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Genesis · 10th January 2006, 13:48

Well, this is the reality of medical "insurance" guys.

What's "reasonable and customary?" Have you ever tried to ask an insurance company that?

I have. I ran a company for over a decade and we had group health insurance. One of the things I tried - and failed - to get was a list of procedures and "reasonable and customary" charges for them.

Why? Because its a legitimate point of comparison among companies when you're shopping for insurance.

Every one of them refused to give it to me.

Every one. Every time.

The only way you find out is after there has been a claim.

IMHO, DAN does not have a leg to stand on here, until and unless they publish what their "reasonable and customary" charges are for given procedures.

As for DAN not leaving people "high and dry", I'd love to believe that, but if I'm forced to pay out of pocket (I CAN do this if necessary) and then submit for reimbursement I am now subject to DAN deciding what is "reasonable and customary" after the event - while my money is already gone.

That's not acceptable.

IMHO DAN needs to publish their schedule of reimbursements - what's "reasonable and customary."

BTW, would you buy insurance on your house if the company wouldn't tell you what the amount they'd pay for a total loss is? I wouldn't and I bet you wouldn't either.

How come we tolerate this nonsense in the health "insurance" field? In the US at least, we not only tolerate it, we've granted these companies an exemption from anti-trust law, allowing them to collude to decide what is "reasonable and customary" between all of them and fix their reimbursement levels, thus sticking us with the bills - or being refused service entirely - if the providers don't like what they're getting paid! At the same time its legal for them to refuse to tell us what those reimbursement levels are - even when every company in the nation does it collectively.

This sort of thing is illegal in virtually every industry. The Insurance Industry carved themselves out an exemption from the body of law that makes this sort of bilking felonious for everyone else.

10th January 2006, 13:48	#6 (permalink)
Genesis Bubbless Box of Death Current Rebreather/s: Home Build Other Rebreather/s: Home Build Join Date: Oct 2005 Location: Sunny Florida Posts: 1,396	Re: D.A.N. America Warning! Well, this is the reality of medical "insurance" guys. What's "reasonable and customary?" Have you ever tried to ask an insurance company that? I have. I ran a company for over a decade and we had group health insurance. One of the things I tried - and failed - to get was a list of procedures and "reasonable and customary" charges for them. Why? Because its a legitimate point of comparison among companies when you're shopping for insurance. Every one of them refused to give it to me. Every one. Every time. The only way you find out is after there has been a claim. IMHO, DAN does not have a leg to stand on here, until and unless they publish what their "reasonable and customary" charges are for given procedures. As for DAN not leaving people "high and dry", I'd love to believe that, but if I'm forced to pay out of pocket (I CAN do this if necessary) and then submit for reimbursement I am now subject to DAN deciding what is "reasonable and customary" after the event - while my money is already gone. That's not acceptable. IMHO DAN needs to publish their schedule of reimbursements - what's "reasonable and customary." BTW, would you buy insurance on your house if the company wouldn't tell you what the amount they'd pay for a total loss is? I wouldn't and I bet you wouldn't either. How come we tolerate this nonsense in the health "insurance" field? In the US at least, we not only tolerate it, we've granted these companies an exemption from anti-trust law, allowing them to collude to decide what is "reasonable and customary" between all of them and fix their reimbursement levels, thus sticking us with the bills - or being refused service entirely - if the providers don't like what they're getting paid! At the same time its legal for them to refuse to tell us what those reimbursement levels are - even when every company in the nation does it collectively. This sort of thing is illegal in virtually every industry. The Insurance Industry carved themselves out an exemption from the body of law that makes this sort of bilking felonious for everyone else. Last edited by Genesis : 10th January 2006 at 13:52.
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