Healthcare Game

The health care industry is one of the world's largest and fastest-growing industries. There is a lot of undercover fuckery that goes on in the Healthcare industry. It's a game and the pharmacy/drug reps work with providers who work with insurance companies trying to get as much money as they can from consumers/patient's. Ever wonder why when you go to the doctor they want to provide you with samples or prescriptions for drugs? Well it's because the drug/pharmacy reps pay them and provide doctors with vacations to offer their drugs. This way a patient takes the drug, has side effects has to visit the physician again to get more prescriptions and the provider bills the patient's insurance company who then refuses to pay the bill and leaves the patient with a high dollar bill to pay. It's a vicious cycle but it continues because the majority of people don't look into their healthcare cost and charges. Even the recent Healthcare Reform aka Obamacare was just another way to get more money from the people.

I have been doing medical insurance coding and billing for almost 6 years, I do everything from coding claims, posting payments, appealing claims, ect. I work with all types of insurance from Tricare/military, Blue Cross Blue Shield, United Healthcare, Medicare, Medicaid, Superior, Aetna, Seton, Humana, Cigna, etc.

If anyone needs help trying to determine whether they owe a bill to their provider or feel something should have been paid by their insurance let me know if you have questions and I will try to help if I know the answer and if not in most cases I can refer you to someone/website that can help. Most patients do not understand the difference between their copay, coinsurance and deductible. All three are different and are considered separate cost.
Copay-A small fixed amount required by a health insurer to be paid by the insured for each outpatient visit or drug prescription. This amount is indicated on your insurance card and is normally between $10-50 depending on the type of insurance you have.

Coinsurance-A co-sharing agreement between the insured and the insurer under a health insurance policy which provides that the insured will cover a set percentage of the covered costs after the deductible has been paid. Similar to co-pay insurance plans except co-pays require the insured to pay a set dollar amount at the time the service is rendered -Often time individuals confuse their coinsurance with their copay.

Deductible-A deductible is the amount you must pay before your insurance starts to pay its portion of costs for a covered health expense. The deductible could be as low as a few hundred dollars or as high as several thousand dollars.-You must review your insurance policy to know how much your deductible is.

Hope this gives you a little insight into the Healthcare game. -1st Ladee’ Queen (July 16, 2013) Courtesy of UPA

The below are some of her sites.

(You can find more UPA posts at

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