More US healthcare, how much do uninsured have to pay?

Factual Questions
1

Ok, we will try this one in GQ, but I suspect it will head off to GD pretty quickly. I have really good medical insurance (HMO), so I am lucky. My wife has seen a series of specialists, had several MRIs, and thankfully is fine now. I have been reviewing her bills.

We will look at this one thing to set the base level of what I am talking about: Her specialist billed the insurance company $1,873.22 for an MRI. The insurance companies replies that they only pay $300 for such a service, and the doctor accepts this amount, and we have to pay 10% or $30.

Now I am going to talk about an uninsured person, and the numbers I use are real numbers that were billed by my wife’s doctors.

So, an uninsured person complains of headaches and the doctor insists on $208 upfront (we had to pay all of our co-pays upfront, back to the example). So the doctor can’t see anything from a cursory exam, so he sends her to a specialist for $345 who orders the $1,873.22 MRI. This uninsured person returns to the specialist for another $345 visit to discuss the MRI results. The specialist has noted something that needs examination by a neurologist. The neurologist demands a $645 pre-pay to tell this uninsured person that several of the angles didn’t come out well, and that he needs another $1,873.22 MRI. Then our uninsured friend goes back to the neurologist, whips out another $645 in cash to be told that what is there is no big deal and that he should go back to the specialist for further analysis and another office visit of $345.

Whew. Now, let’s pretend that this uninsured person had this money on had and while it would be a burden wouldn’t break her it (which is not at all likely in the real world of ininsured). So these batteries of tests and office visits would have required our uninsured hero a total of $6248.44 and still have the same headaches and is not one step further to finding the cause? Would you pay your car mechanic 6 grand for diagnostics but no progress on the car?

Would the doctors REALLY require this type of payment from a regular person or are they bilking the insurance company for what they can? If a person didn’t have insurance and was paying this out of pocket would they be ordering tests, specialists, and follow-up visits, knowing that the patient is going to be complaining about the continuing costs?

2

That sounds like fairly common pricing for an MRI. I asked our deductible specialists about MRI rates and they quoted between about 800-2000, depending on the area being examined.

Those office visit rates sound rather high to me though, my regular doctor charged me around $60 and specialist rates I’ve heard were usually about $100-$150 depending on speciality. Though I suppose some could be higher.

3

IME, the first solution is that uninsured people don’t go to the doctor, for just these reasons.

The second solution is that doctors won’t refer uninsured patients that can’t pay for tests and specialists. Yes, sometimes those tests/specialists are unnecessary and/or just for CYA. Other times, it just means that the patient doesn’t get needed care. For instance, I’ve known several people that were scheduled to have teeth pulled, until they got insurance coverage. Suddenly it was possible to actually FIX the problem (e.g., crowns, root canal, etc.) rather than just pull the teeth. I’ve known similar situations at medical doctors, but don’t remember the details at the moment.

The third solution is that sometimes doctors and facilities will discount for cash payments. Unfortunately, this is usually more-or-less under-the-table, as most insurance carriers (including the Feds) prohibit such behavior. Yes, it’s OK for insurance companies to get a discount, but not a cash-paying patient. That would just be wrong.

I know of one GP practice here that refuses to accept insurance. Their fees are less than half that of the other practices that do take insurance. Why? Because that’s how much less it costs them in staffing, etc., to not have to deal with insurance companies. I’d be willing to bet that their profit margin is higher, too.

I know that I have a routine prescription, generic, that supposedly costs over $300 for a 90 day supply. I have a drug plan as part of my insurance, so it’s discounted. The insurance company pays nothing. I pay $25. A person with no insurance or no drug insurance would have to cough up the full $300+, unless they qualified for one of the low-income programs from the pharmaceutical company, or the pharmacy had a discount program, or some such.

Yes, it’s screwed up beyond all possible belief.

ETA - just looked up my scrip online - I can get it for around $50-60 in Canada.

4

The mechanic didn’t spend a quarter million dollars and 10 years to learn how to fix a car.

5

They actually charge the uninsured MORE. Because you’re getting a discount from your insurer. I was uninsured for a few years - trust me, it’s a huge markup.

6

Yep, basically the uninsured person is out $6,248.44. That IS the retail price of those services.

Either that, or a sympathetic doctor hands them a stack of free samples dropped off by a pharmaceutical rep. I’ve used that strategy a couple times in the past while uninsured.

7

Well for his quarter million and 6 years, he didn’t fix my wife’s headaches, either…but he still gets paid…

8

Yep. And when a lawyers client gets convicted they don’t get their money back either. Furthermore just try to get a mechanic to diagnose your car problem for free, if you find one who will do it let me know. With professional services you are paying for their service not any particular result. In things like law and medicine there is no guarantee. ( except Personal Injury which often is on a don’t win don’t pay basis but you can bet that the lawyer makes damn sure he will win before accepting the case…)

Insurance companies have made medical billing a scam though.

9

I am one of the millions with no insurance.

A few years ago I had to go to a dermatologist for three separate minor skin-related concerns. He looked at my three areas, said two were nothing, handed me a pre-written prescription for the third, and left. He saw me for less than a minute.

When I got to the billing desk, I was handed a statement for $525. Then the woman said, “Oh, I didn’t notice you are self-pay. That’ll be $35.” Now, obviously I appreciate only having to pay $35, but what if she hadn’t noticed that I was self-pay, and I got billed the full $525? They’d still be trying to collect that from me. And how inflated are people’s insurance premiums, because their insurer is paying $525 for less than a minute of the doctor’s time?

The system sucks.

10

Office visits are in increments, like 10, 15, 30 minutes, etc. So whether you use 1% of your time, or 100, the price is the same. What can vary the price is the level of complexity involved- discussing 3 separate problems raises the price of the visit.

The derm office I work in has a price list for insured patients, and one for self-pay patients. I haven’t studied it, but I think the self-pay prices are about 70-80 percent of the insured prices. But I think the highest anyone would have to pay for any kind of visit (no work done, just consulting with the doctor) would be around $150, insurance or not. An office visit for $500+? That’s nuts.

Most PCPs, I agree, wouldn’t order expensive testing for the uninsured unless it were life-threatening, and then they might look for some kind of social program to help defray the costs.

11

My mechanic has not once charged me for diagnostics. Once he ever called me and said something along the lines of “You’re hearing things, there’s nothing wrong. Take the car back.” However, that’s beside the point.

The uninsured will get billed the retail price, at which point they should state that this is not affordable but they are willing to pay <blank>. I have no personal experience in the matter, but I heard that hospitals are a lot happier seeing some payment than none at all. Arrange payments if possible instead of using credit cards, settle for less. After all that’s what the insurance companies are doing, and they can’t exactly skip town or declare personal bankruptcy because of one bill.

Edit: Now if anybody can explain to me why my tonsillectomy was $3k, the anesthesiologist $1.5k and the one night stay (not including surgery or medication) $30k billed to the insurance company, I’d be interested to know. Seriously, $30k of being hooked up to a BP monitor and a humidifier with a guy giving me morphine twice during the night? That works out more per hour than surgery room, anesthesiologist and surgeon.