I did a pile of invoicing, bills and miscellanea today, mostly for house and health things. One of the things that came over my desk was a statement from the insurance company which about gave me a heart attack - a bill for a surgery assistant was set at $5100, and the insurance company said they'd only pay about $1400, which sticks me with $3700. As we'd made our deductible (loooong since) and hit our out-of-pocket cap, this was a $3700 surprise that we weren't really prepared to deal with. I called the surgeon and explained the situation, desperately hoping that they'd billed something using the wrong code or something else easily fixable. "Oh," they explained to me, "you don't owe that, don't worry - that's how we bill these things."
See, each insurance company has a different idea of what is reasonable and customary for a surgery assistant. The standard operating (pun not intended) procedure of medical offices is to bill them the full total for a surgeon, accept whatever the insurance company will pay, and the adjust the remaining bill so I only have to pay $50.
Now, $50 is a helluva lot better than $3700, and I was obviously very relieved and hung up the phone feeling mollified.
But on reflection... does that seem BROKEN to you? Rather than setting a standard price for a necessary service, they charge whatever the market (in this case, an insurance company) will pay - then add $50. Now, first of all, I'm paying for insurance to cover exactly this kind of thing. We pay a lot for our insurance and it's very good. Once I've hit my cap, why should I pay ANOTHER $50 - not because that's what it cost, but because they know they can charge that?
And doesn't this feel like a reason that insurance companies are struggling so badly? Because they're being charged the moon for services. So, the burden is on them to figure out what's normal and customary, and basically a patient is just along for the ride. Seriously. The Torn World licensing system feels reasonable compared to this.
I had another rant I was going to rant about - about being afraid - but that will have to wait until another day.
*With the obvious exception of PBS.