US Healthcare Billing Issues

Interesting trivia - health insurers kind of don't care about these big bills, despite what most people think: https://www.propublica.org/article/why-your-health-insurer-d...

The most backwards thing about US healthcare costs is that it costs more if the insurance doesn't cover it. I got a bill for $75k when my insurance incorrectly denied a claim. After they accepted the claim, they negotiated a price of $27k for the same bill.

I don't understand why insurance companies pay ridiculous bills like this but will fight tooth and nail to avoid paying for obviously necessary procedures.

I'm sure there was a technical mistake on the doc's end! But it's because UHC wants absolutely everyone to make 'mistakes' constantly, because every mistake delays or avoids a payment. Even a delayed payment moves an expense forward, maybe even into a new period, while the revenues are always captured promptly when your employer pays your premium. So, UHC's processes are purposely designed to add as much uncertainty and to be as easy as possible to derail.The sys

he's just mentioning that the fact that doctors are not the ones billing you could cost you double or more.

One of the most unfair characteristics of US healthcare is that if the health insurance company does not cover a claim, then the patient is responsible for the payment. It is unrealistic in practice for a patient to know or understand the process by which claims are made (since they are made by an error prone and disinterested provider administrator, and are made in a non-transparent and highly complex way), and also unrealistic for a patient to be able to do anything about a denied claim, since

This is insurance fraud and abuse. Over-billing is very common in the American medical world. As long as there is no oversite, nor competition, it will continue and grow worse over time.

My partner has been employed with the same large international company for 8 years. She had an elected procedure done that is required by law to be fully covered by insurance. She had 3 calls leading up to the procedure with her health insurance company each time asking them if they were certain it would be covered 100%. I thought that this was overkill but she was worried to the point of being paranoid about it. They assured her each time she would not have to pay any money at all for anything.

The Affordable Care Act requires that "Insurers must spend at least 80–85% of premium dollars on health costs; rebates must be issued if this is violated." So insurers bought hospital networks, inflated the bills, and took their profit from the other side of the equation. Before you forgive your insurance company and blame your pharmacy and doctor, check first that they aren't owned by the same corporation.

"figured it could just grab money from unsophisticated people"This sums up my experience with US Healthcare. They bill expecting you to autopay, and either have no incentive to bill correctly or they outright are trying to scam but the result is that every hospital bill is sus.This also makes insurance a lot less inherently valuable: you are paying for someone to do this untangling shitshow on top of the actual insurance. As if the hospitals just put the billing burden on the cli