As I was looking through Twitter yesterday, I came upon a meme that really grabbed me because, unfortunately, I think it accurately describes many people’s uninformed attitudes about the place of health insurance in their lives and how it is best managed. Yet, I don’t totally blame most people because the “health care” systems and insurance companies are putting in a great effort to deceive people and make them feel totally dependent on insurance “coverage.”
This meme showed two conflicting statements:
- One guy states that a sonogram costs $150 if the payment is in cash.
- The other guy replies, “I’d rather pay the $800 and get credit toward my deductible.”
How crazy is this?
Unfortunately this is a common attitude in our country today. Such an attitude may be the result of people’s natural fear that, somehow or another, they will incur some huge medical bill, and want to be at least partly paid up on their deductible when that disaster happens. However, what if that disaster does not happen in that same year? What if the sonogram is almost the only medical service one receives in the year outside of possibly the follow-up visit to the doctor for the results of the sonogram and a few other routine visits?
I would argue that if a minimal amount of health care is needed in the year that person paid $800 to have a sonogram go through their insurance “coverage,” they probably paid $650 more than necessary just to have that bill count toward their deductible. Not to mention, every year the deductible is wiped clean and starts at zero for the next year. One exception to that rule would be the situation in which some insurance companies allow deductibles accumulated in the last quarter of the year to apply to the next year. However, eventually, the deductible will be reset back to zero.
Another issue with this mentality is that the $800 sonogram paid toward the insurance deductible was most likely based on a negotiated reimbursement rate between one’s insurance company and the service provider. The trick in this negotiation is that the provider (hospitals are generally guilty of this one) charges some outrageous fee and the insurance company has contracted with that provider to pay a lesser amount that may still be fairly ridiculous. The actual charge to the insurance company for the sonogram that was costing the patient $800 is probably much more, and the $800 is considered a “discount,” but only in the insurer/provider universe.
According to an article by Jed Lipinski in the Times-Picayune entitled, “Can’t bring myself to give them that money: Finding out your $284 blood test costs $34 nearby,” (1) a woman found out how insurance companies operate with health systems, much to her chagrin. She had a blood test, a comprehensive metabolic panel for kidney and liver function, done and received a bill from Tulane University Medical Center for $323. The article reported that this patient’s insurance company determined that she owed $284 of that $323. The real clincher was that the same test was available at a nearby lab called Quest Diagnostics for $34.
Now this woman had not made a deliberate choice to pay a large amount instead of a smaller amount to count toward her deductible and clearly felt blindsided by the bill she received. However, I am guessing from my personal experience, that she probably had the blood drawn conveniently at the medical center where she saw her doctor and then analyzed by whatever lab is contracted by Tulane to perform that service.
Another issue here is that it usually all appears so convenient to have one’s blood drawn at the same location as the doctor’s office and patients can just show their card at the front so the insurance carrier is billed for all services. Of course, nobody at the medical center is going to tell patients they can get a better deal elsewhere.
I think that the mentality that one might as well apply all their medical care to their deductible is prevalent because most people assume that ALL health care services are expensive by nature. So why not? Surely they may end up getting their deductible paid off sooner or later in a year because every time they see a doctor or get a medical test, it is guaranteed to be expensive. I believe that is also the reason the Congressional Budget Office attempts to make people panic about repealing and replacing Obamacare – because all medical care is, by nature, expensive so everyone must be “covered.”
However, as the story I just related demonstrates, that is not necessarily true.
I think it’s time that we all become true health care consumers and not blithely stick out our arm or head to a large medical center’s radiology department when we get test orders from the doctor we just saw there. Besides the option of Direct Primary Care in which many common lab tests are available with the cost of a monthly membership, we can look around if the physician we want to keep doesn’t happen to be a DPC doctor. When we have that lab test or x-ray order in our hot little hands, let’s change our mode of operation and ask ourselves, “Can I get this test less expensively somewhere else?”
Maybe we can, maybe we can’t, but why not ask the question?
Better pricing is often available if we shop around, and let’s certainly re-examine our attitudes about paying higher prices just to work toward a deductible. Who knows? If enough people made a habit of shopping around for procedures, the big bad health systems and their crony insurance partners just might think twice about their ridiculous charges and charge something more in line with reality.
I wouldn’t hold my breath on that one though.
Sources for further reading:
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