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Insurance companies

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I've heard different doctors make mention that patient A or B has this or that insurance and they either approve or mention how the insurance they have is sucky.

From a health care perspective, what are some "good" insurance companies and which ones don't provide as well? I don't mean a good insurance company would cover every little option right down to a pedicure, but which ones will push for less proven drugs, fast discharge, deny certain procedures (oncology, reproductive), etc? What is the "feel" for those companies?

sailornurse

Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care. Has 39 years experience.

That depends on what part of the USA you live in. It depends on if it is a commercial/private insurance vs Medicaid, vs Medicare vs. Military such as Tricare.

Health insurance is very similar to car insurance. The consumer picks a company, selects the coverage (deductibles). The insurance companies have a drug formulary that list what meds they will pay for, what the copays will be.

Sometimes in primary care we have to get approval for a certain medication or test such as a CT scan. This is called a "prior authorization" (so I'm giving you some homework look this up and report back what you find out about this).

They all want a fast discharge, the sooner the patient gets out of the hospital the less they pay.

But, health care is a business, hospitals & clinics have to pay the electric bills, the rent etc.

Don't know if you are a student or RN, but for example Medicare does not pay for any meds, that's why there are supplemental plans (Plan D) that a senior can buy to cover medications.

amoLucia

Specializes in LTC.

Another example - my insurance does NOT cover any bariatric related surgeries. Yet there are plans that do cover.

Also, I do the PRE-research re 'covered' meds that I believe my provider might order for me. I've had several issues so I just work with my provider to avoid unnecessary delay r/t paperwork.

Insurance through employers or purchased as an individual plan is not the same universally. I'll use Blue Cross only as a familiar name as an example.

Pt A works for company X and has Blue Cross that pays for prescriptions for $5, will cover massage therapy, gym memberships, and bariatric surgery. Primary care MD and specialist copays are $15. Hospitalization is covered at 100% and premiums are very low and mainly paid by the employer.

Pt B works for company Y and also has Blue Cross but has a $500 deductible, poor Rx coverage, and $50 copay for primary care and $100

for specialists. Hospitalization is a $500 deductible and then covered at 80%. Bariatric surgery, a dietician, or weight loss is not covered nor are many elective or cosmetic procedures. Premiums are high and are paid mainly by employees.

Patient C works for company Z. Also with Blue Cross, insurance carries a $5,000 deductible before covering anything, including Rxs. Premiums are considered mid range and paid at 50% through the employer. There are plan limits and many exclusions as to what is covered and maximum levels of payment for things such as imaging, medications and specialists.

As you can see, Blue Cross insurance varies with each plan. There is not one standard plan nor are there any guarantees that because one Blue Cross plan pays for something, another one automatically will.

roser13, ASN, RN

Specializes in Med/Surg, Ortho, ASC. Has 17 years experience.

Bottom line: You are asking an unanswerable question. No one of us can correctly identify the multi-factorial coverage issues that you are hoping to nail down.

I have no idea why you're asking such a broad question but I doubt that you will receive satisfactory answers.