Cash or Insurance? Thieves & Greed

Are you one of the lucky ones with health insurance? If you are, then have you ever reallylooked at the Explanation of Benefits that have been sent to you after an office visit? I know I have. I’m not only shocked, I’m angry! Let me tell you why.

Here’s a break down of an actual bill. A particular medical service is billed at $2,393.00. But there is a “Contractual Adjustment” of $1,582.76, which leaves a new balance for the billing at $810.24. Let me pause here a moment and reflect on what that means. So, just because one has insurance and the patient has visited the medical care facility that is basically in cahoots with the insurance carrier, they are willing to forgive $1,582.76 of the actual bill, leaving a new “Approved Amount“ billing balance of $810.24. How nice. Oh it’s great news for the individual paying for insurance. But, what happens to the individual who does nothave insurance? Well, I’ll tell you, there isn’t a “Contractual Adjustment”. For those individuals without insurance they get the whopping over priced bill for $2,393.00! Now looking a little further along this Explanation of Benefits, it shows a Coinsurance balance of $162.05. Which means the patient with the insurance card has to pay that amount? So, with that said, the insurance carrier no longer has a bill of $2,393.00, but one for $648.19! Why in the world does our system have to work this way? Greed. Oh most of us love the financial freedom that money can buy us, among other things. But really, come on, this is clearly out of control. Most of us know that when we buy in bulk from a supplier we get a significant discount. For example, if a retailer buys a bulk of lets say, shampoo, since they consistently sell shampoo. It’s expected that they will mark it up to make their profit. It’s expected, and that’s how business works.

Ok, now lets say a painting contractor handles consistent work for a customer. As part of their working arrangement there could be as much as a 10 % discount, which is typical in these situations to compensate for the regular work that is being provided. This same contractor is then asked to provide a rate on a job for an individual who will not be providing long term consistent work. This job would be very comparable to the work provided for the previously mentioned customer. Since this is really a one time deal, his prices may very well increase. Which seems to make sense to me, but the contractor is then thought to be gouging with his prices. Seems to me that our society feels it’s expected for the insurance & health care companies to over charge in the most obscene and exaggerated way but not with the contractor. Our Government is sure to step in and push their weight around for individuals similar to the contractor, even the retailer. Remember hearing about controls on severe over pricing during natural disasters. Point being in can be done. The Government can help. So why not make an acceptable difference when it comes to the welfare of the fellow man and their health? People without medical insurance are looking at thousands of dollars in medical bills for some of the most common tests. These same people may take years to pay off these debts and what happens if they get sick again? What about even the basic wellness check ups? What happens is, they wind up not going to the Dr. at all because they just can’t afford it.

When an insured individual pays their premium, exactly what portion of the monthly insurance payment gets kicked back to the “net worked” medicals providers? Hmmm. How would they even know which facility a patient may choose from the net work if they haven’t even needed one yet? They don’t, plain and simple. People are out there working and earning their way in this country and in many cases can not afford the monthly insurance, yet they are the ones getting the highest billing. This argument has been going on for a long time, and sadly I don’t see any real changes. There are broad spectrums of individuals who reap the benefits of free insurance coverage and don’t work too. How exactly are the ones working hard and not able to afford insurance expected to be “ok” with all of this? This issue is just one of the many issues out there that keep dividing our country. We can choose to buy shampoo from someone else and we can choose another contractor. But we can’t stop the grossly exaggerated and unfair billing of our uninsured medical needs, not with out help from this countries political leaders.