We recently had to sort out some problems with our health insurance. We use a small business co-operative to buy our insurance from one of the major carriers in Massachusetts and one of my priorities since losing full-time work last year has been to ensure that we can make that payment (our largest single bill apart from rent) every month. so you can imagine I was little upset to find out during our Christmas vacation that our claims were being refused. It seems there was some kind of miscommunication between the co-op and the insurer back in October that didn’t get settled until I called them in January. Um yeah, thanks for staying on top of that guys. Glad to know my money’s not being wasted.
Anyway because the insurance had (seemingly) lapsed, the bills were coming to me directly. I nearly had a heart attack. I went to the doctor for some minor issues in November and they ran some blood tests. Nothing exotic, just cholesterol, blood sugar, the standard stuff. The bill just for the lab work was $700! In December we took Isabella for her regular 6-month checkup, which included some boosters and a flu shot. That was $400!
No wonder the health care industry is such a mess. Melanie used to be an office manager for a psychiatric practice in Dallas and she tells me that it’s standard for doctors to overbill. While they had standard contracts with some insurers, for the others they’d bill full rate (which is usually some ridiculous amount) to see what they’d pay. It’s like a used car dealer overcharging for the old junker with the expectation you’ll haggle him down and the hope that you’ll be too naive to do it.
Why turn to employers, gov’t?
Technorati Tags:health care, reform
Dom, you may want to reconsider your claim that doctors commonly overbill (which is called fraud & is a criminal offense) based on your wife’s experience with one doctor. Surely you see the danger is generalizing from such a small sample (yes, my wife, father, sister, & brother-in-law are all physicians
)
Also, the Colts are going to destroy the Pats….and I’ll be there on the 50 yard line, 15 rows behind New England’s bench giving them the business!
Let me clarify. I’m not implying fraud. I’m saying that the cost of health care procedures is artificially inflated because there is not a true free market and that doctors and labs and hospitals and drug companies charge what they do because they can. A psychiatrist’s rate of $400 per hour for a session or a lab’s $700 for standard blood tests would never be charged if people had to pay for their own medical procedures. Instead they ask for the moon, expecting the insurer to offer less, hoping that they will get more than they expect.
To put it another way, if we had “food insurance plans” paid by our employers, supermarkets would charge $70 for a carrot and would let the insurer tell them that they will only pay 70 cents.
If you did that in the free market, like if I walked into a supermarket that had a $70 price tag on a carrot, I’d walk out. I wouldn’t bother with a counter-offer.
Oh, and if I had a nickel for every time I’d heard Colts’ fans claim that their team was going to clobber the Pats in a playoff game, I’d be very rich. Still waiting.
Tony Dungy must really like Hawaii in February because he keeps coaching the AFC Pro Bowl team.
Someday the Colts might beat the Pats in a big game and someday they may go to the Super Bowl and even win it. But until they do, it’s all talk.
I pay over $600 a month for the “privilege” of getting to pay another $5000 in deductibles a year, so long as all my health care is in network. Due to an injury in 2006,I have a total of over $13000 in medical expenses. And how much interest does the ambulance service charge when you can’t pay $3200 up front? 18%!!!!
The medical industry and medical insurance is a racket.
Oh,yeah, if we have a baby we get to pay for that ourselves – $1750 for a home delivery with a midwife.
I’m not certain of the details but I believe the practice of having employers pay for health insurance came from a time either during or just after WWII when employers were not allowed to raise salaries. They got around that by offering “benefits” such as paid time off and insurance.
I don’t know when health insurance was invented, but I do remember not having it as I was growing up. Back in the ‘50s when my father had cancer, the doctor who performed two operations did not send my mother a bill after he died. Since my father had died after the surgery, the doctor felt responsible for not delivering what his services implied, and therefore he didn’t think he deserved to be paid.
When my husband and I were first married—early 70s—I had some medical problems that necessitated several trips to the doctor. The cost of those appointments was so reasonable that filling out the insurance paperwork was too much trouble to bother with it.
Things have changed dramatically in 37 years. Now we are held hostage by our employers who provide our healthcare coverage.
You are SOOOOOO right about the doctor/insurance situation in the 21st century. Behind every rich doctor is an even richer insurance exec (or government beaurocrat, perhaps soon).
But don’t BOTH doctors and insurance agents profit on our fear of sickness and suffering and death?!?! Doctors say, we will make you “healthy” and isn’t that worth $700 (or more), and insurance salesman (often these days, through your employer) say, we will make you “safe”, provide “security”, avoid “risk” and isn’t that worth $600 per month (and a $5000 deductible)?!?!?
Is our goal as Christians to be “healthy” or “safe”?!?!? This is what I think we should be asking ourselves…
Ann—
If Our Lord was not ashamed to compare himself to a physician, we should not be ashamed to go to one.
If we do not make use of people with God-given natural knowledge of healing because we grudge them the pay the laborer deserves, if we rely solely on supernatural help and denigrate the natural kind, we are telling God that we don’t want His good gifts and don’t like His Creation. That’s pretty Gnostic.
Now, we _do_ have the right to complain and negotiate if the laborer wants more than his pay.
We have been taught that pain is our own fault. We can be pain free if we just take a pill, after we have found the money to buy it. The alcohol and drugs some people abuse is a natural outgrowth of our views about pain. Being in pain is not an opportunity to offer it up for expiation, but rather an embarrassment at our shortcoming. Victim souls are not cool.
But even more importantly,we have been taught to avoid death. Death has become the ultimate personal failure instead of a movement into eternity and hopefully a state nearer to God. Culturally we don’t apply the Christian remedy to death any longer. Look at our newest churches. Look at Mahony’s cathedral. The evidence that we have been given the way to survive death has been erased. The walls are blank. Look at an old Orthodox church. The walls are covered with the evidence of eternal life as our old churches were before the iconoclasts were given permission to make it vanish. Satan must hate those images with a passion. They remind him that he has lost.
Satan’s lie is that we shall not die. That lie concerns the temporal kingdom, not the eternal. The temporal kingdom is his. He is the lord of this world. The real victory over death is the eternal kingdom which is God’s—the one our culture, and increasingly our faith here in America, persuades us to ignore.
Rich doctors? No where near as rich as the plaintiff’s attorneys (i.e. ambulance chasers) who have created much of this mess. Their main effect is the cost of malpractice insurance. But the secondary effects are huge – I am sure that the price paid for the lab tests reflects the labs “liability” and the cost of unnecessary tests. Your prescription drug costs include the costs of Government screw-ups like the Vioxx disaster and the Government created problems with vaccine manufacture.
So who do we turn to to fix this? The same Government! Priceless. Boy will we ever get what we deserve….
To give an example of what I feel is probably standardized overbilling:
When we lived in CA, I had a bicycle accident. Luckily, I was wearing a helmet, but I hit my head pretty hard and was rendered unconscious. Someone called an ambulance, which came and transported me to the hospital. I was conscious by the time they loaded me in the ambulance, but still confused. They did the standard things: they put me on a back board and in a cervical collar, gave me oxygen, and started an IV. That was it.
In CA (at least, at that time), if there is a paramedic (as opposed to just an EMT) on the ambulance, they charge you for advanced life support, even if such support was not actually rendered, as it was not in my case. (Is that like charging you for the services of a neurosurgeon if they have one on staff when you go to the hospital to deliver a baby?) Since no advanced life support was rendered, my insurance (Tricare, through the Army) refused to pay for ALS, but since CA law allows such a charge, we were required to pay it out of pocket. Apart from suing the state or something along those lines, we didn’t really have an option.
You may know this, but my husband’s insurance did not pay for my children’s shots. You can get them for a lot less at the public health centers, and then get your checkups at your pediatrician. And ask what they are going to do and how much it will be before they do a test. Some of the tests when they have a cold are unnecessary and really expensive.
There is a trend among some physicians to never accept insurance. This way they charge more reasonable rates. Then the patient submits the bill to their insurance. It’s a win-win-win situation because. The doctors gets the money they need to run their practices. The insurance company pays out less and as a result, patients get lower premiums because lower costs of the insurance companies enables them to compete for business. If only we could make this legally required in every healthcare practice.
Also, Arnold’s health plan is a disaster. As much as I want everyone to have healthcare, his plan will reduce competition and thus the incentive to push toward better and better care. Also, the claim that countries (read: Europe and Canada) that have universal healthcare have healthier citizens and therefore universal healthcare is a good idea. I doubt that tremendously, these countries are healthier because their populations are not nearly as disgustingly obese as America.
Oh Please Matt..“win-win”. Have you ever tried to collect medical insurance?? WHY do you suppose that physicians are insisting that private insurance (as well as Medicare enrollees) pay out of pocket up front? Because they don’t want the hassle of trying to collect.
Sorry, Doug, I can’t help who you’re related to. The name of the healthcare game in this country, at least, is Profit. If you have to rob Peter to pay Paul (i.e., upcode labs/procedures, recommend unnecessary diagnostics etc), that’s just part of it. If a physician can’t pull their own weight in a practice, they’re soon subject to peer pressure.
There is plenty of greed to go around. Insurance companies claim they’re not making $, hospitals claim they’re not making $, M.D.s claim they’re not making $. Bottom line is, the patient (or their fam) is left holding the bag.
Dom, as you learned, ask questions. Don’t assume that you need all the labs your M.D. orders. Find out what services are available your local public health, which is typically more complicated in an urban environment than a rural. If you’re denied any claim by your insurance company: Appeal, appeal, appeal. Never take “we won’t pay” as an answer.
If every patient would just remember that, in the end, the bill won’t be coming to your physician’s house, there would be more accountability in this ‘system’ (I use the term loosely).
You are billed at the “retail” rate. Generally, insurance companies have a “negotiated” (or wholesale) rate which they actually pay. In Wisconsin, it’s between 5% and 80% off-retail, depending on the billable item.
But, for historical example—my oldest child is now 29. The entire pregnancy, labor, and delivery (plus 4-day hospital stay, meals, etc.) was $1,000.00.
Our last child is now 13. HER pregnancy, labor, delivery, (1.5 days in the hospital) came in at $8,000.00 plus change. And it was a standard delivery…
My inusurance carrier sends a copy of the bill to me. When I went to the hospital recently with a kidney stone, the nominal (standard-rate) charge was $580 per hour. The rate for the insurer was $75 per hour. Tell me they’re not ripping someone off. And this was a Catholic hospital. Of course, they kept me there 5 hours, so they could charge for a day of hospitalisaton as well.
In defense of my husband (an MD), I would like to say that the practice of medicine has changed a lot, thanks to insurers. The amount of time allowed for seeing a patient is small to miniscule, and if the doc spends the time the patient needs, he does it on his own dime. Likewise the risk he takes if he follows his own judgement rather than the “standard of care”. Likewise with any associated telephone calls or family discussions. Docs bill everyone the same, but insurers only pay what they have decided. Negotiate rates? Not unless you’re a powerful, large group practice!
DH thinks doctors got way too greedy in the 60’s and early 70’s, and those who began in the 90’s and beyond are, to some extent, reaping what their predecessors sowed. He has talked about starting a practice without taking insurance, not so patients could collect from theirs, but so they could afford the care they actually get—an old-fashioned pay-as-you-go system. However, like most docs his age and younger, he is a hospital employee at his first job (doing research and seeing patients), and a fixed rate independent contracter at his second job (spending ten hours a day seeing patients). A new independent practice is just not economically feasible given the paperwork and associated overhead.
And for those who think their (middle-aged and younger) doctors are rich, please remember that many of them borrowed their way through med school and watched their (very high) loans double during residency and fellowship. $50K/year is a pretty big chunk of change to pay in student loans. That and just the years of training ($40K/year for 80 hour weeks as a resident) are pretty high overhead for the doctors. Not to mention the care for patients and responsibility for their well-being. And there’s no room for mistakes. None. Nor should there be.
Medical economics is a pretty complex field, and it’s a bit like the blind seeing the elephant story. Everyone blames someone else.
But I do feel for the uninsured and self-insured. There is no easy way to pay for medical care under the circumstances. We have been in that situation ourselves (with a kid with a heart problem on expensive medication)—it’s pretty scary.
I read somewhere (I think it was National Review) that if you think healthcare is expensive now, just wait till it’s free.
Maureen,
I did not mean that Christians should not go to doctors when they are sick. I go to doctors when I (or my family) is sick, and I have done this when I had insurance, when I was underinsured, and (as now) when I had no insurance.
What I meant was, our society has an unChristian focus on good bodily health. Good health and physical safety and security are all “true goods” (in the philisophical sense), but they are not the HIGHEST good. That highest good is God himself, and our eventual union with him in the “next world”. This focus does not deny the good of the body (as Gnostics do) but it puts the good of the body in its proper place.
As for how this relates to doctor/insurance costs in modern America? Well, I just think that it would help practically speaking to remember that even with a perfect system of health care delivery, we are still in “danger” of sickness and suffering and death. It is the human condition, ever since the fall.