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A recent public survey revealed that the most pressing problem with our health care system was not that so many people were either underinsured or without insurance altogether, but that health care–all aspects of it–was just too expensive.
Patients, including doctors themselves when they or their families become patients, go into sticker-shock when they see the prices for hospitalizations, drugs, lab tests, and surgical procedures. It’s probably of little comfort to know the details about how the prices got so insane, but basically it was the medical response to the insurance industry and vice versa, taken to the -nth degree. Picture a tennis game with the ball being lobbed higher and higher and higher.
Here’s a quick example: until several years ago, if you had a small skin cancer, a dermatologist would remove it in the office and charge $100 cash. But then health insurance came along. Suddenly the doctor is paid $30 by the insurance company for doing that procedure. Having signed a contract as a “provider,” the doctor’s not allowed to bill you for the rest. So she discovers that by raising her rates, she could squeeze more money from them. If she billed $500 often enough, she finally got her fair $100 reimbursement.
Over time, though, as her office expenses (staff, malpractice insurance, etc.) rose, and when she needed to raise her rates again, the insurance company balked. So she discovered that for a small investment, she could get a space in her office certified as a surgical operating room and add “operating room fees” to the total to maintain her original charge. If the doctor’s nurse injected the novocaine for the procedure, she could bill for a “surgical assistant.” Then she learned the insurance companies actually preferred that she break down the surgical procedure into its component parts, and bill separately for each (“local anesthetic applied” + “removal of cancer” + “repair of skin”).
The term for this is “unbundling.” So currently, if you have a tiny superficial skin cancer and go to one of our major Chicago medical centers, expect to see (as I did) bills totaling $6,500. Insurance pays $3,000. If you’re typically underinsured, you’ll be responsible for about $1,000. If you have no insurance at all, the medical center reduces your bill by 40%, a definite non-bargain at $3,900.
With our dire economic situation, you don’t need to be stuck with a $3,900 skin cancer removal charge. So I’m going to refocus from my standard health tips for a while and teach you some insider tricks to keep your health care costs as low as possible. What’s interesting to me is that a whole new industry is being formed within the health care system itself to meet the needs of the uninsured and underinsured. For example, if you need an MRI, you can, without difficulty, get a perfectly good scan read by a radiologist for about $450 instead of the $3,500 charged at a major medical center. More on that to come.
For today, a very important health tip about COBRA insurance, which may not apply to you personally, but likely does to someone you know. If that’s the case, forward this to them and follow up with a phone call.
Most people have health insurance as part of the benefits package from their jobs. In fact, lots of people remain for years in jobs they loathe simply for the health insurance, especially if along the way they’ve developed a condition that would render them uninsurable. With the recession, people are losing both jobs and health insurance. Fortunately, unemployment insurance is there to keep people financially afloat. For health insurance, the laid-off employee is offered COBRA (Consolidated Omnibus Budget Reconciliation Act), a government-mandated system that gives a former employee the right to continue her health insurance for a certain number of months, with a catch. She has to pay for it.
What an unemployed person quickly discovers is that her well-named COBRA swallows a big chunk of her unemployment benefits. A lot of people actually turn down the COBRA option, figuring they’d rather eat and risk going uninsured.
However (and this is the part worth forwarding), under President Obama’s stimulus package, the government will subsidize 65% of your COBRA expenses. This applies even if you are currently receiving COBRA. To get this benefit, you must notify your former employer to fill out the appropriate paperwork (some restrictions do apply). If you are about to be laid off, remind whoever handles your expiring benefits about this subsidy. If you are currently “on COBRA,” you are currently paying your former employer the total amount for your health insurance. When the new paperwork is in place, your employer will receive 65% of the premium from the government and you will be responsible for an easier-to-swallow 35%.
Because this benefit is so new, many employers and human resources departments don’t know it’s available. At WholeHealth Chicago we received a fax alert from the government outlining President Obama’s new benefit and asking us to alert any patients receiving COBRA benefits or who are about to lose their jobs. I reflected that it was the first time I’d ever received a notification from the federal government that made me smile. I had thought they limited correspondence to tax audits, draft notices, and various warnings not to misbehave.
If you or someone you know gets laid off, don’t turn down COBRA as too expensive. Otherwise, you might find yourself paying $3,600 for a skin cancer removal.
David Edelberg, MD