Let's make a deal.

Part 1: How I save upwards of 50% on my healthcare services every day.

Going on four years later, I finally completed step three of four in getting my knee repaired.

I had contemplated getting a tattoo on my leg that said "HEY DOCTOR: If found unconscious, and if you're bored, can you take this metal out of my leg?" Luckily it didn't come to that.

I've said it before and I'll say it again - I love my #AdventuresInHealthcare. These experiences provide me with the ability to be able to dive face first into our healthcare system, and use my experiences to better empower Employers and Employees alike to make the best decisions related to care delivery, or how to pay for it.

Let's get started.

First, you need to picture yourself in this situation when buying a new car. The salesman approaches, letting you know that they have some great deals on cars. You say "Ok great, I'm sure" to which they reply, "No, seriously! Do you have either State Farm or AllState for Auto Insurance? If so, you get 50% off the sticker price."

You start to get excited, and walk up to the first car (visualize a base model Toyota Camry). The sticker price: $200,000 - but since you have State Farm, its $100,000.

The example I use above could also be applied to Health care. So there you have it, that's how I save money on my expenses thanks to my deeply discounted in-network rates with my health plan (but it wont be this way for long).

Now, lets do one better... if you wreck your new car and need to get a new one - but no matter where you picked it up, was just a copay of $100 - would you shop around for a better deal? No! We cannot rely on consumers to do this - and need to help them be a better steward of their care as well as the finances of the health plan itself.

Americans love feeling like they got a good deal.

We see this every day, in every aspect in life. We have all been tricked to believe the same with health care. The truth is, anyone selling a product or service is happy to give you a good deal, as long as they get to name the starting price. The world of health care is no different.

Elisabeth Rosenthal provides a great history, examples, and remedies in An American Sickness, which is a must read (or listen).

We will look back on 1968-1983 as the golden age for health care providers. Nearly 80% of Americans were covered by Private Insurance, and better yet, when bills were submitted they were simply paid by the insurers. Even up to the 1990's, there were over a dozen major national insurers, which have since consolidated down to four.

As time went on, things started to change. Insurers worked to negotiate "deeper discounts" which was often off of an increased charge master that hospitals created. Medical coding boomed, finding new ways to take advantage of the system due to high auto-adjudication rate at the insurer level, including bundling and billing for those services that weren't rendered at all. It's not always just the cost of care itself, but the cost of care that never happened but we pay for.

Those that paid the highest price were the uninsured, followed by those who were covered under Private Insurance.

To better understand how this continues to happen, we must take a closer look at needs and wants:

• Hospitals need to keep their beds full, and OR's running at full steam, picking up any billable charge along the way that they can muster. They want to tell you that your expenses are so high because that's the cost of care (blame it on regulation, medical malpractice insurance, affordable care act, etc.).
• Insurers need to say that they have a bigger network, better service, deeper discount than the next one. They want to be able to tell a better story to their consumers than their competitor, about how hard they work for you.

What if #1 - What if you didn't get robbed every time you needed health care?

What if hospitals were up front and honest enough to clarify that the reason care costs so much, is actually because they negotiated to rob you blind, and that your insurer was complicit? Ask for a bundled, all-in price and see how far you get. Instead the canned response is that it shouldn't matter to you, since your Insurer was the one picking up the bulk of the tab anyways. I'm paraphrasing, but its true, and I'll show you how.

We could also argue that if we had tort reform when it came to medical malpractice, heavily subsidized education for Medical Students, and even less regulation, care may be less expensive - but experts agree that these may only be a fraction of price gouging (read: distractions).

What if #2 - What if we went single payer?

I always hear people say "I just wish that we could have a single payer system like in _____ country." The truth is that we're pretty damn close to it, and we often fail to realize or leverage these programs to do better as a whole.

About half of all Americans are already covered by Medicare or Medicaid. The Government has actually done a good job of controlling these costs - far better than insurers - even tying reimbursements back to quality. All of the negotiated costs are public information, shrouded in not only secrecy and a cloud of medical code that would make you feel like you were in The Matrix.

What if #3 - What if we could take our plans back to low out of pocket costs of the 1990's?

My first lesson in health insurance came with my Father's Open Heart Surgery in 1993. He needed a mitral valve replaced with a mechanical version. He was 35 at the time - and I was 10 - but I still remember my mother holding the bill for over $100,000 in her hand, and saying "do you realize that if we didn't have good insurance we would have lost everything - including the house?" Their out of pocket cost at the time through Travelers Insurance (now defunct) was $0 for Medical care, but $13.50 for the two meals my mother had delivered to the room when she was there.

Fast forward, and according to 6 Degrees Health and their database, the cost for the same procedure (DRG 221) at the same hospital today still averages around $112,926 for the 20 claims reviewed. On the flip side, my parents' out of pocket under their current health plan would nearly $10,000. Estimated cost today according to CMS for those covered under Medicare and Medicaid? Just under $20,000.

What if #4 - What if we could do better?

The truth is, we can, it just requires a little more work, and ability to let go.

PPO type Network Contracts with a carrier, even in a self-funded plan, are loaded with gag rules and other clauses that hamstring us all from gaining the data, detail, and transparency we crave. The Phia Group refers to as the "Black Box" approach.

Need further proof? Here is the breakdown of personal claim examples that I'll cover in greater detail next time, which were re-priced by AMPS Medical Pricing Solutions:

• Billed for four (4) days of observation at a rate of $2,208 per day as opposed to an inpatient rate of $1,245 per day. That's a $3,852 difference over the four days.
• Billed $836 for Pins as a part of an Exofix to stabilize my leg. R&C cost is $334. It was really to rent them for 3 weeks since they recycle them. (250% mark-up)
• Billed $3,247 for a metal plate, $504 for 6 screws, and $96 for wire thread (total of $3,847). R&C cost adjustment is $1,334. I got to keep these as a souvenir. (288% mark-up)
• Billed $2,825 for Bone Cement. For the same cost, I could have poured a concrete pad for a garage. R&C adjustment is $848. (333% mark-up).

In the end, today there is little stopping us from turning a "good deal" into a bargain.