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Barbarake t1_iz9jsdc wrote

Once a year I get a small check from my insurance company. Evidently at least 80% of the money they take in must be spent on medical care and they usually don't quite meet it, hence the refund. So that's at least 20% right off the top the insurance companies keep.

But that's not all. You have to also remember that doctors and hospitals, etc have to pay people to deal with the insurance companies. The doctors and nurses have to spend extra time doing all sorts of documentation to satisfy the insurance companies. There's lots of costs on the other side that also have to be paid for.

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katarh t1_iza3l4g wrote

Medical coding has to be done regardless of who pays for a procedure - it's the only way to accurately track what happened during a visit.

The problem comes in when you code it incorrectly, and the insurance rejects it because it's not the code they expected. Had a biopsy get initially rejected by my insurance because the hospital used code 111111-X instead of code 111111-Y and it was the dumbest thing.

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oh-propagandhi t1_izbcqj5 wrote

While that's totally true it's not just coding. It's collecting from insurance companies, and each company uses different systems and procedures. If you have one company you are dealing with most of the time (medicare) then you streamline the process on both sides.

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