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Politics & ReligionWell Since every damn forum has one. Might as well leave it out there. This place is loosely moderated and should not be entered if you're weak of heart.
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Perscription plans
Since I'm sure this thread will turn political quickly, given the crowd I figured I'd post it in here already.
So I just got back from the ER with my little girl. We were filming out on this trail Friday and she was playing in the stream for a few hours (not swimming, just wading and splashing) apparently during that time she got some micro-bacteria in her and she hasn't been able to keep any food down all day, ashame too because today was her 5yr b-day party.
So ER doc gives us a prescription and I head over to get it filled. The pharmacist comes back and goes "your insurance company isn't on right now so i can't process this" WTF over??? What's the point of having insurance if i can't access it anytime I need it?
Since this medicine would help my daughter keep food down I was forced to pay the retail price, 160 bucks for 6 tablets because I don't want her throwing up her food. Granted tomorrow when the insurance is "open" they'll run it and I'll get my money back but damn, what a messed up system.
Do insurance company's think folks don't get sick late Saturday night? Is this normal? I've never had this happen to me before.
Since this medicine would help my daughter keep food down I was forced to pay the retail price, 160 bucks for 6 tablets because I don't want her throwing up her food. Granted tomorrow when the insurance is "open" they'll run it and I'll get my money back but damn, what a messed up system.
Do insurance company's think folks don't get sick late Saturday night? Is this normal? I've never had this happen to me before.
Yes, it happens at times but you did the right thing so just get the bill to your insurance company as soon as possible. Its like any other system as nothing is perfect.
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Sounds reasonable to me. You could probably find a plan that worked at all times that was proportionally more costly. If there was much demand there would be an alternative.
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Hope she feels better. Make sure she drinks plenty of water, just little sips so she'll stay hydraged.
Look we'll all make our money back eventually but health that's a different story.
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Insurance finance is all about taking in premiums and delaying payment for as long as possible. They would much rather reimburse you than pay up front. If they delay millions of dollars of payments, they collect investment income on the delayed payments just a little longer and make more money. When they get into financial trouble, it is usually not because they paid out too much, it is because their investments didn't pay off or lost money.
In other words, insurance is a perfectly legal scam, made even more lucrative by the complexities of modern society and the costs of just about everything.
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Ill agree that shit is rediculous i would call your insurance and bitch and tell them you will be finding a new agency. Like you said Insurance needs to be accessable at all times and if not isnt that the purpose of your insurance card? if not hell get the information and take care of it later, if its a serious problem then i know there are certain processes to go about things but my conscience wouldnt let me fuck someone over like that especially a little girl. FUCK OUR GOVERNMENT. its not all bad but there is a ton of shit that could use major improvement.
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that's weird. I've never have that happen to me. I have BCBS and have been with them for 5+ years, and working at a hospital, never had that happen.
And as for a hospital without an ER, that would be a lower level hospital. Not everyone has one.
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Not to hijack, but i think this goes well on the same note.
Whats the point of a hospital without an ER??(my local one doesnt, so i have to drive 30 minutes for an ER.)
ER's lose money for a lot of hospitals, especially in areas where there are a high number of people without insurance. I think at one time all state licensing boards required hospitals to have an ER as part of certification, but that's been repealed in several states in the last 20 years because hospital owners claim its bankrupting them.
Health insurance companies are rapidly adopting a new pricing system for very expensive drugs, asking patients to pay hundreds and even thousands of dollars for prescriptions for medications that may save their lives or slow the progress of serious diseases.
With the new pricing system, insurers abandoned the traditional arrangement that has patients pay a fixed amount, like $10, $20 or $30 for a prescription, no matter what the drug’s actual cost. Instead, they are charging patients a percentage of the cost of certain high-priced drugs, usually 20 to 33 percent, which can amount to thousands of dollars a month.
The system means that the burden of expensive health care can now affect insured people, too.
No one knows how many patients are affected, but hundreds of drugs are priced this new way. They are used to treat diseases that may be fairly common, including multiple sclerosis, rheumatoid arthritis, hemophilia, hepatitis C and some cancers. There are no cheaper equivalents for these drugs, so patients are forced to pay the price or do without.
Insurers say the new system keeps everyone’s premiums down at a time when some of the most innovative and promising new treatments for conditions like cancer and rheumatoid arthritis and multiple sclerosis can cost $100,000 and more a year.
But the result is that patients may have to spend more for a drug than they pay for their mortgages, more, in some cases, than their monthly incomes.
The system, often called Tier 4, began in earnest with Medicare drug plans and spread rapidly. It is now incorporated into 86 percent of those plans. Some have even higher co-payments for certain drugs, a Tier 5.
Now Tier 4 is also showing up in insurance that people buy on their own or acquire through employers, said Dan Mendelson of Avalere Health, a research organization in Washington. It is the fastest-growing segment in private insurance, Mr. Mendelson said. Five years ago it was virtually nonexistent in private plans, he said. Now 10 percent of them have Tier 4 drug categories.
Private insurers began offering Tier 4 plans in response to employers who were looking for ways to keep costs down, said Karen Ignagni, president of America’s Health Insurance Plans, which represents most of the nation’s health insurers. When people who need Tier 4 drugs pay more for them, other subscribers in the plan pay less for their coverage.
But the new system sticks seriously ill people with huge bills, said James Robinson, a health economist at the University of California, Berkeley. “It is very unfortunate social policy,” Dr. Robinson said. “The more the sick person pays, the less the healthy person pays.”
Traditionally, the idea of insurance was to spread the costs of paying for the sick.
“This is an erosion of the traditional concept of insurance,” Mr. Mendelson said. “Those beneficiaries who bear the burden of illness are also bearing the burden of cost.”
I love that last line. The "traditional concept of insurance" has been dead since the creation of HMO's. Health insurance in the US hasn't been about spreading the costs for thirty years. For most of our lives its been about covering the healthiest pool of customers, setting premium pricing for a high probability of expenses, and then challenging every claim.
Remember that success in the insurance industry is measured the same as it is for every other business: Your profits this quarter compared to the last and this year compared to a year ago. If you don't increase those numbers every quarter and every year by a margin the market deems acceptable, the executives who run this company are in trouble.
How do you get annual profit increases in something like the health insurance business? It's not like you can create a new widget and sell that to your existing customers or find a new market. No, the insurance industry is judged the same as every other field but it has to make its money differently. After you've wrung out all of the waste and inefficiency in your operations, the only way for an insurer to increase their profits quarter after quarter and year after year, is to charge more and pay out less.
Simple logic tells you that this is an unsustainable business model. But for the people who can these decisions, the shareholders and executives, it is not in their self-interest to care if its sustainable. Hold the stock as long as its showing 15% annual increases in net profits that drive up the share price and when it falters, dump it for something else. Executives only need to put in four or five years of good results before they are expected to grab their golden parachute and bail.
When the house of cards finally collapses, the insurance companies will be begging for government-financed medicine (run by them in the same manner as now, of course) because it will be the only way they can stay in business. It will be the same shit we're seeing right now in the financial sector - privatize the profit and socialize the losses.
The "traditional concept of insurance" has been dead since the creation of HMO's. Health insurance in the US hasn't been about spreading the costs for thirty years. For most of our lives its been about covering the healthiest pool of customers, setting premium pricing for a high probability of expenses, and then challenging every claim.
How do you get annual profit increases in something like the health insurance business? It's not like you can create a new widget and sell that to your existing customers or find a new market. No, the insurance industry is judged the same as every other field but it has to make its money differently. After you've wrung out all of the waste and inefficiency in your operations, the only way for an insurer to increase their profits quarter after quarter and year after year, is to charge more and pay out less.
Simple logic tells you that this is an unsustainable business model. But for the people who can these decisions, the shareholders and executives, it is not in their self-interest to care if its sustainable. Hold the stock as long as its showing 15% annual increases in net profits that drive up the share price and when it falters, dump it for something else. Executives only need to put in four or five years of good results before they are expected to grab their golden parachute and bail.
Exactly. In the mid 70's some Muthafukkers in the insurance industry changed how health insurance was viewed. It became an investment scam where the key was to minimize payouts. You could track income (premiums) very precisely. All that needed to be controlled were expenses (claims). The health insurance model is all about investing premiums and making profits on investments. Actually paying for care is a "waste product" of the industry.
Add to that, the massive consolidation of the industry, and you have a situation where there is essentially a "monopoly" on health insurance providers (oligopoly really, but with serious "legal" or pseudo-legal collusion on rates and practices).
THAT'S why we need a primary universal policy which is a baseline. Then, insurance companies would have to compete for secondary coverage ("cadillac" care) and actually have to provide a service, since people couldn't be held hostage over lifesaving care.
Perscription plans
