Jul 24, 2019
Problems with health insurance is certainly nothing new and my
recent experience is not unique. Recently, I received a bill for a
test at a 2000% markup over what the company would have accepted
had I paid cash! But because I decided to submit the claim to my
health insurance company (which denied it) I was sent a bill for an
astronomical amount. Obviously, I won't pay the jacked up price but
the whole episode got me thinking, is it ever a good idea to use
your health insurance to pay for 'little tests and
The whole affair began after I had an episode of syncope while
on call. I bumped my head, had to get stitches, etc. On returning
back from Spring Break I went to see my direct primary care
doctor. We felt like a holter monitor was a reasonable test
to be sure I didn't have sort of dysrhythmia (heart rhythm
problem). Because she is a DPC doc, she knew the cash price was
$250 but asked if I'd like to submit it to insurance anyway since
they might cover it. I agreed and wore the device for a week.
I received a bill in the mail six weeks later for $5000! They
would have charged $250 at the outset but had jacked up the price
when submitting to my insurance carrier. My doc then called the
testing company who said that this was a common practice for the
insurance company to deny payment a few times and then they'd send
me a bill for around $250. The episode highlights so much of what's
wrong with the 'system' as it is set up today:
- Patients (me) are looking to get their care for free and don't
think about prices much.
- There are entire departments of people paying (insurers) and
people charging (testing companies, pharmaceuticals, hospitals,
physician offices, etc.) who spend their days and resources sending
back and forth communications that serve no one.
- Insurance companies arbitrarily deny payments of reasonable
tests because it is ordered by the 'wrong' person.
- The testing companies charging increase their prices to
insurers hoping they will pay.
- Even with discounted prices acquired by the insurance
companies, it is often better to negotiate or pay for these smaller
routine test and medications out of pocket without disclosing the
presence of insurance.
Dr. Eric Larson is the host of the
Paradocs and was much younger when this photograph was taken.
Eric Larson: @theparadocsshow
Episode 002: Dr.
Amat, the direct primary care doctor mentioned in this show,
describes what it is like as a DPC doc.
Episode 007: Dr.
Wacasey describes his method for picking insurance and why
insurance is a bad way to pay for most things in medicine.
Thread on Described in the Episode: This is the twitter thread
I referred to in my show.
YouTube for Paradocs:
Here you can watch the video of my late son singing his solo on the
Paradocs YouTube page.
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