(20% of all fees paid for by patient - $50,000 maximum benefit)
In November of 2009, I visited a federal/state funded health clinic and was referred to a nearby hospital for an ultrasound. I was worried that my insurance company (United Healthcare) would refuse to pay for the impending services, based on the pre-condition clause of my policy, so I applied for financial assistance thru the clinic and the hospitals that did the screenings. Fortunately, I qualified for various federal/state funded assistance programs.
(Not Medicaid)
1. The hospital billed my insurance company about $1,000 for the first CT scan, but when the insurance company refused to pay the bill, I was charged an “out-of-pocket” fee of $4,500. The argument for this price discrepancy is that the insurance company buys medical treatment “in-bulk”, so they can pass the discount on their customers. In this case, I do not believe that the price discrepancy reflects a realistic cost savings for the bulk purchaser. Wealthy people generally have insurance, so in reality, the only people who pay the “out-of-pocket” fees are those who qualify for federal/state funded assistance. The truth is, I qualified for federal/state funded financial assistance, and they paid the entire $4,500 fee to the hospital. The divergence in billing allows for the hospital to bilk the government out of money.
2. My insurance company refused to pay for my surgical procedure, so the hospital charged me the “out-of-pocket” rate of $26,000. The hospital where I received my service did not have a government sponsored financial assistance program, so I was expected to pay the full amount. The only payment plan they were willing to put me on had me completing my payments in less than two years ($1,000 month). One week before my bills were going to be sent to collections, I called the hospital and begged for them to set up a more reasonable payment plan. They told me if I wrote a “letter of hardship” and explained my financial situation, then they might be able to waive some or all of the fees. A few months after writing the letter, they waived all of my fees! How does the hospital afford to do this? They charge insured individuals more money than they need to in order to compensate for the patients, such as me, who can’t afford their services.
3. Every doctor that I visited wrote a letter to my insurance company stating that my symptoms had nothing to do with the type of cancer that I was diagnosed with and that the discovery of the tumor was completely incidental. My insurance company was manipulative in regards to describing my rights as a policy holder. They would conveniently “lose” paperwork that I sent them days before deadlines approached. I had to call them on a daily basis to make sure they were moving forward with my requests to review my case. It was not until June of 2010, after I contacted them via my lawyer with threats of a lawsuit, that they finally agreed to pay for what was left of their share of the bills.
4. In August of 2010, my wife graduated from college, and we could not get insurance through her school anymore. Her new employer did not offer her insurance, but she was able to purchase it on her own. I was still self-employed so I needed to purchase a policy on my own, but no insurance companies would accept my application because they said I had a pre-condition. The fact that I carried insurance before the discovery of the condition did not matter. I was forced into a federal/state funded insurance program for a high risk pool of citizens. The bottom line is that the government ends up paying for the medical treatment of the highest risk individuals, and the insurance companies get to refuse policies for high risk applicants, therefore resulting in higher profits for themselves.