re: How much have your insurance premiums gone up this year?

I called and emailed Cigna, they said it was totally legit.

I also filed a grievance with GA insurance commissioner.

Nothing else I can do without suing.

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I'm all about free enterprise, but this is ridiculous.

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Free enterprise isn't hte problem.

If you were the doctor performing a procedure with a total cost of $75 and you knew (and believe me they know precisely what the average dollar per patient is for every type of reimbursement possibility) insurance typically paid 10% of what you billed, how much would you charge?

Does the cost of that laughing gas cost $750? No. But they won't receive anywhere near that from the insurance carrier. Ever wonder why some dentist/doctors will offer discounts if you pay cash?

The entire system is messed up but it's not the doctor/hospitals fault they don't ever get anywhere near 100% of what they "charge" from third party insurance carriers. The amount of money my former company wrote off per month (staffed and managed ED's across the country) was staggering.

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If you were the doctor performing a procedure with a total cost of $75 and you knew (and believe me they know precisely what the average dollar per patient is for every type of reimbursement possibility) insurance typically paid 10% of what you billed, how much would you charge?

Does the cost of that laughing gas cost $750? No. But they won't receive anywhere near that from the insurance carrier. Ever wonder why some dentist/doctors will offer discounts if you pay cash?

The entire system is messed up but it's not the doctor/hospitals fault they don't ever get anywhere near 100% of what they "charge" from third party insurance carriers. The amount of money my former company wrote off per month (staffed and managed ED's across the country) was staggering.

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Ok... then why is healthcare so expensive?

If the providers are just scraping by, and the insurance companies are going bankrupt and pulling out the subsidized exchanges, is there an alien force siphoning money out our economy through the healthcare pipeline?

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In-network discounting is nowhere near 90% for, say, CIGNA.

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Been with cigna 3 years, in-net discounting is like 20%.


The_Watcher is full of shite, and should just go to bed.

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Ok... then why is healthcare so expensive? If the providers are just scraping by, and the insurance companies are going bankrupt and pulling out the subsidized exchanges, is there an alien force siphoning money out our economy through the healthcare pipeline?

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I blame Mercedes, golf instructors, private school administrators, and European ski resorts for charging such ridiculous prices.

How much time do you have? It's so expensive for several reasons. IMO the main one is the two parties directly involved in the decision making process (patient and doctor) of a medical transaction have literally no say in the pricing of said procedures.

Of the patients that do carry insurance, they can have hundreds of different types of plans all of which can either pay more, less, or exactly the same for the exact type of procedure. Which makes pricing tricky.

Then you have your self pay patients. Everyone with insurance subsidizes them. We managed faculties with a $/per patient for self pay patients at $5. The literal average that they paid for an emergency dept visit that normally cost hundreds to thousands of dollars per host was $5. And our company saw over 4.5 million per year. I won't even get started on CMS. I could go on and on but I'm sure no one will read all that

I never said providers were just scraping by. Someone else did.

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Ok... then why is healthcare so expensive?

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"Administrative fees", I.e. Hospital administration and compliance with government regulations.

JAHCO puts all kinds of regulations on such BS things that have no bearing on patient care, and many times make things worse (you pay more).

But, i can tell you, in the hospital, it's $10,000 just to go to sleep in the OR. That doesn't include the anesthesia or surgeon fees. And that's only for the first hour.

For anesthesia, the charges are submitted in 15 minute increments, which is probably why you were charged twice. And don't blame the anesthiologist, that's based on the CPT codes, set by the AMA, and fees for each code are set by the government (Medicare, all other insurance reimbursements are based on Medicare). And if they bill for less than what was actually done, it's fraud, just like over billing. And they can be finned and/or go to jail and lose their license.

Now, being charged for two ear tubes, the first tube would be 100% of allowed, and the second 50% as it's the second non-bundled procedure. The third would be 25%, the fourth 12.5%, and anything else 0%. That's why a lot of docs will do things At separate times, so they can bill 100% twice. I've bitched to our current OB about this very thing, telling him I know exactly why he's doing it and I wasn't going to let him do that.

Speaking of allowed, the charge may be $750, but what is allowed (payable by insurance) is much, much less. And you are only on the hook for what is allowed, nothing over.

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I never said providers were just scraping by

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Some of them are, that's why we're seeing more becoming hospital employees. I didn't take home a paycheck for half a year because I wasn't making enough to pay overhead and have anything left. And I billed for $1 million during that time period, so it wasn't like things were slow. After going through 2 different billing companies and only getting 40% of allowable (less tan 10% of billed), I said frick it and moved to a better situation.