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What's really nonsense is that prices for known covered procedures through insurance aren't available until you've already enrolled into that insurance.

For example, insurance companies will never tell you the "allowed coverage" of anything until you've already enrolled into their insurance in which case you're locked in for 1 year due to open enrollment.

Imagine if you go to the dentist and your insurance says it will cover 100% of preventative care such as a cleaning. There's always a * there which states they will only cover 100% up to their defined "allowed" or "covered" amount which is a value they get to define in secret.

It means if your cleaning costs $150 they might decide to only cover 100% up to $110 because they determined they won't pay more than that and there's no way to find this number out until you've already enrolled and either had the procedure done or have your medical provider submit a claim as a price check but at that point it doesn't matter because you've lost the ability to pick providers by price. The numbers change every year and every provider has different numbers.




...But it's even more complicated than that, because for many providers that submit directly to insurance (this obviously doesn't apply to those you pay out of pocket and then submit to insurance yourself), they will completely either accept the "allowed amount" from the insurance if it's lower than what they would normally charge, or possibly partially accept it, dropping their fee from what it would normally be, but not as far as the allowed amount, leaving you still paying some amount more than the copay.

Single-payer healthcare cannot come soon enough.




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