Insurance company profit: makes one want to vomit, no?

[cyanide12345678]

As much as i have never liked insurance companies, I've been fairly impressed with anthem.

I took my daughter to an ER, she got quite a work up for mis-c and kawasakis - cbc, cmp, esr, crp, chest xray, UA, urine culture, covid swab, covid antibodies.

My plan deductible is $4800 i believe. I completely expected to pay the full deductible. Not a single dollar was paid from the deductible prior to the visit.

Got billed $4500. Insurance discount of $3300 because of their negotiated rates, and then for some unknown reason, they paid $1200 remaining and only applied $12 towards my deductible. I don't understand why they paid 1200 before my deductible was met, maybe they made a mistake? Either way, I'm not going to call them and ask lol. I'll take it.

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[Arcan57]

I've got two letters for you: VA.

The VA has significant issues. Probably the biggest is that it can't pay competitive salaries for docs, nurses, or administrators. Additionally, the scope of their mission has ballooned. 40% of post-9/11 vets are entitled to life-long disability payments and that number is expected to increase to 54% in the next 30 years. That number was 25% in pre-9/11 vets. We don't take into account the cost of caring for veterans when determining the price of going to war, which is probably something that should change.

To some extent, I think it's hard to tease out quality of care at the VA. You can find a study that supports whatever side of the issue you want to be on. Meta-analyses seem to point towards more expensive care but slightly better performance on the majority of metrics compared to non-VA hospitals. However, there's definitely some confirmation bias in the press. Similar to peds, vets represent a special population in whom the general public is less tolerant of adverse events. Also, the sheer size of the VA makes it easy to combine adverse events that are widely dispersed in both location and time into a single narrative.

Nobody's writing articles about a Medicare Advantage plan having 1 oncologist in-network for a city of millions. But if a vet dies of cancer after an inappropriate delay in diagnostics, there's a decent chance it hits at least the local news.

 

[thegenius]

Who changed the title of my post?

 

[Apollyon]

Who changed the title of my post?

I would say something, but some people are on the level of snowflakes in becoming offended. You know, like, calling HR because you made a breeze while walking past.

 

[BoardingDoc]

Who changed the title of my post?

Just checked. The title had the prefix added for clarity as the topic wasn't readily apparent with just the original title.

 

[southerndoc]

@thegenius I edited the title of the thread to reflect the subject. Sorry I should've put a post here but was distracted when I received a phone call of a friend who passed away.

 

[Dred Pirate]

As much as i have never liked insurance companies, I've been fairly impressed with anthem.

I took my daughter to an ER, she got quite a work up for mis-c and kawasakis - cbc, cmp, esr, crp, chest xray, UA, urine culture, covid swab, covid antibodies.

My plan deductible is $4800 i believe. I completely expected to pay the full deductible. Not a single dollar was paid from the deductible prior to the visit.

Got billed $4500. Insurance discount of $3300 because of their negotiated rates, and then for some unknown reason, they paid $1200 remaining and only applied $12 towards my deductible. I don't understand why they paid 1200 before my deductible was met, maybe they made a mistake? Either way, I'm not going to call them and ask lol. I'll take it.

I had something similar, I had a minor hand surgery - I have an high-deductible/HSA plan - I never come close to my deductible (thankfully). I paid $1300 to the surgery center. For some reason about 6 weeks later they sent me a check back saying my insurance company covered the cost. I still have no idea why, but also I didn't question them.

That being said, the profit that some of these companies make is sickening - I am not going to say here that the government is going to be more efficient by any means for the various reasons already stated, but I think reasonable people could make reasonable regulations that could address these concerns -requiring rebates to customers if profits exceed a certain amount, but also putting in limitations on compensation to the c-suite. I don't claim to be a businessman, so don't have the exact numbers that should stated.