Who benefits from insurance: patients, physician, or insurance company?

Question

and why? this is all about insurance contracts and managed care

Answer 1

All three. Patients because insurance pays most of the bill. Doctors because they don't have to rely on patients to get their bill paid. Insurance companies because they profit from the sale of insurance.

Because of insurance patients are more likely to see doctors when they are sick. Doctors will do everything necessary to treat a patient, rather than scaling back on services out of fear they won't get paid. Insurance companies base their premiums on claims paid, so the more they pay out, the more they charge and the more they earn profits.

Answer 2

Benefits from insurance? Primarily the insurance company, sometimes the patient, rarely the physician. Why do I say this? Okay, here we go. Based on insurance reimbursements, doctors are making fifty cents on the dollar OR LESS per patient per visit. In theory, a doctor can charge whatever they want for a service, but if the insurance contract states you're going to get X amount for the service, that's that. Case in point - the office I work for charges $80 for a generic office visit. Aetna pays $29.17 and the patient's copay is $5. So, total payment is $34.17 - or less than half of the charges. And that doesn't count additional time if the insurance company jerks our chain. I'll get to that.
Patients can benefit if their employer picks up a chunk of the premium, or as we have in New York, the state subsidizes the cost if you qualify. They also benefit if all the services they have performed on them are covered with little to no out of pocket expenses.
But, by far, insurance companies benefit the most. They get paid the monthy premium on your plan, regardless of whether or not you use your insurance. THEN, based on their disclaimer, "Quote of benefits is not a guarantee of payment, actual benefits are determined when a claim is received." Meaning, they can do whatever they want with it. More often then not, they "don't receive the claim" - translation, "we didn't feel like processing it, so we chucked it." Sometimes, that's a legitimate excuse - electrionic billing is not foolproof, nor is the post office. Then, you have the improper processing. Sometimes, insurance companies deny things in error - sometimes, they hold the payment pending information from the patient, sometimes they deny things to see what happens - will the doctor's office back down or fight the denial or will the patient suck it up and pay? Either way - the insurance wins because they keep their money. The less the insurance has to pay, the happier they are.

Now, I do realize that over the years, both patients and doctors have bilked the system - but why should that screw the honest ones?

Answer 3

Patients but it depends upon how wisely they have chosen a insurance provider in other words they had to do the homework and be aggressive in their treatment research what the doctors have advised them. Yes our system is a mess but a lot of low income patients don't realize that their Doctors can get them a free 2 year prescription from the manufacture. Physician's are having a hard time bogged down with paper work . Now if your a plastic surgeon their making bucks. Also if patients would take better care of them selves the need for medical might be reduced

Answer 4

Everyone, the insurance companies benefit because there are more people, like myself, who pay for their insurance every month but only have to use is a couple times a year. The physicians benefit because they always get money instead of people racking up big bills they can't pay for. and we benefit because let's face it a 20 or 30 dollar co-pay at the Dr's office is a lot better than 100+ for just an office visit! Same with paying for hospital time and other procedures.

Answer 5

All of the above. Patients benefit, because they can afford a higher level of care, and when there's a major illness, it doesn't bankrupt them. Physicians benefit, because with an insured client, they are pretty much guaranteed to get paid for their services. And the insurance company benefits, theoretically, by making a profit to keep their stock price up and pay a small dividend to their stockholders.

Answer 6

Everyone <.>

It depends on things.

The Physicians tend to whine about Insurence because some of them screw up and they know it,.. and then there are others that are stressed out that not only will they be upset if they screw up but their entire lives will be completely ruined and the constant reminder will remain. There are some that work more money out of things when Insurence is involved..

If you had an accident or were in an accident,.. the Insurence would be the only thing to help you out. I really doubt your friends and family and just pull out over 2k a day for care if anything badly happend to you.

Some Insurence companies are here,.. take money,... and run. One point to things though is that alot of Insurence companies blow a ton of money on Advertisement,.. that doesn't really help anyone but the Insurence companies in the end.

Answer 7

I'll see if I can answer this breifly..........basically Dr.'s can charge whatever they want for any service........without insurance there is no one that is going to mange the market........insurance companies help keep the cost of healthcare down by controling how much a Dr. can charge for any paticular service. A gallon of milk is controlled by how much it cost to produce it and get it to the consumer. In healthcare there are so many intangilbles a price cannot be put on how much any particular service should cost. I hope this help.

To answer your question really everyone benefits.

Answer 8

the only ones to lose on this is the person who can't pay or get charged too much by doctors and insurance companys

Answer 9

all the above. affected person- gets therapy they won't handle to pay for in any different case healthcare expert - gets charge for their bill. it extremely is often at decreased volume, however the healthcare expert workplace gets it paid in finished by utilising a verify which will clean the economic corporation. coverage firms- exist because of the fact they sell the product and individuals pay rates for it.

Answer 10

all of them
otherwies they wouldn't have
opted for it ,isn't it???