MMauler

It was more of a gutjob restoration than a simple “redecoration“ to her own liking. It's not like she just picked some different curtains.

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AmBetter -then sent me a list of orthopedic surgeons with about 50 names-none of whom will accept AmBetter.

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A friend of mine asked me to help him navigate the ACA portal. I put in his information and spent a lot of time looking at all the different plans. I had never heard of Ambetter but they had several plans that looked promising. Both Ambetter and UHC definitely offered the least expensive plans.

When I looked further into both, I found out that they were very lowly rated. The denial rates are obscene. It was rare to find a good review from patients. I told him he’d be better off just sticking with a Blue Cross plan and paying the extra cost. I also told him to stay away from the EPO plans and stick with a PPO or POS plan. The PPO were much more expensive but seemed easier to use.

In the end, he got a Blue Cross POS plan that cost him a little more but so far has approved everything he’s needed. He definitely makes sure to stay in-network per my strong recommendation.

I haven't read the case, however, it sounds like Blue Cross "approved" the procedure but never agreed to pay the full amount as this particular hospital is "out-of-network." I'm guessing that it paid what it was contractually obligated to pay to an out-of-network provider.

There's a reason why insurance companies only pay a small amount for "out-of-network" providers -- i.e., the provider doesn't negotiate their prices and give a discount (often HUGE) to the insurance company. BUT, this is known in advance.

So, while BC "approved" the procedure, they had no contractual relationship with the provider to pay the full amount requested. BC only had to pay what it was required to pay to an out-of-network provider according to its contract with the insured.

THE REST IS ON THE INSURED. I'm not sure when the "no suprise billing" law went into effect, however, the provider now has a duty to inform the patient how much he/she is going to be called upon to pay.


THE MORAL AND NUMBER ONE TAKE-AWAY from this story is that you should ALWAYS make sure that the doctors and hospitals you visit are all IN-NETWORK with your insurance company. I CHECK EVERY F*CKING TIME I GO TO A DOCTOR OR HOSPITAL and I always ask to get an estimate before I have any procedure done.


There was a news story a few years back on one of the local stations talking about how Tulane Hospital was NOTORIOUS for performing surgeries on patients for which Tulane Hospital and certain Tulane doctors were IN-NETWORK but would assigning out-of-network providers (mostly anesthesiologists) during the procedure. The patient had no idea and just assumed that because they were getting the procedure done at an in-network facility and the personal and doctors would also be in-network. Then a month later they received a bill for thousands for dollars because one or more of the providers were out-of-network.

This is one of the things that led to the "no surprise billing" laws.



ETA: I haven't found the story I saw years ago about Tulane Hospital, however, here's a similar story from 2017 about Tulane Hospital and its ER department...

Tulane SUCKS!!!


Here's a national story about out-of-network anesthesiologist working in in-network hospital....

This should be a must listen to for all Westerners...

Everyone in this video should be summarily fired from any position of authority or public trust (especially the faux "journalists") and be forced to issue a public apology admitting that they are complete f*cking morons who do nothing but spread lies and propaganda. If they don’t agree to do it, they should be lined up against a f*cking wall and shot right in a f*cking head.

If he’s not pitching that day and the Mariners let him do it, I’d love to see Kade Anderson.

My body...Abdul-Mohammed's choice.

To be fair, there was Lee Harvey Oswald.

Oh wait, never mind, he came back once he realized that he was going to be a working class plebe and not part of the elitist and exceedingly wealthy proletariat.

All of these little pissheads who are all in on this communist fricking insanity all think that if they can turn the United States into a socialist Third World fricking hell hole that it’ll be all right because they’ll be part of the proletariat. They have no fricking clue that they are actually all going to be part of the suicidal underclass of plebes whose life and existence mean absolutely fricking nothing.

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The only legit takeaway from today

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To those of us who were around in the 70s, the only legitimate take away is the same old same old – wait till next year.