One Woman's Tough Choices in Health Care

4 comments on “One Woman's Tough Choices in Health Care”

1. teatime says:

   October 17, 2009 at 9:49 pm

   Since she has a husband with a pre-existing condition, she really has to choose the way she did. They know they will be using the benefits regularly. The only time that the low premium-high deductible plan may be worth a risk is if there are no dependents, no pre-existing conditions, and no plans to have children in the near future.

   I don’t know much about Health Savings Accounts but if that’s all you’ve got and if you use them to pay cash for services, oh my. Those who pay cash are bearing the brunt of the high cost of healthcare, in many cases. As an example, I had a lengthy period of time between my COBRA benefit ending and Medicare beginning. I discovered that a specialist who received about $100 per visit from BC/BS for seeing me would begin charging me $200 per visit when I had to pay cash. We had a pediatrician who offered cash-paying customers a 40 percent discount for paying on the spot but those docs are few and far between.

   The whole system is set up through contracts, delivering patient volume, doing tests and other billable services. It’s difficult for an individual to navigate.

2. Clueless says:

   October 18, 2009 at 7:37 am

   Agreed. The way insurance works is that Medicare/medicaid agree to pay a fraction of your “usual and customary charge”. Private insurance also agree to pay a fraction, (usually a few percents more) than your usual and customary charge. Thus, if one sets one’s “usual and customary charge at let us say 20 dollars/15 minute visit (the price of a visit to a hairdresser) then medicaid would pay about 3 dollars, medicare about 8 dollars and Blue cross about 12 dollars. You will go broke. Therefore it is necessary to set the “usual and customary charge” at let us say 100 dollars. This means that medicaid pais 15 dollars, medicare 40 dollars and blue cross 60 dollars.

   Now what if you pay cash? Well you will need to pay the “usual and customary charge”. If the doctor says “oh, you can pay me medicare rates” then that is considered “fraud” because if you charge a cash patient 40 dollars then medicaid should be only 40% of that or 16 dollars. The federal government will inspect all your billing for the last 7 years, and throw charges of felony medicare fraud at you, and insist that you pay back the government for every dollar above 16 dollars a patient that you received and will throw you in jail. It has happened to a number of physicians, and cutting the uninsured a break is the largest source of what is called in the popular press “medicare fraud” cases among physicians.

   That is the reason that cash patients pay more. It is the way that Medicare/medicaid is set up, and all insurers follow Medicare’s lead.

   Thus, unless insurance was reformed so that most people had a high deductable policy with a HSA, and paid cash (including those people who currently have standared Medicare/Medicaid since they are now more than 60%) there is no way that a high deductable policy will work for any individual who had a significant medical problem. It would only work if an individual was extremely healthy and simply needed insurance against a sudden catastrophic illness.

3. libraryjim says:

   October 18, 2009 at 10:35 pm

   Surprisingly, many doctors and dentists charge LESS for cash payments then they do if you are reporting your bill to an insurance company. I’ve found this out from experience, not because someone told me.

   Jim Elliott

4. Clueless says:

   October 20, 2009 at 2:13 am

   3. Those would likely be physicians who do not accept medicare and medicaid. If you don’t do so, then you do not have to worry about being charged with “fraud” for giving a cash pay patient a discount. Such physicians simply negotiate their own rates with private insurance, without having to refer to medicare rates.

   Many physicians are dropping medicaid and medicare for these reasons. It allows them to feel good about the way they care for the uninsured, and (since neither Medicaid nor Medicare pay costs of overhead – which are born by the self pay and private insurance folks) it allows doctors to earn more money