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The Water Cooler
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Failed ObamaCare co-ops have not repaid $1.2B in federal loans...
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<blockquote data-quote="NightShade" data-source="post: 2858395" data-attributes="member: 29706"><p>The funny thing is that for my recent shoulder surgery it's nearly the same, however the hospital shows that my plan paid $11,325.44 but due to a coding error I got the ACTUAL full information where the insurance actually paid $1,934.35 their discount was $9,429.78 and my share is 644.78. This is ONLY for the hospital and does not include anesthesiologist charges which were 1330.03 of which 1105.85 were denied and the plan paid 224.18 and shows I owe zero.</p><p></p><p> Another denial shows an office visit is billed at 667.00 of which 39.00 was denied due to a coding error and the discount was 518.69. To me it seems like a plan racket going on when an insurance company can get huge discounts. I wouldn't be surprised if both sides were showing discounts as losses, the insurance company showing it as paid out on the bottom line and the providers showing it as a loss of not recived.</p><p></p><p>The other major racket is the "donut hole" where when you get to a certain amount of coverage you have to pay 100% for a few thousand dollars. My wife's health is pretty bad, the Neurosarcoidosis has to be kept in check with a dose of steroids which over the long term causes diabetes, the pill forms of medications no longer work and even when they did work were doing a poor job of things. Now she has to take insulin, she uses around 3000 units of a long acting a month. Our copay is around 45.00 per month for it but the insurance pays in the 600 to 700 range for it. After a few months we will hit the donut hole and pay for everything. The doctors want to add ANOTHER insulin and 45.00 per month copay and she will end up taking around 900 units per month to start and the insurance will pay another 300 or so for it so we now hit the donut hole in around 2 to 3 months at which point she may as well go dig her own grave if we do it their way. </p><p></p><p>The system is severely broken plain and simple. The "affordable" healthcare act (aka Obummercare) only reinforced the insurance companies bottom line forcing everyone to be insured and nearly guaranteeing that when people get to a certain level of care coverage they will never get past that point. Pay your premiums for 30 years with little more than a cold and when you really get sick live without coverage for most of the year unless you can pay a few thousand out of pocket or get yet another insurance plan.</p></blockquote><p></p>
[QUOTE="NightShade, post: 2858395, member: 29706"] The funny thing is that for my recent shoulder surgery it's nearly the same, however the hospital shows that my plan paid $11,325.44 but due to a coding error I got the ACTUAL full information where the insurance actually paid $1,934.35 their discount was $9,429.78 and my share is 644.78. This is ONLY for the hospital and does not include anesthesiologist charges which were 1330.03 of which 1105.85 were denied and the plan paid 224.18 and shows I owe zero. Another denial shows an office visit is billed at 667.00 of which 39.00 was denied due to a coding error and the discount was 518.69. To me it seems like a plan racket going on when an insurance company can get huge discounts. I wouldn't be surprised if both sides were showing discounts as losses, the insurance company showing it as paid out on the bottom line and the providers showing it as a loss of not recived. The other major racket is the "donut hole" where when you get to a certain amount of coverage you have to pay 100% for a few thousand dollars. My wife's health is pretty bad, the Neurosarcoidosis has to be kept in check with a dose of steroids which over the long term causes diabetes, the pill forms of medications no longer work and even when they did work were doing a poor job of things. Now she has to take insulin, she uses around 3000 units of a long acting a month. Our copay is around 45.00 per month for it but the insurance pays in the 600 to 700 range for it. After a few months we will hit the donut hole and pay for everything. The doctors want to add ANOTHER insulin and 45.00 per month copay and she will end up taking around 900 units per month to start and the insurance will pay another 300 or so for it so we now hit the donut hole in around 2 to 3 months at which point she may as well go dig her own grave if we do it their way. The system is severely broken plain and simple. The "affordable" healthcare act (aka Obummercare) only reinforced the insurance companies bottom line forcing everyone to be insured and nearly guaranteeing that when people get to a certain level of care coverage they will never get past that point. Pay your premiums for 30 years with little more than a cold and when you really get sick live without coverage for most of the year unless you can pay a few thousand out of pocket or get yet another insurance plan. [/QUOTE]
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