Sunday, September 6, 2009

Uninsured Patients Pay More For The Same Care

So: when last in the Dominican Republic, I was hit in the head with a pistol when 3 men tried to rob our group. 2 months I was still having a little dizziness, so I had an MRI of my brain with intravenous contrast to check things out. Last week I received my bill for the MRI. It cost $3,922.00.

Now, here is where things get a little odd and where uninsured patients get an even worse deal than you would expect. The hospital where I had my MRI participates with Anthem, who provides our health insurance coverage. In order to sign on to participate with Anthem (something that you pretty much have to do in Richmond, as the company is a huge player in the area) health care providers have to agree to accept Anthem's "discount". In this case, Anthem writes off $1,500.55 of the bill and determines that only $2,421.45 are actually allowed. So: Anthem determines automatically that 38% of the charges are not permissible.

Now, I pay my co-pay on the lower cost ($2,421.45). However, if you have no insurance, you do not qualify for Anthem's discount, and you are going to be charged the whole $3,922.00. This means that, if you are not able to afford coverage (or are one of the relatively few who chooses not to buy coverage) you pay a lot more. When you consider that most of the uninsured are also the working poor, you can see how quickly costs add up and threaten to crush families' chances of improving their lives.

To summarize: if you cannot afford health insurance, you will pay more for any health care services than you would if you had health insurance. And not just because you're paying for the charge instead of paying a copay--the actual charge is significantly higher.

[As an aside: for all those critics of health insurance reform who feel that young, healthy people may decide that they do not need insurance, this sort of incident shows why everyone should have some level of coverage. Remember that the hospital fees are increased in order to make up for the money lost on those who cannot pay for the care. I certainly didn't ask to be pistol whipped, in the same way that a 20 year old does not ask to be in an automobile accident or a 40 year old farmer does not ask to be mauled by her hogs. If we all contribute to the common good, then all can be protected and helped. At some point we will all need health care, and I think we should all be contributing to provide that care.]

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