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I understand the contract thing...That's why they have the separate fee schedule for in network and out of network providers...In network providers generally agree to accept whatever payment the insurance company pays and not bill for the difference between what was billed and what was paid... Not quite, patient responsibility is a portion of the allowed amount. Insurance portion + Patient Portion = Allowed (Contracted) Amount. Depending on the type of plan you have you could have a small copay, a percentage co-insurance, or a deductible amount. As for out of network providers, they usually get less insurance money and more from the patient, it's how the insurance companies modify patient behavior to get the lowest cost for the service. The pain of the price point drives the patient to make good economic choices.


 

The copay for meds generally is when you fill a prescription not at the ER...There can be a copay sure...My plan says an ER visit is $100 copay

 

I maintain that the healthcare system grossly overcharges in certain areas and that it is unfair and unethical, and should be illegal...I know a large portion of the billing goes to cover overhead and malpractice insurance, but the insurance companies don't need any help in finding an excuse to raise premiums... Have you ever purchased an after market radio for an import car from the dealer? Your pay between 4 and 5 times what it would cost you at Best Buy. You know why? Because of where you received the service. It's the same for health care, buy in a facility you pay a facility rate. The CMS reimbursement schedule has a rate for both facility and non-facility making the price perfectly legal. The concept of DRGs and how hospitals are paid for the majority of their services is way to complex to get into here, but basically they are paid a flat rate based on the diagnosis of the patient, not al a cart by each service provided. As I said, the payment system is so ridiculously complex that it doesn't matter what they charge for a single drug, the insurance companies aren't losing any money on it.


 

And that is part of the problem...You can't receive medical services other than at medical facilities...There is no other option...Therefore, they can charge whatever they want because there is no "open market" for their services...

 

I don't know how to solve the problem completely, but putting a realistic cap on the amount they can charge for dispensing medications at the ER, would be somewhere to start... I know that MORE freedom in the market not LESS freedom is the way to fix the problem. We also, as I said before, need to remove the players who make their living between the patient and the physicians. Those players drive up cost and interfere in the doctor/patient relationship.


 

Overcharging and exorbitant fees drive up insurance premiums as well...I already agreed the people who use the ER facilities for general medical services is a problem...There is no open Market for medical services...

 

 

 

It was mentioned earlier that some people use the ER as a primary doctor facility and I know that's a fact...It's also a fact that some people use it as an excuse to get out of work...They don't want to work on a certain day, so they go to the ER and get a note saying they were seen at that facility and they have an excused absence. There is a lot of abuse of the health care system, and I think a major overhaul is what needs to happen...

 

It seems Canada's free health care system works pretty well, (although it's not completely free) but I doubt we could ever make a system like that work here because they jerk faces in Washington would find a way to screw it up and make it a pain in the rear Canada's system is so good that rich Canadians and their important politicians come to Cleveland or Miami to have their surgery while everyone else waits in line. Canada did not have MRI available to their citizens in 1992 when the US had it in the early 80s. Canada's system isn't free, it's paid for by the taxes taken from every citizen, and like the European systems, they depend on the innovation of the US Healthcare system to move forward because capitalism drives innovation while government and socialism stifle it.


 

When I said free, I also said it's not totally free...I dated a girl from Canada once and they don't pay anything for general medical things...They have to pay a small copay for specialists and surgery that isn't life threatening or that would not interfere with their standard of living...cosmetic surgeries and thing that are not life threatening are all on the consumer to pay, but general wellness visits to the doctors require no pay by the consumer...

 

Of course it's paid by taxes...The girl I dated from Canada said that many Canadian Drs are coming into The U.S. to work because they are paid a flat fee from the Government and they make more money here, plus they can decide which patients they want to see and not see, rather than be assigned patients