4 ms·

Which prices are those? When I go to the doctor I get an insurance statement that says something like: Billed: $800 Paid by insurance: $200 You owe: $0

deleted 13y ago
[deleted]
AmVess 13y ago
Not everyone has insurance, and not not all insurance is good.
alok-g 13y ago
I am not sure, but looking at some of the prices that I have experienced myself, it's the amount paid by insurance.
analog31 13y ago
Not knowing what things cost is one of the reasons why we pay so much. I don't care to know the cost myself, but _nobody_ can figure out the cost structure of our system.
- alok-g 13y ago
  At least in one case I experienced, the staff at the hospital was having the same difficulty, unsurprisingly actually.
  - analog31 13y ago
    I think the system is "designed" to be opaque.
stormqloud 13y ago
Now you know how your insurance company makes so much money. They pay $200 for a service you think costs $800 and WILL cost you $800 if you buy it yourself. You buy insurance based on the FULL cost of the procedure. If you could access $200 yourself you wouldn;t need insurance. You can self insure at these prices. For the benefit of running the "self insurance" plan they are taking the difference between $200 and $800 Anyone else have a company and know what usual profit margins are? Your local pharmacy is lucky to pull off 35%. This is 400% markup that a "retail" person pays over the insurance company. It's not hard to make money when you buy at $200 and sell at $500-600-700 through an insurance policy. This is how companies like AIG (anybody remember them) buy things like ski hills for their executives. See www.stowe.com Americas are building up the next generation of their royalty. Companies with a mission in "health care" that mae 400% margins and buy ski hills for their executuves to use on "retreats". Yup, that makes total sense, to a lobbyist, lawyer or other enemy of the public and democracy. Crony capitalism, not true capitalism and market economy that people think of in the USA. The insurance companies got a major windfall with Obamacare. That lobbying really worked out. He could has just as easily allowed Medicare/Caid to negotiate prices and take over mre of the health care. That wouldn;t give jobs to people that Obama really cares about. North east Liberal lawyers.
- maxerickson 13y ago
  Under the ACA, when the insurance company pays a hospital (or any other medical provider) $200, it is allowed to spend $50 (less for larger programs) on salaries and profits and other expenses. If it gets $300 of premiums and only spends $200 on medical care, it has to send the extra $50 back to the customers (larger programs have to send back $65). More here: http://kff.org/health-reform/perspective/beyond-rebates-how-much-are-consumers-saving-from-the-acas-medical-loss-ratio-provision/ http://kff.org/health-reform/perspective/beyond-rebates-how-...
  - stormqloud 13y ago
    Clearly they have found ways around the rules or it's still way too much money. The fact health insurance companies invest in ski hills is very telling about lack of focus on their real business. Either their real biz makes so much money that they can spend it like drunken sailors or they don;t care about the primary mission of the company and are just buying perks they can use themselves. Either way you split it, it's still a total mess and not what shareholders or customers (patients) are expecting in an healthcare insurance company.

deleted 13y ago

[deleted]

AmVess 13y ago

Not everyone has insurance, and not not all insurance is good.

alok-g 13y ago

I am not sure, but looking at some of the prices that I have experienced myself, it's the amount paid by insurance.

analog31 13y ago

Not knowing what things cost is one of the reasons why we pay so much. I don't care to know the cost myself, but _nobody_ can figure out the cost structure of our system.

alok-g 13y ago
At least in one case I experienced, the staff at the hospital was having the same difficulty, unsurprisingly actually.
- analog31 13y ago
  I think the system is "designed" to be opaque.

stormqloud 13y ago

Now you know how your insurance company makes so much money. They pay $200 for a service you think costs $800 and WILL cost you $800 if you buy it yourself. You buy insurance based on the FULL cost of the procedure. If you could access $200 yourself you wouldn;t need insurance. You can self insure at these prices. For the benefit of running the "self insurance" plan they are taking the difference between $200 and $800 Anyone else have a company and know what usual profit margins are? Your local pharmacy is lucky to pull off 35%. This is 400% markup that a "retail" person pays over the insurance company. It's not hard to make money when you buy at $200 and sell at $500-600-700 through an insurance policy. This is how companies like AIG (anybody remember them) buy things like ski hills for their executives. See www.stowe.com Americas are building up the next generation of their royalty. Companies with a mission in "health care" that mae 400% margins and buy ski hills for their executuves to use on "retreats". Yup, that makes total sense, to a lobbyist, lawyer or other enemy of the public and democracy. Crony capitalism, not true capitalism and market economy that people think of in the USA. The insurance companies got a major windfall with Obamacare. That lobbying really worked out. He could has just as easily allowed Medicare/Caid to negotiate prices and take over mre of the health care. That wouldn;t give jobs to people that Obama really cares about. North east Liberal lawyers.

maxerickson 13y ago
Under the ACA, when the insurance company pays a hospital (or any other medical provider) $200, it is allowed to spend $50 (less for larger programs) on salaries and profits and other expenses. If it gets $300 of premiums and only spends $200 on medical care, it has to send the extra $50 back to the customers (larger programs have to send back $65). More here: http://kff.org/health-reform/perspective/beyond-rebates-how-much-are-consumers-saving-from-the-acas-medical-loss-ratio-provision/ http://kff.org/health-reform/perspective/beyond-rebates-how-...
- stormqloud 13y ago
  Clearly they have found ways around the rules or it's still way too much money. The fact health insurance companies invest in ski hills is very telling about lack of focus on their real business. Either their real biz makes so much money that they can spend it like drunken sailors or they don;t care about the primary mission of the company and are just buying perks they can use themselves. Either way you split it, it's still a total mess and not what shareholders or customers (patients) are expecting in an healthcare insurance company.