So, remember that little thing that happened to me back in August?
That little thing that landed me in the hospital?
I've been paying for that little thing since the day I got out. No! Literally the day I left the hospital there was a bill from the hospital in the mail.
I think, though I'm not positive, that I have finally received and paid the last of the bills. As, I have been paying these bills I became very curious about who was billing what, who was paying what, and what were the balances to all this paper showing up in my mail. Okay, curious may not be the best word. Pissed off may be a better term. It seemed to me that the doctors were billing outrageous amounts, that the insurance company was adjusting that amount by a lot, and that the insurance company was either paying less out of pocket than I was or pretty close to the same.
Turns out I was mostly right on all accounts. Instead of bludgeoning you with numbers let's look at a little visual I put together this morning, because I deal better in visuals.
A 3.5 day stay at the hospital cost over $33 thousand dollars. Had I not had insurance I would have been responsible for ALL of this amount. No adjustments are granted to those that do not have insurance. You are on the hook for the entire amount. Unless you don't care about your credit rating, never want to buy a house, a car or anything else on credit for that matter.In that case you just skip out of the bill.
The insurance company decided that over $29K was just the doctors and hospital being silly. Which they probably were but if they didn't bill this high of an amount I suspect the insurance company would have still adjusted the total. Insurance companies love to take money, they are just not real good about paying that money out when they are supposed to. Funny how that is.
Now, let's get to the part that really pisses me off.( Besides the fact that most Americans are uninsured or under-insured because our legislators are pussies or corporate sell outs and the insurance executives are greedy assholes. Who obviously reduce me to swearing.) It's the $1483.19 that I had to pay out of pocket. While the insurance company paid $2185.83. I pay every single month for insurance. If you were to total those payments up for an entire year it would equal about $2400. That is just for me and does not include what I pay for JR. I have gone to the doctor a sum total of one time this year for a checkup. That's right folks. One time. I'm no mathematician but somehow I get the feeling that I'm getting the short end of this stick. What do I have to do to break even? Get sicker? Get sick more often?
It looks to me that I'm paying every single month to get that adjustment. Why don't they just give me the adjustment to start with and I'll stop paying my insurance premiums every month. I could put that money (looks like about 11%) into a credit union and earn a little interest. Maybe, get ahead? What a concept!
And, don't give me that crap (not that I think any of you would) about you should put some of your money into the medical flex savings account. It's tax free! WhooHoo! I still have to have insurance and I rarely spend $1400 per year on out of pocket medical bills. As I understand it, according to the rules if you put money into a medical flex account you must spend all of it in a given year on medical bills, dental bills or stuff you pick up over the counter. Seriously, I can afford to buy aspirin when I have a headache. I can afford my prescriptions. I can afford my co-pay. And if I couldn't it was because I wasn't working so wouldn't be able to put into the flex savings account anyway. AND, If you don't spend it you lose it. What kind of a crazy ass system is that? I'm better off putting the money in a savings account every month. The interest may be not balance out what I pay in taxes but at least on Sept. 30th that money is still mine.
Whew!
Sorry about the rant. I think I just needed to get this off my chest.
Love,
M
Seriously? Insurance is such krappe. We constantly fight over bills for the boys. My co-workers can attest that I have had words with out local medical system (because God knows you have to call them between 8-5 when you're at work!) Just as an FYI, though, if you are truly financially needy, almost all health systems will help you out. It's long and tiring, but if you don't want to kill your credit, they won't let you die, either.
ReplyDeleteAll of a flex savings account must be used every year, but if you get a high-deductible plan and open a health savings account, you can keep what you don't spend, accrue the money and eventually invest what's in the account like a 401K. Eventually, you can roll that money over to an actual retirement account. We did this very thing this year when they jacked the premiums for our business up a whopping 22% in February, and wish we'd done it YEARS earlier.
ReplyDeleteEveryone complains about the health care system. I know that insurance is a big part of the problem. Having worked in a doctor's office, getting money out of insurance is like pulling teeth. I don't like what a necessary evil insurance is. And we have a pretty good insurance right now.
ReplyDeleteMB: It's nice to know that they don't let you die. I've had words with the medical system but mostly that is with the JR's doctor's office. Turns out they can't talk to me about his bill even though I carry the insurance and pay them.
ReplyDeleteJan: I'm glad to hear that one of those plans work out for you. I only have 1 option for medical insurance and just the flex plan. Stupid state of Texas rules.
Vandy: You are so right. It is a pain for the doctor and the patient. It would be nice if it was more equitable.
Argh, preaching to the choir, love. It's like the insurance and medical field are at war with each other and we're the ones caught in the crosshairs. I still think we need a dollar menu at the doctor office. Let me build (and bill) my own sandwich of procedures, thanks. Maybe get a combo price on the urine/blood samples that aren't covered by insurance when labeled as "experimental".
ReplyDeleteAs a Canadian, I find this entire post terrifying. TERRIFYING.
ReplyDeleteAm I getting this correct. The insurance company reduced the payment by $29K+.
ReplyDeleteWhen you write adjusted that's just insurance-gobshite speak for reduced, right. So are you paying $30,885.27.
P.S. I lose about half the comments I write on these separate little windows generally. But on yours it must be nearing 80%.
I think it has to do with signing in to the google a/c which entails opening a new tab. And somewhere in the middle of this things go puff.
Now, let's get to the part that really pisses me off.( Besides the fact that most Americans are uninsured or under-insured because our legislators are pussies or corporate sell outs and the insurance executives are greedy assholes. Who obviously reduce me to swearing.) It's the $1483.19 that I had to pay out of pocket. While the insurance company paid $2185.83. I pay every single month for insurance. If you were to total those payments up for an entire year it would equal about $2400.
ReplyDeleteAh, but you were paying so eventually you could borrow the market power of the insurance company. That's why they could tell the hospital they weren't going to get $33k. They are big business to lose if the provider decides to try pressing the issue. The total value of having insurance, for you, was theoretically a little more than $31k.
In the rest of the world, such strong arming could come from the government in some fashion or another (Britain, Canada, Taiwan, Japan) or from national insurance companies that are not allowed to make a profit from basic care (Germany).
In both cases, providers tend not to inflate their costs so extravagantly. It is unnecessary - universal coverage means you are more or less guaranteed payment - and the centralization means you can't.
None of those systems are perfect of course. Japan, for instance, pays its providers too little and it is making for shortages. And as far as I know, all of them are seeing significant cost inflation (just not quite as insane as in the United States).
What the Captain said.
ReplyDeleteI'm trying to stay as healthy as possible as I only have emergancy insurance until I can get to 65. Still I'm glad to be retired.
ReplyDeleteLinda
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