LEXIRX330

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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.

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

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?

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.

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

Why not just order it online and have it shipped to you. http://lexus.sewellparts.com/accessories-catalog/Exterior/-2008/3318.html

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.

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

Are you kidding you and I haven't had one of these back and forth exchanges in a long time! I'm lovin it! :) I'm worried about Paul though. I just knew he would be here. By the way Lenore hasn't even come back on SW what did you do? Oh yea back on subject so the republicans didn't try to talk to President about tort reform? I remember on more than one occasion talks of republicans trying to share ideas...but I'd not say them either after he just stole Mark Auribios idea that was getting bipartisan work done on it. (another subject) but purely a political move. Since i am off subject I will say I have to agree with Lenore on one thing too. That walk out stunt was a classless act... It's ok after all the President is the one who was proved wrong by the Supreme Court not me... It's not a tax, there is no way a person can look at this as a tax...blah...blah...what do you know the Supreme Court upheld it as a tax. See this to me is where the whole problem lies. If I don't pay my auto insurance my registration gets suspended and if I want to drive I have to pay a fine. If someone fails to buy health insurance well the IRS will collect it! But it's not a tax. See every speech he gave on this was "it's not a tax, not raising anyone's taxes" Well it was a tax and that is a fact.

Your argument that well we don't know how it will work until it is all in effect is just like theirs we need to pass it to see what is in it. All i know as the last poll that i have seen on this over 60% of people agree with me that they dont want it. I will try one more time. :) the law the parts that have went into effect will drive up cost! That is a fact THEY have already, the exchange (what you think is going to bring down cost) is going to compete with companies who already are told by the government how much money that they have to spend for every dollar they take in for claims, medical expense ratio? Kind of been regulated already hasn't it? This was already here they just made the percentage higher. How will competing with the companies that you are telling how much they can spend work? Would you want to have competition like that in your business SW? The fact that you say competition will help bring down cost well maybe in many things but what you don't understand about the health insurance industry I think is that the government has been regulating them all along. Too much...so the more regulation companies profits disappears and what happens one or two main carriers and no competition. Well since insurance is regulated by the state, states with a lot of regulations have fewer carriers and just as you have said no competition = higher rates. But what you don't see is that the reason there is no competition is because of the regulations. Now back to Medicare since I brought it up by mistake? Where is the money? The problem with the government is simply they can't manage money. Want an example FEMA...another gov. run insurance broke. They have had in just the past few year 4 or 5 extensions just to keep it. As a matter of fact last year they ran out of money. Stopped the entire system...how would you like that to be your health insurance? Wait it doesn't matter the government is just steady printing money and spending money and has not a clue as to how they will pay for any of it. So I am sorry but the private sector will and has always done a better job. Funny too when someone sues the government who pays for their screw ups? You and me that's right. However since "your" president :) had to keep his trial lawyer buddys happy he wouldn't even entertain the idea of tort reform. I tried.

First off you are wrong. Parts of the law have went into effect. Kids can stay on parents plans, preventative care? So yes these things have driven up cost. Steve you and I have had plenty of debates on here. I am saying I am telling the rates are going up. As it is part of my profession and I have given you reasons why. You choose not to read them I guess. Either way I still like you.

Ok Medicaid is what intended on saying my auto correct changed it on me. Steve do you honestly believe that your insurance premiums are going to go down? Have you seen any news coverage on this? What has the law done? There is nothing to address cost and everything is to expand coverage. (that is why the premiums HAVE WENT UP) I don't need to prove a point ask any small employer what happened when the bill was passed. 100% of my groups took a increase. Including mine. So unless a group changed their plan or had a average age decrease, or raised their deductible their premiums went up because of the new coverages that had to be offered. Car insurance is different. I choose to have a car...

Right and if "someone" doesn't by insurance they will be taxed. This is the government forcing you to purchase something. 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. 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? Tell me what is wrong with our healthcare system now? It cost too much, people can't afford it, some people wait to get it then they can't get it do to poor health, some people are dropped and can't get coverage? Other than that we have the best Drs and hospitals and medical facilities in the world. 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.

And there he is! :) now just waiting on Paul! Ok. The exchanges will make it impossible for health insurance companies to compete. It will force companies out of the market and the ones that remain will have their rates sky rocket. Look at Medicaid, there are many Docs that have stopped accepting it. Why? Because the reimbursement rates are so low. There are loads of great things in the health care "law" but it did nothing to address the real peoblem which is the COST. By the way how many times did our great leader say "it isn't a tax"???? Funny it was passed as a TAX? I do agree there is no need for the name calling.

I own a insurance agency and have a couple of offices. We don't specialize in health insurance by any means but I have a dozen or so groups and quite a few individual health care policies on the books. The idea is that the small groups and the individual market is going to fold to the exchange. MD has been full speed ahead in implementing their exchange. So I wasn't saying necessarily for me but who knows who will have to use the exchanges.

So I just called one of my Health Insurance brokers and asked her so what is the Maryland Health Exchange going to look like that we are supposed to start using soon? She said "I have no idea, no one knows what they are doing. I have had 10 emails from carriers and none of them know what the health exchanges will do and where they are going to get funding from. But it appears that the rates will be going up" NICE!

Lenore. How did I know that you would be here with me! Just waiting for SW and Paul to start beating me up...now.

Jim you are right and I will do that as soon as I can from my PC. I posted from my iPhone and didn't even realize that it got put in the wrong subforum. Thanks for pointing it out. Some one else has moved it. Thanks.

Guys I just can't believe this. "it's not a tax" how many times did we here this? But how did the individual mandate get passed as a TAX! What a mess this is going to be...No one even knows what the exchanges will look like and some states haven't even started working on them. Maryland has went full speed ahead on creating them. But congress has already said they won't fund it so...WOW! All I can say is I know how I will vote.

Glad we could help!

Welcome toLOC!

How much damage? Depends how big of deal you want to make of it but I know I would get one hell of a deal on a new car if the hit my GX!

Do you know if the tranny has been serviced? I would just keep doing drain and fills on the tranny.

Welcome to LOC!