Quote:
Originally Posted by John Doe
You're on me about being condescending and then accuse me of watching fox news and spreading misinformation, after you admit you are owned by your ppo and have to wrangle with your provider?
You and your wife have crappy coverage, so get off your ass and get some coverage and take your bs elsewhere.
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As a person without a "group", I can tell you that the coverage that you have is simply not available to most of us.
I recently paid for and had a PPO plan where I could go out of network if I chose to do so. The provider would pay 80% of
reasonable and customary expenses. The issue is the definition of reasonable and customary. The HMO would typically decide that reasonable and customary was about 30% of the retail charges that were presented by the doctor. Therefore, the patient is responsible for the remaining 70%.
The same thing occurs when a person without insurance needs care. They get a bill for 3X or 4X the price that the provider would actually accept from the insurance company. The provider refuses to negotiate the figure downward. Many people are bankrupted due to this practice.
This ongoing system of two prices..........one retail.........one wholesale for the HMO..........has got to stop.
BTW, if I could get your plan at some reasonable cost (say $7K per year), I'd do it in a heartbeat.