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Seriously, **** insurance
https://gladerebooted.net/viewtopic.php?f=7&t=5130		 Page 1 of 1
Author:  Xequecal [ Mon Jan 03, 2011 4:05 pm ]
Post subject:  Seriously, **** insurance
I'm really at the point where I'm wondering how anyone who has ever dealt with insurance can claim the US system works. I'm at the point where I'm willing to accept all the drawbacks of public insurance just so I can ask the doctor, "how much do I have to pay out of pocket for this?" and get a straight answer. Now? He doesn't know. Nobody **** knows until he submits the claim and they pay some random tiny amount that seems to be determined entirely based on whim. I have dental insurance that claims to pay 100% for prophylactic procedures. I went to the dentist and got an examination and cleaning. You know what they paid for this? $46. Out of a $220 total, they paid $46. They say that "the charge exceeds the allowable amount for this procedure." Really? $46 is your allowable amount for a **** medical procedure and you claim to pay 100% on your advertising material? What a **** scam. Oh sure, they explain on the contract that they only pay the allowable amount, but they don't tell you what that is. They for sure don't tell you that they only pay less than 21% for an examination and cleaning, something that every American everywhere gets.

I'm sure looking forward to ending up in the emergency room with a bill of $100k, only to have the insurance tell me, "Oops, the "allowable amount" that we determine entirely ourselves and you have no idea what it is in advance is only $20k! You have to pay the rest yourself!" Why do I even have insurance?

On that note, is anyone sick and tired of having to sign totally incomprehensible contracts in order to procure anything? If you want to sign up for like a cell phone plan they push 20 pages of paper past you in five minutes. Everyone talks about personal responsibility and getting the government out of **** but if the government wasn't regulating this you would end up signing over your kidneys on page 29 of the contract without ever comprehending it. I sure as hell don't know anyone that understands any of their insurance plans, I shudder at the prospect of ever having to comprehend, say, a mortgage contract where my options are to trust what the on-commission bank rep is telling me or pay $5,000 out of my own pocket to have a lawyer look at the hundreds of pages of legalese and explain it to me.
Author:  Lex Luthor [ Mon Jan 03, 2011 4:11 pm ]
Post subject: 
Different people have different plans. It depends on your employer. Mine pays 100% after a deductible. When I went insane and had to stay in the loony bin for 2 weeks, my insurer paid the $12k and all the prescriptions and doctors visits afterwards. I even got half pay while I was on short-term disability. Maybe someday if you decide to join the workforce, you will see.
Author:  NephyrS [ Mon Jan 03, 2011 4:23 pm ]
Post subject: 
This is why I like having health insurance instead of a health plan.

I have a straight up major-medical plan- $1900 deductible.

I pay everything up to $1900, and my insurance carrier pays everything over that, with very few caveats- mostly to do with preferred providers, but everyone I've ever looked at using has been a preferred provider.

I've never had problems with any of my claims, nor have my wife or mother. My mom even went into the emergency room and subsequently a local heart hospital with stress based chest pains, and they covered everything over the deductible no questions asked.
Author:  Xequecal [ Mon Jan 03, 2011 4:28 pm ]
Post subject: 
After some digging on the phone I discovered the problem. They pay 100% in-network, and that particular location is in-network, I looked it up on their website before I went. But it's a father-son operation (they're both dentists) and while the father is in their network, the son is not and he's the guy that did my cleaning. So because I technically saw an out-of-network dentist I have to pay for everything. I have no idea how I could reasonably have forseen this.
Author:  NephyrS [ Mon Jan 03, 2011 5:07 pm ]
Post subject: 
That really sucks. Yours is 100% in network and what, 20% out? At least mine is 100% in network, 80% out of network.
Author:  Ladas [ Mon Jan 03, 2011 5:22 pm ]
Post subject:  Re:
Xequecal wrote:
After some digging on the phone I discovered the problem. They pay 100% in-network, and that particular location is in-network, I looked it up on their website before I went. But it's a father-son operation (they're both dentists) and while the father is in their network, the son is not and he's the guy that did my cleaning. So because I technically saw an out-of-network dentist I have to pay for everything. I have no idea how I could reasonably have forseen this.

Then it's two separate practices, though sharing the same roof (not sure how you look up a location... its by practice, not address), and the entire situation could have been avoid by asking a simple 5 word question.
Author:  Lex Luthor [ Mon Jan 03, 2011 5:24 pm ]
Post subject: 
I wonder if his hard times in high school could have been avoided similarly.
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