Silly insurance rule

[gnappi]

My GF hurt her knee and the problem with pain and swelling did not go away after 10 days or so and went to her doctor. He did an X-ray and ordered a knee brace for her. OK so far...

She went to a med supply place and they said that the insurance would not cover the $200 brace all or in part. When she called the insurance company they said the knee brace will be fully covered IF she got an MRI of the knee.

Now I'm not the most mathematically astute person but it seems like the cost of a knee brace is Faarrr less expensive than an MRI AND covering the knee brace which would set the insurance company back quite a bit.

From the web... "The average cost of an MRI in the United States is about $1,325, but prices can range from $400 to $12,000 depending on factors like the body part being scanned"

So, I'm guessing this what seems like sheer stupidity comes from wanting to bilk Medicare for more than the cost of a simple leg brace.

DOGE WHERE ARE YOU???

 

[Jeepnik]

I have excellent medical insurance. Every month I get statements that detail the cost of services. On a doctors visit I see several columns
First is what the provider charged insurance. Next is what insurance paid (there is usually a huge difference) and finally what I paid ($15 copayment).

Now I'm bright enough to realize you can sell your services for less that 50% of their cost and stay in business very long.

In short medical billing is one of the biggest scams, actually outright fraud, perpetrated today. And the government is complicit. Particularly the IRS and Medicare.

An example of how it works is this. The service actually costs the provider $50. He bills insurance $150. The insurance pays $100. The provider makes $50 and has a $50 loss for a tax right off.

 

[roylt]

Most insurance is a scam.

I was charged 90 dollars for less than an ounce of saline solution. I tried to fight it but it was the "negotiated price" between the insurance company and the hospital. BS.

You could look for a used brace. People use them a short time and discard or donate typically.

 

[redhawker]

Yeah, sometimes makes you wonder. I'm going in for a procedure for my back pain soon. The simple explanation of what they're going to do is to go in my back with a hot needle and burn the nerves that are causing the pain. Now, before the insurance would approve this, I had to go through what is basically the same procedure, twice, at least a month apart, as a "test" to see if this would work. The "test" procedure is basically doing the same thing, except instead of the doctor burning the nerves, he shoots them up with some lidocaine to see if it helps the pain. This lasts a couple of hours, as lidocaine, as you probably know, is the stuff they use to numb your mouth for dental work. The thing is, I can't see how going in my back with a needle and shooting me with lidocaine is much different, expense-wise, than doing the same thing with the hot needle. Therefore, the insurance is covering three procedures instead of one. The fun part is, if they'd done the "real" procedure the first time, I'd have been without (or at least reduced) pain 3 months ago.

 

[peachhead]

MRIs, I have discovered, are part of my deductible. As in, I pay $900 and it goes towards my deductible. So it would be cheaper for me to just buy the brace.

 

[Jim Walsh]

I had a CT scan a couple months ago…$11,400. It was full body if that makes a difference. My co-pay was 40 bucks.

 

[buckeyeshooter]

Here is a bit of insight. When I was living in the USA and it was 15 years ago. My daily blood pressure medicine cost me $30. a month on my insurance co-pay. When I lost my job during the recession of 2008, my insurance was gone and my cost went to $130. per month. When I moved overseas in 2011, my cost went to $8.00 a month. I know my local pharmacy is still making money selling it at $8.00. So, how bad are the drug companies and insurance companies gouging us? Currently, 14 years later, it runs $9.25. Frankly, I am waiting for my next check up because I have lost 118 pounds in the time I have been here and I am pretty sure they will tell me I don't need it now.
As far as health insurance goes, I have a policy that covers my 2 daughters and myself for all inpatient charges, drugs, specialists and transportation...everything. It is good anywhere in the world EXCEPT THE USA and it runs $1600. for all 3 of us per year. I have medicare part A but will not sign up for part B because the cost for just me on a plan that covers less is $1800. also, medicare is generally not accepted in hospitals here because it is too much paperwork and the hospitals don't want the nonsense.

 

[Mobuck]

I haven't paid a medical or doctor bill for years. I just let MediCare and my health insurance fight it out between themselves and the care provider(s). My prescriptions have a very low 'co-pay'.
When I got burned 11/2/22, the only personal expense was for someone to bring me home from the burn center 125 miles away and a second round trip a week later for a follow up and re-dressing.

 

[tazbigdog]

See…thatnis the problem with medical insurance. The doctor ordered it. It should be a done deal. Just like the f’ers that kicked my FIL out of the hospital 2 days after having open heart surgery.

 

[GasGuzzler]

And some say car dealers are thieves. There is no more pungent theft than insurance, especially of the health variety.

 

[Johnny-Baseball]

I have excellent medical insurance. Every month I get statements that detail the cost of services. On a doctors visit I see several columns
First is what the provider charged insurance. Next is what insurance paid (there is usually a huge difference) and finally what I paid ($15 copayment).

Now I'm bright enough to realize you can sell your services for less that 50% of their cost and stay in business very long.

In short medical billing is one of the biggest scams, actually outright fraud, perpetrated today. And the government is complicit. Particularly the IRS and Medicare.

An example of how it works is this. The service actually costs the provider $50. He bills insurance $150. The insurance pays $100. The provider makes $50 and has a $50 loss for a tax right off.

No tax write-off. Why? Because the provider only reports as revenue (on his tax return) what he collected from the insurance company - $100.