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Re: OT - Health insurance and Local hospital discount...


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Posted by Ralph Bauer on April 08, 2012 at 20:40:44 from (75.107.19.155):

In Reply to: OT - Health insurance and Local hospital discount... posted by petetherookie on April 08, 2012 at 18:06:20:

Pete, just wait till you actually get Cancer!! Iwas diagnosed with stage 2b mucenus adendo carcenoma of the appendix, very rare about 1 in 500.000, and I was statistically speaking too young (usually hits in the 50's, I was 37 in 2006). After surgery and before Chemo, I went for a second opinion to MD Anderson in Houston, TX (one of about 15 or so places in the US for that type of cancer at the time), got accepted and since it is an out-of-network provider, my Oklahoma HealthChoice State plan only pays 50% of allowable. Every time I go for lab, chest x-ray and CT, it runs me gross about 5500 -6000 a pop, just switched to annually, went every six months before. Insurance pays, depending if co-pay and deductable are met somewhere near 1200 or less, the rest is NOT discounted by MDA, but they let me pay it off without interest. No further discount, nothing, I tried. They politely tell me that my bill is already discounted by the share my insurance company pays...LOL (not really!!!) I asked what discount I would get paying cash upfront??: 5%! On the other hand, if I had in-network insurance with them, the bill billed to the insurance company would be about 3800. I offered to pay the difference between what my insurance co. pays and 3800, even 4000, no deal!!!!
In all fairness, they changed their re-payment plans to an accelerated payment schedule but I got grandfathered in and was able to add new charges to the old plan. I stopped adding new balances couple years ago because every time I did that, they would raise the monthly amount by another Benjamin. I was told that if your balances become old, 2-3 yrs old and older, they can negotiate deeper discounts, 15-30 %...so I am doing that for now and hope to "negotiate" once my plan charges are paid. Does not make sense!! I currently pay about 22% of my take home every month to MDA!
Talked to my Oncologist there last month, told him the situation and he lets me do the tests here in-network in the future, just reviews them at MDA. He was shocked when I confessed the $$ situation.
On the other hand, the local tiny county hospital, about 26 beds, still gives $$ discounts for the remaining balance that the insurance does not pay on any services, 10-30%, depending how quickly you pay them!!!
What a lot of folks here in the US don't find out is that health insurance companies in Germany and Europe are much, much heavier regulated and still make a profit!! I just hope that none of the folks that scream about the coming changes really get ill, yes, it sounds wonderful to shop for great rates in the open market, but what happens when your available dollars buy you absolutely no coverage? Sure they have a plan for you, but if you can't pay the rates, it's no advantage to be in a capitalistic market. I guess you'll get to move 6 feet under first! And the only one that counts is the winner! Right????? (sorry got a bit onto my soapbox here...).


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