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They are billed one sum for all pharmacy like/related drugsInsurers reimburse based on procedures...not the supplies used.
They reimburse for everything that is covered by the plan. So cotton swabs, bandages, advil and procedures...it's all priced out in the chargemaster. Otherwise, from where do you think they are determining how much insurance reimburses?
Hence they are only billed using procedure codes. Not itemized lists of supplies i.e. "Tylenol" or " IV bags".
Fine. Whatever. Changing the word doesn't change what's happening. If you want to make a semantic argument, fine. Just know it's still an inaccurate argument you're making. The only way you can is to shift the goalposts.
Then you agree, Obamacare with the pre-existing condition option isn't insurance.
Can I be diagnosed with cancer in September and buy "insurance" for the first time in October?.
But it can, see above.
I posted the definition of insurance. Do you agree with it or not?
Are you telling me you don't see the conflict between the definition I posted and Obamacare? Seriously?
So when you said I can't get it anytime I want, you were wrong in my case.
They aren't marking up your " Tylenol"
They pay those charges based on negotiated contracts per plan ...with the hospitals.They are billed one sum for all pharmacy like/related drugsInsurers reimburse based on procedures...not the supplies used.
They reimburse for everything that is covered by the plan. So cotton swabs, bandages, advil and procedures...it's all priced out in the chargemaster. Otherwise, from where do you think they are determining how much insurance reimburses?
Hence they are only billed using procedure codes. Not itemized lists of supplies i.e. "Tylenol" or " IV bags".
Fine. Whatever. Changing the word doesn't change what's happening. If you want to make a semantic argument, fine. Just know it's still an inaccurate argument you're making. The only way you can is to shift the goalposts.
Example
Pharmacy general......$9.00
Pharmacy/radiology....$ 52.00
Labs general....................$9.00
Labs chemistry.................$9.00
ER general......................$ 900.00
So on and do forth...
They aren't marking up your " Tylenol"
It means a sum total of ALL pharmacy related drugs given to you during your stay. Which is billed by the hospital,physicians clinic ,dr office etc...They aren't marking up your " Tylenol"
What an idiot...
FROM YOUR OWN POST: Pharmacy general......$9.00
That is the markup. $9 for tylenol. Of course, you leave plenty out of what you wrote. What do you think "Pharmacy general" means? That's the tylenol markup. Yeesh. For someone who bleats and brays that they worked in this industry, you sure as shit don't know much about it.
Then you agree, Obamacare with the pre-existing condition option isn't insurance.
It is insurance. You don't want to admit it because doing so would spoil your ego.
Can I be diagnosed with cancer in September and buy "insurance" for the first time in October?.
Yeah. You can also not be diagnosed in September, buy insurance in October, and then be diagnosed in January. It doesn't make a difference, you're still diagnosed regardless. The medical issue is there before diagnosis. Insurance is a hedge against the financial impact of that diagnosis whether it occurs before or after you enroll.
But it can, see above.
So then according to you, anyone with any medical condition should not get insurance. According to you, insurance is only for healthy people. That's not what insurance is. Not even close.
I posted the definition of insurance. Do you agree with it or not?
Posting something and understanding it isn't the same thing. Just like being rich and being successful isn't the same thing. Regurgitating dictionary definitions without understanding those definitions doesn't validate your shitty argument. Get over yourself.
Are you telling me you don't see the conflict between the definition I posted and Obamacare? Seriously?
The only conflict that exists is in your little mind.
So when you said I can't get it anytime I want, you were wrong in my case.
I was talking about individual health insurance, and you knew that. And enrollment in a group plan isn't a choice you make...it's a choice your employer makes if/when they hire you. So you can't simply just get an insurance plan whenever. You have to be hired, and then you get the plan. And even then, employers usually require you to wait 60-90 days before you can start using that plan in order to prevent people from doing precisely what you think happens.
It means a sum total of ALL pharmacy related drugs given to you during your stay. Which is billed by the hospital,physicians clinic ,dr office etc...The insurer does not mark up charges.
Again they reimburse based on negotiated contracts. The better the negotiated contracts...the better the reimbursement.
Nope. a thing providing protection against a possible eventuality
Can I be diagnosed with cancer in September and buy "insurance" for the first time in October?
Yeah.
And that's why it is no longer insurance.
It doesn't make a difference, you're still diagnosed regardless.
It's the difference between insurance and welfare.
Posting something and understanding it isn't the same thing.
a thing providing protection against a possible eventuality
Which is why I continue mocking your idiocy.
Why in the world would an employer try to prevent something like that from happening?
The insurer has nothing to do with the mark up of hospital supplies and services.It means a sum total of ALL pharmacy related drugs given to you during your stay. Which is billed by the hospital,physicians clinic ,dr office etc...The insurer does not mark up charges.
I know they don't mark up the charges. The chargemaster does. The insurer contracts with the provider to determine how much of that marked-up charge they will reimburse.
Again they reimburse based on negotiated contracts. The better the negotiated contracts...the better the reimbursement.
Which is what I've been saying. The insurer contracts with the provider to determine how much of the charge in the chargemaster they will reimburse.
Apparently you don't know what a chargemaster even is.It means a sum total of ALL pharmacy related drugs given to you during your stay. Which is billed by the hospital,physicians clinic ,dr office etc...The insurer does not mark up charges.
I know they don't mark up the charges. The chargemaster does. The insurer contracts with the provider to determine how much of that marked-up charge they will reimburse.
Again they reimburse based on negotiated contracts. The better the negotiated contracts...the better the reimbursement.
Which is what I've been saying. The insurer contracts with the provider to determine how much of the charge in the chargemaster they will reimburse.
Nope. a thing providing protection against a possible eventuality
No, not a possible eventuality. *Costs* from the possible eventuality.
Can I be diagnosed with cancer in September and buy "insurance" for the first time in October?
Yeah.
And that's why it is no longer insurance.
Yes, it is insurance. Otherwise, you're saying sick people shouldn't buy insurance at all.
It doesn't make a difference, you're still diagnosed regardless.
It's the difference between insurance and welfare.
So what your argument boils down to is semantics. Completely pointless. You're saying anyone who has a pre-existing condition and enrolls in any health insurance plan on the exchanges is getting welfare. Whereas if they had a pre-existing condition and enrolled in any health insurance plan before the ACA, it was insurance. So this isn't about what it actually is, this is just you not grasping what the ACA does, what insurance companies do, what health insurance is, and how it relates to your actual health care.
Posting something and understanding it isn't the same thing.
a thing providing protection against a possible eventuality
Which is why I continue mocking your idiocy.
Sigh...you're not insuring your health when you get health insurance. You're insuring protection from financial ruin that comes from the costs associated with health care. Health insurance has nothing to do with health care delivery. You are trying to conflate the two because you don't understand what health insurance is.
Why in the world would an employer try to prevent something like that from happening?
So people don't take advantage of their employment, then once they get what they want and have it paid for via the group plan, they leave.
What you're saying is that someone without insurance who is diagnosed with cancer shouldn't buy insurance after they are diagnosed (never mind the fact that not having insurance is probably why they got diagnosed with cancer in the first place...as it went undetected because that person didn't get screenings from a doctor) because somehow it's welfare. How it's welfare, you haven't really explained. You just seem to think that if you get more than what you put in, that amounts to welfare. Which would mean if you incur more health care costs than premiums you pay, according to your standard that is welfare.
On Fox 'n' Friends, Brian Kilmeade lamented that healthy people pay for sick people.
That is literally what health insurance is.
Congrats to the not-presently-on-fire for paying for firefighters.
There are places where you don't have to pay for firefighters.
If your house burns down....you are out of luck.
But you have that choice.
They have private fire departments, dumbass. And if you have a mortgage on your house, the bank requires you to have a contract with a fire service.
Why should anyone feel sorry for a dumbass who doesn't pay for fire service?On Fox 'n' Friends, Brian Kilmeade lamented that healthy people pay for sick people.
That is literally what health insurance is.
Congrats to the not-presently-on-fire for paying for firefighters.
There are places where you don't have to pay for firefighters.
If your house burns down....you are out of luck.
But you have that choice.
They have private fire departments, dumbass. And if you have a mortgage on your house, the bank requires you to have a contract with a fire service.
Yes, they do. The point is that you are not forced to by the service.
There is a consequence if you don't pay......
But you have that choice.
Why should anyone feel sorry for a dumbass who doesn't pay for fire service?On Fox 'n' Friends, Brian Kilmeade lamented that healthy people pay for sick people.
That is literally what health insurance is.
Congrats to the not-presently-on-fire for paying for firefighters.
There are places where you don't have to pay for firefighters.
If your house burns down....you are out of luck.
But you have that choice.
They have private fire departments, dumbass. And if you have a mortgage on your house, the bank requires you to have a contract with a fire service.
Yes, they do. The point is that you are not forced to by the service.
There is a consequence if you don't pay......
But you have that choice.
You really are one stupid son-of-a-bitch.
No, you guys are stupid because you don't know what health insurance is, and you never have. That's why you can't articulate a replacement plan. Because you lack the brain power to understand it. Whether or not you're being deliberately obtuse is a whole other question.
You get a big medical bill and they will put you on a payment program.
Right...they garnish your wages. That's the "payment plan". And when you pay cash, you're paying over-inflated prices that are in the chargemaster. Or they give you a discount, but that discount just gets paid by those on insurance, who have taken personal responsibility.
Thanks for making my point, dickhead. You get a bill for 33K, you sell your car and pay off the hospital.
Math is hard for your guys.
$25K =/= $33K.
So you're still $8K in the hole.
In most cases, there is no reason the government should provide these services. The leftwing argument that nobody would if the government didn't do it is clearly false.Why should anyone feel sorry for a dumbass who doesn't pay for fire service?On Fox 'n' Friends, Brian Kilmeade lamented that healthy people pay for sick people.
That is literally what health insurance is.
Congrats to the not-presently-on-fire for paying for firefighters.
There are places where you don't have to pay for firefighters.
If your house burns down....you are out of luck.
But you have that choice.
They have private fire departments, dumbass. And if you have a mortgage on your house, the bank requires you to have a contract with a fire service.
Yes, they do. The point is that you are not forced to by the service.
There is a consequence if you don't pay......
But you have that choice.
Please show me where I said they should.
My point was that this universal claim of government providing services does not always hold.
In most cases, there is no reason the government should provide these services. The leftwing argument that nobody would if the government didn't do it is clearly false.Why should anyone feel sorry for a dumbass who doesn't pay for fire service?There are places where you don't have to pay for firefighters.
If your house burns down....you are out of luck.
But you have that choice.
They have private fire departments, dumbass. And if you have a mortgage on your house, the bank requires you to have a contract with a fire service.
Yes, they do. The point is that you are not forced to by the service.
There is a consequence if you don't pay......
But you have that choice.
Please show me where I said they should.
My point was that this universal claim of government providing services does not always hold.
Contracting officer for Medicare/Medicaid innovation.I wasn't complaining about Medicare. I was stating a fact. They cover less and pay out less.
Fine. But why do they do that? Because of how much is paid into it. So the reason Aetna reimburses more than Medicare in some cases, is because you're paying higher premiums for Aetna and thus, Aetna can reimburse more. So if you raise the Medicare tax, that leads to more money able to be spent toward reimbursement. So why not just do that, and do away with private insurance altogether? Medicare-for-all is 100% portability, which you don't get with private insurance. So if you are on Medicare you can go to any doctor nationwide that accepts Medicare. If you are on Aetna, you can only go to the doctor in your geographically-limited area, and even then the doctor has to be a part of that insurance network, which isn't a guarantee.
BTW I was offered a job in Washington working Medicare...I know what they pay. And the paper pushers make two/three times what the market rate is for other healthplans across the country.
First of all, Medicare doesn't do Medicare administration. Thanks to the 2003 Medicare Part-D legislation Conservatives passed, all CMS services are done by private companies. So when you say you were "offered a job to work for Medicare", what specifically are you talking about?
What part of the actual pricing for the customer is less because the prices on all items don't change but the required mark up that is reported does ...across the board ....isn't penetrating your thick skull??
No part is less. The patient isn't getting a discount if they don't have insurance and elect to pay cash. They're paying more than the insurer pays for the same procedure. So say X procedure is listed as $50K in the chargemaster. If you have an 80/20 insurance plan, the insurer is paying $40K, and you're paying $10K. If you don't have insurance, X procedure still costs $50K. And instead of only paying $10K, you're paying the full $50K because there is no other payor. So what hospitals do is they intially bill you $75K, and you then apply or ask for a "discount", and the hospital very "generously" reduces your bill to $50K. Which is what your insurance would have paid 80% of anyway, only now you're voluntarily paying what their share would be on top of what you're also paying out-of-pocket, but you're very obliviously paying what the rate is anyway while walking away thinking you got the better of the provider. You didn't. You got hosed.
That's how it works.
It is a product made and sold for profit by the private industry that is forced on Americans by our government. You're welcome
What is the product? I mean, physically, what is the product an insurance company makes?
