Tuesday, November 22, 2016

Multi-level marketing, Madoff, & me

Turns out I can and can't put a price on good health. Over the past nine months, I've had a close-up view of medical care that -- knock on wood! -- I've largely been spared to this point in my life. I'm now doing some accounting at (what I hope to be) the end of this process; or at least the end of this particular knee-ligament reconstruction. Here are the ledger's broad strokes as I've gleaned them...

Since March, my employer has paid $4,608 in insurance premiums. I've been responsible, meanwhile, for $3,357.03 in co-pays and co-insurance. A digital deluge of explanations of benefits has kindly reminded me that, without insurance coverage, all this recent medical attention would've set me back $35,707.11. The insurance folks also let me know their negotiated share of the bills has been $7,685.65 -- effectively, $3,077.65 if we subtract my employer's premium-based contributions.

Bottom line: I should visit the HR office and thank my employer. It's been purchasing my health insurance for over a decade in which I've minimally tapped those contributions for preventive care. Which leaves me wondering: What, if anything, separates this system from a pyramid scheme? Is it the group buying power that negotiated down the full-tilt costs?


4 comments:

  1. I've only had two weeks of knee trouble. I can't imagine 9 months of it. I belong to an HMO, so every visit just costs $10. I am glad to know you are near the end of the process.

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    1. 1 day at a time, Adrienne. Hope your joint prospects start looking up, too.

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  2. So what I'm curious about is the difference between the $35,707.11 and the negotiated $7,685.65. Where did the approximately $28,000 expense disappear to? What a nightmare our health care system is! I'm grateful for the coverage I have, but as a retired person, I'm footing the rather large monthly bill.
    Glad you are on the road to healing!

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  3. I'll never forget when the bills arrived after the first month of cancer treatment for my twenty-something child. (Don't worry-- after a horrible time, all is well.) The bill was for $249,000.00. Holy. Crap. We were personally responsible for something like $5,000 thanks to our insurance policy. As if recovery were not gift enough, knowing we wouldn't have to sell our house was sweet relief.

    I never thought of health insurance as a Ponzi scheme. More like a system where you pay in and hope you never have to use it.... And, yes, the negotiated fees are the whole point. Someone once told me the same services could be billed entirely differently to a different provider.

    Glad to hear you are coming to the end of your disability time.

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