I was chatting with a friend who is currently practicing criminal law in California about this case. We both agreed this case is going to be a challenge for a prosecutor. Clearly the defendant laid in wait, for the defendant to exit his residence and walk in street. However, many states require the presence of aggravating factors such as murder being particularly heinous, cruel, or involving torture. Other factors might include the victim being a law enforcement officer or if the murder occurred during the commission of another man endangering felony, such as a robbery or sexual assault to seek the death penalty. Possession of an unlicensed firearm without serial numbers is not a man endangering crime. These considerations may have moved the NY DA to file for man slaughter in addition to murder one.
There is also the challenge of persuading a jury that the head of a healthcare company accused of denying, delaying, and defending against claims is not at fault. It is likely that many jurors have had negative experiences with health insurance companies. In fact, I will say that every member of that jury has personally or through a relative experienced problems with a healthcare insurer.
These experiences should not affect their deliberations, but they do. Jurors must base their decisions on facts, not personal feelings. Believing otherwise is as unlikely as believing Trump descended from heaven to save America.
Violence should not be a solution. Individuals who commit such acts should face appropriate consequences. Given the mitigating factors, obtaining a first-degree murder conviction by the NYDA appears unlikely due to numerous variables. This individual is responsible for taking the life of another person. There is a penalty for this.
What I believe this incident points are greater regulation of the healthcare insurance industry. For example, setting their profits to a certain level and requiring them to plow these profits back into handling claims in a more equitable manner. Of course, Republicans believe that is a form of communism (in fact it is closer to socialism) but to republicans, communism evokes a stronger feeling of disdain.
Currently independent observers estimate health insurance companies’ average claims ratio is 70%, meaning around 70% of premiums earned are used to cover claims. The loss ratio, which is closely related, typically sits around 80%, showing that 80% of premiums earned go toward covering claims. This ratio could be brought down to somewhere around 15 % and still make huge profits for the companies based on the volume. Another factor is the cost of services. Some trimming there could help resolve this issue. Democrats could run on these issues but for reasons unknown they choose to point to Trump’s shenanigans. Why not do both?
Q: Why did the venerable Sutton’s Drug Store in Chapel Hill close its pharmacy?
A: Because pharmacy benefit managers like United Health Group (through its Optum Rx PBM) routinely reimburse independent pharmacists like Sutton’s below what the indy pharmacist pays for a medication (i.e., the pharmacy loses money filling a prescription), BUT reimburses their own corporate mail order (or retail chain) pharmacy affiliates at a profit. Sutton’s Drug Store, which has operated on Franklin Street for over 100 years, is now a lunch counter and not a “drug store”. The new owner shuttered the pharmacy over a decade ago.
Establsihment figures- media, pundit, business and political- narrrate the murder of Brian Thompson as a gross violation of the rule of law and societal norms. That, despite the fact that ours is a nation forged by violence: guns the leading cause of death of American children, our weapons shipped to Israel to carry out flagrant violations of international law and conduct a wholesale genocide whose primary casualties are kids under the age of fourteen, a president who urges his followers to “fight like hell” prior to their attacking the Capitol.
But violence isn’t always headline-worthy and bloody- to wit, the violence inflicted by the state and elites on Americans who are going broke paying for healthcare. It’s no secret that the US has no peer in terms of how much we pay for the rotten health care we go broke subsidizing with premiums and co-pays and out-of-pocket expenses. A CEO with a fat paycheck who preys on consumers- United Healthcare rejects over 1/3 of all claims- codes to most Americans as a crime boss or a terrorist. Those notorious designations, which are meted out only by the state, place the designees in the crosshairs of the state military-law enforcement-judicial system.
Brian Thompson and others like him are, to hundreds of millions of Americans, terrorists. They take, they deny, they accumulate and they jeer. They pay for protection with lavish acts of political bribery (the state sanctions the bribes as “campaign contributions”) that ordinary Americans can not afford.... becase they are paying inflated health care out-of-pocket costs, jacked-up food costs, surge pricing for toothpaste and inflated health care premiums....all sold by terrorist organizations. Americans remember all too well the mortgage crisis of the aughts in which 10 million people lost their home to foreclosure...and not a single CEO, not one, went to jail- and that’s mind-boggling considering that the United States has more people in prison than any country in the world. JP Morgan Chase CEO Jamie Dimon is worth almost $3 billion.
Thomas has it wrong about those cheering Luigi- they are Democrats and Republicans, leftists and right-wingers bonded by outrage and constituting perhaps the most bipartisan kumbaya of the 21st century. The cheering is not for one man’s death; the cheering is for someone who fought back and struck a blow on behalf of all those who could not or would not. People are fed up and disgusted with being assaulted by cowboy capitalism, cold-hearted greed and a political class that toils for its campaign donors. Brian Thompson’s murder sent a signal- loud and clear- that the masses are restless. Establishment figures will attempt to temper dissent and keep order for the elites to continue feasting, but I daresay they will think twice before they start gouging. At least until Q2 2025 10-K reports are due.
Luigi Mangione? He is innocent until proven guilty but the American public has already pardoned him.
I read somewhere that there is a law that corporations must place the stockholders' needs above anyone else's. I don't think that is appropriate for an industry that deals in life and death. If healthcare for all isn't politically possible, perhaps a change in that law would be.
This is where tax breaks come in. If a corporation engages in a business that serves a public need, such as healthcare insurance, tax breaks should be available. Offering these incentives would make the operation of such a corporation profitable while still serving the needs of its stockholders.
Well said Thomas. I’m not going to defend insurance companies in the least bit, but there’s just as much culpability on the healthcare provider side and big Pharma. A medicine that costs $5,000 a month, when the drug companies know that the people that need it the most are probably the ones that can’t afford it. Or a scan at the hospital that takes 5 minutes and costs $7,500. They are fleecing us just as bad as the insurance companies.
This is the reason you are losing so many subscribers like me.. We know that murder is wrong and dont have to be reminded by you. We also no that this makes a profound statement, one that needs to be made and one that needs to be expanded upon, and not one that needs to be hushed up by you,
C,mon, Odin. “That guy” is dead; yet you want him in prison, too? And just how is Thompson’s murder gonna “fix” the system? I’ll wait. But don’t get me wrong, it most definitely needs fixing. I just don’t think murdering CEOs, or anybody else for that matter, is the way to jump start it. This country has plenty of people smart enough to know what should and needs to be done to fix this system. Question is, do we have enough in positions of power with the WILL to do it?
Should be in prison. He might even still be alive if he was in there. For whatever that is worth.
Him getting killed is like a drunk crashing into your house, revealing the mold that has been building up that people have been covering for years hoping it wouldn't get worse.
Now everybody sees it more clearly and wonders why the hell our government is so bought.
Didn't say this would fix anything. I'm saying nothing else does.
Unless there are hundreds of Progressive politicians who can actually win seats who we can pull out of a hat, or something.
I guess I didnt realize it is progressives cheering the killer. When I first heard about the murder, I figured he will have multiple proposals from goofy women who seem to fall in love with this type prisoner. Of the people I have seen posts about LM about 90% support what he did. I think these are a mix of repubs and dems.
On another topic, there is a point for people in chronic pain, when they are liable to do things like this. My bro in law had such back pain for years, he nearly went mad. He was on heavy barbituates and was still in pain. Chronic pain will make people take unreasonable actions. Sometimes doctors an just not get them out of pain.
I’ve long advocated politicians articulate “damn right” issues; issues most people say or think “damn right” when someone suggests something needs to be done about them. If the inequities in health care in this country isn’t one of those things”damn right” issues, nothing is. You’re right of course, Thomas. Democrats’ championing this shooter put us on the verge of clutching defeat out of the jaws of victory if they don’t wake up and own health care reform.
Health care definitely--a most salient issue. And staying with it. Murmurings about anything happening to Medicare scare me. Although I do not know who is saying exactly what these days about Medicare or Medicaid.... Without Medicare, I'd not be here. Before I became eligible for Medicare, I remember the struggle to pay off the MRI I needed. I was a quarter inch close for qualifying for financial aid. I followed appropriate protocol, wrote detailed letters, kept up with the review process. But to no avail. Since that time and since being on Medicare, I do not know what would have happened as osteoarthritis requires careful followups, ongoing treatments, and physical therapy. And a lot of personal advocacy to navigate the healthcare system. I'm careful when at appointments to inquire from physicians how my visits will be medically coded. I'm emphatic to remind them not to use any term that suggests a treatment is experimental. It's demanding. Another strategy I've learned to use is to become familiar with the NC Department of Insurance and best ways to file a complaint. I've had to turn here more than once with Blue Cross Blue Shield of NC. I've achieved good results when I go as high up on the food chain as I can get. Our Dept. of Insurance has been responsive.
Once again your remarks hit the nail on the head. Most of us feel exactly the same about our helath care system, its costs and our service.
I currently am one of the fortunate ones who is on medicare and can afford my ever increasing supplimental plan and RX plan, so I can see the doctors I want who are accepting medicare, and feel as if my needs are being met.
I have a son who is paying a hefty price with a good amount of out of pocket expenses expected as he is of the age where he should get baseline tests done and address some issues that he has. At least now, thanks to the Democrats, any pre-existing conditions did not interfere with him getting coverage. I hope they find nothing of concern and that he doesn't face any surprises.
I think the insurance companies are making too much money, are making very bad decisions with respect to denying coverage, and are making patients and doctors jump through too many hoops, but I am aghast at the assassination of the CEO. Making this killer into a cult figure will put others in the crosshairs and is just a symbol of how much our country is spiraling back into the "wild wild west" and lawlessesness.
If Republicans roll back The Affordable Care Act and follow through on their desire to privatize Medicare more than it already is and cut back on Medicaide I fear more violence will occur.
Our healthcare system is breaking. Insurance companies and politicians on the wrong side of the argument are in large measure to blame. I hope they will wake up and deal with fixing the situation not hindering it more.
Bravo! Thomas, you got all of that right. What I see of 'progressives' is it's ok 5o hate Jews because of what Netanyahu is doing, and it's ok to cheer on a murderer because they don't like a CEO. I used to consider myself a Progressive. Now I'm just a Liberal who wants good for everyone.
And another aspect as a liberal that believes in reforming our health system and universal access is that the Left has made out the insurance industry as a convenient bogeyman, way beyond the actual part they play in our dysfunctional system.
Insurance company profits are about 2-3 cents on the dollar compared to the 40 cents profit that doctors, hospitals, and pharma make. And even if we were to approve something like Medicare for All, they still use private companies to do the bulk of work, claims processing, so those profits would not disappear.
I never hear Bernie beating up on Doctors and Hospitals though some rightfully on pharma.
Regardless of where the problem is, people like ourselves choose to be insured and there is nothing wrong with health insurance, granted the entire thing needs reform.
Those that holler about denials, Medicare does the same thing, administered by the same companies using the same methods - pre approvals, and requiring diagnosis that fits the procedure. If you want to devise a system with no denials then cost already through the ceiling will go through the clouds.
FTR, that example is not the way that health insurance works... Would love to see that bill to walk through the "perception" etc. Under UNC agreements with any carrier, they cannot balance bill you the difference between what they billed and what is allowed. That is strictly prohibited.
I would be glad to send you a screen shot of my bill. All I have is the summary which just reads, "Billed $5,150.01, Insurance paid, $3,367.37, Remaining Responsibility, $1,782.64." Of that $150 is for laboratory, $5000.00 is for "HC CT Abd Pelvis WO Cont - 74176 (CPT®)," and $0.01 is for "HC Cdsm National Decision Support Company as Defined by the Mcar Aucp - G1004 (HCPCS)" I talked to UNC who told me the bill was between me and Blue Cross Blue Shield. Blue Cross Blue Shield said the balance would go toward my deductible, but would not pay more than the $3,367.43.
ok. my cell is 919-491-4321. It makes sense that the difference was what was applied to deductible, coinsurance and copays (toward your annual out of pocket maximum).
Came here to say what David Smith said. UNC can't balance bill, though sometimes they will try. A while back they sent me a bill for the full amount of a 2-day hospitalization. I had had multiple hospitalizations and it took me a minute to realize it was for care 13 months earlier. Turned out they submitted the charges to my insurance too late- past the deadline in their contract--so came after me instead. After my heart calmed down, I contacted the insurer who informed me that UNC could not bill me after the insurer denied the claim for untimely submission. I had to contact UNC and so did the insurer to "remind" them of this, but they got the message.
I have a lifelong chronic condition. Spent my entire adult life making career choices based on getting and/or keeping insurance, and had a few years before the ACA where I went without because I couldn't work full time and that "high risk" plan that BCBS used to offer before the ACA- the only one in the state- had premiums of over $2k a month back in 2007. I turned 65 a couple years ago and literally cried when I opened that envelope and held my Medicare card. Before that, I was on high deductible marketplace plans from the time they were available. Between premium and deductible, was paying as much as $18k a year before insurance covered dollar one. But learned quickly that those agreements that require UNC to accept the allowed amount as payment in full (no balances billing) made a huge difference. UNC includes less and less detail in their billing, and maybe your $1800+ went to your deductible and copays, but if UNC is in-network, they cannot bill you for more than the insurer's allowed amount. But you may need to sit with the bills and explanation of benefits to make sure they line up.
Could it be that the radiologist was out of network. I know some of the 'surprise billing' legislation is addressing this, but I don't know that it has succeeded in preventing an entity like UNC using a non participant who then can legally bill the non allowable because they have no contract.
It could be but that would be clearly under the scope of No Surprises Act. But I also don't think there are OON radiologists working at UNC. They haven't done any outside deals to my knowledge. And yes, the NSA would prevent that balance bill being sent out. There would need to be a negotiation first.
Looking again at the piece- that was the case- out of network provider. UNC contracts with out of network entities. We need strict laws that if you go to a facility that then uses out of network providers, they need to be bound by the same rules as that facility.
I was chatting with a friend who is currently practicing criminal law in California about this case. We both agreed this case is going to be a challenge for a prosecutor. Clearly the defendant laid in wait, for the defendant to exit his residence and walk in street. However, many states require the presence of aggravating factors such as murder being particularly heinous, cruel, or involving torture. Other factors might include the victim being a law enforcement officer or if the murder occurred during the commission of another man endangering felony, such as a robbery or sexual assault to seek the death penalty. Possession of an unlicensed firearm without serial numbers is not a man endangering crime. These considerations may have moved the NY DA to file for man slaughter in addition to murder one.
There is also the challenge of persuading a jury that the head of a healthcare company accused of denying, delaying, and defending against claims is not at fault. It is likely that many jurors have had negative experiences with health insurance companies. In fact, I will say that every member of that jury has personally or through a relative experienced problems with a healthcare insurer.
These experiences should not affect their deliberations, but they do. Jurors must base their decisions on facts, not personal feelings. Believing otherwise is as unlikely as believing Trump descended from heaven to save America.
Violence should not be a solution. Individuals who commit such acts should face appropriate consequences. Given the mitigating factors, obtaining a first-degree murder conviction by the NYDA appears unlikely due to numerous variables. This individual is responsible for taking the life of another person. There is a penalty for this.
What I believe this incident points are greater regulation of the healthcare insurance industry. For example, setting their profits to a certain level and requiring them to plow these profits back into handling claims in a more equitable manner. Of course, Republicans believe that is a form of communism (in fact it is closer to socialism) but to republicans, communism evokes a stronger feeling of disdain.
Currently independent observers estimate health insurance companies’ average claims ratio is 70%, meaning around 70% of premiums earned are used to cover claims. The loss ratio, which is closely related, typically sits around 80%, showing that 80% of premiums earned go toward covering claims. This ratio could be brought down to somewhere around 15 % and still make huge profits for the companies based on the volume. Another factor is the cost of services. Some trimming there could help resolve this issue. Democrats could run on these issues but for reasons unknown they choose to point to Trump’s shenanigans. Why not do both?
You are entirely correct. This is not some leftist Rittenhouse. He’s no more a hero than Ted Kaczynski.
Q: Why did the venerable Sutton’s Drug Store in Chapel Hill close its pharmacy?
A: Because pharmacy benefit managers like United Health Group (through its Optum Rx PBM) routinely reimburse independent pharmacists like Sutton’s below what the indy pharmacist pays for a medication (i.e., the pharmacy loses money filling a prescription), BUT reimburses their own corporate mail order (or retail chain) pharmacy affiliates at a profit. Sutton’s Drug Store, which has operated on Franklin Street for over 100 years, is now a lunch counter and not a “drug store”. The new owner shuttered the pharmacy over a decade ago.
Establsihment figures- media, pundit, business and political- narrrate the murder of Brian Thompson as a gross violation of the rule of law and societal norms. That, despite the fact that ours is a nation forged by violence: guns the leading cause of death of American children, our weapons shipped to Israel to carry out flagrant violations of international law and conduct a wholesale genocide whose primary casualties are kids under the age of fourteen, a president who urges his followers to “fight like hell” prior to their attacking the Capitol.
But violence isn’t always headline-worthy and bloody- to wit, the violence inflicted by the state and elites on Americans who are going broke paying for healthcare. It’s no secret that the US has no peer in terms of how much we pay for the rotten health care we go broke subsidizing with premiums and co-pays and out-of-pocket expenses. A CEO with a fat paycheck who preys on consumers- United Healthcare rejects over 1/3 of all claims- codes to most Americans as a crime boss or a terrorist. Those notorious designations, which are meted out only by the state, place the designees in the crosshairs of the state military-law enforcement-judicial system.
Brian Thompson and others like him are, to hundreds of millions of Americans, terrorists. They take, they deny, they accumulate and they jeer. They pay for protection with lavish acts of political bribery (the state sanctions the bribes as “campaign contributions”) that ordinary Americans can not afford.... becase they are paying inflated health care out-of-pocket costs, jacked-up food costs, surge pricing for toothpaste and inflated health care premiums....all sold by terrorist organizations. Americans remember all too well the mortgage crisis of the aughts in which 10 million people lost their home to foreclosure...and not a single CEO, not one, went to jail- and that’s mind-boggling considering that the United States has more people in prison than any country in the world. JP Morgan Chase CEO Jamie Dimon is worth almost $3 billion.
Thomas has it wrong about those cheering Luigi- they are Democrats and Republicans, leftists and right-wingers bonded by outrage and constituting perhaps the most bipartisan kumbaya of the 21st century. The cheering is not for one man’s death; the cheering is for someone who fought back and struck a blow on behalf of all those who could not or would not. People are fed up and disgusted with being assaulted by cowboy capitalism, cold-hearted greed and a political class that toils for its campaign donors. Brian Thompson’s murder sent a signal- loud and clear- that the masses are restless. Establishment figures will attempt to temper dissent and keep order for the elites to continue feasting, but I daresay they will think twice before they start gouging. At least until Q2 2025 10-K reports are due.
Luigi Mangione? He is innocent until proven guilty but the American public has already pardoned him.
I read somewhere that there is a law that corporations must place the stockholders' needs above anyone else's. I don't think that is appropriate for an industry that deals in life and death. If healthcare for all isn't politically possible, perhaps a change in that law would be.
This is where tax breaks come in. If a corporation engages in a business that serves a public need, such as healthcare insurance, tax breaks should be available. Offering these incentives would make the operation of such a corporation profitable while still serving the needs of its stockholders.
Well said Thomas. I’m not going to defend insurance companies in the least bit, but there’s just as much culpability on the healthcare provider side and big Pharma. A medicine that costs $5,000 a month, when the drug companies know that the people that need it the most are probably the ones that can’t afford it. Or a scan at the hospital that takes 5 minutes and costs $7,500. They are fleecing us just as bad as the insurance companies.
I loved your piece Thomas. You are one of the most insightful writers out there in my view.
This is the reason you are losing so many subscribers like me.. We know that murder is wrong and dont have to be reminded by you. We also no that this makes a profound statement, one that needs to be made and one that needs to be expanded upon, and not one that needs to be hushed up by you,
Many of us don't care about his motives or his reasoning.
We see what Mangione did as a net positive.
Something we are too scared to do, and we know is wrong.
But we are more and more desperate.
That guy and all CEOs like him should be in prison for life.
But, they are rewarded for their mass murder and torture of people instead.
It SHOULDN'T come to this. WHAT is the alternative?
Spend another few decades protesting and voting while they spend hundreds of millions to make it even worse?
Meanwhile we keep suffering and dying because of sociopathic greed.
:(
C,mon, Odin. “That guy” is dead; yet you want him in prison, too? And just how is Thompson’s murder gonna “fix” the system? I’ll wait. But don’t get me wrong, it most definitely needs fixing. I just don’t think murdering CEOs, or anybody else for that matter, is the way to jump start it. This country has plenty of people smart enough to know what should and needs to be done to fix this system. Question is, do we have enough in positions of power with the WILL to do it?
Should be in prison. He might even still be alive if he was in there. For whatever that is worth.
Him getting killed is like a drunk crashing into your house, revealing the mold that has been building up that people have been covering for years hoping it wouldn't get worse.
Now everybody sees it more clearly and wonders why the hell our government is so bought.
Didn't say this would fix anything. I'm saying nothing else does.
Unless there are hundreds of Progressive politicians who can actually win seats who we can pull out of a hat, or something.
And yes, we can hope against hope that Democrats will hear and respond with Medicare for All.
Oh but will mainstream democrats listen. They are still licking their wounds
I guess I didnt realize it is progressives cheering the killer. When I first heard about the murder, I figured he will have multiple proposals from goofy women who seem to fall in love with this type prisoner. Of the people I have seen posts about LM about 90% support what he did. I think these are a mix of repubs and dems.
On another topic, there is a point for people in chronic pain, when they are liable to do things like this. My bro in law had such back pain for years, he nearly went mad. He was on heavy barbituates and was still in pain. Chronic pain will make people take unreasonable actions. Sometimes doctors an just not get them out of pain.
I’ve long advocated politicians articulate “damn right” issues; issues most people say or think “damn right” when someone suggests something needs to be done about them. If the inequities in health care in this country isn’t one of those things”damn right” issues, nothing is. You’re right of course, Thomas. Democrats’ championing this shooter put us on the verge of clutching defeat out of the jaws of victory if they don’t wake up and own health care reform.
Health care definitely--a most salient issue. And staying with it. Murmurings about anything happening to Medicare scare me. Although I do not know who is saying exactly what these days about Medicare or Medicaid.... Without Medicare, I'd not be here. Before I became eligible for Medicare, I remember the struggle to pay off the MRI I needed. I was a quarter inch close for qualifying for financial aid. I followed appropriate protocol, wrote detailed letters, kept up with the review process. But to no avail. Since that time and since being on Medicare, I do not know what would have happened as osteoarthritis requires careful followups, ongoing treatments, and physical therapy. And a lot of personal advocacy to navigate the healthcare system. I'm careful when at appointments to inquire from physicians how my visits will be medically coded. I'm emphatic to remind them not to use any term that suggests a treatment is experimental. It's demanding. Another strategy I've learned to use is to become familiar with the NC Department of Insurance and best ways to file a complaint. I've had to turn here more than once with Blue Cross Blue Shield of NC. I've achieved good results when I go as high up on the food chain as I can get. Our Dept. of Insurance has been responsive.
Once again your remarks hit the nail on the head. Most of us feel exactly the same about our helath care system, its costs and our service.
I currently am one of the fortunate ones who is on medicare and can afford my ever increasing supplimental plan and RX plan, so I can see the doctors I want who are accepting medicare, and feel as if my needs are being met.
I have a son who is paying a hefty price with a good amount of out of pocket expenses expected as he is of the age where he should get baseline tests done and address some issues that he has. At least now, thanks to the Democrats, any pre-existing conditions did not interfere with him getting coverage. I hope they find nothing of concern and that he doesn't face any surprises.
I think the insurance companies are making too much money, are making very bad decisions with respect to denying coverage, and are making patients and doctors jump through too many hoops, but I am aghast at the assassination of the CEO. Making this killer into a cult figure will put others in the crosshairs and is just a symbol of how much our country is spiraling back into the "wild wild west" and lawlessesness.
If Republicans roll back The Affordable Care Act and follow through on their desire to privatize Medicare more than it already is and cut back on Medicaide I fear more violence will occur.
Our healthcare system is breaking. Insurance companies and politicians on the wrong side of the argument are in large measure to blame. I hope they will wake up and deal with fixing the situation not hindering it more.
Bravo! Thomas, you got all of that right. What I see of 'progressives' is it's ok 5o hate Jews because of what Netanyahu is doing, and it's ok to cheer on a murderer because they don't like a CEO. I used to consider myself a Progressive. Now I'm just a Liberal who wants good for everyone.
So true TM.
And another aspect as a liberal that believes in reforming our health system and universal access is that the Left has made out the insurance industry as a convenient bogeyman, way beyond the actual part they play in our dysfunctional system.
Insurance company profits are about 2-3 cents on the dollar compared to the 40 cents profit that doctors, hospitals, and pharma make. And even if we were to approve something like Medicare for All, they still use private companies to do the bulk of work, claims processing, so those profits would not disappear.
I never hear Bernie beating up on Doctors and Hospitals though some rightfully on pharma.
Regardless of where the problem is, people like ourselves choose to be insured and there is nothing wrong with health insurance, granted the entire thing needs reform.
Those that holler about denials, Medicare does the same thing, administered by the same companies using the same methods - pre approvals, and requiring diagnosis that fits the procedure. If you want to devise a system with no denials then cost already through the ceiling will go through the clouds.
FTR, that example is not the way that health insurance works... Would love to see that bill to walk through the "perception" etc. Under UNC agreements with any carrier, they cannot balance bill you the difference between what they billed and what is allowed. That is strictly prohibited.
I would be glad to send you a screen shot of my bill. All I have is the summary which just reads, "Billed $5,150.01, Insurance paid, $3,367.37, Remaining Responsibility, $1,782.64." Of that $150 is for laboratory, $5000.00 is for "HC CT Abd Pelvis WO Cont - 74176 (CPT®)," and $0.01 is for "HC Cdsm National Decision Support Company as Defined by the Mcar Aucp - G1004 (HCPCS)" I talked to UNC who told me the bill was between me and Blue Cross Blue Shield. Blue Cross Blue Shield said the balance would go toward my deductible, but would not pay more than the $3,367.43.
ok. my cell is 919-491-4321. It makes sense that the difference was what was applied to deductible, coinsurance and copays (toward your annual out of pocket maximum).
Came here to say what David Smith said. UNC can't balance bill, though sometimes they will try. A while back they sent me a bill for the full amount of a 2-day hospitalization. I had had multiple hospitalizations and it took me a minute to realize it was for care 13 months earlier. Turned out they submitted the charges to my insurance too late- past the deadline in their contract--so came after me instead. After my heart calmed down, I contacted the insurer who informed me that UNC could not bill me after the insurer denied the claim for untimely submission. I had to contact UNC and so did the insurer to "remind" them of this, but they got the message.
I have a lifelong chronic condition. Spent my entire adult life making career choices based on getting and/or keeping insurance, and had a few years before the ACA where I went without because I couldn't work full time and that "high risk" plan that BCBS used to offer before the ACA- the only one in the state- had premiums of over $2k a month back in 2007. I turned 65 a couple years ago and literally cried when I opened that envelope and held my Medicare card. Before that, I was on high deductible marketplace plans from the time they were available. Between premium and deductible, was paying as much as $18k a year before insurance covered dollar one. But learned quickly that those agreements that require UNC to accept the allowed amount as payment in full (no balances billing) made a huge difference. UNC includes less and less detail in their billing, and maybe your $1800+ went to your deductible and copays, but if UNC is in-network, they cannot bill you for more than the insurer's allowed amount. But you may need to sit with the bills and explanation of benefits to make sure they line up.
Could it be that the radiologist was out of network. I know some of the 'surprise billing' legislation is addressing this, but I don't know that it has succeeded in preventing an entity like UNC using a non participant who then can legally bill the non allowable because they have no contract.
It could be but that would be clearly under the scope of No Surprises Act. But I also don't think there are OON radiologists working at UNC. They haven't done any outside deals to my knowledge. And yes, the NSA would prevent that balance bill being sent out. There would need to be a negotiation first.
Looking again at the piece- that was the case- out of network provider. UNC contracts with out of network entities. We need strict laws that if you go to a facility that then uses out of network providers, they need to be bound by the same rules as that facility.
Anesthesiologists tend to be out of network as well.