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.

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