If you think you have healthcare insurance, here are a few simple questions you might ask yourself: Have you met your deductible? If so, what were your out of pocket costs for the year? How much did you and your employer pay for your healthcare insurance last year and what did you get for it? And where is your money going? According to the California Health Care Foundation[1] 45 million Americans are “uninsured.” While this number may seem alarming, consider the fact that 100% of American’s are essentially uninsured on the 1st day of January, every year, and they remain so until they have met their deductibles—something that insurance companies are increasingly making an impossible thing to do. You owe it to yourself to find out the actual costs of healthcare in order to make intelligent decisions about what you CAN afford. Here are some more statistics that you might find alarming:

1. In 2004, the average healthcare premium employers were charged for a family of four averaged $9,950[2].

2. By 2006, it is predicted that the average annual family insurance premium will reach $14,500[3].

3. National surveys indicate that the primary reason for being uninsured is for the simple reason that insurance is not affordable[4].

4. There are more Americans (50%) who are now worried that they cannot afford their healthcare insurance than there are (42%) who report being worried about not being able to afford their healthcare[5].

How do bills get paid?

Don’t be fooled by the difference between billing and reimbursement. Your insurance company will readily send you a copy of the amount that was billed for your latest healthcare encounter. What was actually paid—if anything—however, is actually another story and it would behoove you to find this out for yourself. Let me give you an example.

On October 6, 2003, the hospital sent a bill to my insurance carrier (Blue Cross of California) in the amount of $11,569.20 for “Inpatient Services” related to an uncomplicated c-section and a 2-day stay. My insurance carrier “discounted” the bill by $9,869.20 to $1,700.00. This is the “fair and reasonable” amount they “pay” for this service. But wait, who paid? I did! This claim put me over my deductible for the year by whopping $7.70. The amount applied to a member’s deductible is always the amount billed minus the “patient savings” minus any insurance reimbursement and amounts “not allowed.”

Mark my word, essentially, you will require major surgery or you will have a significant accident that results in enormous bills before you will meet your deductible—if you are still even able to meet this amount at all. And until you exceed this amount, you are a cash paying patient. Make no mistake about it.

See for yourself. In my case, the amount applied to the deductible for the above transaction was: $11,569.20 - $9,869.20 - $11.00 = $1,689.00.

If you are still a non-believer, I can show you the bill on April 4, 2003 for $766 where I paid $266 and only $84.26 was applied to the deductible. I have many more examples and I’m sure that if you pay attention, you will find plenty of your own.

But can you really afford to pay cash for healthcare?

Absolutely! What you can’t afford, is healthcare insurance. If you have a family, you already know that this is true. If you are single—maybe, but why throw your money down the toilet when you can get so much more for your hard earned cash!? I have a wife and 4 kids. To pay $6,000.00 in premiums and miscellaneous fees this year is simply unacceptable. I’m joining the ranks of the uninsured and I have a good job! I just called Hollywood Presbyterian Hospital to get an update on the cost of a c-section. Low and behold, the cash price for a c-section is $3,000.00. You can call yourself.

But what if you get injured and have massive bills? You have too much to loose.

Of course you do. Hopefully, however, you are not ignorant enough to believe that your healthcare insurance company is going to bail you out under these circumstances. If for some God forsaken reason you are hit by a truck and spend 2 months in the hospital accumulating millions of dollars in bills, I am afraid that you will still be in a pickle because your insurance carrier is sure to sue the trucker’s insurance carrier etc. for the next 10 years while the collectors come after you for unpaid bills.

You owe it to yourself to get smart and stop giving your hard earned cash to this scandalous industry. Please feel free to comment on this story for a lively discussion!

References

1. California Health Care Foundation, Health Care Costs 101 -- 2005. Mar 2, 2005.

2. The Henry J. Kaiser Family Foundation, Employee Health Benefits: 2004 Annual Survey. Sept 9, 2004.

3. Simmons, H.E. and M.A. Goldberg, Charting the Cost of Inaction. National Coalition on Health Care, May, 2003.

4. The Henry J. Kaiser Family Foundation, Health Care Worries in Context with Other Worries. Oct 4, 2004.

5. The Henry J. Kaiser Family Foundation, The Uninsured: A Primer, Key Facts About Americans without Health Insurance. Nov 10, 2004.

Copyright 2006 Majella.us

About The Author

David Picella is a Nurse Practitioner and a PhD Student who started The Saint Gerard Fertility Care Center of Duarte, CA. The center is a point of entry for women's healthcare services based on a new reproductive science called NaProTechnology. Additional articles by David and other experts in reproductive medicine can be found at: http://www.majella.us