Posted on Sep 23, 2019, 7 p.m.
Does anyone really know what anything costs in healthcare any more? Prices seem to fluctuate from location to location and state to state, and those prices from the same place even change depending on if you have insurance and what carrier. When did medicine become about money, what happened to just wanting to help people?
Across the nation, too many people are getting surprises of bankruptcy inducing bills for thousands of dollars in medical expenses in the mail. In a recent series CBC News is exploring the various reasons, and collaborating with journalists to help to bring some form of transparency to the confusing and inconsistent healthcare market.
Take for instance Frank Esposito who started off with unrelenting back pain that caused him to barely be able to move. MRI scans revealed a bulge in his spine to which a specialist advised him to go to the nearest hospital immediately to address. The herniation was so severe it could cut his nerve, and the doctors at the emergency room said he required surgery.
Luckily for Esposito the surgery was a success, but then the bills started to arrive which amounted to over an overwhelming $650,000 in all. He was denied coverage by his insurance carrier that said his back surgery didn’t qualify as an emergency and was not medically needed, contrary to the expert medical advice. He has since cashed in his retirement savings and hired negotiator to arbitrate his medical bill debt down, and his insurer eventually paid for some of his bills, however he still owes over $220,000.00.
Across the nation there are many people such as Esposito who can’t afford to pay for treatment and insurance denies claims regardless of expert medical advice. There is no transparency in healthcare, as 4 in 10 consumers report receiving a surprise medical bill of over $500 in the previous year according to a 2018 Kaiser Health poll.
"This is somebody who's in pain, who is, you know, immobile. And now has been told, 'OK, you might be paralyzed unless you run to the hospital. How are they supposed to become good shoppers, and make complex, rational decisions? They're going to say, 'Please tell me what to do, because that's your job,’” Dr. Aaron Carroll is a pediatrician and health services researcher.
Even for non-emergencies there can be surprising swings in what a procedure or 10 can cost according to ClearHealthCosts and CBS News. In Dallas a simple blood test can range from $10-$176, and from $15-$126 in San Francisco. In Dallas an abdomen ultrasound can range from $115-$2,459, while in San Francisco that same procedure ranges from $100-$2,800.
Not every patient pays cash prices, especially those with good insurance, the cash prices reflect what the provider will accept. "Plans will have different deductibles, different amounts of co-insurance, different amount of co-payments," Carroll said. "And it also depends of course, what they're charging — what the price is, and then how much you are responsible for that price. That number has gotten much higher than people would think. It can be a significant part of people's incomes."
"I think people have an assumption, right or wrong, that insurance is going to protect them. That's why if we pay that much, we think we're going to be covered, and we're not going to see that surprise bill. So, when you do, people are shocked." adds Carroll.
When you have insurance, and it is the doctor's recommendation to be for the best of your health to get treatment you should have that treatment covered, especially when it is an emergency. Even without insurance people should be able to go to the doctor to get taken care of to become healthy without having to risk losing everything they have, or fall into terrible debt for many years to come. When did people become nothing more than dollar signs, and more importantly why is it allowed? Yes we have top notch healthcare, but can you afford it?
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This article is not intended to provide medical diagnosis, advice, treatment, or endorsement.