You know, I have relatively good insurance and an FSA behind it, so I can pay the deductible. It's the sheer incomprehensibility of the system that baffles me. Along with how the rep could say without laughing that "it's not that we didn't pay it."
I can vouch for this interpretation. I worked for a medical practice doing billing stuff; when insurance co's 'refuse to pay' it means those dollar amounts were written off as contractual discount or denied entirely.
(I keep meaning to write up a US Medical Insurance 101 post, framed as "So You've Adopted an Autobot", because people tend to understand their car insurance better than their medical.)
Well, ok. Still seems a little odd to tell someone "it's not that we didn't pay" when she's staring at a bill quite clearly saying that the insurance didn't pay. Because the system is so wonky, the reason for the not paying is relevant, but the fact of the not paying is also so.
For insurance co's, their process is something along the lines of - decide what to write off entirely - decide what to discount - of what is left (decided to pay), figure out who will pay (them, pt's copay, pt's bill, pt's hsa, etc) 'Who pays' is such a separate issue to them from 'what gets paid'.
Edited (added last clarification) Date: 2011-08-19 12:16 am (UTC)
Fair enough, but that still doesn't mean it makes any sense to say "it's not that we didn't pay" when they decided that I had to pay. That's also not a completely accurate description of how it works for non-HMOs in my state (where the doctor is banned from requiring a HMO member to pay more); since I'm not in an HMO, my doctor can actually require me to pay more than the insurer will take.
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(I keep meaning to write up a US Medical Insurance 101 post, framed as "So You've Adopted an Autobot", because people tend to understand their car insurance better than their medical.)
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- decide what to write off entirely
- decide what to discount
- of what is left (decided to pay), figure out who will pay (them, pt's copay, pt's bill, pt's hsa, etc)
'Who pays' is such a separate issue to them from 'what gets paid'.
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no subject