Thursday, June 3, 2010

Is insurance REALLY a good thing?

I confess. I have a bit of a medical condition. The good news is it's in the "pretty much cured" phase, but I still have a few doctor followup visits to go to to ensure I'm continuing staying healthy. This blog posting is NOT about my condition. I will not reveal that condition because it's irrelevant to anyone outside my close personal friends and family.

Anyways, I've been seeing my specialist ever since I was diagnosed with this condition. I want to say that was like 6-7 years ago. At the time of me being diagnosed, my then employer's biggest source of revenue was insurance companies -- because I was working for a health care company (corporate offices, of course -- we all know I can't deal with sick people).

During my visits with my specialist, I've always had to pay my "Specialist Co-Pay". We'll call it $40.

Then, came the unfortunate incident. But, then came the awesome event where I got new employment. Due to timings and other wait times between the two, I had to get on COBRA for about 2 months (And it's minimum 2 months on COBRA, but that's yet another story).

I had a specialist appointment sometime during the month of November -- COBRA had not kicked in yet (you hafta sign paperwork and get that mailed in and processed and yada yada yada), so when I went to see the specialist, they said I was uninsured and charged me for the office visit -- $75. Not a big deal, and I was pleasantly surprised.

This year marked a change in The Company's health insurance plans. We went from a "Co-Pay" system to a "Co-Insurance" system with the non-HMO plan. This means I'm required to pay out of pocket 100% of a doctor's visit until I meet my deductible, then I have to pay whatever co-insurance percentage is. For example, if I have a $500 deductible then 10% after that and I have a $1000 medical bill, I would have to pay $550 ($500 deductible plus 10% of the remaining $500) and insurance would cover the remaining $450. This is where people spent hours of calculations to find the break-even point in medical costs, but that's not the scope of this blog entry.

Back on topic, I had an appointment with my specialist this year. Due to the co-insurance thing, we pay $0 up front and get billed afterward after insurance pays their portion (which is after contractual discounts and whatever other BS goes into the calculations). I got the bill in the mail the other day.


The same visit type as when I was virtually uninsured before COBRA kicked in. Nothing extra.

How the HELL can you justify charging a patient MORE if they have insurance than if they don't? That's like a company offering a program where if you sign up and pay the premium, you get all kinds of perks -- including 200+% markup on products and services -- all just for being associated with them.

It makes me wonder how Obama's Healthcare Reform Bill will impact the same charges. Will the option of "I'm waiting for COBRA to kick in, so charge me the $75" go away? Will people, by default, have a co-insurance plan like The Company rolled out and if I'm waiting for COBRA to kick in I'll be charged $185?

If I had my choice, I would have said "charge me as if I don't have insurance." -- and send the bill to the insurance company to demonstrate I'm working towards my deductible (because they're not going to reimburse anything until I hit that number). And, if I break my leg, I may have more deductible to work through, but it's that much money I've saved if I don't break my leg.

Why can't we do things like this? Or can we? I really would like to know.

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