ACZoom  ·  Archive-2016

The US medical system continues to confuse and confound - this time my strange tale is regarding the worst aspect of this system - the pricing and the billing.

Some conservatives loudly trumpet that consumers must be made aware of medical costs and that such comparison shopping will reduce the cost of medical care in the US medical system.

Bah, humbug, I say! The system is geared towards making that not work at all. The people who wish to self-insure and pay out of their pocket end up getting a raw deal.

The biggest problem with "comparison shopping" for medical care is that it is not possible. When you are in the doctor's office, and he or she tells you to get a bunch of tests done or a bunch of exams from other specialists - it is impossible to start asking questions and inquire about costs. Then we are told that before getting such exams done, the consumers should call up the insurance company and the doctor to make sure the costs involved are understood. This fails too - it is difficult to get a reasonable answer from them - since they can't know the cost until they examine the patient. And there are so many rules and exceptions that it is really not possible to get any idea of the cost involved before the treatment.

Even after all that, when the time comes to bill the consumer - the self-insured consumer who wants to pay from their own pocket gets completely shafted by the system.

In this story, my mistake was assuming that when my insurance said things like: "we cover preventive care", "we don't cover dental", and "we don't cover eye-glasses", it meant that they would cover preventive eye exams. That was completely wrong. They did not cover preventive eye care.

To add insult to injury, any consumer paying from their pocket for a non-covered charge has to pay the full list price of the medical care. Yikes! These list prices are stratospheric and hospitals have deals with insurance companies so that only a small percentage of that is actually paid by the insurance company.
Such accommodation on cost is not available to the individual consumer!
This means that even if you have a very high-deductible insurance plan and are paying for health-care, if it is a covered charge, you only have to pay the adjusted amount. But if it is not covered, there is no adjustment and the consumer has to be pay an excessive amount - the list price.

This is a completely ridiculous system - direct charges to consumers are far higher than any charges to the insurance companies.

There is some suggestion that consumers paying on their own can get adjustments - just talk to the hospital, talk to the doctor. That has not worked out in my case - after much paper work, just getting the run-around and no budging on the amount. It is not fully resolved yet - maybe there will some adjustment in the end in this case - but nothing yet. This is such a run-around - why can't the system automatically adjust the payments when it is the patient paying it all?

This is one of the most problematic aspects of the US health care. We are told to be aware of prices and shop around, but prices are unclear and vary a lot, and the big players get great reduced prices while individual consumers get to pay inflated list prices.