Dad came over yesterday evening and read through the insurance paperwork. He pointed out that what the insurance company allows is by contract with the provider, and if they disallow 91% of the cost of my chemo, that’s between the insurance company and the provider.
I still don’t get that, as one of my chemo drugs is under patent and costs $10,000 per dose. Where did the $10,000 go? Let alone the other $4,500 the insurance disallowed? As Dad points out, what counts is the bill I get from the hospital, not the benefits statement I get from the carrier. Which I haven’t seen that bill yet.
I understand about how contracted services work. One of the reasons for a crying need for healthcare reform is specifically because everything in American healthcare is drastically overpriced, then negotiated back down only by parties with the power to do such negotiation. In other words, if I walked in off the street and paid for chemo 100% out of pocket, I would be paying this $16,100 bill. Apparently my insurance company can pay the same bill off for $1,500.
Kind of rough on the uninsured, the underinsured and the self-funded, who don’t have the negotiating power to have 90% of their bills waived away like my carrier apparently does. Our premiums and copays go up ahead of inflation every year, and have all my life. Apparently the problem of American recreational abuse of the medical system is so great that we must be forced to pay more to ensure good choices. That was certainly the conservative rhetoric around HSAs a few years ago.
But how the hell do we know what we’re paying when there’s a 90% differential between the list price and the insider price? What constitutes informed choice on my part?
I still don’t think this is over. I’m used to seeing downward adjustments on insurance payouts, and the $2,000 I’ll be paying over the next few months for my out-of-pocket and deductibles are just part of my penalty for being ill, despite all the premiums I’ve paid over the years. This is the “best in the world” system, after all, and I have to pay to play. But where the hell did $14,500 go? And who’s paying for it?
The healthcare system’s financial transparency is even worse than Wall Street’s.