Dr's vs Insurance Companies. (1 Viewer)

Who's the bad guys, Dr's or Insurance Companies


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selenau837

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Who really is the bad guy, the Dr's or the Insurance companies and why?

Once, I see a few responses, I will give my opinion. (it will take me while to write :rolleyes: )
 

alastair69

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The Insurance company's they like taking your money but when you have a need to claim on your insurance there is always a loop hole they get away with not paying out.
 

Kraj

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Well the government does run it all in a way, so how about all of the above? Everyone involved in health care has contributed to its current state: the politicians who use health care funds like their own piggy bank, would rather get political leverage from the issue than actually solve any problems, and are happy pawns of the industry lobbyists; the insurance companies for milking every penny in profit they can while providing as few benefits as possible; the small percentage of doctors who ruin it for everyone with careless practices, overtreating, overmedicating, etc.; the pharmeceutical companies who charge unaffordable prices for medications while consistently reporting some of the highest profits of any industry; and the consumers who overmedicate themselves, live unhealthy lifestyles that drive medical costs up, want the highest-quality care immediately without paying for anything, and prefer the status quo to making even the smallest sacrifices or lifestyle change.
 

MrsGorilla

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Kraj said:
Well the government does run it all in a way, so how about all of the above? Everyone involved in health care has contributed to its current state: the politicians who use health care funds like their own piggy bank, would rather get political leverage from the issue than actually solve any problems, and are happy pawns of the industry lobbyists; the insurance companies for milking every penny in profit they can while providing as few benefits as possible; the small percentage of doctors who ruin it for everyone with careless practices, overtreating, overmedicating, etc.; the pharmeceutical companies who charge unaffordable prices for medications while consistently reporting some of the highest profits of any industry; and the consumers who overmedicate themselves, live unhealthy lifestyles that drive medical costs up, want the highest-quality care immediately without paying for anything, and prefer the status quo to making even the smallest sacrifices or lifestyle change.

Couldn't have said it any better myself. :D
 

ColinEssex

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In the UK, healthcare (the NHS) is free (not to overseas visitors). We don't have the hastle of insurance companies v Dr's. We have to pay for dental care though.

Our battle with insurance is for payouts on household or cars etc.

Col
 

MrsGorilla

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ColinEssex said:
In the UK, healthcare (the NHS) is free (not to overseas visitors). We don't have the hastle of insurance companies v Dr's. We have to pay for dental care though.

Our battle with insurance is for payouts on household or cars etc.

Col

Do you think that's a better system than what we have? How long do you have to wait for procedures, appointments, etc?
 

Kraj

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MrsGorilla said:
Couldn't have said it any better myself. :D
Thank you, kindly! :)

ColinEssex said:
In the UK, healthcare (the NHS) is free (not to overseas visitors). We don't have the hastle of insurance companies v Dr's. We have to pay for dental care though.

Our battle with insurance is for payouts on household or cars etc.

Col
And let's be realistic. You may not pay out of pocket, but it's not free it's funded through taxes.

I'd be curious, though, as to the percentage of income paid in taxes for healthcare in the UK compared to the average expendiature for healthcare in the U.S. Dammnit...now I have to research... Anyone care to shed some light on who gets taxed to pay for health care and how much in the UK?
 
R

Rich

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Kraj said:
... Anyone care to shed some light on who gets taxed to pay for health care and how much in the UK?

Those who earn enough to pay tax and NI, companies also make a contribution to NI.
 

jsanders

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Kraj said:
Thank you, kindly! :)


And let's be realistic. You may not pay out of pocket, but it's not free it's funded through taxes.

I'd be curious, though, as to the percentage of income paid in taxes for healthcare in the UK compared to the average expendiature for healthcare in the U.S. Dammnit...now I have to research... Anyone care to shed some light on who gets taxed to pay for health care and how much in the UK?

The US payes the highest percentage, of all industrialized nations, for health care.
 

jsanders

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Rich said:
but do you get better service? :confused:
Yes and no.
Insured people get the best in the world. That's provable on many levels.
Uninsured...well that’s another mater entirely.

So on balance, I guess it depends on who you ask.
 

reclusivemonkey

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Kraj said:
And let's be realistic. You may not pay out of pocket, but it's not free it's funded through taxes.

I'd be curious, though, as to the percentage of income paid in taxes for healthcare in the UK compared to the average expendiature for healthcare in the U.S. Dammnit...now I have to research... Anyone care to shed some light on who gets taxed to pay for health care and how much in the UK?

http://www.hmrc.gov.uk/employers/rates_and_limits.htm

The national health service was actually introduced in the 19th Century, when a huge percentage of the population were found to be too unhealthy for conscription! Seems odd to decide people aren't healthy enough to go and die, but that's politicians for you...

Hmm, I just posted that NI was a flat rate. That was what I was taught in Economics at school, but that's a long time ago now ;-) It seems it is a rate, although NI goes to other things beside Health Care, such as Social Security and State Pensions. You can't do anything about it, so at least we are getting something back for the money we pay. I've always had pretty good care on the odd occassions I have been ill, so I've no complaints really. Other than "give me my money back you robbing b*******s".
 
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selenau837

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I use to think it was the insurance companies that were bad guys, but now I do not. I feel it is the Doctors over charging for everything that has driven the prices up on the insurance level. Dr’s charge astronomical amounts for such simple procedures simply because they can.

Lets take venipucnture for example. That is where they prick your finger. That takes about 10 seconds. The doctors office will charge on average a $12 fee for that. That doesn’t include the cost of the needle, or the slide. That is for the finger stick itself. Why does it cost 12$. Just think, they do that how many times in a day?? I would say that is inflation.

Extreme cost in procedures is what drives the cost of premiums for insurance up. It is a vicious cycle, that will probably never end.

A lot, of people say, ‘Well my insurance won’t pay for this or that.’. Well it isn’t the insurance companies decision. Usually the company you work for ‘chooses’ the benefits you have. If they want to cover something that is normally not covered, they can have that benefit. Granted you may pay more for the benefit, but you can ultimately have it if the group wants to pay for it.

Mind you, there are several items that will not be paid for; like investigational or experimental procedures. Items like that are common sense.

There are some Doctors out there that do not abuse the system and charge inflated prices for their procedures, but those are far and between. This is simply my opinion and willing to explain more on these thoughts if asked.
 

selenau837

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Rich said:
Can't somebody over there give you a prick free of charge? :confused: :cool:


*sees the bait, but refuses*
Tsk, tsk, tsk....Rich. :p
 

Kraj

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selenau837 said:
Extreme cost in procedures is what drives the cost of premiums for insurance up. It is a vicious cycle, that will probably never end.
It is a vicious cycle and cost of procedures is certianly part of it, but there's plenty more to the story. For one, assuming that $12 was for nothing but the finger prick procedure, most of that $12 goes toward running the doctor's business: office space, staff salaries and benefits, general supplies, maintenance, continuing education, student loans, malpractice insurance (in addition to the usual slew of necessary insurances), equipment costs, and an actual salary for the doctor to live off of.

But on the other side of it you have the insurance companies. Doctors are never, ever paid the amount they bill the insurance company for. Insurance companies use their power as the financial representative of millions of customers to basically determine what they'll pay. When my partner was in the hospital for two weeks, he racked up almost $200,000 in bills. Before the insurance company even started to apply his benefits to that amount it was cut in half. Literally, the insurance company simply told the hospital they were only paying half. Then his benefits started to kick in and eventually the whole ordeal cost him about $2,500 out of pocket.

So part of the inflated costs of procedures is due to the insurance companies' bargaining power.
 
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Rich

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Kraj said:
Then his benefits started to kick in and eventually the whole ordeal cost him about $2,500 out of pocket.

So part of the inflated costs of procedures is due to the insurance companies' bargaining power.

Let me get this right, he has insurance but still has to cough up another 2,500 bucks from his own pocket? :confused:
 

selenau837

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Kraj said:
Doctors are never, ever paid the amount they bill the insurance company for. Insurance companies use their power as the financial representative of millions of customers to basically determine what they'll pay.


So part of the inflated costs of procedures is due to the insurance companies' bargaining power.

The allowed amount is a set upon payment amount. The Dr's know this when they sign up to be in the Prerfered program. A benefit of being a prefered provider is they get more patients. It is a kind of trade off.

The allowed amount is usually 'Resonable and Customary'. Which means they get an average charge for that procedure from the providers in that area. That helps to determin what the allowed amount should be.

Also, look at a hosp bill if the pt has insurance and if they don't. They will bill the patient ALOT less than they bill the insurance. They inflate the prices for insurance memebers.
 

selenau837

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Rich said:
Let me get this right, he has insurance but still has to cough up another 2,500 bucks from his own pocket? :confused:


Yes, that is considered an out of pocket amount. Sometimes that is a ded and coinsurance. Once your ded and coinsurance is met, the insurance will then start paying 100% of your medical bills for that year.

Rarely do people not have to pay a byd or coins. Those that don't have VERY high premimums.
 

Kraj

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Rich said:
Let me get this right, he has insurance but still has to cough up another 2,500 bucks from his own pocket? :confused:
Yup. But the alternative is paying the full $200,000 so....
 

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