Do You REALLY Understand Healthcare?

MedizinYou’re sick. You begrudgingly take off work, using your last sick day of the year available to you. You’d rather not go to the doctor, but your boss is requiring a doctor’s note.

You drag yourself out of bed, buckle the screaming baby up in the car seat, drive to the doctor and sign in.

You provide the receptionist with your insurance card. You write a large check for your deductible (the very reason you’ve been avoiding the doctor). On top of that, you owe a copay, and this is ONLY if that doctor accepts your insurance provider….

Has anyone ever stopped to ask, “What’s going on here?” If you’re practically having to take out a loan to pay your deductible, and you’re expected to fork up a percentage of your bill, then what are your premiums going toward? Insurance retention?

But if we’re all honest with ourselves, I bet we’d say, “I wish insurance didn’t exist.” It’s a hassle at best. I mean, is it really so expensive to pay a doctor to look down your throat and prescribe an antibiotic that you can’t pay a flat rate yourself?

Is insurance really helping us? How much would an X-ray really cost as a flat rate?

And, not to get political here, but… well, I’ll save this question for a later post.

In the meantime, am I the only one who’s had these questions but has been too afraid to ask them? Is there anyone who can explain this or elaborate? Has your insurance provider helped or hurt you? Share your experiences as an insurance subscriber below. Let’s hash this out.

And keep checking back for further posts on this topic. I just might have some more to say on this topic that you and your family can benefit from.

I only share the best on my new Author Facebook Page.

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About Andrew Toy
I'm in the beginning stages of starting my own publishing company that's unlike anything you've ever heard of in the industry. The direction of AdoptingJames is taking a 90-degree turn and will be more writing/publishing-focused. Stay tuned for huge updates and exciting news!

32 Responses to Do You REALLY Understand Healthcare?

  1. Car insurance, health insurance…it’s all one big mystery to me. Why am I paying all this money EVERY month yet I only go to the doctor twice a year at best. As for my car insurance, I haven’t had an accident or any kind of ticket in I don’t know how long yet I’m paying money out that I’ll never get back. But heaven forbid there’s an emergency (car or health), then it’s as if I’m Oliver Twist begging for more porridge. smh.

  2. I think we were much better off when we could barter for care when it was needed. Doctor ratee are now appalling. I see what the office visit base rate is, what my insurance says it’s worth to them & how much I still have to pay. Of course that’s on top of the premium. It would be cheaper to just pay the doctor outright. I guess if I had to have surgery or spend time in the hospital insurance might provide some relief, but not until I met my deductible.

  3. mjmsprt40 says:

    Reblogged this on mjmsprt40, sez me. and commented:
    I’ve had these questions for a long time— part of the reason I haven’t got coverage right now (besides that it’s way too expensive). It’s a racket– no doubt about it.

  4. It was pay as you can years ago. I don’t remember what the cost of an office visit was but I do remember my mom paying for her operation on an installment plan at the doctor’s office. It was difficult but she paid it off, ten dollars at a time. Insurance is now mandated by the new law and we are locked in, pay or be fined by the IRS. A captive market. But it should be about care not cost. Methods and technology have improved and doctors have student loans too but is the care worth the cost? Is it really worth $200 to spend 2 hours in a doctor’s office to only get 8 minutes of the doctor’s time? And most of that is the doctor tapping on a laptop to comply with the law on electronic records. Maybe there is a better way.

  5. George says:

    As the song goes….it’s all about the money. There has to be a special place in hell for insurance companies because not only do the drain you monetarily, they often refuse to pay you for services you need and/or make you appeal multiple times for services or brings that were turned down. Doctors need to pay off their loans and equipment. Like attorney’s they need to bring in a certain amount of money/patients if they’re in a group of doctors or they will be cut loose. The health care system is an administrative nightmare for everyone involved. Pharm companies charge ridiculous prices so the people who really need the drugs can’t afford to pay for them and are forced to life with their conditions. And if yu Karen to the side effects of the drugs you’re reluctant to use them.Insurance costs are through the roof. Equipment costs are ridiculous. This is a money grab for everyone involved in the process and not one person in this country has the balls to say or do anything about it because special interest groups finance campaigns. So it’s a full circle mess that has no chance of being controlled or improved. Not as long as money is at the core of the problem. And if anyone thinks the AHCA act is the answer, think again. It’s sad.

  6. I don’t have health insurance, but, in a recent medical situation, I got better service/better treatment and better accuracy in diagnosis (meaning the doctor didn’t blow me off or made a snap-judgment misdiagnosis) at a (cheaper!) walk-in clinic (which was also much cleaner and in better shape) than I got at the high-profile doctor complex someone I know recommended. It’s not the first time I’ve had a more favorable experience at one of those walk-in clinics, both here, and out-of-state. Some are even open twenty-four hours a day.

  7. toyra99 says:

    I am a retiree. I had pretty decent medical insurance until this year when my company forced me to change plans. The company supplied a brochure describing the plans that you could choose from. The brochure was understandable only to lawyers and doctors. I picked the plan that I guessed was most suited to me since I am single. I now get to pay premiums that are about 20% higher and my deductibles are WAY higher. Under my new plan, a routine physical exam, including the blood tests and the office visit with the doctor to review the results are covered at 100%. Someone told me that ALL medical insurance plans are required to cover this because it is now the law under the Affordable Care Act. What is NOT covered are any prescriptions that the doctor may order. I take Vytorin for cholesterol control. Under my old plan, it was mostly covered by insurance but my portion was pretty high….about $125 for 90 pills (1 daily). Under my new plan, prescriptions are covered at 0 until I meet my very high deductible ($2500 or $3000, can’t remember). If my doctor prescribes Vytorin after the physical exam, and he always does, I will have to pay the entire cost. I went to the pharmacy yesterday just to do some fact finding. 90 pills of Vytorin…..$879. No, that’s not a typo error. I think medical insurance, unless you want to pay $1000 a month in premiums has become, basically, medical catastrophe insurance. If I got REAL sick and had a 30 day hospital stay, for instance, I would meet my $3000 deductible and then a very large portion, or maybe the entire $50,000 estimated cost would be covered. If I went to the doctor’s office because I hurt my elbow tomorrow, I would pay for 100% of the office visit. If the doctor ordered a painkiller prescription, I would pay for 100% of that. If there was a follow up visit to make sure my elbow was ok, I would pay 100% for that, too. It would all be applied to my deductible of course. Why am I paying $290 a month in premiums if nothing but routine preventive care tests are covered? Should I hope I get REAL sick so that I’ll feel like I am getting something for my money? Aw, man. See? Now, you’ve gotten me all fired up ! Thanks for listening. It helps me to get it off y chest, so to speak.

  8. I can say that iit is very confusing, especially when you are trying to get pregnant and you don’t know if your insurance will cover cost… In the end I truly think its just a scam to get your money…

  9. daisy9979 says:

    I was fortunate to have great insurance through my job but when I became unemployed I just went without for a while but the fear of something happening and potential fines drove me to sign up. I will say it was more expensive than I thought it was going to be especially when I applied for lower rates because I don’t have an income right now. I’ve taken steps to lower my monthly expenses while I job hunt but this basically replaced one of the bills I’d eliminated so my experience with the new health care system so far has been very frustrating.

  10. Lynn says:

    For healthy individuals who only go to the doctor once a year or so, then paying as you go is definitely much cheaper. In our thirties and early forties, my husband I did this as we couldn’t afford the premiums at the time. We were fairly healthy, but yet there were things I neglected with my health because I didn’t have insurance. When we did finally have insurance it was horribly expensive and our two deductibles would have bought a decent used car not to mention the total in premiums. I still cringe when I think how much we were paying out of pocket. When I was 49 I had to have surgery and having the insurance made sense. My surgery was 75K . The following year, I was hospitalized for three weeks with severe pneumonia and again, having insurance was a blessing. With both of those events, we were out of pocket around 15K, but that was much better than the full amounts. Although, my husband was a student at the time and we probably would have qualified to have everything written off if we had not had insurance. I’m not sure the quality of care would have been as good though – if I had not had insurance I would not have been given the more expensive robotic, less invasive surgery and I doubt I would have been kept in the hospital as long with my pneumonia. So, all in all I am thankful I had insurance and at least for those two years I feel that it paid off. After those events, I would be hesitant to go without insurance again, even if we had the option. When my husband graduated we did the cobra for a year and then this past fall due to being self-employed we had to go through the exchange for our insurance which is based on your income. I don’t really support the Affordable Care Act on many levels, but it has made our insurance situation better than it was and if we had gone on it in 2014, rather than doing the Cobra we would have saved a lot of money. As to your question about x-rays, not sure of the cost, but I had a CT scan that cost me $1500 out of pocket – it was applied to my deductible. The cost of health care is high and so is insurance. I don’t think there are any easy answers.

  11. Reblogged this on Kittie Phoenix Living Romans 08 and commented:
    This blogger has asked some excellent questions. It would be interesting to see what alternatives could be created by out-of-the-box thinking.

  12. We get free healthcare where I live. The U.S system baffles me and seems rather cruel.

  13. Val_ToWriter says:

    Everyone’s right — insurance is too expensive and way too confusing. My doctor’s office has 3 doctors, and one person who does insurance full-time. They also have an accounts person, plus three receptionists, and of course three nurses, one for each doctor. It is an efficient well-run practice. My husband’s idea of insurance and his arrangement was about the best: he has an health savings account (tax deductible) and high-deductible catastrophic insurance. (He’s pretty healthy.) The other plan that my daughter had when she was doing a year of Americorps was temporary or short-term insurance. It covered nothing, basically, but catastrophic health events. The premium was low; she usually got a break from the doctors in charges because she was paying out-of-pocket. Unfortunately she got a bad case of pneumonia (8 days in the hospital) and insurance paid for ALL of that. So it was a pretty good deal. And it was simple. PS: My husband and I both have Medicare now, and that’s not as simple as you’d expect either! PS again: John Stossel just aired a very interesting program on health care costs; it’s probably online now.

  14. JennyAnne says:

    I hope I don’t get burned here but I live in Canada and we pay our healthcare through our taxes. I know there are many people that say well you have to wait x amount of months to receive any help, and I have to disagree about that. I have never waited more than 2 weeks to see a specialist and I have seen many in the last couple of years. So people say it is free, but we do pay it in one form or another.

    • I’m curious. What do you think about a system where healthcare didn’t exist? If you wanted to see a doctor, you pay him directly?

      • JennyAnne says:

        To be honest I don’t know. All i’ve know is what I have. I think it would be difficult knowing how much my 2 c-sections cost but I was very lucky as my health care covered those costs. Esp with my daughter where she was in the NICU for 2 weeks. I think it would be hard because there are people here in Canada that if they had to pay for health care they wouldn’t get any care at all and wouldn’t be with us right now.

  15. middle_class says:

    I think it’s hard to see the benefits/need for health insurance when you’re younger or enjoy good health. However, like other insurance, it’s protection for major illnesses and hospitalizations. Unfortunately in the U.S. hospitals, pharmaceuticals and health insurance companies are just “business” and seek to make profit at any cost. Note: I’m not saying that they should not make money but there is definitely room to both make money and yet focus on helping people get quality care.

    To me, universal healthcare is the best system if we truly believe that all people should have access to healthcare no matter how much or how little they earn. Yes, you “pay” through tax dollars but the majority of people will benefit in the long run, unless you miraculously enjoy good health forever. At least if you are paying through taxes, you don;t have the confusion with premiums, deductibles, out of pocket maximums and co-pays. I believe with universal healthcare, you simply deal with co-pays which are usually quite low.

    That is not to say that there isn’t a dual system for rich and the rest of us. In Italy and much of Europe I believe, you can pay to go to expensive private clinics if you can afford it.

  16. Here in the UK we have the National Health Service; we pay towards health care through National Insurance contributions while we are working. It’s not a perfect service these days, but we are truly grateful that we have it. It must be very hard on people who can’t afford insurance in your country.

  17. laurabednarz24 says:

    It’s awful. And public aid issue is even worse. There are people that need it and others who buck the system. I see it everyday. Can’t stand it.

  18. maureenc says:

    Last evening I had the need to contact an “after hours GP/doctor as the practice I attend closes at 1800 hours. I waited nearly two hours before I received visit. But that was OK because I had been warned I could take that long. This doctor covered the Greater Brisbane area which is a large area to cover.
    He arrived, gave a very comprehensive Physical and agreed that the antibiotics I was taking (prescribed by my own GP) were not clearing up the infection. Gave me two tablets (Rulide) to take at once, plus two to take this morning! PLUS prescriptions for a course of Rulide and one for Prednisone. All it cost me was a signature…as the service BULK Bills against Medicare , our National Health scheme.
    My two prescriptions cost the grand total of Au $13.00 (subsided by Medicare)
    I am so glad hat I live in Australia

  19. SD Gates says:

    If you are self-pay, know that you do not have to pay the same fee the hospital charges the insurance company. It’s all a game of bluff. The hospitals raise the rates, in hopes of getting a percentage of what they believe is due from the insurance companies – so fees are totally overinflated. And as a cash payer – you can call and argue with the hospital to have those fees brought down to what the services are really worth. It works sometimes. I think fee for service is the way to go. Just completely side step the insurance companies and pay the physician directly (except for really big things).

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