I mean, it’s all there in the fine print when you sign up for or renew your plan. When shopping for plans you are entitled to read policy documents laying out the insurer’s coverage policies for any given treatment. When I worked in medical I encouraged patients to request and read said documents especially for the conditions we treated, double especially for the treatments and medications the patient was then receiving under our care. Some insurers made the policies public and a minority of policies (specifically, regarding patient costs rather than covered vs. non-covered) were considered confidential. We had the right to request said documents after an insurer denies treatment for our patient, so we could appeal the decision by saying the insurer didn’t follow their own agreement with the patient. This is considered a service we did for the patient, gratis, meaning it works into administrative overhead for doctors providing care.
So the decision ultimately falls on the consumer. In practice consumers don’t read the fine print, because nobody wants to do that. Even if they do read it, they likely don’t understand all the implications. However as providers we were contractually obligated not to recommend any particular insurance - which recommendation is what the patients really want when shopping for a new plan. But the U.S. healthcare system operates on the assumption that the decision is made by a well informed consumer when they ‘choose’ to obtain coverage. And it’s not just the healthcare system that operates on this assumption. This is the general rule across the board with everything from insurance to automobiles to construction to landlords. Consumer protection is the exception to the rule. It’s the American way.
Maybe in days of yore, but I think today most people “get to” choose terms of coverage. Chooses to is a different matter, and I think the choices could be improved. But you have a real choice between high deductable, low deductable, high copay, low copay, percentage based coverage, on an annual basis. Whether and how different types of visits are covered, be it ER, urgent care, primary care, specialist visit, diagnostic tests, wellness check.
Oh Jesus! What a non-sequitur. I haven’t been offered a non networked plan for nigh on twenty years and no one I know who is not either in a dying union or a government employee has either.
No matter what your deductible or copays are, you are subject to these swindles where you contract for something (an annual physical, an in network urgent care and radiology consult, an in-network colonoscopy) and the people involved change how they characterize what they have done, and then you have to be a lawyer to fix the results of their illegal actions.
I don’t know what the fuck you are taking about but it has bugger all to do with the subject of this thread.
You seem to have a pathological need to suck the cocks of disgusting, immoral, criminals.
I admit there are swindlers and cheats and do not defend them. For example surprise billing which was the original problem. I’m not even defending the U.S. healthcare system when it ‘works’ so much as opining how it works.
Yeah, every plan has a network and that has been the case for my entire life. But different plans have different levels of coverage for out-of-network (some not covering at all) and if you’re saying it is impossible to find a reasonable plan where you can see a doctor outside of this one specific facility you dislike, I don’t believe you. Or if you’re saying you had no choice but to take a plan where a routine 20m E&M costs you $550 and ins covers $100, again, I don’t believe you. I don’t know how they get that breakdown but if it’s above board I don’t find it credible that you had no real choice in the terms.
Again, I don’t know what insurance you have. But most of our snowbirds from Massachusetts had BCBS MA. And the distinction between preventative and diagnostic is a long standing one that existed way back when I started. It is and has always been exactly as laid out here:
So when you imply oh, they billed it wrong to swindle me out of my money. But also they talked about renewing my meds for this chronic condition and continued to not do anything about my other chronic condition. Well no, if they talked to you about managing a chronic illness it shouldn’t be considered preventative care. Maybe there’s something else going on with your specific bill, but this isn’t the problem.
Yes, it sucks that the healthcare system is set up this way. It’s confusing. But it is supposed to work like this.
Why your insurance only covers 1/5 or so of a normal visit, I don’t know. That is specific to your insurance and should have been clear when you signed the contract. Whether $550 base is a reasonable price in your region, I don’t know, since I didn’t work in MA or for a PCP and I don’t know what specifically is being billed for (it may not just be the 20 minutes you saw the doc).
Have you ever had employer-provided health insurance from a non-Union, non-government employer? I haven’t had a real choice of coverage (being what the deductible is) for decades.
And who, other than some hr executive, gets to “sign the contract”?
I was the benefit administrator for our company’s health insurance, which as I mentioned was a small doctor’s office. We had under 10 employees most of which declined the company insurance in favor of individual plans on the marketplace or spousal coverage.
I saw the prices, I read the fine print, it was part of my job both as a provider and in employer capacity. And of course as an individual seeking insurance.
The marketplace didn’t exist “decades” ago, I should remind you.
I have employer-provided health insurance from a non-union, non-government employer and usually there are a couple of options for coverage, from an HMO with a low employee contribution or no contribution from the employee to a PPO with a larger employee contribution and I think there was another option beyond that. The HMO limits which doctors and hospitals I can use while the PPO lets me visit any doctor or hospital I want.
I’m 47 years old and my entire life my health insurance has always been provided either by a parent, spouse, or employer. I’ve never really had a choice in what plan I have. Choices are for wealthy people. When I was unemployed I wasn’t covered.
The idea that everyone picks their health plan in the US is fucking stupid.
Now, for the first time in my life I technically have a choice; I declined my employer’s health plan in favor of my wife’s, because her coverage is better and cheaper at the same time. But it’s a binary choice and it’s the only time in my life I’ve ever had such a choice. It’s incredibly rare.
You don’t get to pick a health plan like you pick where you want to get lunch. That’s insane.
We choose our plans the same way a person chooses whether to give someone their money when being robbed, or the way people got to vote in the Soviet Union.
I mean, yeah, i could give up the thousands of dollars of employee subsidy, i guess, and shop for plans on the market. If employees at your company routinely do that, your employer must have incredibly bad coverage. Taking the spouse’s insurance isn’t as much of a condemnation of your employer.
We didn’t subsidize employee premiums if they declined our plan. We paid half the premium if they bought in. And we had an expensive plan, bc the boss wanted really good coverage.
Right, you only subsidized if they took the one choice you offered, i assume. Not if they bought outside. That’s why essentially no one who has access to an employer plan buys insurance on the market.
ETA: I’m not really understanding. We had employees with access to our company plan and declined in favor of individual marketplace plans, because those were cheaper. Less coverage, but cheaper. (There were also more expensive marketplace plans with better coverage.)
Your company must have a shit subsidy. Most employees pay so much less for their employers plan that they’d have to be stupid or desperate for better coverage but to take it.