When Sticker Price in Medical Insurance Reminds You Of Buying a GM Car...

Bought a new car recently?  If so, you know sticker price is for suckers... Do two things - wait for the juicy rebates always offered by Detroit automakers, then head to the lot and try to dicker the sales people down even further.  That's right, the marketing machine of US automakers has conditioned us not to move until there's a $5K rebate involved off the top. 

Health care is similar in some ways, but different in some critical aspects.  First up, there's a sticker price that hospital facilities quote to the general public related to what different procedures cost. Think of that as their "sticker price".  Here's the big difference - rebates aren't available to everyone, just to the folks with quality health care plans.  The Blue Cross networks (as well as other big insurance providers) are able to extract HUGE discounts from doctors and facilities alike through the power of their network.  If doctors/hospitals want BCBS patients, they've got to be a part of the network, and to be part of the network they've got to agree to the fee schedule touted by BCBS. 

That's where the discounts/rebates come into play.  The rebates can be huge when compared to the sticker prices touted by hospitals.  Here's a new record in my world I just came across.  Employee goes in for a procedure, with the company billed 19K for the entire bill.  Sticker price from the hospital before BCBS got ahold of the claim and went all Tony Soprano on it?  $152K.  That's right - the sticker price was over 7 times the actual cost ultimately allowed by BCBS.

Which makes me think two things.  First, I'm glad we have a good provider that can extract deep discounts off of sticker price.  Second, the common guy out there who's not covered by a plan like ours and is trying to go without insurance is a car wreck away from a lifetime of bills he can't pay and a probable personal bankruptcy.

There's something wrong with health care when sticker price on medical procedures makes buying a car look like a "one price, no haggle" experience...

Bought a new car recently?  If so, you know sticker price is for suckers... Do two things - wait for the juicy rebates always offered by Detroit automakers, then head to the lot and try to dicker the sales people down even further.  That's right, the marketing machine of US automakers has conditioned us not to move until there's a $5K rebate involved off the top. 

Health care is similar in some ways, but different in some critical aspects.  First up, there's a sticker price that hospital facilities quote to the general public related to what different procedures cost. Think of that as their "sticker price".  Here's the big difference - rebates aren't available to everyone, just to the folks with quality health care plans.  The Blue Cross networks (as well as other big insurance providers) are able to extract HUGE discounts from doctors and facilities alike through the power of their network.  If doctors/hospitals want BCBS patients, they've got to be a part of the network, and to be part of the network they've got to agree to the fee schedule touted by BCBS. 

That's where the discounts/rebates come into play.  The rebates can be huge when compared to the sticker prices touted by hospitals.  Here's a new record in my world I just came across.  Employee goes in for a procedure, with the company billed 19K for the entire bill.  Sticker price from the hospital before BCBS got ahold of the claim and went all Tony Soprano on it?  $152K.  That's right - the sticker price was over 7 times the actual cost ultimately allowed by BCBS.

Which makes me think two things.  First, I'm glad we have a good provider that can extract deep discounts off of sticker price.  Second, the common guy out there who's not covered by a plan like ours and is trying to go without insurance is a car wreck away from a lifetime of bills he can't pay and a probable personal bankruptcy.

There's something wrong with health care when sticker price on medical procedures makes buying a car look like a "one price, no haggle" experience...