Why Your Health Insurer Doesn’t Care About Your Huge Healthcare Bills

Health insurers don’t care because they’re just going to pass the cost on to you and your employer via higher premiums. And the more your employer pays for health insurance fees, the less they can put into your paycheck.

Article like the one linked below make my blood boil.

“After Aetna approved the in-network payment of $70,882 [for a partial hip replacement] (not including the fees of the surgeon and anesthesiologist), Frank’s coinsurance required him to pay the hospital 10 percent of the total.

When Frank called NYU Langone [hospital] to question the charges, the hospital punted him to Aetna, which told him it paid the bill according to its negotiated rates. Neither Aetna nor the hospital would answer his questions about the charges.”

Source: Why Your Health Insurer Doesn’t Care About Your Big… — ProPublica

Here’s a comment left under the article:

I am a physician and have seen these games for years.
It is obvious that the insurers collude with the hospitals and pharmacies, to raise the patients copays.
It is a way of transferring costs onto the consumer.
Each insurance company has a different contract, with each hospital and pharmacy.
For example, I recently needed an MRI. I priced the charges in advance with my local hospital.
If I used my small group blue x policy, I would be charged about $2,200 dollars as my copay. I negotiated to pay the medicare rate in full, and not use my insurance. I paid $240 dollars as the full medicare rate. It was much cheaper for me not to use my insurance, than to use my insurance and pay an inflated copay.

Pharmacies are a little more forthcoming about their pricing, so their games are a little more obvious.
A pharmacy will tell you the price of a drug, but you have to tell them your insurance first.
The chain pharmacies will change the list price for a drug, depending on the insurance.
For example, I told a patient that the silver sulfadiazine cream I was prescribing should cost about $10. The next day they came back furious at me. The local chain pharmacy said it was $440, and their insurance supposedly paid $400, leaving them a copay of $40.

I called around and I found that the full cost at the chain pharmacy without insurance was much less ($35). Walmart had it as one of their $4 drugs. The $440 cream at the chain pharmacy and the $4 cream at Walmart were made by the same generic manufacturer.
I don’t believe that the insurance company was dumb enough to pay $400 dollars for a $4 tube of cream. I think that the list price of the drug was inflated, by mutual agreement between the chain pharmacy and the insurer. By inflating the list price, the patient paid $40 for a $4 tube of cream through their copay. I doubt the insurance company paid anything.

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