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diabolical high deductible plans

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  • #16
    Most doctors I've gone to in recent years require (so they say) an estimated payment up front before the visit. I'm guessing it's a ballpark figure they've come up with over the years. It's often pretty close.  And if there's any difference, I either pay the difference or request a refund, they've yet to initiate the refund on their own.

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    • #17
      My employer has no other options at this point.  We all have High deductible plans.

      We had a child this year so we met our deductible.  However some on our hospital services are provided by our affiliate tertiary care center and gets billed through them.  They did not submit those charges to our insurance and sent us bills several months after the fact.  My wife paid the bills unknowingly.  I saw the charges on Personal capital.  Looked into it and figured it out.  I had to call the other hospital's billing dept and they understand the issue (apparently it happens all the time)  However they wanted the insurance to refund me rather then return the bill we paid in error.  They told me it would be 6 weeks to 6 months.  I was unhappy with this and had to be a pain and asked to speak with a supervisor who was able to correct it the next day.  I spent at least an hour orchestrating this on the phone for a couple of hundred dollars.

      I am a well educated physician who likely knows more then the average Joe about how this stuff works.  I understand why our patients get so frustrated.

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      • #18


        I am a well educated physician who likely knows more then the average Joe about how this stuff works. I understand why our patients get so frustrated.
        Click to expand...


        I think there's a lot the insurance industry can improve in this area alone. Just like obtaining quotes or being billed in other industries, it should be a fairly straight forward process so you don't have to be an expert in healthcare to be able to navigate this field as a consumer.

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        • #19
          Keeping Insurance complicated benefits the insurance company it would seem. As some have alluded to, making folks pay the first $2,000 straight out of pocket is going to make some folks think twice about their visits in general, saving the insurance money.

          If the priorities were customer service, efficiency, and the most people getting health care that needed it, there is no doubt insurance would be structured differently than if the priority were to maintain profits/solvency, meeting minimum regulator requirements, monopolizing the industry so you have to get this type of insurance to afford any type of health care, etc.

           

           

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          • #20
            the media feeds into these greedy provider narratives too:

            https://www.cnn.com/2019/09/10/health/carlsbad-new-mexico-hospital-eprise/index.html

            If the insurance plan didn't have a high deductible, the patient wouldn't have such high out of pocket expenses, and the provider would actually get paid. That's the problem with these plans, they are able to price the premiums below what plans without the high deductible plans would charge, and patients who cannot afford the deductible sign up for the plans, and the provider is portrayed as the bad guy for asking to get paid.   Besides the plans where we get no insurance reimbursement, there are also plans which require an 80 dollar out of pocket copay.  If we do not collect or the patient does not pay, the visit ends up with only a 20-40 dollar reimbursement from the insurance company, below medicaid rates.   The problem is that patients do not want to pay directly for their healthcare, especially is you don't seem to be fixing any problem that they can see.  CKD 1-4 are asympromatic, even a lot of people with ckd stage 5 have minimal symptoms.   We discussed using collections to try to obtain some of these costs but besides many of my patients being impoverished already, the patients at highest risk for needing our service for dialysis are the patients who already don't make follow up visits, pay for medications, etc, the office visit co-payment is going to add another barrier to their care.

             

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            • #21
              We dont have a great system but theres no easy answers. Should patients have "skin in the game?" How many of you have medicaid patients who dont show up to their appointments. Would the no show rate go down if you charge a no show fee?

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              • #22
                Don't charge a no show fee after the fact.  Charge a $50 or $100 reservation fee for the appointment, with that amount applicable to the co-pay for that day's treatment.

                You're hard pressed to get a hotel reservation without paying a deposit.  Why should you get an appointment with someone who has four years of college, four years of med school, X years of residency, Y years of fellowship, etc.?

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                • #23
                  Hotels usually have a 24 hr cancellation policy.
                  I would never think of paying a couple months in advance for the “privilege “ of making an appointment. I would pay for a clearly stated policy. Just a hang up with non refundable deposits. Kind of like airlines charging a $250 change fee on a $150 ticket. Try to avoid those money hungry deals. Most physicians have moved to a policy and even try to accommodate requests.
                  No show is a different flavor than a good faith effort to reschedule.

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                  • #24
                    I just received an interesting letter from BCBS about the "medical loss ratio rule" as set forth by the Affordable Care Act.  The act requires insurance companies to pay out at least 80% of all premiums to medical care for their customers.  Well, it appears in my state, BCBS did not meet that standard and only paid out 76.6% of its premiums towards health care.  It is required to rebate 3.4% of those premiums back to its customers.  So good news to me.

                    What that might mean for a few of these plans that require the patient to pay a steep premiums for absolutely no benefit until deductible is met might be scaled back a little bit.  Either that or lower premiums, which is what happened to me.

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                    • #25
                      “Either that or lower premiums, which is what happened to me.”
                      The devil is in the details. Congratulations, you received a 3.4% discount because the healthcare costs for all those that exceeded the high deductibles didn’t exceed by quite as much as expected. Losses for those individuals wasn’t as bad. Insurance companies would have a terrible collection problem collecting for 2018. Of course an insurance company would want a little cushion, simply spread it on premiums whether the healthcare costs were paid or not. Highly advantageous for the insurance companies. Those that incurred the high deductibles get the same “premium reduction “.
                      That’s ACA. The insurance companies were protected, not the policy holder that paid the deductible.

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                      • #26
                        Back when I had a choice between co pay and high deductible plan I ran the math and if you saved the difference in premiums you could easily cover your deductible. My hospital also provides $1000 to your HSA.
                        I switched years ago even though we were planning on having children. So we have met our deductible every year the past 4 years. ( Darn pregnancies stretch over the new year) but it was slightly in our favor. Hopefully next year we do not come close to the deductible and it will really save us some money.

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