Updated: Sep 29
It's hard to imagine living in a country where medical care is so expensive that it becomes the number one cause for bankruptcy. According to the Bureau of Labor Statistics the average American household spends more than $5,000 annually on health care and while that may not appear to be an amount to cause financial ruin we should look to the reasons why American's are struggling to understand the burden of our current healthcare system.
A majority of people who have insurance may feel like they have to pay exactly what their medical provider or insurer says. After all, you should pay top dollar for medical services since it's supposed to be considerably better than most countries. Or is it?...What's the real value of what we are defining as "value-based" care?
Let's take for instance a routine annual well check.
Whether you cash pay out of pocket, say $120 per visit, or the doctor bills your insurance 3x that amount, you still receive the same service. Name any other industry where you pay more for a service because of who's paying for it.
For most, the well check experience goes something like this:
Schedule an apt one month in advance. Wait 30 minutes to see your actual doctor and when they arrive you have 10-15 minutes to undergo a physicians educated guess on what is going on in your body. No scans, no in-depth conversations, no real value except that you have done a great job checking off the "well-check" off your list or let's see you in a couple weeks after we run some tests that you may or may not need to see what's really going on. That could possibly warrant $120 but not 3x that amount! You might ask yourself what did I receive from that exchange? What was the value I received?
Now under a typical insurance plan you may have to pay an out of pocket co-pay to see your doctor. But did you know that you could request the "cash price" ahead of time to see if the cash price exceeds your co-pay? ..."But why would I do that? If my insurance pays for it, who cares what they charge?" And that, is precisely what the medical and insurance industry has conditioned you to say.
Of course you don't care. Why would it matter? You're paying a monthly fee to cover the unexpected and shouldn't have to think about it what is being charge. Until a medical emergency happens and then you're left to sort through a mountain of medical bills and charges no one will explain, which leads to payment delinquencies and inevitably bankruptcy. Not to mention the extreme amount of stress medical bills come with. Wait, wasn't it your doctor who said stress is the number one killer out there? What kind of practitioner takes care of people physically but then burdens them emotionally? Doesn't this kind of thinking go against their own physicians Hippocratic oath?
This process of medical price gouging continues to happen to millions of American families but with the help of the Hospital Price Transparency Act and value based healthcare initiatives we are educating and empowering families to change --but it starts with you. Families must learn what it means to take ownership over their own health care.
Here are a few tips to help avoid the pitfalls of medical price gouging:
Try negotiating before treatment - ask for what the "cash price" is
Shop around to find cheaper providers before your service
Understand what your insurance covers - and what it doesn’t
Never pay the first bill - request an itemized bill and always check for errors
Seek payment assistance programs
Offer to pay upfront for a discount - or locate a medical bill negotiator
Enroll in a payment plan
At Catalyst Insurance Group, we are educators and advocates for healthcare reform in America, helping individuals, families and small businesses navigate the best in health insurance options using consumer-driven health plans.