Is this for real? Questions about Health Insurance
I got a statement from my health insurance company the other day, a report of what my health care costs were for 2017.
Background: I am 66 years old, on Medicare and paying $134 per month for coverage. Last year I had HealthNet for my doctor appointments and such, with no premium. I don’t make much money so I have free prescription coverage through Medicare. That means my total health insurance cost per month is $134.00
During 2017 I had a colonoscopy, a mammogram, an MRI, one (minor) outpatient surgery by my OB/GYN oncologist, several doctor appointments and some lab work. No illnesses, not even a serious cold, and no prescriptions (except for the colonoscopy prep - yuck.)
The statement said that my medical costs for 2017 were as follows:
Amount billed by medical providers $27,560.71
Amount approved by insurer $. 4,036.19
Amount paid by insurer $. 3,668.96
My share $. 335.00
So, what I want to know is - what about the $23,524 that wasn’t paid by either my insurance company or me? Do all doctors and hospitals and labs, etc. overcharge by that much knowing they’re going to receive such a small amount from the insurance company?
And, if I didn’t have insurance, would I have been responsible for that entire amount? Never mind. I already know the answer to that one. :(
I know at least one woman who has health insurance through her employer and can’t afford an MRI of her lower spine because it would cost her $2,000 out of pocket. In December I had the same procedure at a cost to me of $215. There is something seriously wrong with this picture.
Mind you, I don’t know much about health insurance. I don’t even really understand my coverage, or the difference between Part A and B and C and whatever. When I have questions or problems I contact my insurance agent, who does understand all the things that confuse me.
But I do think that there is something seriously broken in our health care system if someone who is really pretty healthy had medical bills that exceeded my annual salary - and because of my insurance coverage less than 1/4 of the billed amount actually had to be paid. I mean, how is that even possible? What if I had been really sick? Or been in an accident?
And what about that $23,524 that neither the insurance company nor I had to pay? Are those legitimate charges that go unpaid or just seriously inflated so they will get what they actually should charge everyone from the insurance companies?