Why even having health insurance is not enough anymore

Forgive me for going totally off topic (hey its my blog I write what I want) but it is Sunday and not much news on security.  I wanted to write about an article I saw in the NY Times today called "Even the Insured Feel the Strain of Health Costs". The article details that with the hard economic times even people who have health insurance are being bitten by the ever rising costs of health care.  Rising premiums, covering less procedures and care and charging more for prescriptions and medical care combine to put the bite on everyone.  From my own experience here are 4 examples of how even with health insurance, medical care costs are taking a bite:

1. My wife had minor surgery in September.  It was ambulatory surgery where she went in the morning and went home that afternoon/evening.  Even though we have full PPO coverage and it was participating doctors, hospital, etc. my out-of-pocket costs after insurance were almost $3000! The surgeon received a whopping $472 from the insurance company for the operation and the hospital billed like 17k!  When I called the hospital they said they did not expect to get paid that much, but had to bill it so they could get as much as they could.  I than had to negotiate what I would pay out of pocket beyond that. I also had to pay the anesthesia, the prescriptions, etc.

2. Here at StillSecure we had to switch providers again this year because United Health Care wanted another 15 to 20% raise in premiums. In fact that is about normal for health insurance, way above the cost of living and inflation.  We pay a good chunk of our employees insurance premiums, but even so the 20% or so that we have the employee pick up gets bigger and bigger.  Plus the insurance company covers less and less.  This squeeze is frankly baffling. How can you pay more and get less.

3. I had a dental implant a few months back.  Though we pay for dental coverage, our insurance would cover a bridge or cap, but they don't consider implants necessary and would not cover any of it. I had to lay 2k out of pocket. On top of this the panoramic x-ray the oral surgeon took (which again was not covered, another 100 bucks) showed I had an impacted wisdom tooth with a cyst around it.  My dental insurance covered the wisdom tooth, but the cyst removal would be considered under my regular insurance and my dentist was not participating. In fact I could not find a participating oral surgeon in the area.  So I had to an extra $600 dollars out of pocket and of course my out-of-network deductible was $750, so I ate it again.

4. The orthodontist.  This one is perhaps the worst of all and really gets my goat.  My oldest son went for an orthodontic exam. The doctor told my wife that he would probably need braces when he gets older and that current best practices in orthodontics is to put braces on now in a phase 1 and than if necessary they put other braces on later when more of his adult teeth come in. Putting braces on now would lesson the severity of what he would need later.  OK, great lets do it, right?  Wrong!  Our insurance covers a one time payment of $1200. The dentist said if we use it now, the cost for phase 1 would be $3600.  That leaves a balance of $2400 that I have to pay.  However, if I do it without insurance he would charge me $2400 and than I could use the $1200 towards the phase 2 braces my son may need which could be up to 10k. So if we went through insurance the cost was $3600 with $2400 out of pocket or no insurance $2400 out of pocket.  What is wrong with that picture. Whether I have insurance or not, it still costs me $2400!  This is fundamentally what is wrong with our health care system.  The dentist is willing to accept $2400.  He should take the $1200 from my insurance and I should pay him another $1200.  Anything else is ludicrous and in my mind borders on criminal insurance fraud.

We need to restore sanity to the whole system. It is not just the 48 million people in this country that don't have insurance, it is also the costs of the people who do have insurance. Don't tell me that giving us greater limits to put in tax deferred health savings plan are the answer either.  Fundamentally we need the insurance companies to stop sucking the blood of the premium payers. We need the health industry to bill for what the do and what it is worth, not how to maximize what the insurance company pays and most of all we need to make sure that people can afford and receive decent health care!

BTW, if you want to read an excellent blog on this subject, Dr. Stanley Feld, Brad's dad writes a great blog on it.