A recent medical emergency really opened my eyes to the cost of healthcare for those with and without insurance. Over the last several years I have not had health insurance. During that time I paid for doctor visits, prescriptions, and tests out of pocket. I figure the average doctors visit ran me around $100, lab work around $80, and one ER visit was $2200.
Last year I enrolled in an insurance plan through the ACA market place. I hadn't used it until this month except for a doctors visit or two. I didn't even look at the EOB's for those.
Three weeks ago I went to the ER and was admitted to the hospital for a 24 hour stay. After returning home and not having a lot to do during my reincorporation but worrying about just how much this was going to cost me I started looking at the EOB's I received as they come in. I was shocked!!!
The first thing I did was look at the last EOB I had for a routine visit to the doctor back in March. The doctor billed the insurance company for $171.00. The plan paid $43.68 and I paid a $20.00 copay for a total of $63.68 that my doctor received for services. This is the same doctor that without insurance I routinely paid around a $100 a visit.
The first EOB from this visit that came in was for my hospital stay. The total billed was a little under $21,000. The insurance paid $835.20 and I paid $208.80 for a total of $1044 paid to the hospital. Really? They paid less than 5% billed?
Another EOB I received was for an ER visit. The bill was for 2798.94 and my insurance company paid $521. I was billed $2200 for a comparable ER visit while I was uninsured.
I am not a fan of the Affordable Care Act. I personally know people that are paying more out of pocket every year since it has been enacted in both premiums & care costs. I personally don't see where it is saving anyone any money except for those that are fortunate to fall into the just income group just above poverty level or those that live in states that expanded medicaid.
Premiums are once again going to rise in 2017 and insurance companies are opting out of the healthcare market due to a decline profits, even when companies like United Healthcare still has a profit of $2 Billion a year.
Part of the argument for the failure of ACA is that many are opting to pay the "tax" for not having health insurance instead of purchasing health insurance. More of those opting to purchase insurance have more serious medical issues that are "costing" the insurance companies instead of generating them a profit.
Every company and individual goes into business to earn a profit. Inherently there is nothing wrong with that. That's the way free market & capitalism works. Unlike other purchases healthcare and health insurance is something that average consumers don't have a lot of control over. Unlike purchasing most items healthcare services are not a decision of whether or not you want a procedure.
My question is how do we gain control? How do we tell providers & insurers that we want more transparency. Health care services are a product we purchase just like any other product. And we should treat it that way.
We should know what most procedures costs before we have it done. After all it isn't any different than purchasing a loaf of bread. The store selling a loaf of bread and a hospital performing a procedure all have fixed and variable costs they use to calculate the final cost of the product. Add on a profit margin and you have a retail price. Like some industries add a little padding to your margin so that you can offer discounts.
The difference is unlike the store selling a loaf of bread healthcare providers don't have a set cost for their product or service. They base their prices on factors such as what insurance or lack of a person has. They can bill one insurance company for $5000 and receive $500, they can bill another for the same service $10,000 and receive $600, all while billing an individual $20,000 and receiving $5,000 or end up writing it off as a bad debt after a person has paid a few thousand but can no longer afford to make payments. The actual cost of providing that service might be $400. (Here I'm assuming that hospitals wouldn't routinely negotiate reimbursement rates for less than the cost of providing the service.)
After reading another article on here (@anon/true-cost-of-healthcare--david-belk-mds-research-into-the-confusing-and-tangled-state) I found this site (http://truecostofhealthcare.net/introduction/) that gives you a lot to think about when it comes to the costs of healthcare, insurance, and the roadblocks to healthcare reform that would make access to care more efficient and affordable.