Without insurance most hospitals will decrease their pricing significantly BTW. Some by 80%.
The practice is called balance billing. Yes, some states have passed legislation to prevent that kind of billing practice - when a healthcare consumer has zero choice but to use a out-of-network provider, they don’t have to pay more than the in-network rate.
Not true. When my kid got a huge ER bill (because he did what the urgent care folks said…and went to the ER), he was absolutely able to negotiate a much lower rate than what the originally billed him.
But back to the costs…if i wanted to, I could purchase health insurance four DH and myself through my last employer. This is a benefit that is forever. Anyway, it would cost us in excess of $9000 a person…so $18,000 for two people. This does include dental and RX. But really a $20,000 a year cost for a family of four? That doesn’t sound high.
One of my kids pays $4200 or so a year for a high deductible crappy plan. The other has a school plan that was $3700 for the year. That’s already almost $8000 and it’s for the young and healthy family members.
My Medicare total costs per month are about $375. So add $4000 or so more for this family. $12000.
My husband has a very generous employer but even with that, he pays $200 a month.
So…we pay $15,000 a year for our family but out two kids have crappy and high deductible policies.
I’d love to have a decent family plan for $20,000 for all four of us!
DH and I paid just over $20,000 this year for a catastrophic plan with a high deductible. Glad he starts on Medicare in a couple of months.
We all complained about the high cost of higher education, until we figured out the true cost, including employer paid portion (which, BTW, indirectly comes out our paychecks), of the healthcare cost. Unlike tuition, we have to pay the healthcare cost at even faster rate of increase, year after year with no end in sight. What a broken system!
You guys are getting good deals. Many years ago, before we sold our business, our family plan cost over 30K and had a deductible of 14K. That is why it makes me fume when people say they have free health care. It’s not free someone, somewhere is paying. The small companies often pay the most. Large companies pay very little as they can spread risk across many people.
People who own businesses or those with high deductibles compare prices BEFORE doing anything. I once got two MRI’s for about 2.4K rather than 7K with just a phone call. It should be illegal to charge people for things whose price you cannot quote in advance. Another time, my kid had a broken arm and I was not going to pay 300 for a sling ( I had done that with a foot for my kid). We walked next door to Walgreens and got a sling for $7.99. two minutes later. My kid was embarrassed but learned the lesson of not getting taken. The only reason it’s so out of control is that a hospital can take advantage of “not knowing” what their prices are.
If you don’t have insurance, medical charges are usually higher because insurance companies have negotiated rates with the providers.
The hospital decrease the bill by about 50% but the lab and the physician did not. In fact, the lab sent the bill to collections within 2 months while we were trying to figure out the complicated way to get it paid as an emergency out of state claim. Nice of them.
And the hospital decreasing it by 50% still left an $8000 bill for a couple of hours in the hospital ER with very little actual medical attention being given. Most people who don’t have insurance don’t have $8000 (plus the $2k for the doc and lab).
Yes, Colorado is trying to pass a bill that those working at the hospital all have to be in-network or take what the network has negotiated but for right now people are getting SURPRISE! bills. And Surprise, we know this looked like an Urgent Care center but it’s really an ER Offsite so instead of being charged $150 you are being billed $3000 for that splint or antibiotic. Surprise.
When my daughter was born 23 years ago, I never had to figure out what network the provider was in, and she had a big mix of hospital docs, outside docs, and docs from Children’s hospital who came over as ‘guest’ doctors rather than transfer the patient to Children’s and then back to the NICU. The hospital (and NICU) was half ‘regular’ (we had Aetna) and half Kaiser. Kaiser docs were the on-call docs several nights a week and if they treated her, it was not billed separately even though definitely a different network. There were two pediatric eye doctors and you basically got the one on call that week and I wasn’t given a choice or even asked if I wanted an eye doctor. I think my insurance paid everyone but if they didn’t medicaid picked up the rest.
For my friend who had the gall bladder surgery, I know she’s still under her father’s insurance (he works for ICE, so government), her husband is under his parents’, and the baby must be medicaid. What a mess.
This type of thing is common for anesthesiologists, where the patient commonly has no ability to choose one or check if s/he is in-network before the procedure. For example, see https://www.reuters.com/article/us-health-insurance-surprise-billing/bills-from-out-of-network-doctors-rising-at-in-network-hospitals-idUSKCN1V21VS
But if the gall bladder surgery was an emergency, why was it not covered as emergency care by the insurance? Or did the insurance company have an unreasonable expectation that people needing emergency care can select in-network providers while riding the ambulance to the emergency room?
Small business owner here. We pay $2800 per month for our family of 4 (2 adults, 2 dependent young adults). We must pay $3500 out of pocket per person before they start paying 80% of in network costs. Our copay to see a specialist is $60 each visit. My husband is a physician and this is the best we can get. I would love to have catastrophic coverage (hospital stay, cancer treatment, etc) and pay out of pocket for doctor visits. It would be cheaper. If anyone has a suggestion for how to make this more affordable, I’m listening!
^^^ That was almost exactly our situation. However, H went on Medicare 9 months ago, so finally some relief.
I’m 60 and now pay $1200/month for just myself with a $4750 deductible and $70 copay for Dr. visit. Additionally, the prescription portion changed so the prescription deductible ( which used to be $250) is now just part of the over all deductible. And, generics are no longer covered on a first dollar basis but now also come under the deductible.
When ACA changes were made a number of posters here predicted this trajectory. Sometimes I hate to be right.
As for how to make it cheaper…I avoid standard medical docs as much as possible. Luckily I’m healthy and if I developed any symptoms or gut feeling that something was off, I’d go the traditional route. Until then…I go out of pocket to fee for service providers.
I just spent $195 to see a hormone specialist. An hour visit was $175. She is willing to run labs thru the best facility where I also pay OOP - actually cheaper than running thru insurance. Supplement was $20. She will send prescriptions to Canada. Cost is in on particular case 10% of that in the US.
I’ve had a hip issue. Checked it out with an Ortho - made sure to stay out of the network which is the most expensive in the US. Not an ortho issue. Saw an Osteopath -a traditional MD. but again, not in THAT network. Ran several osteopathic manipulations thru insurance - about $320 for a 45 minute visit for each. But it WORKED! Also fully confided in the OD that I considered him my true PCP but was going to continue to see another Dr. so that when I hit Medicare that other network (see below) would be legally bound to take me as a patient.
Massage therapy $110 for 90 minutes is continuing the healing of the hip (bursitis?). Cheap compared to a physical therapy visit run thru insurance.
Compare all this to a recent visit with my PCP in the High Cost Network. This PCP used to be in a private, but in my network, practice which was gobbled up by the high cost provider (HCP) in our area. I went to schedule an ACA fully covered (outside of deductible) well person visit. Well, turns out none of my previous records transferred to the new HCP system. After arriving 60 minutes late Dr spent 15 minutes having me repeat my history so they could enter it in the new record system. Then they listened to my heart and lungs. Finally informed me I qualify for a thyroid level check, Hep C test and colonoscopy under preventative care. I double check with my insurance company and yes - covered as preventative.
I get the bill. $750 !!! For exactly 5 minutes of actual ‘doctoring’. Billed as a level 5 visit - complicated case management. WTH?? I HAVE no issues and my ‘female’ parts are under the care of others. Lab tests billed at full cost - not preventative. Now I’m fighting this coding battle.
The system is broken. Working all the angles and loopholes is a full time job - just like tax planning.
My son has Humana. They sent him a letter saying, “If you have a medical emergency go to the nearest hospital. You will be responsible for the difference if that hospital is outside of your network.” I figure that means he can’t travel. Anywhere. I’m paying his COBRA, $455/ month, but that ends next month. He has qualified for health insurance at work but it’s not clear when it starts so he may have to pick up a month or two of ACA, assuming the end of COBRA is a qualifying event. My husband is on retirement insurance from his former company at $600/mo. My Medicare is about $400/mo. I help my daughter with her deductible. I can do it but it’s only going to get worse, don’t you think?
This just got in my LinkedIn newsfeed (based on the cookies it probably picked off me reading this thread).
https://www.amazon.com/Price-We-Pay-American-Care/dp/1635574110/
Can’t link to the LinkedIn article, which features a few quotes from the book, but it sounds like the book is awesome.
Also by Marty Makary:
https://www.martymd.com/articles
https://www.usatoday.com/story/opinion/2018/02/26/how-bezos-buffett-and-dimon-can-solve-our-too-much-medical-care-crisis-marty-makary-column/349638002/
https://www.usatoday.com/story/opinion/2017/08/04/doctors-stop-opioid-crisis-quit-overprescribing-marty-makary-column/504860001/
https://www.realclearhealth.com/articles/2017/06/08/a_path_to_lowering_health_care_costs__110623.html
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181970
Seems like his main points are overtreatment and billing practices.
UCB, we know you can google. We do. Really. Relax. Get yourself a beer or something.
I am NOT saying that everyone need to run out and buy that book. Just saying that folks on LinkedIn can search for the article based on the name 'cause CC does not allow LinkedIn links.
I haven’t had group insurance since I was 25. I just got the information from Blue Shield for next year. My premium for just me is going up to almost 1000 a month. For the pleasure of my increase I get to have my deductible go up to 1750 and the my share of costs after insurance goes up to 35%. My prescription deductible will also increase. My H has a $7500 deductible that he pays about 700 a month. For the two of us we pay over $20,000 a year for not great insurance not to mention it’s difficult to even find a Internal medicine Dr who takes insurance anymore. We are saving some money now as the last kid on our insurance just got married.
My D who recently married works for a small business that doesn’t offer insurance. Luckily her H was able to add her for under $20 a month. I told my D that she is extremely lucky and that her H should know that his employer is being very generous.
Take lawyers out of it and limit malpractice claims and you will see a drop in costs. No question some practice defensive medicine. Like your dammed if you don’t and dammed if you do. If you don’t order a certain tests the lawyers will use that against you. Etc.
Urgicare centers owned by hospitals are a joke. I see so much wasted expense. Your kid has an ankle sprain. Instead of icing and rest till you can see your foot doctor you go to an Urgicare center that is usually overpriced. They take the wrong x-rays and tell you to ice, give you an ace wrap and tell you to go to a specialist /doctor anyway . What did they actually do? Nothing really. Then I have to usually retake the xray and treat the condition properly.
I tell my patients to call me and don’t go to Urgicare centers. Mostly a waste of time.
Pcp that try to treat outside of what they do is a problem. Like sending everyone for mri. This is actually a huge problem. Can’t tell you how many Pcp I talk to, to let them know the mri was never needed.
The docs who man the urgent care clinics here at the local hospital empire are the worst. One told me that the sharp piece of glass that got lodged in my heel did not need to come out. 'Cause there are many examples of people living with foreign bodies in their tissues. OMG. I told my husband to drive me to the ER where the doc took it out - no issues. I would only go to the urgent care if I know I need antibiotics for a UTI or something like that.
The quality of urgent care varies a lot and is “uneven, “ as expressed in this thread.
I had a pretty good urgent care visit, where I saw a MD who took an X-ray of my ankle and correctly noted that I had broken my fibula.
Unfortunately they then proceeded to give me a soft boot that was actually too short to provide the proper support (only about 8” tall) .
After that, the X-ray was misread by a radiologist as showing NO fracture. I went to an ortho urgent care the next day where they agreed with the urgent care MD that it was a fracture and gave me a boot that reached my knee, which they said was the proper boot. They were able to refer me to the best ankle ortho in our state for follow up.
Next time we have any ortho injury, we know to go straight to ortho urgent care, skipping the regular urgent care (tho it’s closer to our home).
^^^ The reason behind A lot of your increase and high non-employer policy premiums probably due to the changes in the ACA law. Prior to ACA, insurance companies could charge the 50-medicare aged group up to 11 times the younger person rate. ACA capped that to 3x. Recently, it got relaxed to 5X. So, if you’re > 50, not on an employer group plan, and not old enough for Medicare, ouch.
My employer has been very open with the total cost of health insurance since I’ve been there (1997). Health insurance costs have been skyrocketing since at least that time. However, for many of those years, employers would eat most of the increases. Employees didn’t know or didn’t understand. It wasn’t until employers started pushing more of the increases onto their employees that people started making noise => the ACA.
The ACA doesn’t address the root cause of WHY the costs have been skyrocketing, so it’s not going to work in the long run. However, some of the increases can be attributes to increase in services. prior to the ACA law, many (most?) plans didn’t have 100% wellness or birth control. We didn’t. My IUD replacement last week cost $1500. I paid $0. In 2001 I paid $750 out of pocket that didn’t go toward my deductible. My mamogram/lady visit next week should be about $750. I pay $0. My H’s colonoscopy was over $3000. We paid for lab fees. Maybe $200? In the old days, we would have been responsible for that.
At our open enrollment after the ACA law was put into effect, the HR director was explaining the wellness plan concept. She mentioned that the year prior, only 2 women had gotten mammograms. I don’t know how many were on our insurance, bu we have 1300 employees (not counting spouses). Nobody here could afford such things. On the flip side, while going to the doctor for all these tests are a good thing for our health, it costs the insurance companies a lot more. You’d better believe they recoup those costs and then some the following open enrollment year via raised premiums. The more people go to the doctor, even if it’s “Free” or cheap to their pockets, it costs them $$$ in the long run. It’s a vicious cycle.