October 25th, 2008
What is wrong with health care in America, you ask.
Well let me tell you what is wrong. A family member of mine who has Carefirst Blue Cross Blue Shield got some lab work done. This is what the explanation of benefits looks like:
Total charges: $934.00
Less non allowed amount: $803.27
Total paid: $130.73
Further it says in “Remark R033″, “Preferred providers agree to accept our allowance as payment in full. Therefore, the member is not responsible for this portion of the charge.”
Let me help you understand. Someone who has insurance, pays nothing, and the insurance pays $130.73 to the laboratory. But, if you did not have insurance, you would have to pay $934.00 – MORE THAN 7 TIMES! Add to this that $934 would be paid in cash, on the spot, while $130.73 would come 4 months later after much paperwork (so much in fact, that laboratories need to hire full time billing specialists). In case you think this is volume discount, consider that this amounts to an 86% discount!
In plainspeak, this is simply exploitation of the weak – laboratories charge more to who they can, those who have no leverage on them. The strong are those who have insurance. In this respect, the weakness (or the strength) is not provided by the law of the land (the rights), but by the insurance company. If your insurance company is strong, then it will pay $130.73. If it is second grade, perhaps it will pay $200. If it is a third grade insurance company, perhaps it will pay $300. But, on your own, you are the lowest of low, and will pay $934.