A tax supported community hospital has refused to accept 120% of Medicare for an elective surgical procedure needed by a Texas school teacher. Instead they have quoted a cash price exceeding 900% of Medicare, far more than they routinely accept from Medicare and Medicaid patients.
This struggling school teacher whose income is supported by local and state taxpayers is upset. She blames her health insurance plan for not taking care of her in a time of need.
Bottom feeding intake clerks under direction of upper management are simply the messengers. Someone above them has arbitrarily decided to screw with their local school district at the expense of a hapless underpaid employee. Their strategy is intended to drive employee anger, pitting employees against their employer with the goal in this case of forcing the district to open their checkbook to the benefit of a greedy tax supported hospital who routinely accepts less from others.
This small Texas school district in now the “Bad Guy.” The unhappy and frustrated employee has become the epicenter of an employee revolt turning a valuable employee benefit into a negative rather than a positive.
We have seen this happen before. The playbook never changes. In all the years we have managed plans like this we have never had a plan member unable to receive the care they need. There is always help somewhere at a reasonable price.
In one respect the medical industrial complex is no different than that of any other service industry. Consumers have the freedom to shop for prices they can afford for the services they need.
Want to pay $10,000 for a television that can be purchased at another store, same television, for $1,000? Want to pay $100,000 for a surgical procedure that costs $25,000 at a hospital down the street performed by the same surgeon who has privileges there too? The answer is obvious. You don’t go to daddy and ask for an extra $9,000 or $75,000.
Plan members must understand they have the financial power advantage. They have leverage. They have the money. They have the power. And they have back room support to make it happen.
And now the rest of the story………………………..Patient was able to receive the services she needed at a nearby hospital at a fraction of the cost. Her district’s health plan waived all of her financial responsibility, eliminating her deductible and co-insurance out-of-pocket expenses. She is now one happy camper!
