My insurance company is scamming me.

[dblack]

Wow, you make it sound easy.

Very little in life is easy. Especially if you want to retain any semblance of independence. Sign up for slavery if you really want someone to take care of you.

 

[dblack]

I didn't make any dumb decisions. The company changed insurers to save money.

And you put up with it.

 

[1srelluc]

My company provides it. I have no choice.

Sure you have a choice. But none are free.

It's important to review your Summary of Benefits (SBC) for specific details about your plan's out-of-network coverage. Additionally, you can use federal protections like the No Surprises Act to help avoid unexpected out-of-pocket costs.

Finding out stuff before a procedure (since you seem to have the time) is your responsibility.

Of course you could always shop your talents and land with an employer that offers better coverage.

 

[luiza]

Living in Fatty Land is now so funny and sad .
No wonder Americans have become the planet laughing stock.

 

[Winston]

I didn't make any dumb decisions. The company changed insurers to save money.

And once that process starts, switching companies to lower premiums, it becomes like a wheel you can't get off of.

Employer provided health insurance is very much like Obamacare. There are required loss ratios. It is guaranteed issue, pre-existing conditions must be covered. How many employees are on the insurance plan? Yes, health insurance is a racket, but not in the way you might think.

Say you work for a small company, a local independent grocer, a small custom cabinet shop, even a local car dealer. Maybe you got a hundred people covered under the insurance. And that is just it, you are diversifying your risk, which is what insurance really is, with just one hundred people. How the fawk does that make sense?

But anyways, if you are in a small group, and just one person hits some major medical claims, transplant, open-heart surgery, brain surgery is becoming increasingly common. One mother has a preterm birth. The cost of that cascades to the other members of the health insurance plan when the next year's premium is set. So, HR shops it. The only underwriting going in is the age, and sex, of the employees and their dependents. While the current company is basing the premium on claim history, the competing companies do not have access to that claim history, cannot tap the Medical Information Database, and can only base their premium on pure demographics.

So, now the company is on the wheel. Change insurance companies every year. Because that one single dependent, they are still generating claims. And it is terrible to say it, but until that person dies, or their supporting employee retirees or leaves, the company is swirling down the rabbit hole. It is absolutely sick. More than two decades ago I actually encountered someone that was that supporting employee. Kidney dialysis for their spouse, who was on the transplant list. He was actually being pressured to retire. Suffice it to say, after I left the HR office with the VP white as a ghost, that shit stopped. But yes, it still happens and it is still sick.

But now, back to the racket. You think Walmart has that problem? No, and if you are insured under Walmart's plan, well you are diversifying your risk with thousands, no, millions of people. That provides Walmart with a competitive advantage, like other large companies. And there in lies the real reason for the opposition to the ACA. I mean over my working years I have experienced it all. Started working for a large company, double covered. My wife worked for the same company, she covered me and I covered her. Hell, we made babies and got paid. They soon put a stop to that.

I worked for an insurance company. 1099, but they paid half the health insurance premium. Almost 30 years ago, it was two grand a month. Family plan, but we are talking top of the line. No deductible, no co-pay, 100% coverage. It was Mass Mutual, I didn't even know they did health insurance. And the card was black, like a black American Express. Take my wife to the emergency room, sinus infection, but she is claiming her left arm feels numb. When we check in the last thing they ask for is the insurance card, when she puts it in the reader I swear, balloons and confetti were dropped from the ceiling in the back. CAT scan, MRI, I mean she got the whole nine yards. For a sinus infection. I still rib her about it.

I have worked for the small company doing the change every year. And yes, I did my time at Walmart, at a middle level and health insurance was reasonable. I have been on an ACA plan, and now, I work for a private company, albeit one of the largest in the country. I have kind of seen it all. And yes, it is a damn racket.

Employer provided health insurance was created out of a means of going around wage restrictions. I mean if you were a Republican, back in the 40's, you were damn sure opposed to these wage restrictions. Health insurance was a go around, period. But like anything, the big boys, the large companies, they leveraged that health insurance to their advantage.

I have been so blessed. I have not experienced this. But, I do have friends, I do have clients, I do have co-workers, that have been chained to an employer to provide health insurance to a dependent. That is horrible. Honestly, I don't think it is any different than servitude. Yes, slavery. Which really is a subject you don't want to get in to with me.

 

[otto105]

My question was my answer since I don't understand the reason for the statement.

No, answer the question.

Or you too stupid

 

[otto105]

So the diabolical Trump somehow engineered the corruption of Employee Sponsored Healthcare? And tell us how he might have done that.

No, welcome to millions losing their healthcare over billionaire tax breaks.

 

[Dekster]

My health insurance company is owned by my provider, clearly a conflict of interest. I get a diagnosis right away but treatment is always scheduled months away. When I arrive for treatment the waiting rooms are virtually empty, no backup. I believe my provider colludes with the insurance company to delay treatment until I'm in a new deductible year so I'll pay the maximum out of pocket, saving the insurance company money. They also tried to scam me once before by adding an 'out of network' doctor to my case who was not covered by my insurance. I would have had to pay for a doctor that shouldn't even have been in the operating room in the first place. Or, it could have been a 'phantom' doctor that didn't even exist.

It don't think you are being soft-soaped any more than you would be if your insurance company didn't own your provider. Hospitals have contracts with folks and companies. That is why you get billed separately for doctors, imaging, and labwork from your hospital bill even though some of the work may be done in the hospital and included on that bill. For instance even if the ER x-ray is in house and part of your bill, you will likely get an outside provider bill for the person who read your x-ray and prepared the report on it. That person might not be in your network because it is an outside doc who does it as a side hustle.

 

[Crepitus]

Not really.

In my experience, yes. Really.

 

[initforme]

If one is a paying customer, then insurance pays every last claim no questions or analyzing. Otherwise theres no point. They will kerp raising premiums and cover less. And we are at a time we need more people leaving the work force.

 

[dblack]

If there's anything legitimate to ***** about in this thread it's the regulations and tax policies that push us into the employer provided insurance trap.