Monday, September 10, 2012

Health Insurance and Medical Bills

I had a fairly urgent outpatient surgery done on me a few weeks ago. A quick trip to my GP verified that I needed the procedure and he scheduled a meeting with the surgeon for the next afternoon. A week later I showed up at the hospital shortly before seven in the morning and I was sitting in this chair typing on my blog and eating an early lunch by 11:30. No complications and knock on wood so far it's been a very easy recovery which I am now half way through. My care was very good and all the services rendered were timely and professional.

Melissa, Carter and I have a fairly comprehensive medical policy through Blue Cross. Being self employed, we pay the whole break for us We have pretty high deductibles and the deductible is 3X higher for our "family" than it is for either of us, but I'm not going to complain about that right now. We walked into our health insurance policy with our eyes wide open and there are legions of cheaper if less comprehensive options out there.

What I *AM* going to complain about is the tiered billing system that seems to be normative in American health care. We got our hospital portion of the bill today.  Combine that with my surgeon's bill and the anasthesia bill and my little surgery looks mind bogglingly expensive. And so it would be if I was uninsured and had to pay for it out of my pocket which is why I have health insurance in the first place. But what I would have to pay if I didn't have insurance isn't anything like what my insurance company actually pays and thanks to the explanation of benefits they are required to provide I get to see this. Think 20-25 % of the actual "bill" between my deductible and the insurance company's portion and you'd be in the ballpark.

Can you name another service where the difference between the negotiated price for a large entity and the price for a guy off the street who wants to pay in cash is a 75 to 80 %  reduction in favour of the large entity? If I walked in to a feed store or a fertilizer depot and asked for a 75 % discount  I would get laughed out of the store and our customers would be up in arms if we tried it with them...rightly so. In my opinion whatever the price of my surgery is it ought to be pretty well the same regardless of who pays the bill. I understand that a portion of society won't or can't pay their bill and I understand that collecting the money or writing it off needs to be built into the cost. That's standard business procedure. But charging an individual four times what an insurance company pays is not standard business procedure in any other industry I can think of. If what the insurance company pays is actually reflective of the charge then the public is getting hosed in a very, very large way. Frankly if I knew I could pay what the insurance company pays I would probably change my policy from comprehensive to catastrophic and pay the difference out of my pocket. In this writer's opinion addressing this issue would go a very long way to making health care and health insurance a whole lot more affordable for everyone, insured or not.

Getting off my soapbox now. :)


Anonymous said...

Our health insurance system is a huge mess. Don't get me started . . . Glad everything went well and that you'll be OK soon.

Edwina Andreas said...

How is everything going after the surgery? I hope you are a lot better now. It's just sad that many people fall for the tricks of some insurance companies, when in fact, there are ways to avoid this. I hope that all of us does a better job in analyzing the coverage and policies next time to have a better insurance policy.