Can I improve US Health Care System?

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has. – Margaret Mead (Anthropologist)”

Smart shopping is finding a reasonably priced quality item that fits my budget. I have a limited income so I have to budget my lifestyle accordingly most of the time.

As I have been sailing outside of the USA, I didn’t have to carry a US health insurance for three years. In 2018, I planned to stay in the US for several months and I decided to have US health insurance. I am now using health insurance for the first time in four years. I made an effort to find out what the cost of a doctor’s visit, prescription medication, and additional tests are. I found smart shopping wasn’t easy when dealing with health insurance. Most of the health care personnel cannot tell me what my co-payment would be for a special service or a test. I tried to look for a better deal.

For some prescription drugs, I found that using GoodRX.com was much better deal than my insurance co-payment. Some of the pharmacies also offer inexpensive drugs without insurance. It takes a lot of time to research. Before I see my doctor, I search for drugs on GoodRX.com. When I see my doctor, I ask for a paper prescription so I can select a pharmacy offering the best price without using my health insurance. I didn’t use my insurance for prescription drugs at all in 2018.

My insurance co-payment for seeing my primary care physician is $35/visit. I asked them how much it would cost by cash (walk-in). They told me it is $70 for a walk-in visit. It means that I am saving $35 with insurance. However, the invoice from my health insurance company says differently. It says that I saved $220 with insurance. The invoice shows as “Total Bill: $255, Member Discount Price: $158.36, Payment by Insurance Company: $61.64, and My Payment: $35”. Based on this bill, my doctor’s office received a total of $96.64 ($61.64+$35) instead of $70 walk-in price. I can understand that they have overhead cost dealing with insurance paper work. What I don’t understand is what made my insurance company price my doctor’s visit as $255 instead of $70 walk-in price?

When it comes for time for additional tests, I visited different labs and called my insurance company to find out my co-payment. It wasn’t easy. I had a “Diagnostic Mammogram and Ultrasound Test” in November. One month prior, when I visited in the imaging facility, they displayed a list of special (October) discount price without insurance. It showed $245 for “Diagnostic Mammogram/Ultrasound Breast/DEXA/” on the discount list. My cost with insurance for a similar (or less) test in November, shows a Total Bill Amount $1,449, Member Discount $978.99, My Insurance Paid $349.04, and My Payment $120.97. It says I saved $1,328.03. How do they come up with these numbers?

I am an educated person and always try to learn. It is time-consuming and stressful to figure out the invoices from my health insurance company. Do we really need this complicated paper work? I believe simplifying the invoice so that everyone can understand, will improve our health care system. Simply show us realistic total cost with or without insurance before the service, excluding an emergency situation. It doesn’t take a rocket scientist to see that this whole insurance thing is a mass of illusions and lies.

This show that I saved $1,328.03.

October Special Discount Price List by Imaging Center; My exam is about $245 Walk-In Price.


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