Article by Steve Verno
Reprinted here with expressed permission by the author.
In Florida, there are 3,071,000 people who are uninsured. The place where almost all of these people go for health care is the emergency room. As a result, because they are uninsured, their medical bills go unpaid for various reasons. The average emergency room physician bill is $250.00. Multiply that by the number of uninsured and you see a minimum loss to the physician community of Florida in the amount of $767,750,000 if each person has one emergency room visit, but they don't because uninsured patients must use the emergency room for medical care.
This doesn't count the loss when one of these uninsured decides to sue for financial gain. Like any other business, losses have to be added to the cost of business. My brother is uninsured and spent a week, needlessly, in the hospital. He was medically abandoned because he was uninsured. He should have spent one day in the hospital, but because no doctor would see him, my brother rotted. He was released only after I complained to the CEO of the hospital organization. His medical bill = over $30,000. This is why this hospital chain is involved in a class action lawsuit. Can my brother pay this? No. He is unemployed. With what he was charged, my brother could have flown first class to Las Vegas, stayed in a suite at the Bellagio, and gambled $1,000 per day and it would not have come near what he was charged to stay in a semi-private room and watch TV all day, waiting for someone to see him.
His condition? A cyst on his eyebrow, which opened and he was forced to clean it with toilet paper because the nursing staff refused to come to his room when he called them, telling them that the cyst opened and was draining down his face. When they did give him 4 gauze pads, they charged him $75 for these pads which costs about $5.00 in a drug store.If we took one HMO CEOs salary and bonuses for a one year period, we could pay alot of doctor bills for the uninsured.
I am amazed at how much employers are paying insurance companies in premiums. It's almost criminal. In addition, if the employee has family members, then the employee is contributing to the cost of health care. This is why health care is unaffordable. The insurance companies are charging sky rocketing premiums and giving nothing back. Lets say you are a family of 4 and in excellent health. You pay $250 per month in premiums as your part. Your employer is probably paying $500 per month, but lets keep to the $250. In one year, you paid $3,000. Lets say you have a $1,000 deductible. In that one year timeframe, lets say little Suzy was sick and you took her to the doctor. The visit was $150.00 with a $30 co-pay. Not only have you paid out $250 per month in premiums, but you just shelled out $30 more for the visit.
The insurance company applies the bill to your deductible, so to add insult to injury, now you have to pay $130 more. So, what did paying for insurance get you? Bupkiss! You can't even take this off your income tax.Lets say you get real sick. You have $900 in medical bills. The insurance company still applies this to your deductible and you pay out of pocket for the care. Do you really feel comfortable, knowing you have medical care? So far the insurance company hasn't paid a dime. Now you get sicker. The insurance company denies your claim stating the care was not medically necessary. Who ends up paying the tab - you and your employer. Did you ever wonder where the insurance company gets the money to pay these high priced CEOs? Now you know.
I once signed up for dental care that would cost me $120 per month or $2,400 per year. I looked at what I was given for benefits. One free cleaning per year. I had a $300 deductible. At the most, the insurance company would pay 50% for certain covered services. Root canals were not covered, nor were bridges or crowns. I terminated the policy immediately and put the money in a savings account. My wife had to have a tooth removed. Cost: $190. I took the money from the savings account, asked the dentist for a 10% discount and got it and he was paid right then and there. In one year, I put $2,400 in this account, which paid cash for all of our dental care.
Maybe employers would be better, putting the premiums into a savings account and having the employees put their share in as well. Then go to all of the doctors in the area and work out a deal with them to pay 90% of the medical bill immediately in return for providing their employees with medical care. Lets say you have 10 employees and the provider puts $200 per employee per month and each employee puts in $100 per month. This is $3,000 per month in the account. In one year you will have $36,000 for medical bills. If you have a high risk employee, then work out a deal to get low cost health insurance for that employee. But if you get a few employees visiting the doctor per month, you still have the money to pay for the care and the doctor gets paid better and quicker than if they were dealing with the insurance company.
About the Author: Steve is a Certified Master Medical Coder and Certified Master Medical Biller and Medical Coding/Billing Instructor. He also is the co-owner of Lucrum Consulting, LLC. which provides training in medical coding and billing issues, and helps physician's practices in areas such as A/R recovery, appeals, and staff training.
© 2005 Steve Verno