Episode 056
Episode 056: Getting Ripped Off By Health Insurance
Problems with health insurance is certainly nothing new and my recent experience is not unique. Recently, I received a bill for a test at a 2000% markup over what the company would have accepted had I paid cash! But because I decided to submit the claim to my health insurance company (which denied it) I was sent a bill for an astronomical amount. Obviously, I won't pay the jacked up price but the whole episode got me thinking, is it ever a good idea to use your health insurance to pay for 'little tests and maintenance?"
The whole affair began after I had an episode of syncope while on call. I bumped my head, had to get stitches, etc. On returning back from Spring Break I went to see my direct primary care doctor. We felt like a holter monitor was a reasonable test to be sure I didn't have sort of dysrhythmia (heart rhythm problem). Because she is a DPC doc, she knew the cash price was $250 but asked if I'd like to submit it to insurance anyway since they might cover it. I agreed and wore the device for a week.
I received a bill in the mail six weeks later for $5000! They would have charged $250 at the outset but had jacked up the price when submitting to my insurance carrier. My doc then called the testing company who said that this was a common practice for the insurance company to deny payment a few times and then they'd send me a bill for around $250. The episode highlights so much of what's wrong with the 'system' as it is set up today:
- Patients (me) are looking to get their care for free and don't think about prices much.
- There are entire departments of people paying (insurers) and people charging (testing companies, pharmaceuticals, hospitals, physician offices, etc.) who spend their days and resources sending back and forth communications that serve no one.
- Insurance companies arbitrarily deny payments of reasonable tests because it is ordered by the 'wrong' person.
- The testing companies charging increase their prices to insurers hoping they will pay.
- Even with discounted prices acquired by the insurance companies, it is often better to negotiate or pay for these smaller routine test and medications out of pocket without disclosing the presence of insurance.
show notes
Twittering for Eric Larson: @theparadocsshow
Episode 002: Dr. Amat, the direct primary care doctor mentioned in this show, describes what it is like as a DPC doc.
Episode 007: Dr. Wacasey describes his method for picking insurance and why insurance is a bad way to pay for most things in medicine.
Twitter Thread on Described in the Episode: This is the twitter thread I referred to in my show.
YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page.
Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.
