tag:blogger.com,1999:blog-32199165.post1238072421018014876..comments2024-03-27T19:46:20.339-04:00Comments on Blue Country Magic: Could Someone Explain . . .CountryDewhttp://www.blogger.com/profile/03243893531509380824noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-32199165.post-32145030244309259712015-09-11T11:59:54.609-04:002015-09-11T11:59:54.609-04:00Sounds like fraud to me. We need to crack down on ...Sounds like fraud to me. We need to crack down on the drug and insurance companies both. Heatherhttps://www.blogger.com/profile/17700809709293636333noreply@blogger.comtag:blogger.com,1999:blog-32199165.post-21387985276734071202015-09-10T06:31:38.905-04:002015-09-10T06:31:38.905-04:00I worked for 6 years as a medical claims examiner ...I worked for 6 years as a medical claims examiner in the 80's. "Allowable Charges" used to be called "Reasonable and Customary" charges. Using the provider's zip code, the insurance company would take the average of what a particular service (let's say a brace) should cost for that particular area of the country. It was a safeguard against providers who over (or under) charged. It also allowed for the fact that costs vary depending on where someone lives. So if one provider charged $90 for that brace and another charged $75, and yet another charged $110 in that geographic area, the insurance would "allow" the average of $91. From that charge they pay whatever the individual policy allows- whether 80%, etc. As consumers, we can shop around for medical procedures and supplies and purchase from whomever we want, however the system is not consumer friendly at all. I tried calling around once for a price on an ultrasound. No one would give me a quote, stating they needed more information of which only a doctor could supply. Had you chosen to purchase the cheaper priced brace from a different provider on your own, you might have had a hard time getting your ins. company for it. That supplier might not have been on their "Accepted Provider" list. The system is so broken it gives me a headache.Leonorahttps://www.blogger.com/profile/04701518822526054010noreply@blogger.comtag:blogger.com,1999:blog-32199165.post-32239198371641872012015-09-10T03:57:58.714-04:002015-09-10T03:57:58.714-04:00Because they have clauses in the policy structure ...Because they have clauses in the policy structure that allows them to supply Medicare, for instance, instead of just writing a prescription for the item to the patient. zippiknits...sometimeshttps://www.blogger.com/profile/17385498014336581117noreply@blogger.comtag:blogger.com,1999:blog-32199165.post-19129206943460087732015-09-09T21:48:41.706-04:002015-09-09T21:48:41.706-04:00I used to kinda sorta understand this stuff when I...I used to kinda sorta understand this stuff when I worked for doctors. It's creative financing to be sure. We have Kaiser so don't have those issues so I never pay attention. Bev Sykeshttps://www.blogger.com/profile/16794928133704720689noreply@blogger.comtag:blogger.com,1999:blog-32199165.post-43972572074892750062015-09-09T18:31:54.326-04:002015-09-09T18:31:54.326-04:00Health care needs a lot of reform. How it will ac...Health care needs a lot of reform. How it will actually happen is anybody's guess these days.....Michellehttps://www.blogger.com/profile/10123691580195879542noreply@blogger.com