Quote:
Originally Posted by penguinz
I had Coventry when I had knee surgery about 20 years ago. Cost me $50 out of pocket for the surgery and PT.
First follow up with the ortho I mentioned I couldn't believe it was so cheap.
His response was the Coventy was great for patients because it was very inexpensive.
It sucked for doctors because Coventry was very bad about paying out if the did at all.
He said usually when a patient has Coventry he would be lucky to break even on his costs.
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That's not exactly how it works but honestly most doctors don't know a thing about health insurance. There's probably a few that are solo offices or independent from a hospital, but you ask you're average family physician or and ortho how much X company pays and they won't have a clue. But they probably do hear from management or billing that one company is better than the other for their specialty.
Coventry doesn't exist anymore, they were acquired by Aetna about a decade ago and slowly completely phased out into Aetna plans, but they were not unlike any other "big" insurance company. They each have their own fee schedule for the services provided. For example, Blue Cross may pay me $48 for doing one procedure yet United Health only pays me $31 for the exact same thing. I certainly have insurance companies I like better than others, but it mostly boils down to what they pay for services rather than ease of dealing with. Sure, some can be cumbersome at times but they all have to approve or deny claims w/in 30 days of submission and you basically know what you're getting paid before you send it.
So on that note, when people say one insurance company they had was SO MUCH BETTER than a different one they had another time, it usually actually means they had a better plan/contract and not that the insurance company was better. In your example, you didn't only pay $50 because Coventry kicked ass. You paid that amount bc you were either close to hitting your out of pocket max or you had a really good plan with killer copays or cost sharing.
Where people run into trouble with actual insurance companies is when they or their employer use one of the smaller guys that have narrower networks and more stringent pre-authorization requirements. If you have one of Aetna, UHC, Blue Cross, Medicare, Humana, etc, then your insurance company is basically as good as the plan you're signed up for. Not a ton of difference between them other than that, with some mild caveats.