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