Why Your Health Insurer Doesn't Care About Your Big Bills

[turbinetree]

Patients may think their insurers are fighting on their behalf for the best prices. But saving patients money is often not their top priority. Just ask Michael Frank.


by Marshall Allen May 25, 5 a.m. EDT


This story was co-published with NPR.

Michael Frank ran his finger down his medical bill, studying the charges and pausing in disbelief. The numbers didn’t make sense.

His recovery from a partial hip replacement had been difficult. He’d iced and elevated his leg for weeks. He’d pushed his 49-year-old body, limping and wincing, through more than a dozen physical therapy sessions.

The last thing he needed was a botched bill.

His December 2015 surgery to replace the ball in his left hip joint at NYU Langone Medical Center in New York City had been routine. One night in the hospital and no complications.

He was even supposed to get a deal on the cost. His insurance company, Aetna, had negotiated an in-network “member rate” for him. That’s the discounted price insured patients get in return for paying their premiums every month.

https://www.propublica.org/article/why-your-health-insurer-does-not-care-about-your-big-bills

[rickford66]

1. I thought this was always obvious.

It's cheaper for them to pay and pass on the costs to us than to investigate and possibly litigate. You hardly ever hear about medical fraud with private insurance but you always hear about the abuses of Medicaid and Medicare because the Feds go after abuses. It makes private insurance look good compared to government insurance. "Government can't do anything right."

[Demovictory9]

2. always wondered about that. recent blood tests. blood testing co billed $2000. insurance paid $35

denied the rest. why not pressure testing company to stop billing those ridiculous made up numbers?

[Hoyt]

3. And, yet, if an insurer were to remove a hospital like that from their network, folks would scream

that they were being unfair and taking advantage of patients/insureds.

While our greedy health system sucks, patients have some unreasonable expectations as well. To successfully negotiate drug prices, one needs to be able to say "nope, we aren't paying that, we'll just keep treating patients with the old drugs." Imagine the screaming.

Very few patients actually get the estimate of the cost to compare hospitals on elective surgeries like this. They go where they think they'll get the best care, or their doc finds it most convenient. But, most have no idea what good care means.

Not optimistic anything will change, even if Congress ponied up the upfront money (by increasing taxes or cutting military expenditures) to get rid of insurance companies.