It’s time for a little truth. One that has probably eluded you for years- because your employer provides your health insurance. But, if you have to buy your own insurance- or, worse yet, have no insurance, you probably have an inkling of these insidious practices.
Let’s talk first about those who have employer-provided insurance. Even if they pay for part of the insurance, going to the doctor or the hospital is pretty painless. You make an appointment (yes, you may have to choose a physician in your plan), you go to the appointment, you pay nothing (or $ 5, $10, or maybe as much as $ 25), see your doctor, and go home. You have no clue about the “back end”- what the costs of that visit really entail.
It’s my guess that your physician has a standard cost for that annual physical ranging from $ 300 to $ 1000. But, you just completed the process by shelling out your deductible and then went on your way.
So, you have no idea why some folks find themselves unable to visit a doctor- or perhaps even have to file bankruptcy because of their high medical bills. Because, if you have no insurance, then, that bill I just mentioned is the one you have to pay. No insurance company is around to negotiate that fee down to a reasonable level. (The insurance copany calls it “reasonable and customary”- which is true if you have insurance.)
And, if you are self-insured, with a high deductible (the going process nowadays), your know that you will have to shell out $ 1250 to $ 2500 over the course of a year to cover your health care costs. And, let us not forget the actual cost of the insurance (which can range from $ 3000 to $ 6000 a year for a single covered person, until Obamacare really kicks in). Now, that doctor visit means you need to pay your deductible- which is typically $ 25 or $ 35, and then a small amount ($ 75 or so) for the non-covered portion (if you have not exceeded your deductible yet). Not the same for those covered by employer paid insurance, but a whole lot cheaper than those who have no insurance.
This is also one of the reasons why hospitals are buying physician practices. Because the rates the doctors get for examination X and procedure Y are much higher than are the hospital’s rates. So, this is a great way for them to increase their revenue (and profits). Is that illegal? No, not at all.
But, it will not bode well in our efforts to control our health care costs…
Yeah,Roy, the paternalistic approach of employers in the past sure hasn’t done much to kick employees out of the health care nest. And the fact that historically, it’s been all about managing disease instead of health hasn’t been too much of an incentive for healthier behaviors.
I’m one of those self-insured (now-since I started my own business) with the high deductible. After you FINALLY meet that deductible, you still have coinsurance to pay (in my case) and my grandfathered plan still has limits at this point. Ah, what a tangled web we weave. 😉
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Yes, Cathy, I deliberately chose a plan with a real deductible. You hit it- and you are done with paying (except for brand name drugs…) I can live with that. To save the $ 100 a month and have a 20% or 30% copay did not thrill me in the least.
Please, Obamacare, solve THIS problem 🙂
I’m uninsured and have been for years. Finding a policy that I can afford on a fluctuating income is HARD. And yes, medical expenses get really high, and they add up fast. Just a trip to the urgent care where they don’t do anything but wrap a knee and send you home runs hundreds of dollars.
Gwynne:
You may find that Obamacare has some solutions for you in a few weeks. And, yes, that is hard to pay for insurance when the income is so “trendy”… But, even if you choose a very high deductible (which makes the price affordable… for my ancient age, you can get a plan for $150 with a 4K deductible… I just checked out my 94 choices for September), you can get the “arranged pricing” for a physician and other items that makes the annual costs far more affordable.
Hi Roy, don’t know much about American’s Health care Policy or how the normal citizens welcomes Obamacare. Here in Switzerland health insurance is compulsory for all and regulated by Swiss Federal Law on health insurance. We do have a franchise, which is the amount you choose to pay before claiming your health insurance. I guess franchise is similar to deductible in order to reduce the cost of your premium. The Franchise here works on a yearly basis and not on a per cases basis. Therefore, if you have a claime that crosses two financial years, then you will pay two separate amount even if it’s for the same illness or accident..
Thanks for sharing.. Its interesting, will post it to my FB wall.
Lucy
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We have a similar issue here, Lucy, which more and more people will find to be among their circumstances.
It’s the HIGH DEDUCTIBLE plans- the ones that work in concert with (what are called here in the States) Health Savings Accounts (HSA). The HSA works on a calendar year basis- to match your income tax filings. So, you may only cover $X in any given year. (Of course, you could elect to pay a doctor or hospital late- to swing it over to the next year…)
Thanks for the visit and the comment. And, thanks for sharing the Swiss experience!
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