I buy insurance in the retail market. I am trying to optimize my insurance $ by avoiding getting overcharged by providers. This is the goal of my post - figure out how to avoid this.
I figure the only reason I need insurance is for catastrophic illness or accidents. I am quote content paying doctors & labs for infrequent visits & tests, and am happy to pay reasonable rates. I do not need insurance for that. Let me give you a few examples.
My last annual preventive checkup - doc. ordered routine blood tests. Quest Diagnostics billed $120 to the insurance. Insurance paid them $16. Yes, $16. That was the total of all payment received by them.
Another family member needed blood tests this year. Quest billed $256. Insurance paid $64.
Some years ago I visited a oral surgeon (who was listed in my list of dental insurance providers) for a checkup. His fees would have been a payment of $64 as opposed to list price of $150. It turned out this wasn't covered under dental insurance, but by medical insurance instead. And the SOB wasn't listed under medical provider - he was "out of network". He was obviously content to get $64 for his services, but when he saw this opening, the SOB won't accept a dime less than $150. I had no choice but to pay up.
My ideal situation would be
insurance coverage with no payment for the first $5k to $10k per year with full coverage after that
reasonable charges from all providers. I define reasonable as "what private insurance like Aetna or BCBS pays". I expect to pay $16, $64, $64 at the time of service in the above examples, and be done with this.
Any groups etc. that I can join for getting this? This will not be insurance - just ensuring I am not one of those suckers paying list price. Also, my understanding is that just being part of the insurance plan where the insurance doesn't cover me for doctor visits won't make the providers accept "negotiated" fair price - instead charging full price.
