The Outrageous Costs of Healthcare
Etch Shaheen, M.D. May 29,2020
About 60% of Americans struggle to cover a $500 emergency expense and the CEO of a single health insurance company (United Health) makes 43,000 times more than that in a single year. One can understand the public’s outrage and why many believe health insurance companies, and those who run them, are greedy and out of touch.
One would think that with insurance companies making so much money, insurers would lower premiums, or pay for the healthcare costs, of their insured. Well, this is not the case. Insurance companies often deny payments of the healthcare expenses incurred by the insured. Is this because the medical treatment is not necessary or reasonable, or could it be to increase profits of the insurer? Other times, insurers require the patient to pay a percentage of the costs (co-insurance). Other times even if the care or treatment is covered, they will require the patient to pay the first five, ten or twenty thousand dollars (deductible) before the insurer pays a dime. Insurers get more and more creative to find reasons not to pay for, or pay a lower percentage of, the healthcare expenses of the people that trusted them to pay for these very expenses in the first place.
Insurers seem more interested in making profits and are driven to look for ways to increase/maximize profits. So, when an insurer denies making a payment for an expense incurred by a patient, that money can go towards profits. This seems to be the opposite of doing what is best for people and patients. Doctors are supposed to look out for the best interests of patients; doctors take an oath to do no harm. No one said insurers are supposed to look after the best interests of customers/insured. I am not aware of a Hippocratic Oath of insurers to protect the insured as a priority. So, when there is a discrepancy about whether a certain test, treatment or procedure is necessary, where the attending physician states it is needed and the insurer states it is not, who should we trust? Who would you want to decide? Your doctor who is seeing, examining and treating you, who has taken an oath to do no harm and tries to help patients, or your insurer who tries to maximize profits in order to please its shareholders?
Insurance companies sell their insurance policies to the public. These policies are quite long, contain many terms foreign to many in the public and are rather confusing to even the most educated. Keep in mind, many of us that comprise the public, and are customers of insurers, are not sophisticated enough to fully understand the contents of the insurance policies. Whether due to poor judgment, embarrassment, lack of time, misplaced trust or other reasons, the public buys insurance policies that it does not understand. People do not know what would happen, what would be covered, what would be denied and what the costs to the patient would be should the need for care or treatment arise.
Some might argue that the public does indeed understand insurance and what they are buying very well. I respectfully disagree. If someone truly understands something, they should be able to explain it to others and answer most any questions that one might have about it. So, I challenge the insurers to demonstrate that their customers can explain the policies that they have. Are the insured able to not only say how much the policy costs, which is often the biggest reason for selecting a policy over another, but also explain what the deductible, co-pay and co-insurance is on that policy and what does it mean? In plain English, how much will you have to pay?
- If you must go to the ER for a car accident?
- If your child is running a fever and vomiting in the middle of the night and you seek medical attention?
- If you have the worst headache of your life and go to the ER?
If the total ER bill is $12,000:
- How much will you be responsible to pay?
- Will you get a “surprise” bill?
- Will the policyholder be able to give accurate answers to these questions?
If not, then the policyholder does not fully understand the policy and the insurer has failed you, the other healthcare players and the public. Will you know?
- Whether the hospital, ER doctor, the radiologist who reads the images, the anesthesiologist that may be involved or other physician and non-physician providers are in, or out of, network?
- What contracts the insurer has or does not have with the various physician and non-physician providers?
- That the insurer may refuse to pay for tests, procedures and care that the insurance company determines were not needed or authorized?
- You might have to pay for these out-of-pocket?
- How much of what you pay will count towards your deductible?
- Whether the insurer is likely not to pay a single penny until the full amount of the deductible is paid by the policyholder?
Deductibles can be in the thousands, or tens of thousands, of dollars. According to information presented at the American College of Emergency Physician’s Leadership Advocacy Conference held in Washington D.C in May 2019, a typical private insurance deductible is $7,000. Out of curiosity, you may want to check your insurance card. Is the deductible amount printed on your insurance card? Some insurers print it on insurance cards, some don’t. Ever wonder why? Is your total out of pocket costs listed?
Insurers sell insurance plans that cost a lot of money. One can argue that some policies are worse than no insurance at all. Let me give an example. Most people have limited resources and must make choices on how to spend the limited money or resources they have. People choose to buy health insurance so they can get the care they need and avoid having to pay high medical expenses associated with medical treatment that could cause significant financial stress or lead to bankruptcy. The problem is a patient with a high deductible plan may not be able to afford to use the insurance that he spent thousands on. Unless he has additional money to cover the deductible, he may not receive treatment and the insurance company won’t pay a dime. An uninsured patient who has not spent thousands on insurance premiums at least may have what he saved in insurance premium payments to use to pay for his healthcare.
*Excerpt from Chapter Three: INSURANCE COMPANIES from the book Make Healthcare Great Again. Knowledge is Power Publishing. Protected by United States copyright law. Used with permission of author and publisher. Available in paperback and Kindle eBook for purchase on amazon: https://www.amazon.com/dp/B0895HR1MQ