Friday, March 10, 2006

Uninsured vs insured---3/23

If you click on this , it takes you to the 60 Minutes article on the disparity between what uninsured patients and what insurance companies pay.

This documents that the uninsured are overcharged routinely, and nothing indicates that locally it is any different.

Obviously, if you are local, responsible for your bills, uninsured, and have the option, your regular provider, the Salas Clinic, and then the hospital ER are, in order of increasing cost, your most viable alternatives. With the advent of liens against everyone, one does have to consider the consequences of ill health.

No, most patients do not think that healthcare is free, but pricing it 3-4x that which the insurance companies pay is a bit excessive.

When a test is ordered, you ought to be asking: Is this necessary, or is it just to cover the doc's butt, and who is paying for it, me, or him?

9 comments:

Anonymous said...

A truer comment was never made, "is this test really necessary". But, the layperson DOES not know the pertinent information to determine whether a test is necessary or not. Example: I've had the worst headache of my life!" Followed up by a chest xray, possible sinus series xrays, then of all things............a CT head. Not to mention about 5-6 hours in the ER. Making for an extremely overpriced bill. Yes, some of it is to cover the Doc's butt, but pretty much, it's Essent telling the ER Doc's to order as many exams as possible! And where is the clinical backup that says these tests were necessary. Keeping in mind that the pen is definitely mightier in this situation. Justification is merely a penstroke away. Again a catch 22 for the patient. And a nice hunk of change for Essent!

Anonymous said...

What if you just had the same tests, 2-3 days ago? Don't these guys keep records? They said to come back if the problem persists--it did, I did, they did the exact same stuff and I got the exact same answers--nothing. I did learn something: the ER is quiet on Sunday morning. Every other time I've been there the waiting room was packed with people almost getting run over with stretchers. 'course the attitude seemed like Hit me, maybe I'll get seen sooner!

Anonymous said...

What do you expect in a zero-defect society? People gripe about how much medical care costs, but expect platnium-plus care if there's anything wrong. Unreasonable expectations drive the costs of medical care.

Anonymous said...

We aren't talking zero-defect here, and the routine MVA at Parkland is x-rayed less than the person that comes in with a week-old 'pain'. Watching a ER doc popping off a waiting room full of C-collars is truely a sight to behold.

But, the discrepancy between what uninsured and insurance companies pay is because of clout. If you have a group of 1000 patients that you can tell where to go (provider-wise), then you have clout with a hospital. So deals are struck. The uninsured may or not pay, so they have no clout.

Blanco said...

I've seen both sides of this, either you get battered by tests...CMP, CBC, ABG's, CXR, EKG's, CT's...regardless of the patients' complaint or condition, OR you get a Kenalog (or Toradol) injection and a followup referral because the staff is too overwhelmed at the time to work you up. Also try making an appointment for outpatient care, before they even ask the patient's name(or your name if it's for you), they ask if the person has insurance or not! If not, the poor sucker has to "come into financial counseling" to arrange for prior payment arrangement BEFORE an appointment will be made, no exceptions for anyone. What this entails is the patient comes into the financial office and coughs up the cost for whatever needs to be done (the entire amount usually). Heaven help the staff member who refers out a patient to a "non-PRMC" facility, and the bean counters find out...even having the referral forms for them is FORBIDDEN. All you can do is CYA and chart "per patient request"! This also applies to people with insurance, you'd better have your co-pay in hand before expecting any tests or procedures being done!
The worst part is that these policies and the short staffing are distressing to regular staff, who naturally catch the brunt of the anger of people coming in.

Anonymous said...

Does Essent have any managed care contracts? I know they are not a provider for my insurance (Christus was) so if my wife or I need care, we have to go elsewhere. Good thing we DO NOT want to go to Essent.

Anonymous said...

Just as an observation, I had my test done at Red River. Now I was checked in, showed my insurane card and had the test done. However, before I was able to leave I was also nade to pay the difference in cost $290. Yes, I would have paid it anyway - probably when the bill came in the mail. Fortunately, I did have the cash on hand - a rare situation for me at least.

Anonymous said...

Just curious...would the PRMC insurance cover RRR? Or would they be considered "out of network"?

Anonymous said...

RRVR is out of network for PRMC employees. None the less, in some instances, the cost to the patient may still be less at RRVR as their overall charges are 2-3x less. Example: 50% coverded of $1000 (500) is still less than 20% deductable of $3000 (600).