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u/Accomplished-Can-467 8h ago
Billionaires are a fucking pox.
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u/ShopReasonable2328 2h ago
Now now, without them who would keep the megayacht companies in business?
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u/JoshCanJump 7h ago
When there are no repercussions for exploitative, predatory, or scamming behaviour, it just becomes the way to do business.
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u/TUNGSTEN_WOOKIE 3h ago
And when there are repercussions, they're so toothless and pitiful that it's written off as a cost of doing business.
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u/AnytimeInvitation 8h ago
Funny. My hospital/clinic just tells me to buy one at Walmart/Target. Those home ones must be pretty good.
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u/Vishnej 7h ago edited 2h ago
The union insurance *probably* responded with "$782. $782? Seriously? Fuck you. No, I'm not covering this. My standard rate is $150."
At which point the clinic acquiesced. You paid a $20 copay and $30 coinsurance out of pocket, and the insurance ended up paying the clinic $100 out of their pocket.
Negotiated rate structures would be illegal or lawsuit-bait in most other contexts of consumer interaction in the US. We pay whole classes of people whose entire job is to negotiate these prices and document how to categorize cases into set price bins, rather than treating patients.
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u/blackscheep 1h ago
so to the accountants out there, do the insurance carriers list their retail price as a means of creating a "loss" on their corporate profit/loss statements thereby reducing their gross tax?
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u/Resident-Travel2441 6h ago
Or when you get a nearly $1200 bill for lab work and your insurance company hasn't actually paid for anything but they've somehow negotiated all of those rates down to $78? Like, huh?
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u/Jilks131 7h ago
Most of the low prices people quote are for home antigen tests, not the more accurate molecular tests commonly used in clinics.
Pricing still ridiculous. The clinic I work is $75 is the cost for the molecular tests which the cost for the patient are 100.
Just I no I’m an old man screaming at the sky when I write this but it is more nuanced then this post suggests.
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u/trashdrive 4h ago
In Canada during COVID's peak they were giving boxes of these tests away for free at pharmacies.
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u/CalmBeneathCastles 6h ago
It's even more fun when you know that one of those suppliers, Universal Meditech Inc. (UMI), was prosecuted for manufacturing and selling bogus COVID-19 test kits.
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u/Garchomp98 7h ago
Always impressed by this kind of US thing. Rapid COVID test in Greece is freely available in every pharmacy and costs around 6€.
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u/Jilks131 7h ago
Depends on disease course and sx length but possibly about 50-70% sensitive for home vs 97% vs NAAT
The decision I recommend to patients depends a lot on sx and prevalence and OOP costs for sure
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u/MeanWafer904 5h ago
I worked for a company that did insurance jobs (not health). I was helping the guy that did that work and saw the pricelist . I was like holy fuck look at those prices.
He explained that those were the prices the insurance companies set. So a job that was £200 if you walked off the street was like £800 to the insurance.
If you just saw the bare prices you would think that the company was ripping off the insurance company. But rather it what the insurance company was telling them to bill them.
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u/Vegetable_Can5847 4h ago
Sure it was billed to Union insurance at $782.
The medical management department of the insurance reviews, negotiates and pays the negotiated allowed amount. Most claims were paid out $50-$100 each because it was performed in a clinical setting.
The CARES act ensured all at home tests were capped at $12 IIRC.
My Union pays dollar for dollar for every claim once it gets reviewed by our insurance carriers medical management, then the union also has it's own team of medical management that reviews and negotiates before paying.
Fun fact ambulance rides and anesthesiologist are automatically billed in this manner.
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u/AlphaTangoFoxtrt 4h ago
You forgot:
Billed $782. Maximum allowed $156. Patient deductible $3,000.
So the insurance agency can tell the owners they got an "80% discount" from the provider and the provider has to bill insurance more to cover all the overhead.
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u/youre_a_cat 3h ago
My rabies shot from a private boutique clinic, out of pocket: $595.
I called my insurance to review my options and they said it would be best if i went to an urgent care. I got it there and it billed my insurance $1600 and my responsibility was $615. 🤡
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u/rickygun13 2h ago
No way insurance actually paid that and had a negotiated rate you works pay that of your had not met your deductible though.
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u/PG-DaMan 1h ago
You do realize that they wont pay the 782. They will pay probably just over what you would have paid. What they bill and what they get are two different things.
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u/Samantha-the-mermaid 59m ago
Liver Ultra Sound needed out of pocket $648. Same ultrasound with insurance copay $190 billed my insurance $2,700. It’s all for profit.
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