Confused by healthcare decisions?
Understand your health insurance?
Have you reached the point where you’re almost afraid to go to the doctor because you don’t know how much you’re going to have to pay?
I have. And I think it’s about time we made some changes in medical insurance.
Hanging On By a Very Thin Thread
At first glance, healthcare isn’t about building wealth. But once you realize how quickly your finances can be ruined by an expensive medical procedure, suddenly it becomes a very real threat. Or looking at it purely from a cost perspective rather than catastrophic impact, improving our medical insurance system will improve service and reduce costs, lowering your recurring expenses.
In the rain. On my motorcycle. With the bad driver. One minute, I’m minding my own business. Next minute, I’m laid out on the pavement wondering what happened.
End result: wiped out my savings, plus $10,000 in additional debt due to the medical costs. Ever since then, I always have health insurance, just like I always have uninsured motorist insurance. I take insurance very seriously. If you’re serious about your finances, you should too.
Reading SB’s article on why we need health insurance, I realized what I had to say about this deserved more than a comment. I’m no expert in healthcare policy, medical insurance, or the Affordable Care Act, but there are some obvious flaws in the system that can be easily, and inexpensively, fixed.
While I appreciate President Obama’s intent to reform the broken healthcare system, in my opinion, he is wrong to force individuals to have health insurance.
In America, people have the freedom to be idiots, it’s in the Constitution.
But for many, it’s not a choice. When you’re choosing between starvation and insurance, eating always wins.
Health Insurance: Cloaked in Failure
Currently, I’m covered on my wife’s insurance. It’s a large $35 copay, $500 deductible PPO plan, costing us over $500 a month for my coverage. Decent, albeit pricey.
The other day I went in to see a specialist. Spent 20 minutes with the doctor – no tests, just a quick look and some Q&A. Final bill for that 20 minutes? Four hundred thirty eight dollars. Insult to injury, I had to pay the entire $438 myself since it was my first use of the new insurance, and my deductible still applied.
Further back, Mrs. Enwealthen ended up in the emergency room. We weren’t yet married, she was a contract employee, and she had no health insurance. End result: almost $9,000 dollars in medical bills. With amazing luck and some negotiation, she got it reduced by over 70% using cash payment along with reductions due to her low income status due to recent unemployment. She learned her medical coverage lesson the hard way, too.
Regardless of where you stand on the ACA. I think you can agree with me, that the US healthcare system is broken, and something needs to change. CNN, The Daily Beast, Harvard, and even Wired magazine, have weighed in with their opinions on how to fix healthcare costs in the US.
Show Me the Money
One factor in both our experiences was lack of information. Have you ever tried to obtain an estimate for medical services? Try it some time.
Call up your local hospital or urgent care facility and ask them how much it costs to get a simple arm fracture diagnosed and treated. They won’t tell you. It’s almost impossible.
Why is it so difficult? Because different patients receiving the exact same treatment from the exact same doctor at the exact same facility, are charged wildly different amounts.
The same service. The same facility. The same doctor. But not the same price?
Why? Because of the health insurance companies.
The larger the medical insurance company, or the better they negotiate, the better rates they get for their clients. So any healthcare provider has a different rate for each service they perform for each insurance provider they support. Blue Cross allows $100 for that service. United only pays $80. But perhaps Medicare remits $150.
You wonder why dealing with hospital billing services is so difficult? Imagine it from their end. Hundreds of health insurance companies multiplied by the dozens of insurance plans they each offer again times the tens of thousands of possible services offered by a healthcare facility. It’s a flood of prices.
Where’s our modern day Alexander to cut this Gordian knot?
On the patient side, due to lack of price transparency, there’s no way to comparison shop. If I know my broken arm is going to cost me $4,000 to fix at Hospital A, but only $500 to fix at Urgent Care B, then I can make the decision to go to Urgent Care B. Perhaps if it’s a riskier procedure, I choose Hospital A despite the higher price, because of their higher survival rate or world-recognized top orthopedic specialist.
Regardless of who I choose, price transparency gives me choices and eliminates unwelcome surprise.
Step 1: Legislate a single, fixed cost per service per hospital
Price should be regardless of customer financial status, regardless of insurance provider, and regardless of doctor performing the service. It doesn’t have to be fixed per state, or across multiple facilities, just fixed for all instances of that service for that facility.
This gives you price fairness for the entire organization. Setting a broken arm? That’ll be $300, please. Insurance? Doesn’t matter. Doctor? Doesn’t matter.
Step 2: Legislate a cost estimate be provided to every patient at checkin.
You take your car to the mechanic, he gives you a cost estimate. You take your body to the doctor, shouldn’t you get the same?
This gives you price transparency. You know how much you’re going to be billed, and you can make an educated choice about the services you receive and the facility you choose to perform them.
No more sticker shock when you receive the bill weeks after the service. Plus now you have the opportunity for comparison shopping based on price, success rate, or whatever factors matter to you, and you can make an informed choice about your healthcare.
Help Me Help You
Step 3: Contact your representatives
Tell them you want single pricing for medical services, no more different prices for different customers.
Tell them you want to be given a cost estimate before receiving medical service. No more sticker shock. No more surprise bills.
Not sure who to contact? Look up your state and federal representatives at VoteSmart and email them now.
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Have a health insurance horror story? Opinion on other ways to improve our healthcare system? An idea for a catchy name for our new healthcare information bill? Comment below and share your opinion.
Photo of injured piggy bank with crutches courtesy of Ken Teegardin.