Timeline for Is what my dentist is doing legal?
Current License: CC BY-SA 4.0
9 events
| when toggle format | what | by | license | comment | |
|---|---|---|---|---|---|
| Dec 13, 2023 at 17:14 | vote | accept | okwriting | ||
| Dec 11, 2023 at 15:29 | comment | added | Brian | I would differ a bit - while padding charges (submitting VERY large charges) is normal practice, and one expects to see an explanation of benefits (EOB) with a much lower dollar amount allowed, it is NOT normal or legal for the provider to charge for services NOT rendered. That is fraud. However, keep in mind that sometimes medical laypersons may not understand that two things are equivalent, and one is an allowed charge/procedure. For example, some dental providers ONLY provided ceramic fillings, but some insurers only covered amalgam (mercury) fillings, calling ceramic cosmetic enhancement. | |
| Dec 10, 2023 at 22:01 | comment | added | user71659 | @Greendrake The system places choice largely in the hands of the consumer, especially since employers are paying 80% of the costs on average. This applies to government benefits as well, OP is on Medicare Advantage, which means the government is paying a fixed amount to a private insurer to provide elderly health benefits, instead of acting as the insurer themselves. If OP doesn't like the coverage, they are free to switch to some other MA plan. | |
| Dec 10, 2023 at 21:53 | comment | added | user71659 | @Greendrake In the US, it is not mandatory a provider accept insurance, nor any specific insurer or their network. If an insurer doesn't adequately compensate, the provider will simply drop that network, and subscribers will leave. My employer offers 5 different plans, I'll just choose a better one. You also have to consider that 2/3 of employer health plans are self-insured by the employer, the health plan merely passes along the bill with a markup. Quality of health plans is a major factor in hiring and employee retention, so if a company is stingy with their coverage, employees will quit. | |
| Dec 10, 2023 at 21:21 | comment | added | Greendrake | The costs of running insurance business explain why it would rather pay out less, not more than the provider would bill an uninsured patient. It still doesn't make any sense why they would do the opposite. | |
| Dec 10, 2023 at 20:57 | comment | added | user71659 | @Greendrake Insurance claims impose additional costs. For an insured patient, the provider has to code the services done, file a claim, wait a month or so while it's processed and paid, if there's a mistake or dispute, go through adjustment processes, plus the overhead of negotiating rates and contracts, and now insurers are requiring metrics and patient surveys. One provider overcharged my copay, so I got a check in the mail, another attributed my flu shot to a uncovered doctor, so it was free. A cash patient simply receives a cost and is usually required to pay in advance of the services. | |
| Dec 10, 2023 at 13:31 | comment | added | Sneftel | @Greendrake because insurance companies’ products are legally limited to a percentage of benefits paid out, essentially. | |
| Dec 10, 2023 at 8:10 | comment | added | Greendrake | Why on Earth would an insurance company agree to pay more than an uninsured patient would have to? | |
| Dec 10, 2023 at 4:04 | history | answered | user71659 | CC BY-SA 4.0 |