Medical Loopholes and Bullshit

Turd__AuthorityOur medical billing and reimbursement system is so fucked. Hospitals bill 10x what it costs them, insurances all have contracted rates and they pay the hospitals a fraction of the initial bill, then the patient gets the copay. It's all fucked. No insurance is the same.

Anyone have any good insurance stories or loopholes?

Trick #1: you can fight to have your bill reduced by claiming you can't pay it or complaining that's it's too much. This applies for major health systems. Not sure about smaller ones.

Trick #2: if you don't pay your bills and they get sent to collections, don't fret. The majority (not always) of medical bills don't get reported to credit agencies even when sent to collections. You can just wait for it to fall off. The debt collectors won't tell you this because it would disadvantage them. You can always ask as well as demand they don't report if you pay it.

Trick #3: You can negotiate with debt collectors for reduced payments. They buy your debt for fractions so they likely have leeway on this. I got hit with a medical bill my parents missed and I was able to only pay half to make it go away. That's was me being generous because they don't report to credit bureaus.

Loophole #1: So I'm on this crazy expensive injection that CVS Caremark wouldn't cover because it's not first line. Understandable. But my medical coverage, Aetna, covered it so I've been going to an infusion clinic to get them for about a year. Now since I've been on it, CVS has approved my prior authorization because it is considered "continuation of care". Lmao do you realize how fucking ludicrous that is??? Wtf.

Loophole #2: My injection costs a fuck ton of money, $1mil per year if a hospital is billing it (see photo- every 8 weeks). So drug manufacturers have patient assistance programs that they use to get people on their meds and covered. Basically my insurance pays their portion and then the copay is paid by the manufacturer. My specific drug, the manufacturer covers up to like $20k or so a year which is way above my annual deductible and oop max. Why would they do this you may ask? Well because even if they're losing $2k in co-pays per injection, they're still making bank on selling it. The loophole here is that the copay (deductible and out of pocket) is paid by the manufacturer program. If I time stuff right, I can completely avoid paying any deductible or out of pocket expenses ever and just bank into my HSA. It's completely legal too which boggles my mind. One injection maxes out my insurance obligations for the year.

Turd__AuthorityOur medical billing and reimbursement system is so fucked. Hospitals bill 10x what it costs them, insurances all have contracted rates and they pay the hospitals a fraction of the initial bill, then the patient gets the copay. It's all fucked. No insurance is the same.

Anyone have any good insurance stories or loopholes?

Trick #1: you can fight to have your bill reduced by claiming you can't pay it or complaining that's it's too much. This applies for major health systems. Not sure about smaller ones.

Trick #2: if you don't pay your bills and they get sent to collections, don't fret. The majority (not always) of medical bills don't get reported to credit agencies even when sent to collections. You can just wait for it to fall off. The debt collectors won't tell you this because it would disadvantage them. You can always ask as well as demand they don't report if you pay it.

Trick #3: You can negotiate with debt collectors for reduced payments. They buy your debt for fractions so they likely have leeway on this. I got hit with a medical bill my parents missed and I was able to only pay half to make it go away. That's was me being generous because they don't report to credit bureaus.

Loophole #1: So I'm on this crazy expensive injection that CVS Caremark wouldn't cover because it's not first line. Understandable. But my medical coverage, Aetna, covered it so I've been going to an infusion clinic to get them for about a year. Now since I've been on it, CVS has approved my prior authorization because it is considered "continuation of care". Lmao do you realize how fucking ludicrous that is??? Wtf.

Loophole #2: My injection costs a fuck ton of money, $1mil per year if a hospital is billing it (see photo- every 8 weeks). So drug manufacturers have patient assistance programs that they use to get people on their meds and covered. Basically my insurance pays their portion and then the copay is paid by the manufacturer. My specific drug, the manufacturer covers up to like $20k or so a year which is way above my annual deductible and oop max. Why would they do this you may ask? Well because even if they're losing $2k in co-pays per injection, they're still making bank on selling it. The loophole here is that the copay (deductible and out of pocket) is paid by the manufacturer program. If I time stuff right, I can completely avoid paying any deductible or out of pocket expenses ever and just bank into my HSA. It's completely legal too which boggles my mind. One injection maxes out my insurance obligations for the year.

mystery3Is that for the crazy expensive yet super effective hep b treatment or what?

Turd__AuthorityIt's a biologic immunosuppressant for my Crohns disease. It's expensive but definitely does not cost near that much. Insane they billed that