Are you kidding? Have you ever looked at a medical bill?
Amount for procedure: $989
Insurer negotiated amount: $102
I had a special blood test. The bill was something like $150, readjusted down to $35. What was really interesting was a certain item that was billed at a few dollars, and readjusted down to something like a few pennies! What could that be? A BandAid?
This is crazy. There's no other business that gouges like that. Even new car dealers are not so bad.
... DH knew he would be seeing the PCP for one last visit and our insurance would not cover it. I explained the cost of this and DH wanted to see the now out of network PCP.
So he went to his office visit in Jan 2016 and explained to the staff that he wanted to pay for this outside of the insurance. He took a credit card and cash and asked to pay, hopefully with a discount of some sort.
They told him that they could not process an office visit like that. All visits had to be sent to their billing department. He tried to explain that he changed insurance, etc and to not submit it, no one would be paying this but him.
The answer was that they had to submit it, there was no other way. So they submitted it to our 2015 insurance which took a few weeks and rejected it. They billed us and he called to explain and they said they had to submit it to his current insurance. So he gave them the info and it was rejected as out of network and not preapproved.
When the next bill comes he will call them again and at most they will offer a 10% discount. The bill is $178 and our old insurance used to adjust it to $112 as the negotiated rate, but we will probably have to pay $160.
This really bugs me because DH could have just found a new PCP with our new HMO and only paid $40 co-pay (ACA Bronze plan with $6650 deductible but not HSA eligible) but he insisted that he wanted to follow through with the one who changed his dosages.
So yeah, the idea that you can just go in and pay cash and not bother with insurance hassles......I wish it was that simple!
Isn't that crazy? The healthcare providers' bill processors are like automatons that cannot deviate from standard procedures, and the standard procedures do not cover people paying with cash out of their pocket.
Compare that to dental care. My dentist advertised a $49 checkup. So, I showed up, and after an X-ray and quick exam he told me everything looked good but I needed some cleaning. I expected that, as my last dental visit was 3 years ago. The dental assistant told me the cost, and it was reasonable so I accepted, and paid on the way out when it was all done.
An older friend told me that was how it was with doctors when he was growing up. His father was a milkman and did not have health insurance (perhaps back then nobody had health insurance). When the kids were sick, his father just took them to go see the family doctor and paid cash. I don't know how people settled bigger hospital bills back then.
Because in the past, they paid for the same premium with much lower deductible. Now they pay the same cost for $12,000 deductible. I'm sure people thought their health plans would get better post-ACA but they didn't. False promise often results in complaints.
Very few people would have $100,000 hospital bill. I'm 56, I haven't been seriously ill to ever paid that much in any year. If I have to pay $12,000 a year and don't ever get to use it, I'm sure I wouldn't be happy...
When people get older, they will have plenty of chances to use healthcare, and lots of it. That's why Medicare is going bankrupt.
My pre-ACA policy was very simple; below $10K I paid everything, while above $10K they paid everything. There was no copay or coinsurance. The $10K was also max out-of-pocket. Now, with ACA the premium is more, and the max out-of-pocket is also higher.
But, but, but there are some big differences. Pre-existing conditions are no longer excluded. And then, there is now no lifetime limit on coverage. My pre-ACA policy had a lifetime limit, which I never paid attention to because I told myself if I were that sick I would not want to live. It was probably $1M, or perhaps only $500K.
It only takes a few patients whose treatments cost a few $M to drive up the premium for everybody. And perversely, the really sick ones are cheap to cover. They die relatively quickly. Examples include lung cancer patients. After $100K or $200K, they are gone. Brain cancer kills even quicker, and many patients do not respond to treatments at all. Poof, they are gone in a couple of months after diagnosis. On the other hand, some chronic illnesses cost a lot more as they can go on for years before the patient dies, and cause all kinds of complications.