Insurance companies are the scourge of healthcare but they've got so much more money than the doctors to dumb into lobbying that they are golden in DC. See how they controlled the narrative of "surprise billing" instead of the reality which is a surprise lack of coverage.

unmade bed said:

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Not really health insurance companies' fault. They are doing exactly what they are created to do return profits for their owners. The issue is with the 3rd party payer system as a whole.

Not really a government issue either (other than the fact that govt is one of the largest 3rd party payers), except for when government tries to step in and "fix" the issues caused by the 3rd party payer system (which inevitably just makes the issues worse).

Third party payer system is wholly incompatible with reasonably priced efficient health care. Change my mind.

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This is only true if you let insurance companies off the hook for buying off politicians and bureaucrats, and you let government off the hook for taking insurance money and bending over.

What came first, overcharging for services to insurance by providers (hospital, pharmacy, Lab, physicians etc) or denials by insurance?

WHY does a screening colonoscopy get converted to a diagnostic colonoscopy just because they found a polyp? So because they found something, and there was no reason to believe they would or wouldn't, the entire procedure gets billed as diagnostic and is subject to the deductible rather than being covered 100%? So scammy! They should only charge the patient for cutting the thing out and analyzing. The procedure is otherwise same. Recovery is the most expensive part.

AggieDruggist89 said:

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What came first, overcharging for services to insurance by providers (hospital, pharmacy, Lab, physicians etc) or denials by insurance?

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Overcharging for services has become survival. If services are charged at reasonable rates, the insurance companies would still pay from 5-50% so to survive, some services have to overcharge causing uninformed patients to be irate.

Pt = "It costs 2K just to do do an CT? How outrageous"

Reality = Insurance just paid $100 for the CT with $50 going to the radiologist to read. $50 for the machine, tech, facility

Insurance, like taxes, needs to be simplified and reformed completely.

Medaggie said:

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AggieDruggist89 said:

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What came first, overcharging for services to insurance by providers (hospital, pharmacy, Lab, physicians etc) or denials by insurance?

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Overcharging for services has become survival. If services are charged at reasonable rates, the insurance companies would still pay from 5-50% so to survive, some services have to overcharge causing uninformed patients to be irate.

Pt = "It costs 2K just to do do an CT? How outrageous"

Reality = Insurance just paid $100 for the CT with $50 going to the radiologist to read. $50 for the machine, tech, facility

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Of course, that's today, 100%

And today's practice in my opinion is a result of evolution due to culmination of greed on both sides. I think we arrived at today's practice together as payer and provider tried to get a step ahead of each other.

DRG was an attempt by cms to hold Healthcare orgs fiscally accountable.

Medaggie said:

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AggieDruggist89 said:

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What came first, overcharging for services to insurance by providers (hospital, pharmacy, Lab, physicians etc) or denials by insurance?

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Overcharging for services has become survival. If services are charged at reasonable rates, the insurance companies would still pay from 5-50% so to survive, some services have to overcharge causing uninformed patients to be irate.

Pt = "It costs 2K just to do do an CT? How outrageous"

Reality = Insurance just paid $100 for the CT with $50 going to the radiologist to read. $50 for the machine, tech, facility

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When insurance companies are making billions of dollars, AFTER all the things they pay for, "survival" isn't quite the word I'd use for them. And, yes, they were making profits and denying much-needed claims long before Obama became president.

He meant survival for the providers not payers.