Comments on: Customary Charges Are Not Always Reasonable http://www.healthinsurancecolorado.net/blog1/2009/01/24/customary-charges-are-not-always-reasonable/ Research and discussion of the Colorado health insurance industry and the healthcare crisis in America. Sat, 21 Nov 2009 07:36:06 -0700 http://wordpress.org/?v=abc hourly 1 By: Melissa http://www.healthinsurancecolorado.net/blog1/2009/01/24/customary-charges-are-not-always-reasonable/comment-page-1/#comment-13008 Melissa Wed, 28 Jan 2009 17:47:48 +0000 http://www.healthinsurancecolorado.net/blog1/?p=943#comment-13008 Let's also not forget all the varying reimbursements by insurers. The adage, 'it takes two', may be reasonable to state her in this situation of reasonable and customary fees. If insurers balk at the varying prices, they need to take a look at the hypocricy of their balking--there's quite a bit of discrepancy in reimbursements. Possibly it's the 'type' and 'cost' of the plan that the insured buys. But, I've seen far too many examples of reimbursements being 'all over the board'. So what to take from all of this? One, the issue is a very complex one with probably many reasons by insurers and providers as to why the varying costs, and Two, let's all just ask ourselves who's making the money here and who's really benefitting. If you take a look at the profits of each and every major insurer, you'll find the answer. It's certainly not the providers...and I can attest to my own backyard on that one. These databases (owned by insurers themselves) that 'gather' information on helping configure the most reasonable and customary rates for certain procedures, is very circumspect. Check out information on Ingenix and United Health Group to get yourself, as the consumer, properly informed. Let’s also not forget all the varying reimbursements by insurers. The adage, ‘it takes two’, may be reasonable to state her in this situation of reasonable and customary fees. If insurers balk at the varying prices, they need to take a look at the hypocricy of their balking–there’s quite a bit of discrepancy in reimbursements. Possibly it’s the ‘type’ and ‘cost’ of the plan that the insured buys. But, I’ve seen far too many examples of reimbursements being ‘all over the board’.

So what to take from all of this? One, the issue is a very complex one with probably many reasons by insurers and providers as to why the varying costs, and Two, let’s all just ask ourselves who’s making the money here and who’s really benefitting. If you take a look at the profits of each and every major insurer, you’ll find the answer. It’s certainly not the providers…and I can attest to my own backyard on that one.

These databases (owned by insurers themselves) that ‘gather’ information on helping configure the most reasonable and customary rates for certain procedures, is very circumspect. Check out information on Ingenix and United Health Group to get yourself, as the consumer, properly informed.

]]> By: k http://www.healthinsurancecolorado.net/blog1/2009/01/24/customary-charges-are-not-always-reasonable/comment-page-1/#comment-13005 k Tue, 27 Jan 2009 01:55:44 +0000 http://www.healthinsurancecolorado.net/blog1/?p=943#comment-13005 Let us not forget what a mess Ingenix' "UCR" database is. And please check out Dr. Wes's post on the Illinois Fair Billing Act - the table of %discounts off "list price" to be given to uninsured pts by hospital(s)/systems is pretty interesting (not just for the hospitals listed, but also for those not listed.) Let us not forget what a mess Ingenix’ “UCR” database is. And please check out Dr. Wes’s post on the Illinois Fair Billing Act – the table of %discounts off “list price” to be given to uninsured pts by hospital(s)/systems is pretty interesting (not just for the hospitals listed, but also for those not listed.)

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