Don’t Take It Personally, Man

You may be correct to feel that not being told the price of a medical service until after you’ve bought it is like going into a store and not being told, until after you make the purchase, the nonrefundable price, which you are 100% responsible to pay.   Or, like a restaurant where the bill is secret until after you’ve eaten, a policemen waiting to take you in if you refuse to pay whatever the restaurant demands.  Seems unreasonable, un-American, but according to the Patient Protection and Affordable Care Act, the practice is neither of these when it comes to medical services. 

Critics will be critics, and some critics ignore the facts in their zeal to score points, but a few things about the flawed step forward that is Obamacare (The Patient Protection and Affordable Care Act– PPACA) are beyond dispute. Systemically, it is an improvement over what existed before.   The elimination of the grotesque loophole of “pre-existing condition” exclusion from coverage alone was worth the fight.  Giving the medical industry financial incentives to prevent disease rather than continuing to profit off billions in late in the game testing and end of life treatment is another long overdue step in the right direction.  It can’t be denied that millions more Americans have health insurance under the PPACA and access to preventive care, many for free.

 Those things said, huge problems remain with this compromise, authored by a health insurance industry insider,  that keeps the private health insurance and pharmaceutical industries firmly in charge of seeing their profits undisturbed.    Millions are still uninsured under the PPACA and tens of thousands of Americans will continue to die preventable deaths every year from treatable diseases discovered only in their fatal stages at ERs across the country.  

 Individuals may find also find themselves among a few million in an income category a little too high for free service, and too low to qualify for and afford the premium service members of Congress receive.  Such persons will, unfortunately, be a bit screwed by the details of the PPACA.  

The high deductibles, outsize charges for routine services, billing irregularities and other unappealable indignities may cause these patients to feel unprotected and that the mandated health care they pay for each month is sometimes obscenely unaffordable.   These Americans must take solace from the fact that it is truly nothing personal.

 Yes, it’s your individual problem, true, since the bills will be enforced by lawyers sent to collect all charges, but take courage in knowing that you are not alone in being partially unprotected by the Patient Protection and Affordable Care Act, an otherwise wonderful program.  It’s nothing truly personal, surely you can see this.  It affects millions, so stop your belly-aching!

 If you consult for twenty minutes with a physician’s assistant, for example, who has never heard of the symptom you report, repeats your google research while you sit there, and who orders a blood test to rule out certain things, you may have a little sticker shock when you get the bill for $507.   This sticker shock comes about because there is apparently no provision in the law that the patient be informed of cost prior to receiving a service.  Call your insurance company and they will tell you the doctor must first bill them for the service and then the price is determined, according to negotiated rates, and sent back to the doctor, who will in turn bill the patient the deductible amount.  

It’s all right there on the bill:  consult with physician’s assistant:  patient’s responsibility– $180.   Subsequently reduced, without explanation, on a follow-up bill thirty days later, to $110.   Blood test:  $641.  Patient’s responsibility:  $327.   Insurance, oddly, paid the corporation representing the doctor $314 for the blood test.   $437 for a visit to a physician’s assistant?   Call to ask about these charges and you will be told the charges are all correct, sir, all the proper codes were entered, these are the legal rates your insurance company agreed you would pay.   You can take it up with the attorneys who are handling the collection matter for the doctor’s office.  

 Have a nice day and, please, keep in mind that this is strictly legal, enforceable and absolutely NOTHING PERSONAL!   Only a baby would take it personally, though plenty of folks, apparently, are squawking like babies about their treatment under this inarguably great step forward. 

 To be fair, though, would you rather be treated unfairly with the right to be hospitalized (at no expense beyond your premiums and deductibles) when you finally have a stroke or without that right?  You’d have to be a fool not to see that this is a no brainer.   

 

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