I think it's so they can charge some other insurance company the full $500.
Ah, that makes sense.
There was a similar Covid test that we used at some point: it was offered through one of those walk-in ER clinics that I understand to be borderline scams so that they can charge ER prices. There were signs all over the place saying "We promise you will not be responsible for one red cent of the cost of your test" and basically implying that they'll bilk the insurance companies and then waive whatever remains. It's hard to feel bad for the insurance companies, but this also feels like a race to the bottom.
The biggest insurers are government agencies, so they are really trying to be sure to bilk the taxpayers.
2: There was a similar scam a while back on a larger scale, where ambulatory surgery centers were targeting patients with relatively luxurious PPOs that covered out-of-network care with 20% cost-sharing, meant to discourage it compared to in-network, but still cover it. So the ASCs made their prices like ten times the standard rate, billed the plans for 80%, never collected the 20% from patients, and somehow the insurers kept paying those claims for years without noticing anything. (They did eventually realize and sue.)
Anyway, best health-care in the world, unless you get sick or hurt.
I finally bought a fitness tracker and I was so resentful of all the "you can only use this if you agree to let our app access your contacts and make phone calls on your phone and store your heart rate and other data on the cloud" that I said no to a couple of those permission asks and now the wristband just stares back at me with an exclamation point the only thing it will show on the dial. I'm in a stalemate with it.
7: that's how they raise your heartrate, thereby drumming up more business.
4: I have never understood how these practices aren't open-and-shut cases of consumer fraud, it being generally illegal to advertise a good or service at a price one has no intention of actually charging. It's of a piece with hospitals setting their uninsured prices at 10*X, where X is the amount they will actually negotiate to accept.
3: Usually, those coupon codes don't work with public insurance - especially not Medicaid.
The insurance companies set the co-pays to encourage you to use a lower cost option. What would likely be more effective is if your doctor's pay was tied to their using the most cost-effective drugs. If they give you a coupon, you are not sensitive to the price, but they still get to charge the insurer a high price which in turn makes premiums go up.
9: Well, in those cases the consumers weren't being hurt, just the insurance company. But it does seem like it could have been charged as criminal fraud regardless.
It's of a piece with hospitals setting their uninsured prices at 10*X, where X is the amount they will actually negotiate to accept.
In this case, the fig leaf that makes this the legal norm is that these aren't the "uninsured prices", on paper they're the prices for any patient, but of course all insurance, public or private, pays much less as well.
It really is maddening being in that position where you can tell your insurance company is being scammed somehow, but it's not clear what to do about it without making your own life more difficult. Newt had fairly bad eczema for a while, and the dermo prescribed some stuff that would have been quite expensive if we'd gotten the prescription filled at our local pharmacy, but somehow required no copay if we used a delivery-only pharmacy (that is, there wasn't a physical storefront anywhere) the doc asked that we use.
Obviously, some kind of a scam, but my insurance company isn't reimbursing me for time spent investigating things on their behalf, so I went along with it.
It's much less maddening if you accept that the insurance companies are just as evil and can cheer them getting scammed. The current system doesn't make me want to root for anything except injuries.
12: There I wonder if it's a scam. Pharmacy delivery by regular mail is probably cheaper all told than at a counter. Kaiser, which is in a position to know these things, incentivizes it as a result.
My doctor is supposed to be sure I can afford my medicines at every appointment. They ask me that he asked. Fortunately, I get only cheap stuff.
AIHMB my daily medicine for chronic myeloid leukemia has an official price of $15,000+ a month, and I've been taking it for 4 years, and I have never paid a cent.
12: Yeah, that may not be a scam. Insurance companies often encourage you to use mail-order for maintenance meds. It isn't always cheaper, but they tend to believe that for some patients mail order promotes adherence. There is a debate in the literature on this, but it is not necessarily unintentional.
13: There was a public radio program about this with a small union- run plan that was getting clobbered by this. I had a lot of sympathy for them, and don't think they're evil. The money comes out of their members paychecks.
17: I'm glad for you, but that means that people won't have an incentive not to get chronic myeloid leukemia.
Yeah, now that I think of it the surgical center scam I mentioned was often against Aetna as administrator for employer self-funded plans, so, principal-agent problem.
17: Holy cow, I never knew you had chronic leukemia. It sounds bad? Are you doing okay?
12: That particular gambit of very high sticker prices with coupons was being run for a while by a pharma-bro company called Valeant that collapsed in 2016 after some stuff that was very clearly fraud (they had captive pharmacies owned or controlled by executives in the company that filled prescriptions with only outrageously priced Valeant products) instead of the usual "this is disgusting price gouging by pharma-bros but probably legal because America". Same result of nobody going to jail, though, although honestly I'd rather see big pharma make money defrauding big health insurance instead of their usual go-to of crippling the American healthcare system.
20:. Yes, I think they should make me pay something. It's just weird that I pay more for regular inexpensive drugs.
21: I did reveal this previously on Unfogged. I'm fine. This drug I take has almost entirely removed all trace of the disease.
honestly I'd rather see big pharma make money defrauding big health insurance instead of their usual go-to of crippling the American healthcare system
Ultimately, even when it's coming out of the pockets of insurers that are theoretically at risk for higher costs, they can just increase the premiums to pass it on. Thanks to Medical Loss Ratio they can't benefit directly from denying claims, but it's still the soft budget constraint world: "can you afford NOT to pay this?"
Maybe that would be a useful reform, costs of being defrauded do not count as costs for the Medical Loss Ratio.
Well, that's good. Except for the continuous revelations of my ignorance of the people who comment here. Are you white???
26: I thought I remembered that you knew this -- http://www.unfogged.com/archives/comments_16397.html#1994338
29: Not that I'm hurt or anything. It's not like I'm one of your favorite commenters.
This is great! I'm sticking with this precedent, for you to keep track of what I know and when I knew it.
Oh peeee-eeeeeep! What am I forgetting??
But when drug costs are super high for expensive drugs that might not be any better, doctors have to do prior authorizations and they resent them.
If we had Medicare for All, we could all be invested in using our resources wisely.
the thing that is driving up retail insulin prices in the US is a weird runaway process where middlemen companies get discounts for insurance companies and the pharmaceutical companies just jack up the retail cost but the cost through the insurance companies goes up much slower. the pharmaceutical companies keep the retail costs high to make it look like the insurance companies get a good deal through the middlemen companies. The middlemen companies get to keep a portion of any yearly raise in the retail insulin price so the raises keep them happy. It is insane.
pharmaceutical companies do try to give discounts to non-insured poor people, but if you don't qualify you have to pay full retail insulin prices and this kills people when they ration doses and such.
https://care.diabetesjournals.org/content/41/6/1299
the way to fix this is M4A, but theoretically you could halfass it and just outlaw medical discounts
Wow, this was a merry intersection of threads. Jammies just mentioned that the pharmacist couldn't get the coupon to work, and so he just payed $500. My jaw dropped and I definitely reacted to that choice. And now he's having a counter-reaction a la the other thread. ("We've paid a lot for other prescriptions before!" Yes, but! but! Those didn't have a $500 coupon! It's okay to go back and forth and drag things out with the pharmacist to save $500!)