INSURANCE DICTATED HEALTHCARE IS NEITHER SIMPLE NOR TRANSPARENT
I, like many people, have a high deductible plan. Using the same insurance, medication prices still vary widely from pharmacy to pharmacy. For instance, my experience is that CVS costs more that Wal-Mart.
But it gets more confusing. I went to Wal-Mart for refill of meds. I was quoted over $1500 for 90 days worth with my insurance. I asked what the cash price was. $257. I saved over $1200 by NOT using my insurance. How does that make sense? It doesn’t.
We need to hold insurance companies, pharmacy benefit managers, and hospital systems accountable for price opacity. Or frustrated patients and docs will continue to migrate towards direct care practices such as The Men’s Center. Our pricing is entirely transparent and there are NEVER surprise bills.
And by eliminating all of the overhead required to deal with insurance companies, as well as all of the wasted time entering innumerable codes into a computer to satisfy insurance companies, we actually have time to spend with our patients! It is awesome. It’s not complicated.
Now, I am a doctor and also have a certificate in Health Sector Management from Duke. But despite this I am still amazed by the complexity of insurance plans. For the average non-medical person it has to feel like you get a service provided and then spin the wheel of random, unexpected cost to find out what you owe. Its absurd. Of course insurance companies get it quite well- they are going to make huge profits regardless of which plan you have, one way or another, either through premiums, deductibles, or denied claims. It is funny (not haha) when people say “my insurance paid for it”. They don’t actually pay for anything. They take your money, keep a great deal of it, then use the remainder for your healthcare. If they have to spend more, they will manipulate premiums, deductibles, or denials in the future so that they still make the same amount of money. They are making a fortune on the backs of patients and doctors, while adding nothing to the patient experience.
Moreover, hospital systems are supposed to be transparent about their prices. You should never learn what things cost only AFTER the service is provided. However, many hospitals are not very compliant with this. Why would they be? If you knew the difference in price you would probably go elsewhere.
I recently had to get an MRI for my torn achilles. I know that a local hospital charges on the order of $4K for this. They do give a discount if you pay cash rather than use insurance. Even they would rather have a bird in the hand than deal with insurance companies. The people with high deductibles get the most screwed. Frequently their insurance is used and they pay the full price, more than somebody with no insurance.
Anyway, I know that MRIs are MUCH less expensive at non-hospital imaging centers. I called a local one and told them I wanted to pay cash rather than use my high deductible insurance. The price was $537 and I paid in full at the time of my MRI.
Today I got a bill from them for an additional $1600 – they ran it through my insurance apparently. Of course I am going to fight it but it will be a time consuming hassle. To quote The Mandalorian, “THIS IS THE WAY.”
Back to the wheel of misfortune health care cost randomizer – so there are expensive hospitals with different prices for different people, better prices WITHOUT INSURANCE in some cases, and the variety of prices available in the community facilities. And its not easy to know in advance. And surprise bills. It’s a mess. People deserve better.
This is part of the reason we do things the way we do. Totally transparent. No surprises. Eliminate the middlemen. Simplicity. Value over volume.
Stop by and check us out or give us a call at 843-625-4273.