Health Insurance Still Chained To The Workplace
It's a Jewish crack -- "never buy retail." And that includes medical care.
Steve Lopez writes in the LA Times of a man whose kid got a stomachache, how he took the kid to the emergency room and ended up with a $5,000:
When the bill arrived, John Moser felt a sharp pain in his own gut.The cost for just walking in the door of the emergency room? That came to $1,288. The ultrasound nicked him an additional $1,135. A comprehensive metabolic panel (blood analysis) was billed at $1,212.
Moser was also charged $158, accidentally, for the saline solution he had turned down. The total came to $4,852.55, not counting separate bills that would arrive later and total nearly $1,000, including $540 for pathology and $309 for the doctor.
"I was shocked," said Moser.
The first bill, $4,852.55, was confusing, as medical bills often are. It said "your health plan has recently made a payment on your account." It said the balance, $2,571.85, "is now your financial responsibility."
When Moser mentioned the bill to his father, Marvin Moser flipped.
"Yes, the fees in ERs are off the wall all over the country," the professor of medicine told me, but he found Tarzana's to be extraordinary. "The one thing that stands out, beyond belief, is $1,212 for a metabolic panel."
That's a test, Dr. Moser said, in which a technician draws blood for chemical analysis, and it takes just minutes. Moser questioned not only the charge, but the usefulness of the test in his granddaughter's case.
Out of curiosity, I went online to see what a lab might charge for a comprehensive metabolic panel.
Any guesses?
Some labs advertise prices as low as $39.
Glenn Melnick, who teaches hospital economics at USC, was not surprised.
"By and large, these prices are fictitious numbers," said Melnick, who argued that Tarzana and most other hospitals routinely charge astronomical fees, especially for emergency room services.
Of course, and it's all part of a years-long game in which the charge for service, the true cost of the service, and the acceptable payment are in three different orbits. And that doesn't even take into account how the charges are adjusted up or down depending on who's paying them and whether they have worked out a deal. How can patients hope to make sense of such an indefensibly convoluted system?
The important sentence that of course Lopez just tossed of and didn't deal with further:
"He had lost his job in TV production, and later bought his own medical insurance."
The comment I left at the LAT:
Yet another thing the ridiculous Obamacare has not corrected (untouched upon in this tale). We live in a time when nobody stays at one company for a lifetime -- a world of freelancers. Health care should not be tied to one's job. It keeps people who are sick in jobs they want to leave and puts people at square one in health insurance when they do leave a job or if they get fired.I'm in my 40s. I left my first and last corporate job in my early 20s and started paying for an HMO -- and have been ever since. The price only goes up by age, and once I was in, I was in. Health insurance should be a thing an individual purchases for him or herself upon graduating college (or high school if there is no college).
Here, from another commenter, NewsBrowser, is how it would have worked out if they had my HMO, Kaiser:
My eight year old recently went to the ER for the same problem. I have a HMO, Kaiser. Cost was no problem since it was only a seventy five dollar co-pay. My complaint - it took FIVE tries to get the IV started!! When I asked why the IV, the answer was we always start an IV.
I can't reasonably see why it would cost so much, let alone with insurance. I work at Kaiser in urgent care. An uninsured patient is charged $195 for the visit (ideally paid at time of check-in but usually have to bill for it) then will be billed for lab work, imaging studies, and supplies depending on what is done. If you go to the ER it's $250 for the visit, then whatever the charge is for additional stuff. And a BMP full cost without insurance is $59. If I were to find myself without insurance I'd go to Kaiser because their prices are at least reasonable and realistic to the actual cost of things. My mom had gone to the ER at another hospital probably 15 years ago and was billed $1400 for an ice pack.
BunnyGirl at March 25, 2012 1:02 AM
When he left his employment (if he worked for an employer withat least 15 people) current law require that he be offered the opportunity to stay on whatever plan is offered by that company to its current employees for 18 months. That offer generally shocks most employees because they have no concept of how much the employer pays. Generally group insurers have pretty good network contractual arrangements with most health care providers which helps keep payments and thus premiums down. All insurance is not the same and you get what you pay for. It sounds as though the guy bough a limited plan which pays set pricing for services, not a "Comprehensive Major Medical Plan" which is available for individuals as well as businesses. Providers full retail pricing is a joke.
He may have recourse if what he purchased was not properly expllained, but i would bet all he did was say, "I want the lowest price." I have found over the last 30 years or so not to accept as a client anyone that won't listen to a full explanation of what they say they want.
RRRoark at March 25, 2012 1:14 AM
Amy Alkon
http://www.advicegoddess.com/archives/2012/03/25/health_insuranc_6.html#comment-3097913">comment from BunnyGirlThere's a huge Kaiser out there, right by Tarzana, in Woodland Hills.
Amy Alkon
at March 25, 2012 1:25 AM
Three things - repeat these out loud:
1) "Health insurance" is NOT "insurance", because there is NO party who will NOT access the benefits. This is actually socialized medicine. Be honest and enforce that term.
2) The entire purpose of this is to pay doctors. Keep that in mind, and you will be able to ask yourself and others real questions and see some absurdities. Some questions: How is involving government going to get me better care? Why are so many people being paid that have nothing to do with treating me?
3) If you do not pay, you are not a customer, you are a commodity. Things will be done by policy, not the way you desire.
You can avoid all this in this way.
Radwaste at March 25, 2012 4:18 AM
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