Blue Cross Of California - Rate increases every few months

healh insurance - Complaint
Review by goodgrief on 2012-05-03
Rating: StarEmpty StarEmpty StarEmpty StarEmpty Star
ARCADIA, CALIFORNIA -- Blue Cross is the worst insurance company. Within the last 3 years my premium went from about $600 month to $1171 a monh. They seem to have an increase every few monhs. Their benifits are horrible and I have a huge deductible. Not only that, but their reimbursements to doctors are very low. They pocket all of the profit. Everything about the company is horrible. Service people are rude and someimes can"t speak English. Don't buy insurance from this company!!!
Comments:19 Replies - Latest reply on 2012-05-03
Posted by Anonymous on 2012-05-03:
Insurance companies don't reimburse doctors and then pocket the difference. Your doctor sends the insurance company a claim, not money. The insurance pays that claim based on your benefits. Any money left over gets written off, if the doctor is in network. There's no way for the insurance to pocket any money from your doctor since your doctor doesn't send the insurance company any money.
Posted by Churro on 2012-05-03:
The OP never stated doctors send the insurance companies money. They merely stated the insurance company profits from the savings gained by the scheduled allowances which is probably true.

I gotta agree health insurance sucks more and more with each passing year.
Posted by Anonymous on 2012-05-03:
There is no way for the insurance company to pocket the savings. That money either gets written off, or becomes the patient's responsibility.
Posted by Churro on 2012-05-03:
How does the insurance company write off what they didn't pay? That doesn't even make sense.
Posted by Anonymous on 2012-05-03:
It's called a contractual adjustment. I use the term write off because it makes more sense
Posted by Bill on 2012-05-03:
One thing right off the bat - California.
There is a lot of pressure on insurance companies to provide all types of coverage and I'm sure CA leads the pack on this.
Companies are also raising rates in preparation for Obamacare in 2014. I guess they're trying to make as much as they can now.
Apparently you're not in an employer sponsored plan where rates cannot be raised during the year only at the enrollment time.

Another thing is make sure you go to a doctor in their network that way you will get the negotiated fee.
Posted by Churro on 2012-05-03:
Okay, so the insurance company through a "contractual adjustment" reduces the doctor's submitted charges let's say from $200 to $125. Let's say the OP has a $25 co-pay.

Under that scenario the doctor will receive $25 from the OP and $100 from the insurance provider for a total o $125 for $200 of submitted charges. The reduction of $75 is a cost avoidance favoring the insurance company which does indeed add to their profit. That's how I understood the OP's assertion. Regardless though the OP never once stated the doctor was sending the insurance company money.
Posted by Nohandle on 2012-05-03:
Someone explain to me in language I can comprehend. Any company, and I mean any, that makes a profit tends to anger people. I guess they should all be charitable organizations. Blue Cross in my state has more plans than Dr. Carter had little liver pills. Folks grumble if they have to pay an additional penny for anything since they pay a monthly premium which in their opinion should cover everything. I recall with my mother, before her death, insurance didn't pay for drugs and Uncle Sam didn't either. You were on your own.

I personally think any insurance company should promptly pay claims and I mean promptly. Most folks honestly don't understand all the lingo with insurance, at least I don't. There's too many opportunities for error along the way and then it's the patient's responsibility to get it straight. You best hope you have a friend who takes charge and understands it all.
Posted by Anonymous on 2012-05-03:
Assuming the doctor was contracted with the insurance company: the insurance and the dr have a pre agreed upon contract. The insurance pays based off of an allowed amount. Say the dr bills $100 and the insurance allows $20 and the patient has a $20 copay, then the dr gets $40 and the $60 amount gets written off, which is what the dr agreed to when becoming contracted. If the dr not contacted then that difference becomes the members responsibility to pay the dr. So how does the insurance company profit?
Posted by Churro on 2012-05-03:
I think the OP is angered about paying more and getting less while the insurance company's profits continue to skyrocket.
Posted by Churro on 2012-05-03:
LS, the doctor is writing off the difference not the insurance company. The insurance company is profiting from the DR's write off. Like with any business the less I pay out the more I keep.
Posted by Anonymous on 2012-05-03:
The insurance doesn't collect the write off amount.
Posted by Churro on 2012-05-03:
The OP never claimed they did. You falsely made that assumption. The OP stated, "their reimbursements to doctors are very low. They pocket all of the profit". If an insurance company pays out less then that does increase the insurance company's profits as correctly stated by the OP.
Posted by Anonymous on 2012-05-03:
Again, it's not a reimbursement since the dr is not sending actual money to the insurance company. And AGAIN, if the dr is contracted, they agree to be paid that amount.
Posted by Churro on 2012-05-03:
You're the only one relating it to "money" being sent. The OP never made that claim. It's just basic business 101. Profit equals revenues - expenses. The DR write off is lowering the insurance company's expenses which according to the basic profit equation increases profit. That's the gist of what the OP stated. It's just that simple.
Posted by Anonymous on 2012-05-03:
I'm headed to the bar. Wanna join me churro?
Posted by jktshff1 on 2012-05-03:
can I come? Do they have a good red wine?
Posted by Anonymous on 2012-05-03:
Our BC/BS deductible nearly quadrupled last year. I'm glad our employer ditched them for another company.
Posted by Anonymous on 2012-05-03:
Sure Jkt.

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