Anonymous wrote:It should be on the medical offices not patient I feel like there is a loop hole here and it's not evil insurance in this situation

go and view the videos of doctors trying to get approval through peer review, and offic staff trying to appeal denials. It is absolutely an insurance company problem. It's also why so many doctors are going concierge

Anonymous wrote:Then just pay the going rate. I treat health insurance like homeowners' insurance. I never submit anything since I know they won't pay until I hit my very high deductible. If I ever get close then I'd submit all at once. I just pay out of pocket.

Well plenty of us have "reasonable deductibles". Ours is $2500 for the family and we met that this year in May (one family member had some health issues). But we typically meet it in July/August. So it behoves us to put everything thru In Network insurance (OON deductible is $10K and we only use a few OON visits, so we don't file those)

Anonymous wrote:I'm pretty sure it is because they hope you'll give up and let them keep the extra money.

This 1000%!

They are hoping you either won't notice the error or will get frustrated and give up. It's been like that for decades with insurance companies

Profit. Fewer people to bother checking on mistakes is less money to pay out. And unlike medical service there is no "malpractice" for bad billing. There was the consumer protection bureau that started making some headway but clearly was not in the interest of major corporations to have that work out.

OP-the health care system in the USA is a nightmare for many reasons, billing is structured this way because there is a strong insurance lobby who has an interest in maintaining a byzantine system in which people can't discern elements of billing easily. There are services you can hire to dispute major bills with insurance for that reason. It's a pain in the neck. My friend with a kid with severe health issues quit her job and half of her time is spend shuffling her kid to medical appointments and the other half is dealing with their health insurance.

It's a tough fight to maintain any semblence of consumer rights and transparency, particularly in this current political environment.

I moved back to the USA from overseas this year, and health care was so much more transparent and clear where we were. It doesn't have to be this way, but we have the health care system people voted for.

Anonymous wrote:I would love to do this for anyone. I used to do this for a doctor. They don’t have to, but they retained clients better when they were happy with claims.

I would do this as a business.. except: There is huge power in being able to call insurance from the doctor’s line. Using their NPI,…it’s not like I got better customer service..no. It’s just, I have hipaa, I have access to the doctor’s files, I have more pushing power for some reason.

I got some amazing claims taken care of. Appeals that I thought were lost, had worked on for months, got them successfully turned around on the patient’s side.

Sometimes the doctor benefited, but many times the patient benefited. It was amazing.

You could put yourself out there for a fee but then the insurance companies would catch wind and poach you just to shut you down.

Anonymous wrote:

Anonymous wrote:I'm pretty sure it is because they hope you'll give up and let them keep the extra money.

This. A huge amount of people give up. And, if they delay payment on a few thousand people, they are earning how much in interest?

You haven't given your age but presumably you are literate, speak English as a first language, are technologically savvy, etc. You are able to dispute the billing, etc. The insurance companies, however, are counting on there being a lot of elderly people who lack these skills who will not have the wherewithal to fight with them. Furthermore, wait until you have possibly three or four elderly parents between you and your spouse, and you are the only ones capable of disputing all of their many medical bills as well. We have a mom with dementia and my sister has over twenty years of experience as a nursing administrator and even she struggles to sort out all of mom's stuff. My friend's parents set up all the online portals for their medical care and then promptly forgot all their passwords and due to HIPAA regulations, she had to go through a major amount of paperwork just to be added to their portals in order to even get started fighting with their insurance companies. good times.

I would love to do this for anyone. I used to do this for a doctor. They don’t have to, but they retained clients better when they were happy with claims.

I would do this as a business.. except: There is huge power in being able to call insurance from the doctor’s line. Using their NPI,…it’s not like I got better customer service..no. It’s just, I have hipaa, I have access to the doctor’s files, I have more pushing power for some reason.

I got some amazing claims taken care of. Appeals that I thought were lost, had worked on for months, got them successfully turned around on the patient’s side.

Sometimes the doctor benefited, but many times the patient benefited. It was amazing.

Anonymous wrote:It should be on the medical offices not patient I feel like there is a loop hole here and it's not evil insurance in this situation

I don’t know about that. The easiest to deal with, and fewest issues/mistakes are with OON providers whom you have to pay upfront (we see several different OON providers across several family members). So maybe insurance isn’t “evil”, but it definitely complicates things.

Then just pay the going rate. I treat health insurance like homeowners' insurance. I never submit anything since I know they won't pay until I hit my very high deductible. If I ever get close then I'd submit all at once. I just pay out of pocket.

Anonymous wrote:I'm pretty sure it is because they hope you'll give up and let them keep the extra money.

This. A huge amount of people give up. And, if they delay payment on a few thousand people, they are earning how much in interest?

It should be on the medical offices not patient I feel like there is a loop hole here and it's not evil insurance in this situation

Anonymous wrote:I'm pretty sure it is because they hope you'll give up and let them keep the extra money.

Yep.
Purposely overly complex and an enigma.

A bit of laziness too on what (and how) the medical office codes when they submit.

I'm pretty sure it is because they hope you'll give up and let them keep the extra money.

I'm getting increasingly frustrated with how much time I spend on the phone dealing with medical billing and insurance overages. I have a full-time job, and every time there's an error or a dispute, it somehow falls on me to resolve it.

I end up chasing down doctors’ offices, calling insurance reps, deciphering billing codes, and making sure everything is accurate just so I’m not overcharged. Meanwhile, the doctor gets paid, the insurance company takes their premium, and I’m stuck doing unpaid administrative work to keep it all in check.

I charge $300 an hour in my professional work. Maybe I should start invoicing these companies for the hours I spend fixing their mistakes. Why is my time treated like it has no value just because I’m the patient?

None of this feels like it should be my responsibility, and yet if I don’t deal with it, I get stuck with the bill. Can anyone explain why this burden is now on us? Because I’m tired of doing their jobs for free.