Another Reason Why Health Care Reform Is Needed Now

[atlantainsguy]

The following is one of today's Insurance Business Wire stories. It's a good example of why we need to reform our current healh care system. Sure, these guys directly compete with agents, but at least they are using some smart pr to make a point and leverage more business.

BestHealthcareRates.com Reveals Inequities in Medical Insurance Companies Billing
ARROYO GRANDE, Calif.--(BUSINESS WIRE)--BestHealthcareRates.com states uninsured individuals, or those using out of network providers, are being billed up to 1000% more by medical providers than they would bill Medicare for the exact same procedure.
According to Tom Carolan, Director of Client Services at BestHealthcareRates.com, "This sort of abuse happens when people are without medical insurance or choose to use out-of-network healthcare providers. Even though our government has focused much of its attention on how much medical insurance companies pay, the real question is what are providers charging those who have no one to negotiate for them?"
This area of concern, the fees being charged to the uninsured, is one aspect of healthcare that the government's reform policy has not touched. However, it should because there is no recourse for those who are overcharged and no guidelines in place so doctors know what to expect and patients know their options. This is yet another aspect of healthcare that needs to be addressed but is currently being neglected.
Until the government puts a better system in place, the best way to control healthcare costs is to be sure to carry good medical insurance. There are a variety of medical insurance plans out there including ones that allow use of health care providers of choice and they pay a significant portion of the costs. Investigating the various plans available will help find the one that best meets users' needs and help them avoid being overcharged by providers who try to take advantage of patients.
By using BestHealthcareRates.com consumers can get a quote on the family health insurance or individual medical insurance any time of day or night. After simply providing some information, inquirers receive competitive quotes on affordable medical insurance from companies in their area. By taking out such a policy they will be protected from unscrupulous billing from healthcare providers, something the government thus far has neglected to address, despite its attempts at healthcare reform. It seems that the reform debate is still missing some of the most important issues.

atlantainsguly

 

[Crabcake Johnny]

Totally agree. Medical providers charging obscene rates just because they don't have insurance or stating they are "trying to make up for people who don't pay" is totally absurd.

Imagine staying at a hotel for 3 days then checking out. They ask if you're a rewards member. No. They ask if you're an AAA member. No. Ex military? No.

Ok, then for three nights the bill is $3,200. Again, absurd. The "making up for people who don't have insurance and don't pay" to me is the king of all stupidity.

"Waitress, how come my bill is $120. Shouldn't it be $40?" Waitress: "Yes, but over the past 2 days we had 10 people skip on the check and we need to recover that."

I feel some of it should be illegal. Imagine creating a bill for your client with no contract. Can you really just bill anyone whatever you want for a service after its rendered? Would it hold up in court?

Imagine you put in a new kitchen counter top for someone without having any contract then send them a bill for $35,000. Would a judge side with the contractor? Not a shot in hell.

 

[somarco]

Those who don't have insurance end up paying less than anyone, mostly because they are deadbeats.

What providers bill is irrelevant.

The only thing that matters is what they collect which averages less than $0.15 on the dollar.

 

[Crabcake Johnny]

Well I think that's my point. The people without insurance but the means to pay take it right up the a** which is not the way any other business operates.

I think we're far, far past "just get a job" and there are people out there without insurance, lots of money and zero options.

 

[Amber Scherloz]

I totally agree because more and more people are now dependent on an insurance. We have to admit that for every thing we do we have to consider an insurance for it. So things should be developed to cope with the developing world.

 

[Norwayguy]

Totally agree. Medical providers charging obscene rates just because they don't have insurance or stating they are "trying to make up for people who don't pay" is totally absurd.

Imagine staying at a hotel for 3 days then checking out. They ask if you're a rewards member. No. They ask if you're an AAA member. No. Ex military? No.

Ok, then for three nights the bill is $3,200. Again, absurd. The "making up for people who don't have insurance and don't pay" to me is the king of all stupidity.

"Waitress, how come my bill is $120. Shouldn't it be $40?" Waitress: "Yes, but over the past 2 days we had 10 people skip on the check and we need to recover that."

I feel some of it should be illegal. Imagine creating a bill for your client with no contract. Can you really just bill anyone whatever you want for a service after its rendered? Would it hold up in court?

Imagine you put in a new kitchen counter top for someone without having any contract then send them a bill for $35,000. Would a judge side with the contractor? Not a shot in hell.

Okay but here is the problem, how many people ask what the procedure costs before having the procedure done...I think most people would get quotes and references for their kitchen but will go to the first Dr to have a procedure done...Then the next question would be how come you want X but Dr. Jones 10 miles away wants Z...But I think it is becoming harder to negotiate here in Maine more and more Hospitals and Drs are part of large comglomerates...they need to to be able to stand up to the State.

 

[somarco]

how many people ask what the procedure costs before having the procedure done.

How does one effectively shop for the lowest cost on a heart transplant or treatment for bone cancer? Even if you could, do you want the cheapest heart surgeon or the best?

If you have a BMW and take it to a mechanic, they will give you an estimate. Once it goes on the rack if it is going to cost more they give you a call and ask if you want to continue.

I don't think the surgeon is going to wake you up half way through the operation to tell you this is going to cost more than the estimate.

You can shop your meds and even primary care. But when it comes to something major, most folks want the best, no the cheapest.

 

[IAC.Ryan]

How does one effectively shop for the lowest cost on a heart transplant or treatment for bone cancer? Even if you could, do you want the cheapest heart surgeon or the best?

That's the benefit to programs like "My Health Compass" or networks like Health Care Direct out of Milwaukee.

You'd be surprised by how often the best provider is more affordable than the provider around the corner. This is why price transparency is one of the necessary legs to successful reform.

Without knowing prices / rating ahead of time, how can we as an industry expect our clients to be good stewards of their healthcare dollars?

IMO...

 

[Norwayguy]

How does one effectively shop for the lowest cost on a heart transplant or treatment for bone cancer? Even if you could, do you want the cheapest heart surgeon or the best?

If you have a BMW and take it to a mechanic, they will give you an estimate. Once it goes on the rack if it is going to cost more they give you a call and ask if you want to continue.

I don't think the surgeon is going to wake you up half way through the operation to tell you this is going to cost more than the estimate.

You can shop your meds and even primary care. But when it comes to something major, most folks want the best, no the cheapest.

I do not disagree with you on life threatening situations or emergency situations but I have compared the prices of X-Rays back before my provider became owned by the hopsital we had the choice of 2 facilities and the local small town hospital was more expensive because they where amortizing the costs over fewer patients...I guess my issue is in what other industry would we have something done without regard to costs....

Its a non-issue if you have great employer coverage insurance like the teachers I deal with $250 deductible 90/10 coinsurance on the next $5K bills for total out of pocket costs of $750 but if you live in a GI/Community Rated state like I do you might be just as tempted as I am to have that 10K/20K Family deductible policy...And don't even talk about HSAs...they don't work around here I compared an HSA and the savings are not there in the policies available here in Maine..

I know I might be talking about a situation here that is not the case in other states but even with good coverage don't you think you should know what the procedure costs...heck don't you think the person recommending the procedure should know what it costs....Just had x-rays done and I asked what he thought they costs because I knew he didn't have a clue he stated $100 all inclusive....I said maybe $100 for the radiologist to look at them and I was right the bill from the hospital was $375 and the radioligist was another $105.

 

[somarco]

That's the benefit to programs like "My Health Compass" or networks like Health Care Direct out of Milwaukee.

You'd be surprised by how often the best provider is more affordable than the provider around the corner. This is why price transparency is one of the necessary legs to successful reform.

Carriers contract centers of excellence on a per diem basis and do so at a much lower cost, and improved outcome, vs the DIY route where the patient wants to find their own doc.

By the time you get on the wait list for a used heart (kidney, liver, lung . . .) you have a case manager who is directing your care.

Most plans have carrots or sticks designed to drive you to the centers. Price transparency is a nice talking point, but for anything beyond primary care (including Rx) it has little value to the patient.

The human body isn't like a transmission or HVAC unit. There are plenty of ways to find out how much meds cost, lab work, X-rays, routine office visits and even things like vaginal birth.

But how much is a complicated delivery?

Well . . .

Anywhere from $10,000 on up.

When it comes to something major, no one, at least those with insurance, is shopping around for the lowest cost on brain surgery.