Some insurance figures

[cryowizard]

My recent lung episode introduced me to how insurance pricing mechanisms work. Looking at the numbers, I have only one thing to say -- people, get insurance.

This is how it looks on my statements. First line is a total bill for 5 days in the "step down" unit (second-most expensive after ICU), and the second line is a total charge for a return ER visit (blood work, xray, consultation, discharged in 4 hours).

Charges Submitted	Charges at Agreed Pricing	Your Plan Paid	Your Responsibility
$35,400.00	$5,108.00	$5,315.17	$250
$1,613.34	$532.00	$479.61	$100

What baffles me most is a huge discrepancy between the amounts billed by the hospital and the "agreed pricing" for which they settle. This basically means that if you come in from the street, the hospital will charge you 7 times more for care (3 times in case of an ER visit), than what they settle for with an insurance company. Unbelievable. I wonder what happens when a normal guy can't pay a 35K bill. Do they sue him or do they settle for less, like they do with the insurers?

But that's not all. After having paid my coverage to the hospital, the insurance company sent me a letter asking for details of the medical emergency. Was it a car accident? Did it happen on someone's property? Is it a result of someone's negligence? Etc, etc. And finally, do I think someone else is responsible for what happened to me? In other words, they are looking for a way to recover their expenses by suing whomever I believe to be responsible (or whomever I think should be responsible). A sound, if a bit frightening, business practice.

Comments

[cryowizard.livejournal.com]

I was wondering about that too, but somehow I think the hospital will not be nice to you :)