Friday, December 11, 2009

Just one hospital bill ...

I never take having health insurance for granted.

I volunteer at a health clinic where I routinely take phone calls from uninsured people canceling their appointments because, as the date nears, they realize they won't have the cash on hand to pay for the office visit. (Even though patients are charged on a sliding scale based upon income, everyone needs to to pay something.)

I recall the hardship of not having health insurance as a child, when both my father and stepfather were laid off from their corporate jobs. Although my mother and stepmother both worked, neither received employer-sponsored insurance nor earned enough to pay for coverage on the open market.

I won't ever forget the years I had to pay for health insurance premiums from dollar one because although I worked, and my husband worked, we didn't have employer-subsidized group health insurance.

Earlier today I received an Explanation of Benefit Payments from my insurance company. I was again reminded of how fortunate my family is to have employer-sponsored health insurance (which we do through my husband's job)—and how disastrous it would be if we didn't.

My son had outpatient surgery a few weeks ago. The hospital costs for that procedure: $10,842.85.

Because our insurer has a "negotiated reimbursement" rate plan with the hospital, the "allowed amount" for my son's care is $1,503.

Because we've already met our family deductible and out-of-pocket maximum, I need to pay just $300 for the hospital services. The insurance company will reimburse the hospital for $1,203.

If we didn't have insurance, as many families don't, my husband and I would be staring at a $10,842.85 hospital bill for our son's surgery.

I don't fully understand why there's such a vast difference between what an insurance company is invoiced and what an uninsured individual is charged and required to pay. But I do understand how just one hospital bill, from one surgery, can catapult a family into spiraling debt.


Stephanie said...

I have also balked at how insurance companies have the power to barter down the cost of treatments and surgeries. It doesn't seem fair that people are charged willy-nilly for the same services. This boggles my mind.

Jo said...

I agree with Stephanie. It is mind boggling that there are different rates for different people, for the same service. When I was temporarily uninsured several years ago my long time doctor agreed to charge me the insurance negotiated rate because he knew there was no way I could afford the "over the counter" rate. Unfortunately most doctors don't do that, and doctors can't afford to do that for all the uninsured people they might see who need care.

Anonymous said...

Your $10 EOB includes costs for uninsured and illegals. Shut down the borders and get the Feds out of healthcare. The commercial market is efficient if allowed to work. Look how Lasik surgery has come down in price; do you think the Feds could invent and market the iPod/iPhone that everyone loves?
Not sure what about your procedure, but you're fortunate that a system exists to get your treatment. You'd probably wouldn't get it you lived in Canada where there is universal coverage, but not universal access. MRI, forget it. Breast cancer, forget about getting Avastin. And refere back to you first paragraph, everyone needs to pay something. You think healthcare is expensive now, just wait until it's Free.


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