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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

#91

Post by oh_sigh »

maxxxxx wrote: post #71
oh_sigh wrote: post #55

Earlier quoted context omitted.

How well does that system work for a generation that produces fewer adults than are present in the generation? Instead of paying for other peoples health insurance and then other people pay for mine, why can't I just save the money that I would be paying in premiums above and beyond what the rational amount would be and then pay for my own health care when I get older(or, pay for the higher premiums when I get older)…

Are you willing to forego medical care if you have an accident tomorrow and your savings account isn't big enough?

I'm not arguing against insurance - I'm arguing against the government forcing insurance upon groups of people with extremely dissimilar risk profiles and forcing the younger, poorer group to pay to subsidize the older, richer group.

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

#92

Post by DrScump »

kevhito wrote: post #77
mobilefriendly wrote: post #63

Earlier quoted context omitted.

Last year I didn't care because I couldn't afford the ACA, and Christian Medishare met the Obamacare requirement to carry insurance or face a tax penalty. The "health care sharing ministry" operates differently than insurance, my concern isn't denial of coverage but that the entire enterprise will collapse. https://en.wikipedia.org/wiki/Health_care_sharing_ministry

I'm not totally clear on the different situations here. I thought the tax penalty was only about $3k for even fairly wealthy families (family of 4, $150k/yr salary). It sounds like you felt you couldn't afford ACA insurance ($17k) and couldn't afford to pay the penalty either, so you went out and purchased $3k of "insurance" you don't actually have any faith in and didn't really want. Am I confused about the penalty…

If the price of the fine and the price of MediShare are comparable, then any benefits obtained through MediShare are effectively free.

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

#93

Post by snuxoll »

bobcostas55 wrote: post #53
snuxoll wrote: post #47

Earlier quoted context omitted.

That’s still roughly the case, I work for a medical billing company owned by a physician group, we have a pretty large group and are essentially self-insured. I pay ~$220-ish a month for my family of three, the company pays $800+/mo. Boy am I glad to work for a company that pays such a large chunk of my benefits, many other places cover maybe 50% of your dependent costs.

You're still the one paying the $800, the only benefit is you get to do it with pre-tax money. It's not like that money comes out of the aether, it's part of your compensation.

Yes, but taken in context it’s still a huge benefit. You have to keep in mind we have a lot of employees making much more median salaries, a medical biller or coder making in the mid 10’s to low 20’s an hour gets the same benefit I do as a $89K/yr DevOps engineer.

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

#94

Post by pg_bot »

sykh wrote: post #20

Every health care system rations care since no current system has enough resources to care for everyone without some form of waiting. The U.S. health care system rations care in the most immoral way of the advanced nations. A person should not profit by denying care to someone else. As a nation we should try optimizing for a more moral, just system. As I see it that would be something like Medicare for all but I'm op…

There is no silver bullet in health care. The field is too large for any one single solution to cover everyone (3 Trillion USD per year is spent on health care). There needs to be a lot of innovation in a lot of different areas in order to solve the problem.

I started a company with my brother that is attempting to drastically lower costs for primary care. (https://scalpel.com) We build software that allows physicians to set up their own direct primary care clinics. Our beta clinic in South Carolina charges $49 / month for unlimited visits and charges people at cost for things like labs and procedures. So instead of dealing with a labyrinthine medical system people are just working directly with a doctor. We really only care about making money off our memberships which we charge what we believe is a reasonable amount.

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

#95

Post by ianai »

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…

The market would work better if everyone was paying the same prices without "denial-based" inflation.

I think the solution would be to give citizens disease/disorder "endowments." i.e. a yearly health stipend account - it's money they can spend at doctors, but they can't spend on unrelated goods/services (i.e. food). On top of that, additional "stipends" for major life ailments. The trick would be in finding budgets for those stipends. Once individuals have money, though, they have the ability to do the relative value assessment for various treatments.

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

#96

Post by [deleted] »

tptacek wrote: post #32
mobilefriendly wrote: post #27

Earlier quoted context omitted.

ACA is horrendous, unless you're receiving a government subsidy. I'm self-employed and we have one option of insurance provider, and the cheapest plan for my family last year was $18,000 a year with a huge deductible. That's after tax, out of pocket, for a healthy family with no pre-existing. Like all self-employed people I know (who aren't getting government subsidy), I moved my family to Christian Medishare, which…

The rate of increase for health insurance prices went down after the ACA was enacted. The motivation for enacting the ACA was, in large part, the untenable increase in insurance prices in the 10 years leading up to it. People have a bad habit of blaming the ACA for insurance prices. The ACA failed at its goal of making individual health insurance affordable, that is true. But it didn't cause that problem, and it did…

[deleted]

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

#97

Post by unclebucknasty »

mobilefriendly wrote: post #46
tptacek wrote: post #42

Earlier quoted context omitted.

I'm sorry you feel that way, but that's simply not what happened. I cofounded a company that provided insurance to ~40 full-time employees (and provided insurance before the ACA was passed ), and the costs you're seeing today are in line with where costs were outside the ACA and prior to the ACA. No matter what you think about prices, though, the most important thing the ACA did was create a nationwide requirement fo…

It isn't what I think about prices, it is the facts, ACA exchanges up 34% YoY. https://www.cnbc.com/2017/10/25/most-popular-obamacare-plans...

>ACA exchanges up 34% YoY

Stating "YoY" gives the false impression that this is the average increase over some number of years. However, this was simply the projection for 2018 and the article provides the reason:

"The price increases are fuelled by market uncertainty and the elimination of key federal payments to insurers."

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

#98

Post by mancerayder »

mobilefriendly wrote: post #52
snuxoll wrote: post #47

Earlier quoted context omitted.

That’s still roughly the case, I work for a medical billing company owned by a physician group, we have a pretty large group and are essentially self-insured. I pay ~$220-ish a month for my family of three, the company pays $800+/mo. Boy am I glad to work for a company that pays such a large chunk of my benefits, many other places cover maybe 50% of your dependent costs.

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.

False, as a self-employed person you can consider this a business expense. I have for two years with no issues. One-person LLC.

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

#99

Post by mancerayder »

mobilefriendly wrote: post #66
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.

Unfortunately neither Christian Medishare nor our out-of-pocket health care payments are deductible. https://www.medishare.com/blog/is-healthcare-sharing-tax-ded...

Interesting! Are there no other options available? This is clearly an inferior option for the self-employed. I'd go with another provider with a higher premium and without this curious shares thing. How is that legally not health insurance? Baffling. What state are you in?

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

#100

Post by bbddg »

pg_bot wrote: post #94
sykh wrote: post #20

Every health care system rations care since no current system has enough resources to care for everyone without some form of waiting. The U.S. health care system rations care in the most immoral way of the advanced nations. A person should not profit by denying care to someone else. As a nation we should try optimizing for a more moral, just system. As I see it that would be something like Medicare for all but I'm op…

There is no silver bullet in health care. The field is too large for any one single solution to cover everyone (3 Trillion USD per year is spent on health care). There needs to be a lot of innovation in a lot of different areas in order to solve the problem. I started a company with my brother that is attempting to drastically lower costs for primary care. ( https://scalpel.com ) We build software that allows physici…

I think there's plenty of room for innovation but we should start from the principal that everyone gets full access to medical treatment regardless of their ability to pay.
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