Just received my bill for my overnight sleep test

NateS wrote:Medicare is much more sensible - the medical providers know in advance what they are going to get paid, and when they submit that bill and get paid by Medicare they are prohibited from billing you the balance.
Regards, Nate

That is EXACTLY how my BC/BS PPO operated.
And, their reimbursement rates were lower (MUCH LOWER in some cases) than those allowed by Medicare. Yes, they were brutal.

Now that I am on Medicare, they don't really care how much more Medicare pays for things since they only have to pay my 20%.

The ONLY way the health system will ever get sorted out is when all the elected officials in Washington have to be under the same health plan as the people they represent. As long as Congress and other people in the Federal Government have their own sweetheart health plan, they could care less about the rest of us.

zorki1c wrote:The ONLY way the health system will ever get sorted out is when all the elected officials in Washington have to be under the same health plan as the people they represent. As long as Congress and other people in the Federal Government have their own sweetheart health plan, they could care less about the rest of us.

I'm guessing you're expressing that view based on what you have read and heard, mostly by forwarded emails sent by those with a political agenda.

The Federal Employees Health Benefit programs are good, no doubt about it. But, they are not sweetheart deals. Some corporations offer more generous plans. The part of the premium that Uncle pays is substantial, but on the whole not all that much greater, and often less, than corporations pay. My prescription copays are much higher than many corporate employees and retirees. Between me and Uncle my med ins premium is around $1400/month for me and my wife. My share is $430/mo. Plus I pay $96/mo for Medicare Part B. Fed retirees get no break on the FEHB premium even though the ins co pays out a lot less after we go on Medicare. I guess that is built into the prices they negotiate with Uncle every year. Members of Congress and their staff are enrolled in the FEHB along with nearly all other Fed employees. Recently, on this forum, a member whose hubby buys insurance as a small business operator, complained about their premiums. The total was less than my policy's total cost, and Uncle is a huge negotiator and buyer!

The people who are most hurt by the current system are those who pay individually or are part of a small company plan.

Sir NoddinOff wrote:

djhall wrote:The current system is designed to prevent anyone from knowing or comparing prices in order to obtain maximum value for their healthcare dollars. The doctors don't know what anything really costs, and if you track down the billing folks and get the listed price it doesn't mean anything anyway since no one pays that price. If you are insured there a secretive contract price agreed upon between your insurance company and the provider, but that varies by provider and even by plan so no one want's to disclose exactly how much they agreed to accept or pay in case that gets used against them in other negotiations. If you aren't insured then you get some other pricing worked out between you and the hospital based upon your individual situation which makes comparing private pay bottom line prices between individuals meaningless and between providers incredibly difficult. You couldn't design a system to be less friendly cost containment efforts.

I'm thinking djhall is a whistle-blower... how'd you get to know so much about the system, unless you're an 'insider'??? Tell us some more dirty little secrets

Well, I've been an uninsured private-pay consumer for 15 years, I was an agent for one of the big "blue" insurers, my ex worked in medical billing for a large medical chain, and my girlfriend works for one of the big "blue" insurance companies negotiating disputes in coverage and reimbursement rates when a medical provider from her state files a claim against a policy issued from another state (each state is technically a different insurance company under a nationwide parent). As a result I get a lot of exposure to the topic from all different sides.

I pretty much only get to complain about the problems of being uninsured online anymore. Since my girlfriend works for a major insurer and has great employer based coverage, any reference to the plight of the uninsured usually results in an invitation to get down on one knee and pop the question, "Will you insure me?"

zorki1c wrote:The ONLY way the health system will ever get sorted out is when all the elected officials in Washington have to be under the same health plan as the people they represent. As long as Congress and other people in the Federal Government have their own sweetheart health plan, they could care less about the rest of us.

I think that the only people who have a sweetheart health plan, and this can be debated a LOT, is people who are in the Military. Now, we still have things we do have to pay for when it comes to our families, but I have never paid, but then again, with what I do and put up with, I think that is fair.

Here soon I'll be feeling the pain that you all feel when I retire.

Just my two cents.

idamtnboy wrote:

zorki1c wrote:The ONLY way the health system will ever get sorted out is when all the elected officials in Washington have to be under the same health plan as the people they represent. As long as Congress and other people in the Federal Government have their own sweetheart health plan, they could care less about the rest of us.

I'm guessing you're expressing that view based on what you have read and heard, mostly by forwarded emails sent by those with a political agenda.

The Federal Employees Health Benefit programs are good, no doubt about it. But, they are not sweetheart deals. Some corporations offer more generous plans. The part of the premium that Uncle pays is substantial, but on the whole not all that much greater, and often less, than corporations pay. My prescription copays are much higher than many corporate employees and retirees. Between me and Uncle my med ins premium is around $1400/month for me and my wife. My share is $430/mo. Plus I pay $96/mo for Medicare Part B. Fed retirees get no break on the FEHB premium even though the ins co pays out a lot less after we go on Medicare. I guess that is built into the prices they negotiate with Uncle every year. Members of Congress and their staff are enrolled in the FEHB along with nearly all other Fed employees. Recently, on this forum, a member whose hubby buys insurance as a small business operator, complained about their premiums. The total was less than my policy's total cost, and Uncle is a huge negotiator and buyer!

The people who are most hurt by the current system are those who pay individually or are part of a small company plan.

My comment is aimed more at members of Congress who have great health coverage, not to mention retirement benefits enjoyed by few every day workers. I believe they would be more careful on their decisions in those areas if it effected them. Plus you mention plans offered by "some" corporations. Few people working for small companies have the kind of benefits corporate people have --if they have any health benefits at all. And the new law seems to be encouraging employers to drop coverage and make employees get their own benefits. I haven't heard of that happening with government employees. As for my view being based on emails from "those with political agendas" -- well I guess some of us just aren't smart enough to form our own opinions.

zorki1c wrote:My comment is aimed more at members of Congress who have great health coverage, not to mention retirement benefits enjoyed by few every day workers.

Looks like I missed making a vital point clear. The Members of Congress have the same health insurance program all Federal Employees have. The numbers I cite above apply to them. They do not have their own privileged care system, with one exception.

They (but not their families) are eligible to receive limited medical services from the Office of the Attending Physician of the U.S. Capitol, after payment of an annual fee ($491 in 2007). But services don’t include surgery, dental care or eyeglasses, and any prescriptions must be filled at the member’s expense.

House and Senate members (but not their families) also are eligible to receive care at military hospitals. For outpatient care, there is no charge at the Washington, D.C., area hospitals (Walter Reed Army Medical Center and National Naval Medical Center). Inpatient care is billed at rates set by the Department of Defense.

http://www.factcheck.org/2009/08/health ... -congress/

Depending on who you talk to, access to Military Hospital care may or may not be an enviable benefit.

Also, their retirement program is the same as all Federal employees, good but not overly generous. There's no such thing as full pay after one term of service.

There have been many emails floating around about how members of Congress have grandiose health and retirement benefits. They are not correct. Your original comment appears to reflect some of those false claims.

drj130 wrote:

zorki1c wrote:The ONLY way the health system will ever get sorted out is when all the elected officials in Washington have to be under the same health plan as the people they represent. As long as Congress and other people in the Federal Government have their own sweetheart health plan, they could care less about the rest of us.

I think that the only people who have a sweetheart health plan, and this can be debated a LOT, is people who are in the Military. Now, we still have things we do have to pay for when it comes to our families, but I have never paid, but then again, with what I do and put up with, I think that is fair.

Here soon I'll be feeling the pain that you all feel when I retire.

Just my two cents.

I wonder what you think of the quality of military medical care? Can you fill us in on that?

johnthomasmacdonald wrote:JfK medical center for the one night Billed $8,138

My insurance company paid $2,348.53 ( i wonder where they come up with the 53 cents? )

The hospital writes off $5,759.47 as a REWARD for having insurance

Leaving me with a copay of $30

Do people really think that this system makes any sense and that people who can't afford insurance should pay more than TRIPLE what people with insurance pay ( co-pay plus insurance company)

At those prices I would expect them to be able to resurrect JFK too.Jim

Papit wrote:I wonder what you think of the quality of military medical care? Can you fill us in on that?

Just like any health care, it can be good and bad. Sometimes the hoops that I have to go through to get something corrected. A good example of this is an eye exam I had last year. Or rather getting my new glasses. It took 4 tries before they finally got my order correct. Now I'm don't know how much it costs for them to make my glasses, but we're talking 4 tries with 2 pair each try. I'm sure that the Lions Club will love me when I pay them a visit with all these glasses I can't wear.

Trying to get supplies for my APAP (filers, hoses, masks, etc) is a nightmare and a half. I can't even get setup on a recurring schedule like most of you all can. My newest mask (Wisp) and some other items, I had to pay for out of my own pocket. To get new stuff, I have to see my PA, he has to write a new script and put in a referral, then I have to go and see another person so they can ensure that TRICARE has the information, call TRICARE and explain why I want to use someone in the states (who can get me the supplies in a week by mail) than the local DME (who takes about 2-3 weeks to bring me the supplies).

When I retire, I'll have to deal with the VA on this and I've no idea how that will work, but I bet it will be another nightmare as well.

I'm not even going to go into how hard it is for me to get an MRI done. lol

Like I said earlier, it can be good, or it can be bad.