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Health Insurance

It is much more about control than money. The Dems want to hold everybody by the short hairs and lead and shove them in any direction they want.

My younger son had a perfect plan before Obamacare. $500 deductible, only paid if he had something major and/or was hospitalized. If he got the flu, we footed the bill, if he was in a car accident or fell off a roof...he is a carpenter....the insurance kicked in. Premium was about $120/month just for him. Now he has Obamacare, 14k deductible, premiums are tripled....but some kind taxpayer pays about a third of that...but he has coverage for pregnancy, and every doctor is English as second language.

What has gotten lost in this whole discussion is the difference between "health insurance" and "healthcare". Everybody has car insurance, it pays for unforeseen events, accidents, thefts, vandalism, etc. but if you need new tires or an oil change that's out of your pocket, not the insurance company's. Health insurance USED to work the same way, you paid for the small stuff, but if you had something unforeseen the insurance kicked in. That's the way it is supposed to work.

I knew folks that worked for the Kansas Ins. Dept. under Kathleen Sebellius...she was incompetent there...let alone running a Federal program. Typical political hack, and she was a woman, if she had been a minority lesbian she would have been PERFECT!!

I worked for the IL and GA departments of insurance, and was a contract examiner with AZ, NM, OK, CO, KY, GA, and FL insurance departments after I formed my own LLC. I always had steady work under Republican administrations, but got "fired" often after the Dems took over. You know, the Dems who are out to protect you from "the man", the evil corporations, etc.

The Colorado Ins. Dept. doesn't care/doesn't check during its examinations if agents are licensed or in compliance with the law. Its caveat emptor in the marketplace, if an agent screws you out of your money or lies to you, the CO DOI doesn't give a rat's rectum.

The faith-based insurance programs are a great option, one glimmer in the darkness that is US "healthcare" these days.
 
Don't forget that insurance companies often put every 10th claim in "file 13". So providers often pay someone just to keep up with the billing.
Seriously, insurance companies will take a certain number of claims filed by providers and throw them away without even looking at them. Then they hope the provider never follows up. Even Medicare has a one year limit on adjustments... that is adjustments the provider can claim for more $. Medicare can come back to the provider and "reclaim" funds at whim.

Health care is a very complex business / resource. It does need overhaul, but you need people who are at least involved in it to understand how to fix it. Too many "experts" have no clue about healthcare or the human body, and many providers figure out how to look up the latest "thing" that brings in the biggest return.

There are still docs out there that really care about their patients. Unfortunately, they usually also believe that it's still the hay-days of the 1980s and can do whatever they want and everyone will get paid. It isn't like that anymore. Worse yet, too many people believe that someone else should pay for their healthcare.

Argh, my blood pressure's going up.. I need to have a cold one.
 
GodBlessTheUSA said:
Don't forget that insurance companies often put every 10th claim in "file 13".
Seriously, insurance companies will take a certain number of claims filed by providers and throw them away without even looking at them. Then they hope the provider never follows up.
Click to expand...
Really???!!!! I examined over 300 insurance companies in my 40 year career and NEVER found this....NEVER, EVER. To do so would be a violation of the Improper Claims Practices Act....which every state has....and subject the Insurer to civil forfeitures, regulatory actions and re-examination....the latter they tried to avoid like the plague.

What is your documented source for this "information"?
 
In 2012 I worked for a UK company so no health plan. I was on COBRA from my last job until that ran out and my premiums went to about $1,250 per month with a $6,500 deductible. Nice!

Under Obama care my premiums went to $572 per month but I still had that ridiculous deductible. This policy was purchased on the open market, not an exchange.

My current employer offers a plan that is so much better with higher coverages and I pay nothing every two weeks (used to be $9.99) and my deductible is $3,500 but I put $100 every pay period into a HSA with pretax dollars. I do not really like my job but I work from home most weeks and I love that insurance plan.
 
Somebody always gets paid when the law changes and you pay more, call it tax, increase, whatever. "Lawmakers" don't do **** unless their lobbyists tell them to.
 
The Old Jaybird said:
Really???!!!! I examined over 300 insurance companies in my 40 year career and NEVER found this....NEVER, EVER. To do so would be a violation of the Improper Claims Practices Act....which every state has....and subject the Insurer to civil forfeitures, regulatory actions and re-examination....the latter they tried to avoid like the plague.

What is your documented source for this "information"?
Click to expand...

My sources would be the routine number of billing companies, agents, and services, as well as persons who have worked with, or still are working with, insurance companies. I'm not doubting your investigating skills, but did you never hear of claims that were "lost" or "never arrived at the insurance company"? Every hospital, provider, or billing company can attest to the number of times they have to follow up with claims. Not all follow ups are due to things like incorrect coding, many are due to the insurance company saying they never got the initial claim.

And I have heard it, personally, myself, from a person retired from a health insurance company. As far as the Improper Claims Practices Act, each state has its own Unfair Claims / Improper Claims Practices Act. IIRC at least one state's (is it Illinois?) Act says that insurance companies have only 30 days to approve and pay or deny a claim, and I don't think that standard is met on a 100% basis. If the company can say they never got the claim, and the provider doesn't follow up, then the insurance company doesn't pay, and the provider gets stiffed.

I'd honestly be interested to know if you reviewed all the claims submitted to insurance companies as opposed to all the claims they "received". And thank you for watching over the insurance companies.

I'll also add that the mishandling of claims and money goes both ways. I worked for one group that allowed the hospital to do its billing, unfortunately at a premium percentage. The chief of our group would receive a check each month for whatever the hospital told him they'd collected. He would occasionally audit the lists of cases done to see that we were paid for them, but he never actually checked the amount of money we were paid for each case. So the hospital would collect, say $500 for one case, and they'd only pay us $400. But the Case ID data would be on both our records and the list of payments from the hospital. So our chief thought we were being paid correctly for the cases the hospital had collected on. Even then we'd have to ask why up to 10% of the cases we performed were not being collected for. If you don't follow up with insurance companies like a bull dog you'll never collect for 100% of your services.

And just for kicks:

https://www.justice.org/sites/default/files/file-uploads/InsuranceTactics.pdf
 
I just received a bill from the "Medial Center" of Central Georgia for $23.47. The charge related to a visit to an emergent care center in N. Macon on Jan 16th, 2016!

LOL, who takes 16 months to bill?
 
EVERY examination we performed included claim service analysis, time studies in other words. Probably 99% of claims are paid within 30 days....this is almost a nationwide standard....but it is measured from the date the company has complete "proof of loss" as defined in the contract, to the date of payment. If there are incomplete claims, coding errors, etc. the clock doesn't start, by law, until these problems are resolved.

Aflac is very good, their TV commercials claiming one day payments is accurate. Claim received on Tuesday, paid on Wednesday = one processing day.

We paid close attention to "outliers", claims that took longer than normal to process. The numbers of claims for big companies like BC/BS are huge....a million a month is not uncommon. Getting a workable sample is a nightmare. Based upon my experience with large health insurers, 98%+ of claims are paid promptly and correctly.
 
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