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Friday, January 29, 2010
Insurance follies
Here were our two choices, unbeknownst to us:
1. bring my kid for 65$ per office visit
2. pay the copay, and submit bill to insurance, and pay whatever the discounted rate minus whatever insurance company covers
We opted for #2 only because we didn’t know about #1. That is, we simply gave our insurance information, and waited for the bill. Needless to say, publication bias tells you dear reader that the amount we ended up paying with option #2 was more than 65$ per visit.
A few months after we paid our bills, it came to my attention that option 1 was on the table. So, I asked the health provider for a refund of the difference between what we paid under option 2 and what we would have paid under option 1 (a difference of around $200). And barring that, at least a “credit” so that we can get 3 free sessions.
No.
Apparently, once the health provider engages with the insurance company, they enter into a contract with them (and presumably, I entered one with them). And so, only option 2 is on the table. Whatever it is that the contracted rate between the insurance company and health provider is, that’s what the health provider now expects. Whatever the insurance company doesn’t want to pay, that now becomes my responsibility.
It is, without a doubt, a huge scam, where both sides are complicit. The health provider knows they can jack up the rates because they know that insurance is usually the better option under most plans. But, not my plan (that’s because I have low premiums, and high deductibles). So, in this case, I’m the one who falls into the cracks. And those without insurance, well health providers don’t want to turn those people away, so they lower their rates for them. Indeed, I would even think this is illegal. And, I presume the health provider can get away with this by simply “billing” a high rate to the individual, get the 65$ under option 1, and “write off” the difference as goodwill. That is, they can justify legally two rates by saying they only have one rate, but are bad at collections.
The lesson is: if you’ve got a fairly basic insurance plan, don’t think that that is a better deal than simply paying everything out-of-pocket. Some health providers seem to be pretty responsive to the plight of individuals at times, and if you don’t involve the insurance company, they might do something for you. Once the insurance company is brought into the relationship, then you are on another track, and there’s no do-overs.
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