10-06-2013, 05:39 AM
The devil will be in the deductible and the co-pays. Here are some examples:
Hawaii Radiological base rate charges individuals three times as much to an individual as they charge Kaiser for the same mammography. Your co-pay is based on the walk-in rate, Kaisers share is based on the negotiated rate at 33% of the base rate . On a $1,000. bill your 30% copay is $300. Kaisers share on the "adjusted rate is $33.00.
Under ACA the mammography screening is free, however I have had several people tell me their initial screening was "inconclusive" so they were not only terrorized, but sent back for a "diagnostic" X ray which is not covered at a cost of $1200 (or $396 if you are Kaiser). In both cases the second X ray was negative.
As my agent Kaiser or HMSA should be getting me the same deal they negotiate for themselves, otherwise it has the appearance of conclusion for price fixing.
Clinical labs charges half price if you pay at the counter,(you have to know to ask) if you have insurance they or the insurance company bill you for your share. That means with a 50% copay you pay the whole thing.
Because of the American "sue-age system" doctors send you for all kinds of tests you may not need just to protect themselves from the ambulance chasers. So the testing monopolies do real well in an apparent conspiracy with the insurance companies. Does anyone know if they are regulated at all?
I am interested in other peoples experiences in similar situations.
Hawaii Radiological base rate charges individuals three times as much to an individual as they charge Kaiser for the same mammography. Your co-pay is based on the walk-in rate, Kaisers share is based on the negotiated rate at 33% of the base rate . On a $1,000. bill your 30% copay is $300. Kaisers share on the "adjusted rate is $33.00.
Under ACA the mammography screening is free, however I have had several people tell me their initial screening was "inconclusive" so they were not only terrorized, but sent back for a "diagnostic" X ray which is not covered at a cost of $1200 (or $396 if you are Kaiser). In both cases the second X ray was negative.
As my agent Kaiser or HMSA should be getting me the same deal they negotiate for themselves, otherwise it has the appearance of conclusion for price fixing.
Clinical labs charges half price if you pay at the counter,(you have to know to ask) if you have insurance they or the insurance company bill you for your share. That means with a 50% copay you pay the whole thing.
Because of the American "sue-age system" doctors send you for all kinds of tests you may not need just to protect themselves from the ambulance chasers. So the testing monopolies do real well in an apparent conspiracy with the insurance companies. Does anyone know if they are regulated at all?
I am interested in other peoples experiences in similar situations.