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Uninsured pay more for medical costs
Question:
> "That happens everywhere," said Dr. Guy Clifton, the chief of > neurosurgery at the University of Texas- Houston Medical School. "If > it’s not an emergency and you can’t pay for it, you don’t get care." > Copyright 2001 The New York Times Company > — > My website: http://members.home.net/mzuschlag/
<vent> What also ticks me off is that these insurance companies send their holders to these incompetent doctors who say "nothing’s wrong w/ you, "IAIYH," yadda yadda, so YOU have to go to doc to doc to get properly diagnosed, and THEN the insurance companies consider you a liability because they’re paying too much for you!! Get it done right the first time, get it accurately dxed, get it properly treated and SAVE MONEY in the process!! Ok, </vent> over. Counting to one to calm down. 10. 9. 8. 7….. — "There are some people that if they don’t know, you can’t tell ‘em." — Louis Armstrong http://www.geocities.com/SoHo/Nook/9300
Response:
> From the New York Times: > Medical Fees Are Often Higher for Patients Without Insurance > By GINA KOLATA > When patients go to Dr. Stephen Brenner, an internal medicine > specialist, for a routine exam, their bills can vary by 45 percent. The > uninsured pay the most and patients with insurance plans are charged the > least. > It is not his doing, said Dr. Brenner, who practices in New Haven. He > explains that it is because health insurance companies insist on hefty > discounts. "It’s a take it or leave it situation for doctors," Dr. > Brenner said. But he said he knew that the insured paid much less than > their share. For the insured, he said, "it’s almost like getting a BMW > or Mercedes at half price."
My brother is an insulin-dependent diabetic and is also self-employed, hence no employer health insurance. For years he managed to negogiate fees with his internist and often paid the amount insurance companies would have paid. (of course he paid up front, at least until he was well known at a doctor’s office.) Fortunately he now has health and Rx coverage, but he showed me that it’s worth it to discuss fes with your MD. Nann
Response:
Hi Mary, All our bills are paid in full. My doctor was floored by how good I look and walking etc. He gives me piles of samples and helps me so much. Hubby back to work and making 3 times as muchas before and I am selling art from my studio. Plus I got lots of letters and suggestions and got great coverage. But the nicest thing is that I have 2 teams of doctors helping and willing to do anything for us and it is so nice. God is good. Life is good… Judy Hulett
Response:
Hi Nann, You are right. I went for a regular physical on my husband’s insurance from work and the doctor said I had RA and needed a specialist. At that same time my husband took a job with a very wealthy builder and was offered 3 times as much salary. So he took the new job. They offered no insurance. My regular doctor and her nurse and the the office manager got together and decided to call us and offer a payment plan 6 months from that time for $25 a month. The office manager said that if that was too much to call her back. I needed good care. We were so happy and they are so nice. That whole team of people wrote a letter to the rheumatologist introducing me and all and on the first visit he said "your doctor thinks the world of you and wrote a very nice letter about you, I want to put you on a payment plan of $25 a month. So they all know each other and keep in touch. We found out that doctors can do all kinds of things for you like you said Nann. Now all the bills are paid and we don’t even need the payment plan but it was nice of them to offer. He also tells me how to save and I have a buddy who is a pharmacist and he is working right along with me. The nicest part is that I am better and have met so many kind people. I am covered now and painting again. I thought this might help someone. You are right Nann to discuss fees with the doctors. They can make any adjustment.Thank God. Judy
Response:
From the New York Times: Medical Fees Are Often Higher for Patients Without Insurance By GINA KOLATA When patients go to Dr. Stephen Brenner, an internal medicine specialist, for a routine exam, their bills can vary by 45 percent. The uninsured pay the most and patients with insurance plans are charged the least. It is not his doing, said Dr. Brenner, who practices in New Haven. He explains that it is because health insurance companies insist on hefty discounts. "It’s a take it or leave it situation for doctors," Dr. Brenner said. But he said he knew that the insured paid much less than their share. For the insured, he said, "it’s almost like getting a BMW or Mercedes at half price." Other doctors cite more extreme price disparities. A New York gynecologist says he gets $25 for a routine exam for a woman insured by Group Health Insurance and charges $175 for the same exam for a woman without insurance. "It’s horribly ironic," said Paul Menzel, a professor of philosophy at Pacific Lutheran University in Tacoma, Wash. The care of the poor once was supported by the wealthy and the insured, but now the opposite is happening, he said. "It is the people who are most provided for, not the people who are least provided for, who get the benefit of cost-shifting," Professor Menzel said. In a medical emergency, uninsured people can get care, even if they walk away from their bills. But if it is not an emergency, doctors and hospitals may insist on payment, often requiring a deposit in advance. As a result, some uninsured people struggle for years to pay medical bills and others put off seeing a doctor until minor problems become major ones. Some health policy experts like Uwe Reinhardt, an economics professor at Princeton University, see the situation as "brutal and inhumane." But, Professor Reinhardt said, doctors and hospitals are trapped in it. Despite the discounts they have negotiated, some large insurance companies have had their own financial troubles lately. For example, Aetna, the nation’s largest health insurer, reported in January that its fourth quarter earnings had declined by 65 percent. Mark Pauly, a professor of health care systems at the Wharton School of the University of Pennsylvania, said there was no real villain. "I don’t think it’s exactly good versus evil," he said, "it’s just business." The problem crept up on them, doctors and hospital administrators say, after they began agreeing to slash their prices for health insurers in return for a steady flow of patients. Then they found themselves scrambling to maintain their cash flow. They found an answer with patients outside the managed care system, like those with fee-for-service plans in which the patients pay their own bills and are reimbursed by an insurance company. But the uninsured also are outside the system, and have no one to negotiate for them. So they end up charged the higher prices, too. Most patients paying the full fare have no idea that their bill may be many times that of the people next to them in the doctor’s waiting room. And, in interviews, many doctors said they did not offer patients information on pricing disparities, however much they might agonize over the inequities of the system. While this may not be a problem for people who can afford fee-for- service plans, which typically are far more expensive than other health insurance, it can be devastating for the uninsured. "If you’re a partner in a law firm you can afford to pay more than your legal secretary can," said Dr. Darcy Hansen, an internist in private practice in Washington. "But," she said, "it’s the uninsured who really falter." Dr. Hansen said the pattern began about 10 or 15 years ago when she started negotiating with managed care companies. "I thought it was the wave of the future," she said. "I have a lot of poor patients, a lot of single moms who don’t have a huge income. I thought that if they could pay $5 for an office visit they were more likely to come in than if they have to pay a $400 or $500 bill," she said, referring to the co-payment, the amount a patient might have to pay when a managed care company covers virtually the entire bill. "Then the fees slowly ratcheted down," Dr. Hansen said. In the meantime, she said, with fewer and fewer patients who pay the full rates, she has no choice but to keep prices for those patients high. Her take-home income, she said, is half that of two or three years ago. Individual doctors are not the only ones in difficult straits. Hospital administrators say the same sequence of events happened to them, with often devastating effects. The administrators said their problems began about a decade ago when insurance companies offered to make their hospitals "preferred providers," meaning that patients insured by the companies would go to those hospitals en masse, if the hospitals slashed their prices. It sounded workable