Tuesday, April 23, 2013

Fins to the Left, Fins to the Right

by Pa Rock

Our lives are built around routines, and my routines have undergone a substantive change since the heart surgery last month.    No longer do I come home and sort through the junk mail while vegging out in front of the television – for now my junk mail has been washed aside by an unrelenting tide of pesky medical bills.

So far they aren’t enormous  - just constant and constantly bothersome.   Every day I receive anywhere from one to four bills from the hospital or individual doctors indicating that although somebody will ultimately be expected to pay thousands, I am, at this time, required to pay tens of dollars.  So I sit down at the kitchen table and write a handful of small checks and hope that will be enough to keep the wolves from the door until I win the lottery.

Here is how I think it works – and it scares me.  Hospitals and other medical providers intentionally inflate their bills knowing that insurance companies will refuse to pay beyond certain limits.  In the event that the insurance companies don’t pay at all, the patients get charged at the inflated rates.  Patients don’t have the insurance company’s abilities to negotiate payments.

That’s how I think it works.

Here is something else that I have learned.

I became eligible for Medicare seventeen days before my surgery.  I applied for and received Medicare Part A which covers hospital stays – unless the patient is still working.  And that is a big “unless.”  If I wasn’t working, Medicare would have covered 100 % of my medical expenses – but my insurance has deductibles.  I have been told that Medicare will jump in and serve as a secondary insurance, but I’ll believe that when the bills quit coming.

Meanwhile, I feel as though there is blood in the mailbox  – with fins to the left, fins to the right – and I’m the only bait in town.

With apologies to Jimmy Buffett.

1 comment:

Xobekim said...

Your assumption is partly correct. The initial charge by the hospital is the inflated charge. The individual has no bargaining position to negotiate that amount down. The insurance companies are big enough to demand, and get, downward concessions in the pricing from hospitals and medical providers.

The net result is what you figured it out to be, hospitals discount their prices for insurance companies and individuals pay more or go bankrupt. When the patient has no means to pay then the costs are transferred to society by higher insurance premiums and higher hospital and health provider costs.

The Affordable Care and Patient Protection Act cures this spiraling cost by requiring that all persons have insurance, and provides tax breaks for those unable to pay. At the lowest end Medicaid takes care of the poorest. Obamacare also reduces these costs by providing preventative health care services so that patients aren't seeking high cost care at the Emergency Room.