maxwelton@[EMAIL PROTECTED]
wrote:
>
> On Feb 3, 5:29 pm, "Bill Bonde ( 'Hi ho' )"
> I met up with him again. He didn't mention his plight so I asked
> if he had made any progress on getting the insurance
> company to pay. He had landed a really good job at a large
> bank just about a year prior to this, and his reply was that
> one of the VPs had learned about his case and had someone
> within the bank take over to handle it. That was when I had
> to remind him that had he been working most other jobs
> such as menial labor that he would not be so lucky. He had
> nothing else to say about it.
>
I don't think we've been arguing that insurance companies should be able
to deny claims that are legitimate and should be covered under the plain
terms of their policy with the insured.
> Now if you do you due diligence and make sure that you
> won't have this problem you can try but insurance companies
> never cease to amaze me at the reasons they find to deny
> payment. Also keep in mind doctors determine how urgent
> the need for surgery.
>
The doctor and the insurance company should decide if it is covered by
dealing with each other, it is ridiculous to expect the patient to
involve himself in this beyond providing insurance details.
> > > > That's a case you haven't made.
> >
> > > I wouldn't have to make it if you lived under the US system
> > > with private insurance.
> >
> > You have to make your case no matter what.
>
> I am in general good health and have only routine physical
> exams and on occasion a diagnoses for an ailment. But
> when it comes to billing I am amazed at the invoices I receive.
> My rule has become that I won't touch them for at least 90
> days because they are usually wrong. They are wrong because
> there is no standardization in the US system.
>
The Americans are getting those computer things involved in the process,
so hopefully that will help. Standardizing and deciding in a way that
the insured knows he's covered for these things is vital.
> So the provider
> may use an incorrect billing code. The insurance won't pay
> and I receive an invoice that has nothing but a dollar amt. on
> it presumably due to the privacy act. So instead of the provider
> and the insurance company working out what is usually a
> simple problem or mistake I have to get involved. Usually I
> get several different reasons why the insurance did not pay
> before I get the truth. Then I correspond with the provider to
> explain why they didn't get payed. Usually they are very
> co-operative but have gotten creative in storytelling themselves.
> So I usually only have small problems but spend a
> dispro****tionate amt. of time getting to the truth and making
> provider and insurance company communicate. This
> shouldn't he happening but it does
>
To the extent that is happening, you are right, it shouldn't be. This is
a waste of time. Of course it's not the only place in life where time is
needlessly wasted by various companies. In fact, billing in general can
be a nightmare as companies regularly screw it up.
> and from knowing and
> being related to people working in health care I am always
> hearing that Medicare and Medicaid are straight forward
> about billing and I also know people receiving Medicare
> and they don't have the kinds of problems that I describe.
>
They also don't pay entire claims. If the doctor knows how Medicare
works because he deals with them more often than some small insurer,
that's probably the reason.
> So from my perspective Medicare is less of a bureaucracy
> than my insurance provider relation****p.
>
I don't believe that.
> I am lucky in that I have group insurance. I pay a lot for
> it, but if I would never ever want to buy private insurance
> for myself and family. The reason is that it is like
> buying automobile insurance. Your rate it going to
> be based on you past and current health situation.
> Your rate can change if you need a surgery and they
> can drop you at any time.
> Usually they don't want to carry someone for more than
> a year. The rates are usually lowest for men in their 20's
> and highest for anyone over age 55. Having that kind of
> insurance is like flu****ng money down the toilet, but it is
> the kind that Bush wants people to buy.
>
Insurance costs more if you are older, that's true of group insurance
it's just you've somehow got it figured that you aren't paying more.
--
"In August Rudyard's listlessness called for another series of major and
very unpleasant medical examinations.... He later joked ... 'If this is
what Oscar Wilde went to prison for, he ought to have got the Victoria
Cross.'", Andrew Lycett, "Rudyard Kipling"
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