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.

Sure, some Doctors don't participate in any networks and they can do whatever they want. Then I suppose her 20 years of experience and hundreds of clients is just an anomaly Sure, plenty of Docs who don't accept insurance. If they have the clientele to be able to do that, good for them. 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. 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. 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.

Welcome to the LOC and congrats on your purchase!

Congrats!

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. 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.

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. 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... 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.

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.

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.

Yeah order online to be safe...

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.

I thought about having him disappeared, but I didn't! I promise! Tort reform is not a solution in and of itself. I agree its a part of a solution, but there is no alternative plan. Who cares if its called a tax or not? Its semantics. You can't let semantics make up your mind about something like this.

The vast majority don't know anything about it. As a business owner lack of competition makes me more money, but competition is ALWAYS good for the consumer. This is a valid argument, but I still don't see any reason why providing a marketplace for competition in an exchange is going to increase costs? Regulations increase costs, I can agree with you about this in practice. Insurance would be real cheap for healthy people if there were no regulations...because anybody who is sick or has a chance of being sick would be excluded! Insured people who get sick would be terminated from the plan. Thats exactly what we're trying to fix. Requiring young, healthy people to buy into the system is an important component because it helps defray the risk for insurers to help control cost. Its going to be a process though, the exchanges will need time to build as people buy into them. Hey, if you don't want to have a debate, don't post on the subject...and if you don't want me specifically to chime in...don't ask me to ;) SOMETHING has to be done, and there is no plan from your side of the aisle, they were asked time and time again to come up with one...

Parts of it, but not the whole plan. The competition of the exchange is what makes the whole thing work. Until the whole thing is rolled out, we can't say what the final result has been. LOL, you haven't given me any reasons why! Other than it expands coverage without addressing cost. I said that the exchanges the allow people to select among many plans creates competition and thus reduces cost. You've said that the exchanges are going to increase cost...but you haven't told us why you think that. I realize that you are in the insurance business, but admittedly you don't focus on health insurance. The argument that "This is what I do so just believe me without me telling you why" isn't going to hold water with me, you know me better than that. I'm a smart guy, explain it to me. LOL, ditto!

Tricare and the VA...another government run healthcare system that works pretty doggone good huh Josh? My uncle who died about 6 months ago went through a long illness with Tricare as the primary, medicare as the secondary. Not one bill. I have never been to a doctor or had a family member under private insurance deal with a health issue and not had a bunch of bills, whether they were accurate or not. Thats how business works, when you increase competition, premiums go down. Thats the whole point of the exchange. I have been shown no reasoning to expect that they won't, and certainly no rationale to expect that they will go up. I've asked LOTS of people why they think the healthcare bill will cause premiums to rise...and they don't have an answer. No I don't watch TV. Of course I have, but news coverage anymore is so one sided. CNN, MSNBC are all rah rah yeah and FOX is all "he's going to put a horse head in your bed". I prefer to draw my own conclusions. The law hasn't even gone into effect yet! How can you say its done anything at all?!? The whole point of the exchanges is to reduce cost by creating competition. If you want to have a debate, you always have to prove your point. This is how it always is with you guys, you make claims, say things are going to happen...and you have no rationale or evidence to support your position. Don't regurgitate what Fox News tells you...THINK! Decide for yourself. Like I said, I am a small employer. Rates may have gone up short term after the bill was passed, thats becuase they left such a long period for insurance companies to gouge us before it goes into effect and it won't be so easy, I think that was a mistake. BUT, the law isn't even in effect yet, the exchanges don't exist...you have to wait and see what happens when it does kick in before you draw any conclusions. Come on, thats a cop-out argument and you know it. Most people in this country have no choice but to have a car if they want to work. Thats why the Supreme Court upheld the law.

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

How will the exchanges make it impossible for health insurance companies to compete? Medicaid is a completely different ballgame... It wasn't passed as a tax, Roberts simply applied the legal groundwork for the governments' right to tax as a way of upholding the mandate and the penalty that comes with it. The administration is not calling it a tax, nor is it a tax. If you have insurance, you pay no penalty.

Be careful on eBay, if they're not for the right model they wont work.

Okay, we're not going to put up with things like saying people have mental disorders, we're not going to put up with racially charged statements and things like that anymore. Posts are going to be edited, deleted and people are going to get banned if they persist. If we're going to have these discussions here, they're going to be respectful. The flaw in this argument is that employers don't have to provide healthcare now. If they do so, they do so because they want to and it makes sense for their organization. If they were worried about doing things the cheapest way they can, they'd have no coverage now. I'm interested LEXI and Lenore to know specifically what about this healthcare legislation you think is going to be so terrible and why...what is so terrible about the "exchange"?

What year? Is this an ES350? Your profile says GS...

You can use either, I got the H's because they were cheaper.

Just curious. I was over by the auto park in Silver Spring the other day, about 2 hours early for an appointment and I sent over and drove the A6, E Class, and GS. I have driven an E Class before, but it was some time ago, and had never driven an A6. I really didn't like the E class, awkward driving position, boaty ride (boatier than my ES if you can believe it), poor navigation quality, etc) but thats the topic for another thread. What I was surprised by was how much I liked the A6! The interior is a little bland, but if you get a color with something to it, like that saddle brown interior it spices it up, interior quality is excellent, the exterior is smooth and appealing IMHO and I loved how it drove and rode. The GS I think is still sportier, has a more unique exterior (which I still haven't decided 100% if I like that), and no doubt has a nicer interior, but that A6 is easily my second favorite car in the category...

Yeah unfortunately... Welcome to the club!

www.sewellpartsonline.com is probably the best source, http://lexus.sewellparts.com/accessories-catalog/Keys/ES350-2012/2706.html You can log in and tell them you're an LOC member and they'll give you a discount. Welcome to the club!

Makes my temp reading in the car today of 97 look like a joke lol

Sure...but you pay a lot for that service.