[mikester]

Insurance companies negotiate lower rates for their members. Let's say they take an equal premium from 10 - 40 year old guys. then they negotiate rates based on that pool of guys. They know that not all of them are going to get sick, some percentage will and some won't. The risk is how many of them will get sick. That's how the majority of the health care in America works - employers buy into these pools and it costs everyone the same amount. The companies negotiate a contract rate with the providers of 'reasonable and customary' charges.

If you take the insurance companies ability to negotiate what the providers charge and equalize everyone you basically do away with the benefit of group insurance carriers. You drastically change the basis of medical care in the US.

I'm not saying it shouldn't be done, I do believe that would go against our 'market' system but our market system today with this process in place is more like 'capitalist socialism'. The insurance companies act like capitalists to get members to their groups with their premium costs but then the groups themselves are more like socialist environments.

I don't know what the solution is, I'm quite frustrated with medical bills myself. I absolutely hate the way billing is done. I do not think I could be more frustrated with it. I do not think I could hate it any more than I do. I don't hate much...

2 examples:

My wife and son were in a minor car accident back in June of 08. They ended up in the emergency room since my wife was 6 months pregnant at the time. Everyone was fine but I had my then 3 year old checked out by the ER doc. We didn't receive the bill for that part of the ordeal until February of this year. I'm amazed that it took them this long to bill me and I honestly have no idea how to ensure that the bill I am getting is legit. It isn't a significant amount and the car insurance will cover it 100% but still - how do I ensure we aren't getting taken?

Next: My son gives birth to our second son in September. We pay our part in full as soon as we receive the bill. Then This month we get another statement of my wife's account that says she is past due with an additional $100. WTF, we paid in full. So I call them up and they say it is from my son's account. I ask for them to send me a detailed bill.

If legislation is to be done - I think the first thing they should do is consolidate billing through a single provider. If a Dr. needs the services of multiple Drs to complete a procedure, they should consolidate that billing into one bill. You have a team of Drs working on you and they all have bills to be paid - send a single itemized bill to the patient outlining their entire cost for the procedure. It is insane to expect that the patient will be able to keep up with this and I believe that this type of system would be very easy to game. I did a bit of research and all of this is based on 'contract law'. I'm no lawyer so I could be 100% wrong and I don't recall any of the details but it is my understanding that it would be okay for a hospital to continue sending you bills for whatever they think they can bill you for a particular procedure for something like 3 years from the date of service.

I'm sure one of the board attorneys can clarify this but that's just what I recall - mainly that it is stupid.

I'm also no insurance or medical expert - just a frustrated consumer.

Insurance is a game of risk and I believe it is a game we can ill afford to continue to play as a society. There has to be a better way.