AMERICAblog: Take a guess who ripped off consumers/patients for billions?
sparrow
· 5 months ago
Wanna hear some more shocking news? Fish swim in water.
tduffy2
· 5 months ago
Trustworthiness and Insurers should never be used in the same sentence. The only trust they show is to their bottom line. Dead customers keep their overhead down.
Me
· 5 months ago
This happened to my son and daughter-in-law, who had to have emergency surgery (she's fine now). The insurance company underpaid $500 of in-network care (saying it was out of network). When my son called them they said, oops, they'd made a mistake. As it is my son & d-i-l have to pay out $4K of the $16K total (that was for a day surgery, no hospital stay), which is tough for two students working part time. But the surgery saved her eyesight, a necessity for a young woman studying to enter the health care field (cue rich irony music).
ndtovent
· 5 months ago
they also make tons of money by double billling, especially on smaller bills (copays, etc). Many people will just send in a check when they get their statement of benefits showing the amount the insurance pays, and the amount they might owe. Then, when they get the actual bill, they send in another check. The insurance company cashes both, and many times the confused patient is none the wiser.
devlzadvocate
· 5 months ago
I am self-restrained. I tell myself I know nothing about this.
devlzadvocate
· 5 months ago
Oh, what the fuck.
Who processes Medicare claims?
a) the government or b) private insurance companies
devlzadvocate
· 5 months ago
Answer:
b) private insurance companies. Medicare contracts with private insuance companies all over the country to process claims. For example, DME claims may be processed by Blue Cross of Wisconsin. The form you receive says Medicare, but it was processed by Blue Cross of WI. Illinois may process inpatient hospital claims.
So, when you request a PUBLIC OPTION, you'll still have to deal with a private insurer. There is no money to set up a totallly new insurance operation to run a public operation. Medicare doesn't even have it's own!
And a public option WILL have differences throughout the country. Medical techology is not the same in Butte as it is in Miami. And you don't pay a doctor the same amount in LA as you do in Wasilla.
Steve_in_CNJ
· 5 months ago
links? sources? actually a better answer is, so what? medicare contracts with all kinds of entities, including whole hospitals. and probably armies of accountants. what is the point? i'll have to deal with a private hospital and a private doctor if i get sick unless i can use a VA hospital (which i can't).
devlzadvocate
· 5 months ago
My point is that the only way a public option will work is when it is the only option available. A single, uniform option available to all.
And, so what? There are tons of complaints about private insurers ripping off people. You can't get away from them in the current structure.
devlzadvocate
· 5 months ago
Okay, here is a link describing what private insurers (i.e. Medicare contractors/intermediaries/carriers) do for Medicare.
Yet another fact which just proves my point to argue the rethuglican talking points (and anyone ELSEs who's against a public option). Insurance companies will still be involved no matter what kind of plan we have. They won't be eliminated (UNfortunately), at least not anytime soon. They are too ingraned in our (NON)health care culture.
Busboy
· 5 months ago
I've been telling people for years that all of the medicare contracts are subletted. I've said it on this blog for years. Maybe now that one of A-blog's own (devis) has said it; you will believe. I personally know the man who ran the SW operation for medicare for over 10 years. There is no such thing as a "single" medicare provider. Do you think your congressperson would ever give up plausible deniability for the way medicare recipients are treated?
devlzadvocate
· 5 months ago
"one of A-blog's own" LOL. Yeah, right. We always agree on everything.
devlzadvocate
· 5 months ago
But a health insurer's duty isn't to keep us healthy.
That is OUR job.
If we were healthier, we wouldn't need them as much. Focus on environment, food, etc.
Bill
· 5 months ago
Yeah, I'm shocked I tell you, just shocked!
KISSman
· 5 months ago
It's about time they expose these fiends. Too bad nothing will really come of this revelation.
KerrynowCampau
· 5 months ago
Gee, I thought they cared about us....
akmtnbum
· 5 months ago
Who could've guessed? Just last week I moved back home to Alaska from Colorado and still have insurance through Kaiser. Yesterday I ended up with a killer migraine. My father in law, calls in a script for Imitrex for me. Something Kaiser always covered for me in Colorado. The pharmacy in Alaska calls them and they say they won't cover it out of network even though I had called their customer service line to make sure I could fill a script here before my wife went to get it filled. The said they would cover it if I went to an emergency room. Idiots obviously I have already seen a doctor if I have a script, an emergency room would just cost them more. I think they were just trying to make it difficult for me. It worked because I have a feeling if I went to an ER they would still say they can't cover it because I am out of network. They know my coverage runs out at the end of the month. Aholes.
Essie Webber
· 5 months ago
A very quotable summary, tauffy2. The health insurance "industry" is a "Racketeer Influenced (they learned) and Corrupt Organization (RICO)." Should be taken apart like any other Mafia by the Feds but the insurance companies have been running the table for so long their criminal behavior is legal. So elegant, they don't have to come after "customers" like a thug but rather can just let your illness/injury unfold. --Senate in its back pocket and dead customers keeping the overhead down: Indeed!
GusII
· 5 months ago
This has been going on for years. My Depression Baby parents habitually paid a bill immediately after it was delivered. It is terribly difficult for an elderly care giver to keep track of what they should and shouldn’t pay with the daily grind of that care. My mother, a former bookkeeper, over paid my father’s bills. It was worse immediately after his death. Ridiculous for a couple who had, between Medicare and their pensioned private insurance, coverage we all would envy.
When the executor was trying to settle my mother’s estate, the healthcare industrial complex was the largest impediment. The bills just kept coming for covered items. One home medical equipment supplier was still billing 6 months after her death. The executor had to submit a copy of the receipt of ‘pick-up’ 3 times. It is a good thing, in the craziness and grief, I kept everything. The insurance companies logically would not pay for anything dated past her death, the supplier just kept sending bills. It goes beyond just human error.
It’s a business model.
nuthnfiner
· 5 months ago
I'm not defending insurance companies here, but making a profit is what they are supposed to do. As publicly traded companies, their one primary LEGAL obligation is not to keep you healthy or help you get well, their legal obligation is to increase shareholder value.
Somehow though, along the way we decided it would be just dandy to have insurance corporations take over our health care in this country, and now we wonder what happened.
This model was never designed to have your best interests at its heart, so until we decide to change the model, expect the same results, but don't harp about the insurance companies not paying your medical bills. It's kind of their legal obligation to try to take in as much as possible and pay out as little as possible (while honoring the contracts that are their insurance policies).
The Republicans have, as they usually do, taken control of the message, which is, do you want a government bureaucrat standing between you and your doctor. Well, if I have to make a choice, frankly, I'll take the government bureaucrat over the insurance company bureaucrat any day, because WE can decide in who's interest the government bureaucrat is supposed to act. We already know in who's interest the insurance company's bureaucrat will act.
sonofloud
· 5 months ago
Let's elect a real Democrat for president.....Andrew Cuomo 2012
All Comments
Who processes Medicare claims?
a) the government or
b) private insurance companies
b) private insurance companies. Medicare contracts with private insuance companies all over the country to process claims. For example, DME claims may be processed by Blue Cross of Wisconsin. The form you receive says Medicare, but it was processed by Blue Cross of WI. Illinois may process inpatient hospital claims.
So, when you request a PUBLIC OPTION, you'll still have to deal with a private insurer. There is no money to set up a totallly new insurance operation to run a public operation. Medicare doesn't even have it's own!
And a public option WILL have differences throughout the country. Medical techology is not the same in Butte as it is in Miami. And you don't pay a doctor the same amount in LA as you do in Wasilla.
actually a better answer is, so what? medicare contracts with all kinds of entities, including whole hospitals. and probably armies of accountants. what is the point? i'll have to deal with a private hospital and a private doctor if i get sick unless i can use a VA hospital (which i can't).
And, so what? There are tons of complaints about private insurers ripping off people. You can't get away from them in the current structure.
http://www.workworld.org/wwwebhelp/medicare_cla...
Plus my own years of experience.
That is OUR job.
If we were healthier, we wouldn't need them as much. Focus on environment, food, etc.
When the executor was trying to settle my mother’s estate, the healthcare industrial complex was the largest impediment. The bills just kept coming for covered items. One home medical equipment supplier was still billing 6 months after her death. The executor had to submit a copy of the receipt of ‘pick-up’ 3 times. It is a good thing, in the craziness and grief, I kept everything. The insurance companies logically would not pay for anything dated past her death, the supplier just kept sending bills. It goes beyond just human error.
It’s a business model.
Somehow though, along the way we decided it would be just dandy to have insurance corporations take over our health care in this country, and now we wonder what happened.
This model was never designed to have your best interests at its heart, so until we decide to change the model, expect the same results, but don't harp about the insurance companies not paying your medical bills. It's kind of their legal obligation to try to take in as much as possible and pay out as little as possible (while honoring the contracts that are their insurance policies).
The Republicans have, as they usually do, taken control of the message, which is, do you want a government bureaucrat standing between you and your doctor. Well, if I have to make a choice, frankly, I'll take the government bureaucrat over the insurance company bureaucrat any day, because WE can decide in who's interest the government bureaucrat is supposed to act. We already know in who's interest the insurance company's bureaucrat will act.