Nooooobamacare!

[LEXIRX330]

Hey Paul! Glad you have emerged... I agree with you. My wife is a RN she worked at a hospital in the CCU ICU for quite awhile she shifted gears into a different field but is thinking about going back. But one of my clients is a administrator at the hospital and she was just telling me how they changing their systems over too.

And by the way regarding the politicians I would have fired them all for acting the way they have. Dems, Rep we need to just start over. And you are so right that money is just buying the elections.

But I guess I am a true Republican...the family just got back from a mini vacation and as I was stopped in traffic for EVER I was stuck behind a car that had a tag MS DEM with a Obama Biden bumper sticker. Man I wanted to just give her a little tap! You know just a little bump like...WTH is wrong with you. :) kidding of course my wife reminded me the kids were in the car! :)

Who cares if its called a tax or not? Its semantics. You can't let semantics make up your mind about something like this.

Well I do since he said it wasn't a tax. I know what you are saying. :)

[lenore]

Right and if "someone" doesn't by insurance they will be taxed. This is the government forcing you to purchase something.

Correct, its a mandate. The Government forces you to do lots of things, including buy insurance as you know. If you don't buy car insurance...you get fined. You can call that fine a tax, or a fine...its up to you.

And you dont find that wrong? Next they will mandate that you have to turn in your guns, go only to churches that they approve, eat at only the restaurants they approve of. Where does it stop. Free enterprise and your rights will be eliminated and we will end up with the economy of Cuba.

SW you are a smart guy. Medicare is no different than what our healthcare system will look like in the future if this law stands.

How? This law has absolutely no Government run or operated healthcare option, which is what Medicare is. Anyways...Medicare is pretty doggone good, my mother files insurance claims for doctors, she's done it for nearly 20 years. Medicare is easier to deal with and pays more than MANY private insurance companies. My Dad went through a terrible protracted illness with a combination of Medicare and an inexpensive Medicare supplimental. He had no bills. Not one.

You originally sai it was like Medicaid...now Medicare...the two are different.

I know this was created to protect the elderly, but these two systems are the cause of the largest increase of health care cost in the last 50 years. Because government intervined, fraud, waste, double billing, increased. I too have dealt with the elder relatives, and the billing and charges have been absolutely mind boggling. I have seen so many mistakes performed by doctors, insurers, etc that I am completely astounded. And this deluge of garbage is billed to our elderly that in many cases has lost the ability to mentally weed thru the fraud. I personally have caught double billings, billings for visits that never happened, and exhorbant charges for procedures and drugs. Government interventionn has created the ability of Doctors and Hospitals to charge for everything so that they can recover what they feel was miss-priced by the government. You go into a doctors office and offer cash, and the price is usually 40% less. Go figure. If the Congress has been allowed to really solve the problem they would have gone after the real problem, tort reform, and all of the problems I stated above created by the interference of Government in pricing and the fraud it creates when billing.

If small employers drop the plans the bulk of those people will be forced in the exchanges. That is the plan...once that happens the small group market is dead. It will be unaffordable to offer insurance if you are a small employer. It has already started with the implementation of the first parts of the law...how could it not?

You're still not answering my questions:

1. What in this law will force small employers to drop coverage they provide to their employees now? If the small employer finds that their contribution to health care is more than the fine, than they will drop health care entirely and let the government take over the responsibility.

2. What specifically about the "exchange" will drive the cost of insurance up? The whole point is to bring it down by providing a mechanism for competition.

Anytime the government takes over any principal of business costs skyrocket. Look at the post office, Defense contractors, retirement provided for government employees, etc. True market reform and competition is only available in a free market. An Exhange controlled by government will only cause corruption. I guarantee you that the insurers will look for fees and charges to maintain there current profit margins.

So as a small employer when I get my renewal on my health insurance and the rates go up 20% or so what will I do either drop the plan and let the employees buy individual coverage through the exchanges or raise my deductible one the plan.

I'm a small employer too. You again have not answered my question. WHY would you expect your rates will go up 20%?

[lenore]

All I can say, is thank god for Tricare and the VA. LOL.

Dont speak too fast, that system has also been loosing its benefits, especially for retires.

[lenore]

Everyone here is going to be admitted to the E.R. soon if you don't take a deep breath and count to ten. That first Stroke can be a doozie.

The disscussion(?) nets out to be not at all about whether the goverment can force you to buy something, it all ready does. And it is not about insurances exchanges, it's boiled down to a national shame argument.

When G.W.Bush was Pres. there was much talk about doing away with the current Medicare and going to a voucher system. There was some back and forth in Congress and around the country, but ended up a little more than a burp.

When Obama came in and began expaining his idea's for improving the healthcare system, Congress went wild. Remember, it was at this point that the congressonal Repulicals said on the House Floor. "Our only job for the next four years is to get Obama out of office". The Congress we have had since the election has done nothing except fight and throw tantrums. A class of 2nd graders could get more done.

In the meantime, the nations hospitals, Insurance companies, and physicians, have been moving ahead at near Warp speed to streamline and reduce cost of delivery of services, but maintaining quality and copassion.

Physicians and hospitals are forming employed relationships where the financial burden can be lowered and Pay for Performance can be implemented.

My wife is a hospital administrator, and just finished their third software add-on/features upgrade. That one act will save the hospital hundreds of thousands of dollars and standardize communications with Medicare, Insurance co's plus system wide services.

My point is that, the health care field knows the mess the country is in now, and also knows Washington is to busy trying make the other look bad that they won't do anything so it's up to them to lead the way.

The shame part comes in because we have put up with all of this scam. How many of you who are business people would keep any one of these Senator's and Reperseative's on the payroll? Demorcrat or Republican, conservative or liberal, it is our sense of shame that we let this go on. And then our country gets to a point where only the rich can run for office, and the rich pay for the TV commercials and try to set their own agenda.

Healthcare is changing faster than you think. But the one thing I left out above; where does the money come from? Demand that the President and all of Congress stop whining and help us,They are our employees!!.

Paul

Wow, I am in ageement, but the government intervention now is a total recipe for failure. Like I said before i was so rudely editied (kind of like a socialist editing of any common sense) THe two parties need to sit down and do some real deep and new idea problem solving. Both Parties need to throw aways their hats and say we need to fix this, lets put our ideas on the table and hash them out and eliminate the dumb ideas and use a trouble shooting agenda. After all solutions to provide the answers are agreeded upon, recycle them and see if their are problems. Get a total consensus from everyone and present it to America. I have seen what medicare creates and it is not cost effective. How are we going to continue to pay for it.? When only 48% of the nation becomes the contributors, and 52% are on the receiving end something is going to explode. We have to ask ourselves what good is it too work any more if I have to support this other person that doesnt want to work. We all have to rememer the huge cost created by government in everything they do. They are in-efficient at best, and create the worse environment for business to grow.

[lenore]

By the way steve my edited comments were not meant to be racist, by all means it just showed the childish, immature nature of a group in congress that showed their true agenda when trying to perform their duties in Congress. It was in the news on all networks and showed that that group is still pulling the race card when anything they disagree with doesnt go their way. When These types of groups are thrown out our nation will move to becoming a true nation of all peoples. As for my comments of mental disorder etc. that is just my opinion...I am sure many feel right wingers are of the same category. After all I find it offensive to be called a right wing extremist, when my views as a Christian, pro-military, conservative, fiscal responsible, and Constitution loving American are being distorted to mean a radical on the right. I have friends of all races, and love them all as my borthers and sisters. My family is multi-racial and I find my views are shared with their views. If I offended anyone, I am sorry, but I thought these forums were to provide not only discussion, but entertainment to the participants. These are trying times when College grads cant get a job, grown children are living with their parents because of lack of full time employment, and the business climate is so bad, that Companies continue to layoff. Millions (estimated to be over 80 million) only have part time jobs, causing our middle class to dissappear. If this continues than only the rich will survive and the rest of us will be no better than our great grandparents financially. It is a move that shows our kids, grandchildren will have a worst society than we had. (That was a major story in our Local Democratic Newspaper, The Sacramento BEE) If this is the society that Democrats, liberals, progressives want than it will happen, unless the will of the American people make the pendulum swing back the other way.

[LEXIRX330]

Welcome back in here Lenore! Man I knew I could do it...now if I can only get NC in here we have another one of our great political discussions!

As I said I thought it was a classless act to walk out as they did Lenore.

[SW03ES]

I'd love to respond to up your comments on my post Lenore, but the way you have them formatted I can't tell where my comment ends and your response begins...

Can you go back and edit the post so i can tell what you're saying?

I will respond to one thing I did pick out, the idea that telling a doctor or hospital you are paying cash nets a 40% cheaper bill. That is absolutely false. My mother owns a medical billing company, she bills and collectsbfrom insurance companies for doctors,Moshe also bills self pay patients.

Self pay patients pay MORE per service than insurance companies. When a doctor or hospital signs up to be a provider for an insurance company, they agree to accept that company's fee schedule which is far less than what a sell pay patient pays.

If you can make the rest of your comments a little clearer I'd be happy to respond to them too.

[lenore]

I am sorry, but on two occasions my daughter asked what the bill would be for our grandaughter. Broken wrist, staple in the head. In both cases the cash price was cheaper than what the insurance would be required to pay. So It must not be the same everywhere.

[LEXIRX330]

I am sorry, but on two occasions my daughter asked what the bill would be for our grandaughter. Broken wrist, staple in the head. In both cases the cash price was cheaper than what the insurance would be required to pay. So It must not be the same everywhere.

The reason is simple ask Paul to ask his wife. Most facilities keep their prices high to keep the contracted prices high with the networks. So they have to bill $500 for a visit for a broken wrist...insurance company has a set price of say $350. However when you come in and say you are going to pay cash. They will sometimes give a discounted rate which is cheaper than the network prices. I see it all of the time. You want the best example of it Walmart! Go get a prescription filled with insurance on many medications it is higher with insurance than with no insurance! That is a fact and it is screwed up. If they can give someone with no insurance the medication for $4.00 than the should be able to give it to the insurance company for the same price. Now there are many times that the networks save you money when it comes to screenings and X-rays it is a big difference.

Here you go off of a flyer from SAMs club website. (I love it) so I have to pay more because I have insurance.

... $4/$10 generic prescription program. Savings only for cash purchases based on the dispensing Sam’s Club Pharmacy’s cash price. Discounts not available for purchases covered by health insurance or a state/ federal government health care program, on SamsClub.com, or covered by Walmart’s Prescription Program or any Sam’s Club promotion. Restrictions apply. See your local Sam’s Club Pharmacy for details

[LEXIRX330]

I will respond to one thing I did pick out, the idea that telling a doctor or hospital you are paying cash nets a 40% cheaper bill. That is absolutely false. My mother owns a medical billing company, she bills and collectsbfrom insurance companies for doctors,Moshe also bills self pay patients.

Self pay patients pay MORE per service than insurance companies. When a doctor or hospital signs up to be a provider for an insurance company, they agree to accept that company's fee schedule which is far less than what a sell pay patient pays.

Steve this isn't the case all of the time. There are many Drs that will give you a cheaper price when paying cash around here. As I have said they always bill higher. Look at your summary of charges that you get the next time you go to the Doc. It shows what they charge and what the company will pay and if you are responsible for anything. Now my example with Walmart/Sams proves that they offer lower prices on prescriptions and many Docs do the same thing. As I said though there are many times you can't compete with the network prices but most of the time it is hospitals, facility charges, diagnostic fees. But the networks don't always pay the lowest cost.

[lenore]

Funny cash is king....years ago for those little visits you paid cash. Insurance was only used for catrosphic coverage. Maybe we should do that again. There are just too many middle men in the picture...Imagine government as a middle man. Just like Post office, Social Security, Medicare....all messed up by government intervention.

[SW03ES]

I am sorry, but on two occasions my daughter asked what the bill would be for our grandaughter. Broken wrist, staple in the head. In both cases the cash price was cheaper than what the insurance would be required to pay. So It must not be the same everywhere.

Heres how this works.

Let's say you need an MRI, and you have Aetna. If the facility you have the MRI at is a provider in Aetna's network, Aetna says they will pay $1,500 (i made that figure up) The doctor cannot charge an Aetna insured more than Aetna's fee schedule, even if they are paying cash because of a deductible, etc. they agree to the fee schedule when they become an Aetna provider.

Obviously, as a business owner you know Aetna will pay $1,500. You don't charge them less.

Someone else comes in with a BlueCross policy, and they pay $1,000. If the facility is a BlueCross provider also guess what they charge? $1,000.

Now, let's say you walk in off the street and you have no insurance, then they an charge you whatever they want, less, more, whatever. Gnerally in my and my mother's experience its not less than what insurance companies will pay, it's more. That will vary based on local market conditions, etc. We have never done business with a provider who does not charge significantly more for self pay patients than they bill insurance companies, and she has several hundred clients.

Now, if you have insurance, a provider will not, or should not, offer you a different rate for not going through your insurance. First of all, if they try and charge you more they'll get booted out of the network. If they charge less, guess what? The insurance company finds out they will demand a refund for all the other patients they billed the insurance company a higher rate for. And...it's just bad business. All they have to do is file the claim and get the approved amount.

I don't have to look at the "summary of charges" ( that's a federally mandated explanation of benefits or EOB by the way). My mother's company is the one who provides the insurance company the information to create that document.

[SW03ES]

Funny cash is king....years ago for those little visits you paid cash. Insurance was only used for catrosphic coverage. Maybe we should do that again. There are just too many middle men in the picture...Imagine government as a middle man. Just like Post office, Social Security, Medicare....all messed up by government intervention.

Totally out of touch. The issue is people don't have cash. Most Americans dont even have $1,000 they can scrape together. For those of us who do, there are lower cost options where we can self insure through high deductibles, HSAs, etc.

If you can't come up with the decutible at any time, the deductible is too high. Most people can't meet a deductible more than $500 at ay time. THAT'S the problem.

[LEXIRX330]

I am sorry, but on two occasions my daughter asked what the bill would be for our grandaughter. Broken wrist, staple in the head. In both cases the cash price was cheaper than what the insurance would be required to pay. So It must not be the same everywhere.

Heres how this works.

The doctor cannot charge an Aetna insured more than Aetna's fee schedule, even if they are paying cash because of a deductible, etc. they agree to the fee schedule when they become an Aetna provider.

Actually this is wrong. They do charge more. If you look at the benefits summary you will see that. That is their charges that it shows and then it will show allowable charges meaning the contracted price that the network and the facility have agreed on. That is not the billed amount. It says it right on the summary. I understand your mom is doing billing. But that is on the back end and is not when someone walks in. It is completely different. If they are trying to collect on the back end it's not the same as walking in and saying can I pay for this and how much will it cost.

It is done all of the time. Dentist, Docs, Med facilities all do it. Your mom is doing the billing for the Docs not at the office when someone walks in. And guess what when the people don't pay that bill she sends them i(cash customers) it goes to a collection agency. Then the docs get much less if it is ever collected. That is why the price is higher too.

So what do you have to say about the prescription drugs? Same thing isn't it SAMS Walmart also accept insurance so it is a contracted price so how are they charging cash customers less?

[lenore]

From what I read, and have experienced, the medicare price, drives up prices for everyone else. If you pay cash, or negotiate than the price goes down. Having a voucher system would be better for the day to day medical needs as it would create a society that realizes the cost of purchase. Insurance whether it be Government or private gives you a false sense of cost. That is what government has created since medicare. A catrostrophic insurance would be a better solution, and reduce the day to day cost by eliminating the middle man. I agree with LexiRX as it is possible to have cheaper prices if Government is not envolved. Government also becomes a bureacracy creating waste.

[SW03ES]

Actually this is wrong. They do charge more. If you look at the benefits summary you will see that. That is their charges that it shows and then it will show allowable charges meaning the contracted price that the network and the facility have agreed on. That is not the billed amount. It says it right on the summary. I understand your mom is doing billing. But that is on the back end and is not when someone walks in. It is completely different. If they are trying to collect on the back end it's not the same as walking in and saying can I pay for this and how much will it cost.

They're going to bill the insurance company for what their typical charge is, but they're only going to collect the fee schedule amount, and they know this. They cannot bill you for the difference if they participate in your insurance company's network. They bill for more to avoid any types of conflicts with plans where they can collect more, or for self pay people. My point was they collect what the network allowable amount is, and its different for every company and even for different plans. This is 100% fact. I am not wrong.

It is done all of the time. Dentist, Docs, Med facilities all do it. Your mom is doing the billing for the Docs not at the office when someone walks in.

Wrong. She bills for individual doctors as well as entire practice offices. Its no different.

And guess what when the people don't pay that bill she sends them i(cash customers) it goes to a collection agency. Then the docs get much less if it is ever collected. That is why the price is higher too.

This statement makes no sense. Of course a collection agency will collect less...this is not unique to the medical field. I don't understand your point.

\So what do you have to say about the prescription drugs? Same thing isn't it SAMS Walmart also accept insurance so it is a contracted price so how are they charging cash customers less?

Prescription drugs are a totally different thing...pharmacies are not insurance providers.

From what I read' date=' and have experienced, the medicare price, drives up prices for everyone else.[/quote']

Please share your experience that has led you to believe that?

If you pay cash, or negotiate than the price goes down.

You as one sick person cannot negotiate as effectively as a huge insurance company. The Doc will tell you to hit the street and take an insurance patient for the specified amount if you want him to work for less.

Anyways, when you're sick the last thing you need to be worried about is negotiating with doctors...

Having a voucher system would be better for the day to day medical needs as it would create a society that realizes the cost of purchase. Insurance whether it be Government or private gives you a false sense of cost. That is what government has created since medicare. A catrostrophic insurance would be a better solution, and reduce the day to day cost by eliminating the middle man.

The problem is routine medical care is not just the family doctor with a bag and a stethoscope anymore. What about MRIs? CT scans? Bloodwork panels? These things cost thousands of dollars.

[LEXIRX330]

Actually this is wrong. They do charge more. If you look at the benefits summary you will see that. That is their charges that it shows and then it will show allowable charges meaning the contracted price that the network and the facility have agreed on. That is not the billed amount. It says it right on the summary. I understand your mom is doing billing. But that is on the back end and is not when someone walks in. It is completely different. If they are trying to collect on the back end it's not the same as walking in and saying can I pay for this and how much will it cost.

They're going to bill the insurance company for what their typical charge is, but they're only going to collect the fee schedule amount, and they know this. They cannot bill you for the difference if they participate in your insurance company's network. They bill for more to avoid any types of conflicts with plans where they can collect more, or for self pay people. My point was they collect what the network allowable amount is, and its different for every company and even for different plans. This is 100% fact. I am not wrong.

It is done all of the time. Dentist, Docs, Med facilities all do it. Your mom is doing the billing for the Docs not at the office when someone walks in.

Wrong. She bills for individual doctors as well as entire practice offices. Its no different.

And guess what when the people don't pay that bill she sends them i(cash customers) it goes to a collection agency. Then the docs get much less if it is ever collected. That is why the price is higher too.

This statement makes no sense. Of course a collection agency will collect less...this is not unique to the medical field. I don't understand your point.

\So what do you have to say about the prescription drugs? Same thing isn't it SAMS Walmart also accept insurance so it is a contracted price so how are they charging cash customers less?

Prescription drugs are a totally different thing...pharmacies are not insurance providers.

Steve is your mom at the Docs office at the time of service? If not than she would not know. She is billing after the service not at the time of service.

Also Prescription prices are negotiated with the insurance companies too bud.

[SW03ES]

Steve is your mom at the Docs office at the time of service? If not than she would not know. She is billing after the service not at the time of service.

No, but being in the industry for nearly 20 years she knows all the ins and outs of how this all works. Thats like saying you don't know how an insurance adjustment is done because you aren't there when the adjuster looks at the vehicle. What is happening at the time of service that you are seeing that is differing from what I am saying?

Insurance companies do not get billed at the time of service, they get billed after service. Service gets authorized by the insurance company, copays and deductibles may get collected, but the billing happens afterwards. The EOB you get from your insurance company that shows what was charged and what was paid comes after the claim is filed and paid to the provider. Any bill or statement you get from the provider directly is separate, but they cannot bill you for an amount in excess of the fee schedule from your insurer if they participate in your network.

Doctor's do mistakenly (and I'm sure not mistakenly) bill for excess all the time, but they aren't supposed to and you don't have to pay.

Also Prescription prices are negotiated with the insurance companies too bud.

Sure are champ ;) . But, the pharmacy is not a NETWORK PROVIDER like a doctor or medical practice is. The rules and regulations are different, insurance companies don't have control over the pharmacy the way they do a network provider.

Thats why Walmart sells drugs 90 days for $10. They, being an enormous retailer, have negotiated pricing for those drugs (and its certainly not every drug) with the drug companies same way an insurance company would.

Medications are covered based on the medication, not the pharmacy. Insurance companies decide which drugs to cover and not to cover based on agreements with the manufacturers of those drugs, not the pharmacy.

[LEXIRX330]

Steve I do understand how the networks work but I am sorry there are times that this just is not the case. If the Doc doesn't have to deal with any insurance provider and can charge me $xxx.xx then he has his money. I know of many examples when some one has walked in and tell the Doc that they need a physical or a check up and they pay with no insurance much less than my insurance company pays. Hell some Docs are not even accepting insurance or refusing to be in networks because of the hassle. Planned parenthood for example if you have insurance will charge you for a copay well they charge people who have no insurance about the same thing as the people who do what a copay is. So does that mean that insurance company isn't paying anything? I think not. To start with the billing with insurance providers is sort of done at the time of service. They know what your co pays and your deductible and if you have met your deductible like you said. They know what they will get paid. I am not saying that you or your mom is wrong I am saying just like Lenore's example this sort of thing happens and it does.

Either way it will all be changing soon.

[SW03ES]

If the Doc doesn't have to deal with any insurance provider and can charge me $xxx.xx then he has his money.

Sure, some Doctors don't participate in any networks and they can do whatever they want.

I know of many examples when some one has walked in and tell the Doc that they need a physical or a check up and they pay with no insurance much less than my insurance company pays.

Then I suppose her 20 years of experience and hundreds of clients is just an anomaly

Hell some Docs are not even accepting insurance or refusing to be in networks because of the hassle.

Sure, plenty of Docs who don't accept insurance. If they have the clientele to be able to do that, good for them.

Planned parenthood for example if you have insurance will charge you for a copay well they charge people who have no insurance about the same thing as the people who do what a copay is. So does that mean that insurance company isn't paying anything? I think not.

One of our friends just went to planned parenthood to get a birth control prescription because she has no insurance (out of work), bill was nearly $400. That was just a consult and did not include an OBGYN exam. I don't know about you, but my copay isn't $400. People with low incomes get subsidized cost at planned parenthood, but if you aren't low income you get charged WAY more than a copay.

To start with the billing with insurance providers is sort of done at the time of service. They know what your co pays and your deductible and if you have met your deductible like you said. They know what they will get paid. I am not saying that you or your mom is wrong I am saying just like Lenore's example this sort of thing happens and it does.

Billing is absolutely not done at the time of service. It is done after the fact. My Mom gets paid to oversee that billing, and it happens after service. Even if they collect a deductible, they still have to bill.

Either way it will all be changing soon.

LOL, not really. Nothing in the bill that effects how providers deal with insurance companies. From a billing standpoint it will all remain the same.

[LEXIRX330]

I am not saying your moms experience doesn't mean anything? I have never said that and actualy i am in agreement with you in many cases that the networks will have the lower price but not all of the time. The fact that a Doc is a network provider. DOESN'T MEAN that they can not accept a lower cash price. I know for a fact that there are Docs that will accept a lower payment when someone is paying cash than when they bill the insurance company. Not for all services and not all Docs.

As far as the billing Steve they know they are getting the money so what I am saying is when they get their co pay or the deductible they know they will get paid the allowable charges from the insurance company.

Steve we can go back and forth on this until Obama's voted out and the law has been repealed! :) however I don't think we are going to ever agree. It's fine. I don't think you or I know exactly how this law is going to effect everything. But if you think it won't change your insurance call me when your group renewal comes in and let me know if it went up. If the law isn't repealed call me next year when you get that renewal. That is the feedback that I am getting regarding small groups in MD.

Now why is it ok for the companies to get waivers?

[SW03ES]

I can tell you for a fact, that if the insurance company finds out that a in network provider is charging less to someone with cash than they bill the insurance company, they will demand a refund of fees paid out above that price, perhaps for years. The network allows for payment up to a certain amount. If they are charging patients who pay cash less than they bill insurance...that's insurance fraud and the insurance companies will bury those providers. That's partly why they bill more than the allowed amounts.

My mother has had clients that have had insurance companies try and do similar things to. One just a few weeks ago had a company request $350,000 in refunds...and suspending all future claim payments until they get it. That was a small time one doctor operation too. Baseless, but they have to fight it now before they can start collecting payments again.

If providers are doing that...they're stupid.

As for the providers knowing they're going to get paid, LMAO...hardly. It is not easy getting insurance companies to pay claims. They will try and find any loophole they can to deny a claim even after its been approved and service has been provided. I've seen my Mom and her staff stay on hold for hours just to collect $60 for an office visit. It's nuts.

[LEXIRX330]

Kind of funny? Here are three articles telling people how to save money by paying cash. I am sure I can find you loads more. And by the way if the Doc doesn't submit the claim to the carrier than they don't know what he charges.

http://articles.latimes.com/2012/may/27/business/la-fi-medical-prices-20120527

http://guides.wsj.com/health/health-costs/how-to-research-health-care-prices/

http://www.ehow.com/how_2314903_save-hospital-bills.html

And I can imagine there are loads of things that can come up when dealing with the billing getting denied. I have seen some of it first hand. Honestly though I have two kids and they have been to the Doc countless times for you name it. Less than two weeks I have a copy of the EOB that shows what was paid to the Doc. I have had people sit at my desk while I call Carefirst to see why something wasnt paid. Many times it is the way something was billed. Then I call the Docs office or the facility and tell them how the bill should be corrected they resubmit and it is paid. What is funny is how lazy some of the receptionist are...have had this happen a couple of times that they copy the new insurance card and bill the old one.

Now I will admit some carriers are much better pay than others and I can imagine that your mom has loads of BS she has to put up with to collect the money for some of the services. But you can't possibly tell me that the bulk of the claims aren't paid the way they should be. If that is the case there is a problem with the way the bills are being submitted. I still have quite a few individuals on the books and a few groups. It is rare to have a problem with claims getting paid. My own Doc has told me that there are providers he hates dealing with because he feels like he has to pay someone to call on every single bill to get it paid.

I had a small problem myself when my wife had to go to the ER...all over the way the bill was submitted. Took me 1 minute to get it resolved after being on hold for 20 mins with the insurance company. And you know what I had to call the hospital and have them resubmit the claim. Since the entered it in wrong it wasn't going to get paid, they changed it guess what it was paid.

[lenore]

I can only relate when it applies to my mother and mother-in-law. They both have the billable medicals bills after medicare. As for myself and my wife we use a HMO (Kaiser Foundation) And I only pay co-pays for both visits and meds. But the fruadulant billing has been experienced with both mothers. There is just too many codes, subjective billing etc. If doctors were allowed to a item list with charges it would be a beneficial education to folks in what they are really paying. Would be interesting to see what the insurance companys charge versus eliminating them.

I am aware of the cost of medical coverage for the year. Cant wait to see what happens when Obama care hits the fan.

[LEXIRX330]

I can only relate when it applies to my mother and mother-in-law. They both have the billable medicals bills after medicare. As for myself and my wife we use a HMO (Kaiser Foundation) And I only pay co-pays for both visits and meds. But the fruadulant billing has been experienced with both mothers. There is just too many codes, subjective billing etc. If doctors were allowed to a item list with charges it would be a beneficial education to folks in what they are really paying. Would be interesting to see what the insurance companys charge versus eliminating them.

I am aware of the cost of medical coverage for the year. Cant wait to see what happens when Obama care hits the fan.

Medicare is different. That is why they have supplemental plans to cover that. But Lenore the big problem is here is a government run plan. Here's what you have got. Medicare part A Medicare part B got to make sure to sign up for Medicare Supplment or a Medicare Advantage Plan. Oh by the way want Prescription Drugs? Got to sign up for Part D which has a couple of options (by the way most people in the insurance industry will not sell different plans cover different drugs so you sign someone up for the wrong plan big E and O) by the way did I mention you have Plan a,b,c, f and high deductible f for the supplemental plans?

I have a man who works for me that I send all these too. I will do one here and there but if he is available than they go to him. I understand it but just look at how much BS is involved.