The paperwork blizzard following my annual physical checkup

by philg

I had an “annual” physical this year for the first time in a while. This generated a lot of work for the U.S. Postal Service. I received some paperwork in advance via mail. Now I’ve got the follow-up mailings. One of these is a statement from the Obamacare insurance provider. My doc ordered four standard tests at Emerson Hospital, which tried to bill $558.60 for these services. The insurance company, Harvard Pilgrim, decided that the price should be $89.42 instead and apparently this amount was accepted. $23.73 of this was “deductible” applied, so the insurer actually paid out only $65.69 to the hospital. This triggered a hardcopy bill from the hospital for $23.73. I think that there is a theory for Obamacare policies (this one is a “silver” policy that costs about $8,500 per year) that screening procedures are not supposed to require a copayment, but somehow this one did? It looks as though the “lipid panel” was paid in full (well, not the $228.84 that the hospital asked for, but the $37.58 that was the negotiated price) but the “comprehensive metabolic panel” ($88 marked down to $23.73) had to come out of the deductible? ($10,000 per year?)

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14 thoughts on “The paperwork blizzard following my annual physical checkup”

  2. How is it that no one in Washington DC has any decent ideas for fixing the health care system? It is obviously filled with inefficiencies and bogus billing.

  3. All of that billing malarkey has been going on for a long time, long before you ever heard of Barack Obama.

  4. imagine going to walmart and not knowing how much the milk you take off the shelf would cost until a month later, and the price is based on how well bank of america negotiates.

    we need to mandate fixed, published, prices for all medical services.

    1. providers can charge a patient a daily, monthly, and/or yearly FLAT fee
    2. surgeons charge a FLAT fee per procedure, which also covers complications (see the oklahoma survey center for how this works)
    3. rehab facilities charge a FLAT fee for each injured body part
    4. every citizen gets a health savings account funded by the $1.2T we spend on medicaid/medicare. means testing is applied (about $4K/citizen without means testing).
    5. 100% of your medical bills up to the average in the county your provider is based in is paid out of your hsa. you pay the rest until you hit 10% of your income AND your hsa is empty.
    6. insurance kicks in for 100% until the insurer spends $50K in a calendar year, then the government takes over for the year. if your lifetime medical expenses hit $500K you no longer get insurance. you just split the bill with the government.
    7. if you don’t have insurance your out-of-pocket max from #5 goes up to 20%.
    8. cap wholesale rx prices at 110% of manufacturing cost. cap rx retail prices at lower of 110% of wholesale price, or highest retail price in countries with gdps >= 80% of american gdp

  5. forgot to write this in my first comment. but we could just scrap all federal insurance programs (medicare, medicaid, and schip) in order to open veteran’s health administration facilities to the general public:

    “The Veterans Health Administration is the largest integrated health care system in the United States, providing care at 1,245 health care facilities, including 170 VA Medical Centers [hospitals] and 1,065 outpatient sites of care of varying complexity (VHA outpatient clinics), serving more than 9 million enrolled Veterans each year.”

    budget is $65B. $65b/9M = $7222.22/capita

    we would have to make payments out of the $1.2T budgeted for medicaid/medicare under current law to get private facilities to join the network (or just buy them out). in exchange they charge the VHA’s lower, regulated rates. https://www.va.gov/healthbenefits/cost/copays.asp

    waiting lists? yes. death panels? hell yes…but it’s A LOT cheaper.

  7. Marking down hospital bills is known as “claims repricing”. It exists because gigantic unpaid bills are profitable to several groups in unexpected ways. Here’s a doctor (who owns a hospital) explaining it.

    Basically, when a bill of $558 is marked down to $89 (-$469):
    – Hospitals claim a $469 “accounting loss” to maintain their fiction of being a non-profit tax-exempt org (while paying directors multi-million$ salaries).
    – Hospitals get a partial rebate on “losses” from Washington via Medicare/Medicaid payments (the bigger the loss, the more they profit!).
    – Insurers back-charge large policy holders 35% of the $469 “savings” they “negotiate” (much more profitable than just charging a % on top of what they pay out, which most people presume how insurers work).
    – Lawyers seek hospitals with the biggest sticker prices when suing for damages, because the amount awarded is independent of what their client ends up paying.

  8. Also, prices for paying customers must be inflated to cover the cost of uncompensated care which hospitals are required to provide by law.

  9. Not sure why are you blaming any of this on Obamacare. All the insurances have worked exactly the same way since I can remember. I could have written the same story 20 years ago.

  10. Tekumse: Why does the posting mention Obamacare? My understanding is that the U.S. insurance market, of which I am a customer (due to the legal and practical penalties that are in place for refusing to purchase products from the health insurance industry), is currently regulated under a regime known as “Obamacare.”

  11. Surely, for $8500/year you must be getting some equity, frequent flier miles, or lifetime Redsox tickets.

  12. Great pricing by the way, $8500/year . I guess this is an individual plan. Family plan would cost $8500/year * number of members of the family on exchange.

  13. Folks: $8500 buys me what would have been called “catastrophic insurance” in the old days. There is a $10,000 deductible, I think. This is an Obamacare “silver” plan. The “gold” plans that actually pay for the medical services you’d use if you were moderately ill cost a lot more (maybe about $10,000/year more, thus proving that insurance companies aren’t stupid).

  14. Can not believe we are getting used for this. Forced lifetime insurance spending before healthcare spending begin is now to the tune of $1million or more. Most people will not even ever own real estate for this amount. I guess that only 1 in 1000 would ever use up this amount, do not have hard data. I would expect something like this happen in dictatorships, not in liberal democracy. Cancellation of this should be a priority to any and all elected officials.

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