e., every time you go to the doc you're rolling the die; doubly so for emergency stuff that you can't get pre-authorized. "It doesn't happen -that- often" seems to maybe be your argument, but it happens enough, and the consequences of it happening at all are devastating.

nonameiguess 4y ago

Sure, but it's not uncommon, either. If you ever find yourself in a fight with a chronic or long-term condition, check the statement of benefits your insurer sends you every month. They're denying massive amounts of things that you never get a bill for. I even asked my main surgeon's office manager about this once, and he explained to me that insurance companies don't have any sort of upfront published caps on what they're willing to pay and for what, so both sides are kind of winging it. The providers simply bill some very large number that they know is so ridiculous that it has to be larger than the max that will get reimbursed, figuring that by doing so they'll at least guarantee they get that max and not inadvertently sell themselves short. So when you see things like a $14,000 charge for someone consulting over video for 10 minutes of work, or $800 for a bandaid, and you wonder how the hell a charge can possibly be that high, the answer is often that it isn't. That's just an artifact of this blind bidding thing going on between providers and insurers where providers send the largest conceivable bill they can to insurers knowing damn well they won't actually get that much. This also feeds back into why insurance companies have such a horrible incentive to default deny everything. They know the providers are overcharging and charging for bullshit. Both sides are forced into taking equally extreme baseline negotiating positions by the total lack of pricing transparency. It points at a very specific dysfunction of our system that goes well beyond the question of whether the government or private insurance purchasers should bear the bulk of the cost. This is a totally separate and orthogonal problem that both buyer and seller, no matter who they are, treat all transactions, no matter how mundane, like it's a blind silent auction for a rare Vermeer that hasn't seen a public market in 300 years.

lostcolony 4y ago
Oh, I know the incentives. I strongly suspect there's even an additional one you don't list - tax writeoffs. And you're going onto a tangent that I am very much in agreement with (that the whole system is massively broken and suffers all sorts of perverse incentives), but -my- point, if you'll recall, is that not everything gets written off. People still get unexpected medical bills -all the time-, for things their insurance didn't fully cover; this despite their deductible and/or max out of pocket. Or, as I commented before, and which you're...agreeing to, in a whole lot of words, it's a provider choice, and not guaranteed. I.e., every time you go to the doc you're rolling the die; doubly so for emergency stuff that you can't get pre-authorized. "It doesn't happen -that- often" seems to maybe be your argument, but it happens enough, and the consequences of it happening at all are devastating.