Skip to main content

View Diary: Do You REALLY Want To Know How F-Ed Up Health Insurance Is ? (50 comments)

Comment Preferences

  •  The "usual and customary fee" (6+ / 0-)

    makes the contract unenforceable, because the usual and customary fee is whatever the Insurance company says it is and your insurance company covers you for the usual and customary fee. So unless there is away to arbitrate the usual and customary fee by a third party (which ought to be the government) then the insurance company can reimburse whatever the #@!! it wants.

    We shall overcome, someday. Yes we can.

    by Sam Wise Gingy on Sat Feb 21, 2009 at 11:45:43 AM PST

    •  Generally "usual and customary" (1+ / 0-)
      Recommended by:
      WeBetterWinThisTime

      relates to the amount they've agreed to pay the doctors and hospitals deemed to be "in network."  That can be as little as 30% - 60% of what the doctor charges patients when billing directly.

      So when a patient goes out of network, they're screwed twice.  First, generally coverage drops from, say, 80% down to 50%, PLUS they're being billed at the out-of-network rate.  It's just one more way the uninsured in the US are totally screwed.

      the third eye does not weep. it knows. Political compass: -9.75 / -8.72

      by mijita on Sat Feb 21, 2009 at 11:59:58 AM PST

      [ Parent ]

      •  It also screws the insured. (1+ / 0-)
        Recommended by:
        mijita

        Imagine if your auto insurance was based on usual and customary fees. The insurance company could say the UCF for a bumper is $100. The UCF doesn't mean a thing unless there is some objective enforceable means of determining the UCF.

        We shall overcome, someday. Yes we can.

        by Sam Wise Gingy on Sat Feb 21, 2009 at 12:15:55 PM PST

        [ Parent ]

        •  Actually they do have auto insurance (0+ / 0-)

          fees done exactly the same way.  That's why there's approved towers, garages and car rental places.  All of them have negotiated products, parts and labor rates with the insurance companies in order to be placed on the "approved" or "authorized" lists.

          the third eye does not weep. it knows. Political compass: -9.75 / -8.72

          by mijita on Sat Feb 21, 2009 at 12:25:42 PM PST

          [ Parent ]

          •  Those approved shops (1+ / 0-)
            Recommended by:
            mijita

            handle the claim for you as well. The auto insurance company is liable where ever you get the work done.

            We shall overcome, someday. Yes we can.

            by Sam Wise Gingy on Sat Feb 21, 2009 at 12:43:23 PM PST

            [ Parent ]

            •  Right, but the coverage isn't usually (0+ / 0-)

              as good.   Same as with doctors -- I can go out of network, but my coverage suddenly drops down to 50%.

              Back when I had a car, I was told I could get it fixed at a specific garage, but the Allstate  wouldn't cover anything over the "reasonable and customary" charges and they didn't recognize this garage as "approved" (though Ford did).  Since this was my insurance (rather than part of an accident settlement with someone else's), if I wanted better payment, I had to use one of the body shops they put on their approved list.

              the third eye does not weep. it knows. Political compass: -9.75 / -8.72

              by mijita on Sat Feb 21, 2009 at 12:56:34 PM PST

              [ Parent ]

              •  Yes but you have a way to argue (1+ / 0-)
                Recommended by:
                mijita

                what the reasonable and customary fee is on a auto repair. You generally don't on a medical procedure.

                We shall overcome, someday. Yes we can.

                by Sam Wise Gingy on Sat Feb 21, 2009 at 01:06:18 PM PST

                [ Parent ]

                •  With the doctor or the insurance company? (0+ / 0-)

                  We tend to be so intimidated by medicine.  Most doctors I've dealt with are great about negotiating services when needed -- assuming they even know how much is being charged in their name.

                  One of the many bad things about health insurance in the US is the way it makes people feel even less able to understand medical treatment and costs.  :-/

                  the third eye does not weep. it knows. Political compass: -9.75 / -8.72

                  by mijita on Sat Feb 21, 2009 at 01:11:28 PM PST

                  [ Parent ]

      •  Actually, not quite right on the UCR (1+ / 0-)
        Recommended by:
        mijita

        If the provider is in-network, they have negotiated a level of reimbursement and it can vary. The in-network provider cannot balance bill for the difference between the actual charge and the negotiated reimbursement rate.

        The UCR comes into play when you go out-of-network. We know Cuomo recently revealed this scam. The out-of-network provider can balance bill for the difference between the UCR and the actual charge.

Subscribe or Donate to support Daily Kos.

Click here for the mobile view of the site