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M&K's Retrievers
11-29-2012, 11:20 PM
I've been selling employee benefit programs for the past 35 years. During that time I have listened to clients bitch about rate increases and occasionally a few claim problems. For the most part my clients have been more than satisfied with the benefits they received in return for their premium dollar. Most people would rather not collect a dime because they are healthy while others complain that their plan didn't cover some minor crap.

In the past couple of weeks I have been exposed to a couple of things that make me wonder how an insurance company could ever make a profit. A hunting guide/dog trainer friend of mine is a diabetic who is going through kidney dialysis. He is losing his eyesight. I have been taking him to an eye doc for shots (yep, in the eyes) once a month. These are covered but I don't have a clue how much the cost. The last time there the doc wanted to put a drop of something in each eye. $2,000 per drop! His insurance covered it all.

Today I went for my semi annual haircut. The gal that cuts my hair 13 year old grand son has a form of ecoli. This has had him hospitalized for 16+ days. They had to transfer him 90 miles from Sherman, TX to Dallas. Cost $10,000. I asked why they had air medavac him. She said that was in an ambulance. If he has ahus ecoli, there is a shot that "may" help him. The cost is $450,000. One shot. One time. It works or it doesn't. Insurance will cover all of this.

Both of these individuals have/will incurred claims in excess of $500,00-$750,000 which the insurance companies will reimburse the lions share.

How can insurance companies budget for these types of expenses? Perhaps it not the insurance companies that are to blame. Just maybe the providers have a say in this. Ya' think?

Terri
11-30-2012, 12:25 AM
I guess what you think is minor and what someone else things is minor could be very different. You think?

Terri

M&K's Retrievers
11-30-2012, 12:28 AM
I guess what you think is minor and what someone else things is minor could be very different. You think?

Terri

People should pay for the minor stuff themselves while relying on insurance to pay for major expenditures.

Terri
11-30-2012, 12:50 AM
What is a major expenditure for one person can very from person to person. Some think that $250,000.00 a year is rich, it all depends on who you ask.

Terri

huntinman
11-30-2012, 07:02 AM
The insurance companies have just as much right to make a profit as any other business. People love to hate them sort of like the phone company or the cable company. We all pay them and pay them and think we are "wasting" money.... Till we need it... Then we are damn glad we have it. I'm with Mike, Obama and his minions have found an easy target because they know most people already distrust insurance companies... So they bash and bash (all while taking millions in campaign contributions). Then you have the gov't regulating them practically out of of business. Not only the Feds, but the States get in on the act too.

What I don't understand is how any executive in the insurance industry backed Obama the first or second time?

Marvin S
11-30-2012, 07:35 AM
I've been selling employee benefit programs for the past 35 years. During that time I have listened to clients bitch about rate increases and occasionally a few claim problems. For the most part my clients have been more than satisfied with the benefits they received in return for their premium dollar. Most people would rather not collect a dime because they are healthy while others complain that their plan didn't cover some minor crap.

In the past couple of weeks I have been exposed to a couple of things that make me wonder how an insurance company could ever make a profit. A hunting guide/dog trainer friend of mine is a diabetic who is going through kidney dialysis. He is losing his eyesight. I have been taking him to an eye doc for shots (yep, in the eyes) once a month. These are covered but I don't have a clue how much the cost. The last time there the doc wanted to put a drop of something in each eye. $2,000 per drop! His insurance covered it all.

Today I went for my semi annual haircut. The gal that cuts my hair 13 year old grand son has a form of ecoli. This has had him hospitalized for 16+ days. They had to transfer him 90 miles from Sherman, TX to Dallas. Cost $10,000. I asked why they had air medavac him. She said that was in an ambulance. If he has ahus ecoli, there is a shot that "may" help him. The cost is $450,000. One shot. One time. It works or it doesn't. Insurance will cover all of this.

Both of these individuals have/will incurred claims in excess of $500,00-$750,000 which the insurance companies will reimburse the lions share.

How can insurance companies budget for these types of expenses? Perhaps it not the insurance companies that are to blame. Just maybe the providers have a say in this. Ya' think?

IMO - there needs to be a system where those getting treated have skin in the game.

I grew up on a farm - RAW MILK (don't try to get that past the health inspector these days), ate stuff fresh from the garden by wiping the dirt off it, yet nobody got sick. I go in yearly for skin checkups - the gal there said I must have grown up on a farm, as I have no allergies, except to commercial stuff - You have to ask yourself, is the world kids are growing up in too sterile?

I don't have an answer but it seems that those who run up the biggest bills seem to be those who abuse themselves the most, am I wrong?

Again, it's easy to ask for the best when someone else is paying. When you may have to give up something, you think twice about the expense.

And to think, this all started because of wages being froze - Intended or unintended consequences?

Jason Glavich
11-30-2012, 07:48 AM
I've been selling employee benefit programs for the past 35 years. During that time I have listened to clients bitch about rate increases and occasionally a few claim problems. For the most part my clients have been more than satisfied with the benefits they received in return for their premium dollar. Most people would rather not collect a dime because they are healthy while others complain that their plan didn't cover some minor crap.

In the past couple of weeks I have been exposed to a couple of things that make me wonder how an insurance company could ever make a profit. A hunting guide/dog trainer friend of mine is a diabetic who is going through kidney dialysis. He is losing his eyesight. I have been taking him to an eye doc for shots (yep, in the eyes) once a month. These are covered but I don't have a clue how much the cost. The last time there the doc wanted to put a drop of something in each eye. $2,000 per drop! His insurance covered it all.

Today I went for my semi annual haircut. The gal that cuts my hair 13 year old grand son has a form of ecoli. This has had him hospitalized for 16+ days. They had to transfer him 90 miles from Sherman, TX to Dallas. Cost $10,000. I asked why they had air medavac him. She said that was in an ambulance. If he has ahus ecoli, there is a shot that "may" help him. The cost is $450,000. One shot. One time. It works or it doesn't. Insurance will cover all of this.

Both of these individuals have/will incurred claims in excess of $500,00-$750,000 which the insurance companies will reimburse the lions share.

How can insurance companies budget for these types of expenses? Perhaps it not the insurance companies that are to blame. Just maybe the providers have a say in this. Ya' think?

They wont pay that amount, most likely they will pay about 60% of the total cost through negotiations with the hospital. If they took the route of some surgery centers and reduced the admin staff making six figures they could reduce cost. Those shots are most likely sold to the hospital for 1/1000 of the cost they pass onto the patient.

M&K's Retrievers
11-30-2012, 09:15 AM
They wont pay that amount, most likely they will pay about 60% of the total cost through negotiations with the hospital. If they took the route of some surgery centers and reduced the admin staff making six figures they could reduce cost. Those shots are most likely sold to the hospital for 1/1000 of the cost they pass onto the patient.

You should say insurance company. Without insurance the cost usually drops dramatically.

Daniel J Simoens
11-30-2012, 09:47 AM
You should say insurance company. Without insurance the cost usually drops dramatically.

I just had sinus surgery. Before surgery they explained what the charges would be. For the surgery itself, the cost was going to be $6393 but because I had UnitedHealthcare insurance, the negotiated charge was $998. They explained that the difference would be 'written off."

I've heard stories of a lady in LA going to the ER 200+ times in a year with her children for things such as the common cold. Why? because she had a $0 copay for ER.

Jason Glavich
11-30-2012, 11:21 AM
I choose urgent care over my regular doc for 2 reasons, first reason is I do not feel like waiting for 2 weeks to be seen for a problem, 2nd reason is the copay is cheaper for urgent care than my GP.

I find it funny how no insurance brings the cost down so quickly(surgery centers do this quite a bit, surgery center of OK is a great example.), when a bill is 40k and the insurance pays only 5k and it is all covered shows the real cost, the rest is just moving money around that doesnt exist.

menmon
11-30-2012, 11:50 AM
The insurance companies have just as much right to make a profit as any other business. People love to hate them sort of like the phone company or the cable company. We all pay them and pay them and think we are "wasting" money.... Till we need it... Then we are damn glad we have it. I'm with Mike, Obama and his minions have found an easy target because they know most people already distrust insurance companies... So they bash and bash (all while taking millions in campaign contributions). Then you have the gov't regulating them practically out of of business. Not only the Feds, but the States get in on the act too.

What I don't understand is how any executive in the insurance industry backed Obama the first or second time?

It comes across as bashing....but what is really happening is a resitance to change. The current system is breaking us and will if nothing is changed. The new one has fallout to insurance companies and doctors so they are crying and in some cases they have reason, but everyone will adjust and make money under this new system, hopefully if more control on the cost.

I never said this was the best system but what it is...is a change away from one that is bad.

Buzz
11-30-2012, 12:53 PM
For decades, Americans have seen healthcare costs rise by leaps and bounds. But most people don't pay their healthcare bills directly as you point out. They and or their employers pay health insurance companies to be the middle man. So what folks have seen is their insurance costs skyrocket and have blamed the insurance industry, figuring that those are the ones who are getting rich...

Terri
11-30-2012, 01:41 PM
I have lost sight as to the point of this thread. What is the point again? If I have insurance I should still expect to pay out of pocket, even though I'm paying the premium based on the agreed amount after all the factors for profit have been worked out? BUT if I have no insurance I will pay out of pocket for the treatment, but the cost will go down? What is the point, again? It seems like a circle of nonsense.

When I buy insurance of any kind health, life, auto, or pet there are questions that are asked of me. I answer the questions and provide proof to back up the statements I have made. Then the insurance company puts together a plan. The plan includes what it will cost monthly/yearly for them to make a profit and for me to have coverage. I can add deposits, co-pays, deductibles to bring down the cost. I can also have a lot of coverage or a little coverage. This is all part of the plan put together by the insurance company. I can shop around and find a plan that works for me. I think the problem for me is when I sign on to a coverage and find out that I'm paying for a lot of coverage, but all the treatments/service I need are not part of the coverage. It is like buying an extended care package from the car dealership or at Best Buy - big rip offs. I'm not trying to rip off the insurance company or prevent it from making a profit, but there have been times that I have been ticked off at doctors and the insurance company for rejecting my treatment and expecting me to know what medication is covered and which ones are not covered. I did not go to medical or pharmacy school, so all I need is help to make sure I get a treatment I can afford the co-pay without breaking my bank account. Leave out the remark that all covered medication is listed in the insurance manual. Just because I can read does not mean I understand or know what all those drugs treat. I hate to leave the pharmacy holding a filled bottle of medication, but I have done it, because I'm not going to pay more for a treatment than was agreed upon when I signed the contract. So if I'm going to pay out of pocket for my treatment I will redo the contract the following year allowing me to have the money to pay for my uncovered treatment, but still cover major expenses. It works for me so I will no longer be the unhappy person, but I'm not sure how happy the insurance guy is going to be when the percentage he gets from my premium goes down because I switch to only a major medical plan so I can afford to pay out of pocket for all the minor stuff I was paying a higher monthly/yearly premium.

Terri

murral stark
11-30-2012, 05:15 PM
It has puzzled me in the past that someone who does not have insurance can pay less than I am paying after my insurance plan pays. How can that be possible. the same procedure, same medical provider, I pay the co-pay plus still pay more out of pocket than someone that has no insurance at all.

paul young
11-30-2012, 05:21 PM
I've been selling employee benefit programs for the past 35 years. During that time I have listened to clients bitch about rate increases and occasionally a few claim problems. For the most part my clients have been more than satisfied with the benefits they received in return for their premium dollar. Most people would rather not collect a dime because they are healthy while others complain that their plan didn't cover some minor crap.

In the past couple of weeks I have been exposed to a couple of things that make me wonder how an insurance company could ever make a profit. A hunting guide/dog trainer friend of mine is a diabetic who is going through kidney dialysis. He is losing his eyesight. I have been taking him to an eye doc for shots (yep, in the eyes) once a month. These are covered but I don't have a clue how much the cost. The last time there the doc wanted to put a drop of something in each eye. $2,000 per drop! His insurance covered it all.

Today I went for my semi annual haircut. The gal that cuts my hair 13 year old grand son has a form of ecoli. This has had him hospitalized for 16+ days. They had to transfer him 90 miles from Sherman, TX to Dallas. Cost $10,000. I asked why they had air medavac him. She said that was in an ambulance. If he has ahus ecoli, there is a shot that "may" help him. The cost is $450,000. One shot. One time. It works or it doesn't. Insurance will cover all of this.

Both of these individuals have/will incurred claims in excess of $500,00-$750,000 which the insurance companies will reimburse the lions share.

How can insurance companies budget for these types of expenses? Perhaps it not the insurance companies that are to blame. Just maybe the providers have a say in this. Ya' think?



I don't think you have to worry too much about the healthcare companies turning a profit;

http://www.dailyfinance.com/2011/02/04/health-insurers-post-healthy-quarterly-profits-cautious-2011-outlook/

They SHOULD MAKE A PROFIT....please don't think I'm of the opinion that they shouldn't. I'm just not going to lose any sleep over it, and neither should you.-Paul

JDogger
11-30-2012, 05:52 PM
http://i288.photobucket.com/albums/ll176/JDoggger/Kliban%20cartoons/img119-1.jpg

The health insurance plan practiced by my grand-parents....RIP

JD