Insurances - Why so thick-headed?

[darkshadow0001]

Been awhile since I've been here, but I've had a delima with my health insurance company. Why is it when you call them for information you have to talk to different people all the time, and for the matter of fact, each person you talk to gives you different answers?

I try to find out about a doctor's visit I had recently and my insurance told me one thing by some people and another by others. I had a group of people saying that I didn't send in enough information for my claim to be filed and I call back an hour later and another girl says I did, and that they paid for what they were going to pay and they didn't know anything about my refund.

The people that said I didn't send in the right information said that's why I haven't got my refund yet, but I argued with them that I did send in the right information, according to the third person I talked to by your company. They were like "we're sorry you were told the wrong information, but we need more information from you to file the claim". I got tedious with them, and I called back again but this new person (yes, it's someone different each time) said I did have all the right information sent and the claim was processed. So I asked this person why the last one said I didn't. The response: "I don't know, sir."

This is why I don't like insurances, I was almost about ready to give up and just have paid my bill on my own without expecting a reimbursment because I didn't want to deal with that crap. (It was a small bill, anyway) but all they told me to do was send in a copy of my bill along with a claim form with my information on it, and I did. But no, they said it wasn't enough.

I don't know why we have to bother with insurances anyway... you're almost better off paying the doctor's bill on your own...

 

[boobatuba]

And this is one reason why single-payer would save such a tremendous amount of money. One set of rules, better efficiency, less waste of money and resources.

Of course, the lack of a profit motive would be a pretty big deal as well.

 

[Miss Chicken]

I am lucky. 95% of the doctors I visit bulk bill Medicare (I.e. Australia's governmental healthcare provider) meaning all I have to is show my Medicare card and occasionally my pension card. The doctors then send their bill to Medicare. If I doctor doesn't bulk bill I generally pay the bill and then go to the Medicare office and present the bill and within a few days the portion of the bill that Medicare covers is deposited in my bank. I have only had todo that once in the last three years as every other bill has been bulk billed.

 

[darkshadow0001]

I am lucky. 95% of the doctors I visit bulk bill Medicare (I.e. Australia's governmental healthcare provider) meaning all I have to is show my Medicare card and occasionally my pension card. The doctors then send their bill to Medicare. If I doctor doesn't bulk bill I generally pay the bill and then go to the Medicare office and present the bill and within a few days the portion of the bill that Medicare covers is deposited in my bank. I have only had todo that once in the last three years as every other bill has been bulk billed.

Well according to the last girl I talked to that works for my insurance is that the bill was paid for by them, my thing was I was told that I would receive a refund check for the part they would pay for within 6-7 business days. Stupid me, I wait 6-7 business days after I mail the bill/claim form in thinking it was only going to take that long to receive a check after I mail it. One person said they received the information on the 15th of July (I mailed it on the 11th-12th), and that could be why I haven't received anything. The billing at the medical center said it would take up to a month before I received the money, but the employees at my insurance kept saying "oh you'll receive your money 6-7 business days after we receive the information" so I thought I would of had it by now. I guess from now on I'm just going to ask questions at my doctor's office and not the insurance people, because I don't like the answers they give me. They don't make sense and I'm always getting someone different.

 

[Saturn0660]

And this is one reason why single-payer would save such a tremendous amount of money. One set of rules, better efficiency, less waste of money and resources.

Of course, the lack of a profit motive would be a pretty big deal as well.

How would that make it any better? Rules only apply depending on 1. Who's reading/enforcing them. Just because it "should" be paid for doesn't mean it will get paid for..

 

[MacLeod]

You can get this when you call any call centre if you get the right person you're ok. If not you can go round in circles.

Once spend 2-3hrs tring to get a problem sorted with my ISP. I kept getting passed to a different department. I evetually googled it and fixed it in five minutes. Why they couldn't tell me what I needed to know is beyound me.

Was once told to select an option that didn't exists told me select option 4 when I was only given 3.

 

[HobartFloyt]

I was almost about ready to give up and just have paid my bill on my own without expecting a reimbursment because I didn't want to deal with that crap.

That's it in a nutshell. The companies don't want to pay and will run everybody around until they give up, or sue. At the very least they want to avoid paying out at just one more day. I wouldn't be a bit surprised to find that something is wrong with your refund that prevents it from being cashed/paid.

 

[boobatuba]

And this is one reason why single-payer would save such a tremendous amount of money. One set of rules, better efficiency, less waste of money and resources.

Of course, the lack of a profit motive would be a pretty big deal as well.

How would that make it any better? Rules only apply depending on 1. Who's reading/enforcing them. Just because it "should" be paid for doesn't mean it will get paid for..

It would be better because of the elimination of profit motive. There's very little reason to deny a claim when you aren't "pinching pennies" as the private insurers clearly are now.

 

[farmkid]

I don't know why we have to bother with insurances anyway... you're almost better off paying the doctor's bill on your own...

You may be right. I remember reading some time ago about a movement among doctors to stop taking insurance. The article mentioned the experience of one doctor in particular. He stopped taking insurance at all and billed patients at the time of service. The billing structure was very simple; patients paid one of three different amounts, depending on how long their appointment was and they could then send the bill to their insurance if they wanted to. The patients stopped carrying full coverage and only carried high-deductible insurance to cover them in the case of a major problem but paid for all the small stuff out of pocket. Before the change, the doctor and his staff spent 7 minutes billing the patient for every minute the doctor spent with the patient. After the change, that ratio was reversed. All that saved time meant that the doctor didn't have to charge nearly as much for his time. In the end, his patients spent less each year paying out of pocket than they spent on insurance before. Yes, the patients saved money. The doctor was less stressed and could spend more time with his patients so the patients got better care as well.

How would that make it any better? Rules only apply depending on 1. Who's reading/enforcing them. Just because it "should" be paid for doesn't mean it will get paid for..

It would be better because of the elimination of profit motive. There's very little reason to deny a claim when you aren't "pinching pennies" as the private insurers clearly are now.

If the single payer isn't "pinching pennies", then it's going to cost the customers more. Every penny the insurer has to pay out on claims comes from the customers. If more is going out, then more has to come in. This is true whether it's a private company or government. Companies will pinch pennies to reduce their costs so they don't have to charge as much and therefore attract more customers. The only reason insurance would not have to pinch pennies in a single-payer system would be because they have a monopoly and customers can't go anywhere else. That leads to higher costs and horrible inefficiencies.

 

[boobatuba]

If the single payer isn't "pinching pennies", then it's going to cost the customers more. Every penny the insurer has to pay out on claims comes from the customers. If more is going out, then more has to come in. This is true whether it's a private company or government. Companies will pinch pennies to reduce their costs so they don't have to charge as much and therefore attract more customers. The only reason insurance would not have to pinch pennies in a single-payer system would be because they have a monopoly and customers can't go anywhere else. That leads to higher costs and horrible inefficiencies.

What you keep forgetting is that private insurers have to "pinch pennies" to have enough profit to satisfy their stockholders. The government would not. That's a massive amount of money (when you consider all of the profit made by all of the private insurers) to devote to treatment of patients.

Money would also clearly be saved by providers by only having one place to deal with...only one system of processing claims, only one office to communicate with, etc.

Single payer would save a great deal of money. Arguing against that is simply nonsense.

 

[Saturn0660]

Money would also clearly be saved by providers by only having one place to deal with...only one system of processing claims, only one office to communicate with, etc.

Single payer would save a great deal of money. Arguing against that is simply nonsense.

And just think, with said single payer system. THEY and THEY only get to decide what will and won't get paid. And you've got no other choice to go with.. Other your own pocket of course.

 

[Robert Maxwell]

Money would also clearly be saved by providers by only having one place to deal with...only one system of processing claims, only one office to communicate with, etc.

Single payer would save a great deal of money. Arguing against that is simply nonsense.

And just think, with said single payer system. THEY and THEY only get to decide what will and won't get paid. And you've got no other choice to go with.. Other your own pocket of course.

Which is worse than the current situation... how?

 

[boobatuba]

And just think, with said single payer system. THEY and THEY only get to decide what will and won't get paid. And you've got no other choice to go with.. Other your own pocket of course.

And just think...with a government-run single payer system, THEY and THEY only will be able to actually use premiums to TREAT people instead of pay their CEOs and stockholders. What a concept.

As far as "choice" goes now...as RM pointed out, how do you know now that your insurance company will pay for a treatment? If they don't, what is your recourse?

If anything, history has shown that government-run programs tend to lean towards accepting people into programs where private companies tend to lean towards denying claims.

 

[suarezguy]

What you keep forgetting is that private insurers have to "pinch pennies" to have enough profit to satisfy their stockholders. The government would not. That's a massive amount of money (when you consider all of the profit made by all of the private insurers) to devote to treatment of patients.

And just think, with said single payer system. THEY and THEY only get to decide what will and won't get paid. And you've got no other choice to go with.. Other your own pocket of course.

And just think...with a government-run single payer system, THEY and THEY only will be able to actually use premiums to TREAT people instead of pay their CEOs and stockholders. What a concept.

Some executives may be making too much money (conversely, public workers may be making too little, not that those in public health care would have much choice if it were to be the only large player) but very little of health care spending goes towards profit.
http://www.ahipcoverage.com/2011/05...2-of-1-of-total-health-care-spending-in-2010/

 

[boobatuba]

Some executives may be making too much money (conversely, public workers may be making too little, not that those in public health care would have much choice if it were to be the only large player) but very little of health care spending goes towards profit.
http://www.ahipcoverage.com/2011/05...2-of-1-of-total-health-care-spending-in-2010/

I'm getting SO tired of having to explain this over and over and over.

Yes, as a percentage, health insurers make a very small amount of profit. When you add every private insurer in the country together, however, it's a massive amount of money that could be devoted to care instead of CEOs and stockholders.

Take a look here. This is a chart of profits from just the top 13 private insurers in the US from 2007 (there are 36 "major" medical insurers according to this source). If you don't add well, I'll take the liberty of adding up the profits for one year of just those 13. It was nearly $12 BILLION DOLLARS. Billion...with a "B". And that's just 13 companies of 36. And it was 4 years ago.

I don't know how anyone can argue that it wouldn't be better to devote that money to care rather than some individuals' pockets. Now, can we please drop the ridiculous notion that single-payer wouldn't be better than what we have now? If a self-described economic conservative can't convince you, I really don't know who possibly could.

 

[farmkid]

What you keep forgetting is that private insurers have to "pinch pennies" to have enough profit to satisfy their stockholders. The government would not. That's a massive amount of money (when you consider all of the profit made by all of the private insurers) to devote to treatment of patients.

Money would also clearly be saved by providers by only having one place to deal with...only one system of processing claims, only one office to communicate with, etc.

Single payer would save a great deal of money. Arguing against that is simply nonsense.

I didn't forget that. I'm fully aware of that. And, I agree that a single payer system could be much more efficient. For that reason, I'm hopeful that it could work. But every time I think of it, I also remember every other government-run program, which is anything but a model of efficiency. Based on how every other government program runs, I'm led to believe that the bureaucracy, waste, and just plain not caring because it's someone else's (read: taxpayer's) money will far outweigh the profit that private insurers now earn.

On one hand, I like the idea of everyone having medical care and not forgoing care because they can't afford insurance, or if they have insurance, they can't afford the deductible. I also like the idea of everything being paid from the same source, no questions asked. That should be very efficient because it would reduce all the haggling and paperwork and red tape. But, in order to actually work and be more cost-efficient, such a system depends on three things: (1) patients go to the doctor when they need it, not for every sliver/cold/headache they get for which a doctor isn't needed and can't do anything anyway, (2) providers are honest and charge only for what they do, and charge a fair amount, and (3) those running and administering the system actually care about saving money. The problem is that such a system depends on everyone acting responsibly, and experience shows that's a pipe dream that will never happen.

In short, in theory I like the idea, but I believe in reality it's cost would be tremendous.

 

[FPAlpha]

You can get this when you call any call centre if you get the right person you're ok. If not you can go round in circles.

Once spend 2-3hrs tring to get a problem sorted with my ISP. I kept getting passed to a different department. I evetually googled it and fixed it in five minutes. Why they couldn't tell me what I needed to know is beyound me.

Was once told to select an option that didn't exists told me select option 4 when I was only given 3.

That's because people there are not trained professionals but cheap workers who have a basic knowledge about the field and otherwise go by flow chart to "solve" your problem. If i have to call my ISP with a technical problem or anything technical and i have to dial a call centre i usually don't bother explaining them in detail what my problem is but ask to be connected to the tech department where the professionals usually are and it has worked well so far.

I'm not mad or frustrated at these people and i try not to take it out on them if the company they work for fucks me over (i once had a 6 month battle with my phone/ISP company over costs they deducted wrongfully from my account) and they usually comply if i ask for a special department so i get to the back office where the people are who process my case and i can get a direct name and maybe a phone number for future reference.

 

[suarezguy]

Some executives may be making too much money (conversely, public workers may be making too little, not that those in public health care would have much choice if it were to be the only large player) but very little of health care spending goes towards profit.
http://www.ahipcoverage.com/2011/05...2-of-1-of-total-health-care-spending-in-2010/

I'm getting SO tired of having to explain this over and over and over.

Yes, as a percentage, health insurers make a very small amount of profit. When you add every private insurer in the country together, however, it's a massive amount of money that could be devoted to care instead of CEOs and stockholders.

Not massive compared to the system overall and therefore unlikely to have a large impact on the system overall.

It was nearly $12 BILLION DOLLARS. Billion...with a "B". And that's just 13 companies of 36. And it was 4 years ago.

I don't know how anyone can argue that it wouldn't be better to devote that money to care rather than some individuals' pockets.

If you reduce the money doctors make it could reduce the appeal of the profession, not what we should be doing when there's a current doctor shortage.

Among the costs of a single-payer system would be less competition and consumer choice, which I think is significant.

Now, can we please drop the ridiculous notion that single-payer wouldn't be better than what we have now?

It would almost definitely be not that much better (acknowledging that there would only be limited improvements at significant cost is a start to credibility) and could be worse.

If a self-described economic conservative can't convince you, I really don't know who possibly could.

You seem an economic nationalist but not very much into a free market economy.

 

[boobatuba]

I'm going to give up now before I make the mistake of using a word that can get me a warning.

Except for this:

If you reduce the money doctors make it could reduce the appeal of the profession, not what we should be doing when there's a current doctor shortage.

I have no idea where you got that from my statement about saving billions of dollars. I was talking about the profits paid to CEOs and stockholders. That has nothing to do with what doctors make.

 

[suarezguy]

You said "some individuals' pockets" and though you specifically cited profits, you think that not only shareholders but also CEOs make too much money due to the profit nature.
Regardless, if there's too much emphasis on reducing costs doctors would probably be expected to also sacrifice.