I wonder if yours is a PPO? I think they run the numbers differently, but I can’t say how. It has to do with keeping your 20% low, where in an HMO there’s a set co-pay. Also, it could be with mine that it was an ER, non-admitted visit, so my ER co-pay was $150 and the rest was Blue Shield’s to pay. Or maybe different hospitals discount stuff differently. All I know was that I asked the checkout person how much it would be if I paid cash instead of using insurance, and the lady told me $1500. I got the bill 2 months later and the total on that bill was $5000 and it said Blue Shield paid $4850, leaving me with the $150 owed to the hospital. Whether Blue Shield actually paid that amount or a discounted amount invisible to me, I don’t know.
Either way, the insurance price listed was quite inflated compared to what I would have been billed as an uninsured cash patient, according to the checkout person at the hospital. I was still a little high on morphine at the time, so I guess I could be remembering wrong, but I don’t think so. I was really curious. Still am.
It seems like there are so many variables, no one will be sure what the real cost is until the insurance companies are cut out of the picture. I work on the veterinary side and do the majority of the medical purchasing for the clinic where I work, so I have a pretty good idea of the cost of medications and equipment. The markup is unbelievable.
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14439545 Ever see a hospital bill for someone without insurance? It’s at least half if not a quarter of an insured patient’s bill.
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This is not true, uninsured are routinely charged 2/3 to multiple times the insured rate.
As a personal example I was recently given a quote of over $32,000 self pay for a procedure that the average reasonable cost to insurance was in the $11,000-$15,000 range. This is an outpatient procedure needing a specialist taking less than 3 hours.
The health care in the USA will not get any better until all the people with good and affordable insurance cannot get it anymore, and that day’s coming soon. The blame really is in cost. Medical care costs have gotten so expensive that premiums can’t cover them anymore. I know people who don’t have insurance who don’t want to vote for affordable insurance for everyone. They say “I’ll pay for my own health care, thank you”. But I bet they’re not prepared for cancer treatment or open heart surgery.
People also complain about paying monthly health insurance premiums that are less than they pay for their car insurance and it’s definitely more expensive to fix a broken person than it is to fix a car.
American medical students also pay higher tuition at medical schools than their counterparts in most other countries, take longer to get their medical degrees, and take out more loans. This kinda nulifies their higher pay, at least in the first years of their career.
I don’t have insurance, but I definitely want affordable health care for everyone. I can’t wait for the day when I can pay a reasonable amount for coverage along with everyone else.
But as it stands right now, I really can’t afford health insurance on my own (I’m self employed, and things are very tight at the moment). I’m gambling that I will be able to afford to pay for a minor medical issue, and that over time this strategy will save me a lot more money than I would spend on having insurance. However, there’s no way I could pay if I got cancer or needed heart surgery. I’ve pretty much accepted that I would either die without treatment or lose everything in order to get treatment.
And now some doctors aren’t taking patients who don’t have insurance. I was dropped by my neurologist because I don’t have insurance. I was told the last time I tried to make an appointment that they no longer accept people who pay out of pocket. And they aren’t the only ones – I’ve seen this with other doctors as well.
Fortunately, my seizures are under control, finally – it’s been two years since my last one! But that doesn’t mean anything, and even so, I still need to find a new doctor. For now my primary care physician is writing my scrips, thank god.
(Now when I go to make an appointment with a doctor, that’s one of the first questions I ask – “Do you take self-paying patients?”)
Something I find interesting on this page : according to a graphic, medical expenses in the US were in the same range as other countries until the 80s. Then, beginning around the 80s-90s, while the expense in other countries keep raising more or less at the same pace, US expenses begin to rise sharply, the curb becoming almost asymptotic.
I wonder what could be the cause of this rather sudden change.
Whenever I read these threads about the US healthcare system, it seems absolutely horrific. It seems even someone with a fairly good income and insurance can get in to financial trouble by being sick. Even by the twisted standards of the advocates of the system surely they must see it just doesn’t do what it supposed to do, i.e. provide healthcare.
Well, that’s because the US is the home country of [strike]democracy[/strike] capitalism, so everything is privatized!
Didn’t you know that fire protection is already privatized in the US? There was a famous case where the fire men responded to an alarm and then let the house burn down because the owner hadn’t paid his due before, and they wouldn’t accept him paying on the spot.
Did you watch Michael Moore’s Sicko? He interviews a doctor who worked for health insurance company, and her sole job was denying claims all day long. Not because the procedure was not approved, or not covered, just because the policy was to deny first, in the hope that the customers who had a legal claim would give up.
He also interviewed a detective whose sole job was to hunt down old records of pre-existing conditions when customers had a claim, so they could be retro-activly kicked out. Things like denying cancer treatment for a person in their 40s because they’d had acne as teen.
But in the free market, the govt. can’t intervene and forbid these immoral practises, or regulate and control the methods of the insurance companies, because that would be socialist!
Fire protection is privatized in only a tiny fraction of cases. 99% of the time fire protection is provided by the locality. In the case of this person, their rural area decided to drop their local fire service and instead pay the neighboring town for fire protection. But then they had the bright idea that instead of making the payments mandatory, they’d make them voluntary, so anyone who wanted fire protection from the neighboring town would pay for it, and anyone who didn’t pay wouldn’t get coverage.
It’s a very unusual situation that proves the futility of asking average people to plan ahead for low frequency but high impact risks. You can get average people to plan for high frequency/low impact risks but it seems to me that the average human brain can’t accurately assess low frequency/hihg impact risks.
I assumed the US bureaucracy was no more inefficient and expensive than anyone else’s.
Can you provide citation firmly establishing otherwise?
Doctors and nurse’s fees are certainly part of the difference. Billing departments I would like
to know more about. Workmen’s Comp insurance adjusters are an industry segment I had not
thought of, and do contribute to medical cost.
It is not government bureaucracy. Medicare, run by the government, is quite efficient. It is the fact that the various insurance companies have not yet standardized on forms, and that each doctor’s office no matter how small needs at least one person to handle insurance claims. Countries with single payer systems don’t need all that overhead.
Then there is the overhead of fighting with insurance companies about rejecting claims. Despite the fact that the company I work for is big enough to be self-insured, one company kept asking over and over if my wife had her own insurance, and kept delaying payments. They ignored the forms I sent in certifying she didn’t until I called and politely yelled at someone. I can imagine how bad it is for someone without a giant company backing them up.
My father was part of a very early HMO (in the early 1950s) and I’ve never been in one, but I thought that you basically used the HMO doctors and hospitals, and so I don’t understand how you could pay in cash, unless they let non-HMO patients in.
I’m in a PPO and the printed discounts mentioned definitely show up on my statements. I took an option which requires me to use approved doctors (no problem, the approved ones I used are the best around) and which pays 100% after a co-pay.
While insurance companies have some incentive to encourage higher prices so that the percentage of profit they are allowed grows, in any competitive environment, such as handling large companies, they do want to keep payments down. Anyone claiming that single payers can negotiate better prices than players with massive purchasing power is either economically ignorant or accusing the insurance companies of fleecing their customers. So claims that people can do better than negotiated prices don’t pass the smell test. Better than list prices, sure, since they may be inflated to make insurance customers feel better.
Oh dear lord, yes on your last point! This past month has been an escalating exchange of filling out the same form over and over again: “No. We do not have any other health insurance. Really. No, really, Really. I mean it. No matter how often I resubmit this form. Or call you. Quit sending the same damned form, marked urgent, Urgent, URGENT!!! Can’t you read?! Can I speak to your supervisor? Really, we’re none covered under some other imaginary policy. Nyet. Nada. Nein. Non. STOP IT!!!”
This is not correct the overhead per patient for Medicare is more than for private insurance. However because the old people who use Medicare use much more healthcare than the young people who use private insurance it is lower as a percentage of total expenses.
As for the OP this unfortunate young man has catastrophic health insurance, which is appropriate for someone in his age group. The people who gave him the surgery which healed him do not work for free, and so he has a payment plan which is not too onerous. His problem is that he is unable to work while he recovers. Obamacare or any other UHC scheme will not fix this. Unfortunately the reality of life is that people who are medically unable to work, can not afford health insurance. He will probably have to go on SSI and receive coverage through MediCal.
First of all, your cavalier attitude toward your own health is sad. If you are not taking care of yourself (including checking into your health benefits), who do you think is going to advocate on your behalf?
Second, your friend’s situation is unfortunate, but not uncommon. I wish him a speedy recovery.
Third, your friend is way overpaying for his insurance, unless he has some very severe type of pre-existing condition. Actually, I cannot even imagine what type of condition would result in insurance costing an individual almost $400 per month and require a $5000 deductible. Get him online and start comparing insurance plans. Don’t understand the difference between deductibles/co-pays/ and HSAs? Then educate yourself and your friend.
Fourth, IMHO, this sounds like a potential worker comp claim. A healthy 26 year old does not wake up one day in need of a major surgery. Talk with someone who knows about this stuff in California.
Fifth, your friend should be able to negotiate with the hospital (I’m assuming that he was admitted through the ER due to the emergency nature of his condition) on a lowered payment plan if his situation is as dire as your report. He may even be able to have the balance of his bill forgiven.
Sixth, the ACA would not have prevented this. The ACA expands the coverage of insurance but your friend would still need to making a choice and signing up for a health insurance plan. If your friend chose a plan that was extremely expensive with a very high deductible, he would likely still be in the same situation. Under the ACA, the idea is that these type of insurance plans will go away, but no one knows for sure.
That makes sense, and the more I think about it, I think we might be talking Galas to Granny Smiths. While my primary care physician needs to be part of the HMO, emergency room care does not - I can go to any hospital ER and be covered. Since what I went through was not elective and there certainly wasn’t any discussion of price before hand, that seems to be the difference. Perhaps it happened that the private, charitable hospital I went to (Swedish Covenant) lets people pay cash in the ER situations only, so the checkout person told me what it would have been if I was uninsured. Of course she knew I wasn’t going to choose to pay cash over my small co-pay.
At any rate, I don’t understand people who have group (work) insurance available but don’t take it. I have many co-workers, more than I would have thought, who think even the $60/month employee share of the premium is too much and so remain uninsured. I think of that $60 as an investment into my own health, just like setting aside a tiny amount for savings, some is better than none, and the payoff can be huge if something horrible happens.
H.J. Aaron, “The Cost of Health Care Administration in the United States and Canada—Questionable Answers to a Questionable Question,” New England Journal of Medicine 349, no. 8 (2003): 801–303.
S. Woolhandler, T. Campbell, and David U. Himmelstein, “Costs of Health Care Administration in the United States and Canada,” New England Journal of Medicine 349, no. 8 (2003): 768–775.
This postfrom the New York Times shows the differences Woolhandler et al found between the US and Canadian systems:
So in 1999 the US spent three times as much per capita on healthcare administration costs than its northern neighbour.
