Like many people, I’m trying to convince my health insurance company to pay for costs I don’t want to spend cash on.i don’t completely Blame it on Signa. The invoice sent to me by my provider is exorbitant. But the company is embroiled in distorted incentives and rising costs as a third-party payer in a chaotic healthcare system. What sometimes gets lost in the debate between proponents of a market-based healthcare system (we don’t have one) and those who truly believe in a system controlled entirely by government is what patients receive. It is a big problem to separate the responsibility for payment of The bill is ultimately received by an insurance company or government agency.
In my case, I was over 50 and my warranty had expired, so Cigna didn’t want to pay $4,000 a week for a prescription for a Holter monitor. Its the life. It doesn’t matter what reason the insurance company gives for non-payment. From my wife’s experience as a pediatrician and conversations with other doctors, insurance companies, whether it’s private insurance, Medicaid, or Medicare, say that some people never appeal, resulting in cost savings. I know I’m doing the denial on the premise. Pushing back often yields results, and I am confident that we will win in the end.
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Medical Insurance Leading to Increased Medical Expenses
4 gran is a lot of money, so I don’t entirely blame Cigna.completely buy a holter monitor Hundreds to thousands of dollars. The bill sent to the insurance company was for a week’s rental. Of course, the cardiologist’s skill and time cost to read the downloaded data cannot be covered.it is generally run on hundreds of dollars. However, prices for monitoring and data interpretation, like most healthcare products and services, vary. The real healthcare market does little to set prices and inform consumer decisions.
“Contrary to ‘conventional wisdom’, medical insurance, private or otherwise, does not make health care more affordable,” said Jeffrey Singer, a surgeon and senior fellow at the Cato Institute. I have written “Third-party payment systems are a major contributor to healthcare price inflation, which is not surprising.”
Singer cites American-style health “insurance” as an example of Nobel Prize-winning economist Milton Friedman’s last category. 4 ways to spend money: In this case, you are spending someone else’s money for someone else. “This is where people are least motivated to save or buy things that meet their needs and values,” Singer said.
“Special interest allegations, political concerns and nepotism run the game when governments use other people’s money to buy goods and services for others,” he added. “But private insurers are also spending other people’s money—premiums paid to risk pools—on medical services for others. You don’t have to negotiate enough to reach the compensation amount.”
Wayne Weingarden and Celine Bookin of the Center for Health Economics Innovation at the Pacific Institute agree.they Point out In 1960, patients paid 52 percent of their medical costs themselves, private insurance paid 22.8 percent, and government and other third-party payers covered the rest. In 2019, patients only paid 11.3% out-of-pocket, 33.3% covered by private insurance, and 39.3% covered by Medicare and Medicaid.
“This shift in financial responsibility creates an ever-growing conflict of interest between payer bureaucracy and patient needs, and this disagreement plagues the current U.S. healthcare system,” said Weingarden and Buckin. It’s causing undesirable results.”
Good luck if you want to know the price
To alleviate such problems, the Trump administration introduced new rules a few years ago that: Require hospitals to publish prices for service. Good luck if you find it buried on the website.my local hospital provides an Excel spreadsheet that displays over 20 different prices for the same procedure or service, ranging from total charges to copays, Medicare, Medicaid, negotiation results with various insurance companies, and various other categories. increase.
“A colonoscopy can cost hundreds or even thousands of dollars, depending on the hospital and insurance company you use,” NPR says. report After the rule comes into effect. “Hospitals say promoting transparency alone doesn’t do much for consumers. Each patient’s situation is different and can be different, and individual deductibles and insurance plans complicate matters. It’s the body.”
Yes, it is. As long as someone else pays for it, whether it’s an insurance company, Medicaid, or Medicare, that price really matters only to the relatively small number of out-of-pocket patients who receive the care and are obligated to pay it.When comparing services between providers teeth NPR adds that it is important because “in some cases, the cash-only price may be lower than the price the insurer will pay.”
Note that experts do not distinguish between government payers and insurance companies when assessing third-party payer issues. Consumers pay in the form of insurance premiums (private insurance and government programs) and taxes (government programs), but these payments are separate from decisions about price and bill liability. It creates the so-called “economic wedge”.
Third party payers are a problem, both private and government
In 2009, Weingarden, along with co-authors Arthur Laffer and Donna Alduin, wrote that “an economic wedge occurs when government policies separate effort from reward, or consumers from producers.” there is Future Prospects for National Health Insurance. “Consumers have no incentive to control costs when the government, lawyers, or third-party insurance is responsible for paying their bills.”
supporters of Single payer systemagain Medicare for Allwould turn the government into a third party payer of last resort, without even the discipline that would arise from competition among third party payers. It would exacerbate the problems inherent in divorcing from the burden of medical expenses that people use without solving them at all.
“Policy makers need to understand that the key to ‘affordable health care’ is to reduce, not increase, the role of health insurance in people’s lives,” Singer wrote in 2013. rice field. He asked for the patient to be in control of himself. Medical bills.wine garden and bookin also have a favor Transfer of authority and responsibility from third party payers to individuals.
If I had shopped through the free market medical system on a cardiologist’s prescription, I would have had a much better grasp of the actual price, not a collection of categories. prize. I would have been looking for an affordable option.could have chosen either A commercially available home monitor that replaces the Holter monitor. And I’m not going to argue with Cigna that the price we agree on is exorbitant.
