So. Shawn went for a physical. You know, that basic physical, the one you're supposed to have every year, that is "covered" under your insurance plan, even though you have a high deductible.
And . . . he got lab bills for about $700. Yep. Insurance denied two of the three basic labs that go with the physical. Because they are denied, not only do we have to pay for them, but the costs don't even get applied to our deductible. Of course, these are the jacked-up rack rates for the services, the inflated rates that are billed because the provider knows that the insurance company always "adjusts" to what they call "allowable" expenses. The problem, for us, is that our insurance adjusts nothing if it denies coverage and washes its hands of the whole situation.
The doctor, in the office, told Shawn that she thought this would be covered. Of course, she didn't say that it would be covered for sure. A doctor would never place herself at that risk of liability. But she said she thought the labs would be covered.
We, as consumers, have no way of knowing. If we knew ahead of time what labs the doctor was going to ask to run, maybe we could call the insurance before we went to have them done, but that's not generally how it works. Anyway, even if you do call the insurance to try to check on what they cover, they are very dodgy about what they will tell you. I know this from experience. My frustration with insurance representatives is superlative.
The insurance company just slides along under the rider that says, "coverage is subject to change without notice." So there's that. That's what you get when President Obama invites the insurance industry to write the policy on how insurance works, after everybody is required by law to purchase it. It's unfair, and it shouldn't be legal, but it is legal, because the insurance industry got the privilege of designing the law.
And yes, the doctors are overcharging, because if they don't, the insurance companies will drive them into bankruptcy.
Once upon a time, health insurance got involved in health care and started messing everything up. The insurance companies started telling doctors what they could and couldn't do, and how much they could charge. A doctor would provide a service that cost him $10 to provide. He would charge, say, $17, so that he could make enough money to pay the rent on his office, compensate his receptionist and his nurse, earn his own salary to support his family, buy malpractice insurance, and make payments on his medical school loans. Insurance got involved and said, "No! We will only reimburse you $8.50 for this service!" Well, obviously, the doctor couldn't remain solvent in that scenario, so the next time he performed the same service, he looked over his numbers and figured, "Insurance reduced my rates by 50%, so in order to remain viable, I will need to charge $34." And he did.
This back-and-forth parry in rates and reimbursement went on for years, inflating medical costs ridiculously, until many people simply could not afford to get medical care, but the insurance executives continued to profit off the system while doctors struggled to provide healthcare to people who were desperate enough to brave the billing process, and often the doctors simply didn't get paid (which induced them to raise their rates even more, because the money has to come from somewhere, and if half the people are going to default, the people who actually pay their bills must become the financial backbone of the system).
The system was broken beyond repair. Health care costs were skyrocketing. Many people had no way of paying their bills. People began to get angry that it was so difficult and expensive to receive health care.
What would you think the answer to such a problem would be?
Doesn't it seem obvious that insurance is a totally unnecessary layer that inflates costs while enriching savvy business executives while providing no real service to anyone? Doesn't it seem obvious that health insurance needs to be phased out, and some other (ideally non-profit) system invented to help communities help each other out with medical costs?
Apparently not. Apparently all the smart people in President Obama's cabinet thought it would be best to pass a law requiring all American citizens to purchase health insurance, or else be fined by the government. This must be unconstitutional. How can the US government possibly say that its citizens have to buy a particular product? The government can tax its citizens, but how on earth can it mandate a particular purchase? And slap a fine on anyone who fails to comply? Seriously?
But, unconstitutional or not, they decided to write The Affordable Care Act (which brings to life all of the horror of Orwellian doublespeak). Not only that. They invited the insurance companies themselves to send in representatives to write the policy.
And then, after it was passed into law and turned out to be terrible, they feigned surprise that big business had not written a very nice policy. Also, they did nothing to try to fix it.
This is why the democrats lost the last election. It is not because we have a country full of mean-spirited people who want to wipe out Mexicans and Muslims and homosexuals. Most Americans are much more live-and-let-live than you could even imagine.
It's because average people are fed up with being forced by law to pay $1200 per month for health insurance that still has a $6000 deductible, and then going to the doctor for a basic physical--which was supposed to be the one thing that was covered--and coming home with a bill for $700 that will not even be applied to that $6000 deductible.
This is why Hillary lost the election.
In case you were wondering.
(And I did not vote for Trump. But I certainly did not vote for Hillary. And when I heard that Trump was working to repeal Obamacare, I actually felt a glimmer of hope. That hope has not yet come to fruition.)