Sorry, John. I thought I was responding to Walter, not you. Do you actually have a home in the US? where is it?
>>>and the common practise is that insurance companies are paying double of what private patients are paying.
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>That isn't me you're quoting there...
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>>>Hmmm. I read my EOB's very carefully every time I receive medical care. And what I have seen is that the providers bill both the insurance companies and the private patients a horrendous amount of money. However, because the insurance companies have agreements with the participating providers, they (the insurance companies) pay a lot less that the billed amount and the providers write off the difference.
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>The networks do establish a price. What I see is that the providers need to know who your payor is at bill time- because different payors have slightly different requirements and private payers have different rules again. For outpatient care, bills usually are a variant of the official CMS-1500 form for CPT.HCPCS and E/M codes and for inpatient, consumables usually come via an electronic stock system that records every elastoplast with coders applying ICD-9 for actual care delivery. What I see is that a lot of the huge admin cost relates to efforts to leave nothing out but also not to overcharge because of the penalties.
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>>>My understanding is that if I did not have insurance, I would be responsible for paying the amount billed since I do not have the same agreement with the providers that the insurance company does. This is my biggest gripe about health insurance in this country.
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>From what I see for inpatient care, they might not even perform an elective procedure for an uninsured party without surety of payment, or unless there is a charity program against which amounts can be charged.
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>>>Since you seem to hate the US so much, it is very fortunate for you that you do not live here....
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>??!! Not sure where you got that... and how do you know I don't have a home there? ;-)
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