Health Insurance Master Thread

[stooges44]

How crazy is this?

On my EOB it says the hospital billed $26,000 and oxford paid them $43,000 yet I'm still getting hit with a 10% co-insurance bill. Insanity! The hospital received almost doubled what they asked for and I still need to pay a few thousand of my own 

I called the hospital many times already and was finally told straight out, the hospital has contracts with oxford and even if oxford paid them a million bucks I would still be stuck with whatever co-pays/deductibles/co-insurance that are applicable.

I just can't wrap my head around this. Anyone have any ideas of what I can say or do? All the hospital keeps saying is I can setup a payment plan 

[ExGingi]

How crazy is this?

On my EOB it says the hospital billed $26,000 and oxford paid them $43,000 yet I'm still getting hit with a 10% co-insurance bill. Insanity! The hospital received almost doubled what they asked for and I still need to pay a few thousand of my own 

I called the hospital many times already and was finally told straight out, the hospital has contracts with oxford and even if oxford paid them a million bucks I would still be stuck with whatever co-pays/deductibles/co-insurance that are applicable.

I just can't wrap my head around this. Anyone have any ideas of what I can say or do? All the hospital keeps saying is I can setup a payment plan 

I also learned this once the hard way. I had a very generous HSA compatible plan, and for a certain visit to Dr. office I ended up with a bill which was way above what I would have paid in cash. Ever since then I tell them, I pay cash, just give me a detailed receipt and I'll take care (submit it to insurance if warranted due to high deductible).

This is a travesty of the US healthcare system, and Obamacare did nothing to fix it, possibly only made it worse.

[stooges44]

I also learned this once the hard way. I had a very generous HSA compatible plan, and for a certain visit to Dr. office I ended up with a bill which was way above what I would have paid in cash. Ever since then I tell them, I pay cash, just give me a detailed receipt and I'll take care (submit it to insurance if warranted due to high deductible).

This is a travesty of the US healthcare system, and Obamacare did nothing to fix it, possibly only made it worse.

 

[ExGingi]

Honestly, at this point I don't see a fix to this in anything short of a constitutional amendment mandating transparent posted pricing (and public availability of all contracted pricing) for all medical procedures and services.

[incendia]

Honestly, at this point I don't see a fix to this in anything short of a constitutional amendment mandating transparent posted pricing (and public availability of all contracted pricing) for all medical procedures and services.

Why would you a constitutional amendment when a regular law could do the same thing?

[ExGingi]

Why would you a constitutional amendment when a regular law could do the same thing?

Just some hyperbole to express frustration with the travesty of the situation.

Constitutional amendment are much harder to overturn. (And near impossible to pass).

[stooges44]

Oxford told me today that even if I needed a bandaid and I got room and board the hospital still gets their contracted rate of $46K!!!

I'm truly speechless 

[aygart]

The Jerusalem Post: Israeli start-up looks to disrupt US healthcare with Kupat Holim model.
https://www.jpost.com/jpost-tech/israeli-startup-looks-to-disrupt-us-healthcare-with-kupat-holim-model-677574

[ushdadude]

I also learned this once the hard way. I had a very generous HSA compatible plan, and for a certain visit to Dr. office I ended up with a bill which was way above what I would have paid in cash. Ever since then I tell them, I pay cash, just give me a detailed receipt and I'll take care (submit it to insurance if warranted due to high deductible).

This is a travesty of the US healthcare system, and Obamacare did nothing to fix it, possibly only made it worse.

Interesting. I have an HSA eligible plan. When looking at the EOB, I see the billed amount is significantly more than the max allowed. I thought they can't bill insurance more than they would bill a patient. So wouldn't the cash price have to be the "billed amount"?

[Zevi16]

What bothers me most of all is that DRs don’t allow you to ‘pay cash’ for a visit if they see that you have insurance. It’s insane how my co pays and deductibles are higher than most people that pay cash.

[ExGingi]

What bothers me most of all is that DRs don’t allow you to ‘pay cash’ for a visit if they see that you have insurance. It’s insane how my co pays and deductibles are higher than most people that pay cash.

Just tell them you no longer have insurance and are now paying cash for everything.

[ExGingi]

Interesting. I have an HSA eligible plan. When looking at the EOB, I see the billed amount is significantly more than the max allowed. I thought they can't bill insurance more than they would bill a patient. So wouldn't the cash price have to be the "billed amount"?

They never want to be short changed from the maximum allowed so they bill insane amounts.

[ari3]

I am trying to get health insurance thru getcoverednj (nj marketplace). Till now I had regular private insurance but with the increased subsidies next year I am jumping in.

I tried enrolling and it did not let me include my 2 children over 18 on my plan since they file their own tax return. I thought by law any children thru age 26 are eligible to join my plan?

Additionally if theoretically I am currently unsure what their tax status would be for next year and after I enroll I clarify that they are going to file their own return what happens then?