The government is currently working on fixing national health care but does anyone really know how health insurance works? Even if you’ve been lucky enough to always have health insurance through your job, health insurance is very confusing.
The Co Pay seems easy enough. You give the receptionist your insurance card and she asks you for a co pay, usually between $20 and $50. Seems fair enough. It’s not an onerous amount of money and it may even help stop people from going to the doctor’s office who aren’t really sick.
It starts to get a bit confusing with the dreaded deductible, say $500 to $1000. You have, that has to be paid before your health insurer starts to pay anything. It’s super annoying the first time you have to pay a bill you thought your health insurance would pay. You may have 2 different deductibles if family members are covered under your plan. Good luck figuring out which one applies. Fixing National health care to make it simpler and easier has to happen!
Then there is something evil called “co-insurance” which, I think, is the percentage you have to pay for procedures that are not 100% covered for some seemingly random reason.
National Health Care needs fixing
What bothers me the most is the utter lack of transparency. Why is it I have no idea how much a service or procedure will cost until I get a bill? Especially if the issue is recurring and needs multiple visits, procedures, tests, etc. If the entire system wasn’t so complex, someone would be able to explain the cost to the patient. Is this too much to ask?
Why are doctor offices allowed to send blood to labs that are not covered by your health insurance company? I say, if that happens, the doctor office must pay and not the patient.
And why are doctor’s bills so freaking confusing? I am holding a statement with 11 columns, five of which are dollar amounts. There is “Charge”. Ok easy enough. That must be the cost of the procedure. The next column is “Ins. Pmt”. I guess that’s the amount the doctor’s office is expecting the Insurance company to pay, or is it??? “Pat. Pmt.” I assume this is what I’ve paid already since that column only has the amounts that I have already paid in Co Pays.
Next there is a column labelled “Adjust.” I am not certain what is being adjusted but I do remember reading somewhere the insurance companies have made nefarious covenants with doctors on how much they’ll pay for specific procedures. Maybe this is a hint at one of those dark deals? Patients are forbidden to know the details of such things.
The column labelled “Amount” is the truly scary one. There are asterisks next to some items and the total amount due doesn’t match anything else on the statement. When I expected to pay zero and now have a statement which tells me I am overdue for hundreds of dollars, which may turn out to be thousands of dollars, I am in a panic. This is NOT how health insurance should work. Here is a link that may help you understand your doctor bill, AAFP.
You pay for health insurance and aside from a co pay here and there, you shouldn’t have to pay anything else, in my view. That’s National Health Care!
Almost everyone agrees the Affordable Care Act (ACA), aka Obamacare, has some good elements such as children being allowed to stay on parent’s health insurance until they are 26 and coverage for pre-existing conditions. There are also negatives like forcing people to pay a penalty to not have health insurance. That seems burdensome to many people. Sure, it’s a good thing to have more people covered, but there’s got to be a better way of fixing National health care.
Like I said, most everyone agrees it’s good for children up to 26 to be covered, however if the child is still a student getting a masters, he/she should be allowed to continue to be covered as long as they are a student. 26 year olds are pretty healthy generally so the health insurance companies should like this. That’s a win/win in my book.
Simplify Flexible Spending! Did you know you lose your money if you don’t spend it? Have it roll over to next year! And why do I need a prescription for Advil to get reimbursed from Flex Spending? Really?! A prescription for an over the counter drug? Pointless paperwork costs money for no value. These are easy fixes to make National Health care better and simpler.
Lastly, raise your hand if you hate waiting rooms as much as I do. I really do understand if the doctor has some emergency and you have to wait a bit longer for your scheduled appointment. But having to wait 45 minutes every damn time I go to the doctor’s office, really? That’s a lot of emergencies! Actually that is what I call, overbooking your schedule, Doc. I will find another doctor who respects my time and treats me like a human being. You get so excited they called your name, like you’ve won a prize and they take you into a cold room the size of a closet where you wait again, this time naked, for another half hour. WTF? Do what I do. Look through all the drawers and help yourself to as many sterile gauze pads as you can fit in your pockets.