Health Insurance

[MarvB]

So do they (insurance cos) charge companies more to offer a wider selection of deductibles? Like I’ve stated, my family plan is $991/mo (50% of the premium) but I’d much rather pay less and opt for much higher deductibles than the $200/person $600/family we have.

My employer had 800+ employees but yet said that’s our only option for our current plan

 

[RobG]

To be clear, I may be cheap but I ain't "Free".

Do you directly charge people soliciting help? My agent doesn't charge me.

 

[Irishman]

It is a mess. I spent a couple hours on the phone one day after my wife had an outpatient procedure done. We had a significant bill from the anesthesiologist, which should have been covered. The answer I got was the anesthesiologist was an out of network provider. I asked why the hell our network physician used an out of network anesthesiologist. I was told “that was who was available today”.

I had a similar issue a couple of years ago, where the local hospital used an anesthesiologist out of network. You would think that they would know to check if it was in network - are they really that incompetent?

 

[Deleted member 22670]

I had a similar issue a couple of years ago, where the local hospital used an anesthesiologist out of network. You would think that they would know to check if it was in network - are they really that incompetent?

Yes. They are.

 

[Marshian]

As an anesthesiologist, I will admit I’m quite ignorant to the billing and the vast majority of it is beyond my control. I will say though, that most if not all anesthesiologists for any given hospital are either direct hospital employees or are all part of a group that has the exclusive contract for that hospital. Either way, all the anesthesiologists of any given hospital would be part of the same networks. It’s not like primary care or other specialties where you can pick and choose who you use. Also, a reasonable amount of an anesthesiologist’s patient load is add-on or urgent surgeries. By definition, these cases don’t have the luxury of time to shop around for in-network doctors even if there were some, which as I mentioned above, is pretty set in its own way.

 

[OntarioHunter]

As an anesthesiologist, I will admit I’m quite ignorant to the billing and the vast majority of it is beyond my control. I will say though, that most if not all anesthesiologists for any given hospital are either direct hospital employees or are all part of a group that has the exclusive contract for that hospital. Either way, all the anesthesiologists of any given hospital would be part of the same networks. It’s not like primary care or other specialties where you can pick and choose who you use. Also, a reasonable amount of an anesthesiologist’s patient load is add-on or urgent surgeries. By definition, these cases don’t have the luxury of time to shop around for in-network doctors even if there were some, which as I mentioned above, is pretty set in its own way.

I can certainly see an opportunity for hospitals to make money by jumping the network boundary. "I'll pick your anesthesiologist if you pick mine. That way we can both bill out of network." Is it fraud or just clever business practice?

 

[TOGIE]

The freedom to attempt a dub cork rodeo at 29years and 30months of age without fear of bankruptcy.
Is that really too much to ask?

Therein lies the problem with insurance. It is limited in its ability to incent people to participate in the process of improving health. Smoking is about the only thing that they can penalize. But rodeo should probably be on that list too.

i have a suspicion, SAJ, the type of rodeo you're thinking is not the type of rodeo referenced.

point valid regardless

 

[Deleted member 28227]

i have a suspicion, SAJ, the type of rodeo you're thinking is not the type of rodeo referenced.

point valid regardless

 

[SAJ-99]

i have a suspicion, SAJ, the type of rodeo you're thinking is not the type of rodeo referenced.

point valid regardless

After seeing @wllm1313 post, even more valid. Let's just say 'rodeo' of any type.

 

[DouglasR]

If this is you I’m reacting with the angry face.

 

[SAJ-99]

We need health insurance premiums to be based on the development of the prefrontal cortex.

 

[Deleted member 28227]

We need health insurance premiums to be based on the development of the prefrontal cortex.

I mean... how many of you old geezers have given and continue to give yourself gout because you refuse to lay off the salt/red meat and beer?

 

[Ben Lamb]

 

[Irishman]

As an anesthesiologist, I will admit I’m quite ignorant to the billing and the vast majority of it is beyond my control. I will say though, that most if not all anesthesiologists for any given hospital are either direct hospital employees or are all part of a group that has the exclusive contract for that hospital. Either way, all the anesthesiologists of any given hospital would be part of the same networks. It’s not like primary care or other specialties where you can pick and choose who you use. Also, a reasonable amount of an anesthesiologist’s patient load is add-on or urgent surgeries. By definition, these cases don’t have the luxury of time to shop around for in-network doctors even if there were some, which as I mentioned above, is pretty set in its own way.

In my case, it was a procedure that had been planned for months.

 

[SAJ-99]

I mean... how many of you old geezers have given and continue to give yourself gout because you refuse to lay off the salt/red meat and beer?

 

[DouglasR]

I mean... how many of you old geezers have given and continue to give yourself gout because you refuse to lay off the salt/red meat and beer?

Salt’s a mineral and your body needs it bro.
I do cardio.
Leave me alone.

 

[Ben Lamb]

Salt’s a mineral and your body needs it bro.
I do cardio.
Leave me alone.

 

[El Jason]

After raising 10 kinds of hell on the phone I finally got ahold of someone who would listen and I had to take off work and go show them all the bills I’d saved that had been going back and forth between my old address and new one and finally he reinstated the policy.

This makes me think of the first part of the Incredibles movie.

 

[TOGIE]

the problem with incentivizing healthy activities is that it always gets twisted in the political and or corporate realm.

i do think we should incentivize healthy activity and penalize unhealthy activity through insurance premiums, or perhaps some other way

but in the 40's you would be penalized for being gay and rewarded for smoking cigarettes

in the 70's/80's you would be penalized for eating meat and fat and rewarded for eating processed carbs, margarine, consuming coca cola, and forgoing sleep for burning the midnight oil (and i think we all know how well that mindset is going for human health)

these days you would be rewarded for eating a processed soy based "meat" patty and knowing how many different pronouns exist

i have my personal opinions on what should be penalized and incentivized based on what i believe is scientifically based on being nutritionally, physically, and mentally good for you, but a lot of that is at odds with the political establishment and where the money flows, regardless of what i or any reputable scientist believes is best.

whoever makes the decision on who gets rewarded for what, be it the politicians, the healthcare industry, or the corporations are ultimately influenced by money.

i don't know where that brings us in this conversation to be honest.....

but i think having the insurance companies decide on who gets rewarded based on "healthy" behavior is a little fox in the henhouseish

 

[DanWyo]

the problem with incentivizing healthy activities is that it always gets twisted in the political and or corporate realm.

i do think we should incentivize healthy activity and penalize unhealthy activity through insurance premiums, or perhaps some other way

but in the 40's you would be penalized for being gay and rewarded for smoking cigarettes

in the 70's/80's you would be penalized for eating meat and fat and rewarded for eating processed carbs, margarine, consuming coca cola, and forgoing sleep for burning the midnight oil (and i think we all know how well that mindset is going for human health)

these days you would be rewarded for eating a processed soy based "meat" patty and knowing how many different pronouns exist

i have my personal opinions on what should be penalized and incentivized based on what i believe is scientifically based on being nutritionally, physically, and mentally good for you, but a lot of that is at odds with the political establishment and where the money flows, regardless of what i or any reputable scientist believes is best.

whoever makes the decision on who gets rewarded for what, be it the politicians, the healthcare industry, or the corporations are ultimately influenced by money.

i don't know where that brings us in this conversation to be honest.....

but i think having the insurance companies decide on who gets rewarded based on "healthy" behavior is a little fox in the henhouseish

I hear you on this, for sure. And I don’t have a solution to offer.

A lot of healthcare dollars are spent on chronic disease management—type 2 diabetes, high blood pressure, COPD, CHF, obesity….

I’d love to see responsibility for health be put back on the individual, with the healthcare system for support. Healthy weight, regular activity, no smoking, limited alcohol and mental health management are all pretty solidly evidenced based as routes to maintaining health and not being a drain on the healthcare system. However…

Before you heal someone, ask him if he's willing to give up the things that make him sick.

Hippocrates