It would be impossible to cover our country’s health care situation in one post, however, I have to start somewhere. Before the past decade, I recall having employer-based coverage with a modest deductible, let’s say $500 or $1000, that had an out pocket maximum of maybe $2500. Over the past 10 years, my coverage has evolved to a deductible of $2500 to $5000, an out of pocket maximum of $10,000, and with less coverage.
Today I present to you just another small fiasco in our health care system that has become a hot mess. Recently I scheduled an appointment with a doctor as we moved to a new area about a year ago. The objective of the appointment was a routine check-up and blood work. So I went in about a month ago, got the blood work, and everything was fine. Until I got the EOB, that is. Below is a snapshot that explains the services.
The first shocker is the “list price” of the routine blood work. $1329 !! Are you serious? Of course this is the list price if you have insurance, however, they give you a big discount due to their contract with the insurance company. Seems collusive? I think so. At a minimum, it is not transparent and not based on supply and demand. The real joke, or not, depending on you look at it, came when I saw that one of the tests was not covered by insurance. I called the insurance company and asked what test is not covered. It turns out it was for Vitamin D.
Looking at the explanation codes at the bottom and the description, you find the following:
J0151 – An internal protocol, policy, guideline or rule has been used to process this service. If required, a copy will be provided free of charge by calling our Member Services Department.
So, I called member services and asked to get a copy of the guideline. After waiting on hold for 10 minutes, the CSR agreed that I could request a copy and she would send in the mail. I have yet to receive, but at best it will provide comic relief as to why myself and others continue to get ripped off.
When the final tally is added up, my routine visit looks like this:
- Insurance pays $181.14 ($131.20 for visit and $40.94 for bloodwork)
- I pay $339.15 which is applied to my $5000 in-network out of pocket limit
What does this look like to me? That the hospital and insurance companies are making huge money at the expense of the end-consumer. How? By non-transparent pricing convoluted by an agreement between the hospital and the insurance company. Also, the “non-profit” status of the hospital, meaning non-profit in name only. Someone, or some group affiliated with the hospital, is making big money.
Fortunately, I have saved for years, both in an HSA and in general, and paying a bill like this is a minor irritation for me. Is it sustainable for the broader population? I say unlikely. I predict that more and more people will seek out doctors that offer cash prices, or in the case of big expenses, engage in “medical tourism” by getting treatment in another country. It is already happening.