Insurance Companies

I swear, I am going to come back in another life and haunt the health insurance industry!

Maybe someone can explain to me how, after paying over $4000 in premiums in a calendar year, being billed approximately $5000 for procedures, etc., paying coinsurance and co-pays – HOW could we possibly have not met our deductible??

See, here’s how it should work: we pay a random figure – let’s say $500 per month, in premiums; we pay a $15 or $30 co-pay for a doctor visit, and $200 for a hospital stay. If all four of us go to a PCP and a specialist during the year, we’ve paid a total of $180; those bills were $100 each, after the “negotiated insurance reduction”, and since we’ve not met the deductible (yet), we pay the balance too.

So now we’ve paid $800 total, and the family deductible is $500; subtract the $180 co-pays, which are required, and we’ve paid $620 towards the deductible. Simple, yes?

So if someone goes to the hospital, and we have a $2000 bill and must pay a $200 co-pay, then the insurance company should pay 90% of the remaining $1800, or $1620, and we are billed for $180. Right?

Wrong! The insurance companies canNOT be simple, or even correct. Their business practices stink. The are the worst of those preying on regular folks, the dregs, the very lowest of the bottom-feeders. Oh, wait – except for the pharmaceutical companies, but I’ll save that for another day.

So, according to our insurance company – one the Big Ones, not some podunk, fly-by-night, call 1-800-whoever – we’re still SHORT the deductible, yet have approximately $3000 of bills sitting in a nice, neat stack on my desk!

ARGH! It’s days like this that make you want to crawl back into bed!


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