Doctor stops accepting insurance, lowers prices and posts costs online

diehardbiker said:
No no, for example, if you are in car accident and injured in accident, your health insurance have right to refuse cover you, you have to go though car insurance to get covered.
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no. it doesn't work like that. that would be illegal to refuse to cover you if you have paid for the coverage. they did not cover you because they must have found something in fineprint paperworks that get them off the hook. or maybe they found something so far-fetched and took a risk to deny the coverage because most people give up in lawsuits or not bother suing them since they're most likely financially drained. very very very sleezy of them.

diehardbiker said:
If you had accident at home and broke your leg from falling on stairs, sometimes health insurance can refuse cover you.
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technically - it's because they found a legal reason (or loophole) to not cover you... even far-fetched one.

diehardbiker said:
You had no clue what I am going though at this time and see what kind of mess it has causing.

How many times have you seen sign in your doctor office that asked you to please report the injury that was caused by car accident or workplace injury? Once you report it, doctor will freak out and will back off, and asked you to see another doctor not them. That already happened to me.
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yep that happens all the time.

insurance companies hire a department of lawyers and "quibbling" experts to analyze fineprint clauses in contracts and paperworks and also to obfuscate the patients' claims to avoid paying for it.
 
I like this doctor! Now, if he moves into bartering, too, I am so there! Moving to Maine!! :lol:
 
I wish I can share my experience, you have no idea or clue what I am going though. Its battle between my health insurance and other insurance company over who pays what.

Reason why I can't share is that it is both business and personal confidential.

I can't continue argue because I have enough shit on my hand and I have been though HELL than you could image, there are other ADers here that are going though same shit. We have talked lately and we can't believe how the system runs. You will not know until it happens to you.

Jiro said:
no. it doesn't work like that. that would be illegal to refuse to cover you if you have paid for the coverage. they did not cover you because they must have found something in fineprint paperworks that get them off the hook. or maybe they found something so far-fetched and took a risk to deny the coverage because most people give up in lawsuits or not bother suing them since they're most likely financially drained. very very very sleezy of them.


technically - it's because they found a legal reason (or loophole) to not cover you... even far-fetched one.


yep that happens all the time.

insurance companies hire a department of lawyers and "quibbling" experts to analyze fineprint clauses in contracts and paperworks and also to obfuscate the patients' claims to avoid paying for it.
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diehardbiker said:
I wish I can share my experience, you have no idea or clue what I am going though. Its battle between my health insurance and other insurance company over who pays what.

Reason why I can't share is that it is both business and personal confidential.

I can't continue argue because I have enough shit on my hand and I have been though HELL than you could image, there are other ADers here that are going though same shit. We have talked lately and we can't believe how the system runs. You will not know until it happens to you.
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right... you just proved my point. it's because they found a legal reason (or loophole) to not cover you... even far-fetched one because they rather risk a lawsuit by quibbling around because statistically - they make more than they lose money this way since many people tend to give up. when it comes to insurance lawsuit... it's typically 2-5 years.

if you won, then you're just one of the few people who actually stay on thru entire lengthy legal battle from start to end and that's the risk that most insurance companies would gladly take. just a small loss for them...... until they face with one costly disastrous lawsuit that would bankrupt them.
 
The chances are I will win the case. You see, this is wasting the system money, and costing everybody's money. My case isn't cheap, those who are living in New York state is paying for my legal matters. I have not paid a cent. It is not legal reason that they need to be found, it is WHO have to cover the injury I have. Like I just explained to you, personal health insurance does not always cover any accident related injury, even some disease as well,

For example, many of them who got injury in car accident try to avoid using their auto insurance coverage and use health insurance instead. Why? To prevent having their car insurance rate going up. Once one claims medical coverage though car insurance, then within 6 months their insurance will go up, period.

This is not about loophole (RME). And there is NOT one insurance carriers, there are thousands of carrier and they cover for various matters.

If it were not for stupid autonomous system, and streamline everything into one. That way, it will save legal cost, and attorney won't be happy and I will be done with treatment 3 years ago, but I haven't got much treatment yet.

It can happen to anyone, and I advise you to pray that whatever happened to me won't happen to you. BUT if it happens to you, your perspective will change big time.

Jiro said:
right... you just proved my point. it's they found a legal reason (or loophole) to not cover you... even far-fetched one because they rather risk a lawsuit by quibbling around because statistically - they make more than they lose money this way since many people tend to give up.

if you won, then you're just one of the few people who actually go thru lengthy legal battle and that's the risk that most insurance companies would gladly take. just a small loss for them...... until they face with one costly disastrous lawsuit that would bankrupt them.
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Jiro said:
no. it doesn't work like that. that would be illegal to refuse to cover you if you have paid for the coverage. they did not cover you because they must have found something in fineprint paperworks that get them off the hook. or maybe they found something so far-fetched and took a risk to deny the coverage because most people give up in lawsuits or not bother suing them since they're most likely financially drained. very very very sleezy
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Actually, no, he is correct. Health insurance is the last payer for injuries by accident. Health insurance will force you to claim the injuries on auto insurance first. After that health insurance may or may not cover the injuries after that. It depends on the coverage that you have. Works this way with almost any accident. If you fall down the stairs at home, often health insurance will deny the claim until a homeowners claim has been filed.

If you are a contractor working on a home. You will have to file a claim with business insurance and the customers homeowners policy before health insurance will cover it.

It can be a big mess.

*This may vary greatly by state.
 
TXgolfer said:
Actually, no, he is correct. Health insurance is the last payer for injuries by accident. Health insurance will force you to claim the injuries on auto insurance first. After that health insurance may or may not cover the injuries after that. It depends on the coverage that you have. Works this way with almost any accident. If you fall down the stairs at home, often health insurance will deny the claim until a homeowners claim has been filed.

If you are a contractor working on a home. You will have to file a claim with business insurance and the customers homeowners policy before health insurance will cover it.

It can be a big mess.

*This may vary greatly by state.
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you just proved my point. they are not denying him a coverage just because they don't want to. it's because there is a quagmire of policies, laws, and fineprints involved that enable them to get off the hook.
 
Exactly! That is what I am into right now. I wish I can share but problem is medical confidential where I don't want to share, and who is responsibility party involved. They want this case to remain confidential so I respect them. Also, this case is still ongoing. Hopefully soon there will be closing the case.

TXgolfer said:
Actually, no, he is correct. Health insurance is the last payer for injuries by accident. Health insurance will force you to claim the injuries on auto insurance first. After that health insurance may or may not cover the injuries after that. It depends on the coverage that you have. Works this way with almost any accident. If you fall down the stairs at home, often health insurance will deny the claim until a homeowners claim has been filed.

If you are a contractor working on a home. You will have to file a claim with business insurance and the customers homeowners policy before health insurance will cover it.

It can be a big mess.

*This may vary greatly by state.
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And this scares doctors away, and is costing us MONEY in long run.

Jiro said:
you just proved my point. they are not denying him a coverage just because they don't want to. it's because there is a quagmire of policies, laws, and fineprints involved that enable them to get off the hook.
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Jiro said:
you just proved my point. they are not denying him a coverage just because they don't want to. it's because there is a quagmire of policies, laws, and fineprints involved that enable them to get off the hook.
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It's not really "fine print" though. Tat is how insurance works.
 
Wirelessly posted

TXgolfer said:
Jiro said:
no. it doesn't work like that. that would be illegal to refuse to cover you if you have paid for the coverage. they did not cover you because they must have found something in fineprint paperworks that get them off the hook. or maybe they found something so far-fetched and took a risk to deny the coverage because most people give up in lawsuits or not bother suing them since they're most likely financially drained. very very very sleezy
Click to expand...

Actually, no, he is correct. Health insurance is the last payer for injuries by accident. Health insurance will force you to claim the injuries on auto insurance first. After that health insurance may or may not cover the injuries after that. It depends on the coverage that you have. Works this way with almost any accident. If you fall down the stairs at home, often health insurance will deny the claim until a homeowners claim has been filed.

If you are a contractor working on a home. You will have to file a claim with business insurance and the customers homeowners policy before health insurance will cover it.

It can be a big mess.

*This may vary greatly by state.
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Correct. Same as the pharmacy. It is called COB coordenation of billing. The insurance companies are now linked in the system. For an example. A patient wants us to bill medicaid. It declines because the system will pick up that the patient has another insurance policy. We have to bill the primary before we can bill any others. Usually car insurance, we cash it out and the patient has to take it to their insurance company and get reimburst for it.
 
Do you realize that almost all insurance carriers requires doctors to file claim within 90 days or lose the money. If they fail to do so, they can not go back to patient and hey, I want my fees please. It is not going to happen.

And if you see doctor, and doctor reports to your health care within 90 days, and if your health care insurance found out you fell from your tree in your backyard, they will deny the coverage, and you realize that and have to have that doctor contact your homeowners insurance agency, by that time it may be already past 90 days, too late to file claim. It is hurting the doctors directly financially.
 
I read the absolute best article ever on what is wrong health insurance. I'll post it. It's a long read, but it's great read it all the way to the end! I hve no idea if his plan would be feasible to implement and it would take a very long time to phase things out, but I think it's brilliant.

Anyway, I haven't had insurance in forever, a doctors visit for say and ear infection usually costs me $57, that went up last year though I think, I think my visit in the fall for an upper respiratory infection was 70 something. But you can get antibiotic prescriptions at Walmart for $4, my husband was getting prozac at Walmart for $4, I've had insurance companies that made you pay a copay for precriptions and it was more than that.

I think an even better idea for him is something that is mentioned in the article, and I believe he says there are places in California? that do it. He could charge a monthly membership, and it would be less than the $75 office visit, and you could go see the doc whenever and not pay, you pay with your monthly membership.

Here the link How American Health Care Killed My Father - David Goldhill - The Atlantic
 
diehardbiker said:
And this scares doctors away, and is costing us MONEY in long run.
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hmm... well it's certainly not scaring my friends away for sure. and yes it's costing us money and it's costing them profits :lol:
 
diehardbiker said:
Exactly! That is what I am into right now. I wish I can share but problem is medical confidential where I don't want to share, and who is responsibility party involved. They want this case to remain confidential so I respect them. Also, this case is still ongoing. Hopefully soon there will be closing the case.
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they "want"? you mean.... they had you sign the confidentiality agreement?
 
Jiro said:
same thing.
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Perhaps in your way of thinking. :dunno: Most people consider "fine print" as something that is shady or intended to mislead. I this case is strictly SOP for the insurance biz.
 
TXgolfer said:
Perhaps in your way of thinking. :dunno: Most people consider "fine print" as something that is shady or intended to mislead. I this case is strictly SOP for the insurance biz.
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intended to mislead? that would be illegal.

the contracts you sign with insurance company is full of..... ? it's certainly not a "few pages" with font size 12.
 
You have no clue, and Im keeping that way. Sorry. Someday, if it hits you, don't come to me and said, hey buddy, you were right all along.

I suggest you read that paragraph right before the last paragraph in the link that Ambrosia just posted.

I rest my case, Have a great day.
 
Insurance is a complete racket!!! The premiums are ridiculous. The last time we had it I figured it out, for what we paid in premiums every month, one family member could go to the doctor, get a $4 prescription every single week of the year, pay out of pocket and it would cost less than the premiums, you could even through in a $1200 ER visit and it would still be less.

2 weeks before that insurance kicked in I had to take my son to the ER for an allergic reaction, and I had been moaning about whay couldn't this happen a couple weeks later when the insurance kicked in, but it wouldn't have mattered really. There was, I forget 1K or 1500 a year deductible, the bill was for $1200. We'd have had to pay a $100 copay (going towards the deductible) but we'd still have had to pay the whole bill ourselves anyway to meet the deductible. And we were paying $500 a month for this why???? Seriously Health Insurance is just stupid.
 
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