Maybe the Republicans were right about Obama Care?
Miriam
Published on Alternet (http://www.alternet.org)
Home > This One Weird Consequence of Obamacare Could Either Save-or Cost-You
Big Time
________________________________________
This One Weird Consequence of Obamacare Could Either Save-or Cost-You Big
Time
By Larry Schwartz [1] / AlterNet [2]
June 16, 2016
When it comes to the world of health care and health insurance, the rabbit
hole is deep and winding. The Affordable Care Act, aka Obamacare, has
certainly gone a long way toward providing more Americans with health care,
and the newly insured can rest a bit easier when confronted with
catastrophic health care costs, but in the wonderland of health care, it
turns out that in certain cases, having insurance can cost you more money,
not less. In fact, a lot more money.
Let's take the case of one patient in California, whose insurance company
was charged $408 for five common blood tests, a little more than $80 per
test. Her insurance company paid about $140 to the medical center, and the
patient was responsible for the rest, about $270. Frustrated at having to
pay so much for the tests, the patient called the center and asked why the
tests were so expensive. Much to the patient's surprise, she was told that,
had she paid cash, the tests would have been cheaper, an eye-popping $65 per
test less. That's right-with cash, the patient could have paid just $15 per
test.
Or there's the case of a patient in Colorado who needed a knee X-ray, and
was responsible for $600 of the cost, only to discover that if she had paid
cash, the fee would have been $70. An MRI for the same patient? $1,100
through her insurance company, just $600 if she paid out-of-pocket cash up
front. A tonsillectomy in Arizona costs $5,400 through insurance, $2,850 if
paid cash up front. A foot MRI in Flint, Michigan, costs $445 through
insurer, $379 in cash.
Instances like this abound across the country. The assumption on the part of
insurance policy holders that, because of the huge pool of potential
patients, the insurance companies are in a position to get the best possible
price for medical services is, to put it bluntly, false.
There was a time when an uninsured patient forced to pay cash was faced with
a much higher fee than an insured patient. Obamacare, in part, is
responsible for changing that reality. Under the Affordable Care Act, in
order to eliminate price-gouging, tax-exempt hospitals cannot charge
low-income patients more than the negotiated rate that Medicare pays. This,
combined with an effort by many medical institutions to grant discounts for
up-front cash payments in order to avoid later administrative and
debt-collection difficulties, has contributed to changing the fee
structures.
Insurance companies (and the federal government, through Medicare and
Medicaid) must regularly negotiate the fees they will pay hospitals and
doctors for their services. At the same time, more and more hospitals
nationwide have merged, making for less competition in the marketplace and
more leverage in their negotiations with the insurance companies (since, in
the new merged-hospital reality, they no longer have to worry about a
competing hospital undercutting costs). The result is that hospitals, in
order to make up for the lower costs they now must charge poor patients, are
cutting better deals for themselves and (some would say) fleecing the
insurers (and, of course, the policy holders, to whom the costs are
ultimately passed down.)
As more and more Americans opt for high-deductible policies in order to save
money on their monthly premiums, the insured policy holders who have not met
their high deductibles find themselves paying the full insurer-negotiated
rate for medical services, which just happens to be a lot higher than the
discounted up-front cash rate the uninsured are paying. As the
aforementioned patient from Colorado told the Wall Street Journal [3], "I
thought insurance companies negotiated good deals for us. Now things are
totally upside down."
Obviously, paying cash up front, which does not go toward your policy's
health cost deductible, is not always the best option. If you have a low
deductible, and your service is only costing a small co-pay, or if you have
a high deductible but know that your health care costs will be high in any
particular year and you must meet that high deductible in order to have your
additional services covered, then going through your insurance is the way to
go. (For instance, you know you will have a $20,000 hip surgery later in the
year but must meet a $5,000 deductible before the rest of the cost of the
surgery is covered.)
But in many cases, especially if you have a high deductible and do not
anticipate a health crisis (which is the case for most younger policy
holders), it might make sense to forgo paying through your insurance and
just pay cash. But be sensible. It's a judgment call, and if you have had
serious health issues in the past, it's probably not worth gambling. You can
also use your health savings account, if you have one, to pay the up-front
cash (although it will not count toward your deductible).
Paying cash for medical services, when you are insured, can be tricky. There
is some work involved, but the savings are potentially substantial. The key
is to ask questions of both your medical services provider as well as your
insurance company. Under federal law, patients have the right to request
that medical providers not bill their insurers. Once a patient has gone
through the insurer, she cannot change her mind and request to pay the cash
price instead, so it behooves a patient to investigate her options. This is
not always easy. Some institutions are reluctant to be open about their
discount cash rates, fearful it will weaken their negotiations with
insurance companies. Others, though, are happy to be transparent, seeing it
as a way to bring in more business (and make no mistake, health care is Big
Business).
On the insurance side, finding out the negotiated rate for a medical
service, in order to comparison-shop, can be equally tricky, but you can
usually navigate your insurance company's website and find the rate for most
services. There are also websites like Clearhealthcosts.com [4],
Healthcarebluebook.com [5] and Pricinghealthcare.com [6], which have
gathered a lot of information comparing costs. On websites like these, you
might find a mammogram in New York City could cost you $607 or it could cost
you $50. Or you could get a vasectomy for $3,500, or take a train to Yonkers
and pay $450. The choice is yours.
Larry Schwartz is a Brooklyn-based freelance writer with a focus on health,
science and American history.
Share on Facebook Share
Share on Twitter Tweet
Report typos and corrections to 'corrections@xxxxxxxxxxxx'. [7]
[8]
________________________________________
Source URL:
http://www.alternet.org/economy/obamacare-one-weird-consequence-could-either
-save-or-cost-you-big-time
Links:
[1] http://www.alternet.org/authors/larry-schwartz
[2] http://alternet.org
[3]
http://www.wsj.com/articles/how-to-cut-your-health-care-bill-pay-cash-145559
2277
[4] http://clearhealthcosts.com
[5] https://www.healthcarebluebook.com
[6] https://pricinghealthcare.com
[7] mailto:corrections@xxxxxxxxxxxx?Subject=Typo on This One Weird
Consequence of Obamacare Could Either Save-or Cost-You Big Time
[8] http://www.alternet.org/
[9] http://www.alternet.org/%2Bnew_src%2B
Published on Alternet (http://www.alternet.org)
Home > This One Weird Consequence of Obamacare Could Either Save-or Cost-You
Big Time
This One Weird Consequence of Obamacare Could Either Save-or Cost-You Big
Time
By Larry Schwartz [1] / AlterNet [2]
June 16, 2016
AddThis Sharing ButtonsShare to FacebookShare to TwitterShare to Google+More
AddThis Share optionsShare to Email
When it comes to the world of health care and health insurance, the rabbit
hole is deep and winding. The Affordable Care Act, aka Obamacare, has
certainly gone a long way toward providing more Americans with health care,
and the newly insured can rest a bit easier when confronted with
catastrophic health care costs, but in the wonderland of health care, it
turns out that in certain cases, having insurance can cost you more money,
not less. In fact, a lot more money.
Let's take the case of one patient in California, whose insurance company
was charged $408 for five common blood tests, a little more than $80 per
test. Her insurance company paid about $140 to the medical center, and the
patient was responsible for the rest, about $270. Frustrated at having to
pay so much for the tests, the patient called the center and asked why the
tests were so expensive. Much to the patient's surprise, she was told that,
had she paid cash, the tests would have been cheaper, an eye-popping $65 per
test less. That's right-with cash, the patient could have paid just $15 per
test.
Or there's the case of a patient in Colorado who needed a knee X-ray, and
was responsible for $600 of the cost, only to discover that if she had paid
cash, the fee would have been $70. An MRI for the same patient? $1,100
through her insurance company, just $600 if she paid out-of-pocket cash up
front. A tonsillectomy in Arizona costs $5,400 through insurance, $2,850 if
paid cash up front. A foot MRI in Flint, Michigan, costs $445 through
insurer, $379 in cash.
Instances like this abound across the country. The assumption on the part of
insurance policy holders that, because of the huge pool of potential
patients, the insurance companies are in a position to get the best possible
price for medical services is, to put it bluntly, false.
There was a time when an uninsured patient forced to pay cash was faced with
a much higher fee than an insured patient. Obamacare, in part, is
responsible for changing that reality. Under the Affordable Care Act, in
order to eliminate price-gouging, tax-exempt hospitals cannot charge
low-income patients more than the negotiated rate that Medicare pays. This,
combined with an effort by many medical institutions to grant discounts for
up-front cash payments in order to avoid later administrative and
debt-collection difficulties, has contributed to changing the fee
structures.
Insurance companies (and the federal government, through Medicare and
Medicaid) must regularly negotiate the fees they will pay hospitals and
doctors for their services. At the same time, more and more hospitals
nationwide have merged, making for less competition in the marketplace and
more leverage in their negotiations with the insurance companies (since, in
the new merged-hospital reality, they no longer have to worry about a
competing hospital undercutting costs). The result is that hospitals, in
order to make up for the lower costs they now must charge poor patients, are
cutting better deals for themselves and (some would say) fleecing the
insurers (and, of course, the policy holders, to whom the costs are
ultimately passed down.)
As more and more Americans opt for high-deductible policies in order to save
money on their monthly premiums, the insured policy holders who have not met
their high deductibles find themselves paying the full insurer-negotiated
rate for medical services, which just happens to be a lot higher than the
discounted up-front cash rate the uninsured are paying. As the
aforementioned patient from Colorado told the Wall Street Journal [3], "I
thought insurance companies negotiated good deals for us. Now things are
totally upside down."
Obviously, paying cash up front, which does not go toward your policy's
health cost deductible, is not always the best option. If you have a low
deductible, and your service is only costing a small co-pay, or if you have
a high deductible but know that your health care costs will be high in any
particular year and you must meet that high deductible in order to have your
additional services covered, then going through your insurance is the way to
go. (For instance, you know you will have a $20,000 hip surgery later in the
year but must meet a $5,000 deductible before the rest of the cost of the
surgery is covered.)
But in many cases, especially if you have a high deductible and do not
anticipate a health crisis (which is the case for most younger policy
holders), it might make sense to forgo paying through your insurance and
just pay cash. But be sensible. It's a judgment call, and if you have had
serious health issues in the past, it's probably not worth gambling. You can
also use your health savings account, if you have one, to pay the up-front
cash (although it will not count toward your deductible).
Paying cash for medical services, when you are insured, can be tricky. There
is some work involved, but the savings are potentially substantial. The key
is to ask questions of both your medical services provider as well as your
insurance company. Under federal law, patients have the right to request
that medical providers not bill their insurers. Once a patient has gone
through the insurer, she cannot change her mind and request to pay the cash
price instead, so it behooves a patient to investigate her options. This is
not always easy. Some institutions are reluctant to be open about their
discount cash rates, fearful it will weaken their negotiations with
insurance companies. Others, though, are happy to be transparent, seeing it
as a way to bring in more business (and make no mistake, health care is Big
Business).
On the insurance side, finding out the negotiated rate for a medical
service, in order to comparison-shop, can be equally tricky, but you can
usually navigate your insurance company's website and find the rate for most
services. There are also websites like Clearhealthcosts.com [4],
Healthcarebluebook.com [5] and Pricinghealthcare.com [6], which have
gathered a lot of information comparing costs. On websites like these, you
might find a mammogram in New York City could cost you $607 or it could cost
you $50. Or you could get a vasectomy for $3,500, or take a train to Yonkers
and pay $450. The choice is yours.
Larry Schwartz is a Brooklyn-based freelance writer with a focus on health,
science and American history.
Error! Hyperlink reference not valid.
Error! Hyperlink reference not valid.
Report typos and corrections to 'corrections@xxxxxxxxxxxx'. [7]
Error! Hyperlink reference not valid.[8]
Source URL:
http://www.alternet.org/economy/obamacare-one-weird-consequence-could-either
-save-or-cost-you-big-time
Links:
[1] http://www.alternet.org/authors/larry-schwartz
[2] http://alternet.org
[3]
http://www.wsj.com/articles/how-to-cut-your-health-care-bill-pay-cash-145559
2277
[4] http://clearhealthcosts.com
[5] https://www.healthcarebluebook.com
[6] https://pricinghealthcare.com
[7] mailto:corrections@xxxxxxxxxxxx?Subject=Typo on This One Weird
Consequence of Obamacare Could Either Save-or Cost-You Big Time
[8] http://www.alternet.org/
[9] http://www.alternet.org/%2Bnew_src%2B
