Here’s a fun story on the health insurance system that America’s most brilliant technocrats have created…
Woman falls on Christmas (Tuesday) morning and breaks her collarbone. Blue Cross pays 100 percent of the cost of emergency care following an accident. $0 deductible. ED doc says will likely heal on its own. First available consult with an orthopedic specialist is Thursday morning. After a bit of deliberation, it is decided that surgery to insert a plate may be helpful. This will cost the insurer $30,942 ($35,080 “rack rate”). Had it been completed within 72 hours of the emergency visit, it would have been covered completely. Due in part to the holiday and a question about whether the break could heal adequately on its own, the surgery was not done until the following Monday, outside of the 72-hour window (one business day beyond, or maybe not even that if we subtract out Christmas).
Although the procedure is exactly the same, now the insurance customer must pay 15 percent of the total: nearly $5,000!
So the insurance company that you might think would want to encourage patients to step back and consider whether an offered intervention is useful instead gives them a huge financial incentive to sign up for whatever physicians put on the menu during the first 72 hours!
(The good news is that any customer who memorizes the 165-page 2018 benefits document would be well aware of this 72-hour cliff (don’t forget to read the 176-page PDF for 2019, though!).)
- “A $20,243 bike crash: Zuckerberg hospital’s aggressive tactics leave patients with big bills” (Vox), in which the government-run hospital tries to get $24,074 for a $3,831 (market price) visit because “the hospital’s focus is on serving those with public health coverage — even if that means offsetting those costs with high bills for the privately insured. … ‘Our mission is to serve people who are underserved because of their financial needs.'” (the woman involved in the bike accident never had a choice to go to a hospital that was in-network for her Blue Cross)