For years now hospitals and doctor’s offices have been merging into mega-conglomerates, healthcare corporations like Tri-Health, which consist of dozens of hospitals and hundreds of medical professional offices around a region. What this has done has flipped the health insurance industry on it’s head.
In the old days, when costs were somewhat realistic, the insurance companies had the power. They negotiated the “discounted rates” with providers like hospitals and your doctor’s office in exchange for funneling their members to those providers. This worked very well for everyone involved. Patients got a fair price, hospitals and doctors were well compensated, and the insurance company could make plenty of money as long as it paid attention to actuarial details to set realistic premiums and continued to sign new members. Then some business folks got the bright idea to start creating “health networks” out of multiple hospitals and providers…and at first it was working great and actually lowering healthcare costs. But of course, as with any business, the idea it to drive impossible growth and maximum profits, and by the 2000’s these networks were getting large enough to start dictating back tot he insurance companies the rates they would pay. “Pay us $XXXX for this service, or we will tell our network of providers to no longer accept your members” became the new power play in healthcare. And here we are today, where a person like the man in the article ends up paying $70,000 for a $30,000 hip replacement because his insurer is powerless to negotiate with his providers.
And the fact is, insurance companies are FINE with this, as it makes them a fortune. Every time healthcare costs go up, it’s not the insurance companies who take the loss. They simply drop the worst risk people and raise the rates on everyone else. Your employer, the government (in the form of lost tax income) and YOU end up shouldering the increases. They’ve even stopped trying to hide this fact at all. Like the article mentioned, a medial supply that costs the hospital $1,500 will be charged back to insurance at $15,000 simply because they can. There is no justification for it, other than “the insurance company will pay it, so why not?!” Money hats for everyone!
Even acting as your own advocate is no longer viable. As an example, my son was recently having a health issue. We went to his pediatrician and they ordered a series of tests. The tests were $700 “retail”. My insurance company, Humana, knocked a paltry $200 off that, leaving me to pick up the $500 difference (thanks to my HDHC plan, the only one my employer offers). Still, that was fine because we needed to know what was going on. The pediatrician referred my son to a specialist. The specialist charged us $300 for an office visit that lasted literally 5 minutes, in which he did noting but ask a couple of questions, listen to my son’s heart, and feel his abdomen. He then ordered more tests. Those tests cost $400, of which my insurance covered $150, leaving me with another $250 bill for tests. Turns out, the tests he ordered were some of the SAME tests the pediatrician had already done, the specialist was just too lazy to review the file and see they were done. When I discovered this, I tried to fight the charges by telling both the provider network and my insurance company that I wasn’t going to pay for duplicate tests. Neither one cared. My insurance company literally said “They tested for the same thing, but because they coded the test charges differently, we allowed it.”. WTF?! So if I sold Humana an apple for $100, and then sold them another apple for another $100, but wrote “Orange” on the receipt, they’d pay it. Fucking ridiculous.
Single Payer Medicare for All cannot come soon enough. VOTE! VOTE! VOTE!
EDIT : Oh, and for the curious, in the end his issue went away all by itself, thankfully a week prior to the $3,000 (out of my pocket) diagnostic procedure the specialist wanted to do on him.
