First ask how much profit did the insurance company make this year? And last year etc.
Doctor reimbursement has been cut almost yearly and Medicare will be cut again. Already doctors are going to decide not to participate. Things will just get worse and worse. The insurance companies enforce the rules not the doctors. The ball is in their court. No other profession takes a decrease of salary yearly almost. Things that we used to be able to bill for are now all of the sudden bundling or experimental. Really. Payed for 33 years and now experimental. One company says it isnât and the other one says it is. Itâs a mess. Unless the consumer starts to complain enforce, things will never change. You might have to drive an hour or two but Healthcare will be there after your 3 month wait.
This has happened between our huge hospital group and our insurance about once every couple of years. It has also happened between Walgreens and our insurance. It gave everyone big headaches each time, but was resolved as @VeryHappy said.
I think itâs annoying that this happens again and again.
Actually, we chose to ditch Walgreens. But ditching the largest hospital group in the area wasnât an option.
Walgreens is walking distance from my house. I had to switch (not mid year) to using the CVS inside our target store about 4 miles away. Frankly I was relieved because we donât have any other nearby CVS.
This could be a whole other thread. But with all the upheaval with the chains, we actually switched to a locally owned and operated pharmacy. Service is amazing, and the people are so nice. And they deliver locally too, if needed.
But they are going to pay SOMEONE for care that is given. They arenât paying Dr. X but the insured is going to have to go to Dr. Y and Florida blue has to pay that new doc or practice.
I have an HMO and I get letters throughout the year that someone Iâve seen in the past is no longer part of the insurance group. These are often the doctor or nurse practitioner who did my eye exam or a dermatology appt but not my primary care. Sure, Iâd like to see the same person again but they are individuals who got a different job.
The refund is based on claims to premium ratio, and is required by Obamacare. My daughter got almost half her premium back when she was in college because there werenât that many claims (for the entire group, not just her). The next year they lowered the premium (and there was still a refund).
Not all policies run Jan to Dec, and the providers have all different contracts. They have to charge what they have to charge. Maybe theyâve had increases in office overhead including salaries, utilities, rent.