Caribbean Hen wrote: ↑Thu Dec 12, 2024 10:35 am
I'm no fan of the Health Care companies but how come nobody is mad at the ridiculous prices doctors charge and costs for the related testing?
many parts to the problem, and it's a hard fact that these health care companies cannot approve everything because then we wouldn't have any health care
Yes, they do over charge an insane amount
Do you realize they set costs based on what insurance states they are willing to cover?
The chargemaster is a person/document that lists all prices hospitals use to "charge us what they want".
Not all that long ago, within the last century, hospitals worked like anywhere else "Cost of procedure/medicine/etc. + a small percent to make money.
As insurance companies grew, and lobbied for more power, billing got far more complicated. Why? Well, largely because the insurance companies started demanding discounts because of "all the business they send to the hospital". This would have/did result in hospitals losing large amounts of money because thy weren't even getting to keep the cost of whatever it is they did. To ae up for it the hospitals (and this is where they get evil in this) started creating artificial and inflated prices at astronomical rates so that they could go back to the insurance company and go "Here is our price on things, and here is what you need to cover. Look at the incredible discounts we are giving you!!"
As time has gone on those prices have only continued to skyrocket for hospitals to profit more (yes, the admin side of hospitals is also just as evil as how I view insurance administrators) insurance companies have started taking bigger cuts for themselves. They have also started to deny more and more claims as they started realizing if we don't cover things we make more money, and if the person dies we don't have to cover anything anymore. Hell, they discovered they can make doctors out of network because they are "too specialized" and don't want to cover any of it. Hospitals continue to charge those fake prices to everyone regardless of insurance prices It's why they are so willing to negotiate if you tell them you will pay them cash.
So you get hospital admin and health insurance admin both lobbying the government to make it harder for the public to actually get access to the care they need, and be able to pay for it. The healthcare industry spends more on lobbying that the oil and defense industries combined.
It's not the doctors charging those rates. It's the admin.
I did billing for a private practice for a few years. I know a thing or two about how it all works on the backend and all the fighting providers do with insurance companies. It's not the providers. Well, maybe some I can't make a blanket 100% statement like that. Providers and nurses hate insurance as much, if not more, than the general public. There are significant numbers of providers in a private practice, whom are paid directly by insurance who sets the rates they can charge, and it can take months for insurance to pay out a claim to the provider. Let's say you see a provider on 8/1 and bill through insurnace. The chances that provider gets paid for that appointment before November, at the extreme earliest, is significantly lower than the declination rate of UHC. Most are will be waiting until December if not January to get paid for the appointment slot