Medical Insurance Blues

Arriving at my Ob-Gyn’s office for my yearly checkup, I was confronted by a stressed out office manager. “I’m so sorry” she said. “We don’t take Healthnet (my insurance plan) any more”.

Ok, you say, that’s reasonable. They didn’t like the rates that Healthnet was willing to pay, so they said no. But, here’s the catch. They do take quite a few other carriers, one of which is Blue Shield. So here’s how it works. The doctor’s list price for an expanded office visit (a.k.a. annual exam) is $215. Blue Shield’s negotiated rate is $65. Of which the patient pays $20 if she’s met the deductible. Otherwise she pays the …$65. Not $215. Fair enough. But now that my doctor has decided that she won’t accept Heathnet, she won’t even accept from me the negotiated rates that she is accepting from other carriers. No. She wants me to pay the full $215 list price.

I came across this a few years ago when I had surgery. The surgeon’s fee for a one hour (albeit complicated) operation was $10,000. When the insurance explanation of benefits came in, the negotiated fee was $2,000. I paid 20%, which was $400. But, if I hadn’t had insurance, the surgeon would have charged me the full $10,000.

And that is the real cost of not having health insurance, or of going to a provider that isn’t part of your plan. You have to pay list price. And list can be 400% more then the true market price. Sometime even higher than that.

I told my doctor that I’d like to stay with her, but that I couldn’t and wouldn’t pay list price. Fairness dictates, in my opinion, that she accept from me the same negotiated rates that she accepts from insurance companies. Don’t you agree? She doesn’t. No big deal for me, I can change doctors, but it is a big deal when you think of people that are uninsured. Not only do they have to pay their own medical expenses, they have to pay list price. Something’s wrong with this picture.