Which Came First?

Which came first, the chicken or the egg? Oh, I'm not really asking. But that was my first thought in my head when I started to write this article on the insurance industry and the medical industry. Which came first? I mean, they seem to feed on each other, don't you think? The medical industry sets the price for whatever procedure, office visit, surgery, injection, whatever. But the insurance industry decides what they will pay, and “adjust” the amount accordingly.

I am learning way more than I want to about the two. Recently I received a bill for over $8,000 for my one week of dialysis in Orlando. The reason – the insurance company decided the facility I used was “out of network.” At the same time, there were NO “in network” facilities anywhere within a 100-mile radius of where I was staying. And dialysis isn't something you just put back in the closet and forget about it for a week. So, after my social worker argued with the insurance company, they adjusted it down to $790. A whopping 90%.

My question is – if the insurance company marks it down 90%, why then can't the medical facility have started at $790. Why this outrageous difference?

I've seen it all the time on my “normal” doctor visits. The office charges so much for a visit; the insurance company adjusts it down anywhere from 10% to 90%.

When I was in the hospital in late September, the hospital bill for three days was around $20,000, marked down 50% to around $10,000.

So who's the boss here? And what will the new health care plan be like? Same old same old??? Or worse? Or better?



Terry said...

My guess is the insurance co's talk the provider into charging a higher cash price because it makes insurance look like a better deal.

MarmiteToasty said...

youre health care stuff scares me......


JeanieSpokane said...

Terry, good to hear from you - keep on posting to Community Comment & HBO! I'll miss asking you why my computer doesn't work. :)