Triangle View. Cherry Creek Mall, Denver, Colorado, 2017
This might be humorous if it weren’t so…well…messed up. If you know me you know I support a single payer health care system in this country–this, based on my experiences living in Germany, Spain, and Argentina (all told, some 7-8 years out of country).
Here, it seems, we don’t mind having a private, for-profit, entity (your smiling insurance company) regulate our access to medical care (“Sorry, that was a pre-existing condition.” “Sorry, that procedure isn’t included in your plan.”).
What follows is a very small, very typical, but interesting example of how convoluted the system is…
We recently received a bill for $16,793.00 from a local hospital for my wife’s ER visit last year after a fall while rock climbing (she is fine, but the back and neck took a slight hit that definitely needed checking). The bill came to us because I failed to complete some additional paperwork for the insurance company and so they had not yet paid. I have since filled out the appropriate paperwork and the claim was paid.
Here is what we were billed:
–Three different lab charges: $119.00, $109.00, and $74.00
–Five different radiology charges (X-rays): $847.00, $770.00, $714.00, $693.00, and $565.00
–Two CT Scan charges: $5,011.00 and $5,011.00 (same charge, twice)
–One general “ER” charge: $2,789.00
TOTAL: $16,793.00
According to the hospital, if you have no insurance and you could fork over the cash, they would only charge you 60% of the full bill.
In our case, since our insurance company is federally-funded (TriCare), the amount the local hospital will ultimately receive for the bill is a mere $678.57. (Take that, and be happy!)
This begs some questions, of course…
–The same visit to six different ERs throughout the country would very likely net six very (wildly?) different total prices. Why?
–Why the secrecy with the billing codes? No amount of digging on Google could find them. I had to call a human bean at the insurance company to find out what the codes meant.
–Why the five bills for X-rays? And, especially, why the two separate bills for a CT scan when she was in the tube once?
–What specifically is included in the “ER charge”? Or is that just the price of the bed space for three hours?
–Why can a cash customer get a 60% “discount”?
–Why can our insurance company get away with paying pennies on the dollar? If our insurance company is underpaying, how does the hospital make it up? Do they jack up prices to other insurance companies or to private payers? (That’s probably why our bill was so high–had we actually paid it..ha! ha!…it would have helped them make up for other losses.)
–Why can’t a person with no insurance simply pay $687.57 and call it good? After all, that is what the insurance company ended up paying.
–MOST IMPORTANTLY: What was the real, no-kiddin’, actual cost of the services performed? What should we really be paying for our health care? Does anyone really know?
The ugly thing about all this is that it seems like it is all very hush-hush, double secret probation-type stuff. Getting information is difficult. The system is complicated, creaky, unwieldy, and inefficient.
Fact: In the US of A, we spend, as a percent of GDP, a much higher percentage for our health care than any other high-income industrialized county. Why? Are our health outcomes better? Not necessarily.
Fact: The number one cause of personal bankruptcies in this country is the need to sell off everything to pay for emergency health care. This affects not just the uninsured, but the insured as well (“Sorry, that was a pre-existing condition!”). Does that make any sense at all?
Sadly, I have absolutely no hope that this country will ever join the rest of the civilized world with a national health care system. (Especially now, given the change in government that is about to happen on January 20.)
Yes, any significant change would require a major torch-and-pitchfork revolt (with much raucous shouting and angry fist-waving) against the very, very powerful health insurance company lobby who have a “yuuge” influence over our wonderful politicians and how they vote.
No, I don’t see that happening any time soon.
In the meantime, many Americans will just keep sneaking off to Mexico, Colombia, and India for their medical and dental procedures…and, in our case, to avoid all this nonsense we will likely elect to retire to my wife’s home town of Barcelona, Spain.
2 Comments
Spot on my friend!! I work in healthcare and 80% of our hospital overhead is salaries and wages for the staff. Healthcare workers and physicians get paid too much!! Nurses make $20-$35/hr here and we have a few hundred nurses at my facility. Our facility mark up is 300% of Medicare rates. So if a CT scan runs $400 at the Medicare rate and we jack up the price 300% of medicare rates then we charge $1,200 for the CT. Keep in mind no matter what we charge we will still only receive a contracted rate payment from the insurance.
Secondly, medical supply costs are outrageous. You put a “medical” label on something the price goes astronomical. After all is said and done my facility makes about a half a cent on every dollar we expend providing care and most of that goes to salaries and wages. Hopefully somebody will figure out a better mouse trap for healthcare. On the flip side we human beans need to take better care of ourselves, stop taking in all of the sugar, exercise, get a health checkup every year so disease process will be caught early, etc.
Ok I am done…… 🙂
Thanks for the background info, Ollie! Totally agree about taking care of ourselves…I could eat fewer cookies, for sure. Still, accidents and catastrophes will happen and it’s too bad some folks in this country (even WITH insurance) go bankrupt trying to pay their bills. Yes, a better mousetrap is definitely needed.