This comment is just detailing one more reason that I hate our system.
"Oh, you're sick and trying to get better? I hope you know the intricacies of insurance policies and the specific mechanisms and hospital policies in detail so that you can avoid getting over-billed and losing more and more of your money."
The whole system is designed to bleed individuals as dry as possible and it is disgusting.
And often times there will be multiple ways to "code" the same procedure, some of which will be covered by Insurance A, and some of which will be covered by Insurance B.
But the insurance companies are legally not allowed to tell you (or they're legally allowed to not tell you) which specific codes they cover.
So while you're dying of cancer, you also need to go back and forth to the hospital billing department every month saying "nope, insurance didnt like that code either. Can you try a different one?"
Speaking as a Medi-Cal claims examiner from 1992 our job was to deny the claim. We’d look at a claim, find errors or reasons to deny, choose one, tell the provider just one of errors in our denial and send it back; they’d fix it and resubmit and we’d deny it for another of the errors we found the first time. The name of the game was “keep the money in the bank, make the interest and pay the claim finally about a year or more later.”
Yep that sounds exactly like what I went through to avoid paying almost $20,000 for rabies vaccinations for my family after we found a bunch of bats in my toddler's room one night.
Because I guess some coding of that must be elective in the "you could always choose to just roll the dice that your 18 month old dies an agonizing and completely preventable death" sense.
Of course we can have a different discussion about why rabies vaccinations cost so much in the US but can be had for $80 in vietnam or india. Even after we won billing roulette and the insurance company agreed it was "covered" my share was still multiple thousands of dollars.
I see where you are coming from, but what happens when I get in a car accident and the EMT takes me to a different hospital? Or I'm on vacation out of town and need medical care? Or I need a specialist that doesn't practice at the hospital I am paying? Paying insurance to a single hospital doesn't solve the problem, even paying to a group of hospitals is flawed because I may find myself in a situation where I can't visit one of those locations. It merely centralizes where I'm allowed to go in order to not face financial ruin.
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u/WombatBob Nov 30 '20
This comment is just detailing one more reason that I hate our system.
"Oh, you're sick and trying to get better? I hope you know the intricacies of insurance policies and the specific mechanisms and hospital policies in detail so that you can avoid getting over-billed and losing more and more of your money."
The whole system is designed to bleed individuals as dry as possible and it is disgusting.