I have posted it before, but any time a healthcare thread pops up I like to mention a project I co-founded (before Obamacare/Affordable Healthcare Act).
Primary care coverage for $20/month $10 copay for ARNP/PA visits and $25 copay for Doctor visit. Even if someone is covered on the exchange this type of primary care plan can be far more cost effective than paying the copays under many of the plans. See: http://pfccmember.com/Membership_Plans.html
>So I went to my new Oscar-approved doctor, who recommended routine blood work...On April 28th 2014, I received a first bill from the hospital detailing how Oscar covered none of the in-hospital labs and I would need to pay $1640. A second round of labs before April 28th pushed the total bill to over $2000.
Even our little start-up was able to negotiate $99 for blood work labs, which is out of pocket to the patient. If the same patient uses insurance that rate skyrockets, usually requiring patients to pay out of pocket anyway because of giant deductibles.
It is absolutely ridiculous how pricing schemes like that are even legal. Have insurance that covers a non-typical lab test? They bill $1000 to your carrier (regardless of what th e contracted rate will be) and you are usually responsible for a fraction of that because of deductibles. Don't have insurance and are a cash-only customer? They bill you $150. Have insurance and insurance declines to pay? You get billed $1000.
A real example of this, my son had a routine vaccination performed at a Baylor clinic and my insurance company drug their feet on remitting payment to them. So, Baylor turned around and invoiced me for $1250 and was ready to send that to collections. Turns out that the agreed rate with my insurance carrier for that vaccination was well under $100.
It gets even worse than that. Some people are stuck with an HSA.
A HSA is not insurance (it covers nothing), but it looks like insurance (so hospitals still charge you the 'ten times more' price).
A $100 doctor visit, becomes $900 "charged" to your HSA (because you 'have insurance' so they can eat the artificially-inflated cost). But since HSA never covers anything, the insurance always just passes that $900 bill on to you. They stamp "THIS IS NOT A BILL" on the top, but that's a lie, it always requires you to pay money.
You call up the hospital and explain "I don't have insurance, I need the sane price." They say "we can't give you that price, you have insurance." No one in healthcare understands that HSA's aren't insurance, and cover nothing, so no one will let you pay a manageable sum of money.
HSAs are, by legal requirement, only available if you are enrolled in a High-Deductible Health Plan [1], which is insurance and does pay for something, though (as the name suggests) it has a very high annual deductible (for which the HSA is used).
So if you have an HSA, you do, in fact, have insurance.
I have to have a set of bloods 5-6 tests every 6-8 weeks plus 4 quarterly ones for the royal free as a result of my condition - god only knows what that would cost in the USA as people say bless the NHS
Primary care coverage for $20/month $10 copay for ARNP/PA visits and $25 copay for Doctor visit. Even if someone is covered on the exchange this type of primary care plan can be far more cost effective than paying the copays under many of the plans. See: http://pfccmember.com/Membership_Plans.html
>So I went to my new Oscar-approved doctor, who recommended routine blood work...On April 28th 2014, I received a first bill from the hospital detailing how Oscar covered none of the in-hospital labs and I would need to pay $1640. A second round of labs before April 28th pushed the total bill to over $2000.
Even our little start-up was able to negotiate $99 for blood work labs, which is out of pocket to the patient. If the same patient uses insurance that rate skyrockets, usually requiring patients to pay out of pocket anyway because of giant deductibles.