Re: OT: capitation (was Re: Occupancy and Security PIR - Suggestions?)

["Robert L Bass" <no-sales-spam@bassburglaralarms>]

>> I always thought my insurance paid for line-item stuff.
>
> Read the fine print in your policy. Insurance Companies
> collect premiums, they DO NOT pay claims.  That is
> straight from a confidential Shifting Sands Mutual
> financial report...

Hmm.  I wonder how my insurance company works.  They
are one of the largest and so far we've never had a problem
with them denying anything.  Then again, I haven't needed
anything "experimental."

When I first got the invoices from the Moffitt Cancer Center
I was shocked.  The whole procedure -- four months of
chemo -- came with a price tab over $250,000.  The
insurance company would pay a bit more than half of that.
This was in addition to nearly $100,000 for surgery, tests
and other care before the chemo even began, plus five
years of CT Scans, RMI's and other assorted alphabet soup.

Then I read the fine print.  The doctors and the hospitals
agree to accept the insurance company's negotiated
fees as payment in full.  We were responsible for the
deductible which was only a few thousand dollars -- no
big deal.  Presumably not every doctor nor every hospital
has such an agreement.  I wonder what others do.

Whatever the insurer's deal is with the hospitals I went to,
it worked out ok financially for me.  I'm waiting for results
of another biopsy now.  I don't mind the treatment or the
"procedures."  It's waiting to hear the results that I hate.