OT Hilarious Insurance Payment

[jonquiljo]

One of the bigger problems today with the costs of medical care is the fact that the "list price" for goods and services are severely hyper-inflated. Those $10 aspirins are really much more common than you think.

Now that we have this "wonderful" ACA (aka Obamacare) insurance, providers have simply jacked up their rates to, in turn, discount them for the insurers. The people who fall between the cracks (uninsured, not covered by your plan, wrong provider- so not covered) end up on the hook for the full cost of the item or service. So our "affordable health care" now becomes even more unaffordable for those who are now stuck with ACA-type plans. By 2016, all of us will have ACA-type coverage - many people will just not know it. The implementation for the bulk of the business policies is not until 2016 (i.e.- after the mid-term elections). The saying goes that ACA coverage is the "affordable coverage that you cannot afford to use."

The largest flaw in the ACA is the fact that it does nothing to control costs and rates by providers. And that's a big flaw! All the law does is change is who and how the actual policies are paid. In the end, we all end up with the bill somehow - and the overall "bill" is actually bigger. Right now only individual subscribers are stuck with ACA coverage, but wait until the rest of the country is saddled with these policies. Many people will end up stuck with the OP's original bill of $29K because they went to the wrong provider - even though the providers are not clearly identified by the policies. Things like anesthesiologists are usually not picked by the patient and so the chance of the provider not being on the "provider list" are much lower than a year or two ago.

Sorry for ranting, but I've never seen a bigger mess in my life. The marked up prices by providers make it essential to get coverage, yet is Russian roulette when you actually get some procedure done. Drug costs are more marked up even more.

A few not so publicized problems: Many with a permanent green card or naturalized citizen must again prove it in the next month or their coverage will be revoked. The INS (immigration) computers cannot totally verify many people's immigration status. Since alot of these people are of limited English, they don't know how to handle it. I have a friend who is a naturalized citizen and whose daughter was born in the US, and both are being asked to prove it with documents they don't even have easy access to.

A bigger problem that will hit in several months is that when people actually can tabulate their 2014 income, it better not be higher than was predicted by the various state (or federal) government agencies that calculated their "subsidy" (the part that supposedly makes their insurance "affordable." If they made more money than the government predicted, they will get hit with a big tax bill reversing their (predicted) government subsidy for ACA insurance. This could easily come to $5K or more in a year, an amount which very few people have sitting around. The government even admits that the IRS data they used to initially calculate premium subsidies is commonly inaccurate on the generous side. So many people will be stuck with costly bills in 2015 for their 2014 insurance subsidies.

The moral of the story is that when someone offers you a deal, beware! The deal isn't what it appears to be. And those $29K anesthesiologist bills are often shoved in the faces of the insured, not the insurers. The OP was lucky - sorry, but you are!

[photonic]

Time magazine published a great article about the US healthcare system, by Steven Brill, Feb 2013 "Bitter Pill: Why Medical Bills Are Killing Us". It lays out the reality pretty thoroughly using real world examples. I found it very interesting. A long read for a magazine article but worth the read IMO.

This is an absolutely fantastic piece of journalism on this topic and extremely eye opening. Highly recommended.

[jonquiljo]

This is an absolutely fantastic piece of journalism on this topic and extremely eye opening. Highly recommended.

It was a great article. There are a few more I've seen. Basically they all show how we haven't really addressed the major issues surrounding the health care system in the USA.

[jonquiljo]

Found it!! This one is good and amusing!

http://www.nytimes.com/2013/06/02/healt ... .html?_r=0

[herefishy]

The article doesn't mention tort reform - don't you think the high cost of malpractice, and paying massive costs of lawsuits, has a lot to do with healthcare costs?

[Sir NoddinOff]

We can chuckle at these crazy med bills but our children and grandchildren probably won't be as amused, considering the system we are leaving them with (don't even get me started on climate change).

[jonquiljo]

The article doesn't mention tort reform - don't you think the high cost of malpractice, and paying massive costs of lawsuits, has a lot to do with healthcare costs?

I'm not sure that tort reform is a big influence in the overall cost of medical care. It may be, but I have not heard of much concern about lawsuits.

Usually one signs a waiver of legal remedies when they sign up for insurance (at least in California). All disputes between you and your insurance companies are subject to arbitration only. I don't think one can collect damages either on most cases. The only big threat against insurers is "bad faith" insurance practice, and they go out of their way to cover themselves on that.

A friend of ours had a really bad case of medical neglect by an HMO - basically they let him to die. I referred our attorney to his family to see if he could do something about it. My attorney told me that most anything a Dr or hospital does requires a waiver of rights these days. You can't collect much, if anything - and certainly not damages (which is where lawsuits tend to really hurt people). This is true when a medical "mistake" or "neglect" results in someone's death. There are caps on wrongful death suits of less than $100K or so. This is pocket change to an insurer, provider, or hospital - and in fact, is usually cheaper than treating a patient in some cases.

The only people who tend to be at all susceptible to lawsuits are individual physicians. They don't have the kind of cash that can sustain even a minor "hit." Malpractice tends to be hard to prove, and most are insured. This is what I have been told, anyway. I have, in my own experience with litigation, found that our legal system makes it very difficult to get any financial remedy except in extreme cases. Courts are overloaded and it requires lots of documentation just to have a malpractice suit heard.

[JDS74]

The article doesn't mention tort reform - don't you think the high cost of malpractice, and paying massive costs of lawsuits, has a lot to do with healthcare costs?

I haven't kept up in recent years but about 20 years ago, liability insurance for a single practitioner OBGYN was in excess of $300K per year. I'm sure it has gone up quite a bit since then. If the practice has 1,000 patients, that's a cost of $300 per patient before the doc gets any, before the staff get any, and before the rent gets paid. 1,000 patients is a really large solo practice.

[jonquiljo]

The article doesn't mention tort reform - don't you think the high cost of malpractice, and paying massive costs of lawsuits, has a lot to do with healthcare costs?

I haven't kept up in recent years but about 20 years ago, liability insurance for a single practitioner OBGYN was in excess of $300K per year. I'm sure it has gone up quite a bit since then. If the practice has 1,000 patients, that's a cost of $300 per patient before the doc gets any, before the staff get any, and before the rent gets paid. 1,000 patients is a really large solo practice.

That's why they tend to form groups these days - to make a big medical machine with streamlined costs. I don't see many (or any) solo specialists around here, anyway.

[Amenite]

The article doesn't mention tort reform - don't you think the high cost of malpractice, and paying massive costs of lawsuits, has a lot to do with healthcare costs?

The way I see it tort reform without transparent and enforceable standards, accountability and quality controls in medical practice is a win/win for someone, but definitely not me. I've heard some chilling anecdotes in my day, for example one practitioner that had hurt people only to pack the bags and set up shop in another state before winding up in jail. Probably still practicing today. There is no free market for much of the health care we obtain. It is delivered immediately, on demand where it is needed without the luxury of shopping around for a better quality or price. Hard to research that cardiac department when your brain is being starved of oxygen by a heart attack or a stroke for example. I have more reliable information about the safety of a car I want to buy than about my doctor.

[herefishy]

I've always thought that the hospitals, medical device manufacturers, pharmaceutical manufacturers, etc. had to make these ridiculous profits to cover the lawsuits resulting from their usage. If that isn't true, are they just ripping us off because they can? Shouldn't there be something we can do? Wouldn't you think someone in Washington could come up with an answer?