Quote:
Originally posted by bilmore
Well, first, I make a big distinction in my own mind between liability insurers and health care orgs, since I know one industry and not the other, so, to the extent you address just the one, maybe I should beg off in ignorance.
But, to the extent that logic can fill in blanks in actual knowledge:
"The hospital charges me $X for a visit. The insurance company decides that only $X-Y is "reasonable" for the hospital stay. I don't get to do that; why should they?"
Because it's in the contract into which you (or your employer, more likely) entered. Same with auto insurers only paying a certain amount for a wrecked fender; they take known risks based on predictable costs, and aren't willing (understandably) to pay unreasonable amounts as part of their contractual duty. Why should an insurer send off a check for $3000 for a fender when they know that the same fender can be purchased for $300? Why should they pay $4000 for a hospital room when they know that the prevailing reasonable charge is $1200? Heck, this issue alone has probably done more to keep health care costs down from the provider than any other provision. Do you think hospitals and clinics and docs would keep their rates where they are if they knew they could simply pick any desirable charge and get it paid?
A contract for insurance isn't a promise of a blank check. It calls for a premium in exchange for a set of known benefits. Why would you not question your clinic as to the charge being too high, instead of questioning what you've explicitly contracted for from the insurer?
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Actually, what I contracted for was to have my health care costs covered. I don't have any bargaining power witht the providers, the insurer does. It ought to be the one negotiating and argeeing on an amount for the hospital stay. It should not be incumbent on me, on my own, to fight it out with the hospital.
