• Same story, different day...........year ie more of the same fiat floods the world
  • There are no markets
  • "Spreading the ideas of freedom loving people on matters regarding high finance, politics, constructionist Constitution, and mental masturbation of all types"

I’m a former health insurance CEO and this is what Obamacare repeal will do

TAEZZAR

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Nice rant Scorp - double like !!!
 

Rusty Shackelford

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#82
Employer provided insurance is the most expensive insurance one can buy and it was the model for what ACA plans were built around.
 

Joe King

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#84

Uglytruth

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#85
Sat in a meeting with a health insurance guy. Choice was narrowed down to two options for 100 employees so think how big the premiums were & he got a little smug. He stood back & pointed out the differences and said I don't care which one you pick. So I helped him (I'm good that way) I said "yea so long as we buy it from YOU!" He got humbled in 0.1 seconds.

I tried to get the company that already owned the land to self insure & buy a catastrophic policy. There was a beer distributor with about 80 employees, us with 100 & a paving company that in the summer had about 50.
I said lets build a building, hire 1 general Dr. and nurse & also put a day care in for children with an on site Dr. If we pooled all our premiums we would save enough to have a catastrophic policy and have a lot of money left over.
People instead of making an appointment could just stop in for service. I mean your talking maybe 500-600 patients........ or less than 2 a day.......... As usual I was the voice of reason but really the square peg in the round hole.
 
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Rusty Shackelford

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They are similar but employer plans are still more expensive.
Back before my wife got her RN and was eligible for family health insurance, we bought a private plan to cover myself, her and two girls under age 10. My employer did not provide family coverage, just employee and tgey paid 100% of premium which was $500ish/month. The private plan we bought was from same company as my employer plan. with same deductible and OOP max. Difference was no maternity and it was underwritten for preexisting exclusion for 1 yr. The premium for the four of us was $325/month. Once ACA came I we got notice that the company would no longer accept new applications, which was of no concern since we were dropping coverage as wife was now employed. 1yr later we got notice that said company was leaving health insurance market all together.

Employer knew I was buying private insurance as in my opinion the $70 premium I was paying to be on the private plan was worth the ability to have a single $4000 deductible as opposed to 2 $4000 deductibles. They still paid the $500 premium. Agent loved the free money
 

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#87
That's the only real solution I can see.

Today, just to be able to go see a doctor, not only are you paying for the doctor and his/her staff, you are paying the wages of the insurance company's employees and their investors as well as many gov employees.

All that cost has to somehow be added into the overall cost of healthcare. Which is why we have such crazy prices for healthcare. Too many fingers in the bowl.
The three big problems with health care, before and after Obamacare, are poor quality, too much control and high cost. The above post sums up the economics perfectly.
Before, the major problems with health care were caused by the main middleman, insurance companies. To fix it, Obama added yet another middleman, the government, to compound the problems.
We need to get the middlemen out of health care.
 

Usury

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#88
Those bottom 2 lines are what the ins actually paid.
 

southfork

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#89
Seems the damage is done, they wont lower preiums, deductibles, visit and med costs they raised during the aca venture, and I doubt they will lay off the thousands of .gov employees hired to work for the unafforadable care act.
 

TAEZZAR

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Those bottom 2 lines are what the ins actually paid.
The last line is for me to pay, just above it is what the ins. co. paid the doctor. All of the rest is adjustments, for some reason, maybe excessive charges.
What I don't like, is their stupid, non-logical accounting of putting my part in the same column as their part. It is really confusing.
 

Rusty Shackelford

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I have offered to pay cash, for a discount, & been told that it is illegal to give a discount for cash.
Looks as though the scammers have their bases covered.
You are getting jerked around. I have hit my $5000 deductible every year for last three years and that is after the insurance adjustment/assignment. I call billing up and tell them I am ready to pay in full and they always knock of an additional 10% minimum.

Don't get hung up the on the billed charge. Just focus on the accepted assignment that the provider accepts. That's the real name number.

Read up on coding descriptions and it will help you understand if your visit is being billed accurately for services rendered. Most office visits will be a level 2 or 3 visit by definition

https://www.medicalhomeportal.org/link/301
 
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Joe King

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#92
Don't get hung up the on the billed charge.
Why is truth in billing too much to ask for? All I want is a fair charge at the time services are provided to me. Why do they have to play games with billing?

We don't take our cars to the garage only to get a bill multiples of times higher than it should be, only to have to haggle with the accounts receivable department in order to have 'em knock off 10%.
...and I shouldn't have to do that at the doctors office, either. Medical billing is nothing but a scam.
 

Rusty Shackelford

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I agree with everything you say, except:
Are you looking at post 42 ? Were do you see $160 ??

$160ish is easy to see man. Billed $418, accepted a $260 adjustment. $418-$260=$158 (part paid by Medicare and part by you).
 

Rusty Shackelford

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#94
I am all for truth in billing, but I ain't gonna get all bent over it when I know it is a fake number to ignore.

Americans love to haggle. It's why cars are priced at $40k but you walk out the door paying $30k. You didn't Jew tgem down the $10k .. It was baked in but the masses think they just pulled off something special. That's why inflated fake medical prices get a pass cuz the "discount" make people feel good.
 
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southfork

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#95
I had outstanding balances of around 500$ from a cat scan and echo in Nov , I wanted to settle by years end as i took a withdrawl from my 401 , called them up on dec 30 and asked for senior discount as i was retired on limited income ect, they gave me a 20% discount for paying that day. Ive gotten as much as 30% before..

You are getting jerked around. I have hit my $5000 deductible every year for last three years and that is after the insurance adjustment/assignment. I call billing up and tell them I am ready to pay in full and they always knock of an additional 10% minimum.

Don't get hung up the on the billed charge. Just focus on the accepted assignment that the provider accepts. That's the real name number.

Read up on coding descriptions and it will help you understand if your visit is being billed accurately for services rendered. Most office visits will be a level 2 or 3 visit by definition

https://www.medicalhomeportal.org/link/301
 

Joe King

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I had outstanding balances of around 500$ from a cat scan and echo in Nov , I wanted to settle by years end as i took a withdrawl from my 401 , called them up on dec 30 and asked for senior discount as i was retired on limited income ect, they gave me a 20% discount for paying that day. Ive gotten as much as 30% before..
The problem is that they start out with a bill that's about 500% too high.

Edited to add: if I should get a bill for $100, but get one for $500 instead and they then give a generous 50% discount, they are still getting 250% of what the bill should have been with no discount.
....but we're told to think of that as some kind of bargain? Sounds like highway robbery, to me.
 
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Rusty Shackelford

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#97
Much like trying to define affordable in the ACA, defining the cost of service is something that will never be agreed on. Until people refuse to buy the service the price can keep climbing based on demand. They can bitch about it all day long but they still want the service. Consumer desire for service trumps cost u till you decide to pass on service.
 

Joe King

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Much like trying to define affordable in the ACA, defining the cost of service is something that will never be agreed on. Until people refuse to buy the service the price can keep climbing based on demand. They can bitch about it all day long but they still want the service. Consumer desire for service trumps cost u till you decide to pass on service.
I get it, they're trying to charge the absolute maximum the market will bear. a/k/a profit is placed higher than anything else, including their patients well being.
Sounds to me like they need to apply the Hippocratic oath to the billing department too. "Do no harm". As it is now, their goal seems to be to cause as much financial harm to the customer as they possibly can.
 

Rusty Shackelford

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I get it, they're trying to charge the absolute maximum the market will bear. a/k/a profit is placed higher than anything else, including their patients well being.
Sounds to me like they need to apply the Hippocratic oath to the billing department too. "Do no harm". As it is now, their goal seems to be to cause as much financial harm to the customer as they possibly can.
And the same can be said for any service or item produced in the market place. Should a plumber be limited to 1% profits over cost for his vital service? Clean water and sewage disposal derived from a plumbers skill is the lynch pin modern societies are built on (despite the hero line from fire and police).

My example is hyperbole, but boarders on being realistic. Quit buying the product if you find no value in the service. No one forces you to go to a doctor.
 

Rusty Shackelford

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When bills run into the thousands....... other countrys might be a better option.
And you can do that, I agree. Just remember to factor in flight and hotel costs.

I just revert back to my experience. 3-4 full anasthesia out patient surgeries a year. 4-5 post op visits. The occasional blood lab panel monitoring for infection. A mri with an occasional x-Ray with dye. A small variety of RX tied with post op pain and infection management. Annual meeting with PCP for non-surgery issues and maintenace RX. $5000 deductible with $4000 in premium costs. So $9000 a year for everything I am seen for. Really is a bargain IMO and no I don't think I would save a sinhle penny using out of country alternatives.

Sometimes I wonder if the gloom about our current system is coming from those that have never ever really used the system and just project their thoughts on his they imagine it would work if they did use it (which they will at some point, mark my word).
 

Uglytruth

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I agree with 2 things in obamacare.
1. Portability. If I change my job, my car, house, my life insurance don't change so why should my health care? It's just another form of golden handcuffs.
2. Wellness health testing. I do believe if they are in the "health" business they should be very interested in keeping you healthy.
 

Howdy

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If I change my job, my car, house, my life insurance don't change so why should my health care?
When you change jobs or insurance companies, every ailment you have becomes a pre-existing condition. Insurance people would like every ailment to become "pre-existing" so they don't have to pay any claims.
Remember this and do not disclose any ailments until you are sure you want immediate surgery.
Under Obamacare, as you mention, they do not matter. If Trump has it repealed, all those conditions you disclosed because they didn't matter will become pre-existing and the insurance industry wins again.
 

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Well lets face it....... they are really in the fleecing business. Why else employ an expensive army to fight paying a claim?
F pre existing either you are in the health care business or your not.

Or is "Health Care Business" like "Affordable Care Act" or Lottery is "funding for schools" or liquor / cig tax "for the children" or green tax "for the environment" etc........
 

Joe King

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And the same can be said for any service or item produced in the market place. Should a plumber be limited to 1% profits over cost for his vital service? Clean water and sewage disposal derived from a plumbers skill is the lynch pin modern societies are built on (despite the hero line from fire and police).

My example is hyperbole, but boarders on being realistic. Quit buying the product if you find no value in the service. No one forces you to go to a doctor.
Healthcare
is a totally different thing.

Do plumbers take an oath that states they have a special obligation to their fellow human beings and patients? Do they take an oath that takes into account their "customers" economic stability?
Doctors do take such an oath......and then immediately break it by colluding with the insurance companies to fleece their patients. They didn't use to do that, but once healthcare came to be seen as a cash cow for making obscene profits they certainly do.
 

CrimsonGuardJay

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Well lets face it....... they are really in the fleecing business. Why else employ an expensive army to fight paying a claim?
F pre existing either you are in the health care business or your not.

Or is "Health Care Business" like "Affordable Care Act" or Lottery is "funding for schools" or liquor / cig tax "for the children" or green tax "for the environment" etc........
Forcing a business to accept customers that will result in definite economic losses, often huge, is beyond the level of insanity.
 

CrimsonGuardJay

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When you change jobs or insurance companies, every ailment you have becomes a pre-existing condition. Insurance people would like every ailment to become "pre-existing" so they don't have to pay any claims.
Remember this and do not disclose any ailments until you are sure you want immediate surgery.
Under Obamacare, as you mention, they do not matter. If Trump has it repealed, all those conditions you disclosed because they didn't matter will become pre-existing and the insurance industry wins again.
Someone obviously doesn't understand how insurance works.

Group insurance cannot decline someone due to pre-existing, never did, never could. and you could always take COBRA (continuation) until your new job had you enrolled. That's why group insurance was always expensive. Individual insurance was underwritten and worked better for 97% of the population because they could get it and it was much cheaper.

Now that the final trap of the ACA has been sprung, group and individual insurances cost a very similar amount, and you're fucked no matter what you do.
 

Howdy

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Someone obviously doesn't understand how insurance works.

Group insurance cannot decline someone due to pre-existing, never did, never could. and you could always take COBRA (continuation) until your new job had you enrolled. That's why group insurance was always expensive. Individual insurance was underwritten and worked better for 97% of the population because they could get it and it was much cheaper.

Now that the final trap of the ACA has been sprung, group and individual insurances cost a very similar amount, and you're fucked no matter what you do.
I never stated group insurance could decline someone due to pre-existing conditions.
Health care doesn't need insurance companies and complex legislation to add 500% to the cost and mire it down in a convoluted mess that doesn't make any sense.


"It is difficult to get a man to understand something when his salary depends upon his not understanding it."
Upton Sinclair
 

nickndfl

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If Trump makes the rollback retroactive, just think of all the penalty money that will be returned to the people. I should be getting almost $10k which I would invest in tangible assets.
 

Uglytruth

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Forcing a business to accept customers that will result in definite economic losses, often huge, is beyond the level of insanity.
Remember in ANY BUSINESS 80% of your profits come from 20% of your customers. If you can somehow pick the 20% more power to you but most services are not able to do that & health care is a need for most people at one time or another.
If they take out the "care" from "health care" you got nothing but health, good health, bad health, preventable health problems etc......... Might as well call it profit fleecing with paperwork to make it look like we do something.

They insurance co has the ability to average it out to be profitable, monitor and control it & even go so far as to work with the individual. Now if they don't want to be in the "health care" business then GTFO! Besides the obscene profits (hey it worked against the oil companies) health care costs & the shyster lawyers that sue for every fender bender........ Not saying it's a perfect solution.
 

CrimsonGuardJay

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Remember in ANY BUSINESS 80% of your profits come from 20% of your customers. If you can somehow pick the 20% more power to you but most services are not able to do that & health care is a need for most people at one time or another.
If they take out the "care" from "health care" you got nothing but health, good health, bad health, preventable health problems etc......... Might as well call it profit fleecing with paperwork to make it look like we do something.

They insurance co has the ability to average it out to be profitable, monitor and control it & even go so far as to work with the individual. Now if they don't want to be in the "health care" business then GTFO! Besides the obscene profits (hey it worked against the oil companies) health care costs & the shyster lawyers that sue for every fender bender........ Not saying it's a perfect solution.
I also suppose you have also never heard of the medical cost ratio. A federal law enacted in 2010, ALL health insurance companies MUST spend 80% of all premiums on claims for customers, no exception.

This leaves a HUGE margin (not profit) of 20% with which to pay all employees, agents, staff, underwriters, and of course the overhead required to operate a bloody expensive business.

The Obamacare plans generate zero profits, in fact they all suffer a loss, meaning you have to hope that the 1/3 of plans that represent regular, non-subsidized will somehow carry the entire company... which they don't.

Trust me when I say this: health insurance companies are not making "record profits." Any numb-nuts with an IQ of 65 can do the math: almost ALL health insurance companies including UnitedHealth, Aetna, Humana etc HAVE EXITED THE MARKET.

Must be those record profits.
 

Joe King

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almost ALL health insurance companies including UnitedHealth, Aetna, Humana etc HAVE EXITED THE MARKET.
In your professional opinion, what's the best way to get all of them to exit the market? That way, if there's no insurance companies involved, perhaps the providers will lower their prices to that which their customers can actually afford.
 

Uglytruth

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Yes I got my $62 refund check so they could raise my rates $25 a mo.

HUGE margin (not profit) of 20% with which to pay all employees, agents, staff, underwriters
Bloated salaries, army of people to say no, and NONE OF THIS HAS ANYTHING TO DO WITH HEALING PEOPLE! Just paper, nothing tangible.
It's not "insurance" IT'S A SCAM!

We are talking big money here....... if I remember 12% of the US economy......
 

Rusty Shackelford

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to that which their customers can actually afford.
And what is that number? I find that no matter what the number is people will still say it is too high and not affordable. The definition of affordable is wildly different depending on income levels. So is everything to be priced at a level that is affordable to the lowest tier? Or do you have different levels of pricing per income level to subsidize the people that can't afford the true cost?

sorry had to quickly post that answer and had more to add..

I know this is mean to say but it is true. Sometimes you just can't afford all the modern treatments available to you. Just like a if all you can afford is a trailer, buying a Brownstone just aint in the cards. Yet, we constantly see people buying new Bentleys on beat up toyota salaries (health care speaking) as if it is a birth right. Healthcare and treatment is expensive. That will not change, even if you get costs under control. If there are benevolent people that want to individually pick up the costs for others that is awesome, but it should never be in the price for everyman to be forced to pick up.
 
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Joe King

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And what is that number? I find that no matter what the number is people will still say it is too high and not affordable. The definition of affordable is wildly different depending on income levels. So is everything to be priced at a level that is affordable to the lowest tier? Or do you have different levels of pricing per income level to subsidize the people that can't afford the true cost?
I don't know what that number is. It would have to be determined during the initial periods of free market competition that would ensue once all insurance companies exited the market. Just like various plumbers charge various prices for their services relative to the economic realities of their geographical location, doctors would have to do the same, lest they end up going out of business due to the fact no one in their area can afford their rates.
The way I see it, if the doctors only had to bill an amount to cover their own costs plus a reasonable amount for their and thir staffs wages, prices would be a lot cheaper. As it stands now, the bill must not only include the direct costs of treatment, but must also include an amount necessary to pay the costs of the health insurance industry plus their profits.
Edited to add: I'm including the cost of health insurance here, as it is a part of most peoples healthcare costs.

sorry had to quickly post that answer and had more to add..
No need to be sorry. I add after-thoughts to my posts all the time. lol
IMHO, the important part is letting the reader know stuff has been added.


I know this is mean to say but it is true. Sometimes you just can't afford all the modern treatments available to you. Just like a if all you can afford is a trailer, buying a Brownstone just aint in the cards. Yet, we constantly see people buying new Bentleys on beat up toyota salaries (health care speaking) as if it is a birth right. Healthcare and treatment is expensive. That will not change, even if you get costs under control.
How is that any different than not everyone being able to afford anything else? Like new cars, or the latest iphone, or $150 cable tv package? We all make choices in life as to how best to spend our money.
If we want a healthcare system where the best treatment is available to all, the only way to do so is to get the profit motive under control. The way it works now, the profit motive is maximized, hence the massive overcharging for everything. They only overcharge because the current system incentives doing so.


If there are benevolent people that want to individually pick up the costs for others that is awesome, but it should never be in the price for everyman to be forced to pick up.
I agree.
...but the way it works now it is added into the price everyman gets for treatment. The charges always far exceed that required for ones own treatment.
 

Usury

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The fix is to move away from insuring maintenance costs and stick with catastrophic policies combined with HSA accounts for regular doc visits & such.
 

ErrosionOfAccord

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I just had my neck fused. Finally back to work last week. Maybe people noticed I was here A LOT during the past four months, or not. Anyway, the total bill was about $70,000, or somewhat less than my annual gross wages. I spent two months dicking around with doctors who were busy proving to the insurance companies that a discectomy was my only choice for recourse. My injury occurred in early August and I was on company provided disability until last week. The employer is out medical expenses, disability payments, and productivity. I didn't see the operating room until mid November.

Over all, the surgeon used up about five hours of his time and I spent a total of about 60 hours in the hospital with about three of those in the OR. Materials used, a two inch strap of titanium, a small piece of carbon fiber, stitches, bandages, catheter, and a piss bottle. I have yet to see an itemized list of the expenses because the primary and secondary health insurance took care of everything. There were three nurses, an anesthesiologist, a surgeon, and some nerve monitor guy involved.

Now I'm not saying the surgeon didn't earn his wages, prior to the procedure I couldn't stand to have my chin off of my chest. Had I been living in an earlier era a gun would have been my solution and I truly mean that. Modern medicine is amazing! All in though, I bet MY procedure didn't cost more than $15 - 20,000 in parts and labor. I figure the other $50,000 is me subsidizing everyone else, and that my friends is a crock of shit.
 

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Back before my wife got her RN and was eligible for family health insurance, we bought a private plan to cover myself, her and two girls under age 10. My employer did not provide family coverage, just employee and tgey paid 100% of premium which was $500ish/month. The private plan we bought was from same company as my employer plan. with same deductible and OOP max. Difference was no maternity and it was underwritten for preexisting exclusion for 1 yr. The premium for the four of us was $325/month. Once ACA came I we got notice that the company would no longer accept new applications, which was of no concern since we were dropping coverage as wife was now employed. 1yr later we got notice that said company was leaving health insurance market all together.

Employer knew I was buying private insurance as in my opinion the $70 premium I was paying to be on the private plan was worth the ability to have a single $4000 deductible as opposed to 2 $4000 deductibles. They still paid the $500 premium. Agent loved the free money
They left the market completely? Must be those record profits the liberal media keeps telling us about, making us all angry. Clearly, they just didn't have any more room for all the money.
 

CrimsonGuardJay

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I just had my neck fused. Finally back to work last week. Maybe people noticed I was here A LOT during the past four months, or not. Anyway, the total bill was about $70,000, or somewhat less than my annual gross wages. I spent two months dicking around with doctors who were busy proving to the insurance companies that a discectomy was my only choice for recourse. My injury occurred in early August and I was on company provided disability until last week. The employer is out medical expenses, disability payments, and productivity. I didn't see the operating room until mid November.

Over all, the surgeon used up about five hours of his time and I spent a total of about 60 hours in the hospital with about three of those in the OR. Materials used, a two inch strap of titanium, a small piece of carbon fiber, stitches, bandages, catheter, and a piss bottle. I have yet to see an itemized list of the expenses because the primary and secondary health insurance took care of everything. There were three nurses, an anesthesiologist, a surgeon, and some nerve monitor guy involved.

Now I'm not saying the surgeon didn't earn his wages, prior to the procedure I couldn't stand to have my chin off of my chest. Had I been living in an earlier era a gun would have been my solution and I truly mean that. Modern medicine is amazing! All in though, I bet MY procedure didn't cost more than $15 - 20,000 in parts and labor. I figure the other $50,000 is me subsidizing everyone else, and that my friends is a crock of shit.
I'm pretty sure it didn't really even cost that much.
 

Rusty Shackelford

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Jay, I am willing to bet that the example given is what was billed in the EOB, not the actual contracted amount which is all that really matters at the end of the day. I am struggling to find out why everyone focuses on the bogus billed amount that they all know is a fake number instead of focusing on the amount paid by insurance company and or member via deductibles and copays.