Thursday, May 26, 2011

A Complete Lack of Transparency: Health Insurance and Medical Bills in the United States

Go to any store in the U.S. and chances are the prices of all the items for sale are prominently displayed. If not, ask the clerk and you'll quickly find out. Need a cell phone? Monthly charges and plan designs are always disclosed before you buy. Visiting the local auto mechanic? He's required to give you a written estimate before he begins his work. Buying a gallon of milk? The price is right there on the shelf.

But walk into a Doctor's office and ask the price of an x-ray and you will get an entirely different experience. If you have health insurance, chances are the answer from the receptionist will be "we don't know how much the x-ray is. First we have to do the x-ray. Once we're done, we'll submit a claim to the health insurance company. Then they'll tell us how much the x-ray was, if you owe anything, and how much to charge you."

Why are Medical Bills handled so differently? Would we tolerate this with any other industry or business?

The cost of Healthcare in the U.S. is skyrocketing and is on pace to bankrupt our country. But how can anyone begin to control cost when the Doctor's office and the patient don't know what the cost is until after the fact? In essence, the current billing methods used pose a threat to the stability of our healthcare system as well as our economy as a whole. It needs to be fixed, and Healthcare Reform in its current form doesn't do enough to fix it.

So why doesn't the patient or the Doctor's office know what the bill will be until after the patient receives treatment? It has to do with the prices each health insurance company negotiates with each Physician. Like any other business, Health Insurance Companies are constantly working to lower their expenses. It's how they keep their products priced competitively and their profit margins healthy. On the surface, this falls in line with common business practices and makes complete sense. After all, Doctors want to charge as much as they can. Health Insurance Companies want to pay the least amount possible. They balance themselves out, right?