Do Conservatives know what health insurance is?

[BlueGin]

Insurers reimburse based on procedures...not the supplies used.

They reimburse for everything that is covered by the plan. So cotton swabs, bandages, advil and procedures...it's all priced out in the chargemaster. Otherwise, from where do you think they are determining how much insurance reimburses?

Hence they are only billed using procedure codes. Not itemized lists of supplies i.e. "Tylenol" or " IV bags".

Fine. Whatever. Changing the word doesn't change what's happening. If you want to make a semantic argument, fine. Just know it's still an inaccurate argument you're making. The only way you can is to shift the goalposts.

They are billed one sum for all pharmacy like/related drugs

Example


Pharmacy general......$9.00
Pharmacy/radiology....$ 52.00
Labs general....................$9.00
Labs chemistry.................$9.00
ER general......................$ 900.00

So on and do forth...

They aren't marking up your " Tylenol"

 

[The Derp]

Then you agree, Obamacare with the pre-existing condition option isn't insurance.

It is insurance. You don't want to admit it because doing so would spoil your ego.

Can I be diagnosed with cancer in September and buy "insurance" for the first time in October?.

Yeah. You can also not be diagnosed in September, buy insurance in October, and then be diagnosed in January. It doesn't make a difference, you're still diagnosed regardless. The medical issue is there before diagnosis. Insurance is a hedge against the financial impact of that diagnosis whether it occurs before or after you enroll.

But it can, see above.

So then according to you, anyone with any medical condition should not get insurance. According to you, insurance is only for healthy people. That's not what insurance is. Not even close.

I posted the definition of insurance. Do you agree with it or not?

Posting something and understanding it isn't the same thing. Just like being rich and being successful isn't the same thing. Regurgitating dictionary definitions without understanding those definitions doesn't validate your shitty argument. Get over yourself.

Are you telling me you don't see the conflict between the definition I posted and Obamacare? Seriously?

The only conflict that exists is in your little mind.

So when you said I can't get it anytime I want, you were wrong in my case.

I was talking about individual health insurance, and you knew that. And enrollment in a group plan isn't a choice you make...it's a choice your employer makes if/when they hire you. So you can't simply just get an insurance plan whenever. You have to be hired, and then you get the plan. And even then, employers usually require you to wait 60-90 days before you can start using that plan in order to prevent people from doing precisely what you think happens.

 

[The Derp]

They aren't marking up your " Tylenol"

What an idiot...

FROM YOUR OWN POST: Pharmacy general......$9.00

That is the markup. $9 for tylenol. Of course, you leave plenty out of what you wrote. What do you think "Pharmacy general" means? That's the tylenol markup. Yeesh. For someone who bleats and brays that they worked in this industry, you sure as shit don't know much about it.

 

[BlueGin]

Insurers reimburse based on procedures...not the supplies used.

They reimburse for everything that is covered by the plan. So cotton swabs, bandages, advil and procedures...it's all priced out in the chargemaster. Otherwise, from where do you think they are determining how much insurance reimburses?

Hence they are only billed using procedure codes. Not itemized lists of supplies i.e. "Tylenol" or " IV bags".

Fine. Whatever. Changing the word doesn't change what's happening. If you want to make a semantic argument, fine. Just know it's still an inaccurate argument you're making. The only way you can is to shift the goalposts.

They are billed one sum for all pharmacy like/related drugs

Example


Pharmacy general......$9.00
Pharmacy/radiology....$ 52.00
Labs general....................$9.00
Labs chemistry.................$9.00
ER general......................$ 900.00

So on and do forth...

They aren't marking up your " Tylenol"

They pay those charges based on negotiated contracts per plan ...with the hospitals.

The hospitals forward medical records for all procedures. Healthplan reviews reimburses what is covered under negotiated agreements and at what agreed price. If you disagree you can request another audit called a reconsideration with disputed documentation attached.

The chargemaster is a reference only.

 

[BlueGin]

They aren't marking up your " Tylenol"

What an idiot...

FROM YOUR OWN POST: Pharmacy general......$9.00

That is the markup. $9 for tylenol. Of course, you leave plenty out of what you wrote. What do you think "Pharmacy general" means? That's the tylenol markup. Yeesh. For someone who bleats and brays that they worked in this industry, you sure as shit don't know much about it.

It means a sum total of ALL pharmacy related drugs given to you during your stay. Which is billed by the hospital,physicians clinic ,dr office etc...

The insurer does not mark up charges

Again they reimburse based on negotiated contracts. The better the negotiated contracts...the better the reimbursement.

Doesn't matter ...the original charge is always $ 9.00.

 

[Toddsterpatriot]

Then you agree, Obamacare with the pre-existing condition option isn't insurance.

It is insurance. You don't want to admit it because doing so would spoil your ego.

Can I be diagnosed with cancer in September and buy "insurance" for the first time in October?.

Yeah. You can also not be diagnosed in September, buy insurance in October, and then be diagnosed in January. It doesn't make a difference, you're still diagnosed regardless. The medical issue is there before diagnosis. Insurance is a hedge against the financial impact of that diagnosis whether it occurs before or after you enroll.

But it can, see above.

So then according to you, anyone with any medical condition should not get insurance. According to you, insurance is only for healthy people. That's not what insurance is. Not even close.

I posted the definition of insurance. Do you agree with it or not?

Posting something and understanding it isn't the same thing. Just like being rich and being successful isn't the same thing. Regurgitating dictionary definitions without understanding those definitions doesn't validate your shitty argument. Get over yourself.

Are you telling me you don't see the conflict between the definition I posted and Obamacare? Seriously?

The only conflict that exists is in your little mind.

So when you said I can't get it anytime I want, you were wrong in my case.

I was talking about individual health insurance, and you knew that. And enrollment in a group plan isn't a choice you make...it's a choice your employer makes if/when they hire you. So you can't simply just get an insurance plan whenever. You have to be hired, and then you get the plan. And even then, employers usually require you to wait 60-90 days before you can start using that plan in order to prevent people from doing precisely what you think happens.

It is insurance.

Nope.

a thing providing protection against a possible eventuality

You agreed with this definition. Change your mind already?

Can I be diagnosed with cancer in September and buy "insurance" for the first time in October?

Yeah.

And that's why it is no longer insurance.

It doesn't make a difference, you're still diagnosed regardless.

It's the difference between insurance and welfare.

Posting something and understanding it isn't the same thing.

a thing providing protection against a possible eventuality

Which is why I continue mocking your idiocy.

And even then, employers usually require you to wait 60-90 days before you can start using that plan in order to prevent people from doing precisely what you think happens.

Why in the world would an employer try to prevent something like that from happening?

 

[The Derp]

It means a sum total of ALL pharmacy related drugs given to you during your stay. Which is billed by the hospital,physicians clinic ,dr office etc...The insurer does not mark up charges.

I know they don't mark up the charges. The chargemaster does. The insurer contracts with the provider to determine how much of that marked-up charge they will reimburse.

Again they reimburse based on negotiated contracts. The better the negotiated contracts...the better the reimbursement.

Which is what I've been saying. The insurer contracts with the provider to determine how much of the charge in the chargemaster they will reimburse.

 

[The Derp]

Nope. a thing providing protection against a possible eventuality

No, not a possible eventuality. *Costs* from the possible eventuality.

Can I be diagnosed with cancer in September and buy "insurance" for the first time in October?
Yeah.
And that's why it is no longer insurance.

Yes, it is insurance. Otherwise, you're saying sick people shouldn't buy insurance at all.

It doesn't make a difference, you're still diagnosed regardless.
It's the difference between insurance and welfare.

So what your argument boils down to is semantics. Completely pointless. You're saying anyone who has a pre-existing condition and enrolls in any health insurance plan on the exchanges is getting welfare. Whereas if they had a pre-existing condition and enrolled in any health insurance plan before the ACA, it was insurance. So this isn't about what it actually is, this is just you not grasping what the ACA does, what insurance companies do, what health insurance is, and how it relates to your actual health care.

Posting something and understanding it isn't the same thing.
a thing providing protection against a possible eventuality
Which is why I continue mocking your idiocy.

Sigh...you're not insuring your health when you get health insurance. You're insuring protection from financial ruin that comes from the costs associated with health care. Health insurance has nothing to do with health care delivery. You are trying to conflate the two because you don't understand what health insurance is.

Why in the world would an employer try to prevent something like that from happening?

So people don't take advantage of their employment, then once they get what they want and have it paid for via the group plan, they leave.

What you're saying is that someone without insurance who is diagnosed with cancer shouldn't buy insurance after they are diagnosed (never mind the fact that not having insurance is probably why they got diagnosed with cancer in the first place...as it went undetected because that person didn't get screenings from a doctor) because somehow it's welfare. How it's welfare, you haven't really explained. You just seem to think that if you get more than what you put in, that amounts to welfare. Which would mean if you incur more health care costs than premiums you pay, according to your standard that is welfare.

 

[BlueGin]

It means a sum total of ALL pharmacy related drugs given to you during your stay. Which is billed by the hospital,physicians clinic ,dr office etc...The insurer does not mark up charges.

I know they don't mark up the charges. The chargemaster does. The insurer contracts with the provider to determine how much of that marked-up charge they will reimburse.

Again they reimburse based on negotiated contracts. The better the negotiated contracts...the better the reimbursement.

Which is what I've been saying. The insurer contracts with the provider to determine how much of the charge in the chargemaster they will reimburse.

The insurer has nothing to do with the mark up of hospital supplies and services.

The hospital bases pricing on contracts with the buying groups and distributors.

It means a sum total of ALL pharmacy related drugs given to you during your stay. Which is billed by the hospital,physicians clinic ,dr office etc...The insurer does not mark up charges.

I know they don't mark up the charges. The chargemaster does. The insurer contracts with the provider to determine how much of that marked-up charge they will reimburse.

Again they reimburse based on negotiated contracts. The better the negotiated contracts...the better the reimbursement.

Which is what I've been saying. The insurer contracts with the provider to determine how much of the charge in the chargemaster they will reimburse.

Apparently you don't know what a chargemaster even is.

Every hospital has their own chargemaster...some maintained by the hospital some maintained by a third party contracted FOR the hospital.

None of which are maintained/manipulated by the insurance provider. AT ALL

Pricing varies from hospital to hospital due to the fact that they all have different buying group contracts/pricing.

Again...the chargemaster is for reference only.

 

[Toddsterpatriot]

Nope. a thing providing protection against a possible eventuality

No, not a possible eventuality. *Costs* from the possible eventuality.

Can I be diagnosed with cancer in September and buy "insurance" for the first time in October?
Yeah.
And that's why it is no longer insurance.

Yes, it is insurance. Otherwise, you're saying sick people shouldn't buy insurance at all.

It doesn't make a difference, you're still diagnosed regardless.
It's the difference between insurance and welfare.

So what your argument boils down to is semantics. Completely pointless. You're saying anyone who has a pre-existing condition and enrolls in any health insurance plan on the exchanges is getting welfare. Whereas if they had a pre-existing condition and enrolled in any health insurance plan before the ACA, it was insurance. So this isn't about what it actually is, this is just you not grasping what the ACA does, what insurance companies do, what health insurance is, and how it relates to your actual health care.

Posting something and understanding it isn't the same thing.
a thing providing protection against a possible eventuality
Which is why I continue mocking your idiocy.

Sigh...you're not insuring your health when you get health insurance. You're insuring protection from financial ruin that comes from the costs associated with health care. Health insurance has nothing to do with health care delivery. You are trying to conflate the two because you don't understand what health insurance is.

Why in the world would an employer try to prevent something like that from happening?

So people don't take advantage of their employment, then once they get what they want and have it paid for via the group plan, they leave.

What you're saying is that someone without insurance who is diagnosed with cancer shouldn't buy insurance after they are diagnosed (never mind the fact that not having insurance is probably why they got diagnosed with cancer in the first place...as it went undetected because that person didn't get screenings from a doctor) because somehow it's welfare. How it's welfare, you haven't really explained. You just seem to think that if you get more than what you put in, that amounts to welfare. Which would mean if you incur more health care costs than premiums you pay, according to your standard that is welfare.

No, not a possible eventuality

Insurance isn't protection from a possible eventuality? LOL!
My auto insurance isn't financial protection from possible damage caused to/by my car? LOL!

*Costs* from the possible eventuality.

Did you think car insurance put a force field around my car? Of course cost.

Yes, it is insurance.

No, it isn't insurance if your cancer is a certainty as opposed to a possibility.

Otherwise, you're saying sick people shouldn't buy insurance at all.

Under Obamacare, some people have no incentive to buy a policy before they get sick.

So what your argument boils down to is semantics.

Words mean things.
Should I be able to buy a flood policy from the Federal Government when I already have 6 feet of water in my home? Why not? Doesn't flood insurance protect me from financial ruin?

You're saying anyone who has a pre-existing condition and enrolls in any health insurance plan on the exchanges is getting welfare.

Anyone with a serious, expensive condition who buys a policy only after they get diagnosed is getting welfare.

Why in the world would an employer try to prevent something like that from happening?

So people don't take advantage of their employment,

Finally. An admission that taking advantage isn't fair.

What you're saying is that someone without insurance who is diagnosed with cancer shouldn't buy insurance after they are diagnosed

I'm saying you couldn't buy insurance after a cancer diagnosis.
You can get an Obamacare policy.

How it's welfare, you haven't really explained.

The government handing you money, or forcing an insurance company to hand you money, for your care, even though you never before participated in the insurance pool before your illness, is welfare.

You just seem to think that if you get more than what you put in, that amounts to welfare

Nope. I don't think that at all.
I've had auto insurance for decades, never made a claim.
The people who had insurance and made claims larger than their premiums weren't getting welfare.
A person who wrecks his car and gets insurance 5 minutes later and gets a new car from the insurance company is getting welfare.

 

[Sun Devil 92]

On Fox 'n' Friends, Brian Kilmeade lamented that healthy people pay for sick people.

That is literally what health insurance is.

Congrats to the not-presently-on-fire for paying for firefighters.

There are places where you don't have to pay for firefighters.

If your house burns down....you are out of luck.

But you have that choice.

They have private fire departments, dumbass. And if you have a mortgage on your house, the bank requires you to have a contract with a fire service.

Yes, they do. The point is that you are not forced to by the service.

There is a consequence if you don't pay......

But you have that choice.

 

[bripat9643]

On Fox 'n' Friends, Brian Kilmeade lamented that healthy people pay for sick people.

That is literally what health insurance is.

Congrats to the not-presently-on-fire for paying for firefighters.

There are places where you don't have to pay for firefighters.

If your house burns down....you are out of luck.

But you have that choice.

They have private fire departments, dumbass. And if you have a mortgage on your house, the bank requires you to have a contract with a fire service.

Yes, they do. The point is that you are not forced to by the service.

There is a consequence if you don't pay......

But you have that choice.

Why should anyone feel sorry for a dumbass who doesn't pay for fire service?

 

[Sun Devil 92]

On Fox 'n' Friends, Brian Kilmeade lamented that healthy people pay for sick people.

That is literally what health insurance is.

Congrats to the not-presently-on-fire for paying for firefighters.

There are places where you don't have to pay for firefighters.

If your house burns down....you are out of luck.

But you have that choice.

They have private fire departments, dumbass. And if you have a mortgage on your house, the bank requires you to have a contract with a fire service.

Yes, they do. The point is that you are not forced to by the service.

There is a consequence if you don't pay......

But you have that choice.

Why should anyone feel sorry for a dumbass who doesn't pay for fire service?

Please show me where I said they should.

My point was that this universal claim of government providing services does not always hold.

 

[Sun Devil 92]

You really are one stupid son-of-a-*****.

No, you guys are stupid because you don't know what health insurance is, and you never have. That's why you can't articulate a replacement plan. Because you lack the brain power to understand it. Whether or not you're being deliberately obtuse is a whole other question.

You get a big medical bill and they will put you on a payment program.

Right...they garnish your wages. That's the "payment plan". And when you pay cash, you're paying over-inflated prices that are in the chargemaster. Or they give you a discount, but that discount just gets paid by those on insurance, who have taken personal responsibility.

Thanks for making my point, dickhead. You get a bill for 33K, you sell your car and pay off the hospital.

Math is hard for your guys.

$25K =/= $33K.

So you're still $8K in the hole.

Big deal

 

[bripat9643]

On Fox 'n' Friends, Brian Kilmeade lamented that healthy people pay for sick people.

That is literally what health insurance is.

Congrats to the not-presently-on-fire for paying for firefighters.

There are places where you don't have to pay for firefighters.

If your house burns down....you are out of luck.

But you have that choice.

They have private fire departments, dumbass. And if you have a mortgage on your house, the bank requires you to have a contract with a fire service.

Yes, they do. The point is that you are not forced to by the service.

There is a consequence if you don't pay......

But you have that choice.

Why should anyone feel sorry for a dumbass who doesn't pay for fire service?

Please show me where I said they should.

My point was that this universal claim of government providing services does not always hold.

In most cases, there is no reason the government should provide these services. The leftwing argument that nobody would if the government didn't do it is clearly false.

 

[Sun Devil 92]

There are places where you don't have to pay for firefighters.

If your house burns down....you are out of luck.

But you have that choice.

They have private fire departments, dumbass. And if you have a mortgage on your house, the bank requires you to have a contract with a fire service.

Yes, they do. The point is that you are not forced to by the service.

There is a consequence if you don't pay......

But you have that choice.

Why should anyone feel sorry for a dumbass who doesn't pay for fire service?

Please show me where I said they should.

My point was that this universal claim of government providing services does not always hold.

In most cases, there is no reason the government should provide these services. The leftwing argument that nobody would if the government didn't do it is clearly false.

While I agree that it should be a choice, it is hard for me to imagine the government not supplying some of these services.

 

[BlueGin]

I wasn't complaining about Medicare. I was stating a fact. They cover less and pay out less.

Fine. But why do they do that? Because of how much is paid into it. So the reason Aetna reimburses more than Medicare in some cases, is because you're paying higher premiums for Aetna and thus, Aetna can reimburse more. So if you raise the Medicare tax, that leads to more money able to be spent toward reimbursement. So why not just do that, and do away with private insurance altogether? Medicare-for-all is 100% portability, which you don't get with private insurance. So if you are on Medicare you can go to any doctor nationwide that accepts Medicare. If you are on Aetna, you can only go to the doctor in your geographically-limited area, and even then the doctor has to be a part of that insurance network, which isn't a guarantee.

BTW I was offered a job in Washington working Medicare...I know what they pay. And the paper pushers make two/three times what the market rate is for other healthplans across the country.

First of all, Medicare doesn't do Medicare administration. Thanks to the 2003 Medicare Part-D legislation Conservatives passed, all CMS services are done by private companies. So when you say you were "offered a job to work for Medicare", what specifically are you talking about?

Contracting officer for Medicare/Medicaid innovation.

 

[BlueGin]

What part of the actual pricing for the customer is less because the prices on all items don't change but the required mark up that is reported does ...across the board ....isn't penetrating your thick skull??

No part is less. The patient isn't getting a discount if they don't have insurance and elect to pay cash. They're paying more than the insurer pays for the same procedure. So say X procedure is listed as $50K in the chargemaster. If you have an 80/20 insurance plan, the insurer is paying $40K, and you're paying $10K. If you don't have insurance, X procedure still costs $50K. And instead of only paying $10K, you're paying the full $50K because there is no other payor. So what hospitals do is they intially bill you $75K, and you then apply or ask for a "discount", and the hospital very "generously" reduces your bill to $50K. Which is what your insurance would have paid 80% of anyway, only now you're voluntarily paying what their share would be on top of what you're also paying out-of-pocket, but you're very obliviously paying what the rate is anyway while walking away thinking you got the better of the provider. You didn't. You got hosed.

That's how it works.

Once again. Prices ON the chargemaster get updated yearly at a standard mark up...across the board ...they don't update specific line by line pricing details.

Hospitals don't mark up every procedure they do yearly. So as an example

Radiology drugs could have a 2% mark up listed on the chargemaster

But the patient is not charged at the mark up price because the actual price didn't increase at the hospital 2%.


Hence the chargemaster is for reference only. Get it yet?

 

[BlueGin]

And BTW just as an aside...due to Obamacare tanking ...the contracted medical coders maintaining chargemasters are being laid off in mass. Hospitals are having to give those jobs to limited hospital staff. Which means fewer claims get processed each month...which means less money being generated.

Hospitals are starting to get rid of services...such as NICU at multiple facilities...smaller skilled nursing facilities are being closed etc...

 

[Baz Ares]

It is a product made and sold for profit by the private industry that is forced on Americans by our government. You're welcome

What is the product? I mean, physically, what is the product an insurance company makes?

Money is an income product to stock holders. Does this count?
What did I win?