Originally Posted by
Hillie
My wife's expecting our first child and yesterday I logged into my healthcare insurance account and checked out a few claims made by the provider. I never see any bills (apparently my insurance is pretty good), but basically all that stuff is inflated. I understand why Jimmy got screwed over with a $244 bill when he was the one picking up the tab: He's paying the inflated rate, but since he's a single individual, he can't pop the balloon to get to pay a normal rate.
A claim for labwork in my overview:
Expense claimed: $144
Amount paid by plan: $15
Amount paid by employee: $0
That scared me slightly, as I was wondering where that went. Open up the details:
Expense claimed: $144
In-Network discount: $129
Amount paid by plan: $15
Amount paid by employee: $0
WTF??!??!??!?!? I thought healthcare was at least a semi-ethical business practice industry....
So bringing the cost down is going to be difficult: Let's say the doctors are forced to lower their rates. What happens? Lab/doc will claim a reasonable $25 instead of the $144. Insurance thinks "ooh, good stuff! Our almost 90% discount will make us pay a whopping $3!". These rate/discount adjustments need to be done in a synchronized fashion. That brings in A LOT of regulation: bring together literally thousands and thousands of providers and insurers for sync'ing and neverending battles on what the rate should be, or we'll get more regulation on prices: Government will decide what everything costs. Prices too low? Docs will do additional testing. Because discount rates are lower, insurance companies will complain that docs claim too much and will start shovelling these costs onto the patients.
People always have their complaints ready, but it's not an easy problem to solve. One thing is sure: the current situation is not good either. From what I read (not much on thsi subject, I'll be honest), being a health insurance provider is a profitable industry to be in.