Thoughts on Insurance

There was a forum question re; doctors "scamming" patients which got me thinking.

I have a commercial insurance background and stay on top of my medical insurance claims as I've had a number of denials over the years which were actually mistakes on the part of the carrier's claims adjustor.

Sadly, turnover in insurance companies is high. Burnout especially in the claims area is understandable due to the stress. Often the people hired have minimal experience in the field and no medical background. It really is in your best interest to know your policy and ask questions.

I don't think the United States needs universal health care, but we sure do need reform and oversight. Here are some great example from my own claims generating from the pre-surgical process:

*Basic Bloodwork

$832(Billed to BCBS); $104 (BCBS - Allowed)

- Required although I'd just had bi-annual labs with my primary two months prior.

*Medifast Nurse (15mins)

$82.22(Billed to BCBS); $22.93 (BCBS - Allowed)

- Didn't even include the Medifast product

*Pulmonologist (30 mins)

$263 (Billed to BCBS); $134(BCBS - Allowed)

- Wow; he asked the same questions already asked by another dept at the same facility and available online. Listened to my heart and lungs and told me that despite no flags for sleep apnea I had to go to sleep lab and have another "pre-surgical" appt with him.

This is why I love the Mayo Clinic. Their doctors are salaried and while their services are not cheap, they test because it's necessary not to gin up charges.