Healthcare Costs and Billing: Health Insurance Plans

Healthcare in the US is owned and operated by businessmen, whose first priority is profits. Doctors and patients are often lost somewhere within the system that was created for them by the profit seekers.

Salem-News.com

(EUGENE, Ore.) - The American healthcare billing and insurance payment system can best be described as chaotic, bewildering, and nearly incomprehensible. And for those without health insurance, it is totally unfair and cruel.

I spent my corporate life in engineering and management positions.

Yet there is nothing I dread more than receiving my Medicare and gap health insurance packages at the end of each year when once more I am faced with having to read through the thick brochures about the various plans and options and try to select those I feel best for me.

Medicare coverage is so complicated and difficult that the average senior citizen is easily discouraged and tempted to just leave things alone, in which case, for better or worse, coverage will be the same as it was last year, whatever that was.

For those who want help, they can seek out one of the volunteers stationed at various stores who explain the plans and assist with making enlightened choices. Failure to make the “right choices” can result in thousands of dollars in out-of-pocket expenses.

Cost and Billing Practices and Inequities

For those who have insurance, doctor fees and other medical expenses are negotiated by the insurance company and provider. Because of the substantial differences between what doctors charge and what insurance providers will pay, some doctors will not accept Medicare patients because they feel the reimbursement is too low. Following are some examples from my own insurance provider statements:

In this case, the actual doctor fees charged to the insurance company were $829

How about those who have no insurance? They are charged the regular fees, which in this case would be $4,506. Though they are having to pay this out of their own pocket, in this case they will have to pay five times what the insured person and his insurance company will have to pay.

This is the system that the US government, health insurance corporations, and healthcare providers have created for us.

For those lucky enough to have health insurance, variations in coverage among employers and insurance companies are endless. Some companies and businesses provide health insurance options, while others do not.

If one is lucky enough to work for one that does, after retirement he will receive Medicare plus his corporation’s health insurance coverage.

However, many will have only Medicare and gap insurance will be his responsibility.

If a married man is receiving Medicare plus gap insurance from his company and dies, unless other arrangements were made, the company’s insurance for his wife will end, for she was part of his insurance plan.

When patients visit their doctors and run up large medical bills, though the doctor and business clerks are aware that the patient has no insurance, they will not voluntarily discuss their special billing plans or the discount programs that might exist--at that office.

Instead, they often recommend the patient put the charges on their credit cards, which can result in high interest rates, late fees, and if out of hand, can ruin their credit and get the collectors after them.

However, if the patient is having trouble and talks with someone in the doctor’s billing department, they can often work out arrangements where they make monthly payments with no interest.

Some doctor’s offices have special programs whereby patients can apply for assistance. I am aware of one case where an unemployed patient found out about such a program and applied.

He was approved and subsequently advised that he would receive a 50% discount. At first glance, it would appear that the doctor was willing to sacrifice his time and was being very generous.

However, take a look at the above figures comparing the cost discrepancy between doctor charges for the insured and uninsured.

Under the “assistance” program, the uninsured patient’s costs have been reduced from $4,506 to $2253, while the insured patient’s cost was $829. Well, perhaps the doctor wasn’t being so generous after all.

For those who cannot pay for healthcare, there are other federal, state, and county assistance programs available--to those who are willing and able to search them out and deal with the bureaucracy and stress of the application and approval process.

I am certain that most people in need are not aware of such assistance and it certainly isn’t something that is broadcast. This can be tough on those suffering from serious illness--usually people already facing other challenges.

The US government stands alone in its contempt for its citizens

The US is the only modern country without universal healthcare coverage. To add insult to injury, in the US poor people without insurance coverage are charged much higher fees than those with insurance.

Adding to the anxiety and insecurity of this already broken system are the myriad government and individual healthcare provider programs which are available, but not readily made known to them.

Unlike any other modern country, Americans cannot depend upon their government, health insurance companies, or healthcare providers to watch out for their wellbeing.

Healthcare in the US is owned and operated by businessmen, whose first priority is profits.

Doctors and patients are often lost somewhere within the system that was created for them by the profit seekers.

No political party or president can change the sick American healthcare system until its citizens wake up and demand universal healthcare equal to that of European Union countries.

Previous articles by Wayne Pierce on Salem-News.com

• Jan-08-2010: American Healthcare is Becoming a Dangerous Practice - Wayne Pierce for Salem-News.com
• Dec-26-2009: Is it Too Late for the U.S. Economy? - Wayne Pierce for Salem-News.com
• Nov-08-2007: Outsourcing A Nation's Workforce - Commentary by Wayne Pierce Special to Salem-News.com

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Wayne was born in a small farm town in California's San Joaquin Valley. At age ten, he moved with his family to San Jose, California, which at the time had a population of 50,000 and was surrounded by orchards--mostly prunes. At age twenty, he joined IBM, one of the first electronic plants that would evolve into what we know today as Silicon Valley. Most of his college education was acquired through part-time classes while sometimes working ten hours a day. Wayne started on the bottom in the magnetic disk manufacturing facility, which produced the large disks for the earlier IBM computer systems. These magnetically coated disks would evolve into what we know today as hard drives. Wayne's last assignment with IBM was setting up their first inkjet printer lab that became what we know today as the Lexmark printer business. After his retirement from IBM, he wrote human interest stories for a small town newspaper.

You can write to Wayne Pierce at: bus215@aeolusblue.com