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A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

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Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#81

Post by downandout »

lostlogin wrote: post #73
downandout wrote: post #61

This story is couched in terms of how bad things were before Obamacare, but I’d like to point out that things aren’t great now either. To prevent Obamacare from bankrupting them, insurance companies are resorting to legally dubious mass-denials, one of which affected me personally. A few months ago, I woke up the next morning after eating some fast food and began vomiting. I couldn’t stop throwing up, and I couldn’t…

The fact that this cost that much is alarming too. I get that the staff and bed bay aren’t cheap, but the consumables for the situation you describe would probably cost less than $10, and at bulk buy prices perhaps on a couple of dollars.

True, but as patients we obviously have no control over that. Also, ironically, if my insurance had simply processed the claim as they were supposed to, they would have paid far less than I'm being billed. ER cash prices are purposely inflated because insurance reimbursements are typically 1/3rd or less of the billed amount. But when the claim gets denied, they come after the individual for the full cash price.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#82

Post by chrisweekly »

tptacek wrote: post #56
mobilefriendly wrote: post #52

Earlier quoted context omitted.

The injustice of the system is that self-employed have to pay with after-tax dollars while your employer can deduct the cost of providing those benefits.

As I understand it (I hope I understand this, because I rely on it), LLC principals are allowed to deduct the cost of health insurance.

Tangent: people tend to fixate on "LLC" as if it were the only reasonable corp structure for small outfits. S-Corp is often a better choice.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#83

Post by dustingetz »

tptacek wrote: post #79
dustingetz wrote: post #68

Earlier quoted context omitted.

my accountant never allowed me to do this in PA

As I understand it, and your accountant is an expert while I am not, you have to be actually self-employed --- not moonlighting or doing side-work, with your money all coming in through the LLC --- and your spouse can't be eligible for group coverage through their job.

i was sole proprietor of my own pass through llc with no other income and single through oct 2017

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#84

Post by DoreenMichele »

jacobolus wrote: post #76
DoreenMichele wrote: post #64

Earlier quoted context omitted.

And I actually worked in insurance. The Fortune 500 company I worked for paid for me to go to school 8 hours a day for 3 months. I got a certificate from a technical college and additional training. Obamacare is a terrible solution. But don't let industry expertise stop you from your usual antics of feeling like no one is allowed to disagree with you and you need to win every argument, even if it means harassing anyo…

Please don’t adopt this kind of hostile style. It wrecks the whole conversation.

I have been here 8.5 years. I appear to be the only woman to ever have made the leaderboard (under a different handle). I have had exactly one conversation with Thomas where I did not feel completely crapped all over while he routinely positions himself like he is some sort of advocate for women's inclusion.

The discussion was wrecked for me the minute he decided to comment on something I have expertise in where I don't agree with him. It is never a positive experience for me to engage him, he can't be avoided and there is no remedy at all from my end for the situation.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#85

Post by tptacek »

chrisweekly wrote: post #82
tptacek wrote: post #56

Earlier quoted context omitted.

As I understand it (I hope I understand this, because I rely on it), LLC principals are allowed to deduct the cost of health insurance.

Tangent: people tend to fixate on "LLC" as if it were the only reasonable corp structure for small outfits. S-Corp is often a better choice.

It's just the cheapest one to set up. I was assuming that if someone's self-employed and not deducting insurance, they're probably a sole proprietorship, and are probably sensitive to accounting costs.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#86

Post by jacobolus »

DoreenMichele wrote: post #84
jacobolus wrote: post #76

Earlier quoted context omitted.

Please don’t adopt this kind of hostile style. It wrecks the whole conversation.

I have been here 8.5 years. I appear to be the only woman to ever have made the leaderboard (under a different handle). I have had exactly one conversation with Thomas where I did not feel completely crapped all over while he routinely positions himself like he is some sort of advocate for women's inclusion. The discussion was wrecked for me the minute he decided to comment on something I have expertise in where I do…

Edit 2: can a mod please delete this whole thread, starting 3 posts above this one? Arguing about whether tptacek does or does not regularly “crap on people” is neither productive nor topical.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#87

Post by tptacek »

dustingetz wrote: post #83
tptacek wrote: post #79

Earlier quoted context omitted.

As I understand it, and your accountant is an expert while I am not, you have to be actually self-employed --- not moonlighting or doing side-work, with your money all coming in through the LLC --- and your spouse can't be eligible for group coverage through their job.

i was sole proprietor of my own pass through llc with no other income and single through oct 2017

You should maybe ask your accountant why you couldn't deduct, then? I know there are conditions, but this is one of the better-known self-employment deductions.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#88

Post by DoreenMichele »

jacobolus wrote: post #86
DoreenMichele wrote: post #84

Earlier quoted context omitted.

I have been here 8.5 years. I appear to be the only woman to ever have made the leaderboard (under a different handle). I have had exactly one conversation with Thomas where I did not feel completely crapped all over while he routinely positions himself like he is some sort of advocate for women's inclusion. The discussion was wrecked for me the minute he decided to comment on something I have expertise in where I do…

Edit 2: can a mod please delete this whole thread, starting 3 posts above this one? Arguing about whether tptacek does or does not regularly “crap on people” is neither productive nor topical.

You aren't a moderator here. You are just making this worse. And your comments are in violation of the guidelines just as much as mine are.

Edit in reply to your edit:

Maybe you haven't noticed the dearth of women on HN. There are lots of subtle ways to crap on someone. One of those is for all the guys to nitpick a woman's comments, shoot them down, never engage her in the same congenial fashion as the men and then downvote her comments to hell when she gets fed up with such patterns. Oh, and then bonus points for blaming the woman as if she is just wildly misinterpreting the consistent disrespect that she gets subjected to.

Oh, and now you delete the edit I replied to, thus making me look unhinged. Sweet.

And now you are imploring the mods to delete the evidence of your mistreatment of me without apologizing. It just gets dirtier and dirtier.

And now you have deleted everything I replied to.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#89

Post by kevhito »

DoreenMichele wrote: post #72
kevhito wrote: post #65

Earlier quoted context omitted.

$18,000 doesn't sound large, relative to the high prices we all pay. I have a good solid job, and my family plan is $24k per year. That's the most basic family plan my employer offers, but it isn't a high-deductible plan. Of course, most of that is paid by my employer, so I only pay about $4k directly out of my salary. If you are self employed, then you obviously have to pay the employer part too.

For a little perspective, I supported a family of 3 on less than $18k last year and we only had partial coverage. Even though we were homeless for most of the year, the ACA penalty is pretty painful. I am in the midst of filling out my taxes. For a great many Americans, the figure you brush off as not particularly large is an unimaginable amount to come up with for insurance alone.

Sorry, I didn't express myself clearly

I agree, $18k for insurance, or $24k, is an enormous burden for most Americans. I was just trying to point out that that the ACA price the parent was calling an outrageous seemed completely inline with every other insurance policy I have ever had, ACA or not. Insurance in the US is just plain expensive, no doubt about it.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#90

Post by aaavl2821 »

Spooky23 wrote: post #44
maxerickson wrote: post #16

Earlier quoted context omitted.

I think it'd be a good sport to make hospitals eat denied claims. If two giant institutions want to argue about whether something is covered, the patient should not be the loser. We should also better fund Medicare and Medicaid. Taxes should be apparent.

It’s more complex. Medicare is outcome-based. Providers who do a shitty job don’t get paid, which is why hospitals complain about reimbursement. Medicaid is like an ATM machine for providers in many states. There is usually little or no correlation between outcome and payment, and poor fraud controls. That’s why you always hear about providers in NYC and Miami who “visit” 900 patients a day. Additionally, you have th…

actually, most medicare is not outcome based today, although that is the vision.

"value based care" has many meanings. simply using patient satisfaction surveys can be considered value based care, while participating in a double sided risk sharing ACO also qualifies. as of 2016, only 36% of physiicans participated in ACOs, under 30% in patient centered medical homes, 31% in bundled payments (which only impact a subset of diseases). howver, 75% used patients satisfaction surveys, 55% used PQRS, and 64% achieved meaningful use [0]

so the reality is that outcomes based care is still the minority, and real risk-bearing (two-sided risk sharing, full capitation) arrangements are even less common. most care is still reimbursed as FFS. and even as value based care is becoming more common, cost of healthcare is still not decreasing

and yes, medicaid can be fraudulent in some cases, but not always

[0] https://physiciansfoundation.org/wp-content/uploads/2017/12/...

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