From the May 2017 issue of HealthCare Business News magazine

I have been a physician for over 20 years and have seen the medical care in this country seriously deteriorate, with decreasing quality of care and skyrocketing costs. It is particularly frustrating and saddening how increasingly difficult it has become to provide basic health care to patients over the last three to five years. There is little predictability for health care consumers in this country. Patients are increasingly frightened to use their insurance, as it has become a game where hospitals, laboratories and drug companies charge grossly inflated prices in addition to charging different prices to different patient groups for the same service. There is no set pricing.

If you are paying with cash or have a health care savings account (HSA), you may pay 10 to 20 times what a particular insurance patient is being charged. Patients and doctors have no idea what will be charged until the patient gets a bill a few months later. Generic medications that cost pennies a pill, or about $10 to $30 per month just a few years ago, are now hundreds of dollars per month. Routine procedures that were a few hundred dollars two or three years ago are now $20,000 to $30,000. Laboratory tests that were $30 a few years ago are being charged at $300 to $2,000 per test.


In what other industry do you not know the cost before you agree to buy the product or service? What if we had food insurance (food is important, right)? You walk into the grocery store and get a piece of chicken because it is healthy and you believe reasonably priced, but the problem is that the store will not tell you how much the chicken costs (if you push them, they may quote you 10 times the usual cost if you want to pay cash). The store will only take your insurance information and say that they will submit it for payment. So, you walk out with chicken in hand and go home to cook and eat it. A month later, you get a letter stating that your insurance is reviewing the claim. Then, a month after that, you may get a bill for a co-pay of $40 (remember, the chicken only really costs about $6), or they say that the chicken was not covered because it wasn’t “medically necessary” and that a hotdog was the preferred food on your plan, so you owe $2,000.

Another scenario is that the store might say the chicken costs $2,000, but the insurance company states that they disallowed $1,000 (for your benefit) and paid $800 for the chicken, so you now owe $200. You are so happy that you have insurance because you only had to pay 10 percent of the price (not knowing that the chicken should really only cost $6). Alternatively, you may also get a bill for $10,000, saying this is not a covered food (this happens all the time in medicine). When you get billed $10,000, you can try to get your doctor to write numerous letters of appeal, which are rarely effective, or the insurance company may settle with you for $5,000. You may have to take out an equity loan on your house or declare bankruptcy.

May 2017 Magazine

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