To be clear, was that what they were supposed to do because of their contractual obligations, or did they go above and beyond and reduce your hospital bill more than they were supposed to? I mean, it sounds like they're wearing 15 pieces of flair. I'm looking for the cases where they're wearing 37 pieces of flair.
They also deleted the bios of executives on there, more of a safety thing anyway. But yes, don't be loyal to a company.
I have a fictional feel good story about a fictional insurance company, from the Argentine TV series "Los Simuladores" The synopsis: An insurance company refuses on a technicality to provide coverage to a customer who needs an expensive heart treatment in order to survive. The family hires a group of scammers to get the company to pay up. They pose as representatives of the Nobel peace price organization, and convince the CEO of the insurance company that based on a term paper he had once written for his doctorate he has been selected as a possible pre-candidate for the Nobel Price. They later inform him that they found out about the patient with heart trouble, and are concerned that the publicity for not paying for the patient's heart condition will jeopardize his chances, and cause them to remove him from the list. The CEO, seduced by the fake opportunity to win the price, not only agrees to have his company pay for the treatment, but ups the ante and anounces with fanfare that his company will start paying for all preexistent conditions. The result is that his company is flooded by new customers and becomes a huge financial success, revolutionizing the industry, as competitors follow suit to keep up. The patient survives, and the CEO obviously never wins the nobel price, but he becomes a popular media celebrity due to his role in insurance reforms. Of course, that is never going to happen in real life
Wifey and I have been on Medicare A&B and BCBS of MA for over 20 yrs. What the hospitals bill and what they are reimbursed by insurance is unreal. Bill is $150K...Medicare pays $3500 and BCBS $42.50. With multiple stays for my Billie in critical care etc, 5+ Mos in rehab and more ambulance trips than I can count. Hospital billing totaled at least $1 mil + but I don't know how much Ins paid. I have not been billed for any of it.
Most of that bill gets heavily discounted without having to be paid due to insurance company contracts, and Medicare gets the best deals of all. That’s one reason a lot of providers avoid Medicare patients, because their reimbursement rates are lower than other insurance companies. The whole system is just completely ********ed up.
Yes, they officially accept it. But at the clinic level they find ways to limit the Medicare patient panel. For awhile at the company I work for the primary care clinics were only accepting new Medicare patients if they were on one of the Advantage plans. That was because they were short on doctors and were booking out months for new patients (Covid fallout as a lot of doctors either left the area or got out of the profession entirely). I'm pretty sure that's changed now though.
When was the last time a bad guy thought? The people who kidnapped Elizabeth Smart were stupid and it eventually caught up with them. (Sidenote: She was on an airplane some odd years ago when some creepy dude started rubbing her leg...out of all the people who such stuff happens to...) The Oklahoma City bomber/s were caught. The Atlanta bomber was caught because of a slip-up. The Boston Marathon bombers were caught right nearby the attack site. Something tells me this dude is gonna be caught super close to the site of the attack. True, there's cameras all over...but with the authorities looking for someone in the area, wouldn't it make sense for someone to GTFO ASAP to some far-away remote isolate destination. There's a reason why those losing team's shirts and hats generally don't end up in Mexico.
He may have bused up to NY from Atlanta 'Deny,' 'defend,' 'depose' written on shell casings where UnitedHealthcare CEO was killed, official says. As the manhunt continues, officials say the gunman who killed Brian Thompson, 50, may have traveled to New York City from Atlanta by bus last month. https://www.nbcnews.com/news/us-new...on-shot-dead-gunman-bullet-casings-rcna182975
We have providers that are in network for our MA plans decline accepting new patients all the time, that's not new. They are listed that way in our directory. Not accepting Original Medicare but accepting MA plans would have more to do with ease of billing than anything else. Billing UHC is a lot easier than billing CMS and then sending an invoice to either the carrier of the Supp or the patient if they are self-insured for the remaining 20%.
Actually, when I broke my hip, all my stuff sailed through. I had one snafu where I was double billed for an ambulance ride as a squabble between the hospital and insurance, but the hospital was at fault there.
My father owned & ran a decent-sized medical supply company that ultimately was largely supplying O2 for smokers on Medicare/medicaid. This info is 3decades old, but it would often take 6-months-to-a-year to get reimbursements from Medicare/medicaid. (edit to add Medicaid)
I don’t know if this is an insurance positive or the office where I had the work done, but when I had my wisdom teeth out maybe a decade ago we later got a check from the oral surgeon saying the insurance paid more than expected so they refunded us the difference.
So the system worked as designed. All your stuff is supposed to sail through. But when the best case scenario is "well, I guess nothing went wrong", what value does the insurance industry add to the health care system? And is that value worth the amount of money they scrape out of the system to pay themselves?
This might be a geographical issue too, from what I understand Medicare doesn’t adjust its reimbursement rates enough to compensate in regions with a high cost of living. So where I am in the Bay Area providers take a financial hit if they have too many Medicare patients since the amounts they receive are significantly lower than from patients with most PPO plans.
You asked for positive experiences. I was happy about it. Now whether it is the best way to pay for healthcare is a TOTALLY different issue. I’ve been consistent about being for single payer for a long long long time.
To be perfectly honest, your expectations were too low. A company meeting expectations shouldn't be cause for celebration. It's not surprising that expectations surrounding interactions with medical insurance companies are so low, since they have a shitty reputation and don't add any value to a process that is already stressful. I guess if you're relieved that nothing went wrong, that's better than any other alternative, but I'm still waiting for a case where an insurance company exceeds expectations, goes above and beyond, does more than the bare minimum.
I can't get my football club to do this, I'm certainly not expecting my insurance company to ever do this. Welcome to late-stage capitalism.
But there are companies that do this, right? You hear about stories from companies that go above and beyond, to the point where they lose money on that transaction, but hope that the positive feedback from that money-losing transaction will lead to more transactions where they make money. Somehow that never happens in the medical insurance industry - or if it does, I haven't heard about it.