With one thing and another, I hadn’t been to the doctor recently — looking for that affordable health insurance I’d been promised, working irregularly as a freelancer, that sort of thing — and I’d particularly been putting it off because I had thought, based on my bills when I had insurance, that it was gonna cost a fortune. But my doctor finally twisted my arm enough that I guessed I had to go and asked about the cash price for the labs I needed for a type 2 diabetes check. She thought it would be around $300, which was already much better than I’d expected.
So I went in to see her, and she got out the á la carte cash menu from the lab. We went for an A1c (long-term blood sugar, you can read about it here), a general blood workup, and urinalysis.
Total price, including $5 for the needle stick itself, was $62.
I was just a little surprised (read “flabbergasted”). The doctor visit was $163 because I had a longer than usual visit since it’d been a long time since my last one. So, my out-of-pocket cash outlay was $225.
Now, that didn’t even fit with what I’d been seeing on bills from the same clinic under insurance — plus, there was this annoying part where I’d get something done, and six months or a year later I’d get a call from a collection agency asking for their, I don’t know, some small amount, say $50 to $300 to be paid to some medical lab or medical service of which I’d never heard.
This led to some interesting conversations to the effect of:
“You owe our client money.”
“Who’s your client?”
“Acme Medical Providers,” or some such thing.
“Never heard of them.”
. . . until finally, it turns out that “Acme Medical” is some company that contracted with the lab at Boulder Community Health, which was the lab used by my family practice doc, who if they ever billed me at all, did so in a way that I didn’t recognize, since I’d never heard of them.
Between those calls and the insurance paperwork I did get, I knew these labs were very expensive, which is why I’d been putting things off.
So, I thought, “Sixty-two dollars? I’ve been worrying about sixty-two dollars?”
Then it occurred to me to ask, “What would the bill be to the insurance if I had insurance?” The nice nurse at the front desk — and I’m not giving her name on purpose — looked it up and told me: “$740.”
So, I’m not an accountant, but I do have a pretty decent math background, and applying only the tiniest bit of advanced math, I realized that meant they were giving me roughly a 92 percent discount for paying cash. Or, looking at it the other way, that the insurance company price was marked up roughly 1200 percent.
Now, I’ve been covering the health care issue since my first days at PJM, and I’ve talked at length about the arithmetical absurdity of Obamacare and similar plans, but this brought it home to me like nothing in the past: I’d been putting off necessary tests because I didn’t have an extra $1000 to pay for them — only to find out that it was closer to $100 than $1000.
When I’ve mentioned it, the usual reaction is to blame it on insurance companies, but that’s just a reflex: this isn’t the insurance company raising my prices, this is Boulder Community Hospital raising the insurance company’s prices.
It’s not like hospitals are massive money-makers either. BCH is a non-profit, so by definition, it’s not making a profit, but for-profit hospitals don’t make massive profits either.
So I called some of my insurance company contacts and asked why there was this massive markup. “Administrative costs,” they told me. Insurance companies and Medicare/Medicaid want to reduce their costs, so they are more aggressive about what they will and won’t pay for — they have administrative staff whose whole job is to challenge anything they think might be questionable and to argue the point later. So the hospitals and doctors have to hire administrative staff of their own to argue with the insurance company’s administrative staff. The result is that $62 dollars cash becomes $740 when it’s a check from an insurance company.
There is, in fact, an easy solution for this. Go back to the days when you could buy major medical or catastrophic care insurance, and make flexible spending accounts easily available and tax-free. Then we could all buy our tests at 92 percent off, with our own money.