Comment Re:Avoid SGC (Score 1) 149
If Stargate Command comes to your door recruiting, best bet is to politely turn them down.
(This comment is in regards to the first episode of Stargate Universe, in the event that you're curious.)
If Stargate Command comes to your door recruiting, best bet is to politely turn them down.
(This comment is in regards to the first episode of Stargate Universe, in the event that you're curious.)
Actually, they overcharge because of the formula that the insurance companies use to determine the "contract price." If the price is higher - that they bill the insurance - the amount they receive in reimbursement will be closer to what they deserve.
Since I work in pharmacy and have also worked for a few pharmacy benefit managers, I will provide an example of how they bill:
U&C (Usual and customary): $100
Ingredient cost: $50
Gross amount due: $50
Based on the numbers submitted, the insurance will now reimburse the provider $58. Had the provider billed for less, they would receive (a lot) less in reimbursement. There are upper limits to all drugs/procedures/devices/etc, but larger issues come into play, like what "network" the provider is in (it's not just "in" or "out" of network for the provider - they get reimbursed LESS the smaller the company is). Walgreens, for example, recently just refused to continue taking pharmacy insurance provided by Express Scripts because Express scripts refused to pay Walgreens the amount that was DEMANDED. Walgreens ALREADY gets paid at LEAST 10% more than any other pharmacy. (Express Scripts provides (at least) 20% of the nations pharmacy benefits.)
The point being, the insurance companies have it backwards, but larger companies should not be able to abuse their power to leverage higher reimbursement rates. If something costs $100, then it costs $100 no matter where you go - the reimbursement should remain the same. (Yes, I know you can buy in bulk when you're a larger company, but that tends to squash small to mid-size businesses.)
If you think the system is working, ask someone who's waiting for a prompt.