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Health Insurance Options when leaving employer

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AAR2972

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Yea, we know you don't like to read.

So please tell me again, with your drafting plan expertise how I was able to pull this off and know?

Drafting documents does not equal knowing or not knowing how to figure out discounts/allowed rates on the consumer end.

Like I said, I'm not going to waste my time pointing out the ignorance in every single one of your responses. You just keep making yourself look dumber and dumber in front of anyone who has any knowledge on the topic. Apparently you've single-handedly figured out the solution to one of the most elusive problems in the US healthcare industry. I'm just a health benefits attorney who literally specializes in plan/provider payment and reimbursement and represented consumers/patients in claim appeals, but wtf do I know. Maybe I should quit my job - healthcare is easy - just money in money out! DUH!

Everyone listen to this guy. He's the real guru. I was just trolling all of you apparently. He's probably an expert in investing too - it's just money in, money out! Easy! Who needs advice. Nuclear physics? Probably just money in, money out. Actuarial science....oh yea, uh, money in, money out. Stupid actuaries. Stupid lawyers. Stupid everyone. Money in, Money out!!
 

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Jon L

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Yea, we know you don't like to read.



Like I said, I'm not going to waste my time pointing out the ignorance in every single one of your responses. You just keep making yourself look dumber and dumber in front of anyone who has any knowledge on the topic. Apparently you've single-handedly figured out the solution to one of the most elusive problems in the US healthcare industry. I'm just a health benefits attorney who literally specializes in plan/provider payment and reimbursement and represented consumers/patients in claim appeals, but wtf do I know. Maybe I should quit my job - healthcare is easy - just money in money out! DUH!

Everyone listen to this guy. He's the real guru. I was just trolling all of you apparently. He's probably an expert in investing too - it's just money in, money out! Easy! Who needs advice. Nuclear physics? Probably just money in, money out. Actuarial science....oh yea, uh, money in, money out. Stupid actuaries. Stupid lawyers. Stupid everyone. Money in, Money out!!
Tip on how to be an expert: Be humble.

I know a fair amount about developing software. To some people, I'm an expert. I certainly charge a fair amount for my time when my team and I develop software for a client.

However.

Do I know everything? Nope. Its not possible to know everything. Besides that, there are different schools of thought on the best way to develop software. Netflix, for example, hires the absolute best developers they can find, and pays the hundreds of thousands of dollars a year to each of them. They figure that doing that, they save on management costs because they don't need as many developers. Other companies rely on the system of software development they've created to manage their projects effectively. They hire more developers and pay them less. Which way of thinking is correct? Beyond that, which language, hardware, project management methodology is best? Who knows?

You act like you know everything about health insurance and and eliquid brings nothing to the discussion. Even if you were 100% right in this situation, the fact that you have that attitude makes me, your audience, suspect that you don't know as much as you think you know. Its not possible to know everything about the insurance industry. There are different laws state to state, and each person brings a unique combination of needs with them as well.

Eliquid brings some pretty deep business experience to the table. I'm betting that he's at least partly right. You, as an expert, would be more convincing if you acknowledged what he's right about.
 

AAR2972

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Tip on how to be an expert: Be humble.

I know a fair amount about developing software. To some people, I'm an expert. I certainly charge a fair amount for my time when my team and I develop software for a client.

However.

Do I know everything? Nope. Its not possible to know everything. Besides that, there are different schools of thought on the best way to develop software. Netflix, for example, hires the absolute best developers they can find, and pays the hundreds of thousands of dollars a year to each of them. They figure that doing that, they save on management costs because they don't need as many developers. Other companies rely on the system of software development they've created to manage their projects effectively. They hire more developers and pay them less. Which way of thinking is correct? Beyond that, which language, hardware, project management methodology is best? Who knows?

You act like you know everything about health insurance and and eliquid brings nothing to the discussion. Even if you were 100% right in this situation, the fact that you have that attitude makes me, your audience, suspect that you don't know as much as you think you know. Its not possible to know everything about the insurance industry. There are different laws state to state, and each person brings a unique combination of needs with them as well.

Eliquid brings some pretty deep business experience to the table. I'm betting that he's at least partly right. You, as an expert, would be more convincing if you acknowledged what he's right about.

Honest question, did you read the entire progression of this thread to see how I responded from the beginning. You don't need to lecture me on humility. I started my response to this guy with the following:

"Not to rip this, but there are some misstatements here. I'm sure you're an intelligent person so this just displays how ignorant the majority of educated people are about how healthcare operates in this country. I'm an expert and I still struggle sometimes as a healthcare consumer."

I don't know everything about healthcare. Nobody does. But I am at the very least solid on the basics. His fundamental understanding of how the healthcare economy works is misguided, and I attempted to correct that several times. Instead of engaging in socratic dialogue, he retorts and says I'm flat out *wrong*. And at that point, my humility flew out the window.

If I come to you and say, "When it comes to software programming, HTML is all you need to know. The rest of the languages are pretty obsolete" would you even entertain a discussion with me on evaluating different programming languages with that level of ignorance? And then if you take the time to enlighten me, but I still stand my ground and say you're wrong because it's actually simpler than you think...then you get what this thread devolved to.
 

Jon L

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Honest question, did you read the entire progression of this thread to see how I responded from the beginning. You don't need to lecture me on humility. I started my response to this guy with the following:

"Not to rip this, but there are some misstatements here. I'm sure you're an intelligent person so this just displays how ignorant the majority of educated people are about how healthcare operates in this country. I'm an expert and I still struggle sometimes as a healthcare consumer."

I don't know everything about healthcare. Nobody does. But I am at the very least solid on the basics. His fundamental understanding of how the healthcare economy works is misguided, and I attempted to correct that several times. Instead of engaging in socratic dialogue, he retorts and says I'm flat out *wrong*. And at that point, my humility flew out the window.

If I come to you and say, "When it comes to software programming, HTML is all you need to know. The rest of the languages are pretty obsolete" would you even entertain a discussion with me on evaluating different programming languages with that level of ignorance? And then if you take the time to enlighten me, but I still stand my ground and say you're wrong because it's actually simpler than you think...then you get what this thread devolved to.
If someone said, "HTML is all you need to know," I'd ask, "why do you say that?" The reason for that is that they probably have a perfectly valid reason for that statement, and it might be something I hadn't considered before. They also probably have a misunderstanding about something somewhere. If I can figure out what that is, I can help them out. The net of it is that we both benefit from the conversation.

Here's what humility looks like:
*I can learn from each person I come across
*I'm really good at a few things, and I know what those are
*When someone disagrees with me, I can discuss things with them without being offensive or taking offence
*I have a good sense for when I don't have the entire picture of something
*I can take people's feedback and not get defensive
*I can listen to feedback and take the good but leave the bad
 

AAR2972

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If someone said, "HTML is all you need to know," I'd ask, "why do you say that?" The reason for that is that they probably have a perfectly valid reason for that statement, and it might be something I hadn't considered before. They also probably have a misunderstanding about something somewhere. If I can figure out what that is, I can help them out. The net of it is that we both benefit from the conversation.

Here's what humility looks like:
*I can learn from each person I come across
*I'm really good at a few things, and I know what those are
*When someone disagrees with me, I can discuss things with them without being offensive or taking offence
*I have a good sense for when I don't have the entire picture of something
*I can take people's feedback and not get defensive
*I can listen to feedback and take the good but leave the bad

Did you read the thread? I honestly don't think you did and just looked at my last comment and made an assumption about the rest of my behavior. Your comments should be directed towards him, not me.

He had a misunderstanding, and I respectfully and carefully broke down in an explanation why it was wrong. He retorts with the following:

"As someone that has been buying insurance for years and paying out of my pocket, I know this as a fact.

But thanks though."

"It's logic like yours that has common people in the shithole they are in when it comes to healthcare and healthcare pricing. They think about the "upfront costs" like premium and %, not what influences the pricing to begin with, the allowed charges which is basically the discount the network provides."


Yea I'm not going to act like Buddha when someone acts smug like that. I don't give respect to people who don't reciprocate it.
 

Jon L

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Did you read the thread? I honestly don't think you did and just looked at my last comment and made an assumption about the rest of my behavior. Your comments should be directed towards him, not me.

He had a misunderstanding, and I respectfully and carefully broke down in an explanation why it was wrong. He retorts with the following:

"As someone that has been buying insurance for years and paying out of my pocket, I know this as a fact.

But thanks though."

"It's logic like yours that has common people in the shithole they are in when it comes to healthcare and healthcare pricing. They think about the "upfront costs" like premium and %, not what influences the pricing to begin with, the allowed charges which is basically the discount the network provides."


Yea I'm not going to act like Buddha when someone acts smug like that. I don't give respect to people who don't reciprocate it.
I read every word. Best of luck to you.
 

AAR2972

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I think there's a fine line between having humility and being critically unassertive and unconfident. It took me many years to speak with conviction. I was often told I was too humble, too meek, too conciliatory. I understand that putting aside your ego can win you respect; I've internalized How to Win Friends and Influence People. However, I also have learned that being assertive in discussions, while it can be polarizing, is also a way to win respect. When you are confident in yourself and what you say, others absorb that energy and follow you.

I'm a big fan of Greg Doucette, a pro bodybuilder who unabashedly calls people (who claim to be dieting experts) idiots when they say something stupid and proceeds to break down why their statements are stupid. For example:
View: https://www.youtube.com/watch?v=PgbnkgWbLTM
. People have respect for this guy because while he's polarizing, he backs up his assertions and dismantles false facts/logic to battle spread of misinformation. He does not bash his viewers or people coming to learn from him (except to be funny). He destroys people who claim to be knowledgeable yet spew absolute misinformation that contradicts what he knows as an expert, pro bodybuilder.

So yea, I know I'm polarizing. I'm purposefully not practicing humility on the one topic I'm an expert on and understand far better than the average consumer.

I should mention I know a lot about SaaS too since I've been using dropbox and iCloud since 2012. It's all bogus. Computers these days have huge hard drives that hold terabytes of data but everyone's all hyped up about this totally hackable and unsecure technology that does the same thing as a physical hard drive. Data storage means NOTHING if it's just going to be hacked. People don't focus enough on reliable physical security and instead go towards whatever shiny tech thing is out there. It's just data-in, data-out why complicate it.

--

The fundamental misunderstanding by eliquid is the fact that in the United States, we have these large middlemen occupying the healthcare market called "insurers". Consumers (if insured) do not purchase healthcare directly from suppliers (providers/doctors). Rather, insurers come in between suppliers and consumers to muddle the way the exchange of goods typically operate in an economy.

Insurance companies (as well as employers who "self-insure" their plans) are called "payers" because their job is to pay for your healthcare in exchange for a monthly premium from their customers. If insurers do things right, then they are paying less for your healthcare than they are collecting in monthly premiums, thereby making a profit. Thus, it is in the insurer's interest to pay the least amount of money for your healthcare as they can. One way insurers accomplish this is by negotiating discounts for their own benefit with providers because the less they pay your doctors for a given service, the more profit they make off you from that service.

Insurers then hire these very smart people called actuaries who crunch numbers and determine how much to charge you, the consumer, for those goods/services through monthly premiums and "cost-sharing" (deductibles, copays, and coinsurance) and still turn a profit.

To give some very generalized hypotheticals:

Scenario 1: A doctor charges $50,000 for a hip replacement surgery (the billed charge). Aetna negotiates that price down to pay the provider a maximum of $20,000 for that surgery (The allowed charge) in exchange for including them in the their network and driving Aetna members to them. Aetna's actuaries determine that by charging you cost sharing in the forms of a premium of $200/mo + $5,000 deductible and paying 50% of the cost of the surgery after the deductible, they will turn a profit. So with this Aetna plan, you'll pay at least $17,400 that year in out-of-pocket costs for healthcare ($2,400 in premiums + $5,000 deductibles + (50% of $20,000 surgery)).

Scenario 2: Same doctor charges $50,000 for a hip replacement surgery. This time Cigna negotiates that price down a maximum allowed charge of only $40,000 for that surgery. Cigna's actuaries determine that by charging you a premium of $400/mo + $2,500 deductible + imposes a $500 copayment on the member per surgery, they will turn a profit. So with this Cigna plan, you'll pay around $7,800 that year in out-of-pocket costs for healthcare ($4,800 in premiums + $2,500 deductible, and $500 copayment).

So which plan are you choosing? Hopefully not the one with better allowed charges (negotiated discounts).


35098
As you can see from the diagram, you pay premiums to the insurer and share the cost of the service with the insurer either through copayments or coinsurance. As explained in the scenarios, the insurer (actuaries) are the ones setting the premiums and copayments/coinsurer, not the provider/doctor/supplier. The same is true with public plans like Medicare, except it's the government's actuaries negotiating/establishing the rates with providers rather than private insurers.

And that is why comments like these are simply 100% wrong:

It's logic like yours that has common people in the shithole they are in when it comes to healthcare and healthcare pricing. They think about the "upfront costs" like premium and %, not what influences the pricing to begin with, the allowed charges which is basically the discount the network provides.

Everyone runs to see what their premuim is. Everyone runs to see what their Dr visit is or their % in-network after deductible. All of that is shit if the allowed charges ( again the discount ), is NULL.

To make a very simple analogy, this is like saying, "When going grocery shopping, ignore the 'upfront' costs like the price tag of food and any coupons the grocery store may have given you. What really matters is how much the grocery store is paying the distributors for that food." When you're picking a grocery store to shop at, are you looking at which grocer buys food from distributors at the best rates? Of course not, you're just looking at the upfront cost of food on the shelves because that's what impacts your wallet. If Costco buys chicken at $1.00/lb and sells it to you for $6.00/lb, but Sam's Clubs buys chicken at $2.00/lb and sells it to you for $4.00/lb, where are you shopping?? Sam's Club is fine with making less profit for whatever reason, so you buy their cheap price. You don't care that they paid more for the good.

They are the middlemen, they dictate the price of the goods, therefore you as a consumer take their price into the analysis, not the actual supplier's price. There's a reason everyone runs to see what their copayments and coinsurance is on plans. It's because it's the price tag on the shelf. Just because the masses do something, doesn't mean they're idiots. Sometimes it's because it's the most logical thing to do.

---

If the doctor's office told me the fee is typically $500 for this procedure, and the insurance tells me I will owe $40 ( this was not an office visit ), You telling me I can't figure out the discount when I'm responsible for 20% to make that $40?

20% of the $500 is $100... so there is discount I can calculate to figure out how the insurance got to $40 that I will owe. It's math.

Now let's breakdown why what you're doing here directly contradicts your statement that

"[plan cost-sharing and premiums] is shit if the allowed charges ( again the discount ), is NULL."

You call the doctor's office and obtain the procedure code (CPT code) that they would bill your insurance network for a given procedure, and the doctor says they bill $500 for the procedure. You then call Aetna and they say that for CPT code 012345, you will owe only $40 under their PPO plan after paying your cost-share of 20% coinsurance. And so when you do the math you figure out that the allowed charge for CPT code 012345 by Aetna is $200, where Aetna pays $160 and you pay $40. Cool.

Now you call Cigna. Cigna says that for that same CPT code 012345, you will owe $75 after paying your share of 50% coinsurance. When you do the math, you figure out that Cigna actually negotiated a better discount for CPT code 012345 - they're paying the doctor $150. But they stick you with a 50% cost sharing price-tag, leaving you with $75 in out-of-pocket costs.

You're going with the plan with better negotiated discount? Ok, have fun spending more money.

Plus, you're not even taking into account a multitude of other factors, most importantly plan deductibles. What if an insurer negotiates great discounts but they impose a $10,000 deductible before they cover any bills? Or what if this is a copayment plan, where you pay a flat fee for every service rather than a percentage cost-sharing? Who cares what the allowed charge is when you're paying a flat fee for a service rather than a percentage of the allowed charge. Copayment plans are quite common too (though not so much on the individual market).

So your own example illustrates how insurer cost-sharing and total out-of-pocket costs are the only important factors in your analysis of shopping between plans. Negotiated discounts between providers and insurers do not matter.

Sorry to hear you've been spinning your wheels for nothing for so many years. The best thing you can do is request a Summary of Benefits and Coverage (SBC) for each plan you're interested in purchasing and do an analysis of the cost-sharing taking into account the relationship between premiums, deductibles, cost-sharing, and your overall healthcare coverage needs. This is all that is required of a wise consumer to make good purchasing choices in the health insurance market.

Focus on total plan out-of-pocket costs, not negotiated discounts, when you are shopping for health insurance and basically ignore everything eliquid said and you're solid.
 
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eliquid

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Your ignorance on this topic really makes me wonder what law school you went to. But considering you get paid to push health insurance, I guess I shouldn't expect more from you when it comes to helping consumers save more.

There are plenty of people in this country with similar printed out papers/degrees and hefty debt bills, but that doesn't mean they are smart or experts.

Same with people that work a job for X years. Working a certain job on a topic doesn't make you an expert or smart.

You like to push you're an attorney. So what? I know about 100 attorneys personally that specialize in tax. Some are very good at what they do, some are very bad. All have a degree and have been doing it for X years.

I am not going to trust the bad ones, just cause they say they are an attorney and went to school and did this as a job.

And I for sure wouldn't trust any that start out talking about how ignorant people are, like you have done in this thread within the first few sentences of your post. A complete lack or respect. Just shows how high up on your horse you think you are and how much you think you "need to be right".

I mean you even posted about some bodybuilder and how he has to be right and how you emulate that.

Kinda sad because you can be confident and wrong at the same time. I guess you haven't learned that.

Are you trying to prove to yourself that you are right?

So which plan are you choosing? Hopefully not the one with better allowed charges (negotiated discounts).

All your examples take into account only examples where the allowed charges are low, but out of pocket to consumer high.

Your case also does not take into account where a service may not be paid for by the insurance for X reason, but the network discount still applies.

I never once said the total OOP to the consumer wasn't important. In my examples I broke down the end cost to the consumer. You seem to forget that. ALL OF MY EXAMPLES ACCOUNT FOR THAT. Money in, money out accounts for that final OOP.

You act as though I didn't. As common sense, no one is going to take a plan where they KNOWING pay more in the end. DUH.

-- Key word here is the "KNOWING" part. Most people don't know they are paying more because they don't shop around.

The fact is people typically pick insurance on these things:

  1. Premium cost - what most middle class average Americans look at. They only have so much money each month, most will pick the cheapest plans

  2. Deductible - Read #1

  3. OOP - No matter if this is deductible or co-insurance, Read #1 why.

This is where it generally stops for most Americans and most middle class people. You aren't going to out argue me on this.

Most shop on this alone, because this is all that is offered to them. Day jobs typically have 1 insurance provider and several states on the exchanges only have 1 option/provider as well. Typically there are not multiple choices for the average American so they don't tend to shop around.

They have been trained to just look at the 3 numbers above without actually knowing the final total cost since they can't shop around most times.

But none of those 3 variables matters right, if the allowed costs is 100%. Why pick a plan where the premium is $200 a month, the deductible is $1000 for a single person, and the coinsurance is 20% if there is no discount on the allowed cost?

This plan is only good or bad once you measure the allowed cost discount. At that point you find out WHAT YOUR TRUE OOP IS for the year potentially.

Without it, your sinking in a shit hole. Insurance is about "compensation for specified loss, damage, illness, or death in return for payment of a premium". Great, so how much will the consumer be out for that premium though?

You can't know that without knowing the allowed cost too.

Knowing I owe $200 a month + $1,000 deductible + 20% of XXXX number doesn't mean shit to anyone if they don't know what the base price ( the XXXX number, the allowed charge, the discount ) is.

XXXX could be anything. You can't do math on XXXX guessing game numbers.

You need to know the price. You only know this once you know the allowed charge or how much of a discount you are getting. And there can be better discounts had by shopping around and calling and comparing that to what you pay OOP to see if things make sense for you as a total outcome.

Once you know the allowed charge or discount, then those numbers actually make sense to a person.

When you review your medical history and what kind of procedures you have yearly or expect to, then you can actually crunch numbers yourself by calling the insurance company and ACTUALLY find out if this insurance is right for you financially.

Otherwise you end up like most Americans, in a shit hole based on the same logic you, and attorneys like you, are spewing out.

The simple fact is, no one can know what something cost until they know the true price. Knowing the allowed charge, or network discount ( by calling and asking about X procedures ) is the only way to know the true price. This is how you figure out the cost.

The only time you don't potentially need to know this ( for most Americans ), is if your plan says your routine visit is covered 100% or that your doctor visit to your primary is $30. But that's because your know the final outcome already in both options.

Otherwise, when you are left in a co-insurance situation or pre-deductible situation.. you don't know what it is you are paying because you don't know the allowed charge/discount. This is where you get screwed unless you know the numbers.. which is what I have been advocating here in this thread.

Money in, Money out.

Learn your numbers folks when it comes to what you are paying out and what insurance provides a better discount for your premium, co-insurance, and deductible.

You can't plan for the unexpected though, so plan for what's routine for you and your family and pick the better option for you financially where you can still see the doctors you want.

Don't blindly pay if you don't have to.
 
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eliquid

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You call the doctor's office and obtain the procedure code (CPT code) that they would bill your insurance network for a given procedure, and the doctor says they bill $500 for the procedure. You then call Aetna and they say that for CPT code 012345, you will owe only $40 under their PPO plan after paying your cost-share of 20% coinsurance. And so when you do the math you figure out that the allowed charge for CPT code 012345 by Aetna is $200, where Aetna pays $160 and you pay $40. Cool.

Now you call Cigna. Cigna says that for that same CPT code 012345, you will owe $75 after paying your share of 50% coinsurance. When you do the math, you figure out that Cigna actually negotiated a better discount for CPT code 012345 - they're paying the doctor $150. But they stick you with a 50% cost sharing price-tag, leaving you with $75 in out-of-pocket costs.

You're going with the plan with better negotiated discount? Ok, have fun spending more money.

If you think Im advocating learning the allowed charge/discount, so that you can pay MORE in the end, the final total outcome... You sir are highly ignorant and never once read any of my post in this thread.

Laughable!


Insurers then hire these very smart people called actuaries who crunch numbers and determine how much to charge you, the consumer, for those goods/services through monthly premiums and "cost-sharing" (deductibles, copays, and coinsurance) and still turn a profit.

These people work for the insurance companies. Not the end consumers. These people do not "help" consumers save money, they help insurance companies make money.

Not sure why this is even brought up? These people are not working in the consumers favor. This thread is about helping the end user/consumer... these actuaries do not do that. They get paid to help the insurance company make more money, not help a consumer pick the right plan for them.
 
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levijean

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Easy example:

Two competing insurers have exactly the same premium, costs, & benefits for identical coverage plans. You have surgery to repair a torn muscle. Provider bills $10,000 for the operation. Insurer A allows $7,000 charge for the operation. Insurer B allows $3,000 charge for the operation. Which insurer is better for the consumer? Obviously you will pay less with Insurer B. But how can you know this in advance? It is critical information when shopping for coverage.
 

eliquid

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Easy example:

Two competing insurers have exactly the same premium, costs, & benefits for identical coverage plans. You have surgery to repair a torn muscle. Provider bills $10,000 for the operation. Insurer A allows $7,000 charge for the operation. Insurer B allows $3,000 charge for the operation. Which insurer is better for the consumer? Obviously you will pay less with Insurer B. But how can you know this in advance? It is critical information when shopping for coverage.

Yes

You gotta call the insurance companies and ask.

Tell them you are looking into options for coverage and you are curious. Start with the one you have coverage with now. For me, that would be Humana.

Tell them you use this doctor specifically or this hospital/group. See if they are in the network.

Tell them you need this type of care, or this procedure done, or that you get this type of shot every 3 months.

Then find out what the cost is going to be that you are responsible for.

Write that down.

Call the doctor, find out what it's going to cost for your procedure you need. Granted, something like a surgery is going to be complex. There might be multiple charges coming out of that, that is not just your doctors portion.

This is why I said earlier you won't be able to prepare for the unexpected in this and call on all things all the time. It is also why I said to call about what's routine and what you expect to happen so you can get some info.

For example, my kids get allergy shots all the time. My wife has a special procedure done every year for polyps she has to have done. We always seem to have other particular issues as well that crop up every year or every other year such as my wife seems to get bone spurs in her heels every couple of years.

I don't want to get into medical conditions here, but you see my example right?

You're gonna call on all of that. Not stuff that might be 1 surgeon, an anesthesiologist, supplies, a hospital stay, etc. That's going to be complex for you to figure out maybe ( maybe not, I am not sure what surgery you might be getting and what they do with torn muscles ). But you can call on at least maybe the surgeons price and something else and roughly figure out some of it ahead of time.

If you have talked to your doctor about this and he recommended surgery and you have seen the surgeon, you can call them and their billing staff and find out what the charges would be for your procedure. They cannot give you a 100% answer though, anything could come up in the surgery of course.

But at least you will have an idea to start with and some information to use in your research, right?
 

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AAR2972

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Easy example:

Two competing insurers have exactly the same premium, costs, & benefits for identical coverage plans. You have surgery to repair a torn muscle. Provider bills $10,000 for the operation. Insurer A allows $7,000 charge for the operation. Insurer B allows $3,000 charge for the operation. Which insurer is better for the consumer? Obviously you will pay less with Insurer B. But how can you know this in advance? It is critical information when shopping for coverage.

Thank you for making a helpful comment that actually furthers the discussion. Let's break this one down.

You do not obviously pay less with insurer B. If we're assuming these are coinsurance plans where you share a portion of the allowed charge, then yes, potentially. If these are copayment plan designs, then allowed charge isn't even a consideration. But yes, you're correct. When you remove every other variable that is relevant to a consumer when shopping for health insurance, the last variable to worry about is the allowed charge.

However once again, the point of this entire discussion, and how this entire argument with eliquid started in the first place is because I bothered to correct these brain-dead statements:

It's logic like yours that has common people in the shithole they are in when it comes to healthcare and healthcare pricing. They think about the "upfront costs" like premium and %, not what influences the pricing to begin with, the allowed charges which is basically the discount the network provides.
Everyone runs to see what their premuim is. Everyone runs to see what their Dr visit is or their % in-network after deductible. All of that is shit if the allowed charges ( again the discount ), is NULL.


It really should be the reverse. It should be, "Dumb people who are confused and pretend to know what they are talking about focus on the allowed charge (negotiated discount) when shopping. The allowed charge is totally irrelevant when premiums, deductibles, and coinsurance/copayments are shit."

Again, yes, you remove the most important variables, and then maybe allowed charge becomes relevant. This thread is about helping people choose the best health insurance options. Do not focus on things that don't matter and are ultimately out of your control anyways.

You're also correct that you cannot know this information in advance, or really at any time at all. This information is most of the time protected as proprietary. It was just last year that the Trump Admin issued an Executive Order requiring hospitals to disclose their "charge master" list of prices that they bill. It's 2019. There is little to no cost price transparency in the healthcare market. This is a big consumer problem and everyone in the industry knows it. This is why you cannot actually do what the idiot arguing with me is telling you to do.

Now Medicare sets a master fee schedule of rates that insurance companies as a baseline in determine allowed charges. You could think of this as the baseline for where healthcare pricing starts. However, it means nothing for consumers. For example, Medicare has an allowed charge of something like $150 per ambulance ride. However for that same exact ambulance ride, an Aetna plan might reimburse $2,000 and Cigna reimburses $3,000. And yes, the price disparities between public and private insurance are indeed that significant. This is why there's really no such thing as "price" in the healthcare market. Insurers distort the real price of healthcare.

And I just thought of something that would prove everything he said wrong: Medicare negotiates BY FAR the lowest allowed charges with providers compared to any private health insurance plan. So eliquid's logic, wouldn't that mean Medicare is superior and more cost-effective to consumers than any private plan? It's not. Not even close. Most people have to supplement their Medicare coverage because they have too many out-of-pocket costs due to Medicare's cost sharing requirements. If we go by eliquid's logic, Medicare is the most cost-effective source of coverage for consumers in the country. But it absolutely is not.
 

AAR2972

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Kinda sad because you can be confident and wrong at the same time. I guess you haven't learned that.

Oh the irony.

Out of all the diarrhea that you just spewed in your response, the one thing you didn't do is address your braindead comments that started this entire discussion and my carefully explained retorts of them.

It's logic like yours that has common people in the shithole they are in when it comes to healthcare and healthcare pricing. They think about the "upfront costs" like premium and %, not what influences the pricing to begin with, the allowed charges which is basically the discount the network provides.
Everyone runs to see what their premuim is. Everyone runs to see what their Dr visit is or their % in-network after deductible. All of that is shit if the allowed charges ( again the discount ), is NULL.

You just dribble more garbage, presenting it as fact, and confusing the shit out of people. I think at this point, most people can read this thread and make a determination at who is actually providing helpful and well-reasoned information. Half of everything you wrote doesn't even make sense because your writing sucks anyways. Even if you were correct on a point, you don't know how to articulate it. But you're 100% wrong on all your points. If you were right about anything, I'd admit it. I'd swallow my ego. But you're not, and worst of all, you're delusional so you'll never admit that you are wholly ignorant.

Your ignorance on this topic really makes me wonder what law school you went to. But considering you get paid to push health insurance, I guess I shouldn't expect more from you when it comes to helping consumers save more.

This statement alone tells me you have pea brain. You don't even know what you I do for work and you assume that I "push health insurance". Lol. I began my career working for a non-profit organization representing consumers in court when they appealed their health claims and I advised them on the very issues we are discussing today. My current role is also still consumer facing. I did at one point work for a major health insurance company, and that only served to round out my knowledge further on how the industry truly operates.

Same with people that work a job for X years. Working a certain job on a topic doesn't make you an expert or smart.

Man, you really have a lukewarm IQ. No shit that working on a topic doesn't automatically make you an expert or smart, but generally you will know more about that topic than the average person. While there are some tax attorneys who somehow slide by on being bad at their jobs, I guarantee you most seasoned/senior tax attorneys know far more about the tax code than you do. But, knowing you, you probably ignore their advice, mock their profession, call them pompous, and say "iT's JuST mOnEY iN mOnEY OUt, iT's SOO siMplE DUHHH."

I never brought up that I was an attorney in this thread when giving advice. When I was speaking to normal, non-deranged people, I called myself a "health insurance expert" specifically to not draw ire from anti-intellectual "pragmatists" like you who need to simplify life to appease their limited brain capacity.

I only presented my credentials when YOU presented yourself as an expert because "you shop for health insurance and uh like worked at a health care company one time." This is literally the one thing I'm an expert in and spend most of my time learning and advising on. I would not be arguing this adamantly and calling you an idiot on issues like cars, or stocks, or tech, or whatever other topic I don't literally spend 90% of my day focusing on. But you, who shops for coverage to treat his fat wife's bone spurs (tip: it's cheaper to just lose weight. calories in, calories out) and can't explain a concept to save his life, yea, people should listen to you.

Are you trying to prove to yourself that you are right?

No, this is a forum, and this thread will potentially be read by many people looking for reliable information from experts. I'm trying to prove that you're an idiot and no one should listen to anything you've written so they don't waste their time taking your advice. I really wish there was another expert on health insurance in this thread so they could back me up and attest to how void of fact your responses are. I'm trying to set the record straight and prevent people from coming on this thread and getting confused because you came in and muddied the facts for everyone, and then turned around and called me an idiot saying I don't know what I'm talking about. Unreal.

So how about I just post external sources to directly refute your points instead of spinning my wheels and arguing with someone with the deductive skills of a toddler. This one's from the Harvard Business Journal, but let me guess, the professor of medicine at Harvard who wrote this article just has some dumb fancy degree and probably has no idea what he's talking about. You should probably take his job actually. You should take my job.


"President Trump has instructed federal agencies to use their authority (established in part under provisions of the Affordable Care Act, which the administration regards as unconstitutional) to develop federal rules requiring disclosure of hospital prices in consumer-friendly, electronic form. This would include not just the list prices that hospitals purport to charge but the actual, negotiated, discounted prices that hospitals agree upon with insurers. These negotiated fees have been treated in the past as tightly guarded trade secrets by hospitals and health plans."

So tell us again, wise one, how you are able to obtain these prices? Oh you just call up the health insurance company and they tell you the proprietary information? Oh wait no, you first have to do "simple math" and to easily figure out their proprietary information. You delude yourself into thinking you're some type of savvy consumer, but you're actually doing what everyone else to shop, with the added benefit of wasting way more time than the average person. Congrats, you are a fool.

"And finally, the distorting influence of insurance arises. Price isn’t very important for patients whose costs are covered by insurance. To be sure, deductibles sensitize people to prices (with the downside that they discourage the use of essential as well as inessential care). But 5% of Americans account for 50% of health care spending, and they regularly blow through their deductibles. Once they do, price ceases to be an important influence on their decisions."

There's my mic drop. I don't have anything further to add at this point. That should put you in your place. But, I still fully expect you to find a way to undermine this information as well and crown yourself the expert. I would be shocked if you actually admitted you were wrong and admitted that you, as an average consumer (and clearly below average IQ) are misunderstood.

But at this point, we have jury in the audience of this forum. They can decide for themselves which content to heed. I also encourage anyone who is confused to print/email this thread to a health industry expert (preferably a doctor who understands insurance and billing) and review this information with them.
 
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AAR2972

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And just for the record, this asshat went into his past responses and removed comments like this to make it seem like I was being the a**hole this entire time:
As someone that has been buying insurance for years and paying out of my pocket, I know this as a fact.

But thanks though.
Present yourself as an expert and present falsities as facts, then prepared to get shot down. It was only after this comment that I revealed my credentials.
 
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eliquid

( Jason Brown )
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And just for the record, this asshat went into his past responses and removed comments like this to make it seem like I was being the a**hole this entire time:

Present yourself as an expert and present falsities as facts, then prepared to get shot down. It was only after this comment that I revealed my credentials.

Listen dumb a$$ - didn't get enough attention from mommy when you were 6 so you take it out here on the forum...

I removed that comment before you even posted.

You happened to read it before I edited, but posted after I edited.

Look at the time stamps idiot. See why I know you don't know what you're talking about?

My post with timestamp:
35135

Your post where that comment is included:
35134


I removed it not to make you look like an asshat, I removed it before you even COMMENTED idiot to not push this thread into what it is now. YOU made yourself look like an asshat, clown.

Jeez your a moron.

It's people like you that cause others to not even want to visit this forum anymore.

Money in and Money out. You can't change that. ALL OF MY EXAMPLES go into how to get the cheapest total price at the end.

You can't seem to get that in your head, because that big a$$ degree and ego got in the way like you got some big swinging dick to show off.

You're just trying to prove to yourself you're right by posting over and over again.

Learn it.
 
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