What’s wrong with US healthcare 1: Eligible Charges

Did you know that healthcare costs more for uninsured people?  I don’t mean it  costs more because they visit the ER more or put off preventative care.  I mean the same exact service costs more for a person paying out of pocket than for a person whose insurance is paying.

That’s because the insurance company is big and has the power to negotiate lower prices.  Most clinics accept the lower amount.  But not from you, oh no no no.

Look at your “Explanation of Benefits” or whatever the piece of paper your insurance company sends you for each claim is called.  For each line item you’ll see a higher amount and a lower amount.  Then your responsibility, meaning whatever you’re supposed to pay.

The higher amount?  That’s the asking price — the amount the doctor or clinic wants for the service.  The lower amount?  That’s all the insurance co is willing to pay.  The clinic acquiesces and says “I give.  I’ll take the amount you’r offering.”  Usually.  (They could refuse to negotiate prices — some clinics do.  If you go to a clinic where you have to bill your insurance yourself, be careful.)  That piece of paper is documentation of a haggling process.

If you don’t have insurance, no haggle.  You pay the asking price.  Unless you successfully negotiate it down.  Most people don’t negotiate, I suppose  because (1) they don’t know they can and (2) it’s a social problem — a good relationship with your doctor is valuable.

Here’s what happened to me a few years ago when I needed a root canal and had no dental insurance (and please note I do not think that dental care is nearly as out of control as medical care, but the example still holds in this case).  I ended up with a very high bill, much higher than had been estimated.  I didn’t know at the time how things worked.  I paid it.  With my credit card.  And for several years after that I couldn’t extricate myself from carrying a balance on the cc.  Including interest, I paid way more, even, for that root canal.

If I had had dental insurance, the total amount charged by the dentist for the procedure would have been less, leaving my responsibility even smaller.  Wuh?

What did I do wrong?  Well, I could have tried to bargain with the dentist.  Failing that, I could have worked out a payment plan.  If I were in this situation again, I would do those things and they would have saved me money.

But there is a basic ethical flaw in charging people without insurance MORE.  Most uninsured people have LESS money than insured people.

There you go.  Part one in my series of What is wrong with US healthcare.

Regular programming of cute children and endless, useless but pretty loops and rings of thread tomorrow.


About sayingthings

K lives in the US with her man and kiddos, knits, cans, dehydrates, bakes bread, (but doesn't cook regular food, particularly), crochets, spins, gardens, studies for a degree that never seems to end, and um, works. Sometimes she wastes time online. Also -- and family, she's looking at you here -- sometimes she swears and says things you might not agree with. But she still loves you.

Posted on May 19, 2009, in What's wrong with healthcare. Bookmark the permalink. Leave a comment.

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