Consumer Directed Health Plan. One of the biggest jokes in the health insurance industry is the illusion of control. We pretend that you, the consumer, can control your medical expenses. We created products that, by law, have high deductibles, no office visit copays, and no Rx card. We know that you will shop for the best deals in primary care doctors and cardiologists. We are counting on you to force the doctors to justify every blood test, CT scan, and procedure. You know that you are a great shopper. Here’s your chance to prove it.
Can you shop for a deal when they are wheeling you in to the hospital with a blocked artery? “Hold up Mr. EMT. I just got a text alert that Hillcrest is having a sale on bypasses this week.”
But of course, none of this is real. There is no way to know the real cost of medical services in advance. And who amongst us wants health care by the lowest bidder? Plus, do we know anyone who is prepared to say to his doctor, “Another surgery? Gosh I don’t think we should spend so much just to save my life.”
The client is in the early stages of his treatment for prostate cancer. He and his doctors discussed the various ways to remove his prostate, external beam radiation, and even radiation seeds that can be implanted. The patient chose external beam radiation. The doctors then suggested that he also have hormone therapy.
Hormone therapy almost appeared to be an afterthought. By taking pills or getting shots the patient would inhibit testosterone production, shrink the prostate, and slow the growth of cancer. What shot? Which pill? The patient was told that the nurse practitioner would tell him when they met.
The client had a shot and got a bill a few weeks later. Ready? The shot cost $34,228.50. Surprise. The Anthem Blue Cross negotiated price for the shot was $18,932.99. The client’s deductible was $5,500. He blew past that. The client maxed out his share and Anthem paid the rest.
I looked at the bill and the first question I had was, “Did they buy you dinner?” I mean for this price he should have received a gift card for The Cabin. Sadly, all he got was an off switch for his libido. My second question was, “Is this some new miracle drug?” No, he was given Lupron which has been in use for over 30 years. The good news that it was a double shot, good for 6 full months.
$34,228.50 for one shot. Who knew? That’s easy. Everyone but the patient.
We have no control. Remember our friend the next time you wonder why your insurance premiums are going through the roof. I wouldn’t have done anything differently. You would have been just as surprised as he was. This shot is just one more example of a broken system in search of a solution.
Dave
This is from a longtime reader who prefers to remain anonymous:
We got a hospital bill of about $3,900 for a December visit a few weeks ago. We have hit our out of network of $10,300. We are about to hit our in network of $6,850. My employee premiums for health insurance are $5,700 and total employee premium for benefits including health are $8,900. So do the math. How does a family afford $29,000 in care and premiums? We still have a mortgage, food, taxes etc…
Don’t get caught up in the term consumer driven, when the law is called the Affordable Care Act.
I agree with your assessment , There is no way to shop cost in any of your examples, or in 99% of all procedures. Worse yet. There is no incentive to shop cost. Once the client meets the Ded./MOOP everything is covered @100%
A tonsillectomy costs the client $3,000, $6,000 or $6850 depending on the MOOP. . Why should the policy holder shop ( even if he/she could, which we all know is impossible) Your clients will tell you, there is NO INCENTIVE to save the “greedy” insurance company any money?
This is all about how much risk the policy holder is willing to pay for, and choosing a plan design mandated by or all knowing government. Always will be,
From my friend Ellen:
We seem to be in a no-win, no-win situation.
Thousands of people are greatful for Obamacare who would not be covered otherwise.
With the ability for pharmaceuticals and healthcare providers to pick and choose, it’s almost like they can determine who lives and who…well…may not.
Realistically, no Republican individual/group will support anything related to Obamacare or any Democrat-sponsored program.
Given the current political environment, what would YOU recommend to get us out of this mess?
From my brother Rob:
There are never easy answers when in the midst of a health issue. Each Dr. is advising the patient to follow their specialty. Unfortunately, there is no official, only way to go answer.
As someone with his own complications, I wish all the best to your client. Please have them reach out if someone such as myself could be of any support.
Rob
Something HAS to be done for those who are being squeezed hard by ‘the greedy and corrupt system’. Despite paying exorbitant monthly rates for healthcare insurance, I have racked up tens of thousands of dollars in medical debt due to high deductibles and other bills that my insurance can’t, or won’t cover! So even though I have ‘comprehensive’ (and high cost) healthcare insurance, i’m still getting hammered with endless bills that I simply cannot afford to keep up with! So my credit is ‘shot’, and I get tons of daily calls from debt collectors! EVEN THOUGH I HAVE INSURANCE! What a country…
This was supposed to be fixed. It wasn’t.
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