Here is another example of how America’s Health Care System is a rip-off. Both the doctors and the insurance companies are to blame. (This is a true story but the health insurance providers’ names are changed.).
I have health insurance through my employer. Let’s call it EANTA. I contribute 50% of the cost and I have a $4000 deductible for my family coverage. (We will not meet the deductible this year.)
My doctor accepts EATNA and GREEN SABRE insurance.
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I needed to visit my doctor for a quick consultation. I called the office to make the appointment and asked how much the visit will cost.
The receptionist asked me if I was paying out of pocket. I said yes, I was paying out of pocket. (My deducible will not be met so I am paying out of pocket.) She said the appointment will cost $70.
When I get to the office, I asked the receptionist to confirm that my appointment will cost $70.
She looks at my file, notices I have EANTA, and tells me $79.
I explained I was told over the phone the visit cost $70 and I was paying out of pocket. She replied that (a) I had insurance and (b) $79 is the amount the insurance company tells them to charge. She said she will check with the doctor to see if it was OK to charge me $70. I told them to make believe I do not have insurance and I will submit it on my own.
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On the way out I paid $70 and they gave me a receipt for the visit. The receptionist said next time they will not do it this way. The charge must be what EANTA designates as the price.
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Here is a continuation of the dialogue:
Top: (Speaking to the receptionist) I am not angry but I would like to describe a scenario to you.
Top: I come into your office. I need a Strep Test. My insurance company (EANTA) says you can charge me $90 for the test. So you will charge $90 for the visit?
Top: 5 minutes later, Mr. Smith comes into your office and he needs a Strep Test, His insurance provider (GREEN SABRE) says you can charge $80 for the same test. So you will charge him $80 for the visit?
Top: Do you see anything wrong with that? I am getting charged $10 more for the exact same service just because of my insurance provider?
Receptionist: What would you like us to do?
Top: (Half kidding and pointing to the wall in the empty waiting room.) I would like you to put up a big sign like they have in McDonald’s… Show your services and the costs… Strep test $85.. Flu Shot $30… Yearly physical $95…
Receptionist: (Nervous giggle)
Top: I know it’s not likely to happen, but this (a doctor’s office) is the only place where the service provider doesn’t set his own prices. It’s also the only place where the consumer is typically unaware of their charges until a few weeks later, when a 3rd party dictates what they have paid and what I owe.
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THIS IS NOTHING NEW. AS WE ALL KNOW — THERE’S SOMETHING SERIOUSLY WRONG HERE.