What is the first question asked by medical providers when seeking medical care in the United States? After the usual perfunctory “Good Morning” or “Good Afternoon” , it is invaribly “Do you have insurance?”
Insurance companies have negotiated prices upon your behalf for medical care services rendered to you. But, you have no clue what kind of deal has been negotiated upon your behalf. Since you are paying the bill, either in cash due to high deductibles or co-insurance out-of-pocket expenses (fancy word for “your share after insurance pays their share”), or in insurance premiums that seem to go up year after year (even if you dont use the insurance), medical care costs should concern medical care consumers. Yet, that is not the case. Consumers never ask for prices, and never question provider billing statements. Why?
The answer is simple. As a society we have become brainwashed to believe that with insurance we are protected against the high cost of medical care. “It’s not our own money, it’s the insurance company’s money so I really dont care what the cost is, my insurance covers it for me” is today’s mindset.
But is that true? Or do insurance companies simply act as a middle man, or general contractor for our medical care, skimming their cut off the “action?” And, if insurance companies take a loss, who pays for the loss?
Below illustrates an actual encounter with a medical care provider yesterday at an out-patient surgical center in Harlingen, Texas which illustrates what is wrong with our current health care system:
Insurance Person (office clerk): Good afternoon, do you have proof of insurance with you today?
Insurance Victim (patient): Well, that’s what I want to talk to you about. You see, I have insurance and I have cash. I would like to know what the difference would be between a cash price and my insurance price.
Insurance Person: Ok, no problem…………….the cash price is $509……………..and your XXXX price is $548.
Insurance Victim: Ok, I’ll pay cash instead of using my insurance.
Insurance Person: Great, that will be $548 please.
Insurance Victim: Wait!!!, You said the cash price is $509, so that is what I will pay you!
Insurance Person: No sir! Since you told me you have insurance, and that it is with XXXX, we have to file the claim and get back $548. And since you say you have not met your XXXX deductible yet, you need to give me $548 now, before we do the procedure.
Insurance Victim: Wait, that doesnt make sense. What difference does it make that I have insurance? I will pay you cash instead.
Insurance Person: No sir, we have a contract with XXXX and we must have our agreed upon price of $548 before you have your procedure.
Insurance Victim: I dont care if you have a contract with XXXX, I dont have a contract with them nor do I have a contract with you.
Insurance Person: Sorry, our office policy stands. Either you pay $548 up front, or go somewhere else to have your procedure done.
Epilogue – After a very heated discussion in the lobby, much to the entertainment of the patients waiting there, an Agreement was reached. The clinic agreed to accept my cash payment after the procedure is done.
Here is a video that illustrates what is wrong with our current system – http://www.whatstherealcost.org/wtrc/toolbox/connect.html?video&site