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Jul. 25th, 2009 11:12 amText search!!!!!
YEEEESS!!!
YEEEESS!!!
Jul. 25th, 2009
Pretty day...
Jul. 25th, 2009 12:35 pmToday is one of those rare, bright, perfect-temperature, breezy days best spent outside. Will be doing that...
I now know more about my insurance plan than I ever wanted to know.
If a doctor is "in the plan", that means that he or she has agreed to eat the cost that the insurance company doesn't pay (the 'non-allowed amount"). The insurance company reimburses the doctor with the allowed amount, and the rest is his or her loss. Doctors who agree to participate in the plan are in effect exchanging charging what they're actually worth for having more patients. There are kind of a lot of opportunities for degeneration of service. If the doctor is being paid under what the services are actually worth, there may be less motivation to do a perfect job. Likewise, if the doctor has exchanged high fees for more patients, each patient receives less attention. It doesn't seen to be exactly conducive to something good for the patient -- except for one thing: The patient doesn't have to pay a cent for the service.
So... When I broke my wrist and was whisked by ambulance to the emergency room, I was given sedatives, admitted, and the following morning I was assigned to a trauma surgeon who was available at the time. I was pretty much under sedation for the night and morning prior to the surgery. He was not in the plan.
So... that means that the "non-allowed" amount will most probably be more than if he was in the plan (I have to look that up to be sure), and it also means that he has not agreed to eat the cost of the non-allowed amount.
Now, the insurance company has already covered over $7,500.00 of the cost. I had to apply for 2400 of that (the deductible) from a separate agency, but I got it. I got reimbursed for the deductible (yay). The hospital has been paid off and my total cost for the hospital stay and all care received other than the surgery was a whopping $7.50. Therefore, I am happy with my insurance company. Very, very happy.
The problem remains that my trauma surgeon was not in the plan and so is refusing to eat the non-allowed amount. This is not the insurance company's fault - and it's not the doctor's fault. Why should he participate in the plan when he doesn't have to. He's assigned patients from the emergency room, so it's not like anyone has to go out of their way to violate their plan and pick him.
The system's wheel of fortune spun and has now told me, "You owe $2000 out of the 10,000 you incurred".
I'm appealing the decision since I didn't pick the trauma surgeon so it's really not my doing... But on the other hand, it's not the doing of anyone else either, and I *did* receive excellent services and was very lucky to get a good surgeon.
We'll see if they decide to reimburse me. If they do, I'll be sure and recommend that insurance company to anyone and everyone. If not, well, they're still good and saved our rears to the tune of $7500. I don't know. I'd like to be furious, but it's like, why bother. Going outside to enjoy the day.
I now know more about my insurance plan than I ever wanted to know.
If a doctor is "in the plan", that means that he or she has agreed to eat the cost that the insurance company doesn't pay (the 'non-allowed amount"). The insurance company reimburses the doctor with the allowed amount, and the rest is his or her loss. Doctors who agree to participate in the plan are in effect exchanging charging what they're actually worth for having more patients. There are kind of a lot of opportunities for degeneration of service. If the doctor is being paid under what the services are actually worth, there may be less motivation to do a perfect job. Likewise, if the doctor has exchanged high fees for more patients, each patient receives less attention. It doesn't seen to be exactly conducive to something good for the patient -- except for one thing: The patient doesn't have to pay a cent for the service.
So... When I broke my wrist and was whisked by ambulance to the emergency room, I was given sedatives, admitted, and the following morning I was assigned to a trauma surgeon who was available at the time. I was pretty much under sedation for the night and morning prior to the surgery. He was not in the plan.
So... that means that the "non-allowed" amount will most probably be more than if he was in the plan (I have to look that up to be sure), and it also means that he has not agreed to eat the cost of the non-allowed amount.
Now, the insurance company has already covered over $7,500.00 of the cost. I had to apply for 2400 of that (the deductible) from a separate agency, but I got it. I got reimbursed for the deductible (yay). The hospital has been paid off and my total cost for the hospital stay and all care received other than the surgery was a whopping $7.50. Therefore, I am happy with my insurance company. Very, very happy.
The problem remains that my trauma surgeon was not in the plan and so is refusing to eat the non-allowed amount. This is not the insurance company's fault - and it's not the doctor's fault. Why should he participate in the plan when he doesn't have to. He's assigned patients from the emergency room, so it's not like anyone has to go out of their way to violate their plan and pick him.
The system's wheel of fortune spun and has now told me, "You owe $2000 out of the 10,000 you incurred".
I'm appealing the decision since I didn't pick the trauma surgeon so it's really not my doing... But on the other hand, it's not the doing of anyone else either, and I *did* receive excellent services and was very lucky to get a good surgeon.
We'll see if they decide to reimburse me. If they do, I'll be sure and recommend that insurance company to anyone and everyone. If not, well, they're still good and saved our rears to the tune of $7500. I don't know. I'd like to be furious, but it's like, why bother. Going outside to enjoy the day.
Lose = misplace, not be able to find, elude, be without
Loose = not tight, has wiggle-room, a little on the racy side
Lose does not equal Loose.
Thank you.
Edit: Dammit.
Edit of the edited edit: I've had it pointed out to me that this post may be taken as an implication that the people who confuse lose/loose are somehow lazy or stupid. In fact, most of the people I know who do this are at least three times more intelligent than I am and about 8 times more industrious, always doing things, always creating, and multitasking twelve ways simultaneously.
So what I actually believe is that they're perpetrating a nefarious plot just to annoy people like me. No. Actually that's not the case at all - the ones I know are way too busy and creative to be bothered with silliness like that.
Yet... I somehow feel like they wear this confusion like a badge of honor, and secretly delight in annoying the hapless linear thinkers who get annoyed by it. After all, if the annoyed people were busy creating in quadruple processor multitasking land, they wouldn't care...
Loose = not tight, has wiggle-room, a little on the racy side
Lose does not equal Loose.
Thank you.
Edit: Dammit.
Edit of the edited edit: I've had it pointed out to me that this post may be taken as an implication that the people who confuse lose/loose are somehow lazy or stupid. In fact, most of the people I know who do this are at least three times more intelligent than I am and about 8 times more industrious, always doing things, always creating, and multitasking twelve ways simultaneously.
So what I actually believe is that they're perpetrating a nefarious plot just to annoy people like me. No. Actually that's not the case at all - the ones I know are way too busy and creative to be bothered with silliness like that.
Yet... I somehow feel like they wear this confusion like a badge of honor, and secretly delight in annoying the hapless linear thinkers who get annoyed by it. After all, if the annoyed people were busy creating in quadruple processor multitasking land, they wouldn't care...